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A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases

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World Journal of Gastroenterology 2009年第37期15卷 4638-4643页

作者： Fernando Bermejo Santiago García-López digestive Service University Hospital of Fuenlabrada Fuenlabrada Madrid 28942 Spain digestive Service University Hospital Miguel Servet Zaragoza 50009 Spain

Iron deficiency (ID), with or without anemia, is often caused by digestive diseases and should always be investigated, except in very specific situations, as its causes could be serious diseases, such as cancer. Diagnosis of ID is not always easy. Low serum levels of ferritin or transferrin saturation, imply a situation of absolute or functional ID. It is sometimes difficult to differentiate ID anemia from anemia of chronic diseases, which can coexist. In this case, other parameters, such as soluble transferrin receptor activity can be very useful. After an initial evaluation by clinical history, urine analysis, and serological tests for celiac disease, gastroscopy and colonoscopy are the key diagnostic tools for investigating the origin of ID, and will detect the most important and prevalent diseases. If both tests are normal and anemia is not severe, treatment with oral iron can be indicated, along with stopping any treatment with non-steroidal anti-inflammatory drugs. In the absence of response to oral iron, or if the anemia is severe or clinical suspicion of important disease persists, we must insist on diagnostic evaluation. Repeat endoscopic studies should be considered in many cases and if both still show normal results, investigating the small bowel must be considered. The main techniques in this case are capsule endoscopy, followed by enteroscopy.

关键词：消化系统疾病缺铁性贫血诊断工具缺铁症转铁蛋白受体血清学检查非甾体抗炎药身份证

Present and future of new systemic therapies for early and intermediate stages of hepatocellular carcinoma

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World Journal of Gastroenterology 2024年第19期30卷 2512-2522页

作者： Juan Jose Urquijo-Ponce Carlos Alventosa-Mateu Mercedes Latorre-Sánchez Inmaculada Castelló-Miralles Moisés Diago Hepatology Unit Department of digestive diseases Consorcio Hospital General Universitario of ValenciaValencia 46014Spain

Hepatocellular carcinoma(HCC)is a high mortality neoplasm which usually appears on a cirrhotic *** therapeutic arsenal and subsequent prognostic outlook are intrinsically linked to the HCC stage at *** the current deployment of treatments with curative intent(liver resection/local ablation and liver transplantation)in early and intermediate stages,a high rate of HCC recurrence persists,underscoring a pivotal clinical *** systemic therapies(ST),particularly immunotherapy,have demonstrate promising outcomes in terms of increase overall survival,but they are currently bound to the advanced stage of *** review provides a comprehensive analysis of the literature,encompassing studies up to March 10,2024,evaluating the impact of novel ST in the early and intermediate HCC stages,specially focusing on the findings of neoadjuvant and adjuvant regimens,aimed at increasing significantly overall survival and recurrence-free survival after a treatment with curative *** also investigate the potential role of ST in enhancing the downstaging rate for the intermediate-stage HCC initially deemed ineligible for treatment with curative ***,we critically discuss about the current relevance of the results of these studies and the encouraging future implications of ST in the treatment schedules of early and intermediate HCC stages.

关键词： Hepatocellular carcinoma Early stage Intermediate stage Neoadjuvant Adjuvant Systemic therapy

Blood transfusion for the treatment of acute anaemia in inflammatory bowel disease and other digestive diseases

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World Journal of Gastroenterology 2009年第37期15卷 4686-4694页

作者： José Antonio García-Erce Fernando Gomollón Manuel Muoz Transfusion Medicine and Apheresis Unit Haematology and Haemotherapy Regional Service "Miguel Servet" University Hospital Zaragoza 50009 Spain Gastroenterology Unit University Clinical Hospital and Biomedical Investigation Center at Digestive and Hepatic Disease Network c/San Juan Bosco 15 Zaragoza 50009 Spain Transfusion Medicine School of Medicine University of Málaga Málaga 29071 Spain

Allogeneic blood transfusion (ABT) is frequently used as the first therapeutic option for the treatment of acute anaemia in patients with inflammatory bowel disease (IBD), especially when it developed due to gastrointestinal or perioperative blood loss, but is not risk-free. Adverse effects of ABT include, but are not limited to, acute hemolytic reaction (wrong blood or wrong patient), febrile non-hemolytic transfusional reaction, bacterial contamination, transfusion-related acute lung injury, transfusion associated circulatory overload, transfusion-related immuno-modulation, and transmission of almost all infectious diseases (bacteria, virus, protozoa and prion), which might result in increased risk of morbidity and mortality. Unfortunately, the main physiological goal of ABT, i.e. to increase oxygen consumption by the hypoxic tissues, has not been well documented. In contrast, the ABT is usually misused only to increase the haemoglobin level within a f ixed protocol [mostly two by two packed red blood cell (PRC) units] independently of the patient' s tolerance to normovolemic anaemia or his clinical response to the transfusion of PRC units according to a "one-by-one" administration schedule. Evidencebased clinical guidelines may promote best transfusion practices by implementing restrictive transfusion protocols, thus reducing variability and minimizing the avoidable risks of transfusion, and the use of autologous blood and pharmacologic alternatives. In this regard, preoperative autologous blood donation (PABD) consistently diminished the frequency of ABT, although its contribution to ABT avoidance is reduced when performed under a transfusion protocol. In addition, interpretation of utility of PABD in surgical IBD patients is hampered by scarcity of published data. However, the role of autologous red blood cells as drug carriers is promising. Finally, it must be stressed that a combination of methods used within wellconstructed protocols will offer better prospe

关键词：肠疾病临床煽动性 ABT

Radiation injury and gut microbiota-based treatment

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Protein & Cell 2024年第2期15卷 83-97页

作者： Weihong Wang Bota Cui Yongzhan Nie Lijuan Sun Faming Zhang Department of Microbiota Medicine and Medical Center for digestive diseases The Second Affiliated Hospital of Nanjing Medical UniversityNanjing210011China Department of Microbiotherapy Sir Run Run HospitalNanjing Medical UniversityNanjing 211166China State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for digestive diseases Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi'an 710032China National Clinical Research Center for digestive diseases Xi'an 710032China Key Laboratory of Resource Biology and Biotechnology in Western China Ministry of EducationSchool of MedicineNorthwest UniversityXi'an 710069China

The exposure to either medical sources or accidental radiation can cause varying degrees of radiation injury(RI).RI is a common disease involving multiple human body parts and organs,yet effective treatments are currently *** evidence suggests gut microbiota are closely associated with the development and prevention of various *** article summarizes 10 common types of RI and their possible *** also highlights the changes and potential microbiota-based treatments for RI,including probiotics,metabolites,and microbiota ***,a 5P-Framework is proposed to provide a comprehensive strategy for managing RI.

关键词： microbiome ionizing radiation radiation-induced injury short-chain fatty acids fecal microbiota transplant washed microbiota transplantation war nuclear microbiota medicine

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Progress in clinical diagnosis and treatment of colorectal cancer with rare genetic variants

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Cancer Biology & Medicine 2024年第6期21卷 473-483页

作者： Shuyi Chen Jing Gu Kaichun Wu Xiaodi Zhao Yuanyuan Lu State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers and National Clinical Research Center for digestive diseases Xijing Hospital of Digestive DiseasesFourth Military Medical UniversityXi’an 710032China School of Basic Medical Sciences Fourth Military Medical UniversityXi’an 710032China

Targeted therapy is crucial for advanced colorectal cancer(CRC) positive for genetic drivers. With advances in deep sequencing technology and new targeted drugs, existing standard molecular pathological detection systems and therapeutic strategies can no longer meet the requirements for careful management of patients with advanced CRC. Thus, rare genetic variations require diagnosis and targeted therapy in clinical practice. Rare gene mutations, amplifications, and rearrangements are usually associated with poor prognosis and poor response to conventional therapy. This review summarizes the clinical diagnosis and treatment of rare genetic variations, in genes including erb-b2 receptor tyrosine kinase 2(ERBB2), B-Raf proto-oncogene, serine/threonine kinase(BRAF), ALK receptor tyrosine kinase/ROS proto-oncogene 1, receptor tyrosine kinase(ALK/ROS1), neurotrophic receptor tyrosine kinases(NTRKs), ret proto-oncogene(RET), fibroblast growth factor receptor 2(FGFR2), and epidermal growth factor receptor(EGFR), to enhance understanding and identify more accurate personalized treatments for patients with rare genetic variations.

关键词： Genetic variation gene mutation gene amplification gene rearrangement targeted therapy

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Expression and significance of pigment epithelium-derived factor and vascular endothelial growth factor in colorectal adenoma and cancer

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 670-686页

作者： Ye Yang Wu Wen Feng-Lin Chen Ying-Jie Zhang Xiao-Cong Liu Xiao-Yan Yang Shan-Shan Hu Ye Jiang Jing Yuan digestive diseases Chengdu Qingbaijiang District People's HospitalChengdu 610300Sichuan ProvinceChina digestive diseases Chengdu Second People’s HospitalChengdu 610000Sichuan ProvinceChina Graduate School Chengdu Medical CollegeChengdu 610000Sichuan ProvinceChina

BACKGROUND The incidence and mortality of colorectal cancer(CRC)are among the highest in the world,and its occurrence and development are closely related to tumor *** the balance between pigment epithelium-derived factors(PEDF)that inhibit angiogenesis and vascular endothelial growth factors(VEGF)that stimulate angiogenesis is broken,angiogenesis is out of control,resulting in tumor ***,it is very necessary to find more therapeutic targets for CRC for early intervention and later *** To investigate the expression and significance of PEDF,VEGF,and CD31-stained microvessel density values(CD31-MVD)in normal colorectal mucosa,adenoma,and *** In this case-control study,we collected archived wax blocks of specimens from the digestive Endoscopy Center and the General Surgery Department of Chengdu Second People's Hospital from April 2022 to October *** cases of specimen wax blocks were selected as normal intestinal mucosa confirmed by electronic colonoscopy and concurrent biopsy(normal control group),50 cases of specimen wax blocks were selected as colorectal adenoma confirmed by electronic colonoscopy and pathological biopsy(adenoma group),and 50 cases of specimen wax blocks were selected as CRC confirmed by postoperative pathological biopsy after inpatient operation of general surgery(CRC group).An immunohistochemical staining experiment was carried out to detect PEDF and VEGF expression in three groups of specimens,analyze their differences,study the relationship between the two and clinicopathological factors in CRC group,record CD31-MVD in the three groups,and analyze the correlation of PEDF,VEGF,and CD31-MVD in the colorectal adenoma group and the CRC *** F test or adjusted F test is used to analyze measurement data ***-Wallis rank sum test was used between groups for ranked *** chi-square test,adjusted chi-square test,or Fisher's exact test were used to compare the rates betwe

关键词： Pigment epithelium-derived factors Vascular endothelial growth factor Microvessel density Colorectal adenoma Colorectal cancer Targeted therapy

Association between physical activity and risk of gastroesophageal reflux disease:A systematic review and meta-analysis

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Journal of Sport and Health Science 2024年第5期13卷 687-698页

作者： Chuting Yu Tinglu Wang Ye Gao Yunfei Jiao Huishan Jiang Yan Bian Wei Wang Han Lin Lei Xin Luowei Wang Department of Gastroenterology Changhai HospitalNaval Medical UniversityShanghai 200433China National Clinical Research Center for digestive diseases(Shanghai) Shanghai 200433China

Background:Lifestyle plays an important role in preventing and managing gastroesophageal reflux disease(GERD).In response to the conflicting results in previous studies,we performed a systematic review and meta-analysis to investigate this ***:Relevant studies published until January 2023 were retrieved from 6 databases,and the prevalence of symptomatic gastroesophageal reflux(GER)or GERD was determined from the original studies.A random effects model was employed to meta-analyze the association by computing the pooled relative risk(RR)with 95%confidence intervals(95%CIs).Furthermore,subgroup and dose-response analyses were performed to explore subgroup differences and the association between cumulative physical activity(PA)time and ***:This meta-analysis included 33 studies comprising 242,850 participants.A significant negative association was observed between PA and the prevalence of symptomatic GER(RR=0.74,95%CI:0.66-0.83;p<0.01)or GERD(RR=0.80,95%CI:0.76-0.84;p<0.01),suggesting that engaging in PA might confer a protective benefit against *** analyses consistently indicated the presence of this association across nearly all subgroups,particularly among the older individuals(RR_(<40 years):RR_(≥40 years)=0.85:0.69,p<0.01)and smokers(RR_(smoker):RR_(non-smoker)=0.67:0.82,p=0.03).Furthermore,a dose-response analysis revealed that individuals who engaged in 150 min of PA per week had a 72.09%lower risk of developing ***:Maintaining high levels of PA decreased the risk of GERD,particularly among older adults and *** the recommended PA level of 150 min per week may significantly decrease the prevalence of GERD.

关键词： Physical activity Gastroesophageal reflux disease Prevalence Systematic review

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RNA modifications in the progression of liver diseases: from fatty liver to cancer

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Science China Life Sciences 2024年

作者： Simiao Li Wajahat Z Mehal Xinshou Ouyang Yale University School of Medicine Section of digestive diseases Department of Internal Medicine

Non-alcoholic fatty liver disease (NAFLD) has emerged as a prominent global health concern associated with high risk of metabolic syndrome, and has impacted a substantial segment of the population. The disease spectrum ranges from simple fatty liver to non-alcoholic steatohepatitis (NASH), which can progress to cirrhosis and hepatocellular carcinoma (HCC) and is increasingly becoming a prevalent indication for liver transplantation. The existing therapeutic options for NAFLD, NASH, and HCC are limited, underscoring the urgent need for innovative treatment strategies. Insights into gene expression, particularly RNA modifications such as N6methyladenosine (m6A), hold promising avenues for interventions. These modifications play integral roles in RNA metabolism and cellular functions, encompassing the entire NAFLD-NASH-HCC progression. This review will encompass recent insights on diverse RNA modifications, including m6A, pseudouridine (Ψ), N1-methyladenosine (m1A), and 5-methylcytidine (m5C) across various RNA species. It will uncover their significance in crucial aspects such as steatosis, inflammation, fibrosis, and tumorigenesis. Furthermore, prospective research directions and therapeutic implications will be explored, advancing our comprehensive understanding of the intricate interconnected nature of these pathological conditions.

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Role of endoscopic-ultrasound-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent for palliation of malignant biliary obstruction

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 1981-1985页

作者： Smit S Deliwala Emad Qayed Department of Medicine Division of Digestive DiseasesEmory University School of MedicineAtlantaGA 30303United States

In this editorial,we discuss the article by Peng et al in the recent issue of the World Journal of Gastrointestinal Surgery,focusing on the evolving role of endoscopicultrasound-guided biliary drainage(EUS-BD)with electrocautery lumen apposing metal stent(LAMS)for distal malignant biliary *** endoscopy has rapidly advanced in decompression techniques,with growing evidence of its safety and efficacy surpassing percutaneous and surgical *** endoscopic retrograde cholangiopancreatography(ERCP)has been the gold standard for biliary decompression,its failure rate approaches 10.0%,prompting the exploration of alternatives like *** random-effects meta-analysis demonstrated high technical and clinical success of over 90.0% and an adverse event rate of 17.5%,mainly in the form of stent *** based on stent size were not reported but the majority used 6 mm and 8 mm *** the body of literature continues to demonstrate the effectiveness of this technique,the challenges of stent dysfunction need to be addressed in future *** strategy that has shown promise is placement of double-pigtail stents,only 18% received the prophylactic intervention in this *** expect this to improve with time as the technique continues to be refined and *** results above establish EUS-BD with LAMS as a reliable alternative after failed ERCP and considering EUS to ERCP upfront in the same session is an effective *** the promising results,studies must explore the role of EUS-BD as first-line therapy for biliary decompression.

关键词： Endoscopic-ultrasound Malignant biliary obstruction Lumen apposing metal stent Choledochoduodenostomy Hepaticogastrostomy