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Liver parasites:A global endemic and journey from infestation to intervention

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World Journal of gastroenterology 2025年第1期31卷 8-15页

作者： Yumna Shahid Bushra Emman Shahab Abid department of Medicine Section of GastroenterologyAga Khan University HospitalKarachi 75500SindhPakistan Aga Khan Medical College Aga Khan University HospitalKarachi 75500SindhPakistan

Parasites have coexisted with humans throughout history,forming either symbiotic relationships or causing significant morbidity and *** liver is particularly vulnerable to parasitic infections,which can reside in,pass through,or be transported to the liver,leading to severe *** editorial explores various parasites that infect the liver,their clinical implications,and diagnostic considerations,as discussed in the article“Parasites of the liver:A global problem?”.Parasites reach the liver primarily through oral ingestion,mucosal penetration,or the bloodstream,with some larvae even penetrating the *** parasites such as cestodes(Echinococcus),trematodes(Clonorchis,Opisthorchis),nematodes(Ascaris),and protozoa(Entamoeba histolytica)can also cause systemic infections like visceral leishmaniasis,malaria,cryptosporidiosis,and *** infections like clonorchiasis and opisthorchiasis are linked to persistent hepatobiliary inflammation,potentially progressing to cholangiocarcinoma,a fatal bile duct cancer,particularly prevalent in Southeast *** global nature of liver parasite infestations is alarming,with hundreds of millions affected ***,control over treatment quality remains *** the significant public health threat posed by these parasites,international medical organizations must prioritize improved diagnosis,treatment,and preventive *** educational efforts and enhancing healthcare provider training are critical steps toward mitigating the global impact of parasitic liver diseases.

关键词： Liver flukes Nematodes Cestodes Trematodes Protozoa Parasites

Biologics in the management of pediatric inflammatory bowel disease:When and what to choose

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World Journal of Clinical pediatrics 2025年第1期14卷 21-45页

作者： Arghya Samanta Anshu Srivastava department of Pediatric gastroenterology Sanjay Gandhi Postgraduate Institute of Medical SciencesLucknow 226014Uttar PradeshIndia

Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and *** the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel *** available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory *** their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up *** real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in ***,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are *** this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.

关键词： Biologics Children Inflammatory bowel disease Therapeutic drug monitoring Dual biologic

Clinical,laboratory,and therapeutic differences between immunoglobulin E-mediated and non-immunoglobulin E-mediated cow’s milk protein allergy in children

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World Journal of Clinical pediatrics 2025年第1期14卷 78-92页

作者： Hasan M Isa Marwa J Abdulnabi Nawra S Naser Fatema N Lahmda Noor M AlAnsari Zahra H Isa Afaf M Mohamed department of pediatrics Salmaniya Medical ComplexManama 26671Bahrain department of pediatrics Arabian Gulf UniversityManama 26671Bahrain Faculty of Medicine Mansoura UniversityMansoura 35516Egypt Public Health Directorate Ministry of HealthManama 26671Bahrain

BACKGROUND Although breast milk is ideal for newborns,in some cases,it is replaced with cow’s milk,which contains proteins that increase the risk of cow’s milk protein allergy(CMPA).AIM To evaluate CMPA prevalence in Bahrain and compare clinical characteristics of children with immunoglobulin E(IgE)-and non-IgE-mediated *** This retrospective cohort study examined children with CMPA diagnosed at the pediatric gastroenterology outpatient clinic of the Salmaniya Medical Complex,Bahrain,between 2014 and 2022,and assessed CMPA *** presentations,laboratory findings,dietary modifications,and outcomes were compared between children with IgE-mediated and non-IgE-mediated *** variables were compared using Fisher’s exact test or Pearson’sχ2 test,whereas continuous variables were compared using Student’s t-test or the Mann-Whitney U *** Of 8332 patients,6022(72.3%)adhered to their *** them,618(10.3%)were suggested of having CMPA and 595(96.3%)were included;CMPA prevalence was 2%.Most patients were Bahraini(93.8%)and males(55.3%).Non-IgE-mediated type accounted for 77.3%cases and IgE-mediated type,22.7%.IgE-mediated CMPA presented more in boys(P=0.030),and later in life(5.1 months±4.5 months vs 4.2 months±4.2 months,P=0.016,95%CI:0.08-1.73),had more associated diseases(P<0.001);and presented with more cutaneous(P=0.024)and respiratory(P=0.003)manifestations,severe symptoms[rash/dry skin(P=0.031),facial swelling/angioedema(P=0.003),failure to thrive(P=0.013),apparent life-threatening event(P<0.001)],and positive physical findings(P=0.002)than non-IgE-mediated *** patients were exclusively fed cow milk formula(50.3%).The amino acid-based formula(AAF)was most prescribed(60.5%)with no difference between the two types(P=0.173).Although breastfeeding was recommended to 49.6%,only 8.2%were exclusively ***-mediated CMPA was associated with a longer follow-up duration than non-IgE-mediated CMPA(17.3 months±14.0 mo

关键词： Children Milk allergy Immunoglobulin E Breastfeeding Infant formula Bahrain

Diet fortification for mild and moderate picky eating in typically developed children:Opinion review of Middle East consensus

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World Journal of Clinical pediatrics 2025年第1期14卷 139-148页

作者： Mohammed Al-Beltagi Elie Choueiry Najat Alahmadi Zeinab Demerdash Wafaa Helmi Ayesh Khoula Al-Said Fatima Al-Haddad Sanaa Y Shaaban Eslam Tawfik department of Pediatric Faculty of MedicineTanta UniversityTanta 31511Egypt department of Pediatric University Medical CenterKing Abdulla Medical CityArabian Gulf UniversityManama 26671ManamaBahrain Paediatric Intensive and Critical Care Unit Hospital Hôtel Dieu de FranceBeirut 166830BeyrouthLebanon department of Pediatric gastroenterology Hepatology and NutritionMadina Maternity and Children HospitalKing Salman Medical CityAlmadina Almonawarh 41412Almadina AlmonawarhSaudi Arabia department of gastroenterology Hepatology and NutritionAl Amiri HospitalKuwait City 999044Kuwait department of Nutrition Altadawi Speciality HospitalDubai 1853DubayyUnited Arab Emirates department of Paediatric gastroenterology Royal HospitalMuscat 1331MuscatOman department of Dietetic Salmaniya Medical ComplexGovernment HospitalsAl Salmaniya 12ManamaBahrain department of pediatrics Faculty of MedicineAin Shams UniversityCairo 11591Egypt department of Paediatric Faculty of MedicineSuez UniversitySuez 41522Egypt department of Paediatric Sheikh Khalifa Medical CityAbu Dhabi 00000Abu DhabiUnited Arab Emirates

BACKGROUND Picky eating is a commonly observed behavior among children globally,negatively impacting their physical and mental *** common characteristics distinguish peaky eaters,including food selectivity,food neophobia,and food avoidance,there is no clear definition to assess this *** to the unavailability of data regarding picky eating,it wasn’t easy to estimate its *** To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating *** A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky *** discussion covered different topics,including clearly defining mild and moderate picky eating,identifying the role of diet fortification in these cases,and the possibility of developing a systematic approach to diet *** The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar *** of the time,moderate picky eating cases had micronutrient deficiencies with over-or undernutrition;the mild cases only showed inadequate food consumption and/or poor diet *** attention to the organic red flags like growth faltering and development delay and behavioral red flags,including food fixation and anticipatory gagging,will help healthcare professionals evaluate the picky eaters and the caregivers to care for their *** dietary supplementation and commercial food fortification play an important role in picky eating,they were no benefit in the Middle *** The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern *** recommendations would facilitate identifying and managing picky-eating children in the Middle East.

关键词： Picky eating Diet fortification Children Protocol Roundtable discussion Middle East

Proton pump inhibitors and all-cause mortality risk among cancer patients

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World Journal of Clinical Oncology 2025年第1期16卷 34-42页

作者： Arunkumar Krishnan Carolin Victoria Schneider Declan Walsh department of Supportive Oncology Atrium Health Levine CancerCharlotteNC 28204United States department of Medicine Section of Hematology and OncologyWake Forest University School of MedicineWinston-SalemNC 27101United States department of Medicine Ⅲ GastroenterologyMetabolic Diseasesand Intensive CareUniversity Hospital RWTH AachenAachen 52074Germany

BACKGROUND Proton pump inhibitors(PPIs)are widely used,including among cancer patients,to manage gastroesophageal reflux and other gastric acid-related *** evidence suggests associations between long-term PPI use and higher risks for various adverse health outcomes,including greater *** To investigate the association between PPI use and all-cause mortality among cancer patients by a comprehensive analysis after adjustment for various confounders and a robust methodological approach to minimize *** This retrospective cohort study used data from the TriNetX research network,with electronic health records from multiple healthcare *** study employed a new-user,active comparator design,which compared newly treated PPI users with non-users and newly treated histamine2 receptor antagonists(H2RA)users among adult cancer *** prescribed PPIs(esomeprazole,lansoprazole,omeprazole,pantoprazole,or rabeprazole)users were compared to non-users or newly prescribed H2RAs(cimetidine,famotidine,nizatidine,or ranitidine)*** primary outcome was all-cause *** patient in the main group was matched to a patient in the control group using 1:1 propensity score matching to reduce confounding *** Cox regression models were used to estimate hazard ratios(HRs)and 95% confidence interval(CI).RESULTS During the follow-up period(median 5.4±1.8 years for PPI users and 6.5±1.0 years for non-users),PPI users demonstrated a higher all-cause mortality rate than non-users after 1 year,2 years,and at the end of follow up(HRs:2.34-2.72).Compared with H2RA users,PPI users demonstrated a higher rate of all-cause mortality HR:1.51(95%CI:1.41-1.69).Similar results were observed across sensitivity analyses by excluding deaths from the first 9 months and 1-year post-exposure,confirming the robustness of these *** a sensitivity analysis,we analyzed all-cause mortality outcomes between former PPI users and individual

关键词： All-cause mortality Cancer Histamine-2 receptor antagonists Mortality Malignancy Proton pump inhibitors Carcinoma Outcome

Calcium-sensing receptor: A new target for therapy of diarrhea

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World Journal of gastroenterology 2016年第9期22卷 2711-2724页

作者： Sam Xianjun Cheng department of pediatrics Gastroenterology Hepatology and Nutrition University of Florida

Management of acute diarrhea remains a global challenge, particularly in resource-limiting countries. Oral rehydration solution (ORS), a passive rehydrating therapy developed approximately 40 years ago, remains the mainstay treatment. Although ORS is effective for hydration, since it does not inhibit enterotoxin-mediated excessive secretion, reduced absorption and compromised barrier function - the primary mechanisms of diarrhea, ORS does not offer a rapid relief of diarrhea symptom. There are a few alternative therapies available, yet the use of these drugs is limited by their expense, lack of availability and/or safety concerns. Novel anti-diarrheal therapeutic approaches, particularly those simple affordable therapies, are needed. This article explores intestinal calcium-sensing receptor (CaSR), a newly uncovered target for therapy of diarrhea. Unlike others, targeting this host antidiarrheal receptor system appears “all-inclusive”: it is anti-secretory, pro-absorptive, anti-motility, and anti-inflammatory. Thus, activating CaSR reverses changes of both secretory and inflammatory diarrheas. Considering its unique property of using simple nutrients such as calcium, polyamines, and certain amino acids/oligopeptides as activators, it is possible that through targeting of CaSR with a combination of specific nutrients, novel oral rehydrating solutions that are inexpensive and practical to use in all countries may be developed.

关键词： Secretory diarrhea Inflammatory diarrhea Oral rehydration solution Anti-secretory Pro-absorptive Intestinal permeability Intestinal barrier function Enteric nervous system Cholera toxin Escherichia coli heat stable toxin

Reduction in duodenal endocrine cells in irritable bowel syndrome is associated with stem cell abnormalities

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World Journal of gastroenterology 2015年第32期21卷 9577-9587页

作者： Magdy El-Salhy Jan Gunnar Hatlebakk Trygve Hausken section for Neuroendocrine gastroenterology Division of Gastroenterology Department of Clinical Medicine University of Bergen National Centre for Functional Gastrointestinal Disorders Department of Medicine Haukeland University Hospital section for gastroenterology Department of Medicine Stord Hospital

AIM: To determine whether the decreased density of duodenal endocrine cells in irritable bowel syndrome(IBS) is associated with abnormalities in stem cell ***: The study sample comprised 203 patients with IBS(180 females and 23 males with a mean age of 36 years) and a control group of 86 healthy subjects without gastrointestinal complaints(77 females and 9 males with a mean age of 38 years). The patients included 80 with mostly diarrhoea(IBS-D), 47 with both diarrhoea and constipation(IBS-M), and 76 with mostly constipation(IBS-C). Both the patients and controls underwent gastroscopy and four biopsy samples were taken from the descending part of the duodenum, proximal to the papilla of Vater. The biopsy samples were sectioned and immunostained for Musashi 1(Msi-1), neurogenin 3(NEUROG3), secretin, cholecystokinin(CCK), gastric inhibitory peptide(GIP), somatostatin and serotonin. Immunostainingwas performed with an ultra View Universal DAB Detection Kit(v1.02.0018, Venata Medical Systems, Basal, Switzerl and) using the Bench Mark Ult ra immunohistochemistry/in situ hybridization staining module(Venata Medical Systems). Endocrine cell densities were quantified by computerized image analysis using the Olympus cell Sens imaging ***: The densities of Msi-1 and NEUROG3 cells were significantly lower in IBS patients, regardless of the subtype, than in the controls(77 ± 17 vs 8 ± 2; P = 0.0001, and 351 ± 33 vs 103 ± 22; P = 0.00002, respectively). Furthermore, the densities of secretin, and CCK cells were significantly lower in patients with diarrhoea as the predominant IBS symptom(IBS-D) than in the controls(161 ± 11 vs 88 ± 8; P = 0.00007, and 325 ± 41 vs 118 ± 10; P = 0.00006, respectively), but not in patients with constipation as the predominant IBS symptom(IBS-C) or those with both diarrhoea and constipation(IBS-M). The GIP cell density was significantly reduced in both IBS-D(152 ± 12 vs 82 ± 7; P = 0.00003), and IBS-C(152 ± 12 vs 107 ±

关键词： Cholecystokinin Irritable bowel syndrome Musashi-1

Optimizing proton pump inhibitors in Helicobacter pylori treatment:Old and new tricks to improve effectiveness

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World Journal of gastroenterology 2019年第34期25卷 5097-5104页

作者： Enzo Ierardi Giuseppe Losurdo Rosa Federica La Fortezza Mariabeatrice Principi Michele Barone Alfredo Di Leo section of gastroenterology Department of Emergency and Organ Transplantation University of Bari

The survival and replication cycle of Helicobacter pylori(***)is strictly dependant on intragastric pH,since *** enters replicative phase at an almost neutral pH(6-7),while at acid pH(3-6)it turns into its coccoid form,which is resistant to *** these bases,it is crucial to increase intragastric pH by proton pump inhibitors(PPIs)when an antibiotic-based eradicating therapy needs to be ***,several tricks need to be used to optimize eradication rate of different *** administration of the highest dose as possible of PPI,by doubling or increasing the number of pills/day,has shown to be able to improve therapeutic outcome and has often proposed in rescue therapies,even if specific trials have not been performed.A pre-treatment with PPI before starting antibiotics does not seem to be effective,therefore it is ***,the choice of PPI molecule could have a certain weight,since second-generation substances(esomeprazole,rabeprazole)are likely more effective than those of first generation(omeprazole,lansoprazole).A possible explanation is due to their metabolism,which has been proven to be less dependent on cytochrome P450(CYP)2C19 genetic ***,vonoprazan,a competitive inhibitor of H+/K+-ATPase present on luminal membrane of gastric parietal cells has shown the highest efficacy,due to both its highest acid inhibition power and rapid pharmacologic *** current data come only from Eastern Asia,therefore its strong power needs to be confirmed outside this geographic area in Western countries as well as related to the local different antibiotic resistance rates.

关键词： Helicobacter pylori Proton pump inhibitors Eradication Cytochrome P450 Optimization

Noninvasive molecular analysis of Helicobacter pylori : Is it time for tailored first-line therapy?

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World Journal of gastroenterology 2017年第14期23卷 2453-2458页

作者： Enzo Ierardi Floriana Giorgio Andrea Iannone Giuseppe Losurdo Mariabeatrice Principi Michele Barone Antonio Pisani Alfredo Di Leo gastroenterology section Department of Emergency and Organ Transplantation University of Bari

The main problem of Helicobacter pylori(H. pylori) infection management is linked to antibiotic resistances. This phenomenon has grown in the last decade, inducing a dramatic decline in conventional regimen effectiveness. The causes of resistance are point mutations in bacterial DNA, which interfere with antibiotic mechanism of action, especially clarithromycin and levofloxacin. Therefore, international guidelines have recently discouraged their use in areas with a relevant resistance percentage, suggesting first-line schedules with expected high eradication rates, i.e., bismuth containing or non-bismuth quadruple therapies. These regimens require the daily assumption of a large number of tablets. Consequently, a complete adherence is expected only in subjects who may be motivated by the presence of major disorders. However, an incomplete adherence to antibiotic therapies may lead to resistance onset, since sub-inhibitory concentrations could stimulate the selection of resistant mutants. Of note, a recent meta-analysis suggests that susceptibility tests may be more useful for the choice of first than second-line or rescue treatment. Additionally, susceptibility guided therapy has been demonstrated to be highly effective and superior to empiric treatments by both meta-analyses and recent clinical studies. Conventional susceptibility test is represented by culture and antibiogram. However, the method is not available everywhere mainly for methodology-related factors and fails to detect hetero-resistances. Polymerase chain reaction(PCR)-based, culture-free techniques on gastric biopsy samples are accurate in finding even minimal traces of genotypic resistant strains and hetero-resistant status by the identification of specific point mutations. The need for an invasive endoscopic procedure has been the most important limit to their spread. A further step has, moreover, been the detection of point mutations in bacterial DNA fecal samples. Few studies on clarithromycin su

关键词： Helicobacter pylori Antibiotic resistance Noninvasive molecular test Tailored therapy Stool