Helicobacter pylori infection induces DNA double-strand breaks through the ACVR1/IRF3/POLD1 signaling axis to drive gastric tumorigenesis

Helicobacter pylori (H. pylori) infection plays a pivotal role in gastric carcinogenesis through inflammation-related mechanisms. Activin A receptor type I (ACVR1), known for encoding the type I receptor for bone morphogenetic proteins (BMPs), has been identified as a cancer diver gene across various tumors. However, the specific role of AVCR1 in H. pylori-induced gastric tumorigenesis remains incompletely understood. We conducted a comprehensive analysis of the clinical relevance of ACVR1 by integrating data from public databases and our local collection of human gastric tissues. In vitro cell cultures, patient-derived gastric organoids, and transgenic INS-GAS mouse models were used for Western blot, qRT-PCR, immunofluorescence, immunohistochemistry, luciferase assays, ChIP, and comet assays. Furthermore, to investigate the therapeutic potential, we utilized the ACVR1 inhibitor DM3189 in our in vivo studies. H. pylori infection led to increased expression of ACVR1 in gastric epithelial cells, gastric organoid and gastric mucosa of INS-GAS mice. ACVR1 activation led to DNA double-strand break (DSB) accumulation by inhibiting POLD1, a crucial DNA repair enzyme. The activation of POLD1 was facilitated by the transcription factor IRF3, with identified binding sites. Additionally, treatment with the ACVR1 inhibitor DM3189 significantly ameliorated H. pylori-induced gastric pathology and reduced DNA damage in INS-GAS mice. Immunohistochemistry analysis showed elevated levels of ACVR1 in H. pylori-positive gastritis tissues, showing a negative correlation with POLD1 expression. This study uncovers a novel signaling axis of AVCR1/IRF3/POLD1 in the pathogenesis of H. pylori infection. The upregulation of ACVR1 and the suppression of POLD1 upon H. pylori infection establish a connection between the infection, genomic instability, and the development of gastric carcinogenesis.

Reinvestigation into the role of lipopolysaccharide Glycosyltransferases in Helicobacter pylori protein glycosylation

Protein glycosylation has been considered as a fundamental phenomenon shared by all domains of life. In Helicobacter pylori, glycosylation of flagellins A and B with pseudaminic acid have been rigorously confirmed and shown to be essential for flagella assembly and bacterial colonization. In addition to flagellins, several other proteins including RecA, AlpA/B, and BabA/B in H. pylori have also been reported to be glycosylated and to be dependent on the lipopolysaccharide (LPS) biosynthetic pathway. However, these proteins have not been purified for sugar-specific staining or structural analysis to confirm the existence of carbohydrate motifs. Here, using a combined approach of genetics, protein purification, and sugar-specific staining, we demonstrate that RecA is not a glycoprotein. Moreover, using LPS-protein reconstitution experiments, we demonstrate that the presence of O-antigen containing full-length LPS interferes with the electrophoretic mobility of H. pylori RecA and many other proteins including AlpA/B on SDS-PAGE. Finally, we demonstrate that full-length LPS extracted from E. coli affects electrophoretic migration of H. pylori proteins, while full-length LPS extracted from H. pylori similarly influences the electrophoretic migration of E. coli proteins. The impact is more subtle with E. coli LPS compared to H. pylori LPS, indicating that the magnitude of effect of LPS effects on protein mobility is dependent on bacterial source of the LPS. These findings suggest that the effects of full-length LPS on protein electrophoresis may represent a more general phenomenon. As LPS is a unique component of virtually all Gram-negative bacteria, our data suggest that when observing protein electrophoretic mobility shifts between wild-type and LPS mutant strains or between subcellular fractionation samples, the influence of LPS on protein electrophoretic migration should be considered first, rather than interpreting it as potential protein glycosylation that is dependent upon LPS biosynthetic pathway.

Evidence summary on management strategies for gastroesophageal reflux symptoms in patients following esophageal cancer surgery

Objective

This study aimed to summarize evidence-based strategies for the self-management of gastroesophageal reflux symptoms (GERS) at home among patients who have undergone esophageal cancer surgery, providing practical references for clinical practice.

Methods

A systematic evidence summary was conducted based on the reporting standards of the Fudan University Center for Evidence-based Nursing. Literature was retrieved from international and Chinese databases, including guidelines, expert consensus, systematic reviews, and original studies. The search covered the period from the inception of the databases to June 30, 2024. Two independent reviewers appraised the quality of evidence and synthesized recommendations across six domains: reflux symptoms, assessment, treatment, health education, follow-up, and outcome indicators.

Results

A total of 25 high-quality studies were included, comprising 10 guidelines, 10 expert consensus documents, two systematic reviews, and three original studies. Thirty-four evidence items were synthesized, emphasizing a combination of pharmacological treatments, lifestyle modifications, and health education to improve self-management outcomes.

Conclusions

This evidence synthesis highlights effective strategies for home-based self-management of GERS after esophageal cancer surgery. Future research should focus on culturally tailored interventions and large-scale studies to further enhance the applicability and reliability of these findings.

Trial registration

This study was registered at the Fudan University Center for Evidence-Based Nursing (Registration No. ES202446701).

Natural small-molecule compounds targeting Helicobacter pylori virulence factors: A promising strategy for overcoming antibiotic resistance

Helicobacter pylori (H. pylori) infection is an important causal factor of gastritis, peptic ulcer, and gastric cancer. High infection rates and the increasing challenge of antibiotic resistance worldwide have prompted an urgent need to develop novel therapeutic options and antimicrobial agents. This review focuses on the potential of natural small-molecule compounds as novel anti-H. pylori agents-a promising approach that mitigates the risk of resistance development and maintains the microbiome's ecological balance. We detail how H. pylori virulence factors, including urease, CagA, VacA, and biofilm, contribute to pathogenicity and underline the reassuring fact that naturally derived compounds sourced from plants and microorganisms have shown remarkable efficacy in inhibiting these virulence factors. Some compounds also exhibit synergistic effects with conventional antibiotics, potentially overcoming challenges associated with resistant strains. Furthermore, we discuss recent advancements in identifying novel drug targets within the H. pylori virulence spectrum, offering insights into future directions for research and development in H. pylori therapy.

Comparison of three different molecular biology assays (AllPlexTMH. pylori & ClariR assay, Amplidiag® H. pylori + ClariR and RIDA®GENE Helicobacter pylori) to detect Helicobacter pylori and clarithromycin resistance in stool samples

Helicobacter pylori detection and susceptibility profile using feces could optimize guided therapy, when endoscopy is not necessary. This study evaluated the performances of three tests: AllPlexH.pylori&ClariR, RIDAGENEHelicobacterpylori and AmplidiagH.pylori+ClariR assays on stool samples. Stool samples from a documented cohort (50 positive and 25 negative) were analyzed. The gold standard was a composite based on PCR targeting H. pylori and 23S rDNA mutations (A2142C, A2142G, A2143G) on gastric biopsies; and biopsy culture for H.pylori and susceptibility testing. For AllPlex, RidaGene and Amplidiag assays respectively: 55 (73.3%), 75 (100%), 54 (72%) samples could be analyzed; (for detection of H. pylori), sensitivity was 36% (95%CI]28;52%[); 32% (95%CI]21;46%[) and 93% (95%CI]87;100%[); specificity was 100% (95%CI]81;100%[), 83% (95%CI]68;91%[) and 57% (95%CI]33;79%[). (for the Clarithromycin resistance), sensitivity was 18% (95%CI]5;48%[), 25% (95%CI]9;53%[) and 67% (95%CI]39;86%[); specificity was 100% (95%CI]92;100%[). 92% (95%CI]83;97%[) and 97% (95%CI]89;99%[). Innovative technologies could become invaluable tools for mass testing after improvement.

Current Understanding of Optimal Prevention of Helicobacter pylori-Induced Cancer

Gastric cancer is the fifth most common cancer and the fifth most common cause of cancer-related death globally. The key to improving outcomes lies in effective prevention and early detection, which are critical for successful curative interventions. Helicobacter pylori is the strongest known risk factor for gastric cancer, and eradication of this pathogen is critical for reducing cancer risk. By synthesizing current evidence and exploring the advanced therapeutic approaches, this review provides a comprehensive overview of best practices for mitigating gastric cancer through targeted bacterial intervention.

Helicobacter pylori multiplex serology and its dynamics within families during a 3-year prospective follow-up

OBJECTIVES

Transmission routes of Helicobacter pylori (Hp) have been extensively studied, but many aspects remain unclear. This study explored the dynamics of multiplex Hp serology within regular families during a 36-month prospective follow-up.

METHODS

Altogether, 329 families from the Finnish Family HPV study were subjected to sequential blood sampling and now tested also for six Hp proteins, HP0010, HP0073, HP0547, HP0875, HP0887, and HP1564, using multiplex serology assay.

RESULTS

Hp seropositivity, defined as being seropositive to at least three of the six Hp proteins, was more common among the fathers (20%) than mothers (10%). After maternal antibody decay, only a few children tested Hp-seropositive at later follow-up visits, indicating that acquisition of Hp infection is practically non-existent (0.4-2.0%) at an early age. No evidence was found to support the person-to-person transmission of Hp in this cohort because there was no correlation in Hp seropositivity or antibody levels between the spouses and/or their offspring, and individuals who were Hp-seropositive did not seem to increase the risk of other family members to co-test Hp-seropositive.

CONCLUSIONS

Our results perfectly agree with a recently published register-linkage study from Finland, where Hp and Hp-related co-morbidity are predicted to disappear among the native Finns during the 21st century.

Poor Oral Hygiene: A Hidden Risk Factor for Helicobacter pylori Infection

BACKGROUND

Helicobacter pylori (H. pylori) initially enters the human body through the mouth. The correlation between oral health and H. pylori infection status remains a topic of debate in the scientific literature. To elucidate the relationships between H. pylori infection and oral hygiene status and habits, we performed a cross-sectional study among dyspeptic patients.

METHODS

Data were collected from 362 subjects with dyspepsia symptoms who underwent the 13C-urea breath test (13C-UBT) and the H. pylori antigen test (HPS) to test for gastric and oral H. pylori infections between May and August 2023 at The Second Affiliated Hospital of Xi'an Jiaotong University. The participants completed questionnaires on sociodemographic characteristics, medical history, dyspepsia symptoms, oral hygiene status, and oral hygiene practices. In addition, the participants underwent oral exams involving the simplified oral hygiene index (OHI-S), the Debris index (DI-S), the simplified calculus index (CI-S), and the decayed, missing, and filled teeth (DMFT) score.

RESULTS

Oral H. pylori infection status was not associated with sex, body mass index (BMI), education, oral hygiene habits, place of residence, or income. Considering sex and BMI, being over 60 years of age significantly increased the risk of developing oral H. pylori infection (OR = 5.51, 95% CI: 1.56-19.46, P = .0081), whereas a lack of history of antibiotic use was identified as a protective factor (OR = 0.45, 95% CI: 0.26-0.77, P = .0036). Additionally, DMFT >4 (OR = 2.54, 95% CI: 1.15-5.61, P = .0210), 0.67 < OHI-S ≤ 1.33 (OR = 1.98, 95% CI: 1.09-3.59, P = .0246), and 0.33

CONCLUSION

The results of our research indicate a relationship between oral health and oral H. pylori infection, suggesting that poor oral hygiene may be associated with an increased risk of oral H. pylori colonization.

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Key Words

• Dyspepsia
• Helicobacter pylori
• Oral hygiene

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MESH Headings

• Humans
• Helicobacter Infections/epidemiology
• Helicobacter Infections/etiology
• Male
• Female
• Cross-Sectional Studies
• Risk Factors
• Oral Hygiene
• Middle Aged
• Helicobacter pylori
• Adult
• Dyspepsia/microbiology
• Aged
• Breath Tests
• Oral Hygiene Index

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Affiliation(s)

Xiao Zhao Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
Xiao She Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
Haiyan Yang Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
Ziqin Zeng Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
Weicheng Zhi Department of Preventive Health Care, Hospital of Stomatology Xi'an Jiaotong University, Xi'an, Shaanxi, China
Yan Jing Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
Lei Dong Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
Jun Gong Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
Haitao Guan Department of Surgical Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Ping Zhao Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.

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Monitoring the follow-up of autoimmune chronic atrophic gastritis using parietal cell antibodies and markers of gastric function

Increased interest in the pathogenesis and the evolution of autoimmune chronic atrophic gastritis (A-CAG) has led to the search for serological markers that can be used to detect changes in the gastric mucosa at an early stage and to monitor the course of the disease. Parietal cell autoantibodies have been proposed as suitable immunological markers of atrophic damage, as they can be detected in the serum when symptoms of gastritis are not yet present. However, the utility of measuring only the level of parietal cell autoantibodies in the follow-up of A-CAG does not appear to suffice. Recent evidence has suggested that, in monitoring A-CAG, parietal cell antibodies should be associated with an evaluation of gastric function through biochemical and hormonal tests, such as pepsinogens and gastrin 17. This integrated approach will allow for the more effective real-time monitoring of the state of the gastric mucosa. As A-CAG is a progressive disorder associated with an increased risk of gastric cancer and neuroendocrine tumors, the precise follow-up of patients with gastric atrophy needs to be better defined. Further longitudinal studies in large cohorts must be performed with long-term follow-up.

From the operating room: Surgeons' views on difficult laparoscopic cholecystectomies

Backgrounds/Aims

Assessing surgical difficulty in laparoscopic cholecystectomy (LC) is challenging due to variations in surgeon proficiency and institutional protocols. This study evaluates surgeons' perspectives on procedural difficulty and examines how intraoperative findings and preoperative imaging contribute to refining difficulty assessment criteria.

Methods

A cross-sectional survey was conducted among 50 laparoscopic surgeons in India, providing insights into tolerances for surgical duration and blood loss, reasons for conversion, and predictors of complexity. Responses were analyzed using SPSS, with statistical significance set at p < 0.05.

Results

Among surveyed surgeons, 82.0% were male, and 78.0% worked in private institutions and 52.0% had performed over 1,000 LCs. Conversion to open surgery was primarily influenced by significant blood loss (68.0%) and biliary injury (94.0%). While 38.0% preferred surgeries under 60 minutes, 26.0% imposed no time constraints. Key intraoperative challenges included dense adhesions, cholecysto-enteric fistulas, and fibrosis. Less experienced surgeons reported greater challenges with scarring adhesions and anatomical variations, but no significant differences were found for other factors like edematous or necrotic changes. Preoperative imaging was considered essential by most surgeons.

Conclusions

This study underscores the limited reliability of traditional parameters for assessing difficulty in LC. Surgeons highlighted the importance of objective intraoperative findings and preoperative imaging in predicting surgical challenges. Factors such as adhesions, fibrosis, and anatomical variations significantly impact LC difficulty, with decisions regarding conversion to open surgery largely driven by individual judgment rather than experience. Standardized grading systems incorporating these factors could improve surgical planning, reduce complications, and enhance patient outcomes.

Anti-urease therapy: a targeted approach to mitigating antibiotic resistance in Helicobacter pylori while preserving the gut microflora

The global rise in antibiotic resistance has posed significant challenges to the effective management of Helicobacter pylori (H. pylori), a gastric pathogen linked to chronic gastritis, peptic ulcers, and gastric cancer. Conventional antibiotic therapies, while effective, face significant challenges, such as increasing antibiotic resistance, high recurrence rates, and adverse effects such as gut microflora dysbiosis. These limitations have driven the exploration of alternative antibiotic-free therapies, including the use of plant-based compounds, probiotics, nanoparticles, phage therapy, antimicrobial peptides, and H. pylori vaccines. Among these, urease-targeted therapy has shown particular promise. Urease enables the survival and colonization of H. pylori by neutralizing stomach acidity. Targeting this urease without disrupting beneficial gut microflora offers a selective mechanism to impair H. pylori, due to the absence of this enzyme in most of the human gut microbiome. In this review, we highlight advancements and limitations in the field of antibiotic-free therapies, with a particular focus on anti-urease strategies. We explore the structural and functional characteristics of urease, its role in H. pylori pathogenesis, and its potential as a therapeutic target. For the first time, we provide a comprehensive analysis of natural, semisynthetic, and synthetic anti-urease compounds, emphasizing their mechanisms of action, efficacy, and safety profiles. Advances in silico, in vitro, and in vivo studies have identified several promising anti-urease compounds with high specificity and minimal toxicity. By focusing on urease inhibition as a targeted strategy, this review underscores its potential to overcome antibiotic resistance while minimizing gut dysbiosis and improving the outcomes of H. pylori infection treatment.

A preliminary exploration of a predictive model and nomogram for the efficacy of compound digestive enzyme therapy based on serum (PGI, PGII, VIP, and PRDX1) in patients with functional dyspepsia

OBJECTIVE

This study aimed to explore the feasibility of constructing compound digestive enzyme therapeutic effect prediction model based on serum pepsinogen I (PGI), pepsinogen II (PGII), vasoactive intestinal peptide (VIP), and peroxidase 1 (PRDX1) in patients with functional dyspepsia (FD), and draw nomograms, to provide reference for the selection of clinical treatment.

METHODS

A total of 249 FD patients who visited the Department of Gastroenterology in our hospital from January 2021 to December 2024 were selected, and the preoperative clinical and laboratory indicators were collected. the patient cohort was split in a 7:3 ratio into a training set (n = 174) and a validation set (n = 75). The risk factors were screened by univariate and multivariate logistic regression in the training set, and the nomogram model was constructed. The receiver operating characteristic curve (ROC) was drawn and the calibration curve was used to evaluate the effectiveness of the model. The model was verified in the verification set, and the clinical value was evaluated by decision curve analysis (DCA).

RESULTS

The results of multivariate logistic regression showed that PGI, PGII, VIP, PRDX1, white blood cell count, aspartate aminotransferase and high density lipoprotein cholesterol were the independent risk factors for poor efficacy of compound digestive enzymes in the treatment of FD. The C-index was 0.830 and 0.827, respectively, the area under the ROC curve (AUC) was 0.835 (95% CI: 0.792-0.941) and 0.835 (95% CI: 0.687-0.983), and the sensitivity and specificity were 0.768, 0.857, and 0.778, 0.780, respectively.

CONCLUSION

The therapeutic effect prediction model of compound digestive enzyme base on serum PGI, PGII, VIP, PRDX1 in patients with FD has some clinical value, but it still need to be further verified by large sample size and multi-center study.

Insulinoma Associated with MEN1 Syndrome: A Case of Persistent Hypoglycemia in a School-aged Child

Insulinoma is a rare cause of non-ketotic hypoglycemia, both in adults and in children. Pediatric patients account for approximately 5% of all cases, mostly due to isolated benign lesions, but insulinoma may also be part of a multiple endocrine neoplasia type 1 (MEN1) syndrome. We report the case of a patient with multiple hospitalizations related to hypoglycemia and neuroglycopenia symptoms. Multiple studies demonstrated the presence of an insulinoma. Subsequently, an unreported likely pathogenic variant in the MEN1 gene was identified, suggesting that the clinical presentation of this patient should be part of the spectrum of MEN1 syndrome. The primary significance of this report is to underscore that insulinoma may present as the initial manifestation of MEN1 syndrome, reported to account for around 10% of pediatric insulinomas which are associated with MEN1 syndrome. Furthermore, we describe a previously unreported, likely pathogenic variant in the MEN1 gene. This report highlights the importance of the convergence of clinical, biochemical and molecular investigations in establishing a precise diagnosis, prognosis, and appropriate follow-up for pediatric patients with insulinoma.

Magnetic-assisted detection and extraction of dispersed metallic foreign bodies in the abdominal cavity: A case report

BACKGROUND

Gastrointestinal foreign bodies represent a significant clinical challenge in emergency and surgical settings. While accidental ingestion predominates in healthy adults, intentional ingestion is frequently observed in pediatric, psychiatric, and incarcerated populations. Metallic sewing needles, characterized by their sharp morphology and high mobility, pose particular risks of visceral injury and complications due to their penetrative potential. Although preoperative imaging facilitates initial localization, subsequent migration of multiple needles complicates therapeutic interventions, increasing procedural complexity and patient risk.

CASE SUMMARY

We present a novel application of magnetic-assisted localization in managing a complex case of intentional ingestion of 30 metallic sewing needles in a psychiatric patient. The widespread distribution of needles throughout the gastrointestinal tract necessitated an innovative surgical approach. Intraoperative implementation of cylindrical magnetic localization technology enabled precise identification and successful extraction of all foreign bodies while minimizing tissue trauma.

CONCLUSION

Magnetic-assisted localization represents an effective and safe technique to manage multiple magnetic gastrointestinal foreign bodies. This approach offers significant advantages in complex cases, particularly for needle-like metallic objects, and warrants consideration as a valuable tool in gastrointestinal surgery.

Intestinal anti-inflammatory, histopathologic and anti-oxidative regulatory effects of total alkaloids extract from Linum usitatissimum L. (Flaxseed) in vivo

ETHNOPHARMACOLOGICAL RELEVANCE

Linum usitatissimum L., commonly known as flaxseed, is a perennial herb in the Lineaceae family that has been traditionally used to manage gastrointestinal disorders and diarrhea. The health benefits and medicinal applications of flaxseed can be attributed to the presence of some beneficial compounds, such as omega-3 fatty acids, tocopherol, cyclic peptides, alkaloids, mucilage, and phenylpropanoids.

AIM OF THE STUDY

This investigation explored the potential anti-inflammatory and antioxidant properties of the total alkaloid extract of Linum usitatissimum L. seeds (ALU) in a model of Crohn's disease induced by 2,4-dinitrobenzenesulfonic acid (DNBS) in BALB/c mice.

MATERIALS AND METHODS

ALU fraction was chemically characterized by liquid chromatography combined with electrospray ionization mass spectrometry (LC-ESI-MS/MS). Six groups of mice (n=6) were divided as follow: healthy group, colitic control, Dexamethasone treated-group (2.4 mg/kg) and three group for ALU treatment (50, 100 and 200 mg/kg). Intrarectal instillation of DNBS (250 mg/kg) induced colonic inflammation accompanied by body weight loss, colonic architecture modification, inflammatory cells infiltration and excessive inflammatory markers production. Tissues sample were used to assess the histological damages and eventual goblet cells loss (H & E and PAS staining) and to evaluate inflammatory and oxidative statute (MPO, NO, H2O2, MDA, CAT and GSH).

RESULTS

The phytochemical analysis of total alkaloid fraction of LU revealed the presence of 10 compounds. Oral administration of ALU (50, 100, and 200 mg/kg) significantly ameliorated DNBS-induced colitis in mice in a dose-dependent manner. ALU treatment mitigated body weight loss, reduced the weight/length (W/L) ratio, and improved clinical outcomes, including diarrhea and food intake. Histological analyses revealed preserved colonic architecture, enhanced goblet cell numbers, reduced neutrophil infiltration, and minimal mucosal damage, comparable to dexamethasone treatment. ALU also promoted mucosal healing and neutral mucin retention. Furthermore, ALU exerted potent anti-inflammatory and antioxidant effects by modulating key markers such as MPO, NO, H2O2, MDA, CAT, and GSH, supporting its protective role against colonic inflammation.

CONCLUSION

These findings indicate that alkaloid fraction extracted from Linum usitatissimum L. have strong anti- inflammatory and antioxidant properties in a DNBS-induced colitis model in BALB/c mice.

Antibiotic resistance in Helicobacter pylori: a genetic and physiological perspective

The identification of Helicobacter pylori (H. pylori) infection as the primary etiology of gastroduodenal diseases represents a significant advancement in the field of gastroenterology. The management of these diseases has undergone a substantial transformation, and antibiotic treatment is now universally applicable. H. pylori has been the subject of numerous investigations to determine the prevalence of antibiotic resistance. However, many of these studies are limited, particularly regarding the number and representativeness of the strains assessed. Genetic and physiological modifications, such as gene mutations, efflux pump alterations, biofilm formation, and coccoid formation, contribute to the observed resistance. Our review focuses on the emergence of antibiotic-resistant strains, particularly emphasizing the various modifications of H. pylori that confer this resistance. In conclusion, we elucidate the challenges, potential solutions, and prospects in this field, providing researchers with the knowledge necessary to overcome the resistance exhibited by H. pylori.

Helicobacter pylori and gastric disease

The infection caused by Helicobacter pylori is the most common on the planet, affecting half of the global population. It is usually transmitted during childhood and persists for life if untreated. It is the primary cause of chronic gastritis, peptic ulcer, and gastric cancer. In young dyspeptic patients without alarm symptoms, the test-and-treat strategy (detection of H. pylori through a non-invasive test and subsequent eradication) is the preferred approach. The causal role of the infection in the development of gastric adenocarcinoma provides an opportunity to implement preventive strategies. The infection can be diagnosed through invasive methods (requiring endoscopy, such as the rapid urease test or histology) and non-invasive methods (such as the breath test or stool antigen test). The treatment for H. pylori combines a proton pump inhibitor with several antibiotics or bismuth salts.

Genetic Mutations and Small Bowel Ulcerating Disease: Role in Diagnosis?

PURPOSE OF REVIEW

This review examines the role of genetic variations in the pathogenesis of small bowel (SB) ulcers associated with Crohn's disease (CD), NSAID enteropathy, and Cryptogenic Multifocal Ulcerous Stenosing Enteritis (CMUSE)/Chronic Non-Specific Ulcers of the Small Intestine (CNSU), aiming to address current diagnostic challenges.

RECENT FINDINGS

Advances in molecular genetics have revealed significant genetic contributors to SB ulceration. In CD, the NOD2 gene on chromosome 16 and several additional risk variants identified through genome-wide association studies (GWAS)-with key insights from the International Inflammatory Bowel Disease Genetics Consortium-have enhanced our understanding of the pathobiology of the disease. In NSAID enteropathy, polymorphisms in CYP enzymes have been associated with altered drug metabolism and gastrointestinal complications. However, the genetic mechanisms underlying deep ulcers in NSAID enteropathy, as well as CMUSE/CNSU, remain poorly understood. Genetic insights are crucial for understanding SB ulcerative diseases. Future research should focus on identifying specific genetic determinants to improve diagnostic accuracy and therapeutic strategies.

Good clinical practice recommendations for the diagnosis and treatment of functional dyspepsia: An expert review from the Asociación Mexicana de Gastroenterología

INTRODUCTION AND AIMS

Functional dyspepsia (FD) is a highly prevalent condition characterized by upper gastrointestinal symptoms with no apparent organic cause. It is a complex and multifactorial disease that frequently overlaps with other disorders of gut-brain interaction. It is recurrent, has a variable therapeutic response, and affects patient quality of life. Our aim was to formulate good practice recommendations for the management of FD through a consensus review of the disease, updating and complementing the 2017 consensus on dyspepsia from the Asociación Mexicana de Gastroenterología (AMG).

METHODS

Sixteen experts summoned by the AMG carried out a literature review (2017-2024) and formulated good clinical practice recommendations for the diagnosis and treatment of FD. They were discussed until reaching a consensus, and the most recent evidence on the theme was evaluated, utilizing the GRADE system.

RESULTS

Twenty-three good clinical practice recommendations for the management of FD were developed that addressed the following aspects: (1) definition, pathophysiology, and epidemiology; (2) diagnosis; (3) nonpharmacologic treatment; (4) Helicobacter pylori eradication; (5) antisecretory and anti-acid therapy; and (6) prokinetics and neuromodulators.

CONCLUSIONS

FD is one of the most frequent gastrointestinal conditions seen in daily practice. We present good clinical practice recommendations for the specific management of this disorder, taking into account the most recent advances that complement and update the consensus on dyspepsia published by the AMG in 2017.

Effect of Helicobacter pylori Eradication on Metabolic Parameters and Body Composition including Skeletal Muscle Mass: A Matched Case-Control Study

Background/Aims

Findings on the impact of Helicobacter pylori eradication on metabolic parameters are inconsistent. This study aimed to evaluate the effects of H. pylori eradication on metabolic parameters and body composition, including body fat mass and skeletal muscle mass.

Methods

We retrospectively reviewed the data of asymptomatic patients who underwent health screenings, including bioelectrical impedance analysis, before and after H. pylori eradication between 2005 and 2021. After matching individuals based on key factors, we compared lipid profiles, metabolic parameters, and body composition between 823 patients from the eradicated group and 823 patients from the non-eradicated groups.

Results

Blood pressure, erythrocyte sedimentation rate, and glycated hemoglobin values were significantly lower in the eradicated group than in the non-eradicated group. However, changes in body mass index (BMI), body fat mass, appendicular skeletal muscle mass (ASM), waist circumference, and lipid profiles were not significantly different between the two groups. In a subgroup analysis of individuals aged >45 years, blood pressure, erythrocyte sedimentation rate, and glycated hemoglobin changes were significantly lower in the eradicated group than in the non-eradicated group. BMI values were significantly higher in the eradicated group than in the non-eradicated group; however, no significant differences were observed between the two groups regarding changes in body weight, body fat mass, ASM, or waist circumference. Total cholesterol and low-density lipoprotein cholesterol levels were significantly lower in the eradicated group than in non-eradicated group.

Conclusions

H. pylori eradication significantly reduced blood pressure, glucose levels, and systemic inflammation and improved lipid profiles in patients aged >45 years. BMI, body fat mass, ASM, and waist circumference did not significantly differ between patients in the eradicated group and those in the non-eradicated group.

Bee products in the fight against Helicobacter pylori and molecular interactions

Gastric or duodenal ulcers can lead to upper gastrointestinal (GI) bleeding. Infection with Helicobacter pylori (H. pylori) is one of the most common infections in the world and can cause both gastric ulcers and gastric cancer. The treatment aims to eradicate H. pylori and treatment with antibiotics has made it possible to cure gastric ulcers. The most common complication of untreated peptic ulcer disease is bleeding (hematemesis, melena, and anemia), while perforation occurs in a smaller proportion of patients. In some individuals, the infection causes mucosal changes with increasing age that lead to atrophy and intestinal metaplasia. It is believed that atrophy and especially intestinal metaplasia are a prerequisite for the most common form of gastric cancer, adenocarcinoma. There is presently a demand for an alternate treatment devoid of the current strategies drawbacks including recurrence, resistance and antibiotic abuse. The current workhighlights the possibility of bee product-based treatments for preventing and eliminating H. pylori infestation. Sci-finder, Google Scholar, PubMed, ScienceDirect, Web of Science, and Scopus were used for literature screening. Terms and keywords, i.e. "helicobacter pylori", "epidemiology", "chemotherapy", "honey", "propolis", "bee venom", "bioactive compounds", and "mechanism of action" were used in the search. Bee products are important alternatives that have been utilized for treating many ailments due to their diverse biochemical and biological characteristics. Various mechanisms, such as direct antibacterial, antioxidant, anti-inflammatory, and wound healing capacities, are proposed to explain the potential effect of bee products against H. pylori. The bee product's metabolites have a role in the adherence of H. pylori to stomach epithelial cells. The disruption of bacterial cell membranes and the inhibition of virulence factors are the two mechanisms behind the bee product's promising therapeutic applications against H. pylori.

Changes of gastric microflora and metabolites in patients with chronic atrophic gastritis

BACKGROUND

Chronic atrophic gastritis (CAG) is related to the body's microbial and metabolic systems. Combined studies of microbiome and metabolomics can clarify the mechanisms of disease occurrence and progression. We used 16S rRNA sequencing, metagenomics sequencing and metabolomics sequencing to depict the landscapes of bacterium and metabolites, construct correlation networks of different bacterium and metabolites describe potential pathogenic mechanisms of chronic atrophic gastritis.

METHODS

The gastric juices of 30 non-atrophic gastritis (NAG) patients and 30 CAG patients were collected. Gastric microflora was analyzed by 16S rRNA sequencing and metagenomics sequencing. Gastric metabolites were analyzed by LC-MS analysis. Different bioinformatics methods were used to analyze the data of microbiome and metabolome, and to analyze the relationship between them.

RESULTS

In atrophic gastritis, bacteria diversity decreased. The genera with a mean decrease in Gini greater than 1.5 included peptostreptococcus, fusobacterium, prevotella, sphingomonas and bacteroides. KEGG pathway included renal cell carcinoma, proximal tubule bicarbonate reclamation, citrate cycle and aldosterone synthesis and secretion with significant enrichment of differential metabolites. Peptostreptococcus, fusobacterium, prevotella and sphingomonas were in pivot positions of the correlation network of differential metabolites and differential bacterium. Viral carcinogenesis, glycine serine and threonine metabolism, RNA polymerase, galactose metabolism and retinol metabolism were enriched in chronic atrophic gastritis based on the metagenomic sequencing data.

CONCLUSION

Peptostreptococcus, fusobacterium, prevotella, sphingomonas and bacteroides were the essential features that distinguish atrophic gastritis from non-atrophic gastritis, and caused disease by altering various metabolic pathways. Viral carcinogenesis, glycine serine and threonine metabolism, RNA polymerase, galactose metabolism and retinol metabolism may be related to the occurrence and progression of CAG.

Research progress on monocyte/macrophage in the development of gastric cancer

Gastric cancer (GC) is diagnosed more than one million times each year and represents a major cause of cancer-related death worldwide. Although GC presents as a group of different types of disease, chronic inflammation has been strongly associated with tumorigenesis. Monocyte/macrophage play important roles in the development of inflammation and are vital components of the tumor microenvironment (TME). Monocyte/macrophage exert protumor and/or antitumor effects through the release of angiogenic and lymphangiogenic factors. Furthermore, tumor associated macrophages (TAMs) are emerging as key players in GC development. It is necessary to review and elucidate the roles of TAM subsets in GC and their molecular features. In this study, we focused on GC-related subsets of monocytes/macrophages and analyzed signaling related to TAMs in GC as well as the potential roles of these cells as therapeutic targets.

Research trends and hotspots of single nucleotide polymorphisms in endometrial cancer: a bibliometric analysis

BACKGROUND

Endometrial cancer (EC) is a common gynecological malignancy with increasing incidence, especially in developed nations. Understanding genetic variations, particularly single nucleotide polymorphisms (SNPs), is crucial for uncovering the disease's pathogenesis, progression, and treatment responses. This study explores the global research landscape of SNPs in EC, focusing on field evolution, key contributors, and emerging trends.

METHODS

A systematic search of the Web of Science Core Collection (WoSCC) retrieved 838 publications on SNPs in EC from 1991 to 2024. Bibliometric indicators, including publication volume, citation counts, and keyword occurrences, were analyzed using VOSviewer, CiteSpace, and the R package "bibliometrix" for visual mapping and trend analysis.

RESULTS

The United States (230 publications) and China (182 publications) were leaders in research output. Harvard University and the National Cancer Institute were prominent contributors. Key themes included "microsatellite instability" (a hallmark of DNA mismatch repair deficiency) and "genome-wide association studies" (GWAS), identifying susceptibility loci like HNF1B and CYP19A1. Recent trends, such as "Mendelian randomization," have enhanced causal inference in risk factor studies. SNP research has advanced risk prediction models and personalized therapeutic strategies, such as hormone therapy tailored to genetic profiles.

CONCLUSION

SNP research has deepened our understanding of EC's genetic basis, with a growing emphasis on Mendelian randomization and GWAS. These advancements have refined risk prediction and opened new avenues for personalized medicine. Integrating SNP data with environmental and hormonal factors remains crucial for advancing prevention, diagnosis, and treatment strategies in EC.

Randomized multicenter trial comparing minocycline and ornidazole with classical quadruple therapy in Helicobacter pylori treatment

This study evaluated the efficacy, safety, and cost of minocycline, ornidazole, esomeprazole, and bismuth (MOEB) therapy versus classical therapy (amoxicillin, clarithromycin, esomeprazole, and bismuth potassium citrate, ACEB) for Helicobacter pylori eradication. In a randomized trial of 390 patients, MOEB demonstrated superior eradication rates (93.2% per-protocol, 78.5% intention-to-treat) compared to ACEB (82.5% per-protocol, 72.8% intention-to-treat). Adverse events were significantly lower with MOEB (19.3% vs. 33.8%, p = 0.0019). MOEB was also more cost-effective, with a direct cost of 675.7 CNY versus 970.1 CNY for ACEB, yielding an incremental cost-effectiveness ratio of -27.5 CNY per eradication rate. MOEB is a safe, effective, and cost-efficient first-line regimen for H. pylori eradication.

Role of CDH1 gene variants and E-cadherin localization in gastric mucosal cancerization

Background

This study investigates the role of CDH1 gene single nucleotide polymorphisms (SNPs), mRNA transcription levels, and E-cadherin protein localization in Helicobacter pylori (Hp)-associated gastric diseases and their contribution to gastric mucosal carcinogenesis.

Methods

Gastric mucosal samples were analyzed for histopathology (Hematoxylin-Eosin staining) and Hp detection (rapid urease test, Giemsa staining). SNPs at the CDH1 gene rs16260 locus were identified via sequencing, mRNA levels were quantified by real-time PCR, and E-cadherin localization was assessed using Elivision™ Plus. Statistical analyses were performed with SPSS 25.0.

Results

Participants were grouped by gastric mucosal pathology: normal (NOR), gastric inflammation (GI), gastric atrophy (GA), gastric premalignant lesion (GPL), severe dysplasia (GSD), and gastric cancer (GC). No significant differences were found in CDH1 rs16260 genotypes. However, CDH1 transcription was higher in GC compared to NOR and GPL groups. Intestinal metaplasia showed lower CDH1 mRNA levels. E-cadherin expression was higher in GSD and GC compared to other groups. Localization analysis revealed decreased membrane-bound E-cadherin with increased cytoplasmic expression as lesion severity increased. Quantitative analysis showed higher E-cadherin expression in GA than other groups, indicating an initial rise followed by a decline in malignancy. Regression analysis suggested that elevated CDH1 mRNA increased gastric cancer risk, while E-cadherin cytoplasmic ectopic expression heightened the risk of precancerous lesions and gastric cancer.

Conclusion

The A allele of the CDH1 gene rs16260 locus show no effect in gastric mucosal pathological evolution, while the elevated mRNA transcription levels potentially increasing the risk of gastric cancer. The loss and ectopic expression of E-cadherin may be significant risk factors for malignant transformation in the gastric mucosa.

Human immunodeficiency virus and Helicobacter pylori coinfection: Immune modulation and eradication failure

The relationship between Human Immunodeficiency Virus (HIV) and Helicobacter pylori (H. pylori) is bidirectional and complex. Helicobacter pylori, by inducing local gastric and systemic immune responses, counteracts HIV invasion to CD4+ cells and other inflammatory cells and can reactivate HIV in latently infected immune cells. Human Immunodeficiency Virus infection, by reducing secretion of pro-inflammatory cytokines, reduces the incidence of H. pylori-induced gastric pathology. Gastric lymphoma regressed in some cases of people living with HIV (PLWH) after H. pylori eradication. Triple therapy for H. pylori could be associated with a strong immune. Treatment for both H. pylori and HIV can reduce the activation of either organism. However, the primary resistance to antibiotics such as levofloxacin, clarithromycin and metronidazole is higher among PLWH. This review highlights the need for further research and guidelines on the appropriate antibiotics in HIV-H. pylori co-infection particularly in PLWH who receive multiple antibiotic prophylaxis.

A scoping review of worldwide guidelines for diagnosis and treatment of Helicobacter pylori infection

BACKGROUND

This study comprehensively analyzes the diagnostic criteria, eradication indications, treatment, and other information in the latest guidelines published by various countries around the world, so that researchers can have a systematic understanding of Helicobacter pylori and further provide a basis for clinical H. pylori diagnosis and treatment.

METHODS

Nine online databases were searched to find the latest version of guidelines for H. pylori worldwide. Two researchers read the included guidelines independently and extracted the eradication indications, diagnostic criteria, and treatment in the guidelines, conducting a summary of them.

RESULTS

A total of 25 guidelines or consensus were included. Among all diagnostic methods for H. pylori infection, the urea breath test is widely recommended as the first choice. A total of 20 guidelines mentioned indications for H. pylori eradication. Among them, the indications with a higher proportion of recommendations were long-term use of non-steroidal anti-inflammatory drugs (including low-dose aspirin) in 90% of patients with peptic ulcer history or active peptic ulcer disease 80%; gastric mucosa-associated lymphoid tissue (MALT) lymphoma 75%. It is worth mentioning that 40% of the guidelines pointed out that, as long as H. pylori infection is confirmed, it should be eradicated. A total of 24 guidelines mentioned treatment for H. pylori. Among them, bismuth quadruple therapy (a combination of a bismuth, two antibiotics, and a proton pump inhibitor (PPI)) was the most recommended first-line therapy. Levofloxacin triple therapy (a combining of a bismuth, an antibiotic, and a PPI) was the most recommended second-line therapy.

CONCLUSION

Current global Helicobacter pylori management guidelines share foundational consensus, yet exhibit regional variations in diagnostic criteria, eradication indications, and therapeutic regimens due to context-specific epidemiological, socioeconomic, and antimicrobial resistance profiles. Clinical practice should prioritize regionally tailored approaches, integrating local guidelines while maintaining awareness of international recommendations to optimize decision-making. Moreover, health authorities responsible for guideline development must ensure timely updates based on dynamic surveillance of local resistance patterns and socioeconomic realities.

Comparison of Efficacy on First-Line Helicobacter Pylori Eradication Between Potassium-Competitive Acid Blocker (P-CAB)-Based Therapies Versus Proton-Pump Inhibitor (PPI)-Based Therapies: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Helicobacter pylori (H. pylori) is a gram-negative bacterium that infects over half of the world population, accountable for 89% of all gastric cancer cases. The efficacy of the proton-pump inhibitor (PPI) based-triple therapy is declining, while the novel potassium-competitive acid blocker (P-CAB) based therapy gets new attention. However, it remains unclear regarding the optimal duration and number of comedication(s) for P-CAB-based regimens, which P-CAB is the best-in-class, and whether P-CABs perform better than all PPIs.

OBJECTIVE

To compare the efficacy on first-line H. pylori eradication between P-CAB-based therapies versus PPI-based therapies.

METHODS

A systematic review on randomized controlled trials, with network meta-analysis conducted under the Frequentist approach. The P-score method was used to rank the probability of being the best intervention.

RESULTS

For the first-line treatment eradicating H. pylori infection, the 7-day vonoprazan-based triple therapy (VAC7) has the highest P-score for the probability of being the best intervention (0.96). VAC7 has a significantly higher eradication rate of H. pylori than most PPI-based therapies, including esomeprazole-based, lansoprazole-based, pantoprazole-based, and omeprazole-based regimens, as well as the other P-CAB based regimens, such as tegroprazan-based triple regimen (OR: 2.41, 95% CI: 1.13-5.15).

CONCLUSION

Vonoprazan-based triple therapy has a higher eradication rate than PPI-based triple therapies, as well as other P-CABs based regimens. It remains unclear whether VAC7 is superior over vonoprazan-based dual therapy (VA7). Overall, VAC7 should be recommended for clinical and public health interventions, with VA7 as a possible alternative considering the local antimicrobial resistance profiles.

Vonoprazan-based therapy versus standard regimen for Helicobacter pylori infection management in Egypt: an open-label randomized controlled trial

As antibiotic resistance continues to rise, the development of novel H. pylori treatment regimens, combined with regular assessment of existing treatment regimens, is imperative. The study evaluates the efficacy, safety, and compliance of vonoprazan dual and triple therapy (VDT and VTT) both consisting of vonoprazan 20 mg twice daily and amoxicillin/clavulanate 875 mg/125 three times daily plus clarithromycin 500 mg twice daily added in VTT versus standard triple therapy (STT), in which vonoprazan 20 mg in VTT is replaced by PPI standard or double dose all for 14 days, along with investigating factors influencing compliance, treatment response, and symptoms severity. By per-protocol analysis, the eradication rates of the STT, VDT, and VTT groups were 70%, 76.2%, and 79.2%, respectively (p = 0.777) indicating suboptimal efficacy of the three treatment regimens. This necessitates the optimization of dosage and frequency of available treatment regimens as well as the development of new regimens with higher eradication rates. Interestingly, the VDT group demonstrated a better safety profile but with no statistically significant difference in cure rate. No difference in compliance with treatment was found between the groups. Gender, frequency of COVID-19 vaccination, height, and BMI were the only factors assessed influencing infection symptoms severity. ClinicalTrial.gov ID identifier: NCT05614934, first posted date (07/11/2022).

Genomic insights into virulence, biofilm formation, and antimicrobial resistance of multidrug-resistant Helicobacter pylori strains of novel sequence types isolated from Vietnamese patients with gastric diseases

Helicobacter pylori (H. pylori) is a clinically important pathogen associated with gastric diseases. Here, we characterized the genome of multidrug-resistant H. pylori strains of novel sequence types, which were recovered from Vietnamese patients with gastritis or a stomach ulcer. Phenotypic-antibiotic susceptibility testing was performed against amoxicillin, clarithromycin, metronidazol, tetracycline, and levofloxacin using an E-test. The whole genome sequence of three H. pylori strains was de novo assembled, followed by in silico analysis of multilocus sequence typing (MLST), core-genome based phylogeny, genetic determinants associated with virulence, biofilm formation, and antibiotic-resistance. The genome sequence of H. pylori strains exhibited a high similarity with the average nucleotide identity (ANI) values of 98.5% to 99.2%, carried 5 to 7 pathogenicity islands, and 3 to 6 mobilomes. The MLST profile of strains revealed novel sequence types ST4511, ST4512, and ST4513. Core-genome based phylogeny exhibited that the three H. pylori strains belong to the Asian genotype. These strains possessed 128 to 131 virulence genes, including toxin-encoding genes cagA and vacA. Double amoxicillin-resistant mutations on pbp1 and pbp2, or a mutation on pbp3, triple clarithromycin-resistant mutations on 23S rRNA gene and a levofloxacin-resistant mutation on gyrA were detected in antibiotic-resistant strains. Mutations on rdxA were detected in both metronidazole-resistant and -sensitive strains, whereas frxA mutations were detected in only one metronidazole-sensitive strain. Finally, a rifamycin-resistant mutation in rpoB was also detected. This study provides insights into the genome of multidrug-resistant H. pylori strains of a novel sequence type circulating in Vietnam for future investigations of its pathobiology and spread through human populations.

Neuromodulation in Chronic Migraine: Evidence and Recommendations from the GRADE Framework

Chronic migraine (CM) affects approximately 2% of the general population and is defined by the persistence of migraine symptoms for at least 15 days per month for at least 3 months. CM is often refractory to common drug treatments and is associated with a significant burden in functions of daily life during ictal phases, productivity loss, and direct costs. Modulation of pain is considered pivotal to reduce its impact and to improve the quality of life among patients with CM. In recent years, neuromodulation in CM has received growing attention; however, there remains no consensus regarding the effectiveness and safety of these procedures. Previous invasive methods such as occipital nerve neurolysis and interruption of the trigeminal dorsal root are not indicated due to high rates of relapsing pain and frequent procedural complications. Although emerging neuromodulation methods, both noninvasive, such as vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS), remote electrical neuromodulation (REM), and invasive, such as deep brain stimulation (DBS), occipital nerve stimulation (ONS), and high-frequency 10-Hz spinal cord stimulation (HF-10 SNS) have demonstrated promising outcomes in early clinical trials, their use has yet to be integrated into routine clinical practice. In this review, study evidence and strength of recommendations are assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Other conditions such as therapeutic risk/benefit, direct and indirect costs, use of resources, and patient/clinician preferences are also evaluated.

Prospective and multicenter study on clinical-biological factors predictive of chronic colon diverticulitis: DICRO Trial

PURPOSE

This manuscript presents the protocol for a prospective, multicenter study aimed at identifying prognostic factors for the recurrence of diverticulitis. The design, methodology, and analysis plan are detailed, providing a comprehensive framework for evaluating clinical endpoints and intervention outcomes in patients with diverticulitis.

METHODS

Clinical, observational, prospective, and multicenter study of patients diagnosed with acute diverticulitis in the Emergency Department (ED) of 5 Spanish hospitals. The inclusion criteria were patients with acute diverticulitis who did not require emergency surgery. A 2-year follow-up will be carried out. The main objective is the description of prognostic factors of new episodes of acute diverticulitis and the creation of a therapeutic algorithm to select patients who could benefit from early elective surgery. Secondary endpoints are descriptive analyses of quality of life at different periods to establish the evolution of the disease and to correlate symptoms with systemic and local inflammatory markers; and sub-analysis of immunosuppressed patients to assess disease virulence.

CONCLUSION

Determination of a marker predictive of recurrent disease or chronic inflammation would be of benefit in developing a good treatment strategy. One group that would particularly benefit is immunosuppressed patients.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04407793.

Associations Between Antiparietal Cell Antibody Values and Atrophy in a South and Southeast Asian General Population

GOALS

To investigate the association between atrophy severity and antiparietal cell antibody (APCA) levels in South and Southeast Asia.

BACKGROUND

APCA is an autoantibody that damages gastric parietal cells; autoimmune gastritis (AIG) is a chronic gastric inflammatory disease related to APCA and severe predominant corpus atrophy. Although a positive APCA result is a key clinical diagnostic tool for AIG, its rates vary widely among ethnic groups, and its exact relationship with AIG and predominant corpus atrophy remains unclear.

STUDY

Associations between histopathology-assessed and endoscopy-assessed atrophy, APCA positivity rates, Helicobacter pylori status, and pepsinogen levels were investigated in 1982 symptomatic patients from Vietnam, Thailand, Myanmar, Bangladesh, and Nepal.

RESULTS

Overall, 38.5% of participants were negative for Helicobacter pylori infection, while 57.6% had a current infection. A positive APCA result, defined as a titer >10, was present in 44.0% of participants (95% confidence interval: 41.8%-46.3%, 873/1982). Pathologic atrophy, corpus atrophy, and predominant corpus atrophy were found in 8.7% (169/1982), 5.1% (101/1982), and 4.1% (81/1982) of participants, respectively. Positive APCA rates significantly differed among countries (10.6% to 63.8%, P<0.001). No significant correlation was found between APCA results and the presence or severity of atrophy.

CONCLUSIONS

Although APCA positivity was high among symptomatic patients from South and Southeast Asian countries, few had severe predominant corpus atrophy or positive pepsinogen tests, which suggests a low rate of AIG in this population. Long-term surveillance of APCA-positive individuals is necessary to determine the clinical significance of a positive APCA result without AIG.

Comparison of Therapeutic Outcomes Between Concomitant Therapy and Tailored Therapy for Helicobacter pylori: A Multicenter, Prospective, and Randomized Study

BACKGROUND

The increasing trend of clarithromycin resistance in Helicobacter pylori (H. pylori) is the primary cause of failure of standard triple therapy. Concomitant therapy is recommended as an alternative in regions with high rates of clarithromycin resistance. Recently, tailored therapies based on resistance testing have emerged as viable treatment approaches. We aimed to compare the eradication rates and adverse effects of concomitant and tailored therapies.

MATERIALS AND METHODS

We enrolled 319 patients diagnosed with H. pylori infection using dual-priming oligonucleotide (DPO) polymerase chain reaction (PCR) tests conducted in six hospitals across the Daejeon and Chungcheong regions of Korea. Based on DPO-PCR results, patients were randomly assigned to either the concomitant therapy group (non-bismuth quadruple therapy) or the tailored therapy group (standard triple therapy for clarithromycin-sensitive cases and bismuth quadruple therapy for clarithromycin-resistant cases). Demographics, eradication success rates, adverse effects, and patient compliance were assessed. Data were analyzed using modified intention-to-treat (mITT) and per-protocol (PP) analyses.

RESULTS

The eradication rate was significantly higher in the tailored therapy group than in the concomitant therapy group in PP analysis (92.62% vs. 85.21%, p = 0.026). The severity of adverse effects was significantly greater in the concomitant therapy group than in the tailored therapy group (p = 0.025).

CONCLUSION

Considering the high eradication success rate and low severity of adverse effects, tailored therapy based on DPO-PCR is preferable to concomitant therapy without resistance testing for the treatment of H. pylori infection.

TRIAL REGISTRATION

Clinical Research Information Service (CRIS): KCT0004162.

A Case of Penile Cavernosal Abscess Associated With Sigmoid Colovesical Fistula

Introduction

A penile cavernosal abscess is rare and typically attributable to sepsis, trauma, or intracavernosal injections.

Case Presentation

A 65-year-old man with suspicion of non-muscle invasive bladder cancer underwent transurethral resection. Edematous and erythematous mucosa was noted on the posterior wall. The pathological findings showed significant inflammatory cell infiltration, and urothelial carcinoma was ruled out. Abdominal CT post-surgery revealed multiple diverticula in the sigmoid colon and bladder wall thickening, indicating the presence of a fistula. Although colonoscopy and cystography did not show any fistula, the patient developed a penile cavernosal abscess approximately 40 days post-transurethral resection. Emergency penile incision and subcutaneous drainage were performed, followed by laparoscopic sigmoid colectomy after inflammation improved. A complete cure was achieved with continued antibiotic therapy for 5 weeks.

Conclusion

To our knowledge, this is the first report of a penile cavernous abscess associated with a sigmoid colovesical fistula definitively treated by drainage and colectomy.

Discrepancies in the Reporting of Hiatal Hernia Size: A Review

BackgroundIn the current literature there is a paucity of both standardized diagnostic criteria and accurate methods for determining hernia size. The aim of this review is to describe the most common methods for reporting hiatal hernia size.MethodsLiterature search using PubMed and Embase databases was performed. After exclusion and screening, 67 articles were analyzed and data were collected on hernia type and subtype, diagnostic method, size reporting method, and the author's definition of hernia size (measurement protocol).ResultsAuthors publishing on hiatal hernia size employed 8 different methods for diagnosing hiatal hernias and reported data using 7 distinct measurement types. Within individual diagnostic methods there was a further lack of standardization of measurement protocols.ConclusionOur review underscores the critical need for standardized reporting methods in the assessment and reporting of hiatal hernia size. Moving forward, collaboration is essential to establish and adopt standardized guidelines for reporting hiatal hernia size, ultimately improving patient care and outcomes.

Macrophage biology in the pathogenesis of Helicobacter pylori infection

Infection with H. pylori induces chronic gastric inflammation, progressing to peptic ulcer and stomach adenocarcinoma. Macrophages function as innate immune cells and play a vital role in host immune defense against bacterial infection. However, the distinctive mechanism by which H. pylori evades phagocytosis allows it to colonize the stomach and further aggravate gastric preneoplastic pathology. H. pylori exacerbates gastric inflammation by promoting oxidative stress, resisting macrophage phagocytosis, and inducing M1 macrophage polarization. M2 macrophages facilitate the proliferation, invasion, and migration of gastric cancer cells. Various molecular mechanisms governing macrophage function in the pathogenesis of H. pylori infection have been identified. In this review, we summarize recent findings of macrophage interactions with H. pylori infection, with an emphasis on the regulatory mechanisms that determine the clinical outcome of bacterial infection.

Anti-diabetic and anti-urease inhibition potential of Amomum dealbatum Roxb. seeds through a bioassay-guided approach

Using HPLC-PDA and HRMS analysis, five compounds p-coumaric acid, sinapic acid, quercetin, trans-ferulic and gallic acid were identified in seeds of Amomum dealbatum Roxb. The GC-MS analysis identified 1-dodecanol, phenol, 3,5-bis(1,1-dimethylethyl), Oleic Acid and 1-Heptacosanol which possess anti-diabetic properpties. A bioassay-guided technique was used to determine the degree of inhibition that A. dealbatum seeds crude methanol extract and its most active sub-fraction had against the α-glucosidase and Helicobacter pylori urease enzymes. In the Rat L6 myoblast cell line, glucose absorption through the GLUT4 transporter of most active subfraction (EASF80) was examined. According to a molecular docking investigation, these compounds strongly interacted with the GLUT4 transporter, H pylori and α-glucosidase enzyme. Sinapic acid interacted most strongly with the H. pylori urease enzyme while gallic acid interacted with both the α-glucosidase enzyme and the GLUT4 transporter. Additionally, a molecular docking simulation study was carried out to recognise the stability of the complexes.

High galectin expression in Helicobacter pylori-infected gastric mucosa in childhood

BACKGROUND

Mild Th1 and Th17 immune responses in childhood against Helicobacter pylori are presumed to be responsible for H. pylori colonization and mucosal atrophy reduction. However, the mechanism remains unclear. In this study, we aimed to investigate the childhood-specific immune responses observed after H. pylori infection by analyzing galectin expression in the gastric mucosa. We focused on galectin-1 (Gal-1) and galectin-9 (Gal-9), which function to suppress Th1 and Th17 immune responses.

METHODS

We analyzed changes in the expression of Gal-1 and Gal-9 in the gastric mucosa of pediatric patients with H. pylori infection. Ten pediatric patients with and ten patients without H. pylori infection who underwent biopsy to assess the cause of chronic abdominal symptoms using esophagogastroduodenoscopy were evaluated. Gal-1 and Gal-9 expression in the biopsy tissues of the gastric antrum and corpus was analyzed by immunohistochemical staining.

RESULTS

Gal-1 expression was significantly increased in the stromal cells of the corpus owing to H. pylori infection. No alterations in Gal-1 expression due to H. pylori infection were observed in the antral tissue. Helicobacter pylori infection considerably increased Gal-9 expression in all tissues. According to previous reports, the increased expression of Gal-9 associated with H. pylori infection is not observed in adults. Therefore, the increased expression of Gal-9 associated with H. pylori infection is specific to pediatric patients.

CONCLUSION

The increased expression of Gal-1 and Gal-9 may suppress Th1 and Th17 immune responses against H. pylori infection during childhood, promote H. pylori colonization, and reduce inflammation in the gastric mucosa of pediatric patients.

Management of epithelial precancerous conditions and early neoplasia of the stomach (MAPS III): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG) and European Society of Pathology (ESP) Guideline update 2025

At a population level, the European Society of Gastrointestinal Endoscopy (ESGE), the European Helicobacter and Microbiota Study Group (EHMSG), and the European Society of Pathology (ESP) suggest endoscopic screening for gastric cancer (and precancerous conditions) in high-risk regions (age-standardized rate [ASR] > 20 per 100 000 person-years) every 2 to 3 years or, if cost-effectiveness has been proven, in intermediate risk regions (ASR 10-20 per 100 000 person-years) every 5 years, but not in low-risk regions (ASR < 10).ESGE/EHMSG/ESP recommend that irrespective of country of origin, individual gastric risk assessment and stratification of precancerous conditions is recommended for first-time gastroscopy. ESGE/EHMSG/ESP suggest that gastric cancer screening or surveillance in asymptomatic individuals over 80 should be discontinued or not started, and that patients' comorbidities should be considered when treatment of superficial lesions is planned.ESGE/EHMSG/ESP recommend that a high quality endoscopy including the use of virtual chromoendoscopy (VCE), after proper training, is performed for screening, diagnosis, and staging of precancerous conditions (atrophy and intestinal metaplasia) and lesions (dysplasia or cancer), as well as after endoscopic therapy. VCE should be used to guide the sampling site for biopsies in the case of suspected neoplastic lesions as well as to guide biopsies for diagnosis and staging of gastric precancerous conditions, with random biopsies to be taken in the absence of endoscopically suspected changes. When there is a suspected early gastric neoplastic lesion, it should be properly described (location, size, Paris classification, vascular and mucosal pattern), photodocumented, and two targeted biopsies taken.ESGE/EHMSG/ESP do not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection unless there are signs of deep submucosal invasion or if the lesion is not considered suitable for endoscopic resection.ESGE/EHMSG/ESP recommend endoscopic submucosal dissection (ESD) for differentiated gastric lesions clinically staged as dysplastic (low grade and high grade) or as intramucosal carcinoma (of any size if not ulcerated or ≤ 30 mm if ulcerated), with EMR being an alternative for Paris 0-IIa lesions of size ≤ 10 mm with low likelihood of malignancy.ESGE/EHMSG/ESP suggest that a decision about ESD can be considered for malignant lesions clinically staged as having minimal submucosal invasion if differentiated and ≤ 30 mm; or for malignant lesions clinically staged as intramucosal, undifferentiated and ≤ 20 mm; and in both cases with no ulcerative findings.ESGE/EHMSG/ESP recommends patient management based on the following histological risk after endoscopic resection: Curative/very low-risk resection (lymph node metastasis [LNM] risk < 0.5 %-1 %): en bloc R0 resection; dysplastic/pT1a, differentiated lesion, no lymphovascular invasion, independent of size if no ulceration and ≤ 30 mm if ulcerated. No further staging procedure or treatment is recommended.Curative/low-risk resection (LNM risk < 3 %): en bloc R0 resection; lesion with no lymphovascular invasion and: a) pT1b, invasion ≤ 500 µm, differentiated, size ≤ 30 mm; or b) pT1a, undifferentiated, size ≤ 20 mm and no ulceration. Staging should be completed, and further treatment is generally not necessary, but a multidisciplinary discussion is required. Local-risk resection (very low risk of LNM but increased risk of local persistence/recurrence): Piecemeal resection or tumor-positive horizontal margin of a lesion otherwise meeting curative/very low-risk criteria (or meeting low-risk criteria provided that there is no submucosal invasive tumor at the resection margin in the case of piecemeal resection or tumor-positive horizontal margin for pT1b lesions [invasion ≤ 500 µm; well-differentiated; size ≤ 30 mm, and VM0]). Endoscopic surveillance/re-treatment is recommended rather than other additional treatment. High-risk resection (noncurative): Any lesion with any of the following: (a) a positive vertical margin (if carcinoma) or lymphovascular invasion or deep submucosal invasion (> 500 µm from the muscularis mucosae); (b) poorly differentiated lesions if ulceration or size > 20 mm; (c) pT1b differentiated lesions with submucosal invasion ≤ 500 µm with size > 30 mm; or (d) intramucosal ulcerative lesion with size > 30 mm. Complete staging and strong consideration for additional treatments (surgery) in multidisciplinary discussion.ESGE/EHMSG/ESP suggest the use of validated endoscopic classifications of atrophy (e. g. Kimura-Takemoto) or intestinal metaplasia (e. g. endoscopic grading of gastric intestinal metaplasia [EGGIM]) to endoscopically stage precancerous conditions and stratify the risk for gastric cancer.ESGE/EHMSG/ESP recommend that biopsies should be taken from at least two topographic sites (2 biopsies from the antrum/incisura and 2 from the corpus, guided by VCE) in two separate, clearly labeled vials. Additional biopsy from the incisura is optional.ESGE/EHMSG/ESP recommend that patients with extensive endoscopic changes (Kimura C3 + or EGGIM 5 +) or advanced histological stages of atrophic gastritis (severe atrophic changes or intestinal metaplasia, or changes in both antrum and corpus, operative link on gastritis assessment/operative link on gastric intestinal metaplasia [OLGA/OLGIM] III/IV) should be followed up with high quality endoscopy every 3 years, irrespective of the individual's country of origin.ESGE/EHMSG/ESP recommend that no surveillance is proposed for patients with mild to moderate atrophy or intestinal metaplasia restricted to the antrum, in the absence of endoscopic signs of extensive lesions or other risk factors (family history, incomplete intestinal metaplasia, persistent H. pylori infection). This group constitutes most individuals found in clinical practice.ESGE/EHMSG/ESP recommend H. pylori eradication for patients with precancerous conditions and after endoscopic or surgical therapy.ESGE/EHMSG/ESP recommend that patients should be advised to stop smoking and low-dose daily aspirin use may be considered for the prevention of gastric cancer in selected individuals with high risk for cardiovascular events.

Patient- vs organ-based prognostic tools for older patients in critical care units : An observational study with a 3-month follow-up

BACKGROUND

Anticipating a doubling of older adults in Europe by 2050, healthcare systems face substantial challenges, particularly in critical care units. However, there is still a lack of evidence-based knowledge for treating and assessing mortality risk in older patients. This study compared the predictive accuracy of two assessment tools for long-term outcomes among older patients: the Multidimensional Prognostic Index (MPI) and the Sequential Organ Failure Assessment (SOFA). As the MPI is based on a more holistic assessment, it may provide a more accurate prediction than the organ-based SOFA.

OBJECTIVE

Does the MPI provide a more accurate prediction of mortality risk and quality of life for older patients in critical care units than the organ-based SOFA score?

METHODS

In a 6-month study, 96 patients aged 65 and older admitted to intensive (ICU) or intermediate care units (IMC) were enrolled to assess 90-day mortality using a comprehensive geriatric assessment-based MPI and the SOFA score. The follow-up (FU) involved telephone assessments 30 and 90 days after admission, focusing on posthospitalization health and quality of life.

RESULTS

Both MPI (p = 0.039) and SOFA score (p = 0.014) successfully predicted mortality among older IMC and ICU patients in logistic regressions. Receiver operating characteristic (ROC) analyses demonstrated comparable areas under the curve (AUCs) for MPI (0.618) and SOFA score (0.621), as well as a similar sensitivity and specificity (MPI 61.0% and 52.9%; SOFA score: 68.9% and 45.1%, respectively). The MPI at admission moreover correlated significantly with quality of life (p < 0.001, r = -0.631 at discharge; p = 0.005, r = -0.377 at 30-day FU; p = 0.004, r = -0.409 at 90-day FU) and nursing needs (Mann-Whitney U‑test, p = 0.002 at 30-day FU; p = 0.011 at 90-day FU) at FU, while the SOFA score did not show significant associations with respect to these parameters.

CONCLUSIONS

In geriatric critical care, both the MPI and the SOFA score effectively predict mortality risk. While the SOFA score may appear more practical due to its simpler and faster implementation, only the MPI demonstrated significant correlations with quality of life and nursing needs in the FU after 30 and 90 days.

Streptococcus anginosus promotes gastric cancer progression via GSDME-mediated pyroptosis pathway: Molecular mechanisms of action of GSDME, cleaved caspase-3, and NLRP3 proteins

Streptococcus vasculosus is a common oral and intestinal symbiotic bacteria, but it can transform into a pathogen under certain conditions, affecting the host's immune response. Studies have shown that Streptococcus vasculosus may promote tumor growth and metastasis by activating host inflammatory responses. This study simulated the environment of Streptococcus vascularis infection through in vitro cell culture experiment, and observed the influence of streptococcus vascularis at different time points and different concentrations on cancer cells. The expression and activity of GSDME, cleaved caspase-3 and NLRP3 proteins were detected by Western blot, immunofluorescence and flow cytometry. By constructing gene knockout and overexpression cell models, the role of these protein molecules in promoting cancer progression of Streptococcus vascularis was further verified. It was found that GSDME activation is a key step in Pyroptosis occurrence, and cleaved caspase-3 plays an important role in GSDME cleavage activation. The activation of NLRP3 inflammatome is closely related to the inflammatory response induced by Streptococcus vasculosus, and thus affects the tumor microenvironment.

Characteristics of Laryngopharyngeal Reflux in Patients of Different Genders and Ages

OBJECTIVES

To investigate the differences in laryngopharyngeal reflux (LPR) characteristics between gender and age groups based on the Reflux Symptom Index (RSI), Reflux Finding Score (RFS) scale and 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH (HEMII-pH) monitoring.

METHODS

The enrolled were patients with LPR symptoms completed the 24h-HEMII-pH monitoring and divided into two gender groups (male and female) and elderly group (>60 years), middle-aged group (41-60 years) and young group (18-40 years). The total RSI and RFS scores of individuals were counted. Various potential differences as well as incidence of each type of LPR events between gender and age groups were analyzed.

RESULTS

A total of 420 patients were included, with 333 (79.3%) diagnosed with LPR confirmed by 24h-HEMII-pH monitoring. Females (n=49) had a statistically higher LPR positivity (91.0% vs. 76.6%, P < 0.01) than males (n=342). Female patients with LPR had significantly higher RSI scores (14.08 ± 6.72 vs. 11.08 ± 4.82, P < 0.001) than male patients. The positive rate of LPR were 82.6%, 80.7% and 63.3% in the elderly, middle-aged and young groups. The Elderly group had significantly lower RSI scores (10.20 ± 4.06 vs. 12.80 ± 6.58, 12.24 ± 5.57, P < 0.001) but higher RFS scores (9.37 ± 3.25 vs. 8.16 ± 3.34, 8.57 ± 2.58, P < 0.05) than the other two groups. The number of acid hypopharyngeal-proximal reflux episodes (HREs) and distal esophageal acid reflux were significantly higher in elderly than in young patients. Except for non-acid gas HREs, the positive rates of other types of HREs were increasing from young to middle-aged to the elderly group (P < 0.05).

CONCLUSIONS

Female patients with suspected LPR symptoms had a higher positive rate of LPR and RSI score than males. The prevalence of LPR and the number of acid reflux were progressively increasing with age, but the perception of reflux symptoms may diminish.

Risk factors associated with Helicobacter pylori infection in the urban population of China: A nationwide, multi-center, cross-sectional study

OBJECTIVES

To assess the risk factors associated with Helicobacter pylori infection in the urban Chinese population.

METHODS

The study was conducted from March to November 2023, including 12,902 urban participants aged 18-60 years across 52 cities distributed over 26 provinces in China. Risk factors included socioeconomic status, lifestyles, and public understanding. Univariate and multivariate logistic regression analysis was used to calculate corrected odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

According to multivariate logistic regression, risk factors associated with significantly higher H. pylori infection rates included residency in developing (OR 1.27, 95% CI 1.13-1.43) and undeveloped cities (OR 1.15, 95% CI 1.02-1.29), obesity (OR 1.37, 95% CI 1.05-1.78), alcohol consumption (OR 1.16, 95% CI 1.05-1.29), tea consumption (OR 1.11, 95% CI 1.01-1.21), and soft drink consumption (OR 1.24, 95% CI 1.09-1.40). Conversely, individuals with moderate awareness (OR 0.79, 95% CI 0.71-0.88) and high awareness (OR 0.57, 95% CI 0.48-0.69) of H. pylori had lower infection rates.

CONCLUSION

Our findings highlight the importance of promoting a healthy lifestyle and improving the understanding of H. pylori in reducing the infection rate of the bacterial pathogen in the urban Chinese population.

Autophagy Regulates Putative Anion Transporter 1 Expression in Intestinal Epithelial Cells

Putative anion transporter 1 (PAT-1) is the key oxalate-secreting transporter in the intestine and therefore, maintaining its steady-state levels is critical for oxalate homeostasis. Autophagy is known to modulate the expression of intestinal solute transporters; however, its role in regulating PAT-1 has not been examined. Autophagy in Caco-2 cells was induced by either rapamycin treatment or by nutrient deprivation and assessed by conventional autophagy marker proteins. ATG7 (autophagy-related 7) protein expression was attenuated by ATG7-siRNA in Caco-2 cells or by utilising ATG7KO mice. PAT-1 protein levels in Caco-2 cells were significantly reduced by rapamycin or by nutrient deprivation at 48 and 72 h. Concomitantly, the LC3II/I ratio was increased, and p62 levels were significantly decreased, confirming the induction of autophagy. Nutrient deprivation for 6 h also caused a significant decrease in the surface levels of PAT-1. PAT-1 protein levels were increased by the siRNA-mediated ATG7 knockdown in Caco-2 cells and in the ileum of ATG7KO mice. In summary, Autophagy in intestinal epithelial cells modulates the basal levels of PAT-1 protein and may play a critical role in the maintenance of oxalate homeostasis.

Meta-analysis and systematic review of long-term quality of life and recurrence following elective surgery versus non-operative management for colonic diverticulitis

BACKGROUND

Limited data exist on long-term outcomes of elective surgery versus nonoperative management of complicated diverticulitis. We aimed to assess long-term outcomes of nonoperative management versus elective surgery in patients initially conservatively treated for diverticulitis.

METHODS

Systematic review of PubMed and Scopus for studies comparing elective resection and nonoperative management of acute diverticulitis from inception to December 2023 was conducted. Studies reporting long-term outcomes (≥2 years) were included. Main outcomes were quality of life, disease recurrence, and long-term ostomy.

RESULTS

After screening 1,488 studies, 3 randomized controlled trials and 6 retrospective studies (3,621 patients; 44.4% males; median age: 59 years) were included. Elective colon resection was associated with significantly higher Gastrointestinal Quality of Life Index scores (mean difference 6.06, 95% confidence interval 2.22-9.9, P = .002), and Short Form Health Survey-36 scores for both mental and physical components (mean differences: 3.47 and 3.42, respectively). Gastrointestinal Quality of Life Index score difference was more noted in the randomized controlled trial subgroup analysis (mean difference: 8.68, 95% confidence interval 3.37-14.0, P = .001). These effect sizes were small according to Cohen d (0.34 and 0.31, respectively). Elective resection was associated with significantly less disease recurrence (odds ratio 0.29, 95% confidence interval 0.13-0.64, P = .002) than nonoperative management. No significant difference in long-term stoma was observed (odds ratio 1.52, 95% confidence interval 0.89-2.6, P = .12).

CONCLUSION

Elective resection was associated with significantly improved long-term quality of life and reduced recurrence of acute diverticulitis. However, the clinical significance of the difference in quality of life scores between the treatment approaches remains uncertain because of the small effect size observed. Any quality of life improvements must be balanced against surgical morbidity and mortality.

Systematic review for VNS vs. pharmaceutical modulations for multifaceted neurological disorder management through cross-case, network meta-analysis

BACKGROUND

As an adjunct or alternative to conventional pharmacotherapy, vagus nerve stimulation (VNS) which is FDA-approved has arisen as a novel means for various neurological disorders.

METHOD

We searched multiple databases (through 2024) for randomised trials and observational studies of VNS (invasive and transcutaneous) and pharmacological treatments (e.g. cholinergic agents, antiepileptics, antidepressants) across several neurological disorders. Prior to comparing between VNS and pharmacological treatments, subgroup analyses of VNS studies were performed for disorder type, patient demographics, VNS stimulation parameters, and treatment duration to illustrate whether VNS itself can be effective to a satisfactory extent to be compared against the conventional method. Efficacy and adverse effects were evaluated, based on the proportion of patients achieving more than 50 % symptom reduction or equivalent clinical improvement, or all-cause mortality where applicable. Evaluation between VNS and pharmacological treatments was performed through network meta-analysis, followed by assessment of heterogeneity (I2) and meta-regression. Risk of bias was evaluated with Cochrane criteria, and all studies (including those with high risk of bias) were included in the primary analysis (with sensitivity analyses excluding high-bias studies).

RESULTS

We included 56 VNS-related studies (n = 5773 participants) and 29 pharmacological drug-based studies (n = 14827 participants) from spanning epilepsy, depression, migraine/headache, Alzheimer's disease, inflammatory disorders, and heart failure. A network meta-analysis directly comparing VNS to pharmacological drugs yielded an overall advantage for VNS (summary SMD = 0.27 favouring VNS, 95 % CI 0.19-0.35). However, the high heterogeneity and risk of bias have been assessed, indicating potential issues with the VNS studies.

CONCLUSION

Overall, VNS was shown to be a viable therapeutic modality across diverse neurological disorders, superior to standard pharmacological treatments with a distinct adverse effect profile. It appears particularly beneficial in conditions where conventional drugs have limited success (e.g. refractory epilepsy, depression), although patient-specific factors influence outcomes. Further high-quality trials are anticipated to optimise stimulation parameters, confirm long-term benefits, and manage patient selection for VNS.

Poor agreement between biopsies and endoscopic submucosal dissection specimens of Esophageal and Gastric Epithelial Lesions in a western setting

BACKGROUND

Endoscopic forceps biopsy is the primary method for obtaining mucosal tissues, but can lead to false negatives.

AIMS

To assess the agreement between endoscopic biopsies and submucosal dissection specimens in esophageal and gastric epithelial lesions and to identify factors associated.

METHODS

Cross-sectional study using data from the Spanish national multicenter endoscopic submucosal dissection register. Patients, lesions and technical characteristics were prospectively collected. Prognostic factors for discrepancies were analyzed.

RESULTS

604 endoscopic submucosal dissection with previous biopsies were performed between January 2016 and December 2023 across 32 centers. 48.7% presented disagreement between biopsies and endoscopic submucosal dissection; specifically, 40.4% were underestimated by endoscopic biopsy. Carcinoma was detected in 270 endoscopic submucosal dissection specimens, with 54.8% not suspected on the initial biopsy. The carcinomas already diagnosed with the biopsy presented more submucosal and lymphovascular invasion. Notably, a larger lesion (≥ 22 mm) was a significant predictor for histological upstaging.

CONCLUSIONS

The high rate of disagreement between endoscopic forceps biopsy and endoscopic submucosal dissection highlights biopsies limitations in accurately diagnosing esophageal and gastric epithelial lesions. In this setting, endoscopic submucosal dissection should be used not only as a treatment option, but also as a valuable diagnostic tool.