Digestion最新文献

{"title":"Endoscopic evaluation of the gastroesophageal junction and diagnosis of Barrett's esophagus.","authors":"Chika Kusano","doi":"10.1159/000548648","DOIUrl":"https://doi.org/10.1159/000548648","url":null,"abstract":"<p><strong>Background: </strong>Barrett's esophagus (BE) is a recognized precursor to esophageal adenocarcinoma (EAC), yet its endoscopic diagnosis remains inconsistent worldwide. This review summarizes current challenges and recent advancements in the endoscopic diagnosis of BE, including updates from international consensus statements and emerging technologies such as image-enhanced endoscopy (IEE) and artificial intelligence (AI).</p><p><strong>Summary: </strong>This narrative review integrated international guidelines, multicenter studies, expert consensuses, including the Kyoto International Consensus and Asian Barrett Consortium data, and recent trials of diagnostic imaging and quality indicators regarding BE surveillance.</p><p><strong>Key messages: </strong>Discrepancies in defining the gastroesophageal junction (GEJ)-notably between palisade vessels and gastric folds-contribute to the global variability of the BE diagnosis. The Kyoto International Consensus recommends using the distal end of the palisade vessels as a more stable and histologically consistent landmark. Additionally, the Prague C & M criteria offer a standardized approach to measuring the BE length; however, limitations for ultra-short segment BE exist. IEE modalities such as linked color imaging and red dichromatic imaging enhance GEJ visualization, whereas AI systems have the potential for automated BE classification. Quality indicators such as the neoplasia detection rate, inspection time, and adherence to biopsy protocols have been proposed to improve diagnostic consistency and outcomes. Standardizing the endoscopic definition of BE and adopting quality-based surveillance strategies are essential to improving detection and reducing variability. Incorporating IEE and AI-based tools into routine practice may support a more reliable and efficient diagnostic pathway for BE, thus facilitating early EAC detection and prevention worldwide.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-18"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIF-1α regulates the progression of metabolic dysfunction-associated steatotic liver disease.","authors":"Qi Liu, Hao Liu, Yi Zheng, Zhengyi Yang, Sha Wen","doi":"10.1159/000548503","DOIUrl":"https://doi.org/10.1159/000548503","url":null,"abstract":"<p><strong>Background: </strong>With the improvement in living standards, metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease worldwide, garnering increasing concern due to its significant health risks. MASLD encompasses a spectrum of pathological processes ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), liver fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC), and it has become a leading cause of liver-related mortality. Due to the lack of specific therapeutic targets, current diagnostic, treatment, and management strategies for MASLD remain inadequate.</p><p><strong>Summary: </strong>This review aims to explore the pathophysiological manifestations of MASLD, the mechanisms through which HIF-1α contributes to disease progression, and the potential therapeutic approaches targeting HIF-1α, offering feasible strategies for treating advanced MASLD.</p><p><strong>Key message: </strong>Studies suggest that hepatocytes in MASLD are often in a hypoxic state, which activates hypoxia-inducible factor-1α (HIF-1α), playing a crucial role in disease progression. During hypoxia, the expression of HIF-1α increases throughout the different stages of MASLD, interacting with various genes and pathways, influencing lipid metabolism, steatosis, and fibrosis progression.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-16"},"PeriodicalIF":3.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discrete immunohistochemical and clinicopathological features of serrated adenocarcinoma between the proximal and distal colon.","authors":"Naoki Tsugawa, Eiji Kamba, Takashi Murakami, Yudai Otsuki, Kei Nomura, Yuichiro Kadomatsu, Hirofumi Fukushima, Kiichi Sugimoto, Tsuyoshi Saito, Tomoyoshi Shibuya, Takashi Yao, Akihito Nagahara","doi":"10.1159/000548705","DOIUrl":"https://doi.org/10.1159/000548705","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal serrated adenocarcinoma (SAC), a subtype of colorectal adenocarcinoma determined histologically, has characteristics of epithelial serrations. Here, we examined the immunohistochemical and clinicopathological characteristics of colorectal SAC.</p><p><strong>Methods: </strong>Thirty-three specimens, pathologically diagnosed as SAC in our hospital between 2013-2022, were collected for immunohistochemistry of MLH1/MUC2/MUC5AC/p53, and sequencing of BRAF/KRAS mutations.</p><p><strong>Results: </strong>The proximal colon contained 25 lesions and the distal colon had 8. Patients with proximal SACs were predominantly female, whereas those exhibiting distal SACs were predominantly male (P = 0.003). Overall, lymph node and distant metastasis were present in 17 (52%) and 11 (33%) cases, respectively, with no significant differences between the proximal and distal groups. MLH1 expression loss was more frequent in proximal cases (40%) than distal SACs (13%). Most cases (97%) were MUC2+. MUC5AC+ was significantly more frequent in proximal cases (92%) than distal SACs (37%, P = 0.004). Significantly less p53 overexpression was present in proximal cases (40%) vs distal SACs (75%). Genetically, the 12 cases of SAC harboring BRAF mutations were all located in the proximal colon, with a significantly greater frequency (P = 0.030) whereas more frequent KRAS mutations were noted in distal SACs. Throughout 5 years of follow-up, three patients (two proximal SAC cases; one distal SAC case) died (mean 6.7 months after surgery) because of their disease.</p><p><strong>Conclusion: </strong>Proximal SACs exhibit distinct clinicopathological and molecular features compared to distal SACs, largely aligning with the sessile serrated and traditional serrated pathways, respectively.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-22"},"PeriodicalIF":3.6,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"POU4F1 drives colorectal cancer progression by promoting cell proliferation, metastasis, and chemoresistance.","authors":"HaiLi Li, PeiZhen Gao, QingShui Wang, Chao Xu, FangQin Xue","doi":"10.1159/000548266","DOIUrl":"https://doi.org/10.1159/000548266","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer remains one of the most prevalent gastrointestinal malignancies. This study aims to identify key genes associated with colorectal cancer recurrence, offering novel insights for prognostic assessment and personalized treatment strategies.</p><p><strong>Methods: </strong>Leveraging the TCGA dataset, we conducted a comprehensive analysis of differentially expressed genes between recurrent and non-recurrent colorectal cancer patients. We developed a Recurrence Associated Genes Signature (RAGS) model for prognostic evaluation and employed nine machine learning algorithms to predict recurrence risk. Furthermore, we performed extensive functional studies on the most significant genes, examining their expression patterns, prognostic relevance, and effects on cellular proliferation, metastasis, and chemoresistance.</p><p><strong>Results: </strong>Our analyses identified 45 key genes linked to colorectal cancer recurrence and prognosis. Using LASSO regression, we constructed the RAGS model, incorporating TMEM213, SAP25, POU4F1, RSPO4, and PAGE2B. This model demonstrated exceptional performance in predicting overall prognosis and post-chemotherapy outcomes. Among the machine learning algorithms tested, XGBoost exhibited the highest diagnostic accuracy for recurrence prediction, with POU4F1 emerging as the most significant predictive gene. Functional experiments revealed that POU4F1 knockdown substantially inhibited colorectal cancer cell proliferation and metastasis both in vitro and in vivo, while also reducing resistance to 5-fluorouracil and oxaliplatin.</p><p><strong>Conclusion: </strong>This study successfully identified crucial genes associated with colorectal cancer recurrence and developed a robust RAGS prognostic model. The XGBoost algorithm underscored the importance of POU4F1 in predicting colorectal cancer recurrence. Our functional analysis of POU4F1 provides fresh insights into colorectal cancer progression mechanisms and informs the development of targeted therapeutic approaches. These findings not only enhance our understanding of colorectal cancer's molecular underpinnings but also establish a solid foundation for advancing precision diagnosis and treatment in clinical practice.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-33"},"PeriodicalIF":3.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Endoscopy in Gastroesophageal Reflux Disease.","authors":"Hiroko Hosaka, Shiko Kuribayashi, Yuki Itoi, Keigo Sato, Hirohito Tanaka, Yoji Takeuchi, Toshio Uraoka","doi":"10.1159/000548088","DOIUrl":"https://doi.org/10.1159/000548088","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease (GERD) is a common and heterogeneous condition that has traditionally been assessed using endoscopy for visual identification of mucosal injury. In recent years, advances in endoscopic technology have significantly reshaped both the diagnostic and therapeutic approaches to GERD.</p><p><strong>Summary: </strong>Modern imaging modalities, such as high-resolution and image-enhanced endoscopy, now allow for the detection of subtle mucosal changes. Functional endoscopic techniques, including the Endoscopic Pressure Study Integrated System (EPSIS), enable real-time physiological assessment of esophageal function and contribute to a better understanding of GERD pathophysiology. On the therapeutic front, endoscopy has emerged as a viable, minimally invasive alternative to surgery in managing refractory or proton pump inhibitor (PPI)-dependent GERD. Techniques such as anti-reflux mucosectomy, anti-reflux mucosal ablation (ARMA), and endoscopic submucosal dissection for GERD are increasingly recognized for their safety and efficacy.</p><p><strong>Key messages: </strong>(a) Modern endoscopic techniques improve the detection of subtle mucosal and functional abnormalities in GERD. (b)Functional endoscopy techniques offer insights into the mechanisms of GERD symptoms and lower esophageal sphincter dysfunction. (c) Endoscopic therapies are minimally invasive treatment options for patients with PPI-refractory or PPI-dependent GERD. (d) Endoscopy is expected to play a central role in the comprehensive management of GERD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic treatment for early Barrett's neoplasia - a Western perspective.","authors":"Edward Young, Joseph Fantasia, Eugene Phan, Rajvinder Singh","doi":"10.1159/000548561","DOIUrl":"https://doi.org/10.1159/000548561","url":null,"abstract":"<p><strong>Background: </strong>Barrett's oesophagus (BE) is the sole established precursor to oesophageal adenocarcinoma, with striking contrasts in its epidemiology and management between the East and the West.</p><p><strong>Summary: </strong>This review, based on a structured literature search, examines the key divergences in endoscopic management: highlighting the Western emphasis on eradication therapy using ablation techniques such as radiofrequency ablation, contrasted with the Eastern expertise in advanced resection techniques including endoscopic submucosal dissection.</p><p><strong>Key messages: </strong>Despite improving patient outcomes, significant challenges remain, including variable surveillance protocols, controversies regarding non-dysplastic BE and low-grade dysplasia, and optimal strategies for recurrent disease. As gastroesophageal reflux disease and long-segment BE rise in prevalence in the East, and Western proficiency in endoscopic submucosal dissection grows, these once-distinct approaches are poised to converge. As these treatment paradigms align, patients and clinicians alike stand to benefit from more effective, tailored care and better long-term outcomes.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-34"},"PeriodicalIF":3.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Statement.","authors":"Marta Raposo","doi":"10.1159/000548053","DOIUrl":"10.1159/000548053","url":null,"abstract":"","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes and clinical factors associated with conventional therapy failure in intestinal Behçet's disease: A retrospective cohort study in Japan.","authors":"Keita Murakami, Junya Arai, Sozaburo Ihara, Yumi Tsuchida, Haruka Tsuchiya, Mayo Tsuboi, Ken Kurokawa, Nobumi Suzuki, Hiroto Kinoshita, Yoku Hayakawa, Keishi Fujio, Mitsuhiro Fujishiro","doi":"10.1159/000548559","DOIUrl":"https://doi.org/10.1159/000548559","url":null,"abstract":"<p><strong>Background: </strong>We aimed to identify the long-term outcomes and predictive factors for failure of conventional therapy (CT), including 5-aminosalicylic acid, azathioprine, and glucocorticoid, in patients with intestinal Behçet's disease (i-BD).</p><p><strong>Methods: </strong>This retrospective study included 63 patients with i-BD receiving CT at the University of Tokyo Hospital between April 2005 and July 2024. Patients requiring anti-tumor necrosis factor-alpha (TNF-α) agents due to CT failure were categorized into the advanced therapy (AT) group, whereas those controlled with CT were classified as the CT group. Risk factors for CT failure were analyzed using Cox proportional hazards regression, and cumulative failure rates were using the Kaplan-Meier method.</p><p><strong>Results: </strong>Twenty-eight patients (44.8%) required AT during a median follow-up of 93 months. The cumulative 1-, 3-, 5-, and 10-year failure rates of CT were 22.6%, 35.9%, 40.0%, and 50.8%, respectively. Multivariate analysis identified maximum ulcer size ≥3 cm (hazard ratio [HR]: 2.68, 95% confidence interval [CI]: 1.05-6.84, p=0.030), concomitant proton-pump inhibitor (PPI) use (HR: 2.65, 95%CI: 1.06-6.58, p=0.036), C-reactive protein (CRP) ≥4 mg/dL (HR: 2.56, 95%CI: 1.04-6.31, p=0.042), and hematochezia (HR: 2.40, 95%CI: 1.05-5.46, p=0.037) as independent predictors of CT failure. A predictive model using all four factors demonstrated good accuracy (AUC=0.877) for predicting AT requirement. Regarding AT efficacy, 22 patients (78.6%) in the AT group continued AT for at least 1 year, with most achieving clinical and endoscopic remission. Concomitant glucocorticoid use significantly decreased from 12.7±11.7 mg/day at baseline to 2.4±2.5 mg/day at 1 year (p<0.001).</p><p><strong>Conclusions: </strong>Large ulcer size, PPI use, high CRP, and hematochezia are risk factors for CT failure. Anti-TNF-α agents are effective in patients with CT failure, and risk-based treatment strategies may improve disease control in patients with i-BD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-26"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Effect of Impaired Skeletal Muscle Assessed with Computed Tomography Images in Patients with Endoscopic Resection for Esophageal Squamous Cell Carcinoma.","authors":"Naotaro Tanno, Waku Hatta, Yohei Ogata, Kimiko Kayada, Makoto Kawabe, Yutaka Hatayama, Masahiro Saito, Akira Imatani, Tomoyuki Koike, Tomohiro Nakamura, Naoki Nakaya, Atsushi Masamune","doi":"10.1159/000548090","DOIUrl":"https://doi.org/10.1159/000548090","url":null,"abstract":"<p><strong>Introduction: </strong>No studies have investigated the prognostic effect of skeletal muscle mass and quality and adipose tissue distribution in patients who undergo endoscopic resection (ER) for esophageal squamous cell carcinoma (ESCC). Thus, this study aimed to evaluate their association.</p><p><strong>Methods: </strong>We retrospectively collected data from patients who underwent ER for ESCC at our institution between 2005 and 2020. Multivariate Cox analysis was performed to investigate the association of 17 candidate factors, including indices for skeletal muscle mass and quality and adipose tissue distribution assessed with computed tomography (CT) images, with prognosis. Further, we evaluated the association of impaired skeletal muscle, characterized by the combination of low skeletal mass index (SMI) and high intramuscular adipose tissue content (IMAC), with prognosis and early and late mortality.</p><p><strong>Results: </strong>Among 450 patients, 116 (25.8%) died during the median follow-up of 111.6 months. Multivariate analyses revealed low SMI (hazard ratio [HR], 1.65) and high visceral adipose index (HR, 0.48) showed significant association with mortality, in addition to male sex, performance status, Charlson comorbidity index, American Society of Anesthesiologists physical status, and prognostic nutrition index. Conversely, no significant association was revealed in other indices. Impaired skeletal muscle was a risk factor for mortality (HR, 2.87) but not the combination of low SMI and low IMAC. It was significantly associated with late mortality (HR, 4.53) but not with early mortality.</p><p><strong>Conclusion: </strong>Impaired skeletal muscle assessed with CT images was a risk factor for late mortality in patients who underwent ER for ESCC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Statement.","authors":"Marta Raposo","doi":"10.1159/000548054","DOIUrl":"10.1159/000548054","url":null,"abstract":"","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}