INTRODUCTION:Biologic therapy options for ulcerative colitis (UC) have increased in recent years. Although predicting treatment response may support personalized treatment strategies, the predictive value of histopathological features in UC remains unclear. This exploratory study aimed to evaluate the association between ustekinumab effectiveness and pre-treatment histopathological findings. METHODS:This single-center, retrospective, observational pilot study included patients with moderate-to-severe UC who were administered ustekinumab at the Kitasato University Hospital between April 2020 and March 2024. The endpoints were the relationship between pre-treatment histopathological findings, assessed using the Geboes score, and clinical efficacy at weeks 8 and 52, stratified by prior exposure to advanced therapies. RESULTS:The study enrolled 33 patients. Among advanced therapy-naïve (AT-naïve) patients, responders at week 8 were significantly more likely to have low neutrophilic infiltration in the lamina propria than non-responders (66.7% vs. 0%, p = 0.03). Among advanced therapy-exposed (AT-exposed) patients, the degree of neutrophilic or eosinophilic infiltration in colonic tissue at week 8 did not differ significantly between responders and non-responders. Among AT-naïve patients, those who achieved clinical remission at week 52 tended to have mild eosinophilic infiltration in the lamina propria compared with non-responders (80.0% vs. 33.3%, p = 0.07). Among AT-exposed patients, the degree of neutrophilic or eosinophilic infiltration in colonic tissue at week 52 did not differ significantly between responders and non-responders. CONCLUSION:In moderate-to-severe UC, pre-treatment mucosal histopathological assessment may serve as a treatment response marker. This information can guide development of personalized treatment strategies.
INTRODUCTION:This study aimed to investigate the effects of GLP-1 receptor agonists (GLP-1 RAs) on weight, metabolic, and inflammatory bowel disease (IBD) activity parameters in patients with IBD. METHODS:We conducted a systematic search for studies using GLP-1 RAs in IBD patients. The primary outcomes included weight (body mass index, total body weight, total weight loss percentage [TWL%], and >5 and >10 weight loss [WL]) and metabolic parameters (lipid panel and glycated hemoglobin [HbA1c]), while IBD-activity parameters and adverse events were secondary outcomes. RESULTS:Ten studies were included (n = 7,831). Weight parameters showed reductions, with a TWL% of -7.55% (95% confidence interval [CI]: -3.99 to -11.12), with 60% achieving WL >5% (95% CI: 53 to 67) and 40% achieving WL >10% (95% CI: 33 to 47). Metabolic parameters showed improved and stabilized levels, of which LDL decreased from 94.96 mg/dL (95% CI: 79.91 to 110.00) to 90.45 mg/dL (95% CI: 81.58 to 99.33), and HbA1c, in diabetics, from 7.11% (95% CI: 6.62 to 7.59) to 6.76% (95% CI: 6.35 to 7.16). GLP-1 RAs seem not to exacerbate IBD activity, with improved fecal calprotectin from 289.46 μg/g (95% CI: 62.88 to 516.04) to 210.59 μg/g (95% CI: 75.45 to 345.73), with 11% and 6% requiring IV steroids and advanced therapy, respectively. Adverse events occurred at lower rates, with nausea/vomiting being the most common. CONCLUSION:Our findings suggest that GLP-1 RAs may be promising for reducing weight and improving metabolic parameters without exacerbating activity, and may be a safe option for IBD patients. However, larger randomized controlled trials are needed to assess causal inference and long-term effects.
BACKGROUND:Numerous studies have detailed that patients with pancreatitis frequently experience comorbid anxiety and depression, which may arise from physiological factors or psychosocial influences, and these conditions adversely affect daily functioning and quality of life. However, there is still a lack of reviews on epidemiological and mechanistic studies of anxiety and depression in patients with pancreatitis. SUMMARY:Patients with pancreatitis commonly present with comorbid anxiety and depression, with chronic pancreatitis patients being more susceptible than those with acute pancreatitis. The mechanisms underlying this comorbidity are complex and likely multifactorial. Biological factors encompass inflammation-driven cytokine signalling to the brain, Hypothalamic-Pituitary-Adrenal (HPA) axis hyperactivity, gut microbiome dysbiosis, and altered central nervous system plasticity. Psychosocial factors include the emotional burden of pancreatitis, persistent sleep disturbances, substance abuse, and diminished family and social support. Assessment primarily relies on various types of scales, while treatment encompasses a comprehensive approach involving medication, psychological interventions, and family and social support. KEY MESSAGES:This paper reviews the epidemiological characteristics of anxiety and depression in patients with pancreatitis, explores their biological and psychosocial mechanisms, and summarizes key points for the assessment and treatment of this comorbidity.
INTRODUCTION:Clostridioides difficile infection (CDI) is a leading cause of antibiotic-associated diarrhea in critically ill patients. This meta-analysis evaluated whether proton pump inhibitor-based stress ulcer prophylaxis increases CDI risk and examined associated outcomes, including mortality, gastrointestinal bleeding, and other clinical effects in ICU patients. METHODS:The study was prospectively registered on PROSPERO (CRD420251176540). Following PRISMA guidelines, PubMed, Scopus, Cochrane, and Google Scholar were searched (2007 - March 2025) for randomized controlled trials and observational studies comparing PPIs with H2 receptor antagonists (H2RAs) or placebo in ICU patients. Data were pooled using a random-effects model, and heterogeneity was assessed using the I2 statistic. RESULTS:Eight studies (∼58,000 patients) met inclusion criteria. PPI use did not significantly increase CDI risk (OR 1.12; p = 0.49, I2 = 73%) or mortality (RR 1.01; p = 0.70) but significantly reduced gastrointestinal bleeding risk (RR 0.60; p = 0.02), particularly versus H2RAs (RR 0.72; p = 0.0008). No significant differences were found in ICU or hospital length of stay as well as for mechanical ventilation duration. CONCLUSION:In ICU patients, PPI prophylaxis was associated with reduced gastrointestinal bleeding but showed no clear benefit for mortality, ICU or hospital length of stay, or duration of mechanical ventilation. The available evidence does not allow firm conclusions regarding CDI risk because of substantial heterogeneity and very low certainty of evidence. Compared with H2RAs, PPIs provide greater bleeding protection, although possible signals of longer ICU stay and slightly higher mortality require further investigation.
INTRODUCTION:In patients receiving nucleos(t)ide analog (NA) therapy for chronic hepatitis B (CHB)-related cirrhosis, routine endoscopic surveillance may be deferred in the absence of high-risk varices (HRV). We aimed to identify predictors of incident HRV in this population. METHODS:This retrospective cohort study included patients with CHB-related cirrhosis who initiated NA therapy between March 2008 and June 2020 and were followed through May 2024. Eligible patients underwent baseline and on-treatment upper endoscopy. Patients with baseline HRV, prior variceal ligation, use of nonselective β-blockers, other viral hepatitis, alcohol overuse, or malignancy were excluded. The cumulative incidence of HRV and adjusted subdistribution hazard ratios (aSHRs) were estimated using competing-risk methods. A point-based risk prediction model was derived from multivariable regression coefficients. RESULTS:Among the 110 included patients, 14 (12.7%) developed HRV over a median follow-up of 3.6 years (IQR, 2.0-5.6). In multivariable analysis, fibrosis-4 (FIB-4) ≥4.0 (aSHR 9.77; 95% CI, 1.45-65.7), coexisting metabolic dysfunction-associated steatotic liver disease (MASLD) (aSHR 6.37; 95% CI, 1.84-22.0), and albumin-bilirubin (ALBI) grade >1 (aSHR 3.02; 95% CI, 1.21-7.55) were independently associated with incident HRV and were assigned 3, 2, and 1 point, respectively, in the prediction model. At 3 years, the cumulative incidence of HRV was 1.5% (95% CI, 0-4.5) in the low-risk group (0-3 points) and 21.4% (95% CI, 8.0-34.8) in the high-risk group (4-6 points) (p = 0.001). CONCLUSION:MASLD, FIB-4, and ALBI grade predict incident HRV in NA-treated CHB cirrhosis, enabling risk-stratified endoscopic surveillance.
Background Enteral feeding via percutaneous endoscopic gastrostomy (PEG) is commonly used for patients requiring long-term nutritional support. However, PEG insertion carries a risk of infection, including methicillin-resistant Staphylococcus aureus (MRSA) peristomal infections. This systematic review and meta-analysis aimed to evaluate the association between MRSA colonization and the risk of PEG-related infections. Methods A systematic search was conducted in four major databases—Embase, Medline, Cochrane, and Scopus—focusing on studies reporting MRSA colonization and PEG-related infections. Data were analyzed using RevMan v5.3. Odds ratios (OR) were calculated for dichotomous outcomes using a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the I² statistic. Results Five studies encompassing 286 patients were included in the meta-analysis. Among them, 77 patients were nasopharyngeal MRSA-positive, and 209 were MRSA-negative. MRSA colonization was significantly associated with an increased risk of PEG-related peristomal infection (OR: 24.31; 95% CI: 5.20–113.65; p < 0.0001). Heterogeneity among studies was low, supporting the robustness of the findings. Conclusion Nasopharyngeal MRSA colonization is strongly associated with a higher risk of PEG site infection. These findings highlight the importance of MRSA screening and consideration of colonization status prior to PEG tube insertion. Enhanced infection control strategies should be implemented in MRSA-positive patients to mitigate the risk of complications. Further research is warranted to determine the most effective preventive measures tailored to MRSA-colonized individuals undergoing PEG placement.
INTRODUCTION:Familial dysautonomia (FD) is characterized by abnormal function of autonomic and sensory nervous systems. Gastrointestinal (GI) symptoms are extremely prevalent in FD patients, but the impact of FD on the pancreas is less well described. We aimed to elucidate the incidence and characteristics of acute pancreatitis (AP) in a population of FD patients and to identify potential risk factors. METHODS:A retrospective review was performed on FD patients treated at a single tertiary center between 1981 and 2020. FD patients were included in the study, except those who died before 6 months. Data collected included demographics, FD symptoms, medication use, laboratory results, imaging results, and surgical and hospitalization history. Statistical analysis was performed to determine prevalence of AP in FD patients and FD-related symptoms. RESULTS:Out of 192 FD patients, 49% were male, and average age at the time of evaluation was 25.3 years (range: 1-59 years). Most patients had GI (n = 179, 96.8%) and respiratory (n = 166, 88.3%) FD manifestations. More than 33% of patients had an FD crisis frequency of more than four times/year. The incidence of AP among this FD population was 288.5 cases per 100,000 person-years, 8.5 times higher than the incidence in the general population. There was no significant difference in the prevalence of pancreatitis risk factors when comparing FD patients who developed AP to FD patients who did not. CONCLUSIONS:There is a significantly increased risk for pancreatitis among FD patients that is not explained by traditional pancreatitis risk factors. This increased risk may be due to sphincter of Oddi dysfunction as part of their autonomic nervous system abnormalities.
INTRODUCTION:Helicobacter pylori (H. pylori) infection is highly prevalent in Zambia, with an estimated population prevalence of 79%. However, data on eradication treatment outcomes in routine clinical practice are lacking. METHODS:We conducted a single-arm cohort study in Lusaka, Zambia, to evaluate the effectiveness of empirical H. pylori eradication therapy using stool antigen testing (SAT). Symptomatic patients with confirmed H. pylori infection were treated empirically with clarithromycin-, tinidazole-, and omeprazole-based regimens. Eradication was assessed using SAT at least 4 weeks after completion of therapy. Demographic and clinical factors associated with treatment outcomes were analysed using multivariate logistic regression in Stata version 15. RESULTS:Of 331 patients tested, 216 (65%) were positive for H. pylori infection. Post-treatment SAT results were available for 139 (64%) patients, of whom 93 (67%) were female. The median age was 43 years (interquartile range: 36-54). Overall, eradication was achieved in 85 patients, yielding a treatment success rate of 61%. Multivariate analysis demonstrated that a history of prior eradication attempts (odds ratio [OR]: 0.20, 95% confidence interval [CI]: 0.04-0.60) was independently associated with treatment failure. In contrast, the occurrence of dysgeusia during therapy (OR: 3.20, 95% CI: 1.20-8.70) and prior proton pump inhibitor use (OR: 5.30, 95% CI: 1.40-19.80) were associated with higher odds of eradication. CONCLUSION:The effectiveness of empirical clarithromycin-based therapy for H. pylori infection in Zambia is suboptimal and falls below internationally recommended targets. These findings underscore the need to reassess empirical treatment strategies, particularly among patients with previous eradication attempts, and highlight the importance of locally informed antibiotic selection.
BACKGROUND:Endoscopic submucosal dissection (ESD) is of great value in the medical field as an effective means for the treatment of early gastrointestinal cancer and precancerous lesions. However, due to its technical difficulty and long procedure time, ESD is prone to complications such as perforation, bleeding, and infection. In particular, perforation facilitates the entry of pathogenic microorganisms into the blood circulation through iatrogenic wounds, increasing the risk of bacteremia, which may lead to serious adverse events such as peritonitis and septic shock. SUMMARY:This narrative review, based on a systematic search of PubMed, Embase, and the Cochrane Library through January 2026, analyzes the risk of bacteremia in ESD across different parts of the digestive tract and the necessity of antibiotic therapy, aiming to provide a reference for more in-depth exploration and clinical application. KEY MESSAGES:Current evidence indicates that the overall incidence of bacteremia after ESD is low (typically <5%), mostly transient, and rarely progresses to clinical infection.
BACKGROUND:The rate of gastric cancer has reduced globally in all ages in recent years, but some data have started to emerge of a slowing in the decrease or even an increase in those aged >50 years, particularly in wealthier countries. Helicobacter pylori infection is associated with 89% of gastric cancer diagnoses worldwide, and its eradication is associated with a risk reduction. This review aims to assess the various approaches to diagnosing this carcinogenic pathogen. SUMMARY:A test-and-treat approach (noninvasive H. pylori testing for symptomatic patients) towards young people has been advocated among European populations to date, and has been validated for improving symptoms of dyspepsia, and shown cost savings compared to symptomatic dyspepsia treatment alone. Randomised data on the reduction of gastric cancer since the introduction of this approach are lacking, but some retrospective studies show a clear cancer benefit to eradication. Several pilot studies in high-incidence countries have demonstrated cost-effective and real-world reductions in gastric cancer rates with population-based H. pylori screenings (screen-and-treat approach). Many of these countries have adopted national gastric cancer prevention strategies that incorporate H. pylori screening. Abundant modelling data in these countries show economic benefits to nearly all types of screening programmes; however, data in European populations, who have documented lower risks of both infection and progression to gastric cancer, are lacking. Modelled data suggest it may be feasible, but currently no guidelines recommend this approach. Currently, prospective European studies are underway to assess the practicality and cost-effectiveness of various methods of screening. We discuss the use of both endoscopy (test-scope-and-treat) and biomarkers as possible adjuncts to potential population-based screening to ensure maximum gastric cancer reduction from any such proposed approach. KEY MESSAGES:Prospective data from H. pylori high-incidence countries in Asia have shown a clear reduction in gastric cancer diagnoses after the introduction of population screening. Cost-effectiveness of population-wide screening is well documented in these countries and forms part of many national gastric cancer screening programmes. Modelled data from H. pylori low-incidence countries show population-based screening may be cost-effective, but real-world feasibility data are lacking.
INTRODUCTION:The high rates of Helicobacter pylori resistance to antibiotics and increasing eradication failure have received much attention worldwide. METHODS:Gastric mucosa specimens were collected from 7,921 patients with H. pylori infection confirmed by urea breath test from January 2015 to December 2024. H. pylori isolation and culture were performed, followed by antimicrobial susceptibility testing. RESULTS:The overall and multidrug resistance (MDR) rates of the 5,205 H. pylori isolates to antibiotics were 95.93% and 18.83%, respectively. The listed antibiotic resistance rates in descending order were metronidazole (94.33%), levofloxacin (36.14%), clarithromycin (32.10%), amoxicillin (0.48%), and furazolidone or tetracycline (0%). The analysis demonstrated no significant difference between resistance rates for periods 2015-2019 (95.90%) and 2020-2024 (96.11%) (p > 0.05). Resistance rates differed significantly between the two periods: levofloxacin (35.33% vs. 41.62%), clarithromycin (27.86% vs. 60.93%), and amoxicillin (0.33% vs. 1.50%) (p < 0.05). The MDR rates increased significantly from 16.75% in 2015-2019 to 32.93% in 2020-2024 (p < 0.001). Treatment-experienced patients demonstrated elevated resistance levels and MDR rates (99.31% and 39.45%) in comparison to treatment-naïve individuals (94.99% and 15.02%; p ≤ 0.001). Besides, treatment-experienced patients exhibited significantly higher resistance rates to metronidazole (97.92%), clarithromycin (67.47%), levofloxacin (46.02%), and amoxicillin (1.04%) compared to treatment-naïve patients (92.54%, 32.07%, 35.04%, 0%; p < 0.001). CONCLUSION:The study revealed elevated overall resistance rates and MDR rates of H. pylori to metronidazole, clarithromycin, and levofloxacin, with significantly higher rates observed in treatment-experienced patients. Notably, a rising pattern in resistance rates to levofloxacin, clarithromycin, amoxicillin, and MDR rates was observed in recent years.
BACKGROUND:Early-onset colorectal cancer (EOCRC; age <50 years) is rising in Australia despite improving outcomes in older adults. EOCRC shows a strong birth cohort effect, disproportionate growth in left-sided and rectal tumours, and more frequent stage III-IV presentation. Most cases occur without a family history, suggesting that environmental and biological pressures are accelerating carcinogenesis in otherwise average-risk hosts. SUMMARY:Traditional risk factors such as obesity, metabolic syndrome, sedentary behaviour, alcohol, and smoking likely contribute through insulin resistance, chronic inflammation, and insulin-like growth factor 1-mediated signalling, but they do not fully explain the recent acceleration or distal predominance of EOCRC. Hereditary syndromes account for only a minority of cases, and tumour driver mutation patterns broadly resemble those of later-onset colorectal cancer, supporting earlier triggering rather than novel genetics. Emerging evidence implicates gut dysbiosis and exposures that disrupt mucosal defences or cause direct DNA damage. Colibactin-producing Escherichia coli may induce distinctive mutational signatures enriched in early and distal tumours. Microplastics and plasticisers may impair barrier function and promote low-grade inflammation, while per- and polyfluoroalkyl substances and related endocrine-disrupting chemicals are linked to metabolic and immune perturbation and altered bile acid biology. Antibiotic exposure, particularly early in life, may reduce microbial diversity and favour pathobionts. Inflammatory phenotypes, including inflammatory bowel disease, provide an additional model of inflammation-driven carcinogenesis relevant to EOCRC. KEY MESSAGES:EOCRC in Australia is a growing clinical and public health challenge that cannot be explained by inherited predisposition alone. A unifying exposome model may help integrate dietary, microbial, inflammatory, and environmental drivers of risk. Clinicians should promote earlier participation in the National Bowel Cancer Screening Program, including the 45-49 opt-in pathway, expedite investigation of rectal bleeding, altered bowel habit, and iron deficiency anaemia in younger adults, and embed lifestyle counselling into routine and survivorship care. Research priorities include prospective cohorts with early-life exposure data, integrated exposomics, microbiome profiling, and mutational signature analysis to clarify modifiable drivers and guide prevention.
Background: Guidelines for the management of reflux-like symptoms (primarily heartburn and regurgitation) offer limited guidance to support decision-making in the nonprescription setting. This review aimed to summarize and compare nonprescription treatment options within the context of reflux-like symptom pathophysiology and provide a practical evidence-based tool to help guide tailored treatment selection. Summary: A patient-centered approach should consider the requirement for reactive versus preventative therapies and each product's unique characteristics. Antacids neutralize refluxed acid in the esophagus, providing temporary relief from occasional heartburn. Raft-forming alginate formulations provide relief of heartburn and regurgitation after meals by forming a viscous gel near the gastroesophageal junction, neutralizing the postprandial acid pocket and coating the esophagus when refluxed. Histamine-2 receptor antagonists reduce gastric acid secretion within 30 min, lasting for up to 12 h, making them useful for treatment and prevention of heartburn, but tachyphylaxis is a limitation. Nonprescription proton pump inhibitors are most effective for preventing frequent acid-related symptoms. They are packaged as a 2-week course for daily use, achieving maximum effect after a few days. Key Messages: Important differences exist among self-management treatment options for reflux-like symptoms. A standardized algorithm is proposed to help tailor treatment selection according to symptom profile. .
BACKGROUND:The World Bank classified "developing countries" as all 135 countries with low- or middle-income economies, whose 6.7 billion people represent 84% of the world's population. Other parameters, such as household crowding, poor sanitation, reduced income, limited education, and unsafe drinking water, are often used to refine this definition. A wide range of prevalence, from 18.9% in Switzerland to 87.7% in Nigeria, is reported, and the association between Helicobacter pylori infection and socioeconomic status is well established. After successful eradication, infection can recur due to recrudescence or reinfection. SUMMARY:We compared the results of our two meta-analyses from 2008 to 2024, demonstrating the recurrence rates in developing versus developed countries. We also looked at the continuous change over time in the recurrence rate of H. pylori after a successful eradication in developing countries. We found that the disparity between "developed" and "developing" countries in the recurrence of H. pylori infection has disappeared, following a continuous decrease in recurrence rates of H. pylori in developing countries. KEY MESSAGES:We assume that H. pylori recurrence may be a marker for the socioeconomic state, and our results point toward a process in which "developing" countries advance toward becoming "developed."
Introduction: Gastric intestinal metaplasia (GIM) is a precancerous lesion of gastric cancer. Despite increasing interest for association between obesity and gastric cancer, there is still ongoing controversy for effect of obesity on gastric cancer. Therefore, it is important to discover obesity index with reliable predictability for GIM. METHODS:Study participants were 85,986 Koreans who were free of GIM at endoscopy. They were categorized by quartile levels of body mass index (BMI), waist circumference (WC), and Chinese visceral adipose index (CVAI). Cox proportional hazard assumption was used to evaluate hazard ratio (HR) and 95% confidence interval (CI) for incident GIM (adjusted HR [95% CI]) according to quartile levels of BMI, WC, and CVAI for about 8 years of follow-up. Using the time ROC package, ROC and area under curve (AUC) were calculated for each quartile group of BMI, WC, and CVAI at 2, 4, 6, and 8 years. RESULTS:In men, BMI ≥ quartile 3, WC ≥ quartile 2, and CVAI ≥ quartile 2 were more significantly associated with incident GIM, compared with quartile 1 groups (reference). In women, while BMI and WC did not show the significant association with GIM, CVAI was solely associated with the increased risk of GIM. Time-dependent ROC and AUC analyses indicated that CVAI was superior to BMI and WC in predicting GIM among both men and women. The predictive ability of CVAI was more prominent in women than men. CONCLUSION:CVAI was an effective predictor for GIM, surpassing the predictive ability of BMI and WC. .
Introduction: Circulating tumor DNA (ctDNA) assays are emerging as promising noninvasive tools for colorectal cancer (CRC) screening. This updated systematic review and meta-analysis evaluated the diagnostic accuracy of blood-based ctDNA assays for early CRC detection in asymptomatic adults. METHODS:We included prospective and cross-sectional diagnostic accuracy studies comparing ctDNA assays (mutation, methylation, or fragment-based) against colonoscopy or histopathology. Study-level 2 × 2 data were extracted to calculate sensitivity and specificity. Pooled estimates were derived using a Reitsma bivariate random-effects model. Secondary measures like diagnostic odds ratio (DOR), positive and negative likelihood ratios (PLR, NLR), positive predictive value (PPV), and negative predictive value (NPV) were synthesized on transformed scales and back-transformed for reporting. Subgroup analyses by assay type and meta-regression explored heterogeneity. Risk of bias was assessed with QUADAS-2 and certainty of evidence with GRADE. RESULTS:Ten studies met inclusion criteria, nine contributing to pooled estimates. The pooled sensitivity was 0.887 (95% CI, 0.848-0.920) and specificity 0.913 (95% CI, 0.898-0.928). A sensitivity analysis excluding studies with high risk of bias in patient selection yielded a comparable pooled sensitivity of 0.857 (95% CI, 0.794-0.904) and specificity of 0.900 (95% CI, 0.897-0.904). The SROC curve yielded an AUC of 0.97, indicating excellent discrimination. Secondary pooled metrics included a DOR of 83.9, PLR of 9.2, and NLR of 0.12. PPV was low (<20%), but NPV remained high (>99%) at screening prevalences of 0.5-2%. Subgroup analyses by assay type revealed no significant differences in diagnostic accuracy. CONCLUSION:Blood-based ctDNA assays show high pooled sensitivity, specificity, and discrimination for CRC detection, but limited predictive value at screening prevalence and study heterogeneity constrain clinical adoption. Large, standardized, population-based studies are warranted. .
Introduction: Upper gastrointestinal bleeding (UGIB) is a common emergency where poor endoscopic visualization due to retained blood and clots hampers diagnosis and therapy. Prokinetic agents and nasogastric (NG) lavage are used to improve visualization, but their comparative effectiveness remains unclear. This study evaluated the comparative efficacy of prokinetics - with or without NG lavage - versus NG lavage alone, prokinetics alone, or placebo in improving endoscopic visualization in UGIB. METHODS:A systematic search of five databases up to April 2025 identified randomized controlled trials (RCTs) comparing erythromycin, metoclopramide, NG lavage, or combinations against placebo. Network meta-analysis using a frequentist random-effects model assessed the primary outcome of adequate visualization. Secondary outcomes included visualization score, endoscopy duration, and blood transfusion units within 24 h. Risk ratios (RRs) and standardized mean differences (SMDs) were calculated. Treatments were ranked using Surface Under the Cumulative Ranking curve (SUCRA). RESULTS:A total of 10 RCTs (1,083 patients) were included: erythromycin (n = 226), erythromycin+NG lavage (n = 186), metoclopramide (n = 34), metoclopramide+NG lavage (n = 143), NG lavage alone (n = 333), and placebo (n = 161). Erythromycin + NG lavage ranked highest for adequate visualization (RR: 2.49; 95% CI: 1.57-3.95; SUCRA: 92%), followed by erythromycin (RR: 2.24; 95% CI: 1.56-3.21) and NG lavage (RR: 1.70; 95% CI: 1.06-2.73). Erythromycin improved visualization score (SMD: 0.86; 95% CI: 0.36-1.36; SUCRA: 73%). No significant differences were found for endoscopy duration or transfusion units. CONCLUSION:Erythromycin, particularly when combined with NG lavage, appears most effective for improving endoscopic visualization in UGIB. However, this procedural benefit did not translate into reductions in endoscopy duration or 24-h transfusion requirements, and the impact on other patient-centered outcomes remains uncertain. .
BACKGROUND:Breath testing to study gastric emptying (GE) has been criticized that its conventional analysis provides only an overall GE velocity (half-emptying time) that is far off from the scintigraphic scale, and it cannot give a whole pattern of time-GE curve comparable to what the scintigraphy expresses ("true" GE). SUMMARY:GE breath tests (GEBT) approximate absorption of the 13C-marker (GE) from pulmonary 13CO2elimination. The Wagner-Nelson (WN) method has long been used for accurately describing drug absorption based on urinary elimination. Then, GEBT with WN analysis has been reported to provide a time-GE curve comparable to the "true" GE of both solid and liquid meals. To handle the WN method properly, attention should be directed to the two assumptions on which the WN method relies; one-compartment model and first-order kinetics. The former is responsible for the slight overestimation of the "true" GE of liquids. The latter is associated with the necessity of longer sampling time, more than 6 h, which could reduce the convenience of GEBT, but a recent study has proposed how to address this problem. KEY MESSAGES:The WN method gives a complete picture of the time-resolved GE curve (and not just lag phase or half-time values) equivalent to what nuclear scintigraphic studies do.
INTRODUCTION:Helicobacter pylori is a major global health challenge, causing significant gastrointestinal diseases and contributing to gastric cancer risk. This study evaluated the safety and efficacy of esomeprazole-containing regimens for H. pylori eradication in treatment-naïve and previously treated patients. METHODS:This retrospective multicenter cohort study included 2,530 patients diagnosed with H. pylori infection. Patients received one of five esomeprazole-containing regimens for 14 days. Eradication was assessed 4-6 weeks post-treatment using stool antigen tests, urea breath tests, or histopathology. Analyses included intention to treat (ITT) and per protocol (PP). Demographics, socioeconomic status, prior treatment history, adverse events, and eradication rates were analyzed. RESULTS:Of 2,530 enrolled, 2,489 were analyzed per protocol. The overall eradication rate was 87.3% (ITT) and 88.7% (PP). Treatment-naïve patients achieved higher eradication rates (89.7%) compared with previously treated patients (85.2%, p = 0.003). Bismuth subcitrate-based (96.5% PP in naïve; 86.7% in experienced) and doxycycline-based regimens (92.3% PP in naïve; 84.3% in experienced) demonstrated the highest efficacy. Adverse events occurred in 34.9% of patients, with no severe events. Socioeconomic status influenced outcomes, with eradication rates of 90.8% in high, 89.4% in middle, and 80.0% in low SES groups (p = 0.0001). CONCLUSIONS:Esomeprazole-containing regimens are effective and well tolerated for H. pylori eradication. Bismuth- and doxycycline-based quadruple therapies achieved the highest eradication rates, particularly in treatment-naïve patients. Tailored strategies incorporating bismuth or quadruple therapy may benefit patients with prior treatment failures or from lower socioeconomic backgrounds. Further research should consider regional resistance patterns and prospective designs.
Introduction: Gastrointestinal stromal tumors (GISTs) are clinically heterogeneous mesenchymal tumors, and accurate assessment of their malignancy is crucial for determining treatment strategies and predicting patient prognosis. This study aims to establish and validate a preoperative prediction model for the malignant risk of GIST based on endoscopic ultrasound (EUS) findings. Methods: In this retrospective study, we collected data from patients with GIST at Sichuan Provincial People's Hospital. Statistical analyses involved univariate and multivariate logistic regression models, with Firth's bias reduction penalty likelihood logistic regression employed to address data separation and multicollinearity. Model discrimination was assessed using AUC, and the Bootstrap ROC method was used for validation. Finally, a nomogram was constructed to visually represent the predictive model. Results: In this study, we analyzed 500 patients with GIST, including low (n = 393) and high-risk groups (n = 107). Univariate and multivariate logistic regression analyses revealed hard elastography and contrast-enhanced EUS (CE-EUS) of visible tumor vessels as potent independent risk factors associated with GIST malignancy. Firth's bias reduction penalty likelihood logistic regression confirmed hard elastography (OR = 146.222, 95% CI: 12.597-1,017.552) and CE-EUS with visible tumor vessels (OR = 402.853, 95% CI: 12.732-7,633.787) as significant predictors. Finally, we identified five optimal predictors (including size, shape, echogenicity, elastography, and visible tumor vessels). The predictive model demonstrated exceptional accuracy with an AUC of 0.9998, further validated by bootstrap ROC analysis showing an AUC of 1. Conclusion: A nomogram incorporating tumor size, shape, echogenicity, elastography, and visible tumor vessels was developed. However, because internal validation indicated overfitting, the model's clinical utility requires rigorous external validation.
