Canadian Journal of Gastroenterology and Hepatology最新文献

{"title":"A Preliminary Exploratory Study on the Application of Gd-EOB-DTPA-Enhanced MRI for Assessing Gallbladder Ejection Fraction in Cholecystolithiasis Patients.","authors":"Ruikun Zhang, Boqian Chen, Xiaobing Li, Xuan Zheng, Yang Liu, Renjie Zhang, Qingteng Zeng, Hengyu Tian, Qinghua He, Shenfeng Wu, Yuan Gao, Zhujing Li, Hanqing Lyu, Jialin Liu","doi":"10.1155/cjgh/8851215","DOIUrl":"10.1155/cjgh/8851215","url":null,"abstract":"<p><strong>Objective: </strong>To preliminarily explore the feasibility and clinical implications of using gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for assessing the gallbladder ejection fraction (GBEF) in patients with cholecystolithiasis.</p><p><strong>Methods: </strong>This retrospective analysis encompassed 81 patients with gallstones who underwent Gd-EOB-DTPA-enhanced MRI. Gallbladder volume was measured during fasting and at 1 h after a lipid-rich meal to calculate the GBEF. Two radiologists independently reviewed the images for GBEF, structural anomalies, and biliary patency.</p><p><strong>Results: </strong>The mean GBEF was 62.29% ± 25.2%. Sixty patients demonstrated a GBEF > 50%, while 21 had a GBEF ≤ 50%. The imaging also facilitated the identification of gallbladder malformations (41/81) and abnormal pancreaticobiliary junctions (20/81). Bile flow into the gallbladder via the cystic duct and into the duodenum was observed in 66 patients.</p><p><strong>Conclusion: </strong>This exploratory study suggests that Gd-EOB-DTPA-enhanced MRI is a feasible modality for simultaneous anatomical evaluation and functional assessment of the GBEF in cholecystolithiasis patients. It provides a comprehensive visualization of biliary dynamics. However, the findings are preliminary, and further validation against standard modalities with controlled study design is required to establish its accuracy and clinical utility.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 ","pages":"8851215"},"PeriodicalIF":2.3,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12771634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Inflammatory Bowel Disease and Venous Leg Ulcers: Insight From Mendelian Randomization Analyses.","authors":"Yanfeng Lin, Xiaohui Qin, Haiyan Zhang, Jinke Huang","doi":"10.1155/cjgh/6767725","DOIUrl":"10.1155/cjgh/6767725","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the potential causal relationship between inflammatory bowel disease (IBD) and venous leg ulcers (VLU) using Mendelian randomization (MR).</p><p><strong>Materials and methods: </strong>Independent genetic variants for IBD and VLU were selected as instruments from previously published genome-wide association studies (GWAS) in people of primarily European descent. MR analyses were carried out utilizing inverse-variance weighted (IVW), weighted median, MR Egger, simple mode, and weighted mode.</p><p><strong>Results: </strong>Genetically predicted IBD was not associated with VLU, according to the IVW analysis (OR 0.95, 95% CI 0.88-1.03, p = 0.23). MR Egger (OR 0.93, 95% CI 0.76-1.12, p = 0.44), weighted mode (OR 1.06, 95% CI 0.87-1.29, p = 0.55), simple mode (OR 1.03, 95% CI 0.79-1.34, p = 0.83), and weighted median (OR 0.99, 95% CI 0.89-1.10, p = 0.90) all produced results in line with IVW. According to the IVW technique, UC (OR 1.02, 95% CI 0.95-1.10, p = 0.62) and CD (OR 0.97, 95% CI 0.90-1.04, p = 0.36) did not appear to be associated with VLU in subtype analyses.</p><p><strong>Conclusion: </strong>The MR investigation found no genetic evidence to support a causal relationship between IBD and VLU. This finding clarifies that observed clinical associations are unlikely to be driven by shared genetics, and this genetic insight helps refine the clinical assessment of VLU in patients with IBD.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e6767725"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective Analysis of 411 Cases of Spontaneous Portosystemic Shunt Complicated With Oesophageal and Gastric Variceal Bleeding in Cirrhotic Patients.","authors":"Zhaoyi Chen, Jing Li, Xi Wang, Xuecan Mei, Yaxian Kuai, Huixian Li, Derun Kong","doi":"10.1155/cjgh/4623854","DOIUrl":"10.1155/cjgh/4623854","url":null,"abstract":"<p><p>This study is aimed at evaluating the incidence and clinical characteristics of spontaneous portosystemic shunts (SPSSs) in cirrhotic patients with oesophageal and gastric variceal bleeding (EGVB) and investigating the impact of SPSSs on the course of EGVB. A retrospective analysis of 1110 cirrhotic patients with EGVB was conducted to determine SPSS incidence and characteristics and evaluate the impact of SPSS size and endoscopic treatments. The SPSS incidence was 94.26% (411/436), with gastric renal shunts (78.89%) being the most common. SPSSs were categorized by diameter as follows: S-SPSS (≤ 5 mm), M-SPSS (5-8 mm), and L-SPSS (≥ 8 mm). A larger SPSS diameter was correlated with higher model for end-stage liver disease (MELD) scores, international normalized ratios (INRs), total bilirubin (TB) levels, and portal vein thrombosis. During the 12-month follow-up, the L-SPSS group had a lower rebleeding rate (3.38%) than the S-SPSS (14.64%) and M-SPSS (16.88%) groups. A larger SPSS diameter was associated with a 77% reduction in rebleeding risk (HR = 0.23, p = 0.016). In summary, a larger SPSS diameter is linked to worse liver function but reduced rebleeding risk in cirrhotic patients with EGVB.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e4623854"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Positive Correlation of Basal Metabolic Rate With Significant Liver Fibrosis in Adults With MASLD and Obesity: Results From NHANES 2017-2020.","authors":"Shu-Qin Zheng, Jing-Tao Qin, Yi-Shan He, Xue-Ming Zhang, Yuan Xue","doi":"10.1155/cjgh/3293133","DOIUrl":"10.1155/cjgh/3293133","url":null,"abstract":"<p><strong>Background and aim: </strong>Since the stage of liver fibrosis is closely associated with mortality in nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD), it is essential to identify patients at risk of fibrosis progression. Basal metabolic rate (BMR) has gained attention in weight management for individuals with obesity. This study aimed to assess the accuracy of BMR in predicting the severity of fibrosis in patients with NAFLD or MASLD.</p><p><strong>Methods: </strong>Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020.03 were analyzed. Noninvasive diagnosis of liver steatosis was performed using the controlled attenuation parameter (CAP) measured by FibroScan. BMR calculated using the Harris-Benedict equation (BMRh) and the Mifflin-St Jeor equation (BMRm) was included in the analysis.</p><p><strong>Results: </strong>A total of 4184 individuals with MASLD were included, of whom 639 (15.27%) had significant fibrosis. Among 1577 individuals with NAFLD, 223 (14.14%) had significant fibrosis. Participants with significant fibrosis were older and had higher CAP, BMRh, and BMRm values (all p < 0.05). Multivariate analysis identified BMR as an independent risk factor for significant fibrosis. In obesity participants with MASLD or NAFLD, both BMRh and BMRm were positively correlated with BMI, CAP, and liver stiffness measurement (all p < 0.01). For obesity participants with MASLD or NAFLD, both BMRh- or BMRm-incorporating models had higher AUROCs than aspartate transaminase-to-platelet ratio index, fibrosis-4, and gamma-glutamyl transpeptidase to platelet ratio in predicting significant fibrosis (all p < 0.001).</p><p><strong>Conclusion: </strong>BMR is elevated in individuals with NAFLD or MASLD and significant liver fibrosis. The novel model combining age, male gender, BMR, aspartate transaminase, white blood cell counts, platelet counts, and diabetes outperformed conventional noninvasive scoring systems in predicting significant fibrosis in individuals with MASLD and obesity.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e3293133"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13157316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short- and Long-Term Healthcare Costs Attributable to Hepatitis B Among Newcomers to Ontario, Canada: A Matched Cohort Study.","authors":"Kikanwa Anyiwe, Jordan J Feld, Eleanor Pullenayegum, William W L Wong, Lena Nguyen, Beate Sander","doi":"10.1155/cjgh/2330427","DOIUrl":"10.1155/cjgh/2330427","url":null,"abstract":"<p><strong>Background: </strong>Healthcare expenditures across the clinical trajectory of hepatitis B virus (HBV) infection are inadequately characterized, particularly among immigrants. Our aim is to quantify HBV-attributable short- and long-term costs among a population of newcomers to the province of Ontario.</p><p><strong>Methods: </strong>We performed a cost-of-illness study with an incidence-based, matched cohort design, employing linked population-based laboratory and health administrative data, and permanent residence data from Immigration, Refugees and Citizenship Canada (IRCC). We identified newcomers diagnosed with HBV between January 1, 2004, and December 31, 2018, and dichotomized the study cohort into individuals with or without liver complications before diagnosis. We used propensity score matching and phase-of-care costing to quantify monthly attributable costs for each of six HBV phases and longitudinal costs for one, five, and ten years following diagnosis. Costs were quantified in 2021 Canadian dollars.</p><p><strong>Results: </strong>Among n = 30,677 newcomers with HBV, 2.7 percent had complications before diagnosis. Mean monthly phase costs were higher for individuals with complications before diagnosis relative to those without for prediagnosis care ($439, 95% CI: $250-$645 vs. $22, 95% CI: $12-$34), initial care for HBV ($1545, 95% CI: $1196-$1945 vs. $331, 95% CI: $299-$369), continuing care for HBV ($537, 95% CI: $314-$760 vs. $73, 95% CI: $55-$92), and final care ($7271, 95% CI: $3749-$10,747 vs. $3430, 95% CI: $1813-$5061).</p><p><strong>Conclusions: </strong>Findings emphasize the dynamic nature of HBV-attributable costs and highlight the importance of care following diagnosis and complication onset.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e2330427"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultra-Large Spontaneous Portosystemic Shunt is Correlated With a Higher Hepatic Venous Pressure Gradient and Increased Risk of Hepatic Encephalopathy.","authors":"Xiao-Juan Lei, Yu-Bing Jiao, Xin-Hui Huang, Sheng-Zhao Li, Qiao Ke, Wu-Hua Guo","doi":"10.1155/cjgh/4788170","DOIUrl":"10.1155/cjgh/4788170","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous portosystemic shunts (SPSSs) frequently develop in individuals with cirrhosis. However, their clinical impact on the hepatic venous pressure gradient (HVPG) and liver function remains complex and a subject of ongoing debate. This retrospective study evaluated the relationship between SPSS diameter, particularly ultra-large SPSS, and HVPG, liver dysfunction, and their predictive value in patients with cirrhosis.</p><p><strong>Methods: </strong>A retrospective study was conducted on 90 cirrhotic patients. The patients were categorized into three groups: no SPSS (none or φ < 3 mm), small SPSS (3 ≤ φ < 8 mm), and large SPSS (φ ≥ 8 mm). The large SPSS group was further stratified into large (8 ≤ φ < 14.5 mm) and ultra-large (φ ≥ 14.5 mm) subgroups based on a receiver operating characteristic (ROC)-derived cutoff for hepatic encephalopathy (HE). Clinical parameters, HVPG, and vascular diameters were analyzed.</p><p><strong>Results: </strong>The large SPSS group had higher total bilirubin and a higher incidence of HE than the no SPSS group. Within the large SPSS cohort, the ultra-large subgroup (≥ 14.5 mm) demonstrated significantly worse liver function (lower albumin, higher bilirubin, prolonged PT, increased INR, and poorer Child-Pugh/MELD scores), a higher proportion of Child-Pugh Class C, and elevated HVPG values (18.7 vs. 16.6 mmHg, p = 0.03) compared to the large subgroup. Critically, SPSS diameter showed a significant positive correlation with HVPG (R = 0.314, p = 0.013). The incidence of HE was also significantly higher in the ultra-large subgroup (55.52% vs. 11%, p = 0.001).</p><p><strong>Conclusions: </strong>The portal pressure-lowering effect of SPSS does not correlate linearly with its diameter, exhibiting a threshold-dependent attenuation as shunt size exceeds 14.5 mm. This cutoff may serve as a predictor of increased risk for HE and liver dysfunction in cirrhosis, supporting its potential role in clinical risk stratification and decision-making for cirrhosis patients with SPSS.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e4788170"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147464039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic Closure of Mucosal Defect to Prevent Delayed Bleeding After Endoscopic Papillectomy.","authors":"Jinpei Dong, Guigen Teng, Lu Zhang, Haixia Niu, Dapeng Bian, Qiushi Feng","doi":"10.1155/cjgh/5663582","DOIUrl":"10.1155/cjgh/5663582","url":null,"abstract":"<p><strong>Background: </strong>Delayed bleeding is a serious complication of endoscopic papillectomy (EP). The aim of this study was to evaluate the efficacy of preventing delayed bleeding of clip after EP.</p><p><strong>Methods: </strong>Consecutive patients diagnosed with ampullary benign tumors who received EP from January 1^st 2013 to December 31^st 2024 were analyzed retrospectively. EP was performed with the snare polypectomy technique. Biliary duct stent and pancreatic duct stent were routinely placed. The resection site is closed completely by clips.</p><p><strong>Results: </strong>Fifty major papilla benign tumors patients with a mean age of 55.9 ± 10.7 years were found. All of the lesions were En bloc removed in a single endoscopic procedure. The pancreatic duct stents and biliary duct stents were successfully placed in 47 (94%) and 49 patients (98%), respectively. Two patients had positive horizontal margin, 35 patients had negative horizontal margin, and in 13 patients, horizontal margin was compromised by cautery effect. None of the patients had vertical positive margin, 39 patients had vertical negative margin, and in 11 patients, vertical margin was compromised by cautery effect. Post-EP bleeding was observed in 2 patients (4%), which was classified as mild. Post-EP hyperamylasemia was observed in 13 patients (26%), and post-EP pancreatitis was observed in 7 patients (14%), 6 were mild pancreatitis and 1 was severe pancreatitis. Intraoperative perforation occurred in 1 patient, which was clamped with hemostatic clips. No cholangitis was observed. The mean follow-up duration was 378.1 ± 305.7 days. Histologically confirmed recurrence at the resection site was detected in 6 patients (12%).</p><p><strong>Conclusions: </strong>This study demonstrated that preventive closure of the resection site by clips was technically feasible and effective in preventing delayed bleeding after EP, without increasing the risk of postprocedure pancreatitis and cholangitis.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e5663582"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147475913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrative Transcriptomics Across Etiologies Reveals Common and Disease-Specific Fibrogenic Signatures in Liver Fibrosis.","authors":"Wenyan Yang, Long Li, Yamei Ye, Chun Lin, Cheng Zhang, Haibin Tu","doi":"10.1155/cjgh/9254321","DOIUrl":"10.1155/cjgh/9254321","url":null,"abstract":"<p><strong>Background: </strong>Chronic liver diseases caused by metabolic, viral, and mixed etiologies frequently converge on fibrosis and cirrhosis; however, the extent to which fibrogenic mechanisms are shared across etiologies versus disease-specific remains incompletely defined.</p><p><strong>Methods: </strong>Four GEO datasets were analyzed: GSE135251 (NAFLD-related fibrosis), GSE84044 (HBV-related fibrosis), GSE197112 (mixed-etiology fibrosis), and GSE14323 (cirrhosis versus normal). Differential expression analysis was performed separately within each dataset using DESeq2 for RNA-seq and limma for microarray data. Shared genes were identified by cross-dataset intersection. For downstream network and ordination analyses, gene-level matrices were harmonized across platforms and batch-adjusted using ComBat, with PCA before and after correction provided in the supporting information. WGCNA and random forest were then applied to the integrated matrix, and the final seven hub genes were defined as genes supported by recurrent differential expression, co-expression prioritization, and random forest feature importance. The final seven-gene hub panel was further used for exploratory age-stratified visualization and regression analysis. Functional enrichment, miRNA-mRNA mapping, PPI analysis, PCoA, UMAP, RT-qPCR, and western blotting were performed.</p><p><strong>Results: </strong>Across the four cohorts, 434-787 differentially expressed genes were identified per dataset, and 26 genes were consistently upregulated across all etiologies. Enrichment analyses converged on extracellular matrix organization, TGF-β, PI3K-Akt, MAPK, and Wnt-related signaling. The final seven hub genes were MAOA, LOC102724200, SLC16A3, GPM6B, CST7, MT3, and ZNF142. Exploratory age analyses in the age-annotated GSE84044 cohort suggested that a subset of the final seven hub genes varied with age; however, these findings should be interpreted cautiously because age metadata were not uniformly available across all public cohorts. RT-qPCR in 10 fibrotic and 10 nonfibrotic liver tissues confirmed upregulation of the seven hub genes, and western blotting supported increased protein abundance of CST7, MT3, SLC16A3, and MAOA.</p><p><strong>Conclusions: </strong>This integrative analysis identifies both shared and etiology-associated transcriptional programs in liver fibrosis and defines a multistep strategy for prioritizing conserved hub genes. The seven validated hub genes represent candidate biomarkers for fibrotic liver injury, whereas the exploratory age-related findings based on this seven-gene panel remain hypothesis-generating. This workflow may support future cross-platform transcriptomic studies of hepatic fibrosis.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e9254321"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13341641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thromboembolic Risks in Pancreatic Ductal Adenocarcinoma: A Review of Anatomical and Clinical Variations.","authors":"Lei Zhang, Weili Zheng, Yi Bao","doi":"10.1155/cjgh/7566020","DOIUrl":"10.1155/cjgh/7566020","url":null,"abstract":"<p><p>This review article presents the anatomical and clinical variations in patients with pancreatic ductal adenocarcinoma (PDAC) arising from the head and body/tail regions. It discusses the distinctive risk factors for venous thromboembolism (VTE) formation and assesses various parameters for monitoring VTE and intervention strategies. Pancreaticoduodenectomy is typically performed for tumors in the head region of the pancreas, while distal pancreatectomy with splenectomy is performed for tumors arising from the body or tail of the pancreas. This article also reviews the stratified analysis of VTE risks in PDAC based on tumor origin, aiming to establish valuable VTE risk factor assessment tools and prophylactic anticoagulation strategies. Furthermore, it focuses on PDAC patients with tumors arising from distinct pancreatic anatomical locations to improve quality of life, reduce thrombotic risks, and optimize clinical outcomes.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e7566020"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rifaximin Plus Probiotics Reshape Gut Microbiota, Serum Propionate, and Mucosal Immunity in Cirrhosis-Related Hepatic Encephalopathy Microbiota-Immune Remodeling in HE.","authors":"Yiping Wang, Hui Zhu, Shujun Wang, Danni Hu, Mengdan Xu, Luna Lee, Dylan Lee","doi":"10.1155/cjgh/2389961","DOIUrl":"10.1155/cjgh/2389961","url":null,"abstract":"<p><strong>Background: </strong>Hepatic encephalopathy (HE) remains a major cause of hospitalization and readmission in cirrhosis and is closely linked to hyperammonemia, microbial dysbiosis, impaired short-chain fatty acid (SCFA) output, barrier dysfunction, and altered mucosal immunity. We evaluated whether adding a multistrain probiotic to rifaximin was associated with greater neurometabolic improvement and coordinated gut-liver-brain axis changes.</p><p><strong>Methods: </strong>In this prospective, 6-month, randomized, open-label, assessor-blinded, three-arm controlled study, 61 adults with cirrhosis-related HE received standard care alone (Con, n = 20), standard care plus rifaximin 550 mg twice daily (Rif, n = 20), or rifaximin plus a multistrain probiotic (1 × 10^9 CFU three times daily; Rif + Pro, n = 21). The main prespecified biochemical readout was serum ammonia at Month 6. A composite HE index incorporating mental status, flapping tremor, number connection test, and ammonia grade was analyzed as a prespecified exploratory neurometabolic score. A predefined mechanistic subset underwent 16S rRNA microbiome profiling, serum SCFA measurement, and fecal secretory IgA (SIgA) testing.</p><p><strong>Results: </strong>Baseline characteristics did not differ across arms. Post-treatment serum ammonia decreased in a graded pattern (Con 177 ± 43.2, Rif 143 ± 37.5, Rif + Pro 117 ± 34.3 μmol/L), with parallel improvement in the exploratory HE index (10.0 ± 4.9, 5.3 ± 4.7, and 3.7 ± 4.1, respectively). In the mechanistic subset, the microbial community structure differed by treatment (PERMANOVA p = 0.006). Rif + Pro was associated with higher serum propionate, increased Lactobacillus salivarius-associated signal, reduced Bacteroides ovatus-associated signal, and marked fecal SIgA elevation compared with standard care or rifaximin alone. The SIgA-propionate relationship was interpreted as exploratory.</p><p><strong>Conclusions: </strong>Rifaximin plus multistrain probiotics was associated with greater improvement in serum ammonia and exploratory HE severity readouts than rifaximin alone, accompanied by coordinated microbial, metabolic, and mucosal immune changes. These findings support confirmation in adequately powered event-driven trials with strain-resolved profiling and targeted metabolomics.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e2389961"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13364995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}