Translational gastroenterology and hepatology最新文献

Background and objective: Cognitive behavioral therapy (CBT) is a common treatment modality for patients with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). CBT may not be a good fit for all patients and some may instead benefit from an acceptance and commitment therapy (ACT) approach. This narrative review presents evidence for the use of ACT in adult patients with IBS or IBD. The authors also suggest instances in which patients with IBS or IBD may benefit from ACT and discuss future directions of research.

Methods: Between August 2023 and January 2024, databases such as Google Scholar, institutional libraries, and PubMed were used to review the literature on ACT in patients with IBS and IBD. A variety of search terms were included. Non-English, pediatric, and studies that did not employ a full ACT protocol were excluded.

Key content and findings: ACT for IBS studies typically utilized a self-help book or a one-day workshop intervention, with results indicating reductions in IBS and mood symptoms and improvements in quality of life. Within IBD, three randomized controlled trials (RCTs) tested the impact of ACT, two of which found reductions in stress, depression, and anxiety symptoms.

Conclusions: Despite the limited number of studies testing a full ACT protocol in patient populations with IBS or IBD, results indicate potential efficacy in managing not only symptoms, but also facets of quality of life. Future studies should utilize robust experimental designs and comprehensively test the effectiveness of ACT in IBS and IBD patient populations with both process and outcome measures.

Background: At present, there is a dearth of comprehensive data at the global, national, and regional levels regarding the adult non-alcoholic fatty liver disease (NAFLD) prevalence. This cross-sectional study aims at ascertaining the prevalence of NAFLD and non-alcoholic steatohepatitis (NASH), utilizing body mass index (BMI) as a determining factor.

Methods: Based on the NHANES database, sigmoidal fitting curves were generated to establish the relationship between BMI and the risk of NAFLD/NASH. Utilizing BMI data from the NCD Risk Factor Collaboration (NCD-RisC) database at both global and regional levels, the prevalence of NAFLD/NASH among adults was estimated from 1975 to 2016, encompassing global, regional, and national perspectives. Additionally, projections were made to forecast the prevalence of adult NAFLD/NASH from 2017 to 2030.

Results: In 2016, the global prevalence of NAFLD was 41.12% for males and 37.32% for females, while the global prevalence of NASH was 15.79% for males and 16.48% for females. The prevalence of NAFLD/NASH increased with higher BMI in both genders. Over the period from 1975 to 2016, there has been a gradual increase in the global prevalence of NAFLD/NASH in adults, and this trend is expected to continue between 2017 and 2030. In males, the prevalence of adult NAFLD/NASH was found to be highest in High-income Western countries, while it was highest in Central Asia, Middle East, and North African countries after 1995.

Conclusions: The prevalence of adult NAFLD/NASH has been observed to increase annually, with significant variations in burden across different countries and regions.

Background and objective: Systemic therapy for hepatocellular carcinoma (HCC) is recommended in transarterial chemoembolization (TACE)-refractory and unsuitable cases. In Japan, TACE is broadly classified into conventional TACE (C-TACE), balloon occluded TACE (B-TACE), and drug-eluting beads TACE. However, the type of TACE recommended for TACE-refractory or unsuitable cases has not been elucidated, and a targeted approach for individual cases and appropriate TACE selection is important. B-TACE is considered a valuable therapeutic option in the management of HCC. The technique involves the precise placement of a microcatheter with a balloon into the target hepatic artery, followed by selective occlusion of the hepatic artery, including tumor-feeding vessels, using the balloon. By leveraging the hemodynamic changes resulting from arterial occlusion, B-TACE enables effective accumulation of chemotherapeutic agents within the tumor. Incorporating B-TACE into the treatment strategy for HCC is of utmost importance. Therefore, this article provides an overview of the technique.

Methods: A comprehensive review of all available literature in the English language through December 1, 2023 utilizing PubMed was conducted.

Key content and findings: In the intermediate stage, TACE and systemic therapy play complementary roles, and it is important to select a treatment strategy that considers tumor status and hepatic reserve. However, no study has investigated the various types of TACE in the treatment of such patients. Currently, TACE in Japan is broadly classified into C-TACE, B-TACE, and drug-eluting beads TACE (DEB-TACE). This article outlines the evolution of B-TACE for HCC. We identified retrospective and prospective studies evaluating B-TACE. In this review, we evaluate data on B-TACE for HCC.

Conclusions: In the era of systemic therapy, B-TACE may play a complementary and synergy effect role.

Background: Prognostic factors are complicated and changeable for locally advanced gastric cancer (GC) patients. This study aimed to perform a novel prognostic model on survival for locally advanced GC patients who have received neoadjuvant chemotherapy and radical surgery.

Methods: The locally advanced GC patients with neoadjuvant chemotherapy were included in this study from Zhongshan Hospital, Fudan University. A nomogram was developed based on independent prognostic factors identified through a multivariable Cox regression model. Model performance was evaluated in training and independent external cohorts in terms of calibration, discrimination, and clinical usefulness.

Results: A total of 273 patients received radical resections. The median progression-free survival (PFS) and overall survival (OS) for all patients were 43.8 and 61.2 months, respectively. Nomogram showed that Lauren type made the greatest contribution to prognosis, followed by ypN. The prognostic nomogram had excellent discriminative ability, with a C-index of 0.689 [95% confidence interval (CI): 0.661-0.716], and an area under the receiver operating characteristic (ROC) curve (AUC) of 0.778, 0.746, and 0.725 for 3-, 5- and 10-year OS, respectively. Similar results were obtained in the external validation cohort. Based on the nomogram, the whole cohort was divided into high-risk and low-risk groups. And risk group classification was significantly associated with clinical characteristics, and produced an AUC value of 0.781, 0.748, and 0.727 for 3-, 5- and 10-year OS, respectively. Furthermore, compared with the tumor-node-metastasis (TNM) staging system (8th edition), Japanese criteria, and German criteria, the decision curve analysis (DCA) graphically demonstrated that the new model had more optimal net benefits in predicting the 3-, 5-, and 10-year OS for GC patients. Both C-index and time-dependent ROC curve demonstrated that the nomogram had a stronger capability for accurately predicting prognosis compared with the other staging system.

Conclusions: The nomogram model is an effective support tool to predict OS in GC patients undergoing perioperative chemotherapy followed by radical surgery.

Liver cirrhosis is a chronic condition that is associated with a variety of complications across organ systems. Patients with cirrhosis also suffer from immune dysfunction, which may predispose them to catastrophic bacterial and fungal infections. Bacterial infections in liver cirrhosis have been well-documented, however, data remains scarce regarding fungal infections. Candida and Aspergillus have been reported as the most common pathogens among patients with cirrhosis, causing both invasive and non-invasive infections. However, other pathogens such as Coccidioides, Pneumocystis, Cryptococcus, and Rhizopus have been increasing in incidence. Diagnosis of fungal infection is often difficult, particularly in regards to distinguishing colonization from invasive infection. Serum markers such as beta-D-glucan (BDG) and galactomannan are beneficial diagnostic tools in conjunction with fungal cultures and imaging modalities. Bronchoscopy with bronchoalveolar lavage (BAL) or lung biopsy can be useful adjuncts as well. Liver transplantation is another important consideration as invasive fungal infection (IFI) is a contraindication to transplant surgery. Additionally, patients are at increased risk for infection due to immunosuppression in the post-transplant period. We aim to discuss the mechanisms responsible for immune dysfunction in advanced liver disease, the epidemiology of fungal infections in this population, as well as presentations and management considerations pertaining to specific pathogens and antifungal regimens.

Background: Hypervigilance has emerged as an important construct in esophageal symptom reporting, but a review of the literature does not currently exist. This scoping review aimed to generate a comprehensive overview of the literature on hypervigilance in esophageal diseases and summarize the evidence for each esophageal disease.

Methods: Guided by the Joanna Briggs Institute scoping review methodology, articles that were peer-reviewed original studies, published in English, and included adult patients with at least one esophageal disease were included. Articles were retrieved from PubMed and Embase databases and screened first by title and abstract for an initial round of exclusions, and then again by full text for a second round of exclusions.

Results: Nineteen studies were included. Studies were categorized by primary diagnosis: achalasia (1, 5%), eosinophilic esophagitis (1, 5%), gastroesophageal reflux disease (GERD) (6, 32%), laryngopharyngeal reflux (3, 16%), non-cardiac chest pain (3, 16%), and multi-disorder samples (5, 26%). Studies primarily evaluated associations between hypervigilance and symptom severity, psychosocial functioning, health-related quality of life, and physiological disease variables. A number of studies also evaluated hypervigilance across esophageal diseases or presentations (e.g., across motility disorders, across GERD phenotypes).

Conclusions: The role of hypervigilance in symptom reporting has been investigated in multiple esophageal conditions. Findings suggest potential clinical utility in assessing hypervigilance, such as for disease conceptualization and treatment planning. Future research is needed in larger samples, with consistent measures of hypervigilance, and using data synthesis methodology (i.e., systematic reviews) to better compare and contrast findings across studies.

Background: African American patients frequently receive nonstandard treatment and demonstrate poorer overall survival (OS) outcomes compared to White patients. Our objective was to analysis whether racial/ethnic disparities in rectal cancer-specific mortality remain after accounting for clinical characteristics, treatment, and access-to-care-related factors.

Methods: Individuals diagnosed with rectal cancer between 2011 and 2020 were identified using the Surveillance, Epidemiology, and End Results Database. The cumulative incidence of rectal cancer-specific mortality was computed. Sub-distribution hazard ratios (sdHRs) and 95% confidence intervals (CIs) for rectal cancer-specific mortality associated with race/ethnicity were estimated using Fine and Gray model with stepwise adjustments for clinical characteristics, treatment modalities, and factors related to access-to-care.

Results: Among 54,370 patients, non-Hispanic (NH) Black individuals exhibited the highest cumulative incidence of rectal cancer-specific mortality (39%), followed by American Indian/Alaska Native (AI/AN) (35%), Hispanics (32%), NH-White (31%), and Asian/Pacific Islander (API) (30%). After adjusting for clinical characteristics, NH-Black patients had a 28% increased risk of rectal cancer mortality (sdHR, 1.28; 95% CI: 1.20-1.35) compared to NH-White patients. In contrast, mortality disparities between Hispanic-White, AI/AN-White, and API-White groups were not significant. The Black-White mortality differences persisted even after adjustments for treatment and access-to-care-related factors. In stratified analyses, among patients with a median household income below $59,999, AI/AN patients showed higher mortality than NH-Whites when adjusted for clinical characteristics (sdHR, 1.32; 95% CI: 1.03-1.70).

Conclusions: Overall, the racial/ethnic disparities in rectal cancer-specific mortality were largely attributable to differences in clinical characteristics, treatment modalities, and factors related to access-to-care. These findings emphasize the critical need for equitable healthcare to effectively address and reduce the significant racial/ethnic disparities in rectal cancer outcomes.

Background and objective: Although more frequent in the adult population, rectal prolapse is a common anorectal condition that can occur in children and adolescents. While many cases spontaneously resolve without the need for intervention, the advent of newer minimally invasive procedures and operations have provided options for pediatric patients. Here, we review the pathophysiology, etiology, presentation, diagnosis and principles of management of rectal prolapse in the pediatric population as it has evolved over the past several decades.

Methods: The literature was queried from free databases available to the public including the National Institute of Health National Library of Medicine MEDLINE and PubMed for manuscripts published from January 1, 1975 to December 1, 2023. Manuscripts without an accompanying English translation or those written entirely in foreign languages were excluded.

Key content and findings: Numerous conditions contribute to rectal prolapse in children, including constipation, gastrointestinal infectious and non-infectious etiologies, cystic fibrosis, malnutrition, neurogenic, anatomic, lead points, and abuse. Initial management of rectal prolapse is medical management, addressing the underlying condition associated with rectal prolapse along with attempted manual reduction. For patients with recurrent rectal prolapse, a variety of noninvasive and procedural management options are available including injection sclerotherapy and anal encirclement in addition to surgical rectopexy by open and newer minimally invasive methods.

Conclusions: Despite significant advances in the evaluation, procedural and surgical management of pediatric anorectal conditions in the last few decades, there continues to be substantial variation in clinicians' and surgeons' practice for the treatment of rectal prolapse in children and adolescents. Much remains to be studied in the future to improve clinical outcomes for this patient population.

Over the past few years, there has been an increasing interest in investigating tumor-infiltrating lymphocytes. B lymphocytes (B cells) are extensively distributed within tertiary lymphoid structure (TLS) as multifaceted subgroups and are intimately linked to the anti-tumor properties of TLS, as well as the survival and prognostication of individuals. While the investigation of T lymphocytes in the TLS has advanced to the level of clinical practice, the study of B cells remains limited. The principal impediment to the utilization of B cells in immunotherapy is their notable dual impact on tumors. Compared with tumors in other parts and systems, the function of B cells in the microenvironment of digestive system tumors to promote tumors proliferation, differentiation and migration cannot be ignored. Therefore, this review collects the studies of B cell subsets in tumor microenvironments, particularly related single cell sequencing research. The multifaceted role and function of B cells are investigated in esophageal, liver, colorectal, gastric and pancreatic cancers. And through the identification of B cell subsets and specific markers, this review attempts to explain the reasons why B cells produce different tumor-promoting effects in those tumors. The insights gleaned from this review may provide potential help and support the development of B cell-based immunotherapies.