Arab Journal of Gastroenterology最新文献

Hepatocellular carcinoma (HCC) is the main histopathological type of liver cancer and the fourth major cause of cancer-related mortality globally, yet the treatment options are very limited. Ferroptosis is a unique iron-dependent form of oxidative cell death process that plays essential regulatory roles in the occurrence and development of HCC. However, the underlying mechanism in ferroptosis regulation in HCC remains inadequately understood. Aberrant activation of fibroblast growth factor 19-fibroblast growth factor receptor 4-βKlotho (FGF19-FGFR4-KLB) signaling is considered carcinogenic driving pathway in patients with HCC. Recently, increasing evidence has shown that FGFR4 inhibition could trigger ferroptosis process in many tumors. However, as an important ligand of FGFR4, the role of FGF19 in the regulation of ferroptosis remains unclear. In this research, results of western blotting and reactive oxygen species (ROS) assay demonstrated that knock down of KLB enhance the expression of TFRC, a driver gene of ferroptosis, thus blocking the ferroptosis inhibitory effect of FGF19. Based on these available evidence and data, we hypothesize that FGF19 signaling inhibit the ferroptotic cell death in HCC cells through FGFR4-KLB co-receptors, while suppression of FGFR4-KLB could block FGF19 signaling, thus trigger ferroptosis process.

Background and study aim: Comprehensive identification and prioritization of artificial intelligence methods developed for the analysis of gastrointestinal endoscopic images can help in selecting the most appropriate techniques. This study aimed to introduce the best artificial intelligence techniques developed for analyzing gastrointestinal endoscopic images using fuzzy AHP-TOPSIS methods.

Patients and methods: To identify the artificial intelligence techniques developed, a systematic search was conducted across five reputable databases. Subsequently, the Delphi method was employed to establish appropriate criteria for selecting the best artificial intelligence techniques. To estimate the relative weights of these criteria, the fuzzy analytical hierarchy process (FAHP) was utilized. Finally, to prioritize the identified artificial intelligence techniques, the technique for order preference by similarity to the ideal solution (TOPSIS) method was applied.

Results: 70 artificial intelligence techniques were identified. Seven selection criteria were introduced: validity, accuracy, comprehensiveness, processing time, cost, simplicity, and executive capability. The top methods selected were the computer-aided detection (CAD) system (0.8203), the human color appearance model (CIECAM) (0.8122), the combined method (PD-CNN-PCC-EELM) (0.8109), the combined method (DNN-CAD) (0.7928), and the ResNet18 deep learning model (0.7921), respectively.

Conclusions: These findings represent a comprehensive approach to the developed techniques, which can be utilized to design methods with improved performance in the future.

Background and study aims: To investigate the efficacy of Shugan Hewei Decoction in the treatment of chronic atrophic gastritis (CAG) and its effect on gastric mucosal pathology.

Patients and methods: A total of 72 patients with CAG admitted from October 2022 to December 2023 were enrolled and divided into two groups using a random number table method. The control group (36 cases) was treated with oral Weifuchun, while the study group (36 cases) received oral Shugan Hewei Decoction. The two groups were compared in terms of total treatment effectiveness rate, incidence of adverse reactions, scores of primary and secondary symptoms (before and after treatment), gastric function indices (pepsinogenⅠ [PGⅠ], pepsinogenⅠ/pepsinogenⅡ [PGⅠ/PGⅡ], and gastrin-17 [G-17]), and scores of gastric mucosal pathological indices (intestinal metaplasia, glandular atrophy, and dysplasia).

Results: The total treatment effectiveness rate in the study group was significantly higher than that in the control group, while the total incidence of adverse reactions was significantly lower (both P < 0.05). Before treatment, there were no significant differences between the two groups in scores of primary and secondary symptoms, gastric function indices, or scores of gastric mucosal pathological indices (all P > 0.05). After treatment, the study group showed significantly lower scores of primary and secondary symptoms and gastric mucosal pathological indices, as well as significantly higher gastric function indices compared with the control group (all P < 0.05).

Conclusion: Shugan Hewei Decoction exhibits favorable efficacy and high safety in the treatment of CAG. It can significantly improve the gastric mucosal pathological state, thus holding relatively high application value in CAG patients.

Background and study aims: A third subtype of inflammatory bowel disease (IBD) is indeterminate colitis (IC). The clinical course of IC has not been well defined in children. The aim of this study was to evaluate the outcomes of children with IC during the follow-up period.

Patients and methods: All data were retrospectively reviewed in children diagnosed with IC in our center between 2010 and 2022. Patients' demographics, family history, laboratory findings at diagnosis, serologic immune markers, and clinical findings were noted.

Results: Among 185 children diagnosed with IBD between 2010 and 2022, 29 (15.7 %) were classified as having IC. Sixteen patients (55.1 %) were male. A concomitant autoimmune disease was present in seven patients (25 %). Five of the seven patients with additional autoimmune diseases were female. Among the patients with IC, 14 (48 %) had pancolonic involvement in colonoscopy at the time of diagnosis. During follow-up, extraintestinal features of IBD manifested in four (13.7 %) patients, three (10.3 %) patients with arthritis, and one patient (3.4 %) with arthritis and psoriasis. Six patients (20.6 %) harbored pathogenic variants in IBD-related genes, including NOD2 (n = 2), IL10RA (n = 1), and Mediterranean fever (MEFV) (n = 3). Two patients were reclassified as having ulcerative colitis (UC) and Crohn's disease (CD) during follow-up.

Conclusion: The detection of significant genetic mutations in one-fifth of the patients highlights the need for genetic evaluation, particularly in those with additional autoimmune conditions. Close monitoring of patients in this regard is crucial to ensure the success of treatment and to address any potential complications arising from immune-related issues. More comprehensive studies are essential in this context to understand the course of the disease and improve patient care.

Background and study aims: Falling eradication rates of Helicobacter pylori (H. Pylori) have prompted changes in the first-line bismuth-containing quadruple therapy. This study aimed to assess the effectiveness of different proton-pump inhibitor (PPI) based quadruple regimens for H. pylori eradication.

Patients and methods: Electronic records were examined to acquire information on H. pylori-positive patients treated with a 14-day bismuth-containing quadruple regimen (PPIs, amoxicillin, clarithromycin, and bismuth). Patient demographics and eradication regimen data were also analyzed. Four groups were formed based on the different PPIs: ilaprazole, esomeprazole, omeprazole, and rabeprazole groups. Eradication rates were calculated, and the effectiveness of the treatment regimens was compared.

Results: A total of 2637 patients were included, comprising 1469 males and 1168 females. Of these, 22.4 % (n = 590) were treated with an ilaprazole-based quadruple regimen, 33.8 % (n = 892) with an esomeprazole-based regimen, 16.6 % (n = 439) with an omeprazole-based regimen, and 27.2 % (n = 716) with a rabeprazole-based regimen. Eradication rates were significantly higher in the esomeprazole-based regimen than in the ilaprazole-, omeprazole-, and rabeprazole-based regimens (75.2 % vs. 65.8 % vs. 65.4 % vs. 70.9 %, P = 0.001).

Conclusions: The eradication rates across various PPI-based quadruple regimens were comparable; however, the regimen comprising amoxicillin and clarithromycin demonstrated low efficacy and is not advised in settings with high clarithromycin resistance. Among the effective therapeutic regimens, the esomeprazole-based regimen exhibited a slightly higher eradication rate.

Background and study aims: Helicobacter pylori is a major cause of peptic ulcer disease and is strongly associated with gastric cancer. Rising resistance to Clarithromycin-based regimens has led to evaluation of alternative therapies, including Levofloxacin-based combinations. This study aimed to compare the efficacy of Clarithromycin- versus Levofloxacin-containing triple therapy in a Jordanian population, and to assess the impact of diagnostic methods and metronidazole use on treatment outcomes.

Patients and methods: In this prospective, non-randomized controlled trial, 364 adults with confirmed H. pylori infection were recruited from two governmental hospitals in Jordan. Patients received either Clarithromycin- or Levofloxacin-based triple therapy, with or without metronidazole. Diagnosis and treatment response were assessed using gastric biopsy, rapid urease test, or stool antigen test. Follow-up testing occurred four weeks post-treatment. Chi-square tests and Cramer's V were used for statistical analysis.

Results: The overall eradication rate was 65.1 %. Clarithromycin-based therapy showed a higher eradication rate (70.8 %) than Levofloxacin-based therapy (60.2 %), though the difference was not statistically significant (P = 0.64). Among patients diagnosed via stool antigen testing, Clarithromycin therapy was significantly more effective (66.3 % vs. 40.4 %, P = 0.003). Neither metronidazole addition nor type of proton pump inhibitor influenced eradication outcomes.

Conclusion: Clarithromycin-based therapy may be more effective than Levofloxacin-based regimens, particularly when stool antigen testing is used for diagnosis. These findings emphasize the importance of selecting treatment based on local resistance patterns and diagnostic approaches. Further studies are needed to confirm these results and optimize H. pylori treatment strategies.

Background and study aims: Non-invasive liver indices are valuable tools for identifying patients with Metabolic dysfunction-associated steatotic liver disease, given their simplicity and relatively low cost. This study examined the accuracy of several published indices, the hepatic steatosis index (HSI), Framingham steatosis index (FSI), and Dallas steatosis index (DSI), in predicting steatosis compared to the Transient elastography controlled attenuation parameter (CAP).

Patients and methods: This is a retrospective cross-sectional study on 720 patients who underwent a FibroScan at the American University of Beirut Medical Center, between 2015 and 2020. The following indices, HSI, FSI, and DSI were calculated. The sensitivity, specificity, and C-statistics of each index were determined and compared to CAP.

Results: Out of 557patients who met inclusion criteria, 67 % were found to have hepatic steatosis with an average CAP 289.5 (±70.9). The mean age was 50 (±15.6), and 70 % were male. Those patients were found to have higher BMI and higher prevalence of diabetes and HTN as well as dyslipidemia than the control group with no steatosis. The FSI outperformed the other two indices with fair accuracy in detecting hepatic steatosis based on the C-statistics. HSI and DSI, on the other hand, showed poor discriminatory ability. At the cut-off, where specificity was 90 %, the FSI had the highest sensitivity, 49.6 %, compared to the DSI, 28.6 %, and HSI, 21.8 %.

Conclusion: Our study demonstrated the non-invasive index FSI's accuracy in diagnosing steatosis compared to the transient elastography-CAP and highlighted its superiority to other indices, the HSI and DSI.

Pancreatitis is a serious inflammatory disorder marked by a disruption between protective enzymes and stress signals released through various processes. The key features of both acute and chronic pancreatitis include oxidative stress and damage to acinar cells, which are indicative of these inflammatory conditions. The advancement of acute pancreatitis (AP) to chronic pancreatitis (CP) occurs due to the development of fibrosis and atrophy due to chronic inflammation and autodigestion. Various factors contribute to the pathological characteristics of these diseases. The severity of pancreatitis is influenced by the levels of activated inflammatory mediators such as interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), nuclear factor kappa B (NF-κB), chemokines, and cytokines. Additionally, the activation of the mitogen-activated protein kinase (MAPK) pathway and the opening of the mitochondrial membrane transition pore in the pancreas have been linked to the onset of pancreatitis. Increasing experimental evidence suggests that certain phytochemical compounds found in natural plants may have a positive impact on AP. Curcumin, the bioactive phytochemical from turmeric, exhibits potent anti-inflammatory and anti-oxidative properties. In the current review, we focus on curcumin's antioxidant and anti-inflammatory properties, which can contribute to the prevention and treatment of pancreatitis.

Solid pseudopapillary neoplasm (SPN) is a rare pancreatic tumor with low malignant potential, most commonly observed in young women. These tumors are frequently asymptomatic and are often detected incidentally during imaging performed for unrelated reasons. We present a unique case of a 27-year-old female with a pancreatic SPN that remained undiagnosed for ten years due to its isodense appearance on initial computed tomography imaging. The lesion remained stable in size and configuration over a decade and was eventually identified incidentally. Notably, progressive atrophy developed in the distal pancreas, likely secondary to ductal obstruction by the mass. This case highlights the diagnostic challenges of atypical SPNs, emphasizes the importance of careful image interpretation, and provides rare insight into the tumor's natural history in the absence of treatment.