Journal of Gastroenterology and Hepatology最新文献

Gastric cancer (GC) has become a serious threat to global health with escalating incidence and mortality. There is a lack of effective approach to evaluate prognostic survival and stratify high-risk patients due to the highly heterogeneous characteristics of GC. In this study, we integrated N6-methyladenosine (m⁶A) RNA modification, ferroptosis gene sets, and lncRNA transcriptomic data together, established and validated a novel six-lncRNA profile associating with the survival of GC. The m⁶A-ferroptosis lncRNA signature could identify high-risk GC patients and characterize the immunosuppressive tumor microenvironment (TME). In our GC cohort, the 3- and 5-year survival rates of the high-risk compared with low-risk subgroup were 27.8% versus 54.8% and 22.2% versus 50.0%, respectively. Multiplex immunofluorescence assays indicated that high-risk GC samples frequently had less infiltration of CD8⁺ T cells but exhibited abundant immunosuppressive M2-polarized macrophages and Tregs. The differentially expressed genes were primarily enriched in oxidative stress response, reactive oxygen species, RNA metabolic processes, the PI3K-Akt signaling axis, and leukocyte transendothelial migration pathways. Accordingly, high-risk patients might be sensitive to inhibitors targeted at PDK1, tyrosine kinase, PI3K, and HIF-proly1 hydroxylase, whereas the low-risk subgroup might benefit from blockade of ErbB, TrkA, PARP, and Ribosomal S6 kinase. Moreover, we demonstrated that the high-risk factor AC129507.1 in the lncRNA signature was a novel target of the m⁶A regulatory axis WTAP/YTHDF3/ALKBH5, and depletion of AC129507.1 could markedly induce ferroptosis in GC. Collectively, these findings provide a candidate strategy for risk classification and better clinical management of GC and shed new insight into the underlying mechanism of AC129507.1 in GC development.

Background and aim: The effectiveness of standard endoscopic treatment (SET) for non-variceal upper gastrointestinal bleeding (NVUGIB) may vary, particularly depending on the bleeding site, lesion size, and etiology. Recent studies suggest that hemostatic powder (HP) may effectively control bleeding secondary to malignant upper gastrointestinal lesions, but its efficacy in benign etiology for NVUGIB remains uncertain. This systematic review and meta-analysis aimed to compare the effectiveness of HP versus SET as first-line therapy for patients with non-malignant causes of NVUGIB.

Methods: We systematically searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) from inception to January 2025. We used risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes with their corresponding 95% confidence intervals (CIs).

Results: We included 5 RCTs (708 patients). Compared to SET, HP was associated with marginally lower risk of further bleeding during esophagogastroduodenoscopy (EGD) (RR 1.04; 95% CI [1.001, 1.084]; p = 0.04) and similar rebleeding rate within 1, 3, 7, 15, and 30 days. The need for a second endoscopic treatment and the mean procedure time were similar between the groups. Subgroup analyses showed that HP has a lower risk of further bleeding during EGD only when analyzing Forrest IIa lesions, but not in active bleeding.

Conclusions: In patients with non-malignant NVUGIB, HP demonstrated lower risk of further bleeding during EGD in cases with non-bleeding visible vessels. There was no statistically significant difference in further bleeding during EGD for active bleeding, nor in rebleeding risk at 1, 3, 7, 15, or 30 days.

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.

This case report describes a 73-year-old man with more than 1 year of intermittent dysphagia, initially suspected of having esophageal malignancy based on imaging and endoscopic findings. However, multiple mucosal biopsies revealed only mild dysplasia without eosinophilic infiltration. Endoscopic ultrasound performed at our hospital revealed a preserved four-layer esophageal wall structure with diffuse thickening of the muscularis propria at 30-40 cm from the incisors. Definitive diagnosis was ultimately achieved through peroral endoscopic myotomy (POEM) combined with biopsy, which revealed marked eosinophilic infiltration confined to the muscularis propria, consistent with eosinophilic esophageal myositis. POEM provided both diagnostic and therapeutic benefits, leading to substantial clinical improvement and weight gain over 1 year of follow-up without the use of corticosteroids.

Gastrointestinal (GI) cancers represent a significant global health burden, being among the leading causes of cancer-related deaths. The prognosis for patients remains unsatisfactory, largely because most cancers are detected at advanced stages. Traditional diagnostic methods, such as radiological and histopathological examinations and serum tumor markers like AFP, CEA, CA-125, and CA-199, possess limitations in sensitivity and specificity, particularly for early screening. A major drawback of tissue biopsy is its inability to fully capture the inherent heterogeneity within tumors, as mutations can differ between primary and metastatic sites. In this context, liquid biopsy has emerged as a promising, minimally invasive alternative for detecting cancer-associated materials present in various body fluids. The concept of liquid biopsy, initially centered on circulating tumor cells, has expanded to encompass other critical biomarkers such as circulating tumor DNA, extracellular vesicles, and circulating tumor RNA. Analyzing these biomarkers using advanced techniques like next-generation sequencing or proteomics can unveil a wealth of potential information. Liquid biopsy offers numerous advantages, being less invasive, more convenient, potentially more cost-effective, and providing a dynamic, real-time snapshot of the entire tumor burden that reflects both intertumoral and intratumoral heterogeneity. This review provides an overview of key liquid biopsy biomarkers and their associated detection technologies, discusses their burgeoning clinical applications across various GI cancer types, and highlights the current challenges and future directions in this rapidly evolving field.