World Journal of Gastroenterology最新文献

Artificial intelligence (AI) is revolutionizing medical imaging, particularly in chronic liver diseases assessment. AI technologies, including machine learning and deep learning, are increasingly integrated with multiparametric ultrasound (US) techniques to provide more accurate, objective, and non-invasive evaluations of liver fibrosis and steatosis. Analyzing large datasets from US images, AI enhances diagnostic precision, enabling better quantification of liver stiffness and fat content, which are essential for diagnosing and staging liver fibrosis and steatosis. Combining advanced US modalities, such as elastography and doppler imaging with AI, has demonstrated improved sensitivity in identifying different stages of liver disease and distinguishing various degrees of steatotic liver. These advancements also contribute to greater reproducibility and reduced operator dependency, addressing some of the limitations of traditional methods. The clinical implications of AI in liver disease are vast, ranging from early detection to predicting disease progression and evaluating treatment response. Despite these promising developments, challenges such as the need for large-scale datasets, algorithm transparency, and clinical validation remain. The aim of this review is to explore the current applications and future potential of AI in liver fibrosis and steatosis assessment using multiparametric US, highlighting the technological advances and clinical relevance of this emerging field.

Small intestinal villi are essential for nutrient absorption, and their impairment can lead to malabsorption. Small intestinal villous atrophy (VA) encompasses a heterogeneous group of disorders, including immune-mediated conditions (e.g., celiac disease, autoimmune enteropathy, inborn errors of immunity), lymphoproliferative disorders (e.g., enteropathy-associated T-cell lymphoma), infectious causes (e.g., tropical sprue, Whipple's disease), iatrogenic factors (e.g., Olmesartan-associated enteropathy, graft-vs-host disease), as well as inflammatory and idiopathic types. These disorders are often rare and challenging to distinguish due to overlapping clinical, serological, endoscopic, and histopathological features. Through a systematic literature search using keywords such as small intestinal VA, malabsorption, and specific enteropathies, this review provides a comprehensive overview of diagnostic clues for VA and malabsorption. We systematically summarize the pathological characteristics of each condition to assist pathologists and clinicians in accurately identifying the underlying etiologies. Current studies still have many limitations and lack broader and deeper investigations into these diseases. Therefore, future research should focus on the development of novel diagnostic tools, predictive models, therapeutic targets, and mechanistic molecular studies to refine both diagnosis and management strategies.

Background: Ulcerative colitis (UC) is a chronic and treatment-resistant disorder requiring potent therapeutics that are effective and safe. Cedrol (CE) is a bioactive natural product present in many traditional Chinese medicines. It is known for its suppression of inflammation and mitigation of oxidative stress. Its therapeutic efficacy and mechanistic underpinnings in UC remain uncharacterized.

Aim: To investigate the therapeutic potential and mechanisms of CE in UC.

Methods: The anti-inflammatory activity and intestinal barrier-repairing effects of CE were assessed in a dextran sulfate sodium-induced murine colitis model. Network pharmacology was employed to predict potential targets and pathways. Then molecular docking and dynamics simulations were utilized to confirm a stable interaction between CE and the toll-like receptor 4 (TLR4)/myeloid differentiation factor 2 (MD2) complex. The anti-inflammatory mechanisms were further verified using in vitro assays. Additionally, the gut microbiota composition was analyzed via 16S rRNA gene sequencing.

Results: CE significantly alleviated colitis symptoms, mitigated histopathological damage, and suppressed inflammation. Moreover, CE restored intestinal barrier integrity by enhancing mucus secretion and upregulating tight junction proteins (zonula occludens 1, occludin, claudin-1). Mechanistically, CE stably bound to MD2, inhibiting lipopolysaccharide-induced TLR4 signaling in RAW264.7 cells. This led to suppression of the downstream mitogen-activated protein kinase and nuclear factor kappa B signaling pathways, downregulating the expression of tumor necrosis factor-alpha, interleukin-1β, and interleukin-6. Gut microbiota analysis revealed that CE reversed dextran sulfate sodium-induced dysbiosis with significant enrichment of butyrogenic Christensenella minuta.

Conclusion: CE acted on MD2 to suppress proinflammatory cascades, promoting mucosal barrier reconstitution and microbiota remodeling and supporting its therapeutic use in UC.

To establish practical, evidence-based strategies for noninvasive assessment and referral of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) in Japan, we must address the urgent clinical need for accurate risk stratification and timely specialist intervention. A panel of 11 Japanese hepatology experts conducted a modified Delphi process to evaluate consensus recommendations regarding the use of noninvasive tests (NITs), including the fibrosis-4 index, enhanced liver fibrosis test, Mac-2-binding protein glycosylation isomer, type IV collagen 7S, cytokeratin-18 fragments, and imaging modalities such as ultrasound elastography and magnetic resonance elastography, for MASLD assessment and clinical referral. Practical algorithms were developed based on current Japanese data and panel consensus. The expert panel validated the utility of NITs as reliable tools for identifying patients with MASLD at risk for advanced fibrosis. Sequential use of NITs improved diagnostic accuracy and referral appropriateness while minimizing unnecessary specialist consultations. The proposed algorithms offer stepwise guidance for primary care physicians, supporting efficient, evidence-based decision-making. However, prospective longitudinal studies remain necessary for full prognostic validation of NITs in MASLD management. Noninvasive testing algorithms enable effective risk stratification and referral for MASLD in real-world Japanese practice with anticipated benefit for patient outcomes and healthcare systems. Broader adoption and further validation are warranted.

This commentary critically appraises the study by Li et al which pioneered the exploration of the triglyceride-glucose (TyG) index as a prognostic marker in hepatitis B virus-related advanced hepatocellular carcinoma patients undergoing combined camrelizumab and lenvatinib therapy. While we acknowledge the study's clinical relevance in proposing an easily accessible metabolic biomarker, we delve into the mechanistic plausibility linking insulin resistance to immunotherapy response and angiogenic inhibition. We further critically examine the methodological limitations, including the retrospective design, the population-specific TyG cut-off value, and unaddressed metabolic confounders. We highlight the imperative for future research to validate its utility across diverse etiologies and treatment settings, and to unravel the underlying immunometabolic pathways.

Background: Crohn's disease (CD) is a chronic inflammatory bowel disease with unknown etiology. Inflammatory chemical mediators synthesized from arachidonic acid, an n-6 polyunsaturated fatty acid (PUFA), have been shown to activate CD. Additionally, n-3 PUFAs are metabolized by the same enzyme as n-6 PUFAs and known to inhibit the arachidonic acid cascade. Our previous study noted that the presence of erythrocyte membrane fatty acids is a characteristic finding in Japanese CD patients. It was thus speculated that FADS2 gene polymorphisms, which induce PUFA metabolizing enzymes, are involved in the pathogenesis of CD, though no such relationship was found.

Aim: To investigate the relationship of FADS2 polymorphisms with serum and erythrocyte membrane fatty acid composition ratios, and disease activity.

Methods: Using previously reported findings regarding FADS2 genetic polymorphisms, the records of 52 CD patients undergoing treatment at Jikei University Kashiwa Hospital were analyzed. Mutations noted were divided into three groups; wild-type (GG), heterozygous mutants (GA), and homozygous (AA), with the activities of delta-6 and delta-5 desaturases compared using redefined d6d index (rd.d6di) and d5d index (d5di). Additionally, comparisons of serum and erythrocyte membranes for fatty acid composition, and also gene polymorphisms and CD activity index (CDAI) were performed.

Results: The presence of the rs174538 mutation in FADS2 resulted in reduction of only rd.d6di in the erythrocyte membrane (P < 0.01). In contrast, that mutation was found to be associated with d5di induced by FADS1 in serum (P = 0.019) as well as the erythrocyte membrane (P < 0.0001), and also with reduction in the fatty acid composition of arachidonic acid in both serum (P < 0.0001) and the erythrocyte membrane (P < 0.01). Regarding disease activity, a positive correlation of CDAI score with rd.d6di in both serum (P < 0.05) and the erythrocyte membrane (P < 0.05) was found only in the rs174538 wild-type group. In contrast, there was no correction between CDAI and d5di in either serum or erythrocyte membrane samples.

Conclusion: The rs174538 mutation alters the fatty acid profile through strong linkage to the FADS1 gene. In wild-type individuals, rd.d6di was positively correlated with CDAI, suggesting predictive utility of disease severity.

Background: Ulcerative colitis (UC) is a chronic and debilitating inflammatory bowel disease. Cumulative evidence indicates that excess hydrogen peroxide, a potent neutrophilic chemotactic agent, produced by colonic epithelial cells has a causal role leading to infiltration of neutrophils into the colonic mucosa and subsequent development of UC. This evidence-based mechanism identifies hydrogen peroxide as a therapeutic target for reducing agents in the treatment of UC.

Case summary: Presented is a 41-year-old female with a 26-year history of refractory UC. Having developed steroid dependence and never achieving complete remission on treatment by conventional and advanced therapies, she began treatment with oral R-dihydrolipoic acid (RDLA), a lipid-soluble reducing agent with intracellular site of action. Within a week, rectal bleeding ceased. She was asymptomatic for three years until a highly stressful experience, when she noticed blood in her stool. RDLA was discontinued, and she began treatment with oral sodium thiosulfate pentahydrate (STS), a reducing agent with extracellular site of action. After a week, rectal bleeding ceased, and she resumed oral RDLA and discontinued STS. To date, she remains asymptomatic with normal stool calprotectin while on RDLA.

Conclusion: STS and RDLA are reducing agents that serve as highly effective and safe therapy for the induction and maintenance of remission in UC, even in patients refractory or poorly controlled by conventional and advanced therapies. Should preliminary findings be validated by subsequent clinical trials, the use of reducing agents could potentially prevent thousands of colectomies and represent a paradigm shift in the treatment of UC.

Background: Despite societal guidelines recommending targeted screening for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC) in individuals with gastroesophageal reflux symptoms (GERS), screening adherence is suboptimal. Current screening approaches fail to identify individuals not seeking medical consultation for GERS or whose GERS are managed with 'over-the-counter' (OTC) acid suppressant therapies.

Aim: To assess patients' self-management and help-seeking behavior for GERS.

Methods: This cross-sectional study collected data from the Dutch general population aged 18-75 years between January and April 2023 using a web-based survey. The survey included questions regarding self-management (e.g., use of acid suppressant therapy with or without prescription) and help-seeking behavior (e.g., consulting a primary care provider) for GERS. Simple random sampling was performed to select individuals within the target age group. In total, 18156 randomly selected individuals were invited to participate. The study protocol was registered in ClinicalTrials.gov (identifier: NCT05689918).

Results: Of the 18156 invited individuals, 3214 participants (17.7%) completed the survey, of which 1572 participants (48.9%) reported GERS. Of these, 904 participants (57.5%) had never consulted a primary care provider for these symptoms, of which 331 participants (36.6%) reported taking OTC acid suppressant therapy in the past six months and 100 participants (11.1%) fulfilled the screening criteria for BE and EAC according to the European Society of Gastrointestinal Endoscopy Guideline.

Conclusion: The population fulfilling the screening criteria for BE and EAC is incompletely identified, suggesting potential underutilization of medical consultation. Raising public awareness of GERS as a risk factor for EAC is needed.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasingly prevalent condition associated with hepatic complications and cardiovascular and renal events. Given its significant clinical impact, the development of new strategies for early diagnosis and treatment is essential to improve patient outcomes. Over the past decade, the integration of artificial intelligence (AI) into gastroenterology has led to transformative advancements in medical practice. AI represents a major step towards personalized medicine, offering the potential to enhance diagnostic accuracy, refine prognostic assessments, and optimize treatment strategies. Its applications are rapidly expanding. This article explores the emerging role of AI in the management of MASLD, emphasizing its ability to improve clinical prediction, enhance the diagnostic performance of imaging modalities, and support histopathological confirmation. Additionally, it examines the development of AI-guided personalized treatments, where lifestyle modifications and close monitoring play a pivotal role in achieving therapeutic success.

This editorial examines the emerging potential of traditional Chinese medicine (TCM) in enhancing postoperative recovery following gastroenteroscopy, highlighted by a 2025 randomized controlled trial by Hong et al. The study, involving 120 patients, demonstrates that meridian flow injection (MFI) combined with transcutaneous electrical acupoint stimulation (TEAS) significantly improves gastrointestinal (GI) function, evidenced by a reduced time to first defecation (3.20 ± 1.04 days vs 3.98 ± 1.27 days, P < 0.001), lowers stress biomarkers (e.g., reduced cortisol and norepinephrine), and enhances clinical efficacy (93.33% vs 75.00%, P = 0.006). Leveraging TCM's five-element theory and Ziwu Liuzhu timing, the intervention targets key acupoints such as Zusanli (ST36) with a herbal paste comprising Qingpi, Houpu, and rhubarb, delivered transdermally to optimize bioavailability. This approach harmonizes ancient TCM principles with contemporary evidence-based practice, offering a holistic strategy to address postoperative nausea, delayed motility, and patient discomfort. Currently, integrative methods like MFI-TEAS are gaining traction, supported by recent meta-analyses that affirm TEAS's efficacy in accelerating GI recovery across surgical contexts, including shortened times to first exhaust and defecation. This reflects a growing recognition of TCM's role in perioperative care amidst rising global endoscopy demands. Looking forward, future research should prioritize multicenter, double-blinded trials to enhance generalizability, adhere to standardized reporting frameworks such as CONSORT and STRICTA, and employ advanced tools like multi-omics and functional magnetic resonance imaging to elucidate mechanistic pathways, including gut-brain axis modulation and microbiota-immune interactions. Such developments promise to refine these interventions, fostering a seamless integration of TCM with Western medicine and delivering tailored, patient-centered solutions to improve postoperative outcomes worldwide.