Journal of Gastroenterology and Hepatology最新文献

Hepatocellular carcinoma (HCC) remains one of the most prevalent and lethal malignancies worldwide, characterized by late diagnosis, limited therapeutic options, and poor prognosis. Conventional systemic therapies such as sorafenib and its successors provide only modest survival benefits and are frequently complicated by toxicity and drug resistance. In recent years, immunotherapy has emerged as a promising avenue, yet its efficacy is often restricted by the profoundly immunosuppressive tumor microenvironment (TME). Within this landscape, exosomes-nanoscale extracellular vesicles secreted by tumor, stromal, and immune cells-have gained increasing attention for their central role in intercellular communication. They influence immune modulation, metabolic reprogramming, and therapeutic resistance, while also serving as potential biomarkers, nanocarriers, and vaccine platforms. Tumor-derived exosomes (TEXs) contribute to immune evasion by suppressing CD8⁺ T cells, polarizing macrophages toward protumoral phenotypes, and enhancing immune checkpoint resistance. Conversely, engineered exosomes demonstrate significant therapeutic potential by reprogramming TAMs, improving drug delivery, and acting as cancer vaccines. Despite these advances, challenges remain in exosome biogenesis, heterogeneity, large-scale production, and off-target effects, which hinder clinical translation. Furthermore, interactions between exosomes and gut microbiota in modulating hepatic immunity represent an emerging frontier with unexplored therapeutic implications. Continued advances in bioengineering, nanotechnology, and systems biology are expected to refine exosome-based therapies, offering novel, personalized strategies to improve outcomes for HCC patients.

Background and aim: Endoscopic ultrasound (EUS)-guided drainage is widely used for postoperative pancreatic fluid collections (PO-PFCs). However, concerns regarding adverse events persist. We aimed to assess clinical outcomes and identify risk factors for adverse events following endoscopic ultrasound-guided drainage of postoperative pancreatic fluid collections after distal pancreatectomy.

Methods: We retrospectively analyzed 124 patients who underwent EUS-guided drainage for PO-PFCs following distal pancreatectomy. The clinical and procedural data were also evaluated. Risk factors for adverse events and post-procedural bleeding were identified using univariate and multivariate logistic regression analyses. Subgroup analyses were performed before and after the introduction of the electrocautery-enhanced lumen-apposing metal stent (EC-LAMS).

Results: Technical and clinical success rates were 100% and 92.7%, respectively. Adverse events occurred in 25.8% (32/124) of patients. Moderate-to-severe bleeding occurred in 11 patients, of whom 10 required embolization or emergency surgery. Paracolic gutter extension was an independent risk factor for adverse events. Factors associated with post-procedural bleeding included paracolic extension, longer procedure time, antiplatelet or anticoagulant use, and the combined use of electrocautery and mechanical dilators. In the subgroup analysis before and after EC-LAMS introduction, adverse events were less frequent (31.9% vs. 18.2%), but the difference was not statistically significant (p = 0.10).

Conclusions: EUS-guided drainage of PO-PFCs is effective but carries the risk of adverse events. Ongoing refinements in the technique and device design appear to have improved safety over time. Careful case selection and early recognition of adverse events are essential for optimizing patient outcomes.

Background and aim: Colorectal cancer (CRC) is a major global health concern, with molecular and histopathological subtypes influencing disease progression. Mutations in the v-Raf murine sarcoma viral oncogene homolog B (BRAF) gene, particularly the V600E variant, define a subset associated with aggressive features. The impact of BRAF mutations on early-stage CRC prognosis and their interaction with mismatch repair (MMR) status remains less characterized.

Methods: We conducted a retrospective analysis of prospectively collected data from two tertiary institutions on Stage II-III CRC patients. BRAF/MMR subgroups were defined (BRAFmut/pMMR, BRAFmut/dMMR, BRAFwt/pMMR, and BRAFwt/dMMR). Associations with patient/tumor characteristics, adjuvant treatment, and long-term outcomes were assessed. Univariate and multivariate analyses were used to evaluate disease recurrence and mortality.

Results: Of 157 eligible patients, univariate analyses indicated poorer outcomes for those with pMMR CRC. Multivariate analysis examining disease recurrence and death highlights that pMMR patients perform worse, but significantly, this analysis revealed that BRAFmut is a significant predictor of mortality in the nonmetastatic setting, irrespective of MMR status.

Conclusions: Nonmetastatic BRAFmut CRC carries a dismal prognosis, irrespective of MMR status. Routine testing for BRAF^V600E mutation alongside MMR assessment is advocated to inform personalized management, potentially impacting surveillance, adjuvant therapy decisions, and eligibility for targeted therapies.

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.

Background and aim: The consumption of meat, particularly processed and red meat, is believed to increase the risk of colorectal cancer (CRC). This study aims to conduct a meta-analysis to clarify the association between the consumption of red meat, processed meat, and white meat with the risk of CRC, thereby providing a scientific foundation for CRC prevention.

Methods: As of March 2024, we comprehensively searched the Cochrane Library, PubMed, and EMBASE databases for relevant studies. A random-effects model was utilized to calculate the relative risk (RR) and 95% confidence interval (CI), while the I² statistic was used to evaluate the heterogeneity among the studies. Funnel plots and Egger's test were used to assess publication bias, and stratified analyses were conducted based on tumor site, gender, geographic region, and the MD scoring system.

Results: This study includes a total of 31 studies, comprising 12 cohort studies and 19 case-control studies. In cohort studies, the associations observed were as follows: red meat: OR = 1.11 (95% CI: 1.02-1.20), processed meat: OR = 1.17 (95% CI: 1.09-1.25), and white meat: OR = 0.95 (95% CI: 0.72-1.19). In case-control studies, the associations were as follows: red meat: OR = 1.12 (95% CI: 1.03-1.20), processed meat: OR = 1.12 (95% CI: 1.00-1.23), and white meat: OR = 0.95 (95% CI: 0.85-1.24).

Conclusion: The consumption of red and processed meat demonstrated a statistically significant positive correlation with an elevated risk of CRC; however, the consumption of white meat did not exhibit such an association.

Helicobacter pylori infection remains globally prevalent and is a major cause of chronic gastritis, peptic ulcer disease, and gastric cancer (GC). The Asia-Pacific region has the highest global burden of infection and GC mortality; however, the effectiveness of eradication therapy is increasingly being compromised by antibiotic resistance. Between 1990 and 2022, resistance to clarithromycin (CAM), metronidazole (MNZ), and levofloxacin (LVX) increased markedly from 7%, 37%, and 9% to 30%, 61%, and 35%, respectively, whereas resistance to amoxicillin and tetracycline remained low at approximately 4%. Multidrug-resistant H. pylori strains are increasingly being reported in Southeast Asia. The resistance rates among the pediatric and adolescent population in East Asia are similarly high, 37% for CAM, 51% for MNZ, and 19% for LVX, suggesting intrafamilial transmission. The key molecular mechanisms include genetic mutations in 23S rRNA, rdxA/frxA, and gyrA/gyrB, along with adaptive traits such as efflux pump activation and biofilm formation, and coccoid transformation. East Asian countries have adopted divergent strategies, including vonoprazan-based triple therapy in Japan, bismuth-containing quadruple therapy as the preferred first-line regimen in Taiwan, Hong Kong, and China, and tailored regimens based on susceptibility testing in Korea. Future directions include susceptibility-guided therapy, molecular diagnostic testing, family-based eradication, and the development of nonantibiotic therapies. Establishing regional resistance surveillance networks and integrating H. pylori management into national antimicrobial stewardship programs are essential to maintain eradication success and prevent GC. Addressing antibiotic resistance in H. pylori is an urgent public health priority, and coordinated regional strategies are required in the Asia-Pacific region.

A 62-year-old man presented with neurological symptoms, and head computed tomography revealed multiple brain metastases. Subsequent evaluation identified a 30-mm Type 2 ulcerative lesion in the lower gastric body, diagnosed as moderately differentiated tubular adenocarcinoma. In addition, numerous small, patchy white lesions with a large "white globe appearance (WGA)-like" appearance were observed endoscopically throughout the stomach. Histological analysis confirmed lymphatic invasion of adenocarcinoma in these areas. These findings suggest that a large WGA-like appearance may reflect lymphatic dissemination and could serve as endoscopic markers for evaluating tumor invasion depth and metastatic potential in gastric cancer.

Background: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a group of chronic intestinal diseases possibly linked to genetic, environmental, and dietary factors. Recently, studies on caffeine intake and IBD risk have increased, but results remain controversial.

Objective: To explore the relationship between caffeine intake and IBD risk through a systematic review and meta-analysis.

Methods: This study searched multiple databases for prospective, cross-sectional and case-control studies examining caffeine intake and IBD risk, including CNKI, VIP, Wanfang, PubMed, Embase, JBI, and WOS, from database inception to May 21, 2024. Two researchers independently extracted literature data and evaluated quality using Stata 16.0 software for meta-analysis.

Results: A total of 21 studies with 13 209 participants were included. The meta-analysis showed no significant association between caffeine intake and IBD (RR = 0.84, 95% CI = 0.68-1.04). In Americans, caffeine increased UC risk by 68% (RR = 1.68, 95% CI = 1.17-2.42). Age analysis showed caffeine increased IBD risk by 4.52 times in those ≤18 (RR = 4.52, 95% CI = 1.59-12.88) but decreased risk by 7% in those >18 (RR = 0.93, 95% CI = 0.73-1.18). Coffee reduced UC risk by 57% (RR = 0.43, 95% CI = 0.29-0.65), tea by 46% (RR = 0.54, 95% CI = 0.31-0.92). Caffeine increased CD risk by 80% in smokers (RR = 1.80, 95% CI = 1.25-2.60).

Conclusion: The relationship between caffeine intake and IBD risk varies by region, age, caffeine source, smoking, and education level. In Asia and Europe, coffee and tea reduce UC risk, whereas in America and among adolescents, caffeine may increase UC risk. Smoking and education level also significantly influence this relationship, suggesting various factors must be considered to assess caffeine's impact on IBD risk accurately.