Laparoendoscopic Rendezvous: An Effective and Safe Approach in the Management of Cholecysto-Choledocholithiasis in Selected Patients

Background: Different techniques have been proposed to manage Cholecysto-choledocholithiasis (CCL) advantageously in one stage. Among these, Laparoendoscopic Rendezvous (LERV) addresses the CCL issue with a laparoscopic cholecystectomy, with insertion of a guide wire into the common bile duct through an incision of the cystic duct, followed by the clearance of the bile duct carried out by the endoscopists. The aim of this study was to evaluate the safety and the efficacy of the one-stage vs. a two-stage approach (pre-operative ERCP followed by cholecystectomy), and to compare our results with data from the current literature. Methods: All patients that underwent LERV in our facilities between January 2018 and December 2023 were evaluated. As a control group, we included patients that underwent a two-stage technique called the "sequential approach". The primary outcome was to evaluate the efficacy in obtaining complete clearance of the common bile duct (CBD). The secondary outcomes included morbidity, mortality, operative time, conversion rate, hospital stay and CDB stone recurrence. Results: 120 patients in the LERV group were included; meanwhile, 70 patients underwent pre-operative ERCP plus cholecystectomy. A 97% bile duct clearance success rate in the LERV group and 93% in the ERCP group was observed, respectively. The median intraoperative time for the one-stage technique was 122 min (p < 0.001) and the median hospital stay was 4 days (p < 0.001). In the LERV group, an overall morbidity of 15% was reported (18/120): 15 Clavien-Dindo type 1, one type 3a and two type 3b (p < 0.001). At a median follow-up of 14 months, five patients experienced stone recurrence. In the ERCP group, we had a 93% success rate; meanwhile, we had longer hospitalization (p < 0.001), 27% post-ERCP pancreatitis (p < 0.001) and a cumulative morbidity of 30%. Conclusions: LERV offers the advantages of a being single-stage procedure and shorter hospitalization, with a lower risk of clinically relevant post-ERCP pancreatitis and failed CBD cannulation.

The epidemiological study of family-based Helicobacter pylori screening and its benefits: a cross-sectional study

This study aimed to manage Helicobacter pylori (H. pylori) infection through a family-centered approach. It conducted a two-year follow-up on infected individuals' family members in Yichun, Jiangxi, China, to gain comprehensive insights into the transmission dynamics, treatment adherence, and associated risk factors of H. pylori within households. A retrospective analysis was performed on the data obtained from households in Yichun City that participated in the nationwide multicenter H. pylori prevalence study in 2021, along with the corresponding subsequent follow-up data. The collected information encompassed fundamental demographic details of the families, their lifestyle patterns, and the status of H. pylori infection. Among 514 households, 222 comprised two individuals, whereas 68 constituted larger families with five or more members. All member was infected in 9.34% of households. Larger family sizes (≥ 5 individuals) and higher generational counts were closely associated with H. pylori infection (e.g., family size > 6: OR 4.46, 95%CI 1.29 to 15.46). Adult age, marital status, and household members' infections were identified as primary risk factors (e.g., married individuals: OR 2.03, 95%CI 1.56 to 2.65). Students and previously uninfected individuals exhibited lower infection risks (e.g., tested as negative: OR 0.48, 95%CI 0.31 to 0.73). Maternal, paternal, or sibling infections were linked to increased risks of child infections (e.g., mother infected: OR 2.58 95%CI 1.37 to 4.87). Successful eradication in ≥ 2 individuals reduced the infection risk for other members (OR 0.25, 95%CI (0.07 to 0.89). H. pylori displayed noticeable clustering infection characteristics within families. This study lends support to family-based management strategies, but given suboptimal adherence to household management, there is a need to enhance education on the hazards of H. pylori before implementing screening programs.

Multiplex PCR-Mass Spectrometry Mini-Sequencing Technology Detected Antibiotic Resistance of Helicobacter pylori to Six Antibiotics

The abuse of antibiotics has led to widespread resistance to Helicobacter pylori (H. pylori) in the population. There is an urgent need to establish a method to detect multiple antibiotic resistance rapidly. This study aimed to construct a novel strategy for the high-throughput detection of H. pylori's resistance to varying antibiotics using multiplex PCR-mass spectrometry mini-sequencing (mPCR-MS mini-sequencing) technology. This study detected the resistance of H. pylori to six antibiotics using eight mutated sites (23S rRNA-2143; pbp1A-1667, 1684, 1240; gyrA-261, 271, 573; and 16S rRNA-928) of four resistance genes (pbp1A, gyrA, 23S rRNA, and 16S rRNA), and 525 were detected in all 528 results (99.43%). Then, the culture-based phenotypic drug susceptibility testing (DST) method was used as a reference for drug resistance detection. We found that the consistency rate between mPCR-MS mini-sequencing with the DST results of amoxicillin (AMX), moxifloxacin (MOX), levofloxacin (LEV), clarithromycin (CLA), azithromycin (AZI), and tetracycline (TET) were 95.5% (63/66), 77.3% (51/66), 68.2% (45/66), 93.9% (62/66), 92.4% (61/66), and 97.0% (64/66), respectively. This method was high-throughput and extensible, easily improving the entire detection system by adding new mutation sites. mPCR-MS mini-sequencing technology provides a new approach to mutation sites related to H. pylori's antibiotic resistance.

Bioaccessible Bread Melanoidins Modulate Oxidative Stress, Reduce Inflammation and Suppress Adhesion of Helicobacter pylori to Caco-2 Cells

Background/Objectives: Helicobacter pylori is a major contributor to gastric infections; it is prevalent in humans and associated with gastrointestinal diseases. In recent years, the increase in antimicrobial resistance has contributed to the need for alternative approaches, prompting interest in natural products with antimicrobial and antivirulence properties. This study investigated the effect of bioaccessible melanoidins from common and soft bread crust against H. pylori infection. Methods: Melanoidins were extracted using dead-end ultrafiltration, and bioaccessible fractions were obtained through in vitro digestion. The bactericidal effect of melanoidins was assessed at 2% and 4% concentrations over 24 and 48 h. The effect on H. pylori adhesion of 100 μg/mL and 200 μg/mL of gastric and intestinal bioaccessible fractions of melanoidins was evaluated in Caco-2 cells. Results: The bactericidal effect of melanoidins revealed significant efficacy, with a greater effect for soft bread melanoidins. The gastric fractions exhibited a higher inhibitory effect, which is crucial for gastric mucosa, the primary site of H. pylori infection. Both bioaccessible fractions showed anti-inflammatory and antioxidant effects against H. pylori-induced inflammation, particularly in the gastric fractions. This was evidenced by a reduction in interleukin-6 and interleukin-8 release and an enhancement in interleukin-10 release. The observed reduction in reactive oxygen species (ROS) and the maintenance of glutathione levels indicate an improved redox status. Conclusions: This study emphasizes the potential of melanoidins, especially from soft bread, as bioactive compounds against H. pylori, offering insights for future functional food development.

Accelerated biological aging mediates the association between inflammatory markers with Helicobacter pylori infection and mortality

BACKGROUND

The aim of this study was to explore the systemic inflammation response in relation to mortality in Helicobacter pylori (H. pylori) infection, and whether this relationship was mediated by accelerated biological aging.

METHODS

This cross-sectional study encompassed U.S. participants from National Health and Nutrition Examination Survey (NHANES) in 1999-2000. Kaplan-Meier survival curve, Cox regression analysis, K-means clustering, mediation analysis and restricted cubic spline (RCS) were used to explore the relationships between inflammatory markers, biological aging, H. pylori infection and all-cause mortality.

RESULTS

A total of 3509 U.S. participants enrolled form NHANES 1999-2000. Compared with H. pylori seronegative participants, H. pylori seropositive participants had significantly higher all-cause mortality (P < 0.001). Among these H. pylori seropositive participants, both phenotypic age acceleration (PhenoAgeAccel) and all-cause mortality were positively associated with the increased levels of inflammation (P < 0.001). A significant indirect effect of inflammatory markers (neutrophil count and systemic inflammatory response index (SIRI)) with H. pylori infection on all-cause mortality through PhenoageAccel was found, and the proportions mediated were 50.0% and 49.1%, respectively.

CONCLUSION

The elevation of blood inflammatory markers is positively associated with an increased risk of all-cause mortality in H. pylori infection among U.S. population, and accelerated biological aging might be one of its biological mechanisms.

A comparison of the efficacy and safety of Chinese patent medicine combined with Western medicine for Helicobacter pylori-related gastric ulcer: A systematic review and network meta-analysis

BACKGROUND

The aim of this network meta-analysis (NMA) was to compare the effectiveness and safety of different Chinese patent medicines (CPMs) combined with Western medicines (WMs) regimen versus WMs alone in the treatment of Helicobacter pylori-related gastric ulcer (GU).

METHODS

A comprehensive search was conducted on databases from their inception to May 31, 2023, to identify all randomized controlled trials (RCTs) that investigated the efficacy of CPMs in combination with conventional WMs in the treatment of patients with H pylori-related GU. Using Cochrane risk of bias assessment tool, we evaluated the methodological quality of RCTs. R version 4.2.3 and Stata version 15.1 software were cross-merged to conduct pairwise NMA.

RESULTS

A total of 35 studies involving 4667 patients and 11 CPMs were identified. Eleven CPMs were analyzed, including Pingwei Capsule (PWC), Kangfuxin Solution (KFXS), Shugan Jieyu Capsule (SGJYC), Weisu Granule (WSG), Qiwei Weitong Capsule (QWWTC), Beiling Weitong Granule (BLWTG), Anweiyang Capsule (AWYC), Jinghua Weikang Capsule (JHWKC), Weifuchun Tablet (WFCT), Wenweishu Capsule (WWSC), and Weidean Capsule (WDAC). Results showed that the combination of CPM and WM was more effective relative to the WM regimen alone. NMA revealed that WWSC combined with the WM yielded superior results in enhancing clinical outcomes and mitigating GU recurrence rates. PWC combined with the WM showed the best performance in improving the H pylori eradication rate. WFCT combined with the WM had the most optimal performance in controlling gastrin (GAS) and motilin (MTL) levels. KFXS combined with the WM showed the best results in terms of reducing the incidence of adverse events.

CONCLUSION

Our NMA findings indicate that the combination of WWSC, PWC, WFCT, and KFXS with WM may be more effective and advantageous outcomes compared to other CPMs. Due to the limitations of this study, future research should employ larger sample sizes and multicenter RCTs to conduct real-world clinical studies.

Immunoinformatic strategy for developing multi-epitope subunit vaccine against Helicobacter pylori

Helicobacter pylori is a gram-negative bacterium that persistently infects the human stomach, leading to peptic ulcers, gastritis, and an increased risk of gastric cancer. The extremophilic characteristics of this bacterium make it resistant to current drug treatments, and there are no licensed vaccines available against H. pylori. Computational approaches offer a viable alternative for designing antigenic, stable, and safe vaccines to control infections caused by this pathogen. In this study, we employed an immunoinformatic strategy to design a set of candidate multi-epitope subunit vaccines by combining the most potent B and T cell epitopes from three targeted antigenic proteins (BabA, CagA, and VacA). Out of the 12 hypothetical vaccines generated, two (HP_VaX_V1 and HP_VaX_V2) were found to be strongly immunogenic, non-allergenic, and structurally stable. The proposed vaccine candidates were evaluated based on population coverage, molecular docking, immune simulations, codon adaptation, secondary mRNA structure, and in silico cloning. The vaccine candidates exhibited antigenic scores of 1.19 and 1.01, with 93.5% and 90.4% of the most rama-favored regions, respectively. HP_VaX_V1 and HP_VaX_V2 exhibited the strongest binding affinity towards TLR-7 and TLR-8, as determined by molecular docking simulations (ΔG = -20.3 and -20.9, respectively). Afterward, multi-scale normal mode analysis simulation revealed the structural flexibility and stability of vaccine candidates. Additionally, immune simulations showed elevated levels of cell-mediated immunity, while repeated exposure simulations indicated rapid antigen clearance. Finally, in silico cloning was performed using the expression vector pET28a (+) with optimized restriction sites to develop a viable strategy for large-scale production of the chosen vaccine constructs. These analyses suggest that the proposed vaccines may elicit potent immune responses against H. pylori, but laboratory validation is needed to verify their safety and immunogenicity.

Risk of Gastric Adenocarcinoma After Eradication of Helicobacter pylori

BACKGROUND AND AIMS

Helicobacter pylori infection of the stomach is the main risk factor for gastric noncardia adenocarcinoma; however, less is known on how eradication of H pylori influences the risk of this tumor over time, particularly in Western populations. The aim of this study was to delineate how the risk of gastric noncardia adenocarcinoma develops over time after H pylori eradication treatment in a Western population compared with the background population.

METHODS

This population-based cohort study included all adults having received H pylori eradication treatment between 1995 and 2019 in any of the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). Standardized incidence ratios (SIRs) with 95% confidence intervals (CIs) were calculated by comparing the gastric noncardia adenocarcinoma incidence in the study cohort with the incidence in the background population of the same age, sex, calendar period, and country. Time trends in SIR were assessed using Poisson regression.

RESULTS

Among 659,592 participants having received H pylori eradication treatment, contributing 5,480,873 person-years at risk, 1311 developed gastric noncardia adenocarcinoma. During up to 24 years of follow-up, the SIR was initially higher than the background population (SIR, 2.27; 95% CI 2.10-2.44, 1-5 years after treatment), and then gradually decreased over time and approached the level of the background population from 11 years after treatment (SIR, 1.11; 95% CI 0.98-1.27, 11-24 years after treatment).

CONCLUSION

This study revealed a decreasing incidence of gastric noncardia adenocarcinoma after H pylori eradication treatment in 5 Western populations. The risk became virtually similar to the background population from 11 years after treatment.

Targeting Helicobacter pylori Through the "Muco-Microbiotic Layer" Lens: The Challenge of Probiotics and Microbiota Nanovesicles

The muco-microbiotic layer represents a critical biological frontier in gastroenterology, emphasizing the intricate interplay between the protective mucus, its resident microbiota, and extracellular vesicles. This review explores the functional morphology of the gastric mucosa, focusing on the gastric muco-microbiotic layer, its role as a protective barrier, and its dynamic interaction with some of the most insidious pathogens such as Helicobacter pylori (H. pylori). Highlighting the multifaceted mechanisms of H. pylori pathogenesis, we have delved into bacterial virulence factors, host immune responses, and the microbiota's regulatory effects. Novel therapeutic strategies for H. pylori eradication, including traditional antibiotic therapies and emerging adjuvant treatments like probiotics and probiotic-derived extracellular vesicles, are critically examined. These findings underscore the potential of targeting nanovesicular interactions in the gastric mucosa, proposing a paradigm shift in the management of H. pylori infections to improve patient outcomes while mitigating antibiotic resistance.

Natural products based on Correa's cascade for the treatment of gastric cancer trilogy: Current status and future perspective

Gastric carcinoma (GC) is a malignancy with multifactorial involvement, multicellular regulation, and multistage evolution. The classic Correa's cascade of intestinal GC specifies a trilogy of malignant transformation of the gastric mucosa, in which normal gastric mucosa gradually progresses from inactive or chronic active gastritis (Phase I) to gastric precancerous lesions (Phase II) and finally to GC (Phase III). Correa's cascade highlights the evolutionary pattern of GC and the importance of early intervention to prevent malignant transformation of the gastric mucosa. Intervening in early gastric mucosal lesions, i.e., Phase I and II, will be the key strategy to prevent and treat GC. Natural products (NPs) have been an important source for drug development due to abundant sources, tremendous safety, and multiple pharmacodynamic mechanisms. This review is the first to investigate and summarize the multi-step effects and regulatory mechanisms of NPs on the Correa's cascade in gastric carcinogenesis. In phase I, NPs modulate Helicobacter pylori urease activity, motility, adhesion, virulence factors, and drug resistance, thereby inhibiting H. pylori-induced gastric mucosal inflammation and oxidative stress, and facilitating ulcer healing. In Phase II, NPs modulate multiple pathways and mediators regulating gastric mucosal cell cycle, apoptosis, autophagy, and angiogenesis to reverse gastric precancerous lesions. In Phase III, NPs suppress cell proliferation, migration, invasion, angiogenesis, and cancer stem cells, induce apoptosis and autophagy, and enhance chemotherapeutic drug sensitivity for the treatment of GC. In contrast to existing work, we hope to uncover NPs with sequential therapeutic effects on multiple phases of GC development, providing new ideas for gastric cancer prevention, treatment, and drug development.

Over- and Underuse of Proton Pump Inhibitors in Nursing Homes: A Multisite Longitudinal Cohort Study

OBJECTIVES

Proton pump inhibitors (PPIs) are used to manage excess stomach acid production and provide gastroprotection from bleeding risk-increasing drugs (BRIDs). We aimed to determine the prevalence of potentially inappropriate PPI use in nursing homes and associated factors.

DESIGN

Longitudinal cohort study using 8 years of electronic data.

SETTING AND PARTICIPANTS

The study included 6439 permanent residents aged ≥65 years from 34 homes managed by 2 aged care providers in New South Wales.

METHOD

Continuous PPI use (>12 weeks) in the absence of long-term BRID (>30 days) use was deemed inappropriate overuse whereas long-term BRID use without concomitant PPI for gastroprotection was classified as inappropriate underuse. Binary logistic regression was used to determine factors associated with PPI overuse.

RESULTS

Fifty-four percent of residents (n = 3478) received a PPI, with a median duration of 46 weeks, whereas 58.5% (n = 3770) were long-term BRID users. Four of 5 PPI users (83.6%, n = 2906) used PPIs for >12 weeks, and after accounting for BRID use, the prevalence of inappropriate PPI overuse was 27.1% (n = 944). PPI overuse was 4 times more likely in residents in provider A compared with residents in provider B [odds ratio (OR) 4.08, 95% CI 2.73-6.09]. The prevalence of PPI underuse was 38.5% (n = 1452).

CONCLUSIONS AND IMPLICATIONS

One in 4 PPI users exceeded the clinically recommended duration, whereas 2 in 5 long-term BRID users did not receive a PPI for gastroprotection. There is a pressing need for tailored interventions, such as medication reviews and deprescribing initiatives, to improve PPI prescribing.

Multidisciplinary Approach Improves Eradication Rate and Safety in Refractory Helicobacter pylori Infection

INTRODUCTION

Helicobacter pylori (HP) infection is prevalent worldwide and contributes to various gastrointestinal diseases. Eradication therapy is crucial in managing HP infection, but antibiotic resistance has led to refractory cases, complicating treatment outcomes and increasing the risk of adverse events. This study aimed to evaluate the effectiveness of a multidisciplinary approach, termed HP Multidisciplinary Team (MDT) Clinic, in improving eradication rates and safety in patients with refractory HP infection.

METHODS

Between November 2020 and November 2023, 153 patients with refractory HP infection were included, with 51 patients in the non-HP-MDT group and 102 patients in the HP-MDT group. The HP-MDT clinic provided personalized treatment plans, patient education, and follow-up. Genetic testing was conducted in selected cases to assess resistance patterns.

RESULTS

Patients attending the HP-MDT clinic showed significantly higher eradication rates compared with those in the non-HP-MDT group (80.39% vs 50.98%, P < 0.001). Logistic regression analysis confirmed that HP-MDT clinic attendance was independently associated with higher eradication rates (odds ratio: 4.43, 95% CI: 2.02 to 9.71, P < 0.001). Genetic testing revealed high rates of antibiotic resistance, particularly to clarithromycin (10/11, 90.91%) and metronidazole (11/11, 100%). Despite resistance, the HP-MDT approach achieved a high eradication rate of 92.31%. Adverse drug reactions occurred in 12.75% of patients in the HP-MDT group, predominantly mild gastrointestinal symptoms.

DISCUSSION

The HP-MDT clinic, integrating medical, pharmaceutical, and nursing expertise, significantly improved eradication rates and safety in patients with refractory HP infection. Personalized treatment plans, patient education, and genetic testing contributed to successful outcomes with minimal adverse events.

Spectrum of Upper Gastrointestinal Diseases in Patients Presenting with Dyspepsia-A First Report from Myanmar

Background

Dyspepsia is associated with a variety of benign and malignant gastrointestinal diseases. The aim of the study was to evaluate the spectrum of upper gastrointestinal endoscopic findings in patients presenting with dyspepsia.

Methods

This is a retrospective study on consecutive patients with dyspepsia undergoing upper gastrointestinal endoscopy at the gastroenterology department of Thingangyun General Hospital, University of Medicine 2, Yangon, from January 1, 2017, to December 31, 2019.

Results

In this study, 1650 patients were recruited retrospectively. Forty-nine patients were excluded due to incomplete data entry. There were 883 female (55%) out of 1601 patients. The mean age was 50.5 ± 15.82 years. The endoscopic findings were gastric/duodenal erosion (10.8%), erosive esophagitis (5.1%), duodenal ulcer (3.5%), gastric ulcer (4.4%), gastroesophageal varices (3.49%), esophageal cancer (0.8%), and gastric cancer (5.3%); in which early-onset gastric cancer contributed for 17.6%. Miscellaneous diagnoses were 4.2%, and findings were normal at 62.5%. Significant endoscopy findings were diagnosed in patients over 45 years of age. Helicobacter pylori infection was found in 40.6% of the total study population, 52% of gastric cancers, 50% of gastric ulcers, 51.2% of duodenal ulcers, and 49.3% of gastric/duodenal erosions.

Conclusion

Significant endoscopic findings in dyspeptic patients are frequent in our data. A considerable number of gastric cancer were diagnosed in patients under 45 years of age. H. pylori is prevalent in our dyspepsia population. The age threshold of 40-45 years for both males and females could be reasonable for the use of endoscopy in patients with dyspepsia in our population.

Dietary intake of isoflavones and coumestrol and risk of pancreatic cancer in the prostate, lung, colorectal, and ovarian cancer screening trial

BACKGROUND

Although phytoestrogens modulated pancreatic tumour growth in experimental studies, it remains unclear whether phytoestrogen intake is associated with pancreatic cancer.

METHODS

Of 92,278 persons who completed the Diet History Questionnaire in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, 346 were diagnosed with pancreatic cancer within a median follow-up of 9.4 years. Cox proportional hazards regression was used to evaluate pancreatic cancer risk in relation to phytoestrogen intake.

RESULTS

After adjustment for confounders, intakes of glycitein and formononetin were associated with a reduced risk of pancreatic cancer [highest vs. lowest quartile, hazard ratio (HR) (95% confidence interval (CI)) for glycitein: 0.60 (0.39, 0.92); P for linear trend: 0.01; HR for formononetin: 0.51 (0.37, 0.70); P for linear trend: 0.005]. These associations were stronger and their linear trends across the quartiles of intakes were more statistically significant among ever smokers than never-smokers. A reduced risk was also observed for ever smokers in the highest quartile of total isoflavones or daidzein compared with those in the lowest quartile.

CONCLUSIONS

Our study suggests that high intakes of total isoflavones and some individual isoflavones were inversely associated with pancreatic cancer risk, but this potential protective effect was confined to ever smokers.

Yiqi Huayu Jiedu formula inhibits JAK2/STAT3-mediated partial EMT in treating chronic atrophic gastritis

BACKGROUND

Chronic atrophic gastritis (CAG) is a precursor to gastric cancer, a leading cause of cancer-related deaths worldwide. Despite current therapeutic strategies, preventing the transition from gastritis to cancer remains a challenge. Traditional Chinese Medicine (TCM), particularly the Yiqi-Huayu-Jiedu (YQHYJD) formula, have exhibited promising results in CAG management. However, the pharmacological underpinnings of this formula remain elusive.

PURPOSE

The study aimed to elucidate the pharmacological mechanisms of the YQHYJD formula in treating CAG and its role in inhibiting the progression to gastric cancer through the modulation of the "inflammation-cancer" sequence.

METHODS

Mass spectrometric analysis of YQHYJD formula-containing serum was conducted to determine the active compounds involved in CAG treatment. A CAG rat model was induced using a combination of deoxycholic acid and ammonia, while a gastric precancerous lesion cell model was generated by exposing GES-1 cells to deoxycholic acid. Both models were treated with varying concentrations of the YQHYJD formula to assess its effects of the JAK2/STAT3 signaling-mediated epithelial-mesenchymal transition (EMT) pathway.

RESULTS

Mass spectrometry analysis identified 80 active compounds in the YQHYJD formula, including quercetin. Network pharmacology analysis revealed that these active compounds may exert their therapeutic effects on CAG through various mechanisms, including the JAK/STAT signaling. Using rat and cellular models of CAG, we found that the JAK/STAT pathway is activated alongside partial epithelial-mesenchymal transition (pEMT). YQHYJD treatment effectively mitigated the activation of the JAK2/STAT3 activation and pEMT. Furthermore, the therapeutic effect of the YQHYJD formula was maintained even in the presence of Colivelin or overexpressed STAT3.

CONCLUSIONS

The YQHYJD formula treats CAG by inhibiting the JAK2/STAT3 -mediated pEMT, thereby suppressing the gastric "inflammation-cancer" transformation. This study provides mechanistic insights into the efficacy of YQHYJD in CAG treatment and suggests new therapeutic strategies for preventing gastric cancer development.

A rare case of sporadic metastatic colorectal cancer with glioblastoma multiforme: a challenging clinical scenario

Colorectal cancer (CRC) is the third most commonly diagnosed and leading cause of death worldwide. On the other hand, glioblastoma multiforme (GBM) is the most prevalent and aggressive primary malignant brain tumor in adults. Inherited diseases of DNA mismatch repair (MMR) can cause multiple cancers in the same patient including CRC and GBM. In this study, we report a 59-year-old woman presented with fatigue, constipation, abdominal distention, perianal pain, right-sided arm weakness, and personality changes. After investigations, it was diagnosed that sporadic metastatic CRC and GBM occurred simultaneously in the same patient, which was confirmed by colonoscopy, biopsy, imaging, and molecular testing. As the treatment of two cancers in the same patient is unique and complex, the absence of guidelines for such cases was discussed in a multidisciplinary tumor board including surgeons, medical, and radiation oncologists.

Serum metabolic profiling analysis of chronic gastritis and gastric cancer by untargeted metabolomics

Chronic gastritis (CG), particularly when associated with Helicobacter pylori (H. pylori) infection, is a significant precursor to gastric cancer (GC), a leading cause of cancer-related deaths worldwide. The persistent inflammation in CG, driven by factors such as H. pylori, induces oxidative stress and DNA damage in gastric epithelial cells, which can lead to malignant transformation. Atrophic gastritis, a form of CG, can be categorized into autoimmune and H. pylori-associated types, both of which increase the risk of GC development, particularly when compounded by external factors like smoking and dietary habits. This manuscript explores the pathophysiological mechanisms underlying CG and its progression to GC, highlighting the critical role of metabolomics in advancing our understanding of these processes. Metabolomics, the comprehensive study of metabolites, offers a novel approach to identifying biomarkers that could facilitate early detection and improve the accuracy of GC diagnosis and prognosis. The analysis of metabolic alterations, particularly in glucose, lipid, and amino acid metabolism, reveals distinct biochemical pathways associated with the progression from benign gastritis to malignancy. Integrating metabolomic profiling with traditional diagnostic methods can revolutionize GC management, enabling more personalized treatment strategies and improving clinical outcomes. However, significant challenges remain, including the need to validate biomarkers across diverse populations and standardize metabolomic techniques. Future research should address these challenges to fully realize the potential of metabolomics in early GC detection and treatment, ultimately aiming to reduce the global burden of this deadly disease.

Effect of daphnetin, the coumarin derivative isolated from Daphne genus, on Helicobacter pylori adhesion to gastric epithelial cells

BACKGROUND

Adherence of Helicobacter pylori to the surface of the gastric mucosa is the initial and crucial step for its survival and colonization in the harsh conditions of the stomach. We had previously demonstrated that daphnetin has anti-adhesion effect.

PURPOSE

This study aims to explore the mechanisms of daphnetin to reduce H. pylori adhesion to gastric epithelial cells (GES-1).

METHODS

Fluorescence microscopy and urease assay were used to observe and validate the anti-adhesion effect of daphnetin. Terminal deoxynucleotidyl transferase dUTP nick end labeling, comet assay and agarose gel-based assay were conducted to evaluate the level of DNA damage. Quantitative real-time polymerase chain reaction, western blotting, electrophoretic mobility shifts assay and enzyme-linked immunosorbent assay were performed to investigate the mechanisms of the anti-adhesion effect of daphnetin.

RESULTS

Our results showed that daphnetin decreased H. pylori adhesion to GES-1 in time- and dose-dependent manners. The mechanisms by which daphnetin inhibits H. pylori adhesion involved the inducing of DNA double-strand breaks, the up-regulating of recA transcription leading to RecA binding at 1018-1597 site in the babA promoter, the decreasing of babA/babB transcription ratio, the decreasing of BabA expression and its interaction with Lewis b antigen.

CONCLUSION

Our results suggested that daphnetin significantly inhibits H. pylori adhesion to GES-1 through the RecA-BabA pathway. To our knowledge, this is the first report on the mechanisms of daphnetin affecting H. pylori adhesion to GES-1.

Perioperative care bundle versus conventional perioperative care in pediatric patients undergoing minimally invasive digestive endoscopy

Objective

To investigate the effect of perioperative care bundle in pediatric patients undergoing minimally invasive digestive endoscopy.

Methods

This was a retrospective study using clinical records of pediatric patients who underwent minimally invasive digestive endoscopy surgery at Hebei Children's Hospital from May 2020 to October 2023. Patients were divided into Care bundle group and Conventional care group based on the treatment received and matched for age, gender, and body mass index in 1:1 ratio. Perioperative vital signs, postoperative recovery, incidence of complications, and family members' satisfaction with nursing care were analyzed.

Results

A total of 98 pediatric patients were included, with 49 patients in each group. After surgery, diastolic blood pressure (DBP), systolic blood pressure (SBP), heart rate (HR), and mean arterial pressure (MAP) of both groups increased compared to preoperative values and were significantly lower in the Care bundle group compared to the Conventional care group (P<0.05). The time for anal exhaust, time for defecation, time to first out-of-bed activity, time to start eating after surgery, and length of hospital stay were shorter in the Care bundle than the Conventional care group (all P<0.05). The incidence of complications in the Care bundle group (4.08%) was lower than the Conventional care group (16.32%) (P<0.05). The overall family members' satisfaction with the nursing care was considerably higher in the Care bundle group (93.88%) compared to the Conventional care group (81.63%) (P<0.05).

Conclusions

Perioperative care bundle in pediatric patients undergoing minimally invasive digestive endoscopy was shown to be more efficacious than the conventional perioperative care.

Prevalence of Endoscopic and Histological Lesions at Upper Endoscopy: A Cross-Sectional, Multicentre Study in Clinical Practice

Background/Aim

Prevalence of gastroduodenal endoscopic and histological lesions may modify over time due to different factors. We assessed both macroscopic and histological lesions currently detected at upper endoscopy performed in routine practice.

Patients and Methods

Clinical, endoscopic, and histological data of consecutive adult patients referred for upper endoscopy in the 28 participating centres were analysed. Only patients who underwent the first endoscopic examination were considered. Prevalence of erosive/ulcerative lesions, cancers and extensive precancerous lesions in the stomach, and Helicobacter pylori infection was computed.

Results

A total of 1,431 patients underwent endoscopy for gastro-oesophageal reflux symptoms (31.5%), dyspepsia (29.4%), or alarm symptoms (18.5%). Erosive oesophagitis or Barrett's oesophagus was detected in 210 (14.7%) cases, peptic ulcer in 49 (3.4%), and a neoplastic lesion in 17 (1.2%). H. pylori was present in 201 (22.6%) cases, and extensive precancerous lesions on gastric mucosa in 46 (5.6%) patients. Gastric lesions were more prevalent in patients aged ≥50 years (26% vs. 18%; p = 0.001), and peptic ulcers were more frequently detected in patients with H. pylori (9.4% vs. 2.3%; p = 0.001) and in males (5.8% vs. 1.6%; p = 0.001), while neoplastic lesions in patients with alarm symptoms (3.8% vs. 0.6%; p = 0.001).

Conclusions

The overall endoscopic lesions were more prevalent in patients aged ≥50 years, peptic ulcer and erosions were more frequent in H. pylori-infected patients, and extensive gastric precancerous lesions were present in less than 6% of cases.

Exploring the potential protective and anti-inflammatory effects of the crude ethanolic extract of Annona squamosa Linn fruit against Ethanol-mediated gastric erosion

Background

Annona squamosa L. is a medically important fruit that belongs to the family Annonaceae and has many medical benefits, including antiulcer effects.

Aim

The present study explored the potential protection and anti-inflammatory effects of the crude ethanolic extract of Annona squamosa L. (EEA) against ethanol-mediated peptic sever erosion using a rodent model in comparison with a synthetic compound broadly used in clinics to tackle peptic disturbances, known as Omeprazole.

Methods

To do that, twenty-four both sex Wistar rats were assigned into four groups (six rats per group), namely control negative (C-) and control positive (C+) both received normal saline, Omeprazole (OM) administered OM at a dose of 20 mg/kg of body, and crude EEA received the extract at a dose of 200 mg/kg for two weeks. All groups except the C- group received absolute ethanol at a dose of 5 ml/kg of body weight for 1 hour. After euthanization, the gross ulcer index and protection ratio results exhibited a good percentage of protection in the EEA group compared with the C+ and OM groups.

Results

These results were correlated with histopathological examination, which indicated that the gastric lesion of the EEA showed erosion in the pits area and isthmus, including destruction of parietal cells, whereas the gastric lesion of the C+ group showed severe necrosis of epithelial cells of the gastric mucosa, resulting in the absence of all mucosal layers of the affected area. In addition, the results revealed the anti-inflammatory properties of EEA through its ability to control the regulation of TNF-α and IL-1α. Both proteins were downregulated in response to the presence of EEA. Conclusion: To our knowledge, this is the first study to detect high IL-1α in ethanol-induced severe gastric erosion. These results suggested that EEA exhibited protective and anti-inflammatory effects against ethanol-mediated gastric erosion.

Epidemiological, Clinical, and Evolutionary Profile of Helicobacter pylori Infection in the Pediatric Population of the Eastern Region of Morocco: A Series of 118 Cases

INTRODUCTION

Helicobacter pylori (H. pylori) is a bacterium that affects a significant portion of the global population and can lead to gastroduodenal ulcers and gastric cancers in adulthood. In pediatric practice, H. pylori infection is a common concern, although most affected children remain asymptomatic. This study aims to describe the epidemiological, clinical, endoscopic, and histological profile of H. pylori gastritis in the pediatric population of the Eastern region of Morocco.

MATERIALS AND METHODS

 Patients aged between one and 16 years who underwent upper gastrointestinal endoscopy between January 2022 and June 2024 were included in this study. Gastric biopsies were taken, and the presence of H. pylori infection was confirmed by Giemsa staining. Demographic data and clinical and endoscopic characteristics were collected, along with histopathological results according to theSydneysystem.

RESULTS

Among the 230 children studied, 118 (51%) were infected with H. pylori, with the prevalence of infection increasing with age, notably in children aged between 10 to 16 years (46.61%). A female predominance was observed, representing 59% of the cases. The majority of children (68%) came from disadvantaged socioeconomic backgrounds. Abdominal pain was the primary symptom, reported in 60.5% of infected children. All patients exhibited macroscopic gastritis, with petechial and erosive features found in 59% and 62% of cases, respectively. Histologically, H. pylori gastritis was active in 87.2% of cases in the antrum, with a follicular pattern observed in 43.2%. Gastric atrophy was present in 25.42% of the children. The H. pylori eradication rate in our study was 94.92%, with therapeutic failure observed in 5.08% of patients, mainly due to insufficient treatment adherence.

CONCLUSION

Helicobacter pylori infection can cause several gastrointestinal issues, and early detection and treatment are important to prevent complications and promote successful eradication.

Predictive Value of Transabdominal Ultrasonography in Detecting Extrahepatic Bile Duct Obstructive Lesions Compared with Endoscopic Retrograde Cholangiopancreatography

BACKGROUND & OBJECTIVE

Transabdominal ultrasonography (TAUS) remains the initial imaging modality in diagnosis of bile duct obstructive lesions. The purpose of this study was to investigate the predictive value of TAUS in detecting bile duct obstructive lesions in comparison with endoscopic retrograde cholangiopancreatography (ERCP) as the standard method.

METHODS

This retrospective descriptive study analyzed the electronic records of the patients diagnosed with obstructive jaundice from April 2017 to November 2022 at Alsafwa Consultative Medical Center in Almukalla City, Hadhramout, Yemen. All patients involved were diagnosed by TAUS and the diagnosis was confirmed by ERCP. A comparison of the diagnoses was performed.

RESULTS

TAUS and ERCP demonstrated high compatibility in bile duct obstructive lesions, with substantial agreement in detecting cholangiocarcinoma, bile duct stricture, stones, pancreatic cancer, and ampulla of Vater mass (compatibility ranging from 71.4% to 100%, Cohen's Kappa = 0.748, p < 0.001). Pearson correlation indicated strong agreement between the two methods (r=0.856). TAUS showed high sensitivity, and positive predictive value (PPV), particularly for bile duct stones (99.4% sensitivity, 86.7% PPV), and pancreatic carcinoma (94.3% sensitivity, 82.5% PPV), with significant effectiveness in identifying other conditions like bile duct stricture (42.6% sensitivity, 88.5% PPV) and cholangiocarcinoma (70.6% sensitivity, 100% PPV). (p<0.001). Overall, TAUS and ERCP displayed excellent compatibility across various diagnoses, with near-perfect agreement in determining the causes in the ampulla of Vater and bile duct (Kappa= 0.899, p<0.001).

CONCLUSION

TAUS is a reliable and highly valuable imaging modality for detecting and determining the cause and level of bile duct obstruction in patients with obstructive jaundice which offers a non-invasive approach, radiation free, with minimal risk of serious complications.

Comparison of tegoprazan and proton pump inhibitors for first-line Helicobacter pylori eradication: a systematic review with meta-analysis

BACKGROUND

Tegoprazan (TPZ), a potassium-competitive acid blocker with potent gastric acid-suppressing activity, may be a potential agent for treating Helicobacter pylori infection. The study aimed to evaluate the efficacy of TPZ-based therapy for H. pylori eradication compared with proton pump inhibitor (PPI)-based therapy.

RESEARCH DESIGN AND METHODS

A comprehensive literature search was conducted up to August 2024 using PubMed, Embase, and the Cochrane Library to investigate the beneficial effects of TPZ-based therapy for H. pylori eradication. Studies that evaluated the eradication rates between the TPZ- and PPI-based therapies were included. The authors conducted a meta-analysis to calculate the eradication rate and pooled risk ratio (RR) with a 95% confidence interval.

RESULTS

Seven studies involving 3200 patients were included. H. pylori eradication rates did not differ significantly between the TPZ- and PPI-based therapies based on the intention-to-treat (77.3% vs. 76.4%, p = 0.68; pooled RR = 1.01 [0.97-1.05]) and per-protocol (84.3% vs. 84.2%, p = 0.69; pooled RR = 1.01 [0.98-1.04]) analyses. Additionally, no significant difference was observed in the adverse drug events between TPZ- and PPI-based therapies (27.2% vs. 30.8%, p = 0.26; pooled RR = 0.91 [0.76-1.08]).

CONCLUSIONS

H. pylori eradication and adverse drug event rates with TPZ- and PPI-based treatments were similar.

Efficacy of probiotics regimens for Helicobacter pylori eradication: A systematic review, pairwise, and network meta-analysis of randomized controlled trials

BACKGROUND

Helicobacter pylori (H. pylori) infection increases the risks of chronic gastritis, peptic ulcer diseases, and the incidence of gastric cancer. However, antibiotic resistance and adverse effects led to the emergence of alternative treatments such as probiotics supplementation. This systematic review and network meta-analysis aims to assess the efficacy and safety of incorporating probiotics into the various eradication regimens for H. pylori.

METHODS

We searched PubMed, Embase, Scopus, Cochrane, and Web of Science from inception to May 2023, for randomized controlled trials (RCTs) comparing standard therapy (triple or quadrable therapy). for H. pylori with or without probiotic supplementation. Dichotomous data was reported using an odds ratio (OR) for intention-to-treat (ITT) and risk ratios (RR) for side effects with a 95 % confidence interval (CI).

RESULTS

We included 91 RCTs involving 13,680 patients. Adding probiotics to standard treatment was associated with a higher H. pylori eradication rate in the ITT analysis (78.75 % vs 62.43 %, OR = 1.62, 95 % CI: 1.41 to 1.87, P < 0.0001), and per-protocol (PP) analysis (80.33 % vs 72.63 %, OR = 1.60, 95 % CI: 1.34 to 1.91, P < 0.0001). Meanwhile, dyspepsia, gastric ulcer, and peptic ulcer were comparable in both groups. The probiotics group was associated with significantly fewer side effects including, abdominal pain (RR = 0.68, 95 % CI: 0.54 to 0.86), bad taste (RR = 0.64, 95 % CI: 0.53 to 0.78), diarrhea (RR = 0.49, 95 % CI: 0.40 to 0.61), epigastric pain/bloating (RR = 0.76, 95 % CI: 0.65 to 0.88), headache/dizziness (RR = 0.46, 95 % CI: 0.29 to 0.74), (RR = 0.65, 95 % CI: 0.55 to 0.77), or nausea/vomiting (RR = 0.69, 95 % CI: 0.56 to 0.83). The network meta-analysis showed that, compared to the placebo, Bifidobacterium longum had the highest efficacy in eradicating H. pylori (ITT: 81.06 % vs 64.88 %, PP: 88 % vs 75.71 %) (OR = 2.52, 95 % CI: 1.18 to 5.49).

CONCLUSION

Adding probiotics to standard H. pylori therapy not only increased the rate of eradication but also reduced some of the adverse reactions throughout therapy, particularly nausea, vomiting, diarrhea, abdominal pain, epigastric pain/bloating, and taste issues.

Gut microbiota in symptomatic uncomplicated diverticular disease stratifies by severity of abdominal pain

OBJECTIVE

Patients with symptomatic uncomplicated diverticular disease (SUDD) may have a disrupted gut microbiota. However, current data are from small sample studies, and reported associations vary widely across studies. We aimed to profile the fecal microbiota in SUDD patients enrolled in primary care.

METHODS

A retrospective study was conducted in SUDD ( N  = 72) and asymptomatic diverticulosis (AD) ( N  = 30), the latter serving as a control group.

RESULTS

No significant differences in alpha and beta diversity were found between SUDD and AD, but SUDD was discriminated by a higher relative abundance of the family Streptococcaceae and the genera Alistipes , Agathobacter , and Butyricimonas . Interestingly, the gut microbiota of SUDD patients stratified by the severity of abdominal pain [according to the visual analog scale (VAS)]. In particular, higher diversity and health-associated taxa (such as Bifidobacterium , Eubacterium coprostanoligenes group, and Dorea ) characterized mild (VAS score 1-3) SUDD, Proteobacteria , Veillonellaceae and Blautia moderate (VAS score 4-7) SUDD, and Prevotellaceae and Megasphaera severe (VAS score 8-10) SUDD.

CONCLUSION

Our analysis suggests that specific taxa may be related to SUDD, but the associations vary depending on the severity of abdominal pain. In addition to advancing our ecological understanding of this complex disease, our findings may pave the way for the incorporation of gut microbiota profiling into clinical practice to aid patient management, including stratification and treatment.

First-Line Levofloxacin-Based Triple Therapy Versus Standard Bismuth-Based Quadruple Therapy for Helicobacter pylori Eradication in Saudi Arabia: A Retrospective Single-Center Study

Background and Aims

Antibiotic resistance in Saudi Arabia has led to decreased efficacy of conventional triple therapy for Helicobacter pylori (H. pylori) eradication, prompting the development of alternative treatments like levofloxacin-based triple and bismuth-based quadruple therapies. However, comparative data regarding its efficacy are lacking. Therefore, this study's goal was to compare the efficacy of levofloxacin-based triple therapy with that of standard bismuth-based quadruple therapy as first-line regimens.

Methods

This retrospective analysis included 197 treatment-naïve adults with H. pylori infection who received levofloxacin-based triple (levofloxacin + amoxicillin + PPI) therapy (n = 81) or standard bismuth-based quadruple (bismuth + tetracycline + metronidazole + PPI) therapy (n = 116). H. pylori eradication was evaluated 4-8 weeks after medication administration using the 13C-urea breath test, and variables that could affect the rate of success were examined.

Results

There were no differences between groups in terms of age, sex, nationality, or type of proton pump inhibitor (PPI) used. The bismuth-based quadruple therapy group exhibited a markedly superior success rate compared to the levofloxacin-based triple therapy group when the latter was administered for 7 or 10 days (81.03% vs. 6.66%, p < 0.001, and 81.03% vs. 36.1%, p < 0.001, respectively). However, when the levofloxacin-based triple therapy was extended to 14 days, its H. pylori eradication rate became comparable to that of the 10-day bismuth-based quadruple therapy (81.03% vs. 80%, p = 0.898). Eradication rates for both regimens were similar for patients aged ≥ 60, non-Saudi, when using omeprazole and those treated with levofloxacin-based triple therapy for 14 days.

Conclusion

Quadruple treatment based on bismuth is superior to triple therapy based on levofloxacin for eradicating H. pylori in Saudi Arabia and should be used as a first-line treatment. However, the 14-day levofloxacin-based triple treatment had an H. pylori eradication rate comparable to that of the 10-day bismuth-based quadruple therapy.

Accuracy of Fecal Polymerase Chain Reaction Testing in Clarithromycin-Resistant Helicobacter Pylori: A Systematic Review and Meta-Analysis

INTRODUCTION

The increasing prevalence of clarithromycin (CLA)-resistant Helicobacter pylori(H. pylori) strains poses a significant challenge in the management of H. pylori infections. This systematic review and meta-analysis investigates the diagnostic accuracy of polymerase chain reaction (PCR) in identifying CLA-resistant H. pylori strains in stool.

METHODS

A comprehensive literature search was conducted using PubMed, Embase, and Cochrane databases from database inception to April 30, 2023. Eligible studies evaluated the effectiveness of PCR stool tests in detecting CLA-resistant H. pylori strains in adults (>18-year-old). Studies of pediatric populations, alternative methods to PCR or stool samples, and reference tests other than gastric biopsy were excluded. The bivariate random-effects model was used to pool diagnostic accuracy from the included studies.

RESULTS

The analysis of 11 prospective diagnostic studies with a total of 866 patients showed a pooled sensitivity of 0.97 (95% CI: 0.9-0.99) and a pooled specificity of 0.98 (95% CI: 0.81-1.00). Subgroup analysis based on the used technique demonstrated consistent findings without notable variations. The diagnostic odds ratio was calculated at 1843.92 (95% CI: 134.28-25,321.3). The positive likelihood ratio was determined as 51.02 (95% CI: 4.61-564.5), while the negative likelihood ratio was found to be 0.03 (95% CI: 0.01-0.1).

DISCUSSION

PCR testing for clarithromycin-resistant H. pylori was highly sensitive and specific across studies with proven reliability in clinical practice, particularly in outpatient settings. Their implementation offers cost-effectiveness and the potential for tailored treatment strategies, holding promise for improved patient outcomes.

Real-Time Gastric Juice Analysis to Rule Out the Presence of Autoimmune Gastritis: A Case-Control Study

BACKGROUND

Autoimmune gastritis (AIG) is an infrequent disease predisposing to both neuroendocrine tumours and cancer. This study aimed to evaluate whether pH measurement of gastric juice allows accurate exclusion of the presence of AIG in real time so that gastric mucosa sampling on normal-appearing mucosa may be avoided.

METHODS

This study enrolled patients diagnosed with AIG and matched controls (ratio 1:5) who underwent upper endoscopy with standard gastric mucosa sampling and real-time, gastric juice pH assessment. A threshold of pH less than 4.5 was adopted as cut-off to rule out the presence of a feature of AIG. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated.

RESULTS

Data of 40 patients (M/F: 19/21; mean age: 58 years, range: 18-89) with AIG and 212 matched controls were evaluated. Among AIG patients, the feature of atrophy/metaplasia of the oxyntic mucosa was staged as mild in 9 cases, moderate in 9, and severe in the remaining 22 patients. Gastric juice analysis showed a pH value >4.5 in 29 (72.5%) patients and 12 (5.7%) controls. Sensitivity, specificity, accuracy, PPV, NPV, LR+, and LR- were 73% (95% CI = 0.57-0.84), 94% (95% CI = 0.90-0.97), 71% (95% CI = 0.64-0.74), 95% (95% CI = 0.93-0.97), 91% (95% CI = 0.87-0.95), 12.9 (95% CI = 7.19-23.03), and 0.29 (95% CI = 0.18-0.48), respectively. The histological assessment of false-negative cases showed the presence of only mild-moderate atrophy of oxyntic mucosa in 6 (54.5%) cases, and severe in the others.

CONCLUSIONS

Our data found that real-time pH evaluation of gastric juice allows ruling out AIG with a very high NPV, but further studies are needed.

Laparoscopic fundoplication improves esophageal motility in patients with gastroesophageal reflux disease: a high-volume single-center controlled study in the era of high-resolution manometry and 24-hour pH impedance

BACKGROUND

Most existing literature studies reported that laparoscopic fundoplication (LF) is safe in the setting of ineffective or weak peristalsis. However, the effect of the wrap on esophageal motility is still debated. This study aimed to assess how a functioning and effective fundoplication could affect esophageal motility in patients with gastroesophageal reflux disease (GERD).

METHODS

This study analyzed prospectively collected data on patients who underwent laparoscopic Nissen (LN) fundoplication or laparoscopic Toupet (LT) fundoplication for GERD at our department between 2010 and 2022. Demographic and clinical characteristics were recorded. Patients were evaluated using the Gastroesophageal Reflux Disease Questionnaire (GerdQ), barium swallow, endoscopy, high-resolution manometry (HRM), and 24-hour pH impedance (multichannel intraluminal impedance and pH monitoring [MII-pH]) before and after surgery. HRM was reviewed by 2 experts, following the criteria of the Chicago Classification (version 4.0). LF failure was objectively defined in case of abnormal postoperative MII-pH according to the Lyon 2.0 criteria with/without an abnormal GerdQ.

RESULTS

During the study period, 124 patients with GERD (89 males and 35 females) were recruited. Of note, 58 patients underwent LN fundoplication, and 66 patients underwent LT fundoplication. All procedures were completed laparoscopically, and the 90-day postoperative mortality was nil. At the postoperative MII-pH, good outcome was recorded in 103 patients, and failure was recorded in 21 patients. There was a significant association between a successful LF and the normalization of esophageal motility (P < .05).

CONCLUSION

Our data confirmed that LF is an effective treatment in patients with GERD, regardless of esophageal motility status. Moreover, our results indicate that LF could determine a normalization of motility abnormalities in patients with GERD.

Leaky gut in systemic inflammation: exploring the link between gastrointestinal disorders and age-related diseases

Global average life expectancy has steadily increased over the last several decades and is projected to reach ~ 77 years by 2050. As it stands, the number of people > 60 years currently outnumbers children younger than 5 years, and by 2050, it is anticipated that the global population of people aged > 60 years will double, surpassing 2.1 billion. This demographic shift in our population is expected to have substantial consequences on health services globally due to the disease burden associated with aging. Osteoarthritis, chronic obstructive pulmonary disease, diabetes, cardiovascular disease, and cognitive decline associated with dementia are among the most common age-related diseases and contribute significantly to morbidity and mortality in the aged population. Many of these age-related diseases have been linked to chronic low-grade systemic inflammation which often accompanies aging. Gastrointestinal barrier dysfunction, also known as "leaky gut," has been shown to contribute to systemic inflammation in several diseases including inflammatory bowel disease and irritable bowel syndrome, but its role in the development and/or progression of chronic low-grade systemic inflammation during aging is unclear. This review outlines current literature on the leaky gut in aging, how leaky gut might contribute to systemic inflammation, and the links between gastrointestinal inflammatory diseases and common age-related diseases to provide insight into a potential relationship between the intestinal barrier and inflammation.

Development and validation of a prognostic model based on disulfidptosis-related ferroptosis genes: DRD4 and SLC2A3 as biomarkers for predicting prognosis in colon cancer

Background

Disulfidptosis and ferroptosis are emerging cell death modalities crucial to cancer progression, yet their prognostic potential in colon cancer (CC) remains underexplored. This study develops and validates a prognostic model based on DRD4 and SLC2A3, two genes involved in key biological processes in CC. DRD4 regulates cell proliferation, migration, and apoptosis, while SLC2A3 enhances glucose uptake via the Warburg effect, promoting tumor growth. High expression of both genes is linked to poor prognosis, advanced stages, and increased aggressiveness, enabling precise stratification of patients and accurate prognostic predictions.

Methods

Transcriptomic and clinical data from 476 CC samples and 41 normal colon samples were obtained from The Cancer Genome Atlas (TCGA) database, with 452 patient samples utilized for survival analysis. A training cohort and a validation cohort were generated through random allocation. Disulfidptosis-related ferroptosis genes (DRFGs) were identified using Pearson correlation analysis, and a prognostic model was built using the least absolute shrinkage and selection operator (LASSO) and Cox regression analysis. External validation was performed using the Gene Expression Omnibus (GEO) datasets (GSE17538 and GSE38832), and clinical samples were further analyzed through immunohistochemistry. Predictors in the nomogram included age, gender, tumor stage, and risk score. The C-index of the final model was used to assess its prognostic accuracy.

Results

The results were validated using external cohorts from the GEO database and immunohistochemistry experiments. A prognostic model incorporating DRD4 and SLC2A3 effectively stratified CC patients into high- and low-risk groups, revealing distinct differences in survival times, immune landscapes, and biological characteristics. High expression levels of DRD4 and SLC2A3 correlated with advanced clinicopathological stages and poor prognosis, with a C-index of 0.75 indicating strong predictive accuracy. Immunohistochemistry confirmed the upregulation of both genes in CC tissues, further validating the model's clinical relevance.

Conclusions

This DRFG-based prognostic model offers an effective tool for predicting clinical outcomes in CC and can guide personalized treatment strategies. The upregulation of DRD4 and SLC2A3 suggests their potential as therapeutic targets. Future studies should focus on elucidating the underlying mechanisms of these biomarkers to enhance their clinical application.

The efficacy and safety of Vonoprazan and Tegoprazan in Helicobacter pylori eradication: a comprehensive systematic review and meta-analysis of randomized controlled trials

Background

Potassium-competitive acid blocker (P-CAB)-based therapies are emerging as promising alternatives for eradicating Helicobacter pylori infection. However, the comparative efficacy of P-CAB-based therapy versus proton-pump inhibitor (PPI)-based therapy in treating H. pylori infection remains uncertain.

Objectives

This meta-analysis evaluated the efficacy and safety of P-CAB-based therapies, including Vonoprazan (VPZ) and Tegoprazan (TPZ), compared to PPI-based therapies for H. pylori infection. Subgroup analysis assessed the influence of drug history, experimental drug, treatment duration, combination therapies, and geographic regions on treatment outcomes.

Design

Meta-analysis.

Data sources and methods

Comprehensive searches were conducted in major databases, including PubMed, Embase, the Cochrane Library, and Web of Science, up to January 1, 2024. The primary outcome was the eradication rate, analyzed by intention-to-treat (ITT). Secondary outcomes included adverse events. Heterogeneity among studies was assessed using the χ2 test and the I 2 test. I 2 > 50% or p < 0.05 indicated significant heterogeneity.

Results

The analysis totally included 28 randomized controlled trials (RCTs) comprising 37 studies and 8818 patients diagnosed with H. pylori infection. Of these, 14 RCTs, including 20 studies and 4286 patients, compared P-CAB-based therapy with 14-day bismuth-based quadruple therapy (BQT). P-CAB-based therapy exhibited superior eradication rates compared to both 14-day BQT and PPI-based therapy (ITT analysis: 87.0% vs 79.8%, risk ratio (RR) = 1.08, 95% CI: 1.04-1.12, p < 0.0001; and 85.6% vs 77.8%, RR = 1.09, 95% CI: 1.05-1.12, p < 0.00001, respectively). This enhanced efficacy was particularly pronounced in patients with clarithromycin-resistant infections (73.7% vs 41.5%, RR = 1.53, 95% CI: 1.07-2.20, p = 0.02). Subgroup analysis demonstrated higher eradication rates with P-CAB-based therapy in treatment-naïve participants, VPZ recipients, and those receiving 7- or 14-day regimens (dual, triple, or quadruple therapy). However, no significant differences were observed in treatment-experienced subgroups, TPZ recipients, or those on 10-day regimens. In addition, P-CAB-based therapy showed a lower incidence of adverse events than PPI-based treatments (RR = 0.73, 95% CI: 0.63-0.86, p < 0.0001).

Conclusion

P-CAB-based therapies are more effective than traditional PPI-based treatments for eradicating H. pylori infection, with a reduced incidence of adverse events.

PROSPERO registration

CRD42024503665.

High-dose dual therapy for Helicobacter pylori eradication inducing less impact on the gut microbiota

BACKGROUND

Helicobacter pylori (H. pylori) eradication regimens may have different effects on the gut microbiota. Few studies have analyzed the safety of high-dose dual therapy (HDDT) from a micro-ecological perspective. This study aimed to compare the impact of H. pylori eradication with HDDT and bismuth quadruple therapy (BQT) on gut microbiota.

PATIENTS AND METHODS

H. Pylori-infected treatment-naive patients were recruited and screened from September 2023 to April 2024 and randomly assigned to the HDDT group (esomeprazole 20 mg, amoxicillin 750 mg, qid, 14 days) or BQT group (esomeprazole 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth potassium citrate 600 mg, bid, 14 days). Fresh stool specimens were collected and stored before treatment and at week 2 and week 8 after treatment. The diversity and composition of the gut microbiota were compared and analyzed in both groups using 16 S rRNA gene sequencing.

RESULTS

Forty-nine H. pylori positive patients were enrolled and randomly assigned to either the HDDT (n = 24) or the BQT group (n = 25) group. Compared with baseline, alpha and beta diversities significantly changed at week 2 after receiving BQT and did not recover fully at week 8. However, in the HDDT group, the diversities at week 2 changed mildly without statistical significance, compared to baseline. Additionally, a greater number of species had alterations in their abundances in the BQT group compared to the HDDT group at week 2. However, the abundances of these species were restored to their previous levels at week 8 in both the HDDT and BQT groups.

CONCLUSIONS

Compared to BQT, HDDT exerted less impact on the diversity and composition of the gut microbiota.

CLINICAL TRIAL REGISTRATION

ChiCTR2100053268.

Short- and Long-Term Nutritional Status in Children and Adolescents with Celiac Disease Following a Gluten-Free Diet: A Systematic Review

BACKGROUND/OBJECTIVES

Numerous studies have highlighted the nutritional imbalances that are commonly observed in children and adolescents diagnosed with celiac disease (CD) who follow a gluten-free diet (GFD). However, the development and timeline of these nutritional deficiencies remain unclear. The aim of the present study is to investigate the short-term (≥6 months to <12 months) and long-term (≥12 months) association between adherence to a GFD and nutrient intake as well as micronutrient blood status in children and adolescents aged from 0 to 18 years with CD.

METHODS

A systematic review was conducted in PubMed and Scopus for observational studies published up to June 2024.

RESULTS

A total of 15 studies (case-control, cross-sectional, and prospective studies) with 2004 children and adolescents were included. Their quality was assessed using the ROBINS-E tool. Despite the lack of high-quality data and the heterogeneity of the methods used in the included studies, the results of the cross-sectional/case-control studies show that, in the short term, children and adolescents with CD consumed excessive amounts of protein and carbohydrates compared to controls. After long-term adherence to a GFD, significant changes in the diets of children and adolescents with CD persisted. Fat intake was higher, while protein intake remained excessive compared to controls. Based on prospective studies, vitamin C and iodine intake improved both in the short and long term after adherence to a GFD. However, most other nutrients either remain inadequate or continue to decline, indicating that it is difficult to meet nutrient requirements despite dietary adjustments.

CONCLUSIONS

Gaps in adherence to dietary recommendations appear to be widespread in children and adolescents with CD, emphasizing the need for improved diet quality and regular monitoring.

Antiplatelet Therapy in Low-Platelet-Count Patients After Percutaneous Coronary Intervention for Acute Coronary Syndromes

The risk of cardiovascular events increases considerably after an acute coronary syndrome (ACS), particularly in the first few months. Dual antiplatelet therapy represents the mainstay of secondary prevention during this period, but is associated with a not-negligible risk of bleeding which, among other factors, is influenced by the platelet count. Thrombocytopenic patients may experience an ACS, and several patients with ACSs develop thrombocytopenia during hospitalization: the management of antithrombotic therapy in this setting represents a challenge. Here, we review the available evidence on the use of antithrombotic therapy in patients with low platelet counts after an ACS.

Point-of-Care Diagnosis of Atrophic Gastritis by Serological Biomarker Test (GastroPanel® Quick Test) in Gastroscopy Referral Patients in India

Background: Increased demand of the serological biomarker test (GastroPanel®) in non-invasive diagnosis of gastric cancer (GC) risk conditions, i.e., atrophic gastritis (AG) and Helicobacter pylori (Hp) infection, prompted the design of GastroPanel® Quick test (GPQT) (Biohit Oyj, Helsinki, Finland) for point-of-care (POC) settings. Objective: This study validated the diagnostic accuracy (DA) of GPQT in diagnosis of AG and Hp among gastroscopy referral patients. Methods: Altogether, 266 patients were enrolled among the consecutive gastroscopy referrals at the Department of Gastroenterology, Fortis Hospital (Punjab, India). All patients underwent gastroscopy with biopsies (n = 249) classified using the Updated Sydney System (USS) and finger prick blood sampling for GPQT testing. Results: Biopsy-confirmed AG was found in 15.3% (38/249) of the patients. The overall agreement between the GPQT and the USS classification was 71.4% (95% CI 65.4-77.0%), with the weighted kappa (κw) of 0.823 (95% CI 0.773-0.862). In ROC analysis for moderate/severe AG of the corpus (AGC) endpoint, AUC = 0.990 (95% CI 0.979-1.000) and AUC = 0.971 (95% CI 0.948-0.995) for PGI and PGI/PGII, respectively. Hp IgG Ab test detected biopsy-confirmed Hp with AUC = 0.836 (95% CI 0.783-0.889). Conclusions: The GPQT favourably competes in accuracy with the ELISA test version (unified-GP) in diagnosis of AG and Hp in patients referred for diagnostic gastroscopy.

Co-culture of Helicobacter pylori with oral microorganisms in human saliva

OBJECTIVE

Helicobacter pylori is known for colonizing the gastric mucosa and instigating severe upper gastrointestinal diseases such as gastritis, gastroduodenal ulcers, and gastric cancer. To date, there is no data available on the oral cavity as transmission site, whether H. pylori can survive in the oral cavity or in human saliva. The aim of the study was to investigate the influence of oral microorganisms and human saliva on the survival of H. pylori in human saliva.

METHODS

H. pylori strains KE, a motile derivate of type strain H. pylori 26695, and H. pylori SS1, a clinical isolate from a gastric biopsy, were grown in human pooled saliva (pooled from 4 healthy human donors, 0.22 μm filter-sterilized) or in BBF (Brucella browth formula; control) either as mono-cultures or in co-culture with Streptococcus mutans, Streptococcus oralis, Actinomyces naeslundii, Lacticaseibacillus casei and Candida dubliniensis. Bacterial survival of H. pylori and the oral microorganisms were investigated using colony forming units (CFU) assay and MALDI-TOF MS at baseline and after 24, 48 and 168 h.

RESULTS

In saliva, H. pylori KE demonstrated enhanced survival in co-culture with S. mutans, A. naeslundii, and C. dubliniensis, enduring for at least 48 h. In contrast, L. casei and S. oralis inhibited H. pylori KE in saliva. H. pylori KE could not be cultured after 168 h in saliva, neither in mono- nor co-culture. In contrast, H. pylori SS1 in saliva could be cultured after 168 h in co-culture with S. mutans and C. dubliniensis, but not in mono-culture. In BBF, H. pylori KE could be cultured after 168 h with S. mutans, L. casei and C. dubliniensis, and H. pylori SS1 with L. casei and C. dubliniensis, but not with S. mutans. Notably, the co-cultured microorganisms survived at high CFU numbers similar to those of the monocultures.

CONCLUSION

The study suggests that H. pylori can transiently survive in human saliva and even with presence of certain oral microorganisms. However, it may not be a permanent resident of the oral microbiota. The co-survival with oral microorganisms emphasizes the necessity for studying the role of the oral microbiota in the infectious and transmission cycle of H. pylori.

Hp eradication decreased the expression level of PG II in patients of Hp negative with gastric intestinal metaplasia: a retrospective cross-sectional study

AIMS

This study aims to assess the serum levels of pepsinogen (PG)I, PG II, and gastrin (G17) in patients with gastric intestinal metaplasia (GIM) and evaluate their correlation with demographic characteristics.

METHODS

A total of 247 normal controls (NC) and 240 patients diagnosed with GIM were enrolled in this study. All participants underwent a gastroscopy procedure followed by pathological examination for diagnosis confirmation. The expression level of PGI, PG II, and G 17 was detected by fluorescence immunochromatography and Hp infection was detected by 13-carbon breath test. The demographic characteristics of the subjects were obtained through questionnaires.

RESULTS

Compared to the NC group, the GIM group showed a reduction in PG II expression level [10.71(6.40,16.89) VS 9.21(6.14,14.55), p = 0.010]. GIM patients had a higher prevalence of previous Hp eradication history (14.98% VS 23.75%, p = 0.014). The low PG II group exhibited a higher incidence rate of GIM compared to the high PG II group (54.10% VS 44.44%, p = 0 0.020). In the Hp-negative(Hp-) group, there was a decrease in both PGI and PG II expression levels when compared to the Hp-positive(Hp+) group [146.73 ± 78.53 VS 125.61 ± 68.75 and 10.19(7.27, 16.58) VS 7.36(5.62,12.53), p = 0.036 and p < 0.001]. Among patients without Hp eradication history, those with low PG II levels had a higher proportion of individuals with a history of Hp eradication than those with high PG II levels (29.31% VS 3.13%, p = 0.003). Additionally, within the subgroup that underwent Hp eradication, there was a decrease in PG II expression level compared to the subgroup without Hp eradication (6.16(5.13, 7.52) VS 8.73(5.67, 13.35), p = 0.041).

CONCLUSION

The prevalence of GIM was significantly associated with low levels of PG II. There was a significant association between HP eradication history and the prevalence of GIM. Hp eradication history resulted in reduced expression levels of PG II in Hp- GIM patients.

Prevalence of Helicobacter pylori infection in Chinese military personnel: A cross-sectional, multicenter-based study

BACKGROUND

Helicobacter pylori (H. pylori) infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia, gastritis, and peptic ulcer, which are common diseases in military personnel. Current guidelines in China state all patients with evidence of active infection with H. pylori are offered treatment. However, the prevalence of H. pylori infection and its regional distribution in the military population remain unclear, which hinders effective prevention and treatment strategies. Understanding the prevalence of H. pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.

AIM

To investigate the prevalence of H. pylori infection in the Chinese military population in different geographic areas.

METHODS

This multicenter, retrospective study included 22421 individuals from five tertiary hospitals located in north, east, southwest, and northwest cities of China. H. pylori infection was identified using the urea breath test, which had been performed between January 2020 and December 2021.

RESULTS

Of the 22421 military service members, 7416 (33.1%) were urea breath test-positive. The highest prevalence of H. pylori was in the 30-39 years age group for military personnel, with an infection rate of 34.9%. The majority of infected subjects were younger than 40-years-old, accounting for 70.4% of the infected population. The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing, Nanjing, and Guangzhou, with prevalence rates of 44.3%, 37.9%, 29.0%, 31.1%, and 32.3%, respectively.

CONCLUSION

H. pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.

Association between non-insulin-based insulin resistance surrogate makers and Helicobacter pylori infection: a population-based study

BACKGROUND

Current evidence on the associations between insulin resistance (IR) and Helicobacter pylori (H. pylori) infection remains limited. This study aimed to investigate the association between non-insulin-based surrogate markers of IR, including the triglyceride glucose (TyG) index, triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, and the metabolic score for IR (METS-IR), and H. pylori infection in U.S.

POPULATIONS

METHODS

This cross-sectional study involving 939 U.S. participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2000. The associations between three IR surrogate markers and H. pylori infection were respectively investigated using logistic regression model, restricted cubic spline (RCS) curve and subgroup analysis.

RESULTS

Three IR surrogate markers levels were significantly elevated in H. pylori infection participants. There was a positive association between three IR surrogate markers and H. pylori infection, even after adjusting for potential confounding variables by three different models. In subgroup analysis, the adjusted association between three IR surrogate markers and H. pylori infection were more likely to be observed in female and Non-Hispanic White. Additionally, the RCS curve revealed a positive linear correlation between TyG index and H. pylori infection across all three models, and between METS-IR and H. pylori infection in Model 3. However, a positive nonlinear correlation was observed between TG/HDL-C ratio and H. pylori infection in all three models.

CONCLUSIONS

These findings suggest that non-insulin-based IR surrogate markers including TyG index, TG/HDL-C ratio, and METS-IR were all positively associated with H. pylori infection. These markers may serve as the potential indicators for identifying the risk of H. pylori infection in U.S.

POPULATIONS

CLINICAL TRIAL NUMBER

Not applicable.

Staging of operative link on gastritis assessment and operative link on gastric intestinal metaplasia systems for risk assessment of early gastric cancer: a case-control study

AIMS

Operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia assessment (OLGIM) systems are histological staging systems of gastritis for gastric cancer (GC) risk estimation. Intermediate OLGA/OLGIM stages are of concern in a region with high incidence of GC. This study aimed to validate OLGA and OLGIM staging systems for early GC (EGC) in Chinese population.

METHODS

This single-centre, case-control study included 196 patients with EGC and 196 age-matched and sex-matched health screening control subjects. OLGA and OLGIM systems, and other clinical parameters were evaluated using logistic regression analysis.

RESULTS

OLGA and OLGIM stages II/III/IV were more prevalent in patients with EGC than in the control subjects. Multivariable analysis revealed family history of GC, previous Helicobacter pylori (H. pylori) infection, OLGA stages II and III-IV, OLGIM stages II and III-IV as independent risk factors for EGC (ORs, 4.04, 1.87, 2.52, 6.79, 4.11 and 10.78, respectively). Area under the receiver operating characteristic curve on EGC risk estimation was improved for OLGIM compared with OLGA (0.78 vs 0.71, p<0.001). Autoantibody seropositivity of gastric mucosa was not associated with EGC risk stratified by H. pylori status.

CONCLUSIONS

Surveillance of intermediate-risk patients (OLGA/OLGIM II) should be emphasised in our region. The OLGIM may be preferred over the OLGA for EGC risk estimation.

Global, regional, and national trends in colorectal cancer burden from 1990 to 2021 and projections to 2040

BACKGROUND

Colorectal cancer (CRC) is a common malignancy with notable recent shifts in its burden distribution. Current data on CRC burden can guide screening, early detection, and treatment strategies for efficient resource allocation.

METHODS

This study utilized data from the latest Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study. Initially, a series of descriptive statistics were performed on the incident cases, deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of CRC. Percentage changes and average annual percentage changes (AAPC) were then calculated to understand the trends in CRC disease burden. Decomposition and frontier analyses were conducted, and finally, the Bayesian age-period-cohort (BAPC) model was used to predict changes in ASRs up to 2040.

RESULTS

The GBD 2021 estimates indicate a significant increase in the global incident cases, deaths, and DALYs of CRC from 1990 to 2021. The age-standardized incidence rate (ASIR) increased (AAPC: 0.2), while the age-standardized mortality rate (ASMR) (AAPC: -0.72) and age-standardized DALYs rate (AAPC: -0.73) decreased. Males bore a higher disease burden than females, though the trends in disease burden changes were similar for both sexes. Although developed regions had higher incident cases, deaths, and DALYs, they showed more significant declines in ASRs. Decomposition analysis revealed that population growth and aging were the primary drivers of the increased disease burden. Frontier analysis showed that as the Socio-demographic Index increased, the disparity in CRC ASRs among countries widened, with developed regions having greater potential to reduce these rates. The By 2040, the BAPC model projects significant declines in global ASMR and age-standardized DALYs rates, while ASIR is expected to decrease in females but increase in males and across both sexes.

CONCLUSION

CRC remains a significant public health issue with regional and gender differences, necessitating region- and population-specific prevention strategies.

Cas14VIDet: A visual instant method free from PAM restriction for antibiotic resistance bacteria detection

A personalized treatment strategy that selects sensitive antibiotics based on Helicobacter pylori (H. pylori) resistance genes is currently the most effective approach to address the challenge of H. pylori eradication. However, the widespread adoption of this strategy is hindered by the long processing times and high costs associated with traditional resistance gene detection methods. In this study, we combined ultra-fast PCR with CRISPR/Cas14 into a single reaction system, establishing a rapid, one-pot visual platform named Cas14VIDet (Cas14-based Visual Instant Detection) for detecting H. pylori resistance genes. Cas14VIDet does not require a PAM sequence and excels in identifying single nucleotide polymorphisms, with the detection sensitivity approaching the level of a single bacterial colony (100 CFU/mL). The entire detection process can be completed within 10 min, and results are directly observable with the naked eye. We validated Cas14VIDet by testing 50 clinical samples and compared it with Sanger sequencing. The results showed that Cas14VIDet achieved 100% sensitivity, 100% specificity, and 100% accuracy in detecting H. pylori resistance genes to levofloxacin. Therefore, we believe this method holds great potential for rapid detection of H. pylori resistance, potentially supporting personalized treatment of H. pylori infections in the future.

Occurrence of Helicobacter pylori in drinking water sources and antimicrobial resistance profile in the central region of Peru

Introduction

Contamination of drinking water by Helicobacter pylori can cause serious diseases, including cancer. The determinants of the infection rate are socioeconomic status, low standard of living and overcrowding. In addition, exposure to environmental sources contaminated with feces, such as water and vegetables, is another risk factor for infection. We analyzed the occurrence of H. pylori in drinking water sources and the antimicrobial resistance profile in central Peru.

Methods

Water samples were collected from taps in four provinces of the Junín region. Previously, biofilm sampling was performed from the internal surface of the taps. The samples were cultured on modified brain heart infusion blood agar at 37 °C under microaerophilic conditions for seven days. Antibiotic sensitivity of H. pylori was determined by the Kirby Bauer diffusion method.

Results

The results revealed that pH (9.25) and turbidity (5.15 NTU) exceeded the Peruvian environmental quality standards for drinking water. The amount of free chlorine residual in the H. pylori positive water samples ranged from 0.02 to 0.12 mg/L. H. pylori was present in 2/192 tap water samples (1.04 %) and in 3/192 tap biofilm samples (1.56 %). It was observed that 100 % of H. pylori isolates from water samples from the Chilca district showed resistance to nalidixic acid and 66.67 % to both amoxicillin and chloramphenicol. Resistance to nalidixic acid of H. pylori isolates obtained from biofilm samples from taps in the El Tambo district ranged from 66.67 % to 100 %.

Conclusion

The study findings reveal that water samples and tap biofilms in the Chilca, El Tambo and Huamancaca chico districts in the Junín region harbor H. pylori. They also reveal variability in the pattern of resistance to more than one antibiotic tested from one district to another.

Digestive cancers: mechanisms, therapeutics and management

Cancers of the digestive system are major contributors to global cancer-associated morbidity and mortality, accounting for 35% of annual cases of cancer deaths. The etiologies, molecular features, and therapeutic management of these cancer entities are highly heterogeneous and complex. Over the last decade, genomic and functional studies have provided unprecedented insights into the biology of digestive cancers, identifying genetic drivers of tumor progression and key interaction points of tumor cells with the immune system. This knowledge is continuously translated into novel treatment concepts and targets, which are dynamically reshaping the therapeutic landscape of these tumors. In this review, we provide a concise overview of the etiology and molecular pathology of the six most common cancers of the digestive system, including esophageal, gastric, biliary tract, pancreatic, hepatocellular, and colorectal cancers. We comprehensively describe the current stage-dependent pharmacological management of these malignancies, including chemo-, targeted, and immunotherapy. For each cancer entity, we provide an overview of recent therapeutic advancements and research progress. Finally, we describe how novel insights into tumor heterogeneity and immune evasion deepen our understanding of therapy resistance and provide an outlook on innovative therapeutic strategies that will shape the future management of digestive cancers, including CAR-T cell therapy, novel antibody-drug conjugates and targeted therapies.