World Journal of Gastroenterology最新文献

In the pre-biologic era, immunomodulators such as azathioprine, 6-mercaptopurine, and methotrexate (MTX) were widely used as first-line maintenance therapies in Crohn's disease. However, in the current era shaped by biologics, their role has shifted toward adjunctive use, primarily in combination with anti-tumor necrosis factor agents to reduce immunogenicity. Amid growing concerns about thiopurine-associated risks, MTX is receiving renewed attention for its favorable safety profile; however, this agent remains inconsistently utilized in gastroenterology despite its frontline status in rheumatology. This discrepancy was highlighted in a recent nationwide survey by Bonnaud et al published in the World Journal of Gastroenterology, which offers timely insights into MTX prescribing behaviors among French gastroenterologists. Although 71% of respondents reported using MTX, primarily via subcutaneous injection, it is still perceived as a secondary choice after thiopurines. Importantly, this underuse appears to be driven more by clinical inertia and limited guidance rather than by lack of efficacy or safety concerns. Clinicians increasingly recognize the value of MTX, particularly in patients with joint involvement, Epstein-Barr virus negativity, or increased malignancy risk. Notably, even non-prescribers viewed the drug favorably, suggesting that usage barriers may be modifiable. In light of evolving treatment goals that prioritize safety, cost-effectiveness, and individualized care, this editorial argues that MTX should no longer be viewed as a fallback but as a strategic first-line option in well-defined high-risk populations. The survey underscores a persistent gap between guidelines and real-world practice, reinforcing the urgent need for clearer algorithms and education to support the repositioning of MTX in modern Crohn's disease management.

Background: Familial adenomatous polyposis (FAP) is a disorder of autosomal dominant inheritance that is responsible for around 1% of colorectal cancer (CRC) cases.

Aim: To determine the mutation profile of FAP-specific to the Hungarian population.

Methods: This prospective single-center study enrolled patients with clinically suspected FAP or attenuated FAP (aFAP). Whole-exome next-generation sequencing was performed to detect variants of 50 FAP priority genes and 173 CRC predisposing genes or other CRC disease-associated genes. To identify larger deletions and insertions, a multiplex amplifiable probe hybridization technique was used. The identified genes were then classified according to the American College of Medical Genetics and Genomics guidelines.

Results: A total of 26 index patients with clinically suspected FAP (n = 21) and aFAP (n = 5) were enrolled. APC gene alterations were confirmed in 92.31% of the cases (region 1B deletion, n = 2; whole-gene deletion, n = 4; frameshift mutation, n = 2; nonsense mutation, n = 5, and splice mutation, n = 1), with the remaining two cases having CHEK2 and MSH3 gene alterations. According to pathogenicity, 21 cases had pathogenic mutations, 6 cases had likely pathogenic mutations, and 16 cases had variants of unknown significance (VUS). The most frequent of the latter were the POLE (n = 5) and PIEZO1 (n = 4) gene variants.

Conclusion: Germline mutations in the APC gene were confirmed in more than 90% of Hungarian patients with clinically suspected FAP. Although the role of VUS genes is unclear, they are highly likely to play a role in the development of CRC.

Gastrointestinal (GI) cancers remain a leading cause of cancer-related morbidity and mortality worldwide. Artificial intelligence (AI), particularly machine learning and deep learning (DL), has shown promise in enhancing cancer detection, diagnosis, and prognostication. A narrative review of literature published from January 2015 to march 2025 was conducted using PubMed, Web of Science, and Scopus. Search terms included "gastrointestinal cancer", "artificial intelligence", "machine learning", "deep learning", "radiomics", "multimodal detection" and "predictive modeling". Studies were included if they focused on clinically relevant AI applications in GI oncology. AI algorithms for GI cancer detection have achieved high performance across imaging modalities, with endoscopic DL systems reporting accuracies of 85%-97% for polyp detection and segmentation. Radiomics-based models have predicted molecular biomarkers such as programmed cell death ligand 2 expression with area under the curves up to 0.92. Large language models applied to radiology reports demonstrated diagnostic accuracy comparable to junior radiologists (78.9% vs 80.0%), though without incremental value when combined with human interpretation. Multimodal AI approaches integrating imaging, pathology, and clinical data show emerging potential for precision oncology. AI in GI oncology has reached clinically relevant accuracy levels in multiple diagnostic tasks, with multimodal approaches and predictive biomarker modeling offering new opportunities for personalized care. However, broader validation, integration into clinical workflows, and attention to ethical, legal, and social implications remain critical for widespread adoption.

Background: Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection (MISRLR). However, limited technical guidance is available.

Aim: To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.

Methods: We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024. Beginning in October 2019, a liver surface-guided encirclement of hepatoduodenal ligament (LSEH) was used for repeat Pringle taping. Perioperative outcomes including Pringle taping success, operative time, blood loss, conversion rate, morbidity, and mortality were assessed.

Results: Laparoscopic and robotic approaches were used in 63 patients and 9 patients, respectively. The median operative time, blood loss, and hospital stay were 331.5 minutes, 70 mL, and 8 days, respectively. Open conversion occurred in two cases (2.8%) due to severe adhesions and right renal vein injury. Clavien-Dindo grade ≥ III complications occurred in 5.6% of cases with no mortality. Anti-adhesion barriers were used in 54 patients (75.0%). LSEH was attempted in 57 cases, improving Pringle taping success from 33.0% to 91.4% (P < 0.001). LSEH succeeded in all patients with prior open liver resection (n = 11). Among 6 patients in whom LSEH failed, 3 patients (50.0%) had undergone a third liver resection, and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.

Conclusion: The newly developed LSEH technique for Pringle taping in MISRLR was feasible, enhancing safety and reproducibility even in patients with a history of open liver resection.

Cholelithiasis has a complex pathogenesis, necessitating better therapeutic and preventive strategies. We recently read with interest Wang et al's study on lysine acetyltransferase 2A (KAT2A)-mediated adenosine monophosphate-activated protein kinase (AMPK) succinylation in cholelithiasis. Using mouse models and gallbladder mucosal epithelial cells, they found that KAT2A inhibits gallstones through AMPK K170 succinylation, thereby activating the AMPK/silent information regulator 1 pathway to reduce inflammation and pyroptosis. This study is the first to connect lysine succinylation with cholelithiasis, offering new insights and identifying succinylation as a potential therapeutic target. Future research should confirm these findings using patient samples, investigate other post-translational modifications, and use structural biology to clarify succinylation-induced conformational changes, thereby bridging basic research to clinical applications.

Acute pancreatitis (AP) is sudden inflammation of the pancreas, which can lead to multiple organ dysfunction in severe cases. Hypertriglyceridemia (HTG) is the third most common cause. In recent years, HTG-induced AP (HTG-AP) has garnered increasing attention. Compared to AP caused by other causes, HTG-AP often has a more subtle onset but is more likely to progress to a severe, critical illness that poses a serious threat to a patient's life and health. Research suggests a potential connection between the gut microbiota and AP, which could be mediated by bacterial metabolites, immune cells, and inflammatory factors. This is supported by observations of microbial imbalance and higher intestinal permeability in patients with AP. In addition, studies have shown that HTG-induced changes in gut microbiota can worsen AP by negatively impacting the host metabolism, immune response, and function of the intestinal barrier. In this review, we summarize recent clinical and animal studies on the role and mechanism of gut microbiota in the severity of AP aggravated by HTG. The application prospects of the newly proposed microbial-host-isozyme concept are summarized, focusing on its potential for the precision diagnosis and treatment of HTG-AP through gut microbiota regulation.

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.