Hasil untuk "Diseases of the digestive system. Gastroenterology"

Yoshiki Narimatsu, Cayetano Pleguezuelos-Manzano, Daniel Hornikx et al.

Degradation of mucins at the host–microbial mucus interphase involves glycosidases that release monosaccharides from O-glycans and mucinases that cleave the mucin protein backbone. Mucinases recognize and cleave peptide bonds at specific sequence motifs with varying O-glycan structures required and/or permissible. Mucinases that digest mucins with intact O-glycans can potentially destroy the protective mucus, while mucinases that only digest mucins with partially degraded O-glycans may serve at a later stage of nutrient sourcing from mucins. Here, we discovered nine CBM-bearing M60-like mucinases across gut commensals and opportunists, including a conserved Bacteroides fragilis mucinase denoted HC11. We also investigated the previously described Bacteroides thetaiotaomicron mucinase BT4244, which together delineates two functional classes with distinct preferences: BT4244 for bis-Tn (GalNAcα1-O-Ser/Thr) and HC11 for bis-T (Galβ1-3GalNAcα1-O-Ser/Thr) O-glycans. Both mucinases harbor carbohydrate-binding modules (CBM32) that bind their cognate O-glycan motifs and are required – together with the catalytic domains – for efficient cleavage of extended mucin domains, which is consistent with cooperative engagement, but are not required for the cleavage of short glycopeptides. We show B. fragilis strains secrete HC11 and degrade mucins only after the removal of sialic acids. Together, these findings expand the mucinase repertoire by nine enzymes spanning commensals and opportunists, demonstrate that CBM32 domains are essential for efficient cleavage of extended mucin substrates likely by promoting multivalent engagement and substrate positioning, and nominateidentify CBM–catalytic cooperation as a mechanism and intervention point for controlling mucus turnover and barrier integrity.

Ye Zhou, Bo Yang, Jianxin Zhao et al.

The infant gut microbiota, orchestrated by human milk oligosaccharides (HMOs), forms a critical foundation for lifelong health. Despite their recognized importance, the molecular strategies through which HMOs govern microbial competition and niche establishment remain poorly understood. Moving beyond ecological observations, this review synthesizes current mechanistic evidence on the molecular machinery of HMO metabolism in microbial assembly. We explore the specialized enzymes that confer competitive advantages and the metabolic networks fueled by HMO breakdown. Furthermore, we distinguish substrate-driven effects from the hypothesized signaling roles of intact HMOs in modulating host-microbe interactions, indicating where the evidence is associative versus causal. By integrating these pathways, we provide a blueprint for leveraging HMO biology to develop targeted nutritional interventions for preventing early-life disorders.

Ming-Ying Lu, Jacky Chung-Hao Wu, Henry Horng-Shing Lu et al.

The global burden of hepatocellular carcinoma (HCC) has shifted from viral to nonviral etiologies. However, successful antiviral therapy does not fully eliminate the risk of HCC, underscoring the demand for more effective surveillance strategies. Current screening methods, such as semiannual ultrasonography and the measurement of α-fetoprotein levels, offer suboptimal sensitivity for early detection. A cost-effective, reliable surveillance approach remains an unmet need. The Barcelona Clinic Liver Cancer staging system provides a framework to guide HCC therapy; yet, some gray zone exists, particularly for patients with intermediate-stage disease. Although tyrosine kinase inhibitors and immunotherapies have transformed the therapeutic landscape, their efficacies vary among patients, highlighting the necessity for personalized treatment strategies. In response to these challenges, artificial intelligence (AI) approaches have emerged as transformative tools in healthcare. By processing complex, nonlinear relationships and uncovering hidden patterns in clinical data, AI methods offer capabilities beyond those of traditional statistical methods. Furthermore, AI-driven multi-omics analysis holds promise for identifying novel biomarkers, thereby advancing precision medicine for HCC patients. This review introduces the potential of AI applications in enhancing the diagnosis, treatment, and prognosis of HCC.

Runsheng Hong, Zhixue Li, Meng Li et al.

Background: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), can affect the hepatobiliary system and pancreas, substantially impacting the life quality of patients. Objectives: To evaluate the quality of evidence and comprehensively assess the validity of associations of IBD with hepatobiliary and pancreatic diseases. Design: We performed an umbrella review of existing meta-analyses in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) recommendations. Data sources and methods: We systematically searched PubMed, Embase, and Web of Science from inception to April 2024, to identify and appraise meta-analyses examining IBD and risk of hepatobiliary and pancreatic manifestations. Methodologic quality was assessed with A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the strength of evidence was graded according to prespecified criteria. Results: A total of 14 meta-analyses of observational studies were included. The strongest-validity evidence suggested the significant associations between IBD and risk of gallstones (odds ratio (OR) = 1.72; 95% confidence interval (CI) = 1.40–2.12) and acute pancreatitis (OR = 3.11; 95% CI = 2.93–3.30). Highly suggestive evidence indicated a significantly increased risk of hepatobiliary cancer in UC (incidence rate ratio (IRR) = 2.05; 95% CI = 1.52–2.76) and CD (IRR = 2.31; 95% CI = 1.25–4.28). In addition, highly suggestive evidence indicated that IBD was associated with portal venous system thrombosis. Suggestive evidence showed a significantly higher prevalence of primary sclerosing cholangitis, non-alcoholic fatty liver disease, autoimmune hepatitis, and autoimmune pancreatitis in IBD patients than in the general population. Conclusion: The associations between IBD and multiple hepatobiliary and pancreatic disorders showed varying levels of evidence and magnitude of risk. Further high-quality primary studies are needed to identify IBD patients who are more at risk and would benefit the most from screening and prevention programs. Trial registration (PROSPERO): CRD42023451461.

Sumanpreet Kaur, Neha Jindal, Amandeep Kaur et al.

Abstract Background Colonoscopy is important for diagnosis, assessment and dysplasia screening in inflammatory bowel disease (IBD). A good bowel preparation is required for complete and adequate assessment. Trial design Randomised, assessor blinded parallel arm trial with 1:1 allocation. Methods Patients with IBD undergoing colonoscopy were randomised to control group (standard preparation with written instructions) or experimental group (additional brief video educational intervention). Outcome assessors and colonoscopist were masked to the allocation. Primary outcome was adequacy of bowel preparation (Boston bowel preparation score of ≥ 6). Results Of 130 patients randomised, 107 (57% males, mean age 38.4 years, 84% with ulcerative colitis) were analysed. The groups were similar for baseline characters (age, gender, rural residence, educational status, duration of illness, IBD therapies, and endoscopic activity). Adequate bowel preparation was present similar numbers in experimental group compared to control group (43.1% versus 35%) (p = 0.43). The groups were similar for perfect preparation (7.8% versus 8.9%) (p = 0.84), worsening of disease activity (3.9% versus 3.7%) (p = 1.00), time to cecal intubation (240, 191 s versus 268, 228 s) (p = 0.43), tolerance (45.1% versus 30.4%)(p = 0.12), and willingness to undergo a repeat colonoscopy (54.9% versus 55.4%)(p = 0.97). Conclusion A brief educational video intervention did not improve bowel preparation in patients with IBD undergoing colonoscopy. Trial registration CTRI/2023/09/057436 on 11 September 2023.

Maho Toyota, Masaaki Miyo, Koichi Okuya et al.

Solitary fibrous tumors (SFT) are rare mesenchymal neoplasms, and surgical resection with a negative margin is considered to have a good prognosis. It is commonly located in the thoracic cavity but rarely develops in the pelvis. One of the features of the Hugo RAS system is the independent robotic arm carts that enable high flexibility of settings and safe operations with reduced interference, even in a narrow pelvis, which may be particularly useful in surgery for pelvic masses. A 34-year-old woman presented to our hospital with a pelvic mass detected by transvaginal ultrasound during a prenatal check-up. Colonoscopy, computed tomography, and magnetic resonance imaging suggested a gastrointestinal stromal tumor, smooth muscle tumor, schwannoma, and SFT. However, since a definitive diagnosis could not be obtained and continuity with the rectum could not be ruled out, intersphincteric resection (ISR) was performed for diagnostic and therapeutic purposes. The pathological results showed complete resection of the SFT with negative margins, and the patient had a good postoperative course. Herein, we report the first case of safe and complete resection of a massive pelvic SFT using the Hugo RAS system.

Wenjing Yang, Tianming Yu, Yingzi Cong

Nguyen Tai Thu, Pham Dang Hai, Nguyen Thi Kieu Ly et al.

Abstract Background Cirrhosis is associated with chronic cardiovascular dysfunction termed cirrhotic cardiomyopathy (CCM), characterized by myocardial hypertrophy and diastolic dysfunction. Detecting early cardiac changes is crucial, especially in patients undergoing liver transplantation. Objective: This study aims to evaluate left ventricular systolic function in cirrhotic patients undergoing liver transplantation using speckle-tracking echocardiography. Methods A prospective observational study was conducted involving 54 cirrhotic patients who underwent liver transplantation, along with 28 age- and sex-matched healthy controls. Echocardiography, including conventional and two-dimensional speckle tracking echocardiography (2D-STE), was performed at baseline and one-month post-transplantation. Results The mean age in the cirrhotic group was 52.2 ± 12.7 years, with no significant difference compared to the control group. Viral hepatitis was the predominant etiology of cirrhosis (68.6%). Conventional echocardiography did not reveal significant differences between groups in LV ejection fraction [62% (56–69) vs. 59% (56–62); p = 0.830]. However, in cirrhotic patients, 2D-STE demonstrated significantly lower LV global longitudinal strain (LV-GLS) [17.5 (15.5–19.1) vs 19.0 (18.0–19.7), p = 0.006]. Post-transplantation, conventional echocardiography indices remained unchanged, while 2D-STE showed remarkable improvement in LV function, with increased LV-GLS compared to pre-transplantation value. Conclusions 2D-STE is a valuable tool for detecting and monitoring left ventricular systolic dysfunction in liver cirrhosis patients, particularly following transplantation. While conventional echocardiography may not detect subtle changes, 2D-STE reveals improvements in LV function post-transplantation, emphasizing its role in assessing cirrhotic cardiomyopathy.

Ethan M. Cohen, MD, Ayowumi A. Adekolu, MD, Rohit Agrawal, MD et al.

Shadi S. Yarandi, Subhash Kulkarni, Monalee Saha et al.

N. B. Gubergrits

In her article, the author does not provide biographical data of Professor Iryna Ivanovna Degtyareva, but shares thoughts, feelings, memories about the Teacher. Iryna Ivanivna Degtyareva was an outstanding person in every aspect. The author was amazed by her remarkable appearance when she first met her in 1976. She was a striking lady who captivated by her charm, talent, and, most importantly, professionalism. Then, Iryna Ivanivna was appointed as a reviewer of the candidate’s dissertation by N. B. Gubergrits before approbation. Iryna Ivanivna spent almost the whole day with N. B. Gubergrits, a young physician who had just graduated from a medical university, since it was her first time meeting her. The two of them sat until late at the department of faculty therapy of the Kyiv Medical Institute, where Iryna Ivanivna worked at the time. Her remarks were undoubtedly well‑grounded. However, Iryna Ivanivna did not only provide criticism; she offered instant guidance on how to fix errors and avoid “sharp edges”, all the while pointing out the advantages of the work. Then, like lately, everything was fair. Inflexibility accompanied this justice. Iryna Ivanivna’s first major lesson was to work hard and overcome barriers in the pursuit of truth and results. This extraordinary lady and scientist had a great intellect, tolerance for students’ mistakes, total loyalty to them, and unwavering determination to work with them. N. B. Gubergrits sought Professor Iryna Ivanivna Degtyareva’s consultation for her doctoral dissertation as a result. Iryna Ivanivna’s brilliant mind «burst out» with ideas that she genuinely shared with her students. The contribution of Iryna Ivanivna to the doctoral dissertation of N. B. Gubergrits and her title of professor are enormous. Much has been achieved with her help. Iryna Ivanivna took great pride in her students, including Ihor Mykolayovych Skrypnyk, Mykhaylo Yuriyovych Kolomoyets, and Natalya Vyacheslavivna Kharchenko. To her, they were more than just students. She looked after them in life as well as in science. Many clinicians use Iryna Ivanivna’s monographs as reference textbooks, including «Clinical Gastroenterology» and «Peptic Ulcer».

Ryusei Yamamoto, Katsushi Yoshida, Masataka Ando et al.

Retroperitoneal and mediastinal emphysema after colon resection is extremely rare, especially in the absence of anastomotic leakage. The feasibility and safety of conservative treatment for this complication are unknown. We report a patient who underwent open sigmoid colon resection for colon cancer and developed retroperitoneal and mediastinal emphysema that was not caused by anastomotic leakage. Retroperitoneal and mediastinal emphysema occurred as a result of diverticular perforation. We were able to treat this patient successfully with conservative management.

A. Vidal-Realpe, R.A. Dueñas-Cuellar, V.E. Niño-Castaño et al.

Resumen: Introducción y objetivos: La infección por virus de Epstein-Barr (VEB) es un factor etiológico de un subgrupo de cáncer gástrico (cáncer gástrico asciado a virus de Epstein-Barr [CaGVEB]). El objetivo del estudio fue caracterizar la clínico-histopatología de la infección por VEB en muestras de adenocarcinoma gástrico de tipo intestinal. Material y métodos: Se estudiaron 28 de 180 muestras de gastrectomías parafinizadas, se realizó hibridación in situ cromogénica (CISH) para reconocimiento del VEB. Se obtuvieron datos sociodemográficos e histopatológicos de historias clínicas. Resultados: Resultaron positivas 21.4% de las muestras para VEB. La característica morfológica predominante fue patrón en encaje con denso infiltrado inflamatorio. De los pacientes CaGVEB+ 50% eran hombres, mediana de edad 59 años (rango 50-75), y de los CaGVEB– 77.2% eran hombres, mediana de edad 66 años (rango 34-89); 10.7% de los CaGVEB+ y 53.6% de los CaGVEB− se asociaron a infección por Helicobacter pylori (H. pylori). Entre los CaGVEB+, la localización del tumor más frecuente fue cardias (17.9%) y entre los CaGVEB− fue cardias y fondo (71.4%). En la clasificación según grado histológico, los CaGVEB+ se asociaron a grados 2 y 3 (7.1%), y los CaGVEB− a grado 2 (35.7%). Para la clasificación Borrmann, 17.9% de los CaGVEB+ presentaron clasificación III, mientras que 39.3% y 21.4% de CaGVEB− presentaron clasificación III y IV, respectivamente. Conclusiones: Este estudio presenta características clínico-histopatológicas asociadas a CaGVEB+ que pueden contribuir con la selección de casos candidatos a ser estudiados por métodos moleculares dirigidos a la identificación de la infección por VEB en adenocarcinoma gástrico de tipo intestinal. Abstract: Introduction and aims: Epstein-Barr virus (EBV) infection is an etiologic factor in EBV-associated gastric carcinoma (EBVaGC). The aim of our study was to describe the clinical and histopathologic characteristics of EBV infection in intestinal-type gastric adenocarcinoma samples. Material and methods: Of 180 paraffin-embedded gastrectomy samples, 28 were studied. Chromogenic in situ hybridization was performed to detect EBV. Sociodemographic and histopathologic data were obtained from the patients’ clinical histories. Results: A total of 21.4% of the samples were positive for EBV. The predominant morphologic characteristic was the lace pattern, with dense inflammatory infiltration. Fifty percent of the EBVaGC + patients were men, and the median age of the positive patients was 59 years (range: 50-75); 77.2% of the EBVaGC– patients were men, and the median age of the negative patients was 66 years (range: 34-89). Helicobacter pylori infection was associated with 10.7% of the EBVaGC + patients and 53.6% of the EBVaGC– patients. In the EBVaGC + patients, the cardia was the most frequent tumor location (17.9%), 7.1% had histologic grades 2 and 3, and 17.9% presented with Borrmann classification type III. In the EBVaGC– patients, the cardia and fundus were the most frequent tumor locations (71.4%), 35.7% had histologic grade 2, and 39.3% and 21.4% presented with Borrmann classification type III and IV, respectively. Conclusions: The present study describes the clinical and histopathologic characteristics associated with EBVaGC positivity. Those data may aid in the selection of cases that are candidates for analysis through molecular methods aimed at identifying EBV infection in intestinal-type gastric adenocarcinoma.

Soichiro Ota, Michika Hamada, Ken-ichi Muramatsu et al.

A 74-year-old man, who lived alone, was found in an unconscious state in his house by a neighbor after mail accumulated in his mailbox. He had asthma and nephrotic syndrome, which had been treated by prednisolone (10 mg) for more than 10 years, and steroid-induced DM. He had been obese since his 20s and had never drunk or smoked in his life. On arrival, he was obese and in a coma and shock state with respiratory failure. He therefore underwent rapid fluid resuscitation, tracheal intubation, mechanical ventilation, with cardiopressor treatment. Whole body computed tomography revealed atrophic liver and excess visceral fat. The clinical diagnosis was septic shock, acute respiratory failure, renal failure with hyperkalemia, cerebral ischemia, liver cirrhosis, rhabdomyolysis, DM, and upper gastrointestinal bleeding. On day 3, his circulation, respiratory function, and consciousness stabilized, and he was extubated. Further studies led to a diagnosis of burn-out nonalcoholic steatohepatitis (NASH). His condition was complicated by adrenal insufficiency, pulmonary embolism, lower extremity motor weakness, and left leg phlegmon during hospitalization. He was transferred to another hospital for rehabilitation on day 34 after the improvement of phlegmon. The present case showed the potential for NASH to develop in individuals with long-term steroid use. The further accumulation and analysis of cases is required to determine whether this possibility is correct or not.

Kristen A. Engevik, Melinda A. Engevik

The lumen of the gastrointestinal tract harbors a diverse community of microbes, fungi, archaea, and viruses. In addition to occupying the same enteric niche, recent evidence suggests that microbes and viruses can act synergistically and, in some cases, promote disease. In this review, we focus on the disease-promoting interactions of the gut microbiota and rotavirus, norovirus, poliovirus, reovirus, and astrovirus. Microbes and microbial compounds can directly interact with viruses, promote viral fitness, alter the glycan structure of viral adhesion sites, and influence the immune system, among other mechanisms. These interactions can directly and indirectly affect viral infection. By focusing on microbe–virus interplay, we hope to identify potential strategies for targeting offending microbes and minimizing viral infection.

Shiu Kum Lam, George K K Lau

Abstract Two patients with idiopathic multitudinous fundic gland polyposis, a hitherto undescribed condition, were reported. They presented incidentally with a multitude of fundic gland polyps, 52 and 147, without a family history of polyposis, and these polyps were not attributable to the chronic use of proton pump inhibitors. All polyps were removed by hot‐biopsy polypectomy, and each was individually subjected to pathological examination, which showed no evidence of dysplasia. When confronted with gastric polyps of clinically undetermined origin, endoscopists would, to exclude dysplasia, usually resect all if they are few and sample some and survey the others periodically if they are numerous. The condition reported presents a management dilemma: Because the number of the polyps is such that they are manageable by total polypectomy, should this be carried out, despite the labor intensiveness involved, to exclude dysplasia, and are the polyps a variant of syndromic polyposis and therefore carry a malignant potential and inform the need for periodic surveillance and to investigate the patient's kindred? The frequency of this condition and whether it is truly not associated with dysplasia require further studies.

C. Bucci, M. Amato, F. Zingone et al.

Background. Patients with inflammatory bowel diseases could experience mouth and teeth disorders and alterations in psychological mood. Vice versa, the psychological status may influence the presence of oral diseases. Aim. To evaluate in inflammatory bowel disease patients the prevalence of sleep bruxism and its correlation with the presence of oral diseases, quality of sleep, and psychological disturbances. Methods. Patients were consecutively recruited in our clinic and examined for temporomandibular disorders, dental enamel disorders, sleep bruxism, and recurrent aphthous stomatitis by two dentists. Patients also underwent Pittsburgh Sleep Quality Index and Beck Depression Inventory Scale questionnaires. Results. 47 patients and 46 controls were included. Sleep bruxism and enamel wear disorders were more frequent in Crohn’s disease patients when compared with ulcerative colitis patients and controls (p=0.03 and p=0.02, resp.). Among groups, no differences were noted for enamel hypoplasia, temporomandibular disorders, recurrent aphthous stomatitis, depression, and quality of sleep. We found a positive correlation between bruxism and temporomandibular disorders (Spearman 0.6, p<0.001) and between bruxism and pathological sleep (Pittsburgh Sleep Quality Index > 5) (Spearman 0.3, p<0.005). Conclusion. Bruxism and enamel wear disorders should be routinely searched in Crohn’s disease patients. Moreover, the attention of healthcare givers to sleep disturbances should be addressed to all inflammatory bowel disease patients.