BMC Gastroenterology最新文献

Background: Refractory reflux-like symptoms (rRLS) are frequently encountered in clinical practice and often reflect heterogeneous underlying mechanisms beyond acid exposure alone. Esophageal mucosal impedance has emerged as a marker of mucosal integrity, yet its role in phenotyping rRLS remains incompletely defined.

Methods: In this retrospective study, adult patients with reflux-like symptoms who underwent multichannel intraluminal impedance-pH monitoring and high-resolution manometry were enrolled. Patients exhibiting persistent reflux-like symptoms despite ≥ 8 weeks of double-dose PPI therapy were defined as having rRLS. Baseline impedance (BI) and mean nocturnal baseline impedance (MNBI) were assessed at three esophageal levels, with particular focus on the mid-esophagus (9 cm above the lower esophageal sphincter). Among patients with refractory symptoms, final diagnoses were established using clinical evaluation, endoscopy, impedance-pH monitoring, and manometry, allowing classification into refractory gastroesophageal reflux disease (GERD), functional heartburn/reflux hypersensitivity (FH/FES) and esophageal structural or functional abnormalities (ESFA).

Results: Among 165 patients, 73 (44.2%) exhibited rRLS. BI at the mid-esophageal level was significantly lower in refractory compared with non-refractory patients, whereas impedance values at proximal and distal levels showed no significant differences. In refractory patients, MNBI at the mid-esophagus differed significantly across diagnostic phenotypes. Lower MNBI values were associated with esophageal structural or functional abnormalities, while higher values were more frequently observed in functional heartburn or reflux hypersensitivity.

Conclusions: Mid-esophageal mucosal impedance reflects impairment of mucosal integrity and may contribute to the physiological phenotyping of patients with rRLS. Location-specific impedance assessment could serve as a complementary tool to conventional reflux testing, aiding in mechanism-based classification. However, it should not be used in isolation to guide therapeutic decisions.

Introduction: Inflammatory bowel diseases (IBD), mainly represented by Crohn's disease and ulcerative colitis, have a multifactorial etiology and a growing incidence in developing countries. In Brazil, studies on their occurrence and relationship with social conditions remain scarce, which reinforces the importance of updated epidemiological analyses.

Method: Ecological study using secondary data on hospital admissions extracted from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS). Population data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), and socioeconomic indicators (HDI-M, SVI, and Gini Index) from the Institute for Applied Economic Research (IPEA). Incidence rates were age-standardized according to the WHO world standard population. For time trend analysis, Prais-Winsten linear regression was applied, and to assess relationships with socioeconomic variables, linear regression analysis was used. The statistical software employed was Stata version 18.0.

Results: Between 2010 and 2023, there were 64,303 hospital admissions for IBD in Brazil. The highest frequency was observed among women, adults aged 20 to 59 years, and in the Southeast region, while the lowest occurred in the North region. Regarding incidence, there was a significant increase among men, individuals under 19 years old, adults aged 20 to 59 years, and in the Northeast and Southeast regions. Nationally, an annual growth of 2% in incidence was observed. No significant associations were found with socioeconomic indicators, but regional analyses revealed important relationships with HDI-M and SVI.

Conclusion: The results demonstrate an increase in hospital admissions for IBD in Brazil, particularly among younger groups and in specific regions, indicating changes in the epidemiological profile. These findings highlight the need for public policies focused on early diagnosis, equitable access to specialized services, and the strengthening of epidemiological surveillance. Future research should explore environmental, nutritional, and social factors that may influence the occurrence and progression of IBD.

Background and aims: Lower gastrointestinal bleeding is a prevalent issue in the general population, particularly among older adults. Identifying risk factors is essential for improving healthcare outcomes. This study seeks to evaluate the clinical outcomes related to the use of medications recognized as risk factors, as well as the influence of age, in patients experiencing lower gastrointestinal hemorrhage. The primary endpoint of the study is to examine the effect of age and medication use on 30-day mortality, while the secondary endpoint was to investigate the need for endoscopic treatment, amount of transfusion, need for surgery-embolization, and length of hospital stay.

Methods: A retrospective cohort analysis was conducted on patients with lower gastrointestinal bleeding who were admitted to the emergency department at a single tertiary referral center. Patients were divided into two groups: those under 65 years of age and those aged 65 and older. Additionally, the older patients were further categorized into subgroups based on the specific antiplatelet or anticoagulant medications they were taking. We examined the demographic information of the patients, their presenting findings, colonoscopic diagnoses, the number of erythrocyte transfusions received, the need for embolization or surgery, the length of hospital stay, and the rates of 30-day mortality.

Results: A total of 181 patients were retrospectively reviewed. Of the patients, 113 (62.4%) were aged over 65 years, while 68 (37.6%) were aged under 65 years. The most common cause of bleeding in geriatric patients is colonic diverticula (39%), while in the other group it is hemorrhoids/anal fissures (35%). The 30-day mortality, need for transfusion, number of transfusions, and length of hospital stay were higher in the geriatric group. 105 patients (58%) were receiving anticoagulant, antiplatelet, or nonsteroidal anti-inflammatory drugs. In geriatric patients, medication history did not affect endoscopic treatment, 30-day mortality, surgical needs, the number and amount of transfusions, or length of hospital stay.

Conclusions: Lower gastrointestinal bleeding has more adverse outcomes in geriatric people. Although anticoagulant and antiplatelet medications increase the risk of bleeding, they have not significantly influenced the clinical outcomes associated with it.

Background: The efficacy of conventional chemoradiotherapy for colorectal cancer is often limited by resistance, with epithelial-mesenchymal transition being a key mechanism. Although the artemisinin derivative artemether (ARE) has shown antitumor potential, it remains unclear whether it can enhance radiosensitivity and reverse chemo-radiation resistance in colorectal cancer by regulating EMT. This study aimed to investigate the radiosensitizing and resistance-reversing effects of ARE on human colorectal cancer xenografts in nude mice and to elucidate the underlying mechanism related to EMT regulation.

Methods: A nude mouse xenograft model using human colorectal cancer HCT116 and HCT116-chemo-radiation resistant (HCT116-CRR) cells was established.

Results: ARE combined with radiotherapy suppressed tumor growth in nude mice and induced cell death via necrosis and apoptosis. After ARE combined with radiotherapy, β-Catenin was increased in human colorectal cancer HCT116 cells implanted in nude mice, while Vimentin was decreased. In HCT116-CRR cells transplanted into nude mice, the E-cadherin and β-Catenin were upregulated, whereas N-Cadherin, Vimentin, Snail, Slug, and Twist were downregulated. ARE effectively significantly enhanced radiosensitivity and reversed chemo-radiation resistance by suppressing EMT.

Conclusions: These findings provide both mechanistic insights and experimental validation for the potential application of ARE as a radiosensitizer in colorectal cancer radiotherapy.