BMC Gastroenterology最新文献

Objective: An exploration of the influence of probiotics combined with immune checkpoint suppressors and chemotherapeutic agents on digestive system function, intestinal immunity and prognosis in patients with metastatic colorectal carcinoma.

Methods: This was a quasi-experimental study. During March 2019 to March 2020, 96 patients with metastatic colorectal carcinoma were arbitrarily classified into control group (n = 48) and intervention group (n = 48). The control group received only immune checkpoint inhibitors or chemotherapy, while the intervention group received immune checkpoint inhibitors or chemotherapy, plus probiotic therapy. Survival and complication rates after 6 months, 12 months and 2 years of treatment were calculated. Intestinal barrier function, immune function and quality of life were analyzed before and after treatment.

Results: Ninety-six patients were recorded at the follow-up demonstrating superior survival in the intervention group after 6 months, 12 months and 2 years of therapy. D-lactate and diamine oxidase (DAO) levels were elevated in the intervention group after treatment, with smaller elevations (P < 0.05). The levels of Bifidobacterium and Lactobacillus were remarkably higher in the intervention group after treatment compared to the control group prior to and following therapy (P < 0.05). The amount of Enterococcus and Escherichia coli in the intervention group after treatment was obviously lower compared to the pre-treatment and control groups (P < 0.05). CD3⁺, CD4⁺, and CD4⁺/CD8⁺ levels were found to be higher in the intervention group (P < 0.05), while CD8⁺ levels were reduced in the intervention group (P < 0.05). All dimensions of the QLQC-30 scale were higher in the intervention group (P < 0.05). The incidence of complications such as nausea and vomiting, loss of appetite, bloating and diarrhea was considerably reduced in the intervention group (P < 0.05).

Conclusion: Immune checkpoint suppressors combined with chemotherapeutic agents or probiotic regimens can obviously enhance the prognosis of patients with metastatic colorectal carcinoma. This combination therapeutic strategy can balance the imbalanced intestinal flora, improve intestinal function, and lessen the incidence of adverse events, so it is worthy of clinical application and can lessen the incidence of adverse reactions.

Background: KRAS mutations in rectal cancer are associated with a conflict prognosis. This study aimed to compare clinicopathological outcomes of patients and tumor criteria between wKRAS and mKRAS, as well as overall survival in the two groups.

Methods: The research retrospectively analyzed a cohort of 193 patients who received surgical treatment for rectal adenocarcinoma between May 2015 and December 2023. The patients were categorized into two groups according to their KRAS status: wild-type KRAS (wKRAS) and mutant KRAS (mKRAS), with performing research on mKRAS ^G12D and mKRAS ^G13D mutation.

Results: The mKRAS group included 100 patients(51.8%) and had no significantly difference in age, sex, distance from anus, tumor node metastasis(TNM), lymphovascular invasion(LVI), grade differentiation, and perineural invasion(PNI), carcinoembryonic antigen(CEA) level than that in wKRAS group.KRAS^G12D group had significantly more poorer differentiation(9/34,26.5% vs. 10/93,10.7%,p = 0.046), PNI(24/34,70.6%vs.42/93,45.2%,p = 0.016) and higher TD(8/34,23.5% vs.8/93,8.6%,p = 0.035) respectively, p < 0.05. Compared with the wKRAS group, the mean OS of mKRAS group was worse(58.07 m vs.57.55 m), but had no significant difference(p = 0.0866). In comparison to the wKRAS group, the overall survival duration was notably reduced in the KRAS^G12D group (p = 0.0482), whereas no significant difference was observed in the KRAS^G13D group (p = 0.1848). Additionally, a COX survival analysis was conducted, revealing that KRAS^G12D, along with higher TNM stage, LVI, tumor deposits, and PNI, were all associated with a decrease in survival time for patients with rectal cancer; however, these factors did not reach statistical significance (p > 0.05).

Conclusion: The overall survival duration for wKRAS was superior to that of mKRAS; however, the difference between the two groups was not statistically significant. In contrast, the survival time for KRAS^G12D was significantly poorer than that for wKRAS, while no such difference was observed for KRAS^G13D.

Retrospectively registered: K2024-07-037.2024,7.

Objective: To investigate the effect of capecitabine on the sensitivity of oxaliplatin and on the level of transcription factor forkhead box P1 (FOXP1) and gamma-glutamyl transpeptidase (GGT) in patients with intermediate and advanced gastric cancer.

Methods: A total of 152 Patients with advanced gastric cancer who were continuously diagnosed and treated in our hospital were selected as the study objects. The general data were retrospectively analyzed. The patients in the control group received oxaliplatin, while the patients in the study group received capecitabine on the basis of the control group. The FOXP1 expression level was detected using immunohistochemistry. Serum levels of GGT were measured by chemiluminescence. Protein levels were detected by Western blot. The prognostic factors were analyzed by the COX regression model. The Kaplan-Meier survival curve was used to analyze the survival of gastric cancer.

Results: The effective rates (complete response, partial response, and stability) of the study group and the control group were 94.74% and 76.32%, respectively. Compared with adjacent normal tissues, the expression level of FOXP1 in gastric cancer tissues was lower (P < 0.05). After treatment, the average expression level of FOXP1 in the gastric cancer tissue of the study group was higher than the control group (P < 0.05). Moreover, lower FOXP1 expression was associated with lower overall survival (OS) (1-year survival and 3-year survival were 75.76% and 53.03%, respectively) (P < 0.05). Further analysis showed that capecitabine combined with oxaliplatin down-regulated the expression of DNA repair related-proteins and up-regulated the expression of key molecules of the apoptosis pathway, thus enhancing the killing effect of oxaliplatin on gastric cancer cells (P < 0.05). Both the 1-year and 3-year survival rates of the study group were higher than that in the control group (P < 0.05). The 1-year survival rate of 152 patients with gastric cancer was 84.87% (129/152) and the 3-year survival rate was 63.17% (96/152). Age, tumor-node-metastasis (TNM) stage, lymph node metastasis, chemotherapy regimen, FOXP1, and GGT levels were important factors in determining OS.

Conclusion: Capecitabine effectively enhanced the sensitivity of intermediate and advanced gastric cancer to oxaliplatin, improved the therapeutic effect and ameliorated the prognosis of patients.

Background: Liver diseases are a public health problem in developing regions, and the majority of them are asymptomatic. Evidence on the current burden of liver disease and associated context-specific risk factors is scarce in the study area, where various risk factors for liver disease, including khat chewing, smoking, and aflatoxin exposure, are common. This study was to assess the magnitude, patterns, and factors associated with liver disease among patients visiting governmental hospitals in eastern Ethiopia.

Methods: A facility-based cross-sectional study was conducted among randomly selected 388 clinically suspected adults for liver disease visiting a public hospital in Dire Dawa, Ethiopia. Data was collected using a combination of structured questionnaires, physical examinations, and investigations through interviews, medical chart reviews, liver enzymes, and the results of ultrasound examinations. Bivariable and multivariable logistic regression analyses were employed to determine the factors associated with liver disease. Candidate variables in bivariable analysis were selected based on p-values < 0.25, biological plausibility, and evidence of associations from previous studies. The level of significance was considered at a P-value < 0.05, and the adjusted odds ratio with a 95% confidence interval was reported.

Results: A total of 388 (92%) adults were included and liver disease was diagnosed among 295 (76%; 71.5-80.2) of the study participants, where chronic liver disease due to non-viral (65.1%) and viral causes (34.9%) were prevalent. The risk of liver disease was higher among females (AOR = 3.43; 1.80-6.55) and under grade twelve (AOR = 3.90; 1.95-7.82) compared to counterparts. Furthermore, alcohol consumption (AOR = 3.14; 1.33-7.32), khat chewing (AOR = 1.69; 0.91-3.15), a history of hospitalization (AOR = 4.20; 2.29-7.11), and a history of intestinal parasite infection (AOR = 1.17; 0.55-2.49) were found to be positively associated with an increased risk of liver disease among adults.

Conclusions: Liver disease detection rate was found to be high and could be associated with substance use (alcohol and khat), history of hospitalization, and worm infection, which can be incorporated into the prevention strategies of liver diseases.

Background: Digestive system carcinomas (DSC) constitute a significant proportion of solid tumors, with incidence rates rising steadily each year. The systemic inflammation response index (SIRI) has been identified as a potential prognostic marker for survival in various types DSC. This meta-analysis aimed to evaluate the prognostic value of SIRI in patients with DSC.

Methods: We conducted a comprehensive literature search of PubMed, Web of Science Core Collection, Embase, and Cochrane Library databases, searching for studies published from inception to May 30, 2023. Eligible studies included cohort studies that assessed the association between pre-treatment SIRI levels and DSC prognosis. We extracted and synthesized hazard ratios (HRs) and 95% confidence intervals (CIs) using STATA/SE 12.0, stratifying HRs based on univariable and multivariable analysis. Due to substantial heterogeneity, we applied a random-effect model for all pooled analyses. The primary outcome of interest was the overall survival (OS), while secondary outcomes included progression-free survival (PFS), disease-free survival (DFS), time to progression (TTP), and disease specific survival (DSS). Publication bias was evaluated using Begg's test and Egger's tests.

Results: A total of 34 cohort studies encompassing 9628 participants were included in this meta-analysis. Notable heterogeneity was observedin the OS (I² = 76.5%, p < 0.001) and PFS (I² = 82.8%, p = 0.001) subgroups, whereas no significant heterogeneity was detected in the DFS, TTP, and DSS subgroups. Elevated SIRI was found to be significantly associated with shorter OS (HR = 1.98, 95% CI: 1.70-2.30, tau² = 0.0966) and poorer PFS (HR = 2.36, 95% CI: 1.58-3.53, tau² = 0.1319), DFS (HR = 1.80, 95% CI: 1.61-2.01, tau² < 0.0001), TTP (HR = 2.03, 95% CI: 1.47-2.81, tau² = 0.0232), and DSS (HR = 1.99, 95% CI: 1.46-2.72, tau² < 0.0001). Furthermore, an increase in SIRI following treatment was linked to reduced OS, TTP, and DFS, while a decrease in SIRI post-treatment corresponded with improved OS, TTP, and DFS compared to baseline levels.

Conclusions: Elevated SIRI is associated with poorer clinical outcomes in patients with DSC. This index may serve as a valuable prognostic biomarker, offering a promising tool for predicting survival in DSC patients.

Prospero: REGISTRATION NUMBER: CRD42023430962.

Purpose: The relationship between high-output stoma (HOS) and low anterior resection syndrome (LARS) was previously unclear. This study investigated the association between HOS and major LARS in rectal cancer patients with preventive stoma.

Methods: We conducted a retrospective analysis of 653 rectal cancer patients who underwent prophylactic ileostomy reversal after low anterior resection at the Fourth Hospital of Hebei Medical University between 2018 and 2021. Patients were categorized into HOS and non-HOS groups based on stoma output within 3 months before surgery. Major LARS was assessed using the LARS score. The association between HOS and major LARS was analyzed using multifactor logistic regression models, subgroup analyses, and smoothing curve fitting methods.

Results: Among the 653 patients, 53 (8.1%) experienced HOS, and 81 (12.4%) developed major LARS after stoma closure. The HOS group exhibited a significantly higher risk of major LARS compared to the non-HOS group (P < 0.001). Multivariate logistic regression indicated that HOS was associated with a 210% increased risk of major LARS (OR: 3.10; 95% CI: 1.56, 6.14; P = 0.001). Subgroup analysis revealed that this association was more pronounced in older patients (age > 60), those without hypertension, with N0-N1 staging, a history of chemotherapy, and longer stoma closure intervals (Q3, Q4).

Conclusion: HOS is significantly associated with major LARS in rectal cancer patients, particularly in certain clinical subgroups. These findings suggest the need for careful management of HOS to potentially reduce LARS occurrence after stoma closure.

Background: CA19-9 is a classical tumor marker and plays an important role in the diagnosis of biliary and pancreatic cancer. However, a few cases reported that the tumor maker CA19-9 is abnormally elevated in patients with calculous cholecystitis, but the relation between severity of calculous cholecystitis and serum CA19-9 level are still unknown.

Methods: Total 105 calculous cholecystitis patients from first hospital were collected and divided into high serum CA19-9 group(high group, n = 35) and normal serum CA19-9 group(normal group, n = 70). Perioperative data including blood cell count, inflammatory markers, liver function, imaging and operation-related parameters from these patients were collected for analysis and verified with second group of 105 calculous cholecystitis patients from second hospital. Besides, the gallbladder specimens were collected for immunohistochemical staining and mRNA sequencing.

Results: Abdominal pain occur in more than 90% patients in high group, which is similar with that of normal group. But WBC, neutrophils count, NLR, CRP level and IL-6 level is higher in high group than that of normal group. In addition, the gallbladder wall thickness, the operation duration and the operation conversion rate is also higher in high group, which is verified from second hospital. Higher expression of CA19-9 was found by immunohistochemical staining in gallbladder specimen and more autophagy pathway related genes enriched in high group.

Conclusions: This study demonstrated that higher level of serum CA19-9 correlates with more severe cholecystitis in calculous cholecystitis patients for the first time, which will provide helpful information for clinical practice and basic research in related field.

Background: Maintaining effective disease control in patients with inflammatory bowel disease (IBD) is both a significant goal and challenge. Drawing on the Common-Sense Model of Self-Regulation (CSM) and related research, this study investigates how IBD activity status influences disease control through both direct and indirect pathways.

Methods: A cross-sectional survey was conducted among 310 IBD patients who attended a tertiary general hospital, the leader of the IBD Alliance Group in Chongqing City, between March and August 2024. Structural equation modeling (SEM) was utilized to assess the role and magnitude of various influencing factor pathways. Relying on AMOS26 software, the path effects and magnitude of various factors in the disease control process were analyzed using structural equation modeling (SEM) to test hypothetical models.

Results: A total of 306 valid questionnaires were collected, with a mean IBD-control score of 12.14 ± 3.665. There was a negative link between disease activity and IBD-control (P < 0.01) and a positive correlation between chronic illness management self-efficacy, IBD self-management behavior, and IBD-control (P < 0.01). Path analysis showed that IBD activity negatively predicted IBD control (β = -0.715, P = 0.01). Chronic disease management self-efficacy partially mediated this relationship (β = -0.071, P = 0.012). A significant chain-mediated pathway was identified, where IBD activity affected IBD control via self-efficacy guided by self-management behavior (β = -0.025, P = 0.007). However, the pathway where IBD activity influenced control through self-efficacy and subsequently self-management behavior showed only marginal significance (P = 0.074).

Conclusion: Effective self-management behaviors improve IBD control. High disease activity may reduce chronic disease management self-efficacy, impairing IBD control. Positive feedback loops involving self-management behaviors and enhanced self-efficacy are crucial for better disease control, as patients who perceive positive outcomes are more motivated to maintain these behaviors.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease and can affect individuals without producing any symptoms. We aimed to explore the value of serum sirtuin-1 (Sirt-1) in the diagnosis of MASLD.

Methods: This case-control study analyzed data collected from 190 individuals aged 20 to 60 years. Anthropometric parameters, demographic information, and serum biochemical variables-including glycemic parameters, lipid profiles, liver enzymes, and Sirt-1 levels-were assessed. The correlation between serum Sirt-1 and biochemical variables was examined using Pearson's correlation coefficient. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic value of serum Sirt-1 in the context of MASLD.

Results: Serum Sirt-1 levels was significantly lower in the MASLD group (p < 0.001) and was inversely correlated with serum insulin (r = -0.163, p = 0.025), HOMA-IR (r = -0.169, p = 0.020) and triglyceride (r = -0.190, p = 0.009) and positively correlated with serum levels of high-density lipoprotein cholesterol (HDL-C) (r = 0.214, p = 0.003). The area under the curve (AUC) of Sirt-1 to predict the presence of MASLD was 0.76 (p < 0.001, 95% CI: 0.69, 0.82) with a sensitivity of 78.9, specificity of 61.1, positive predictive value (PPV) of 67.0%, and negative predictive value (NPV) of 74.0%. The optimal cutoff, determined using Youden's index, was 23.75 ng/mL. This indicates that serum Sirt-1 levels below 23.75 ng/mL may be indicative of MASLD.

Conclusions: The present study demonstrated that serum Sirt-1 levels were significantly lower in patients with MASLD. Furthermore, these levels were correlated with various metabolic parameters, including insulin resistance and the serum lipid profile. A serum Sirt-1 level below the cutoff of 23.75 ng/mL exhibited a significant association with the presence of MASLD, suggesting its potential utility in identifying patients with this condition.

Background: Oxidative stress is associated with functional bowel disorders. The Oxidative Balance Score (OBS) is used to represent the overall level of oxidative stress experienced by an individual. Sex differences are exhibited in the occurrence of constipation and diarrhea. This population-based study aimed to examine the association between the OBS, constipation, and diarrhea, among adults in the United States (US), stratified by sex.

Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) database spanning from 2007 to 2010, a cross-sectional study including 4,462 participants (2,386 males and 2,076 females) was performed to assess the relationship between the OBS, constipation, and diarrhea, among adult men and women in the US. Constipation and diarrhea were identified according to bowel frequency and stool type, as outlined in the Bowel Health Questionnaire. The independent variable was the OBS based on 20 types of dietary and lifestyle components. We conducted a binary logistic regression subgroup analysis by sex, and a univariate subgroup analysis; and used a restricted cubic spline (RCS) to illustrate the relationship between the OBS and abnormal bowel health.

Results: After adjusting for all covariates, a multivariate binary logistic regression analysis revealed that the OBS was negatively correlated with constipation in males [odds ratios (OR) (95% confidence intervals (CI)): 0.937 (0.888, 0.988), P = 0.017], and diarrhea in females [OR (95%CI): 0.951 (0.916, 0.987), P = 0.009]. RCS analysis identified a negative linear trend between OBS and constipation in males (P for non-linearity = 0.63), as well as between OBS and diarrhea in females (P for non-linearity > 0.05).

Conclusion: The current study found a negative correlation between the OBS and the risk of constipation in males, along with diarrhea in females. Oxidative stress, gut microbiota, and sex differences may be associated with intestinal dysfunction. These findings suggest that antioxidant-rich dietary modifications may be an effective strategy for preventing constipation in males and diarrhea in females.