BMC Gastroenterology最新文献

Background: Upper gastrointestinal bleeding (UGIB) in pediatric patients is a significant clinical concern requiring prompt diagnosis and management. This study aims to provide a descriptive analysis of the common causes of UGIB in pediatric patients in Kerman, Iran.

Methods: A cross-sectional study was conducted at Afzalipour Hospital, Kerman, from January 2022 to December 2023. All pediatric patients under 18 years with UGIB were included. Data on demographics, clinical presentation, and endoscopic findings were collected and analyzed.

Results: A total of 120 patients were included, with a mean age of 8.8 ± 4.7 years. Hematemesis was the predominant presenting feature (57.5%). All patients underwent endoscopy, with a diagnostic yield of 88.4%. Gastric erosion was the most common cause of UGIB (33.3%), followed by esophageal varices (13.3%). The etiology varied across age groups, with Mallory-Weiss syndrome being the second most common cause in infants. Blood transfusion was required in 31.67% of patients.

Conclusion: This study highlights the common causes and clinical features of pediatric UGIB in Kerman, Iran. Gastric erosion (33.3%) was the most frequent cause, and endoscopy achieved a high diagnostic yield (88.4%). Blood transfusion was necessary in 31.67% of patients. These findings emphasize the need for age-specific diagnostic strategies and reflect regional differences in UGIB etiology.

Background: Single nucleotide polymorphisms (SNPs) in patatin-like phospholipase domain-containing protein 3 (PNPLA3), transmembrane 6 superfamily member 2 (TM6SF2) and membrane bound O-acyltransferase domain containing 7 (MBOAT7) genes were reported to be strongly associated with non-alcoholic fatty liver disease (NAFLD) pathogenicity among different populations. We investigated whether these SNPs are associated with prognostic factors and genetic biomarkers of non-alcoholic steatohepatitis (NASH)-related hepatocellular carcinoma (HCC) in the Sri Lankan context.

Methods: We conducted an exploratory study to evaluate the prevalence of five SNPs (PNPLA3 rs738409, PNPLA3 rs2281135, PNPLA3 rs2294918, TM6SF2 rs58542926 and MBOAT7 rs641738) as genetic risk factors for NASH-HCC pathogenicity. We genotyped 48 NASH-HCC patient samples collected at a clinical setting using a minisequencing method. Impact of each SNP with tumor prognostic factors such as nodularity, tumor size and AFP (alpha-feto protein) level was analyzed using chi square test. We also analyzed the expression of micro RNA-122 (miR-122) in serum and leukocyte telomere length via quantitative real-time PCR. Associations between each SNP with micro RNA-122 (miR-122) expression level and leukocyte telomere length of NASH-HCC patients were analyzed using one-way analysis of variance (ANOVA) test and independent t test. Relationships among tested SNPs and some well-established HCC risk factors such as age, BMI, gender, diabetes status and the cirrhotic stage were also analyzed using chi square test, independent t-test and One-way ANOVA test.

Results: Our analyses demonstrated significant associations between PNPLA3 rs2281135 variant and tumor nodularity. Also, PNPLA3 rs2281135 and PNPLA3 rs2294918 variants were significantly associated with miR-122 expression levels of NASH-HCC patients. Further, age and body mass index (BMI) were significantly associated with PNPLA3 rs2281135 variant in our study cohort.

Conclusion: We found that in the Sri Lankan NASH-related HCC cohort, some PNPLA3 variants (rs2281135 and rs2294918) correlate with tumor nodularity, higher miR-122 expression, and distinct demographic features such as age and BMI. Our work highlights the role of specific SNPs in tumor aggressiveness, contributing to the precision screening for HCC in NASH patients.

Background: Muscle cramps are among the common debilitating complications of liver cirrhosis. Since this complication lacks effective treatments, we aimed to evaluate the effectiveness of L-carnitine supplementation in reducing the frequency, duration, and severity of muscle cramps in patients with liver cirrhosis.

Methods: The present retrospective cohort was conducted on adult patients referred between November 2022 and December 2023 to a tertiary referral hospital in Shiraz, Iran. Patients with confirmed liver cirrhosis who had muscle cramps ≥ 4 times per month without other secondary etiologies for muscle cramps were evaluated for inclusion. They were included if they had taken an oral L-carnitine supplement of 1000 mg/day for one month and had available medical records of the assessment of their cramps before and one month after starting the supplement.

Results: From the 702 patients screened, 195 (27.8%) had muscle cramps, and 91 (13.0%) met the inclusion criteria. The respective median age and cirrhosis duration (interquartile range (IQR)) of the included patients were 61.0 (16.0) and 2.0 (3.0) years, and 48 (53%) were male. Median daily, weekly, and monthly cramp frequency and severity were higher in females (P-values < 0.05). We noted reduced daily, weekly, and monthly frequency of the cramps, their severity, and their mean duration following L-carnitine supplementation (respective median (IQR) of absolute percentage change: 100 (100.0), 60 (88.33), 50 (75.0), 50 (77.5), and 40.0 (44.58); P-values < 0.001). Additionally, daily, weekly, and monthly cramps completely resolved in 29 (31.9%), 21 (23.1%), and 13 (14.3%) after supplementation. BMI correlated with the percentage change of all the mentioned cramp indices (P-values < 0.05), and age correlated with the percentage change in the monthly frequency of cramps (P-value = 0.042). Changes in cramp indices did not differ significantly between males and females.

Conclusions: L-carnitine supplementation seems to be a promising therapeutic option for cramps in liver cirrhosis. Further studies with control groups and larger samples are required to confirm this finding.

Objectives: Computed tomography (CT) colonography is increasingly recognized as a valuable modality for diagnosing colorectal lesions, however, the interpretation workload remains challenging for physicians. Deep learning-based artificial intelligence (AI) algorithms have been employed for imaging diagnoses. In this study, we examined the sensitivity of neoplastic lesions in CT colonography images.

Methods: Lesion location and size were evaluated during colonoscopy and a large-scale database including a dataset for AI learning and external validation was created. The DICOM data used as training data and internal validation data (total 453 patients) for this study were colorectal cancer screening test data from two multicenter joint trial conducted in Japan and data from two institutions. External validation data (137 patients) were from other two institutions. Lesions were categorized into ≥6 mm, 6 to 10 mm, and ≥10 mm. During this study, we adopted a neural network structure that was designed based on the faster R-CNNs to detect colorectal lesion. The sensitivity of detecting colorectal lesions was verified when one and two positions were integrated.

Results: Internal validation yielded sensitivity of 0.815, 0.738, and 0.883 for lesions ≥6 mm, 6 to 10 mm, and ≥10 mm, respectively, with a false lesion limit of three. Two external validation produced rates of 0.705 and 0.707, 0.575 and 0.573, and 0.760 and 0.779 for each lesion category. Combining two positions for each patient in calculating the sensitivity resulted in significantly improved rates for each lesion category.

Conclusions: The sensitivity of CT colonography images using the AI algorithm was improved by integrating evaluations in two positions. Validation experiments involving radiologists who can interpret images as well as AI to determine the auxiliary diagnosis can reduce the workload of physicians.

Objective: With the rising incidence of MASLD, extensive drug research has been conducted in clinical trials. The study examined the design principles and research objectives of MASLD therapeutics, in order to offer guidance to clinical trial participants and decision makers.

Methods: By searching the clinical research trial data registered on clinicaltrials.gov platform, 1209 interventional clinical trials were screened. These trials were subsequently evaluated based on clinical stage, trial design, intervention modalities, outcome metrics, and other pertinent factors.

Results: A total of 1,209 trials were included, of which 199 were registered from 2000 to 2012 (16.46%) and 1010 were registered from 2013 to 2024 (83.54%), reflecting the growing body of research on MASLD. Regarding the intervention model type, single-group designs were employed in 232 (19.19%) trials, and parallel designs were employed in 873(72.21%). A total of 13 trials were early phase 1 (1.08%), 152 (12.57%) were phase 1, 34 (2.81%) were phase 1/phase 2, 301 were phase 2 (24.90%), 19 (1.57%) were phase 2/phase 3, 72 (5.96%) were phase 3, and 84 (6.95%) were phase 4. Within these trials, the three primary clinical outcomes for drug interventions were hepatic histological improvement, hepatic fat content and adverse events. Furthermore, 140 drug interventional trials with results for therapeutic purposes (This accounted for 88.61% of the 158 drug interventional trials with results) primarily aimed to improve MASLD through mechanisms such as metabolic and energy balance, inflammatory and immunomodulatory, and lipid reduction, targeting primarily PPAR, FXR, ACC and GLP-1.

Conclusion: This study suggests the basic characteristics of global MASLD clinical trial design, and the current global interventional clinical trials are mainly focused on drug-related treatments, and drugs to improve inflammation and metabolism are still the first choice for MASLD drug intervention studies.

Background: Depression is common in people living with Inflammatory Bowel Disease (IBD). Depression rates increase with active disease and are linked to poorer clinical outcomes. Previous studies investigating the relationship between contemporaneous IBD disease activity and depression are often poorly controlled, use small samples and/or rely on self-reported measures of disease activity. Depression and self-reported disease activity (SRDA) are linked to increased healthcare usage, however, objective inflammation is rarely statistically controlled. The primary aim was to understand how self-reported disease activity and inflammation are related to depression. Secondary aims included assessing the relative influence of self-reported disease activity, inflammation and depression on healthcare usage.

Methods: This was a cross-sectional analysis of baseline data collected as part of a randomised controlled trial (trial registration no: ISRCTN71618461) of a digital treatment for symptom self-management in IBD (n = 599). Bivariate associations of demographic and clinical variables with depression were conducted to identify relevant covariates. Multiple linear regressions assessed (i) the relationships between depression (Patient Health Questionnaire-9 (PHQ-9)), SRDA (IBD-Control) and intestinal inflammation (faecal calprotectin (FCP)) and (ii) whether these variables explained variance in healthcare usage and economic indicators.

Results: Depression was significantly predicted by SRDA (β = -0.82, p < 0.001) but not FCP, with the model explaining 37% of the variance in depression (F(2,596) = 175.1, p < 0.001). FCP was only weakly associated with SRDA (r = -0.16, p < 0.001). Depression was independently associated with visits to primary care (β = 0.19, p < 0.001), IBD secondary care (β = 0.13, p < 0.001), IBD-related A&E attendance (β = 0.10 p < 0.05) and the impact of IBD on productivity (β = 0.24 p < 0.001) in the last 3 months.

Conclusions: Depression was related to SRDA but not FCP. Depression was also associated with healthcare usage even when SRDA and inflammation were statistically controlled. Routinely assessing and treating depression in IBD alongside managing inflammation may improve symptoms for patients and reduce healthcare costs.

Background: Gastric cancer (GC) is a pressing global health concern, with prognosis intricately linked to the tumour stage and tumour microenvironment, especially, the presence of immune cells. Notably, CD8 + T cells play a pivotal role in the anti-tumour immune response, prompting investigations into their correlation with GC survival. This study aimed to investigate the intricate interplay between CD8 + T cells, particularly within the context of CXCR6, and survival outcomes in patients with GC.

Methods: Utilising datasets from The Cancer Genome Atlas, Gene Expression Omnibus, and Tumor Immune Dysfunction and Exclusion, the study employed xCell and Weighted Gene Co-expression Network Analysis to assess CD8 + T cell infiltration and identify key gene clusters. The prognostic significance of CXCR6 was evaluated via immunohistochemical staining of a GC tissue microarray.

Results: High CD8 + T cell infiltration correlated with improved survival in patients with GC. CXCR6 was identified as a prognostic gene and its expression was predominantly observed in CD8 + T cells. CXCR6 expression positively correlated with improved overall and disease-free survival. Furthermore, CXCR6 expression was associated with an immunoreactive microenvironment.

Conclusion: This study established that high CD8 + T-cell infiltration is related to CXCR6 expression, making it a key factor in predicting a favorable GC prognosis. The role of CXCR6 in shaping the tumour microenvironment and its potential utility in immunotherapy response prediction highlights its significance in GC management.

Background: Chronic liver disease is an on-going loss of liver structure and functions that lasts for at least six months. About 1.5 billion population suffered with this devastating disease worldwide.

Objectives: The aim of this study is to assess the treatment outcome and associated factors in patients with chronic liver disease at Bahir Dar, North West Ethiopia.

Method: A retrospective cross sectional study was conducted in both governmental and private hospitals of Bahir Dar city from January to August 2024. All patients with liver disease for at least six months and treated for their specific causes and/or complications were included. Descriptive statistics was employed to explain socio-demographic and relevant clinical characteristics. Binary logistic regression was employed to determine associated factors with poor treatment outcome. Texts, tables and charts used to present statistically and/or clinically significant results. A p-value of < 0.05 was considered statistically significant.

Result: A total of 213 medical records of chronic liver disease patients were reviewed. Most of the study participants (72.8%) were male and resided in rural area (63.8%). Viral hepatitis was the most frequent (60.0%) etiology followed by parasitic (23.0%) and alcohol misuse (11.5%). The percentage of patients with chronic liver disease who experienced poor treatment outcomes was 39.0% and 54.2% were not taking medications specifically tailored to their condition. Stages of chronic liver disease (AOR = 2.68; 95%CI: 1.50-4.76, p = 0.001), carcinoma status (AOR = 2.68; 95%CI: 1.07-6.68, p = 0.035) and treatment duration (AOR = 0.38; 95%CI: 0.15-0.98, p = 0.045) were independent predictors for poor treatment outcome.

Conclusion: The overall treatment outcome of chronic liver disease in our study was inadequate. Decompensated stages of cirrhosis, cellular carcinoma and shorter treatment duration were significant factors of treatment failure. Timely initiation of appropriate therapy is warranted to improve the treatment outcome of chronic liver disease patients.

Introduction: Gastrointestinal infections represent a worldwide public health problem. In Colombia, the incidence reaches 21.4 cases per 1,000 inhabitants. Given the limitations of traditional diagnostic methods in terms of sensitivity and specificity, the gastrointestinal panel (GIP) has emerged as a promising tool, allowing rapid detection of 22 pathogens. This study aimed to describe the clinical and microbiological characteristics of immunosuppressed and immunocompetent adult patients with diarrhea and the influence of the gastrointestinal panel in their treatment in a high-complexity hospital in Colombia.

Materials and methods: A cross-sectional observational study was carried out including 350 adult patients treated at the Fundación Valle del Lili hospital between 2021 and 2022. Demographic and clinical variables, GIP findings and treatment were analyzed by univariate and bivariate analysis. We compare immunocompromised and immunocompetent adult patients using Chi-square tests, Fisher's F test for qualitative variables, Student's t-test, and the Mann-Whitney U test for quantitative variables. A significance level of 5% was applied to demonstrate the significance of the variables in all the tests used.

Results: The results showed that 52% were men, with an average age of 52 years. 72.0% presented acute diarrhea, being inflammatory in 60.1%. 39.1% of the patients were immunosuppressed, mainly transplant recipients (31.3%). 53% of the GIPs were positive, with up to 5 pathogens per sample. Bacteria were detected in 80%, viruses in 14.4%, and parasites in 5.5%. The most frequent bacteria were enteropathogenic E. coli (43.0%), enteroaggregative E. coli (18.6%), and C. difficile (17.4%). Norovirus was the predominant virus (67.7%) and Cryptosporidium the most common parasite (41.7%). A higher frequency of Vibrio spp. was observed in non-immunosuppressed patients (p = 0.004) and of enterotoxigenic E. coli in immunosuppressed patients. 41.0% of patients received antibiotic/antiviral therapy, 83% empirically. GIP influenced the treatment of 56.7% of patients, with a 90.0% recovery rate.

Conclusion: This study confirms that GIP is a valuable diagnostic tool in the management of adult patients with diarrheal disease, particularly in immunocompromised patients. In our setting it is still a costly and difficult to access test, which makes it necessary to standardize the indications for its application. Future studies could evaluate its cost-effectiveness in our context.

Background: Upper gastrointestinal bleeding (UGIB) is a prevalent and severe complication of cirrhosis, often resulting from esophagogastric variceal bleeding (EVB). This condition poses significant life-threatening risks. Once bleeding occurs, the risk of recurrent episodes substantially increases, further compromising liver function and worsening patient outcomes. This study aims to identify risk factors for UGIB in cirrhotic patients using clinical examination data and to develop a non-invasive predictive model to improve diagnostic precision and efficiency.

Methods: Based on the inclusion and exclusion criteria, the study included 140 cirrhotic patients hospitalized at the First Affiliated Hospital of Nanjing Medical University between June 2022 and May 2023, who experienced UGIB within six months after discharge. These patients were compared with 151 cirrhotic patients hospitalized at the same hospital during the same period, who were discharged within six months without experiencing UGIB. General characteristics of the patients during hospitalisation, laboratory parameters on admission, and liver and spleen stiffness were retrospectively collected, and a retrospective case-control study was conducted. All patients were randomly assigned to the training and validation sets in a ratio of 7:3. Independent factors associated with UGIB were identified by univariate analysis, multivariate logistic regression analysis, and stepwise regression analysis, on the basis of which a predictive model was developed. The model's performance was assessed via receiver operating characteristic (ROC) curve and decision curve analysis (DCA) and was compared with established prognostic models, including the Child-Pugh and MELD scores.

Results: The study analyzed 291 patients with cirrhosis, of whom 208 were allocated to the training set and 83 to the validation set. Independent predictors were identified, and predictive models were constructed using multivariate logistic regression analysis, and stepwise regression analysis in the training set, followed by validation in the validation set. The stepwise regression analysis identified ascites, spleen stiffness, albumin, fibrinogen, total cholesterol, and total bilirubin as independent predictors of UGIB (P < 0.05). These variables were incorporated into the predictive model. The area under the curve (AUC) for UGIB prediction was 0.956 in the training set and 0.909 in the validation set, demonstrating strong predictive performance. Furthermore, comparative analysis using ROC and DCA demonstrated that the developed model outperformed established scoring systems, such as the Child-Pugh score and the MELD score.

Conclusion: Ascites, spleen stiffness, albumin, fibrinogen, total cholesterol and total bilirubin as independent predictors of UGIB in cirrhotic patients.