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Gut microbiota predicts the diagnosis of ulcerative colitis in Saudi children

World Journal of Clinical Pediatrics 2024年第1期13卷 118-124页

作者： Mohammad El Mouzan Ahmed Al Sarkhy Asaad Assiri department of Pediatrics Gastroenterology UnitKing Saud UniversityRiyadh 11461Saudi Arabia

BACKGROUND Ulcerative colitis(UC)is an immune-mediated chronic inflammatory condition with a worldwide *** the etiology of this disease is still unknown,the understanding of the role of the microbiota is becoming increasingly *** To investigate the predictive power of the gut microbiota for the diagnosis of UC in a cohort of newly diagnosed treatment-naïve Saudi children with *** The study population included 20 children with a confirmed diagnosis of UC and 20 healthy *** DNA was extracted and sequenced,and shotgun metagenomic analysis was performed for bacteria and *** and bioinformatics demonstrated significant dysbiosis in the form of reduced alpha diversity,beta diversity,and significant difference of abundance of taxa between children with UC and control *** receiver operating characteristic curve,a probability curve,was used to determine the difference between the UC and control *** area under the curve(AUC)represents the degree of separability between the UC group and the control *** AUC was calculated for all identified bacterial species and for bacterial species identified by the random forest classification algorithm as important potential biomarkers of UC.A similar method of AUC calculation for all bacteriophages and important species was *** The median age and range were 14(0.5-21)and 12.9(6.8-16.3)years for children with UC and controls,respectively,and 40%and 35%were male for children with UC and controls,*** AUC for all identified bacterial species was 89.5%.However,when using the bacterial species identified as important by random forest classification algorithm analysis, the accuracy increased to 97.6%. Similarly, the AUC for all theidentified bacteriophages was 87.4%, but this value increased to 94.5% when the important bacteriophagebiomarkers were *** very high to excellent AUCs of fecal bacterial and viral species sugge

关键词： Ulcerative colitis Microbiota Area under the curve Children Saudi Arabia

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Discontinuation of therapy in inflammatory bowel disease: Current views

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World Journal of Clinical Cases 2024年第10期12卷 1718-1727页

作者： Antonio Meštrović Marko Kumric Josko Bozic department of gastroenterology University Hospital of SplitSplit 21000Croatia department of Pathophysiology University of Split School of MedicineSplit 21000Croatia

The timely introduction and adjustment of the appropriate drug in accordance with previously well-defined treatment goals is the foundation of the approach in the treatment of inflammatory bowel disease(IBD).The therapeutic approach is still evolving in terms of the mechanism of action but also in terms of the possibility of maintaining *** patients with achieved long-term remission,the question of de-escalation or discontinuation of therapy arises,considering the possible side effects and economic burden of long-term *** each of the drugs used in IBD(5-aminosalycaltes,immunomodulators,biological drugs,small molecules)there is a risk of ***,studies show that more than 50%of patients who discontinue therapy will *** on the findings of large studies and meta-analysis,relapse of disease can be expected in about half of the patients after therapy withdrawal,in case of monotherapy with aminosalicylates,immunomodulators or biological ***,longer relapse-free periods are recorded with withdrawal of medication in patients who had previously been on combination therapies immunomodulators and anti-tumor necrosis *** needs to be stressed that randomised clinical trials regarding withdrawal from medications are still *** making a decision on discontinuation of therapy,it is important to distinguish potential candidates and predictive factors for the possibility of disease *** calprotectin level has currently been identified as the strongest predictive factor for *** other predictive factors have also been identified,such as:High Crohn's disease activity index or Harvey Bradshaw index,younger age(40 years),smoking,young age of disease onset,steroid use 6-12 months before *** important factor in the decision to withdraw medication is the success of re-treatment with the same or other *** decision to discontinue therapy must be based on in

关键词： Inflammatory bowel disease Therapy discontinuation Therapy de-escalation Ulcerative colitis Crohn’s disease

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Artificial intelligence in detection of small bowel lesions and their bleeding risk:A new step forward

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World Journal of gastroenterology 2024年第18期30卷 2482-2484页

作者： Silvia Cocca Giuseppina Pontillo Giuseppe Grande Rita Conigliaro gastroenterology and Endoscopy Unit Azienda Ospedaliero Universitaria Policlinico di ModenaModena 41121Italy gastroenterology and Endoscopy Unit Presidio Ospedaliero San Giuseppe Moscati(AversaCE)-ASL CasertaCaserta 81100Italy department of gastroenterology and Digestive Endoscopy Azienda Ospedaliero Universitaria di ModenaModena 41121Italy

The present letter to the editor is related to the study with the title“Automatic detection of small bowel(SB)lesions with different bleeding risk based on deep learning models”.Capsule endoscopy(CE)is the main tool to assess SB diseases but it is a time-consuming procedure with a significant error *** development of artificial intelligence(AI)in CE could simplify physicians’*** novel deep learning model by Zhang et al seems to be able to identify various SB lesions and their bleeding risk,and it could pave the way to next perspective studies to better enhance the diagnostic support of AI in the detection of different types of SB lesions in clinical practice.

关键词： Capsule endoscopy Small bowel Artificial intelligence Bleeding risk Vascular lesions

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Metabolic dysfunction-associated fatty liver disease and low muscle strength: A comment

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World Journal of gastroenterology 2024年第17期30卷 2371-2373页

作者： Masood Muhammad Karim Amna Subhan Butt department of gastroenterology The Aga Khan University HospitalKarachi 74800SindhPakistan department of Medicine Aga Khan University HospitalKarachi 74800Pakistan

The diagnosis of non-alcoholic fatty liver disease(NAFLD)and metabolic dysfunction-associated fatty liver disease only on the basis of laboratory parameter score such as Hepatic Steatosis Index which includes liver enzymes,gender,basal metabolic index,and presence of diabetic mellitus is not sufficient to exclude other causes of deranged liver enzymes especially medications and autoimmune related liver *** the guideline suggests ultrasound is the preferred first-line diagnostic procedure for imaging of NAFLD,as it provides additional diagnostic information and the combination of biomarkers/scores and transient elastography might confer additional diagnostic accuracy and evident from previous similar studies too.

关键词： Non-alcoholic fatty liver disease Metabolic dysfunction associated fatty liver disease Low muscle strength Hepatic Steatosis Index Letter to the editor

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The outcomes and safety of patients undergoing endoscopic retrograde cholangiopancreatography combining a single-use cholangioscope and a single-use duodenoscope:A multicenter retrospective international study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 71-76页

作者： Alessandro Fugazza Matteo Colombo Michel Kahaleh V.Raman Muthusamy Bick Benjamin Wim Laleman Carmelo Barbera Carlo Fabbri Jose Nieto Abed Al-Lehibi Mohan Ramchandani Amy Tyberg Haroon Shahid Avik Sarkar Dean Ehrlich Stuart Shermand Cecilia Binda Marco Spadaccini Andrea Iannone Kareem Khalaf Nageshwar Reddy Andrea Anderloni Alessandro Repici Division of gastroenterology and Digestive Endoscopy Humanitas Research Hospital-IRCCSVia Manzoni 5620089RozzanoMilanoItaly gastroenterology Rutgers Robert Wood JohnsonNew BrunswickNew JerseyUSA Vatche and Tamar Manoukian Division of Digestive Diseases University of CaliforniaLos Angeles School of Medicine at UCLALos AngelesCaliforniaUSA Division of Digestive and Liver Disorders Indiana University School of MedicineIndianapolisINUSA department of gastroenterology and Hepatology University Hospitals LeuvenKU Leuven3000 LeuvenBelgium U.O.C.di Gastroenterologia ed Endoscopia Digestiva Ospedale Giuseppe MazziniASL TeramoItaly gastroenterology and Digestive Endoscopy Unit Forlì-Cesena HospitalsAUSL RomagnaForlì-CesenaItaly Borland Groover Clinic JacksonvilleFloridaUSA department of gastroenterology and Hepatology King Fahad Medical CityRiyadhSaudi Arabia Asian Institute of gastroenterology HyderabadIndia Section of gastroenterology Department of Emergency and Organ TransplantationUniversity of BariBari 70124Italy department of Biomedical Sciences Humanitas UniversityVia Rita Levi Montalcini 420090Pieve EmanueleMilanItaly

Background: Duodenoscope-related multidrug-resistant organism(MDRO) infections raise concerns. Disposable duodenoscopes have been recently introduced in the market and approved by regulatory agencies with the aim to reduce the risk of endoscopic retrograde cholangiopancreatography(ERCP) associated infections. The aim of this study was to evaluate the outcome of procedures performed with single-use duodenoscopes in patients with clinical indications to single-operator cholangiopancreatoscopy. Methods: This is a multicenter international, retrospective study combining all patients who underwent complex biliopancreatic interventions using the combination of a single-use duodenoscope and a single-use cholangioscope. The primary outcome was technical success defined as ERCP completion for the intended clinical indication. Secondary outcomes were procedural duration, rate of cross-over to reusable duodenoscope, operator-reported satisfaction score(1 to 10) on performance rating of the single-use duodenoscope, and adverse event(AE) rate. Results: A total of 66 patients(26, 39.4% female) were included in the study. ERCP was categorized according to ASGE ERCP grading system as 47(71.2%) grade 3 and 19(28.8%) grade 4. The technical success rate was 98.5%(65/66). Procedural duration was 64(interquartile range 15-189) min, cross-over rate to reusable duodenoscope was 1/66(1.5%). The satisfaction score of the single-use duodenoscope classified by the operators was 8.6 ± 1.3 points. Four patients(6.1%) experienced AEs not directly related to the single-use duodenoscope, namely 2 post-ERCP pancreatitis(PEP), 1 cholangitis and 1 ***: Single-use duodenoscope is effective, reliable and safe even in technically challenging procedures with a non-inferiority to reusable duodenoscope, making these devices a viable alternative to standard reusable equipment.

关键词： Single-operator cholangioscopy Single-use duodenoscope Endoscopic retrograde cholangiopancreatography Indeterminate biliary stricture Difficult biliary stones

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Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 699-715页

作者： Ankit Agarwal Sagnik Biswas Shekhar Swaroop Arnav Aggarwal Ayush Agarwal Gautam Jain Anshuman Elhence Arun Vaidya Amit Gupte Ravi Mohanka Ramesh Kumar Ashwani Kumar Mishra Shivanand Gamanagatti Shashi Bala Paul Subrat Kumar Acharya Akash Shukla Shalimar department of gastroenterology and Human Nutrition All India Institute of Medical SciencesNew Delhi 110029DelhiIndia department of gastroenterology Seth Gordhandas Sunderdas Medical College and KEM HospitalMumbai 400012MaharashtraIndia department of gastroenterology Sir HN Reliance Foundation HospitalMumbai 400004India department of Liver Transplant and HPB Sir HN Reliance Foundation HospitalMumbai 400004India department of gastroenterology All India Institute of Medical SciencesPatna 801507India Professor of Biostatistics National Drug Dependence Treatment Centre(NDDTC)All India Institute of Medical SciencesNew Delhi 110029India department of Radiodiagnosis All India Institute of Medical SciencesNew Delhi 110029DelhiIndia

BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in *** A total of 904 BCS patients from New Delhi,India and 1140 from Mumbai,India were *** prevalence and incidence of HCC were determined,and among patients with BCS-HCC,the viability and outcomes of interventional therapy were *** In the New Delhi cohort of 35 BCS-HCC patients,18 had HCC at index presentation(prevalence 1.99%),and 17 developed HCC over a follow-up of 4601 person-years,[incidence 0.36(0.22-0.57)per 100 person-years].BCS-HCC patients were older when compared to patients with BCS alone(P=0.001)and had a higher proportion of inferior vena cava block,cirrhosis,and long-segment vascular *** median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up(13029 ng/mL vs 500 ng/mL,P=0.01).Of the 35 BCS-HCC,26(74.3%)underwent radiological interventions for BCS,and 22(62.8%)patients underwent treatment for HCC[transarterial chemoembolization in 18(81.8%),oral tyrosine kinase inhibitor in 3(13.6%),and transarterial radioembolization in 1(4.5%)].The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo(P=0.0001).In contrast to the New Delhi cohort,the Mumbai cohort of BCS-HCC patients were predominantly males,presented with a more advanced HCC[Barcelona Clinic Liver Cancer C and D],and 2 patients underwent liver *** HCC is not uncommon in patients with *** interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes.

关键词： Budd chiari syndrome Cancer Cirrhosis Thrombosis Liver Varices Transarterial chemoembolization Hepatic venous outflow tract obstruction

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Colo-colonic intussusception as a rare complication of colonoscopy with polypectomy: Two case reports

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1939-1947页

作者： Sai-Heng Xiang Guo-Qiang Xu department of gastroenterology The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina

BACKGROUND Colonoscopy is the most frequently used diagnostic and therapeutic tool for the treatment of colorectal *** the complication rate is low,it can be potentially *** is a rare and severe complication often associated with *** a handful of post-colonoscopy intussusception cases have been reported,making this study a valuable addition to the medical *** SUMMARY Case 1:A 61-year-old man underwent colonoscopy with polypectomy for chronic abdominal *** patient experienced abdominal pain 11 hours later but was still discharged after pain *** was readmitted due to recurring *** tomography(CT)showed colo-colonic *** conservative management and attempts at endoscopic reduction failed;therefore,laparoscopic right hemicolectomy was *** examination revealed tubular adenomas in the polyps and inflammation in the resected *** 2:A 59-year-old woman underwent colonoscopy with polypectomy for a polyp in the transverse *** experienced upper abdominal pain,fever,nausea,and vomiting 9 hours after the *** CT and blood tests revealed a colo-colonic intussusception near the hepatic flexure and an elevated white blood cell *** attempts at endoscopic reduction failed and conservative treatment showed no *** underwent successful laparoscopic reduction and recovered *** examination of the resected polyp revealed *** Post-colonoscopy intussusception in adults is rare,and polypectomy may contribute to its *** diagnosis is crucial,with prompt CT examination serving as *** excluding malignancies,conservative management and reduction of intussusception should be considered before surgical bowel resection.

关键词： Intussusception Colonoscopy Polypectomy Complication Case report

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Real-world efficacy and safety of tofacitinib treatment in Asian patients with ulcerative colitis

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World Journal of gastroenterology 2024年第13期30卷 1871-1886页

作者： Kentaro Kojima Kenji Watanabe Mikio Kawai Soichi Yagi Koji Kaku Maiko Ikenouchi Toshiyuki Sato Koji Kamikozuru Yoko Yokoyama Tetsuya Takagawa Masahito Shimizu Shinichiro Shinzaki department of gastroenterology Hyogo Medical UniversityNishinomiya 663-8501Japan department of gastroenterology Gifu University Graduate School of MedicineGifu 501-1194Japan department of Internal Medicine for Inflammatory Bowel Disease The University of ToyamaToyama 930-0194Japan Center for Clinical Research and Education Hyogo Medical UniversityNishinomiya 663-8501Japan

BACKGROUND Real-world data on tofacitinib(TOF)covering a period of more than 1 year for a sufficient number of Asian patients with ulcerative colitis(UC)are *** To investigate the long-term efficacy and safety of TOF treatment for UC,including clinical *** We performed a retrospective single-center observational analysis of 111 UC patients administered TOF at Hyogo Medical University as a tertiary inflammatory bowel disease *** consecutive UC patients who received TOF between May 2018 and February 2020 were *** were followed up until August *** primary outcome was the clinical response rate at week *** outcomes included clinical remission at week 8,cumulative persistence rate of TOF administration,colectomy-free survival,relapse after tapering of TOF and predictors of clinical response at week 8 and week *** The clinical response and remission rates were 66.3%and 50.5%at week 8,and 47.1%and 43.5%at week 48,*** overall cumulative clinical remission rate was 61.7%at week 48 and history of anti-tumor necrosis factor-alpha(TNF-α)agents use had no influence(P=0.25).The cumulative TOF persistence rate at week 48 was significantly lower in patients without clinical remission than in those with remission at week 8(30.9%vs 88.1%;P<0.001).Baseline partial Mayo Score was significantly lower in responders vs non-responders at week 8(odds ratio:0.61,95%confidence interval:0.45-0.82,P=0.001).Relapse occurred in 45.7%of patients after TOF tapering,and 85.7%of patients responded within 4 wk after *** 6 patients with herpes zoster(HZ)developed the infection after achieving remission by *** TOF was more effective in UC patients with mild activity at baseline and its efficacy was not affected by previous treatment with anti-TNF-α*** relapsed patients responded again after re-increase of TOF and nearly half relapsed after tapering off *** attention is needed for tapering and H

关键词： Ulcerative colitis Tofacitinib Janus kinase inhibitor Real-world Biologics

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Effect of screening colonoscopy frequency on colorectal cancer mortality in patients with a family history of colorectal cancer

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 354-363页

作者： Li Zheng Bin Li Ling Lei Li-Jia Wang Zhi-Ping Zeng Jian-Dong Yang department of gastroenterology The First Hospital of NanchangNanchang 330008Jiangxi ProvinceChina department of General Surgery The First Hospital of NanchangNanchang 330008Jiangxi ProvinceChina

BACKGROUND Colorectal cancer is a common malignant tumor in China,and its incidence in the elderly is increasing *** bowel disease is a group of chronic non-specific intestinal inflammatory diseases,including ulcerative colitis and Crohn’s *** included the clinicopathological and follow-up data of patients with colorectal cancer who underwent laparoscopic colectomy or open colectomy at our Gastrointestinal department between January 2019 and December *** indicators,oncological indicators,and survival rates were compared between the *** results of 104 patients who met the above criteria were extracted from the database(laparoscopic colectomy group=63,open colectomy group=41),and there were no statistically significant differences in the baseline data or follow-up time between the two *** Intraoperative blood loss,time to first ambulation,and time to first fluid intake were significantly lower in the laparoscopic colectomy group than in the open colectomy *** differences in overall mortality,tumor-related mortality,and recurrence rates between the two groups were not statistically significant,and survival analysis showed that the differences in the cumulative overall survival,tumor-related survival,and cumulative recurrence-free rates between the two groups were not statistically *** In elderly patients with colorectal cancer,laparoscopic colectomy has better short-term outcomes than open colectomy,and laparoscopic colectomy has superior long-term survival outcomes compared with open colectomy.

关键词： Colorectal cancer Laparoscopic surgery Open surgery Prognosis Laparoscopic colectomy Open colectomy

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Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio:Markers predicting immune-checkpoint inhibitor efficacy and immune-related adverse events

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 577-582页

作者： Qiu-Yu Jiang Ru-Yi Xue department of gastroenterology and Hepatology Zhongshan HospitalShanghai Institute of Liver DiseaseFudan UniversityShanghai 200032China department of gastroenterology and Hepatology Shanghai Baoshan District Wusong Central Hospital(Zhongshan Hospital Wusong BranchFudan University)Shanghai 200940China

We conducted a comprehensive review of existing prediction models pertaining to the efficacy of immune-checkpoint inhibitor(ICI)and the occurrence of immune-related adverse events(irAEs).The predictive potential of neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)in determining ICI effectiveness has been extensively investigated,while limited research has been conducted on predicting ***,the combined model incor-porating NLR and PLR,either with each other or in conjunction with additional markers such as carcinoembryonic antigen,exhibits superior predictive capabilities compared to individual markers *** and PLR are promising markers for clinical *** models ought to incorporate established efficacious models and newly identified ones,thereby constituting a multifactor composite ***,efforts should be made to explore effective clinical application approaches that enhance the predictive accuracy and efficiency.

关键词： Neutrophil-to-lymphocyte ratio Platelet-to-lymphocyte ratio Immunecheckpoint inhibitor Immune-related adverse event

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