BMC Gastroenterology最新文献

Background: Irritable bowel syndrome (IBS) is one of the most common brain-gut interaction disorders, characterized by chronic abdominal pain, altered bowel habits, and heightened stress responses that significantly affect patients' psychological functioning and quality of life. Given that chronic stress plays a central role in the onset and maintenance of IBS symptoms, identifying psychological resources that promote adaptation and well-being is crucial. The present study aimed to examine the mediating role of resilience in the relationship between cognitive flexibility and psychological well-being among patients with IBS.

Method: This descriptive-correlational study employed a structural equation modeling approach. The statistical population included all IBS patients who referred to the Gastrointestinal Health Center at Al-Zahra Hospital in Isfahan in 2024. A sample of 300 patients was selected using convenience sampling. Data were collected using the Psychological Well-Being Scale, Cognitive Flexibility Inventory, and Connor-Davidson Resilience Scale, and analyzed using SPSS and AMOS version 28.

Findings: Results showed that cognitive flexibility and resilience significantly predicted psychological well-being, and that resilience mediated the relationship between cognitive flexibility and psychological well-being. These findings highlight the importance of resilience and cognitive flexibility as protective psychological resources that help patients manage stress and improve well-being in the context of IBS.

Background: Gastroesophageal reflux disease (GERD) is a common chronic digestive disorder with a growing epidemiological footprint worldwide. However, the specific characteristics and burden of GERD in East Asia, particularly in China, remain insufficiently documented.

Methods: This study conducted a comprehensive assessment of the incidence, disability-adjusted life years (DALYs), and prevalence of GERD in China and East Asia using data from the Global Burden of Disease (GBD) project from 1990 to 2021. We applied cross-national comparisons, longitudinal temporal analyses, and subgroup analyses to examine the disease burden in East Asia, particularly in China. Additionally, cutting-edge analytical methods were employed to forecast the disease burden trends from 2022 to 2046.

Results: In 2021, the East Asian recorded 396,791,145 new cases of GERD, accounting for 12.24% of the global total. China contributed 9.99%, 9.88%, and 9.85% of the global incidence, DALYs, and prevalence, respectively, establishing itself as the highest number of cases in East Asia. From 1990 to 2021, China experienced rising crude rates of incidence, DALYs, and prevalence, alongside a significant rise in total case numbers. The GERD burden was more pronounced in Chinese women than in men, particularly within the age groups of 50-59 and 30-34. The incidence for middle-aged and younger adults surpassed those reported in Japan and Republic of Korea. Projections suggest that, in contrast to the stable age-standardized incidence anticipated in Japan and Republic of Korea, both the total number of cases and the age-standardized incidence of GERD in China are expected to continue rising until 2046. Notably, a strong positive correlation was observed between the Socio-Demographic Index (SDI) and both age-standardized DALYs (r = 0.822, p < 0.001) and incidence(r = 0.824, p < 0.001).

Conclusion: GERD poses a substantial and growing public health challenge in East Asia, particularly in China, with high crude incidence, DALYs, and prevalence estimates. The burden is higher among young and middle-aged women in China, underscoring the need for targeted clinical and preventive strategies in this demographic.

Background: Colorectal cancer (CRC) is one of the most prevalent malignant diseases worldwide and displays significant heterogeneity. The aim of this study was to investigate the application of machine learning algorithms to incorporate preoperative laboratory tests for predicting the 5-year recurrence risk in patients with stage III colon cancer (CC) postsurgery.

Methods: This study included two patient cohorts: the Zhejiang Cancer Hospital CC cohort (ZCC set, n = 290), which served as the training cohort, and the Dongyang CC cohort (DYC set, n = 125), which was utilized as an external testing cohort. Univariate analysis was initially performed on the 48 preoperative laboratory tests and 15 clinical and pathological features within the training cohort to pinpoint potential predictors. Features with a p value less than 0.05 were incorporated, and six machine learning models-logistic regression, random forest, XGBoost, support vector machine (SVM), back propagation neural network (BP NET), and K-nearest neighbour (KNN)-were employed to develop a model for predicting the 5-year recurrence risk in patients with stage III colon cancer. The prediction efficacy was assessed by calculating the area under the curve (AUC) of the machine learning model using the external test dataset, and comparisons were performed via the DeLong test. Ultimately, the Shapley additive explanations (SHAP) algorithm was applied to rank feature importance and compute the SHAP values for each feature, which were then visualized.

Results: Univariate analysis identified 10 laboratory tests and 6 clinical and pathological features that were incorporated into six machine learning models. The random forest model exhibited the highest predictive performance in the test cohort, with an AUC of 0.845. Logistic regression closely trailed, achieving an AUC of 0.823. The DeLong test revealed that the predictive performance of the random forest model was comparable to that of logistic regression and outperformed the other models. SHAP analysis indicated that the most important feature for predicting the 5-year recurrence risk of stage III colon cancer was perineural invasion, followed by FIB and then PT.

Conclusions: A machine learning model constructed using preoperative laboratory tests and clinical and pathological features can assist in predicting the 5-year recurrence risk of patients with stage III colon cancer. This model provides potential reference values for the clinical development of individualized treatment strategies.

Background: Relative fat mass (RFM) is a simple anthropometric indicator of body fat. Although its association with hepatic steatosis has been examined in previous studies, its predictive value for the more severe stages of liver disease, specifically advanced hepatic fibrosis (AHF) and cirrhosis, has not been systematically evaluated. This study aimed to explore the associations between RFM and the presence of MASLD, AHF, and cirrhosis.

Methods: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2023. Logistic regression models were constructed to estimate the associations of RFM with the prevalence of MASLD, AHF, and cirrhosis, adjusting for relevant demographic, lifestyle, and clinical covariates. To facilitate clinical interpretation, odds ratios (ORs) were calculated per standard deviation (SD) increase in RFM. Restricted cubic spline (RCS) models were applied to explore the nonlinear relationships. Subgroup analyses were conducted to assess robustness, and mediation analyses were performed to evaluate the potential indirect effects of diabetes and dyslipidemia.

Results: Among 5,327 participants, 2,453 had MASLD, 230 had AHF, and 93 had cirrhosis. When analyzed per SD increase in RFM, the adjusted ORs were 1.93 (95% CI: 1.64-2.27) for MASLD, 1.98 (95% CI: 1.45-2.71) for AHF, and 1.83 (95% CI: 1.33-2.52) for cirrhosis, indicating substantial clinical relevance. Nonlinear associations were observed in spline analyses. The associations were generally consistent across subgroups. Mediation analysis indicated partial mediation by diabetes and dyslipidemia.

Conclusion: This study suggests that higher RFM is positively and nonlinearly associated with MASLD, and more importantly, with the risk of AHF and cirrhosis. Given its simplicity and non-invasiveness, RFM may serve as a practical adjunct screening indicator for identifying individuals at elevated risk of advanced fibrosis within the MASLD spectrum. Longitudinal studies are needed to validate these findings.

Background: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder, affecting 10%-15% of the global population, characterized by symptoms such as abdominal pain, bloating, and altered bowel habits. A low fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP) diet has shown promise in managing IBS symptoms. This study evaluates the combined impact of continuity care guided by Orem's Self-Care Model with a low FODMAP diet on gut microbiota composition and IBS symptoms.

Methods: A retrospective cohort study included 196 patients with IBS, divided into conventional treatment (n = 84) and low FODMAP care (n = 112) groups. The intervention spanned six weeks, integrating Orem's Model to enhance dietary adherence. Outcomes were assessed using IBS Symptom Severity Scale (IBS-SSS), gut microbiota analysis via qPCR, and quality of life measures (IBS-QOL, SF-36).

Results: Baseline characteristics between the groups showed no significant differences. Post-intervention, the low FODMAP group experienced significant improvements in IBS-SSS scores, reporting reduced abdominal pain severity (P = 0.01), frequency (P = 0.002), bloating (P = 0.006), and greater bowel movement satisfaction (P = 0.003). Gut microbiota analysis revealed increased Bifidobacterium and Lactobacillus, and decreased Enterococcus levels in the low FODMAP group (P < 0.001). SF-36 scores indicated elevated physical functioning (P < 0.001), role physical (P = 0.002), and mental health (P = 0.005) domains. Notably, IBS-QOL scores improved markedly, especially in dysphoria (P = 0.003), worry about symptoms (P = 0.001), and food avoidance (P = 0.004).

Conclusion: The integration of a low FODMAP diet with continuity care guided by Orem's Self-Care Model significantly alleviates IBS symptoms and improves gut microbiota composition and quality of life.