Gastroenterology Report最新文献

Dysfunction of the vagus nerve has been suggested as a contributing factor in various gastrointestinal disorders, prompting interest in vagus nerve stimulation (VNS) as a non-pharmacological therapy. We performed a systematic review to determine the efficacy of invasive and non-invasive VNS in gastrointestinal disorders, including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), functional dyspepsia (FD), functional constipation, gastroesophageal reflux disease, and gastroparesis. We applied a systematic search of the literature in the PubMed, Embase, Web of Science, and Cochrane Library databases in order to identify studies comparing VNS with an adequate control condition (sham stimulation) in patients with gastrointestinal disorders. The primary outcome was adequate symptom relief. Methodological quality was evaluated using the revised Cochrane risk-of-bias tool. Meta-analyses were not performed due to study heterogeneity. Seven randomized controlled trials investigating non-invasive VNS were included, with a total of 644 patients: FD (n = 426), IBD (n = 22), IBS (n = 92), and abdominal pain-related functional gastrointestinal disorder (n = 104), with a mean age ranging from 15 to 65 years. Non-invasive VNS significantly improved symptoms across all subsets of patients, as measured differently according to disease type, compared with sham stimulation. Adverse events, if reported, were low, with no serious complications. Putative mechanisms of action were assumed to be related to anti-inflammatory and anti-nociceptive effects. Non-invasive VNS holds promise as a safe therapy for diverse gastrointestinal disorders. However, these findings are derived from studies with small sample sizes and provide preliminary insights. Further research is warranted to define its exact position within the therapeutic arsenal.

Intrahepatic cholangiocarcinoma (iCCA) is an aggressive liver malignancy that arises from second-order biliary epithelial cells. Its incidence is gradually increasing worldwide. Well-known risk factors have been described, although in many cases, they are not identifiable. Treatment options are continuously expanding, but the prognosis of iCCA remains dismal. R0 liver resection remains the only curative treatment, but only a limited number of patients can benefit from it. Frequently, major hepatectomies are needed to completely remove the tumour. This could contraindicate surgery or increase postoperative morbidity in patients with chronic liver disease and small remnant liver volume. In cases of anticipated inadequate future liver remnant, regenerative techniques may be used to expand resectability. The role and extent of lymphadenectomy in iCCA are still matters of debate. Improvements in iCCA diagnosis and better understanding of genetic profiles might lead to optimized surgical approaches and drug therapies. The role of neoadjuvant and adjuvant therapies is broadening, gaining more and more acceptance in clinical practice. Combining surgery with locoregional therapies and novel drugs, such as checkpoint-inhibitors and molecular-targeted molecules, might improve treatment options and survival rates. Liver transplantation, after very poor initial results, is now receiving attention for the treatment of patients with unresectable very early iCCA (i.e. <2 cm) in cirrhotic livers, showing survival outcomes comparable to those of hepatocellular carcinoma. Ongoing prospective protocols are testing the efficacy of liver transplantation for patients with unresectable, advanced tumours confined to the liver, with sustained response to neoadjuvant treatment. In such a continuously changing landscape, the aim of our work is to review the state-of-the-art in the surgical and medical treatment of iCCA.

Background and aim: High complex anal fistula is a clinical challenge for proctologists and a nightmare for patients. Although the sphincter-sparing approach seems an ideal surgical intervention, there remains room for improvement in treatment efficacy. Herein, we introduce an enhanced sphincter-sparing approach, namely the fistula occlusion with the internal sphincter flap (FOISF), for treating high complex anal fistulas.

Methods: This study evaluated 15 patients with high complex anal fistulas who underwent FOISF between October 2021 and December 2022 in the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou, P. R. China). Data on success rates, anal function, and various surgical characteristics were subjected to rigorous analysis.

Results: All patients underwent the FOISF procedure, with a median operation time of 53 min. Fourteen patients achieved primary intention healing, while one patient healed by second intention. No recurrence was observed over a follow-up period of 14-30 months. All patients exhibited satisfactory anal continence, with no statistically significant difference observed between preoperative and postoperative Wexner scores (P = 0.331). A significant improvement in the quality of life was observed when compared with the preoperative assessment (P < 0.001).

Conclusion: The preliminary results of the FOISF procedure present an effective approach to treat high complex anal fistula.

Hepatic fibrosis, a degenerative liver lesion, significantly contributes to the deterioration and mortality among patients with chronic liver diseases. The condition arises from various factors including toxins, such as alcohol, infections like different types of viral hepatitis, and metabolic diseases. Currently, there are no effective treatments available for liver fibrosis. Recent research has shown that adiponectin (ADPN) exhibits inhibitory effects on hepatic fibrosis. ADPN, an adipocytokine secreted by mature adipocytes, features receptors that are widely distributed across multiple tissues, especially the liver. In the liver, direct effects of ADPN on liver fibrosis include reducing inflammation and regulating hepatic stellate cell proliferation and migration. And its indirect effects include alleviating hepatic endoplasmic reticulum stress and reducing inflammation in hepatic lobules, thereby mitigating hepatic fibrosis. This review aims to elucidate the regulatory role of ADPN in liver fibrosis, explore how ADPN and its receptors alleviate endoplasmic reticulum stress, summarize ADPN detection methods, and discuss its potential as a novel marker and therapeutic agent in combating hepatic fibrosis.

Background: Hypercoagulability has been shown to act as an important component of ulcerative colitis (UC) pathogenesis and disease activity, and is strongly correlated with the occurrence of venous thromboembolism (VTE). This study aimed at providing novel therapeutic clues for hypercoagulable active UC.

Methods: The coagulation score model was developed using VTE cohorts, and the predictive performance of this model was evaluated by coagulation subtypes of UC patients, which were clustered by the unsupervised method. Subsequently, the response of UC of distinct coagulation types, as identified by the coagulation scoring model, to different biological agents was evaluated. Immunoinflammatory cells and molecules that were associated with hypercoagulable active UC were explored by employing gene set variation analysis, single-sample gene set enrichment analysis, univariate logistic regression analysis, and immunohistochemistry.

Results: A coagulation scoring model was established, which includes five key coagulation factors (ARHGAP35, CD46, BTK, C1QB, and F2R), and accurately distinguished the coagulation subtypes of UC. When comparing anti-TNF-α agents with other biological agents after determining the model, especially golimumab, it showed more effective treatment for hypercoagulable active UC. CXCL8 has been identified as playing an important role in the tightly interconnected network between the immune-inflammatory system and coagulation system in UC. Immunohistochemical analysis showed that the expression of CXCL8, BTK, C1QB, and F2R was upregulated in active UC.

Conclusions: Anti-TNF-α agents have significant therapeutic effects on hypercoagulable active UC, and the strong association between CXCL8, hypercoagulation, and disease activity provides a novel therapeutic insight into hypercoagulable active UC.

[This corrects the article DOI: 10.1093/gastro/goad072.].

Background: Early detection of colorectal cancer (CRC) is crucial to enhance the disease treatment and prognosis of patients. Colonoscopy remains the gold standard for CRC detection; however, it requires trained personnel with expensive tools. Currently, serum metabolites have been discovered to be used to discriminate patients with polyps and CRC. This study aimed to identify the most commonly detected predictive serum metabolites for polyps and CRC.

Methods: A systematic search of the Web of Science, PubMed, and Cochrane Library databases was conducted using PRISMA guidelines. Ten studies investigating serum metabolite biomarkers of CRC and polyps using different analytical platforms and study populations were included. QUADOMICS tool was used to analyse the quality of the included studies. All reported metabolites were then enriched into the pathways using MetaboAnalyst 5.0.

Results: We found that several potential signature metabolites overlapped between studies, including tyrosine, lysine, cystine, arabinose, and lactate for CRC and lactate and glutamate for polyps. The most affected pathways related to CRC were the urea cycle, glutathione metabolism, purine metabolism, glutamate metabolism, and ammonia recycling. In contrast, those affected in the polyps were the urea cycle, glutamate metabolism, glutathione metabolism, arginine and proline metabolism, and carnitine synthesis.

Conclusions: This review has found commonly detected serum metabolites for polyps and CRC with huge potential to be used in clinical settings. However, the differences between altered pathways in polyps and CRC, other external factors, and their effects on the regulation level, sensitivity, and specificity of each identified metabolite remained unclear, which could benefit from a further extensive cohort study and well-defined analysis equipment.