World Journal of Gastroenterology最新文献

Background: Accurate prediction of hepatocellular carcinoma (HCC) recurrence after curative therapy remains challenging. Mac-2 binding protein glycosylation isomer (M2BPGi), a serum marker of liver fibrosis, may serve as a noninvasive prognostic biomarker.

Aim: To evaluate the association between preoperative M2BPGi levels and HCC recurrence following curative treatment.

Methods: We searched PubMed Cochrane CENTRAL, EMBASE, and BIOSIS Citation Index for English-language studies in humans reporting HCC recurrence outcomes stratified by high vs low serum M2BPGi. Four retrospective studies (total n = 494) met inclusion criteria for meta-analysis. Data on recurrence-related survival (recurrence-free, tumor-free, or progression-free survival) and unadjusted and/or adjusted hazard ratios (HR) for high vs low M2BPGi were extracted. Random-effects meta-analyses were performed separately for univariate and multivariate HRs. Heterogeneity was assessed by I ² and publication bias by Egger's test.

Results: High preoperative M2BPGi was significantly associated with increased recurrence risk. The pooled unadjusted HR was 2.98 (95%CI: 1.50-5.91; P < 0.01; I ² = 38.3%), and the pooled adjusted HR was 2.22 (95%CI: 1.48-3.32; P < 0.01; I ² = 0%). Meta-regression showed no effect of varying cutoff thresholds on HRs, and Egger's tests indicated no evidence of publication bias in the multivariate results. The bias-corrected estimated of the univariate HR remained statistically significant (HR = 2.31, 95%CI: 1.21-4.41, P = 0.021, I ² = 32%).

Conclusion: Preoperative serum M2BPGi is a promising biomarker for HCC recurrence after hepatectomy. Its strong association with risk, minimal heterogeneity across studies, and ease of measurement support its potential clinical utility.

Hepatocellular carcinoma (HCC), the predominant form of primary liver cancer, significantly threatens to global health. Despite considerable advances in diagnostic and therapeutic approaches in recent years, the prognosis for patients with HCC remains unsatisfactory. The emergence of artificial intelligence (AI), particularly deep learning technologies, offers new hope for improving the diagnosis and treatment of HCC. Researchers have extensively explored ways to integrate deep learning models into the clinical management of HCC patients, which provides a valuable foundation for developing more personalized treatment strategies. Compared with other detection methods, computed tomography (CT) has attracted significant research interest because of its comprehensive advantages, including wide availability and high resolution, making it well suited for AI-powered analysis. This review systematically integrates deep learning technologies for HCC based on CT imaging, while focusing primarily on tumor diagnosis, segmentation, treatment response prediction, and patient prognosis prediction. Moreover, we review popular deep learning networks in various fields and describe the advantages of these prevalent deep learning models for different applications. Furthermore, we discuss the outstanding challenges in applying deep learning to extract information from CT images for the diagnosis and treatment of HCC patients. These insights could provide guidance for subsequent studies.

Background: Low drug concentrations have been linked to antidrug antibody (ADA) formation. High clearance is a major reason for low drug levels leading to treatment failure in patients with inflammatory bowel disease (IBD) receiving infliximab (IFX).

Aim: To explore the predictive value of initial IFX clearance on outcomes and assess the impact of Bayesian model (iDose)-guided IFX dosing on clearance and outcomes during induction and early maintenance treatment.

Methods: Data from a Phase 3 study of 220 CT-P13/originator IFX-treated patients with Crohn's disease were used to develop probability models for outcomes including mucosal healing (MHEAL), biomarker response [C-reactive protein (CRP)], ADA development, a composite endpoint and time to first ADA formation, based on initial clearance. Subsequently, patients with characteristics suggesting rapid initial clearance were enrolled in a ≤ 120-day (October 2018 to December 2019) compassionate use program of iDose-guided IFX treatment as a proof of concept to determine if the probabilities from initial clearance could be improved with individualized therapy. Serial serum IFX concentrations, clearance, outcome probabilities, and treatment outcomes were analyzed.

Results: In the CT-P13 study, population pharmacokinetic was consistent with previously published models. Initial clearance was a significant predictor of several outcomes including MHEAL, CRP normalization, a composite endpoint ((1) CDAI at week 54 was at least 150 points less than baseline; (2) MHEAL at week 54; (3) CRP was in normal range at week 54; and (4) FCP was less than 250 at week 54) and ADA formation. In the proof-of-concept study, 10 patients received iDose-guided IFX treatment. Initial clearance ranged from 0.017 L/day to 1.11 L/day, prompting up to three IFX infusions within the first 2 weeks. Two patients were discontinued due to ADA. Generally, clearance slowed over time and inflammatory biomarker levels improved. There were no adverse effects.

Conclusion: Initial IFX clearance correlates with efficacy metrics and ADA formation. These probability curves may be useful to identify patients at risk of treatment failure or ADA who may benefit from individualized therapy. iDose-guided treatment successfully achieved targeted serum IFX concentrations, reducing risk of ADA formation. Proactive therapeutic drug monitoring and targeted dosing based on early IFX clearance may improve treatment outcomes for patients with IBD.

The study by Ruiz-Malagón et al marks a significant advancement in understanding the role of growth differentiation factor 15 (GDF15) in inflammatory bowel disease (IBD). Using both in vivo and in vitro models, the researchers detected elevated circulating GDF15 levels in patients with both ulcerative colitis (UC) and Crohn's disease (CD), and its level correlates with markers of inflammation and intestinal permeability. Utilizing colonic organoids and T84 cells, they demonstrated that GDF15 increases intestinal permeability by reducing the expression of zonula occludens-1 (ZO-1) and claudin 1. They concluded that targeting GDF15 may offer a promising strategy to preserve intestinal barrier integrity and potentially reducing immune overactivation. However, results from a small-sample sized study (CD patients 21, UC patients 18, and healthy controls 23) signals interpretation with caution. Genetic approaches are needed to validate the findings that GDF15 alters the intestinal barrier and increases permeability by decreasing the levels of ZO-1 and claudin 1. GDF15 serves as a double-edged mediator with context-dependent protective or pathogenic roles, and clarifying this duality is a critical goal for translational research. Overall, the study represents a critical step in understanding the pathogenesis of IBD, highlighting both progresses made and the work still required for clinical translation.

Endoscopic resection is standard for small, well-differentiated rectal neuroendocrine tumors, but management of intermediate lesions remains unsettled. In a large single-center cohort with propensity score matching, endoscopic treatment of grade 1 tumors measuring 1.0-1.5 cm achieved high negative-margin rates and no observed recurrences over a median 54-month follow-up, mirroring outcomes for lesions < 1 cm. Lymphovascular invasion was absent in the intermediate group, and endoscopic submucosal dissection was used more often than mucosal resection. These data support endoscopic resection as a feasible organ preserving option in carefully staged, well differentiated intermediate size tumors. Priorities now include prospective, multicenter validation; standardized pre-resection staging with high-resolution endoscopy and endoscopic ultrasound; refined risk stratification incorporating depth and lymphovascular invasion; pragmatic surveillance schedules; and assessment of patient-reported outcomes, function, and costs. Developing decision tools and targeted training to optimize endoscopic technique may further expand safe, individualized care, and health economic analyses.

Colorectal cancer (CRC) adjuvant therapy is evolving from tumor-node-metastasis stage-based strategies toward molecular-profiling-guided precision medicine. This minireview, based on a comprehensive literature search in PubMed and Web of Science using keywords related to CRC biomarkers and adjuvant therapy (from 2010 to 2025), examines how key biomarkers, including mismatch repair (MMR) status, rat sarcoma viral oncogene homolog/rapidly accelerated fibrosarcoma mutations, consensus molecular subtypes, and circulating tumor DNA, refine risk stratification and treatment selection. Despite consensus guidelines advocating individualized therapy, significant disparities persist in real-world implementation due to technical variability in testing, limited or evolving evidence for specific scenarios (e.g., adjuvant immunotherapy for MMR-deficient/microsatellite instability-high patients, wherein phase 3 trials such as ATOMIC have yet to report mature overall survival data), and health economic barriers. The minireview analyzes gaps across testing, decision-making, and dynamic monitoring phases, and proposes integrated solutions involving technological innovation (e.g., artificial intelligence-integrated multiomics, circulating tumor DNA monitoring), optimized clinical pathways, and supportive health policies. Bridging these gaps requires multidisciplinary collaboration to translate molecular insights into equitable, personalized adjuvant care for CRC patients.

Background: Inflammatory bowel disease (IBD) is a chronic, gastrointestinal condition including ulcerative colitis and Crohn's disease. Patients diagnosed with IBD are more susceptible to infections and frequently require antibiotics.

Aim: To analyze the antibiotic consumption of IBD inpatients and project future relevant trends.

Methods: We retrospectively collected the demographic and antibiotic usage data from the IBD patients hospitalized between 2015 and 2024. The antibiotics were classified, and the consumption intensity was calculated. The appropriate statistical methods were applied to compare the differences between groups. The Monte Carlo simulation was used to forecast the antibiotic consumption from 2025 to 2027.

Results: A total of 1985 hospitalizations and 372 antibiotic prescriptions were included in this work. The antibiotic-exposed patients were older, had longer hospital stays, and higher costs. Males and ulcerative colitis patients showed a higher antibiotic usage. The highest consumption was observed in 2019, 2022, and 2024. The common indications were intestinal infections and perioperative prophylaxis. Cephalosporins and β-lactam antimicrobials were most commonly used, while carbapenems and glycopeptide antibacterials increased during 2022-2024. Although the antibiotic usage rates decreased in 2020-2024 when compared to 2015-2019, the consumption intensity significantly increased. The Monte Carlo simulation projected a 170.0% (95% uncertainty interval: -42.1% to 689.7%) consumption increase by 2027.

Conclusion: These findings highlight the need to strengthen antibiotic stewardship and infection control strategies in IBD inpatient management to prevent further escalation of antimicrobial resistance.

This letter comments on a web-enabled, dynamic nomogram developed for early sepsis-risk estimation in adults with acute liver failure (ALF) admitted to the intensive care unit. The study successfully established and validated the sepsis in ALF model using five routinely available variables: Age, total bilirubin, lactate dehydrogenase, albumin, and mechanical ventilation. Across cohorts, the model demonstrated strong discrimination and outperformed traditional scores. We commend the inclusion of both Western and Chinese intensive care unit cohorts, which enhances the cross-population generalizability of the findings. This letter highlights the strengths of the model, including its web-based dynamic calculator and effective risk stratification, while also acknowledging limitations such as reliance on baseline admission data, restriction to intensive care unit populations, and the absence of infection-related biomarkers. We encourage further prospective, multicenter investigations to refine the sepsis in ALF model and expand its clinical utility.

Colonic diverticular hemorrhage is a major cause of acute lower gastrointestinal bleeding, particularly in aging populations with increasing prevalence of diverticulosis. Its pathogenesis is multifactorial, involving vascular fragility of the vasa recta, mechanical stress, and patient-related factors such as comorbidities and use of antithrombotic agents. Diagnosis remains challenging due to the intermittent nature of bleeding, with colonoscopy serving as the primary tool and computed tomography angiography providing complementary value for source localization. Endoscopic therapy, especially band ligation, has demonstrated superiority over clipping in reducing rebleeding, while transcatheter arterial embolization has emerged as an effective salvage approach when endoscopic treatment fails. Surgical intervention is reserved for refractory or complicated cases. Recent advances include risk stratification models to guide management and early feeding strategies to accelerate recovery. Despite these improvements, challenges remain in recurrence prevention and individualized treatment selection. This editorial synthesizes current evidence on the etiology, diagnostic modalities, and evolving therapeutic strategies of colonic diverticular hemorrhage, aiming to support clinical decision-making and optimize patient outcomes.

Background: Screening for latent tuberculosis (LTB) before initiating advanced therapy for inflammatory bowel disease (IBD) helps reduce the risk of tuberculosis (TB) development. However, there is limited data on screening practices from TB-endemic regions.

Aim: To study the practices of screening for LTB and study the incidence of TB in patients with IBD on biological and small molecule inhibitors.

Methods: This retrospective multicentre study analyzed LTB screening practices in IBD patients starting advanced therapies between 2018 and 2022. We included patients who were initiated on biologics (infliximab, adalimumab, vedolizumab) or small molecule inhibitors (tofacitinib). We assessed compliance with LTB screening methods, including the tuberculin skin test, interferon-gamma release assay (IGRA), chest X-ray, and computed tomography chest, both at initiation and annually. We also evaluated the incidence of active TB and its predictors.

Results: Of 378 patients (mean age: 36.9 ± 14.9 years, males: 56.9%), 158 (41.8%) and 216 (57.1%) had ulcerative colitis and Crohn's disease, respectively. Advanced therapy used were anti-tumor necrosis factor in 309 (81.74%), tofacitinib in 41 (10.84%) and vedolizumab in 28 (7.40%). Standard screening and diligent screening strategy was employed in 59% and 33% of patients, respectively. Compliance with tuberculin skin test and IGRA was noted in 261 (69.04%) and 298 (78.83%) patients, respectively. Chest X-Ray and computed tomography chest were performed in 300 (79.36%) and 242 (64.02%), respectively. Annual screening in those on advanced therapy for > 1 year was performed in 27.2% (50/184). Active TB developed in 17 (4.49%); 15 (88.23%) were on anti-tumor necrosis factor. LTB was detected in 40 (10.72%), with most diagnosed on the basis of IGRA (21/40, 52.50%). Among 17 patients who developed active TB, LTB screen was negative in 12 (70.58%).

Conclusion: Standard screening practices for LTB, prior to starting advanced therapy, remain suboptimal (< 60%) in India despite high TB endemicity.