Journal of Gastroenterology最新文献

{"title":"Proposal of discontinuation criteria of atezolizumab plus bevacizumab after curative conversion therapy for unresectable early-to-intermediate-stage hepatocellular carcinoma: a multicenter proof-of-concept study.","authors":"Tomoko Aoki, Masatoshi Kudo, Naoshi Nishida, Kazuomi Ueshima, Kaoru Tsuchiya, Toshifumi Tada, Masahiro Morita, Hirokazu Chishina, Masahiro Takita, Satoru Hagiwara, Hiroshi Ida, Yasunori Minami, Hidekatsu Kuroda, Noriaki Nakamura, Atsushi Hiraoka, Tetsu Tomonari, Joji Tani, Atsushi Naganuma, Satoru Kakizaki, Chikara Ogawa, Takeshi Hatanaka, Toru Ishikawa, Kazuhito Kawata, Atsushi Takebe, Ippei Matsumoto, Masaaki Hidaka, Masayuki Kurosaki, Takashi Kumada, Namiki Izumi","doi":"10.1007/s00535-025-02233-z","DOIUrl":"https://doi.org/10.1007/s00535-025-02233-z","url":null,"abstract":"<p><strong>Background: </strong>Achieving complete response (CR) is a desirable goal in early-to-intermediate-stage hepatocellular carcinoma (HCC). While systemic and locoregional therapies show promise, optimal drug discontinuation criteria remain unclear. This study aims to investigate drug-off criteria for atezolizumab plus bevacizumab as a proof-of-concept study.</p><p><strong>Methods: </strong>This retrospective multicenter study included child-pugh class A patients with unresectable HCC without extrahepatic spread or macrovascular invasion who received atezolizumab plus bevacizumab as first-line therapy. Modified clinical CR (mCCR) was defined as CR per mRECIST with sustained normal alpha-fetoprotein (AFP) levels (< 10.0 ng/dl). Recurrence-free survival (RFS) and overall survival (OS) were analyzed based on the \"drug-off\" criteria defined by following: (1) mRECIST CR with locoregional therapies, (2) sustained normalization of AFP/AFP-L3/ des-gamma-carboxy prothrombin (DCP) for 12-24 weeks, and (3) complete tumor vascularity disappearance by contrast-enhanced ultrasonography (CEUS) or pathological curative resection.</p><p><strong>Results: </strong>The median follow-up was 16.5 months (95% CI 15.2-17.8). Among 51 patients achieving mCCR, 11 underwent surgery, with pathological CR in three cases. In contrast, viable lesions were observed in 7 of 40 cases assessed using CEUS. All patients meeting the drug-off criteria (n = 9) showed no recurrence and none of them experienced mortality, while 45.2% (19/42) of those not meeting the criteria experienced recurrence (median RFS: 12.8 months, p = 0.007). The median OS was not reached in dug-off criteria met patients (n = 9), 37.7 months (95% CI: NA) in non-criteria met patients (n = 42), and 27.1 months (95% CI 16.7-37.6) in non-mCCR patients (n = 184) (p < 0.001).</p><p><strong>Conclusion: </strong>In patients with unresectable and TACE-unsuitable early-to-intermediate-stage HCC who met the drug-off criteria, significantly improved RFS and OS were observed compared those who did not meet the criteria. However, further validation studies are required to confirm the utility of the criteria.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a capsule endoscopy scoring system for the early diagnosis of small bowel Crohn's disease.","authors":"Yuya Ogino, Kento Sadashima, Yuichiro Yoshida, Hironobu Takedomi, Nanae Tsuruoka, Yasuhisa Sakata, Ayako Takamori, Tadakazu Hisamatsu, Takayuki Matsumoto, Motohiro Esaki","doi":"10.1007/s00535-025-02235-x","DOIUrl":"https://doi.org/10.1007/s00535-025-02235-x","url":null,"abstract":"<p><strong>Background: </strong>Small bowel capsule endoscopy (SBCE) is a reliable method of evaluating small bowel mucosal lesions, and its use in Crohn's disease (CD) is increasing. We previously reported useful SBCE findings for early diagnosis of CD. In the present study, we developed a scoring model for early diagnosis of CD using SBCE findings.</p><p><strong>Methods: </strong>We collected clinical and SBCE data of 110 patients with small bowel mucosal lesions and randomly divided them into derivation and validation cohorts. After selecting variables for scoring models by univariate analysis, the adopted model was determined. The score of each variable was based on the odds ratio obtained by multivariate analysis, and the cut-off value for the diagnosis of CD was examined by receiver operating characteristic analysis. Its reliability was verified in the validation cohort.</p><p><strong>Results: </strong>The model containing age (≤ 30 vs. ≥ 31), linear erosion, and circumferential alignment had the best fit (odds ratios of 4.97, 7.56, and 5.34, respectively). The linear erosion score was defined as 4 points, circumferential alignment as 4, and age of ≤ 30 years as 3. When the cut-off value was defined as 7 points, the scoring model had 85.4% sensitivity, 80.0% specificity, 83.7% positive predictive value, and 82.1% negative predictive value for diagnosis of CD. The validation cohort demonstrated an area under the curve of 0.93, similar to the derivation cohort.</p><p><strong>Conclusion: </strong>We developed a scoring model for early diagnosis of CD based on SBCE findings, possibly contributing to the improvement of the long-term outcome of CD.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term evaluation of Helicobacter pylori screening in school health checkups: an 11-year study in Japan.","authors":"Takuma Okamura, Akihiro Ito, Yugo Iwaya, Tadanobu Nagaya, Atsuhiro Hirayama, Hiroyoshi Ota, Taiji Akamatsu","doi":"10.1007/s00535-025-02236-w","DOIUrl":"https://doi.org/10.1007/s00535-025-02236-w","url":null,"abstract":"<p><strong>Background: </strong>The eradication of Helicobacter pylori (H. pylori) at a younger age is considered effective in preventing gastric cancer. Toward this goal, we introduced primary H. pylori screening into routine high school health screenings in 2007. The present study aimed to elucidate the clinicopathological characteristics of H. pylori-infected students and evaluate the effectiveness of H. pylori screening in high school populations.</p><p><strong>Methods: </strong>Primary screening using a urinary anti-H. pylori antibody test was conducted on high school students from 2007 to 2017. Students who tested positive for this examination were recommended secondary screening by esophagogastroduodenoscopy (EGD), with eradication therapy for those with confirmed H. pylori infection. We analyzed data from 2007 to 2011 as the early period and from 2012 to 2017 as the late period.</p><p><strong>Results: </strong>Over 11 years, 5178 of 5193 (99.7%) subjects received primary screening, among which 184 students (3.6%) tested positive. The primary screening-positive rate decreased significantly from 4.7% in the early period to 2.8% in the late period (p < 0.01). EGD as secondary screening in 103 students (56%) revealed nodular gastritis (83.3%) as the most common endoscopic finding. H. pylori infection was diagnosed in 90 students (87.4%). The resistance rate of H. pylori to clarithromycin was 41.1%. The initial eradication therapy success rate by treatment selection according to H. pylori susceptibility was 96.5%.</p><p><strong>Conclusions: </strong>The introduction of H. pylori screening into school health checkups achieved high participation rates and appeared useful for identifying and treating H. pylori infection in young populations.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and predictability of the Chicago Classification of Pouchitis in ulcerative colitis: a multicenter study in Japan.","authors":"Shintaro Akiyama, Ryohei Hayashi, Takeshi Takasago, Kurando Kusunoki, Hiroki Ikeuchi, Kento Takenaka, Kazuhiro Watanabe, Kazutaka Koganei, Nobuhiro Ueno, Mikihiro Fujiya, Naoki Hosoe, Fumikazu Koyama, Yasuhisa Sakata, Motohiro Esaki, Ken Takeuchi, Makoto Naganuma, Kiichiro Tsuchiya","doi":"10.1007/s00535-025-02231-1","DOIUrl":"https://doi.org/10.1007/s00535-025-02231-1","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic phenotypes of pouchitis according to the Chicago Classification have been reported to be associated with poor pouch outcomes in ulcerative colitis (UC). Here, we aimed to assess the prevalence of endoscopic phenotypes and their predictability for pouch outcomes.</p><p><strong>Methods: </strong>This retrospective multicenter study included UC patients aged 18 years or older who underwent total colectomy between January 2000 and March 2020. The primary endpoints were frequencies of endoscopic phenotypes of the Chicago Classification and their predictability for chronic pouchitis and pouch failure. Endoscopic findings were evaluated at the initial pouchoscopy and at 3 and 10 years after ileostomy takedown.</p><p><strong>Results: </strong>A total of 392 eligible patients were identified. The frequencies of chronic pouchitis and pouch failure were 32% and 4.9%, respectively. Focal inflammation and inlet involvement at the initial postoperative pouchoscopy were significantly associated with subsequent risk of chronic pouchitis and pouch failure, respectively. Thirty percent of the patients with focal inflammation progressed to diffuse inflammation when chronic pouchitis developed. Multivariate analysis showed chronic pouchitis was significantly associated with diffuse inflammation and cuffitis observed throughout the clinical course. The proportion of pouch-related fistula was significantly lower in our cohort than in the US cohort (4.8% vs 19%, P < 0.001), and pouch-related fistula was an independent risk factor for pouch failure.</p><p><strong>Conclusions: </strong>We demonstrated the predictability of the Chicago Classification for pouch outcomes, and a lower prevalence of pouch-related fistula, resulting in a lower pouch failure risk in our multicenter cohort.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cox proportional hazards regression reveals more than a 100-fold difference in cancer risk by the length of Barrett's esophagus in Japan.","authors":"Katsunori Iijima, Sho Fukuda, Kenta Watanabe","doi":"10.1007/s00535-024-02208-6","DOIUrl":"10.1007/s00535-024-02208-6","url":null,"abstract":"","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":"387-388"},"PeriodicalIF":6.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver fibrotic burden across the spectrum of hypothyroidism.","authors":"Tingting Du, Yuchai Huang, Yongman Lv, Gang Yuan","doi":"10.1007/s00535-024-02184-x","DOIUrl":"10.1007/s00535-024-02184-x","url":null,"abstract":"<p><strong>Background: </strong>Data regarding the prevalence of hepatic fibrotic burden across the spectrum of hypothyroidism are scarce. Hence, we aimed to evaluate the prevalence of liver fibrotic burden across the spectrum of hypothyroidism.</p><p><strong>Methods: </strong>30,091 individuals who attended a Health Management Centre between 2019 and 2021 were cross-sectionally analyzed. Participants were categorized as having strict-normal thyroid function, low-normal thyroid function, subclinical hypothyroidism, and overt hypothyroidism. Hepatic fibrosis was assessed by vibration-controlled transient elastography (VCTE). Significant and advanced fibrosis were defined as liver stiffness measurement in VCTE of 8.1-9.6 and 9.7-13.5 kPa, respectively.</p><p><strong>Results: </strong>Among both men and women, low-normal thyroid function group, subclinical hypothyroidism group, and overt hypothyroidism group all have more liver fibrosis present, including mild fibrosis, significant fibrosis, advanced fibrosis, and cirrhosis, than the strict-normal thyroid function group. The low-normal thyroid function group have the similar liver fibrotic burden to the subclinical hypothyroidism group. The highest liver fibrotic burden was noted in the overt hypothyroidism group. Both significant and advanced liver fibrosis were significantly associated with low-normal thyroid function, subclinical hypothyroidism, and overt hypothyroidism in both men and women.</p><p><strong>Conclusions: </strong>Liver fibrotic burden are highly prevalent in subjects with overt hypothyroidism. Moreover, fibrotic burden increased across the spectrum of hypothyroidism even within the low normal thyroid function. These results suggested that screening for liver fibrosis in patients with hypothyroidism is necessary.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":"315-327"},"PeriodicalIF":6.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11880098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acknowledgements.","authors":"","doi":"10.1007/s00535-025-02229-9","DOIUrl":"10.1007/s00535-025-02229-9","url":null,"abstract":"","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":"392-395"},"PeriodicalIF":6.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"YAP acts as an independent prognostic marker and regulates growth and metastasis of gastrointestinal stromal tumors via FBXW7-YAP pathway.","authors":"Xiyu Wu, Kohei Yamashita, Chihiro Matsumoto, Weiliyun Zhang, Ming Ding, Kazuto Harada, Keisuke Kosumi, Kojiro Eto, Satoshi Ida, Yuji Miyamoto, Masaaki Iwatsuki","doi":"10.1007/s00535-024-02180-1","DOIUrl":"10.1007/s00535-024-02180-1","url":null,"abstract":"<p><strong>Background: </strong>Although imatinib (IM) and subsequent tyrosine kinase inhibitors (TKIs) significantly improve the prognosis of GIST patients by delaying metastasis and recurrence, most patients experience limited efficacy due to toxicity and secondary resistance. We evaluated Yes-associated protein (YAP), a coactivator of the Hippo pathway accounting for IM resistance and aggressive GIST phenotypes, in GISTs. The degradation of YAP is mediated by FBXW7, and FBXW7 predicts recurrence and IM efficacy for GIST patients. Here, we aimed to identify the potential of YAP as a prognostic marker for patients with GISTs, and the molecular mechanism of FBXW7-YAP pathway in GIST cells.</p><p><strong>Methods: </strong>We measured YAP expression in 167 GIST cases using immunohistochemical staining, correlated its expression levels with clinicopathological features, and the molecular mechanism underlying the FBXW7-YAP pathway was further examined in vitro and in vivo.</p><p><strong>Results: </strong>Compared to 80 (47.9%) cases in the low YAP expression group, 87 (52.1%) cases with high YAP expression associated with a poorer prognosis in terms of overall survival (P = 0.004) and recurrence-free survival (P = 0.003). YAP expression was identified as a significant independent factor affecting the 5-year overall survival (P = 0.005) and recurrence-free survival rates (P = 0.007). Moreover, YAP was directly targeted by FBXW7 to affect proliferation, invasion, and migration in GIST cells. High YAP expression correlated with FBXW7 deficiency, as shown in xenograft and metastasis mouse models.</p><p><strong>Conclusions: </strong>YAP expression serves as a predictive marker of recurrence for GIST patients with curative resection, highlighting its potential as a novel therapeutic target that warrants further investigation.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":"275-284"},"PeriodicalIF":6.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Japanese version of the Esophageal Hypervigilance and Anxiety Scale for esophageal symptoms.","authors":"Akinari Sawada, Yoshimasa Hoshikawa, Hiroko Hosaka, Masahiro Saito, Hirotaka Tsuru, Shunsuke Kato, Eikichi Ihara, Tomoyuki Koike, Toshio Uraoka, Kunio Kasugai, Katsuhiko Iwakiri, Daniel Sifrim, John Erik Pandolfino, Tiffany H Taft, Yasuhiro Fujiwara","doi":"10.1007/s00535-024-02193-w","DOIUrl":"10.1007/s00535-024-02193-w","url":null,"abstract":"<p><strong>Background: </strong>The Esophageal Hypervigilance and Anxiety Scale (EHAS) is an English questionnaire created in the USA to assess these factors in all patients with esophageal diseases. The aim of this study was to develop and validate the Japanese version of EHAS and investigate the relationship between EHAS scores and symptoms in untreated disorders of esophagogastric junction (EGJ) outflow.</p><p><strong>Methods: </strong>This prospective study recruited patients who underwent high-resolution manometry (HRM) at six tertiary centers in Japan. The EHAS was translated to Japanese using standard forward and backward translation methods. Patients completed the following questionnaires: the Japanese EHAS, Eckardt score, Gastroesophageal Reflux Disease Questionnaire, and Hospital Anxiety and Depression Scale for assessment of construct validity. Logistic regression analysis identified factors associated with esophageal symptom severity in untreated disorders of EGJ outflow.</p><p><strong>Results: </strong>Overall, we analyzed 432 patients. Their main symptoms were dysphagia and reflux. The most common HRM diagnosis was normal (35.9%), followed by achalasia (29.4%). The Japanese EHAS demonstrated excellent reliability, and construct validity, with two subscales similar to the original EHAS. Total EHAS score moderately correlated to Eckardt score (r = 0.545, p < 0.001). In 113 patients with untreated disorders of EGJ outflow, multivariable analysis demonstrated that younger age, type II achalasia, and higher EHAS score were independently associated with higher Eckardt score.</p><p><strong>Conclusions: </strong>The Japanese EHAS is a reliable and valid questionnaire. Its subscale scores can be used as in the original version with some caution. Future studies are warranted to assess the appropriateness of factor loading.</p>","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":"265-274"},"PeriodicalIF":6.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refining risk assessment in Barrett's esophagus: addressing follow-up and diagnostic limitations.","authors":"Jing Jia, Ying He, Ling Hu","doi":"10.1007/s00535-024-02207-7","DOIUrl":"10.1007/s00535-024-02207-7","url":null,"abstract":"","PeriodicalId":16059,"journal":{"name":"Journal of Gastroenterology","volume":" ","pages":"385-386"},"PeriodicalIF":6.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}