BMC Gastroenterology最新文献

Background: Dietary decision-making plays a crucial role in the management of patients with inflammatory bowel disease (IBD). However, it is complex and involves multiple challenges. Decision-making competence may assist healthcare professionals (HCPs) in evaluating patients' competence to make healthy dietary decisions and to design targeted dietary support programs. Assessment of healthy dietary decision-making competence is essential for guiding IBD patients in daily dietary management. Currently, no valid instrument is available to measure this construct. This study aimed to develop an instrument to evaluate healthy dietary decision-making competence in patients with IBD.

Methods: The development and test of the healthy dietary decision-making competence scale (HDMCS) proceeded according to two phases: (i) instrument development: identifying preliminary items through literature reviews, interviews with 24 patients, an expert panel with 24 experts and cognitive interviews with 8 patients. (ii) scale verification: surveying 354 patients with IBD from five tertiary general hospitals in Nanjing and Shenzhen city, China. Item analysis, exploratory factor analysis, confirmatory factor analysis, and reliability rest were performed to evaluate the reliability and validity of this scale.

Results: The exploratory factor analysis and confirmatory factor analysis yield a four-factor scale (χ²/df = 1.972, RMSEA = 0.068, GFI = 0.848, IFI = 0.929 and CFI = 0.928). The four factors were 'dietary management perception', 'resource utilization competence', 'decisional balance competence' and 'post-decision reflection competence'. The reliability was demonstrated to be acceptable, with the Cronbach's alpha coefficient of 0.941, and the 4 factors were from 0.818 to 0.912. Test-retest reliability (by ICC) of the total scale was 0.874.

Conclusions: The HDMCS demonstrated satisfactory reliability and validity to warrant further development as a measure of dietary decision-competence of patients with IBD. By evaluating dietary decision-making competence across multiple domains, HCPs could gain a comprehensive understanding of patients' beliefs, preferences, and values related to dietary decisions, thereby tailoring interventions accordingly.

Objective: As a major demographic within the workforce, individuals with inflammatory bowel disease (IBD) represent a unique and significant burden on society's productivity. The impact of IBD on this population is substantial, with serious long-term consequences. However, the trend of this disease burden remains unclear. This study aims to comprehensively assess the current status and changing trends of the disease burden associated with IBD in the working population, with the goal of providing valuable insights for the prevention, treatment, and formulation of healthcare policies.

Methods: Using data from the Global Burden of Disease Study 2021, we conducted a stratified analysis of IBD data based on demographic characteristics, year, country/region, and the Social Development Index (SDI). We also employed various statistical techniques, including Joinpoint regression analysis, inequality analysis, frontier analysis, decomposition analysis, and Bayesian age-period-cohort predictive modeling.

Results: In 2021, the age-standardized incidence rate (ASIR) of IBD in the global working population was 6.48 (95% UI: 4.95, 8.32) per 100,000 person-years, the age-standardized prevalence rate (ASPR) was 62.37 (95% UI: 49.68, 77.50) per 100,000, the age-standardized Disability-Adjusted Life Year rate (ASDR) was 19.54 (95% UI: 15.64, 24.17) per 100,000 person-years, and the age-standardized mortality rate (ASMR) was 0.23 (95% UI: 0.20, 0.27) per 100,000. From 1990 to 2021, the age-standardized ASIR of IBD in the working population showed a gradual increase, whereas the age-standardized ASPR, ASDR, and ASMR consistently decreased. Specifically, the burden of the disease increased with age. The ASIR, ASDR, and ASMR were higher in males compared to females, whereas the ASPR was higher in females. However, the trends were similar between the sexes. Additionally, with increasing SDI, the age-standardized ASIR and ASPR gradually increased, while the ASMR decreased. It is projected that by 2050, the age-standardized ASIR and ASPR of IBD in the working population will improve, while the ASMR and ASDR will show an increasing trend.

Conclusion: Although the ASPR, ASDR, and ASMR in the working population have shown a downward trend, the ASIR continues to rise. This highlights both the advancements in healthcare and the need to strengthen prevention and early screening efforts to address this increasingly significant public health challenge.

Background: The coronavirus disease 2019 (COVID-19) pandemic profoundly altered healthcare systems and patient behavior worldwide, resulting in a significant decrease in hospital visits and delays in diagnosis and treatment. Thus, we aimed to investigate behavioral changes in patients undergoing colorectal cancer surgery during the pandemic, identify vulnerable populations, and determine the impact of such changes on cancer progression.

Methods: We conducted a comprehensive survey of patients who underwent colorectal cancer surgery at Osaka University Hospital and Minoh City Hospital between January 2021 and June 2023. Participants were asked about their clinical symptoms, regular and additional medical visits, and screenings. Behavioral changes were defined as pandemic-related postponements or cancellations of additional screenings and regular medical visits. Clinical and pathological data were collected retrospectively from medical records.

Results: Among the 98 patients who completed the survey, 83 met the inclusion criteria (43 males, average age 70 years). Behavioral changes due to the pandemic were observed in 8.4% of patients. Clinical symptoms, particularly rectal bleeding, were more common in the latter part of the study period (P = 0.014). Women were more likely to change their behavior (P = 0.038), and the disease stage tended to be more advanced in patients who changed their behavior (P = 0.062).

Conclusions: The COVID-19 pandemic led to significant behavioral changes, resulting in delayed medical consultations and more advanced cancer diagnoses. These findings highlight the need for robust public health strategies to promote regular medical checkups and timely screening, especially among vulnerable groups, during global health crises.

Background and aim: Colonoscopic insertion remains technically challenging. While cap-assisted colonoscopy (CAC) reduces the cecal intubation time (CIT), sigmoid colon water exchange (SWE) enhances linear scope advancement. We hypothesized that combined water exchange and cap-assisted colonoscopy (SWC) would optimize the CIT and improve patient tolerance during unsedated colonoscopy.

Patients and methods: This prospective randomized controlled trial (RCT) included 200 subjects scheduled for unsedated colonoscopy at a tertiary endoscopy center in Wuhan, China. The participants were randomly assigned to receive either SWC (intervention, n=100) or CAC (control, n=100). The primary outcome was CIT (minutes). The secondary outcomes included pain scores, the polyp detection rate (PDR), bowel preparation quality (Boston Bowel Preparation Scale (BBPS)), and patient willingness to repeat the procedure.

Results: Compared with CAC, SWC significantly reduced the median CIT (5.0 [IQR 4.0-7.0] min vs. 7.0 [6.0-10.0] min; P < 0.001). The left colon pain scores were lower with SWC (1.0 [1.0-2.0] vs. 2.0 [1.0-3.0]; P < 0.001), and the willingness to repeat was greater (96.0% vs. 85.9%; P = 0.024). The PDRs (61.6% vs. 58.6%; P = 0.663) and BBPS scores (P = 0.213) were comparable. Multivariate analysis revealed that SWC, better bowel preparation, younger age, no prior abdominal surgery, and the absence of constipation were independent predictors of a shorter CIT.

Conclusion: SWC shortens the CIT, reduces discomfort, and improves patient acceptance without compromising procedural quality-advantages conducive to promoting and popularizing unsedated colonoscopy.

Trial registration: The registry titled "Transparent cap combined water exchange enteroscopy versus transparent cap method enteroscopy in time to cecal intubation: a prospective study"was registered in the Chinese Clinical Trial Registry on 14/05/2025 (clinical trial registration number: ChiCTR2500102387).Retrospectively registered.

Purpose: Appendicoliths are one of the important causes of acute appendicitis. Currently, there is no consensus on the relationship between appendicoliths and complicated appendicitis, and opinions on the treatment of appendicolith-associated appendicitis vary. This study aims to determine the significance of appendicolith in acute complicated appendicitis and to assess the characteristics of appendicoliths and Computed tomography (CT) features associated with complicated appendicitis.

Methods: A retrospective analysis was conducted on patients who underwent surgical treatment for acute appendicitis at the affiliated hospital of Qingdao University from January 2016 to October 2023. Acute appendicitis was classified into two groups with and without appendicolith based on CT findings, intraoperative observations, and postoperative pathology. The clinical data of the two groups were analyzed and compared. Further subgroup analysis was performed within the appendicolith group based on pathological findings, comparing the location, size, and number of appendicoliths, as well as the length, diameter, and CT features of the appendix.

Results: Among 331 patients with acute appendicitis, 179 had appendicolith, of which 106 were complicated appendicitis and 73 were uncomplicated appendicitis. Among 152 patients without appendicolith, 44 had complicated appendicitis and 108 had uncomplicated appendicitis. appendicoliths were independently associated with complicated appendicitis (OR = 1.88, 95% CI: 1.04-3.40, p = 0.036). In patients with appendicolith appendicitis, three factors were independently associated with complicated appendicitis: appendiceal diameter (OR = 1.20; 95% CI: 1.03-1.40), moderate-severe fat stranding (OR = 17.61; 95% CI: 3.19-97.33), and periappendiceal air (OR = 9.78; 95% CI: 1.17-81.46).

Conclusion: Appendiceal appendicoliths are closely related to acute complicated appendicitis. The diameter of the appendix and moderate-severe fat stranding, periappendiceal air on CT are significant indicators for identifying complicated appendicitis in acute appendicitis with appendicolith.

Aim: The purpose of this study is to explore the prognostic evaluation value of Ki67 and pSmad3L (S204) for gastric cancer (GC) patients by jointly analyzing their expression levels in GC tissues.

Methods: This single-center observational study enrolled 98 patients with pathologically confirmed GC, collecting 82 paired samples of tumor and adjacent normal tissues. Immunohistochemistry was utilized to detect the expression levels of CD133, E-cad, Ki67, and pSmad3L (S204). Pearson correlation coefficients were calculated to assess inter-protein relationships, while chi-square tests evaluated associations with clinicopathological parameters. Kaplan-Meier analysis generated survival curves, and univariate and multivariate COX regression analyses were conducted to establish a prognostic prediction model.

Results: Compared with adjacent normal tissues, the expressions of CD133, E-cad, and Ki67 were upregulated in GC tissues. The high expression of CD133 was associated with the tumor type, and the high expression of Ki67 was related to tumor grading and distant metastasis. Multivariate analysis showed that the depth of invasion, lymph node metastasis, Ki67, and pSmad3L (S204) were independent prognostic risk factors for GC patients. The co-expression of high levels of Ki67 and pSmad3L (S204) predicted a poor prognosis.

Conclusion: High expression of Ki67 and high expression of pSmad3L(S204) are independent risk factors for the prognosis of patients with GC, and the combined analysis of Ki67 and pSmad3L(S204) can help to improve the risk prediction.