Gastroenterology Report最新文献

Background and aims: Ingested sharp objects pose increased risks of adverse events compared with other foreign bodies. We conducted the largest systematic review to date of sharp wooden object ingestions to elucidate patterns in clinical presentation and guide management practices.

Methods: Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science Core Collection databases were searched for cases of adults who ingested sharp wooden objects. Descriptive statistics were reported for risk factors, clinical presentations, laboratory and imaging findings, adverse events, and treatments.

Results: Analysis of 479 cases showed that most patients were unaware of ingestion (74.8%) and toothpicks were the most common ingested item (92.5%). Male sex (70.1%), substance use (9.4%), and edentulousness (6.1%) were risk factors. Common symptoms included abdominal pain (83.7%) and fever (36.7%). Imaging identified the object in 48.1% of cases, with computed tomography being the most sensitive (54.7%). Objects were commonly found in the gastrointestinal tract (79.3%). They were consistently found in the gastrointestinal tract when patients were aware of ingestion or imaging showed an intraluminal/transluminal location. Endoscopy visualized the objects 76.1% of the time, with successful removal in 88.8% of cases; 4.7% of patients required surgery following endoscopic removal. Adverse events included perforation (87.5%) and abscess (33.0%), with a mortality rate of 5.0%.

Conclusions: Ingestion of sharp wooden objects presents heterogeneously and can lead to serious complications. Endoscopic removal is safe and effective. We propose a clinical algorithm to guide physicians in diagnosing and managing suspected sharp wooden object ingestion.

Background: Long-term exposure to constant light is becoming a prevalent lifestyle that is associated with irritable bowel syndrome (IBS), a chronic functional gastrointestinal disorder. Intestinal stem cells (ISCs) are an important population of cells that maintain homeostasis and function of intestinal tissues. The purpose of this study was to identify the effects of long-term constant light exposure on gastrointestinal function and the potential mechanisms of sympathetic activity on ISC.

Methods: Rats housed in a 24 h constant light chamber for 4 weeks were used as the constant light exposure animal model. Hematoxylin-eosin staining and immunohistochemical examination were used to determine the pathological changes of the intestine. Propranolol (ARs inhibitor; 40 mg/kg/day), metoprolol (ADRβ1 inhibitor; 50 mg/kg/day), and Box5 (Wnt5a inhibitor; 2 μg/day) were used to examine the effect of sympathoexcitation and Wnt signaling pathway on constant light-induced gastrointestinal disorders.

Results: We found that 4 weeks of constant light exposure in rats resulted in a decrease in the number of ISC and an increase in sympathetic activity. Intestinal β1-adrenoceptor expression and reactive oxygen species (ROS) were significantly increased, but Wnt5a expression decreased in the continuous light-exposed rats. Similarly, we found that administration of the β1-adrenoceptor antagonist metoprolol for 4 weeks attenuated the effects of continuous light exposure on the intestine, which was rescued by the reintroduction of Wnt5a.

Conclusion: Taken together, these data indicate that sympathoexcitation is critical for disruption of ISC under constant light exposure, suggesting that targeting β1-adrenoceptor/oxidative stress/Wnt5a axis may be a potential strategy for ISC disruption induced by prolonged sustained light exposure, providing a new direction for IBS treatment.

In the present narrative review, we have summarized the current evidence on the natural progression of metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis observed through the placebo arm in clinical trials and observational studies. The outcomes scrutinized throughout our review were histology-related changes, non-invasive fibrosis markers, indicators of decompensation, end-stage hepatic complications, and mortality reported during the different clinical trials. Given the short duration of clinical trials, observational studies were included to obtain better insight into the long-term progression and prognosis of MASH cirrhosis. Lastly, new updates about MASH cirrhosis treatments were listed, and the results of these randomized clinical trials were described to enhance our understanding of our current standing in the treatment of MASH cirrhosis.

Background and aims: Constipated patients have higher risk of poor bowel preparation and suffer from dysfunction of the intestinal motor. Chewing gum can stimulate gut motility and enhanced instructions can improve the quality of bowel preparation. The objective of this study was to investigate whether chewing gum combined with WeChat-enhanced instruction can increase the quality of bowel preparation in constipated patients.

Methods: This was a single-center, endoscopist-blinded, randomized-controlled trial. Patients were assigned (1:1) to the chewing gum and WeChat-enhanced instruction (CGW) group and the control group. Patients in both groups received 3 L of polyethylene glycol (PEG) before colonoscopy. Patients in the CGW group were asked to chew one piece of gum for 20 min after drinking each 1 L of PEG and received enhanced instruction via WeChat the day before colonoscopy. The quality of the bowel preparation (primary outcome), adenoma and/or polyp detection rate (ADR/PDR), number of polyps and/or adenomas, procedure time, and adverse events were compared.

Results: A total of 115 patients were finally analysed, including 60 in the CGW group and 55 in the control group. The proportion of adequate bowel preparation and the Boston Bowel Preparation Scale score were not statistically different between the two groups (76.7% vs 70.9%; 6.80 ± 1.42 vs 6.40 ± 1.78; both P > 0.05). There was no significant difference in the ADR/PDR and number of polyps and/or adenomas (both P > 0.05). However, there was a significantly higher incidence of nausea in the CGW group than in the control group (33.3% vs 16.4%, P = 0.036).

Conclusions: Chewing gum combined with WeChat-enhanced instruction does not improve the quality of bowel preparation for colonoscopy in constipated patients but does increase the incidence of nausea.

Background: Colorectal cancer (CRC) is one of the most aggressive malignancies of the digestive tract, characterized by aberrant post-transcriptional RNA modifications, including pseudouridine (Ψ). TruB pseudouridine synthase family member 1 (TRUB1) is a key pseudouridine synthase but its role in CRC progression remains unclear.

Methods: Public databases and CRC cell lines were analysed to assess TRUB1 expression in CRC. Receiver-operating characteristic (ROC) curve analysis and survival analysis were performed to evaluate the diagnostic and prognostic significance of TRUB1. The impact of TRUB1 on tumor proliferation and Ψ modification was examined in TRUB1-knock-down HCT116 cell lines. Mechanistically, RNA sequencing of control and TRUB1-knock-down HCT116 cells was conducted to identify potential pathways, which were validated by using real-time polymerase chain reaction (PCR), Western blot, and immunofluorescence assays.

Results: TRUB1 was significantly upregulated in CRC tumor tissues and cell lines. ROC analysis showed that TRUB1 had strong diagnostic potential and its overexpression was associated with poorer overall survival in CRC patients. In TRUB1-knock-down HCT116 cells, apoptosis increased and tumor growth slowed in nude mice, with a corresponding increase in apoptosis-related proteins and decreased Ψ modification. Mechanistically, RNA sequencing indicated that tumor necrosis factor α signaling via the nuclear factor kappa B (NFκB) pathway was activated in TRUB1-knock-down HCT116 cells. Further analysis identified Baculoviral inhibitor of apoptosis proteins repeat-containing 3 (BIRC3) as a potential downstream target gene that was regulated by TRUB1 in the NFκB pathway.

Conclusions: TRUB1 serves as a potential biomarker for CRC diagnosis and prognosis, and it can inhibit apoptosis in CRC cells via BIRC3-mediated NFκB signaling.

Background and aims: This study explored the efficacy of a prophylactic intestinal decompression tube in reducing the incidence of post-endoscopic submucosal dissection electrocoagulation syndrome (PECS).

Methods: A total of 157 eligible patients with colorectal mucosal lesions scheduled for endoscopic submucosal dissection (ESD) were prospectively recruited; after drop out 11 patients, 146 patients were randomly assigned to an experimental group (group 1, n = 73) or control group (group 2, n = 73). Patients in the experimental group underwent placement of an intestinal decompression drainage tube after ESD, while the control group received no additional treatment after ESD. The primary outcome was the incidence of PECS. Secondary outcomes included the incidence of postoperative complications, time to removal of the intestinal decompression tube, the degree of abdominal pain as measured by the visual analog scale (VAS), and the participants' self-rated comfort level with the intestinal decompression tube.

Results: A total of 146 patients (n = 73 per group) were finally analyzed between July 2022 and February 2023. All tumors were successfully resected en bloc. A significant difference in the incidence of PECS was found between group 1 and group 2 (5.5% vs 16.4%; P = 0.034). Precisely, 61.6% of patients felt painless for intestinal decompression tube, and no severe or unbearable pain was reported.

Conclusions: The placement of intestinal decompression drainage tube could reduce the incidence of PECS after colorectal ESD, which might play a preventive role in the occurrence of PECS.

Background: Colorectal cancer (CRC) is the third-most-common malignancy and the second-leading cause of cancer-related deaths worldwide and current screening methods such as guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT), and colonoscopy have their own pros and cons. This study aimed to assess the effectiveness of a fecal DNA methylation test by using methylated SDC2 (mSDC2) as the epigenetic biomarker for detecting CRC in a screening-naïve population.

Methods: Fecal mSDC2 test and FIT were simultaneously performed on eligible 40- to 74-year-old adults of a regional township in China. Subjects with positive results were recommended for colonoscopy. Data of positivity rates, positive predicted values (PPVs), and detection rates associated with clinical characteristics were analysed.

Results: The positivity rate of mSDC2 was 7.6% for 10,578 participants with valid results from both fecal mSDC2 test and FIT. With an adherence rate of 63.8% to colonoscopy referral, 25 CRCs, 189 advanced adenomas (AAs), and 165 non-advanced adenomas (NAAs) and polyps were detected. The PPVs of mSDC2 were 4.93%, 37.28%, and 32.54% for CRC, AA, and non-advanced lesions, respectively. When the CRCs and AAs were counted as positive findings, the fecal mSDC2 test showed a higher detective rate than FIT (relative risk [RR], 1.313 [1.129-1.528], P < 0.001). When NAAs and polyps were also specified as treatable lesions, the mSDC2 test was more effective in detecting these benign growths (RR, 1.872 [1.419-2.410]; P < 0.001). A combination of mSDC2 and FIT detected 29 CRCs, 298 AAs, and 234 NAAs and polyps. Overall, the fecal mSDC2 test had a higher detection rate for both advanced and non-advanced colonic lesions. The false-positive rate of the fecal mSDC2 test was comparable to that of FIT (RR, 1.169 [0.974-1.403]; P = 0.113).

Conclusions: The single-target stool-based mSDC2 test can effectively and accurately detect CRC and precancerous lesions in a large-scale CRC-screening program.

Trial registration number: NCT05374369.

Background: Pancreatic cancer (PC) is a heterogeneous disease with various histological and molecular subtypes. This study aimed to provide updated epidemiological estimates, survival outcomes, and treatment information for PC based on histological subtypes in the USA.

Methods: Data from the US Cancer Statistics and Surveillance, Epidemiology, and End Results (SEER)-17 databases (2000-2020) were used, including adults aged ≥20 years who were diagnosed with PC. The trends of incidence and prevalence by histological types were calculated by using the Joinpoint Regression model. Survival by histological type was analysed by using Kaplan-Meier curves and log-rank tests for group comparisons.

Results: Overall, the age-adjusted PC incidence per 100,000 increased from 9.54 to 12.05 in SEER-17 and from 9.75 to 12.19 in the US Cancer Statistics between 2001 and 2019. A further SEER-17 study comprised 113,681 PC cases that were sorted by histologic type between 2000 and 2020. The incidence per 100,000 of invasive intraductal papillary mucinous neoplasm (IPMN) and invasive mucinous cystic neoplasm (MCN) decreased (IPMN from 0.67 to 0.20 and MCN from 0.05 to 0.01) whereas that of other histological subtypes increased. Survival analysis indicated the best outcomes for solid pseudopapillary tumors and the poorest for squamous cell carcinoma. At the localized stage, the proportion of surgery in the treatment modalities varied depending on the biological behavior; the proportion of surgery for pancreatic neuroendocrine tumor was the highest and that for pancreatic ductal adenocarcinoma (PDAC) was the lowest. At the distant metastasis stage, a chemotherapy-based regimen remained the primary treatment of PDAC, pancreatic neuroendocrine tumor, and IPMN.

Conclusions: PC incidence and prevalence have been increasing. The incidence of IPMN and MCN decreased whereas that of other subtypes increased. Treatment distribution varies among subtypes and stages.