Johannes Raphael Westphal, Nadine Koch, Ramiro Vilchez-Vargas, Riccardo Vasapolli, Didem Saka, Peter Malfertheiner, Christian Schulz
{"title":"In vivo inhibition of Helicobacter pylori through probiotics and gastrointestinal commensals: a critical review.","authors":"Johannes Raphael Westphal, Nadine Koch, Ramiro Vilchez-Vargas, Riccardo Vasapolli, Didem Saka, Peter Malfertheiner, Christian Schulz","doi":"10.1159/000546119","DOIUrl":"https://doi.org/10.1159/000546119","url":null,"abstract":"<p><strong>Introduction: </strong>Helicobacter pylori eradication is increasingly challenged, due to high antibiotic resistance rates in H. pylori and treatment failure. Consequently, new treatment regimens are needed. Probiotic and gastrointestinal bacteria exert anti-H. pylori activity in vivo, thus being potential add-on candidates for future eradication strategies.</p><p><strong>Methods: </strong>In this review we summarized the currently available literature for in vivo inhibition of H. pylori. Included studies address anti-H. pylori effects in mouse and rat models caused by potentially beneficial bacteria. Research on literature was further extended to clinical eradication studies in humans.</p><p><strong>Results: </strong>Several bacterial strains, mainly belonging to the Lactobacillus-genus, inhibited H. pylori in vivo. In animal studies probiotic bacteria and commensals reduced H. pylori colonisation and the inflammatory response. Certain probiotic species lead to a decrease of H. pylori colonisation. However, H. pylori eradication with current probiotic therapy is not obtained.</p><p><strong>Conclusion: </strong>Probiotic and gastrointestinal commensals are beneficial in H. pylori eradication therapy. Their current role is the reduction of adverse events and H. pylori load.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-18"},"PeriodicalIF":2.0,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Step by Step: A Meta-Analysis and Systematic Review on the Impact of Walking on Colonoscopy Outcomes.","authors":"Islam Mohamed, Hazem Abosheaishaa, Sarah George, Khushi Parekh, Nina Henry, Suman Manek, Lauren Baetje, Mira Bhatia, Fouad Jaber, Syed Hammad Rahman, Maya Mahmoud, Yazan Abboud, Dushyant Singh Dahiya, Nikki Duong, Yusuke Hashimoto","doi":"10.1159/000545844","DOIUrl":"https://doi.org/10.1159/000545844","url":null,"abstract":"<p><p>Introduction Colorectal cancer screening relies on effective bowel preparation before a colonoscopy. Walking has emerged as a potential adjunct strategy to achieve bowel cleansing prior to colonoscopy. We investigated the efficacy of walking as a potential adjunct strategy to bowel preparation methods. Methods Our search encompassed Embase, Medline, Cochrane, and Scopus databases. Search results underwent screening utilizing Covidence based on predefined criteria. Data extraction performed by independent reviewers involved general characteristics, baseline patient characteristics, and outcome measures. Risk of Bias evaluation employed the RoB 2 tool for RCTs. Statistical analysis utilized RevMan v5.3, employing mean differences and random-effects models. Statistical significance was indicated by p-value < 0.05. Heterogeneity was assessed with I-square tests. Results Our meta-analysis included four RCTs with a total of 1218 patients. We found that walking did not yield a significant difference in total BPPS score compared to control groups. Walking led to statistically significant improvements in ascending, transverse, and descending colon BPPS scores. Walking did not significantly affect cecal intubation time or total procedure time. While there was no significant difference in the time to first diarrhea, the total number of diarrheal episodes was significantly impacted. Conclusion While walking did not significantly affect total BPPS scores, procedural timelines, or cecal intubation, it demonstrated significant improvements in ascending, transverse, and descending colon BPPS scores and diarrheal instances. These findings suggest that walking may have a beneficial effect on specific aspects of bowel preparation for colonoscopy, highlighting its potential as an adjunctive strategy in enhancing colonoscopy outcomes.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-22"},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Efficacy and Feasibility of Tissue-clearing Technique and Three-dimensional Imaging in the Human Gastrointestinal Tissues Using LUCID.","authors":"Hiroya Mizutani, Satoshi Ono, Yuko Miura, Daisuke Ohki, Chihiro Takeuchi, Yosuke Tsuji, Nobutake Yamamichi, Hiroshi Onodera, Mitsuhiro Fujishiro","doi":"10.1159/000546173","DOIUrl":"https://doi.org/10.1159/000546173","url":null,"abstract":"<p><strong>Introduction: </strong>The applicability of tissue-clearing technology and 3D imaging in human specimens has not been fully investigated. We investigated the effectiveness and feasibility of the ilLUminate Cleared organs to IDentify target molecules (LUCID) protocol using human gastrointestinal specimens.</p><p><strong>Methods: </strong>The gastrointestinal mucosa specimens resected via ESD including the esophagus, stomach, duodenum, and large intestine were fluorescently stained and optically cleared using LUCID. Cleared specimens were imaged three-dimensionally by confocal laser scanning microscope, and the observable depth at any five points was measured and compared to non-cleared specimens, respectively. After clearing and imaging, the specimens were restored to the PPFE form again, and conventional two-dimensional pathological evaluation using hematoxylin-eosin (HE), Ki67 (MIB-1), p53, and E-cadherin staining was performed to compare them with their pre-clearing state.</p><p><strong>Results: </strong>The observable depth was significantly extended after clearing for specimens from each organ (esophagus 228.3±14.9 µm vs. 1036.7±62.9 µm, p<0.05; stomach 115.2±5.5 µm vs. 428.7±15.9 µm, p<0.05; duodenum 256.2±9.5 µm vs. 787.0±18.6 µm, p<0.05, large intestine 113.9±5.4 µm vs. 436.6±18.5 µm, p<0.05). The pathological evaluation after clearing revealed a preserved fine structure and staining and showed no apparent deformation, degeneration, or tissue damage compared with before clearing.</p><p><strong>Conclusions: </strong>The effectiveness of tissue clearing using LUCID on human gastrointestinal specimens was demonstrated, and the LUCID protocol had minimal impact on specimen morphology and staining. Although many limitations and issues remain, LUCID is expected to be a method that enables comprehensive analysis of the three-dimensional structure of human gastrointestinal mucosa and lesions.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-15"},"PeriodicalIF":2.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143969688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Causal Relationship between Helicobacter pylori Infection and Autoimmune Diseases of the Digestive System: Evidence from a Mendelian Randomization Study.","authors":"Shuang Zhang, Pengyue Zhang, Xin Hu","doi":"10.1159/000545597","DOIUrl":"10.1159/000545597","url":null,"abstract":"<p><strong>Introduction: </strong>The association between Helicobacter pylori (H. pylori) infection and digestive autoimmune diseases remains unclear, with inconsistent findings in previous observational studies. We conducted Mendelian randomization (MR) analysis to systematically explore the causal relationship and delve into the pathogenesis based on gut microbiota.</p><p><strong>Methods: </strong>This study encompassed anti-H. pylori IgG levels and genome-wide association studies (GWASs) for multiple digestive autoimmune diseases, utilizing diverse MR methodologies to assess the causal relationship between H. pylori antibody levels and these diseases. Associations between H. pylori and ulcerative colitis (UC) were examined using genetic variants from MiBioGen associated with 194 gut microbiota traits. Additionally, a series of sensitivity analyses were performed to validate the results of the initial MR analyses.</p><p><strong>Results: </strong>Our study showed a significant association between anti-H. pylori IgG levels and the incidence risk of UC (β = -0.001, p = 0.011). No causal associations were observed with the incidence risk of primary biliary cirrhosis, primary sclerosing cholangitis, celiac disease, and Crohn's disease (CD). Multiple gut microbiota were found to be correlated with H. pylori infection and UC. Particularly noteworthy is the negative correlation between the abundance of the genus.Anaerofilum and H. pylori antibody levels (β = -0.174, p = 0.048). Notably, genus.Anaerofilum exhibited a positive genetic correlation with an increased risk of UC (β = 0.0014, p = 0.0029).</p><p><strong>Conclusion: </strong>MR analysis confirmed a causal association between anti-H. pylori IgG and UC, but not with CD. The genus.Anaerofilum may increase the risk of UC by inhibiting H. pylori infection.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"LKM Immunofluorescence Is Associated with DILI, Especially after Metamizole Intake.","authors":"Kilian Bock, Bastian Engel, Elmar Jaeckel, Heiner Wedemeyer, Ingmar Mederacke, Young-Seon Mederacke","doi":"10.1159/000545507","DOIUrl":"10.1159/000545507","url":null,"abstract":"<p><strong>Introduction: </strong>Drug-induced liver injury (DILI) is a rare but potentially serious clinical condition. One phenotype of DILI is termed drug-induced autoimmune like hepatitis (DI-ALH) that presents with laboratory and histological features indistinguishable from autoimmune hepatitis. Liver kidney microsomal antibodies (LKM-antibodies) are common in the diagnosis of AIH but were also described to be associated with halothane-induced DILI. Also, the antigens of anti-LKM-1 and anti-LKM-2 belong to the cytochrome P450 enzyme family that is involved in the metabolism of various drugs. Therefore, we aimed to study the impact of LKM-antibodies in the diagnostic work-up of suspected DILI in a large cohort of patients with liver injury in a tertiary care centre.</p><p><strong>Methods: </strong>We screened a large single centre hospital database and retrospectively identified 63,300 cases with liver injury as defined: AST or ALT >3 upper limit of normal (ULN) or AP or TBI >2 ULN. Of those, 82 cases with LKM immunofluorescence positivity (titre ≥1: 160) were identified, of which 64 patients fulfilled the inclusion criteria for this study.</p><p><strong>Results: </strong>Positive LKM immunofluorescence was associated with drug-induced autoimmune-like hepatitis (DI-ALH). Metamizole association was identified in half of the patients (n = 33, 52%). Eight patients with metamizole associated DI-ALHs required liver transplantation and 1 patient died.</p><p><strong>Conclusion: </strong>DI-ALH, especially after metamizole administration, can be a reason for a positivity in LKM immunofluorescence tests. Metamizole DI-ALH has a high liver-related mortality.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gallbladder Cancer: A Grand Challenge for Every Surgeon.","authors":"Liwei Pang, Hanwen Hu, Zhen Wang","doi":"10.1159/000545510","DOIUrl":"10.1159/000545510","url":null,"abstract":"","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-3"},"PeriodicalIF":2.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of Safety and Efficacy of Diazepam and Midazolam for Moderate Sedation during Gastric Endoscopic Submucosal Dissection.","authors":"Jun Takada, Takuji Iwashita, Kiichi Otani, Naoya Masuda, Hiroki Taniguchi, Yukari Tezuka, Masamichi Arao, Kentaro Kojima, Sachiyo Onishi, Masaya Kubota, Takashi Ibuka, Masahito Shimizu","doi":"10.1159/000545093","DOIUrl":"10.1159/000545093","url":null,"abstract":"<p><strong>Introduction: </strong>The appropriate use of benzodiazepines for sedation during prolonged therapeutic endoscopy has not yet been established. This retrospective observational study compared the safety and efficacy of diazepam (DZP) and midazolam (MDZ) under moderate sedation during gastric endoscopic submucosal dissection (ESD).</p><p><strong>Methods: </strong>We studied 554 patients who underwent gastric ESD under sedation with DZP or MDZ combined with pentazocine. Sedation depth was assessed and recorded using the Richmond Agitation-Sedation Scale (RASS). According to the American Society of Anesthesiologists definition of sedation levels, RASS scores of -4 to -2 points indicated moderate sedation, whereas a score of -5 points indicated deep sedation. Sedation levels, respiratory and circulatory dynamics during the procedure, and the incidence of ESD-related pneumonia were compared.</p><p><strong>Results: </strong>Of these, 273 and 281 patients received DZP and MDZ, respectively. No significant differences were observed in the occurrence of deep sedation (DZP:MDZ = 12.1%:15.4%) or in the proportion of patients who maintained moderate intraoperative sedation (76.2%:80.4%). Respiratory parameters showed no significant differences; however, blood pressure reduction was more common in the MDZ group (4.8%:11.0%, p = 0.007). Multivariate analysis identified MDZ as a significant factor associated with blood pressure reduction. The incidence of ESD-related pneumonia did not differ between the two groups.</p><p><strong>Conclusions: </strong>DZP and MDZ were similarly effective in maintaining adequate sedation levels during gastric ESD. Respiratory depression did not differ between the groups; however, circulatory depression was more pronounced in the MDZ group.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam Mylonakis, Panagiotis Sakarellos, Paraskevas Gkolfakis, Athanasios Sioulas, Georgios D Lianos, Vasileios Tatsis, George Pappas-Gogos, Ioannis S Papanikolaou, Dimitrios Schizas
{"title":"From Lens to Scalpel: A Systematic Literature Review of Intestinal Obstruction after Video Capsule Endoscopy.","authors":"Adam Mylonakis, Panagiotis Sakarellos, Paraskevas Gkolfakis, Athanasios Sioulas, Georgios D Lianos, Vasileios Tatsis, George Pappas-Gogos, Ioannis S Papanikolaou, Dimitrios Schizas","doi":"10.1159/000544891","DOIUrl":"10.1159/000544891","url":null,"abstract":"<p><strong>Introduction: </strong>Video capsule endoscopy (VCE) is a valuable noninvasive diagnostic tool for gastrointestinal disorders, but it carries a risk of capsule retention and subsequent bowel obstruction. The aim of the present study was to examine the manifestations, diagnostic approaches, treatment modalities, and outcome of patients with bowel obstruction due to VCE.</p><p><strong>Methods: </strong>A comprehensive search was conducted in PubMed/Medline, Embase, Cochrane, and Scopus databases focusing on intestinal obstruction post-VCE.</p><p><strong>Results: </strong>Out of 399 unique articles, 27 studies were included, involving 30 patients, with an average age of 54 ± 22.3 years and a female-to-male ratio of 1.9:1. Common indications for VCE included Crohn's disease, anemia, abdominal pain with diarrhea, and obscure gastrointestinal bleeding. The obstruction most often occurred in the small intestine, predominantly in the ileum (20 patients, 67%) and the duodenum (5 patients, 17%). Diagnostic methods included CT scans in 19 cases (66%) and X-ray imaging in 8 cases (28%). Treatment varied from conservative management to surgical intervention, and no cases of mortality or morbidity were reported.</p><p><strong>Conclusions: </strong>This study highlights the importance of a multidisciplinary approach of such cases, concentrating on tailored therapeutic strategies to prevent and address complications related to VCE. Further research with larger cohorts is needed for a deeper understanding of risk factors and long-term outcomes.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ine De Greef, Gabriele Bislenghi, Isabelle Terrasson, João Sabino, Marc Ferrante, André D'Hoore, Bram Verstockt, Séverine Vermeire
{"title":"No Increased Risk of Venous Thromboembolism or Infectious Complications after Janus Kinase Inhibitor Exposure in Patients with Ulcerative Colitis Undergoing Surgery.","authors":"Ine De Greef, Gabriele Bislenghi, Isabelle Terrasson, João Sabino, Marc Ferrante, André D'Hoore, Bram Verstockt, Séverine Vermeire","doi":"10.1159/000544062","DOIUrl":"10.1159/000544062","url":null,"abstract":"<p><strong>Introduction: </strong>Total colectomy for ulcerative colitis (UC) is associated with postoperative morbidity, including venous thromboembolic events (VTE). In light of recent concerns about increased major adverse events associated with Janus kinase (JAK) inhibitor exposure, we aimed to evaluate the postoperative VTE risk as well as other complications in UC patients undergoing colectomy.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included all UC patients who underwent (procto)colectomy between 2013 and March 2022 and documented the 180-day postoperative non-infectious and infectious complications.</p><p><strong>Results: </strong>One hundred seventy-five UC patients (43.4% women, median age 41.0 years) underwent colectomy. Forty-nine patients (28.0%) were operated in an urgent setting. In the 12 weeks prior to surgery, 53 (30.3%) patients had received anti-TNF agents, 40 (22.9%) anti-adhesion therapy, 16 (9.1%) anti-IL12/23, and 34 (19.4%) JAK inhibitors. Preoperatively, 26 patients (14.9%) received moderate-to-high doses of systemic corticosteroids. All except 2 patients received prophylactic low-molecular-weight heparin postoperatively. During the 180-day postoperative period, 2 patients developed thrombosis, all incidental findings on abdominal CT scan. No VTE was seen in the patients who underwent colectomy while on JAK inhibitor. Three out of 34 JAK inhibitor-treated patients (8.8%) developed a postoperative infectious complication, while the overall incidence of infectious complications was 17.1%.</p><p><strong>Conclusion: </strong>Our findings suggest that the overall VTE risk in UC patients undergoing colectomy is low with adequate antithrombotic prophylaxis. JAK inhibitor use prior to surgery was not linked to increased short-term thromboembolic or infectious complications. However, the limited sample size warrants further study in larger cohorts.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}