Journal of gastrointestinal and liver diseases : JGLD最新文献

Background and aims: Inflammatory and fibrotic strictures are common in inflammatory bowel diseases (IBD) and are challenging conditions to manage. Endoscopic stricturotomy (ESt) is considered as an emerging treatment option. We aimed to summarise evidence on the efficacy of ESt for the treatment of IBD-associated strictures.

Methods: The databases Pubmed and Cochrane Controlled Trial Register were searched to identify all reports related to ESt in IBD, published till January 2025. A systematic review was conducted identifying clinical and endoscopic improvement.

Results: 18 studies involving 317 patients were included in the analysis. ESt improved symptoms in 64.2% of patients after a median follow-up of 7.8 months. Endoscopic improvement was detected in 22% of patients after 9 months. Mean length of treated strictures was 1.6 cm. Major adverse events resulted in 5.6% of patients treated by ESt.

Conclusions: Endoscopic stricturotomy seems to be an effective option for treatment of IBD' strictures. However further data is required to confirm the role of ESt in this setting.

Background and aims: Vonoprazan (Vo) and amoxicillin (Amx) dual therapy has shown promising results for Helicobacter pylori (H. pylori) eradication. However, its efficacy needs to be verified in an area with a high prevalence of both H. pylori and gastric cancer. It is also unknown if the modified Vo-Amx plus bismuth (Bis) regimen might increase the eradication rate. We aimed to investigate the efficacy and safety of Vo-Amx and Vo-Amx-Bis regimens, compared to bismuth-containing quadruple therapy (BQT) for H. pylori eradication, as well as factors that affect the curing rate.

Methods: A total of 342 treatment-naïve H. pylori-infected patients were screened and 255 were enrolled and randomized into Vo-Amx, Vo-Amx-Bis, and BQT groups for treatment. H. pylori infection status was determined by 13C-urea breath test. The eradication rate and incidence of adverse events were assessed, and factors that might affect the curing rate were also analyzed.

Results: In per-protocol (PP) analysis, H. pylori eradication rates in Vo-Amx, Vo-Amx-Bis, and BQT groups were 95.1%, 92.7%, and 90.4%, respectively (p>0.05). In intention-to-treat (ITT) analysis, eradication rates in Vo-Amx, Vo-Amx-Bis, and BQT groups were 91.8%, 89.4%, and 88.2%, respectively (p>0.05). The eradication efficacy of Vo-Amx and Vo-Amx-Bis groups was non-inferior to that of BQT group, and the incidence of side effects (including nausea, vomiting, anorexia, abdominal pain, diarrhea, palpitation, dizziness, and debilitation) was lower than that of BQT group (6.1% and 4.9%, vs 45.8%, respectively, p<0.001). Successful eradication was associated with lower body surface area (BSA) in BQT group (p<0.05), but not in Vo-Amx and Vo-Amx-Bis groups. Gender, cigarette smoking, alcohol drinking, side effects, education level, body mass index, infection status of family members, and the frequency of dining out did not affect the curing rate in all three groups (p> 0.05).

Conclusions: Efficacy of the two Vo-containing regimens was comparable and non-inferior to the BQT in this region, and could serve as the first-line regimen for H. pylori eradication, and reduced use of one antibiotic per each patient treatment in real-world clinical application.

Hemorrhoidal disease (HD) is a prevalent anorectal disorder that affects up to 36% of the general population. It is characterized by symptomatic enlargement and displacement of anal cushions, frequently associated with pain, bleeding, and reduced quality of life. The pathophysiology of HD includes vascular congestion, venous stasis, and vascular dilatation, promoted by increased nitric oxide activity. Inflammatory responses are considered crucial in HD, with NF-κB playing a major role. Treatment strategies for HD vary from conservative approaches to office-based and surgical interventions. Conservative therapies, such as topical agents and flavonoid-based systemic treatments, serve as the mainstay of low-grade HD management, while invasive procedures are reserved for refractory cases. Topical formulations containing fluocinolone acetonide (FLA) and ketocaine hydrochloride (KH) combine anti-inflammatory and anesthetic effects, providing rapid and sustained relief from pain, itching, and inflammation. FLA exerts potent anti-inflammatory effects by inhibiting NF-κB and induces vasoconstrictive activity by reducing nitric oxide levels, while KH provides localized analgesia by blocking sodium channels. Collectively, these agents mitigate vascular congestion, inflammation, and HD symptoms. Clinical evidence supports the efficacy of this combination in alleviating acute symptoms, reducing recurrence, and improving patient outcomes. The FLA/KH formulation provides targeted local action with minimal systemic absorption and predominantly mild and transient adverse events. Treatment with FLA/KH is an effective and well-tolerated option for managing acute HD. Furthermore, its combination with flavonoid-based supplements, which improve venous tone and reduce capillary permeability, may aid in preventing recurrence. This combined approach leverages the rapid symptom relief provided by topical agents and the long-term benefits of systemic therapies, promoting comprehensive HD management and reducing the risk of recurrence.

Background and aims: Fatty liver disease (FLD) is a prevalent condition linked to metabolic disorders and can progress to severe liver diseases. Alterations in apolipoprotein (Apo) levels may provide valuable insights for diagnosing and managing FLD. This systematic review and meta-analysis evaluates these changes across different FLD phenotypes to evaluate their potential as diagnostic biomarkers.

Methods: We evaluated studies from PubMed, EMBASE, and Scopus using a predefined search string. Predefined inclusion and exclusion criteria were applied, and the risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). The main summary outcome was the mean difference (MD) in Apo levels.

Results: Out of 773 initial articles, 55 studies involving 432,328 individuals were included. In NAFLD patients vs. controls, ApoA levels showed a MD of -0.029 (95% CI: -0.133, 0.075), ApoA-I had a MD of -0.064 (95%CI: -0.107, -0.021), and ApoB levels had a MD of 0.098 (95%CI: 0.076, 0.120), while ApoB100 had an MD of 0.042 (95% CI: 0.008, 0.076). For NASH vs. controls, ApoA-I levels had a MD of -0.108 (95% CI: -0.125, -0.091) and ApoB levels had a MD of 0.123 (95% CI: 0.054, 0.193), while ApoB100 had a MD of 0.042 (95% CI: -0.051,0.136). In MAFLD vs. controls, ApoA-I levels had a MD of -0.068 (95% CI: -0.124, -0.012) and ApoB a MD of 0.099 (95% CI: 0.091, 0.107). For diabetic NAFLD vs. T2DM (type 2 diabetes mellitus) without NAFLD, ApoA levels had an MD of 0.028 (95% CI: -0.147, 0.204) and ApoB levels an MD of 0.081 (95% CI: 0.040, 0.122).

Conclusions: In NAFLD patients, ApoA-I levels were lower and ApoB and ApoB100 levels were higher compared to controls, with similar patterns seen in NASH patients, who also had higher ApoB levels than those with simple steatosis. MAFLD patients had elevated ApoB and ApoE levels, while overweight/obese NAFLD patients had higher ApoB levels than controls.

Background and aims: It is not known whether the gut microbiota (GM) may vary according to the endoscopic severity of diverticular disease (DD). We aimed to profile the GM in DD patients according to the severity of the diverticular inflammation and complication assessment (DICA) classification (DICA 1 vs. DICA 2 vs. DICA 3).

Methods: We retrospectively assessed the GM in a population of patients with DD. We analyzed stool samples collected by fecal swab for microbiological studies. Among them, we identified DD patients in whom DD was scored according to DICA classification. The severity of the abdominal pain was measured using a 10-point visual analogue scale (VAS).

Results: The GM of 71 DD patients [49 (69.0%) were scored as DICA1, 18 (25.4%) as DICA2, and 4 (5.6%) as DICA3 was analysed. The three groups did not differ in alpha diversity, but significantly separated in the PCoA of beta diversity (p=0.018). Taxonomically, DICA1 group was characterized by higher relative abundances of the phylum Actinobacteriota, the families Erysipelatoclostridiaceae and Bacteroidaceae, and the genera Lachnospiraceae ND3007 group and Bacteroides (p≤0.1); DICA2 group was mainly discriminated by higher proportions of Streptococcaceae (p=0.018); DICA3 group was mainly discriminated by the phylum Bacteroidota, the families Prevotellaceae and Succinivibrionaceae, and the genera Prevotella, Alloprevotella and Dialister (p≤0.045). Stratifiyng patients by abdominal pain severity, only for the DICA2 group the PCoA of beta diversity showed a significant separation between the moderate and severe groups (p=0.024), with the latter also showing higher alpha diversity (p=0.05). Taxonomically, the severe group was enriched in the families Enterobacteriaceae and Erysipelotrichaceae, and the genera Megasphaera and Veillonella, while depleted in Sutterellaceae and Blautia compared to the moderate group (p≤0.08).

Conclusions: GM in DD may vary according to endoscopic disease severity and clinical characteristics. Such associations may improve patient stratification and clinical management.

Background and aims: The implantation of uncovered self-expanding metal stents (UCSEMS) is an established method for the palliative treatment of malignant hilar biliary obstruction (MHBO). However, with advances in chemotherapy extending patient survival, individuals treated primarily with UCSEMS increasingly encounter overgrowth of the tumour in the stent lumen and occlusion. In this study, we aimed to compare various methods of managing occluded UCSEMS.

Methods: We analyzed a cohort of 49 patients with malignant hilar biliary obstruction who were treated with UCSEMS implantation as first-line endoscopic treatment. We evaluated their follow-up data, recorded complications, and assessed the methods used to manage occluded stents: balloon cleaning, plastic stent in stent implantation, UCSEMS stent in stent implantation, fully covered self-expandable metal stent (FCSEMS) stent in stent implantation and radiofrequency ablation (RFA).

Results: Technical and clinical success rates of the reinterventions were 91.2% and 61.4%, respectively. Depending on the type of revisionary drainage method used, clinical success rates were as follows: 50% for balloon cleaning only, 66% for plastic stent placement, 68% for FCSEMS stent placement, 80% for RFA with simultaneous plastic stent placement, and 80% for UCSEMS stent placement (p=0.366). The mean time to the second reintervention (second ERCP after UCSEMS placement) was 238, 201, 264, 78, and 205 days, respectively (p=0.4999). The mean interval time for all reinterventions was 48, 75, 71, 66, and 95 days, respectively (p=0.0326).

Conclusions: All techniques demonstrated high technical feasibility. While UCSEMS re-stenting and RFA with plastic stents showed promising trends in clinical success and stent patency, definitive conclusions about superiority cannot be drawn. Further multicentre prospective studies are needed to validate these findings.