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Metformin and pancreatic neuroendocrine tumors:A systematic review and meta-analysis

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World Journal of gastroenterology 2024年第7期30卷 759-769页

作者： Maja Cigrovski Berkovic Alessandro Coppola Vibor Sesa Anna Mrzljak Quirino Lai department for Sport and Exercise medicine Faculty of Kinesiology University of ZagrebZagreb 10000Croatia department of Surgery Sapienza University of RomeRome 00185Italy department of gastroenterology and hepatology Liver Transplant CenterUniversity Hospital Centre ZagrebZagreb 10000Croatia department of medicine School of MedicineZagreb 10000Croatia General Surgery and Organ Transplantation Unit Department of SurgerySapienza University of RomeRome 00018Italy

BACKGROUND Most patients with advanced pancreatic neuroendocrine tumors(pNETs)die due to tumor ***,identifying new therapies with low toxicity and good tolerability to use concomitantly with the established pNET treatment is *** this perspective,metformin is emerging as a molecule of *** studies have described metformin,a widely used agent for the treatment of patients with type 2 diabetes mellitus(T2DM),to be effective in modulating different tumor-related events,including cancer incidence,recurrence and survival by inhibiting mTOR *** systematic review evaluates the role of T2DM and metformin in the insurgence and post-treatment outcomes in patients with *** To systematically analyze and summarize evidence related to the diagnostic and prognostic value of T2DM and metformin for predicting the insurgence and posttreatment outcomes of *** A systematic review of the published literature was undertaken,focusing on the role of T2DM and metformin in insurgence and prognosis of pNET,measured through outcomes of tumor-free survival(TFS),overall survival and progression free *** A total of 13 studies(5674 patients)were included in this *** of 809 pNET cases from five retrospective studies(low study heterogeneity with I^(2)=0%)confirms the correlation between T2DM and insurgence of pNET(OR=2.13,95%CI=1.56-4.55;P<0.001).The pooled data from 1174 pNET patients showed the correlation between T2DM and post-treatment TFS in pNET patients(hazard ratio=1.84,95%CI=0.78-2.90;P<0.001).The study heterogeneity was intermediate,with I^(2)=51%.A few studies limited the possibility of performing pooled analysis in the setting of metformin;therefore,results were heterogeneous,with no statistical relevance to the use of this drug in the diagnosis and prognosis of *** T2DM represents a risk factor for the insurgence of pNET and is a significant predictor of poor post-treatment TFS

关键词： Pancreatic neuroendocrine tumors Type 2 diabetes mellitus Prognosis Treatment Metformin

Is endoscopic ultrasound a promising technique in the diagnosis and treatment of liver diseases?

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World Journal of gastroenterology 2024年第22期30卷 2920-2922页

作者： Enver Zerem Željko Puljiz Boris Zdilar Suad Kunosic Admir Kurtcehajic Omar Zerem department of Medical Sciences The Academy of Sciences and Arts of Bosnia and HerzegovinaSarajevo 71000Sarajevo CantonBosnia and Herzegovina department of gastroenterology and hepatology University Clinical Center SplitSplit 21000Croatia department of medicine Croatian Military AcademyZagreb 10000Croatia department of Physics Faculty of Natural Sciences and MathematicsUniversity of TuzlaTuzla 75000Tuzla KantonBosnia and Herzegovina department of gastroenterology and hepatology Blue Medical GroupTuzla 75000Tuzla KantonBosnia and Herzegovina department of Internal medicine Cantonal Hospital“Safet Mujić”MostarMostar 88000Bosnia and Herzegovina

Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver *** some countries,its use is restricted to radiologists,limiting access for other clinicians,such as *** ultrasound,as a novel technique,plays a crucial role in diagnosis and treatment of digestive ***,its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists,leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.

关键词： Endoscopic ultrasound Percutaneous ultrasound Liver biopsy Fine needle aspiration Focal liver lesion Liver abscess drainage

Practical approach to linear endoscopic ultrasound examination of the gallbladder

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World Journal of Radiology 2024年第6期16卷 184-195页

作者： Hussein Hassan Okasha Eyad Gadour Hassan Atalla Omar AbdAllah AbdEl-Hameed Reem Ezzat Ahmed Elsayed Alzamzamy Elsayed Ghoneem Rasha Ahmad Matar Zeinab Hassan Bogdan Miutescu Ayman Qawasmi Katarzyna M Pawlak Ahmed Elmeligui department of Internal medicine Division of Gastroenterology and HepatologyKasr Al-Aini School of MedicineCairo UniversityCairo 11562Egypt department of gastroenterology and hepatology King Abdulaziz Hospital-National GuardAhsa 31982Saudi Arabia department of medicine School of MedicineZamzam University CollegeKhartoum 11113Sudan department of Internal medicine Hepatology and Gastroenterology UnitFaculty of MedicineMansoura UniversityMansoura 35516Egypt department of Internal medicine Faculty of MedicineAssiut UniversityAssiut 71511Egypt department of gastroenterology and Heptology Maadi Armed Forces Medical ComplexMilitary Medical AcademyCairo 11728Egypt department of gastroenterology and Advance Endoscopy Sultant Qaboos Comprehensive Cancer Care and Research CentreMuscat 0961Oman department of Internal medicine Stockport Hospitals NHS Foundation TrustManchester SK27JEUnited Kingdom department of gastroenterology and hepatology Victor Babes University of Medicine and PharmacyTimisoara 300041Romania Advanced Regional Research Centre in gastroenterology and hepatology Victor Babes University of Medicine and PharmacyTimisoara 30041Romania department of gastroenterology Al-Makassed Islamic Charitable Society HospitalCairo 11124Egypt Division of gastroenterology St.Michael’s HospitalUniversity of TorontoToronto M5B 1W8Canada department of gastroenterology Southend University HospitalEssex SS26XTUnited Kingdom

The gallbladder(GB)is a susceptible organ,prone to various pathologies that can be identified using different imaging *** ultrasound(TUS)is typically the initial diagnostic method due to its numerous well-established ***,in cases of uncertainty or when a definitive diagnosis cannot be established,computed tomography(CT)or magnetic resonance imaging may be employed to provide more detailed ***,CT scans may sometimes offer inadequate spatial resolution,which can limit the differentiation of GB lesions,particularly when smaller yet clinically relevant abnormalities are ***,endoscopic ultrasound(EUS)provides higher frequency compared to TUS,superior spatial resolution,and the option for contrast-enhanced harmonic imaging,enabling a more comprehensive ***,EUS can serve as a supplementary tool when conventional imaging methods are *** review will describe the standard EUS examination of the GB,focusing on its endosonographic characteristics in various GB path-ologies.

关键词： Endoscopic ultrasound Linear endoscopic ultrasound Gallbladder anatomy Gallbladder pathologies Therapeutic endoscopic ultrasound

Portal hypertension in patients with nonalcoholic fatty liver disease:Current knowledge and challenges

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World Journal of gastroenterology 2024年第4期30卷 290-307页

作者： Anita Madir Ivica Grgurevic Emmanuel A Tsochatzis Massimo Pinzani department of gastroenterology Hepatology and Clinical NutritionUniversity Hospital DubravaZagreb 10000Croatia School of medicine University of ZagrebZagreb 10000Croatia faculty of Pharmacy and Biochemistry University of ZagrebZagreb 10000Croatia UCL Institute for Liver and Digestive Health Royal Free Hospital and University College LondonLondon NW32PFUnited Kingdom

Portal hypertension(PH)has traditionally been observed as a consequence of significant fibrosis and cirrhosis in advanced non-alcoholic fatty liver disease(NAFLD).However,recent studies have provided evidence that PH may develop in earlier stages of NAFLD,suggesting that there are additional pathogenetic mechanisms at work in addition to liver *** early development of PH in NAFLD is associated with hepatocellular lipid accumulation and ballooning,leading to the compression of liver *** compression and intraluminal obstacles cause mechanical forces such as strain,shear stress and elevated hydrostatic pressure that in turn activate mechanotransduction pathways,resulting in endothelial dysfunction and the development of *** spatial distribution of histological and functional changes in the periportal and perisinusoidal areas of the liver lobule are considered responsible for the pre-sinusoidal component of PH in patients with ***,current diagnostic methods such as hepatic venous pressure gradient(HVPG)measurement tend to underestimate portal pressure(PP)in NAFLD patients,who might decompensate below the HVPG threshold of 10 mmHg,which is traditionally considered the most relevant indicator of clinically significant portal hypertension(CSPH).This creates further challenges in finding a reliable diagnostic method to stratify the prognostic risk in this population of *** theory,the measurement of the portal pressure gradient guided by endoscopic ultrasound might overcome the limitations of HVPG measurement by avoiding the influence of the pre-sinusoidal component,but more investigations are needed to test its clinical utility for this *** and spleen stiffness measurement in combination with platelet count is currently the best-validated non-invasive approach for diagnosing CSPH and varices needing *** change remains the cornerstone of the treatment of PH in NAFLD,together with correcting the comp

关键词： Non-alcoholic fatty liver disease Portal hypertension Mechanotransduction Endothelial dysfunction Hepatic venous pressure gradient

Diagnostic and prognostic performances of GALAD score in staging and 1-year mortality of hepatocellular carcinoma: A prospective study

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World Journal of gastroenterology 2024年第17期30卷 2343-2353页

作者： Oraphan Jitpraphawan Witchakorn Ruamtawee Mala Treewatchareekorn Supatsri Sethasine Division of gastroenterology and hepatology Department of MedicineNavamindradhiraj UniversityDusit 10300BangkokThailand Clinical Research Center Research Facilitation DivisionNavamindradhiraj UniversityDusit 10300BangkokThailand Division of Clinical Chemistry and Immunology Navamindradhiraj UniversityDusit 10300BangkokThailand

BACKGROUND The GALAD score has improved early hepatocellular carcinoma(HCC)detection *** role of the GALAD score in staging and predicting tumor characteristics or clinical outcome of HCC remains of particular *** To determine the diagnostic/prognostic performances of the GALAD score at various phases of initial diagnosis,tumor features,and 1-year mortality of HCC and compare the performance of the GALAD score with those of other serum *** This prospective,diagnostic/prognostic study was conducted among patients with newly diagnosed HCC at the liver center of Vajira *** patients had HCC staging allocation using the Barcelona Clinic Liver Cancer(BCLC)***,HCC etiology,and HCC features were *** and the GALAD score were obtained at *** performance of the GALAD score and biomarkers were prospectively *** Exactly 115 individuals were diagnosed with *** GALAD score increased with disease *** BCLC-0/A and BCLC-B/C/D,the GALAD score predicted HCC staging with an area under the curve(AUC)of 0.868(95%CI:0.80–0.93).For identifying the curative HCC,the AUC of GALAD score was significantly higher than that of Alpha-fetoprotein(AFP)(0.753)and Lens culinaris agglutinin-reactive fraction of AFP-L3(0.706),and as good as that of Protein induced by vitamin K absence-II(PIVKA-II)(0.897).For detecting aggressive features,the GALAD score gave an AUC of 0.839(95%CI:0.75–0.92)and significantly outperformed compared to that of AFP(0.761)and AFP-L3(0.697),with a trend of superiority to that of PIVKA-II(0.772).The performance to predict 1-year mortality of GALAD score(AUC:0.711,95%CI:0.60–0.82)was better than that of AFP(0.541)and as good as that of PIVKA-II(0.736).The optimal cutoff value of GALAD score was≥6.83,with a specificity of 72.63%for exhibiting substantial reduction in the 1-year *** The GALAD model can diagnose HCC at the curative stage,includin

关键词： Alpha-fetoprotein Barcelona clinic liver cancer GALAD score Hepatocellular carcinoma Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein Protein induced by vitamin K absence-II

Vonoprazan-amoxicillin dual regimen with Saccharomyces boulardii as a rescue therapy for Helicobacter pylori:Current perspectives and implications

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World Journal of gastroenterology 2024年第10期30卷 1280-1286页

作者： Valerie Josephine Dirjayanto Jessica Audrey Daniel Martin Simadibrata faculty of medicine Universitas IndonesiaJakarta Pusat 10430DKI JakartaIndonesia Division of gastroenterology and hepatology Mayo ClinicRochesterMinnesota 55905United States Nuffield department of Population Health University of OxfordOxford OX37LFUnited Kingdom

Yu et al’s study in the World Journal of gastroenterology(2023)introduced a novel regimen of Vonoprazan-amoxicillin dual therapy combined with Saccharomyces boulardii(***)for the rescue therapy against Helicobacter pylori(***),a pathogen responsible for peptic ulcers and gastric *** is a potassium-competitive acid blocker renowned for its rapid and long-lasting acid suppression,which is minimally affected by *** to proton pump inhibitors,which bind irreversibly to cysteine residues in the H+/K+-ATPase pump,Vonoprazan competes with the K+ions,prevents the ions from binding to the pump and blocks acid *** with increasing antibiotic resistance,effects on the gut microbiota,patient compliance,and side effects have led to the advent of a dual regimen for *** studies suggested that *** plays a role in stabilizing the gut barrier which improves *** eradication *** an acceptable safety profile,the dual-adjunct regimen was effective regardless of prior treatment failure and antibiotic resistance profile,thereby strengthening the applicability in clinical ***,*** comes in various formulations and dosages,warranting further exploration into the optimal dosage for supplementation in rescue ***,larger,randomized,double-blinded controlled trials are warranted to confirm these promising results.

关键词： Vonoprazan Saccharomyces boulardii Helicobacter pylori Rescue therapy Eradication rate

Role of fecal microbiota transplant in management of hepatic encephalopathy: Current trends and future directions

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World Journal of hepatology 2024年第1期16卷 17-32页

作者： Yash R Shah Hassam Ali Angad Tiwari David Guevara-Lazo Natalia Nombera-Aznaran Bhanu Siva Mohan Pinnam Manesh Kumar Gangwani Harishankar Gopakumar Amir H Sohail SriLakshmiDevi Kanumilli Ernesto Calderon-Martinez Geetha Krishnamoorthy Nimish Thakral Dushyant Singh Dahiya department of Internal medicine Trinity Health Oakland/Wayne State UniversityPontiacMI 48341United States Division of gastroenterology and hepatology East Carolina University/Brody School of MedicineGreenvilleNC 27858United States department of Internal medicine Maharani Laxmi Bai Medical CollegeJhansi 284001India faculty of medicine Universidad Peruana Cayetano HerediaLima 15102Peru department of Internal medicine John H.Stroger Hospital of Cook CountyChicagoIL 60612United States department of Internal medicine The University of ToledoToledoOH 43606United States department of gastroenterology and hepatology University of Illinois College of Medicine at PeoriaPeoriaIL 61605United States department of Surgery University of New MexicoAlbuquerqueNM 87106United States department of Internal medicine GSL Medical CollegeRajamahendravaram 533296India department of Internal medicine Universidad Nacional Autonoma de MexicoCiudad De Mexico 04510Mexico department of Digestive Diseases and Nutrition University of KentuckyLexingtonKY 40536United States Division of gastroenterology Hepatology&MotilityThe University of Kansas School of MedicineKansas CityKS 66160United States

Fecal microbiota transplantation(FMT)offers a potential treatment avenue for hepatic encephalopathy(HE)by leveraging beneficial bacterial displacement to restore a balanced gut *** prevalence of HE varies with liver disease severity and *** pathogenesis involves ammonia toxicity,gut-brain communication disruption,and *** aims to restore gut microbiota balance,addressing these ***'s efficacy has been explored in various conditions,including *** suggest that FMT can modulate gut microbiota,reduce ammonia levels,and alleviate *** has shown promise in alcohol-associated,hepatitis B and C-associated,and non-alcoholic fatty liver *** include improved liver function,cognitive function,and the slowing of disease ***,larger,controlled studies are needed to validate its effectiveness in these *** have shown cognitive improvements through FMT,with potential benefits in cirrhotic ***,trials have demonstrated reduced serious adverse events and cognitive enhancements in FMT arms compared to the standard of *** evidence is promising,challenges remain:Limited patient numbers,varied dosages,administration routes,and donor *** large-scale,controlled trials are essential to establish standardized guidelines and ensure FMT's clinical applications and *** FMT holds potential for HE management,ongoing research is needed to address these challenges,optimize protocols,and expand its availability as a therapeutic option for diverse hepatic conditions.

关键词： Hepatic encephalopathy Fecal microbiota transplant Cognitive impairment Liver cirrhosis Chronic liver disease

Positive health:An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders

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World Journal of gastroenterology 2024年第28期30卷 3418-3427页

作者： Anja H W M Lemlijn-Slenter Karolina AP Wijnands Gijs van der Hamsvoort Luuk P van Iperen Nico Wolter Angelique E de Rijk Ad AM Masclee department of Social medicine Faculty of HealthMedicine and Life sciencesCare and Public Health Research Institute Maastricht UniversityMaastricht 6200 MDLimburgNetherlands Division of gastroenterology and hepatology Department of Internal MedicineSchool of Nutrition and Translational Research in MetabolismMaastricht 6200 MDLimburgNetherlands Social Medical Affairs Employee Insurance Agency(UWV)Heerlen 6400 ACLimburgNetherlands department of Research Academic Knowledge Center Work and Health South-East Netherlands(AKAG-ZON)Heerlen 6400 ACLimburgNetherlands

BACKGROUND The concept of positive health(PH)supports an integrated approach for patients by taking into account six dimensions of *** approach is especially relevant for patients with chronic *** gastrointestinal and hepatopancreatico-biliary(GI-HPB)disorders are among the top-6 of the most prevalent chronically affected organ *** impact of chronic GI-HPB disorders on individuals may be disproportionally high because:(1)The affected organ system frequently contributes to a malnourished state;and(2)persons with chronic GIHPB disorders are often younger than persons with chronic diseases in other organ *** To describe and quantify the dimensions of PH in patients with chronic GI-HPB *** Prospective,observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GIHPB disorder attending the Outpatient department of the Maastricht university Medical *** questionnaires and data from patient files were used to quantify the six dimensions of *** consistency was tested with McDonald’s ***-order Pearson correlations and t-tests were used to assess associations and differences.A P value<0.05 was considered *** The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general *** quality of life,participation and daily functioning,GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems,but depressive symptoms(in 35%)and malnutrition(in 45%)were more frequent in patients with chronic GI-HPB *** scores between the six dimensions were only very weak to weak,forcing us to quantify each domain *** All six dimensions of PH are impaired in the GI-HPB *** and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.

关键词： Positive health Chronic gut disorders Gastrointestinal disorders Hepato-pancreatico-biliary disorders Integrated care

Constipation and colonoscopy

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World Journal of Gastrointestinal Endoscopy 2024年第5期16卷 244-249页

作者： Dusan Dj Popovic Branka Filipovic faculty of medicine University of BelgradeBelgrade 11000Serbia department of gastroenterology and hepatology Clinic for Internal MedicineUniversity Clinical Hospital Center“Dr.Dragisa Misovic-Dedinje”Belgrade 11000Serbia

Constipation is a significant sociomedical problem,which can be caused by various *** the diagnostic approach to patients with constipation,the following data are usually sufficient:History,complete physical examination(including rectal examination),and additional diagnostic tests.A colonoscopy is not a necessary diagnostic method for all patients with ***,if patients have alarm symptoms/signs,that suggest an organic reason for constipation,a colonoscopy is *** most important alarm symptoms/signs are age>50 years,gastrointestinal bleeding,new-onset constipation,a palpable mass in the abdomen and rectum,weight loss,anemia,inflammatory bowel disease,and family history positive for colorectal *** endoscopists do not like to deal with patients with *** are two reasons for this,namely the difficulty of endoscopy and the adequacy of *** are adversely affected by *** improve the quality of colonoscopy in these patients,good examination techniques and often more extensive preparation are *** colonoscopy technique implies adequate psychological preparation of the patient,careful insertion of the endoscope with minimal insufflation,and early detection and resolution of *** preparation for colonoscopy often requires prolonged preparation and sometimes the addition of other laxatives.

关键词： Constipation Functional constipation Colonoscopy Bowel preparation Polyethylene glycol