Journal of Gastroenterology and Hepatology最新文献_第10页

Endoscopic Ultrasound-Guided Coiling Plus Glue Injection Compared With Other Endoscopic Modalities in Managing Gastric Varices: A Systematic Review and Meta-Analysis 超声内镜引导下盘绕加胶注射与其他内镜治疗胃静脉曲张的比较：一项系统综述和荟萃分析。

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-08 DOI: 10.1111/jgh.70190

Zinat Mohammadpour, Maria Castrejon Moreno, Bobak Moazzami, Sanjivan Mudaliar, Roberto Trasolini, Arka De, Sahaj Rathi, Rajit Aziz Gilhotra

Background and Aims

Gastric varices (GV) are a major complication of portal hypertension, with a high risk of severe bleeding. Conventional endoscopic glue injection or endoscopic ultrasound (EUS) directed therapies have been used for treatment. However, each has its limitations. EUS-guided combination of coil and glue injection has emerged as a potential strategy to improve outcomes. This meta-analysis compares the efficacy and safety of EUS-coil and glue to other endoscopic modalities in GV management.

Methods

Five databases were systematically searched until October 2024. Data were pooled using risk ratios (RRs) with 95% confidence intervals (CIs) via a random-effect model. Heterogeneity was assessed using the I² statistic, and subgroup and sensitivity analyses were performed. The risk of bias in studies and the certainty of the evidence were evaluated.

Results

Nine studies with 579 patients met the inclusion criteria. Compared with other modalities, EUS-coil and glue had a lower risk of reintervention (RR = 0.32, 95% CIs = 0.21–0.50) and a higher rate of GV obliteration (RR = 1.18, 95% CIs = 1.03–1.37). There was no significant difference in mortality risk (RR = 0.87, 95% CIs = 0.54–1.40). The overall risk of adverse events (RR = 0.55, 95% CIs = 0.34–0.90) was lower, particularly rebleeding (RR = 0.36, 95% CIs = 0.22–0.59). The certainty of evidence ranged from very low to moderate due to bias and study heterogeneity.

Conclusions

EUS-coil and glue injection offers superior efficacy and a favorable safety profile compared with other endoscopic treatments for GV. However, the quality of the evidence warrants further well-designed studies to assess long-term outcomes.

背景和目的：胃静脉曲张（GV）是门脉高压的主要并发症，具有严重出血的高风险。传统的内镜注射胶或内镜超声（EUS）指导治疗已被用于治疗。然而，每种方法都有其局限性。eus引导下线圈和胶水注射的结合已成为改善预后的潜在策略。本荟萃分析比较了EUS-coil和glue与其他内镜治疗GV的疗效和安全性。方法：系统检索5个数据库至2024年10月。通过随机效应模型，采用95%置信区间的风险比（rr）合并数据。采用I2统计量评估异质性，并进行亚组分析和敏感性分析。评估了研究的偏倚风险和证据的确定性。结果：9项研究579例患者符合纳入标准。与其他方式相比，EUS-coil和glue的再干预风险较低（RR = 0.32, 95% ci = 0.21-0.50）， GV闭塞率较高（RR = 1.18, 95% ci = 1.03-1.37）。两组死亡风险无显著差异（RR = 0.87, 95% ci = 0.54 ~ 1.40）。不良事件的总风险（RR = 0.55, 95% ci = 0.34-0.90）较低，尤其是再出血（RR = 0.36, 95% ci = 0.22-0.59）。由于偏倚和研究异质性，证据的确定性从非常低到中等。结论：与其他内镜治疗方法相比，EUS-coil联合胶水注射治疗GV具有更好的疗效和良好的安全性。然而，证据的质量保证了进一步精心设计的研究来评估长期结果。

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引用次数: 0

Psychosine Alleviates Colitis via Inhibiting Th1 and Th17 Cell Immune Responses in Inflammatory Bowel Diseases 通过抑制炎症性肠病患者的Th1和Th17细胞免疫应答来缓解结肠炎。

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-08 DOI: 10.1111/jgh.70199

Ritian Lin, Jiayi Tu, Shan Li, Qinjuan Sun, Lan Zhong

Background

Aberrant T-helper 1 (Th1) and Th17 cell activation is involved in the pathogenesis of inflammatory bowel disease (IBD). Psychosine is known to induce apoptosis, promote astrocyte activation, and inhibit osteoclastogenesis. However, the role of psychosine on Th1 and Th17 cell immune responses has not been previously reported. In this study, we investigate the role of psychosine in the modulation of CD4⁺ T cells.

Methods

Peripheral blood CD4⁺ (PB-CD4⁺) T cells were isolated from both IBD patients and healthy controls and cultured with psychosine, and the expression of IFN-γ and IL-17A was analyzed using a flow cytometer and enzyme-linked immunosorbent assay. The DSS-induced colitis model was established in mice; the expression of inflammatory cytokines was determined by flow cytometer and quantitative real-time polymerase chain reaction.

Results

We found that psychosine suppresses the expression of IFN-γ and IL-17A and Th1 and Th17 cell differentiation in PB-CD4⁺ T cells. Meanwhile, psychosine was observed to inhibit the proliferation of PB-CD4⁺ T cells and intestinal mucosal inflammation. In vivo, psychosine alleviated DSS-induced colitis in mice by inhibiting Th1 and Th17 cell immune responses.

Conclusion

Our data reveal that psychosine reduces mucosal inflammation by preventing excessive Th1 and Th17 cell-mediated immune responses. Supplementation of psychosine may serve as a novel therapeutic approach for the treatment of IBD.

背景：异常t -辅助性1 （Th1）和Th17细胞活化参与炎症性肠病（IBD）的发病机制。众所周知，精神碱可以诱导细胞凋亡，促进星形胶质细胞活化，抑制破骨细胞的发生。然而，精神素在Th1和Th17细胞免疫应答中的作用尚未见报道。在这项研究中，我们研究了精神素在CD4+ T细胞调节中的作用。方法：分别从IBD患者和健康对照者外周血中分离CD4+ (PB-CD4+) T细胞，用精神素培养，采用流式细胞仪和酶联免疫吸附法分析IFN-γ和IL-17A的表达。建立dss诱导小鼠结肠炎模型；采用流式细胞仪和实时定量聚合酶链反应检测炎症因子的表达。结果：我们发现精神素能抑制PB-CD4+ T细胞中IFN-γ和IL-17A的表达以及Th1和Th17的细胞分化。同时观察到精神素对PB-CD4+ T细胞增殖和肠黏膜炎症的抑制作用。在体内，精神素通过抑制Th1和Th17细胞免疫应答来减轻dss诱导的小鼠结肠炎。结论：我们的数据显示，精神素通过防止过量的Th1和Th17细胞介导的免疫反应来减轻粘膜炎症。补充精神素可能成为治疗IBD的一种新的治疗方法。

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引用次数: 0

Bile Acid Metabolites Control Th17/Treg Balance in Primary Biliary Cholangitis: Mechanisms of Disease Progression and Therapeutic Targets 原发性胆道胆管炎中胆汁酸代谢物控制Th17/Treg平衡：疾病进展机制和治疗靶点

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-07 DOI: 10.1111/jgh.70189

Zhiqian Liu, Haitao Jiang, Fuqing Li, Rui Xie, Hong Wang

Primary biliary cholangitis (PBC) is a prototypical autoimmune hepatobiliary disease that is pathologically characterized by persistent cholestasis and selective obliteration of the interlobular bile ducts. T helper cell 17 (Th17) and regulatory T cells (Treg) are critically implicated in the immunopathogenesis of PBC. Accumulated bile acid metabolites, such as isoalloLCA, in patients with PBC modulate the differentiation and functional dynamics of Tregs and Th17 cells. Notably, disruption of the Th17/Treg balance in PBC exacerbates biliary inflammation, accelerates the deterioration of hepatic fibrosis, and increases the likelihood of evolving hepatocellular carcinoma (HCC). Recent advances in targeting the bile acid metabolites to control the Th17/Treg balance have unveiled novel therapeutic avenues. Pharmacological agents have demonstrated efficacy in maintaining the Th17/Treg rebalance, showing significant therapeutic promise for PBC. This review provides new insights into the treatment of PBC by systematically summarizing the central role of bile acid metabolites in the differentiation of Th17 and Treg cells and investigating the feasibility of related targeted therapies.

原发性胆道胆管炎（PBC）是一种典型的自身免疫性肝胆疾病，其病理特征是持续性胆汁淤积和选择性小叶间胆管阻塞。辅助性T细胞17 （Th17）和调节性T细胞（Treg）在PBC的免疫发病机制中起关键作用。PBC患者积累的胆汁酸代谢物，如异allolca，调节Tregs和Th17细胞的分化和功能动态。值得注意的是，PBC中Th17/Treg平衡的破坏加剧了胆道炎症，加速了肝纤维化的恶化，并增加了发展为肝细胞癌（HCC）的可能性。针对胆汁酸代谢物控制Th17/Treg平衡的最新进展揭示了新的治疗途径。药物已被证明在维持Th17/Treg平衡方面有效，显示出对PBC的显著治疗前景。本文系统总结了胆汁酸代谢物在Th17和Treg细胞分化中的核心作用，并探讨了相关靶向治疗的可行性，为PBC的治疗提供了新的思路。

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引用次数: 0

Objective Assessment of Visibility of Colorectal Lesions Using Eye Tracking for New Image-Enhanced Endoscopy Observation 目的评价眼动追踪在新型图像增强内镜观察中对结直肠病变可见性的影响。

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-05 DOI: 10.1111/jgh.70191

Aiji Hattori, Hiroaki Ikematsu, Hiroki Yamashita, Takuma Oguro, Mitsuhiro Goto, Takeaki Yamazaki, Maasa Sasabe, Nobuhisa Minakata, Takashi Watanabe, Tomohiro Mitsui, Atsushi Inaba, Hironori Sunakawa, Keiichiro Nakajo, Tatsuro Murano, Tomohiro Kadota, Kensuke Shinmura, Hayato Nakagawa, Tomonori Yano

Background and Aim

This study aimed to objectively evaluate colorectal lesion visibility using white-light imaging (WLI), narrow-band imaging (NBI), and texture and color enhancement imaging (TXI) with an eye tracking system.

Methods

Twelve endoscopists assessed 120 images of 30 colorectal lesions (29 adenomas, one sessile serrated lesion) captured using WLI, NBI, TXI mode-1, and TXI mode-2. Eye movements were recorded to analyze the lesion detection ability and time taken. The miss rate (calculated as the ratio of missed lesions from 360 images) and detection time (defined as the time from displaying the image to the start of gaze on lesions) were compared among the four modalities.

Results

The miss rates of WLI, NBI, TXI mode-1, and TXI mode-2 were 16.4%, 6.4%, 11.7%, and 16.7%, respectively. The miss rate of NBI was significantly lower than those of WLI and TXI mode-2 (p < 0.001). The detection times (median [interquartile range]) of WLI, NBI, TXI mode-1, and TXI mode-2 were 0.71 (0.43–1.37) s, 0.54 (0.34–0.89) s, 0.63 (0.44–1.13) s, and 0.64 (0.37–1.28) s, respectively. NBI had the shortest detection time among the four modalities (p < 0.001 compared with WLI and TXI mode-2; p = 0.005 compared with TXI mode-1).

Conclusions

Objective assessment using the eye tracking system revealed that NBI provided the best colorectal lesion visibility, with the lowest miss rate and shortest detection time.

背景与目的：本研究旨在利用眼动追踪系统的白光成像（WLI）、窄带成像（NBI）和纹理和色彩增强成像（TXI）客观评价结直肠病变的可见性。方法：12名内镜医师评估了使用WLI、NBI、TXI -1和TXI -2捕获的30个结直肠病变（29个腺瘤，1个无底锯齿状病变）的120张图像。记录眼球运动，分析病变检测能力和所需时间。比较四种模式的缺失率（以360张图像中缺失病灶的比例计算）和检测时间（定义为从显示图像到开始注视病灶的时间）。结果：WLI、NBI、TXI模式1、TXI模式2的漏检率分别为16.4%、6.4%、11.7%、16.7%。结论：采用眼动追踪系统进行客观评价，NBI的结直肠病变可见性最佳，漏检率最低，检测时间最短。

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引用次数: 0

Rome III Versus Rome IV Criteria for Diagnosing Irritable Bowel Syndrome in a Southeast Asian Population: Insights From the Rome Foundation Global Epidemiology Study Household Survey 在东南亚人群中诊断肠易激综合征的罗马III与罗马IV标准：来自罗马基金会全球流行病学研究家庭调查的见解

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-04 DOI: 10.1111/jgh.70174

Daniel Martin Simadibrata, Thai Hau Koo, Amanda Pitarini Utari, Mina Ayad, Kueh Yee Cheng, Ami D. Sperber, Bangdiwala Shrikant I, Olafur S. Palsson, Ari Fahrial Syam, Yeong Yeh Lee

Introduction

Previous Asian studies have reported a substantial decline in irritable bowel syndrome (IBS) prevalence following the adoption of the Rome IV diagnostic criteria. However, comparative data on IBS prevalence using Rome III and Rome IV criteria remain sparse, especially in Southeast Asia.

Methods

We analyzed household survey data from the Rome Foundation Global Epidemiology Study conducted in Malaysia and Indonesia, the only Southeast Asian countries included in the study, utilizing household-based sampling. We compared diagnostic sensitivity between Rome III and Rome IV criteria for IBS and examined demographic characteristics, symptom severity, psychological distress, quality of life (QoL), healthcare utilization, and dietary habits among identified IBS participants.

Result

Of 3411 participants (Malaysia: 2072; Indonesia: 1339), 177 (5.2%) fulfilled IBS criteria according to either Rome III or IV criteria. Among these, 115 (65%) met only the Rome III criteria, 50 (28%) met both the Rome III and IV criteria, and 12 (7%) exclusively met the Rome IV criteria. Compared with those diagnosed by Rome III, individuals identified by Rome IV criteria were younger and predominantly female. Only 31% of the Rome III IBS cases remained classified as IBS under the Rome IV criteria, while others were reclassified as unspecified bowel disorder (24%) or functional constipation (17%). While healthcare utilization rates were similar across groups, Rome IV IBS participants exhibited significantly higher symptom severity, lower anxiety levels, and poorer mental health-related QoL. Dietary assessments revealed significantly lower intake of milk, meat products, fish, eggs, vegetables and legumes, fruit, bread, and pasta among Rome IV IBS participants.

Conclusion

The Rome IV criteria for IBS demonstrate reduced diagnostic sensitivity compared with the Rome III criteria in the Southeast Asian populations. Individuals meeting the Rome IV criteria displayed distinct demographic and clinical characteristics, including greater symptom severity and reduced mental health-related QoL.

导言：先前的亚洲研究报道，采用罗马IV诊断标准后，肠易激综合征（IBS）患病率大幅下降。然而，使用罗马III和罗马IV标准的IBS患病率的比较数据仍然很少，特别是在东南亚。方法：我们分析了罗马基金会全球流行病学研究在马来西亚和印度尼西亚进行的家庭调查数据，这是该研究中唯一的东南亚国家，采用基于家庭的抽样。我们比较了罗马III和罗马IV标准对IBS的诊断敏感性，并检查了确定的IBS参与者的人口统计学特征、症状严重程度、心理困扰、生活质量（QoL）、医疗保健利用和饮食习惯。结果：在3411名参与者中（马来西亚：2072名；印度尼西亚：1339名），177名（5.2%）符合罗马III或IV标准的IBS标准。其中，115家（65%）仅符合罗马III标准，50家（28%）同时符合罗马III和罗马IV标准，12家（7%）完全符合罗马IV标准。与罗马III诊断的患者相比，罗马IV诊断的患者更年轻，且以女性为主。根据Rome IV标准，只有31%的Rome III型IBS病例被归类为IBS，而其他病例被重新归类为未明确的肠道疾病（24%）或功能性便秘（17%）。虽然各组之间的医疗保健使用率相似，但Rome IV IBS参与者表现出明显更高的症状严重程度，更低的焦虑水平和更差的精神健康相关生活质量。饮食评估显示，在罗马IV型IBS参与者中，牛奶、肉制品、鱼、蛋、蔬菜和豆类、水果、面包和面食的摄入量显著降低。结论：在东南亚人群中，IBS的Rome IV标准的诊断敏感性低于Rome III标准。符合Rome IV标准的个体表现出明显的人口学和临床特征，包括更严重的症状和更低的精神健康相关生活质量。

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引用次数: 0

The Saline-Immersion/Irrigation TEchnique for Endoscopic Submucosal Dissection of Colorectal Lesions: Outcomes From a Large Western Cohort 盐水浸泡/冲洗技术用于内镜下结肠直肠病变粘膜下剥离：来自西方大型队列的结果。

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-03 DOI: 10.1111/jgh.70163

Elisabet Maristany Bosch, Georgios Kalopitas, Alessandro Rimondi, Hironori Yamamoto, Alberto Murino, Edward J. Despott

Background and Study Aims

Endoscopic submucosal dissection (ESD) is increasingly used for the resection of complex lesions of the gastrointestinal tract. However, its adoption in the management of colonic lesions in Western practice remains challenging, mainly due to the anatomical complexities of the colon. The saline-immersion/irrigation technique (SITE), combined with the pocket-creation method (PCM) may help to overcome these challenges. This study evaluates outcomes of SITE-PCM ESD in a Western tertiary center.

Methods

We analyzed consecutive colorectal ESD procedures performed at our center between 2017 and 2024. SITE-PCM was used in all cases. Lesion characteristics, procedural outcomes, histopathological findings, adverse events, and follow-up data were analyzed.

Results

A total of 181 lesions in 177 patients were resected en bloc using SITE-PCM ESD. Sixty lesions (33.1%) were located in the proximal colon, while 79 (43.6%) were rectal lesions. R0 and curative resection rates were 92.3% and 90.6%, respectively. The median procedure time was 120 min. Adverse events occurred in 4.4% of cases, with only three patients necessitating hospitalization and nonsurgical intervention due to delayed bleeding, and one patient requiring surgical management after a delayed perforation. Notably, 93.4% of the procedures were performed under conscious sedation.

Conclusions

In our experience SITE-PCM-ESD appears to be a safe and effective minimally invasive approach for complex colorectal lesions. It achieves high R0 and curative resection rates with low adverse events and is feasible under conscious sedation. These findings support broader adoption of SITE-PCM in Western practice and justify prospective multicenter validation.

背景与研究目的：内镜下粘膜剥离术（ESD）越来越多地用于胃肠道复杂病变的切除。然而，在西方实践中，结肠病变的治疗仍然具有挑战性，主要是由于结肠解剖的复杂性。盐水浸泡/灌溉技术（SITE）与口袋创造方法（PCM）相结合，可能有助于克服这些挑战。本研究评估了西部三级中心SITE-PCM ESD的结果。方法：我们分析了2017年至2024年在我中心连续进行的结直肠ESD手术。所有病例均采用SITE-PCM。分析病变特征、手术结果、组织病理学结果、不良事件和随访数据。结果：177例患者共181个病灶采用SITE-PCM ESD整体切除。60例（33.1%）位于结肠近端，79例（43.6%）位于直肠。R0和治愈率分别为92.3%和90.6%。中位手术时间为120分钟。4.4%的病例发生了不良事件，只有3例患者因延迟出血需要住院和非手术干预，1例患者因延迟穿孔需要手术治疗。值得注意的是，93.4%的手术是在清醒镇静下进行的。结论：根据我们的经验，SITE-PCM-ESD是一种安全有效的微创治疗复杂结直肠病变的方法。该方法具有较高的R0和治愈率，不良事件发生率低，在清醒镇静下可行。这些发现支持SITE-PCM在西方实践中的广泛采用，并证明了前瞻性的多中心验证。

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引用次数: 0

Evaluation of Factors Influencing Specialist Referral Among Individuals Tested Positive for HBsAg in Health Check Programs in Hong Kong 影响香港健康检查中HBsAg阳性个体转诊的因素评估。

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-03 DOI: 10.1111/jgh.70151

Henry Lik Yuen Chan, Judy Man Lee Lee, Christie Fung Yin Cheng, Aggie Fung Sheung Chan, Dorothy Man Ching Tung, Grace Lai Hung Wong, Patrick Chun Yip Tsoi, Tsz Kei Pun, Terry Cheuk Fung Yip

Background and Aims

Linkage of hepatitis B virus (HBV)-infected individuals to medical care is a major hurdle in the HBV elimination care cascade. This study aimed to investigate the rate and factors influencing specialist referral of HBV cases identified in health check programs.

Methods

This was a retrospective study among consecutive individuals undergoing health check programs with hepatitis B surface antigen (HBsAg) tested in a hospital from 2014 to 2023. Clinical data were captured from the hospital electronic database. Letter of referral after health check was recorded.

Results

A total of 28 940 individuals underwent health check with HBsAg tested. Six hundred and seventy-three HBsAg-positive individuals were eligible for analysis. Overall, 322 (47.8%) individuals received referral to hepatology specialist. There was a trend of increasing referral with time over the 10 years; trend slope (95% confidence interval): 5.0% (3.5%–6.4%) per year; p < 0.001. HBV DNA was tested in 207 (30.8%) individuals. On multivariable analysis, with reference to individuals with no HBV DNA tested, HBV DNA ≥ 2000 IU/mL was the strongest independent factor associated with referral (adjusted odds ratio 21.42; 95% confidence interval 8.79–52.24; p < 0.001). Detectable HBV DNA < 2000 IU/mL had a modest association with referral (adjusted odds ratio 1.84; 95% confidence interval 1.08–3.11; p = 0.024).

Conclusions

Elevated HBV DNA is an important factor associated with specialist referral among HBsAg-positive individuals identified at health check programs. These findings suggest that implementing reflex HBV DNA testing could be a key strategy to improve specialist referral and facilitate linkage to care.

背景和目的：乙型肝炎病毒（HBV）感染者与医疗护理的联系是HBV消除护理级联的主要障碍。本研究旨在探讨健康检查中发现的HBV病例转诊率及影响转诊的因素。方法：这是一项回顾性研究，对2014年至2023年在某医院接受乙肝表面抗原（HBsAg）检测的连续个体进行健康检查。临床数据从医院的电子数据库中获取。记录健康检查后的转介信。结果：共有28940人接受健康检查并检测HBsAg。673名hbsag阳性个体符合分析条件。总体而言，322人（47.8%）接受了肝病专家的转诊。随着时间的推移，转诊有增加的趋势；趋势斜率（95%置信区间）：5.0%(3.5%-6.4%)/年；结论：HBV DNA升高是健康检查中发现的hbsag阳性个体转诊的重要因素。这些发现表明，实施反射性HBV DNA检测可能是改善专科转诊和促进与护理联系的关键策略。

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引用次数: 0

Optimizing Colorectal Polyp Screening: A Novel Artificial Intelligence-Assisted Colonoscopy Diagnostic System Based on NICE Classification 优化结肠息肉筛查：一种基于NICE分类的新型人工智能辅助结肠镜诊断系统。

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-03 DOI: 10.1111/jgh.70198

Lin Lin, Song Yan, Xu Xin, Yao Shuangzhe, Hui Yangyang, Yang Mo, Sun Jiachen, Wang Yufeng, Feng Yue, Mu Jinbao, Gao Wei, Zheng Zhongqing, Wang Bangmao, Chen Xin

Background

This study aims to evaluate the diagnostic performance of an enhanced artificial intelligence-assisted colonoscopy system, CAD-N-Pro, based on the NICE (Narrow-band Imaging International Colorectal Endoscopic) classification.

Methods

Compared to the previous CAD-N system, this study optimized the algorithm into a segmentation network to comprehensively assess the diagnostic performance of the CAD-N-Pro model. A total of 14 675 images from 5 hospitals were classified using the NICE classification for training, internal and external validation. The model's performance was also compared with the previous CAD-N model. To validate the clinical applicability, 200 colonoscopy videos were prospectively collected and analyzed, with comparisons made among endoscopists of different seniority.

Results

In external image validation, CAD-N-Pro demonstrated excellent diagnostic accuracy across polyp types, with an overall AUC of 0.979. The system achieved accuracies of 0.966 for type 1 polyps and type 2 polyps (95% CI 0.956–0.975), and 0.997 for type 3 polyps (95% CI 0.993–0.999), 0.994 for normal background (95% CI 0.990–0.997). In the video validation, the performance of CAD-N-Pro was demonstrated to be superior to that of endoscopists with different years of experience, particularly in the diagnosis of type 1 and type 2 polyps. Moreover, CAD-N-Pro exhibited superior performance to endoscopists in detecting colorectal polyps of different sizes, especially those < 10 mm. For polyps larger than 10 mm, its performance was comparable to that of endoscopists with > 3 years of experience.

Conclusion

The optimized CAD-N-Pro model enhances optical diagnostic accuracy for colorectal polyps, providing a robust tool for clinical decision-making in real-time colonoscopy examinations.

背景：本研究旨在评估基于NICE（窄带成像国际结直肠内镜）分类的增强型人工智能辅助结肠镜检查系统CAD-N-Pro的诊断性能。方法：与以往的CAD-N系统相比，本研究将算法优化为一个分割网络，综合评估CAD-N- pro模型的诊断性能。采用NICE分类对来自5家医院的14675张图像进行分类，进行训练、内部和外部验证。并与之前的CAD-N模型进行了性能比较。为了验证临床适用性，前瞻性地收集和分析了200个结肠镜检查视频，并对不同资历的内镜医师进行了比较。结果：在外部图像验证中，CAD-N-Pro对息肉类型的诊断准确率很高，总体AUC为0.979。该系统对1型和2型息肉的准确率为0.966 (95% CI 0.956-0.975)，对3型息肉的准确率为0.997 (95% CI 0.993-0.999)，对正常背景的准确率为0.994 （95% CI 0.990-0.997）。在视频验证中，CAD-N-Pro的表现优于具有不同年数经验的内镜医师，特别是在诊断1型和2型息肉方面。此外，CAD-N-Pro在检测不同大小的结肠直肠息肉方面表现优于内镜医师，特别是具有3年经验的内镜医师。结论：优化后的CAD-N-Pro模型提高了对结直肠息肉的光学诊断准确性，为实时结肠镜检查的临床决策提供了强有力的工具。

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引用次数: 0

Safety of Potassium-Competitive Acid Blockers Compared With Proton Pump Inhibitors in Patients With Gastroesophageal Reflux Disease and Peptic Ulcer Disease: A Systematic Review and Meta-Analysis 与质子泵抑制剂相比，钾竞争性酸阻滞剂在胃食管反流病和消化性溃疡患者中的安全性：一项系统综述和荟萃分析

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-02 DOI: 10.1111/jgh.70178

Yewon Jang, Jongho Park, Dahee Kang, Jae Hyun Kim, Hyuk Soon Choi, Ha-Lim Jeon, Hankil Lee

Background and Aim

Potassium-competitive acid blockers (P-CABs) are a novel class of acid suppressants developed to overcome the limitations of proton pump inhibitors (PPIs), providing rapid and sustained acid suppression. While PPI-related adverse events (AEs) are well-documented, safety data on P-CABs remain limited. This study systematically reviewed AEs of P-CABs compared with PPIs, with a meta-analysis focusing on hypergastrinemia.

Methods

Following a preregistered PROSPERO protocol (CRD42024565011), we searched for randomized controlled trials (RCTs) and observational studies comparing P-CABs and PPIs in patients with gastroesophageal reflux disease or peptic ulcer disease. Frequently reported AEs and serious AEs (SAEs) were qualitatively synthesized; hypergastrinemia was quantitatively analyzed using a random-effects model.

Results

Ten RCTs and one observational study were included. Nine studies reported specific AEs, with diarrhea reported in seven studies and constipation, nasopharyngitis, and liver-related events, each reported in three. Most AEs had reporting rates below 5%, except diarrhea, nasopharyngitis, and upper respiratory tract inflammation, which exceeded 5% in both groups. Fracture demonstrated the largest relative difference between the groups, with a threefold higher rate in the P-CAB group. SAEs were observed in fewer than 10% of patients in both groups in most studies. A meta-analysis of six studies showed greater serum gastrin elevation in the P-CAB group compared with the PPI group (mean difference: 130.92 pg/mL, 95% confidence intervals: 36.37–225.47).

Conclusions

P-CABs demonstrate a comparable AE risk to PPIs but monitoring for hypergastrinemia and hepatic dysfunction is essential. Further research is required to support safer clinical use.

背景和目的：钾竞争酸阻滞剂（p - cab）是一类新型的酸抑制剂，旨在克服质子泵抑制剂（PPIs）的局限性，提供快速和持续的酸抑制。虽然与ppi相关的不良事件（ae）有充分的记录，但p - cab的安全性数据仍然有限。本研究系统地回顾了p - cab与PPIs的ae，并对高胃泌素血症进行了荟萃分析。方法：根据预注册的PROSPERO方案（CRD42024565011），我们检索了比较P-CABs和PPIs在胃食管反流病或消化性溃疡疾病患者中的应用的随机对照试验（rct）和观察性研究。定性合成频繁报道的ae和严重ae (SAEs)；采用随机效应模型定量分析高胃泌素血症。结果：纳入10项随机对照试验和1项观察性研究。9项研究报告了特异性不良反应，7项研究报告了腹泻，3项研究报告了便秘、鼻咽炎和肝脏相关事件。大多数不良反应的报告率低于5%，但腹泻、鼻咽炎和上呼吸道炎症在两组中均超过5%。骨折在两组间表现出最大的相对差异，P-CAB组的发生率高出三倍。在大多数研究中，两组患者中SAEs的发生率均低于10%。六项研究的荟萃分析显示，P-CAB组的血清胃泌素升高高于PPI组（平均差异：130.92 pg/mL， 95%可信区间：36.37-225.47）。结论：p - cab显示出与PPIs相当的AE风险，但监测高胃泌素血症和肝功能障碍是必要的。需要进一步的研究来支持更安全的临床使用。

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引用次数: 0

Esophageal Lichen Planus Developed in a Patient With Achalasia 贲门失弛缓症患者发生食管扁平苔藓。

IF 3.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastroenterology and Hepatology

Pub Date : 2025-12-02 DOI: 10.1111/jgh.70188

Masayoshi Kure, Ippei Tanaka, Yuto Shimamura, Haruhiro Inoue

An 80-year-old man underwent follow-up endoscopy 2 months after peroral endoscopic myotomy (POEM) for achalasia. Pre-POEM endoscopy had revealed a 60 mm, white, flat, elevated lesion with a rough surface in the mid-thoracic esophagus. As it was distant from the myotomy site and lacked malignant features, POEM was prioritized.

Follow-up endoscopy showed persistent granular white mucosa with mild erythema (Figure 1A). Magnified narrowband imaging (NBI) demonstrated whitish surface changes and vascular patterns classified as Type A under the Japan Esophageal Society classification (Figure 1B), supporting a benign etiology. Endocytoscopy revealed dense cytoplasmic staining and indistinct nuclei, suggesting keratinization (Figure 2A). Although biopsy revealed no malignancy, the lesion's size, appearance, and persistence prompted diagnostic endoscopic submucosal dissection (ESD).

Histopathological examination demonstrated marked squamous epithelial keratinization, dense lymphocytic infiltration in and beneath the epithelium, and elongation of the basal rete ridges (Figure 2B). Immunohistochemical staining showed negative p53 and basal-layer confined Ki-67 expression, confirming a diagnosis of esophageal lichen planus (ELP).

ELP is a rare manifestation of lichen planus, a chronic inflammatory disorder more commonly involving the oral mucosa [1, 2]. Although benign, ELP may mimic verrucous carcinoma and carry a potential risk of malignant transformation [3, 4]. This case highlights the importance of careful endoscopic evaluation and diagnostic resection in achalasia patients, who are at increased risk of esophageal squamous cell carcinoma [5].

The authors received no specific funding for this work.

The authors declare no conflicts of interest.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

一位80岁的男性在经口内窥镜肌切开术（POEM）治疗贲门失弛缓症2个月后接受了随访内窥镜检查。poem前内镜检查显示，在胸椎中段食道有一个60毫米、白色、平坦、隆起、表面粗糙的病变。由于离肌切开术部位较远且无恶性特征，因此优先考虑POEM。随访内镜检查显示持续颗粒状白色粘膜伴轻度红斑（图1A）。放大窄带成像（NBI）显示白色的表面改变和血管模式，在日本食管学会分类中被归类为A型（图1B），支持良性病因。胞内镜检查显示细胞质染色致密，细胞核模糊，提示角化（图2A）。虽然活检未发现恶性肿瘤，但病变的大小，外观和持续性提示内镜下粘膜下剥离（ESD）诊断。组织病理学检查显示明显的鳞状上皮角质化，上皮内和上皮下密集的淋巴细胞浸润，基底网脊伸长（图2B）。免疫组化染色显示p53和基底层受限Ki-67表达阴性，证实食管扁平苔藓（ELP）的诊断。ELP是扁平苔藓的一种罕见表现，扁平苔藓是一种慢性炎症性疾病，更常累及口腔黏膜[1,2]。虽然是良性的，但ELP可能与疣状癌相似，并具有恶性转化的潜在风险[3,4]。本病例强调了贲门失弛缓症患者仔细内镜评估和诊断切除的重要性，贲门失弛缓症患者患食管鳞状细胞癌的风险增加。作者没有得到这项工作的特别资助。作者声明无利益冲突。数据共享不适用于本文，因为在当前研究中没有生成或分析数据集。

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引用次数: 0