BMC Gastroenterology最新文献

Background: Needle knives are the most commonly used instrument during endoscopic treatment for gastric submucosal tumors (SMTs). The conventional resection method involves fully extending the needle-shaped knife head, which allows it to more easily penetrate the muscularis propria while stripping the muscle layer of the tumor. We propose a semi-blunt dissection method that can effectively reduce damage to the muscularis propria.

Methods: A total of 113 patients who underwent endoscopic resection of gastric SMTs originating from the muscularis propria were retrospectively analyzed. The conventional method consisted of 73 patients; The other group consisted of 40 patients underwent the semi-blunt dissection method.

Results: There was no significant difference between the two groups in age, sex, or lesion location. The intraoperative operational variable, the maximum diameter of gastric muscularis propria damage, was significantly greater in conventional method group than the other group (1.06 ± 0.48 cm vs. 0.46 ± 0.09 cm, p < 0.001). There was also no significant difference between the two groups in terms of histological diagnosis, postoperative complications and the percentage of histologically positive resection margins.

Conclusion: The semi-blunt dissection method has certain advantages in the endoscopic resection of gastric tumors originating from the muscularis propria, including a small extent of gastric muscularis propria damage and a shorter postoperative hospital stay.

Introduction: This cross-sectional study was conducted to examine the association between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) and metabolic dysfunction-associated steatotic liver disease (MASLD), particularly in populations with obesity and type 2 diabetes (T2D).

Methods: The analysis included 3784 participants who were 20 years and older, using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018. The prevalence of MASLD was determined using multivariable logistic regression analysis, which calculated odds ratios (ORs) and 95% confidence intervals (CIs). Conducted was an analysis employing a smooth curve fitting approach to explore the potential nonlinear association between NHHR and MASLD. Subgroup analyses were performed based on age, sex, body mass index (BMI) and T2D status to evaluate the robustness of the results, with interaction tests conducted.

Results: NHHR showed a consistently positive association with MASLD across all models. In the fully adjusted model, compared with the low NHHR group, participants in the middle and high NHHR group were associated with higher prevalence of MASLD (OR = 1.51, 95%CI = 1.25-1.83, p < 0.001, OR = 1.97, 95%CI = 1.62-2.41, p < 0.001, respectively). This positive relationship was significant across all subgroups, confirming a robust association between NHHR and MASLD.

Conclusions: This cross-sectional study found a significant linear positive relationship between NHHR and MASLD, which remained significant across different age, sex, BMI and T2D groups. These findings suggest that NHHR may have the potential to serve as a predictor for screening MASLD in populations with obesity or T2D.

Background: Sepsis is a serious consequence of acute pancreatitis (AP) that requires immediate detection and treatment. Triglyceride-glucose (TyG) index demonstrated predictive ability for a number of diseases. In an effort to enhance clinical care and early warning systems, this study examined the association between the TyG index and sepsis risk with the aim of improving clinical care and early warning systems.

Methods: Patients who were first admitted and satisfied the diagnostic criteria for acute pancreatitis (ICD-9: 5770; ICD-10: K85) were chosen from the MIMIC-IV database, excluding those lacking essential demographic or laboratory data. Using the Sepsis-3.0 criteria. Depending on whether they had sepsis or not, patients were divided into sepsis group and non-sepsis group. Utilizing the formula ln[(triglycerides mg/dl) × (glucose mg/dl)/2], the TyG index was calculated. The Boruta algorithm and Xgboost model were used for feature selection in order to pinpoint the important variables affecting results. Logistic regression with univariate and multivariate factors were used to assess the association between the TyG index and the start of sepsis after admission.

Results: Twenty-eight thousand AP patients were screened in all, among which 661 patients were ultimately included in the study. Of these, 228 patients (34.5%) developed sepsis. The TyG index was shown to have a significant correlation (OR = 1.891, 95% CI: 1.408-2.555) with sepsis, and an increased risk of sepsis was observed with an increase in the TyG index (all P values for trend < 0.001). Subgroup analysis showed that among patients of various ages, sexes, and with hypertension and diabetes, there was a positive association between the TyG index and the probability of sepsis (all P values for trend < 0.05). The combination of the TyG index with clinical indicators had an area under the curve (AUC) of 0.828 (0.794-0.862), which was significantly greater than that of the TyG index alone (0.657 [0.613-0.701]), with a statistically significant difference (Z= -7.362, P < 0.001).

Conclusion: In patients who have AP, the TyG index is substantially linked to a higher risk of sepsis, and when combined with clinical markers, its predictive power for sepsis is enhanced. The findings imply that the TyG index might be a helpful detection for determining which AP patients are at a higher risk of developing sepsis.

Background: Steatotic liver disease (SLD) was a newly proposed disease category derived from metabolic dysfunction-associated fatty liver disease (MAFLD). MAFLD and sarcopenia were independent risk factors for mortality. We aimed to evaluate the impacts of SLD subtypes, MAFLD, and sarcopenia on mortality.

Methods: A total of 6543 subjects were identified from the National Health and Nutrition Examination Survey 1999-2006 with the latest Linked Mortality file. Hepatic steatosis, advanced fibrosis, and sarcopenia were determined by the laboratory- and anthropometry- based fatty liver index and fibrosis-4 index, and dual-energy X-ray absorptiometry-based appendicular skeletal muscle mass index, respectively. Associations of SLD subtypes, MAFLD, and sarcopenia with mortality were estimated using the weighted Cox proportional hazards model.

Results: During a mean follow-up time of 15.7 years, 1567 (16.7%) deaths occurred including 494 (4.9%) deaths from cardiovascular diseases and 372 (4.1%) from cancer. The all-cause mortality rates of MAFLD, metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-associated liver disease (MetALD), other aetiology SLD, MASLD without sarcopenia, and MASLD with sarcopenia were 21.0%, 19.8%, 30.2%, 30.9%, 19.2%, and 75.5%, respectively. MAFLD increased the risk of all-cause mortality (hazard ratio [HR] 1.26, 95% confidence interval [CI] 1.00-1.59). MASLD predicted all-cause mortality (HR 1.17, 95% CI 1.03-1.33) but this prediction became insignificant after adjustment for metabolic risks. In contrast, MetALD and other aetiology SLD were significantly associated with all-cause mortality (HR 1.83, 95% CI 1.21-2.76; HR 2.50, 95% CI 1.82-3.44, respectively), predominantly associated with cancer-specific mortality (HR 2.42, 95% CI 1.23-4.74; HR 2.49, 95% CI 1.05-5.90, respectively). MASLD with sarcopenia increased the risk of all-cause mortality by almost twice (HR 2.19, 95% CI 1.37-3.49) and further coexisting advanced fibrosis additively increased mortality (HR 3.41, 95% CI 1.92-6.05).

Conclusion: SLD definition identified a more homogeneous group with metabolically hepatic steatosis at higher risks of mortality. MASLD or MASLD-related advanced fibrosis and sarcopenia additively increased mortality.

Background: Patients with suspected acute gallstone disease typically undergo abdominal ultrasound. MRCP is often used for patients with abnormal LFTs, potentially making ultrasound unnecessary for this group. Despite high inter-reader variability in MRCP interpretation, new AI technologies may automate and standardize detection and measurement.

Method: Patients with suspected acute gallstone disease and abnormal liver function tests were randomized into two diagnostic pathways, direct MRCP and standard care. Admission data, healthcare resource use, and clinical outcomes were recorded. National Health Service national 20/21 tariffs were used to calculate and compare healthcare costs. MRCP scans were subsequently analysed using MRCP + software (Perspectum Ltd).

Results: 27 participants were enrolled over 12 months, 15 to direct MRCP and 11 to standard care. One patient was excluded from analysis. Mean patient time to diagnostic report and mean per patient associated direct medical cost and mean cost to diagnosis for the direct MRCP and standard of care group was 2.53 days, £449.54, and £647 respectively for the direct MRCP group and 4.18 days costing £742.06 and £896 for standard care. MRCP + analysis of 11 scans showed significant differences between the groups in terms of gallbladder volume (80.2mm³ gallstone present versus 30.1mm³ without, p = 0.018 and cystic duct median width (4.6 mm gallstone present versus 2.7 mm without, p = 0.042).

Conclusions: Direct MRCP may be a feasible and potentially cost-effective diagnostic strategy for patients with suspected acute gallstone disease and deranged LFTs. Automated measurement of MRCP parameters shows promise in detecting obstruction. Larger trials are warranted to assess this potential.

Clinical trial number: This study is registered with ClinicalTrials.gov (NCT03709030). Registration date: October 17, 2018.

Background: Colorectal cancer (CRC) is the second deadliest carcinoma across the globe and has been known as a multi-factor induced-disease. Emerging research have demonstrated that bacterial colonization may contribute to the initiation and promotion of the CRC. The presence of Fusobacterium nucleatum (F. nucleatum) and Bacteroides fragilis (B. fragilis) in the gut is associated with the development of CRC. In this study, the prevalence of F. nucleatum and B. fragilis among CRC patients has been assessed worldwide through a systematic review and meta-analysis.

Methods: The extensive search was performed using "Fusobacterium nucleatum", "Bacteroides fragilis", "Colorectal cancer" and all relevant keywords. Then, a systematic paper screening was done following a comprehensive search in Embase, Web of Science, and PubMed databases while the time range was limited between the years 2000 and 2024. Afterwards, statistical analysis was performed utilizing the comprehensive meta-analysis (CMA) software (version 2.0, Biostat, USA).

Results: According to the meta-analysis of prevalence studies, the prevalence of F. nucleatum among 19 countries and B. fragilis among 10 countries were indicated to be 38.9% (95% CI 33.7-44.3%) and 42.5% (95% CI 34.4-51.1%), respectively, among the CRC patients. It was then revealed that Asia had the highest prevalence of F. nucleatum while most of the B. fragilis isolates in CRC cases were reported in European countries. Moreover, the data suggested that the most common comorbidity observed among the CRC cases was diabetes.

Conclusion: Our results emphasized the high prevalence of F. nucleatum and B. fragilis in CRC patients. Based on this meta-analysis review, regulating the gut microbiota in CRC patients seemed to be a promising approach to improving the efficacy of CRC therapy.

Background: This study aims to compare the effectiveness and safety of traditional endoscopic submucosal dissection (ESD), endoscopic submucosal tunneling dissection (ESTD), and endoscopic submucosal dissection with C-shaped incision (ESD-C) in the treatment of superficial esophageal cancer and precancerous lesions, providing reference and guidance for the treatment of esophageal cancer.

Methods: A retrospective analysis was conducted on the clinical data of patients who underwent ESD (n = 96), ESTD (n = 103), and ESD-C (n = 98) for superficial esophageal cancer or precancerous lesions between January 2017 and December 2022. Through comparative analysis, the effectiveness and safety of the three surgical methods were evaluated, and the risk factors for postoperative esophageal stricture were explored.

Results: In terms of total operative time and dissection time, the ESD group > ESTD group > ESD-C group; in terms of dissection speed, the ESD group < ESTD group < ESD-C group; in terms of dissection area, the ESD group < ESTD group and ESD-C group; and in terms of wound treatment time, the ESD group > ESTD group and ESD-C group. In terms of surgical outcomes, the en bloc resection rate was 100% in all three groups, with complete resection rates of 86.84%, 90.79%, and 88.16% in the ESD, ESTD, and ESD-C groups, respectively. The risk factors for postoperative esophageal stricture included dissection area, circumferential proportion of the lesion, and injury to the muscularis propria.

Conclusion: Among the three surgical approaches, ESD-C demonstrated superior performance in operative time, resection speed, and procedural efficiency. Increased circumferential involvement of the lesion, larger resection area, and greater injury to the muscularis propria were associated with a heightened risk of postoperative esophageal stricture.

Background: Clostridioides difficile infection (CDI) in inflammatory bowel disease (IBD) has been associated with poor clinical outcomes. The relationship between biologic therapy and CDI is controversial. We aimed to assess whether biologic therapy increases CDI risk among IBD patients, to identify factors associated with increased CDI risk, and to characterize CDI episodes in our population.

Methods: We included patients diagnosed with IBD (IBD-cohort) and immune-mediated inflammatory rheumatic diseases (Rheuma-cohort). Risk factors for CDI were assessed using a logistic regression model. We also estimated the incidence rate of CDI for each biologic.

Results: We included 1866 patients: 1041 from the IBD-cohort and 825 from the Rheuma-cohort. The diagnosis of IBD was the major risk factor for developing CDI in the overall population (OR: 18.29, CI 95%: 5.59-59.80, p < 0.001). Within the IBD-cohort, patients with ulcerative colitis had an increased risk for CDI compared to Crohn's disease (OR:2.00, 95% CI: 1.18-3.42, p = 0.011). Although the subgroup of IBD patients receiving biologics showed a higher incidence of CDI compared to unexposed IBD patients, biologic therapy was not an independent risk factor for CDI in the logistic regression model; nevertheless, patients who received 3 or more biologic agents had a significantly higher risk for CDI (OR: 3.09, CI 95% 1.13-8.47, p = 0.028).

Conclusions: IBD significantly increases the risk of CDI among patients treated with biologic therapy; although such treatments do not seem to individually increase the risk, the number of biologics received may be a new predictor of CDI.

Background: Small nucleolar RNA host gene (SNHG) family were reported involved in various biological processes and may be used as a promising prognostic marker in esophageal cancer (EC). A meta-analysis was performed to investigate the relationship between SNHG expression and prognosis of EC in this study.

Methods: Relevant databases were browsed to obtain suitable publications. Hazard ratio (HR) with 95% confidence interval (CI) were extracted to explore the association between SNHG expression and EC prognosis. Odds ratio (OR) with 95%CI were extracted to assess the association between SNHG expression and other clinicopathological parameters. Sensitivity analysis and publication bias were performed to explore the reliability and robustness of the results. Bio-informatics has been explored in order to confirm our conclusions more comprehensively.

Results: 16 studies comprising 1229 patients were enrolled. The results showed that increasing SNHG expression indicated worse overall survival (HR: 1.392, 95%CI = 0.876-1.908). SNHG2, SNHG5, and SNHG12 were down-regulated, while other SNHGs were up-regulated in EC. In populations with low expression of SNHG2, SNHG5, and SNHG12, increasing SNHG expression predicted a favorable cancer prognosis (HR: 0.511, 95%CI = 0.322-0.700). Conversely, in populations with high expression of other SNHGs, SNHG expression indicated poor prognosis (OR: 2.340, 95%CI = 1.744-2.936). Elevated SNHG expression also implied advanced TNM stage (OR 1.578, 95%CI = 1.273-1.956) and lymph node metastasis (OR: 1.533, 95%CI = 1.205-1.950).

Conclusion: Increased expression of SNHG2, SNHG5, and SNHG12, and decreased expression of other SNHGs tended to have a favorable prognosis in patients with EC. These findings suggest that SNHG may serve as a prognostic marker and therapeutic target for EC.