Canadian Journal of Gastroenterology and Hepatology最新文献

{"title":"Impact of Cirrhosis Etiology and Intensive Care Accessibility on Upper Gastrointestinal Bleeding: A Prospective Observational Study.","authors":"Mariana Barros Marcondes, Clara Fantinelli Moreno, Cíntia Mitsue Pereira Suzuki, Maxwell Antonio Garcia Rodrigues, Alecsandro Moreira, Xingshun Qi, Fernando Gomes Romeiro","doi":"10.1155/cjgh/1409025","DOIUrl":"10.1155/cjgh/1409025","url":null,"abstract":"<p><strong>Background: </strong>Upper gastrointestinal bleeding (UGIB) is a significant cause of cirrhosis decompensation; however, there is still controversy on risk factors for poor outcomes. This study aims to explore the impact of additional variables, such as liver disease etiology and intensive care unit (ICU) accessibility, on mortality, rebleeding, and infection rates.</p><p><strong>Methods: </strong>Cox regression analysis was employed to identify predictors associated with mortality and rebleeding, while Poisson regression analysis was utilized to assess associations with infections.</p><p><strong>Results: </strong>A total of 228 patients were included, with the majority classified as Child-Pugh B and C. Among them, 96 patients (42.1%) had alcohol-associated liver disease (ALD), of which 45 (46.9%) were in alcohol abstinence. One hundred and ninety-five patients (85.5%) survived, while 33 (14.5%) died. Intubation was required for 31 patients (13.6%), and 28 were transferred to the ICU. Antibiotic prophylaxis was administered to 219 patients (96%), and 55 (24.1%) developed infections. Both orotracheal intubation and transfusions were associated with high mortality, whereas ALD was linked to a lower risk of death (p < 0.001, 0.029, and 0.005, respectively). Intubation was also correlated with an increased risk of rebleeding, while transfer to ICU reduced this complication (p = 0.012 and 0.045, respectively). The Child-Pugh score and length of hospitalization were associated with the occurrence of infections (p = 0.037 and < 0.001, respectively).</p><p><strong>Conclusions: </strong>Intubation, transfusions, liver disease etiology, and ICU accessibility are critical predictors following UGIB in cirrhosis. Additionally, the Child-Pugh score and duration of hospitalization are directly proportional to the risk of infections in this context.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04662918.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e1409025"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148101971","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":"Risk Group Stratification for True Early Recurrence After Ablation for Hepatomas.","authors":"Yi-Hao Yen, Kwong-Ming Kee, Chao-Hung Hung, Chien-Hung Chen, Tsung-Hui Hu, Jing-Houng Wang, Sheng-Nan Lu","doi":"10.1155/cjgh/8778095","DOIUrl":"10.1155/cjgh/8778095","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is a lethal cancer. Early recurrence, i.e., recurrence within two years of curative treatment, is a major determinant of ultimate survival.</p><p><strong>Materials and methods: </strong>We included 625 patients with newly diagnosed early-stage HCC, i.e., Barcelona Clinic Liver Cancer (BCLC) Stage 0 or A, and Child-Pugh Class A liver disease who underwent percutaneous radiofrequency ablation (RFA) between 2011 and 2021 at our institution with a follow-up period of > 2 years. The patients were divided into Group 1 (patients who developed nonlocal recurrence or died within two years after RFA; n = 300 [48.0%]) and Group 2 (patients who developed local recurrence within two years or were recurrence-free and were alive for two years after RFA; n = 325 [52.0%]).</p><p><strong>Results: </strong>Multivariate analysis showed that a Model for End-Stage Liver Disease (MELD) score of > 9, anti-hepatitis C virus (HCV) positivity, the presence of image-defined cirrhosis, treatment with antiviral therapies for hepatitis B virus or HCV, alpha-fetoprotein ≥ 20 ng/mL, multiple tumors, and larger tumor size were independent factors associated with Group 1. A nomogram was developed based on these variables to predict Group 1, with a concordance index of 68.3% (95% CI = 64.1%-72.5%). The 10-year overall survival of Group 1 was 28%, and that of Group 2 was 64%.</p><p><strong>Conclusion: </strong>We developed a nomogram to predict true early recurrence (i.e., nonlocal recurrence) of HCC after RFA.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e8778095"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340616","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":"Novel Potential Markers of Metabolic Dysfunction-Associated Steatohepatitis Prone to Hepatocellular Carcinoma.","authors":"Chen Ling, Yuya Wang, Susu Liu, Guitao Huo, Yanwei Yang, Nan Xu, Hong Wang, Haoyang Zhao, Zeqiang Zhang, Rui Fu, Yuwei Zhao, Changfa Fan","doi":"10.1155/cjgh/7390933","DOIUrl":"10.1155/cjgh/7390933","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatohepatitis (MASH), the progressive phenotype of metabolic dysfunction-associated steatotic liver disease (MASLD), is well recognized for its increased risk of progressing to cirrhosis and hepatocellular carcinoma (HCC). However, early diagnosis and identification of the MASH patients with a tendency toward malignancy HCC remain a significant challenge.</p><p><strong>Method: </strong>In previous studies, we established a novel conditional inducible HRAS gene expression murine model with normal diet and lifestyle conditions, which exhibited 100% HCC incidence and recapitulated the four major progression stages of MASH to HCC: MASH, fibrosis, cirrhosis, and HCC. Based on this model, we revealed the potential markers of MASH prone to HCC characteristics of malignant MASH through RNA-Seq and bioinformatics analysis, and further confirmed by pathological biopsy, biochemical tests, inflammatory cytokines measurement, Oil O red staining, and immunohistochemical examination.</p><p><strong>Results: </strong>For MASH, the initial stage of HCC, we observed evidence of hyperlipidemia and insulin resistance in the HRAS mouse model based on blood morphology, biochemical parameters, and insulin tolerance test. Furthermore, the pathological features of MASH were confirmed by the presence of hepatocellular fatty vacuolar changes, lipid droplet accumulation, and inflammation. Then, RNA-Seq analysis revealed the molecular signatures of malignant MASH and revealed three novel potential markers associated with adverse progression of MASH to HCC: Klk1b4, Alox5, and Pla2g2e.</p><p><strong>Conclusion: </strong>Based on a stable and novel murine model of MASH prone to HCC, we, for the first time, presented a comprehensive molecular signature and identified novel potential adverse progression markers of MASH prone to malignant HCC, which contributed possibly to early clinical diagnosis and prognostic assessment, even becoming potential therapeutic target.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e7390933"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13203792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036707","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":"Independent Prognosis Prediction of Hepatocellular Carcinoma Using MicroRNA-Based Single and Combined Biomarkers.","authors":"Long-Bin Jeng, Wen-Ling Chan, Chiao-Fang Teng","doi":"10.1155/cjgh/1491679","DOIUrl":"10.1155/cjgh/1491679","url":null,"abstract":"<p><p>Although there are various treatment modalities available for hepatocellular carcinoma (HCC), HCC is still among the most common causes of cancer-related death globally. Identifying independent biomarkers of poor prognosis in HCC patients remains a critical goal to allow timely intervention and ameliorate patient survival. MicroRNAs (miRNAs), the most widely investigated small noncoding RNAs to date, play a crucial role in regulating the initiation and progression of HCC. The expression of numerous miRNAs is altered in tumor tissues and blood specimens of HCC patients, underscoring their potential as promising prognostic biomarkers. This review offers an exhaustive overview of the current literature examining tissue- and circulation-derived miRNAs as single or combined independent prognostic biomarkers in HCC patients.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e1491679"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13310390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148340636","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":"Improving Nausea Through Breathing Interventions: A Trial of Written Instructions for Diaphragmatic Breathing Versus a Biofeedback Device.","authors":"Subhankar Chakraborty","doi":"10.1155/cjgh/2341938","DOIUrl":"10.1155/cjgh/2341938","url":null,"abstract":"<p><strong>Background: </strong>Nausea is a distressing symptom affecting ∼7% of the population. Pharmacologic options are limited and often ineffective for chronic nausea. Nonpharmacologic strategies, such as breathing exercises, have shown promise in reducing stress and GI symptoms, but their role in chronic nausea has not been studied. This study addresses this knowledge gap by comparing written diaphragmatic breathing (DB) instructions with a biofeedback device (CalmiGo) for their effect on nausea severity.</p><p><strong>Methods: </strong>In a prospective study, we investigated the effects of breathing exercises using either written instructions for DB or a biofeedback respiratory practice device (CalmiGo) on self-reported severity of nausea. Participants were randomized to either intervention and asked to practice the exercises three times daily for 3 min each time for 6 Weeks. Nausea was evaluated at baseline and every week for 7 Weeks via online self-reported surveys.</p><p><strong>Results: </strong>A total of 85 adults with nausea (n = 44, 51.7% severe nausea) were randomized to either DB (n = 36) or CalmiGo (n = 49). There was no difference between the two groups at baseline in demographic features, anxiety, depression, or nausea severity. Nausea improved at all-time points in both groups with a medium to large effect size. However, after applying false discovery rate correction, the improvement remained significant for DB only at weeks one to three and borderline significant at weeks four to five and Week 7. There was no difference in response rates between the two groups. Age, body mass index, baseline anxiety, and whether one was diabetic were predictive of improvement in nausea after 4 Weeks.</p><p><strong>Conclusion: </strong>In a pilot study, we observed that brief breathing exercises improve nausea. Breathing exercises may be useful as a nonpharmacologic option in the management of nausea, although larger trials are needed to confirm these findings.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e2341938"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436783","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":"Clinical Evaluation of a Stool-Based Molecular Point-of-Care Test Kit for Noninvasive Detection of Helicobacter pylori Infection and Clarithromycin Resistance.","authors":"Momoko Tsuda, Yoshiyuki Watanabe, Kimitoshi Kubo, Mototsugu Kato","doi":"10.1155/cjgh/4505059","DOIUrl":"https://doi.org/10.1155/cjgh/4505059","url":null,"abstract":"<p><strong>Aim: </strong>Although molecular point-of-care testing using intragastric fluid has improved the speed and accuracy of Helicobacter pylori (H. pylori) diagnosis and clarithromycin (CAM) resistance detection, it still requires endoscopy, which limits its application in routine screening and settings where invasive procedures cannot be performed. We aimed to evaluate the clinical performance of the Smart Gene™ molecular point-of-care testing kit using stool specimens for H. pylori infection and CAM resistance detection.</p><p><strong>Methods: </strong>We used stool specimens from 75 patients with suspected H. pylori infection. All participants underwent conventional diagnostic tests (urea breath test, stool antigen test, culture, and real-time polymerase chain reaction). CAM resistance-associated mutations (Positions 2142 and 2143 in the 23S rRNA gene) were analyzed using pyrosequencing.</p><p><strong>Results: </strong>The stool-based Smart Gene kit demonstrated a sensitivity of 96.1% and specificity of 100% for H. pylori detection. The sensitivity and specificity for detecting CAM resistance were 100% and 97.0%, respectively, compared to antibiotic susceptibility testing. High concordance was observed between the intragastric polymerase chain reaction and culture results despite the lower stool DNA concentration. The results were obtained within approximately 1 h.</p><p><strong>Conclusions: </strong>The Smart Gene™ stool kit offers a rapid, accurate, and noninvasive alternative for diagnosing H. pylori infection and CAM resistance. Its diagnostic performance is comparable to that of the gold-standard invasive methods while offering practical advantages for outpatient use, mass screening, and nonendoscopy-feasible populations. This approach increases early H. pylori detection and improves eradication outcomes and contributes to more effective gastric cancer prevention strategies (approval number: R4-0426001).</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e4505059"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117021","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":"Optimising Blood Test Monitoring Frequency for Inflammatory Bowel Disease Patients: Balancing Adherence, Comfort and Risk.","authors":"Abhimati Ravikulan, James Irwin","doi":"10.1155/cjgh/9272557","DOIUrl":"10.1155/cjgh/9272557","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) therapies can cause myelosuppression and hepatitis. The European Crohn's and Colitis Organisation (ECCO) recommends 3-monthly blood test monitoring; however, these recommendations are largely based on expert consensus, and real-world evidence informing optimal long-term monitoring intervals remains limited.</p><p><strong>Aim: </strong>To determine the incidence of medication-related hepatitis and myelosuppression in a population-based IBD cohort and estimate the laboratory monitoring burden required to detect clinically significant adverse events.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the Manawatū IBD incidence cohort. Patients diagnosed with IBD between 1 January 2011 and 31 December 2015 were followed longitudinally until 31 December 2022. Medication exposure, laboratory results, and clinical outcomes were recorded. Hepatitis was defined as alanine aminotransferase (ALT) > 2 × the upper limit of normal, while myelosuppression was defined as a neutrophil count < 1.0 × 10⁹/L. Patients were followed from diagnosis until the first outcome event or last recorded follow-up. Medication exposure was analysed as a time-varying variable using cox proportional hazards regression, and the duration of laboratory monitoring required to detect one adverse event was calculated.</p><p><strong>Results: </strong>Among 204 incident cases, 12 were excluded due to prediagnosis hepatitis or myelosuppression, leaving 192 patients for analysis. Twenty-four hepatitis events and two myelosuppression events were observed during 1739 patient-years of follow-up. 6-mercaptopurine (hazard ratio [HR] 39.2, p < 0.001), azathioprine (HR 6.26, p = 0.002), methotrexate (HR 9.94, p = 0.004) and lower mean corpuscular volume (HR 0.89, p = 0.001) were independently associated with hepatitis. Following the initial 6 months of therapy, one hepatitis event was detected for every 33 patient-years of stable thiopurine exposure monitored with routine quarterly blood testing.</p><p><strong>Conclusion: </strong>Clinically significant hepatitis and myelosuppression were uncommon in this population-based IBD cohort, particularly after the initial 6 months of therapy. These findings suggest that reduced laboratory monitoring frequency in carefully selected patients with established treatment stability warrants evaluation.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2026 1","pages":"e9272557"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13646887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128796","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":"Associations Between Gastroenteropancreatic Neuroendocrine Neoplasms and Inflammatory Factors: Insights From a Two-Sample Mendelian Randomization Analysis.","authors":"Huimin Guo, Yu Li, Bowei Liu, Songtao Liu","doi":"10.1155/cjgh/2591387","DOIUrl":"10.1155/cjgh/2591387","url":null,"abstract":"<p><strong>Purpose: </strong>Inflammation is implicated in the pathogenesis of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs); however, the causal nature of this association remains unclear. This study sought to evaluate the causal relationships between GEP-NENs and inflammatory factors using a two-sample Mendelian randomization (MR) approach.</p><p><strong>Methods: </strong>We performed a two-sample MR analysis to investigate the causal associations between 91 inflammatory proteins and 731 immune cell traits as exposures and the five subtypes of GEP-NENs as the outcomes. The analytical approach employed various methodologies, such as inverse variance weighting, MR-Egger, weighted mode, weighted median, and simple mode. To evaluate the robustness of the results, sensitivity analyses were conducted, which encompassed MR Egger regression, MR multiple gene residual and outlier detection, leave-one-out analysis, and Cochran's <i>Q</i> test. False discovery rate (FDR) correction was applied, and causal relationships at the gene level were deemed significant at <i>p</i> < 0.05 after FDR adjustment.</p><p><strong>Results: </strong>After FDR correction, the findings revealed robust causal associations between genetically predicted HLA DR++ monocyte %leukocyte (OR = 3.09, 95% CI: 1.76-5.44, <i>p</i> < 0.001, FDR = 0.022), HLA DR on CD14+ CD16- monocyte (OR = 1.72, 95% CI: 1.34-2.22, <i>p</i> < 0.001, FDR = 0.010), and HLA DR on CD14+ monocyte (OR = 1.76, 95% CI: 1.36-2.29, <i>p</i> < 0.001, FDR = 0.010) and genetically predicted stomach NENs. Reverse analysis revealed that GEP-NENs had no major impact on inflammation.</p><p><strong>Conclusion: </strong>These findings reveal the immune mechanisms underlying GEP-NENs and highlight potential therapeutic strategies targeting the immune microenvironment of GEP-NENs.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2025 ","pages":"2591387"},"PeriodicalIF":2.3,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12741578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145851219","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":"Impact of Urgent Versus Early Endoscopy on Outcomes in Acute Upper Gastrointestinal Bleeding: A Retrospective Study.","authors":"Katarzyna Stasik, Katarzyna Ferenc, Krystian Partyka, Wojciech Kilisiński, Rafał Filip","doi":"10.1155/cjgh/4328051","DOIUrl":"10.1155/cjgh/4328051","url":null,"abstract":"<p><strong>Background and aims: </strong>Acute upper gastrointestinal (UGI) bleeding from variceal and nonvariceal sources is a leading cause of morbidity and mortality. Although current international guidelines recommend performing endoscopy within 24 h of presentation, the added value of very early (\"urgent,\" < 6 h) versus \"early\" (6-24 h) endoscopy remains unclear. Therefore, this study aimed to analyze the impact of urgent versus early endoscopy on clinical outcomes.</p><p><strong>Methods: </strong>In this retrospective cohort study, we reviewed the medical records of 599 patients admitted to the emergency or gastroenterology department who underwent UGI endoscopy. Patients were stratified by timing, urgent endoscopy within 6 h of specialist consultation and early endoscopy between 6-24 h postconsultation. The protocol was approved by the University of Rzeszów Ethics Committee and conducted in accordance with the Declaration of Helsinki.</p><p><strong>Results: </strong>Compared to the early group, patients undergoing urgent endoscopy were younger (<i>p</i> = 0.013), predominantly male, and had higher baseline heart rates (<i>p</i> = 0.0371). Apart from more frequent hypertension in the early group (<i>p</i> = 0.0007), comorbiditiy profiles were otherwise similar. The urgent endoscopy group had longer hospital stays (6.88 vs. 5.95, <i>p</i> = 0.774), more frequent rebleeding within 7 days (<i>p</i> = 0.0213), and slightly higher 30-day all-cause mortality rates. Factors associated with poor prognosis included increases in Rockall's and GB's scores (42% and 19% higher risk per point, respectively) and the presence of active bleeding (105% higher odds).</p><p><strong>Conclusions: </strong>In unadjusted analyses, urgent endoscopy (< 6 h) was associated with worse outcomes, likely reflecting the selection of more severely ill patients. After propensity-score matching for baseline risk factors, however, the timing of endoscopy (< 6 h vs. 6-24 h) was no longer an independent predictor of outcomes. These findings suggest that clinicians' decisions and outcome differences are driven by overall severity of presentation and comorbid burden, rather than the effect of ultra-early endoscopy itself.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2025 ","pages":"4328051"},"PeriodicalIF":2.3,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12665192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655687","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":"The Role of Macrophage Polarization and Ferroptosis in the Progression of Liver Fibrosis.","authors":"Jeri Nobia Purnama, Mohammad Ghozali, Desak Made Malini, Ratu Safitri","doi":"10.1155/cjgh/1200073","DOIUrl":"10.1155/cjgh/1200073","url":null,"abstract":"<p><p>Liver fibrosis is a pathological condition marked by excessive extracellular matrix accumulation, potentially leading to cirrhosis. Macrophages play a vital role in regulating inflammatory responses, facilitating tissue repair, and orchestrating extracellular matrix remodeling through their differentiation into proinflammatory and anti-inflammatory phenotypes. Hepatic stellate cell activation and the progression of fibrosis have been linked to ferroptosis, a controlled cell death process triggered by iron and characterized by lipid peroxidation. This review explores the interaction between ferroptosis and macrophage polarization in iron-overload-induced liver fibrosis. It examines how ferroptosis intensifies inflammatory and fibrotic processes through macrophage activity and identifies key macrophage marker proteins involved. Understanding this interplay offers novel therapeutic insights targeting macrophage polarization to mitigate liver fibrosis, particularly in conditions such as hemochromatosis and chronic transfusion-dependent disorders.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2025 ","pages":"1200073"},"PeriodicalIF":2.3,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12658345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649815","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}