BMC Gastroenterology最新文献

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.

Background: In patients with chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD), non-invasive diagnosis of advanced fibrosis remains challenging, while these stages are critical for prognosis and therapeutic decision-making. Existing non-invasive models cannot simultaneously ensure effective rule-out and rule-in, whereas the dual cutoff strategy provides a feasible clinical approach. This study aimed to evaluate the diagnostic performance of Liver stiffness measurement-to-platelet ratio index (LPRI) for advanced fibrosis in this population and to explore its clinical utility in risk stratification.

Methods: A retrospective analysis was performed on 673 CHB patients with NAFLD confirmed by liver biopsy from 2018 to 2025. Receiver operating characteristic (ROC) curves were constructed to analyze and compare the diagnostic performance of LPRI, liver stiffness measurement (LSM), the fibrosis-4 index (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and Hui score in diagnosing stage S3 fibrosis, advanced fibrosis, and cirrhosis. A dual cutoff strategy was applied, using 90% sensitivity and specificity to determine rule-out and rule-in thresholds, stratifying patients into low-risk, indeterminate, and high-risk groups for clinical risk management.

Results: LPRI values were markedly higher in patients with stage S3 fibrosis and cirrhosis compared with those in the S1-S2 stages. LPRI demonstrated good diagnostic performance for advanced fibrosis and stage S3 fibrosis, with AUROCs of 0.904 and 0.854, respectively. For cirrhosis, LPRI achieved an AUROC of 0.919, outperforming LSM, APRI, and Hui score (P < 0.05). For advanced fibrosis, the rule-out threshold was 5.39 (Se = 90.0%, Sp = 79.3%), with 75.0% of patients classified as low risk. The rule-in threshold was 6.93 (Sp = 90.0%, Se = 63.8%), with 14.9% in the high-risk zone and 10.1% in the indeterminate zone (5.39-6.93). For cirrhosis, the rule-out threshold was 6.44 (Se = 90.0%, Sp = 74.1%), with 82.0% classified as low risk. The rule-in threshold was 6.74 (Sp = 90.0%, Se = 77.4%), defining 16.6% as high risk and 1.4% as indeterminate (6.44-6.74).

Conclusion: LPRI shows good value in predicting and excluding advanced fibrosis and cirrhosis in patients with CHB combined with NAFLD, and can reduce diagnostic uncertainty for advanced fibrosis, thereby decreasing unnecessary liver biopsies and improving screening efficiency.