Digestive diseases (Basel, Switzerland)最新文献

{"title":"Letter to the Editor regarding the Article \"Muscular Injury Is a Risk Factor for Post-Entire Circumferential Esophageal Endoscopic Submucosal Dissection Stricture\".","authors":"Ade Chen, Fuping Shen","doi":"10.1159/000547942","DOIUrl":"10.1159/000547942","url":null,"abstract":"","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"747-748"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Acute Cholangitis Caused by Extended-Spectrum Beta-Lactamase and AmpC-Producing Organisms.","authors":"Takuro Nishiwaki, Shigenobu Yoshimura, Naoto Hosokawa, Hiroki Matsui, Takashi Ashikawa, Tomoyuki Funato, So Nakaji, Hirokazu Takahashi","doi":"10.1159/000546606","DOIUrl":"10.1159/000546606","url":null,"abstract":"<p><strong>Introduction: </strong>Prompt antibiotic administration is essential in the management of acute cholangitis (AC). In selecting initial antibiotics, it is important to consider both the severity of the condition and the antimicrobial activity spectrum, particularly against major resistant bacteria. Extended-spectrum β-lactamases and AmpC productions are key factors in pathogen resistance; however, knowledge of patient characteristics in cholangitis management remains limited. We aimed to analyze risk factors for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and for chromosomally mediated AmpC-producing Enterobacteriaceae (CAE).</p><p><strong>Methods: </strong>This study retrospectively analyzed patients with AC who underwent endoscopic retrograde cholangiopancreatography (ERCP) at a tertiary center in Japan between April 1, 2018, and April 30, 2024. This analysis focused on evaluating the first episode of AC during hospitalization.</p><p><strong>Results: </strong>A total of 721 patients with cholangitis underwent ERCP. ESBL-E was detected as the causative pathogen in 22 cases, whereas CAE was identified in 113 cases. Patients with CAE experienced a significantly higher recurrence rate within 60 days (15.9% vs. 4.3%, p < 0.001) and required more frequent escalation to broad-spectrum antibiotics (19.5% vs. 8.7%, p = 0.001). No significant differences in clinical outcomes were observed between patients with and without ESBL-E. Multivariate analysis identified independent risk factors for AC caused by ESBL-E: previous antibiotic use within 90 days, dialysis, and residence in nursing homes. For CAE, independent risk factors included antibiotic use within 90 days and a history of endoscopic sphincterotomy (EST).</p><p><strong>Conclusion: </strong>In AC, recent antibiotic use, dialysis, and institutionalization are associated with ESBL-E, whereas recent antibiotic use and a history of EST are linked to CAE.</p>","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"445-454"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bowel Preparation for Colonoscopy: The Patient Point of View.","authors":"Gianeugenio Tontini, Cristiano Spada, Franco Radaelli, Pier Alberto Testoni, Giorgio Ciprandi, Maurizio Vecchi","doi":"10.1159/000547968","DOIUrl":"10.1159/000547968","url":null,"abstract":"<p><strong>Introduction: </strong>Colonoscopy is a common procedure that requires adequate bowel preparation. Polyethylene glycol (PEG) is widely used but commonly associated with patient complaints, including the split-dose administration schedule. Mannitol could be an attractive alternative as it acts quickly, requires low volumes, and is palatable. A recent Phase III international, multicenter, randomized study (SATISFACTION) compared the efficacy and safety of bowel preparation using same-day oral mannitol or a split-dose regimen of 2L PEG-ASC. This study investigated the effects of the two laxatives on the Bowel Cleansing Impact Review (BOCLIR), a questionnaire exploring the degree of satisfaction of patients undergoing preparation for a colonoscopy.</p><p><strong>Methods: </strong>The BOCLIR measures the acceptability and tolerability of bowel cleansers on three unidimensional scales (satisfaction, symptoms, and activity limitations). The total score is the sum of the three sub-scores and ranges from 0 to 110, with higher scores representing worse patient experiences.</p><p><strong>Results: </strong>This analysis included 476 patients who completed the BOCLIR questionnaire: 236 in the mannitol group and 240 in the PEG-ASC group. The difference in the least square means of the total score was -8.01 (95% CI: -10.70 to -5.31), with a highly significant difference in favor of mannitol (p < 0.0001).</p><p><strong>Conclusion: </strong>This analysis of the SATISFACTION study shows that bowel preparation with mannitol was far preferable to PEG-ASC in terms of acceptability and tolerability. Based on these results, mannitol may be close to an ideal preparation from the patient's point of view.</p>","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"659-666"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12668715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Vonoprazan-Based Triple Therapy with Sitafloxacin and Amoxicillin for Third-Line <italic>Helicobacter pylori</italic> Eradication: A Multicenter Prospective Analysis on Drug Resistance and <italic>gyrA</italic> Mutations.","authors":"Shunpei Wasaki, Hideki Mori, Juntaro Matsuzaki, Hidekazu Suzuki, Kenro Hirata, Hiroyuki Imaeda, Masahiro Yoshioka, Atsushi Nakazawa, Akira Okazawa, Takanori Kanai, Tatsuhiro Masaoka","doi":"10.1159/000546914","DOIUrl":"10.1159/000546914","url":null,"abstract":"<p><strong>Introduction: </strong>Vonoprazan (VPZ) is a potent gastric acid secretion inhibitor used to improve the outcomes of Helicobacter pylori (H. pylori) eradication treatments. However, the increasing prevalence of antibiotic-resistant H. pylori strains has limited the efficacy of H. pylori eradication therapies. The aim of this study was to evaluate the efficacy and safety of a 7-day triple therapy with VPZ, amoxicillin (AMOX), and sitafloxacin (STFX) as a third-line H. pylori eradication treatment.</p><p><strong>Methods: </strong>Patients in whom second-line eradication therapy failed were enrolled. The minimum inhibitory concentrations of STFX and AMOX, as well as the gyrA mutation status of H. pylori strains, were determined before treatment. The patients received VPZ (20 mg) twice daily, AMOX (500 mg) four times daily, and STFX (100 mg) twice daily for 7 days (vonoprazan-amoxicillin-sitafloxacin [VAS] group). Successful eradication was evaluated using the 13C-urea breath test.</p><p><strong>Results: </strong>Of the 114 patients enrolled, 75 were treated with the VAS regimen. The overall eradication rate in the VAS group was 90.7% and 94.4% in the intention-to-treat and per-protocol populations, respectively. The VAS regimen completely eradicated gyrA mutation-negative H. pylori strains. Furthermore, it eradicated all strains containing gyrA mutations at position D91. Adverse events were observed in 38.7% of patients, and treatment was discontinued in 1 patient because of eruption, diarrhea, and headache.</p><p><strong>Conclusion: </strong>Overall, the 7-day VAS regimen exhibited an excellent safety profile and efficacy as a third-line eradication treatment, even against gyrA mutation-positive H. pylori strains.</p>","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"498-505"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comprehensive Review of Genetic Mutations Occurring in the Development and Progression of Gastric Cancer.","authors":"Yalan Li, Qianqian Xu, Zhuo Chen, Mengting Chen, Kunyu Han, Zhuqing Zhang, Aling Shen, Xiaoyan Fu","doi":"10.1159/000547374","DOIUrl":"10.1159/000547374","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer (GC), a leading cause of mortality globally, is a complex condition stemming from various factors including unhealthy lifestyle habits, genetic mutations expressed in a single nucleotide, environmental effects, and chronic Helicobacter pylori infections. The development and progression of GC are gradual over many years, with a lack of specific symptoms in early stages. This results in late diagnosis at advanced stages when the cancer is more aggressive, which in turn significantly impacts the prognosis and treatment options.</p><p><strong>Summary: </strong>This review examines research focused on genetic mutations and mechanisms that contribute to the development and advancement of GC. We analyzed the literature on genetic mutations in GC from 1 January 2012 to 12 March 2025. These studies were derived from PubMed, Google Scholar, and the Web of Science. The following MeSH terms were used to explore these databases and to derive the relevant data: \"gastric cancer\" AND \"stomach cancer\" AND \"genetic mutations\" OR \"genes\" AND \"onset\" OR \"development\" AND \"progression\" OR \"advancement.\"</p><p><strong>Key messages: </strong>Our analysis revealed various genetic and molecular alterations in GC, including the overexpression of receptors and cancer-causing genes and the inactivation of tumor-suppressing genes. APC, ATM, BRCA1, BRCA2, CDH1, CDH2, MLH1, MSH2, MSH6, SMAD4, TP53, PIK3CA, and RHOA were linked to the onset and progression of GC, with CDH1 mutations emerging as the most prevalent. Identifying the genetic alterations underlying the onset and development of GC is essential, as it can enable prompt diagnosis and help establish effective preventive measures for this condition.</p>","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"630-640"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Dose Escalation and Associated Direct Costs of Biologics in Management of Ulcerative Colitis: A Retrospective Database Study.","authors":"Miguel Regueiro, Tania Gulati, Ashmita Bandyopadhyay, Deborah A Fisher, Richard Moses, Thomas Creveling, Payal Jha, Navneet Upadhyay","doi":"10.1159/000547994","DOIUrl":"10.1159/000547994","url":null,"abstract":"<p><p><p>Introduction: Dose escalation with biologics is common among patients with ulcerative colitis (UC). We investigated the dose escalation and associated incremental costs among patients treated with biologics for UC.</p><p><strong>Methods: </strong>This study utilized the Merative™ MarketScan® database in the USA to identify adults with at least two claims for UC and at least two refill/infusion claims for maintenance doses of biologics (including adalimumab, infliximab, ustekinumab, and vedolizumab) from January 1, 2015, to December 31, 2022. Patients were stratified by the presence (bio-experienced) or absence (bio-naïve) of other advanced therapy claims during the baseline period (12 months before index date). Descriptive statistics were used to summarize the dose escalation measures (frequency and magnitude of dose escalation, incremental cost due to dose escalation, and time-to-first dose escalation).</p><p><strong>Results: </strong>Of 1,812 patients with UC who were on biologics during the maintenance phase, 56.3% had dose escalation. Overall, magnitude of dose escalation was 119.9% adalimumab, 34.9% infliximab, 81.6% ustekinumab, and 55.4% vedolizumab. Overall, median time-to-first dose escalation after initiating maintenance therapy ranged from nearly a month to 5 months (adalimumab: 0.8, infliximab: 5.1, ustekinumab: 1.3, and vedolizumab: 5.1). Estimated incremental annual cost per patient incurred due to dose escalation in US dollars was USD 37,359 for adalimumab (bio-naïve: USD 36,367; bio-experienced: USD 44,180) and USD 73,765 for ustekinumab (bio-naïve: USD 74,554; bio-experienced: USD 73,599).</p><p><strong>Conclusions: </strong>Dose escalation with biologics for UC in the USA is common. This practice has substantially increased the average medication cost of biologics to payers/patients compared to their approved doses. </p>.</p>","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"641-652"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"40 Years of Digestive Diseases.","authors":"Peter Malfertheiner","doi":"10.1159/000546601","DOIUrl":"10.1159/000546601","url":null,"abstract":"","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"381-382"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of RHEMITT Score in a Retrospective Cohort with Overt Small Bowel Bleeding.","authors":"Raquel Ballester-Clau, Conor Costigan, James O Apos Connell, Montse Martínez, Deirdre McNamara","doi":"10.1159/000546171","DOIUrl":"10.1159/000546171","url":null,"abstract":"<p><strong>Introduction: </strong>The RHEMITT score (RS) has showed an excellent accuracy to predict rebleeding after video capsule endoscopy (VCE), in patients with small bowel bleeding (SBB). However, RS was developed and subsequently validated in a heterogeneous population of patients with overt and occult SBB. As the bleeding presentation is a recognized independent predictor for rebleeding, the aim of this study was to assess the RS utility in a homogeneous cohort of patients admitted with only overt SBB.</p><p><strong>Methods: </strong>Retrospective, single centre study, including patients admitted with overt SBB. RS was calculated and the rebleeding rates compared. The follow-up was 12 months. Univariate analysis used simple logistic regression, chi-squared test, or Mann-Whitney as needed. To test the performance of the score, ROC analysis was performed selecting the optimal cut-off point maximized by the Youden index. A rebleeding-free survival was also assessed.</p><p><strong>Results: </strong>Seventy-nine patients were included, 62% showed relevant findings on VCE. In total, 27.8% rebled, of which 63.3% rebled within the first 6 months. The rate of rebleeding in low-risk RS category was 10.5%, in the intermediate-risk 30.2% and in the high-risk 57.1%. Urea (p = 0.008), relevant findings on VCE (p = 0.021), and high-risk RS category (p = 0.048) were predictive factors for rebleeding. The area under the curve for RS was 0.665 (95% confidence interval 0.773-0.526). The Kaplan-Meier plots were not statistically different according to the RS categories (log-rank p = 0.113).</p><p><strong>Conclusion: </strong>High-risk RS performed well in predicting rebleeding in this cohort of patients with overt SBB. However, in low and intermediate RS categories further research is warranted.</p>","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"653-658"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut Microbiota as a Key Player in Health and Disease with a Focus on Long-Term Alterations in Post-COVID.","authors":"Ana Bačić, Tijana Gmizić, Tea Takić, Marija Zdravković, Marija Branković, Mirjana Rajilić-Stojanović","doi":"10.1159/000548507","DOIUrl":"10.1159/000548507","url":null,"abstract":"<p><strong>Introduction: </strong>Gut microbiota plays a critical role in health and may contribute to post-COVID manifestations, as alterations in microbial communities have been observed in affected individuals. This study aimed to identify microbial and biochemical signatures in post-COVID individuals after an extended period following acute infection.</p><p><strong>Methods: </strong>A total of 90 subjects were recruited, divided into three equal groups: post-COVID, fully recovered individuals, and healthy controls. The post-COVID group was further stratified by symptom duration and severity. Fecal microbiota was analyzed using 16S rRNA gene sequencing (V₃-V₄ region), with differential abundance assessed through LEfSE. Biochemical parameters were measured using the Mindray BS800 system. Spearman's correlation was applied to explore associations between taxonomic groups and biochemical markers.</p><p><strong>Results: </strong>Several microbial taxa exhibited positive correlations with high-density lipoprotein (HDL) levels and negative associations with non-HDL lipid parameters and CRP, highlighting their potential role in health. Individuals with a history of COVID-19 showed a significantly lower relative abundance of Phascolarctobacterium, Slackia, Enterorhabdus, and Senegalimassilia (p < 0.05, LDA >2) compared to healthy controls. In participants with post-COVID symptoms, Eggerthella was significantly enriched, with Holdemania, Gemella, and two uncultured Lachnospiraceae showing a trend toward higher abundance. Severe post-COVID cases showed higher Parasutterella abundance, while long-lasting symptoms (>1 year) were associated with Dialister enrichment and Phascolarctobacterium depletion compared to controls and fully recovered individuals.</p><p><strong>Conclusion: </strong>Gut microbiota alterations were observed in post-COVID individuals even after a prolonged period following acute infection, suggesting a potential link between microbial imbalance and lingering symptoms, though causality cannot be confirmed.</p>","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"731-746"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interaction Effect of Helicobacter pylori Infection and Family History of Gastric Cancer on the Detection Age of Significant Gastric Precancerous Conditions.","authors":"Duc Trong Quach, Mai Ngoc Luu, Doan Thi Nha Nguyen, Duc Qui Phan, Quoc Van Ha, Khanh Van Do, Toru Hiyama","doi":"10.1159/000546653","DOIUrl":"10.1159/000546653","url":null,"abstract":"<p><strong>Introduction: </strong>Helicobacter pylori (H. pylori) eradication aimed at the prevention of gastric cancer development should ideally be administered before the establishment of significant gastric precancerous conditions (SGPCs), including advanced gastric atrophy, intestinal metaplasia, and dysplasia. We evaluated the interaction effect of H. pylori infection and positive family history of gastric cancer (FHx) on the age at which SGPCs are detected.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among treatment-naïve adult patients with upper gastrointestinal symptoms. Factors associated with SGPCs were identified using multivariable logistic regression. Age cutoffs for predicting SGPCs were determined using predicted probabilities from an interaction logistic regression model accounting for various probability thresholds.</p><p><strong>Results: </strong>There were 761 patients with a median age of 42.0 years. The SGPC predictors included H. pylori infection (OR: 2.269, 95% CI: 1.626-3.165), positive FHx (OR = 1.754, 95% CI: 1.144-2.689), and age (OR = 1.072, 95% CI: 1.054-1.091). Neither positive FHx nor H. pylori infection alone markedly altered the SGPC probabilities under the age of 30 years, but H. pylori infection increased the SGPC probabilities after the age of 30 years. The earliest SGPC onset occurred in patients with both positive FHx and H. pylori infection. At the probability threshold of 0.20, the age cutoffs for detecting SGPCs were 41, 35, 33, and 19 years for patients without positive FHx and H. pylori infection, with positive FHx only, with H. pylori infection only, and with both positive FHx and H. pylori infection, respectively.</p><p><strong>Conclusions: </strong>A positive FHx has a synergistic effect with H. pylori on the development of SGPCs and should be considered when determining the appropriate age for H. pylori eradication.</p>","PeriodicalId":520605,"journal":{"name":"Digestive diseases (Basel, Switzerland)","volume":" ","pages":"400-410"},"PeriodicalIF":2.1,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144201354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}