World Journal of Gastroenterology最新文献

{"title":"Dynamic nomogram predicts sepsis risk in patients with acute liver failure: Analysis of intensive care database with external validation.","authors":"Rui Qi, Xin Wang, Zhi-Dan Kuang, Xue-Yi Shang, Fang Lin, Dan Chang, Jin-Song Mu","doi":"10.3748/wjg.v31.i31.105229","DOIUrl":"10.3748/wjg.v31.i31.105229","url":null,"abstract":"<p><strong>Background: </strong>Acute liver failure (ALF) with sepsis is associated with rapid disease progression and high mortality. Therefore, early detection of high-risk sepsis subgroups in patients with ALF is crucial.</p><p><strong>Aim: </strong>To develop and validate an accurate nomogram model for predicting the risk of sepsis in patients with ALF.</p><p><strong>Methods: </strong>We retrieved data from the Medical Information Mart for Intensive Care (MIMIC) IV database and the Fifth Medical Center of Chinese PLA General Hospital (FMCPH). Univariate and multivariate logistic regression analysis were used to identify risk factors for sepsis in ALF and were subsequently incorporated to construct a nomogram model [sepsis in ALF (SIALF)]. The discrimination ability, calibration, and clinical applicability of the SIALF model were evaluated by the area under receiver operating characteristic curve, calibration curves, and decision curve analysis, respectively. The Kaplan-Meier curves were used for robustness check. The SIALF model was internally validated using the bootstrapping method with the MIMIC validation cohort and externally validated by the FMCPH cohort.</p><p><strong>Results: </strong>A total of 738 patients with ALF patients were included in this study, with 510 from the MIMIC IV database and 228 from the FMCPH cohort. In the MIMIC IV cohort, 387 (75.89%) patients developed sepsis. Multivariate logistic regression analysis revealed that age [odds ratio (OR) = 1.016, 95% confidence interval (CI): 1.003-1.028, <i>P</i> = 0.017], total bilirubin (OR = 1.047, 95%CI: 1.008-1.088, <i>P</i> = 0.017), lactate dehydrogenase (OR = 1.001, 95%CI: 1.000-1.001, <i>P</i> < 0.001), albumin (OR = 0.436, 95%CI: 0.274-0.692, <i>P</i> = 0.003), and mechanical ventilation (OR = 1.985, 95%CI: 1.269-3.105, <i>P</i> = 0.003) were independent risk factors associated with sepsis in patients with ALF. The SIALF model demonstrated satisfactory accuracy and clinical utility with area under receiver operating characteristic curve values of 0.849, 0.847, and 0.835 for the internal derivation, internal validation, and external validation cohort, respectively, which outperformed the Sequential Organ Failure Assessment scores of 0.733, 0.746, and 0.721 and systemic inflammatory response syndrome scores of 0.578, 0.653, and 0.615, respectively. The decision curve analysis and calibration curves indicated superior clinical utility and efficiency than other score systems. Based on the risk stratification score derived from the SIALF model, the Kaplan-Meier curves effectively discriminated the real high-risk subpopulation. To enhance the clinical utility, we constructed an online dynamic version, enabling physicians to evaluate patients' condition and track disease progression in real-time.</p><p><strong>Conclusion: </strong>Based on easily identifiable clinical data, we developed the SIALF model to predict the risk of sepsis in patients with ALF. The model demonstrated ","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 31","pages":"105229"},"PeriodicalIF":5.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993659","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":"Age- and gender-specific dynamics and next-generation reference intervals for pepsinogen in northern China.","authors":"Miao-Miao Zhang, Dong Zhu, Hai-Bin Zhao, Xiu-Ying Zhao","doi":"10.3748/wjg.v31.i31.108977","DOIUrl":"10.3748/wjg.v31.i31.108977","url":null,"abstract":"<p><strong>Background: </strong>Pepsinogen (PG) and the PG I/II ratio (PGR) are critical indicators for diagnosing <i>Helicobacter pylori</i> infection and chronic atrophic gastritis, and assessing gastric cancer risk. Existing reference intervals (RIs) often overlook age, sex, and demographic variations. Partitioned RIs, while considering these factors, fail to capture the gradual age-related physiological changes. Next-generation RIs offer a solution to this limitation.</p><p><strong>Aim: </strong>To investigate age- and sex-specific dynamics of PG and establish next-generation RIs for adults and the elderly in northern China.</p><p><strong>Methods: </strong>After screening, 708 healthy individuals were included in this observational study. Serum PG was measured using chemiluminescence immunoassay. Age- and sex-related effects on PG were analyzed with a two-way analysis of variance. RI partitioning was determined by the standard deviation ratio (SDR). Traditional RIs were established using a non-parametric approach. Generalized Additive Models for Location, Scale, and Shape (GAMLSS) modeled age-related trends and continuous reference percentiles for PG I and PG II. Reference limit flagging rates for both RI types were compared.</p><p><strong>Results: </strong>PG I and PG II levels were influenced by age (<i>P</i> < 0.001) and sex (<i>P</i> < 0.001), while PGR remained stable. Age-specific RIs were required for PG I (SDR = 0.366) and PG II (SDR = 0.424). Partitioned RIs were established for PG I and PG II, with a single RI for PGR. GAMLSS modeling revealed distinct age-dependent trajectories: PG I increased from a median of 39.75 μg/L at age 20 years to 49.75 μg/L at age 60 years, a 25.16% increase, after which it plateaued through age 80 years. In contrast, PG II showed a continuous rise throughout the age range, with the median value increasing from 5.07 μg/L at age 20 years to 8.36 μg/L at age 80 years, corresponding to a 64.89% increase. Continuous reference percentiles intuitively reflected these trends and were detailed in this study. Next-generation RIs demonstrated superior accuracy compared to partitioned RIs when applied to specific age subgroups.</p><p><strong>Conclusion: </strong>This study elucidates the age- and sex-specific dynamics of PG and, to our knowledge, is the first to establish next-generation RIs for PG, supporting more individualized interpretation in laboratory medicine.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 31","pages":"108977"},"PeriodicalIF":5.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993625","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":"Efficacy and safety of different doses of dexmedetomidine on gastrointestinal function recovery after laparoscopic colorectal surgery.","authors":"Ying Chen, Wen-Lu Tang, Chun-Tian Li, Yu Zhao, Bing Li, Lian-Ming Liao, Tian-Hua Lin, Liang-Cheng Zhang","doi":"10.3748/wjg.v31.i31.110582","DOIUrl":"10.3748/wjg.v31.i31.110582","url":null,"abstract":"<p><strong>Background: </strong>Postoperative gastrointestinal recovery affects hospital stay time and patient's quality of life. Studies suggest that the use of dexmedetomidine during the perioperative period can promote post operational recovery of gastrointestinal function.</p><p><strong>Aim: </strong>To evaluate the efficacy and safety of different doses of dexmedetomidine on postoperative gastrointestinal function recovery after laparoscopic colorectal surgery.</p><p><strong>Methods: </strong>In this large-sample, retrospective study, 879 patients undergoing laparoscopic colorectal surgery were categorized into three groups: A control group receiving no dexmedetomidine (<i>n</i> = 281), a low-dose group receiving an intraoperative bolus of 0.5 μg/kg dexmedetomidine followed by a continuous infusion of 0.2 μg/kg/hour (<i>n</i> = 313), and a high-dose group receiving a 1.0 μg/kg bolus followed by a 0.5 μg/kg/hour infusion (<i>n</i> = 285). Time to postoperative first flatus, feces, and regular diet, and the intake, feeling nauseated, emesis, physical examination, and duration of symptoms score were evaluated.</p><p><strong>Results: </strong>Multiple linear regression analysis showed that age, gender, body mass index, American Society of Anesthesiologists classification, comorbidities and surgical site were not related to the time to first flatus (all <i>P</i> > 0.05). The times to postoperative first flatus, first feces, and regular diet were earlier in both dexmedetomidine groups than the control group (both <i>P</i> < 0.05). More patients in the control group experienced postoperative gastrointestinal intolerance (both <i>P</i> < 0.05). There was no significant difference between the high- and the low-dose groups (<i>P</i> > 0.05). The incidence of intraoperative bradycardia in the high-dose group was higher than that in the control group (19.15% <i>vs</i> 8.19%, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Both low- and high-dose dexmedetomidine regimens enhance postoperative gastrointestinal recovery after laparoscopic colorectal surgery. The low-dose regimen demonstrates superior safety, supporting its integration into multimodal enhanced recovery pathways.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 31","pages":"110582"},"PeriodicalIF":5.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993049","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":"Textbook outcome and associated risk factors in laparoscopic transcystic common bile duct exploration.","authors":"Deng-Sheng Zhu, Zhen Zhang, Xiao-Rui Huang, Jing-Zhao Zhang, Zhi-Wei Zhang, Xin-Yi Guo, Huan Zheng, Tong Guo, Ya-Hong Yu","doi":"10.3748/wjg.v31.i31.109994","DOIUrl":"10.3748/wjg.v31.i31.109994","url":null,"abstract":"<p><strong>Background: </strong>Textbook outcome (TO), an emerging composite metric for surgical quality assessment, has recently gained recognition for evaluating perioperative results. Laparoscopic transcystic common bile duct exploration (LTCBDE) has become a widely adopted minimally invasive technique for treating cholecystolithiasis with choledocholithiasis. Despite its growing clinical application, TO has not yet been formally defined for LTCBDE, nor have its failure-associated risk factors been systematically examined.</p><p><strong>Aim: </strong>To define TO for LTCBDE, establish standardized criteria, and identify risk factors for TO failure <i>via</i> logistic regression.</p><p><strong>Methods: </strong>A retrospective cohort of 388 patients who underwent LTCBDE in combination with laparoscopic cholecystectomy at the Department of Biliopancreatic Surgery, Tongji Hospital, from January 2018 to October 2024, was analyzed. The study delineated TO criteria for LTCBDE, calculated the rate of TO achievement, and employed logistic regression to determine independent predictors of TO failure.</p><p><strong>Results: </strong>TO was defined as the absence of the following seven criteria: Conversion to open surgery, postoperative complications (Clavien-Dindo grade ≥ 2), biliary leakage (International Study Group of Pancreatic Surgery/International Study Group of Liver Surgery grade B/C), delayed removal of drainage tube (> 4 days), postoperative interventions, prolonged length of stay (> 7 days), and 30-day readmission or mortality. Among 388 patients, 276 (71.1%) achieved TO. The primary causes of TO failure included delayed removal of drainage tube (94 cases, 83.9%), prolonged length of stay (50 cases, 44.6%). Multivariate analysis revealed four independent risk factors for TO failure: Preoperative endoscopic retrograde cholangiopancreatography (<i>P</i> = 0.022), advanced age (<i>P</i> = 0.010), prolonged anesthesia time (<i>P</i> < 0.001), and elevated preoperative alkaline phosphatase levels (<i>P</i> = 0.048).</p><p><strong>Conclusion: </strong>These findings suggest that applying the concept of TO to LTCBDE enhances surgical quality evaluation and supports early identification of high-risk patients, facilitating personalized clinical decisions and optimizing individual management.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 31","pages":"109994"},"PeriodicalIF":5.4,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993611","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":"Cardiopulmonary changes and its association with clinical features in noncirrhotic portal hypertension.","authors":"Harish Gopalakrishna, My-Le Nguyen, Maria Mironova, Gracia M Viana Rodriguez, Rownock Afruza, Moumita Chakraborty, Matthew G Menkart, Jenna L Oringher, Shani Scott, Gayatri B Nair, David E Kleiner, Christopher Koh, Michael Fallon, Vandana Sachdev, Theo Heller","doi":"10.3748/wjg.v31.i30.109256","DOIUrl":"10.3748/wjg.v31.i30.109256","url":null,"abstract":"<p><strong>Background: </strong>Cardiopulmonary changes in noncirrhotic portal hypertension (NCPH) are poorly understood.</p><p><strong>Aim: </strong>To investigate cardiopulmonary changes using transthoracic echocardiography (TTE) in NCPH and their correlation with clinical features.</p><p><strong>Methods: </strong>Prospective cohort including 10 preclinical NCPH [without portal hypertension (PH)] and 32 NCPH subjects who underwent TTE with agitated saline injection and comprehensive clinical evaluation were assessed. PH was defined by presence of either varices, ascites or portosystemic shunting. Intrapulmonary vascular dilatation (IPVD) is defined as appearance of microbubbles in the left atrium after three heartbeats. Right ventricular systolic pressure (RVSP) > 38 mmHg was used to identify possible porto-pulmonary hypertension. Cardiomyopathy is defined using cirrhotic cardiomyopathy consortium criteria.</p><p><strong>Results: </strong>Among 42 subjects, 17 (40%) had IPVD, 4 (9.5%) had RVSP > 38 mmHg, and 6 (14%) had cardiomyopathy. Aspartate aminotransferase to alanine aminotransferase (AST/ALT) (1.3 <i>vs</i> 1, <i>P</i> = 0.04) and liver stiffness measurement (LSM) (12.4 kPa <i>vs</i> 7.1 kPa, <i>P</i> = 0.03) were higher in those with IPVD. Presence of either LSM > 10 or AST/ALT > 1.2 aided in identifying subjects with IPVD-sensitivity, specificity, and accuracy of 76%. RVSP correlated with oxygen saturation (<i>r</i> = -0.33), and free right hepatic vein pressure (<i>r</i> = 0.43). Those with PH had higher left atrial volume (LAV) (62 mL <i>vs</i> 48 mL, <i>P</i> < 0.01), and LAV index (LAVI) (35 m² <i>vs</i> 23 m², <i>P</i> < 0.01) compared to those without PH. Total bile acids, especially primary bile acids positively correlated with LAV (<i>r</i> = 0.36), and LAVI (<i>r</i> = 0.41).</p><p><strong>Conclusion: </strong>Similar to cirrhotic patients, cardiopulmonary changes are prevalent in NCPH, especially among those with PH. In NCPH, cardiopulmonary changes occur despite preserved synthetic function, suggesting the NCPH model's value in understanding cardiopulmonary dysfunction in liver disease.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 30","pages":"109256"},"PeriodicalIF":5.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993571","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":"Clinical efficacy and mechanism of <i>Bletilla striata</i> and Chinese herbal compounds in treatment of peptic ulcer.","authors":"Yi-Tong Sun, Fang Zhou, Hong-Xin Zheng, Jing-Dong Xiao","doi":"10.3748/wjg.v31.i30.110145","DOIUrl":"10.3748/wjg.v31.i30.110145","url":null,"abstract":"<p><p>Peptic ulcer (PU) is characterized by inflammation, necrosis, and erosion of the gastrointestinal mucosa caused by various pathogenic factors, leading to ulcer formation. The stomach and duodenum are the most commonly affected sites. <i>Bletilla striata</i>, a traditional Chinese medicinal herb, contains diverse chemical constituents and exhibits multiple pharmacological effects. As a key component in various traditional Chinese medicine compound formulations, it has demonstrated notable clinical efficacy. Moreover, it has a solid research foundation and broad application prospects in the treatment of gastrointestinal diseases. This paper systematically elaborates on the clinical efficacy and mechanisms of action of Bletilla striata in the treatment of PUs, drawing from ancient medical literature and traditional formula applications to provide support for clinical use.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 30","pages":"110145"},"PeriodicalIF":5.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993550","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":"Integrating inflammation, nutrition, and artificial intelligence: A new era in colorectal cancer prognostic scoring.","authors":"Semra Demirli Atici, Aras Emre Canda, Mustafa Cem Terzi","doi":"10.3748/wjg.v31.i30.108431","DOIUrl":"10.3748/wjg.v31.i30.108431","url":null,"abstract":"<p><p>Traditional tumor-node-metastasis staging overlooks key prognostic factors such as inflammation and nutrition, limiting individualized treatment in colorectal cancer. Integrating biochemical markers with artificial intelligence can significantly improve survival prediction and treatment personalization by analyzing complex, multimodal data. This evolving approach holds transformative potential for precision oncology.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 30","pages":"108431"},"PeriodicalIF":5.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993603","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":"Computed tomography-based deep learning and multi-instance learning for predicting microvascular invasion and prognosis in hepatocellular carcinoma.","authors":"Yong-Yi Cen, Hai-Yang Nong, Xiao-Xiao Huang, Xiu-Xian Lu, Chang-Hong Pu, Li-Hong Huang, Xiao-Jun Zheng, Zhao-Lin Pan, Yin Huang, Ke Ding, De-You Huang","doi":"10.3748/wjg.v31.i30.109186","DOIUrl":"10.3748/wjg.v31.i30.109186","url":null,"abstract":"<p><strong>Background: </strong>Microvascular invasion (MVI) is an important prognostic factor in hepatocellular carcinoma (HCC), but its preoperative prediction remains challenging.</p><p><strong>Aim: </strong>To develop and validate a 2.5-dimensional (2.5D) deep learning-based multi-instance learning (MIL) model (MIL signature) for predicting MVI in HCC, evaluate and compare its performance against the radiomics signature and clinical signature, and assess its prognostic predictive value in both surgical resection and transcatheter arterial chemoembolization (TACE) cohorts.</p><p><strong>Methods: </strong>A retrospective cohort consisting of 192 patients with pathologically confirmed HCC was included, of whom 68 were MVI-positive and 124 were MVI-negative. The patients were randomly assigned to a training set (134 patients) and a validation set (58 patients) in a 7:3 ratio. An additional 45 HCC patients undergoing TACE treatment were included in the TACE validation cohort. A modeling strategy based on computed tomography arterial phase images was implemented, utilizing 2.5D deep learning in combination with a MIL framework for the prediction of MVI in HCC. Moreover, this method was compared with the radiomics signature and clinical signatures, and the predictive performance of the various models was evaluated using receiver operating characteristic curves and decision curve analysis (DCA), with DeLong's test applied to compare the area under the curve (AUC) between models. Kaplan-Meier curves were utilized to analyze differences in recurrence-free survival (RFS) or progression-free survival (PFS) among different HCC treatment cohorts stratified by MIL signature risk.</p><p><strong>Results: </strong>MIL signature demonstrated superior performance in the validation set (AUC = 0.877), significantly surpassing the radiomics signature (AUC = 0.727, <i>P</i> = 0.047) and clinical signature (AUC = 0.631, <i>P</i> = 0.004). DCA curves indicated that the MIL signature provided a greater clinical net benefit across the full spectrum of risk thresholds. In the prognostic analysis, high- and low-risk groups stratified by the MIL signature exhibited significant differences in RFS within the surgical resection cohort (training set <i>P</i> = 0.0058, validation set <i>P</i> = 0.031) and PFS within the TACE treatment cohort (<i>P</i> = 0.045).</p><p><strong>Conclusion: </strong>MIL signature demonstrates more accurate MVI prediction in HCC, surpassing radiomics signature and clinical signature, and offers precise prognostic stratification, thereby providing new technical support for personalized HCC treatment strategies.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 30","pages":"109186"},"PeriodicalIF":5.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041462","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":"Outcomes of 5-aminosalicylates withdrawal due to non-adherence in ulcerative colitis patients: A step toward evaluating intermittent therapy.","authors":"Ali Atay, Mucahit Ergul, Oguz Ozturk, Kadir C Acun, Yavuz Cagir, Muhammed B Durak, Ilhami Yuksel","doi":"10.3748/wjg.v31.i30.110112","DOIUrl":"10.3748/wjg.v31.i30.110112","url":null,"abstract":"<p><strong>Background: </strong>5-aminosalicylates (5-ASA) are the primary treatment for mild to moderate ulcerative colitis (UC). Maintenance therapy with 5-ASA has been shown to reduce both the risk of relapse and colorectal cancer.</p><p><strong>Aim: </strong>To evaluate the outcomes of 5-ASA withdrawal due to non-adherence in UC patients while in remission on monotherapy.</p><p><strong>Methods: </strong>Adult patients with UC who were followed up between July 2019 and April 2025 were screened. Patients in remission receiving 5-ASA monotherapy who experienced treatment withdrawal due to non-adherence were included in this study.</p><p><strong>Results: </strong>Among 880 patients with UC, 30 (3.4%) had 5-ASA withdrawal due to non-adherence while in remission on monotherapy. Twelve patients (40%) had disease relapse after a median of 20 months. The rate of patients in remission was 89% in the first year, decreasing to 73% in the second year, and to 64% in the third year. There were no significant differences between patients with and without relapse in terms of demographics, disease extent, remission duration before 5-ASA withdrawal, previous medications, steroid dependence, 5-ASA formulation, baseline inflammatory markers, or partial and endoscopic Mayo scores. Most patients (75%) who experienced relapse were successfully treated with 5-ASA monotherapy, while one-fourth of them required corticosteroids. No patients required biologic agents, hospitalization, or surgical intervention.</p><p><strong>Conclusion: </strong>Intermittent therapy may be safe and feasible for UC patients, especially those in long-term remission, with treatment interruption up to one year considered acceptable.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 30","pages":"110112"},"PeriodicalIF":5.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993579","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":"Prognostic value of signet-ring cell carcinoma proportion in undifferentiated gastric cancer: Implications for endoscopic treatment decisions.","authors":"Chanyoung Kim, Hye Seung Lee, Hee Young Na, Hyun Jung Kwon, Ji Ae Lee, Yun-Suhk Suh, So Hyun Kang, Hyung-Ho Kim, Sang-Hoon Ahn, Hyeon Jeong Oh","doi":"10.3748/wjg.v31.i30.109465","DOIUrl":"10.3748/wjg.v31.i30.109465","url":null,"abstract":"<p><strong>Background: </strong>Poorly cohesive gastric carcinomas are classified based on the proportion of signet-ring cell carcinoma (SRCC) components. In surgically resected gastric cancer, SRCC is diagnosed when the signet-ring cell (SRC) component constitutes ≥ 50% of the entire tumor, whereas poorly cohesive carcinoma (PCC) not otherwise specified is diagnosed when the proportion of the SRC component is < 50% of the entire tumor. The SRCC proportion in PCC varies along the spectrum, and its prognostic significance in gastric cancer remains unclear.</p><p><strong>Aim: </strong>To investigate how the proportion of SRCC affects tumor pathology, clinical outcomes, and prognosis and treatment decision-making.</p><p><strong>Methods: </strong>This retrospective study included 1066 patients with PCC who underwent gastric cancer surgery at Seoul National University Bundang Hospital from 2016 to 2023. Patients were classified into four groups based on the SRCC proportion: < 10%, ≥ 10% and < 50%, ≥ 50% and < 90%, and ≥ 90%. Clinicopathological and molecular data were compared between the groups. The correlation between SRCC proportion and pathological factors associated with indications for endoscopic resection in patients with early-stage gastric cancer (EGC) was analyzed.</p><p><strong>Results: </strong>A higher SRCC proportion was associated with smaller tumor size, lower tumor stage pathological tumor-node-metastasis, and reduced rates of lymphatic, vascular, and neural invasion (<i>P <</i> 0.001). Notably, the ≥ 90% SRCC group exhibited the highest recurrence-free survival (<i>P =</i> 0.0072) and overall survival (<i>P =</i> 0.0002). In EGC, lower SRCC rates were correlated with increased ulceration, larger tumor size, and deeper submucosal invasion (<i>P <</i> 0.001).</p><p><strong>Conclusion: </strong>Higher SRCC proportions in the PCC correlate with lower tumor aggressiveness and improved prognosis. Its role in EGC should be validated as a factor influencing therapeutic strategies, including endoscopic submucosal dissection.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 30","pages":"109465"},"PeriodicalIF":5.4,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993641","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}