World Journal of Gastroenterology最新文献

Background: Anxiety is a common comorbidity in patients with Crohn's disease (CD). Data on the imaging characteristics of brain microstructure and cerebral perfusion in CD with anxiety are limited.

Aim: To compare the imaging characteristics of brain microstructure and cerebral perfusion among CD patients with or without anxiety and healthy individuals.

Methods: This prospective comparative study enrolled consecutive patients with active CD and healthy individuals who visited the study hospital between January 2022 and January 2023. Anxiety was measured using the Hospital Anxiety and Depression Scale-Anxiety. The imaging characteristics of brain microstructure and cerebral perfusion were measured by diffusion kurtosis imaging and intravoxel incoherent motion.

Results: A total of 57 participants were enrolled. Among the patients with active CD, 16 had anxiety. Compared with healthy individuals, patients with active CD demonstrated significantly lower radial kurtosis values in the right cerebellar region 6, lower axial kurtosis (AK) values in the right insula, left superior temporal gyrus, and right thalamus, and higher slow and fast apparent diffusion coefficients (ADC_slow and ADC_fast) in the bilateral frontal lobe, bilateral temporal lobe, and bilateral insular lobe (all P < 0.05). Compared with patients with CD without anxiety, patients with CD and anxiety exhibited significantly higher ADC_slow values in the left insular lobe and lower AK values in the right insula and right anterior cuneus (all P < 0.05).

Conclusion: There are variations in brain microstructure and perfusion among CD patients with/without anxiety and healthy individuals, suggesting potential use in assessing anxiety-related changes in active CD.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective intervention for managing complications of portal hypertension, particularly acute variceal bleeding (AVB). While effective in reducing portal pressure and preventing rebleeding, TIPS is associated with a considerable risk of overt hepatic encephalopathy (OHE), a complication that significantly elevates mortality rates.

Aim: To develop a machine learning (ML) model to predict OHE occurrence post-TIPS in patients with AVB using a 5-year dataset.

Methods: This retrospective single-center study included 218 patients with AVB who underwent TIPS. The dataset was divided into training (70%) and testing (30%) sets. Critical features were identified using embedded methods and recursive feature elimination. Three ML algorithms-random forest, extreme gradient boosting, and logistic regression-were validated via 10-fold cross-validation. SHapley Additive exPlanations analysis was employed to interpret the model's predictions. Survival analysis was conducted using Kaplan-Meier curves and stepwise Cox regression analysis to compare overall survival (OS) between patients with and without OHE.

Results: The median OS of the study cohort was 47.83 ± 22.95 months. Among the models evaluated, logistic regression demonstrated the highest performance with an area under the curve (AUC) of 0.825. Key predictors identified were Child-Pugh score, age, and portal vein thrombosis. Kaplan-Meier analysis revealed that patients without OHE had a significantly longer OS (P = 0.005). The 5-year survival rate was 78.4%, with an OHE incidence of 15.1%. Both actual OHE status and predicted OHE value were significant predictors in each Cox model, with model-predicted OHE achieving an AUC of 88.1 in survival prediction.

Conclusion: The ML model accurately predicts post-TIPS OHE and outperforms traditional models, supporting its use in improving outcomes in patients with AVB.

As a new type of pollutant, the harm caused by microplastics (MPs) to organisms has been the research focus. Recently, the proportion of MPs ingested through the digestive tract has gradually increased with the popularity of fast-food products, such as takeout. The damage to the digestive system has attracted increasing attention. We reviewed the literature regarding toxicity of MPs and observed that they have different effects on multiple organs of the digestive system. The mechanism may be related to the toxic effects of MPs themselves, interactions with various substances in the biological body, and participation in various signaling pathways to induce adverse reactions as a carrier of toxins to increase the time and amount of body absorption. Based on the toxicity mechanism of MPs, we propose specific suggestions to provide a theoretical reference for the government and relevant departments.

In this article, we comment on the article by Cheng et al published in recently. Posthepatectomy liver failure (PHLF) remains a leading cause of hepatectomy-related mortality and can be evaluated according to liver reserve function. Liver stiffness (LS) measured by ultrasonic elastography and spleen area demonstrate a strong correlation with hepatic proliferation, fibrosis, and portal vein congestion, thus indirectly reflecting liver reserve function. This article highlights a meticulous study aimed at investigating the potential of two-dimensional shear wave elastography in assessing LS, as well as its integration with spleen area, surgical factors, and laboratory indicators, for predicting the risk of PHLF in hepatocellular carcinoma patients. In this article, we discussed the non-invasive elastography modality by ultrasound and magnetic resonance imaging to assess LS. Based on literature data, we subsequently suggested that several risk factors may contribute to PHLF, including excessive intrahepatic neutrophil accumulation, the formation of neutrophil extracellular traps, end-stage liver disease scores, and albumin-bilirubin scores. Therefore, a more comprehensive study incorporating detailed information requires further investigation.

In this article, we discuss the study by Cheng et al, published in the World Journal of Gastroenterology, focusing on predictive methods for post-hepatectomy liver failure (PHLF). PHLF is a common and serious complication, and accurate prediction is critical for clinical management. The study examines the potential of ultrasound elastography and splenic size in predicting PHLF. Ultrasound elastography reflects liver functional reserve, while splenic size provides additional predictive value. By integrating these factors with serological markers, we developed a comprehensive prediction model that effectively stratifies patient risk and supports personalized clinical decisions. This approach offers new insights into predicting PHLF. These methods not only assist clinicians in identifying high-risk patients earlier but also provide scientific support for personalized treatment strategies. Future research will aim to validate the model's accuracy with larger sample sizes, further enhancing the clinical application of these non-invasive indicators.

Background: Gastrointestinal (GI) vascular bleeding disorders pose significant clinical challenges due to their complex pathogenesis and varied treatment responses. Despite advancements in diagnostic and therapeutic techniques, optimal management strategies remain elusive, necessitating further research.

Aim: To assess research trends and clinical advancements in GI vascular bleeding disorders, highlighting key themes and therapeutic progress.

Methods: A bibliometric analysis was conducted using the Web of Science Core Collection database, reviewing publications from 2000 to 2024 to identify trends, high-frequency keywords, and key contributions from leading research institutions. In addition, a case study highlighted the effective application of sirolimus in managing colonic angioectasia in a patient with recurrent GI bleeding who had not responded to previous treatments.

Results: The analysis reviewed 470 scholarly articles from 203 countries, involving 2817 authors across 1502 institutions. The United States led in publication contributions, with strong collaborations with countries like China, England, and Germany. A significant trend was observed in the shift from traditional endoscopic interventions to pharmacological therapies, particularly highlighting the successful use of sirolimus in treating colonic angioectasia. High-frequency keywords such as "angiodysplasia", "colon", and "management" were identified, indicating key research themes. The study also noted a growing interest in drug therapies, as evidenced by the increasing prominence of keywords like "thalidomide" since 2018.

Conclusion: This study links bibliometric analysis and clinical insights, highlighting the shift to pharmacological management in GI vascular bleeding disorders to improve patient outcomes.

Background: Mucosal healing (MH) is the major therapeutic target for Crohn's disease (CD). As the most commonly involved intestinal segment, small bowel (SB) assessment is crucial for CD patients. Yet, it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.

Aim: To establish a noninvasive radiomic model based on computed tomography enterography (CTE) for MH assessment in SBCD patients.

Methods: Seventy-three patients diagnosed with SBCD were included and divided into a training cohort (n = 55) and a test cohort (n = 18). Radiomic features were obtained from CTE images to establish a radiomic model. Patient demographics were analysed to establish a clinical model. A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features. The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA), respectively.

Results: Of the 73 patients enrolled, 25 patients achieved MH. The radiomic-clinical nomogram had an area under the ROC curve of 0.961 (95% confidence interval: 0.886-1.000) in the training cohort and 0.958 (0.877-1.000) in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone, as demonstrated by DCA.

Conclusion: These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.

Background: Helicobacter pylori (H. pylori) infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia, gastritis, and peptic ulcer, which are common diseases in military personnel. Current guidelines in China state all patients with evidence of active infection with H. pylori are offered treatment. However, the prevalence of H. pylori infection and its regional distribution in the military population remain unclear, which hinders effective prevention and treatment strategies. Understanding the prevalence of H. pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.

Aim: To investigate the prevalence of H. pylori infection in the Chinese military population in different geographic areas.

Methods: This multicenter, retrospective study included 22421 individuals from five tertiary hospitals located in north, east, southwest, and northwest cities of China. H. pylori infection was identified using the urea breath test, which had been performed between January 2020 and December 2021.

Results: Of the 22421 military service members, 7416 (33.1%) were urea breath test-positive. The highest prevalence of H. pylori was in the 30-39 years age group for military personnel, with an infection rate of 34.9%. The majority of infected subjects were younger than 40-years-old, accounting for 70.4% of the infected population. The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing, Nanjing, and Guangzhou, with prevalence rates of 44.3%, 37.9%, 29.0%, 31.1%, and 32.3%, respectively.

Conclusion: H. pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.

Background: Hepatocellular carcinoma (HCC) is the most common subtype of primary liver cancer with varied incidence and epidemiology worldwide. Sorafenib is still a recommended treatment for a large proportion of patients with advanced HCC. Different patterns of treatment responsiveness have been identified in differentiated hepatoblastoma HepG2 cells and metastatic HCC SNU449 cells.

Aim: To define the long non-codingRNA-microRNA-mRNA (lncRNA-miRNA-mRNA) predicted signatures related to selected hallmarks of cancer (apoptosis, autophagy, cell stress, cell dedifferentiation and invasiveness) in RNAseq studies using Sorafenib-treated HepG2 and SNU449 cells. Various available software analyses allowed us to establish the lncRNA-miRNA-mRNA regulatory axes following treatment in HepG2 and SNU449 cells.

Methods: HepG2 and SNU449 cells were treated with Sorafenib (10 μmol/L) for 24 hours. Total RNA, including small and long RNA, was extracted with a commercial miRNeasy kit. RNAseq was carried out for the identification of changes in lncRNA-miRNA-mRNA regulatory axes.

Results: MALAT, THAP9-AS1 and SNGH17 appeared to coordinately regulate miR-374b-3p and miR-769-5p that led to upregulation of SMAD7, TIRARP, TFAP4 and FAXDC2 in HepG2 cells. SNHG12, EPB41 L4A-AS1, LINC01578, SNHG12 and GAS5 interacted with let-7b-3p, miR-195-5p and VEGFA in SNU449 cells. The axes MALAT1/hsa-mir-374b-3p/SMAD7 and MALAT1/hsa-mir-769-5p/TFAP4 were of high relevance for Sorafenib response in HepG2 cells, whereas PVT1/hsa-miR-195-5p/VEGFA was responsible for the differential response of SNU449 cells to Sorafenib treatment.

Conclusion: Critical lncRNAs acting as sponges of miRNA were identified that regulated mRNA expression, whose proteins mainly increased the antitumor effectiveness of the treatment (SMAD7, TIRARP, TFAP4, FAXDC2 and ADRB2). However, the broad regulatory axis leading to increased VEGFA expression may be related to the side effect of Sorafenib in SNU449 cells.

Fecal incontinence is a common condition that can significantly impact patients' quality of life. Obstetric anal sphincter injury and anorectal surgeries are common etiologies. Endoanal ultrasound and anorectal manometry are important diagnostic tools for evaluating patients. There are various treatment options, including diet, lifestyle modifications, drugs, biofeedback therapy, tibial and sacral nerve neuromodulation therapy, and surgery. In this editorial, we will discuss current controversies and novel approaches to fecal incontinence. Screening for asymptomatic anal sphincter defects after obstetric anal sphincter injury and in patients with inflammatory bowel disease is not generally recommended, but may be helpful in selected patients. The Garg incontinence score is a new score that includes the assessment of solid, liquid, flatus, mucous, stress and urge fecal incontinence. Novel tests such as translumbosacral anorectal magnetic stimulation and novel therapies such as translumbosacral neuromodulation therapy are promising diagnostic and treatment options, for both fecal incontinence and neuropathy. Home biofeedback therapy can overcome some limitations of the office-based therapy. Skeletal muscle-derived cell implantation of the external anal sphincter has been further studied as a possible treatment option. Sacral neuromodulation may be useful in scleroderma, congenital fecal incontinence and inflammatory bowel disease but merits further study.