GI articles 2021-09-07 - 2021-10-07
| This issue includes 449 articles. Hope you enjoy reading and benefit from our work! |
Guidelines
| Endoscopy |
Weak recommendation, low quality of evidence. 10: ESGE suggests dividing EUS-FNA material into smears (two per pass) and liquid-based cytology (LBC), or the whole of the EUS-FNA material can be processed as LBC, depending on local experience. Weak recommendation, low quality evidence. |
| Gastroenterology |
To achieve these goals, the American Gastroenterological Association assembled a multidisciplinary panel of experts to develop a Clinical Care Pathway providing explicit guidance on the screening, diagnosis, and treatment of NAFLD. This article describes the NAFLD Clinical Care Pathway they developed and provides a rationale supporting proposed steps to assist clinicians in diagnosing and managing NAFLD with clinically significant fibrosis (stage F2-F4) based on the best available evidence. This Pathway is intended to be applicable in any setting where care for patients with NAFLD is provided, including primary care, endocrine, obesity medicine, and gastroenterology practices. |
| Gastrointest Endosc |
| Gut |
IDA may present in primary care or across a range of specialties in secondary care, and because of this and the insidious nature of the condition it has not always been optimally managed despite the considerable burden of disease- with investigation sometimes being inappropriate, incorrectly timed or incomplete, and the role of IRT for symptom relief neglected. It is therefore important that contemporary guidelines for the management of IDA are available to al clinicians. This document is a revision of previous British Society of Gastroenterology guidelines, updated in the light of subsequent evidence and developments. |
| Neurogastroenterol Motil |
A multinational group of European experts summarized the current state of consensus on the definition, diagnosis and management of FD. |
Meta-analysis
meta-analyses and systematic reviews
| Aliment Pharmacol Ther |
Pooled 3-year PCCRC prevalence was 8.2% (95% CI = 6.9%-9.4%). Despite WEO standardised methodology to define and calculate PCCRC rates, there was significant heterogeneity among studies. Comparing rates between populations remains challenging and additional studies are needed to better understand the global PCCRC burden to inform quality assurance programs. |
| Clin Gastroenterol Hepatol |
Steatosis was found to be related with CHD involvement, with moderate to severe steatosis related to clinical CAD. Early screening and prompt intervention for CHD in NAFLD are warranted for holistic care in NAFLD. |
The quality of IBD care can be improved with diverse interventions that range from simple to complex. However, these interventions are not universally successful. Clinicians should emulate successful interventions and design new initiatives to narrow gaps in care quality. |
| Gastroenterology |
This meta-analysis provides a comprehensive overview of the global incidence of acute pancreatitis over the last 56 years and demonstrates a steadily rising incidence over time in most countries of the Western world. More studies are needed to better define the changing incidence of acute pancreatitis in Asia, Africa, and Latin America. |
Our meta-analysis demonstrated that patients with IMIDs have a reduced response to mRNA COVID-19 vaccines. These results suggest that IMID patients receiving mRNA vaccines should complete the vaccine series without delay and support the strategy of providing a 3rd dose of the vaccine. |
| Gastrointest Endosc |
Transpancreatic sphincterotomy increases success rate of biliary cannulation as compared to persistence with the standard cannulation techniques. Early needle-knife techniques and transpancreatic sphincterotomy are superior to the other interventions in decreasing PEP rates and should be considered in patients with difficult cannulation. |
WATS-3D increases dysplasia detection, however, the clinical significance of this increased dysplasia detection remains uncertain. Data from endoscopic follow up to ascertain FB histology in patients with dysplasia based solely on WATS-3D are needed to determine the optimal clinical application and significance of WATS only dysplasia. |
| Gut |
VR is common after NA discontinuation, however, CR was only seen in one-third of patients at 12 months. Stopping NA therapy can be followed by HBsAg clearance, and rates are higher with longer follow-up. |
| Inflamm Bowel Dis |
Surgical disparities based on sociologic and structural factors reflect unidentified differences in multidisciplinary disease management. A broad, multidimensional approach to disparities research with more granular and diverse data sources is needed to improve health care quality and equity for inflammatory bowel disease. |
| J Crohns Colitis |
Response criteria and time-points of response assessment varied between studies complicating direct comparison of parameter changes and their relation to treatment outcomes. To ensure a unified approach in routine care and clinical trials, we provide recommendations and definitions for key parameters for intestinal ultrasound response to incorporate into future prospective studies. |
Machine learning-based prediction models based on routinely collected data generally perform better than traditional statistical models in risk prediction in IBD, though frequently have high risk of bias. Future studies examining these approaches are warranted, with special focus on external validation and clinical applicability. |
The associations between endoscopic recurrence and subsequent clinical recurrence lend support to the choice of endoscopic recurrence to monitor postoperative disease activity and as a primary endpoint in clinical trials of postoperative Crohn's disease. |
| J Hepatol |
Researchers conducting meta-analyses in this area must make many methodological decisions to mitigate bias but are ultimately limited to the methodologies of the included studies. It is therefore important for researchers, as well as the audience of published meta-analyses, to be aware of the quality of the observational studies and meta-analyses in terms of the patient characteristics, study design and statistical methodologies used. This review aims to help navigate the published meta-analyses on this topic and to provide researchers with recommendations for future work. |
| Neurogastroenterol Motil |
The prevalence of GERD in Chinese college freshmen is significantly lower than that in worldwide youth populations. Alcohol, green tea, and coffee consumption could be potential risk factors for GERD. Future large-scale epidemiological studies are warranted for reliable identification of beverage-related risk factors for GERD in young populations. |
Open access
Articles that are open access at time of publication, full text is typically available in PMC (link provided)
There are 11 open access articles in this group, most (if not all of them) can be accessed through PMC as full text. Press on the title to get full text.
| Clin Gastroenterol Hepatol |
Routine serological testing of the vaccination response and a third vaccination in patients with low or absent response seem advisable. These vulnerable cohorts need further research on the effects of heterologous vaccination and intermittent reduction of immunosuppression before booster vaccinations.
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Increased Hepatic Expression of SARS-CoV-2 Entry Points and Proinflammatory Cytokines in Cirrhosis. 2 Unfortunately, the presence of hepatic decompensation at baseline has been shown to be an independent predictor of all-cause mortality in patients with coronavirus disease 2019 (COVID-19). 1 Patients with decompensated cirrhosis contracting COVID-19 have a poor outcome, with an overall reported mortality of over 30%. 1 . |
| Gastroenterology |
Our meta-analysis demonstrated that patients with IMIDs have a reduced response to mRNA COVID-19 vaccines. These results suggest that IMID patients receiving mRNA vaccines should complete the vaccine series without delay and support the strategy of providing a 3rd dose of the vaccine.
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| Inflamm Bowel Dis |
The lower and less durable SARS-CoV-2 S-RBD IgG response to natural infection in IBD patients receiving biologics puts them at risk of reinfection. The robust response to immunization is likely protective.
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| J Hepatol |
Studies
RCT, clinical trials, retrospective studies, etc…
| Aliment Pharmacol Ther |
Moderate-to-substantial agreement was observed between central and local endoscopic reads. Where disagreements occurred, local reads were systematically lower than central reads at most timepoints, suggesting potential bias. ClinicalTrials.gov identifier NCT01465763, NCT01458951, NCT01458574, NCT01470612. |
This is the largest collective descriptive study of bevacizumab-induced gastrointestinal perforations, and sheds light on this often fatal complication. We additionally identified and described a rare subgroup of patients experiencing bevacizumab-induced gastro-oesophageal perforation not previously described. |
Adding bezafibrate to UDCA in patients with UDCA-refractory PBC showed a significant decrease in fibrosis and inflammatory histological scores at 5 years. These beneficial effects warrant further evaluation in long-term cohort studies and controlled trials. |
Seronegative coeliac disease has a more aggressive disease phenotype than seropositive coeliac disease. These data argue against over-reliance on serology for the diagnosis of coeliac disease and support a strict clinical and histologic follow-up in seronegative coeliac disease. |
Despite H. pylori eradication, the long-term risk of UGIB was still higher than in H. pylori-negative control subjects. The protective effects of eradication therapy in preventing UGIB appeared to be limited to younger patients, and to within the first 2 years after eradication. |
Patients with sustained benefit to anti-TNFα after 2 years are at low risk of subsequent loss of response. |
Lymphocytic gastritis and its relationships with other gastrointestinal disorders. Most cases of LyG may represent a self-limited expression, frequently associated with other GI conditions, such as Hp infection, CD, and MC. In most patients, LyG is likely to resolve within a year after its initial diagnosis. |
Medication use and microscopic colitis. Compared to similar patients with diarrhoea, cases with microscopic colitis were not more likely to have taken previously implicated medications. They had more diarrhoea following cholecystectomy, suggesting that bile may play a role in symptoms or aetiology. We conclude that the appropriate choice of controls is crucial to understanding risk factors for microscopic colitis. |
This first population PK model for subcutaneous CT-P13 supports fixed subcutaneous maintenance dosing, although heavy patients had lower cumulative drug exposure. |
TMF was non-inferior to TDF in terms of anti-HBV efficacy and showed better bone and renal safety. (NCT03903796). |
Among Chinese patients with Crohn's disease, dose optimisation by NUDT15 C415T reduced the rate of thiopurine-induced leucopenia, without significant influence on efficacy. Using 50% dose reduction for heterozygotes, and alternative drugs for homozygotes, are practicable strategies. Clinical trial number NCT02929706. |
Pemafibrate did not decrease liver fat content but had significant reduction in MRE-based liver stiffness. Pemafibrate may be a promising therapeutic agent for NAFLD/NASH, and also be a candidate for combination therapy with agents that reduce liver fat content. ClinicalTrials.gov, number NCT03350165. |
The change in liver stiffness in subjects with NAFLD was not significantly different between semaglutide and placebo. However, semaglutide significantly reduced liver steatosis compared with placebo which, together with improvements in liver enzymes and metabolic parameters, suggests a positive impact on disease activity and metabolic profile. ClinicalTrials.gov identifier NCT03357380. |
After 50 years of follow-up, 75% CD patients had undergone surgery, with most needing repeat surgery. The risk of intestinal and extra-intestinal cancers, as well as mortality, was higher among CD patients than the background population. |
Objective measures of disease activity are not associated with symptoms of psychological illness in patients with IBD. Clinicians should consider underlying mental illness in patients with IBD with active gastrointestinal symptoms. |
| Am J Gastroenterol |
The most cost-effective approach for treat-to-target monitoring in CD is up-front biomarker-based monitoring followed by endoscopy-based monitoring if not in endoscopic remission by 1 year and then returning to biomarker-based monitoring once in endoscopic remission. |
A Pragmatic Randomized Controlled Trial of an Endoscopist Audit and Feedback Report for Colonoscopy. A/F reports for colonoscopy improve performance in lower performing endoscopists (ClinicalTrials.gov NCT02595775). |
High-impact gastroenterology publications influence Google searches and local population-based healthcare utilization. |
In a large nationwide database of more than 33,000 gastrostomy procedures, PEG was associated with a lower incidence of adverse outcomes and the 30-day mortality than IRG. |
This multicenter randomized controlled trial confirmed that the cap-assisted technique is more effective and less costly than the conventional approach and should be first-line treatment for esophageal FBI. |
Currently, there are limited data on esophageal lichen planus patients, and no formal management guidelines for this disease, which al gastroenterologists will see in practice. This article reviews the etiology and histopathology of LP and provides a comprehensive discussion of the clinical features, diagnosis, and management of esophageal disease from the gastroenterologist's perspective. Finally, we address the esophageal complications of LP. |
The prucalopride arm had a higher proportion of bloating responders vs placebo in this study population. |
Episodic LLV among untreated patients with compensated cirrhosis does not increase the risk of disease progression compared with MVR status. Thus, the benefits of AVT for episodic LLV should be re-evaluated. |
The AI-assisted sponge cytology is feasible, safe, and acceptable for ESCC screening in community, with high accuracy for detecting esophageal squamous high-grade lesions. |
Improvement of clinical trial transparency is needed in gastroenterology. |
Alcohol abstinence reduced the risk of HCC in patients with alcohol-related cirrhosis, but only in those without a history of decompensated disease. This finding emphasizes the need for an early diagnosis of alcohol-related liver disease and for implementing strategies leading to an increase in the rate of achieving and maintaining abstinence among this population. |
COVID-19-related healthcare restrictions significantly affected access to DAAs. Studies exploring the long-term effects on reduced treatment are needed. |
Relative Adrenal Insufficiency in Decompensated Cirrhotic Children: Does It Affect Outcome? RAI is a risk factor for development of complications in pediatric cirrhosis over short-term follow-up. The PELD-delta cortisol score is a promising prognostic model for predicting follow-up complications. |
Targeted intravenous albumin infusions increased serum sodium level in hospitalized hyponatremic patients with cirrhosis, but this did not improve outcome. |
In our cohort, SSTs on PPI compared with SSTs off PPI were noninferior for sensitivity, specificity, and PPV. These results suggest that PPI withdrawal before SSTs may not be necessary. |
Commonly practiced rectal perception testing is correlated with several disease states and thus has clinical relevance. However, most disease states were correlated with 2 or even only 1 abnormal threshold, and agreement between thresholds was limited. This may suggest each threshold measures different pathophysiological pathways. We suggest al 3 thresholds be measured and reported separately in routine clinical testing. |
| Clin Gastroenterol Hepatol |
A Cost-Effectiveness Analysis for Post-ERCP Pancreatitis Prophylaxis in the United States. Rectal indomethacin was the cost-effective strategy for preventing PEP in both average-risk and high-risk patients undergoing ERCP. All strategies were cost-effective when compared to no-prophylaxis in high-risk patients, while al strategies except for aggressive hydration with lactated ringers were cost-effective in average-risk patients. Further studies are needed to improve the utilization of PEP prevention strategies. |
Cachexia is Prevalent in Patients With Hepatocellular Carcinoma and Associated With Worse Prognosis. Nearly 1 in 4 patients with HCC present with cachexia, including many with compensated cirrhosis or early stage tumors. The presence of cancer-associated weight loss appears to be an early and independent predictor of worse outcomes in patients with HCC. |
In this U.S. multicenter tandem colonoscopy randomized controlled trial, we demonstrate a decrease in AMR and SSL miss rate and an increase in first-pass APC with the use of a CADe-system when compared with HDWL colonoscopy. |
Distinctive Clinical Correlates of Small Intestinal Bacterial Overgrowth with Methanogens. Patients with SIBO caused by methane-producing Archaea display a different spectrum of associated symptoms and clinical conditions compared to patients with SIBO caused by hydrogen-producing bacteria, particularly a lower incidence of vitamin B12 deficiency. |
Duodenal Mucosal Barrier in Functional Dyspepsia. In FD, there is a modest reduction in the expression of several duodenal epithelial barrier proteins, which may be secondary to upregulation of regulatory miRNAs, and increased small intestinal permeability measured in vivo. |
Sustained improvements in fistulizing CD were seen with both vedolizumab regimens. An additional dose at week 10 does not appear to alter treatment outcomes. Safety profile was consistent with other vedolizumab studies. |
Fatty pancreas is independently associated with subsequent DM development but not hypertension or dyslipidemia. |
In the largest study of CP patients who underwent DXA screening, the majority had osteopathy. There are overlapping risk factors with osteopathy in the general population, but the high prevalence in men and younger women supports the need for future investigations into the mechanisms of bone loss in CP. ClinicalTrials.gov number, NCT03099850. |
This multinational cohort study implies that HBeAg positivity at the onset of antiviral treatment seems to be an independent factor associated with a lower risk of HCC in patients with chronic hepatitis B without cirrhosis, but not in those with cirrhosis. |
Low Prevalence of Screen-Detected Colorectal Cancer in an Average-Risk Population: The New Normal. The experience of ongoing studies enrolling average-risk individuals is that the prevalence rates are substantially lower. A 2020 study from a community-based cohort undergoing CRC screening with fecal immunochemical testing followed by diagnostic colonoscopy reported a CRC prevalence rate of 1.46 per 1000, or 0.15%. 3 The aim of our study is to report the screen-detected prevalence of CRC and advanced neoplasia in average-risk asymptomatic individuals from selected academic and community medical centers in the United States, Canada, and Germany and describe associated risk factors. |
The available evidence suggests decreasing the dose after a successful induction therapy. 3 No study has reported the efficacy of a continuous progressive dose reduction; thus, it is unknown if al patients need to use the same dosages and for how long. 4,5 . |
Patients' Risk Tolerance for Non-Dietary Therapies in Celiac Disease. 1 The only established therapy is strict adherence to a gluten-free diet. 2,3 Recently there has been growth in the development of novel non-dietary therapies for patients with CD, 4 which are driven by dissatisfaction with the burden of the gluten-free diet. 5,6 . |
Individuals concurrently exposed to antibiotics and bowel purgative had slightly higher rates of surrogate IBS outcomes compared with matched controls who did not receive antibiotics concurrently with bowel purgative. |
Routine serological testing of the vaccination response and a third vaccination in patients with low or absent response seem advisable. These vulnerable cohorts need further research on the effects of heterologous vaccination and intermittent reduction of immunosuppression before booster vaccinations. |
No differences in procedural outcomes were noted except for more frequent cecal intubation after High-SD (96.6% vs 94.9%, P=0.02). Amongst the High-SD group, adequate bowel preparation was greater after a clear liquid diet (93.6% vs 87.9%, p<0.01, but this was not seen in the Low-SD group CONCLUSIONS: High-SD provides statistically greater yet clinically comparable results for adequate bowel preparation compared to Low-SD, while Low-SD results in less symptoms, with greater willingness-to-repeat and tolerability. The overall impact of diet was modest. |
We propose a modified model by removing the MED component, which is easier to calculate, predicts accurately severe AP, and maintains significantly distinct early trajectories. |
Older IBD patients treated with vedolizumab had a lower risk of infection-related hospitalization compared with those initiating anti-TNFs. We observed no difference in effectiveness defined by hospitalizations, surgery, or new corticosteroid use. |
Work Loss in Patients With Celiac Disease: A Population-based Longitudinal Study. Patients with CD lost more work days than comparators before their diagnosis, and this loss increased after diagnosis. Identifying patients with an increased risk of work loss may serve as a target to mitigate work disability, and thereby reduce work loss, in patients with CD. |
| Endoscopy |
Non inferiority of the rate of gastric cancer diagnosis by AI was demonstrated but superiority is not demonstrated. |
Our findings emphasize that when comparing colonoscopy performance measures between endoscopy centres, case-mix adjustment should be considered. |
The 20mm LAMS is similar to the 15mm LAMS in terms of safety and efficacy for patients undergoing EUS-GE for malignant GOO. The 20 mm LAMS allows a more advanced diet and is, thus, the preferred LAMS during EUS-GE. |
Deep mural injury type III-V occurred in 7.4 % and was treated successfully with clips. CONCLUSION : EMR-C may be an alternative therapeutic option for removal of benign nonlifting polyp tissue. Although recurrence still occurs, repeat endoscopic therapy usually leads to complete polyp clearance. |
eFTR is a relatively safe and effective method to resect small T1 CRC, both as primary and secondary treatment. eFTR can expand endoscopic treatment options for T1 CRC and could help to reduce surgical overtreatment. Future studies should focus on long-term outcomes. |
The new FESDC strategy is safe and allows permanent endoscopic closure of GI fistulas in 61% of the patients, and 54% of those with previous attempt. Further studies are war-ranted to determine the place of this technic in the management of chronic GI fistula. |
Interobserver agreement between expert endosonographers regarding morphological features of PFCs appeared suboptimal, while decisions on therapeutic approaches seemed more homogeneous. Studies to achieve standardization of the diagnostic endosonographic criteria and therapeutic approaches to PFCs are warranted. |
Extending treatment criteria for Barrett's neoplasia: results of a nationwide cohort of 138 ESDs. In expert hands, ESD is safe and allows for removal of bulky intraluminal neoplasia and submucosal cancer. ESD of the latter is, however, associated with a positive deep resection margin in half of the patients, yet only one third had actual persisting neoplasia at endoscopic FU. To better stratify R1-patients with an indication for additional surgery, repeat endoscopy after healing of the ESD wound may help in predicting residual cancer. |
Non-thermal Resection Device for Ablation of Barrett's Esophagus - a Feasibility and Safety Study. For the endoscopic ablation of BE, the EndoRotor procedure was found to be technically demanding with a longer procedure time compared to established ablation techniques and a high complication rate. Based on these results, we do not recommend the EndoRotor as a first-line ablation technique for the eradication of BE. |
ER outcomes for SDETs were generally acceptable. ESD by highly experienced endoscopists might be an option for very large SDETs. |
the prevalence of ≥10 adenomas in a FIT-based CRC screening program is 2.2% and a small proportion of inherited syndromes are detected even amongst those with ≥ 20 adenomas. Low rate of post-colonoscopy CRC is observed and the risk of AN beyond the first SVC tends to progressively decrease throughout successive follow-up. |
| Gastroenterology |
A Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction. The report is broken into five parts: 1) Definition and evidence for Brain-Gut Behavior Therapies (BGBT); 2) The Gut-Brain Axis as the mechanistic basis for BGBT; 3) Targets of Brain-Gut Behavior Therapies; 4) Common and Unique Therapeutic techniques seen in BGBT; and 5) Who and How to Refer for BGBT CONCLUSIONS: We chose to not only review for the reader the 5 existing classes of BGBT and their evidence, but to connect DGBI-specific behavioral targets and techniques as they relate directly, or in some cases indirectly, to the Gut-Brain-Axis. In doing so, we expect to increase GI providers' confidence in identifying and referring appropriate candidates for BGBT and also support clinical decision making for mental health professionals providing BGBT. Both gastrointestinal medical providers and behavioral health providers have an opportunity to optimize care for DGBI through a collaborative, integrated approach that begins with an effective patient-provider relationship, thoughtful communication about the brain-gut-axis and, when appropriate, a well-communicated referral to BGBT. |
These studies establish SOX9 as a central regulator of an enhancer-driven stem cell-like program and carry important implications for developing therapeutics directed at overcoming differentiation defects in CRC. |
Our observations strongly suggest that inflammation suppression should be combined with microbiota management where possible to improve the efficacy of UC treatment. |
Our data suggest a crucial role for XBP1 in coordinating epithelial DNA damage responses and stem cell function via a p53-DDIT4L-dependent feedback mechanism. |
GPR120 inhibits colitis through regulation of CD4+T cell IL-10 production. Our findings demonstrate the role of GPR120 in regulating intestinal CD4 + T cell production of IL-10 to inhibit colitis development, which identifies GPR120 as a potential therapeutic target for treating IBD. |
Altogether, our study shows the power of imaging mass cytometry and its ability to both quantify immune cell types and characterize their spatial interactions within the inflammatory environment by a single analysis platform. |
MELD 3.0: The Model for End-Stage Liver Disease Updated for the Modern Era. MELD 3.0 affords more accurate mortality prediction in general than MELDNa and addresses determinants of wait list outcomes, including the sex disparity. |
We show miR-802 suppresses pancreatic cancer initiation by repressing oncogenic Kras-induced ADM. The role of miR-802 in ADM fills the gap in our understanding of oncogenic Kras-induced F-actin reorganization, acinar reprogramming and PDAC initiation. Modulation of the miR-802-RhoA-F-Actin network may be a new strategy to interfere with pancreatic carcinogenesis. |
MUC5AC/β-catenin/c-Myc axis increases the uptake and utilization of glutamine in PC cells and co-targeting this axis along with gemcitabine may improve the therapeutic efficacy in PC. |
Our work revealed a novel DPCNE model, showed HCC with longer gradual phase were more severe, identified CAD as a promising biomarker for early recurrence of HCC, and supported the diploid origin of polyploid HCC. |
Therefore, STRAP is a target of and is required in Apc mutation/deletion-induced intestinal tumorigenesis through a novel feed-forward STRAP/MEK-ERK/Wnt-β-catenin/STRAP regulatory axis. |
This work provides the first evidence of transferable, donor-derived strains that correlate with clinical response to FMT in UC and reveals O. splanchnicus as a key component promoting both metabolic and immune cell protection from colitis. These mechanistic features will help enable strategies to enhance the therapeutic efficacy of microbial therapy for UC. |
Ultra-processed foods and the risk of IBD: is it time to modify diet? Recent epidemiological and pre-clinical studies have additionally examined the impact of non-nutritional dietary components on IBD. Ultra-processed foods (UPF), as defined by the NOVA classification, are foods of mainly industrial origin, often containing little or no whole foods but many ingredients including food additives such as artificial colors and flavors, stabilizers, emulsifiers, and preservatives(Public Health Nutr 2019;22:936-941). The objective of the study by Narula et al (BMJ 2021;374:n1554) was to examine the association between intake of UPF and the risk of developing IBD. |
| Gastrointest Endosc |
The AI-DDx was comparable with experts and outperformed novice and intermediate endoscopists for the differential diagnosis of gastric mucosal lesion. The AI-ID performed better than EUS for the invasion-depth evaluation (https //aiscopeseoul.com/). |
The developed deep learning algorithm accurately detected and differentiated malignant strictures from benign biliary conditions. The introduction of artificial intelligence algorithms to DSOC systems may significantly increase its diagnostic yield for malignant strictures. |
For patients with cholelithiasis with IPC, LC-IOC is a cost-effective approach that should limit preoperative testing and may shorten length of hospital stay. Our findings may be used to design institutional and organizational management protocols. |
This large-scale study proved that short SBE-assisted ERCP in patients with surgically altered anatomy was effective. Moreover, it clarified factors affecting the procedure results. Proficiency with alternative treatment techniques is required in difficult cases. |
Endoscopic vacuum therapy is a promising treatment method for UGI leaks and perforations. Further studies are needed to establish the indications for successful EVT. |
Perioperative use of antibiotics was not effective in reducing incidence of PECS in patients undergoing colorectal ESD. |
NDBE found on WATS3D has a very low risk of progression. CD reported on WATS3D appears to be a neoplastic precursor lesion, with a risk of progression in this study significantly higher than NDBE, but lower than LGD. The clinical utility of CD requires further investigation. |
The results show that ENDOANGEL-LD has great potential for assisting endoscopists in screening gastric lesions and suspicious neoplasms in clinical work. |
A minority of colonoscopies with inadequate bowel preparation are recommended to be repeated within 1 year, which may have implications for potential missed lesions. Further understanding of reasons driving recommendations is an important next step to improving guideline-concordant colonoscopy practice. |
The new PED system seems to be a safe and effective treatment tool for WOPN resulting in fewer interventions and lower hospital duration when compared with published data on using conventional instruments. Randomized controlled trials comparing the PED system with conventional DEN are needed. |
| Gut |
Chief cell plasticity is the origin of metaplasia following acute injury in the stomach mucosa. Our study provides pivotal evidence for cell plasticity and lineage contributions from differentiated gastric chief cells during acute metaplasia development. |
Diet quality and risk and severity of COVID-19: a prospective cohort study. A diet characterised by healthy plant-based foods was associated with lower risk and severity of COVID-19. This association may be particularly evident among individuals living in areas with higher socioeconomic deprivation. |
This prospective, serial and large-scale ctDNA profiling study reveals the temporal heterogeneity of mCRC-related somatic variants, which should be given special attention in clinical practice, as evidenced by the finding that the shift in plasma RAS/BRAF mutational status can yield a drastic change in survival outcomes. |
Histone H3K27 demethylase KDM6A is an epigenetic gatekeeper of mTORC1 signalling in cancer. KDM6A is an important tumour suppressor in gastrointestinal cancers and acts as an epigenetic toggle for mTORC1 signalling. Patients with KDM6A-deficient tumours could benefit of targeted therapy focusing on mTORC1 inhibition. |
Our study combines in vivo lineage tracing and scRNA-seq to reveal the heterogeneity and dynamics of Prom1+ HCC cells, providing insights into the mechanistic role of malignant CSC-like cells in HCC progression. |
Multi-omics epiAT signatures reflect systemic IR and obesity subphenotypes distinct from other fat depots. Our data suggest a previously unrecognised role of human epiploic fat in the context of obesity, impaired insulin sensitivity and related diseases. |
Compared with matched population controls, patients with biopsy-proven NAFLD had significantly higher incidence of MACE, including IHD, stroke, CHF and CV mortality. Excess risk was evident across al stages of NAFLD and increased with worsening disease severity. |
Objectives Transcriptomic-based subtyping, consensus molecular subtyping (CMS) and colorectal cancer intrinsic subtyping (CRIS) identify a patient subpopulation with mesenchymal traits (CMS4/CRIS-B) and poorer outcome. Here, we investigated the relationship between prevalence of prevalence as a high-risk subpopulation that may benefit from therapeutics targeting mesenchymal biology. |
In light of the high proportion of patients with IBS responding to GFD, the diagnostic accuracy of CLE is too low to recommend widespread use of this invasive procedure. Trail registration number This study was registered as clinical trial in the German Registry for Clinical Studies (DRKS00010123). |
AIM2 can play a driver role in epithelial carcinogenesis by linking cytokine-STAT3 signalling, innate immunity and epithelial cell migration, independent of inflammasome activation. |
The human liver microenvironment shapes the homing and function of CD4+ T-cell populations. Objective Tissue-resident memory T cells (T and a novel functionally distinct recirculating population, respectively, both shaped by the liver microenvironment to achieve diverse immunosurveillance. |
Timing of endoscopy for acute upper gastrointestinal bleeding: a territory-wide cohort study. Compared with urgent and late endoscopy among patients who have received therapeutic endoscopies, early endoscopy was associated with superior outcomes especially among patients with non-variceal bleeding. This supports the notion that non-variceal AUGIB patients should receive endoscopy within 24 hours, but also emphasises the importance of prior resuscitation and pharmacotherapy. |
| Hepatology |
A simple bacterium links heart infection to inflammatory liver disease. The alteration of the intestinal microbiome has emerged as a key environmental factor increasingly recognized in the pathogenesis of various diseases. Veillonella species are commensal flora bacteria that have been isolated especially in gastrointestinal tract of humans, yet have rarely been implicated in serious infections such as endocarditis. |
Aging increases the susceptibility of alcohol-induced liver injury in mice and humans via the downregulation of the neutrophilic SIRT1-C/EBPα-miR-223 axis, which could be a novel therapeutic target for the prevention and/or treatment of ALD. |
In patients with HCV-SVR, BMS-986263 administration was generally well tolerated through Week 36 and resulted in METAVIR and Ishak score improvements. Further evaluation of BMS-986263 in patients with active fibrogenesis is warranted. |
Ductular Reaction Promotes Intrahepatic Angiogenesis Via Slit2-Robo1 Signaling. However, ROBO1/2 deficiency did not affect angiogenesis in partial hepatectomy. In patients with advanced alcoholic disease, angiogenesis was associated with DR, and upregulation of SLIT2-ROBO1 correlated with DR and disease severity. In vitro, human liver-derived organoids produced SLIT2 and induced tube formation of endothelial cells. Overall, our data indicate that DR expansion promotes angiogenesis through the Slit2-Robo1 pathway and recognize DR cells as key players in liver wound-healing response. |
E. coli and the Etiology of Human PBC: Anti-mitochondrial Antibodies and Spreading Determinants. In conclusion, our data are consistent with an exposure to E. coli that elicits specific antibody to ePDC-E2 resulting in determinant spreading and the classic autoantibody to hPDC-E2LD. We argue this is the first step to development of human PBC. |
TM-induced ER stress and autophagic flux promoted HBV replication and the release of SVPs and naked capsids through the autophagosome-late endosome/MVB axis. |
Frailty is associated with increased risk of cirrhosis disease progression and death. Frailty was an independent predictor of cirrhosis progression or death, and unplanned hospitalization across compensated and decompensated cirrhosis patients. Future studies are needed to evaluate the possibility of slowing cirrhosis disease progression by reversing or preventing frailty. |
Here, we provide evidence for NET formation in patients with ALF. Elevated plasma levels of MPO-DNA complexes in patients with ALF were associated with poor outcome, which suggests that NET formation contributes to disease progression. |
Over the last decade, genome-wide association studies (GWAS) have allowed for the dissection of the genetic susceptibility to complex liver diseases. 1 In a recent issue of Nature communications, Chen and colleagues conducted a meta-analysis of GWAS collected in ~390,000 individuals of the UK BioBank and ~160,000 Japanese individuals from the BioBank Japan to expand the understanding of the genetic determinants of serum levels of liver-related enzymes. 2 . |
Genomic evolution and the impact of SLIT2 mutation in relapsed intrahepatic cholangiocarcinoma. We characterized genomic evolution during ICC relapse and identified SLIT2 as a driver of tumor dissemination and tumor-associated neutrophil infiltration. |
Targeting mTORC1 or glucose to cardiolipin synthesis, in combination with IR, strongly diminishes tumor burden. Finally, activation of glucose metabolism predicts poor response to radiotherapy in cancer patients. Taken together, we uncover here a previously unrecognized link between radiation resistance and metabolic integration and suggest that metabolically dismantling the radio-resistant features of tumors may provide potential combination approaches for radiotherapy in HCC. |
Indeed, transcriptional profiling and functional analysis of adult mouse EHD organoids uncover their distinct differentiation and proliferative potential relative to IHD organoids. CONCLUSION: Our data show that IHD cells regenerate upon resumption of Jag/Notch signaling, from multipotent progenitors originating from an Fgf-dependent extrahepatic stem cell niche. We posit that if Jagged/Notch signaling is augmented, via normal stochastic variation, gene therapy, or a Notch agonist, regeneration of IHD cells in ALGS patients may be enhanced. |
Melanoma-Differentiation-Associated gene 5 protects against nonalcoholic steatohepatitis in mice. These data indicate that MDA5 is an essential suppressor in NASH, the findings support MDA5 as a novel regulator of ASK1 and a promising therapeutic target for NASH. |
c-Myc-educated hepatocytes promoted immunosuppression by overproducing TGFβ1, which promoted HCC development. MicroRNA-206, by attenuating TGFβ1 overproduction, disrupted the communication of malignant hepatocytes with CTLs and Tregs, which prevented HCC. MicroRNA-206 represents a potential immunotherapeutic agent against HCC. |
Boosting mitochondrial activity by silencing MCJ could pave the way for a novel protective approach after major liver resection or IRI, specially in metabolically compromised, IRI susceptible organs. |
MRE-based LSM is independently predictive of development of future cirrhosis and decompensation, and has predictive value in future transplant/death in CLD patients. |
MEFIB has higher diagnostic accuracy than FAST for significant fibrosis in NAFLD, and our results support the utility of a two-step strategy for detecting significant fibrosis in NAFLD. |
Here we demonstrated that PVT in cirrhotic patients consists of intimal fibrosis with an additional fibrin-rich thrombus in only one-third of the cases. We hypothesize that our observations may explain why not al portal vein thrombi in cirrhotic patients recanalise by anticoagulant therapy. |
Optimizing Hepatitis B Virus Screening in the United States Using a Simple Demographics-Based Model. Our machine learning model provides a simple, targeted approach to HBV screening, using only easily-obtained demographic data. |
OTUB1 Alleviates Nonalcoholic Steatosis through Inhibition of the TRAF6-ASK1 Signaling Pathways. OTUB1 is a key suppressor of NASH that inhibits polyubiquitinations of TRAF6 and attenuated TRAF6-mediated ASK1 activation. Targeting the OTUB1-TRAF6-ASK1 axis may be a promising novel therapeutic strategy for NASH. |
NAS are characterized by a microscopic phenotype of chronic biliary hypoxia due to loss of microvasculature, resulting in reduced proliferation and differentiation of PBG stem/progenitor cells into mature cholangiocytes. These findings suggest that persistent biliary hypoxia is a key mechanism underlying the development of NAS after OLT. |
Together, our study unveils a previously undefined role of RORα in LrNK cell/ILC1 maintenance and function, providing insights into the harnessing of LrNK cell/ILC1 activity in the treatment of liver cancer. |
The Immunogenomic Landscape of Resected Intrahepatic Cholangiocarcinoma. Using two approaches, we identify high PD-1 or LAG3 and low CD3/CD4/ICOS specifically in the tumor center as associated with poor survival. Moreover, loss-of-function BAP1 mutations are associated with and cause elevated expression of the immunosuppressive checkpoint marker B7H4. In conclusion, this study provides a foundation on which to rationally improve and tailor immunotherapy approaches for this difficult-to-treat disease. |
The RNA binding protein HuR is a gatekeeper of liver homeostasis. HuR is a gatekeeper of liver homeostasis preventing NAFLD-related fibrosis and HCC, suggesting that the HuR-dependent network could be exploited therapeutically. |
In conclusion, current findings unfolded a protective role of ZHX2 against NASH progression by transcriptionally activating PTEN. These findings shed light on the therapeutic potential of targeting ZHX2 for treating NASH and related metabolic disorders. |
The viral hepatitis B care cascade: A population-based comparison of immigrant groups. Lifetime prevalence was estimated as 163,309 (1.34%) overall, 115,722 (3.42%) among al immigrants, and 50,876 (9.37%) among those from highly endemic countries. Compared to long-term residents, immigrants were more likely to be diagnosed (aRR: 4.55 [95%CI: 4.46, 4.63]), engaged with care (aRR: 1.07 [95%CI: 1.04, 1.09]), and initiate treatment (aRR: 1.09 [95%CI: 1.03, 1.16]). In conclusion, immigrants fared well compared to long-term residents along the care cascade, having higher rates of diagnosis and slightly better measures in subsequent cascade stages, although intensified screening efforts and better strategies to facilitate linkage to care are still needed. |
Therapeutic Targeting of Hepatic ACSL4 Ameliorates Non-alcoholic Steatohepatitis in Mice. Suppression of ACSL4 expression promoted mitochondrial respiration, thereby enhancing the capacity of hepatocytes to mediate β-oxidation of fatty acids and to minimize lipid accumulation by up-regulating PGC1α. Moreover, we found that abemaciclib is a potent and selective ACSL4 inhibitor, low-dose of abemaciclib significantly ameliorated most of the NAFLD symptoms in multiple NAFLD mice models. Therefore, inhibition of ACSL4 is a potential alternative therapeutic approach for NAFLD. |
Liver ZBTB20 serves as a key regulator of LPL expression and plasma triglyceride metabolism, and could be a therapeutic target for hypertriglyceridemia. |
| Inflamm Bowel Dis |
The lower and less durable SARS-CoV-2 S-RBD IgG response to natural infection in IBD patients receiving biologics puts them at risk of reinfection. The robust response to immunization is likely protective. |
Four weeks of postdischarge VTE prophylaxis results in higher QALYs compared with inpatient prophylaxis alone and prevents 1 postdischarge VTE among 78 patients with IBD. Although postdischarge VTE prophylaxis for al patients with IBD is not cost-effective, it should be considered in a case-by-case scenario, considering VTE risk profile, costs, and patient preference. |
Efficacy of Ustekinumab in Crohn's Disease With and Without Concurrent Autoimmune Skin Disease. Concurrent autoimmune skin disease in CD is associated with greater ustekinumab effectiveness in controlling intestinal inflammation. |
Expanding Contributions of Monogenic Very Early Onset Inflammatory Bowel Disease. One describes a patient with life-threatening VEOIBD and a mutation in ITGA6, illustrating the importance of the epithelial barrier in maintaining mucosal homeostasis. The other describes the presentation and management of 10 patients with VEOIBD secondary to damaging mutations in MVK, resulting in mevalonate kinase deficiency. Though most monogenic causes of VEOIBD remain "private," understanding the different categories of pathways affected in children with VEOIBD is critical and has already resulted in invaluable insight in the management of patients with VEOIBD and may hold strong implications for the care of IBD overall. |
Costs and HRU are significantly higher for patients with PAF CD vs non-PAF CD patients, highlighting the economic burden of the disease. |
IUS is feasible and accurate throughout pregnancy, although visualization of the sigmoid and TI decreases in the third trimester. IUS provides objective information on disease activity, extent, and treatment response, even during second and third trimester, and offers a noninvasive strategy to closely monitor patients during pregnancy. |
Intracolonic administration of BIBP significantly reduced TNF and interferon (IFN)-γ release from UC biopsies, whereas BIIE downregulated only IFN-γ (P < .05). BIBP significantly reduced TNF and interferon (IFN)-γ release from UC biopsies, whereas BIIE downregulated only IFN-γ (P < .05). Our data suggest a promising therapeutic value for NPY1R inhibition in alleviating intestinal inflammation in UC, possibly as enemas to IBD patients. |
Long-term Antibiotic Treatment in Pouchitis-Patterns of Use and Safety. Patients with pouchitis may require prolonged antibiotic treatment, reflecting clinical benefit and favorable safety profile. Few adverse events and resistant infections were observed with long-term antibiotics use. However, resistant microbial strains selection, which are potentially transmittable, warrants consideration of different therapeutic alternatives. |
Mevalonate Kinase Deficiency: A Cause of Severe Very-Early-Onset Inflammatory Bowel Disease. Mevalonate kinase deficiency should be considered in patients with severe very-early-onset inflammatory bowel disease (IBD), especially in patients with a history of recurrent or chronic fever, peritoneal adhesions, and atypical IBD pathology. Anti-interleukin-1 therapy may be efficacious in these patients with monogenic very-early-onset IBD. |
Inflammatory bowel disease patients consider bowel preparation as the most important element in acceptance of CRC surveillance. Heterogeneity in preferences was explained by 3 latent subgroups. These findings may help to develop an individualized endoscopic surveillance strategy in IBD patients. |
Physical Activity in Patients With Inflammatory Bowel Disease: A Narrative Review. Physicians may consider discussing PA interventions with their patients on an individual basis, especially if they report impaired QoL, fatigue, depression, or anxiety, until disease-specific guidelines are available. Including PA as part of a primary prevention strategy in high-risk patients could be considered. |
The Pediatric Inflammatory Bowel Disease Medical Home: A Proposed Model. Children and young adults with IBD have equally complex care needs, with additional challenges not faced by the adult population such as growth, physical and psychosocial development, and transition of care from pediatric to adult providers. Thus, we advocate that the components of the PCMH are equally-if not more-important in caring for the pediatric patient population. In this article, we review what is known about the application of the PCMH model in adult IBD care, describe care delivery within the Center for Pediatric and Adolescent IBD at Nationwide Children's Hospital as an example of a pediatric IBD medical home, and propose a research agenda to further the development and dissemination of comprehensive care delivery for children and adolescents with IBD. |
| J Crohns Colitis |
In this article, we explain the basic terminologies and provide particular focus on the foundations behind state-of-the-art AI methodologies in both imaging and text. We explore the growing applications of AI in medicine, with a specific focus on IBD to inform the practicing gastroenterologist and IBD specialist. Finally, we outline possible future uses of these technologies in daily clinical practice. |
An association between improvements in patient-reported general well-being and clinical remission/response was observed using outcomes of stool frequency and abdominal pain, supporting the clinical remission/response endpoint definitions used in Crohn's disease clinical studies. |
In this small case series, two thirds of patients developed lymphoma in the IBD-affected area, and almost two thirds had a history of thiopurine or anti-TNF use. Biologics were restarted without recurrence of lymphoma in half of the remitters. |
Clinically active IBD may be a risk factor for severe COVID-19, particularly in younger patients. IBD disease control, including through medication compliance, and strategies to mitigate the risk of COVID-19 infection amongst patients with active IBD (e.g., distancing, immunization) are key to limit adverse COVID-19 outcomes. |
Orofacial Granulomatosis associated with Crohn's Disease: a multi-centre case series. OFG associated with CD may occur before, concurrently or after the diagnosis of CD. Perianal and UGI disease are common associations and there is a significant symptom burden in many. Remission can be obtained with a variety of immunosuppressive treatments, including several CD approved biologicals. |
The risk of neurodegenerative diseases was higher in IBD patients than in the non-IBD population. |
The complex relationship between microbiota, immune response and creeping fat in Crohn's disease. The dysfunction of creeping fat worsens the inflammatory course of Crohn's disease and may favour intestinal fibrosis and fistulizing complications. However, our current knowledge of the pathophysiology and pathogenic role of creeping fat is controversial and a better understanding might provide new therapeutic targets for Crohn's disease. We aim to review and update the key cellular and molecular alterations involved in this inflammatory process that link the pathological components of Crohn's disease with the development of creeping fat. |
This study shows that genotype and multiple disease phenotypes strongly associate with the plasma inflammatory proteome in IBD and identifies disease-associated pathways that may help to improve disease management in the future. |
There is an increased risk of VTE in the PIBD population compared to the general paediatric population. Awareness of VTE occurrence and prevention should be extended to al PIBD patients with active disease, especially those hospitalized. |
The process of developing a disease activity index in microscopic colitis. The E-MCAI was developed using the methods advocated by the FDA. The evaluation indicates good content validity. Further evaluation will be performed to accomplish construct validity, reliability, and responsiveness in future cross-sectional and longitudinal studies. |
UCED alone appeared to achieve higher clinical remission and mucosal healing than single donor FT with or without diet. The study was stopped for futility by a safety monitoring board. |
| J Hepatol |
The ADAMTSL2 protein and an 8-protein soluble biomarker panel are highly associated with at-risk NASH and significant fibrosis with superior performance to standard of care fibrosis scores. |
This GBM-based model provides the best predictive power for HCC risk in Korean and Caucasian patients with CHB treated with entecavir or tenofovir. |
Burden of liver disease progression in hospitalized patients with type 2 diabetes mellitus. In this analysis of data from two hospital-based cohorts of patients with T2D, alcohol use disorders, rather than obesity, contributed to most of the liver burden. These results suggest that patients with T2D should be advised to drink minimal amounts of alcohol. |
CircACTN4 was upregulated in ICC and promoted ICC proliferation and metastasis by acting as a molecular sponge of miR-424-5p, as well as by interacting with YBX1 to transcriptionally activate FZD7. These results suggested that circACTN4 is a potential prognostic marker and therapeutic target for ICC. |
In this national cohort of U.S.-based HBV patients on antiviral treatment, most models performed well in predicting HCC risk, low risk group by several models (PAGE-B, m-PAGE-B, CAMD, AASL-HCC, REAL-B) did not develop HCC within 3-year timeframe. Further studies are warranted to examine whether these patients could be excluded from HCC surveillance. |
HIF-1α modulates sex-specific Th17/Treg responses during hepatic amoebiasis. Hepatic HIF-1α modulates the sex-specific outcome of murine E. histolytica infection. The results suggest that in male mice, Th17 cells can be modulated by hepatic HIF-1α via IL-6, indicating marked involvement in the immunopathology underlying abscess development. Strong expression of Foxp3 by hepatic Tregs from female mice suggests a potent immunosuppressive function, leading to initiation of liver regeneration. |
Incidence of liver and non-liver-related outcomes in patients with HCV-cirrhosis after SVR. Cirrhotic patients with an SVR to DAA face risks of liver-related and non-liver related events and mortality; however, their incidence is strongly influenced by pre-DAA patient history. |
Approximately half of the patients with an infliximab-induced liver injury had slow improvement in ALT despite cessation of therapy and were treated with corticosteroids. Treatment response was good with prompt resolution of liver test abnormalities. Relapse of liver injury was not observed after tapering of corticosteroids despite prolonged follow-up and no patients developed DILI due to a second biologic. |
Inhibition of ATG3 ameliorates liver steatosis by increasing mitochondrial function. Collectively, these findings indicate that ATG3 is a novel protein implicated in the development of steatosis. |
Multicenter study on recent portal venous system thrombosis associated with cytomegalovirus disease. In patients with recent PVT, features of mononucleosis syndrome should raise suspicion of CMV disease. CMV disease does not influence thrombosis extension nor recanalization. More than half "CMV positive" patients have another risk factor for thrombosis, with a particular link with prothrombin gene mutation. |
Saroglitazar at 2 mg and 4 mg daily was tolerated and resulted in rapid and sustained improvements in ALP. Further studies are underway at 2 mg and 1 mg daily dose due to higher incidence of elevated liver enzymes observed with 4 mg dose. ClinicalTrials.gov Identifier NCT03112681 |
Rifaximin-treated patients were less likely to develop infection with resolution of overt and covert HE. Rifaximin-α reduced oralisation of the gut with mucin-degrading species attenuating systemic inflammation. These data link rifaximin-α as having a role in gut barrier repair as a mechanism by which it ameliorates bacterial translocation and systemic endotoxemia in cirrhosis. |
TTC39B destabilizes retinoblastoma protein promoting hepatic lipogenesis in a sex-specific fashion. We have uncovered a conserved sexual dimorphism in the regulation of hepatic lipogenic genes with effects of T39 mediated through pRb/E2F1 in females and VAPB/SCAP in both sexes. T39 inhibition could be a novel strategy to downregulate PNPLA3 and treat NAFLD in women. |
UL-FABP levels are independently associated with 3-month clinical course in patients with DC, in terms of mortality and ACLF development. If confirmed in larger studies, urinary L-FABP appears to be a good biomarker candidate for use in prognosis prediction in DC, together with MELDNa score. |
| Neurogastroenterol Motil |
NPS/NPSR system might be a novel target for the treatment of stress-related GI dysmotility. |
Characteristics of, and natural history among, individuals with Rome IV functional bowel disorders. Individuals with Rome IV-defined IBS exhibited higher levels of anxiety, depression, or somatoform-type symptom reporting. IBS was the most stable and the likeliest disorder that the other four functional bowel disorders would fluctuate to. |
Children with chronic nausea and orthostatic intolerance have altered connectivity in the default mode network and salience network/insula, which supports over-monitoring of their body and altered processing of bodily states resulting in interoceptive hyper self-awareness. The connectivity of the salience network would not support optimal regulation of appropriate attention to internal and external stimuli, and the hyper-connected default mode network may result in a persistent self-referential state with feelings of emotion, pain, and anxiety. |
Chronic opioid use is associated with obstructive and spastic disorders in the esophagus. Opioid use is associated with multiple abnormalities on esophageal motility and these effects may be dose-dependent. |
Effects of menthol on esophageal motility in humans: Studies using high-resolution manometry. Intraluminal infusion of menthol reduces UES basal pressure and inhibits peristaltic frequency of secondary peristalsis. The data suggest that the triggering of secondary peristalsis is probably modulated by TRPM8-sensitive mechanoreceptors; however, the activation of TRPM8 from menthol does not alter esophageal motility following deglutition or distension-induced secondary peristalsis. |
Enhancing the utility of antroduodenal manometry in pediatric intestinal pseudo-obstruction. As opposed to conventional analysis protocols, the newly developed enhanced ADM analysis and associated score is not only able to discriminate between PIPO and non-PIPO patients, but also between distinct histopathological pathologies. Further studies are required to assess the utility of enhanced ADM analysis in larger populations. |
Improvement in constipation and diarrhea both predicted improvement in abdominal pain, suggesting that addressing these factors is central to the management of abdominal pain in functional gastrointestinal disorders. |
TEA at PC6 and ST36 administrated at early stage of AP reduces abdominal pain, improves GI motility, and inhibits inflammatory cytokine, TNF-α, probably mediated via the autonomic and ghrelin mechanisms. |
Irritable bowel syndrome is strongly associated with the primary and idiopathic mast cell disorders. s/inferences In a large US database encompassing >53 million patients over >20 years, patients with IBS are at least 4 times more likely to have a MCD than the general population. Further study of mast cell involvement in the pathogenesis of IBS is warranted. |
5% of patients classified as "normal" at 4 h had an abnormal GE pattern based on the proposed criteria for LRGE. This highlights the importance of applying these hourly decrement thresholds to identify LRGE as a new diagnostic entity explaining postprandial symptoms. |
The SEFCQ showed satisfactory psychometric properties. Low self-efficacy in defecation correlates with anxiety and may contribute to poor adherence to behavior change, which exacerbates the symptoms of constipation. Further study is needed to apply social cognitive intervention to increase children's self-efficacy in defecation and assess its effect on treatment outcomes. |
Neuronal-enriched extracellular vesicles in individuals with IBS: A pilot study of COMT and BDNF. Lower levels of mature BDNF in IBS participants, preliminary patterns detected in cargo content of nEVs, and relevance of COMT and IBS status to CES-D scores, offer insight on depressive symptomatology and brain-gut dysregulation in IBS. Lower COMT levels in nEVs of African Americans highlight the relevance of race when conducting such analyses across diverse populations. |
Disordered defecation is a prevalent etiology in DGBI patients with bloating unresponsive to conservative measures; pelvic floor biofeedback treatment to improve the defecation effort significantly relieved bloating (http //www.isrctn.com, ISRCTN17004079). |
Prevalence and clinical correlates of antinuclear antibody in patients with gastroparesis. The prevalence of a positive ANA in patients with gastroparesis was high at ~17% and did not differ significantly based on etiology. In idiopathic patients, ANA positivity was associated with rheumatoid arthritis, systemic sclerosis, and elevated ESR. ANA-positive gastroparesis represents a subset who often have other autoimmune symptoms or disorders, but less severe nausea and vomiting. |
Although patients who met the Rome IV criteria had more severe symptoms at baseline and were more likely to exhibit psychological comorbidity, they did not appear to have a worse prognosis than those with physician-diagnosed IBS. |
Background Most esophageal motility studies are based on animals. It is necessary to explore smooth muscle motility in the human esophagus. This study was undertaken to explore the feasibility of in vitro culture of smooth muscle cells (SMCs) from human esophagogastric junction (EGJ) and to determine changes of intracellular calcium (Ca 2+ ) fluorescence ([Ca 2+ ] in EGJ SMCs represent a complex interaction of intracellular Ca 2+ release and extracellular Ca 2+ influx. |
. These results demonstrate the feasibility of a SDB intervention in adults with IBS and suggest improvements in microvascular function in the absence of changes in symptoms or autonomic function in this population. |
Transient hypopharyngeal intrabolus pressurization patterns: Clinically relevant or normal variant? Bolus distension and PEJ relaxation were miss-timed during TP swallows, impeding bolus flow and leading to a brief period of pressurization of the pharyngeal chamber by muscular propulsive forces. While TP swallows were identified in both Controls and Patients, increased IBPs were most apparent for Patient swallows indicating that the extent of IBP increase may differentiate pathological TP swallows. |
Reviews/Editorials
Plenty of the editorials have full text available through the publisher website using the provided link
| Aliment Pharmacol Ther |
Review article: targeting the B cell activation system in autoimmune hepatitis. The B cell activation system has profound effects on B and T cell function in autoimmune diseases. Blockade therapy is being actively evaluated in autoimmune hepatitis. Clarification of the critical pathogenic components of the B cell activation system will improve the targeting, efficacy, and safety of blockade therapy in this disease. |
Group hypnotherapy for adults, and self-help hypnotherapy for children, may be cost-effective treatments that can widen access for patients with milder IBS in primary care settings. Further research is needed to determine the effectiveness of group hypnotherapy for patients with severe, refractory IBS. |
Therapeutic aspects of bile acid signalling in the gut-liver axis. Experimental evidence suggests that bile acid signalling improves the intestinal barrier and protects against bacterial translocation in cirrhosis. FXR agonists have displayed efficacy for the treatment of cholestatic and metabolic liver disease in randomised controlled clinical trials. However, similar effects remain to be shown in advanced liver disease, particularly in patients with decompensated cirrhosis. |
| Am J Gastroenterol |
Proactive TDM with tumor necrosis factor-antagonist monotherapy is recommended as an alternative to the combination of tumor necrosis factor-antagonists with immunomodulators. Although observational data support this approach, randomized controlled trials do not. We argue that there is considerable work left to be performed before embracing proactive TDM as an equivalent alternative to combination therapy in inflammatory bowel disease. |
| Clin Gastroenterol Hepatol |
Increased Hepatic Expression of SARS-CoV-2 Entry Points and Proinflammatory Cytokines in Cirrhosis. 2 Unfortunately, the presence of hepatic decompensation at baseline has been shown to be an independent predictor of all-cause mortality in patients with coronavirus disease 2019 (COVID-19). 1 Patients with decompensated cirrhosis contracting COVID-19 have a poor outcome, with an overall reported mortality of over 30%. 1 . |
| Gastroenterology |
The evidence that nonsteroidal anti-inflammatory drugs suppress the incidence, growth, and metastasis of gastrointestinal cancer supports the concept that a nonsteroidal anti-inflammatory drug target, cyclooxygenase, and its downstream bioactive lipid products may provide one of the links between inflammation and cancer. Preclinical studies have demonstrated that the cyclooxygenase-2-prostaglandin E pathway on gastrointestinal cancer development. Our focus was to highlight recent advances in our understanding of how this pathway induces tumor immune evasion. |
| Gastrointest Endosc |
PT-GBD can prove superior technical success than EUS-GBD if very large sample size will be accrued, thus limiting the single patient benefit. Clinical success is probably equivalent. EUS-GBD convincingly decreased overall adverse events and unplanned readmissions whereas the need for reinterventions requires additional studies. |
| Gut |
Alternative splicing of viral transcripts: the dark side of HBV. HBV-spliced RNAs have long been unconsidered, probably due to their uneasy detection in comparison to unspliced forms as well as for their dispensable role during viral replication. However, recent data highlighted the relevance of these HBV-spliced variants through (1) the trans-regulation of the alternative splicing of viral transcripts along the course of liver disease; (2) the ability to generate defective particle formation, putative biomarker of the liver disease progression; (3) modulation of viral replication; and (4) their intrinsic propensity to encode for novel viral proteins involved in liver pathogenesis and immune response. Altogether, tricky regulation of HBV alternative splicing may contribute to modulate multiple viral and cellular processes al along the course of HBV-related liver disease. |
| Hepatology |
Can we rely on changes in HVPG in patients with cirrhosis? Because the portal vein is located between two capillary beds, the hepatic sinusoids and the splanchnic capillaries, measuring portal pressure directly is difficult. Wedging a catheter (or occluding it with a balloon) in a suprahepatic vein is less invasive and, despite being an indirect method, correlates very well with direct portal pressure measurements in alcoholic- and viral hepatitis-induced cirrhosis (1). Correction of the wedged (or occluded) pressure with an internal zero (the free hepatic vein pressure) gives way to the hepatic venous pressure gradient (HVPG) (2). |
Thus far, a limited number of population-based studies using non-invasive tests in different areas of the world indicate that a significant percentage of subjects without known liver disease (around 5% in general populations and a higher rate -18 to 27%- in populations with risk factors for liver disease) have significant undetected liver fibrosis or established cirrhosis. Larger international studies are required to show the harms and benefits before concluding that screening for liver fibrosis should be applied to populations at risk for chronic liver diseases. Screening for liver fibrosis has the potential for changing the current approach from diagnosing chronic liver diseases late when patients have already developed complications of cirrhosis to diagnosing liver fibrosis in asymptomatic subjects providing the opportunity of preventing disease progression. |
Of several research methodologies, the sessions were focused to a) study disease burden of ALD using large administrative databases, b) develop biomarkers for non-invasive diagnosis of alcoholic hepatitis (AH) and estimation of disease prognosis, c) identify novel therapeutic targets for ALD and AH, d) derive accurate models to predict prognosis or post-transplant alcohol relapse as a basis for developing treatment algorithm and a uniform protocol on patient selection criteria for liver transplantation, and e) examine qualitative research methodologies in studying the barriers to implementation of multidisciplinary integrated care model by hepatology and addiction teams for the management of dual pathology of liver disease and of alcohol use disorder. Prospective multicenter studies are required to address many of these clinical unmet needs. Further, multidisciplinary care models are needed to improve long-term outcomes in patients with ALD. |
In this issue, Cholankeril et al demonstrate a clear and convincing increase in listing and transplantation for alcohol-associated liver disease (ALD) in the United States that coincides with the onset of the COVID pandemic. Even before the pandemic, the global burden of ALD was heavy and increasing. In the US, the 12-month prevalence of alcohol use disorder prior to COVID was at least 13.9% and most commonly observed in young, male patients but with rising rates in women as well. |
| J Hepatol |
This has direct implications in treatment strategies, which always include the use of direct-acting antiviral agents sometimes associated with immunosuppressants. The role of direct-acting antiviral agents has been well established in patients with cryoglobulinemia vasculitis. Its positive impact on B cell non-Hodgkin lymphoma needs to be confirmed in larger studies with longer follow-up. |
NAFLD-driven HCC: Safety and efficacy of current and emerging treatment options. This review article summarizes the currently available evidence for the efficacy and safety of the various treatment modalities for HCC. There are insufficient data to draw any conclusion and to modify the current management of HCC patients with regard to etiology. However, in light of the growing relevance of NAFLD-HCC, future clinical trials should assess whether HCC etiology - and NAFLD/NASH in particular - influence the safety and efficacy of a given treatment. |
Overlooked subclinical portal hypertension in non-cirrhotic NAFLD: Is it real and how to measure it? Although clinically significant portal hypertension (HVPG ≥ 10 mmHg) retains is prognostic significance in NASH Subclinical portal hypertension (HVPG, 6-9.5 mm Hg) in NAFLD has been repeatedly detected in the absence of cirrhosis or even significant fibrosis, although the impact of these findings on disease outcomes remains unclear. Mechanocrine signaling pathways in various types of liver cells offer molecular basis for the adverse effects of subclinical portal hypertension and suggest a bidirectional relationship between portal pressure and fibrosis. These findings may guide efforts to improve risk assessment and identify novel therapeutic targets in NAFLD. |
Rational HCC screening approaches for patients with NAFLD. There are few direct data to support or refute the efficacy or effectiveness of HCC surveillance in NAFLD or to guide its application. We use evidence on surveillance in other conditions and studies on the clinical course of patients with NAFLD to arrive at recommendations for rational approaches to HCC surveillance in this growing cohort of patients. We also outline gaps in research and practice, including opportunities to advance the field. |
| Neurogastroenterol Motil |
Based on the presence of duodenal pathology in adult FD patients, Ronkainen et al provide the first prospective evidence for duodenal eosinophils potentially driving anxiety. Also in this edition, associations between gastroduodenal pathology and rumination syndrome, which may coexist with FD, have now been confirmed in children by Friesen et al Together these findings confirm not only the potential role of duodenal alterations in determining overlapping upper GI but also psychological symptoms, which result from bidirectional and complex interactions. In this review, we provide an overview of the recent advances in this field and highlight the novel contributions of the original studies of Ronkainen et al and Friesen et al to this topic. |
Letters&Replies
Letters to the editors and authors’ replies
| Aliment Pharmacol Ther |
| Am J Gastroenterol |
| Clin Gastroenterol Hepatol |
| Gastroenterology |
| Gastrointest Endosc |
| Gut |
| Hepatology |
Letter to the editor: Autoimmune hepatitis after COVID-19 vaccination. A rare adverse effect? The vaccines against the severe acute respiratory syndrome coronavirus-2(SARS-CoV-2) were granted a fast-track authorization due to the catastrophic consequences of Coronavirus disease-2019 pandemic. Although these vaccines have proven their efficacy, safety has been a concern. Up till now 2 cases of autoimmune hepatitis(AIH) after anti-SARS-CoV-2 vaccination have been reported. |
We read the article by McMahon et al with great interest. The authors found that hepatitis B virus (HBV) genotype was strongly associated with hepatocellular carcinoma (HCC) incidence in the Hepatitis B Alaska cohort and suggested that HBV genotype should be considered in risk factor stratification of HCC. Although inspiring, several issues warrant further clarification. |
Letter to the Editor: On the Mechanisms of Biliary Flux. Vartak et al's recent publicatioin reviews their previous provocative data that water flow into the bile canaliculus is not in response to an osmotic gradient, as initially proposed by Sperber. However their technique, photoactivation of a non-fluorescent precursor of fluorescein, has not been validated. In contrast, a similar technique, enzymatic activation of a non-fluorescent precursor of fluorescein supported the concept of osmotically generated canalicular water flow and confirmed that peristalsis also participates in the flow of fluid from the canaliculi into the duct system as originally described by Philips. |
Letter to the Editor: Postdiagnosis aspirin use associated with decreased biliary tract cancer? We read with great interest the article by Liao et al (1) revealing postdiagnosis aspirin was associated with improved biliary tract cancer (BTC)-specific mortality of various subtypes. We agree the author collected data from the national, multicenter Cancer Registration Database and conducted a great cohort study. However, we would like to highlight some key points. |
We wish to congratulate Louvet et al on their significant contribution to the literature surrounding the important issue of acute liver injury caused by therapeutic acetaminophen (APAP) dosing (1). Their paper highlights that this syndrome invariably occurs in one of three clinical situations: Excessive alcohol intake, fasting ≥1 day and malnutrition, and typically occurs with prolonged APAP ingestion. |
It was with great interest that we read the article entitled "Serum Bioavailable, Rather Than Total, 25-hydroxyvitamin D Levels Are Associated With Hepatocellular Carcinoma Survival" by Fang et al [1]. In this study, the authors investigated the relationship between total, free and bioavailable serum 25-hydroxyvitamin D (25OHD) levels and survival in a large prospective cohort of patients with hepatocellular carcinoma (HCC). |
We appreciate the interest of Zhai and colleagues in our article recently published in Hepatology on the association between serum levels of total, free, and bioavailable 25-hydroxyvitamin D (25OHD) and hepatocellular carcinoma (HCC) survival (1) . They raised three important points, especially the last two, which allow us to further evaluate the predictive performance of bioavailable 25OHD for HCC prognosis. |
Response to 21-1766: Challenging the dogma of canalicular bile flow. Clarification - We do not comment on water flow from hepatocytes "into the bile canaliculus" but instead, have studied bile flux within the canalicular network. Validation of Photoactivation - We validated the mentioned photoactivation technique in biological structures, provided raw data and have discussed the imaging technicalities in detail; for example, this intravital video shows how photoactivated material moves unidirectionally in the blood stream. |
| J Hepatol |
| Neurogastroenterol Motil |
Others
all remaining publications eg case reports, images of the month, etc…
| Am J Gastroenterol |
| Clin Gastroenterol Hepatol |
| Endoscopy |
| Gastroenterology |
| Gastrointest Endosc |
| Gut |
| Hepatology |
| Inflamm Bowel Dis |
| J Crohns Colitis |
| J Hepatol |
| Neurogastroenterol Motil |