BMC Gastroenterology最新文献

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide. However, there is a lack of cost-effective and accurate biomarkers to assess the degree of hepatic steatosis. Estimated small dense low-density lipoprotein cholesterol (EsdLDL-C), a calculated value derived from triglyceride (TG) and low-density lipoprotein cholesterol (LDL-C) levels, has emerged as a potential indicator. This study aimed to explore the relationship between EsdLDL-C and the severity of hepatic steatosis.

Methods: This single-center retrospective study estimated and directly measured small dense low-density lipoprotein cholesterol (sdLDL-C) in 1,969 patients who underwent serum lipid testing at Changzhou Third People's Hospital between January and July 2024. Among these, 461 patients diagnosed with MASLD were included in the study. These patients were further classified into mild (Mil) and moderate-to-severe (Mod-Sev) groups based on controlled attenuation parameter (CAP) values to explore the relationship between EsdLDL-C and the severity of hepatic steatosis.

Results: The correlation coefficient (R) between EsdLDL-C and DsdLDL-C was 0.837, with a bias of 0.223. Both EsdLDL-C (OR 1.095, 95% CI 1.029-1.180) and visceral fat area (VFA) (OR 1.019, 95% CI 1.010-1.028) were identified as independent risk factors for Mod-Sev steatosis compared to the Mil group. After adjusting for all confounders, patients with MASLD had a 1.155-fold increased risk of developing Mod-Sev hepatic steatosis for each unit increase in EsdLDL-C. Furthermore, EsdLDL-C demonstrated good predictive value for Mod-Sev steatosis in MASLD patients, with an area under the curve (AUC) of 0.825 (95% CI 0.784-0.867).

Conclusions: EsdLDL-C may serve as a practical and cost-effective biomarker for identifying high-risk MASLD patients.

Trial registration: The retrospective study was approved by the Ethics Committee of Changzhou Third People's Hospital (02 A-A20230015), and a waiver of informed consent was agreed to, as the data were obtained from medical records, and a waiver of informed consent would not have affected the participants.

Background: Primary liver cancer is a highly aggressive neoplasm with high incidence and mortality. Due to the high ability to metastasis, the 5-year survival rate of patients with primary liver cancer is poor.

Aim: To investigate the clinical value of systemic immunoinflammatory index (SII) in predicting recurrence and metastasis after interventional therapy in patients with primary liver cancer.

Methods: Total 186 patients with primary liver cancer were included and underwent Transcatheter arterial chemoembolization (TACE), and followed up for 3 years. Then, patients were divided into 110 cases in the recurrent metastasis group and 76 cases in the non-recurrent metastasis group according to presence or absence of recurrence and metastasis. Baseline data, SII and alpha-fetoprotein (AFP) levels were compared. Cox proportional hazards regression analysis was used to analyze factors affecting recurrence and metastasis. ROC curve was used to analyze SII and AFP levels in predicting recurrence and metastasis after interventional therapy in patients. Kaplan-Meier survival curves were used to evaluate the survival of patients.

Results: The SII index and AFP levels in the recurrence and metastasis group were higher than those in the non-recurrence and metastasis group (P < 0.001). Cox proportional hazards regression analysis confirmed tumor size ≥ 5 cm, presence of vascular tumor thrombus, presence of vascular invasion, no tumor capsule, SII index, AFP Levels were closely related to the recurrence and metastasis of patients with primary liver cancer (P < 0.05). ROC curve analysis showed that AUC of SII and AFP predicted recurrence and metastasis after intervention were 0.797 and 0.839, respectively, and the jointed AUC was 0.910. After a 3-years of follow-up, the overall survival rate of the 186 patients was 45.70% (85/186). Kaplan-Meier survival curve analysis showed that patients with high SII levels had shorter survival time than that of patients with low SII levels (P < 0.05).

Conclusion: Preoperative SII was closely associated with early recurrence and metastasis, and combined with AFP may have higher value in predicting recurrence and metastasis after interventional therapy in patients with primary liver cancer.

Background: The objective was to develop a biological age prediction model (NC-BA) for the Chinese population to enrich the relevant studies in this population. And to investigate the association between accelerated age and NAFLD.

Methods: On the basis of the physical examination data of people without noninfectious chronic diseases (PWNCDs) in Nanchang, Jiangxi, China, the biological age measurement method was developed via three feature selection methods (all-subset regression, LASSO regression (LR), and recursive feature elimination) and three machine learning algorithms (generalized linear model (GLM), support vector machine, and deep generalized linear model (deep GLM)). Model performance was evaluated by the coefficient of determination (R²) and mean absolute error (MAE). National Health and Nutrition Examination Survey (NHANES) data were used to verify the model's generalizability. The standardized age deviation (SAD) was calculated to explore the associations between age acceleration and the risk of morbidity and mortality from NAFLD.

Results: The physical examination data of 26,356 PWNCDs were collected in Nanchang. Among the 26 biomarkers, 26 and 24 biomarkers were associated with chronological age in the male and female groups, respectively (P < 0.05). The model combining the LR and deep GLM algorithms provided the most accurate measurement of chronological age (r = 0.58, MAE = 5.33) and was named the Nanchang-biological age (NC-BA) model. The generalizability of the NC-BA model was verified in the NHANES dataset (r = 0.57, MAE = 7.12). There was a significant correlation between NC-BA and existing biological age indicators (Klemera-Doubal method biological age (KDM-BA), PhenoAge, and homeostatic dysregulation (HD), r = 0.42-0.66, P < 0.05). The physical examination data of 1,663 and 1,445 patients with NAFLD from the Nanchang population and NHANES, respectively, were obtained. The SAD values of NAFLD patients were significantly greater than those of PWNCDs (P < 0.001). The SAD values of NAFLD patients with younger chronological ages were greater (P < 0.001). Higher SAD values were associated with a greater risk of all-cause mortality (HR = 1.73, P = 0.005).

Conclusions: This study provides a new model for biological age measurement in the Chinese population. There is a clear link between NAFLD and age acceleration.

Background and aim: Hyperalgesia and hypersensitivity in patients with Inflammatory Bowel Disease (IBD) can be related to central nervous system (CNS) changes, particularly in the pain pathways. The objective of this study was to examine the neuronal density of the cingulate cortex area (CC) and amygdala in an animal model of colitis.

Materials and methods: In this experiment, 13 male Wistar rats were subjected to study. Colitis was induced in the rats by transrectally administering 1 cc of acetic acid 3% under sedation with xylazine 10% (5 mg/kg). After 14 days of colitis, the rats were euthanized under high doses of anesthesia with ketamine (50 mg/kg), xylazine (10 mg/kg), and diazepam (2.5 mg/kg). Their brains were then removed surgically. Six-micrometer-thick brain slices were stained with cresyl violet, and the neuronal density of the amygdala, area 1 of the cingulate cortex area (CC1), and area 2 of the cingulate cortex area (CC2) was assessed via microscopic imaging.

Results: The mean ± standard deviation (SD) of the neuronal density in CC1 was significantly decreased in rats with colitis compared to the control group in both the right CC1 (43.53 ± 9.63 vs. 62.7 ± 11.89; p-value ˂ 0.001), and left CC1 (41.19 ± 9.05 and 63.1 ± 7.44; p-value ˂ 0.001). Additionally, the neuronal density of CC2 in the colitis group was found to be significantly lower than that of the controls in both the right CC2 (57.8 ± 13.23 vs. 87.95 ± 8.76; p-value ˂ 0.001), and left CC2 (55.42 ± 11.3 vs. 98 ± 8.99; p-value ˂ 0.001). Furthermore, the amygdala had a lower neuronal density in both hemispheres in rats with colitis in comparison to the controls bilaterally: right hemisphere (24.51 ± 5.49 and 36.3 ± 7.44; p-value = 0.360), and left hemisphere (24.52 ± 5.53 VS. 35.25 ± 5.6; P-value = 0.869).

Conclusion: This study showed that colitis can reduce the neuronal density within cortical areas and amygdala of both hemispheres. Considering the cingulate cortex's role in suppressing pain perception, any harm inflicted upon this region of the brain can has the ability to impact the cognitive and sensory aspects of pain.

Background: White light (conventional) colonoscopy (WLC) is widely used for colorectal cancer screening, diagnosis and surveillance but endoscopists may fail to detect adenomas. Our goal was to assess and synthesize overall and subgroup-specific adenoma miss rates (AMR) of WLC in daily practice.

Methods: We conducted a systematic review in MEDLINE, EMBASE, Cochrane Library, and grey literature on studies evaluating diagnostic WLC accuracy in tandem studies with novel-colonoscopic technologies (NCT) in subjects undergoing screening, diagnostic or surveillance colonoscopy. Information on study design, AMR overall and specific for adenoma size, histology, location, morphology and further outcomes were extracted and reported in standardized evidence tables. Study quality was assessed using the QUADAS-2 tool. Random-effects meta-analyses and meta-regression were performed to estimate pooled estimates for AMR with 95% confidence intervals (95% CI) and to explain heterogeneity.

Results: Out of 5,963 identified studies, we included sixteen studies with 4,101 individuals in our meta-analysis. One in three adenomas (34%; 95% CI: 30-38%) was missed by WLC in daily practice individuals. Subgroup analyses showed significant AMR differences by size (36%, adenomas 1-5 mm; 27%, adenomas 6-9 mm; 12%, adenomas ≥ 10 mm), histology (non-advanced: 42%, advanced: 21%), morphology (flat: 50%, polypoid: 27%), but not by location (distal: 36%, proximal: 36%).

Conclusions: Based on our meta-analysis, one in three adenomas could be missed by WLC. This may significantly contribute to interval cancers. Our results should be considered in health technology assessment when interpreting sensitivity of fecal occult blood or other screening tests derived from studies using WLC as "gold standard".

Background: Evidence indicated that KIF3C, a member of the kinesin superfamily of motor proteins, exhibits significant upregulation across various cancer types. Consequently, its impact on cancer advancement, including cell proliferation, migration, and invasion, is evident. Nonetheless, the comprehension of KIF3C's expression and role in colorectal cancer (CRC) remains limited.

Methods: Immunohistochemistry was used to evaluate the presence of KIF3C in CRC. The expression levels of KIF3C were assessed in CRC cells through western blot analysis (WB) and real-time polymerase chain reaction (RT-qPCR). KIF3C was knockdown and overexpressed using lentiviral vectors in the human CRC cell lines SW-480, HCT-116, and SW-620. In vitro experiments such as transwell assays, scratch wound healing, colony formation assays, counting cell CCK-8, and signaling pathway experiments were conducted to validate the KIF3C function in CRC cells.

Results: We demonstrated that KIF3C is highly expressed in cells and tissues of CRC, and this expression is closely associated with tumor prognosis. It was shown that KIF3C knockdown significantly inhibited tumor cell proliferation and migration in CRC cells. Additionally, the KIF3C signaling pathway experiment in this study promoted the CRC progression by upregulating the PI3K/AKT, Bax, and Bcl-2 pathways.

Conclusions: KIF3C knockdown promoted CRC proliferation, as it could be a potential therapeutic target for treating CRC.

Background: Poor bowel preparation has been a great problem of endoscopists for a long time. Low-residue diet (LRD) is often recommended on the day before colonoscopy. However, the quality of bowel preparation with LRD alone is suboptimal. The aim of our study was to examine whether patients who consumed LRD with oral nutritional supplements (ONSs) had higher quality of bowel preparation than patients who consumed LRD alone before colonoscopy.

Methods: An endoscopist-blinded, randomized controlled trial was conducted in inpatients who scheduled for colonoscopy with sedation. Patients were randomized to the non-ONS group and the ONS group. The primary outcomes were the rates of adequate bowel preparation measured by the Boston Bowel Preparation Scale (BBPS), the Ottawa Bowel Preparation Scale (OBPS) and the Colon Endoscopic Bubble Scale (CEBuS). The secondary outcomes were the adenoma detection rate (ADR), polyp detection rate (PDR), intubation time, withdrawal time and rates of adverse events.

Results: In both groups, 100 patients were analyzed. The rates of adequate bowel preparation measured by the BBPS and OBPS and PDR were significantly higher in the ONS group than in the non-ONS group (all P < 0.05). However, no significant differences were observed in the CEBuS scores, ADR, intubation time and rates of adverse events between the two groups (all P > 0.05). The withdrawal time was longer in the non-ONS group than the in the ONS group (P < 0.05).

Conclusions: LRD with ONSs helps increase the quality of bowel preparation. To help with colorectal cancer (CRC) screening, further studies are warrant.

Trial registration: [Chinese Clinical Trial Registry], [ChiCTR2400091660], [31/10/2024], [Retrospectively registered].

Background: Imbalance in the gut microbiota is a key factor in the pathogenesis of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis. The Dietary Index for Gut Microbiota (DI-GM) integrates the potential relationship between diet and gut microbiota diversity. This study aims to investigate the association between DI-GM and the risk of NAFLD and liver fibrosis, providing theoretical support for dietary intervention strategies.

Methods: This study utilized data from NHANES 2017-2020, including 6,181 eligible adult participants. The relationship between DI-GM and the risk of NAFLD and liver fibrosis was assessed using DI-GM quartiles, multivariate logistic regression, and restricted cubic spline (RCS) analysis. Subgroup analysis was performed to explore the predictive role of DI-GM in different populations. All analyses were weighted to ensure the representativeness of the results.

Results: DI-GM was negatively associated with the risks of NAFLD and liver fibrosis. As DI-GM scores increased, the risk of NAFLD and liver fibrosis significantly decreased (52.81%, 43.16%, 40.40%, and 31.98%, p < 0.05; 17.52%, 9.04%, 7.21%, and 6.78%, p < 0.05). Multivariate logistic regression analysis revealed that, in the unadjusted model (Model 1), for each unit increase in DI-GM, the risk of NAFLD decreased by 6.9% (OR = 0.931, 95% CI: 0.886-0.979, p < 0.001), while the risk of liver fibrosis decreased by 15.6% (OR = 0.844, 95% CI: 0.757-0.941, p < 0.05). In the quartile analysis, individuals in the highest DI-GM quartile (Q4) had a 58% lower risk of NAFLD compared to those in the lowest quartile (Q1) (OR = 0.42, 95% CI: 0.219-0.806, p < 0.001). The results remained significant even after adjusting for covariates. RCS analysis showed that DI-GM had a nonlinear relationship with the risks of NAFLD and liver fibrosis, with inflection points at scores of 2 and 5, indicating enhanced protective effects.

Conclusion: This study reveals a negative association between DI-GM and the risk of NAFLD and liver fibrosis, highlighting the potential role of healthy dietary patterns in the prevention and management of NAFLD and liver fibrosis through gut microbiota modulation, providing a theoretical basis for dietary interventions.

Background: This study aimed to compare the bowel cleansing efficacy, adverse reactions, and patient compliance of two low-volume bowel preparation regimens, sodium picosulfate (PICO) and 2 L polyethylene glycol electrolyte lavage solution (2 L PEG-ELS).

Methods: This single-center, prospective observational trial was conducted at the Gastrointestinal Endoscopy Center of The Third People's Hospital of Chengdu between May and October 2023. Patients undergoing colonoscopy were enrolled, with the primary outcome being the rate of adequate bowel cleansing, as assessed by the Boston Bowel Preparation Scale (BBPS) with three segments scoring ≥ 2. Secondary outcomes included polyp detection rate, adverse reactions, patient compliance, and the BBPS total and segment scores.

Results: A total of 5423 patients were included, divided into the PICO group (n = 739) and the 2 L PEG-ELS group (n = 4684) based on the bowel preparation regimen they chose. There were no statistically significant differences between the PICO and 2 L PEG-ELS groups in adequate bowel cleansing rate (92.2% vs. 91.3%, P = 0.437) and polyp detection rate (42.2% vs. 45.5%, P = 0.096). However, the PICO group achieved a better performance in the BBPS scores of the total [(6.90 ± 1.19) vs. (6.81 ± 1.14), P = 0.016] and the right colon [(2.15 ± 0.53) vs. (2.11 ± 0.51), P = 0.005] compared to the 2 L PEG-ELS group. In terms of adverse reactions, the 2 L PEG-ELS group reported more nausea (11.7% vs. 5.7%, P < 0.001) and the PICO group reported more sleep disturbances (24.5% vs. 14.6%, P < 0.001), but the willingness to repeat the procedure with the same regimen was similar high in the 2 L PEG-ELS and PICO groups (99% vs. 99.2%, P = 0.588).

Conclusion: In this prospective observational study, both PICO and 2 L PEG-ELS are safe and effective options for bowel cleansing in the Chinese population.

Background: Acute pancreatitis (AP) is a common cause of acute hospital admissions in digestive system diseases. In East Asia, hypertriglyceridemia is gradually emerged as the second most common cause of pancreatitis. Vigilance for recurrence and unplanned readmissions due to other causes is still necessary after discharge. studies on hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are scarce and mainly consists of retrospective studies.

Methods: This was a prospective cohort study of adult patients with first episode of HTG-AP from December 2019 to February 2021 who were followed up for two years. Unscheduled readmission after the index discharge was the primary outcome. The Cox proportional-hazards model, and the Fine and Gray's competing-risk model were applied to the analyses.

Results: Totally, 293 survival patients were followed-up after discharge. The overall unplanned readmission rate was 30.0% in two years. Among them, 60 (20.5%) patients were readmitted to hospital once, 16 (5.5%) were readmitted twice, and 13 (4.4%) were readmitted three times or more. In summary, a total of 143 cases of readmission information were collected during the follow-up period. The recurrence accounts for a significant 77.3% proportion and stands as the primary cause for readmission. Cox regression model favors infection (Hazard ratio [HR], 3.066; 95% confidence interval [CI], 1.192-7.888; P = 0.02) and age lower than 41.5 years old (HR, 3.157; 95% CI 1.883-5.292; P < 0.01) as independent risk factors for patient readmission by multivariate analysis. The competing-risk model support the similar results compared with the former.

Conclusion: Unplanned readmission of patients with hypertriglyceridemia-induced acute pancreatitis is common, especially for young patients with occurrence of any infection during hospitalization, and warrant further investigation.