BMC Gastroenterology最新文献

Background: This study investigates the role of interhospital transfer (IHT) in lower gastrointestinal bleeding (LGIB) management and its impact on patient outcomes, focusing on mortality rates, complication occurrences, procedural performance, and resource utilization in patients diagnosed with LGIB.

Methods: This retrospective cohort study used data from the National Inpatient Sample database from 2017 to 2020. It included adult patients diagnosed with LGIB, assessing the impact of IHT on outcomes such as mortality, complication rates, procedural performance, and resource utilization. Adjusted odds ratios (AOR) and adjusted mean differences (AMD) were used to evaluate these impacts.

Results: A total of 393,495 LGIB patients were analyzed, with 31,565 (8.02%) undergoing interhospital transfer. Transferred patients exhibited significantly higher inpatient mortality (AOR 1.96, P < 0.01). They also faced increased risks of acute kidney injury (AOR 1.32, P < 0.01), septic shock (AOR 2.11, P < 0.01), and intensive care unit admission (AOR: 2.61, P < 0.01). These patients were more likely to undergo interventional radiology-guided embolization (AOR 2.68, P < 0.01) and showed variations in colonoscopy procedures. Resource utilization was also higher among transferred patients, with an increased mean length of hospital stay by 4.37 days (P < 0.01) and higher hospitalization charges (mean difference $61,239, P < 0.01).

Conclusion: Interhospital transfer in LGIB patients is associated with increased mortality, greater resource utilization, and the need for more specialized procedural interventions. Enhanced clinical vigilance and tailored resource allocation for transferred LGIB patients are necessary. Future research should optimize care strategies for these high-risk patients.

Aim: To assess the real-life, long-term effectiveness and safety of tofacitinib in a large cohort of patients with refractory or difficult-to-treat ulcerative colitis (UC).

Methods: This multicenter, retrospective, observational cohort study included patients with moderately to severely active UC who received tofacitinib for at least 8 weeks. Clinical remission and response, endoscopic response and remission, biochemical response and remission, steroid-free clinical remission, primary and secondary loss of response, drug discontinuation, the need for dose optimization, the need for colectomy, and adverse events were evaluated over up to 30 months.

Results: We included 127 patients with UC, with a mean age of 40.3 ± 14.2 years; 58.2% were male, 75.6% had pancolitis, and 79.5% had previously failed at least one biological therapy, predominantly anti-TNF agents (70.1%). Clinical remission was observed in 31.5% of patients at weeks 12-16, 46.5% at 26 ± 4 weeks, and 37.0% at 1 year. Steroid-free clinical remission was achieved in 28.6%, 44.8%, and 37.1% of patients at the same time points, respectively. Biochemical remission was achieved in 33.6% of patients at 26 ± 4 weeks and 29.3% at 1 year. Endoscopic response and endoscopic remission within 1 year were observed in 46.0% and 15.3% of patients, respectively. Ten patients (7.9%) required colectomy, and 13 patients (10.2%) required hospitalization, all of whom had been previously exposed to biologics. The colectomy rate was significantly greater in patients with serum albumin levels ≤ 3.5 g/dL (21.4% vs. 4.1%, p = 0.013).

Conclusion: In this large, long-term real-world study involving patients with predominantly biologically refractory UC, tofacitinib effectively induced clinical remission and endoscopic improvement and prevented colectomy for more than 30 months, with a favorable safety profile. Notably, baseline hypoalbuminemia was associated with higher colectomy rates.

Background: Micronutrient deficiency is commonly observed in patients with inflammatory bowel disease (IBD), yet the role of certain dietary trace elements in the risk of IBD development remains unclear.

Objectives: This study aimed to investigate the relationship between vitamin C, D, and K intake and IBD risk.

Methods: This study included 3,591 participants from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression were conducted to assess associations between vitamin C, D, and K intake and IBD risk while controlling for multiple confounders. Subgroup analyses were employed to test the robustness of the associations across participants with various characteristics. Additionally, restricted cubic spline (RCS) analysis was conducted to investigate potential nonlinear relationships.

Results: In the fully adjusted model, each 1 mcg increase in vitamin D intake was linked to an approximately 51% decrease in IBD risk (adjusted OR = 0.49, 95% CI: 0.25-0.98, p = 0.045). The benefit appeared stronger in women, individuals without hypertension, and non-smokers. No statistically significant associations were found between vitamin C or vitamin K intake and IBD risk. However, among individuals without diabetes, each 1 mcg increase in vitamin K intake was associated with an approximate 67% reduction in IBD risk (adjusted OR = 0.33, 95% CI: 0.12-0.94, p = 0.039). RCS analysis suggested a linear relationship between dietary micronutrient intake and IBD risk (vitamin D: p for nonlinearity = 0.127, p for overall = 0.015; vitamin C: p for nonlinearity = 0.984, p for overall = 0.937; vitamin K: p for nonlinearity = 0.736, p for overall = 0.434).

Conclusion: Increased vitamin D intake may reduce the risk of IBD, with more pronounced benefits in certain subgroups, highlighting the potential of vitamin D supplementation as a novel therapeutic approach for IBD prevention and management. Future well-designed studies should further test the therapeutic effects of vitamin D supplementation and investigate the associations of other dietary trace elements with IBD risk to better inform prevention and treatment approaches.

Background: Liver biopsy is a procedure whereby a biopsy needle is used to extract tissue from the liver parenchyma or focal lesions of the liver for pathological or microbiological examination. Percutaneous liver biopsy(PC-LB) is the most commonly employed and least expensive modality. However, it is associated with a significant risk of bleeding complications, which may potentially result in patient mortality. The objective of this study was to investigate the efficacy of Absorbable Gelatin Sponge sheet filler agent (AGS-SFA) in preventing bleeding complications during liver tissue biopsy and to validate a cost-effective surgical technique.

Methods: In this study, patients who underwent ultrasound-guided percutaneous liver tissue biopsy at our hospital were selected and randomly assigned to either an observation or control group. The observation group employed the use of AGS-SFA to fill the biopsy needle channel. Immediately following the biopsy procedure, the biopsy needle path was examined using Doppler ultrasound. The incidence of bleeding complications following biopsy and the associated factors influencing bleeding were analysed in the two groups.

Results: The observation and control groups were successfully biopsied, with a 100% success rate for both. The incidence of bleeding complications was significantly lower in the observation group than in the control group. Four factors, including fatty liver, prothrombin time, albumin and INR, were found to have a significant effect on biopsy bleeding in the control group.

Conclusion: The use of coaxial needles to inject AGS-SFA is an effective and economical procedure that significantly improves the safety of biopsy without increasing the burden of patient care.

Background: Various studies have shown that the controlling nutritional status (CONUT) score contributes to assessing the prognosis of cancer patients. This study aimed to establish a nomogram based on the CONUT score and several other important parameters based on patient age and tumor characteristics to accurately forecast the overall survival (OS) of patients with resectable gastric cancer (GC).

Methods: This study retrospectively recruited 404 individuals who received a potentially curative radical gastrectomy performed by the same group of surgeons at our medical center from January 2019 to December 2021. We used Cox regression analysis to identify independent prognostic factors influencing patients' OS. We establish a nomogram based on the outcomes of the multivariate analysis to forecast the 1, 2, and 3-year OS of GC patients.

Results: Univariate Cox regression analysis revealed that the age, body mass index (BMI), hemoglobin (HGB), serum albumin (ALB), Serum carcinoembryonic antigen (CEA), CONUT score, tumor size, pT stage, pN stage, nerve invasion, vascular invasion, tumor differentiation, and postoperative chemotherapy were prognostic indicators of postoperative OS in GC patients (all P < 0.05). Multivariate Cox regression analysis indicated that the age (P = 0.015), CONUT score (P = 0.002), pT stage (T3 vs T1: P = 0.011, T4 vs T1: P = 0.026), pN stage (N2 vs N0: P = 0.002, N3 vs N0: P < 0.001), nerve invasion (P = 0.021) were the independent risk factors. The nomogram based on the CONUT score, with a C-index of 0.792, enhanced the predictive ability of the TNM staging system alone, which had a C-index of 0.718 for OS.

Conclusion: The CONUT score can independently predict the OS for individuals with GC following surgery. The nomogram based on the CONUT score is a reliable tool for forecasting the postoperative survival of individuals with GC and may identify those patients wholesale benefit from a more aggressive treatment protocol.

Background: Thrombospondin type 1 domain-containing 7 A (THSD7A) expression, an angiogenesis-related protein, has been implicated in various aspects of cancer progression, reflecting its potential as a prognostic marker for various cancers. Therefore, we investigated the prognostic value of THSD7A expression in colorectal cancer (CRC).

Methods: A total of 95 patients with CRC were included. The patients were stratified into two groups according to THSD7A expression status determined by immunohistochemistry [negative (no staining), and positive (expression ≥ 1% of cancer cells)]. The overall survival (OS) of prognostic subgroups was estimated by Kaplan Meier method. The prognostic value of THSD7A expression was evaluated by univariable and multivariable Cox regression models.

Results: THSD7A was expressed in 42.1% of CRC patients. Patients with no THSD7A expression had inferior OS than patients with THSD7A expression (72.9 months vs. median OS was not reached, p = 0.001, respectively). Our multivariate analyses revealed that the independent predictors of OS were poor differentiation of tumor (HR: 2.603, p = 0.002), advanced stage (HR: 3.210, p < 0.001), and the loss of THSD7A expression (HR: 3.094, p = 0.001).

Conclusions: The present study showed that THSD7A expression could serve as a potential prognostic marker for CRC cancer. Further research is warranted to elucidate the exact underlying THSD7A-mediated cancer progression and to explore its clinical use in improving CRC prognostication and treatment strategies.

Background: In this survey, we compared endoscopists' approach to treatment of gastroesophageal varices (GOV) in patients with cirrhosis between developed and developing countries. The objective of this study was to undertake a comparative analysis of the approaches employed by endoscopists in developed and developing countries with regard to the treatment of GOV in patients with cirrhosis.

Methods: Between Jan 2019 to Aug 2019, we administered a questionnaire-based online survey internationally via e-mail. A total of 148 endoscopists from five countries were invited to participate in the survey, and 93 responses were received (response rate: 62.8%). The questionnaire covered several aspects: characteristics of the respondents, primary prophylactics, endoscopic therapy, and secondary prophylactics for acute variceal bleeding (AVB). The answers were compared between developed and developing countries using the chi-square test. For all tests, a P value of < 0.05 was considered significant.

Results: There was a significant difference between developed and developing countries in practice settings (P = 0.001), the years of independent gastroenterology or endoscopic practice (P = 0.036), treating non-hemorrhagic large gastric varices with medicine (P = 0.019), and selection of preferred initial endoscopic therapy for active gastric fundic variceal bleeding (P = 0.015). Notably, developed and developing countries did not significantly differ in terms of treatment of non-hemorrhagic esophageal varices (P = 0.076), initial endoscopic therapy for active gastric cardia variceal bleeding (P = 0.272), timing of secondary prophylaxis (P = 0.104), timing of endoscopy (P = 0.073), measures for secondary prophylaxis (P = 0.166), and basis for the selection of management preferences (P = 0.278).

Conclusion: There were some differences in the practice of endoscopists for GOV in patients with cirrhosis between developing and developed countries. We speculate that these differences may affect the costs, management of primary bleeding, and chances of rebleeding in GOV. Furthermore, the equipment and technical conditions of different hospitals may also significantly influence the endoscopist's choice of treatment modality. We hope that future studies will place greater emphasis on this aspect as continuing education of and providing updated equipment to endoscopists are of paramount importance.

Background: Pembrolizumab, a PD-1 inhibitor, has shown potential for treating advanced gastric and gastroesophageal junction (GEJ) cancer. This meta-analysis evaluates its efficacy and safety, alone or combined with chemotherapy, in this population.

Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Databases including PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science were searched up to October 31, 2024. Twelve studies comprising 4,069 patients were included. The primary outcomes were overall survival (OS) and progression-free survival (PFS); secondary outcomes included objective response rate (ORR), adverse events (AEs), and grade ≥ 3 AEs. Effect sizes were calculated using mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs).

Results: Pembrolizumab combined with chemotherapy significantly improved OS (MD = 1.92 months; 95% CI: 0.94 to 2.91) and ORR (MD = 11.05%; 95% CI: 6.29 to 15.82) compared to chemotherapy alone. Pembrolizumab monotherapy did not show a significant effect on OS (MD = 0.24 months; 95% CI: -1.15 to 1.63) and was associated with a significant reduction in PFS (MD = -2.28 months; 95% CI: -2.85 to -1.71) compared to chemotherapy alone. For safety, pembrolizumab monotherapy significantly reduced the risk of AEs (OR = 0.68; 95% CI: 0.57 to 0.81) and grade ≥ 3 AEs (OR = 0.39; 95% CI: 0.30 to 0.51) compared to chemotherapy. Pembrolizumab combined with chemotherapy did not significantly alter the risk of AEs (OR = 1.01; 95% CI: 0.90 to 1.13) or grade ≥ 3 AEs (OR = 1.12; 95% CI: 0.99 to 1.27) compared to chemotherapy alone.

Conclusion: Pembrolizumab combined with chemotherapy improves survival and response rates with a manageable safety profile in advanced gastric and GEJ cancers. Monotherapy shows limited efficacy, highlighting the need for combination strategies and patient selection.

Background: The RCT study on the efficacy of continuous active warming (CAW) in patients undergoing laparoscopic gastrectomy is scarce. The purpose of this research was to determine if a significant difference between continuous active warming (CAW) and active warming when body temperature is below 36 °C (BAW) in terms of incidence of intraoperative hypothermia and clinical rehabilitation in patients undergoing laparoscopic gastrectomy surgery.

Methods: A prospective, randomized and controlled trial with a sample of 62 patients who underwent elective total laparoscopic radical gastrectomy was conducted. Patients assigned to CAW group were warmed immediately since the surgical incision procedure, the others were warmed while the body bladder temperature dropped to 36 °C. The bladder temperature of the patient was recorded every 30 min during the operation. One-way ANOVA and ANOVA with repeated measures were used for comparisons between multiple groups, independent samples t-test for pair-wise comparisons.

Results: This study included a total of 62 patients, with 31 in each group. Among them, there were 52 males and 10 females, with an age range of 39 to 83 years. The mean age in the CAW group was (62.52 ± 8.15) years, and in the BAW group, it was (62.74 ± 9.20) years. The overall incidence of hypothermia was 16.13% in 62 patients who underwent elective total laparoscopic radical gastrectomy. The incidence of shivering and agitation after operation was both 3.23% in CAW group, and it was 32.26% and 29.03% in BAW group. Time from end of surgery to tracheal extubation in CAW group was significantly lower than BAW group. In addition, continuous active warming could shorten time to first postoperative flatus of patients and relieve postoperative pain.

Conclusion: Our study showed that continuous active warming in patients undergoing laparoscopic gastrectomy decreased the incidence of intraoperative hypothermia and contributed to postoperative rehabilitation.

Trial registration: It was permitted by the Ethics Committee of Xijing Hospital, Air Force Military Medical University, China. No. KY20212024-C-1 25/01/2021 and was registered with the Chinese Clinical Trial Registration Center (11/02/2025) ( www.chictr.org.cn ; registration number: ChiCTR2500097060).

Purpose: This study aimed to explore the clinical factors associated with lymph node metastasis (LNM) and survival in T2 colon cancer.

Method: Patients with T2 colon cancer and receiving radical surgery from 2017 to 2021 in our hospital were retrospectively enrolled. Patients were divided into two groups according to the LN status (LNM, non-LNM). The demographic, radiological, pathological, and survival data were collected and analyzed. Logistic regression was used to find the factors associated with LNM, and cox regression was adopted to identify factors contributing to poor survival. All the data analysis was performed by SPSS 22.0 and R.

Results: A total of 150 patients were included in this study, among them thirty were with LNM (20%). The LNM group had significantly higher incidence of lymph-vascular invasion (LVI) and perineural invasion. Besides, positive LNs had more proportion of irregular margin (P < 0.001) and heterogeneity (P < 0.001) than the negative ones. The multivariate analysis indicated that LVI and heterogeneity of LN were independent risk factors of LNM in T2 colon cancer. The disease-free survival (DFS) was 80% and 93.3% in the LNM and non-LNM group (P = 0.02), respectively. Besides, the overall survival (OS) was 92.9% and 95% in the LNM and non-LNM group (P = 0.103), respectively. The results indicated that elevated CA199 value and LNM were independent risk factors contributing to poorer OS and DFS.

Conclusion: The current data indicated LVI and LN heterogeneity were independent risk factors of LNM in T2 colon cancer. More extended surgery should be considered when these factors were detected.