BMC Gastroenterology最新文献

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.

Objectives: Lactate clearance (LC) has emerged as a potential prognostic marker in critically ill patients. However, its role in predicting massive transfusion (MT) requirements in upper gastrointestinal bleeding (UGIB) patients remains unclear. This study aimed to evaluate the predictive value of LC for MT requirements in patients with UGIB.

Methods: This retrospective study included 452 patients diagnosed with UGIB between September 2021 and September 2023. Patients were divided into MT and non-MT groups, with MT defined as ≥ 10 units of red blood cell transfusion within 24 h or ≥ 4 units within 1 h. LC was calculated as [(Initial lactate - 1-hour lactate)/Initial lactate] × 100. Appropriate statistical analyses were performed to evaluate the predictive value of LC for MT.

Results: A total of 33 patients (7.3%) required MT, whereas 419 (92.7%) did not. LC was significantly lower in the MT group (p < 0.001). ROC analysis revealed that LC had an area under the curve (AUC) of 0.840 (95% CI: 0.799-0.880), with a cutoff value of 30% (sensitivity: 87.9%, specificity: 74.0%). When combined with the Glasgow-Blatchford score (GBS), the diagnostic accuracy improved further (AUC = 0.880, 95% CI: 0.855-0.920).

Conclusion: Lower LC was associated with a higher likelihood of MT in UGIB patients. When combined with the GBS, LC may support early risk stratification during initial assessment. However, given the retrospective design, these findings should be interpreted cautiously and require external validation in prospective multicenter studies before clinical implementation.

Objective: Although gastric secretory dysfunction is common in H.pylori-associated gastropathy, the precise mechanisms underlying these functional alterations across different H.pylori antibody subtypes remain incompletely elucidated. This cross-sectional clinical observational study aimed to systematically investigate the associations between specific H.pylori antibody subtype infection status and multiple gastric functional parameters, thereby elucidating potential differences in their impact on gastric secretory function.

Methods: A total of 2,618 patients were included in this analysis. Serum levels of pepsinogen I (PGI), pepsinogen II (PGII), the PGI/PGII ratio (PGR), gastrin-17 (G-17), and H.pylori antibody subtypes were measured. A cross-sectional study design was employed to analyze baseline characteristics and serological data.

Results: Compared to the H.pylori-positive group, the H.pylori-negative group demonstrated significantly higher PGI (P = 0.020) and PGR (P < 0.001) levels, while PGII levels were markedly lower (P < 0.001). In the H.pylori subtype analysis, both H.pylori(I) and H.pylori(II) groups exhibited elevated PGII levels compared to the negative group, whereas PGR showed a progressive decreasing trend: H.pylori(I) < H.pylori(II) < H.pylori(-) (P < 0.001). Furthermore, both infected groups had significantly higher G-17 levels than the H.pylori(-) group (all P < 0.001). Males showed higher PGI levels in the infected groups, while in the H.pylori(-) group, multiple parameters (PGII, PGI, G-17) were elevated in males compared to females (P < 0.05). Patients aged ≤ 60 years had lower PGI and PGII levels but higher PGR (P < 0.05). Correlation analysis further indicated that G-17 was positively correlated with PGII and negatively correlated with PGR (P < 0.05).

Conclusions: H.pylori infection characteristically alters gastric functional serum markers in a virulence-dependent manner. These patterns biologically reflect the continuous pathological process from gastric mucosal inflammation to atrophy. Our findings underscore the clinical relevance of integrating H.pylori subtyping with gastric function assessment in gastric cancer risk screening, providing a novel perspective for the precise identification of high-risk individuals.

Background: Colorectal cancer (CRC) ranks third in incidence and fourth in cancer-related mortality worldwide. It typically begins as benign polyps that may progress to malignancy through cumulative genetic alterations. Inflammatory bowel disease (IBD) is a major risk factor for CRC, and Mycobacterium avium subspecies paratuberculosis (MAP) has been implicated in its pathogenesis and may also contribute to CRC development, particularly in regions with MAP-infected livestock.

Methods: In this case-control study which included 147 participants, we analyzed 74 patients with colorectal conditions, encompassing both precancerous and cancerous types, alongside 73 healthy controls (HCs). The Participants underwent colonoscopy at a clinical center in Golestan province, and provided informed consent and relevant health data. Exclusion criteria included recent antibiotic use and a history of gastrointestinal disease. Genomic DNA was extracted from intestinal mucus samples and analyzed using nested PCR.

Results: In our study, the prevalence of MAP was significantly higher in precancerous (46.7%) and cancerous patients (57.1%) compared to HCs (13.3%, p < 0.0001), suggesting a possible association with disease progression that warrants further investigation.

Conclusion: The study highlights a strong association between MAP and colorectal neoplasia, especially in patients with precancerous and cancerous conditions. Despite no notable differences in lifestyle factors between groups, MAP's prevalence points to its potential influence on CRC progression. This warrants further investigation into MAP's role in CRC, particularly in regions with MAP-infected livestock, for public health insights and prevention strategies.