Journal of gastrointestinal and liver diseases : JGLD最新文献

Proton pump inhibitors (PPIs) one of the most prescribed drugs worldwide, inhibit acid secretion in the stomach by irreversible hydrogen/potassium adenosine triphosphatase (H+/K+ ATPase) blocking. Currently conventional PPIs in markets are mainly in racemic forms (containing both R- and S- forms). It has been suggested that the beneficial effects of racemic PPIs mostly depend on one of the enantiomers, and a drug containing pure enantiomers might be superior to racemic PPIs. Enantiomers are mirror image stereoisomers of a molecule. In this article, we aim to analyze the comparative studies of the enantiomers of PPIs with non-racemic counter-parts and to assess whether enantiomers, as suggested by certain studies and primarily promoted by some pharmaceutical companies, demonstrate superior efficacy.

Burning mouth syndrome (BMS) is a chronic nociplastic pain condition of unknown etiology, predominantly affecting women and highly comorbid with depression and anxiety. This narrative review proposes a comprehensive model integrating the significant role of the oral and intestinal microbiomes in BMS pathology. We explore how microbial dysbiosis compromises barrier functions, leading to systemic and neuroinflammation, and subsequently modulates key brain networks involved in pain processing and emotional regulation. Evidence suggests that dysbiosis within the oral microbiome (e.g., increased Streptococcus, Rothia, Bergeyella, Granulicatella, Neisseria) and/or the intestinal microbiome contributes to BMS pathology. This dysbiosis can compromise oral and intestinal barrier functions, leading to the systemic dissemination of bacterial components and inflammatory mediators. These factors induce neuroinflammation, which directly influences and dysregulates key brain networks such as the default mode network and salience network, crucial for pain processing and emotional regulation. The vagus nerve serves as a critical bidirectional communication pathway within this axis. Preliminary studies indicate potential therapeutic benefits of probiotics (e.g., Lactobacillus reuteri in BMS), but large-scale evidence is still emerging. The pathology of BMS, intertwined with depression and anxiety, can be significantly influenced by the oral and intestinal microbiomes. Dysbiosis contributes to chronic systemic and neuroinflammation, driving maladaptive changes in brain networks and neurotransmitter systems. While promising, the field is nascent, requiring further causal studies, detailed mechanistic insights, and robust clinical trials to establish the full therapeutic potential of microbiome-targeted interventions.

Background and aims: Until recently, the only available treatment option for hepatitis D virus (HDV) was the off-label use of interferon, which is associated with limited efficacy and considerable side effects. The approval of the first HDV-direct antiviral, bulevirtide (BLV), has introduced a targeted therapeutic option for patients with chronic hepatitis delta. We assessed the clinical efficacy of BLV in our HDV patients.

Methods: We conducted a retrospective analysis of all patients diagnosed with HDV infection in our department over the past 10 years. For statistical analysis, we performed multivariate analysis of variance, MANOVA.

Results: 26 patients tested positive for HDV antibodies (17 developed chronic hepatitis delta). Eleven patients received BVD. At treatment initiation, liver cirrhosis was present in three patients in the bulevirtide group (MELD-Na: 9-10; Child-Pugh: 5-7) and in three patients in the no bulevirtide group (MELD-Na: 13-18; Child-Pugh: 5-8). Over 12 months of follow-up, bulevirtide recipients showed reductions in alanine aminotransferase (ALT; mean baseline 88 U/L vs 59 U/L; controls 230 U/L vs 206 U/L; MANOVA between-subject effect: p<0.05), aspartate aminotransferase (AST; 68 U/L vs 56 U/L; controls 208 U/L vs 151 U/L; p<0.05), bilirubin (0.74 mg/dL vs 0.65 mg/dL; controls 1.48 mg/dL vs 1.17 mg/dL; p<0.005), HDV-RNA (1,323,182 copies/mL vs 36,975 copies/mL; controls 416,825 copies/mL vs 17,914,733 copies/mL; p<0.05) a statistically significant time-by-group interaction was found for both Child-Pugh scores (p<0.0001) and MELD-Na scores (p<0.05), indicating improved liver function over time in the BLV group compared to controls. No progression of liver fibrosis was observed.

Conclusions: Bulevirtide is a safe and effective treatment for chronic hepatitis delta in a real-world clinical setting. These findings support its role as a sustainable therapeutic option for patients with HDV infection.

Background and aims: Intestinal secretagogues and prokinetic agents are commonly used for managing irritable bowel syndrome with constipation (IBS-C). However, no studies have provided direct head-to-head comparisons of these medications. This study aimed to evaluate the dose-stratified relationships and safety profiles of multiple agents to treat IBS-C.

Methods: We searched PubMed, Embase, Cochran Library, and Web of Science for randomized controlled trials (RCTs) from their inception until 21 November 2024. Eligible trials assessed the efficacy and safety of intestinal secretagogues or prokinetic agents in patients with IBS-C. The outcomes were abdominal symptoms, stool characteristics, and the incidence of adverse events.

Results: A total of 1,152 articles were identified, and 16 trials involving five drugs with various dosing regimens were included. Our results suggest that linaclotide (62.5 μg qd, 290 μg qd, 500 μg qd and tenapanor 50mg bid) may be superior to placebo and tenapanor (5 mg bid) in improving abdominal pain. Linaclotide (290 μg qd) was significantly more effective than placebo in alleviating abdominal cramping and increasing bowel movement frequency. Regarding safety, linaclotide (125 μg qd) was associated with a higher incidence of adverse events than both linaclotide (62.5 μg qd) and placebo. Tenapanor (50 mg bid) and linaclotide (125 μg qd) were linked to more adverse events than tenapanor (20 mg bid). Linaclotide (290 μg qd) also had a higher incidence of adverse reactions than placebo.

Conclusions: For patients with IBS-C, higher doses of linaclotide and tenapanor may provide enhanced symptom relief, but caution is warranted regarding their safety profiles.