Abstract These days, a wide range of diseases are thought to be primarily caused by chronic inflammation. Anti‐inflammatory medications are therefore frequently used in conventional therapy for inflammatory conditions; however, several drugs have undesirable side effects. Natural products are viable substitutes that may yield novel bioactive chemicals that could serve as lead molecules for novel anti‐inflammatory drugs. An abundant supply of new chemicals can be found in marine environments due to their vast biological and chemical diversity. Some of the major chemical components from marine species, including sesquiterpenoids, diterpenes, steroids, polysaccharides, alkaloids, fatty acids, and proteins, have been extracted and reported to be anti‐inflammatory. An emphasis on previous and recent pre‐clinical and clinical research updates on marine natural communities and their synthetic congeners with possible anti‐inflammatory properties is compiled in this review.
Achalasia is a rare esophageal motility disorder causing dysphagia, chest pain, vomiting, and weight loss, significantly impairing quality of life. Peroral endoscopic myotomy (POEM) has emerged as a minimally invasive and effective treatment. However, limited data compare the outcomes of POEM between type I and type II achalasia based on the Chicago Classification. This single-center retrospective study included patients diagnosed with achalasia (Eckardt score >= 4) who underwent POEM at Kaohsiung Chang Gung Memorial Hospital from December 2016 to May 2023. The Eckardt score was assessed 6 months after the POEM procedure, while the High-Resolution Manometry had an average median follow-up of 30.5 months. Primary outcomes included changes in Eckardt score, lower esophageal sphincter (LES) pressure, upper esophageal sphincter (UES) pressure, and integrated relaxation pressure. Secondary outcomes included hospital stay, operation time, weight gain, and adverse event rates. A total of 39 patients (17 with type I and 22 with type II achalasia) were analyzed, with a median follow-up of 30.5 months. Both subtypes showed significant improvements in Eckardt scores (p < .001) and weight gain (type I: p = .023; type II: p = .03). No significant differences were observed between subtypes in Eckardt score reduction (p = .458) or weight gain (p = .693). Type II patients had shorter hospital stays (p = .017). While LES pressure decreased significantly in type I patients after POEM (p = .007), it did not reach statistical significance in type II patients (p = .051). Our study demonstrated that POEM therapy effectively improves symptoms and facilitates weight gain in both type I and type II achalasia, with no significant differences in primary outcomes.
Coronavirus disease 2019 (COVID-19) vaccines are effective in preventing severe disease in patients with inflammatory bowel disease (IBD), but the risk of infection following vaccination in ulcerative colitis (UC) versus Crohn's disease (CD) patients remains unclear. This study compares the risk of COVID-19 infection between UC and CD patients postvaccination. A retrospective cohort study was conducted on IBD patients who received at least two doses of the COVID-19 vaccine at China Medical University Hospital between January 1, 2020, and October 31, 2024. The study included 169 IBD patients (96 UC, 73 CD). Demographic data, vaccination history, and medical records were analyzed. Logistic regression assessed the odds of COVID-19 infection, adjusting for potential confounders. UC patients were significantly older than CD patients (44.92 +/- 13.72 years vs. 37.27 +/- 15.27 years, p = .0008). The overall prevalence of COVID-19 infection was 49.11%, with UC patients having a significantly higher infection rate (56.25%) compared to CD patients (39.73%, p = .0333). Logistic regression showed UC patients had an odds ratio of 1.95 (95% confidence interval [CI] = 1.05-3.62) and an adjusted odds ratio of 2.78 (95% CI = 1.20-6.44), indicating a 1.95- to 2.78-fold higher risk of infection. A trend toward reduced infection risk with more vaccine doses was observed, with medication use not significantly affecting infection risk. Our study showed that vaccinated UC patients had a significantly higher risk of COVID-19 infection compared to CD patients, highlighting the need for tailored monitoring and care strategies for UC patients, even postvaccination.
Intestinal ultrasound (IUS) is a non-invasive imaging method used to evaluate bowel wall inflammation and monitor disease activity in inflammatory bowel disease (IBD) patients. Both the European Crohn's and Colitis Organization and the American Gastroenterological Association endorse IUS for monitoring disease activity and identifying complications at the point of care. However, to date, no published data are available regarding the use of IUS for IBD management in Taiwan. Similar to the specificity of IUS in visualizing gut inflammation, immunoglobulin A (IgA) is a key immunoglobulin central to gut mucosal immunity. Recent studies have explored the involvement of IgA in IBD, but the relationship between IgA levels and bowel wall inflammation was unknown. We enrolled 28 IBD patients, including 19 with ulcerative colitis (UC) and 9 with Crohn's disease (CD), from the outpatient clinic of China Medical University Medical Center. All patients underwent IUS between July 2023 and August 2024. Ultrasound scores were based on the Milan ultrasound criteria (MUC) for UC and the bowel ultrasound score (BUSS) for CD. Plasma levels of erythrocyte sedimentation rate, C-reactive protein (CRP), albumin, IgA, partial Mayo score, and Crohn's disease activity index (CDAI) were collected at baseline, during treatment, and after 52 weeks of advanced therapy (Adalimumab, Vedolizumab, or Tofacitinib). IUS findings were closely correlated with disease activity. In UC, the MUC score was positively correlated with CRP (R-2 = 0.4888, p < .0001), partial Mayo score (R-2 = 0.3652, p = .0002), and negatively with albumin levels (R-2 = 0.3747, p = .0002). In CD, the BUSS score showed a positive correlation with CDAI (R-2 = 0.2694, p = .0394). Plasma IgA levels were significantly associated with bowel wall thickness (BWT) in both UC and CD (R-2 = 0.1759, p = .0041). Furthermore, plasma IgA was strongly correlated with the BUSS score (R-2 = 0.6585, p = .0001) in CD patients. Notably, when BWT exceeded 3.5 mm, plasma IgA levels increased significantly (p = .0025). These results demonstrate that IUS is an effective tool for monitoring disease activity and evaluating therapeutic responses in IBD patients. Besides, plasma IgA reflects the bowel wall inflammation, particularly in conjunction with IUS.
Metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed with new diagnostic criteria, which involves hepatic steatosis and metabolic dysfunction in 2020. The relationship between MAFLD and osteoporosis is not well understood. This study included participants from the Taiwan Bio-Bank cohort, where MAFLD was defined as hepatic steatosis plus having one of overweight/obesity, diabetes mellitus (DM), or >= 2 metabolic risk abnormalities in lean/normal weight subjects. Hepatic steatosis was diagnosed using liver ultrasonography, and osteoporosis was defined as T-scores <-2.5 using dual-energy x-ray absorptiometry. The final analysis included 22 554 participants (age 55.52 +/- 10.31; males 35.95%), of which 39.1% were diagnosed with MAFLD and 16.9% had osteoporosis. Compared to non-MAFLD subjects, MAFLD patients were older, had a higher percentage of males and metabolic diseases including DM, hypertension and hyperlipidemia, higher levels of body mass index (BMI), ALT, and NAFLD fibrosis scores, but a lower percentage of osteoporosis. In univariate analysis, MAFLD had an inverse association with osteoporosis, but in multivariate analysis, it showed an increased probability of osteoporosis. Stepwise logistic regression revealed that BMI was the major confounding factor influencing the direction of association between MAFLD and osteoporosis. Subgroup analysis showed that MAFLD patients had a higher percentage and probability of osteoporosis than those without in subjects with BMI <23 kg/m2. In conclusion, the large database found the increased risk of osteoporosis exists only in MAFLD patients with lean/normal weight. Screening for bone health and preventive measures for osteoporosis should be undergone for these patients.
Recent trends show an alarming rise in pancreatic cancer prevalence among young individuals. Previous studies have presented differences in age at diagnosis. The study aimed to examine the likelihood of a younger age at diagnosis in individuals exposed to known risk factors, compared with those without exposure. We conducted a retrospective cohort analysis of hospitalized patients in Taiwan. The Kaplan-Meier method and a Cox proportional hazards model were used to evaluate survival probabilities and diagnosis risk, respectively. We then performed a systematic review and meta-analysis to examine the association of the risk of early-diagnosis pancreatic cancer with smoking and alcohol drinking across different countries. In the cohort of 121 patients with pancreatic cancer, smokers and drinkers were diagnosed at 5.8 and 5.9 years younger than non-smokers and non-drinkers, respectively, while those who both smoked and drank were diagnosed 9.7 years earlier. Survival analysis confirmed these findings after adjusting for covariates (smokers: hazard ratio [HR] = 1.75, p = .019; drinkers: HR = 1.78, p = .023), with patients who both smoked and drank having a substantially higher risk of earlier diagnosis (HR = 3.66, 95% confidence interval = 1.97-6.81, p < .001). Meta-analysis revealed that early smoking initiation (<20 years) was linked to a higher risk of pancreatic cancer (pooled HR = 1.46) compared with late initiation (>= 20 years) (pooled HR = 1.39), consistent across various stratifications. Cigarette smoking and alcohol drinking are linked to younger age at pancreatic cancer diagnosis, with early smoking initiation increasing this risk further. These findings underscore the need for targeted interventions to reduce smoking and excessive alcohol drinking to delay the onset and reduce the incidence of pancreatic cancer, highlighting the importance of early preventive measures.
Pharyngeal high‐resolution manometry with impedance (P‐HRM‐I) is an established assessment method used to evaluate pharyngeal swallowing. It provides precise quantification of swallowing biomechanics that enable the detection of alterations in swallowing physiology. By identifying and localizing the mechanical breakdown during swallowing, P‐HRM‐I can be used to meaningfully guide clinical decision making and can assist in evaluating treatment techniques by demonstrating an intervention's true effect on the pharyngeal swallowing mechanics. Although P‐HRM‐I uptake in the research field has grown exponentially, its application in the clinical setting remains protracted. The expertise of Gastroenterology in esophageal HRM provides the basis for a foreseeable extension to P‐HRM‐I, which is emerging in some international centers. This review article describes the standardized P‐HRM‐I assessment procedure and analysis principles relevant to pharyngeal dysphagia conditions often seen in Gastroenterology practice. Analysis and interpretation using the cloud‐based platform, Swallow Gateway ( www.swallowgateway.com ), are detailed using outcome measures agreed upon by international expert consensus. Descriptions of three illustrative case examples of upper esophageal sphincter (UES) dysfunction are outlined, including longitudinally in a patient diagnosed with motor neurone disease, and two cases pre‐and post‐procedural interventions; one involving a dilatation and the other a cricopharyngeal‐peroral endoscopic myotomy.
Colonoscopy plays a critical role in the management of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). Through endoscopic findings and histologic evaluation via biopsy, colonoscopy facilitates the diagnosis of UC and CD and enables the differentiation from other conditions such as intestinal tuberculosis and Behçet's disease. Evaluating endoscopic activity, including mucosal healing, not only aids in formulating the initial treatment plan but also provides an objective assessment of treatment response, guiding decisions on whether to continue or modify existing therapies. Furthermore, colonoscopy is instrumental in assessing postoperative recurrence, thereby informing potential treatment modifications. It also monitors for IBD-related complications, such as strictures, fistulas, and dysplasia, allowing for timely intervention. In the realm of IBD treatment, colonoscopy contributes significantly through procedures such as endoscopic resection of UC-associated dysplasia, endoscopic balloon dilation of strictures, and endoscopic fistulotomy with abscess drainage. Recent applications of artificial intelligence (AI) in colonoscopy for IBD showed promising results. In UC, AI demonstrated high accuracy in assessing both endoscopic and histologic activity. Furthermore, AI-determined endoscopic activity accurately predicted clinical outcomes, such as relapse and hospitalization. Additionally, AI-assisted endoscopy has proven accurate in differentiating between CD and intestinal tuberculosis.
Hepatitis C virus (HCV) reinfection remains a significant concern in high-risk groups such as people living with HIV (PLWH), people who inject drugs (PWID), and patients undergoing hemodialysis (HD), even after achieving a sustained virologic response (SVR). This retrospective study focused on three high-risk groups of HCV patients who achieved SVR12 following direct-acting antiviral agents therapy between January 2018 and June 2022. We rechecked HCV RNA levels at least once after SVR12, defining reinfection as the presence of detectable viremia. We enrolled 149 HCV patients, including 22 PLWH from sexual transmission, 52 PLWH combined with PWID, 41 PWID, and 34 undergoing HD. The number of patients reinfected was 3, 7, 5, and 0 in each group. The rates of reinfection per 100 person-years of follow-up were 6.1, 6.1, 5.2, and 0. The median time to reinfection was shortest among PWID at 1.95 years and longest among PLWH from sexual transmission at 3.17 years. The reinfection rate is low in patients on hemodialysis but remains particularly high in the PLWH and PWID groups. Effective HIV prevention and syringe services programs remain critical in meeting the needs of these high-risk populations.
The classification of metabolic dysfunction-associated fatty liver disease (MAFLD), derived from non-alcoholic fatty liver disease (NAFLD), is a consensus-driven proposed nomenclature that is defined inclusively as fatty liver disease (FLD) concomitantly with the presence of obesity, metabolic dysregulation, and/or type 2 diabetes mellitus (T2DM). However, questions persist regarding the pertinent factors and dynamic changes of MAFLD under the current definition. A data-driven cluster analysis was performed on 145 patients meeting both MAFLD and NAFLD criteria at a tertiary hospital in Taiwan. Initially, high-correlation factors associated with the severity of hepatic steatosis were identified. Subsequently, cluster analysis was employed to delineate distinct phenotypes among MAFLD patients. Finally, the factors were subjected to further analysis based on the categorical classification of MAFLD, steatosis staging, and the resulting clusters. The top five correlation factors—Controlled Attenuation Parameter (CAP), Body Mass Index (BMI), Alanine Aminotransferase (ALT), Triglycerides (TG), Insulin, and Serum Uric Acid (UA)—are significantly associated with the severity of hepatic steatosis. Subsequent clustering unveiled substantial disparities among three cohorts across 12 of 16 biochemical parameters, encompassing CAP, BMI, Aspartate Aminotransferase (AST), ALT, TG, TG-HDL ratio, insulin, Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), UA, age, Creatinine (Cr), and liver stiffness. In addition, three distinct MAFLD clusters emerged: Cluster I ( n = 19; characterized by mild hepatic steatosis, mild obesity, and age-related), Cluster II ( n = 88; featuring moderate hepatic steatosis), and Cluster III ( n = 38; exhibiting severe hepatic steatosis, severe obesity, and insulin resistance-related markers). In our study, five metabolic parameters, BMI, ALT, TG, insulin, and UA, prove indicative of hepatic steatosis in MAFLD patients. The indispensable role of serum UA in the development and severity of MAFLD was highlighted. This data-driven cluster analysis also offers an innovative classification tool and personalized medical recommendations for distinct MAFLD phenotyping.
This study compared the treatment outcomes of patients with hepatitis C virus (HCV) treated with direct‐acting antivirals (DAAs) at Taipei Medical University Hospital and Fangliao General Hospital in Pingtung, focusing on the efficacy of oral pangenotypic DAAs, including Epclusa (sofosbuvir/velpatasvir) and Maviret (glecaprevir/pibrentasvir), in improving various clinical indicators and reducing liver fibrosis in patients with hepatitis C. This study collected data from 583 patients with hepatitis C who underwent treatment with pangenotypic DAAs at Taipei Medical University Hospital and Fangliao General Hospital between 2017 and 2023. After exclusion of those lost to follow‐up or with incomplete information, 482 patients were enrolled for statistical analysis. This study compared the improvements in liver function and liver fibrosis indicators after treatment in both settings. A total of 482 patients with chronic HCV were enrolled: 239 from Pingtung and 243 from Taipei. Compared with the patients in Taipei, the average age of the patients in Fangliao was older, and the average degree of liver fibrosis, as indicated by the Fibrosis‐4 (FIB‐4) index, was higher. Liver fibrosis reduction was more pronounced among the patients in Fangliao than those in Taipei, with improvements of 0.5 in Taipei and 0.7815 in Fangliao ( p < .05). Furthermore, the reduction in liver fibrosis among patients using Epclusa was greater than that among patients using Maviret. However, in multivariate linear regression analysis, neither geographical location nor drug type was statistically significant. Age and pretreatment FIB‐4 index were the primary factors affecting posttreatment improvement. This study underscores that treatment with DAAs improves liver function and reduces liver fibrosis in both urban and rural settings. Patients with hepatitis C who are older and have a higher FIB‐4 index should be given priority for DAA treatment.
Endoscopic ductal clearance is associated with failure of stone extraction, recurrent stone formation, and lethal morbidities that need emergent surgical drainage. There are limited hospital-based studies in Sudan and ongoing debate with fear among surgeons regarding choledochoduodenostomy (CDD) performance due to its high-risk morbidities. Hence, this study aimed to determine the surgical outcomes of CDD in the treatment of benign obstructive jaundice because of choledocholithiasis to reach excellent surgical practice. This is a prospective study conducted during the period between March 2021 and February 2023 at Ibn Sina specialized hospital, Khartoum, Sudan, on 81 patients diagnosed with benign obstructive jaundice due to secondary choledocholithiasis. They underwent elective open common bile duct exploration with side-to-side CDD. Benign obstructive jaundice was more prevalent in females (65.4%), in the ratio (2:1). Distribution of patients according to age ranged between 46 and 60 years, representing (45.7%) of patients. The most significant reported comorbidity was obesity (BMI >= 30 kg/m2) in (48.1%) of cases. Clinical scleral icterus was noticed in all (100%) patients. Magnetic resonance cholangiopancreatography revealed stones within the dilated common bile duct (2 cm) in (36.25%) of cases. The longest operative surgical time was 180 min in (48.75%) of patients. Postoperative complications were found in (6.2%) patients who had mild suppurative cholangitis. The mortality rate was zero. Side-to-side CDD is a safe, effective surgical procedure for permanent biliary drainage in patients who are diagnosed with benign obstructive jaundice. Moreover, if the facility for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is lacking, then common bile duct exploration with CDD should be the choice of treatment.
Recent developments in Helicobacter pylori (H. pylori) treatment have highlighted the rising resistance to clarithromycin. Conversely, amoxicillin resistance remains relatively low in both first-line and rescue treatments. Evidence has shown that the effectiveness of high-dose amoxicillin/proton pump inhibitor dual therapy varies in different countries. The effectiveness of combining high-dose amoxicillin with potassium-competitive acid blocker (PCAB) and bismuth as a mono-antibiotic strategy for H. pylori eradication remains to be determined. To assess the efficacy and safety of a 14-day regimen combining bismuth, high-dose amoxicillin, and PCAB (Bap therapy) as both first-line and rescue treatment for H. pylori infection, and to identify the factors that affect the outcome of this novel therapeutic approach. We conducted a retrospective cohort study of patients with H. pylori infection treated with Bap therapy from January 2021 to March 2024 across four hospitals in Taiwan. The regimen consisted of tripotassium dicitrato bismuthate (300 mg four times daily), high-dose amoxicillin (750 mg four times daily), and vonoprazan (20 mg twice daily) for 14 days. Patients returned in the second week to assess drug adherence and adverse events. Post-treatment H. pylori status was assessed at least 4 weeks following Bap therapy. Fifty-one patients receiving Bap therapy as either first-line (n = 45) or rescue treatment (n = 6) were analyzed. Eradication rates in first-line treatment were 95.6% (95% confidence interval [CI]: 89.6%-100.0%), 97.7% (95% CI: 93.3%-100.0%), and 100.0% in intention-to-treat, modified intention-to-treat, and per-protocol analyses, respectively. For rescue therapy, the corresponding eradication rates were all 100%. Adverse event rates were 6.7% for first-line and 0% for rescue treatments, with adherence rates of 95.6% and 100%, respectively. Univariate analysis indicated significantly lower eradication rates in patients with poor drug adherence (50% vs. 100%; p = .040), while factors such as smoking, alcohol consumption, clarithromycin, and metronidazole resistance did not influence outcomes. The 14-day Bap therapy demonstrates high efficacy and safety for both first-line and rescue treatments of H. pylori infection, making it a potential standard treatment option for H. pylori eradication. This study underscores the importance of adherence to therapy and warrants further research to validate the effectiveness of this mono-antibiotic approach across different lines of treatment for H. pylori infection.
Acute pancreatitis exhibits varying degrees of severity and may lead to complications such as peripancreatic fluid collections, which can develop into pseudocysts or walled-off necrosis. Interventions are necessary in cases of organ failure, bleeding, or infection. For endoscopic drainage, biomedical researchers have optimized stents such as double pigtail plastic stents (DPSs), modified fully covered self-expanding stents (mFCSEMSs), or lumen-apposing metallic stents (LAMSs). However, the most suitable type of stent for this purpose remains to be determined. Thus, we conducted the present systematic review and network meta-analysis of randomized controlled trials (RCTs) to compare efficacy and safety among various stents for the drainage of necrotic collection from necrotizing pancreatitis. PubMed, Embase, and Cochrane Library were comprehensively searched for RCTs (published before January 7, 2024) comparing various stents used for draining acute pancreatitis-associated peripancreatic fluid collections. In addition, we manually searched the reference lists of the included RCTs as well as relevant review articles and clinical guidelines. The primary study outcome was clinical success, and the secondary outcomes were technical success and adverse events. This study included four RCTs (a total of 200 patients). A direct meta-analysis indicated no significant difference in the rate of clinical success between LAMSs and DPSs (risk ratio [RR]: 1.02; 95% confidence interval [CI]: 0.89-1.16) or between DPSs and mFCSEMSs (RR: 1.05; 95% CI: 0.85-1.28). Moreover, an indirect comparison between LAMSs and mFCSEMSs revealed nonsignificant between-stent difference in the rate of clinical success (mFCSEMS vs. LAMS, odds ratio: 1.41; 95% CI: 0.13-15.06). A network meta-analysis identified DPSs to be the best device for the drainage of necrotic collection from necrotizing pancreatitis (P-score: 0.24, 0.53, and 0.73 for DPSs, mFCSEMSs, and LAMSs, respectively). Furthermore, the network meta-analysis revealed that the rate of adverse events was the lowest for mFCSEMSs. The direct meta-analysis indicated no significant difference in the rate of adverse events between LAMSs and DPSs (RR: 0.50; 95% CI: 0.06-4.10) or between mFCSEMSs and DPSs (RR: 0.19; 95% CI: 0.01-3.78). Among the three types of stents examined in the present study, the rate of clinical success was the highest for DPSs and that of adverse events was the lowest for mFCSEMSs. Systematic reviews should be conducted frequently to update the literature with findings from new RCTs on this crucial topic.
