Digestion最新文献

{"title":"Annual Trends in the Diagnosis of Autoimmune Gastritis over 11 Years at a Single Facility in Japan.","authors":"Kaoru Nakano, Toshiaki Hirasawa, Ayaka Takasu, Yuka Higashi, Souya Nunobe, Masayuki Shimoda, Kengo Takeuchi, Hiroshi Kawachi","doi":"10.1159/000544812","DOIUrl":"10.1159/000544812","url":null,"abstract":"<p><strong>Introduction: </strong>Autoimmune gastritis (AIG), a type of chronic atrophic gastritis, is characterized by positive anti-parietal cell antibodies and mucosal atrophy predominantly in the corpus. In Japan, AIG has garnered increasing attention owing to the recent decline in Helicobacter pylori (HP) infection rates, leading to the proposal of diagnostic criteria. These criteria encompass serological test results, endoscopic findings, and histological findings, emphasizing the need for collaboration between endoscopists and pathologists to make an accurate diagnosis. In the present study, we aimed to clarify the annual number of patients with AIG diagnosed over the past 11 years and analyze their endoscopic and histological characteristics.</p><p><strong>Methods: </strong>We retrospectively reviewed patients with AIG newly diagnosed at our institution between 2013 and 2023. Patients were categorized into the \"prior endoscopically diagnosed group\" (ED group) and the \"prior pathologically diagnosed group\" (PD group). The annual trend in AIG diagnosis was analyzed, and clinicopathological characteristics were compared between the groups.</p><p><strong>Results: </strong>In total, 118 patients were diagnosed with AIG during the study period. The number of diagnoses increased after 2018, when a focused effort to identify AIG began, peaking in 2021 with 32 cases. All patients diagnosed before 2018 belonged to the ED group, but subsequent years saw increases in both groups of patients. The PD group had significantly more cases of coexisting gastric carcinoma (86.3% vs. 26.9%, p < 0.001) or HP-associated gastritis (72.4% vs. 32.8%, p = 0.002) than the ED group, whereas the ED group frequently exhibited typical endoscopic findings, such as atrophic gastritis predominantly in the corpus and adherent mucus.</p><p><strong>Conclusion: </strong>Accurate diagnosis of AIG requires familiarity with the diagnostic criteria by endoscopists and pathologists. In cases complicated by gastric carcinoma or HP-associated gastritis, endoscopic findings alone may not suffice for diagnosis, underscoring the critical role of pathologists in interpreting histological findings.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-11"},"PeriodicalIF":3.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585036","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":"Xiayuxue Decoction Plays an Antidevelopment Role in Hepatocellular Carcinoma through Intestinal-Hepatic Axis.","authors":"Ting Zhou, Liyuan Pei, Ya Chen, Xuejing Wang, Hongyu Fang, Xiaoyan Zeng, Xuefei Tian","doi":"10.1159/000543834","DOIUrl":"10.1159/000543834","url":null,"abstract":"<p><strong>Introduction: </strong>In recent years, the effect of \"intestinal-hepatic axis\" in tumorigenesis of hepatocellular carcinoma (HCC) has been paid more and more attention, and the imbalance of gut microbiota is closely related to the pathogenesis of HCC. The Xiayuxue decoction (XYXD) has inhibitory effect on hepatic fibrosis, but the effect of XYXD on HCC is not clear.</p><p><strong>Methods: </strong>We induced HCC mouse model by diethylnitrosamine and CCL4. HCC mice were treated with XYXD gavage. Hematoxylin-eosin staining was used to detect the pathological changes of liver tissue in mice. Immunohistochemistry was used to detect the level of Ki-67 in liver tumor and ZO-1 in colon tissue. The level of inflammatory factors in plasma, liver, and colon tissue of mice was detected by ELISA. The changes of macrophages and neutrophils in colorectal tissues of mice were counted by immunofluorescence. 16S sequencing was used to analyze the effect of XYXD treatment on gut microbiota of HCC mice.</p><p><strong>Results: </strong>Our study found that XYXD could inhibit the progress of HCC. XYXD upregulated the expression levels of ZO-1, occludin, and claudin in colon tissue to repair intestinal mucosal barrier. XYXD could alleviate the infiltration of intestinal immune cells in HCC mice by inhibiting the data of macrophages and neutrophils in colon tissue and downregulating SIgA level. XYXD also regulated the composition of intestinal microorganisms and improved the diversity of gut microbiota, thus affecting the progress of HCC.</p><p><strong>Conclusion: </strong>XYXD inhibits the progress of HCC by influencing gut microbiota to regulate intestinal and liver inflammation and intestinal immune response.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-15"},"PeriodicalIF":3.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499709","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":"Artificial Intelligence in Colonoscopy: Where Are We Now in 2024?","authors":"Wan Ying Lai, Kenneth Weicong Lin, Loi Pooi Ling, James W Li, Louis H S Lau, Philip W Y Chiu","doi":"10.1159/000544030","DOIUrl":"10.1159/000544030","url":null,"abstract":"<p><strong>Introduction: </strong>Colonoscopy has a crucial role in reducing colorectal cancer incidence and mortality. Different artificial intelligence (AI) systems were developed to further improve its quality assurance (computer-aided quality improvement [CAQ]), lesion detection (computer-aided detection [CADe]), and lesion characterization (computer-aided characterization [CADx]). There were studies investigating the roles of these AI systems in different domains of standard colonoscopies.</p><p><strong>Methods: </strong>In this state-of-the-art narrative review, we summarize the current evidence, discuss existing limitations, as well as explore the future directions of AI in colonoscopy.</p><p><strong>Results: </strong>CAQ enhances colonoscopy quality through real-time feedback and quality monitoring systems, but the studies have inconsistent results due to small training datasets and varied methodologies. CADe increases adenoma detection rate and reduces adenoma missed rates, but there are concerns about false positives, unnecessary polypectomies, potential deskilling of endoscopists, and cost-effectiveness. CADx systems have mixed results and accuracies in differentiating polyp types, and its use is further hindered by inadequate representation of sessile serrated lesions and a lack of rigorous trials comparing it with standard colonoscopy.</p><p><strong>Conclusion: </strong>Despite the emerging evidence of AI-assisted colonoscopy, its potential drawbacks and limitations may hinder the further implementation in real-world clinical practice. Long-term data on clinical efficacy, cost-effectiveness, liability, and data sharing are the key areas to be addressed.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-14"},"PeriodicalIF":3.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412753","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":"Dynamic Observation of Colonic Lesions, Commensal Microbiome, and Mycobiome Variations in Trinitrobenzene Sulfonic Acid-Induced Experimental Crohn's Disease in Rats.","authors":"Mingjiang Liu, Huiwen Wang, Junjie Huang, Yuying Huai, Chenglong Yu, Guoqing Fang, Minxia Zhang, Ruonan Bo, Kai Fan, Jingui Li","doi":"10.1159/000543337","DOIUrl":"10.1159/000543337","url":null,"abstract":"<p><strong>Introduction: </strong>Crohn's disease (CD) is an inflammatory bowel disease characterized by chronic inflammation of the entire digestive lining. Although the pathogenesis of CD remains unclear, multiple factors, especially altered microbiota, are among its causes.</p><p><strong>Methods: </strong>In this study, an experimental CD model was established by trinitrobenzene sulfonic acid (TNBS) enema. Then the dynamic changes of colonic tissue lesions, tight junctions, inflammation response, and oxidative stress are respectively tested by hematoxylin and eosin staining, immunofluorescence staining, and commercial kits. 16S rRNA and ITS sequencing of colonic feces were applied to analyze the composition and diversity of the microbiome and mycobiome for lasting 5 weeks.</p><p><strong>Results: </strong>As a result, despite TNBS being applied only once time, the stimuli-caused injury reached a peak in the second week (the most severe period), after which symptoms began to gradually return to the normal stage. Additionally, consistent with the TNBS-caused colonic damage, deaths were also concentrated within 2 weeks after modeling, with only one death occurring in the subsequent period despite ongoing inflammation and other typical symptoms. In terms of gut bacteria, microbiome diversity decreased significantly while mycobiome diversity increased, along with the enrichment of harmful microbiota and shrinkage of probiotic microorganisms.</p><p><strong>Conclusion: </strong>Therefore, the data suggested that TNBS-induced CD can be roughly divided into two phases: the acute inflammatory phase (weeks 1-2) and the chronic inflammatory phase (weeks 3-5). However, the microbiome and mycobiome dysbiosis did not return to normal within the trial period. Hence, our findings may facilitate a better comprehension of the dynamic progress of experimental TNBS-induced CD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-15"},"PeriodicalIF":3.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398660","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}

{"title":"Cost-Effectiveness Analysis of Endoscopic Treatment versus Medication Strategy for Proton Pump Inhibitor-Refractory Gastroesophageal Reflux Disease.","authors":"Fumiaki Ishibashi, Sho Suzuki, Kentaro Mochida, Takao Tonishi, Yuichi Ishibashi","doi":"10.1159/000543365","DOIUrl":"10.1159/000543365","url":null,"abstract":"<p><strong>Introduction: </strong>Potassium-competitive acid blockers are effective against proton pump inhibitor-refractory gastroesophageal reflux disease; however, their long-term use is associated with economic disadvantages. Endoscopic procedures may reduce potassium-competitive acid blocker use. This study aimed to determine the optimal treatment strategy for patients with proton pump inhibitor-refractory gastroesophageal reflux disease from a cost-effectiveness perspective.</p><p><strong>Methods: </strong>Using a Markov state transition model to simulate symptom changes in patients with proton pump inhibitor-refractory gastroesophageal reflux disease, the cost-effectiveness of two strategies was compared: endoscopic treatment (anti-reflux mucosectomy or endoscopic submucosal dissection for gastroesophageal reflux disease) followed by potassium-competitive acid blocker versus medication with high-dose potassium-competitive acid blocker. In both strategies, potassium-competitive acid blocker maintained symptoms at the lowest controllable dose. The time horizon varied from 10 to 50 years. The quality-adjusted life year and incremental cost-effectiveness ratio were calculated. Willingness to pay was set at 5,000,000 Japanese yen.</p><p><strong>Results: </strong>The quality-adjusted life years gained were 0.90 and 0.95 for the endoscopic treatment and medication strategies, respectively. The incremental cost-effectiveness ratio varied with the follow-up period after the initial treatment, with the endoscopic treatment strategy being more cost-effective than the medication strategy at ≥50 years of follow-up. A dose reduction success rate of <84.1% for high-dose potassium-competitive acid blocker and an endoscopic treatment success rate of >66.8% were required to determine the superiority of the endoscopic treatment strategy at the 50-year follow-up after treatment.</p><p><strong>Conclusions: </strong>The endoscopic treatment strategy is not cost-effective unless the patient is followed up for >50 years after the initial treatment.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"277-286"},"PeriodicalIF":3.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920751","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":"Questionnaire Survey on the Diagnosis and Treatments of Eosinophilic Gastrointestinal Diseases in Asia.","authors":"Yoshikazu Tsuzuki, Akiko Shiotani, Kazuya Miyaguchi, Shouko Ono, Yutaka Saito, Mitsushige Sugimoto, Yuji Naito, Sachiyo Nomura, Osamu Handa, Tadakazu Hisamatsu, Mitsuhiro Fujishiro, Takahisa Matsuda, Yoshinori Morita, Naohisa Yahagi, Francis K L Chan, Tiing Leong Ang, Murdani Abdullah, Maria Carla Tablante, Varayu Prachayakul, Baiwen Li, Hwoon-Yong Jung, Hisashi Matsumoto, Rie Shiomi, Hiroyuki Imaeda","doi":"10.1159/000544725","DOIUrl":"10.1159/000544725","url":null,"abstract":"<p><strong>Introduction: </strong>Eosinophilic gastrointestinal disease (EGID) is divided into eosinophilic esophagitis (EoE) and non-eosinophilic esophagitis eosinophilic gastrointestinal disease (non-EoE-EGID), based on the involved gastrointestinal organs. The present survey was performed to provide an overview of the current status of the epidemiology, diagnosis, and treatment of EGID in Asia.</p><p><strong>Methods: </strong>Responses to the questionnaire were obtained from 228 doctors at various institutions in eight Asian countries. The questionnaire consisted of 52 questions on EoE and non-EoE EGID.</p><p><strong>Results: </strong>Responses to questionnaire were obtained from 228 doctors from eight countries. The most common participation facilities were university hospitals, followed by public hospitals, private hospitals, and private clinics. 1-10 were the most frequent patients per year in each institution for both EoE and non-EoE-EGID. The 30s and 40s are common age groups for both EoE and non-EoE-EGID. Although endoscopic findings vary among countries, 15 or more eosinophil infiltrations in high-power fields as a diagnostic criterion are used in all countries for EoE. As treatments, the prescription rates of Proton pump inhibitor, diet, topical and systemic steroids, and biologics were similar among the eight countries in EoE. Non-EoE-EGID showed a similar trend to EoE in epidemiology, symptoms, diagnosis, and treatment.</p><p><strong>Conclusion: </strong>The questionnaire survey partially revealed the current status of the epidemiology, symptoms, diagnosis, and treatment of EGID in Asian countries.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"153-164"},"PeriodicalIF":3.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412952","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}