BMC Gastroenterology最新文献

Objectives: Gastrointestinal (GI) cancers are a major cause of morbidity and mortality worldwide. However, there has been no comprehensive assessment of GI cancers in Asia.

Study design: This was an epidemiological study.

Methods: The study calculated the incidence and deaths of six common GI cancers in Asia between 1990 and 2019 using data from the Global Burden of Disease study. The data are presented by sex, age, year, location, and risk factors, and are shown as counts and rates.

Results: In 2019, the age-standardized incidence rates (ASIR) for colorectal, esophageal, gallbladder and biliary tract (GBTC), liver, pancreatic, and stomach cancers were 23.88, 8.24, 2.77, 7.97, 5.41, and 19.77, respectively. The age-standardized death rates (ASDR) for colorectal, esophageal, GBTC, liver, pancreatic, and stomach cancers were 12.49, 7.73, 2.53, 7.22, 5.47, and 14.67, respectively. From 1990 to 2019, there was an increasing trend in incidence and deaths for esophageal, liver, and stomach cancer, while a decreasing trend was observed in colorectal, GBTC, and pancreatic cancer. The burden of GI cancer increased successively in older generations and was higher in males than in females. Furthermore, this burden varied significantly across Asian subregions and countries. Dietary risks, smoking, alcohol use, and high BMI contribute to GI cancer mortality.

Conclusions: GI cancers continue to be the primary contributor to the tumor burden in Asia, with increasing absolute numbers but varying age-standardized measures over the past three decades.

Background and aims: Primary biliary cholangitis (PBC) is a chronic, progressive autoimmune liver disease. Some patients with PBC do not adequately respond to Ursodeoxycholic acid (UDCA) as a first-line treatment, putting them at an increased risk of disease progression. Peroxisome Proliferator-Activated Receptor (PPAR) agonists are emerging as promising therapeutic options for PBC. We aim to investigate the efficacy and safety of PPAR agonists in treating PBC patients.

Methods: PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov were searched for Randomized Controlled Trials (RCTs) investigating the use of PPAR agonists in combination with UDCA in patients with PBC, compared to UDCA alone. Mean differences (MD) for continuous variables and risk ratios (RR) for dichotomous variables were calculated to compare treatment response endpoints.

Results: A total of 17 studies with 1219 PBC cases were included in the current review. Alkaline phosphatase (ALP) levels had a significantly greater decline in PPAR and UDCA arms than in UDCA alone (MD - 131.15, 95% CI - 155.95 to - 106.36). Furthermore, in combination therapy arms, gamma-glutamyl transferase (GGT) (MD - 55.69, 95% CI - 76.26 to - 35.13) and total bilirubin (MD - 0.08, 95% CI - 0.14 to - 0.03) were significantly lower than in the UDCA alone group.

Conclusions: The current study demonstrates that combining UDCA and PPAR agonists effectively reduces ALP, GGT, and Bilirubin levels, crucial markers for effective therapy in PBC patients.

Background: Whether include high-sensitivity C-reactive protein (Hs-CRP) in diagnostic flow remains debatable during the updated definition to metabolic dysfunction-associated steatotic liver disease (MASLD) despite systemic inflammation contributes to the disease development and progression. We aimed to identify values of hs-CRP compared to other inflammatory markers derived from routine blood tests in MASLD.

Materials and methods: This cross-sectional study included consecutive participants (ultrasound-diagnosed MASLD: 1,006, healthy controls: 582), and 175 patients received liver biopsy., with 733 and 310 patients underwent magnetic resonance imaging proton density fat fraction for liver fat content (LFC) quantification and two-dimensional shear-wave elastography liver stiffness measurements (LSM), respectively.

Results: Multiple linear regression analysis revealed a significant positive association between hs-CRP and LFC among overweight/obesity group patients (β 0.19, P = 0.03), and LSM among lean/normal weight group (β 0.30, P < 0.001). For the metabolic dysfunction-associated steatohepatitis (MASH), the hs-CRP and the ratio of monocytes to high-density lipoprotein both performed well in the overweight/obesity group and type 2 diabetes group (Overweight/obesity group, hs-CPR AUC 0.65 and 0.74, P = 0.02), bu no valuable inflammatory indicators were observed in MASH and liver fibrosis.

Conclusion: Hs-CRP levels are associated with LFC in overweight/obese MASLD and liver stiffness in lean MASLD patients, yet the reported AUC values suggest weak predictive ability.

Trial registration: The study protocol was registered at the Chinese Clinical Trial Registry, (ChiCTR-ChiCTR2000034197), approved by the First Affiliated Hospital of Sun Yat-sen University institutional with the regional medical ethics committees (Approval number: [2020] No. 187), and performed in accordance with the ethical standards of the 1964 Declaration of Helsinki. Written informed consent was obtained from all the patients.

Background: This meta-analysis aimed to evaluate the factors influencing enteral nutrition feeding intolerance in critically ill patients.

Methods: PubMed, Embase, Scopus, Medline, Web of Science, CNKI, VIP, WanFang and CBM databases were searched. A sensitivity analysis was carried out to explore the influence of individual studies on the pooled results of the included studies using a fixed-effects model or a random-effects model. The pooled results were expressed as the odds ratios (ORs) and 95% confidence intervals (Cls). Finally, a funnel plot was developed to describe the publication bias.

Results: Twenty-three studies involving 30,688 participants were included. Meta-analysis results showed that age, body mass index (BMI), APACHE II score, renal insufficiency, digestive system diseases, hypoproteinemia, sepsis, and post-pyloric feeding, starting feeding within 48 h, feeding pattern, nutritional formula, sedative drugs, vasoactive drugs, use of more than two antibiotics, oral potassium preparation, mechanical ventilation, days of mechanical ventilation, length of ICU stay, and mortality were the influencing factors of enteral nutrition feeding intolerance in critically ill patients. The results of the sensitivity analysis showed that the direction of the pooled effect size did not change after excluding each study one by one, suggesting that the results of the meta-analysis were robust.

Conclusions: According to the influencing factors, medical staff can pay attention to the high-risk patients at ICU admission to reduce the risk of feeding intolerance.

Background: Gallstones are a common digestive disorder, yet the association between the fibrosis-4 index (FIB-4) and gallstone formation remains poorly understood. This study explores the link between FIB-4 levels and gallstone prevalence among US adults.

Methods: This study was based on data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES), which included 7,771 participants. The association between FIB-4 and gallstone risk was analyzed using multivariate logistic regression with restricted cubic spline (RCS) analysis to assess nonlinear correlations, and threshold effects analysis to identify inflection points. Robustness checks included subgroup analysis.

Results: The weighted prevalence of gallstones in this study was 11%. Multiple logistic regression analysis showed that FIB-4 levels were significantly and positively associated with the risk of gallstones. In the fully adjusted model, each unit increase in FIB-4 as a continuous variable increased the risk of gallstones by 19% (OR = 1.19, 95% CI: 1.10, 1.29). When FIB-4 was grouped by quartiles, the risk of gallstones was increased by 60% (OR = 1.60, 95% CI: 1.25, 2.03) in the Q4 group compared to the Q1 group. RCS analysis further revealed a nonlinear positive correlation between FIB-4 and gallstones (P for nonlinear = 0.015) with an inflection point at 2.43, (P for log likelihood ratio test = 0.001). Bonferroni-corrected subgroup analyses showed that the association of FIB-4 with gallstones was statistically significant among non-Hispanic whites, those without heart failure, those without coronary heart disease, alcohol drinkers, and smokers (P < 0.00217).

Conclusion: In this study, we found that elevated levels of FIB-4 were significantly and positively association with the risk of gallstones, and showed a non-linear trend. FIB-4 may have a potential application in the risk assessment of gallstones.

Objective: To evaluate the safety and effectiveness of the novel long transparent cap-assisted clip closure technique in closing gastrointestinal defects.

Methods: A retrospective analysis was performed on clinical data of patients who underwent endoscopic resection for gastric submucosal tumors at the First Affiliated Hospital of Zhengzhou University from January 2020 to November 2023. Patients were categorized into the Long Transparent Cap-Assisted Clip Closure group (LTCCC group) and the Purse-String Suture group (PSS group) based on the method of wound closure after ER. Primary outcomes included closure success rates and closure time, and secondary outcomes covered postoperative hospital stays, occurrence of adverse events, tumor characteristics, and follow-up status.

Results: The closure success rate was 100% in both groups. The closure time in the LTC group was shorter than that in the PSS group (17.44 ± 7.71 min vs. 28.81 ± 9.20 min, P < 0.001). There were no statistically significant differences in postoperative hospital stays and adverse event rates between the two groups (P > 0.05). Good wound healing was observed during follow-up. No residual lesions, tumor recurrence, metastasis, gastrointestinal fistulae, or sinuses were found during a median follow-up of 32 (5 ~ 73) months.

Conclusion: The long transparent cap-assisted clip closure technique is a simple, safe, and effective method for closing gastrointestinal defects, and can be considered as a treatment option for endoscopic closure of such defects.

Background: Cryoablation simulation based on Finite Element Method (FEM) can facilitate preoperative planning for liver tumors. However, it has limited application in clinical practice due to its time-consuming process and improvable accuracy. We aimed to propose a FEM-based simulation model for rapid and accurate prediction of the iceball size during the hepatic cryofreezing cycle.

Methods: A 3D simulation model was presented to predict the iceball size (frozen isotherm boundaries) in biological liver tissues undergoing cryofreezing based on the Pennes bioheat equation. The simulated results for three cryoprobe types were evaluated in the ex vivo porcine livers and clinical data. In ex vivo experiments, CT-based measurements of iceball size were fitted as growth curves and compared to the simulated results. Eight patient cases of CT-guided percutaneous hepatic cryoablation procedures were retrospectively collected for clinical validation. The Dice Score Coefficient (DSC) and Hausdorff distance (HD) were used to measure the similarity between simulation and ground truth segmentation.

Results: The measurements in the ex vivo experiments showed a close similarity between the simulated and experimental iceball growth curves for three cryoprobe models, with all mean absolute error<2.9 mm and coefficient of determination>0.85. In the clinical validation, the simulation model achieved high accuracy with a DSC of 0.87 ± 0.03 and an HD of 2.0 ± 0.4 mm. The average computational time was 23.2 s for all simulations.

Conclusion: Our simulation model achieves accurate iceball size predictions within a short time during hepatic cryoablation and potentially allows for the implementation of the preoperative cryoablation planning system.

Background: The aim of this study is to investigate the correlation of triglyceride-glucose (TyG) index and triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio with acute pancreatitis (AP), and to compare the predictive value of the two indexes for severe AP (SAP).

Methods: This study was a clinical cross-sectional study. Spearman's correlation, logistic regression analysis and receiver operating characteristic (ROC) curves were used to investigate the relationship between the TyG index and TG/HDL-C ratio with SAP.

Results: Of the 311 enrolled AP patients, the mean age was 62.59 ± 9.03 years, and 131 (42.12%) were male. A total of 34 (10.93%) patients met the diagnostic criteria for SAP. The results of Spearman's correlation showed that TyG index (Spearman rho = 0.262; p < 0.001), TG/HDL-C ratio (Spearman rho = 0.206; p < 0.001) were associated with SAP. Logistic regression analysis showed that TyG index was independently and positively correlated with SAP [odds ratio (OR), 4.311; 95% confidence interval (CI), 1.222-15.208; p = 0.023]. However, this association was not further confirmed on TG/HDL-C ratio (OR, 2.530; 95% CI, 0.883-7.251; p = 0.084). According to the ROC curve analysis, the area under the curve (AUC) for TyG index was 0.712 (p < 0.001), and the AUC for TG/HDL-C ratio was 0.691 (p < 0.001).

Conclusions: TyG index and TG/HDL-C ratio have different diagnostic values in AP patients. And the TyG index may be a more useful auxiliary tool for predicting SAP.

Introduction: Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by progressive bile duct destruction, leading to cholestasis and, if untreated, liver failure. Although ursodeoxycholic acid (UDCA) remains the first-line treatment, many patients exhibit an inadequate response, necessitating alternative therapeutic options. Seladelpar, a peroxisome proliferator-activated receptor delta (PPAR-δ) agonist, has emerged as a promising alternative due to its anti-inflammatory and anti-fibrotic properties.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to evaluate the efficacy and safety of Seladelpar in patients with PBC. A comprehensive database search was performed to identify studies comparing Seladelpar with placebo. Primary and secondary outcomes, including alkaline phosphatase (ALP) normalization, biochemical response, and adverse events, were analyzed.

Results: Three RCTs, comprising 496 patients, were included. Seladelpar significantly improved ALP normalization and biochemical response compared to placebo. Additionally, it effectively reduced ALP and ALT levels from baseline to follow-up. Adverse events, including abdominal pain and headache, were reported, with a higher incidence observed in the Seladelpar group, while other adverse events showed no significant differences between groups.

Conclusion: Seladelpar appears to be an effective treatment for PBC, demonstrating significant improvements in key liver function markers. While it has shown therapeutic benefits, further research is warranted to evaluate its long-term safety, particularly regarding adverse event incidence, and to determine its efficacy across different dosages.