世界胃肠病理生理学杂志(电子版)(英文版)最新文献

Constipation is a common yet underrecognized gastrointestinal complication among critically ill adults, significantly impacting morbidity, length of stay, and overall prognosis. This narrative review explores the current understanding of constipation in the critical care setting, emphasizing the challenges in its definition and identification due to variability in clinical presentation and lack of standardized diagnostic criteria. We examine contributing factors such as immobility, opioid use, altered fluid and electrolyte balance, and the effects of critical illness itself on gastrointestinal motility. Furthermore, we discuss available and emerging management strategies in critically ill adults, including pharmacologic and non-pharmacologic interventions, and highlight the importance of early identification and targeted therapy in improving patient outcomes. Finally, we address the prognostic implications of constipation in critically ill adults and the need for prospective studies to better define its impact and inform evidence-based guidelines. This review aims to raise awareness and stimulate further research into this often-overlooked aspect of gastrointestinal pathophysiology in the intensive care unit.

Background: Various therapeutic options are available for the treatment of Crohn's disease (CD). About 30%-40% patients experience primary non-response, and 20%-30% secondary loss of response to biological therapy. Predicting therapeutic response is challenging and an area of active research. Gut microbiota has emerged as an important player in the pathogenesis of CD and also appears to be a promising biomarker for predicting therapeutic response.

Aim: To systematically review the literature on the current status of gut microbiota as a tool to predict response to treatment in adults with CD.

Methods: We searched the literature database (PubMed, Scopus, and Cochrane database) from inception to August 2025. We screened for studies reporting on adult patients with CD receiving biologic or immunomodulator therapies, with baseline microbiome analyses performed prior to treatment. Papers reporting on baseline gut microbiota as a predictor of therapeutic response were finally included. The utility of bacterial diversity, microbial community structure, and the role of specific operational taxonomic units as biomarkers of therapeutic response was reviewed. The results were grouped based on the bacterial parameters studied and presented in separate tables. The quality of the included studies was assessed using the MINORS criteria. The review was registered prospectively in PROSPERO.

Results: After applying the selection criteria, sixteen studies were included in this systematic review. The majority of the papers were from Europe and the United States. All except two papers assessed gut bacterial population using 16S rRNA gene sequencing. Ten of the sixteen studies were of high quality. Among the sixteen studies included, most identified an association between microbial taxa and treatment response, while the relation with alpha-diversity was inconsistent. The functional characteristics were reported in only four studies and were found to be useful. The best prediction was achieved when microbial characteristics were combined with clinical and other parameters, with area under the curve values up to 0.96.

Conclusion: The overall results suggest good performance of microbial parameters as a novel biomarker of therapeutic response. However, there are variations across individual studies, probably related to the methodology of assessing microbial communities and the therapeutic agent used. Future multicenter studies integrating microbial, clinical, and metabolomic data are warranted to develop predictive models for personalized therapy in CD.

Background: Chronic mesenteric ischemia (CMI) is a rare but serious cause of postprandial abdominal pain and weight loss, often diagnosed late.

Case summary: We report two cases with prolonged history of vague abdominal pain, early satiety, and significant weight loss. Extensive workups for functional and structural gastrointestinal disorders were unrevealing. The diagnosis was ultimately prompted by gastroenterologist re-review of prior computed tomography abdomen studies-performed earlier during the investigation but not specifically targeting the mesenteric vasculature. On close inspection, both scans revealed extensive vascular calcifications involving the superior mesenteric and celiac arteries, which had not been mentioned in the original radiology reports. Subsequent dedicated vascular imaging confirmed significant mesenteric artery stenosis. Both patients underwent successful endovascular intervention with complete resolution of symptoms.

Conclusion: These cases highlight the importance of clinician-led image review and maintaining a high index of suspicion for CMI in elderly patients with unexplained gastrointestinal symptoms presenting to the gastroenterology department.

Background: The gut microbiome is integral to human health, with emerging research underscoring its potential impact on ocular health through the gut-eye axis. Various ocular disorders, such as dry eye syndrome, retinal vascular diseases, macular degeneration, and glaucoma, may be influenced by gut dysbiosis, which could significantly contribute to their development and progression.

Aim: To evaluate the influence of the gut microbiome on the pathogenesis and progression of various ocular diseases.

Methods: An extensive search of the scientific literature was undertaken by adhering to Preferred Reporting Items for Systematic Reviews & Meta-Analyses standards, using PubMed (MEDLINE), Scopus, EMBASE, and the Cochrane Library as sources to locate studies addressing the relationship between the gut microbiome and human health. To capture all relevant publications, search terms were systematically applied across these major databases, without limiting the search by language or publication date. Inclusion criteria covered randomized controlled trials, non-randomized controlled trial, prospective studies, cross-sectional studies, and case-control studies. Out of the 3077 articles, 36 full texts were included in the review.

Results: Ocular health appears to be shaped by the gut microbial community through mechanisms such as immune regulation, preservation of the blood-retinal barrier, and the generation of protective metabolites. Disturbances in this microbial balance can provoke measurable alterations in host immunity, providing a plausible immunopathogenic pathway that connects intestinal dysbiosis with eye disease. Both laboratory models and early human data suggest that targeted interventions, including prebiotics, probiotics, synbiotics, and faecal microbiota transfer, hold therapeutic potential.

Conclusion: The gut-eye relationship reflects a multifaceted interaction in which the intestinal microbiome contributes to ocular health through complex biological pathways. Integrating microbiome assessments into diagnostic methods can revolutionize disease management through early detection and targeted interventions. Further, randomised controlled clinical trials are necessary for ocular diseases to prove causal relationships.

Acute appendicitis remains one of the most common causes of emergency abdominal surgery globally. Imaging plays a pivotal role in confirming or excluding the diagnosis and identifying complications that influence management pathways. This narrative review synthesizes contemporary evidence and consensus-based imaging protocols for appendicitis, with a focus on computed tomography, magnetic resonance imaging, and ultrasound. The article explores advanced diagnostic criteria, interpretation challenges, imaging algorithms derived from professional society guidelines, and special considerations including pregnancy and pediatric populations. Clinical practice recommendations by the World Society of Emergency Surgery, European Association of Endoscopic Surgery, American College of Radiology, and Infectious Diseases Society of America are incorporated to frame best practices.

In general, the use of steroids is associated with three forms of liver injury that include hepatitis B reactivation, drug-induced liver injury, and steatosis/steatohepatitis. Drug-induced liver injury is a known but rare adverse effect of high-dose steroids. While corticosteroids, including methylprednisolone, are generally considered safe, high doses have been linked to hepatic injury. This form of insult is often idiosyncratic and unpredictable. We present the case of a 60-year-old female who was admitted due to a 6-week history of paresthesia and weakness involving her bilateral hands and feet. Magnetic resonance imaging of the brain, cervical, and thoracic regions revealed several enhancing lesions, highly concerning for multiple sclerosis. One day following high-dose intravenous methylprednisolone, liver enzymes were found to be significantly elevated on her complete metabolic panel. Steroid therapy was discontinued, and liver enzymes returned to normal values within 4 days. Symptoms ultimately resolved following a 7-day course of plasmapheresis. This article brings attention to providers about this rare adverse effect, especially to clinical specialists who often use high-dose steroids. Suggestions regarding monitoring and treatment are also provided.

Background: Hepatectomy triggers complex metabolic changes as the liver adapts to the loss of functional mass and initiates regeneration. These changes impact carbohydrate, lipid, and protein metabolism, as well as energy and oxygen dynamics. A deeper understanding of these shifts is essential for improving perioperative management and enhancing long-term outcomes.

Aim: To review and synthesise the current understanding of metabolic changes following hepatectomy and explore their implications for perioperative care, postoperative recovery, and long-term patient outcomes.

Methods: A narrative review was conducted using PubMed, Cochrane, and Scopus databases to identify relevant human studies published up to December 2024. Search terms included "hepatectomy", "liver resection", "metabolic changes", and related phrases. Studies focusing on metabolic adaptations-specifically changes in glucose, lipid, protein metabolism, and energy consumption-were included.

Results: Hepatectomy induces a shift toward gluconeogenesis and transient insulin resistance, increased lipid oxidation, amino acid imbalance, and a heightened inflammatory response, especially during ischaemia-reperfusion injury. These changes vary with the extent of resection and the presence of underlying liver disease. Novel insights include the role of the physiologic Pringle manoeuvre (a pharmacologic alternative to mechanical clamping) and metabolomic biomarkers for assessing surgical risk and liver regeneration.

Conclusion: Understanding the metabolic adaptations following hepatectomy provides an opportunity to optimise perioperative care strategies such as nutrition, glucose and lipid management, and mitigation of ischaemia-reperfusion injury. Integrating these insights may enhance surgical outcomes, particularly in patients with hepatocellular carcinoma or non-alcoholic fatty liver disease.

Background: Kirsten rat sarcoma viral oncogene homolog (KRAS), neuroblastoma RAS viral oncogene homolog (NRAS), and v-raf murine sarcoma viral oncogene homolog B1 (BRAF) nucleotide variants may generate quantitatively or qualitatively various protein activities, which may be reflected in their differential association with tumor characteristics.

Aim: To examine the association between these mutations and colorectal cancer (CRC) progression stages.

Methods: A retrospective analysis was conducted on 799 patients with CRC, whose tumor samples were examined for mutations in the hot-spots of the KRAS, NRAS, and BRAF genes at the University of Texas Medical Branch, spanning from January 2016 to July 2023. Statistical analyses were performed to assess the association of specific nucleotide changes with tumor, nodes, and metastasis stages.

Results: KRAS mutations were found in 39.5% of cases, NRAS mutations in 4.4%, and BRAF mutations in 6.0%. The KRAS p.Gly12Val and p.Gly13Asp mutations were positively associated with pathological stage 4 tumors. Additionally, the KRAS p.Gly12Asp and p.Gly12Val mutations were linked to an increased risk of distant metastasis. Meanwhile, the BRAF Val600Glu mutation was associated with a higher likelihood of lymph node involvement.

Conclusion: Our findings support the potential prognostic utility of specific KRAS (p.Gly12Val, p.Gly12Asp, and p.Gly13Asp) and BRAF p.Val600Glu mutations in CRC. These results are preliminary and require validation through larger, multi-center studies before they can be considered reliable in clinical practice.

Background: An 81-year-old patient presented to our center with pancreatic head cancer, obstructive jaundice, and acute cholecystitis. Due to duodenal tumor infiltration, both endoscopic retrograde cholangiopancreatography and endoscopic ultrasound (EUS)-guided choledochoduodenostomy were technically challenging.

Case summary: An EUS-guided gallbladder drainage along with an EUS-guided fine needle biopsy were performed, resulting in a diagnosis of pancreatic cancer resolution of jaundice and improvement in acute cholecystitis, all in a safe and effective single endoscopic session.

Conclusion: This case demonstrated the successful use of EUS-guided gallbladder drainage and EUS-guided fine needle biopsy in a patient with pancreatic cancer invading the duodenal wall.

Diverticular disease (DD) represents a prevalent clinical challenge, especially in the aging population. The sigmoid colon is the most frequently affected area. However, the presence of DD in the upper gastrointestinal tract, including the duodenum and jejunum, underscores the need for comprehensive understanding and management. In this minireview we analyzed the epidemiology, pathogenesis, clinical presentation, diagnosis, and management of DD with a specific focus on jejunal diverticulosis. Although the incidence of gastrointestinal DD increases with age, the male and female prevalence is the same. Clinical presentation is either asymptomatic or with unclear abdominal symptoms. However, complications such as perforation and bleeding can occur in a subset of patients and demand urgent diagnosis and surgical treatment. Imaging alternatives, including CT and enteroscopy, play key roles in diagnosis. Surgical management is warranted in cases with persistent bleeding or more complicated acute abdomen. Jejunal diverticulosis (JD) is a less common condition and poses a unique diagnostic and therapeutic challenge. Bleeding has been reported as the most important complication in JD. Therefore, early diagnosis and management are critical to improve patient outcomes and reduce morbidity and mortality. This article highlighted the importance of considering JD in the differential diagnosis of gastrointestinal bleeding, especially in patients with concurrent colon diverticulosis in which the bleeding source remains unidentified. Therefore, current challenges in JD are better understanding the etiopathology and optimal management strategies.