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Artificial intelligence in gastroenterology:Ethical and diagnostic challenges in clinical practice

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World Journal of gastroenterology 2025年第10期31卷 144-150页

作者： Davide Ramoni Alessandro Scuricini Federico Carbone Luca Liberale Fabrizio Montecucco Department of internal medicine University of GenoaGenoa 16132Italy First Clinic of internal medicine Department of Internal MedicineItalian Cardiovascular NetworkIRCCS Ospedale Policlinico San MartinoGenoa 16132Italy

This article discusses the manuscript recently published in the World Journal of gastroenterology,which explores the application of deep learning models in decision-making processes via wireless capsule *** artificial intelligence(AI)into gastrointestinal disease diagnosis represents a transformative step toward precision medicine,enhancing real-time accuracy in detecting multi-category lesions at earlier stages,including small bowel lesions and precancerous polyps,ultimately improving patient ***,the use of AI in clinical settings raises ethical considerations that extend beyond technological *** of patient privacy,data security,and potential diagnostic biases require careful *** models must prioritize diverse and representative datasets to mitigate inequities and ensure diagnostic accuracy across ***,balancing AI with clinical expertise is crucial,positioning AI as a supportive tool rather than a replacement for physician *** these ethical challenges will support the responsible deployment of AI,through equitable contribution to patient-centered care.

关键词： Artificial intelligence Endoscopy Ethical implication Gastrointestinal disease Machine learning Omics Precision medicine Wireless capsule endoscopy

Capsule endoscopy:Do we still need it after 24 years of clinical use?

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World Journal of gastroenterology 2025年第5期31卷 140-147页

作者： Ahmed Tawheed Alaa Ismail Mohab S Amer Osama Elnahas Tawhid Mowafy Department of Endemic medicine Faculty of MedicineHelwan UniversityCairo 11795Egypt Faculty of medicine Helwan UniversityCairo 11795Egypt Department of Research SMART Company for Research ServicesCairo 11795Egypt Department of internal medicine Gardenia Medical CenterDoha 0000Qatar

In this letter,we comment on a recent article published in the World Journal of gastroenterology by Xiao et al,where the authors aimed to use a deep learning model to automatically detect gastrointestinal lesions during capsule endoscopy(CE).CE was first presented in 2000 and was approved by the Food and Drug Administration in *** indications of CE overlap with those of regular diagnostic ***,in clinical practice,CE is usually used to detect lesions in areas inaccessible to standard endoscopies or in cases of bleeding that might be missed during conventional *** the emergence of CE,many physiological and technical challenges have been faced and *** this letter,we summarize the current challenges and briefly mention the proposed methods to overcome these challenges to answer a central question:Do we still need CE?

关键词： Capsule endoscopy Wireless capsule endoscopy Obscure gastrointestinal bleeding Artificial intelligence in gastroenterology Therapeutic capsule endoscopy

Elafibranor:A promising therapeutic approach for liver fibrosis and gut barrier dysfunction in alcohol-associated liver disease

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World Journal of gastroenterology 2025年第3期31卷 123-126页

作者： Chun-Han Cheng Wen-Rui Hao Tzu-Hurng Cheng Department of Medical Education Linkou Chang Gung Memorial HospitalTaoyuan 33305TaiwanChina Division of Cardiology Department of Internal MedicineShuang Ho HospitalMinistry of Health and WelfareTaipei Medical UniversityNew Taipei City 23561TaiwanChina Division of Cardiology Department of Internal MedicineSchool of MedicineCollege of MedicineTaipei Medical UniversityTaipei 11002TaiwanChina Department of Biochemistry School of MedicineCollege of MedicineChina Medical UniversityTaichung 404328TaiwanChina

This article discusses the recent study written by Koizumi et ***-associated liver disease(ALD)is a major cause of liver-related morbidity and mortality,which is driven by complex mechanisms,including lipid accumulation,apoptosis,and inflammatory responses exacerbated by gut barrier *** study explored the therapeutic potential of elafibranor,a dual peroxisome proliferatoractivated receptor alpha/delta *** clinical trials,elafibranor has shown promise for the treatment of other liver conditions;however,its effects on ALD remain *** authors’findings indicate that elafibranor significantly reduced liver fibrosis and enhanced gut barrier integrity in patients with *** positive effects of elafibranor are mediated through multiple *** promotes lipid metabolism,reduces oxidative stress,and inhibits inflammatory responses by restoring gut barrier ***,it improves hepatocyte function by enhancing autophagic and antioxidant capacity,and it mitigates inflammation by suppressing the lipopolysaccharide/toll-like receptor 4/nuclear factor kappa B signaling *** findings indicate that elafibranor has promising clinical *** addition,the study highlights elafibranor’s potential as a therapeutic agent for liver diseases,particularly *** article underscores the importance of understanding the mechanistic pathways underlying ALD and suggests directions for future research aimed at elucidating the benefits and limitations of elafibranor.

关键词： Elafibranor Liver fibrosis Gut barrier function Alcohol-associated liver disease Peroxisome proliferatoractivated receptor agonists

Effect of brush rinse on the diagnostic accuracy of biliary stricture evaluation:A multicenter trial

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World Journal of Clinical Cases 2025年第15期13卷 7-15页

作者： Hoonsub So Sung Ill Jang Sung Woo Ko Seung Bae Yoon Young Sub Lee SungJo Bang Misung Kim Hye-Jeong Choi Department of internal medicine Ulsan University HospitalUniversity of Ulsan College of MedicineUlsan 44033South Korea Department of internal medicine Institute of GastroenterologyGangnam Severance HospitalYonsei University College of MedicineSeoul 06273South Korea Department of internal medicine Eunpyeong St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 03312South Korea Department of Hospital Pathology Eunpyeong St.Mary's HospitalCollege of MedicineThe Catholic University of KoreaSeoul 03312South Korea Department of Pathology Ulsan University HospitalUniversity of Ulsan College of MedicineUlsan 44033South Korea

BACKGROUND Brush cytology is the most commonly used technique for tissue acquisition during endoscopic retrograde cholangiopancreatography for the evaluation of biliary ***,brush cytology is limited by its low sensitivity due to insufficient cellular *** To evaluate the impact of the sheath-rinse technique on improving the cellularity *** A total of 112 patients with suspected malignant biliary strictures were enrolled at two tertiary centers in South *** sample cellularity and diagnostic accuracy of brush-wash and sheath-rinse specimens were *** A significantly increased number of total cell clusters per representative 20×field was recorded in the sheath-rinse compared with the brush-wash specimens(median:12 vs 3,P50 cells)clusters(median:8 vs 3,P<0.001),medium(6-49 cells)(median:7 vs 3,P<0.001),and small(2-5 cells)clusters(median:9 vs 3,P<0.001)were *** accuracy and sensitivity for differentiating malignancy were superior with sheath-rinsing than with the brush-wash method(72.3%vs 62.5%,P<0.001 and 69.9%vs 59.2%,P<0.001,respectively).CONCLUSION Incorporating sheath-rinse specimens significantly improved the yield and diagnostic accuracy of biliary brush ***-rinsing should be integrated into routine clinical practice to improve diagnostic performance for biliary strictures.

关键词： Endoscopic retrograde cholangiopancreatography Cytopathology Diagnostic yield Biliary stricture Sheath-rinsing

Gut virome:New key players in the pathogenesis of inflammatory bowel disease

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World Journal of Methodology 2025年第2期15卷 27-43页

作者： Helal F Hetta Rehab Ahmed Yasmin N Ramadan Hayam Fathy Mohammed Khorshid Mohamed M Mabrouk Mai Hashem Department of Medical Microbiology and Immunology Faculty of MedicineAssiut UniversityAssiut 71515Egypt Division of Microbiology Immunology and BiotechnologyFaculty of pharmacyUniversity of TabukTabuk 71491Saudi Arabia Division of Microbiology Immunology and BiotechnologyDepartment of Natural Products and Alternative MedicineFaculty of PharmacyUniversity of TabukTabuk 71491Saudi Arabia Department of internal medicine Division HepatogastroenterologyAssiut UniversityAssiut 71515Egypt Department of Clinical Research Egyptian Developers of Gastroenterology and Endoscopy FoundationCairo 11936Egypt Department of internal medicine Faculty of Medicine.Tanta UniversityTanta 31527Egypt Department of Tropical medicine Gastroenterology and HepatologyAssiut University HospitalAssiut 71515Egypt

Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the *** the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immunological response,environmental exposure,particularly the gut microbiota,and genetic suscept-ibility represents the major *** gut virome is a group of viruses found in great frequency in the gastrointestinal tract of *** gut virome varies greatly among individuals and is influenced by factors including lifestyle,diet,health and disease conditions,geography,and *** majority of research has focused on the significance of gut bacteria in the progression of IBD,although viral populations represent an important component of the *** conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.

关键词： Inflammatory bowel disease Pathogenesis Gut virome Bacteriophage Eukaryotic viruses

Relationship between gastric mucosal atrophy by endoscopy and non-ampullary duodenal epithelial tumors

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World Journal of Gastrointestinal Oncology 2025年第2期17卷 84-92页

作者： Kazuya Ohno Eiji Nakatani Takafumi Kurokami Asami Kawai Ryosuke Itai Masanori Matsuda Yuichi Masui Tatsunori Satoh Shinya Ikeda Taiyo Hirata Shodai Takeda Makoto Suzuki Ken Haruma Department of gastroenterology Shizuoka General HospitalShizuoka 420-8527Japan Research Support Center Graduate School of Public HealthShizuoka Graduate University of Public HealthShizuoka 420-0881Japan Department of Pathology Shizuoka General HospitalShizuoka 420-8527Japan Department of General internal medicine 2 Kawasaki Medical SchoolOkayama 700-8505Japan

BACKGROUND The pathogenesis of non-ampullary duodenal epithelial tumors(NADETs)is not fully *** that express gastric-type mucin phenotypes(GNADETs)are noteworthy because of their high *** foveolar metaplasia,from which G-NADETs originate,protects the duodenal mucosa from gastric *** gastric acid secretion is affected by endoscopic gastric mucosal atrophy(EGMA),we hypothesized that EGMA would be associated with *** To evaluate the association between EGMA and the occurrence of *** This cross-sectional retrospective study investigated the relationship between EGMA and NADETs in 134 *** duodenum was divided into parts 1(bulb),2(superior duodenal angle to the papilla),and 3(anal side of the papilla to the horizontal part).The effects of gastric acidity and presence of Brunner’s glands were *** was divided into types C(no or mild atrophy)and O(severe atrophy).Mucin phenotype expressions in NADETs were divided into gastric,intestinal,gastrointestinal,and *** When NADETs were classified according to EGMA,105 were classified as type C and 29 as type O.G-NADETs were present in 11.9%(16 cases)of all cases,and all 16 cases were of type *** G-NADETs,93.8%(15 cases)were present in part 1 or *** was an association between G-NADETs and type C in part 1,and 50.0%(eight of 16 cases)of G-NADETs were associated with a current or previous Helicobacter pylori infection ***,all eight cases occurred in part *** G-NADETs were significantly associated with type *** acidity and Brunner's gland growth may be associated with G-NADETs.

关键词： Gastric acidity Gastric foveolar metaplasia Gastric mucosal atrophy Helicobacter pylori Mucin phenotype Nonampullary duodenal epithelial tumor

Treatment of hepatitis C in compensated cirrhotic patients is equally effective before and after liver transplantation

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World Journal of gastroenterology 2013年第21期19卷 3255-3262页

作者： Francesca Romana Ponziani Eleonora Brigida Annicchiarico Massimo Siciliano Francesca D'Aversa Maurizio Pompili Antonio Gasbarrini uoc internal medicine and gastroenterology Policlinico A GemelliCatholic University of Rome00168 RomeItaly

AIM: To investigate differences in tolerability and response to treatment in compensated cirrhotic patients affected by hepatitis C virus (HCV) infection before and after liver transplantation. METHODS: Forty-three HCV non-liver transplanted (LT) cirrhotics (mean age 55 ± 8 years, 65.1% male, Child-Pugh-A, genotype 1-4: 65.1%, 2-3: 34.9%) and 17 LT recipients with recurrent HCV-related cirrhosis (mean age 57 ± 9 years, 88.2% male, Child-Pugh-A, genotype 1-4: 76.5%, 2-3: 23.5%) were included in the analysis from retrospective series. All patients received recombinant or pegylated interferon plus ribavirin at a standard dose and duration. Adverse events were recorded and classified according to the Common Terminology Criteria for Adverse Events. The mean duration of follow-up was of 4.3 ± 1.8 years after the end of the treatment. RESULTS: An early virological response (EVR) was achieved in 30/43 (69.8%) non-LT and in 8/17 (47.1%) LT cirrhotics, a sustained virological response (SVR) in 18/43 (41.9%) and 5/17 (29.4 %), respectively. No sta- tistical difference was observed in EVR and SVR rates between the two groups. Among HCV non-LT cirrhotics, 6/43 (13.9%) discontinued the treatment prematurely, 11.6% of them receiving ≤ 80% of treatment; 8/17 (47%) LT cirrhotics withdrew the treatment, 35.2% of them receiving ≤ 80% of treatment. If compared with LT-ones (P = 0.015), an higher risk of treatment discontinuation could affect LT cirrhotics, who undergo more frequently ≤ 80% of treatment (P = 0.05). None of the non-LT cirrhotics died after the end of the treatment. With no regards to the achievement of SVR, LT cirrhotic patients showed a reduced survival in respect to non-LT ones (87% at 1 year, 76% at 3 and 5 years after the end of treatment).CONCLUSION: HCV antiviral treatment is equally effective in compensated cirrhotics both before and after LT, which patients show a higher risk of premature treatment withdrawal and a reduced survival, independently of the achieveme

关键词： Hepatitis C virus Hepatitis C virus antiviral treatment Liver cirrhosis Liver transplantation Sustained virological response, Efficacy Safety

Critical assessment of the reported bidirectional associations between gallstone, non-alcoholic fatty liver, and kidney stone diseases

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World Journal of gastroenterology 2025年第5期31卷 133-136页

作者： Jing-Jing Lu Yuan-Zhi Chen Yuan-Peng Huang Department of internal medicine Xiamen Hospital of Traditional Chinese MedicineThe Affiliated with Fujian University of Traditional Chinese MedicineXiamen 361015Fujian ProvinceChina The Eighth School of Clinical medicine Xiamen Hospital Beijing University of Chinese MedicineXiamen 361015Fujian ProvinceChina School of Public Health Xiamen UniversityXiamen 361102Fujian ProvinceChina

The recent article by Jiang et al published in World Journal of gastroenterology reports substantial bidirectional associations between gallstone disease(GSD),non-alcoholic fatty liver disease(NAFLD),and kidney stone disease(KSD),based on multicenter cross-sectional studies and a systematic review with *** the findings have the potential to significantly impact clinical and pre-ventive strategies,several methodological issues merit closer *** letter critiques key aspects of the study,including sample population hetero-geneity,potential confounding variables,and the reliance on cross-sectional data that may limit causal *** also discuss the generalizability of these results to broader populations given the study's focus on the Chinese *** addressing these concerns,we suggest a more nuanced interpretation of the associations between GSD,NAFLD,and KSD,advocating for longitudinal studies to validate these findings and enhance their applicability in global health contexts.

关键词： Gallstone disease Non-alcoholic fatty liver disease Kidney stone disease Bidirectional associations Meta-analysis

Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents

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World Journal of gastroenterology 2015年第11期21卷 3308-3316页

作者： Eun Soo Kim Geun Am Song Kwang Bum Cho Kyung Sik Park Kyeong Ok Kim Byung Ik Jang Eun Young Kim Seong Woo Jeon Hyun Seok Lee Chang Heon Yang Yong Kook Lee Dong Wook Lee Sung Kook Kim Tae Oh Kim Jonghun Lee Hyung Wook Kim Sam Ryong Jee Seun Ja Park Hyun Jin Kim Division of gastroenterology Department of Internal MedicineKeimyung University School of Medicine Division of gastroenterology Department of Internal MedicinePusan National University School of Medicine Division of gastroenterology Department of Internal MedicineYeungnam University College of Medicine Division of gastroenterology Department of Internal MedicineCatholic University of Daegu School of Medicine Division of gastroenterology Department of Internal MedicineKyungpook National University School of Medicine Division of gastroenterology Department of Internal MedicineDongguk University School of Medicine Division of gastroenterology Department of Internal MedicineInje University College of Medicine Division of gastroenterology Department of Internal MedicineDong-A University Medical Center Division of gastroenterology Department of Internal MedicineKosin University College of Medicine Division of gastroenterology Department of Internal MedicineGyeongsang National University School of Medicine

AIM:To evaluate the incidence and risk factors of Korean tuberculosis(TB) infection in patients with inflammatory bowel disease(IBD) undergoing anti-TNF ***:The data of IBD patients treated with anti-TNFs in 13 tertiary referral hospitals located in the southeastern region of Korea were collected *** failed to show response or were intolerant to conventional treatments,including steroids or *** measures for latent TB infection(LTBI)and the incidence and risk factors ofactive TB infection after treatment with anti-TNFs were ***:Overall,376 IBD patients treated with antiTNF agents were recruited(male 255,mean age of anti-TNF therapy 32.5±13.0 years);277 had Crohn’s disease,99 had ulcerative colitis,294 used infliximab,and 82 used *** anti-TNF treatment,screening tests for LTBI including an interferon gamma release assay or a tuberculin skin test were performed in 82.2%of *** patients(8%)had *** cases of active TB infection including one TB-related mortality occurred during 801 personyears(PY)follow-up(1997.4 cases per 100000 PY)after anti-TNF ***(OR=5.76,95%CI:1.57-21.20,P=0.008)and WBC count<5000 mm3(OR=4.5,95%CI:1.51-13.44,P=0.007)during follow-up were identified as independently associated risk ***:Anti-TNFs significantly increase the risk of TB infection in Korean patients with *** considerable burden of TB and marked immunosuppression might be attributed to this risk.

关键词： Tuberculosis Anti-TNF Korea Inflammatory bowel dis