Journal of Gastroenterology最新文献

Background: No studies have evaluated the prevalence of supragastric belching (SGB) in Japanese patients with proton pump inhibitor (PPI)-refractory non-erosive reflux disease (NERD) under off-PPI conditions. This study aimed to clarify the association between excessive SGB and esophageal reflux factors.

Methods: Seventy-nine patients with PPI-refractory NERD under off-PPI treatment were evaluated using 24-h multichannel intraluminal impedance pH monitoring and high-resolution impedance manometry.

Results: The prevalence values of excessive SGB overall and in the true NERD, reflux hypersensitivity, and function heartburn subtypes were 19.0%, 35.7%, 5.3%, and 12.5%, respectively. The monitoring results demonstrated that, compared with those without excessive SGB, patients with excessive SGB had a significantly higher total number of reflux events (63 episodes vs. 39 episodes, p = 0.01) and significantly greater acid exposure time (6.1% vs. 1.35%, p = 0.01). However, bolus exposure did not differ significantly between the groups (p = 0.09). The manometry findings showed no significant differences in lower esophageal sphincter pressure, integrated relaxation pressure, and distal contractile integral between the groups. Regarding gastroesophageal reflux, 22% of the SGB episodes were preceded by reflux, 55% occurred independently, and 23% were followed by reflux.

Conclusions: The prevalence of excessive SGB in Japanese patients with PPI-refractory NERD under off-PPI conditions was 19.0% and most commonly observed in patients with true NERD (35.7%). Patients with excessive SGB exhibited increased esophageal acid exposure, and reflux events were sometimes observed before SGB episodes.

Background: Gastrointestinal stromal tumors (GISTs) are malignant subepithelial tumors, known for their poor prognosis due to distant metastasis. Because GIST is covered by a normal mucosal layer, effective tissue biopsy under conventional endoscopy is difficult, thereby leading to delayed diagnosis and a dismal prognosis. We performed molecular imaging of GIST targeting c-KIT using fluorescence-labeled anti-c-KIT antibody/fragments and fluorescent endoscopy.

Methods: Mouse anti-human c-KIT monoclonal antibody, its F(ab')₂ and Fab fragments were labeled with AF680. Two GIST cell lines (GIST-T1, GIST-882M) were used for experiments. Antibodies were intravenously administered to mice xenografted with GIST-T1 or GIST-882M, and each tumor was observed using IVIS Spectrum and self-developed simple fluorescent endoscopy.

Results: The GIST-T1 cell live imaging revealed strong signals on cell membranes after 1 min incubation, and thereafter, they aggregated and internalized inside the cells within 130 min in all antibody/fragment groups. In vivo mouse experiments, AF680-labeled IgG slowly accumulated in tumors peaking at 24 h after injection. However, AF680-labeled F(ab')₂ and Fab rapidly accumulated in tumors peaking at 1-2 h, and completely cleared from the body within 24 h. Fab showed the strongest fluorescence intensity in tumors. Fluorescence endoscopy could clearly detect GIST xenograft tumors 1-2 h after AF680-labeled F(ab')₂ and Fab injection.

Conclusions: AF680-labeled antibody/fragments showed clear and specific fluorescence signals in GIST xenografts in mice. Particularly, AF680-labeled Fab showed the strongest signal intensity at 1-2 h post-administration and rapid clearance, suggestive of the safety. This approach may enable molecular imaging diagnosis of GIST by endoscopy in outpatient settings in the future.

Background: Patients with esophageal motility disorders (EMDs) sometimes develop bacterial pneumonia (BP). However, factors associated with BP in patients with EMDs and whether peroral endoscopic myotomy (POEM) reduces BP development are unclear. Therefore, this study aimed to identify factors associated with BP development and evaluate the preventive potential of POEM in patients with EMDs.

Methods: This study included 623 patients diagnosed with EMDs at our institution between April 2015 and March 2023. Factors associated with BP were analyzed by comparing characteristics between patients who developed BP within 1 year before diagnosis using multivariable analysis. The potential of POEM to prevent BP development was assessed using Cox regression analysis, considering treatment status as a time-varying covariate.

Results: Of the 623 patients, 31 (5.0%) developed BP within 1 year before diagnosis. Older age (odds ratio [OR] = 1.29, 95% confidence interval [CI] 1.04-1.59, p = 0.019; 10-year increments), lower body mass index (OR = 0.87, 95% CI 0.78-0.98, p = 0.026), and manometric diagnosis of spastic esophageal disorders (OR = 2.97, 95% CI 1.24-7.16, p = 0.015) were significantly associated with BP. Treatment status of POEM was proved to be a significant factor for developing BP using Cox regression analysis (hazard ratio = 0.17, 95% CI 0.039-0.75, p = 0.019).

Conclusions: Risk factors associated with BP in patients with EMDs were older age, lower body mass index, and manometric diagnosis of spastic esophageal disorders. POEM could decrease spasm-related bolus reflux, improve patients' nutritional status through resolution of transit disturbance, and reduce respiratory complications, suggesting that POEM could help prevent BP development.

Background: Inflammatory bowel disease (IBD) significantly impacts employment and work productivity, necessitating support for balancing work and treatment (SBWT). While SBWT systems have been formalized in Japan, awareness among healthcare professionals remains low. This study aimed to evaluate the effectiveness of an educational program on SBWT for healthcare professionals in Hokkaido, Japan.

Methods: A 2-year questionnaire-based study was conducted across eight medical facilities in Hokkaido, Japan, from November 2022 to November 2024. The educational program, comprising lecture-based and self-directed learning formats, addressed six key components of SBWT. Pre- and post-program surveys assessed changes in awareness, interest, and behaviors related to SBWT.

Results: Pre-program awareness of SBWT was low (36.7% among doctors, 28.2% among medical staff). Post-program, awareness increased significantly to 81.3% and 58.3%, respectively (p < 0.01). Interest in SBWT improved across several categories for both groups, with greater gains among medical staff. Behavioral changes, such as detailed employment-related consultations with IBD patients and improved reporting practices from medical staff to doctors, were observed but not statistically significant. Lecture-based learning was more effective than self-directed methods, in increasing awareness, interest, and engagement with SBWT, particularly for medical staff.

Conclusions: The educational program successfully enhanced awareness and interest in SBWT, with lecture-based methods proving more effective for medical staff. These findings emphasize the need for tailored educational strategies based on baseline knowledge. Future initiatives should focus on sustaining knowledge acquisition, expanding programs nationwide, and assessing long-term impacts on healthcare practices and patient outcomes.

Background: Despite the high success rate of direct-acting antivirals (DAAs) in achieving sustained virologic response (SVR) in patients with chronic hepatitis C virus (HCV) infection, the risk of hepatocellular carcinoma (HCC) persists in some patients. Cardiometabolic factors, including type 2 diabetes mellitus (T2DM), have been reported as risk factors for de novo HCC after SVR. However, the impact of metabolic dysfunction-associated steatotic liver disease (MASLD) on HCC development after SVR, particularly in Japanese patients, remains unclear.

Methods: A total of 512 HCV-infected patients who achieved SVR following DAA therapy were enrolled in this study. Clinical and laboratory data at 24 weeks after the end of therapy (SVR24) were assessed to determine the impact of MASLD on the development of HCC. Risk factors for HCC occurrence were analyzed using the Fine and Gray subdistribution hazard model.

Results: During a median follow-up of 56 months, HCC developed in 33 patients (6.4%). Patients with MASLD at SVR24 had a significantly higher cumulative incidence of HCC than those without MASLD (P < 0.001). Multivariable analysis identified MASLD, age, male, albumin-bilirubin-platelets (aMAP) score, and FibroScan-AST (FAST) score at SVR24 as independent risk factors for HCC development. Both aMAP and FAST scores were positively correlated with the number of cardiometabolic risk factors.

Conclusions: MASLD is a significant determinant of post-SVR HCC risk among Japanese patients. Risk stratification incorporating MASLD, aMAP, and FAST scores may contribute to the development of optimized, patient-tailored HCC surveillance strategies and improve long-term outcomes in the Japanese clinical setting.

Beyond the hallmark social and sensory difficulties in autism spectrum disorder (ASD), the comorbid gastrointestinal (GI) conditions and their potential link to the severity of core symptoms require clinical attention. Although evidence indicates that autistic children face a greater risk of GI disorders and require more intensive nutritional management compared to neurotypical peers, standard guidelines for managing GI symptoms in this population remain lacking. This review seeks to pinpoint critical considerations for the implementation of nutrition-based strategies aimed at addressing GI dysfunction in individuals with ASD. By emphasizing clinical translation and the mechanistic understanding of these strategies, it highlights the importance of restoring gut homeostasis as a pathway to improve functional independence and overall well-being. Furthermore, we outline priorities for clinical research aimed at developing evidence-based nutritional recommendations to support GI health in autistic individuals, emphasizing personalized and population-specific needs.

Background: The concept of metabolic dysfunction-associated steatotic disease (MASLD) is increasingly being recognized. The mechanisms contributing to hepatocellular injury include oxidative stress owing to mitochondrial dysfunction, endoplasmic reticulum (ER) stress owing to abnormal protein accumulation in the rough ER, and disruption of cellular homeostasis and metabolic regulation to autophagic dysfunction. However, the morphological abnormalities of these intracellular organelles remain unclear.

Methods: Liver tissues from model mice of MASLD, patients with MASLD, and respective controls were subjected to histopathological examination using light microscopy, and intracellular organelles were analyzed via transmission electron microscopy (TEM).

Results: In model mice of MASLD, the progression of MASLD pathology was associated with abnormalities in mitochondria, glycogen granules, and rough ER. Based on these findings, the electron microscopic observations of these intracellular organelles were classified, weighted, and evaluated in liver tissues of patients with MASLD. The electron microscopic findings were significantly relatively frequent in patients with MASLD and correlated with existing histopathological scoring.

Conclusions: Using TEM, we identified characteristic abnormalities in intracellular organelles specific to MASLD. These findings contribute to the understanding of the mechanisms underlying hepatocellular injury in MASLD.

Background: Comprehensive genomic profiling (CGP) tests are increasingly used to explore the genomically matched therapies for solid tumors. The aim of this study is to investigate factors associated with actionable gene aberrations in pancreatic cancer (PC) using real-world data from the Center for Advanced Cancer Genome Therapy (C-CAT) database.

Methods: Among 6768 patients with unresectable and recurrent PC registered in the C-CAT database between June 2019 and July 2023, we identified 4628 patients who underwent tissue-based CGP tests using either FoundationOne^® CDx (F1CDx) or OncoGuide^™ NCC Oncopanel (NOP). We investigated the incidence of actionable gene aberrations and the factors associated with their detection.

Results: The cohort included 3,554 patients who underwent F1CDx and 1128 NOP, with surgical specimens in 50% of the cases. Adenocarcinoma was the predominant subtype (95%), and KRAS mutations were found in 90%. The overall incidence of actionable gene aberrations was 27%. The most common gene abnormalities were BRCA2 (3.4%), followed by ATM (2.9%), ERBB2 (2.8%), PIK3 CA (2.5%), and BRAF (1.9%). Multivariable analysis revealed that acinar cell carcinoma (ACC) (Odds ratio [OR] 1.87, 95% confidence interval [CI] 1.00-2.67), KRAS wild type (KRAS_WT) (OR 3.09, 95% CI 2.49-3.85), and use of F1CDx (OR 2.38, 95% CI 1.98-2.85) were significantly associated with actionable gene aberrations.

Conclusions: Actionable gene aberrations were more likely in cases of ACC, KRAS_WT, and F1CDx usage. The choice of CGP test should be made on a case-by-case basis, as other factors beyond actionable gene aberrations also need to be considered.