JGH Open最新文献_第2页

Differentiation of Gallbladder Adenomyomatosis and Polyps in a Western Cohort: Prevalence, Ultrasound Characteristics, and Diagnostic Challenges 西方人群胆囊腺肌瘤病和息肉的鉴别：患病率、超声特征和诊断挑战。

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2026-01-19 DOI: 10.1002/jgh3.70343

Marie Neumann, Michael Kallenbach, Ulrike Morgera, Andrea Cariati, Lars Morawietz, Frank Jacobsen, Frank Dubois, Sebastian Herberger, Falko Hanisch, Slim Khouja, Wolfram Wermke, Yvonne Dörffel

Background

Gallbladder adenomyomatosis and polyps are common benign lesions that can mimic malignancy on imaging, often leading to unnecessary cholecystectomy. Despite frequent sonographic detection, the prevalence of adenomyomatosis in living cohorts remains poorly defined.

Aim

To determine the prevalence and characterize the sonographic features of gallbladder adenomyomatosis and polyps in a large unselected cohort, and to assess clinical relevance.

Methods

We retrospectively analyzed 2674 patients (≥ 16 years) who underwent abdominal ultrasound over 20 months. Examinations were performed by highly experienced sonographers using B-mode, color Doppler, superb microvascular imaging and contrast-enhanced ultrasound. Adenomyomatosis and polyps were classified based on morphology, wall involvement, vascularity, and Rokitansky–Aschoff sinuses (RAS). Follow-up imaging was available in 68 of 123 patients with polyps (median 76 months).

Results

Adenomyomatosis was diagnosed in 32 patients (1.2%). Characteristic features included hypoechoic or isoechoic thickened wall with anechoic or microlith-filled RAS, often producing comet-tail and twinkling artifacts. Only one patient required cholecystectomy due to symptomatic diffuse disease. Gallbladder polyps were identified in 123 patients (4.6%). Most polyps remained stable or showed minimal growth, with only three patients undergoing surgery, revealing two cholesterol polyps and one precancerous intracholecystic papillary neoplasm (0.04% of the total cohort).

Conclusion

Structured, high-quality ultrasound enables reliable differentiation of adenomyomatosis and benign polyps from lesions suspicious for malignancy. The vast majority of findings are benign, supporting conservative management. These results provide a reference standard for sonographic assessment and emphasize the importance of awareness and systematic evaluation of gallbladder wall abnormalities.

背景：胆囊腺肌瘤病和息肉是常见的良性病变，在影像学上可以模仿恶性肿瘤，经常导致不必要的胆囊切除术。尽管频繁的超声检查，腺肌瘤病的患病率在生活队列仍然不明确。目的：确定胆囊腺肌瘤病和息肉在大量未选择队列中的患病率和超声特征，并评估临床相关性。方法：回顾性分析2674例（≥16岁）在20个月内接受腹部超声检查的患者。检查由经验丰富的超声医师使用b超，彩色多普勒，高超微血管成像和对比增强超声。腺肌瘤病和息肉根据形态学、管壁受损伤、血管分布和Rokitansky-Aschoff窦（RAS）进行分类。123例息肉患者中有68例（中位76个月）进行了随访成像。结果：确诊腺肌瘤32例（1.2%）。特征包括低回声或等回声壁增厚，无回声或微石填充的RAS，经常产生彗星尾和闪烁伪影。仅有1例患者因症状性弥漫性疾病需要胆囊切除术。胆囊息肉123例（4.6%）。大多数息肉保持稳定或生长很小，只有3例患者接受了手术，发现2例胆固醇息肉和1例癌前胆囊内乳头状肿瘤（占总队列的0.04%）。结论：结构化、高质量的超声能够可靠地鉴别腺肌瘤病和良性息肉与可疑的恶性病变。绝大多数结果是良性的，支持保守治疗。这些结果为超声评估提供了参考标准，并强调了对胆囊壁异常的认识和系统评估的重要性。

{"title":"Differentiation of Gallbladder Adenomyomatosis and Polyps in a Western Cohort: Prevalence, Ultrasound Characteristics, and Diagnostic Challenges","authors":"Marie Neumann, Michael Kallenbach, Ulrike Morgera, Andrea Cariati, Lars Morawietz, Frank Jacobsen, Frank Dubois, Sebastian Herberger, Falko Hanisch, Slim Khouja, Wolfram Wermke, Yvonne Dörffel","doi":"10.1002/jgh3.70343","DOIUrl":"10.1002/jgh3.70343","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gallbladder adenomyomatosis and polyps are common benign lesions that can mimic malignancy on imaging, often leading to unnecessary cholecystectomy. Despite frequent sonographic detection, the prevalence of adenomyomatosis in living cohorts remains poorly defined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine the prevalence and characterize the sonographic features of gallbladder adenomyomatosis and polyps in a large unselected cohort, and to assess clinical relevance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 2674 patients (≥ 16 years) who underwent abdominal ultrasound over 20 months. Examinations were performed by highly experienced sonographers using B-mode, color Doppler, superb microvascular imaging and contrast-enhanced ultrasound. Adenomyomatosis and polyps were classified based on morphology, wall involvement, vascularity, and Rokitansky–Aschoff sinuses (RAS). Follow-up imaging was available in 68 of 123 patients with polyps (median 76 months).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Adenomyomatosis was diagnosed in 32 patients (1.2%). Characteristic features included hypoechoic or isoechoic thickened wall with anechoic or microlith-filled RAS, often producing comet-tail and twinkling artifacts. Only one patient required cholecystectomy due to symptomatic diffuse disease. Gallbladder polyps were identified in 123 patients (4.6%). Most polyps remained stable or showed minimal growth, with only three patients undergoing surgery, revealing two cholesterol polyps and one precancerous intracholecystic papillary neoplasm (0.04% of the total cohort).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Structured, high-quality ultrasound enables reliable differentiation of adenomyomatosis and benign polyps from lesions suspicious for malignancy. The vast majority of findings are benign, supporting conservative management. These results provide a reference standard for sonographic assessment and emphasize the importance of awareness and systematic evaluation of gallbladder wall abnormalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146020194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Anti-Tubercular Drug-Induced Liver Injury: Current Understanding and Emerging Directions 抗结核药物性肝损伤：当前认识和新兴方向

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2026-01-18 DOI: 10.1002/jgh3.70338

Shubham Prasad, Himanshu Narang, Saurabh Kedia, Vineet Ahuja

Most common adverse effect causing cessation of anti-tubercular treatment (ATT) is drug-induced liver injury (DILI) which is unpredictable due to its idiosyncratic nature. ATT is the most common cause of DILI and drug-induced acute liver failure (ALF) in South East Asia. Spectrum of ATT-DILI ranges from asymptomatic raised transaminases to acute hepatitis to acute liver failure (ALF). ALF due to ATT has a more aggressive course with up to 70% mortality. Both modifiable and non-modifiable risk factors are involved. Increasing age, female gender, genetic predisposition, poor nutrition, underlying liver disease, and concomitant viral infections make one prone to ATT-DILI. Thus, pretreatment evaluation is very important. Diagnosis of ATT-DILI is challenging due to lack of specific diagnostic tests; rather, it is a diagnosis of exclusion. Mild transient asymptomatic raised transaminases is due to hepatic adaptation and does not require any modification or cessation of ATT. Early detection of clinically significant DILI by frequent monitoring is associated with better prognosis and low mortality. Prompt withdrawal of all the potential hepatotoxic drugs is the key step in the management. Since the benefit of first-line ATT outweighs the monitored risk, reintroduction is always considered after normalization of raised transaminases. Ideal regimen is sequential reintroduction with incremental dosage of least hepatotoxic drug first, but evidence for this is lacking. Since hepatotoxicity rate is similar across different regimens, reintroduction is individualized based on perceived clinical risk. Future research is needed to identify specific biomarker panel for diagnosing ATT-DILI.

导致停止抗结核治疗（ATT）的最常见不良反应是药物性肝损伤（DILI），由于其特殊性质，这是不可预测的。在东南亚，ATT是DILI和药物性急性肝衰竭（ALF）最常见的原因。at - dili的范围从无症状的转氨酶升高到急性肝炎到急性肝衰竭（ALF）。由ATT引起的ALF病程更具侵袭性，死亡率高达70%。包括可改变的和不可改变的风险因素。年龄增长、女性、遗传易感性、营养不良、潜在的肝脏疾病和伴随的病毒感染使人容易发生at - dili。因此，预处理评价是非常重要的。由于缺乏特定的诊断测试，诊断at - dili具有挑战性；相反，它是一种排斥的诊断。轻度短暂无症状转氨酶升高是由于肝脏适应，不需要任何改变或停止ATT。通过频繁监测早期发现具有临床意义的DILI可获得较好的预后和较低的死亡率。及时停用所有潜在的肝毒性药物是治疗的关键步骤。由于一线ATT的益处大于监测的风险，因此在转氨酶升高正常化后，总是考虑重新引入。理想的治疗方案是序贯重新引入，首先增加肝毒性最小药物的剂量，但缺乏证据。由于不同方案的肝毒性率相似，因此重新引入是基于感知到的临床风险的个体化。未来的研究需要确定诊断at - dili的特异性生物标志物。

{"title":"Anti-Tubercular Drug-Induced Liver Injury: Current Understanding and Emerging Directions","authors":"Shubham Prasad, Himanshu Narang, Saurabh Kedia, Vineet Ahuja","doi":"10.1002/jgh3.70338","DOIUrl":"https://doi.org/10.1002/jgh3.70338","url":null,"abstract":"<p>Most common adverse effect causing cessation of anti-tubercular treatment (ATT) is drug-induced liver injury (DILI) which is unpredictable due to its idiosyncratic nature. ATT is the most common cause of DILI and drug-induced acute liver failure (ALF) in South East Asia. Spectrum of ATT-DILI ranges from asymptomatic raised transaminases to acute hepatitis to acute liver failure (ALF). ALF due to ATT has a more aggressive course with up to 70% mortality. Both modifiable and non-modifiable risk factors are involved. Increasing age, female gender, genetic predisposition, poor nutrition, underlying liver disease, and concomitant viral infections make one prone to ATT-DILI. Thus, pretreatment evaluation is very important. Diagnosis of ATT-DILI is challenging due to lack of specific diagnostic tests; rather, it is a diagnosis of exclusion. Mild transient asymptomatic raised transaminases is due to hepatic adaptation and does not require any modification or cessation of ATT. Early detection of clinically significant DILI by frequent monitoring is associated with better prognosis and low mortality. Prompt withdrawal of all the potential hepatotoxic drugs is the key step in the management. Since the benefit of first-line ATT outweighs the monitored risk, reintroduction is always considered after normalization of raised transaminases. Ideal regimen is sequential reintroduction with incremental dosage of least hepatotoxic drug first, but evidence for this is lacking. Since hepatotoxicity rate is similar across different regimens, reintroduction is individualized based on perceived clinical risk. Future research is needed to identify specific biomarker panel for diagnosing ATT-DILI.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dietary Characteristics Associated With High Defecation Frequency and Constipation in Japanese Adults: A Cross-Sectional Study 日本成年人与高排便频率和便秘相关的饮食特征：一项横断面研究。

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2026-01-09 DOI: 10.1002/jgh3.70334

Hirokazu Taniguchi, Miho Ueda, Yukiko Kobayashi, Takatomo Shima

Aims

The aim of this study was to evaluate the association between defecation frequency and dietary characteristics in adult men and women to identify factors associated with appropriate defecation frequency.

Methods

We performed a cross-sectional study of 11,595 participants (n = 6142 men and 5453 women) aged 30–79 years using annual health check data collected between 2018 and 2023. Data on dietary characteristics and defecation frequency were collected using a self-reported questionnaire. Participants were divided according to defecation frequency into high- (≥ 3 times/day) and middle-frequency defecation groups, and a constipation group (≤ every 3 days).

Results

The proportion of high-frequency defecation was higher in men, whereas constipation was higher in women. For both sexes, high-frequency defecation was associated with higher BMI, triglyceride, and hepatic enzyme levels, whereas constipation was associated with lower BMI, triglyceride, and hepatic enzyme levels. Multivariable-adjusted logistic regression analysis indicated that, in men, high-frequency defecation was associated with eating a snack after dinner. The risk of constipation was negatively associated with frequent consumption of vegetables in both sexes, and fruits in women only. The prevalence of constipation was positively and strongly associated with skipping breakfast every day in both men and women.

Conclusion

This study found a correlation between increased defecation frequency and obesity-related characteristics, such as elevated BMI, triglycerides, and hepatic enzyme levels, in both men and women. Fiber-rich food intake may have a preventive effect against constipation, whereas skipping breakfast every day was associated with constipation prevalence in both sexes.

目的：本研究的目的是评估成年男性和女性排便频率与饮食特征之间的关系，以确定与适当排便频率相关的因素。方法：我们对11,595名年龄在30-79岁之间的参与者（n = 6142名男性和5453名女性）进行了横断面研究，使用了2018年至2023年收集的年度健康检查数据。饮食特征和排便频率的数据通过自我报告问卷收集。根据排便频率分为高（≥3次/天）、中频排便组和便秘组（≤每3天一次）。结果：高频排便比例男性较高，而便秘比例女性较高。对于两性来说，频繁排便与较高的BMI、甘油三酯和肝酶水平有关，而便秘与较低的BMI、甘油三酯和肝酶水平有关。多变量调整逻辑回归分析表明，在男性中，频繁排便与晚餐后吃零食有关。无论男女，便秘的风险与经常食用蔬菜呈负相关，而女性只食用水果。无论男女，便秘的发病率都与每天不吃早餐呈正相关。结论：该研究发现，在男性和女性中，排便频率增加与肥胖相关特征（如BMI、甘油三酯和肝酶水平升高）之间存在相关性。摄入富含纤维的食物可能对便秘有预防作用，而每天不吃早餐则与男女便秘患病率有关。

{"title":"Dietary Characteristics Associated With High Defecation Frequency and Constipation in Japanese Adults: A Cross-Sectional Study","authors":"Hirokazu Taniguchi, Miho Ueda, Yukiko Kobayashi, Takatomo Shima","doi":"10.1002/jgh3.70334","DOIUrl":"10.1002/jgh3.70334","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The aim of this study was to evaluate the association between defecation frequency and dietary characteristics in adult men and women to identify factors associated with appropriate defecation frequency.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a cross-sectional study of 11,595 participants (<i>n</i> = 6142 men and 5453 women) aged 30–79 years using annual health check data collected between 2018 and 2023. Data on dietary characteristics and defecation frequency were collected using a self-reported questionnaire. Participants were divided according to defecation frequency into high- (≥ 3 times/day) and middle-frequency defecation groups, and a constipation group (≤ every 3 days).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The proportion of high-frequency defecation was higher in men, whereas constipation was higher in women. For both sexes, high-frequency defecation was associated with higher BMI, triglyceride, and hepatic enzyme levels, whereas constipation was associated with lower BMI, triglyceride, and hepatic enzyme levels. Multivariable-adjusted logistic regression analysis indicated that, in men, high-frequency defecation was associated with eating a snack after dinner. The risk of constipation was negatively associated with frequent consumption of vegetables in both sexes, and fruits in women only. The prevalence of constipation was positively and strongly associated with skipping breakfast every day in both men and women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study found a correlation between increased defecation frequency and obesity-related characteristics, such as elevated BMI, triglycerides, and hepatic enzyme levels, in both men and women. Fiber-rich food intake may have a preventive effect against constipation, whereas skipping breakfast every day was associated with constipation prevalence in both sexes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12788986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145953369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Eosinophilic Esophagitis in the Middle East: Insight From a Comprehensive Systematic Review 中东嗜酸性粒细胞性食管炎：来自全面系统综述的见解。

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2026-01-05 DOI: 10.1002/jgh3.70305

Nouran Alwisi, Sidra Abdul Moqeeth, Muneera Al-Mohannadi

Background

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus, defined by esophageal dysfunction and dense eosinophilic infiltration (≥ 15 eosinophils per HPF) in biopsies, after exclusion of other causes. While its global incidence is rising, data from the Middle East remain limited and fragmented. This systematic review aims to comprehensively synthesize available evidence on EoE in Middle Eastern populations, focusing on clinical presentations, allergic comorbidities, diagnostic practices, histological and endoscopic findings, and management strategies.

Methods

A systematic search of PubMed, Scopus, Embase, and Web of Science was conducted through July 2025. Studies were included if they reported original data on EoE patients from Middle Eastern countries, describing demographics, clinical features, diagnosis, or management. Data extraction and quality appraisal were performed independently by two reviewers, using Joanna Briggs Institute (JBI) tools.

Results

Sixty seven studies comprising 2870 EoE patients from 11 Middle Eastern countries were included. A pronounced male predominance was observed (male-to-female ratios: approximately 2:1 in adults, 2.5:1 in children). Clinical presentations mirrored global patterns, with dysphagia and food impaction as predominant symptoms. Allergic comorbidities were commonly reported. Diagnostic criteria were consistent, but underdiagnosis and misclassification were noted. Histological and endoscopic findings were broadly in line with international data, though mucosal remodeling and strictures were frequently observed, suggesting diagnostic delays. Management approaches included the use of PPIs, corticosteroids, dietary elimination, and, in selected cases, dupilumab.

Conclusions

Middle Eastern EoE patients display clinical features, comorbidities, and management patterns like those seen globally. Unique regional aspects such as dietary exposures, allergic profiles, and diagnostic challenges highlight the need for improved clinician awareness and standardized diagnostic protocols.

背景：嗜酸性粒细胞性食管炎（EoE）是一种慢性的、免疫介导的食管炎症性疾病，在排除其他原因后，以食管功能障碍和密集的嗜酸性粒细胞浸润（每HPF≥15个嗜酸性粒细胞）为特征。虽然其全球发病率正在上升，但来自中东的数据仍然有限且支离破碎。本系统综述旨在全面综合中东人群EoE的现有证据，重点关注临床表现、过敏合并症、诊断方法、组织学和内窥镜检查结果以及管理策略。方法：系统检索PubMed、Scopus、Embase和Web of Science，检索时间截止到2025年7月。如果研究报告了中东国家EoE患者的原始数据，描述了人口统计学、临床特征、诊断或管理，则纳入研究。数据提取和质量评估由两名审稿人独立完成，使用乔安娜布里格斯研究所（JBI）的工具。结果：纳入了67项研究，包括来自11个中东国家的2870例EoE患者。观察到明显的男性优势（男女比例：成人约为2:1，儿童为2.5:1）。临床表现反映了全球模式，以吞咽困难和食物嵌塞为主要症状。过敏性合并症是常见的报道。诊断标准一致，但存在漏诊和误分。组织学和内窥镜检查结果与国际数据大体一致，尽管经常观察到粘膜重塑和狭窄，提示诊断延迟。管理方法包括使用PPIs、皮质类固醇、饮食消除，并在选定的病例中使用杜匹单抗。结论：中东EoE患者表现出与全球相似的临床特征、合并症和管理模式。独特的区域方面，如饮食暴露、过敏概况和诊断挑战，突出了提高临床医生意识和标准化诊断方案的必要性。

{"title":"Eosinophilic Esophagitis in the Middle East: Insight From a Comprehensive Systematic Review","authors":"Nouran Alwisi, Sidra Abdul Moqeeth, Muneera Al-Mohannadi","doi":"10.1002/jgh3.70305","DOIUrl":"10.1002/jgh3.70305","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus, defined by esophageal dysfunction and dense eosinophilic infiltration (≥ 15 eosinophils per HPF) in biopsies, after exclusion of other causes. While its global incidence is rising, data from the Middle East remain limited and fragmented. This systematic review aims to comprehensively synthesize available evidence on EoE in Middle Eastern populations, focusing on clinical presentations, allergic comorbidities, diagnostic practices, histological and endoscopic findings, and management strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search of PubMed, Scopus, Embase, and Web of Science was conducted through July 2025. Studies were included if they reported original data on EoE patients from Middle Eastern countries, describing demographics, clinical features, diagnosis, or management. Data extraction and quality appraisal were performed independently by two reviewers, using Joanna Briggs Institute (JBI) tools.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty seven studies comprising 2870 EoE patients from 11 Middle Eastern countries were included. A pronounced male predominance was observed (male-to-female ratios: approximately 2:1 in adults, 2.5:1 in children). Clinical presentations mirrored global patterns, with dysphagia and food impaction as predominant symptoms. Allergic comorbidities were commonly reported. Diagnostic criteria were consistent, but underdiagnosis and misclassification were noted. Histological and endoscopic findings were broadly in line with international data, though mucosal remodeling and strictures were frequently observed, suggesting diagnostic delays. Management approaches included the use of PPIs, corticosteroids, dietary elimination, and, in selected cases, dupilumab.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Middle Eastern EoE patients display clinical features, comorbidities, and management patterns like those seen globally. Unique regional aspects such as dietary exposures, allergic profiles, and diagnostic challenges highlight the need for improved clinician awareness and standardized diagnostic protocols.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12766703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Genetically Validated Immune Susceptibility Markers for Crohn's Disease: A Multi-Omics Mendelian Randomization Analysis 基因验证的克罗恩病免疫易感性标记：多组孟德尔随机分析

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2026-01-01 DOI: 10.1002/jgh3.70332

Zeyang Li

Background

Crohn's disease (CD) is a chronic inflammatory bowel disorder with a multifactorial genetic, immune, and environmental basis, yet robustly validated therapeutic targets remain limited. We applied a multi-omics Mendelian randomization (MR) framework and colocalization to prioritize genetically supported immune susceptibility loci for CD.

Methods

A two-sample MR framework was used, integrating protein quantitative trait loci (pQTL) and expression quantitative trait loci (eQTL) datasets with genome-wide association study (GWAS) data on CD from the Finnish biobank. After identifying 994 pQTL genes, 610 genes overlapping with known druggable targets were selected. Causal associations with CD were evaluated using inverse variance weighted (IVW) MR. Significant hits were further validated through colocalization analysis and summary-data-based Mendelian randomization (SMR).

Results

IVW analysis identified 56 pQTL genes significantly associated with CD risk, with six genes (including HLA-A, MST1, and CDH5) passing false discovery rate (FDR) correction. Colocalization analysis indicated that HLA-A and MST1 shared causal variants with CD. Subsequent eQTL-based MR and SMR analysis confirmed the causal association of HLA-A expression with increased CD risk (SMR OR = 1.434, p = 4.10 × 10⁻⁵), with no evidence of heterogeneity.

Conclusion

These findings suggest that HLA-A represents a genetically validated immune susceptibility marker in CD. By integrating pQTL, eQTL, colocalization, and SMR analyses, it highlights the utility of multi-omics MR in uncovering novel genetic contributors to complex diseases. Further experimental and clinical validation is warranted to explore the translational potential of targeting HLA-A in CD treatment.

克罗恩病（CD）是一种慢性炎症性肠疾病，具有多因素遗传、免疫和环境基础，但有效的治疗靶点仍然有限。我们采用多组学孟德尔随机化（MR）框架和共定位来确定遗传支持的CD免疫易感性位点的优先级。方法采用双样本MR框架，将蛋白质数量性状位点（pQTL）和表达数量性状位点（eQTL）数据集与来自芬兰生物库的CD全基因组关联研究（GWAS）数据整合。在鉴定出994个pQTL基因后，筛选出610个与已知药物靶点重叠的基因。使用逆方差加权（IVW） mr评估与CD的因果关系，通过共定位分析和基于汇总数据的孟德尔随机化（SMR）进一步验证显著命中。结果IVW分析鉴定出56个与CD风险显著相关的pQTL基因，其中6个基因（包括HLA-A、MST1和CDH5）通过错误发现率（FDR）校正。共定位分析表明HLA-A和MST1与CD有共同的因果变异。随后基于eqtl的MR和SMR分析证实了HLA-A表达与CD风险增加的因果关系（SMR OR = 1.434, p = 4.10 × 10−5），没有证据表明存在异质性。这些研究结果表明，HLA-A是一种经过遗传验证的CD免疫易感性标志物。通过整合pQTL、eQTL、共定位和SMR分析，它突出了多组学MR在揭示复杂疾病的新遗传因素方面的应用。进一步的实验和临床验证是必要的，以探索靶向HLA-A在CD治疗中的转化潜力。

{"title":"Genetically Validated Immune Susceptibility Markers for Crohn's Disease: A Multi-Omics Mendelian Randomization Analysis","authors":"Zeyang Li","doi":"10.1002/jgh3.70332","DOIUrl":"https://doi.org/10.1002/jgh3.70332","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Crohn's disease (CD) is a chronic inflammatory bowel disorder with a multifactorial genetic, immune, and environmental basis, yet robustly validated therapeutic targets remain limited. We applied a multi-omics Mendelian randomization (MR) framework and colocalization to prioritize genetically supported immune susceptibility loci for CD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A two-sample MR framework was used, integrating protein quantitative trait loci (pQTL) and expression quantitative trait loci (eQTL) datasets with genome-wide association study (GWAS) data on CD from the Finnish biobank. After identifying 994 pQTL genes, 610 genes overlapping with known druggable targets were selected. Causal associations with CD were evaluated using inverse variance weighted (IVW) MR. Significant hits were further validated through colocalization analysis and summary-data-based Mendelian randomization (SMR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>IVW analysis identified 56 pQTL genes significantly associated with CD risk, with six genes (including <i>HLA-A</i>, <i>MST1</i>, and <i>CDH5</i>) passing false discovery rate (FDR) correction. Colocalization analysis indicated that <i>HLA-A</i> and <i>MST1</i> shared causal variants with CD. Subsequent eQTL-based MR and SMR analysis confirmed the causal association of <i>HLA-A</i> expression with increased CD risk (SMR OR = 1.434, <i>p</i> = 4.10 × 10<sup>−5</sup>), with no evidence of heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings suggest that HLA-A represents a genetically validated immune susceptibility marker in CD. By integrating pQTL, eQTL, colocalization, and SMR analyses, it highlights the utility of multi-omics MR in uncovering novel genetic contributors to complex diseases. Further experimental and clinical validation is warranted to explore the translational potential of targeting <i>HLA-A</i> in CD treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Outcomes of Abdominal Tuberculosis Referred for Surgical Management in a Tertiary Care Center in Nepal 尼泊尔三级保健中心腹部结核转诊手术治疗的结果

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2026-01-01 DOI: 10.1002/jgh3.70335

Kunal Bikram Deo, Parbatraj Regmi, Gobardhan Nepal, Rakesh Kumar Gupta, Shailesh Adhikary

Background

While abdominal tuberculosis (ATB) is a great masquerader, it can cause significant morbidity and mortality. We aim to evaluate the presentation and management outcomes of patients with abdominal TB referred to us for surgical management.

Methods

This is a retrospective study of patients with definitive or presumed ATB from January 2010 to July 2022 at a tertiary care hospital in Nepal. The data on clinical presentation, diagnosis, management, and short-term outcomes were analyzed.

Results

Sixty-six patients with a definitive (25) and presumed (41) diagnosis of ATB were analyzed with a mean age of 32.6 years. Patients presented with moderate to severe anemia (57.1%), intestinal obstruction (53.0%), abdominal lump (30.3%), intestinal bleeding (4.5%), and peritonitis (27.3%) including intestinal perforation (6.1%). A total of 34 (51.5%) patients received surgical management. Intestinal obstruction was a significant risk factor for the need of surgery. Conservative management was successful in 37.1% and 31.3% of patients with intestinal obstruction and peritonitis respectively. Ileum and caecum were the most common sites of intestinal tuberculosis. Bowel resection and stoma were done in 13 (38.2%) and 10 (29.4%) patients respectively. There were 4 (6.1%) overall mortality including two operative mortalities. The common surgical complications were iatrogenic bowel injuries (13.1%), wound infection (32.3%), rectus sheath dehiscence (17.6%), and intra-abdominal abscess (14.7%). The median hospital stay was 8.5 days.

Conclusion

Surgical intervention in complicated ATB is associated with high morbidity and mortality. Judicious conservative management in ATB can be tried in selected patients.

背景腹部结核（ATB）是一个巨大的伪装者，它可以引起显著的发病率和死亡率。我们的目的是评估腹部结核病患者的表现和治疗结果，这些患者转介给我们进行手术治疗。方法对2010年1月至2022年7月在尼泊尔一家三级医院确诊或推定ATB的患者进行回顾性研究。分析了临床表现、诊断、治疗和短期结果的数据。结果确诊（25例）和推定（41例）ATB患者66例，平均年龄32.6岁。患者表现为中重度贫血（57.1%）、肠梗阻（53.0%）、腹部肿块（30.3%）、肠出血（4.5%）、腹膜炎（27.3%）伴肠穿孔（6.1%）。34例（51.5%）患者接受手术治疗。肠梗阻是需要手术的重要危险因素。肠梗阻和腹膜炎的保守治疗成功率分别为37.1%和31.3%。回肠和盲肠是肠结核最常见的部位。分别有13例（38.2%）和10例（29.4%）患者行肠切除术和造口术。总死亡率为4例（6.1%），包括2例手术死亡率。常见的手术并发症为医源性肠损伤（13.1%）、伤口感染（32.3%）、直肌鞘裂（17.6%）、腹内脓肿（14.7%）。平均住院时间为8.5天。结论手术治疗合并ATB的发病率和死亡率高。选择性患者可尝试对ATB进行明智的保守治疗。

{"title":"Outcomes of Abdominal Tuberculosis Referred for Surgical Management in a Tertiary Care Center in Nepal","authors":"Kunal Bikram Deo, Parbatraj Regmi, Gobardhan Nepal, Rakesh Kumar Gupta, Shailesh Adhikary","doi":"10.1002/jgh3.70335","DOIUrl":"https://doi.org/10.1002/jgh3.70335","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While abdominal tuberculosis (ATB) is a great masquerader, it can cause significant morbidity and mortality. We aim to evaluate the presentation and management outcomes of patients with abdominal TB referred to us for surgical management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective study of patients with definitive or presumed ATB from January 2010 to July 2022 at a tertiary care hospital in Nepal. The data on clinical presentation, diagnosis, management, and short-term outcomes were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-six patients with a definitive (25) and presumed (41) diagnosis of ATB were analyzed with a mean age of 32.6 years. Patients presented with moderate to severe anemia (57.1%), intestinal obstruction (53.0%), abdominal lump (30.3%), intestinal bleeding (4.5%), and peritonitis (27.3%) including intestinal perforation (6.1%). A total of 34 (51.5%) patients received surgical management. Intestinal obstruction was a significant risk factor for the need of surgery. Conservative management was successful in 37.1% and 31.3% of patients with intestinal obstruction and peritonitis respectively. Ileum and caecum were the most common sites of intestinal tuberculosis. Bowel resection and stoma were done in 13 (38.2%) and 10 (29.4%) patients respectively. There were 4 (6.1%) overall mortality including two operative mortalities. The common surgical complications were iatrogenic bowel injuries (13.1%), wound infection (32.3%), rectus sheath dehiscence (17.6%), and intra-abdominal abscess (14.7%). The median hospital stay was 8.5 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Surgical intervention in complicated ATB is associated with high morbidity and mortality. Judicious conservative management in ATB can be tried in selected patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145887421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessment of Circulating Tumor DNA for Early Detection of Hepatocellular Carcinoma in Alpha-Fetoprotein–Negative Patients With Cirrhotic Nodules 循环肿瘤DNA对甲胎蛋白阴性肝硬化结节患者肝细胞癌早期检测的评估。

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2025-12-29 DOI: 10.1002/jgh3.70331

Li-Jun Chang, Ming-Chin Yu, Wei-Chen Lee, Fu-Chun Chan, Ying-Jun Pan, Dar-In Tai, Wen-Hui Su

Aims

Early detection is essential for improving hepatocellular carcinoma's (HCC) prognosis. However, the diagnostic performance of the current interventions remains unsatisfactory, particularly in patients with cirrhotic nodules. We aimed to develop a predictive model for the early detection of HCC using circulating tumor DNA (ctDNA) profiles based on 86 cancer-related genes.

Methods

This model was initially evaluated on a discovery cohort of 25 patients with HCC and 9 patients with chronic hepatitis and then validated in a prospective control cohort of 15 alpha-fetoprotein-negative patients with cirrhotic nodules.

Results

In the discovery cohort, our ctDNA-based model achieved an area under the receiver operating characteristic curve of 0.8675, with a sensitivity of 88.0% and a specificity of 88.9%. CtDNA mutations in FGFR3, NF1, ALK, ERBB2, and NRAS were significantly associated with HCC prognosis. In the validation cohort, the ctDNA assay was positive in 8 of the 15 patients. Over a five-year follow-up period, 50% of ctDNA-positive patients were diagnosed with early-stage HCC, with a mean lead time of 26.6 months compared to standard clinical assessments.

Conclusion

By enabling diagnosis months earlier than conventional methods, ctDNA-based testing may enhance HCC surveillance and facilitate a more personalized approach to cancer monitoring.

目的：早期发现是改善肝细胞癌预后的关键。然而，目前干预措施的诊断性能仍然不令人满意，特别是在肝硬化结节患者中。我们的目标是建立一种基于86种癌症相关基因的循环肿瘤DNA （ctDNA）谱的早期HCC检测预测模型。方法：该模型最初在25例HCC患者和9例慢性肝炎患者的发现队列中进行评估，然后在15例肝硬化结节的甲胎蛋白阴性患者的前瞻性对照队列中进行验证。结果：在发现队列中，我们基于ctdna的模型实现了接受者工作特征曲线下的面积为0.8675，灵敏度为88.0%，特异性为88.9%。FGFR3、NF1、ALK、ERBB2和NRAS的CtDNA突变与HCC预后显著相关。在验证队列中，15例患者中有8例ctDNA检测呈阳性。在5年的随访期间，50%的ctdna阳性患者被诊断为早期HCC，与标准临床评估相比，平均提前期为26.6个月。结论：通过比传统方法早几个月诊断，基于ctdna的检测可以增强HCC监测，并促进更个性化的癌症监测方法。

{"title":"Assessment of Circulating Tumor DNA for Early Detection of Hepatocellular Carcinoma in Alpha-Fetoprotein–Negative Patients With Cirrhotic Nodules","authors":"Li-Jun Chang, Ming-Chin Yu, Wei-Chen Lee, Fu-Chun Chan, Ying-Jun Pan, Dar-In Tai, Wen-Hui Su","doi":"10.1002/jgh3.70331","DOIUrl":"10.1002/jgh3.70331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Early detection is essential for improving hepatocellular carcinoma's (HCC) prognosis. However, the diagnostic performance of the current interventions remains unsatisfactory, particularly in patients with cirrhotic nodules. We aimed to develop a predictive model for the early detection of HCC using circulating tumor DNA (ctDNA) profiles based on 86 cancer-related genes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This model was initially evaluated on a discovery cohort of 25 patients with HCC and 9 patients with chronic hepatitis and then validated in a prospective control cohort of 15 alpha-fetoprotein-negative patients with cirrhotic nodules.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the discovery cohort, our ctDNA-based model achieved an area under the receiver operating characteristic curve of 0.8675, with a sensitivity of 88.0% and a specificity of 88.9%. CtDNA mutations in FGFR3, NF1, ALK, ERBB2, and NRAS were significantly associated with HCC prognosis. In the validation cohort, the ctDNA assay was positive in 8 of the 15 patients. Over a five-year follow-up period, 50% of ctDNA-positive patients were diagnosed with early-stage HCC, with a mean lead time of 26.6 months compared to standard clinical assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>By enabling diagnosis months earlier than conventional methods, ctDNA-based testing may enhance HCC surveillance and facilitate a more personalized approach to cancer monitoring.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12748524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Causal Relationship Between Butyrate and Dyspepsia: Evidence From Two-Sample Mendelian Randomization Analysis of CSF Metabolites 丁酸盐与消化不良之间的因果关系：来自脑脊液代谢物两样本孟德尔随机化分析的证据。

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2025-12-28 DOI: 10.1002/jgh3.70333

Yichen Cai, Yujie Jiang, Heran Zhou, Caixia Sheng, Jia Zhu, Tao Zhu, Guoxiang Fu, Hancheng Fan

Background

Dyspepsia is a prevalent gastrointestinal disorder with complex pathogenesis involving the gut-brain axis. While alterations in gut microbiota have been linked to dyspepsia, the role of central nervous system metabolites, particularly those in cerebrospinal fluid (CSF), remains unexplored.

Objective

To investigate the potential causal relationship between CSF metabolites and dyspepsia using a two-sample Mendelian randomization (MR) approach.

Methods

We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics. CSF metabolite data were derived from 532 individuals across two cohorts, and dyspepsia outcome data were obtained from the UK Biobank (7586 cases and 353 608 controls). Instrumental variables (SNPs) were selected based on genome-wide significance (p < 5 × 10⁻⁸), with clumping to eliminate linkage disequilibrium. The inverse-variance weighted (IVW) method was the primary analytical approach, supplemented by MR-Egger, weighted median, and weighted mode methods. Sensitivity analyses, including heterogeneity tests and MR-PRESSO, were used to assess the robustness of the findings.

Results

Among 71 CSF metabolites tested, only butyrate (4:0) showed a significant inverse causal association with dyspepsia (IVW OR = 0.997, 95% CI: 0.996–0.998, p < 0.001; P_FDR = 0.007). Sensitivity analyses indicated no evidence of heterogeneity or pleiotropy. Additional enrichment analysis revealed involvement of genes associated with serine-type peptidase and protein catabolic processes.

Conclusions

Our study provides the first genetic evidence linking elevated CSF butyrate levels to a reduced risk of dyspepsia, highlighting a potential neuroprotective role within the gut-brain axis.

背景：消化不良是一种常见的胃肠道疾病，发病机制复杂，涉及肠-脑轴。虽然肠道微生物群的改变与消化不良有关，但中枢神经系统代谢物，特别是脑脊液代谢物的作用仍未得到探索。目的：采用双样本孟德尔随机化（MR）方法探讨脑脊液代谢物与消化不良之间的潜在因果关系。方法：采用全基因组关联研究（GWAS）汇总统计对两样本进行MR分析。脑脊液代谢物数据来自两个队列的532名个体，消化不良结局数据来自英国生物银行（7586例和353 608例对照）。工具变量（SNPs）是根据全基因组显著性（p -8）选择的，通过聚集来消除连锁不平衡。反方差加权（IVW）法为主要分析方法，MR-Egger法、加权中位数法和加权众数法为辅。采用敏感性分析（包括异质性检验和MR-PRESSO）来评估研究结果的稳健性。结果：在71种脑脊液代谢物中，只有丁酸盐（4:0）与消化不良呈显著负相关（IVW OR = 0.997, 95% CI: 0.996-0.998, p p FDR = 0.007）。敏感性分析显示没有异质性或多效性的证据。额外的富集分析显示与丝氨酸型肽酶和蛋白质分解代谢过程相关的基因参与。结论：我们的研究提供了第一个将脑脊液丁酸盐水平升高与降低消化不良风险联系起来的遗传证据，强调了肠-脑轴内潜在的神经保护作用。

{"title":"Causal Relationship Between Butyrate and Dyspepsia: Evidence From Two-Sample Mendelian Randomization Analysis of CSF Metabolites","authors":"Yichen Cai, Yujie Jiang, Heran Zhou, Caixia Sheng, Jia Zhu, Tao Zhu, Guoxiang Fu, Hancheng Fan","doi":"10.1002/jgh3.70333","DOIUrl":"10.1002/jgh3.70333","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Dyspepsia is a prevalent gastrointestinal disorder with complex pathogenesis involving the gut-brain axis. While alterations in gut microbiota have been linked to dyspepsia, the role of central nervous system metabolites, particularly those in cerebrospinal fluid (CSF), remains unexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the potential causal relationship between CSF metabolites and dyspepsia using a two-sample Mendelian randomization (MR) approach.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics. CSF metabolite data were derived from 532 individuals across two cohorts, and dyspepsia outcome data were obtained from the UK Biobank (7586 cases and 353 608 controls). Instrumental variables (SNPs) were selected based on genome-wide significance (<i>p</i> < 5 × 10<sup>−8</sup>), with clumping to eliminate linkage disequilibrium. The inverse-variance weighted (IVW) method was the primary analytical approach, supplemented by MR-Egger, weighted median, and weighted mode methods. Sensitivity analyses, including heterogeneity tests and MR-PRESSO, were used to assess the robustness of the findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 71 CSF metabolites tested, only butyrate (4:0) showed a significant inverse causal association with dyspepsia (IVW OR = 0.997, 95% CI: 0.996–0.998, <i>p</i> < 0.001; <i>P</i><sub>FDR</sub> = 0.007). Sensitivity analyses indicated no evidence of heterogeneity or pleiotropy. Additional enrichment analysis revealed involvement of genes associated with serine-type peptidase and protein catabolic processes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study provides the first genetic evidence linking elevated CSF butyrate levels to a reduced risk of dyspepsia, highlighting a potential neuroprotective role within the gut-brain axis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12744957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145858052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Post-Cholecystectomy Gut Microbiota Follows a Time-Varying Change—A Pilot Study 胆囊切除术后肠道微生物群随时间变化的初步研究。

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2025-12-28 DOI: 10.1002/jgh3.70329

Yu-Tse Chiu, Fu-Jen Lee, Chen-Ya Kuo, Po-Chih Yang, Jia-Uei Wong, Kai-Shun Liang, Ching-Hung Tseng, Jaw-Town Lin, Chun-Ying Wu, Chi-Yang Chang

Background

Gut microbiota is proposed to be a key factor for post-cholecystectomy diarrhea (PCD). Long-term follow-up showed decreasing PCD over time, suggesting microbiota change is time-dependent. Our study aimed to analyze gut microbiota and PCD at different times to clarify their time-varying features.

Methods

Patients aged 20–70 receiving laparoscopic cholecystectomy were recruited prospectively. Subjects with prior abdominal surgery, major systemic diseases, use of antibiotics, probiotics, or proton pump inhibitors within 1 month were excluded. Stool was analyzed at baseline (BL) and 6th, 12th month post-surgery. Microbial diversity was assessed with R phyloseq package, and differential abundance of taxonomic composition with LEfSe/metagenomeSeq.

Results

Ten patients were enrolled. Bristol stool scale peaked at 1 M (3.9 → 4.5 → 3.4; p = 0.167/0.059 for BL/1 M and 1 M/12 M). Diversity was significantly lower at 6 M in observed and Chao1 (p = 0.036/0.002). LEfSe indicated bimodal changes in Lactobacillus/Ruminococcus, with consistently increasing Fusobacterium. MetagenomeSeq revealed higher Prevotella at 6 M. These taxa changes have been implicated in prior studies on PCD and increased colorectal cancer after cholecystectomy. At phylum level, the decreased Firmicutes/Bacteroidetes at 6 M suggests different mechanisms than irritable bowel syndrome.

Conclusions

This study showed time-varying trends of microbial diversity and composition. Larger studies are needed for further validation.

背景：肠道菌群被认为是胆囊切除术后腹泻（PCD）的关键因素。长期随访显示PCD随着时间的推移而降低，这表明微生物群的变化是时间依赖性的。我们的研究旨在分析不同时间的肠道微生物群和PCD，以阐明它们的时变特征。方法：前瞻性招募20 ~ 70岁行腹腔镜胆囊切除术的患者。排除既往腹部手术、重大全身性疾病、1个月内使用抗生素、益生菌或质子泵抑制剂的受试者。在基线（BL）和术后第6、12个月分析粪便。用R phyloseq包评估微生物多样性，用LEfSe/metagenomeSeq评估分类组成的差异丰度。结果：10例患者入组。布里斯托大便量表在1 M时达到最高值（3.9→4.5→3.4；BL/1 M和1 M/12 M的p = 0.167/0.059）。群落多样性在6 M处显著降低（p = 0.036/0.002）。LEfSe显示乳酸菌/瘤胃球菌双峰变化，梭杆菌持续增加。MetagenomeSeq在6 M处显示较高的普雷沃氏菌。这些分类群的变化与胆囊切除术后PCD和结直肠癌增加的先前研究有关。在门水平上，6 M厚壁菌门/拟杆菌门的减少与肠易激综合征的机制不同。结论：该研究显示了微生物多样性和组成随时间变化的趋势。需要更大规模的研究来进一步验证。

{"title":"The Post-Cholecystectomy Gut Microbiota Follows a Time-Varying Change—A Pilot Study","authors":"Yu-Tse Chiu, Fu-Jen Lee, Chen-Ya Kuo, Po-Chih Yang, Jia-Uei Wong, Kai-Shun Liang, Ching-Hung Tseng, Jaw-Town Lin, Chun-Ying Wu, Chi-Yang Chang","doi":"10.1002/jgh3.70329","DOIUrl":"10.1002/jgh3.70329","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gut microbiota is proposed to be a key factor for post-cholecystectomy diarrhea (PCD). Long-term follow-up showed decreasing PCD over time, suggesting microbiota change is time-dependent. Our study aimed to analyze gut microbiota and PCD at different times to clarify their time-varying features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged 20–70 receiving laparoscopic cholecystectomy were recruited prospectively. Subjects with prior abdominal surgery, major systemic diseases, use of antibiotics, probiotics, or proton pump inhibitors within 1 month were excluded. Stool was analyzed at baseline (BL) and 6th, 12th month post-surgery. Microbial diversity was assessed with R phyloseq package, and differential abundance of taxonomic composition with LEfSe/metagenomeSeq.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten patients were enrolled. Bristol stool scale peaked at 1 M (3.9 → 4.5 → 3.4; <i>p</i> = 0.167/0.059 for BL/1 M and 1 M/12 M). Diversity was significantly lower at 6 M in observed and Chao1 (<i>p</i> = 0.036/0.002). LEfSe indicated bimodal changes in <i>Lactobacillus</i>/<i>Ruminococcus</i>, with consistently increasing <i>Fusobacterium</i>. MetagenomeSeq revealed higher <i>Prevotella</i> at 6 M. These taxa changes have been implicated in prior studies on PCD and increased colorectal cancer after cholecystectomy. At phylum level, the decreased <i>Firmicutes</i>/<i>Bacteroidetes</i> at 6 M suggests different mechanisms than irritable bowel syndrome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study showed time-varying trends of microbial diversity and composition. Larger studies are needed for further validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12744953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145858081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Helicobacter pylori and Inflammatory Bowel Disease: Unraveling the Complex Interactions and Clinical Implications 幽门螺杆菌和炎症性肠病：揭示复杂的相互作用和临床意义。

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2025-12-28 DOI: 10.1002/jgh3.70319

Elaheh Karimzadeh-Soureshjani, Farab Pourhasan, Pouria Ahmadi Simab, Nabi Jomehzadeh, Ali Saeedi-Boroujeni

Helicobacter pylori infection has been extensively studied in relation to various gastrointestinal disorders, with emerging evidence suggesting a significant association with inflammatory bowel disease (IBD). Epidemiological studies consistently demonstrate an inverse relationship between H. pylori infection and IBD development, particularly Crohn's disease (CD). Meta-analyses reveal a significantly lower prevalence of H. pylori among IBD patients compared to healthy controls, supporting the hypothesis of a potential protective effect. This negative correlation appears particularly strong for virulent strains expressing CagA, suggesting strain-specific immunomodulatory properties. The protective mechanisms may involve H. pylori's ability to modulate host immune responses and maintain gut microbial homeostasis. Experimental models show that H. pylori colonization can induce regulatory T-cell responses and downregulate pro-inflammatory cytokines, potentially creating an immunological balance that protects against IBD development. Conversely, H. pylori eradication has been associated with increased IBD incidence and disease flares, possibly through disruption of established microbial ecosystems and immune regulation. Clinical observations further support this relationship, demonstrating that H. pylori-positive CD patients often experience milder disease courses with fewer complications. However, the interaction remains complex, as H. pylori infection may also exert detrimental effects in certain contexts. The bacterium's influence appears to depend on multiple factors, including infection timing, strain characteristics, and host genetic background. Current evidence highlights the crucial interplay between H. pylori, gut microbiota composition, and mucosal immunity in shaping IBD pathogenesis. Future research should focus on elucidating precise molecular mechanisms and evaluating whether targeted modulation of H. pylori could offer therapeutic potential, while considering potential risks.

幽门螺杆菌感染与各种胃肠道疾病的关系已被广泛研究，新出现的证据表明它与炎症性肠病（IBD）有显著关联。流行病学研究一致表明幽门螺杆菌感染与IBD发展呈反比关系，尤其是克罗恩病（CD）。荟萃分析显示，与健康对照组相比，IBD患者的幽门螺杆菌患病率显着降低，支持了潜在保护作用的假设。这种负相关在表达CagA的毒力菌株中表现得尤其强烈，这表明菌株具有特异性免疫调节特性。这种保护机制可能涉及幽门螺杆菌调节宿主免疫反应和维持肠道微生物稳态的能力。实验模型表明，幽门螺杆菌定殖可以诱导调节性t细胞反应并下调促炎细胞因子，潜在地形成免疫平衡，防止IBD的发展。相反，幽门螺杆菌的根除可能通过破坏已建立的微生物生态系统和免疫调节，与IBD发病率增加和疾病发作有关。临床观察进一步支持这种关系，表明幽门螺旋杆菌阳性的乳糜泻患者通常经历较轻的病程，并发症较少。然而，这种相互作用仍然很复杂，因为幽门螺杆菌感染在某些情况下也可能产生有害影响。细菌的影响似乎取决于多种因素，包括感染时间、菌株特征和宿主遗传背景。目前的证据强调了幽门螺杆菌、肠道菌群组成和粘膜免疫在形成IBD发病机制中的重要相互作用。未来的研究应集中在阐明精确的分子机制和评估靶向调节幽门螺杆菌是否具有治疗潜力，同时考虑潜在的风险。

{"title":"Helicobacter pylori and Inflammatory Bowel Disease: Unraveling the Complex Interactions and Clinical Implications","authors":"Elaheh Karimzadeh-Soureshjani, Farab Pourhasan, Pouria Ahmadi Simab, Nabi Jomehzadeh, Ali Saeedi-Boroujeni","doi":"10.1002/jgh3.70319","DOIUrl":"10.1002/jgh3.70319","url":null,"abstract":"<p><i>Helicobacter pylori</i> infection has been extensively studied in relation to various gastrointestinal disorders, with emerging evidence suggesting a significant association with inflammatory bowel disease (IBD). Epidemiological studies consistently demonstrate an inverse relationship between <i>H. pylori</i> infection and IBD development, particularly Crohn's disease (CD). Meta-analyses reveal a significantly lower prevalence of <i>H. pylori</i> among IBD patients compared to healthy controls, supporting the hypothesis of a potential protective effect. This negative correlation appears particularly strong for virulent strains expressing <i>CagA</i>, suggesting strain-specific immunomodulatory properties. The protective mechanisms may involve <i>H. pylori</i>'s ability to modulate host immune responses and maintain gut microbial homeostasis. Experimental models show that <i>H. pylori</i> colonization can induce regulatory T-cell responses and downregulate pro-inflammatory cytokines, potentially creating an immunological balance that protects against IBD development. Conversely, <i>H. pylori</i> eradication has been associated with increased IBD incidence and disease flares, possibly through disruption of established microbial ecosystems and immune regulation. Clinical observations further support this relationship, demonstrating that <i>H. pylori</i>-positive CD patients often experience milder disease courses with fewer complications. However, the interaction remains complex, as <i>H. pylori</i> infection may also exert detrimental effects in certain contexts. The bacterium's influence appears to depend on multiple factors, including infection timing, strain characteristics, and host genetic background. Current evidence highlights the crucial interplay between <i>H. pylori</i>, gut microbiota composition, and mucosal immunity in shaping IBD pathogenesis. Future research should focus on elucidating precise molecular mechanisms and evaluating whether targeted modulation of <i>H. pylori</i> could offer therapeutic potential, while considering potential risks.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145865770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0