Journal of gastrointestinal and liver diseases : JGLD最新文献

Background and aims: Constipation is commonly seen among patients with cardiovascular diseases and is linked to adverse outcomes. However, the association between constipation and the risk of acute myocardial infarction (AMI) remains conflicting. Therefore, we aimed to conduct a systematic review and meta-analysis to summarize the available data on this topic.

Method: We identified potentially eligible studies from the MEDLINE and EMBASE databases, searching from inception to May 2024, to investigate the association between constipation and the risk of developing AMI. To be included, studies needed to compare incidence of AMI between cohorts with and without constipation. Effect size and 95% confidence intervals (CIs) were combined using the generic inverse variance method. All statistical analyses were performed by Review Manager 5.4.

Results: Our meta-analysis included seven studies that met the eligibility criteria. There were 5,351,976 participants, with a mean age of 57.8 years and 74% were males. We found that patients with constipation had a 14% increased risk of AMI with a pooled risk ratio (RR) of 1.14 (95%CI: 1.08-1.14; I²=85%; p<0.001) compared to those without constipation.

Conclusions: Our study revealed that constipation is associated with a higher risk of AMI. Emphasizing and addressing gastrointestinal health, including constipation, as an important issue is essential for comprehensive cardiovascular care.

Background and aims: Crohn's disease (CD) is an inflammatory bowel disease with limited treatment options for patients with mild to moderately active disease. There is a lack of consensus for using traditional Chinese medicine (TCM) for symptom relief. This review aimed to assess the efficacy of TCM compared to placebo for CD symptom severity relief in patients with mild to moderate CD.

Methods: We searched MEDLINE via PubMed, the Cochrane Library, Scopus, and CINAHL for articles and reviewed results from Web of Science, Google Scholar, clinicaltrials.gov, and reference lists of included studies. We included randomized control trials comparing TCM to placebo in patients with mild to moderate CD to evaluate change in objective symptom severity [Crohn's Disease Activity Index (CDAI) and Crohn's Disease Endoscopic Index of Severity (CDEIS)]. We imported selected articles for dual blinded review, used random-effects models to calculate the mean CDAI and CDEIS differences between TCM and placebo, and qualitatively analyzed differences in inflammatory biomarkers and quality of life.

Results: The search identified 232 relevant studies. We included five studies, totalling 292 participants utilizing acupuncture and herb-partitioned moxibustion. The studies demonstrated a more significant decrease in mean CDAI score due to TCM compared to placebo [-49.91 (95% CI: -64.97, -34.84; p<0.00001); (I2 = 61%, p=0.03)]. Two studies also demonstrated an overall difference in mean CDEIS between TCM and placebo [-2.96 (95% CI: -6.31, 0.40; p=0.08); (I2 = 53%, p=0.140)]. Improvements in quality of life scores were greater in TCM versus placebo groups. There were mixed results for changes in inflammatory biomarkers.

Conclusion: Our findings suggest that TCM may improve objective CD symptoms compared to placebo. Additional studies with more extensive and diverse populations are necessary to determine TCM's true effects on CD patients.

Background and aims: Tumor recurrence poses a significant challenge post-liver transplantation (LT) for hepatocellular carcinoma (HCC), necessitating the development of more precise predictive tools. In this study we aimed to investigate nucleolin as a biomarker for predicting HCC recurrence after LT.

Methods: A cohort of 241 HCC patients undergoing LT was enrolled from three medical facilities spanning January 1, 2015, to December 31, 2017. Utilizing tissue microarrays, we assessed the predictive potential of nucleolin. Survival analyses, including Kaplan-Meier and log-rank tests, were employed to scrutinize overall survival and recurrence-free survival. Based on univariate and multivariate Cox regression analyses of preoperative parameters, nomogram and risk score were designed to predict HCC recurrence and determine the effectiveness of the model.

Results: The expression of nucleolin in HCC nucleus was increased. High nucleolin expression in tumor tissues correlated with poor overall survival and recurrence-free survival (5-year overall survival ratios: 34% vs. 64.8%, 5-year recurrence-free survival ratios: 36.1% vs.67.9%, all p<0.001). Multivariate Cox regression analysis identified nucleolin expression score, Hangzhou criteria, HBsAg, tumor differentiation and alpha-fetoprotein level as independent risk factors for tumor recurrence in HCC patients post- LT. A new nomogram is established based on the above risk factors with effective prediction efficiency (area under time-dependent receiver operating characteristic =0.742, concordance-index =0.7742).

Conclusions: Nucleolin can be combined with a nomogram as an effective tool to predict recurrence in HCC patients following LT.

Irritable Bowel Syndrome (IBS) is a prevalent functional gastrointestinal disorder that significantly impacts the quality of life and the healthcare system. Beyond well-established symptoms such as recurrent abdominal pain and altered bowel habits, emerging evidence highlights a crucial yet underexplored aspect of cognitive dysfunction in patients suffering from IBS. This review aims to investigate the potential mechanisms linking IBS to cognitive dysfunction, emphasizing the role of the gut-brain axis and its biological and psychosocial determinants. A literature review was conducted using major medical databases, including Pubmed and Scopus, to identify relevant studies published in the last decade, focusing on clinical and experimental research assessing cognitive impairment in IBS patients. The review underscores the need for increased clinical recognition of cognitive dysfunction in IBS by highlighting the cognitive dysfunction in IBS patients with a focus on pathogenesis from disturbances in gut microbiota, inflammation, altered neurotransmitter levels, and psychological stress with various treatment modalities targeting these pathways, including probiotics, cognitive-behavioural therapy, and pharmacological interventions, showing promising results in mitigating cognitive symptoms.

Background and aims: Decompensation of cirrhosis significantly decreases survival, thus, prevention of complications is paramount. We used machine learning techniques to identify parameters predicting decompensation.

Methods: Several machine learning techniques were applied to the INCA trial database containing pro- and retrospective data from 983 patients. Laboratory, clinical, and genetic data were analysed. After performing hierarchical clustering, Permutation Feature Importance was used to evaluate the impact of parameters on the prediction of decompensation.

Results: Achieving an accuracy of 81.6% on training and 70.5% on test data, Random Forests were best for retrospective prediction. In prospective assessment, Support Vector Machines performed best with an accuracy of 78.6% and 73.8%, respectively. Permutation Feature Importance demonstrated that baseline albumin and bilirubin levels and maximum bilirubin were the highest ranked parameters associated with former decompensation. In the prospective analysis, the maximum bilirubin value and the baseline values of sodium and albumin were ranked highest. In addition to the parameters of established scores, NOD2 genotype and inflammatory markers were highly ranked.

Conclusions: Laboratory parameters, genetic variants and infections can help to predict the risk of cirrhosis decompensation. This proof-of-concept study adds data for the future development of advanced models to identify patients at risk.