Reflux Seen on a Barium Swallow is Not a Substitute For Ambulatory Reflux Monitoring in Symptomatic Patients

OBJECTIVE

Gastroesophageal reflux (GER) is often reported in barium studies (GERB). We aimed to evaluate whether GERB associates with parameters defining conclusive reflux using Lyon criteria on esophageal physiological testing (GERpH).

METHODS

Adults who underwent both ambulatory reflux monitoring off antisecretory therapy and barium esophagogram between 2018 and 2023 were eligible for inclusion in this retrospective study. All reflux monitoring studies were independently reviewed to extract acid exposure time (AET) and number of reflux episodes. GERpH was diagnosed based on Lyon consensus criteria, and compared with GERB reported on barium esophagogram. Performance characteristics of GERB in predicting AET >6% and GERpH by Lyon criteria were calculated.

RESULTS

Of 182 patients (median age: 55.0 y, 69.8% females, median body mass index: 29.8 kg/m2), 61 had GERB and 101 had GERpH, whereas 58 had neither GERB nor GERpH. AET >6% was seen in 39.3% with GERB, and never with GERB without GERpH. The sensitivity and specificity of GERB in predicting AET >6% were 31.6% and 65.1%; corresponding values in predicting conclusive gastroesophageal reflux disease were 37.6% and 71.6%, respectively. A hiatus hernia (HH) was seen in 46.8% with GERB and was associated with higher median AET (6.0% vs 3.8% without HH, P = 0.003) and higher frequency of AET >6% (50.6% vs 32.5%, P = 0.032), but not higher reflux episodes (P ≥ 0.51).

CONCLUSIONS

In patients with symptoms suspicious of reflux disease, reflux seen on a barium esophagogram has suboptimal performance characteristics in predicting conclusive gastroesophageal reflux disease. HH identified on barium esophagography is associated with a higher reflux burden on reflux monitoring.

Real-world effectiveness and safety of 1L polyethylene glycol and ascorbic acid for bowel preparation in patients aged 80 years or older

Background and study aims

Clinical trials and real-world studies show a 1L polyethene glycol and ascorbic acid solution (1L PEG-ASC) to be an effective and safe bowel preparation for colonoscopy in the general population. Here, the effectiveness and safety of 1L PEG-ASC were evaluated in patients aged 80 years or older in a real-world setting.

Patients and methods

A post-hoc analysis of an observational, multicenter, retrospective study assessed the effectiveness and safety of 1L PEG-ASC on outpatients aged ≥ 80 years old undergoing colonoscopy at eight centers in Spain and Portugal. Cleansing quality was assessed using the Boston Bowel Preparation Scale, with overall scores ≥ 6 and all segmental scores ≥ 2 considered adequate colon cleansing, and overall scores ≥ 8 or 3 in the right colon considered high-quality cleansing. Cecal intubation rate, withdrawal time, polyp and adenoma detection rates (ADR), and adverse events (AEs) were also monitored.

Results

Data were analyzed from 423 patients aged ≥ 80 years; mean age 83.5 years (±3.2) and 49.2% males. The adequate colon cleansing success rate was 88.9%, with high-quality cleansing of the overall and right colon achieved in 54.1% and 46.1% of patients, respectively. Colonoscopy was complete in 94.1% of cases and the ADR was 51.3%. At least one AE was experienced by 4.5% of participants, the most frequent being mild dehydration (2.8%) and nausea (1.2%).

Conclusions

This post-hoc analysis confirms 1L PEG-ASC to be an effective and safe bowel cleansing preparation for patients aged 80 years or older in a real-world setting.

The Role of Quorum Sensing in Phage Lifecycle Decision: A Switch Between Lytic and Lysogenic Pathways

Phages, the most abundant and diverse lifeforms on Earth, require strict parasitism for survival. During infection, temperate phages integrate both intracellular and extracellular host information to decide between lysis and lysogeny for replication. While various environmental and physiological factors influence the lysis-lysogeny decision, recent insights into phage-bacterium interactions reveal phages' ability to communicate with and influence bacteria, leveraging the host's quorum sensing system or small molecular signals. This article provides a succinct overview of current research advancements in this field, enhancing our understanding of phage-host dynamics and providing insights into bacteria's multicellular behavior in antiviral defense.

Endoscopic transpapillary gallbladder stenting vs percutaneous cholecystostomy for managing acute cholecystitis: Nationwide propensity score study

Background and study aims

Cholecystectomy is the standard treatment for acute cholecystitis, but it may not be suitable for all patients. For those who cannot undergo surgery, a percutaneous cholecystostomy tube (PCT) and ERCP-guided transpapillary gallbladder drainage are viable options. We aimed to perform a nationwide study to assess 30-day readmission rates, adverse events (AEs), and mortality rates in these two cohorts.

Patients and methods

We conducted a nationwide cohort study using data from the Nationwide Readmissions Database (NRD) from 2016 to 2019. We identified patients with acute cholecystitis during the index admission who underwent either PCT or ERCP-guided gallbladder drainage. Propensity score matching along with multivariable regression was used to compare cohorts.

Results

During the study period, 3,592 patients (average age 63.0 years) underwent endoscopic drainage, whereas 80,372 patients (average 70.8 years) underwent Interventional Radiology drainage. Utilizing multivariate Cox regression analysis, compared with ERCP, PCT had a higher risk for 30-day readmission (adjusted hazard ratio [aHR] 1.47; 95% confidence interval [CI] 1.27 to 1.71; P < 0.001). The PCT group had a significantly higher rate of readmission for acute cholecystitis compared with the ERCP group (2.72% vs 0.86%; P < 0.005). Cox proportional hazard ratio showed a 3.41-fold increased risk (95% CI 1.99 to 5.84) for readmission in the PCT group. ERCP was consistently associated with lower rates of post-procedural AEs compared with PCT including acute hypoxemic respiratory failure ( P < 0.001), acute renal failure ( P < 0.001), shock ( P < 0.001), and need for blood transfusions ( P < 0.001).

Conclusions

Our nationwide analysis revealed that ERCP-guided gallbladder drainage should be the preferred approach for managing acute cholecystitis when unfit for surgery.

Accelerating Earlier Access to Anti-TNF-α Agents with Biosimilar Medicines in the Management of Inflammatory Bowel Disease

Data indicate that earlier initiation of anti-tumor necrosis factor alpha (anti-TNF-α) biologic medicines may prevent progression to irreversible bowel damage and improve outcomes for patients with inflammatory bowel disease (IBD), particularly Crohn's disease. However, the high cost of such therapies may restrict access and prevent timely treatment of IBD. Biosimilar anti-TNF-α medicines may represent a valuable opportunity for cost savings and optimized patient outcomes by improving access to advanced therapies and allowing earlier anti-TNF-α treatment initiation. Biosimilar anti-TNF-α medicines have been shown to offer consistent therapeutic outcomes to their reference medicines, yet despite entering the IBD treatment armamentarium over 10 years ago, their implementation in clinical practice remains suboptimal. Factors limiting the 'real' use of biosimilar anti-TNF-α medicines may include an ongoing lack of understanding and acceptance of biosimilars by both healthcare professionals (HCPs) and patients, as well as systemic factors such as formulary decisions outside of the control of the prescriber. In this review, an expert panel of gastroenterologists discusses HCP-level considerations to improve biosimilar anti-TNF-α utilization in IBD in order to support early anti-TNF-α initiation and maximize patient outcomes.

Combining mechanistic modeling with machine learning as a strategy to predict inflammatory bowel disease clinical scores

Disease activity scores are efficacy endpoints in clinical trials of inflammatory bowel disease (IBD) therapies. Crohn's disease activity index (CDAI), Mayo endoscopic score (MES) and Mayo score are frequently used in clinical trials. They rely on either the physician's observation of the inflammatory state of the patient's gastrointestinal tissue alone or combined with the patient's subjective evaluation of general wellbeing. Given the importance of these scores in evaluating the efficacy of drug treatment and disease severity, there has been interest in developing a computational approach to reliably predict these scores. A promising approach is using mechanistic models such as quantitative systems pharmacology (QSP) which simulate the mechanisms of the disease and its modulation by the drug pharmacology. However, extending QSP model simulations to clinical score predictions has been challenging due to the limited availability of gut biopsy measurements and the subjective nature of some of the evaluation criteria for these scores that cannot be described using mechanistic relationships. In this perspective, we examine details of IBD disease activity scores and current progress in building predictive models for these scores (such as biomarkers for disease activity). Then, we propose a method to leverage simulated markers of inflammation from a QSP model to predict IBD clinical scores using a machine learning algorithm. We will demonstrate how this combined approach can be used to (1) explore mechanistic insights underlying clinical observations; and (2) simulate novel therapeutic strategies that could potentially improve clinical outcomes.

Psychosocial risks in metabolic dysfunction-associated steatotic liver disease

INTRODUCTION

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly becoming more prevalent in the general population. MASLD is more common in persons with low socioeconomic status (SES), yet little is known about the psychosocial challenges associated with this disease, and clinical recommendations on how to approach psychosocial challenges are lacking.

AREAS COVERED

A PubMed search using the search terms MASLD, psychosocial risks, stigmatization, psychiatric comorbidities (i.e. depression, bipolar disorder, psychosis, attention deficit hyperactivity disorder, and substance abuse), SES, quality of life (QoL), over the past 20 years (2004-2024) was performed.

EXPERT OPINION

Persons with MASLD often experience psychosocial adversities that may be expressed as lower SES, high prevalence of depression, and reduced QoL. Knowledge gaps remain regarding the association between severe mental disorders (e.g. psychosis and bipolar disorders). Timely detection and treatment of MASLD in persons with psychosocial risks may require attention and cross-field collaboration. Studies on QoL in persons with MASLD differ in methodology which makes formal comparisons difficult. Psychosocial adversity may be a barrier to lifestyle modifications, which remain the cornerstone of MASLD management. Guidelines on how to address psychosocial adversities in a clinical setting are warranted to improve outcomes and decrease further multimorbidity.

Persistent challenges in the diagnosis of acute pancreatitis due to primary hyperparathyroidism during pregnancy

In this manuscript, we provide critical commentary on the systematic review by Augustin et al, which investigated acute pancreatitis induced by primary hyperparathyroidism during pregnancy. Although this is an infrequent complication, it poses severe risks to both maternal and fetal health. Due to its infrequent occurrence in clinical practice, this review is based on an analysis of individual case reports over the past 55 years. While this is not the first study to utilize this sampling method for primary hyperparathyroidism-induced acute pancreatitis, it is unique in that it has a sufficiently large sample size with statistically significant results. Our discussion focuses on the diagnostic challenges associated with this condition, which are grounded in the mechanisms of parathyroid hormone secretion and variations in serum calcium levels. We also address the limitations of the current review and suggest potential strategies to increase diagnostic accuracy and improve health outcomes for both mothers and fetuses during pregnancy.

IgA vasculitis induced by tumor necrosis factor-α antagonists: clinical features, diagnosis and management

INTRODUCTION

Anti-TNF therapies are commonly employed in the treatment of autoimmune disorders, yet they are associated with a rare side effect known as IgA vasculitis (IgAV), whose clinical presentation remains poorly understood. This study aims to clarify the features of IgAV linked to anti-TNF treatments to aid in prompt recognition and management.

METHODS

Case reports on TNF-α-antagonist-associated IgAV dated up to February 29, 2024, were retrieved for retrospective analysis.

RESULTS

A total of 35 cases from 30 publications were identified. The average age of patients was 36 years (range 11 to 69), with 31.4% being pediatric cases. The primary conditions treated were Crohn's disease (45.7%) and ulcerative colitis (22.9%). Infliximab (42.9%) and adalimumab (37.1%) were the most frequently used agents. The onset of IgAV after initiating anti-TNF therapy occurred at a median of 10 months (range 1 day to 11 years). Clinical symptoms predominantly involved the skin (97.1%), kidneys (68.6%), joints (57.1%), and gastrointestinal tract (40.0%). Renal failure developed in 11.4% of patients. Histopathology revealed leukocytoclastic vasculitis in the skin and mainly proliferative nephritis in renal biopsies, with significant IgA deposition observed. Most patients (80.0%) ceased anti-TNF treatment, and the majority received corticosteroids (96.2%) and dapsone (15.4%) as part of their treatment. Remission was achieved in 34 patients, while one patient worsened. Among the 14 patients who restarted anti-TNF therapy, 9 experienced a recurrence of IgAV.

CONCLUSION

IgAV associated with anti-TNF therapy may emerge months into treatment and can lead to severe renal complications necessitating ongoing surveillance. Halting anti-TNF therapy is imperative, but the decision to resume treatment must be weighed carefully against the risk of primary disease exacerbation and IgAV recurrence.

Pharmacogenetics in Response to Biological Agents in Inflammatory Bowel Disease: A Systematic Review

Inflammatory bowel diseases (IBDs) are chronic inflammatory disorders influenced by microbial, environmental, genetic, and immune factors. The introduction of biological agents has transformed IBD therapy, improving symptoms, reducing complications, and enhancing patients' quality of life. However, approximately 30% of patients exhibit primary non-response, and 50% experience a loss of response over time. Genetic and non-genetic factors contribute to variability in treatment outcomes. This systematic review aims to thoroughly analyze and assess existing studies exploring the relationships between genetic variations and individual responses to biologic drugs, in order to identify genetic markers that are predictive of treatment efficacy, risk of adverse effects, or drug toxicity, thereby informing clinical practice and guiding future research. PubMed and EMBASE papers were reviewed by three independent reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines. Of the 883 records screened, 99 met the inclusion criteria. The findings of this review represent an initial step toward personalized medicine in IBD, with the potential to improve clinical outcomes in biological therapy.

Genetic evidence for amlodipine's protective role in gastroesophageal reflux disease: A focus on CACNB2

OBJECTIVE

This study aims to elucidate the causal relationship between genetically predicted amlodipine use and the risk of gastroesophageal reflux disease (GERD) using a bidirectional Mendelian Randomization (MR) approach and to explore the underlying genetic and molecular mechanisms through functional enrichment analysis and the construction of a competing endogenous RNA (ceRNA) network.

METHODS

Publicly available GWAS datasets from the Neale Lab consortium were used, including data on amlodipine (13,693 cases, 323,466 controls) and GERD (14,316 cases, 322,843 controls). Genome-wide significant SNPs were selected as instrumental variables and clustered by linkage disequilibrium. MR analysis was conducted using R software with all five methods. Sensitivity analyses assessed pleiotropy and heterogeneity. Drug target genes were analyzed using GO and KEGG pathways. GeneMANIA was used for network visualization, and a ceRNA network was constructed with Cytoscape. Differential gene expression analysis on GERD-related datasets from GEO validated the findings.

RESULTS

The MR analysis indicated a significant negative association between genetically predicted amlodipine use and GERD risk (IVW OR = 0.872, 95% CI = 0.812-0.937, P = 0.0002). Sensitivity analyses confirmed the robustness of these findings, showing no evidence of pleiotropy or heterogeneity. The enrichment analysis identified key biological processes and pathways involving calcium ion transport and signaling. The ceRNA network highlighted core targets such as CACNB2, which were further validated by differential expression analysis intersecting drug target genes with GERD-related gene expression changes.

CONCLUSION

This study provides robust evidence of a protective effect of amlodipine against GERD, supported by genetic and molecular analyses. The findings suggest that calcium channel blockers like amlodipine could be repurposed for GERD treatment. The identification of CACNB2 and other core targets in the ceRNA network offers novel insights into the pathophysiology of GERD and potential therapeutic targets, paving the way for personalized medicine approaches to improve patient outcomes.

Orally Administrated Inulin-Modified Nanozymes for CT-Guided IBD Theranostics

Background

Inflammatory bowel disease (IBD) is a chronic inflammatory bowel disease with no clinical cure. Excessive production of reactive oxygen species (ROS) at the inflammatory sites leads to the onset and progression of IBD. And the current non-invasive imaging methods are not ideal for the diagnosis and monitoring of IBD.

Methods

Herein, we developed inulin (IN)-coated cerium oxide nanoparticles (CeO2@IN NPs) for treatment and monitoring of IBD guided by computed tomography (CT). The physicochemical properties, ROS scavenging ability and CT imaging capabilities of CeO2@IN were investigated in vitro. Moreover, the therapeutic and targeted inflammation imaging effects of CeO2@IN were validated in dextran sulfate sodium (DSS)-induced colitis model.

Results

CeO2@IN with catalase (CAT) and superoxide dismutase (SOD) capabilities effectively scavenged ROS, thus protecting the cells against oxidative stress. In colitis model mice, orally administered CeO2@IN successfully traversed the gastrointestinal tract to reach the colon under the protection of IN, and effectively reduced intestinal inflammation, thereby maintaining the intestinal epithelial integrity. Notably, CeO2@IN performed better than conventional CT contrast agents for gastrointestinal tract imaging, particularly in detecting the inflamed areas in the colon. In addition, CeO2@IN exhibited excellent biocompatibility in vitro and in vivo.

Conclusion

The study provided a novel integrated diagnostic and therapeutic tool for the treatment and monitoring of IBD, presenting great potential as a clinical application for IBD.

Real-World Setting of Efficacy and Safety of 3 Years of Rifaximin Administration in Japanese Patients with Hepatic Encephalopathy: A Multicenter Retrospective Study

Background/Objectives: Rifaximin is a therapeutic agent for patients with hepatic encephalopathy (HE); however, there is little data on the effects of its long-term (>1 year) administration in Japanese patients with cirrhosis. The effects and safety of 3-year rifaximin treatment on HE was investigated in Japan. Methods: A total of 190 Japanese patients with cirrhosis who were continuously administered rifaximin for more than 1 year suffered overt or covert HE, which was diagnosed by a physician. Laboratory data were collected at baseline, 3, 6, 12, 18, 24, 30, and 36 months following rifaximin administration. We examined the cumulative overt HE incidences, overall survival rates, and hepatic functional reserves following rifaximin treatment. The occurrence of adverse events was also assessed. Results: The levels of ammonia improved significantly after 3 months of rifaximin administration, which continued for 3 years. Serum albumin and prothrombin activity also significantly improved 3 years after initiation of rifaximin treatment. Cumulative overt HE incidences were 12.1%, 19.7%, and 24.9% at 1, 2, and 3 years, respectively. The survival rates following rifaximin treatment were 100%, 88.9%, and 77.8% at 1, 2, and 3 years, respectively. In contrast, renal function and electrolytes did not change following rifaximin administration. Only three (1.6%) patients discontinued rifaximin therapy because of severe diarrhea after 1 year of rifaximin administration. No other serious adverse events were observed. Conclusions: Three years of continuous rifaximin (RFX) treatment was both effective and safe for patients with hepatic encephalopathy. Liver function improved and did not worsen during treatment.

Anti-Infective Bacteriophage Immobilized Nitric Oxide-Releasing Surface for Prevention of Thrombosis and Device-Associated Infections

The treatment of critically ill patients has made great strides in the past few decades due to the rapid development of indwelling medical devices. Despite immense advancements in the design of these devices, indwelling medical device-associated infections and thrombosis are two major clinical problems that may lead to device failure and compromise clinical outcomes. Antibiotics are the current treatment choice for these infections; however, the global emergence of antibiotic-resistance and their biofilm formation abilities complicate the management of such infections. Moreover, systemic administration of anticoagulants has been used to counter medical device-induced thrombosis, but a range of serious adverse effects associated with all types of available anticoagulants entails exploring alternative options to counter device-associated thrombosis. In this study, bacteriophages (phages) were covalently immobilized on polydimethylsiloxane (PDMS) surface containing the nitric oxide (NO) donor S-nitroso-N-acetylpenicillamine (SNAP) via SNAP impregnation method. This dual strategy combines the targeted antibacterial activity of phages against bacterial pathogens with the antibacterial-antithrombotic activity of NO released from the polymeric surface. The PDMS, SNAP-PDMS, phage-immobilized PDMS (PDMS-Phage), and phage-immobilized SNAP-PDMS (SNAP-PDMS-Phage) surfaces were characterized for their surface topology, elemental composition, contact angle, SNAP loading, NO release and phage distribution. SNAP-PDMS and SNAP-PDMS-Phage surfaces showed similar and consistent NO release profiles over 24 h of incubation. Immobilization of whole phages on PDMS and SNAP-PDMS was achieved with densities of 2.4 ± 0.54 and 2.1 ± 0.33 phages μm-2, respectively. Immobilized phages were found to retain their activity, and SNAP-PDMS-Phage surfaces showed a significant reduction in planktonic (99.99 ± 0.08%) as well as adhered (99.80 ± 0.05%) Escherichia coli as compared to controls in log killing assays. The SNAP-PDMS-Phage surfaces also exhibited significantly reduced platelet adhesion by 64.65 ± 2.95% as compared to control PDMS surfaces. All fabricated surfaces were found to be nonhemolytic and do not exhibit any significant cytotoxic effects toward mammalian fibroblast cells. This study is the first of its kind to demonstrate the combinatorial pertinence of phages and NO to prevent antibiotic-resistant/sensitive bacterial infections and thrombosis associated with indwelling medical devices.

Engineered Exosomes Carrying Super-Repressor IκB Reduced Biliary Atresia-Induced Liver Fibrosis in Minipig and Mouse Models

Background and Aim: Biliary atresia is a rare, progressive disease that affects the bile ducts in newborns. Persistent bile duct obstruction induces various pathological conditions, including jaundice, inflammation, and liver fibrosis; however, the exact pathogenesis of biliary atresia is not yet fully understood. Nuclear factor-κB (NF-κB) is widely acknowledged as a key regulator in the pathogenesis of hepatitis and liver fibrosis, and extensive research has been conducted to develop strategies to effectively inhibit its activity to mitigate liver damage. Exosome-based therapeutic platforms offer targeted NF-κB inhibition with low immunogenicity and enhanced liver-specific delivery. This study aimed to evaluate the therapeutic efficacy of Exo-SrIκB in treating cholestatic liver fibrosis using experimental animal models. Methods: Exo-SrIκB (an exosome-based therapy containing the super-repressor IκB protein) using EXPLOR technology (Exosome engineering for Protein Loading via Optically Reversible protein-protein interactions) to encapsulate the super repressor IκB (SrIκB) within exosomes. The therapeutic efficacy of Exo-SrIκB was assessed in minipig and mouse models with experimentally induced cholestatic liver disease. Results: Administration of Exo-SrIκB significantly attenuated liver fibrosis progression in both animal models by inhibiting NF-κB nuclear translocation and reducing the expression of fibrotic markers. Treated animals exhibited reduced collagen deposition, lower α-SMA levels, and improved hepatic function compared to untreated controls. Conclusion: Exo-SrIκB effectively suppressed NF-κB signaling and alleviated liver fibrosis in experimental cholestatic liver disease models, suggesting that exosome-based therapeutics may offer a targeted and biocompatible application to managing liver fibrosis and other chronic liver diseases.

Endoscopic ultrasound-guided treatment of isolated gastric varices

In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024. We focus specifically on the management of gastric varices (GV), which is a significant consequence of portal hypertension, is currently advised to include beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt for secondary prophylaxis or active bleeding. Although it has been studied, direct endoscopic injection of cyanoacrylate glue has limitations, such as the inability to fully characterize GV endoscopically and the potential for distant glue embolism. In order to achieve this, endoscopic ultrasound has been used to support GV characterization, real-time therapy imaging, and Doppler obliteration verification.

Reflux after peroral endoscopic myotomy: The dilemma and the options

Per oral endoscopic myotomy (POEM) is rapidly emerging as the treatment of choice for achalasia cardia, but its success is marred by problematic reflux. Although symptomatic reflux rates are low and often comparable to that after laparoscopic Hellers myotomy (LHM), a high incidence of pathologic reflux has been noted after POEM. This poses a dilemma as to what is true reflux, and in determining the indications and optimal endpoints for managing post-POEM reflux. The two pertinent reasons for the difference in reflux rates between LHM and POEM are the variation in length and location of myotomy and the absence of an anti-reflux procedure in POEM. Proton pump inhibitor remains the most sought-after treatment of POEM derived reflux. Nevertheless, modifications in the procedural technique of POEM and the addition of endoscopic fundoplication can probably emerge as a game changer. This article briefly reviews the incidence, causes, controversies, predictive factors, and management strategies related to post-POEM reflux.

Dietary Tannic Acid Improves Hepatic Health and Capacity to Deal with Temperature Fluctuation in the Chinese Soft-Shelled Turtle (Pelodiscus sinensis)

To assess the impact of tannic acid (TA) on the hepatic health of the Chinese soft-shelled turtle, the individuals were fed diets containing 0 (CG), 0.5, 1, 2, and 4 g/kg TA diets for 60 days (0 hps). Afterwards, the turtles were challenged with 15 °C cold stress for 24 h (24 hps) and then recovered to 28 °C for 24 h (48 hps). The results indicated that 4 g/kg TA has a significant toxic effect on the turtles after 60-day administration. The hepatic T-SOD, CAT, GSH-Px, and T-AOC activities in the TA2 were increased at 0 hps and 24 hps (p < 0.05) compared with CG. Similarly, Sod1, Sod2, Cat, Gsh-px3, and Gsh-px4 mRNA levels in the TA2 were higher than in the other four groups at 0 hps and 24 hps (p < 0.05). The histology data showed that 4 g/kg TA induced injuries in liver at 0 hps and after temperature fluctuation, whereas the 2 g/kg TA effectively attenuated the hepatic injuries. A total of 202 differentially expressed metabolites (DEMs) in the CG vs. TA2 and 115 DEMs in the LTCG vs. LTTA2 were separately detected by the metabolome. The cephalosporin C, protoporphyrin, bis(2-ethylhexyl) phthalate, 2-acetamidoethylphosphonat, verbasosid, and norcocain, were obvious DEMs in the CG vs. TA2. Furthermore, valienone 7-phosphate, 5-HETE, pregnanetriolone, 4-keto-anhydrotetracyclin, dephospho-CoA, and lysoPC(18:4(6Z,9Z,12Z,15Z)/0:0) were top DEMs in the LTCG vs. LTTA2. The "adipocytokine signaling pathway" and "AMPK signaling pathway" were the key pathways enriched in the CG vs. TA2, while "fatty acid biosynthesis", "steroid biosynthesis", and "linoleic acid metabolism" were most abundant in the LTCG vs. LTTA2. Generally, this research indicated that 2 g/kg TA could protect hepatic health from temperature fluctuations by improving antioxidant capacity, reducing histological injuries, and regulating lipid-related signaling pathways.

Comparative Analysis of Gut Microbiota in Patients with Irritable Bowel Syndrome and Healthy Controls

Background/Objectives: Growing evidence highlights the pivotal role of gut dysbiosis in the pathophysiology of irritable bowel syndrome (IBS). Despite this, the identification of an "IBS microbiota signature" remains elusive, primarily due to the influence of genetic, dietary, and environmental factors. To address these confounding variables, it is critical to perform comparative analyses using a control group derived from the same community as the IBS patients. This study aimed to evaluate and contrast the gut microbiota composition of IBS patients with healthy controls. Methods: We compared the gut microbiota from stool samples of 25 IBS patients diagnosed according to the Rome IV criteria, and 110 healthy subjects without acute or chronic diseases and not on continuous medication. The high-throughput sequencing of the V3-V4 regions of the 16S rRNA gene was conducted for microbiota analysis. Results: The IBS gut microbiota was richer but exhibited lower alpha diversity compared to the control group, suggesting simplification and imbalance. A beta diversity analysis revealed overall compositional differences between the two groups. A heat tree analysis highlighted key IBS-associated changes, including a decrease in Firmicutes, mainly due to Clostridia, and an increase in Bacteroidota, driven by an expansion of Bacteroidales families. Differential expression analyses identified important genera within these taxa like Bacteroides, Faecalibacterium, and Blautia, which could serve as microbiota-based biomarkers for IBS. Conclusions: Our results reveal both statistically and clinically significant differences in gut microbiota composition and diversity between IBS patients and healthy controls from the same community. These findings provide a deeper understanding of how alterations in the gut microbiota may contribute to IBS symptoms, offering new insights into the diagnosis and potential treatments.

Early enteral nutrition with fructooligosaccharides improves prognosis in severe acute pancreatitis

Soluble dietary fiber, notably as an adjunct to early enteral nutrition (EEN), is gaining prominence in clinical therapy. This study evaluates the effect of fructooligosaccharides (FOS), a new soluble dietary fiber, on the prognosis of patients with severe acute pancreatitis (SAP). In a retrospective cohort study at the Third Xiangya Hospital of Central South University from July 2017 to July 2023, 110 SAP patients were analyzed. TPF (enteral nutritional suspension of total protein)-normal and TPF-FOS groups both received standard EEN solutions; the latter additionally received FOS. Outcomes were compared between the groups. The study included 37 patients in the TPF-FOS group and 73 patients in the TPF-normal group. Mortality was 13.50% in the TPF-FOS group and 34.20% in the TPF-normal group (P < 0.05). FOS was identified as an independent protective factor (OR: 0.826, P = 0.041). The TPF-FOS group showed lower rates of intra-abdominal infection and decreased the level of inflammation (P < 0.05). FOS potentially acts as an independent protective factor against death in SAP. Additionally, the supplementation of EEN with FOS may contribute to reducing mortality and improving the prognosis of SAP patients.

Phages as potential life-saving therapeutic option in the treatment of multidrug-resistant urinary tract infections

Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and increasing antimicrobial resistance (AMR) challenges conventional antibiotic treatments. Phage therapy (PT) has emerged as a promising alternative due to its specificity, safety and efficacy against multidrug-resistant (MDR) pathogens causing infectious diseases. PT demonstrates significant potential in treating chronic and recurrent UTIs, also including catheter-associated infection by reducing bacterial biofilms, delaying catheter blockage, and enhancing antibiotic efficacy when used in combination. Clinical trials and case studies have reported high rates of bacterial eradication and symptom improvement with minimal side effects. Although endotoxin release and immune activation during treatment should continue to be investigated. The aim of this review is to present issues related to the use of phages in the treatment of UTIs of various etiological origins in selected patients, including those with comorbidities, taking into account the legal regulations, safety and effectiveness of this experimental therapy. The growing prevalence of MDR uropathogens highlights the urgent need for alternative therapies, such as those based on phages in order to treat antibiotic-resistant infections and improve patient outcomes. Despite the great potential of PT, its clinical implementation and use of phages as a routine treatment for bacterial infections requires rigorous trials, standardized production protocols and regulatory advancements.

Impact of Antimicrobial Resistance of Pseudomonas aeruginosa in Urine of Small Companion Animals in Global Context: Comprehensive Analysis

The isolation of multidrug-resistant (MDR) bacteria from the urinary tracts of pets is increasingly common, particularly in animals with concurrent health conditions. Pseudomonas aeruginosa (PA) is one of the most significant antimicrobial-resistant bacteria affecting cats and dogs within the European Union (EU). This study aims to review the prevalence and antimicrobial resistance patterns of PA isolated from urine samples of small animals globally. This pathogen is known for its opportunistic infections and is a significant concern in veterinary medicine due to its inherent resistance to multiple antibiotics and its ability to acquire additional resistance mechanisms. This review seeks to enhance educational initiatives regarding the management of emerging MDR bacteria.

pH-Dependent Drug Delivery Systems for Ulcerative Colitis Treatment

Inflammatory bowel diseases (IBDs), such as ulcerative colitis (UC) or Crohn's disease, are becoming a growing global problem due to the limitations of current treatments, which fail to address the needs of patients effectively. UC is characterized by the widespread inflammation of the mucosal lining, affecting both the rectum and the entire length of the colon. Over the past forty years, traditional treatments for IBDs have primarily relied on anti-inflammatory drugs and immunosuppressive medications. Treatment could be more effective if drugs could be specifically targeted to act directly on the colon. Conventional drug delivery systems for IBDs encounter numerous challenges on their way to the colon, such as physiological barriers and disease severity. To address these issues, pH-dependent carriers have emerged as a promising advancement, offering a more effective and tolerable treatment for UC. These carriers enable localized, targeted action, reducing side effects and preventing the premature clearance of drugs from inflamed colon tissues. pH-responsive systems are a leading approach for targeted drug release in colitis treatment as they take advantage of the varying pH levels throughout the gastrointestinal tract (GIT). By incorporating pH-sensitive polymers, they ensure drug protection and controlled release in the lower GIT. This review will discuss the advantages and limitations of pH-dependent drug delivery systems for colon-targeted drug delivery.

Evaluating the implementation of a multicomponent intervention to improve faecal immunochemical test-based (FIT) colorectal cancer screening in primary care

Screening has proven effective at reducing the incidence and mortality of colorectal cancer (CRC). The faecal immunochemical test (FIT) is recommended for screening people aged 50-74 years at average risk of CRC in Alberta, Canada. This project implemented a multicomponent intervention in real-world, primary care settings in Alberta to improve the FIT participation rate and evaluated the reach, effectiveness and implementation outcomes.The multicomponent intervention comprised of in-clinic FIT kit distribution, patient education and reminder calls, was implemented in four primary care clinics. Reach was measured as the proportion of patients receiving the intervention. Effectiveness was measured by comparing the proportion of patients completing FIT during preintervention and perintervention periods. Implementation was measured by the perceived acceptability, appropriateness and feasibility of providers in implementing the intervention. Data were collected from electronic medical records and validated survey tools.Four clinics implemented the intervention during an 8-month study period (September 2021 to April 2022); 99% of eligible patients received a FIT kit. The baseline FIT completion rate across participating clinics was 62%, which increased by 13 percentage points to 75% during the intervention period. Of the 75% who completed the FIT, 56% did without a reminder call, whereas 19% did so after receiving one or more reminders. More than 90% of providers perceived the intervention implementation as acceptable, feasible and appropriate.The multicomponent FIT intervention was perceived as acceptable, feasible, and appropriate and improved the FIT screening rates in pilot clinics. An implementation guidance document has been developed and tested to communicate the implementation process for use by other primary care clinics and aid in the spread of the intervention across Alberta. Implementing this intervention in routine practice can help decrease the incidence and mortality of CRC.

Evaluating the reflux suppression properties of Gaviscon Infant powder with different milk formulations using an in vitro model of the infant stomach

Gastroesophageal reflux (GER) is common in babies and infants and is characterized by effortless regurgitation (with or without vomiting), which is a common symptom of other infant conditions, including cow's milk protein allergy (CMPA). Various milk formulations are commercially available to help manage GER and CMPA symptoms (extensively hydrolyzed [eHF], partially hydrolyzed [pHF], and amino-acid formulas [AAF]). We aimed to understand if an alginate product (Gaviscon Infant powder) worked as intended in the presence of different milk formulations. A previously evaluated artificial infant stomach model simulated an internal pressure-inducing reflux event (five reflux events performed at 5 min intervals). Suppression activity of Gaviscon Infant combined with eHF, pHF, and AAF was assessed by measuring the height that the refluxate event traveled up a tube mimicking the infant esophagus, alongside a benchmark unhydrolyzed formulation (uHF) with Gaviscon Infant and a negative control without Gaviscon Infant. Each experiment was repeated six times per formulation in a random order. Gaviscon Infant combined with each milk formulation produced a lower height of refluxate versus the negative control. When formulations combined with Gaviscon Infant were grouped by category (eHF, pHF, AAF), two or more products from each category showed a lower refluxate height than the benchmark (uHF). There was a significant difference in median refluxate height (p = 0.0011 in Wilcoxon rank sum test) when comparing Gaviscon Infant combined with eHF against Gaviscon Infant combined with pHF, AAF, or uHF (benchmark). Refluxate height did not change significantly between events one and five for each milk formulation combined with Gaviscon Infant. In an artificial infant stomach model, Gaviscon Infant combined with different milk formulations (uHF, eHF, pHF, AAF) produced a lower refluxate height compared with a negative control (uHF without Gaviscon Infant), suggesting that Gaviscon Infant suppresses reflux as intended when used with different milk formulations.

Unveiling the metabolomic profile of growth hormone deficiency children using NMR spectroscopy

INTRODUCTION

The diagnosis of Growth Hormone Deficiency (GHD) during childhood has been the subject of much controversy over the last few years. Aiming to accurate medical treatment, there is a need for biomarker discovery.

OBJECTIVE

To characterize the metabolic profile of GHD children, examine the effect of GH administration on the metabolic signature, and investigate the correlations between metabolites and IGF-1.

METHODS

Nuclear Magnetic Resonance (NMR)-based untargeted and targeted metabolomic approach applied to study the metabolic profiles of children with GHD. Plasma, serum, and urine samples were collected from twenty-two children diagnosed with GHD and forty-eight age matched controls from the Pediatric Endocrinology Unit of the University Hospital of Patras. Experimental data were examined by both multivariate and univariate statistical analysis.

RESULTS

The results of this pilot study revealed a different metabolic fingerprint of children with GHD in comparison to age-matched healthy individuals. However, the detected alterations in the metabolite patterns before and after GH treatment were subtle and of minor discriminative statistical power.

CONCLUSIONS

This study provides evidence that metabolome plays a pivotal role in GHD, but large-scale multicenter studies are warranted to validate the results.

Selenium Mitigates Caerulein and LPS-induced Severe Acute Pancreatitis by Inhibiting MAPK, NF-κB, and STAT3 Signaling via the Nrf2/HO-1 Pathway

Severe acute pancreatitis (SAP) leads to systemic inflammation, resulting in multiorgan damage. Acute lung injury and acute respiratory distress syndrome develop in one-third of SAP patients, with a high mortality rate of 60% due to secondary complications. Patients with pancreatitis often have selenium deficiency, and selenium supplements may provide beneficial effects. This study examined the protective role of selenium in a model of SAP induced by caerulein + lipopolysaccharide (cae + LPS). Mice were administered selenium (1 mg/kg) before being challenged with caerulein (6 injections of 50 μg/kg) and LPS (10 mg/kg). At 3 h after the last caerulein injection, blood was collected for estimating pancreatic enzymes and cytokine levels, and the mice were euthanized. We performed morphological and histological studies, measured levels of protease and oxidative stress markers and conducted western blot, ELISA, and RT-qPCR analyses. We examined lung tissue histologically and estimated myeloperoxidase levels. Selenium pretreatment significantly reduced pancreatic enzyme levels such as amylase, lipase, and proteases (specifically MMPs) and reversed tissue injury in the pancreas and lungs caused by cae + LPS. In addition, selenium-treated mice showed decreased levels of inflammatory markers and chemokines. Examination of the downstream inflammatory pathways confirmed the protective effect of selenium, which mediates its anti-inflammatory and antioxidant action by inhibiting the major inflammatory signaling pathways (MAPKs, NF-κB, and STAT3) and activating the phosphorylation of Nrf2 via Nrf2/HO-1 pathways. These findings suggest that selenium may be a potential therapeutic option for treating SAP-associated secondary complications.

Efficacy of Potassium-Competitive Acid Blockers Versus Proton Pump Inhibitors for Gastric Ulcers: Bayesian and Frequentist Network Meta-Analysis With Cross-Inference Through a Quality management System

Purpose

Proton pump inhibitors (PPIs) have been the mainstay treatment for gastric ulcer (GU) for over 30 years. However, since the discovery of a new class of acid suppressants, potassium-competitive acid blockers (P-CABs), the desire for a therapeutic agent has continued and the clinical trials on P-CABs have been conducted. In this regard, we aimed to assess whether P-CABs are noninferior to PPIs in patients with GU in terms of efficacy.

Methods

We performed a systematic review and network meta-analysis (NMA) based on randomized controlled trials (RCTs). Additionally, we used a new methodology of inference concept with the purpose of grouping between P-CABs and PPIs. Moreover, our quality management system was integrated throughout the research to ensure data accuracy.

Findings

We initially screened 438 studies and extracted 10 homogeneous GU RCTs with 6315 participants. The odds ratios (ORs) for the 4-week cure rate in Bayesian + frequentist NMA, tegoprazan 100 mg (OR = 4.14, 95% credible interval [CI] 0.56-26.3) and pantoprazole 40 mg (OR = 4.12, 95% CI 1.90-8.88) were the largest, respectively. The ORs for the 8-week cure rate in Bayesian + frequentist NMA, lansoprazole 30 mg (OR = 8.77, 95% credible interval [CI] 0.95-78.9) and lansoprazole 30 mg (OR = 7.91, 95% CI 2.60-24.03) was the largest, respectively.

Conclusions

The results of the NMA reveal that the cure rates of P-CABs in cases of GU were not inferior to those of PPIs. As the inference by grouping PPIs and P-CABs, the results showed similar trends in terms of effectiveness between the two therapeutic classes.

Patient perspectives on acromegaly disease burden: insights from a community meeting

Objective

A profound mismatch between biological and symptom control in acromegaly creates a high disease burden despite achieving optimal biological control. There is a great need to learn more about the perspectives of patients living with acromegaly.

Methods

Acromegaly Community hosted a virtual meeting in January 2021 and prepared a detailed report capturing participants' input on acromegaly symptoms and current and future treatment approaches. The findings of this report are reviewed and summarized in this study.

Results

Fatigue/muscle weakness (92%) and joint pain/arthritis (90%) are the two most common and troublesome symptoms reported by meeting participants. Acromegaly negatively impacts all aspects of daily living: social interaction (49%); exercise (42%); sports/recreational activities (39%); household activities (38%); attending school or job (38%); family relationships (33%); and walking (26%). Anxiety/depression is experienced by 75% of respondents. Eighty-three percent of patients underwent pituitary surgery, and over 71% of patients require medical therapy. Patients desire future improvements in medication efficacy, tolerability, and administration; mental health resources for themselves and their families; and other multimodal approaches to address their physical symptoms, specifically hunger, weight gain, muscle weakness, and joint pains.

Conclusion

Acromegaly patients experience significant physical and psychological burdens despite biochemical control, highlighting the need for comprehensive and patient-centered care. In particular, the impacts on activities of daily living (ADLs) and heavy psychosocial and socioeconomic burdens are striking. We advocate for periodic screening for impacted ADLs, multidisciplinary teams to proactively address these symptoms, and call for further research on under-evaluated aspects of the disease.

Anti-Inflammatory and Antimicrobial Effects of Herbal Formulation Called Apo-Taat Using Extended-Spectrum ß-Lactamase-Producing Escherichia coli Isolates

Pathogens contaminate drinking water in tropical countries causing diarrheal diseases. The conventional treatment for diarrhea is antibiotics. However, overuse and misuse of antibiotics has enabled pathogens to adapt, causing global antibiotic resistance and proliferation of extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-E. coli), which causes diarrhea and high levels of inflammatory cytokines. Apo-taat, consisting of equal proportions of Phyllanthus emblica and Caesalpinia sappan, has been used to treat diarrhea and bloody diarrhea. Its antibacterial activity against E. coli ATCC 25922 has been reported, but its inhibitory effect against ESBL-E. coli has yet to be documented. This study investigated the antibacterial effect of Apo-taat extract against ESBL-E. coli and its anti-inflammatory activity. Antibacterial activity was determined by the microtiter plate-based method. HPLC was used to determine the brazilin and gallic acid contents in Apo-taat extract. Effects of herbal extracts on nitric oxide, IL-6, and TNF-α were investigated in RAW 264.7 cells. Results were that Apo-taat extract showed MIC values against ESBL-E. coli in the range of 0.625 to 2.5 mg/mL. Its 50% inhibitory concentration against nitric oxide and IL-6 production was 83.96 ± 10.60 and 83.06 ± 2.07 μg/mL, respectively, and it had slight inhibition against TNF-α. These findings suggest that Apo-taat may have an antibacterial impact on ESBL-E. coli and anti-inflammatory activity. Furthermore, safety and clinical trials should be conducted in the future.

Combating enteropathogenic and multidrug resistant Escherichia coli using the lytic bacteriophage vB_EcoM_ECO78, which disrupts bacterial biofilm formation and exhibits a remarkable environmental stability

AIM

The current study aimed to establish a phenotypic and genotypic characterization record of a novel lytic bacteriophage (phage) against multidrug-resistant (MDR) Escherichia coli (E. coli) infections.

METHODS AND RESULTS

Phenotypic characterization of the isolated phage included the assessment of phage morphology, host range, stability, and antibiofilm activity. The isolated phage vB_EcoM_ECO78 demonstrated a high lytic activity against MDR E. coli and E. coli serotypes O78: K80: H12 and O26: H11. Additionally, it showed a marked antibiofilm activity and high physical stability at a wide range of temperatures and pH. Genotypic investigations identified a double-stranded DNA genome of 165 912 base pairs (bp) spanning 258 open reading frames (ORFs), out of which 149 ORFs were identified and annotated. In vivo analysis further confirmed the therapeutic potential of vB_EcoM_ECO78 which effectively increased the survival of mice infected with MDR E. coli.

CONCLUSION

The isolated phage vB_EcoM_ECO78 exhibits considerable stability and antibiofilm activity against MDR E. coli isolates, supported by notable environmental fitness and in vivo antibacterial capability.

Failure or future? Exploring alternative antibacterials: a comparative analysis of antibiotics and naturally derived biopolymers

The global crisis of antimicrobial resistance (AMR) is escalating due to the misuse and overuse of antibiotics, the slow development of new therapies, and the rise of multidrug-resistant (MDR) infections. Traditional antibiotic treatments face limitations, including the development of resistance, disruption of the microbiota, adverse side effects, and environmental impact, emphasizing the urgent need for innovative alternative antibacterial strategies. This review critically examines naturally derived biopolymers with intrinsic (essential feature) antibacterial properties as a sustainable, next-generation alternative to traditional antibiotics. These biopolymers may address bacterial resistance uniquely by disrupting bacterial membranes rather than cellular functions, potentially reducing microbiota interference. Through a comparative analysis of the mechanisms and applications of antibiotics and antibacterial naturally derived biopolymers, this review highlights the potential of such biopolymers to address AMR while supporting human and environmental health.

Optical imaging guidance in oncologic surgery and interventional oncology

Over recent decades, optical imaging (OI) has become an integral part of medical imaging, offering significant advantages over other modalities, such as computed tomography (CT) and magnetic resonance imaging (MRI). OI is distinguished by its real-time imaging capability, cost-effectiveness, portability, absence of ionizing radiation, and high patient acceptability. The introduction of advanced optical dyes (including FDA-approved agents like indocyanine green, Cytalux, and Gleolan) has greatly enhanced its clinical utility. OI has shown clear benefits in the management of patients with cancer, originally by open surgery and now extending to minimally invasive, image-guided interventional procedures. This review highlights recent developments in OI for oncology, emphasizing its benefits for clinicians in guiding surgical and interventional procedures.

Isolation and characterization of a broad-spectrum bacteriophage against multi-drug resistant Escherichia coli from waterfowl field

Escherichia coli (E. coli) is a significant pathogen responsible for intestinal infections and foodborne diseases. The rise of antibiotic resistance poses a significant challenge to global public health. Traditional antibiotic therapy is becoming increasingly ineffective, highlighting the urgent need for innovative control strategies. This study explores the potential of bacteriophages as a sustainable alternative to traditional antibiotics. From 2021 to 2022, a total of 183 non-repetitive duck source fecal samples were collected from Mianyang City, Sichuan Province, and 126 strains of E. coli were isolated. The minimum inhibitory concentration (MIC) test showed that these strains exhibited high resistance to piperacillin (96.8%), tetracycline (88.9%), and chloramphenicol (86.5%). It is concerning that 93.7% of the isolates are classified as multidrug-resistant (MDR), posing a significant threat to existing treatment options. 20 bacteriophages were isolated from fecal and soil samples, among which 5 bacteriophages were selected for further analysis. Bacteriophage YP6 showed excellent lytic effects on MDR strains, especially strain MY104, as well as representative serotypes O1 (E. coli MY51) and O18 (E. coli MY106). The identification of YP6 as a member of the Myoviridae family was conducted using transmission electron microscopy, and it was found to have an optimal infection factor of 0.1. Bacteriophages exhibit significant thermal and pH stability, maintaining survival at temperatures up to 60 °C and pH ranges of 4 to 10. Whole genome sequencing confirmed that YP6 has a double stranded DNA genome of 139,323 base pairs (bp), and no antibiotic resistance or virulence genes were found, indicating a low possibility of horizontal gene transfer. In addition, YP6 effectively inhibits the formation of E. coli biofilm, which is a key factor in chronic infections. The in vivo experiments using Galleria mellonella (G. mellonella) larvae have shown that it has a significant protective effect against MDR E. coli infection. In summary, bacteriophage YP6 is expected to become a therapeutic agent against MDR E. coli infection due to its broad host range, environmental stability, and biofilm inhibition properties. Future research should optimize bacteriophage preparations, evaluate the safety and efficacy of animal models, and establish clinical application plans in the field of food safety.

Asymptomatic Inflammatory Bowel Disease Diagnosed During Colorectal Cancer Population Screening in Catalonia: Characteristics and Natural History

INTRODUCTION

Inflammatory bowel disease (IBD) is usually diagnosed when symptomatic. Prognosis and evolution of preclinical IBD is largely unknown. However, colorectal cancer screening programs (CRCSP) detect a subset of patients with IBD with no symptoms. The aim of this study was to describe the natural history of asymptomatic IBD diagnosed through CRCSP.

METHODS

An observational, longitudinal, and retrospective study was performed at 22 centers in Catalonia between January 2010 and December 2019 including patients with asymptomatic IBD detected in the CRCSP. Demographic data and IBD characteristics, evolution, and treatment were recorded. Descriptive statistics and Kaplan-Meier analysis were used for the analysis. Data were given separately for IBD, Crohn's disease (CD), ulcerative colitis (UC), and IBD unclassified (IBDU).

RESULTS

One hundred eighty-eight patients were included: 103 UC (54.8%), 60 CD (31.9%), and 25 IBDU (13.3%). Sixty-six (35.1%) were women, and the average age was 59.9 ± 5.9 years. Sixty-four patients (34.0%) developed symptoms after a median follow-up of 35.6 months. Diarrhea was the most frequent symptom for CD and IBDU (25.4% and 11.5%, respectively) and blood in stools for UC (21.4%). The median time to first symptom was 11.6 months. Treatment was prescribed in 135 patients (72.2%); mesalazine was the most prescribed drug (123 patients; 65.4%). Thirteen patients (6.9%) required biological treatment. None underwent surgery.

DISCUSSION

Around one-third of asymptomatic patients with IBD developed symptoms after a medium follow-up of 3 years. Only 6.9% required biological treatment, and none required surgery. Overall, prognosis of asymptomatic IBD seems better.

Mortality Patterns of Esophageal Cancer in the United States: A 21-Year Retrospective Analysis

OBJECTIVES

Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first 5 years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States.

METHODS

The mortality trends among adults with EC were analyzed using data from the CDC WONDER database. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joinpoint regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups.

RESULTS

Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999 to 2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and nonmetropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared with states falling in the lower 10th percentile.

CONCLUSIONS

Over the last 2 decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

Endoscopic ultrasonography-guided coil embolization and cyanoacrylate injection versus cyanoacrylate injection alone for gastric varices: a randomized comparative study

BACKGROUND

Bleeding from gastric varices is life-threatening, with significant rebleeding risk despite standard cyanoacrylate glue injection therapy. Our aim was to evaluate the efficacy and safety of endoscopic ultrasonography (EUS)-guided coil embolization with cyanoacrylate injection (Coil+CYA) compared with EUS-guided cyanoacrylate injection alone (CYA) for the treatment of gastric varices.

METHODS

The study was conducted at a tertiary referral center in India, using a single-blinded, prospective, and parallel-group randomized design. A total of 50 patients were randomly assigned (1 : 1) to Coil+CYA or CYA. The primary outcome was clinical success (i.e. variceal obliteration). Secondary outcomes involved technical success, gastric variceal recurrence during follow-up, rebleeding episodes, reintervention, and survival.

RESULTS

Post-intervention, gastric variceal obliteration assessed by EUS was higher in the Coil+CYA group (100% vs. 92.3%; P = 0.49), with both groups achieving 100% technical success. Rebleeding episodes during 0-12 and 12-24 weeks were comparable in the two groups. At 12 weeks, on EUS, variceal reappearance was less common in the Coil+CYA group (12.5% vs. 19.2%; P = 0.70). Significantly fewer reinterventions were needed in the Coil+CYA group (20.8% vs. 53.8%; P = 0.03). The time to reintervention was significantly longer in the Coil+CYA group (P = 0.01), and the survival time was also longer (P = 0.04).

CONCLUSIONS

EUS-guided coil embolization with cyanoacrylate injection achieved superior clinical success, reducing the need for reintervention and resulting in improved survival compared with cyanoacrylate injection alone.

Structures, antioxidant, and angiotensin I-converting enzyme (ACE)-inhibitory activities of peptides derived from protein hydrolysates of three phenolics-rich legume genera

Lentil, black soybean, and black turtle bean are rich in phenolic antioxidants but belong to different scientific genera with different protein structures. This study's objective was to compare the characteristics of peptides derived from the protein hydrolysates of these legumes. Proteins were isolated, cooked, and subjected to in vitro digestion with pepsin, trypsin, and chymotrypsin. Hydrolyzed peptides were fractionated by ultrafiltration (UF), anion-exchange chromatography, and gel-permeation chromatography (GPC). GPC-eluted peptides of <3 kDa with high angiotensin I-converting enzyme (ACE)-inhibitory activities were sequenced. Antioxidant profiles of peptides from the three legumes analyzed by five methods did not follow the same activity patterns associated with the decreases in peptide's molecular size. Among the UF fractions, the <3 kDa fraction had the highest ACE-inhibition with approximately 45%, 42%, and 39% at 100 µg/mL. Stepwise purifications of the hydrolysates enhanced the ACE-inhibitory capacity (IC50) by two to nine folds after GPC to approximately 85, 64, and 93 µg/mL for lentil, black soybean, and black turtle bean, respectively. The 210 peptides sequenced in the <3 kDa fractions had chain-lengths, ranging from 6 to 18 amino acids with lentil having the shortest average length of 7.7 per peptide. Overall, based on chemical analyses, peptides contributed higher antioxidant capacity and ACE-inhibition than phenolics in legumes. Black turtle bean may need to be heated more prior to consumption to achieve the same digestibility as lentil and soy proteins. Results provided a foundation for making bioactive peptides from the three legumes. PRACTICAL APPLICATION: Three antioxidant-rich legume genera, lentil, black soybean, and black turtle bean, produced different peptides with different angiotensin I-converting enzyme (ACE) potencies and different peptide lengths. The results provided a scientific basis for producing peptides from the selected genera for the development of functional foods or dietary supplement with high antioxidant, ACE inhibitory activities, and digestibility.

US National Estimates of Contemporary Mortality Rates in Patients With Ulcerative Colitis Undergoing Colectomy

INTRODUCTION

Despite a growing armamentarium of medical therapies for ulcerative colitis, colectomy remains an important therapeutic option. To better inform shared decision-making about surgery, we estimated the contemporary risk of mortality after colectomy.

METHODS

Mortality rates were estimated using the National Inpatient Sample (2016-2020). Factors associated with postcolectomy death were evaluated in multivariable regression.

RESULTS

Postcolectomy mortality occurred in 1.2% (95% CI: 0.8%, 1.9%) of hospitalizations. Comorbidity burden, emergent laparotomy, and delays to surgery >5 days after admission were associated with mortality.

DISCUSSION

Colectomy may be associated with mortality; however, this risk is heterogeneous based on patient- and procedural-related factors.

Prevalence of faecal incontinence in patients with inflammatory bowel disease: Severity and its relationship with quality of life

AIMS

To describe the prevalence of faecal incontinence in patients with inflammatory bowel disease, assess its severity, and correlation with quality of life. We adhered to relevant EQUATOR guidelines, STROBE method.

DESIGN

Correlational-descriptive study.

METHODS

Hebrew-speaking patients seen at an inflammatory bowel disease clinic in a large tertiary medical center in Jerusalem between February 2020 and December 2020 completed the Faecal Incontinence Severity Index and the Faecal Incontinence Quality of Life Scale.

RESULTS

Ninety-six patients participated in the study, of which 70 (72.9%) had Crohn's disease, and 26 (27.1%) had ulcerative colitis. Eighty-five (88.5%) reported faecal incontinence with an overall Faecal Incontinence Severity Index mean of 27.66 (SD 15.99), yet only 14 (14.7%) reported that their physician or nurse inquired about faecal incontinence. Quality of life scores for patients with faecal incontinence was the lowest on the coping/behaviour scale (M = 2.44; SD 0.94) and the highest on the depression/self-perception scale (M = 2.86; SD 1.04). Significant correlations were found between faecal incontinence severity and quality of life in all scales except for self-embarrassment. Moderate correlations in the same scales were noted in patients with Ulcerative Colitis, while no significant correlations were found in the Crohn's Disease group.

CONCLUSION

A high proportion of inflammatory bowel disease patients reported faecal incontinence associated with impaired quality of life. Only a few were questioned about faecal incontinence by their physician or nurse.

IMPACT

There is limited literature regarding the prevalence and severity of faecal incontinence in inflammatory bowel disease patients. A high proportion of patients reported faecal incontinence, which negatively correlated with quality of life. Physicians and nurses must inquire about faecal incontinence to improve patient care.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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.

Diagnostic accuracy of interleukin-6 as a biomarker for early prediction of severe acute pancreatitis: A systematic review and meta-analysis

Background

Acute pancreatitis (AP) is an inflammatory disease of the pancreas with varying severity. The mortality rate varies from 20% to 40% among severe acute pancreatitis (SAP). Interleukin-6 (IL-6) is a pro- and anti-inflammatory cytokine that involves various infections, inflammations, and systemic disorders. Injury to acinar cells leads to necrosis, releasing proinflammatory cytokines, including IL-6, which peaks earlier. The lack of extensive data regarding the association of IL-6 with AP influences us to do this meta-analysis for early detection and treatment of AP to prevent multiorgan failure.

Methods

We searched the PubMed, Cochrane Library, and Google Scholar databases for relevant articles published from inception to June 2024. We examined the positive and negative likelihood ratios, diagnostic odds ratios, and pooled sensitivity and specificity. We used the QUADAS-2 tool to evaluate the risk of bias.

Results

This meta-analysis included 13 studies involving 1386 patients with AP, of which 343 had SAP and 1043 had mild and moderately severe AP. The positive and negative likelihood ratios were 3.5 (95% CI 2.6 to 4.5) and 0.25 (95% CI 0.16 to 0.40). The diagnostic odds ratio of IL-6 to diagnose SAP is 14 (95% CI: 7 to 27), and the summary receiver operating characteristic curve is 0.85 (95% CI: 0.82-0.88).

Conclusion

Based on the results of this meta-analysis, serum IL-6 is a promising biomarker for diagnosing SAP in the early stage. However, a larger-scale study involving a more extensive population is necessary due to the considerable variation between the studies.

European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below the level that allows the normal digestion of nutrients. Pancreatic disease and surgery are the main causes of PEI. However, other conditions and upper gastrointestinal surgery can also affect the digestive function of the pancreas. PEI can cause symptoms of nutritional malabsorption and deficiencies, which affect the quality of life and increase morbidity and mortality. These guidelines were developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. After a systematic literature review, the evidence was evaluated according to the Oxford Center for Evidence-Based Medicine and the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted on using the Delphi method. The diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzyme replacement therapy (PERT), together with dietary advice and support, are the cornerstones of PEI therapy. PERT is indicated in patients with PEI that is secondary to pancreatic disease, pancreatic surgery, or other metabolic or gastroenterological conditions. Specific recommendations concerning the management of PEI under various clinical conditions are provided based on evidence and expert opinions. This evidence-based guideline summarizes the prevalence, clinical impact, and general diagnostic and therapeutic approaches for PEI, as well as the specifics of PEI in different clinical conditions. Finally, the unmet needs for future research are discussed.

Characteristics, Complications, and Outcomes of Critical Illness in Patients with Parkinson Disease

BACKGROUND

Adults with Parkinson disease (PD) are hospitalized at higher rates than age-matched controls, and these hospitalizations are associated with significant morbidity. However, little is known about the consequences of critical illness requiring intensive care unit (ICU)-level care in patients with PD. The aim of this study was to define the characteristics and outcomes of adults with PD admitted to the ICU.

METHODS

We performed a retrospective nested case-control study using the Medical Information Mart for Intensive Care IV data set. Adults with PD were identified, and the index ICU admission for these subjects was matched 1:4 with index ICU admissions without a PD diagnosis based on age, sex, comorbidities, illness severity, ICU type, and need for mechanical ventilation. Primary outcomes were in-hospital mortality and discharge location. Secondary outcomes were length of stay and prespecified complications.

RESULTS

A total of 630 adults with PD were identified. Patients with PD were older and were more likely to be male, have more comorbidities, and have higher illness severity at presentation. A matched analysis revealed adults with PD did not have a significant difference in in-hospital mortality but were more likely to be discharged to a higher level of care. Adults with PD had longer hospital lengths of stay and increased odds of delirium, pressure ulcers, and ileus.

CONCLUSIONS

During critical illness, patients with PD are at increased risk for longer hospital lengths of stay and complications and require a higher level of care at discharge than matched controls. These findings reveal targets for interventions to improve outcomes for patients with PD and may inform discussions about goals of care in this population.

Impact of obesity and diabetes on colorectal cancer in Saudi Arabia is associated with liver γ‑glutamyl transferase abnormality

Colorectal cancer (CRC) is a leading global cause of death. In Saudi Arabia, it is the most common cancer among men and the third most common among women. Obesity, diabetes and CRC have become significant health concerns. The present study aimed to explore the connection between liver function markers, obesity and diabetes in patients with CRC. In addition to exploring whether the incidence of CRC had increased in Saudi Arabia. The present study conducted a retrospective chart review based on data from the Saudi Ministry of National Guard Hospitals. Clinical laboratory assays of patients with CRC with obesity and/or diabetes between 2015 and 2021 were analysed, and various factors were considered. This study found that CRC is more prevalent in overweight and obese individuals, primarily aged 50 years and older. Diabetes was more common in patients with CRC (61.76%) compared with non-diabetic individuals (38.24%). Additionally, the protein γ-glutamyl transferase might serve as a potential biomarker for CRC in overweight and obese patients. Notably, the age of CRC diagnosis in Saudi Arabian patients in the present study was lower than previously reported. The present study provided insight into the relationship between obesity, diabetes and liver function markers in Saudi Arabian patients with CRC. It also highlighted the increasing incidence of CRC in Saudi Arabia, emphasizing the need for further attention and research.

Another Crohn's Disease Mimicker: A Case of Angiotensin-Converting Enzyme Inhibitor-Induced Intestinal Angioedema

Angiotensin-converting enzyme inhibitors are a common cause of drug-induced angioedema, which rarely affects the gut. We present a 32-year-old White woman with Crohn's disease on lisinopril experiencing 1 year of episodic abdominal pain, nausea, and vomiting, prompting multiple steroid tapers and a switch in biologic therapy. She was hospitalized and was profoundly hypotensive on arrival. Initial imaging showed marked small bowel wall thickening and free fluid in the abdomen. She had rapid symptomatic and radiographic improvement after only 24 hours and was diagnosed with angiotensin-converting enzyme inhibitor-induced intestinal angioedema, an important Crohn's disease mimicker that may lead to unwanted management if unrecognized.

Effects of gut microbiota and metabolites on pancreatitis: a 2-sample Mendelian randomization study

BACKGROUND

Acute pancreatitis (AP) and chronic pancreatitis (CP) have high incidences and poor prognoses. The early screening of at-risk populations still awaits further study. The limitation was mainly based on observational studies, with limited sample size and the presence of confounding factors. This study used a 2-sample Mendelian randomization (MR) analysis based on publicly available data from genome-wide association studies to reveal the causal effect of gut microbiota and metabolites on pancreatitis.

METHODS

This study collected summary statistics on gut microbiota, metabolites, AP, and CP. A 2-sample MR analysis was performed using MR-Egger, inverse variance-weighted, MR Pleiotropy RESidual Sum and Outlier, maximum likelihood, and weighted median.

RESULTS

The 2-sample MR showed that only Eubacterium coprostanoligenes was an independent protective factor for AP among all gut microbiota, and the other microbiota were not significant for pancreatitis. Unsaturated fatty acids in metabolites are protective factors for both AP (odds ratio [OR], 0.730; 95% CI, 0.593-0.899; P = .003) and CP (OR, 0.660; 95% CI, 0.457-0.916; P = .013). Furthermore, carnitine was a protective factor CP, and glucose was an independent risk factor for CP.

CONCLUSION

This study provides potential evidence of the causal role of gut microbiota and metabolites on pancreatitis, which may be conducive for designing microbiome and metabolite interventions on AP or CP in the future.

Unraveling the mechanisms underlying air pollution-induced dysfunction of the oral-gut-brain axis: implications for human health and well-being

Air pollution exposure has become an international health issue that poses many risks to life and health. The bidirectional regulatory network, known as the oral-gut-brain axis connects the oral cavity, intestine, and central nervous system, as well as its influence on health outcomes from exposure to air pollution is receiving increased attention. This article systematically details the epidemiological evidence linking air pollutants to diseases affecting the oral, respiratory, intestinal, and nervous systems, while also explaining the route of air pollutants via the oral-gut-brain axis. The oral-gut-brain axis anomalies resulting from air pollution and their underlying molecular processes are also covered. The study provides a fresh viewpoint on how exposure to air pollution affects health and investigates cutting-edge preventative and therapeutic techniques.

Genetic and pharmacological targeting of HINT2 promotes OXPHOS to alleviate inflammatory responses and cell necrosis in acute pancreatitis

The necrosis of pancreatic acinar cells is a key molecular event in the progression of acute pancreatitis (AP), with disturbances in mitochondrial energy metabolism considered to be a direct causative factor of acinar cell necrosis. Histidine triad nucleotide-binding protein 2 (HINT2) has been implicated in the development of various diseases, whereas its involvement in the progression of AP remains unclear. This study aims to investigate the role of HINT2 in AP. HINT2 expression in pancreatic tissues was significantly downregulated after AP. The results of glutathione-S-transferase (GST) pull-down and proteomics analyses revealed the involvement of HINT2 in regulating mitochondrial oxidative phosphorylation (OXPHOS) in AP mice. Moreover, lentivirus-mediated HINT2 overexpression not only alleviated AP-induced ATP depletion, but also relieved inflammatory responses and cell necrosis. Mechanistically, HINT2 interacted with cytochrome C oxidase II (MTCO2) to promote mitochondrial OXPHOS, thereby reducing ROS accumulation and inhibiting the activation of inflammatory signaling pathway. Besides, HINT2 act as a direct pharmacological target of Emo to elicit protective effects on AP. Importantly, Emo upregulates the expression of HINT2 and OXPHOS complex proteins and enhances the interaction between HINT2 and MTCO2. Furthermore, CRISPR/Cas9-mediated HINT2 knockout significantly impaired the protective effects of Emo against AP-induced mitochondrial energy metabolism disorders, inflammatory responses, and acinar cell necrosis. Overall, these results uncover a previously unexplored role for HINT2 in maintaining mitochondrial energy metabolism in pancreatic acinar cells and reveals novel mechanism and target for Emo-mediated AP remission.