Turkish Journal of Gastroenterology最新文献

Background/aims: The effect of a gluten-free diet on the small intestinal mucosa in patients with celiac disease (CD) is unclear. The occurrence of mucosal healing and the permanence of villous atrophy in celiac patients under a gluten-free diet were investigated.

Material and methods: The symptoms, laboratory values, autoantibody levels, and endoscopic mucosal biopsy samples of 115 celiac patients, 56 of whom were in remission at different time periods since diagnosis, were examined.

Results: Although 61.8% of patients said they were compliant with the gluten-free diet, 48.7% were in remission. Sixty-seven percent (n = 77) of patients with CD reported at least one symptom. Only weight loss was associated with disease activity (P = .019). While only 5 (8.9%) of the patients in remission were endoscopically and histopathologically normal, villous atrophy was detected in 69.9% of the patients. Villous atrophy was present in 86% of patients within the first 5 years of diagnosis, while this rate was 59% in patients older than 10 years. Logistic regression analysis showed that compliance with diet (odds ratio [OR]: 4.39; P < .001) and normal endoscopic appearance of the mucosa (OR: 13.01; P < .001) were the strongest predictive factors of remission.

Conclusion: Diet compliance and remission rates of celiac patients increase over time. However, histologically, intraepithelial lymphocytosis almost never improves, and villous atrophy persists in most patients even if they comply with the diet. Although the asymptomatic nature of the patients, their autoantibody titers, and their dietary compliance are considered important indicators of remission, these parameters do not clearly reflect the histological status of the mucosa.

Background/aims: Aspiration pneumonia is a pulmonary infection that occurs when food, liquid, saliva, or vomit is aspirated into the lungs. Percutaneous enteral gastrostomy (PEG) prevents aspiration pneumonia while ensuring the patient receives adequate nutrition. The authors aimed to evaluate the incidence and risk factors of post-PEG aspiration pneumonia.

Materials and methods: Elderly patients who underwent PEG between January 2019 and December 2023 were included in this retro- spective study. The incidence of aspiration pneumonia was compared between the periods before and after PEG. Mortality rates and risk factors of post-PEG aspiration pneumonia were investigated.

Results: A total of 430 out of 534 patients who underwent PEG were included. The aspiration pneumonia rate was 30.1% (n = 133) before PEG and 21.9% (n = 94) after PEG (P = .003). The 1-year mortality rate of post-PEG aspiration pneumonia was 58.5% (n = 55). Age ≥ 80 years (OR: 3.11; 95% CI, 1.12-8.76), home residency (OR: 3.31; 95% CI, 0.99-10.8), discontinuation of primary caregiver who had been trained about PEG (OR: 5.8; 95% CI, 1.4-25.2), chronic lung disease (OR: 3.016; 95% CI, 1.17-7.77), history of recurrent aspiration pneumonia prior to PEG (OR: 3.401; 95% CI, 1.073-10.779), spending ≥20 hours of the day in supine position (OR: 6.512; 95% CI, 1.879-28.103), requiring PEG due to stroke (OR: 2.46; 95% CI, 1.062-5.69), and esophagus cancer (OR: 3.047; 95% CI, 1.174-8.88) were associated with post-PEG aspiration pneumonia.

Conclusion: Percutaneous enteral gastrostomy reduces aspiration pneumonia in general, but there remain risks, particularly in patients with stroke or esophageal cancer. Supine position and discontinuation of primary caregiver who had been trained about PEG are major risk factors.

Background/aims: Colorectal adenoma is a high-risk precursor lesion of colorectal cancer. Sanzi formula (SZF), a traditional Chinese medicine compound for the treatment of this disease, inhibits the growth of colorectal adenomas. This study aimed to investigate the mechanism by which SZF blocks the growth of colorectal adenomas in Apcmin/+ mice.

Materials and methods: C57BL/6J mice were used as the control group and were fed a normal diet. To create the colorectal adenoma model, Apcmin/+ mice were fed high-fat chow. Each administration group was given the appropriate drug by gavage at the same time as the modeling. The body weight, adenoma size, and adenoma number of mice in each group were recorded, and the colorectal tissue was subjected to HE staining and histopathological evaluation. The effect of SZF on inflammatory factors, tight junction (TJ) proteins, pathway proteins, and mRNA content in colorectal adenoma was examined by enzyme-linked immunosorbent assay, western blotting, immunofluorescence analysis, and quantitative real-time polymerase chain reaction.

Results: The results showed that all dose groups of SZF improved the size, number, and histopathological damage of adenomas. All dose groups of SZF resulted in lower inflammatory factors, higher levels of TJ proteins, and lower levels of pathway proteins and mRNA. Particularly, the high-dose group of SZF was more effective.

Conclusion: Sanzi formula interfered with the progression of colorectal adenoma in Apcmin/+ mice by repairing the intestinal barrier function and blocking the Wnt/β-catenin signaling pathway, which provided a new idea and scientific basis for clinical treatment.

Background/aims: The treatment of hepatocellular carcinoma (HCC), which accounts for 90% of all liver cancers, is highly varied. The use of second-line treatments following progression on first-line atezolizumab and bevacizumab (Atez/Bev) for advanced HCC remains controversial. The aim of this study was to analyze the real-world clinical results of second-line treatments in progression after Atez/Bev and to determine the factors affecting prognosis.

Materials and methods: Fifty-eight patients treated with second-line sorafenib, regorafenib, and cabozantinib for progression after first-line Atez/Bev for advanced/metastatic HCC from 20 centers in Türkiye between October 2020 and June 2024 were retrospectively analyzed. Responses were evaluated by Response criteria, specifically Response Evaluation Criteria in Solid Tumors (RECIST v1.1) criteria. Median overall survival (OS) and progression-free survival (PFS) were computed with the Kaplan-Meier method. The Cox regression model was utilized to analyze multivariate analyses.

Results: About 82.8% of the patients were male and the median age of the whole group was 62 (range, 18-78) years. All patients progressed after first-line Atez/Bev and were given second-line treatment. The most commonly used second-line treatment option was sorafenib (70.7%), followed by regorafenib (12.1%) and cabozantinib (10.3%). Both median PFS (4.1 months) and median OS (7.8 months) were longer in patients treated with sorafenib compared to other treatments. In univariate analyses, Child-Pugh score B, high alpha-fetoprotein (AFP) levels (>200 ng/mL), extrahepatic spread, and Prognostic Nutritional Index (PNI) < 47.6 substantially raised the risk of overall mortality. Multivariate analysis showed that extrahepatic spread (HR (Hazard ratio): 0.41, P = .012), PNI level (HR: 0.24, P = .005), and AFP level (HR:1.97, P = .049) were independent predictors of OS.

Conclusion: Although second-line therapies after Atez/Bev show different degrees of efficacy, survival rates are consistent with the literature. Extrahepatic spread, AFP level, and PNI level are the main prognostic factors. In light of this information, personalized treatment strategies may improve outcomes for this challenging patient group.

Background/aims: Berberine (BBR), an isoquinoline alkaloid derived from Berberis plants, exhibits anti-inflammatory, anti-cancer, and antioxidant properties. This study explored the role of BBR in chronic atrophic gastritis (CAG).

Materials and methods: The 1-methyl-3-nitro-1-nitrosoguanidine and an irregular diet were used to establish the CAG model. Chronic atrophic gastritis rats were administered BBR at different doses via gavage, and teprenone (TEP) served as the positive control drug. We monitored and measured changes in body weight and food intake, pepsin activity, and gastric acid levels in the rats. Hematoxylin and eosin staining was utilized to scan the pathological condition in the gastric mucosal tissue of rats, while enzyme-linked immunosorbent assay was utilized to analyze alterations in serum inflammatory factors and hormone levels. Western blot was employed to evaluate protein expression. Additionally, 16S rRNA was conducted to assess changes in the intestinal flora of CAG rats.

Results: Berberine increased body weight and food intake, improved gastric atrophy, and enhanced pepsin activity and total acidity of gastric juice in CAG rats. BBR treatment led to decreased levels of inflammation factors and motilin, while gastrin and somatostatin levels were elevated in CAG rats. Additionally, BBR inhibited the NF-κB and MAPK pathway in these rats. Berberine treatment also regulated the composition and abundance of intestinal flora. These microbiome alterations suggest a possible role in modulating gut inflammation associated with CAG.

Conclusion: Berberine may alleviate CAG injury by reducing inflammation and regulating intestinal flora, which may be closely associated with the NF-κB and MAPK pathways.

Background/aims: Manometric measurements are crucial for diagnosing esophageal motility disorders. High-resolution manometry (HRM) studies mainly use 2 catheter systems: solid state (SS) and water perfused (WP), each with distinct advantages. This study aimed to establish normal values for esophageal manometry using both 36-channel WP and SS catheters in healthy volunteers.

Materials and methods: This study, conducted between January 2017 and September 2018, included 44 healthy volunteers with no upper gastrointestinal symptoms or history of gastrointestinal surgery (except inguinal hernia repair or appendectomy). Participants gave written informed consent, abstained from medications and alcohol, and underwent normal endoscopy. They then had 2 consecutive esophageal manometry sessions, 1 day apart, using a 36-channel SS-HRM catheter and a 36-channel WP-HRM catheter. All tracings were analyzed using the Chicago classification version 3.0.

Results: Four participants were excluded due to gastroesophageal reflux disease (GERD). Of the remaining 40 (age 37.4 ± 7.6, 62.5% male), all underwent WP-HRM, and 34 underwent SS-HRM. In SS-HRM, 74 of 386 swallows were <450 mm Hg·s·cm; in WP-HRM, 151 of 441 swallows were <<450 mm Hg·s·cm. Thus, 4 of 34 volunteers (11.8%) in SS-HRM and 12 of 40 (30%) in WP-HRM had ≥50% swallows with DCI <450 mm Hg·s·cm. Median IRP4 was 17 (7-27) mm Hg in SS-HRM vs. 6 (0-18) mm Hg in WP-HRM. The 5th-95th percentile DCI was 183-2962 mm Hg·s·cm in SS-HRM vs. 65.5-1711.5 mm Hg·s·cm in WP-HRM.

Conclusion: This study compares normal values and differences in WP-HRM and SS-HRM among healthy Turkish volunteers, demonstrating differing diagnostic criteria and providing valuable reference data for future studies.