JGH Open最新文献

Background and Aim

Helicobacter pylori is an oncobacteria that infects about half of the world's population and has a well-established role in the etiology of gastric diseases. Lately, this infection has also been associated with extragastric diseases, such as neuropsychiatric, cardiovascular, metabolic, hematological, and dermatological comorbidities. Elucidating risk factors for comorbidities can contribute to reducing mortality and public health costs. Therefore, the aim of this study is to investigate the association between H. pylori infection and extragastric comorbidities.

Materials and Methods

This is a cross-sectional hospital-based case–control study that was conducted in Goiás from 2019 to 2022. The study patients were classified into H. pylori-negative and H. pylori-positive groups.

Results

A total of 156 participants were included in the study, and the prevalence of the bacteria was 45.5%. In the H. pylori-positive group, the most frequent diseases were hypertension, anemia, rheumatic disease, and diabetes. The presence of comorbidities was similar between the groups, with the exception of psychiatric illnesses. The male patients were more likely to be infected with H. pylori (odds ratios [ORs] = 2.63, 95% CI: 1.26–5.50), while the H. pylori-positive group was less likely to have psychiatric illnesses (OR = 0.32, 95% CI: 0.11–0.92).

Conclusion

The prevalence of H. pylori infection was 45.5%, and males were more likely to be infected by the bacteria. The most frequent comorbidities in the H. pylori-positive group were hypertension, anemia, rheumatic disease, and diabetes. H. pylori-negative patients were more likely to have psychiatric illnesses.

Aims

Recent evidence suggests that gastroesophageal reflux disease (GERD) is associated with cardiovascular diseases, including increased coronary artery calcification. However, whether GERD is a risk factor for acute myocardial infarction (AMI) remains uncertain. This study aims to clarify this association through a systematic review and meta-analysis.

Methods and Results

We searched MEDLINE and EMBASE databases from inception to January 2025, including cohort studies that compared AMI incidence in individuals with and without GERD. Relative risk (RR), hazard ratio (HR), and 95% confidence intervals (CIs) were extracted and combined using a random-effects model with the generic inverse variance method. Our meta-analysis included six cohort studies with 1 324 362 participants. Patients with GERD had a 27% increased risk of incident AMI compared to those without GERD (pooled RR: 1.27, 95% CI: 1.13–1.47; I² = 88%, p = 0.0001). The funnel plot showed no significant publication bias. Potential mechanisms underlying this association include chronic inflammation, oxidative stress, and autonomic dysfunction.

Conclusion

These findings suggest that GERD may contribute to AMI risk, highlighting the need for further research into preventive strategies and targeted interventions, such as acid suppression therapy and lifestyle modifications, to mitigate cardiovascular risk in GERD patients. Future studies should also explore mechanistic pathways to better understand this link and improve patient care.

Background and Aim

In Mainland China, Helicobacter pylori infection is prevalent in about 50% of adults. However, there is limited real-world evidence on its diagnosis and treatment patterns. This study investigated diagnosis, treatment patterns, and effectiveness of eradication treatment in patients with Helicobacter pylori infections in China.

Methods and Results

This retrospective, observational, real-world study used data from electronic medical records databases from three hospitals in Shanghai City, Shandong Province, and Zhejiang Province. Patients (≥ 18 years) with an H. pylori infection diagnosis between January 01, 2019, and December 31, 2021, were included. Of the 22 971 included patients (mean [standard deviation] age: 44.2 [14.2] years; female: 54.6%), 13 233 (57.6%) received eradication therapy and 1626 (7.1%) received efficacy evaluation testing. Overall, 85.4% of patients received bismuth-based quadruple therapies (BQTs), and 7.6% and 7.1% received triple and dual therapies, respectively. For BQT, the most common antibiotic combinations included amoxicillin and clarithromycin (38.7%), amoxicillin and furazolidone (18.4%), and amoxicillin and levofloxacin (17.8%). A 14-day treatment duration was most common for BQT; however, from 2020 to 2021, the number of patients with a 14-day treatment duration decreased. BQT had the highest eradication rate (76.7%), followed by dual (57.0%) and triple (48.4%) therapies. Eradication rates for amoxicillin and clarithromycin and for amoxicillin and furazolidone BQTs were 76.1% and 87.4%, respectively.

Conclusions

Treatment of H. pylori infections in China is fairly consistent with the national guidelines, with room for further improvement and standardization, especially with respect to antibiotic combinations, treatment duration, and efficacy evaluation testing.

Trial Registration: ClinicalTrials.gov identifier: NCT05073367

Objective

To explore the mediating effect of nighttime sleep duration between digestive diseases and depressive symptoms among middle-aged and elderly adults, so as to guide clinical intervention and treatment of depression related to digestive diseases.

Methods

Based on the data of the China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2020, difference analysis, Spearman correlation analysis, and multivariate logistic regression were conducted to analyze the relationships among digestive diseases, nighttime sleep duration, and depressive symptoms. The mediating effect model was established and tested by the Bootstrap method.

Results

The prevalence rate of digestive diseases was 23.05%, and the detection rate of depressive symptoms was 35.90%. Correlation and regression analysis indicated that digestive diseases (OR = 1.62, 95% CI: 1.45–1.81) and insufficient nighttime sleep (OR = 2.22, 95% CI: 2.01–2.45) significantly impacted depressive symptoms. The results of the mediating effect model showed that insufficient nighttime sleep had a partial mediating effect between digestive diseases and depressive symptoms among middle-aged and elderly adults.

Conclusion

Digestive diseases can lead to insufficient nighttime sleep and promote the occurrence of depressive symptoms among middle-aged and elderly adults. Therefore, in clinical practice, when treating digestive patients with comorbid depression, the quality and duration of their nighttime sleep should not be ignored. Improving sleep conditions is expected to alleviate depressive symptoms.

Purpose

The aims of this study were to assess the effects of a whole diet strategy, a Monash Pouch Diet (MPD), on pouch-related symptoms, inflammation, quality of life, and stool characteristics in a cohort of patients with symptomatic pouches and a history of pouchitis compared with a typical Australian pouch diet.

Methods

In this randomized, double-blind, placebo-controlled dietary feeding trial, patients with ileoanal pouches received either a Monash Pouch diet or a typical Australian diet for 7 weeks. Clinical scores (Pouch Disease Activity Index, PDAI), pouch symptoms, tolerability, fecal calprotectin, and quality of life were measured pre- and post-intervention. The primary outcome consisted of the proportion of patients achieving symptomatic remission (clinical PDAI ≤ 2).

Results

All patients on the MPD experienced worsening symptoms, and the trial was terminated early. The majority of the participants reported partial adherence (50%–80%) and poor tolerability (median: 40 mm). Quality of life outcomes were highly variable across dietary arms, and fecal indices showed no consistent trends related to diet.

Conclusion

This double-blinded, placebo-controlled, dietary feeding trial failed to determine the effect of the Monash Pouch Diet on pouchitis but suggests that the design of dietary trials for pouch patients requires careful consideration.

Background

While Western real-world studies have demonstrated the therapeutic effect of upadacitinib in Crohn's disease (CD), data on Asian populations are scarce, and no real-world data from Japan have been reported. Therefore, this study aimed to assess the induction efficacy and safety of upadacitinib in Japanese patients with active CD.

Methods

This retrospective study included CD patients who initiated upadacitinib at 10 inflammatory bowel disease (IBD) centers in Japan by December 2024. Clinical response, clinical remission, biomarker improvements, and adverse events were analyzed. Clinical response was defined as Crohn's Disease Activity Index (CDAI) < 150 or a decrease in CDAI (ΔCDAI) > 70, while clinical remission was defined as CDAI < 150.

Results

A total of 33 patients (16 males, 17 females) were included. The median age at upadacitinib administration was 40 years, with a median disease duration of 9.3 years. The median baseline values were 264 for CDAI, 14 for Simple Endoscopic Score for Crohn's Disease (SES-CD), and 9.8 mg/L for serum C-reactive protein (CRP). Corticosteroids were co-administered in 11 patients (33.3%). Prior biologic therapy had been used in 25 patients (75.8%), including 7 patients with one biologic and 18 patients with two or more biologics. Extraintestinal manifestations were observed in 12 patients (36.4%), and perianal lesions in 15 patients (45.5%). All patients started upadacitinib at 45 mg/day. The clinical response, clinical remission, and steroid-free clinical remission rates were 76.7%, 53.3%, and 36.7% by week 4; 83.3%, 63.3%, and 56.7% by week 8; and 86.7%, 70%, and 70% by week 12, respectively. Significant improvements in CDAI, serum CRP, and albumin were observed at week 12 or the last visit, compared to baseline. Improvement was observed in 66.7% of cases with extraintestinal manifestations and 46.7% of cases with perianal lesions. Adverse events occurred in 45.5% of patients, with acne being the most common (12.1%). No serious adverse events leading to death were reported. The continuation rate of upadacitinib at week 12 or the last visit was 93.3%.

Conclusion

Upadacitinib demonstrated high induction efficacy and acceptable safety in Japanese patients with active CD.

Aims

Concerns regarding the adverse impact of coronavirus disease 2019 (COVID-19) on cancer care survival have been raised; however, clear evidence remains limited. Therefore, we aimed to investigate the influence of the COVID-19 pandemic on gastric cancer management in Japan using real-world data from the Tokushukai Real-World Data project.

Methods and Results

This retrospective cohort study was conducted across 46 Tokushukai Medical Group hospitals in Japan, identifying patients newly diagnosed with gastric cancer between January 2017 and December 2022. Patients with active double cancers or non-epithelial tumors were excluded. We used data between January 2017 and March 2020 as the baseline (pre-COVID-19 period) to assess the changes in the number of diagnoses, screening detections, disease stage at diagnosis, and prognosis between April 2020 and December 2022 (mid-COVID-19 period). This study included 14 125 patients with 14 446 gastric cancer cases. Compared with the pre-COVID-19 period, the mid-COVID-19 period exhibited a 12% (95% confidence interval [CI]: 3%–20%) decrease in screening detections, a 9% (95% CI: 1%–18%) increase in metastatic stage detection, a 14% (95% CI: 7%–20%) decrease in curative surgery, and a 32% (95% CI: 19%–43%) decrease in radiation therapy. The analysis also revealed a 9.4% (95% CI: 2.0%–17.2%) increase in mortality in the mid-COVID-19 period compared with the pre-COVID-19 period.

Conclusion

This nationwide, real-world study provides robust evidence that COVID-19 has reduced survival rates for Japanese patients with gastric cancer by disrupting diagnosis and treatment.