Gastroenterology Report最新文献

{"title":"Symptom burden in chronic liver disease.","authors":"Ammar Hassan, Ivonne Hurtado Diaz De Leon, Elliot B Tapper","doi":"10.1093/gastro/goae078","DOIUrl":"10.1093/gastro/goae078","url":null,"abstract":"<p><p>Chronic liver disease (CLD) is a significant contributor to global mortality. For people who are living with CLD, however, there is a substantial and often overlooked burden of physical and psychological symptoms that significantly affect health-related quality of life. CLD frequently presents with a multitude of interrelated and intricate symptoms, including fatigue, pruritus, muscle cramps, sexual dysfunction, and falls. Increasingly, there is interest in studying and developing interventional strategies to provide a more global approach to managing these complex patients. Moreover, in addition to established guidelines for the management of conventional complications, such as ascites and hepatic encephalopathy, there have been efforts in developing evidence-based guidance for the treatment of the more subjective yet still problematic elements. This review will address the management of these less \"classical\" but nonetheless important symptoms.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918105","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":"Advances in the management of complications from cirrhosis.","authors":"Jasleen Singh, Mark Ebaid, Sammy Saab","doi":"10.1093/gastro/goae072","DOIUrl":"10.1093/gastro/goae072","url":null,"abstract":"<p><p>Cirrhosis with complications of liver decompensation and hepatocellular carcinoma (HCC) constitute a leading cause of morbidity and mortality worldwide. Portal hypertension is central to the progression of liver disease and decompensation. The most recent Baveno VII guidance included revision of the nomenclature for chronic liver disease, termed compensated advanced chronic liver disease, and leveraged the use of liver stiffness measurement to categorize the degree of portal hypertension. Additionally, non-selective beta blockers, especially carvedilol, can improve portal hypertension and may even have a survival benefit. Procedural techniques with interventional radiology have become more advanced in the management of refractory ascites and variceal bleeding, leading to improved prognosis in patients with decompensated liver disease. While lactulose and rifaximin are the preferred treatments for hepatic encephalopathy, many alternative treatment options may be used in refractory cases and even procedural interventions such as shunt embolization may be of benefit. The approval of terlipressin for the treatment of hepatorenal syndrome (HRS) in the USA has improved the way in which HRS is managed and will be discussed in detail. Malnutrition, frailty, and sarcopenia lead to poorer outcomes in patients with decompensated liver disease and should be addressed in this patient population. Palliative care interventions can lead to improved quality of life and clinical outcomes. Lastly, the investigation of systemic therapies, in particular immunotherapy, has revolutionized the management of HCC. These topics will be discussed in detail in this review.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894883","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":"Pancreatic pseudocyst, gastric outlet obstruction, superior mesenteric artery syndrome and renal vein entrapment syndrome in groove pancreatitis: a case report.","authors":"Amanda N Myles, Porsha Okiye, Ghida Akhdar, Raheem Robertson, Dylan Hewlett","doi":"10.1093/gastro/goae079","DOIUrl":"10.1093/gastro/goae079","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11290811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861613","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":"Interventional endoscopy in inflammatory bowel disease: a comprehensive review.","authors":"Partha Pal, D Nageshwar Reddy","doi":"10.1093/gastro/goae075","DOIUrl":"10.1093/gastro/goae075","url":null,"abstract":"<p><p>Interventional endoscopy can play a key role in the multidisciplinary management of complex inflammatory bowel disease (IBD) as an adjunct to medical and surgical therapy. The primary role of interventional IBD (IIBD) includes the treatment of Crohn's disease-related stricture, fistula, and abscess. Endoscopic balloon dilation (EBD), endoscopic stricturotomy, and placement of endoscopic stents are different forms of endoscopic stricture therapy. EBD is the most widely used therapy whereas endoscopic stricturotomy has higher long-term efficacy than EBD. Fully covered and partially covered self-expanding metal stents are useful in long and refractory strictures whereas lumen-apposing metal stents can be used in short, and anastomotic strictures. Endoscopic fistula/abscess therapy includes endoscopic fistulotomy, seton placement, endoscopic ultrasound-guided drainage of rectal/pelvic abscess, and endoscopic injection of filling agents (fistula plug/glue/stem cell). Endoscopic seton placement and fistulotomy are mainly feasible in short, superficial, single tract fistula and in those with prior surgical seton placement. Similarly, endoscopic fistulotomy is usually feasible in short, superficial, single-tract fistula. Endoscopic closure therapies like over-the-scope clips, suturing, and self-expanding metal stent should be avoided for <i>de novo</i>/bowel to hollow organ fistulas. Other indications include management of postoperative complications in IBD such as management of surgical leaks and complications of pouchitis in ulcerative colitis. Additional indications include endoscopic resection of ulcerative colitis-associated neoplasia (by endoscopic mucosal resection, endoscopic submucosal dissection, and endoscopic full-thickness resection), retrieval of retained capsule endoscope, and control of bleeding. IIBD therapies can potentially act as a bridge between medical and surgical therapy for properly selected IBD patients.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11272179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762657","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":"HLA-DQA1*05 correlates with increased risk of anti-drug antibody development and reduced response to infliximab in Chinese patients with Crohn's disease.","authors":"Wei Wang, Qi Zhang, Junzhang Zhao, Tao Liu, Jiayin Yao, Xiang Peng, Min Zhi, Min Zhang","doi":"10.1093/gastro/goae074","DOIUrl":"10.1093/gastro/goae074","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of anti-TNF therapy in Crohn's disease (CD), such as infliximab, is often compromised by the development of anti-drug antibodies (ADAs). The genetic variation HLA-DQA1*05 has been linked to the immunogenicity of biologics, influencing ADA formation. This study investigates the correlation between HLA-DQA1*05 and ADA formation in CD patients treated with infliximab in a Chinese Han population and assesses clinical outcomes.</p><p><strong>Methods: </strong>In this retrospective cohort study, 345 infliximab-exposed CD patients were genotyped for HLADQ A1*05A <math><mo>></mo></math> G (rs2097432). We evaluated the risk of ADA development, loss of infliximab response, adverse events, and treatment discontinuation among variant and wild-type allele individuals.</p><p><strong>Results: </strong>A higher percentage of patients with ADAs formation was observed in HLA-DQA1*05 G variant carriers compared with HLA-DQA1*05 wild-type carriers (58.5% vs 42.9%, <i>P </i>=<i> </i>0.004). HLA-DQA1*05 carriage significantly increased the risk of ADAs development (adjusted hazard ratio = 1.65, 95% CI 1.18-2.30, <i>P </i>=<i> </i>0.003) and was associated with a greater likelihood of infliximab response loss (adjusted HR = 2.55, 95% CI 1.78-3.68, <i>P </i><<i> </i>0.0001) and treatment discontinuation (adjusted HR = 2.21, 95% CI 1.59-3.06, <i>P </i><<i> </i>0.0001). Interestingly, combined therapy with immunomodulators increased the risk of response loss in HLA-DQA1*05 variant carriers.</p><p><strong>Conclusions: </strong>HLA-DQA1*05 significantly predicts ADAs formation and impacts treatment outcomes in infliximab-treated CD patients. Pre-treatment screening for this genetic factor could therefore be instrumental in personalizing anti-TNF therapy strategies for these patients.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11269678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762656","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":"Low-pressure versus standard-pressure pneumoperitoneum in minimally invasive colorectal surgery: a systematic review, meta-analysis, and meta-regression analysis.","authors":"Justin Dourado, Peter Rogers, Nir Horesh, Sameh Hany Emile, Pauline Aeschbacher, Steven D Wexner","doi":"10.1093/gastro/goae052","DOIUrl":"10.1093/gastro/goae052","url":null,"abstract":"<p><strong>Background: </strong>We aimed to assess the efficacy and safety of low-pressure pneumoperitoneum (LPP) in minimally invasive colorectal surgery.</p><p><strong>Methods: </strong>A PRISMA-compliant systematic review/meta-analysis was conducted, searching PubMed, Scopus, Google Scholar, and clinicaltrials.gov for randomized-controlled trials assessing outcomes of LPP vs standard-pressure pneumoperitoneum (SPP) in colorectal surgery. Efficacy outcomes [pain score in post-anesthesia care unit (PACU), pain score postoperative day 1 (POD1), operative time, and hospital stay] and safety outcomes (blood loss and postoperative complications) were analyzed. Risk of bias2 tool assessed bias risk. The certainty of evidence was graded using GRADE.</p><p><strong>Results: </strong>Four studies included 537 patients (male 59.8%). LPP was undertaken in 280 (52.1%) patients and associated with lower pain scores in PACU [weighted mean difference: -1.06, 95% confidence interval (CI): -1.65 to -0.47, <i>P </i>=<i> </i>0.004, <i>I</i> ² <i> </i>=<i> </i>0%] and POD1 (weighted mean difference: -0.49, 95% CI: -0.91 to -0.07, <i>P </i>=<i> </i>0.024, <i>I</i> ² <i> </i>=<i> </i>0%). Meta-regression showed that age [standard error (SE): 0.036, <i>P </i><<i> </i>0.001], male sex (SE: 0.006, <i>P </i><<i> </i>0.001), and operative time (SE: 0.002, <i>P </i>=<i> </i>0.027) were significantly associated with increased complications with LPP. In addition, 5.9%-14.5% of surgeons using LLP requested pressure increases to equal the SPP group. The grade of evidence was high for pain score in PACU and on POD1 postoperative complications and major complications, and blood loss, moderate for operative time, low for intraoperative complications, and very low for length of stay.</p><p><strong>Conclusions: </strong>LPP was associated with lower pain scores in PACU and on POD1 with similar operative times, length of stay, and safety profile compared with SPP in colorectal surgery. Although LPP was not associated with increased complications, older patients, males, patients undergoing laparoscopic surgery, and those with longer operative times may be at risk of increased complications.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11259227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735664","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":"Spatial transcriptomics of gastric cancer brain metastasis reveals atypical vasculature strategies with supportive immune profiles.","authors":"Kaijing Liu, Ying Wang, Chunhua Wang, Chengcheng Guo, Dun Zhang, Yu Zhong, Lin Yin, Yunxin Lu, Furong Liu, Yang Zhang, Dongsheng Zhang","doi":"10.1093/gastro/goae067","DOIUrl":"10.1093/gastro/goae067","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer brain metastasis (GCBM) represents a rare but highly aggressive malignancy. Metastatic cancer cells are highly heterogeneous and differentially remodels brain vasculature and immune microenvironments, which affects the treatment effectiveness and patient outcome. This study aimed to investigate the spatial interactions among different cell components, especially the vasculature system and the brain microenvironment of GCBM patients.</p><p><strong>Methods: </strong>We used digital spatial profiling to examine 140 regions composing tumor, immune, and brain tissues from three GCBM patients. Transcriptomic data with spatial information were analyzed for tissue areas related to different blood recruitment strategies. For validation, independent analysis of patient bulk transcriptomic data and <i>in vivo</i> single-cell transcriptomic data were performed.</p><p><strong>Results: </strong>Angiogenesis and blood vessel co-option co-existed within the same GCBM lesion. Tumors with high epithelial-mesenchymal transition and an enhanced transcriptomic gene signature composed of <i>CTNNB1</i>, <i>SPARC</i>, <i>VIM</i>, <i>SMAD3</i>, <i>SMAD4</i>, <i>TGFB1</i>, <i>TGFB2</i>, and <i>TGFB3</i> were more prone to adopt blood vessel co-option than angiogenesis. Enriched macrophage infiltration, angiogenic chemokines, and <i>NAMPT</i> were found in angiogenic areas, while increased T cells, T cell activating cytokines, and reduced <i>NAMPT</i> were found in vessel co-option regions. Spatially, angiogenesis was enriched at the tumor edge, which showed higher <i>DMBT1</i> expression than the tumor center.</p><p><strong>Conclusions: </strong>This study mapped the orchestrated spatial characteristics of tumor and immunological compositions that support the conventional and atypical vascularization strategies in GCBM. Our data provided molecular insights for more effective combinations of anti-vascular and immune therapies.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11257699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724928","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":"Global patterns in the epidemiology, cancer risk, and surgical implications of inflammatory bowel disease.","authors":"Yiming Zhang, Xiaotian Chu, Li Wang, Hong Yang","doi":"10.1093/gastro/goae053","DOIUrl":"10.1093/gastro/goae053","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD), mainly including ulcerative colitis and Crohn's disease, imposes a huge medical and economic burden worldwide. Recently, the diagnosis, treatment, and surveillance of IBD have advanced rapidly, which has changed the epidemiology, cancer risk, and surgery risk of IBD. Here, we reviewed the recent literature on the epidemiology, IBD-related cancer, and IBD-related surgery. We created a choropleth map to show the worldwide incidence trend for Crohn's disease and ulcerative colitis. We also found that the cancer risk and surgery risk of IBD are declining and discussed some risk factors associated with them. Based on the recent trend, we proposed several suggestions and hoped to reduce the global burden of IBD as far as possible.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565121","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":"Colorectal cancer and inulin supplementation: the good, the bad, and the unhelpful.","authors":"Manon Oliero, Ahmed Amine Alaoui, Claire McCartney, Manuela M Santos","doi":"10.1093/gastro/goae058","DOIUrl":"10.1093/gastro/goae058","url":null,"abstract":"<p><p>The prebiotic inulin has been vaunted for its potential to reduce the risk of colorectal cancer. Inulin fermentation resulting in the production of short-chain fatty acids, primarily butyrate, has been reported to be associated with properties that are beneficial for gut health and has led to an increased consumption of inulin in the Western population through processed food and over-the-counter dietary supplements. However, in clinical trials, there is limited evidence of the efficacy of inulin in preventing colorectal cancer. Moreover, recent data suggest that improper inulin consumption may even be harmful for gastro-intestinal health under certain circumstances. The main objective of this review is to provide insight into the beneficial and potentially detrimental effects of inulin supplementation in the context of colorectal cancer prevention and enhancement of treatment efficacy.</p>","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11231048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565120","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":"Solitary pouch ulcer syndrome-a newly recognized phenotype of the ileal pouch disorders.","authors":"Bo Shen, Huai-Bin Mabel Ko, Hong Ma, Ravi Kiran, James Church","doi":"10.1093/gastro/goae073","DOIUrl":"10.1093/gastro/goae073","url":null,"abstract":"","PeriodicalId":54275,"journal":{"name":"Gastroenterology Report","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11229333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141560355","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}