World Journal of Gastroenterology最新文献

Background: Gastrointestinal endoscopy technology has significantly improved the diagnostic accuracy and the successful treatment of gastrointestinal diseases. However, a series of ethical issues have emerged, such as expanding treatment indications, which affect the fair distribution of medical resources. There is limited research on ethical issues in the field of digestive endoscopy.

Aim: To investigate the level of ethical awareness among gastrointestinal endoscopy practitioners and analyze the ethical issues involved in gastrointestinal endoscopy technology.

Methods: A questionnaire survey was performed to collect relevant data (gender, age, degree of education, professional title, personnel category, the level of understanding medical ethical principles, ethics training and its learning pathways) from gastrointestinal endoscopy practitioners at the Second Hospital of Dalian Medical University and Dalian Friendship Hospital, including licensed physicians and nurses (including trainees and graduate students).

Results: The majority of gastrointestinal endoscopy practitioners have received training on ethics, but there is still considerable room for improvement in their ethical awareness. Different learning pathways may affect the mastery of ethical principles, and understanding of ethical principles is more easily achieved through hospital ethics institutions.

Conclusion: To address the ethical issues in gastrointestinal endoscopy technology, it is necessary to enhance the humanistic education of gastrointestinal endoscopy practitioners, incorporate ethical standards into the technology assessment process, and establish a patient-centered diagnostic and treatment model to improve the ethical awareness of practitioners and achieve a balance between technology and ethics.

Gastric ulcer (GU) represents a clinically significant manifestation of peptic ulcer disease, driven by a complex interplay of microbial, environmental, and immune-inflammatory factors. A recent cross-sectional study by Shen et al systematically evaluated six complete blood count-derived inflammatory indices: Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation and demonstrated their positive associations with GU prevalence, identifying SIRI as the strongest predictor. This editorial contextualizes these findings within the broader literature, clarifies that these indices reflect systemic rather than GU-specific inflammation, highlights methodological strengths and major limitations, and proposes a conceptual clinical algorithm for integrating SIRI into GU risk assessment. Future multicenter studies incorporating Helicobacter pylori infection, non-steroidal anti-inflammatory drug exposure, and prospective design are essential to validate and translate these findings into clinical practice.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by clinical symptoms of diarrhea and mucopurulent bloody stools, and its incidence is increasing globally. The etiology and pathogenesis of UC remain elusive. Current therapeutic approaches, including anti-inflammatory, immunosuppressive and immunomodulating agents, are often limited in efficacy and frequently associated with adverse drug reactions. Therefore, there is an urgent need to develop safer and more effective treatment strategies to address the limitations of existing therapies. Scutellaria baicalensis Georgi (HQ), a traditional Chinese medicinal herb, has been employed in the treatment of UC for over 2000 years. Recent studies have demonstrated that HQ contains multiple active components capable of treating UC through anti-inflammation, immune modulation, intestinal barrier protection, antioxidant activity, and regulation of the gut microbiota. This paper reviews recent studies on the mechanism of action and clinical trials of HQ in treating UC based on relevant literature, with the aim of providing valuable insights into future treatment approaches.

Background: Laparoscopic distal pancreatectomy (LDP) has emerged as the preferred approach for both benign and malignant lesions located in the pancreatic body and tail. Nevertheless, a notable deficiency persists in the absence of a standardized, procedure-specific metric for evaluating and comparing surgical quality. A composite measure termed "textbook outcome (TO)", which encompasses key short-term endpoints, has been validated in laparoscopic pancreatoduodenectomy but has not yet been established in dedicated LDP cohorts. The definition and prediction of TO in this context could aid in facilitating cross-institutional benchmarking and fostering advancements in quality improvement.

Aim: To establish procedure-specific criteria for TO and identify independent predictors of TO failure in patients undergoing LDP.

Methods: Consecutive patients who underwent LDP at a single high-volume pancreatic center between January 2015 and August 2022 were retrospectively analyzed. TO was defined as the absence of clinically relevant postoperative pancreatic fistula (grade B/C), post-pancreatectomy hemorrhage (grade B/C), severe complications (Clavien-Dindo ≥ III), readmission within 30 days, and in-hospital or 30-day mortality. Multivariable logistic regression was employed to identify independent predictors of TO failure, and a nomogram was constructed and internally validated.

Results: Among 405 eligible patients, 286 (70.6%) attained TO. Multivariable analysis revealed that female sex [odds ratio (OR) = 0.62, 95% confidence interval (CI): 0.39-0.99] conferred a protective effect, while preoperative endoscopic ultrasound-guided fine-needle aspiration (OR = 2.66, 95%CI: 1.05-6.73), pancreatic portal hypertension (OR = 2.81, 95%CI: 1.06-7.45), and cystic-solid (OR = 2.51, 95%CI: 1.34-4.69) or solid lesions (OR = 1.91, 95%CI: 1.06-3.44) were independently associated with TO failure (all P < 0.05). The derived nomogram exhibited modest discrimination and calibration when assessed in both the training and validation datasets.

Conclusion: The proposed LDP-specific definition of TO is feasible and discriminative, and the developed nomogram provides an objective tool for individualized risk assessment.

The etiopathogenesis of gastrointestinal diseases is varied in nature. Various etiogenic factors described are infective, inflammatory, viral, bacterial, parasitic, dietary and lifestyle change. Rare causative agents are immunological, and others associated as idiopathic, are undiagnosed by all possible means. Some of the rare diseases are congenital in nature, passing from the parent to the child. Many of the undiagnosed diseases are now being diagnosed as genetic and the genes have been implicated as a causative agent. There is a search for newer treatments for such diseases, which is called genomic medicine. Genomic medicine is an emerging medical discipline that involves the use of genomic information about an individual. This is used both for diagnostic as well as therapeutic decisions to improve the current health domain and pave the way for policymakers for its clinical use. In the developing era of precision medicine, genomics, epigenomics, environmental exposure, and other data would be used to more accurately guide individual diagnosis and treatment. Genomic medicine is already making an impact in the fields of oncology, pharmacology, rare, infectious and many undiagnosed diseases. It is beginning to fuel new approaches in certain medical specialties. Oncology is at the leading edge of incorporating genomics, as diagnostics for genetic and genomic markers are increasingly included in cancer screening, and to guide tailored treatment strategies. Genetics and genetic medicine have been reported to play a role in gastroenterology in several ways, including genetic testing (hereditary pancreatitis and hereditary gastrointestinal cancer syndromes). Genetic testing can also help subtype diseases, such as classifying pancreatitis as idiopathic or hereditary. Gene therapy is a promising approach for treating gastrointestinal diseases that are not effectively treated by conventional pharmaceuticals and surgeries. Gene therapy strategies include gene addition, gene editing, messenger RNA therapy, and gene silencing. Understanding genetic determinants, advances in genetics, have led to a better understanding of the genetic factors that contribute to human disease. Family-member risk stratification and genetic diagnosis can help identify family members who are at risk, which can lead to preventive treatments, lifestyle recommendations, and routine follow ups. Selecting target genes helps identify the gene targets associated with each gastrointestinal disease. Common gastrointestinal diseases associated with genetic abnormalities include-inflammatory bowel disease, gastroesophageal reflux disease, non-alcoholic fatty liver disease, and irritable bowel syndrome. With advancing tools and technology, research in the search of newer and individualized treatment, genes and genetic medicines are expected to play a significant role in human health and gastroenterology.

Colorectal cancer (CRC) remains a major global health challenge, with high recurrence and mortality despite advances in surgery, chemotherapy, and immunotherapy. The study by He et al identifies a novel mechanism by which peroxiredoxin 1 (Prdx1) inhibits CRC progression through induction of pyroptosis, a pro-inflammatory form of programmed cell death. Traditionally viewed as an intracellular antioxidant that protects tumors from oxidative stress, Prdx1 assumes a paradoxical immunogenic role when released extracellularly as a damage-associated molecular pattern. Using patient samples, recombinant protein assays, and murine xenograft models, the authors demonstrate that Prdx1 activates the NOD-, LRR- and pyrin domain-containing protein 3 inflammasome/caspase-1/gasdermin D pathway, triggering membrane pore formation, tumor cell lysis, and release of interleukin-1β/interleukin-18. This cascade not only halts tumor proliferation, invasion, and migration but may also enhance anti-tumor immune surveillance. The study's strengths include rigorous mechanistic validation, clinical cohort data, inhibitor-based causal proof, and in vivo confirmation. However, questions remain regarding the upstream receptor for Prdx1, heterogeneity across CRC subtypes, and the balance between therapeutic benefit and inflammatory toxicity. By establishing Prdx1-induced pyroptosis as a driver of tumor suppression, this work advances a promising paradigm in CRC therapy, linking cell death to immune activation and pointing toward future biomarker-driven, pyroptosis-based interventions.

We read with great interest the study by Zhang et al on Yiyi Fuzi Baijiang powder (YFB), which exemplifies the power of modern methods to validate traditional Chinese medicine (TCM). The key insight is that YFB doesn't merely alter "good" or "bad" bacteria but restores the gut microbiota's holistic equilibrium. This is powerfully shown by its paradoxical reduction of anaerobic probiotics like Bifido bacterium, rectifying the diseased, hypoxic environment, causing their aberrant overgrowth. This challenges the conventional probiotic paradigm and underscores a core TCM principle: Herbal formulas treat disease by restoring the body's overall functional balance. Future research should focus on the interplay between herbal components, intestinal oxygen, and microbial metabolites to further unravel this sophisticated dialogue.

Background: The accurate prediction of lymph node metastasis (LNM) is crucial for managing locally advanced (T3/T4) colorectal cancer (CRC). However, both traditional histopathology and standard slide-level deep learning often fail to capture the sparse and diagnostically critical features of metastatic potential.

Aim: To develop and validate a case-level multiple-instance learning (MIL) framework mimicking a pathologist's comprehensive review and improve T3/T4 CRC LNM prediction.

Methods: The whole-slide images of 130 patients with T3/T4 CRC were retrospectively collected. A case-level MIL framework utilising the CONCH v1.5 and UNI2-h deep learning models was trained on features from all haematoxylin and eosin-stained primary tumour slides for each patient. These pathological features were subsequently integrated with clinical data, and model performance was evaluated using the area under the curve (AUC).

Results: The case-level framework demonstrated superior LNM prediction over slide-level training, with the CONCH v1.5 model achieving a mean AUC (± SD) of 0.899 ± 0.033 vs 0.814 ± 0.083, respectively. Integrating pathology features with clinical data further enhanced performance, yielding a top model with a mean AUC of 0.904 ± 0.047, in sharp contrast to a clinical-only model (mean AUC 0.584 ± 0.084). Crucially, a pathologist's review confirmed that the model-identified high-attention regions correspond to known high-risk histopathological features.

Conclusion: A case-level MIL framework provides a superior approach for predicting LNM in advanced CRC. This method shows promise for risk stratification and therapy decisions, requiring further validation.

Background: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is a prevalent and potentially serious complication in patients undergoing endoscopic retrograde cholangiopancreatography.

Aim: To comprehensively assess the efficacy of indomethacin therapy in reducing PEP risk.

Methods: We searched PubMed, EMBASE, Scopus, and Cochrane Library databases to identify randomized controlled trials (RCTs) that compared rectal indomethacin with a control group to prevent PEP. Duplicates were removed, and studies were included based on the established inclusion criteria. We used the Cochrane Collaboration's tool to assess the risk of bias in the RCTs. A random-effects model was applied to produce pooled risk ratios (RRs) with 95% confidence intervals (CIs).

Results: We included a total of 30 RCTs involving 16977 patients. Compared to the control group, rectal indomethacin showed comparable rates of overall PEP (PEP; RR = 0.85, 95%CI: 0.69-1.04, I ² = 79%) with no statistically significant difference of RR in mild (RR = 0.92, 95%CI: 0.74-1.14), moderate (RR = 0.78, 95%CI: 0.59-1.02), or severe PEP (RR = 1.12, 95%CI: 0.75-1.67). There was also no difference in cases of adverse events (RR = 0.97, 95%CI: 0.69-1.35), abdominal pain (RR = 1.14, 95%CI: 0.80-1.62), bleeding (RR = 1.07, 95%CI: 0.70-1.63), or mortality (RR = 0.86, 95%CI: 0.56-1.33) between the two groups. Subgroup analyses were also performed.

Conclusion: Rectal indomethacin appears to be safe and may offer benefit in selected high-risk patients, though findings should be interpreted with caution due to high heterogeneity.

Background: Chronic hepatitis B virus (HBV) infection acquired in childhood frequently presents with mild or nonspecific symptoms, yet a distinct subset of pediatric patients develops rapid progression to liver cirrhosis (LC) before adulthood.

Aim: To identify clinical and pathological characteristics of pediatric HBV-related LC.

Methods: A total of 1332 pediatric patients with chronic HBV infection from the Fifth Medical Center of PLA General Hospital from January 2010 to January 2023 were included in this study. We identified 62 pediatric HBV-related LC by liver biopsy from the group. Subsequently, we described the clinical and pathological characteristics of pediatric LC. And 64 pediatric chronic hepatitis B (CHB; age and sex were matched with pediatric LC group) and 69 adult HBV-related LC (sex were matched with pediatric LC group) were enrolled to further demonstrate clinical and pathological differences between pediatric LC, pediatric CHB and adult LC.

Results: We enrolled 62 pediatric LC, including 54 (87.1%) males and 8 (12.9%) females. The median age was 11 (4-14) years old. The pediatric LC group showed significantly lower median quantitative HBV DNA loads (log₁₀IU/mL: 6.3 vs 17.4, P < 0.001), reduced HBsAg titers (log₁₀IU/mL: 3.11 vs 8.956, P < 0.0001), and diminished hepatitis B e antigen-positive positive rate (81.4% vs 93.8%, P < 0.05) compared with pediatric CHB. A higher proportion of pediatric patients were asymptomatic (77.4%) compared to adult patients (11.6%) as they first diagnosed as LC, pediatric LC showed milder initial symptoms compared with adult patients such as fatigue (4.8% vs 27.5%), abdominal discomfort (9.7% vs 23.2%), nausea (0% vs 10.1%), and poor appetite (6.5% vs 8.7%; all P < 0.0001). Notably, pediatric LC can achieve a significant percentage of functional cure compared with adult LC as 17.4% and 0%. The incidence of progression of LC in children after antiviral therapy continues to be much lower than that in adult LC (hazard ratio = 6.102, 95% confidence interval: 1.72-21.65, P = 0.00051). While the incidence of LC remission in children after antiviral therapy continues to be much higher than that in adult LC (hazard ratio = 0.055, 95% confidence interval: 0.07128-0.2802, P < 0.0001).

Conclusion: Pediatric patients with HBV-related cirrhosis exhibit elevated virological parameters and heightened transaminase levels than adult patients. However, the frequent paucity of overt clinical symptoms contributes to diagnostic challenges. Notably, early initiation of antiviral therapy in this population substantially improved clinical outcomes.