Hasil untuk "Diseases of the digestive system. Gastroenterology"

Stijn J M Niessen, Robert Shiel, Astrid Wehner et al.

Simple Summary After having achieved international consensus over disease, diagnosis, classification, and monitoring concepts in the area of companion animal diabetes mellitus, Cushing’s syndrome, and hypoadrenocorticism, a group of 14 experts and one chair embarked on the third cycle of project “Agreeing Language in Veterinary Endocrinology” (ALIVE), this time focusing on thyroid disease terminology. This cycle’s methods followed, like previous ones, a modified Delphi-approach with small changes to improve efficiency and flexibility, including an off-site chair. For the first time, additionally, feedback on definitions of a previous cycle was incorporated, leading to an update of diabetes mellitus related definitions of ALIVE Cycle 1. This third cycle was completed successfully, accomplishing a majority-based consensus among panellists and international veterinary endocrinology society memberships over 78 thyroid related terminology and five updated diabetes mellitus definitions. As has been the case with the definitions created for other hormonal diseases, it is hoped this work will improve education, research, diagnosis, and treatment in cats and dogs with endocrine disease.

Su Wang, Catherine Freeland, Seng Gee Lim et al.

Summary: The terminology used to describe chronic hepatitis B (CHB) infection remains inconsistent and fragmented across liver societies, clinical settings, and research domains. This lack of alignment poses barriers to care, complicates clinical trial design, and can generate confusion among providers, people living with hepatitis B, and researchers. This article examines the impact of discordant CHB infection terminology on care delivery and research, highlighting specific challenges with commonly used terms, such as “immune tolerant,” “indeterminate” or “grey zone”, as well as with terms used for hepatitis B surface antigen loss, including “resolved infection”, “occult infection” or “functional cure.” Although recent guidelines have moved towards simplification, global uniformity remains lacking, particularly regarding definitions of disease phases and thresholds for initiating treatment. We call for alignment of terminology to improve care, increase treatment uptake, enhance patient engagement, and accelerate HBV research and elimination efforts. We propose a multistakeholder consensus process to create a unified and practical nomenclature that distinguishes between terminology for clinical care and terminology for research and drug development. We also call for intentional inclusion of people with lived experience in this process to ensure the language used is meaningful, empowering, and stigma-free. With the HBV field on the cusp of transformative therapies and simplified treatment algorithms, now is the time to harmonise the language we use. A globally unified chronic HBV infection terminology stands to enhance access to care, improve comparability of research data, and strengthen collaboration across the HBV community – all of which are critical to accelerating progress towards hepatitis B elimination.

A. Salahi-Niri, M. Zali, A. Yadegar

Objective: Helicobacter pylori remains one of the most prevalent bacterial infections globally. While H. pylori eradication reduces gastric cancer risk, increasing antimicrobial resistance (AMR) impairs the effective treatment with major geographic variability. This systematic review summarizes the global epidemiology, mechanisms of resistance, clinical consequences, and emerging strategies to address H. pylori AMR. Materials and Methods: We systematically searched PubMed, Scopus, and Web of Science for articles published between 2000 and June 2025. Keywords included “Helicobacter pylori”, “antimicrobial resistance”, “clarithromycin”, “metronidazole”, “levofloxacin”, “children”, and “epidemiology”. Inclusion criteria comprised English-language studies in human subjects reporting prevalence, mechanisms, or treatment outcomes related to resistance. Excluded were case reports, animal studies, and small series (<20 patients). Emphasis was placed on multicenter trials, surveillance reports, and systematic reviews. Results: Analysis of included studies demonstrated that clarithromycin resistance exceeds 20-30% in many regions, particularly East Asia and Southern Europe, undermining traditional triple therapy. Metronidazole resistance is widespread, ranging from 30-70% globally, while levofloxacin resistance shows alarming upward trends. Amoxicillin and tetracycline resistance remain rare, while rifabutin retains activity against multidrug-resistant strains. Pediatric populations exhibit especially high clarithromycin and metronidazole resistance, with pooled prevalence exceeding 35% in some regions, limiting therapeutic options. Molecular mechanisms primarily involve point mutations in 23S rRNA, rdxA/frxA, and gyrA genes, while next-generation sequencing has identified additional candidate loci. Novel strategies, including bismuth-based quadruple therapy, vonoprazan-based dual regimens, and molecular-guided therapy improve outcomes. Adjunctive measures such as probiotics, antimicrobial peptides, and stewardship interventions offer further promise. Conclusions: H. pylori AMR represents a critical barrier to eradication worldwide. Expanded global surveillance, rapid molecular diagnostics, and personalized therapy are urgently needed. Future research should prioritize pediatric-focused strategies, non-antibiotic alternatives, and equitable access to optimized regimens. Coordinated international action is essential to contain resistance and preserve the benefits of eradication.

Josephine Otuagomah, Alana Newcomb, T. Gwag et al.

Abstract Cluster of differentiation 47 (CD47) is a widely expressed transmembrane protein that serves as a critical immunoregulatory checkpoint in both homeostatic and pathological conditions of the digestive system. It interacts with signal regulatory protein alpha to send a ‘do not eat me’ signal, thereby preventing phagocytosis and shaping immune responses. Beyond immunity, CD47 also influences cell death, growth and metabolism through interactions with integrins and thrombospondin-1. Recent studies implicate CD47 as a central nexus in the pathogenesis of diverse liver and gastrointestinal disorders, including metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatohepatitis, inflammatory bowel disease, liver ischaemia-reperfusion injury, drug-induced liver injury and gastrointestinal malignancies such as hepatocellular carcinoma, colorectal and pancreatic cancers. CD47 contributes to disease progression through immune modulation, endothelial dysfunction, fibrogenic activation and suppression of antitumour immunity. This review summarises current mechanistic insights into CD47 signalling across digestive diseases and highlights its emerging potential as a therapeutic target for immunometabolic and oncological interventions in gastroenterology and hepatology.

Aleksandra Szlachcic, K. Nawrot-Porąbka

Physiology, as a science, is the foundation of modern medical knowledge and the starting point for understanding the mechanisms of most diseases. The dynamic development of physiology at the Jagiellonian University dates back to the 14th century, but the last 150 years have yielded notable discoveries, including those of Napoleon Cybulski. Over the last century, the Department of Physiology at the Jagiellonian University have made a valuable contribution to the development of experimental and clinical gastroenterology, which Prof. Stanisław Konturek greatly expanded. This paper aims to present the biography and achievements of Prof. Konturek against the background of a short history of the Department of Physiology. For research purposes, historical studies on the development of the Krakow school of physiology over the centuries, as well as biographical notes and interviews conducted with Prof. Stanisław Konturek, were used and analyzed. The most significant findings of the Department of Physiology in the 19th century, including the discovery of adrenaline and research on brain electrophysiology, are undoubtedly associated with Professor Napoleon Cybulski. The most valuable achievements of Prof. Stanisław Konturek include the role of neuropeptides and intestinal hormones in the physiology and pathology of the digestive system, as well as the involvement of Helicobacter pylori in the development of inflammatory, dysplastic, and neoplastic changes in the gastric mucosa. Professor Konturek was one of the most outstanding physiologists of our time. His scientific legacy includes 650 articles, numerous books, and many successors, professors, and doctors who continue his work.

A. Muñoz-Urribarri, Kelly Angulo Arze, Carolina Llerena Luna et al.

Lixin Zhu, Wensheng Liu, Razan H. Alkhouri et al.

Vasa Adi Wisnu Wardana, Titong Sugihartono, M. Miftahussurur

Background: The American College of Gastroenterology (ACG) currently recommends the Truelove and Witts scoring system for evaluating Ulcerative Colitis (UC) disease activity. Inflammatory markers such as Matrix Metallopeptidase 9 (MMP-9), High-sensitivity C-Reactive Protein (HsCRP), and Erythrocyte Sedimentation Rate (ESR) have previously been shown to correlate with intestinal inflammation. To evaluate the association of MMP-9, HsCRP, and LED with disease activity and treatment duration in UC according to the Truelove and Witts criteria.Methods: An observational analytic study with a cross-sectional design was conducted involving subjects with UC diagnosed pathologically and receiving 5-ASA therapy at the Gastroenterohepatology Outpatient Department of Dr. Soetomo Hospital. MMP-9, HsCRP, and ESR serum levels were measured. The disease activity was determined based on the Truelove and Witts criteria. Analysis was done by spearman's correlation. P-values and correlation coefficients (r) were presented.Results: Among the 31 subjects, the majority were female (67.7%) with an average age of 46.84 years. Approximately 35.5% subjects had been treated for more than 6 months. The MMP-9 and HsCRP serum levels were above normal range (71% and 93.5% subjects, respectively). The majority (74.2%) of the subjects had normal ESR levels. Among the investigated inflammatory markers, only ESR levels significantly had a very weak positive correlation (p=0.010; r=0.004).Conclusion: ESR serves as an effective biomarker for UC disease activity compared to MMP-9 and HsCRP. Further study is warranted to explore the role of these biomarkers in UC management.Keywords: ESR, HsCRP, MMP-9, Truelove and Witts, ulcerative colitis

Sara Mansoorshahi, Cindy Scurlock, Scientific Advisory Board of the Turner Syndrome Society of t Research Registry et al.

Background Many different clinical specialists provide care to patients with Turner syndrome (TS), who have highly variable clinical manifestations. Therefore, a national TS registry is essential to inform a cohesive approach to healthcare and research. In 2015, the Turner Syndrome Society of the United States (TSSUS) created the Turner Syndrome Research Registry (TSRR) to engage directly with community participants who voluntarily provide longitudinal data about their experiences with TS. TSRR projects are collaborative partnerships between people with TS, TSSUS, and researchers. Results To ensure that registry workflows conform to the data privacy choices of participants, TSSUS collaborated with UTHealth Houston in 2021 to create a new version of the TSRR that completely separates participant health data (stored at UTHealth) and personal identifiers (maintained at TSSUS). We developed an innovative Visual Basic (VB) script that, when embedded into Microsoft Outlook, redirects REDCap surveys through TSSUS to participants by matching registry IDs to participant email addresses. Additionally, the utilization of REDCap allows for portability of data as it is an open source platform. Conclusion In this report, we will highlight three recent changes that more closely align the TSRR with this mission: a unique and equal collaborative partnership between UTHealth and TSSUS, an open-source platform, REDCap, that ensures data portability and compatibility across institutions, and an innovative survey routing system that retains participant confidentiality without sacrificing REDCap survey distribution capabilities to connect researchers with thousands of participants.

M. Sheppard, A. Wal, J. Banner et al.

Cardiomyopathies (CMP) comprise a heterogenous group of diseases affecting primarily the myocardium, either genetic and/or acquired in origin. While many classification systems have been proposed in the clinical setting, there is no internationally agreed pathological consensus concerning the diagnostic approach to inherited CMP at autopsy. A document on autopsy diagnosis of CMP is needed because the complexity of the pathologic backgrounds requires proper insight and expertise. In cases presenting with cardiac hypertrophy and/or dilatation/scarring with normal coronary arteries, a suspicion of inherited CMP must be considered, and a histological examination is essential. Establishing the actual cause of the disease may require a number of tissue-based and/or fluid-based investigations, be it histological, ultrastructural, or molecular. A history of illicit drug use must be looked for. Sudden death is frequently the first manifestation of disease in case of CMP, especially in the young. Also, during routine clinical or forensic autopsies, a suspicion of CMP may arise based on clinical data or pathological findings at autopsy. It is thus a challenge to make a diagnosis of a CMP at autopsy. The pathology report should provide the relevant data and a cardiac diagnosis which can help the family in furthering investigations, including genetic testing in case of genetic forms of CMP. With the explosion in molecular testing and the concept of the molecular autopsy, the pathologist should use strict criteria in the diagnosis of CMP, and helpful for clinical geneticists and cardiologists who advise the family as to the possibility of a genetic disease.

R. O’shea, Perica Davitkov, C. Ko et al.

1. Digestive Disease and Surgery Institute, Cleveland Clinic / Cleveland Clinic Lerner College of Medicine, Cleveland Ohio 2. Division of Gastroenterology, University of Washington, Seattle Washington 3. Division of Hematology and Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville FL, 4. Division of Gastroenterology, Department of Medicine, University of Michigan, Ann Arbor Michigan; Ann Arbor VA Healthcare System, Ann Arbor Michigan 5. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 6. Division of Gastroenterology and Hepatology, VA Northeast Ohio Health Care System, Case Western Reserve University School of Medicine, Cleveland, Ohio

N. B. Gubergrits, N. V. Byelyayeva, K. Y. Linevska et al.

A few main directions can be distinguished in the scientific and practical activities of M. M. Gubergrits. Even his first studies contributed to the history of the development of domestic cardiology. He continued the work started by V. P. Obraztsov on the III normal heart sound, studied changes in heart tones and the formation of a gallop rhythm, the rhythm of a neurasthenic quail, was one of the first to evaluate the clinical significance of the electrocardiographic technique, and tried to use it for better understanding the effect of certain drugs on the heart. He described disorders of the cardiovascular system in severe infectious diseases (epidemic typhus, relapsing fever, and typhoid fever) and thrombosis of the splenic vein. An important part of the scientific activity of M. M. Gubergrits was the pain problem. An outstanding humanist scientist could not ignore this human suffering from various diseases. He was interested not only in the origin of pain in diseases of the heart, liver, and kidneys but also in pain as a general problem of physiology and pathology. However, he most clearly revealed himself as a talented clinician in gastroenterology by constantly combining thoughtful observation at the patient’s bedside with clinical and physiological experimentation. Back in 1929, in his work on the mechanism of gastric secretion, he established the effect of mechanical irritation of the gastric mucosa on the secretion of gastric juice. He described a unique palpatory symptom of a bigastric stomach (changes in the position of the lower border of the stomach, re‑determined by splashing noise). He had a keen interest in peptic ulcer disease. His studies on pancreatic physiology and pathology have retained their value to the present day: data on excretory function, the adaptability of exocrine function to different diets, the possibility of a partial violation of this function (dyspancreatism), as well as the organ’s functional study technique developed in his clinic. M. M. Gubergrits described the pain zone in the pathology of the head and body of the pancreas. In addition, he described concomitant diseases of the liver and pancreas and the liver’s involvement in the pathological process in gastric, duodenal, and large intestinal diseases. The studies by M. M. Gubergrits on the clinical picture of pancreatic diseases played a significant role in the further research. To a large extent, his statements on the diagnosis of pancreatitis have retained their significance. He emphasized the importance of such symptoms as pathological hunger, thirst, polyuria, weight loss, pain in the epigastric area, sometimes jaundice, diarrhea with creatorrhea and steatorrhea, and changes in the blood and urine.

Jordan J. Feld, Wendy C. King, Anna S. Lok

T. Rokkas

Background: Patients with COVID-19 usually manifest fever and respiratory symptoms. However, some patients also experience gastrointestinal (GI) symptoms such as diarrhea, vomiting and abdominal pain. In addition, SARS-CoV-2 RNA has been detected in feces of infected patients. Currently there is huge evolving research interest in this potentially lethal disease. We systematically reviewed and meta-analyzed the evidence suggesting involvement of the digestive system in COVID-19. Methods: PubMed, Medline and Embase databases were searched up to 10 April 2020, using suitable keywords. Individual and pooled prevalence rates with 95% confidence intervals (CI) were calculated using the fixed- or random-effects model as appropriate. Heterogeneity between studies was calculated employing the Cochran Q test and I2 values, whereas the possibility of publication bias was examined by constructing funnel plots. Additionally, subgroup and sensitivity analyses were performed. Results: In adult COVID-19 patients, the prevalence rates (95%CI) for all GI symptoms, and separately for diarrhea, nausea/vomiting, and abdominal discomfort/pain were 9.8% (6.4-14.7), 10.4% (95%CI 7.7-13.9), 7.7% (95%CI 4.8-12.1), and 6.9% (95%CI 3.9-11.9) respectively. The prevalence rates for children were 9.6% (95%CI 6.3-14.3) for all symptoms, 9.6% (95%CI 6.3-14.3) for diarrhea, and 6.8% (95% CI 4.2-11) for nausea/vomiting. In 30.3% (95%CI 10.5-61.6) of the patients SARS-CoV-2 RNA was detected in feces. Conclusions: A percentage of patients with COVID-19 will manifest symptoms from the digestive system. The GI tract may be a target organ and potential transmission route of SARS-CoV-2, with important implications for disease management and transmission.

Jie Jiang, Yuandi Ma, Yameng Liu et al.

Abstract Nonalcoholic steatohepatitis (NASH) is a rapidly developing pathology around the world, with limited treatment options available. Some farnesoid X receptor (FXR) agonists have been applied in clinical trials for NASH, but side effects such as pruritus and low‐density lipoprotein elevation have been reported. Intestinal FXR is recognized as a promising therapeutic target for metabolic diseases. Glycine‐β‐muricholic acid (Gly‐MCA) is an intestine‐specific FXR antagonist previously shown to have favorable metabolic effects on obesity and insulin resistance. Herein, we identify a role for Gly‐MCA in the pathogenesis of NASH, and explore the underlying molecular mechanism. Gly‐MCA improved lipid accumulation, inflammatory response, and collagen deposition in two different NASH models. Mechanistically, Gly‐MCA decreased intestine‐derived ceramides by suppressing ceramide synthesis–related genes via decreasing intestinal FXR signaling, leading to lower liver endoplasmic reticulum (ER) stress and proinflammatory cytokine production. The role of bile acid metabolism and adiposity was excluded in the suppression of NASH by Gly‐MCA, and a correlation was found between intestine‐derived ceramides and NASH severity. This study revealed that Gly‐MCA, an intestine‐specific FXR antagonist, has beneficial effects on NASH by reducing ceramide levels circulating to liver via lowering intestinal FXR signaling, and ceramide production, followed by decreased liver ER stress and NASH progression. Intestinal FXR is a promising drug target and Gly‐MCA a novel agent for the prevention and treatment of NASH.

Kehui Liu, Yezhou Ding, Yumin Xu et al.

Abstract Background Immunoglobulin light chain (AL) amyloidosis commonly affects the kidney or heart, but may also involve the liver at a histopathological level. Early diagnosis of AL amyloidosis is important for proper management with desirable outcome. We reported here an unusual case of AL amyloidosis, presenting primarily with multiple serous cavity effusion, accompanied with rapidly progressive cholestasis. Case presentation A previously healthy 63-year-old man presented with dysuria, frequent urination, oliguria and oedema of lower extremities for one month, accompanied with jaundice and hypoproteinemia. CT demonstrated multiple serous cavity effusion, focal hypodense lesions in the liver, and focal low-density in the spleen. Laparoscopy with liver biopsy revealed liver and spleen fibrosis with congestion, no visceral rupture, following haemorrhagic ascites from abdominocentesis. This patient was transferred to our (tertiary) hospital. The diagnosis of amyloidosis was confirmed with histopathology/immunohistochemistry. Haematopoietic stem cell transplantation was not applicable, however chemotherapy was advised, due to the patient’s Mayo score 3. The patient declined chemotherapy and was self-discharged back to his hometown hospital with palliative care, however only lasted a further one-month. Discussion The lesson we have learnt from this case that any patients with multiple serous cavity effusion and isolated hepatic involvement, primary amyloidosis should be considered. Multiple serous cavity effusion may serve as an indicator for poor prognosis of hepatic AL amyloidosis.

Catarina Gomes, Catarina O’Neill, Rolando Pinho et al.

Introduction: The European Society of Gastrointestinal Endoscopy (ESGE) identified the need to benchmark the quality of small bowel capsule endoscopy (SBCE) and produced a set of performance measures (PM). The aim of this study is to critically evaluate the accordance of the PM for SBCE in two Portuguese centers with different SBCE platforms. Methods: The authors conducted a cross-sectional analysis of consecutive SBCE performed in an 18-month period in 2 Portuguese centers that used two different SBCE platforms Mirocam® (IntroMedic, Seoul, South Korea) and PillCam® (Medtronic, Yokneam, Israel). A total of 10 PM (6 key, 4 minor) were evaluated and compared between the 2 centers. Results: A total of 493 SBCE were included. The minimum standard established by ESGE was reached in 3/6 key PM (complete visualization, lesion detection rate, and capsule retention rate), and none of the 4 minor PM. PM compliance significantly differed between the 2 centers: complete small bowel visualization 95.9 and 90% (p = 0.01), diagnostic yield 50.6 and 63% (p = 0.005), adequate small bowel cleansing level according to Brotz scale 69.54 and 84.6% (p ≤ 0.001), patients with high risk of capsule retention offered a patency capsule 4.2 and 73% (p ≤ 0.001), respectively. Conclusion: This study highlights and critically discusses technical and organizational issues that should be considered in defining more realistic PM thresholds, aiming to improve SBCE quality.

L. Yao, Jun Zhang, Jun Liu et al.

Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China b Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China Wuhan EndoAngel Medical Technology Company, Wuhan, China Department of Gastroenterology, Wuhan Union Hospital, Huazhong University of Science and Technology, Wuhan, China Wuhan Puai Hospital, Wuhan, China g Department of Ophthalmology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, Hubei 430060, China

Fahdah F. Al-sunaid, Maha M. Al-homidi, Rawan M. Al-qahtani et al.

Abstract Background Adherence to a gluten-free diet (GFD) and food insecurity (FI) may influence health-related quality of life (HRQOL) in individuals with celiac disease (CD). This study aimed to investigate the association between adherence to a GFD, FI, and HRQOL in individuals with CD. Methods This cross-sectional study included 97 adults (mean age: 34 ± 9 years) diagnosed with CD. The participants were on a GFD for more than 6 months. Sociodemographic characteristics and medical history were assessed. Adherence to a GFD, FI, and HRQOL were assessed using validated questionnaires. Results Most participants (73%) adhered to a GFD, and 62% were experiencing FI. Individuals with CD faced difficulty in accessing GF foods due to the high cost (90%) and limited availability (79%). The mean overall HRQOL score was 60. Scores on the physical and mental health domains were 69 and 47, respectively. Adherence to a GFD was significantly associated with FI (P = 0.02), while there was no association between adherence to a GFD and HRQOL measures (P > 0.05). Participants facing FI had lower scores in emotional well-being and mental health domains, and overall HRQOL (P < 0.05). Conclusions The findings of the present study demonstrate that FI influences adherence to a GFD, and that FI is associated with HRQOL in terms of both emotional well-being and mental health.