Journal of Gastroenterology and Hepatology最新文献

Gastric intestinal metaplasia (GIM), a precancerous gastric lesion, represents a critical transitional stage in the Correa cascade that progresses from chronic inflammation to gastric adenocarcinoma (GAC). Emerging evidence implicates neutrophils as key orchestrators of GIM pathogenesis through multifaceted interactions within the tumor microenvironment. Therapeutic strategies targeting neutrophil activation, migration, and effector functions, including autophagy modulation and phenotypic reprogramming to an anti-inflammatory N2 state, hold promise in reversing GIM progression. This review synthesizes the current knowledge on neutrophil-mediated mechanisms and explores clinically actionable pathways for GIM reversibility.

Background and aims: Despite improved therapies targeting inflammation in inflammatory bowel disease, persistent gastrointestinal and extraintestinal symptoms in those believed to be in remission are highly prevalent with significant impact on patient function and quality of life. This review aims to summarize the scale of the problem, to identify the limitations of previous studies, and to propose how these may be addressed.

Methods: The published literature was extensively reviewed.

Results: Persistent gastrointestinal symptoms are reported in up to 40% of patients with inflammatory bowel disease in apparent remission and have mostly been characterized using the Rome criteria, which are unvalidated in this population. They are also closely linked to anxiety/depression and fatigue. Importantly, studies have frequently failed to use tests with high negative predictive values to exclude intestinal inflammation and have assumed severe symptoms are inflammatory in nature. The presence of ongoing inflammation and different mechanisms underlying the development of symptom-generating abnormalities, including visceral hypersensitivity and central sensitization, that are shared by disorders of gut-brain interaction are evident in the small number of studies performed. Thus, the concept that inflammatory and noninflammatory symptoms are mutually exclusive may be fallacious.

Conclusions: Persistent gastrointestinal symptoms are common in patients with inflammatory bowel disease in apparent remission, but variable criteria to define inflammatory remission may introduce a high risk of bias within existing literature. Further research using objective and robust measures of inflammatory remission is key to better defining this population and to clarifying pathophysiological mechanisms so that effective management strategies can be developed.

Background and aim: Increasing antibiotic resistance rates and cost constraints necessitate optimized Helicobacter pylori therapies. This trial compared the efficacy, safety, and cost-effectiveness of vonoprazan-amoxicillin dual therapy versus bismuth quadruple therapy for H. pylori eradication using China's centralized procurement antibiotics.

Methods: In this multicenter, randomized, controlled trial, 534 treatment-naïve H. pylori-infected patients were assessed, with 450 patients ultimately assigned to the VNCDPA-dual (vonoprazan 20 mg BID + amoxicillin 1 g TID), B-quadruple (esomeprazole 20 mg BID + non-procurement amoxicillin 1 g BID + clarithromycin 500 mg BID + bismuth 600 mg BID), or BNCDPA-quadruple group (same as B-quadruple but with amoxicillin obtained via centralized procurement). Eradication rates were assessed using the urea breath test [per-protocol (PP) and intention-to-treat (ITT) analyses]. Adverse events (AEs) and costs were systematically evaluated.

Results: Eradication rates were comparable among groups [92.1% (B-quadruple) vs. 90.7% (BNCDPA-quadruple) vs. 91.7% (VNCDPA-dual) in PP analysis (p = 0.889); 85.3% vs. 84.7% vs. and 88.0% in ITT analysis (p = 0.947)]. VNCDPA-dual demonstrated superior safety, with significantly fewer AEs (6.8% vs. 17.9%-19%; p = 0.003), particularly dysgeusia (1.4% vs. 15.2%-15.6%; p < 0.001). Centralized procurement amoxicillin reduced costs by 44% (¥239 per course vs. ¥315 per course) without compromising efficacy. Compliance was highest in the VNCDPA-dual group (99% vs. 95.9.7%-95.2% in the quadruple groups, p < 0.04).

Conclusion: This study confirms that 10-day vonoprazan-amoxicillin dual therapy (using National Centralized Drug Procurement antibiotics) demonstrates noninferior efficacy to bismuth quadruple therapy while offering superior safety, better compliance, and the advantage of shorter treatment duration. These findings support its adoption as a first-line regimen for large-scale H. pylori eradication programs.

Chronic non-viral liver diseases (CNVLD), including alcohol-related liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD), have increased in prevalence, surpassing viral hepatitis as the main cause of hepatocellular carcinoma (HCC) in the last decade; thus, the identification of bloodstream biomarkers is essential for early diagnosis, risk stratification, and monitoring progression. This study aimed to systematically integrate and compare proteomic evidence from blood-based studies to identify differentially expressed proteins (DEPs) associated with ALD, MASLD, and HCC of non-viral etiology, to prioritize them as candidates for shared biomarkers and diagnostics for each disease. A systematic review was conducted, followed by a qualitative meta-analysis to identify DEPs bloodstream biomarkers. Biomarkers were compared across diseases to detect overlaps. Functional enrichment, network, and topological analyses were used to evaluate their biological relevance. We identified 16 diagnostic biomarkers for ALD, 53 for MASLD, and 8 for HCC. Four biomarkers were shared among ALD and MASLD, two among ALD and HCC, and two among MASLD and HCC. Functional analyses indicated platelet dysfunction and coagulation pathway alterations in ALD; lipid metabolism dysregulation in MASLD; and a combination of these processes in HCC patients. Network analysis highlighted key biomarkers with potential diagnostic and prognostic applications. The identified biomarkers reflect both shared and disease-specific molecular mechanisms in the progression of CNVLD toward HCC. Their consistent presence across independent studies supports their potential integration into diagnostic and prognostic panels, particularly in the context of the rising prevalence of ALD and MASLD worldwide.

Background and aims: Malignant biliary obstruction (MBO) often necessitates endoscopic retrograde cholangiopancreatography (ERCP) for biliary drainage. Although ERCP is the standard treatment, post-procedural infections such as cholangitis and cholecystitis remain clinically important. Current guidelines recommend prophylactic antibiotics only for high-risk cases. However, data focused specifically on patients with distal MBO (DMBO) undergoing stent placement are limited. This study evaluated the effect of peri-ERCP antibiotics on post-ERCP infectious adverse events in DMBO.

Methods: This multicenter retrospective study included 508 patients who underwent initial biliary stent placement for DMBO between January 2020 and August 2024 at five institutions. Patients were categorized according to whether they received peri-ERCP antibiotics. Propensity score matching (1:1) was performed using clinically relevant covariates. The primary outcome was the incidence of infectious adverse events (cholangitis or cholecystitis) within 5 days of ERCP.

Results: After matching, 165 patients were included in each group. The incidence of infectious adverse events was significantly lower in the peri-ERCP antibiotic group (3.6%) compared with the nonantibiotic group (10.3%), with a risk difference (RD) of 6.7% (95% confidence interval [CI]: 1.2-12.1). Post-ERCP pancreatitis occurred in 10 patients (6.1%) without prophylaxis and 16 (9.7%) with prophylaxis, showing no significant difference (RD: -3.6%, 95% CI: -9.4 to 2.2). Subgroup analysis suggested greater benefit in patients with nonpancreatic cancer (RD, 0.206; 95% CI, 0.07-0.342; p = 0.011) or a bile duct diameter > 10 mm (RD, 0.104; 95% CI, 0.046-0.163; p = 0.001).

Conclusions: Peri-ERCP antibiotics may reduce post-ERCP infectious adverse events in patients with DMBO.

Background: Adequate bowel preparation is crucial for high-quality colonoscopy; however, assessing preparation adequacy can be burdensome for both healthcare providers and patients. In this study, we aimed to develop artificial intelligence (AI) models for the automated identification of bowel PREParation for cOlonoscOpy (AI-PREPOO).

Methods: On the day of colonoscopy, participants were instructed to use smartphones to photograph their stool in the toilet after each bowel movement following initiation of polyethylene glycol solution and upload the images to a secure web server. All images were labeled as "ready" or "not ready" for colonoscopy based on clarity and the absence of solid content. Using these labeled images, four image-recognition models based on different deep learning architectures (AI-PREPOO 1-4) were developed using transfer learning to classify stool status as "ready" or "not ready."

Results: A total of 282 stool images were collected from 37 patients, with 141 images labeled as "ready" and 141 as "not ready." These images were divided into training (224 images) and test (58 images) sets, and the training set was augmented to 2240 images. All models trained on the augmented dataset achieved high performance, with area under the curve (AUC) values exceeding 0.90. AI-PREPOO 1, based on MobileNetV3-Small, demonstrated the most balanced sensitivity-specificity profile (AUC, 0.95; sensitivity, 0.93; specificity, 0.86).

Conclusions: We developed AI-based models capable of accurately assessing bowel preparation adequacy. AI-PREPOO 1 showed a well-balanced diagnostic performance, suggesting its potential to facilitate bowel preparation assessment and reduce the burden on healthcare providers and patients.

Background and aim: Endoscopic submucosal dissection (ESD) is widely used to treat superficial Barrett's esophageal adenocarcinoma (sBEA) in Japan. However, ESD for sBEA remains technically challenging because of respiratory motion and esophageal peristalsis. No studies have reported predictive factors for technical difficulty during ESDs for sBEA. This study aimed to identify predictive factors for technical difficulty during ESDs for sBEA.

Methods: This retrospective single-center cohort study included patients who were diagnosed with sBEA and subsequently underwent ESDs between April 2006 and January 2025. Patients with previous esophagectomies, chemoradiotherapy, and who underwent staged circumferential ESDs or simultaneous resections of multiple lesions were excluded. Technical difficulty was defined as resection times ≥ 120 min, perforations, incomplete treatment, or piecemeal resections. Univariate and multivariate logistic regression analyses were performed to identify the predictive factors for technical difficulty.

Results: In total, 188 patients with 199 lesions were analyzed, and 33 (16.6%) lesions met the criteria for technical difficulty. Multivariate analysis identified long-segment Barrett's esophagus (LSBE) (adjusted odds ratio [OR]: 2.380; 95% confidence interval [CI]: 1.010-5.620; p = 0.048) and circumferential involvement of ≥ 1/2 of the esophagus (adjusted OR: 4.460; 95% CI: 1.290-15.400; p = 0.018) as independent predictive factors. These were also associated with lower R0 resection and negative horizontal margin rates and a higher incidence of post-ESD strictures.

Conclusions: LSBE and circumferential involvement of ≥ 1/2 of the esophagus were identified as significant predictors of technical difficulty in ESDs for sBEA. Preoperative recognition of these factors may facilitate appropriate operator assignment and procedural strategies.