Malnutrition is common in patients with advanced esophageal cancer and is associated with poor outcomes. While esophageal stenting can relieve dysphagia, oral intake alone is often insufficient. Percutaneous endoscopic gastrostomy (PEG) provides reliable nutritional support but does not address obstructive symptoms. Data on the combined use of these approaches are limited. We retrospectively analyzed 16 patients with esophageal cancer who underwent combined esophageal stenting and PEG between January 2016 and December 2024, including 10 who underwent simultaneous procedures and 6 who underwent non-simultaneous procedures. Changes in serum albumin, hemoglobin, and Karnofsky Performance Status (KPS) scores from baseline to 1 month after treatment were analyzed. The mean age was 63.13 ± 10.36 years, and 75.0

Gastrostomy tube placement is the preferred modality for long-term nutritional management in individuals with oral feeding disorders. However, acceptance of this intervention is often impeded by reluctance to discontinue oral feeding, concerns about increased caregiver burden, and apprehension regarding life prolongation with diminished quality of life. These factors may generate decisional conflict, negatively affecting patients’ physical and psychological well-being and treatment outcomes. In this study, we aimed to explore the facilitators and barriers influencing gastrostomy-related decision-making among patients with cancer and dysphagia, providing a theoretical and empirical basis for developing culturally tailored decision aids and structured communication pathways. A qualitative descriptive design was employed. In-depth one-on-one interviews were conducted with 18 patients with cancer and dysphagia who had engaged in gastrostomy decision-making at two tertiary hospitals in Fujian Province, China. The transcripts were coded using NVivo and analyzed using conventional content analysis. Three overarching themes with seven subthemes were identified. Theme 1 included decision-making motivation, which comprised three subthemes: disease perception and survival needs, supportive communication from healthcare providers, and support from family members and peers. Theme 2 included decision-making challenges, which included two subthemes: emotional-rational dissonance and insufficient decision-making information. Theme 3 comprised decision-making optimization and included two subthemes: enhancing the transparency of gastrostomy-related information and improving the efficacy of healthcare provider-patient communication. Effective healthcare provider-patient communication and support from family members and peers emerged as key facilitators of decision-making regarding gastrostomy tube placement, whereas emotional-rational conflicts and informational deficits constituted major barriers. Future efforts should focus on developing culturally tailored, multimodal decision aids integrating paper and digital formats, establishing structured communication pathways that integrate these tools, and strengthening family-peer support while ensuring that autonomous decisions are aligned with patient values. Not applicable.

Acute variceal bleeding (AVB) is a common life-threatening complication of portal hypertension (PHT), having a six-week mortality of 10%-20%. Major advances in the hemodynamic management, risk stratification, pharmacotherapy, endoscopy techniques, hemostatic devices and radiological interventions have led to improved management and outcome of AVB patients in the recent past. Therefore, the APASL Portal Hypertension Working Party, chose a panel of experts, primarily from the Asia-Pacific region, to identify important developments and controversial areas in the field of AVB. They discussed through a pre-defined and structured process, advances in the field and proposed updates to the previous APASL AVB guidelines. These included emphasis on safe transportation, defining time frames for AVB episodes and re-bleeding, reporting of clinical outcomes, optimizing early intervention strategies, pharmacotherapy, medical management, endoscopic therapies, and salvage modalities, including TIPS and self-expanding metal stents. The current updates also cover variceal bleeding in special populations and situations, the skill sets required for managing AVB patients, and the research priorities in the field. The updated guidelines are based on the latest evidence and incorporate emerging trends to provide a contemporary template for management of AVB in both patients with cirrhosis and non-cirrhotic portal hypertension.

Helicobacter pylori (H. pylori) infection is a major driver of gastric diseases, but with a global prevalence of nearly 50%, precise risk stratification among infected individuals remains challenging. Here, we constructed a comprehensive H. pylori proteome microarray encompassing 1,631 proteins and applied it to screen sera from patients with chronic atrophic gastritis (CAG), providing a practical entry point to dissect virulence-host interactions that shape disease progression. Through systematic screening, we identified glutamate pyruvate transaminase (Gpt) as a CAG-associated antigen. In independent validation cohorts, anti-Gpt IgG demonstrated high accuracy in distinguishing patients with CAG from those with chronic non-atrophic gastritis among H. pylori-infected individuals. Mechanistically, Gpt binds to the cystine/glutamate antiporter subunit SLC7A11 with nanomolar affinity (KD = 14.8 nM), destabilizing the SLC7A11-SLC3A2 heterodimer and thereby impairing cystine uptake. Consequently, Gpt reduces the antioxidant capacity of gastric epithelial cells by depleting glutathione, downregulating GPX4, and increasing lipid peroxidation, ultimately triggering ferroptosis. This ferroptotic phenotype is reversed by the ferroptosis inhibitor liproxstatin-1 and is markedly reduced during infection with a gpt-deficient H. pylori strain. Finally, in gastric biopsy samples from patients with CAG, Gpt expression spatially coincides with malondialdehyde accumulation, supporting in vivo activation of ferroptosis. These findings identify Gpt as a previously unrecognized H. pylori virulence factor that promotes CAG through ferroptosis, and they highlight anti-Gpt IgG as a promising noninvasive biomarker for risk stratification in H. pylori infection, enabling the identification of individuals at higher risk of progressing to precancerous gastric lesions.

BACKGROUND:Stricture is a major adverse event following esophageal endoscopic submucosal dissection (ESD). Although postoperative esophageal stenosis after ESD is clearly associated with large mucosal defects, there are no quantitative criteria for the degree of the defect. We aimed to examine the predictive factors associated with the development of esophageal stenosis after ESD, and to explore quantitative indicators for predicting postoperative stenosis. PATIENTS AND METHODS:A retrospective analysis of endoscopic data from patients with esophageal ESD was conducted. The area and perimeter of the resected mucosa defect were measured by Image Pro Plus 6.0. Logistic regression, receiver operating characteristic (ROC) curve, and nomogram model were adopted for analysis. RESULTS:The median area of resected mucosal defect was 527.74 mm2 (IQR 322.80-823.48), the median perimeter was 91.75 mm (IQR 71.69-118.32), and the median circumferential ratio was 33% (IQR 20-40). Owing to collinearity between the perimeter and area of the resected mucosal defect, these variables were analyzed individually in the multivariate analysis (r = 0.958, P < 0.001). All three factors mentioned above were identified as independent risk factors for postoperative esophageal stenosis (P < 0.05), while intraoperative muscularis propria injury was not (P > 0.05). On the basis of the above results, prediction models were constructed and validated internally. The concordance statistics (C-statistics) of the training and validation sets including perimeter or area were 0.875 and 0.830 and 0.747 and 0.835, respectively. The Hosmer-Lemeshow goodness-of-fit test results were not significant (P > 0.05). CONCLUSIONS:Accurate quantification of the area and perimeter of resected mucosa by image analysis technology can accurately predict esophageal stenosis after ESD.

To investigate the effects of colonoscopic administration of probiotics on patients with irritable bowel syndrome with predominant diarrhea (IBS-D) by a single-center, randomized-controlled trial. Consecutive outpatients at the First Affiliated Hospital of Fujian Medical University who met the Rome IV diagnostic criteria for IBS-D (n = 22) and healthy subjects (n = 10) from January 2017 to January 2018 were enrolled. IBS-D patients were randomly divided into either the probiotics or the placebo group. During the colonoscopy examination, a suspension of live combined Bifidobacterium with Lactobacillus tablets and normal saline was sprayed into the right colon of patients in the probiotics and the placebo group, respectively. All subjects’ clinical data and stool samples were collected before, 2 weeks and 4 weeks after colonoscopic treatment. Twenty-nine subjects completed the follow-up. A significant difference was found in the frequency of defecation at 2 weeks, and the abdominal Visual Analog Score and Bristol stool scale at 4 weeks after probiotics treatment. The gastrointestinal symptom rating scale and IBS severity score decreased significantly and the IBS Quality of Life Instrument score increased 2 weeks after probiotics treatment (p < 0.05). The comprehensive therapeutic index was 70.0

Abstract Malnutrition in cancer patients is the result of a variety of factors. Decreased intake, absorption disorders, metabolic disorders and increased REE are the main causes of malnutrition. The incidence of malnutrition in cancer patients is higher than that in patients with benign diseases, and the consequences are more serious. Malnourished cancer patients have more comorbidities and complications, higher medical costs, shorter survival times, and decreased tolerance and sensitivity to tumor-control therapy. Therefore, cancer patients are in greater need of nutrition therapy, which should become a necessary basic treatment and a first-line treatment for cancer. NST should be the core member of the multidisciplinary integrated treatment [multidisciplinary treatment (MDT) to holistic integrative management (HIM)] of cancer.

Self-expanding metal stents (SEMS) relieve dysphagia but may cause complications. This study assessed the safety of long-term SEMS indwelling, identified risk factors, and developed a Cox model for restenosis prediction. A retrospective study was conducted at two centers, including 412 patients who underwent stenting (2015–2025). Complications were compared across indwelling times (< 30, 30–59, ≥ 60 days) and indications (benign, malignant). Logistic regression, Kaplan–Meier, and Cox analyses identified predictors, and a nomogram was constructed. The overall complication rate was 64.6

BACKGROUND:The Rockall score (RS) is used to assess the prognosis of patients with nonvariceal upper gastrointestinal bleeding. Aims: To establish the Revised Rockall Score (RRS) that incorporates an assessment of endoscopic treatment results, and analyze the discriminative ability of the RRS for 30-day rebleeding and mortality in patients with nonvariceal upper gastrointestinal bleeding. METHODS:We retrospectively analyzed data from 432 patients between January 2016 and December 2019 (derivation cohort), and further evaluated in an independent population of 290 patients between January 2020 and December 2022 (validation cohort). Clinical records and biological data were collected. The outcome variables were rebleeding and mortality, whereas the explanatory variables were the RS and RRS. The predictive accuracy of the two scoring systems was evaluated using the receiver operating characteristic curve (AUROC). RESULTS:In the derivation cohort, the RRS achieved a higher area under the AUROC for predicting rebleeding (AUROC: RS, 0.75; RRS, 0.88; p < 0.0001), mortality (AUROC: RS, 0.87; RRS, 0.94; p = 0.001), and rebleeding and/or mortality (AUROC: RS, 0.78; RRS, 0.90; p < 0.0001) than the RS. In the validation cohort, the RRS also achieved a higher AUROC for predicting rebleeding (AUROC: RS, 0.80; RRS, 0.89; p < 0.001), mortality (AUROC: RS, 0.79; RRS, 0.89; p = 0.004), and rebleeding and/or mortality (AUROC: RS, 0.80; RRS, 0.91; p < 0.001) than the RS. CONCLUSIONS:Compared to the RS, the RRS had higher discriminative ability in predicting the risk of rebleeding and mortality.

To compare the clinical outcomes in patients with acute perforated peptic ulcer (PPU) treated with over-the-scope clip (OTSC), non-surgical, and surgical interventions, and to explore the effectiveness and safety of OTSC closure. Hospital stay, antibiotic use, diet resumption time, and mortality rate were analyzed retrospectively. Binary Logistic regression analysis was used to identify the risk factors influencing PPU complicated with sepsis. Patients were divided into three treatment groups: OTSC (n = 62), non-surgical (n = 72), and surgical (n = 55) groups. The median time (IQR) from symptom onset to admission was 9.0 (4–23) h. 88.71

This review provides an overview of the treatment options available for gastric varices (GV) with a focus on endoscopic methods. Various minimally invasive techniques, including endoscopic band ligation, endoscopic cyanoacrylate injection, and transjugular intrahepatic portosystemic shunt, can be applied to the treatment of GV. Endoscopic cyanoacrylate injection is now recognized as a first-line treatment for GV. Endoscopic ultrasound-guided cyanoacrylate injection combined with coils has shown good security and effectiveness. Thrombin injection therapy is a promising treatment, with a similar hemostasis rate to cyanoacrylate injection but with fewer serious complications. With the deepening understanding of the hemodynamics of the GV system, various treatment methods and their combination are gradually evaluated to provide patients with safer and more effective treatment options.

Transnasal intubation is a clinical operation usually performed blindly at the bedside.Mild adverse events,such as epistaxis and tube misplacement,are relatively common.Esophageal bleeding or perforation and other serious adverse events are rare.In the present study,two cases of severe diffuse esophageal bleeding caused by the blind placement of a nasogastric tube are described.These cases were successfully treated using a covered metal stent or Sengstaken-Blakemore tube.A review of the literature regarding the possible causes of such adverse events and the potential endoscopic treatments for severe hemorrhage are discussed.

Purpose: To explore the effects of the clinical pathway on the outcomes of patients with non-variceal upper gastrointestinal bleeding. Materials and Methods: Randomized controlled trial. The study was conducted in two medical centers in China from 1 June 2022 to 31 December 2022. Patients with a diagnosis of non-variceal upper gastrointestinal bleeding who provided written informed consent were consecutively assigned to the intervention group. The patients in the intervention group were treated using the clinical pathway, while the control group received routine care and follow-up. Time, cost, complications, and prognostic indicators were analyzed. Intentional-to-treat analysis and per-protocol analysis were used for data analysis. Results: A total of 114 eligible patients with non-variceal upper gastrointestinal bleeding were randomly divided into two groups and included in the intention-to-treat analysis. In addition, 106 patients were included in the per-protocol analysis. The median age of the 106 patients was 57 years (range, 18-92 years) and 83.0% were male. There were no significant differences between groups regarding the baseline characteristics. The intervention group demonstrated a statistically significantly shorter length of stay, lower hospital cost (ie, cost during hospitalization, cost in the emergency room, and cost in the ward), significantly fewer cases of complications, and a higher level of patient satisfaction when compared with the control group. There was no significant difference between the two groups in the rates of transfusion, repeat endoscopy, rebleeding readmission, and mortality. Conclusion: The implementation of the clinical pathway for patients with non-variceal upper gastrointestinal bleeding may help improve patient outcomes and satisfaction.

Imbalance in the microbiota has been identified in Crohn's disease (CD). We explored the difference of the microbiota in fecal and intestinal mucosa (including ileocecal junction, terminal ileum and transverse colon) in pediatric patients with active CD, CD patients in remission, nonspecific enteritis (NE) and the healthy children. Seven children had active CD, 5 cases of patients achieve remission (CDR), 19 were NE patients, and 11 were healthy controls (Col). A total of 168 samples were collected. Microbiota compositions were analyzed using 16 ​S rRNA sequencing. The results showed that, in fecal samples, Clostridium_sensu_stricto, Enterobacter and Akkermansia had a higher relative abundance in the CD group than that in CDR, Col and NE groups. Fusobacterium and Streptococcus showed a higher abundance in both CD and CDR than that in Col group. In intestinal mucosa samples, the bacterial communities of the three sampling sites were extremely similar. Escherichia-Shigella was the most abundant mucosal bacteria in the CD group, and the abundance of Bacillus, Ruminococcus_torques_group, Streptococcus, Faecalibacterium and Blautia was lower in the CD group than in other groups. In conclusion, as a very characteristic bacteria, the abundance of Escherichia-Shigella in the intestinal mucosa can be used as a diagnostic criterion for CD patients. Also, the Bacilus and Blautia, which were not as prominent as Escherichia-Shigella could still be used as a diagnostic candidate due to their neatness in CD patients. Mucosal samples may be better than stool samples when assessing the community and diversity of patients' intestinal microbes.

BACKGROUND/AIM:Gastric acid reflux into the esophagus can cause irritation and inflammation of the esophagus and progress to reflux esophagitis (RE). Vitamin D3 (VitD3) has anti-inflammatory effects and plays an important regulatory role in adaptive and innate immunity. We hypothesized that VitD3 may play a protective role in RE. MATERIALS AND METHODS:Seventy male Sprague-Dawley rats were used, and acute RE (n=35) or chronic RE (n=35) were surgically induced. The effects of different doses of VitD3 on morphological changes and alteration of pro-inflammatory cytokine levels were examined in the rat models. Western blot analysis was performed to determine protein expression levels of IL-1β, IL-6, and IL-8 in esophageal tissues. Serum levels of VitD3 and calcium were determined using enzyme-linked immunosorbent assays. RESULTS:The protein expression of pro-inflammatory cytokines IL-1β, IL-6, and IL-8 was found significantly increased in RE. VitD3 treatment significantly reduced the levels of these pro-inflammatory cytokines in both the low-dose and high-dose VitD3 groups compared to control groups in acute RE, but not chronic RE. Macrographic and histopathological examination revealed various degrees of esophageal impairment in rats following surgical induction of acute or chronic RE in rats. These impairments were not improved by VitD3. Morphological grading of esophageal mucosa showed no significant differences between acute and chronic RE. Elevated serum levels of calcium were observed after VitD3 treatment. CONCLUSION:IL-1β, IL-6, and IL-8 levels were significantly elevated in RE. The abnormal increase in these important pro-inflammatory cytokines was suppressed by VitD3 in the rat models of acute RE. These novel findings suggest a potential protective role of VitD3 in early-stage RE.