World Journal of Gastroenterology最新文献

The incidence and prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) have continued to increase in recent years, making it one of the most common chronic liver diseases worldwide. MASLD is highly comorbid with obesity, type 2 diabetes, cardiovascular disease, and chronic kidney disease, posing a serious threat to public health and creating a significant medical and socioeconomic burden. Despite advances in research, current clinical practice still faces considerable challenges in early screening, risk stratification, prognostic prediction, and long-term therapeutic monitoring. Recent advances in artificial intelligence (AI) have provided transformative opportunities to address these challenges. AI has demonstrated unique advantages in imaging interpretation, multiomics integration, electronic health record analysis, and remote health management, significantly improving the accuracy and efficiency of the noninvasive diagnosis, individualized risk stratification, precision therapy, and dynamic disease monitoring of MASLD. In this mini-review, the latest advances in AI applications for MASLD diagnosis and management are systematically summarized, and a forward-looking perspective on the role of AI in enabling the next generation of smart health care systems for MASLD is offered, with the aim of providing theoretical and practical guidance for the clinical management of this disease.

Antibiotic resistance in Helicobacter pylori is reshaping eradication strategies worldwide. Analysis of 1408 treatment-naive isolates collected across Taiwan between 2019 and 2024 reveals a striking shift in resistance patterns. Tetracycline resistance, once negligible, rose to 3.5%, threatening the durability of bismuth-based quadruple therapy. Conversely, metronidazole resistance declined markedly, while clarithromycin and levofloxacin resistance remained stable at moderate levels, with levofloxacin showing significant regional variation. Emerging dual resistance involving tetracycline underscores the fragility of empiric regimens and highlights the need for culture-guided or molecular approaches. These findings reflect the dual influence of stewardship successes and environmental antibiotic pressures, while also signaling the limits of empiricism in eradication therapy. Potassium-competitive acid blockers provide a promising pharmacologic pivot, capable of enhancing antibiotic efficacy and sustaining eradication outcomes. Taiwan's resistance profile thus offers both cautionary lessons and actionable insights for future regional and global treatment strategies.

Background: Indolent T-cell lymphoma of the gastrointestinal tract (iTCL-GI) is a rare mature T-cell lymphoma that has been formally recognized as a distinct entity in the 5^th Edition World Health Organization Classification of Tumours of Haematolymphoid Tumours. However, the coexistence of iTCL-GI with epithelial malignancies is rare in clinical practice. This study reports a case of iTCL-GI with gastric signet-ring cell carcinoma (SRCC). We aim to increase diagnostic awareness among clinicians and pathologists regarding multiple primary tumors.

Case summary: A 65-year-old female presented with a 5-month history of lower abdominal pain, bloating, and vomiting. An abdominal computed tomography scan revealed irregular thickening of the gastric wall. Endoscopy revealed diffuse mucosal edema and rigid mucosa along the lesser curvature of the gastric body. There was a 1.5 cm mucosal protrusion on the greater curvature. Biopsy revealed that the lamina propria was expanded by a dense, nondestructive infiltrate of small lymphocytes in the greater curvature, which were characterized by a CD3+/CD8+/TIA-1+ immunophenotype with a low Ki-67 index. Clonal T-cell receptor rearrangement was detected, but the Epstein-Barr virus encoded RNA's was negative. Lesions on the lesser curvature of the gastric body were confirmed to be SRCCs. After three months of follow-up, the patient completed four cycles of chemotherapy targeting the SRCC. While her abdominal pain improved, she experienced a weight loss of 5 kg.

Conclusion: Clinicians and pathologists must integrate assessment of these rare cases to prevent misdiagnosis and guide clinical practice.

Background: Visceral fat deposition in the pancreas in the absence of significant alcohol use is termed non-alcoholic fatty pancreas disease (NAFPD) and is closely associated with metabolic dysfunction-associated steatotic liver disease (MASLD). However, few studies have assessed the relationship between the severity of NAFPD and the degree of hepatic inflammation and fibrosis in patients with MASLD.

Aim: To evaluate how NAFPD correlates with degrees of hepatic steatosis, steatohepatitis, and hepatic fibrosis in patients with MASLD.

Methods: We performed a retrospective cohort study of patients in the Yale New Haven Health System with a diagnosis of MASLD. Chart and primary imaging data were reviewed to evaluate the degree of pancreatic steatosis and its relationship to hepatic steatosis, steatohepatitis, fibrosis, and other metabolic parameters.

Results: Ninety-nine participants were identified who met additional inclusion criteria (liver biopsy and non-contrast enhanced computed tomography scan of the abdomen). 76 out of the 99 patients in our cohort met the imaging criteria for NAFPD. However, there was no association between the degree of pancreatic steatosis and hepatic steatosis (either on imaging or biopsy), or the degree of pancreatic steatosis and advanced forms of MASLD, such as the degree of metabolic dysfunction-associated steatohepatitis or stage of hepatic fibrosis.

Conclusion: MASLD and NAFPD are co-occurring diseases resulting from and contributing to metabolic dysregulation. Our study confirms this association but does not support a strong association between pancreatic steatosis and hepatic steatohepatitis or fibrosis in this cohort; larger prospective, longitudinal studies are needed in the future to better define the complex interplay of MASLD, NAFPD, and metabolic health.

We read with great interest the article by Sun et al addressing the prognostic role of tumor deposits (TDs) and negative lymph nodes in N1c colorectal cancer. Their proposal of the NLNTD index is a valuable step toward refining risk stratification in this subgroup. In our recently published population-based cohort of 111106 patients with early-stage colon cancer, TD positivity, classified as N1c according to AJCC definitions, was independently associated with significantly worse overall and disease-specific survival, even after propensity score matching. Taken together, these findings show that TDs are adverse prognostic factors across stages. They should inform treatment planning and follow-up, rather than be regarded as incidental.

Background: Despite advances in the treatment of ulcerative colitis (UC), some patients remain refractory to the currently available treatments. Dual biologic therapy (DBT) has emerged as a promising strategy for these patients.

Case summary: A patient with extensive UC presented with steroid dependence and contraindications (past medical history included breast cancer and previous myocardial infarction) to treatment with tumor necrosis factor and Janus kinase inhibitors. DBT of α4β7 integrin antagonist (vedolizumab) and interleukin 23p19 inhibitor (mirikizumab) resulted in a sustained clinical and biochemical remission. No adverse events were recorded during the follow-up.

Conclusion: This case highlighted the challenge of managing refractory UC, especially in frail patients.

Background: Hepatitis delta virus (HDV) infection is the most severe form of chronic viral hepatitis, yet sex-based clinical differences remain poorly defined. Understanding these differences may inform disease management and guide research.

Aim: To investigate sex-related differences in demographic and clinical characteristics of patients with chronic HDV infection in a nationwide, real-world Italian setting.

Methods: We analyzed demographic, clinical, and virological data from 513 hepatitis B surface antigen/anti-HDV-positive patients, consecutively enrolled between 2019 and 2024, across 58 liver clinics in the Italian PITER HDV cohort. A propensity score-weighted logistic regression model evaluated the association between sex and cirrhosis and/or hepatocellular carcinoma.

Results: Among 513 patients (61.6% male), median age (56.0 years) and age distribution were similar by sex (P = 0.41). Cirrhosis was frequent: 73.4% vs 66.0% (anti-HDV-positive) and 77.8% vs 74.2% (HDV RNA-positive) in males and females, respectively. HDV RNA levels were comparable (P = 0.93). The highest proportion of females with cirrhosis (33.8%) was in the 56-60-year group, similar to males (34.9%). Among patients with cirrhosis aged ≤ 40 years, females, (80.9% of whom of non-Italian origin), were more represented than males (16.1% vs 6.5% respectively, P < 0.05). Male sex was associated with cirrhosis (odds ratio = 1.85; 95% confidence interval: 1.004-3.40). Among HDV RNA-positive patients, males more often had hepatocellular carcinoma, elevated gamma-glutamyl transpeptidase, alcohol use, diabetes, hypertension, steatotic liver disease, and hepatitis C virus/human immunodeficiency virus coinfection. Interferon eligibility was similar.

Conclusion: HDV-infected females develop cirrhosis earlier, without liver disease cofactors, while males show advanced liver disease with multiple cofactors. Tailored care for young migrant women and cofactor-guided management for men may improve HDV outcomes, promoting equity.

Background: Inflammation is closely related to survival and disease progression in patients with cancer. However, the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma (HCC) treated with Lenvatinib has not been fully elucidated.

Aim: To compare different inflammation scores' prognostic values, and establish novel nomogram for predicting overall survival (OS) in HCC patients on Lenvatinib.

Methods: In total, 144 patients with HCC treated with Lenvatinib were enrolled in this study. The prognostic value of pre-treatment inflammation-based scores was retrospectively analyzed, including the platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, lymphocyte-to-C-reactive protein ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, C-reactive protein-to-albumin ratio, and prognostic nutritional index (PNI). Kaplan-Meier survival curves and time-dependent receiver operating characteristic analysis were used to assess predictive accuracy. Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors predicting OS and construct a prognostic nomogram.

Results: All the inflammation-based scores demonstrated good discrimination in terms of OS (all P < 0.05), and the PNI emerged as an independent predictor of OS in multivariate analysis (hazard ratio = 4.097; 95% confidence interval: 1.405-11.944; P = 0.01). We selected three independent prognostic factors (macrovascular invasion, metastasis, and PNI) to generate a nomogram for OS.

Conclusion: The PNI is a prognostic indicator for assessing OS in patients with HCC treated with Lenvatinib and is superior to other inflammation-based scores in predicting OS.

Background: The enhanced recovery after surgery (ERAS) perioperative management framework has been well-documented to improve surgical outcomes and alleviate financial burdens for patients. Against the backdrop of a rapidly aging global population, the incidence of gastric cancer (GC) among elderly individuals continues to increase.

Aim: To validate the feasibility and safety of the ERAS protocol in elderly GC patients, thereby enhancing its evidence-based medical foundation.

Methods: A retrospective analysis of 161 GC patients who underwent ERAS between January 2022 and January 2024 was conducted. The subjects included 79 young patients (< 65 years) and 82 elderly patients (≥ 65 years). The rates of ERAS compliance, postoperative ventilation time, postoperative hospital stay, reoperation rate, mortality rate, postoperative inflammatory markers C-reactive protein (CRP), white blood cells (WBCs), IL-2, IL-6, and the rate of postoperative complications (anastomotic leakage, incision infection, pulmonary infection) were compared between these two groups.

Results: The incidence of complications in the elderly group was significantly higher than that in the young group, and included hypertension (P = 0.002), diabetes (P = 0.005), respiratory disease (P = 0.034), and heart disease (P = 0.016). In terms of American Society of Anesthesiologists (ASA) grading indicators, the overall ASA grade in the elderly group was biased toward grade II, which was significantly higher than that in the young group (P < 0.001). There was no significant difference in sex, body mass index, preoperative albumin, preoperative WBCs, TNM classification, differentiation, number of lymph node metastasis, and preoperative IL-6 between the two groups. There were no significant differences between the two groups in terms of operative method, surgical approach, conversion to open surgery, operation time, intraoperative bleeding volume, and number of lymph nodes dissected (all P values > 0.05). There were no significant differences between the two groups in ERAS completion rate, reoperation, postoperative first ventilation time, postoperative hospital stays, postoperative anastomotic leakage, postoperative incision infection, postoperative pulmonary infection, and serum inflammatory markers (WBCs, CRP and IL-6) on postoperative day 1 and 3 (all P values > 0.05). No patients in either group died within 30 days after surgery.

Conclusion: The application of ERAS protocols in elderly patients is feasible and safe, and its management measures are universally applicable to patients of different ages.

Background: Esophageal squamous cell carcinoma (ESCC) is a cancer with a poor prognosis, characterized by distinct geographical distribution and family clustering.

Aim: To investigate if ethnic differences (Han vs Kazakh) cause molecular variations in ESCC patients via genomic sequencing 299 samples.

Methods: Here, we sequenced samples from 299 ESCC patients collected from Henan Key Laboratory for Esophageal Cancer Research and National Key Laboratory of Metabolic Dysregulation and Esophageal Cancer Prevention and Treatment, The First Affiliated Hospital of Zhengzhou University, including Han and Kazakh ethnic groups, and performed a genomic comparative analysis of these two ethnic cohorts.

Results: ESCC patients of Kazakh ethnicity present with a later age of onset compared to Han. Kazakh patients exhibit a slightly higher tumor mutation burden compared to their Han counterparts. Three genes GIGYF1, CACNA1D, and ACOT11 exhibited mutation frequencies threefold higher in Kazakh patients than in Han. This enrichment may be associated with Kazakhs' adaptation to cold climates and consumption of high-calorie diets. Among Han patients, the apolipoprotein B messenger RNA-editing enzyme catalytic polypeptide (APOBEC)-associated single base substitutions (SBS) 13 mutational signature is more prevalent, whereas SBS6, indicative of DNA mismatch repair deficiency, is more common in Kazakh patients. Additionally, Han Chinese patients with APOBEC-enriched tumors exhibit a significantly higher mutation load than those without. Moreover, patients lacking the APOBEC signature demonstrate superior survival probability compared to the APOBEC-enriched group.

Conclusion: Living environment and diet are major factors in the development of ESCC. Genomic difference may provide guidance for the formulation of clinical treatment plans for ESCC from different ethnics regions.