Digestion最新文献

{"title":"High-Fat Diet-Induced Gut Microbiota Disruption Promotes Colorectal Cancer Lymphatic Metastasis via Propionate/GPR41 Signaling.","authors":"Jialei Wang, Qingying Tan, Min Ni, Feng Chen, Junlong Yang, Guoliang Wang, Xiaoyong Zhao, Xiaoli Zhang, Sen Zhang","doi":"10.1159/000545843","DOIUrl":"10.1159/000545843","url":null,"abstract":"<p><strong>Introduction: </strong>High-fat diets (HFDs) are known to affect the gut microbiome structure and potentially promote the development and metastasis of colorectal cancer (CRC). This study aims to elucidate the molecular mechanisms through which gut microbiome dysbiosis, mediated by the propionate/GPR41 signaling pathway, promotes lymphangiogenesis and lymph node (LN) metastasis in CRC, providing new insights for CRC treatment.</p><p><strong>Methods: </strong>Microbial diversity and composition in rectal cancer were compared between CRC patients and healthy controls using 16S rRNA sequencing. Key genes related to short-chain fatty acid metabolism, HFD, and gut microbiota were identified. In vitro assays assessed CRC cell proliferation, migration, invasion, and lymphangiogenesis. A CRC mouse model on an HFD was used to measure fecal propionate levels and analyze GPR41 expression in tumors. In vivo fluorescence imaging was employed to track cancer cell migration and lymph node metastasis.</p><p><strong>Results: </strong>HFD-induced microbial dysbiosis led to a significant reduction in SCFA-producing bacteria and an increase in proinflammatory species. This dysbiosis contributed to the suppression of propionate's protective effects. Propionate inhibited CRC cell proliferation, migration, and invasion under HFD conditions by activating the GPR41 pathway. Silencing GPR41 reversed these inhibitory effects, highlighting the key role of GPR41 in mediating propionate's antitumor effects. In vivo experiments further confirmed that propionate suppressed HFD-enhanced CRC lymphatic metastasis through the GPR41 signaling pathway, linking microbial dysbiosis with the modulation of cancer progression.</p><p><strong>Conclusion: </strong>This study reveals that HFD promotes CRC lymphangiogenesis and LN metastasis through gut microbiota dysbiosis and suppression of the propionate-activated GPR41 signaling pathway. These findings highlight the therapeutic potential of targeting the propionate/GPR41 axis, offering a promising strategy for developing novel anticancer therapies.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-18"},"PeriodicalIF":3.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173021","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":"Biodegradable Stents for the Treatment of Refractory Benign Esophageal Strictures: Systematic Review and Meta-Analysis.","authors":"Daniel Tyč, Nina Vaněčková, Josef Hanuš, Iva Selke Krulichová","doi":"10.1159/000546377","DOIUrl":"10.1159/000546377","url":null,"abstract":"<p><strong>Introduction: </strong>Refractory benign esophageal strictures (RBES) pose significant clinical challenges. Biodegradable (BD) stents have emerged as alternatives to traditional stenting methods, offering the possibility of reducing the need for multiple procedures. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of BD stents in the treatment of RBES.</p><p><strong>Methods: </strong>The PubMed, Web of Science, Scopus, Cochrane, and Science Direct databases were searched according to the PRISMA statement. Studies that focused on the clinical outcomes of BD stents used in adult patients with RBES were included. Data on technical success and complication rates were analyzed using random-effects models. Efficacy data were analyzed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>The review included 15 studies with 241 BD stent implantations. The technical success rates were consistently high in all studies. The median time to restenosis was 21 weeks, with survival rates of 38.4% at 26 weeks and 27.0% at 52 weeks. The rate of complications requiring intervention was relatively low, but significant hyperplasia and pain occurred in 16.4% and 8.8% of the cases, respectively. Significant heterogeneity was observed in hyperplasia-related outcomes, which required a detailed subgroup analysis to investigate the underlying causes.</p><p><strong>Conclusion: </strong>BD stents provide acceptable results in terms of efficacy and safety for the treatment of RBES. However, the evidence is limited owing to the lack of randomized controlled trials and comparative studies. Future research should focus on these areas to strengthen the clinical evidence regarding BD stents.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-12"},"PeriodicalIF":3.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12215169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of GALNT12 as a Novel Potential Diagnostic and Prognostic Marker for Esophageal Squamous Cell Carcinoma by Integrated Bioinformatics Analysis.","authors":"Zhaowei Chen, Lili Kang, Zhenze Yang, Yaoqing Cai, Shuyong Yu, Ping Li, Jian Song","doi":"10.1159/000546092","DOIUrl":"https://doi.org/10.1159/000546092","url":null,"abstract":"<p><strong>Background: </strong>Esophageal squamous cell carcinoma (ESCC) is a highly fatal cancer with unclear molecular underpinnings. This study utilized bioinformatics to uncover key genes and pathways associated with ESCC and to identify prognostic markers.</p><p><strong>Methods: </strong>We identified the differentially expressed genes (DEGs) using three datasets (GSE53625, GSE67269, and GSE23400-GPL96). Meanwhile, Weighted gene co-expression network analysis (WGCNA) constructed gene co-expression networks based on the GSE23400-GLP97 dataset. Machine-learning algorithms further identified the most critical genes. Additionally, we validated the expression and diagnostic potential of the hub genes using the GSE161533 and GSE38129 datasets. Survival analysis and Gene Set Enrichment Analysis (GSEA) revealed the prognostic value and potential functions of the hub genes, respectively.</p><p><strong>Results: </strong>The study identified 240 DGEs (103 upregulated and 137 downregulated). Concurrently, WGCNA pinpointed 209 genes associated with ESCC. Subsequently, machine-learning algorithms identify four hub genes, including KIF14, GALNT12, MGLL, and EMP1. Moreover, their expression differences and potential as diagnostic biomarkers for ESCC were validated. Survival analysis indicated that elevated GALNT12 expression was associated with a poor prognosis of ESCC patients. GSEA delineated the involvement of GALNT12 in critical biological pathways.</p><p><strong>Conclusions: </strong>Our results identified GALNT12 as a novel potential diagnostic and prognostic marker for ESCC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-18"},"PeriodicalIF":3.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991687","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":"Metagenomics Study Suggests the Role of Vitamins and Gut Microbiome in Autism Spectrum Disorder.","authors":"Ez Sadoon Mahdi, Majid Komijani, Anita Alaghmand","doi":"10.1159/000545483","DOIUrl":"10.1159/000545483","url":null,"abstract":"<p><strong>Introduction: </strong>Autism is a neurological disability that often appears after the age of three in children, also known as an autism spectrum disorder (ASD). Several studies have examined the influence of some environmental factors, and many parameters related to the behavior of autistic patients have been measured in order to find ways to reduce ASD. This study investigates the relationship between ASD and serum levels of vitamin D3, B12, folic acid, and the gut microbiome.</p><p><strong>Methods: </strong>The serum levels of vitamin D3, B12, and folic acid in ASD patients were measured by the ELISA method and compared to healthy groups. DNA was extracted from stool samples of ASD patients and the control group, and then the gut microbiome was investigated via a metagenomics approach. Metagenomics sequencing was performed to analyze the 16S rRNA gene sequencing for phylum and sub phylum level microbiome.</p><p><strong>Result: </strong>The result showed no significant change in the VitD3 and folate levels of ASD patients compared to the control group (p = 0.157 and p = 0.0505, respectively). There was a significant difference in the VitB12 level between control healthy individuals and ASD patients, in which the serum VitB12 concentration was significantly lower than the control group (p = 0.0001). Our results regarding gut metagenomics showed that the abundance of the Actinobacteria by the phylum level was significantly higher in the ASD patients compared to the control group (p = 0.0013). The abundance of the Firmicutes by the phylum level was significantly lower in the ASD patients compared to the control group (p = 0.0016). The abundance of Bifidobacteriaceae, and Ruminococcaceae by the family level was significantly higher in the ASD patients compared to the control group (p = 0.0004 and p = 0.0489, respectively). Our results indicated less species richness in the ASD patients compared to the control group.</p><p><strong>Conclusion: </strong>Patients with ASD have lower serum levels of vitamin B12 and different gut microbiome compared to healthy controls. Low vitamin B12 levels and altered gut microbiome are significantly associated with ASD in this study. However, further research is needed to determine whether these factors could serve as predictors of severe outcomes in ASD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-15"},"PeriodicalIF":3.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997404","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":"Investigation of Recognition Areas by Explainable Artificial Intelligence for Colonoscopy Images of Irritable Bowel Syndrome.","authors":"Hiroshi Mihara, Shun Kuraishi, Haruka Fujinami, Takayuki Ando, Ichiro Yasuda","doi":"10.1159/000546183","DOIUrl":"10.1159/000546183","url":null,"abstract":"<p><strong>Introduction: </strong>Irritable bowel syndrome (IBS) is a condition in which gastroenterological endoscopists cannot detect anomalies using colonoscopy, yet an artificial intelligence (AI) developed for IBS colonoscopy images has been able to distinguish between IBS and healthy individuals with high accuracy. However, it was unclear which areas the AI identified as abnormal. The aim of this study was to elucidate how AI identifies regions typical of IBS by constructing an additional explainable AI (XAI).</p><p><strong>Methods: </strong>Colonoscopy images of healthy individuals, patients with constipation-predominant IBS, and patients with diarrhea-predominant IBS, which are available in a repository (<ext-link ext-link-type=\"doi\" xlink:href=\"https://doi.org/10.5061/dryad.9s4mw6mkp\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">https://doi.org/10.5061/dryad.9s4mw6mkp</ext-link>), were used. After setting up a Python environment on a local PC, the XAI models for the three groups were developed. Images not used in the AI construction were then evaluated using XAI. XAI-generated images were independently assessed by two evaluators, H.M. and S.K., to record and reconcile the characteristic differences among the three groups.</p><p><strong>Results: </strong>Images correctly identified as those of healthy individuals by XAI were evaluated as characteristics over the entire image. By contrast, for IBS, only parts of the images were evaluated as characteristic regions. For diarrhea-predominant IBS, regions characterized by clear vascular boundaries, homogeneity or erythematous tones, or narrow and somewhat dark-appearing sections of the intestinal tract were identified. For constipation-predominant IBS, regions characterized by unclear vascular boundaries, faded tones, or dark sections where the end was not visible were identified.</p><p><strong>Conclusion: </strong>An XAI for IBS was collaboratively developed by endoscopists and clinical engineers, enabling the visualization of regions characteristic of IBS and healthy individuals. The real-time display of XAI is expected to further advance the elucidation of IBS pathophysiology.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and Verification of B4GALNT2 as an Epigenetic Marker in Ulcerative Colitis.","authors":"Yi Zhu, Yuan Zhou, Honggang Jiang, Zhiheng Chen, Bohao Lu, Jiaming Wu","doi":"10.1159/000545944","DOIUrl":"10.1159/000545944","url":null,"abstract":"<p><strong>Introduction: </strong>Ulcerative colitis (UC) represents an inflammatory bowel disease characterized with a multifaceted pathogenesis, which may be attributed to influence by genetic factors. This study aimed to identify and validate novel markers associated with UC, with a specific focus on their regulation through DNA methylation.</p><p><strong>Methods: </strong>Gene expression and DNA methylation profiling of intestinal mucosal tissues from UC and healthy controls was retrieved from the GEO repository. Differentially expressed and methylated genes were examined in UC. Subsequently, overlapped analyses were performed to identify highly expressed and hypomethylated genes, as well as lowly expressed and hypermethylated genes. Functional annotation, transcription factor-mRNA network analysis, and protein-protein interaction (PPI) network analysis were conducted for above genes. Dextran sodium sulfate (DSS)-induced LOVO and Caco-2 cells were established to stimulate UC injury. The expression and methylation of B4GALNT2 was verified by real-time quantitative polymerase chain reaction and methylation-specific PCR. Cell Counting Kit-8, flow cytometry, Western blot, and enzyme-linked immunosorbent assay were used to measure cell survival, apoptosis, and cytokine levels after B4GALNT2 overexpression.</p><p><strong>Results: </strong>Our study screened 1 downregulated and hypermethylated gene (B4GALNT2) and 114 upregulated and hypomethylated genes in UC. They were markedly associated with immune response. Totally, 10 potential transcription factors were predicted. The PPI network revealed their complex interactions. B4GALNT2 was confirmed to be downregulated and hypermethylated in DSS-induced intestinal epithelial cells and in DSS-induced UC mouse model. B4GALNT2 overexpression enhanced cell viability and weakened apoptosis and cytokine production and release of DSS-induced intestinal epithelial cells.</p><p><strong>Conclusion: </strong>Collectively, this study integrally analyzed DNA methylation and gene expression in UC as well as identified and verified B4GALNT2 as a key epigenetic marker.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-19"},"PeriodicalIF":3.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985173","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":"Weakly Supervised Deep Learning Can Analyze Focal Liver Lesions in Contrast-Enhanced Ultrasound.","authors":"Adil Oezsoy, James Alexander Brooks, Marko van Treeck, Yvonne Doerffel, Ulrike Morgera, Jens Berger, Marco Gustav, Oliver Lester Saldanha, Tom Luedde, Jakob Nikolas Kather, Tobias Paul Seraphin, Michael Kallenbach","doi":"10.1159/000545098","DOIUrl":"10.1159/000545098","url":null,"abstract":"<p><strong>Introduction: </strong>Assessing the malignancy of focal liver lesions (FLLs) is an important yet challenging aspect of routine patient care. Contrast-enhanced ultrasound (CEUS) has proved to be a highly reliable tool but is very dependent on the examiner's expertise. The emergence of artificial intelligence has opened doors to algorithms that could potentially aid in the diagnostic process. In this study, we evaluate the performance of a weakly supervised deep learning model in classifying FLLs as malignant or benign.</p><p><strong>Methods: </strong>Our retrospective feasibility study was based on a cohort of patients from a tertiary care hospital in Germany undergoing routine CEUS examination to evaluate malignancy of FLL. We trained a weakly supervised attention-based multiple instance learning algorithm during 5-fold cross-validation to distinguish malignant from benign liver tumors, without using any manual annotations, only case labels. We aggregated the on-average best performing cross-validation cycle and tested this combined model on a held-out test set. We evaluated its performance using standard performance metrics and developed explainability methods to gain insight into the model's decisions.</p><p><strong>Results: </strong>We enrolled 370 patients, comprising a total of 955,938 images extracted from CEUS videos or manually captured during the examination. Our combined model was able to identify malignant lesions with a mean area under the receiver operating curve of 0.844 in the cross-validation experiment and 0.94 (95% CI: 0.89-0.99) in the held-out test set. The accuracy, sensitivity, specificity, and F1-Score of the combined model in finding malignant lesions in the held-out test, yielded 80.0%, 81.8%, 84.6%, and 0.81, respectively. Our exploratory analysis using visual explainability methods revealed that the model appears to prioritize information that is also highly relevant to expert clinicians in this task.</p><p><strong>Conclusion: </strong>Weakly supervised deep learning can classify malignancy in CEUS examinations of FLLs and thus might one day be able to assist doctors' decision-making in clinical routine.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572465","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":"Identification of a Novel Activated NK-Associated Gene Score Associated with Diagnosis and Biological Therapy Response in Ulcerative Colitis.","authors":"Siyuan Dong, Yu Zhang, Lingna Ye, Qian Cao","doi":"10.1159/000540939","DOIUrl":"10.1159/000540939","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Natural killer (NK) cells are associated with the pathogenesis of ulcerative colitis (UC); however, their precise contributions remain unclear. The present study aimed to investigate the diagnostic value of the activated NK-associated gene (ANAG) score in UC and evaluate its predictive value in response to biological therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Bulk RNA-seq and scRNA-seq datasets were obtained from the Gene Expression Omnibus (GEO) and Single Cell Portal (SCP) databases. In the bulk RNA-seq, differentially expressed genes (DEGs) were screened by the \"Batch correction\" and \"Robust rank aggregation\" (RRA) methods. The immune infiltration landscape was estimated using single-sample gene set enrichment analysis (ssGSEA) and CIBERSORT. DEGs that correlated with activated NK cells were identified as activated NK-associated genes (ANAGs). Protein-protein interaction (PPI) analysis and least absolute shrinkage and selection operator (LASSO) regression were used to screen key ANAGs and establish an ANAG score. The expression levels of the four key ANAGs were validated in human samples by real-time quantitative polymerase chain reaction (RT-qPCR) and immunofluorescence. The potential therapeutic drugs for UC were identified using the DSigDB database. Through scRNA-seq data analysis, the cell scores based on the ANAGs were calculated by \"AddModuleScore\" and \"AUCell.\"&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Immune infiltration analysis revealed a higher abundance of activated NK cells in noninflamed UC tissues (ssGSEA, p &lt; 0.001; CIBERSORT, p &lt; 0.01). Fifty-four DEGs correlated with activated NK cells were identified as ANAGs. The ANAG score was established using four key ANAGs (SELP, TIMP1, MMP7, and ABCG2). The ANAG scores were significantly higher in inflamed tissues (p &lt; 0.001) and in biological therapy nonresponders (NR) tissues before treatment (golimumab, p &lt; 0.05; ustekinumab, p &lt; 0.001). The ANAG score demonstrated an excellent diagnostic value (AUC = 0.979). Patients with higher ANAG scores before treatment were more likely to experience a lack of response to golimumab or ustekinumab (golimumab, p &lt; 0.05; ustekinumab, p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study established a novel ANAG score with the ability to precisely diagnose UC and distinguish the efficacy of biological treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Natural killer (NK) cells are associated with the pathogenesis of ulcerative colitis (UC); however, their precise contributions remain unclear. The present study aimed to investigate the diagnostic value of the activated NK-associated gene (ANAG) score in UC and evaluate its predictive value in response to biological therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Bulk RNA-seq and scRNA-seq datasets were obtained from the Gene Expression Omnibus (GEO) and Single Cell Portal (SCP) databases. In the bulk RNA-seq, differentially expressed genes (DEGs) were screened by the \"Batch correctio","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-22"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal Cancer: Epidemiology, Risk Factors, and Public Health Strategies.","authors":"Takahisa Matsuda, Ai Fujimoto, Yoshinori Igarashi","doi":"10.1159/000543921","DOIUrl":"10.1159/000543921","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) is a significant global health issue, ranking as the third most commonly diagnosed cancer and the second leading cause of cancer-related deaths. Countries with a high Human Development Index (HDI) report the highest incidence rates, driven by dietary and lifestyle factors. In contrast, low-to-middle HDI countries are experiencing rising CRC rates due to urbanization and westernization. Japan exemplifies this shift, with increasing CRC incidence linked to the adoption of westernized diets. Despite advances in screening and treatment, CRC-related mortality remains substantial, with 53,088 deaths reported in Japan.</p><p><strong>Summary: </strong>This review examines global and regional CRC trends, focusing on incidence, mortality, and risk factors such as genetic predispositions, diet, and lifestyle influences. The review highlights the growing burden of CRC in Japan and other regions where dietary changes and urbanization are prevalent. Key findings include the significant impact of processed foods, sugary beverages, obesity, alcohol, and smoking on CRC risk, as well as the protective effects of vitamin D, calcium, and fermented foods. The role of inflammatory bowel disease and diabetes in CRC risk is also discussed. Furthermore, the review emphasizes the importance of public health initiatives, including organized screening programs, in mitigating the CRC burden.</p><p><strong>Key messages: </strong>Understanding the interplay between genetic, lifestyle, and environmental factors is crucial for developing effective prevention strategies. Enhancing CRC screening, early detection, and public health interventions can significantly reduce CRC-related mortality. Continued research and collaboration are essential for advancing CRC prevention and improving global health outcomes.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"91-99"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406256","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":"Urgent Contrast-Enhanced Computed Tomography before Early Colonoscopy in the Management of Colonic Diverticular Bleeding: A Multicenter Randomized Controlled Trial.","authors":"Yuichiro Hirai, Toshio Uraoka, Michiko Wada, Hideki Mori, Ai Fujimoto, Yuko Sakakibara, Tatsuya Toyokawa, Takashi Kagaya, Yoshihiro Sasaki, Tomohiko Mannami, Toshio Kuwai, Noriko Watanabe, Hiroshige Hamada, Naoki Esaka, Toshihisa Kimura, Hiroyuki Fujii, Yasuo Hosoda, Masaaki Shimada, Hideharu Miyabayashi, Shinichi Somada, Katsuhiro Mabe, Shuji Inoue, Hiroki Saito, Kensuke Furuya, Norio Kawamura, Tomohiro Kudo, Keisuke Hori, Naoto Sakamoto, Mototsugu Kato, Nobuya Higuchi, Naohiko Harada","doi":"10.1159/000541942","DOIUrl":"10.1159/000541942","url":null,"abstract":"<p><strong>Introduction: </strong>Contrast-enhanced computed tomography (CE-CT) has been gaining attention as an initial investigation in the management of colonic diverticular bleeding (CDB), yet the role of CE-CT other than its diagnostic yield has not been adequately clarified. We aimed to determine whether the use of urgent CE-CT improves identification of stigmata of recent hemorrhage (SRH) in subsequently performed early colonoscopy (≤24 h of arrival) or other clinical outcomes of CDB.</p><p><strong>Methods: </strong>We conducted a randomized, open-label, controlled trial at 23 institutions in Japan. Outpatients with suspected CDB were randomly assigned to undergo either urgent CE-CT followed by early colonoscopy (urgent-CE-CT + early-colonoscopy group) or early colonoscopy alone (early-colonoscopy group). The primary outcome was SRH identification. Secondary outcomes included successful endoscopic hemostasis, early (<30 days) and late (<1 year) rebleeding, length of hospital stay, and transfusion requirements.</p><p><strong>Results: </strong>In total, 240 patients, mostly in a hemodynamically stable condition, were randomized. A contrast extravasation on CE-CT was observed in 20 of 115 patients (17.4%) in the urgent-CE-CT + early-colonoscopy group. SRH was identified in 23 of 115 patients (20.0%) in the urgent-CE-CT + early-colonoscopy group and 21 of 118 patients (17.8%) in the early-colonoscopy group (difference, 2.2; 95% confidence interval [CI], -7.9 to 12.3; p = 0.739). Successful endoscopic hemostasis was achieved in 21 patients in each group (18.3% and 17.8%, respectively) (difference, 0.5; 95% CI, -9.4 to 10.4; p = 1.000). There were also no significant differences between groups in early and late rebleeding, length of hospital stay, and transfusion requirements.</p><p><strong>Conclusion: </strong>The use of urgent CE-CT before early colonoscopy did not improve SRH identification or other clinical outcomes in patients with suspected CDB in a hemodynamically stable condition. The routine use of urgent CE-CT as an initial investigation is not recommended in this population, also considering the low rate of extravasation-positive cases (UMIN registry number, UMIN000026865).</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"176-188"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460479","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}