BACKGROUND Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction and is characterized by chronic abdominal pain and altered bowel habits. Current evidence indicates that immune activation and autoantibody production contribute to IBS pathogenesis. However, the mechanisms by which autoantibodies affect the enteric nervous system and contribute to IBS-related symptoms are poorly understood.AIM To investigate the role of anti-human antigen D [HuD, also known as ELAV-like protein 4 (ELAVL4)] autoantibodies in enteric neuronal apoptosis in an IBS animal model. METHODS A passive-transfer rat model of IBS was generated by intraperitoneal administration of HuD autoantibodies. Gastrointestinal motility, visceral sensitivity, fecal output, and water content were assessed. Enteric neuronal apoptosis in intestinal tissues and primary enteric neurons was analyzed by immunofluorescence. Mechanisms were examined using quantitative reverse transcription polymerase chain reaction, western blotting, and confocal microscopy. Interventions included recombinant HuD, immunoglobulin, 5-hydroxytryptamine receptor modulators, and protein kinase C (PKC) agonists. RESULTS Administration of HuD autoantibodies induced IBS-like phenotypes in rats. We observed increased fecal output, elevated fecal water content, accelerated intestinal transit, and enhanced visceral hypersensitivity. HuD autoantibody exposure significantly increased enteric neuronal apoptosis in vivo and in vitro and suppressed the expression of special AT-rich sequence-binding protein 1 (SATB1). Mechanistically, HuD autoantibodies disrupted HuD-mediated RNA regulation, leading to SATB1 downregulation and inhibition of the phosphatidylinositol 3-kinase (PI3K)-protein kinase B (AKT) signaling pathway. PKC activation restored HuD and SATB1 expression, reactivated PI3K-AKT signaling, and significantly reduced neuronal apoptosis. Treatment with immunoglobulin and 5-hydroxytryptamine receptor agonists showed limited or inconsistent protective effects. CONCLUSION HuD autoantibodies induced enteric neuronal apoptosis through disruption of the HuD-SATB1-PI3K-AKT signaling axis and contributed to IBS-like gastrointestinal dysfunction. Activation of PKC may be a potential therapeutic strategy for IBS.

BACKGROUND Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction and is characterized by chronic abdominal pain and altered bowel habits. Current evidence indicates that immune activation and autoantibody production contribute to IBS pathogenesis. However, the mechanisms by which autoantibodies affect the enteric nervous system and contribute to IBS-related symptoms are poorly understood. AIM To investigate the role of anti-HuD autoantibodies in enteric neuronal apoptosis in an IBS animal model. METHODS A passive-transfer rat model of IBS was generated by intraperitoneal administration of HuD autoantibodies. Gastrointestinal motility, visceral sensitivity, fecal output, and water content were assessed. Enteric neuronal apoptosis in intestinal tissues and primary enteric neurons was analyzed by immunofluorescence. Mechanisms were examined using quantitative reverse transcription polymerase chain reaction, western blotting, and confocal microscopy. Interventions included recombinant HuD, immunoglobulin, 5-hydroxytryptamine receptor modulators, and protein kinase C (PKC) agonists. RESULTS Administration of HuD autoantibodies induced IBS-like phenotypes in rats. We observed increased fecal output, elevated fecal water content, accelerated intestinal transit, and enhanced visceral hypersensitivity. HuD autoantibody exposure significantly increased enteric neuronal apoptosis in vivo and in vitro and suppressed the expression of special AT-rich sequence-binding protein 1 (SATB1). Mechanistically, HuD autoantibodies disrupted HuD-mediated RNA regulation, leading to SATB1 downregulation and inhibition of the phosphatidylinositol 3-kinase (PI3K)-protein kinase B (AKT) signaling pathway. PKC activation restored HuD and SATB1 expression, reactivated PI3K-AKT signaling, and significantly reduced neuronal apoptosis. Treatment with immunoglobulin and 5-hydroxytryptamine receptor agonists showed limited or inconsistent protective effects. CONCLUSION HuD autoantibodies induced enteric neuronal apoptosis through disruption of the HuD-SATB1-PI3K-AKT signaling axis and contributed to IBS-like gastrointestinal dysfunction. Activation of PKC may be a potential therapeutic strategy for IBS.

Metabolic dysfunction-associated steatotic liver disease (MASLD), as a metabolic liver disease, is emerging as the most prevalent chronic liver disease worldwide. Metabolic dysfunction-associated steatohepatitis (MASH) is the severe form of MASLD, which progresses from simple steatosis to an inflammatory state, even fibrosis and hepatocellular carcinoma. Accumulating evidence has proved that cell death is a hallmark of MASH, while the specific pathogenesis remains unclear. Several cell deaths, including apoptosis, necroptosis, autophagy, and pyroptosis, have been studied in MASLD/MASH. In recent years, ferroptosis, a novel iron-dependent non-apoptotic form of cell death characterized by the excessive accumulation of intracellular iron and lipid peroxidation, has emerged as a promising target in MASLD/MASH. In this review, we mainly summarize the mechanism of ferroptosis and describe the role of ferroptosis in the progression of MASLD to MASH and related diseases, including liver fibrosis and hepatocellular carcinoma. Then, we discussed the crosstalk between ferroptosis and other cell deaths in MASLD/MASH. Finally, we focus on the potential therapeutic applications of targeting ferroptosis in MASH, which might shed light on the future directions of MASH treatment.

Helicobacter pylori (H. pylori) eradication regimens may have different effects on the gut microbiota. Few studies have analyzed the safety of high-dose dual therapy (HDDT) from a micro-ecological perspective. This study aimed to compare the impact of H. pylori eradication with HDDT and bismuth quadruple therapy (BQT) on gut microbiota. H. Pylori-infected treatment-naive patients were recruited and screened from September 2023 to April 2024 and randomly assigned to the HDDT group (esomeprazole 20 mg, amoxicillin 750 mg, qid, 14 days) or BQT group (esomeprazole 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth potassium citrate 600 mg, bid, 14 days). Fresh stool specimens were collected and stored before treatment and at week 2 and week 8 after treatment. The diversity and composition of the gut microbiota were compared and analyzed in both groups using 16 S rRNA gene sequencing. Forty-nine H. pylori positive patients were enrolled and randomly assigned to either the HDDT (n = 24) or the BQT group (n = 25) group. Compared with baseline, alpha and beta diversities significantly changed at week 2 after receiving BQT and did not recover fully at week 8. However, in the HDDT group, the diversities at week 2 changed mildly without statistical significance, compared to baseline. Additionally, a greater number of species had alterations in their abundances in the BQT group compared to the HDDT group at week 2. However, the abundances of these species were restored to their previous levels at week 8 in both the HDDT and BQT groups. Compared to BQT, HDDT exerted less impact on the diversity and composition of the gut microbiota. ChiCTR2100053268.

This study investigates the knowledge of the high-dose dual therapy (HDDT) in the eradication of Helicobacter pylori (H pylori) infection among gastroenterologists in China. A survey was conducted among gastroenterologists in China using the "Questionnaire Star," and the questionnaire link was sent by WeChat. Descriptive methods were used for statistical analysis. A total of 863 valid questionnaires were collected. The awareness rate of HDDT was 96.5%, and the clinical utilization rate was 69.1%.12.4%, 29.9%, and 25.6% gastroenterologists chose HDDT for the first-line, rescue and refractory treatment of H pylori infection. Amoxicillin was the most commonly used antibiotic in HDDT, followed by clarithromycin, furazolidone, levofloxacin, metronidazole, cefuroxime and tetracycline. Potassium-competitive acid blockers (51.8%) were the most commonly acid inhibitors in high-dose double therapy, followed by proton pump inhibitors and H2-receptor blockers. Most gastroenterologists believed that high-dose double therapy would become the main method of first-line and rescue treatment of H pylori infection. HDDT maybe the main treatment of H pylori eradication, but the application of the HDDT among gastroenterologists in China is insufficient. Better education should be carried out in future to improve the ability of gastroenterologists to standardize the treatment of H pylori infection.

Background:Aspirin is widely used to prevent and treat cardiovascular diseases. The most common side effect is gastrointestinal damage. In recent years, aspirin-associated enteropathy has received increasing attention. This study aimed to establish a chronic model of aspirin-associated enteropathy, investigate the effect of enteric-coated aspirin on the intestinal flora, and explore the specific molecular mechanism of small intestinal damage. Methods:C57BL/6J mice were given aspirin for 45 days to induce chronic small intestinal injury. The intestinal mucosal injury was observed macroscopically and microscopically. Intestinal mucus levels were assessed by PAS staining. The intestinal permeability was measured by FD4. The oxidative stress levels of the small intestine were detected by immunofluorescence and immunohistochemistry. The mRNA and protein levels of inflammatory factors, tight junctions, and antioxidant defense-related genes were measured by qRT-PCR and Western Blot. The MPO activity, SOD activity and MDA content in serum were measured. The mitochondrial morphology and paracellular space were observed under transmission electron microscopy. The fecal samples were analyzed by high-throughput sequencing of 16S rRNA V3-V4 amplicons. Results:Aspirin induced weight loss, reduced food intake and increased faecal occult blood in mice. Aspirin led to a shortened small intestine, macroscopic and microscopic damage to the intestinal mucosa, and local inflammation. Aspirin disrupted the intestinal barriers and increased the permeability of the small intestine. Aspirin destroyed mitochondrial structure and damaged antioxidant capacity, and aspirin may induce oxidative stress through Nrf2/Gpx4 signaling pathway. Intestinal flora analysis showed that aspirin could induce changes in the abundance of Akkermansia and Lactobacillus. Conclusion:Long-term administration of enteric-coated aspirin successfully established a chronic small intestinal injury model in mice. It increased oxidative stress in the small intestine by disrupting mitochondrial structure and impairing antioxidant capacity. This damaged the intestinal mucosal barrier, increased intestinal permeability, and triggered gut microbial dysbiosis and inflammation.

BACKGROUND:Short videos have demonstrated huge potential in disseminating health information in recent years. However, to our knowledge, no study has examined information about colorectal polyps on short-video sharing platforms. OBJECTIVE:This study aimed to analyze the content and quality of colorectal polyps-related videos on short-video sharing platforms. METHODS:The terms "" (intestinal polyps) or "" (colonic polyps) or "" (rectal polyps) or "" (colorectal polyps) or "" (polyps of large intestine) were used to search in TikTok (ByteDance), WeChat (Tencent Holdings Limited), and Xiaohongshu (Xingyin Information Technology Limited) between May 26 and June 8, 2024, and then the top 100 videos for each search term on different platforms were included and recorded. The Journal of American Medical Association (JAMA) score, the Global Quality Scale (GQS), the modified DISCERN, and the Patient Education Materials Assessment Tool (PEMAT) were used to evaluate the content and quality of selected videos by 2 independent researchers. SPSS (version 22.0; IBM Corp) and GraphPad Prism (version 9.0; Dotmatics) were used for analyzing the data. Descriptive statistics were generated, and the differences between groups were compared. Spearman correlation analysis was used to evaluate the relationship between quantitative variables. RESULTS:A total of 816 eligible videos were included for further analysis, which mainly conveyed disease-related knowledge (n=635, 77.8%). Most videos were uploaded by physicians (n=709, 86.9%). These videos had an average JAMA score of 2.0 (SD 0.6), GQS score of 2.5 (SD 0.8), modified DISCERN score of 2.5 (SD 0.8), understandability of 80.4% (SD 15.6%), and actionability of 42.2% (SD 36.1%). Videos uploaded by news agencies were of higher quality and received more likes and comments (all P<.05). The number of collections and shares of videos about posttreatment caveats were more than those for other content (P=.03 and P=.006). There was a positive correlation between the number of likes, comments, collections, and shares (all P<.001). The duration and the number of fans were positively correlated with the quality of videos (all P<.05). CONCLUSIONS:There are numerous videos about colorectal polyps on short-video sharing platforms, but the reliability and quality of these videos are not good enough and need to be improved.

BACKGROUND N6-methyladenosine (m6A) methylation modification exists in Epstein-Barr virus (EBV) primary infection, latency, and lytic reactivation. It also modifies EBV latent genes and lytic genes. EBV-associated gastric cancer (EBVaGC) is a distinctive molecular subtype of GC. We hypothesized EBV and m6A methylation regulators interact with each other in EBVaGC to differentiate it from other types of GC. AIM To investigate the mechanisms of m6A methylation regulators in EBVaGC to determine the differentiating factors from other types of GC. METHODS First, The Cancer Gene Atlas and Gene Expression Omnibus databases were used to analyze the expression pattern of m6A methylation regulators between EBVaGC and EBV-negative GC (EBVnGC). Second, we identified Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment of m6A-related differentially expressed genes. We quantified the relative abundance of immune cells and inflammatory factors in the tumor microenvironment (TME). Finally, cell counting kit-8 cell proliferation test, transwell test, and flow cytometry were used to verify the effect of insulin-like growth factor binding protein 1 (IGFBP1) in EBVaGC cell lines. RESULTS m6A methylation regulators were involved in the occurrence and development of EBVaGC. Compared with EBVnGC, the expression levels of m6A methylation regulators Wilms tumor 1-associated protein, RNA binding motif protein 15B, CBL proto-oncogene like 1, leucine rich pentatricopeptide repeat containing, heterogeneous nuclear ribonucleoprotein A2B1, IGFBP1, and insulin-like growth factor 2 binding protein 1 were significantly downregulated in EBVaGC (P < 0.05). The overall survival rate of EBVaGC patients with a lower expression level of IGFBP1 was significantly higher (P = 0.046). GO and KEGG functional enrichment analyses showed that the immunity pathways were significantly activated and rich in immune cell infiltration in EBVaGC. Compared with EBVnGC, the infiltration of activated CD4+ T cells, activated CD8+ T cells, monocytes, activated dendritic cells, and plasmacytoid dendritic cells were significantly upregulated in EBVaGC (P < 0.001). In EBVaGC, the expression level of proinflammatory factors interleukin (IL)-17, IL-21, and interferon-γ and immunosuppressive factor IL-10 were significantly increased (P < 0.05). In vitro experiments demonstrated that the expression level of IGFBP1 was significantly lower in an EBVaGC cell line (SNU719) than in an EBVnGC cell line (AGS) (P < 0.05). IGFBP1 overexpression significantly attenuated proliferation and migration and promoted the apoptosis levels in SNU719. Interfering IGFBP1 significantly promoted proliferation and migration and attenuated the apoptosis levels in AGS. CONCLUSION m6A regulators could remodel the TME of EBVaGC, which is classified as an immune-inflamed phenotype and referred to as a “hot” tumor. Among these regulators, we demonstrated that IGFBP1 affected proliferation, migration, and apoptosis.

Increasing antibiotic resistance is the primary reason for treatment failure of Helicobacter pylori (H. pylori) infection. To enhance the eradication rate, minimize the development of secondary resistance, and alleviate the socioeconomic burden, it is crucial to select H. pylori-sensitive antibiotics carefully. Furazolidone has been used for H. pylori eradication in developing countries for decades due to its affordability and low resistance rate. Numerous studies have demonstrated that furazolidone-containing regimens are more efficacious than those containing other antibiotics, as both first- and second-line therapies, and are also well tolerated. However, utility of furazolidone is restricted or not optimal in certain countries due to its infrequent but potentially severe adverse effects. The decision to discontinue usage of furazolidone because of concerns regarding adverse effects may be misguided. Here we comprehensively reviewed the studies on furazolidone at different dosages and treatment durations for H. pylori eradication. Further research on the mechanisms of action and clinical trials of furazolidone are of great practical importance.

ObjectiveThis meta-analysis aimed to comprehensively explore the risk factors for inadequate bowel preparation (IBP).MethodsWe searched the Embase, PubMed, Web of Science, and The Cochrane Library databases up to August 24, 2023, to identify observational studies and randomized controlled trials (RCTs) that examined risk factors for IBP. A random effects model was used to pool the adjusted odds ratios and 95% confidence intervals.ResultsA total of 125 studies (91 observational studies, 34 RCTs) were included. Meta-analyses of observational studies revealed that three preparation-related factors, namely, characteristics of last stool (solid or brown liquid), incomplete preparation intake, and incorrect diet restriction, were strong predictors of IBP. The other factors were moderately correlated with IBP incidence, including demographic variables (age, body mass index, male sex, Medicaid insurance, and current smoking), comorbidities (diabetes, liver cirrhosis, psychiatric disease, Parkinson's disease, previous IBP, poor mobility, inpatient, and Bristol stool form 1/2), medications (tricyclic antidepressants, opioids, antidepressants, narcotics, antipsychotics, and calcium channel blockers), and preparation-related factors (preparation-to-colonoscopy interval not within 3 to 5/6 h, nonsplit preparation, and preparation instructions not followed). No colonoscopy indications were found to be related to IBP. Meta-analyses of RCTs showed that education, constipation, stroke/dementia, and discomfort during preparation were also moderately associated with IBP. Most of the other findings were consistent with the pooled results of observational studies. However, primarily due to imprecision and inconsistency, the certainty of evidence for most factors was very low to moderate.ConclusionsWe summarized five categories of risk factors for IBP. Compared to demographic variables, comorbidities, medications, and colonoscopy indications, preparation-related elements were more strongly associated with IBP. These findings may help clinicians identify high-risk individuals and provide guidance for IBP prevention.

Background Contradictory evidence suggested gastric xanthelasma (GX) was associated with some upper gastrointestinal (GI) diseases. Additionally, no research has been performed on the relationship between esophageal/duodenal xanthelasma and upper GI diseases. Methods Individuals who underwent esophagogastroduodenoscopy at Tongji Hospital, Tongji Medical College, participated in this retrospective study. This study evaluated whether the risk of GX or esophageal/duodenal xanthelasma was influenced by the following gastroesophageal diseases: superficial gastritis, gastric polyp, bile reflux, peptic ulcer, reflux esophagitis, Barrett’s esophagus, esophageal cancer, atrophic gastritis (AG), intestinal metaplasia (IM), dysplasia, gastric cancer, and Helicobacter pylori (H. pylori) infection. Furthermore, subgroup analysis was conducted to establish the relationship between the number of GX and upper GI diseases. Results Of the 69,071 subjects reviewed, 1,220 (1.77%) had GX, and 54 (0.08%) had esophageal/duodenal xanthelasma. There was no difference in the prevalence of upper GI diseases between patients with and without esophageal/duodenal xanthelasma. Nevertheless, compared with non-xanthelasma patients, GX patients had a greater proportion of AG, IM, dysplasia, gastric cancer, and H. pylori infection and a lower incidence of superficial gastritis (p < 0.05). The multivariate logistic regression analysis indicated AG (OR = 1.83, 95%CI: 1.56–2.16), IM (OR = 2.42, 95%CI: 2.41–2.85), and H. pylori infection (OR = 1.32, 95%CI: 1.17–1.50) were independent risk factors for GX. In addition, patients with multiple GXs had a higher rate of AG and IM than those with single GX. Conclusion Esophageal/duodenal xanthelasma may not be associated with upper GI diseases, and further research is needed to support this hypothesis. Notably, GX, especially multiple GXs, may be a more easily detected warning sign of AG, IM, or H. pylori infection.

Hepatocellular carcinoma (HCC) is the most prevalent form of liver cancer and has an increasing incidence worldwide. The management of HCC still has many restrictions, despite the fact that there are now numerous treatment options, including liver transplantation/resection, locoregional treatments (LRT), and systemic medication. As a turning point in the history of cancer treatment, the discovery of the immune checkpoints and the development of their inhibitors provide new hope for HCC patients. However, limited objective response rate and insignificant overall survival improvement are still urgent problems to be solved for immune checkpoint inhibitors (ICIs). Combination therapies are considered a solution for improving the effectiveness and response rate of ICIs, and several forms of combination treatments are currently being actively researched. In this review, we summarize the mainstream combination strategies, explain their theoretical basis, introduce several important and ongoing clinical trials, and suggest some potential future paths in this area at the conclusion of the review. AVAILABILITY OF DATA AND MATERIALS: Not applicable.

BACKGROUND:High-dose dual therapy (HDDT) is an emerging and promising therapeutic regime for Helicobacter pylori (H. pylori) eradication. However, the pharmacokinetics of the components of HDDT, amoxicillin and proton pump inhibitor, are likely to be affected by body size. In this study, we aimed to find out the impact of body size on the efficacy of HDDT. METHODS:We collected the medical data of 385 treatment-naive patients infected with H. pylori who received HDDT (esomeprazole 20 mg and amoxicillin 750 mg four times daily) for 14 days from July 2020 to December 2021. The associations among the eradication efficacy, adverse events, and variables (sex, age, height, body weight, body mass index (BMI), body surface area (BSA), smoking, drinking, etc.) were analyzed respectively in our study. Among these factors, continuous variables were classified into categorical variables using the cut-off values which were calculated by receiver operating characteristic analysis. RESULTS:The eradication rate of HDDT was 89.9%. There were 55 (14.3%) patients who occurred adverse events during the treatment. Patients with height <170.5 cm, body weight <60.5 kg, BMI <20.55 kg/m2 , BSA <1.69 m2 had a higher eradication rate (92.1% vs. 84.0%, 93.1% vs. 86.8%, 96.0% vs. 87.8%, 93.4% vs. 84.8%, all p < .05). The multivariate analysis showed that BSA ≥1.69 m2 (OR 2.53, 95% CI: 1.28-4.99, p = .007) was the only independent predictor of eradication failure. CONCLUSION:HDDT could achieve better eradication efficacy in patients with small BSA. Clinicians should be aware of the impact of BSA on the H. pylori eradication rate and pay more attention to patients with large BSA.

BACKGROUND:This study aimed to obtain an overview of clinical trials on Helicobacter pylori (H. pylori) eradication and analyze the global trends and hotspots in this field. METHODS:We collected the data from clinical trials focused on H. pylori eradication in the primary clinical trial registries from 2000 to 2022 in the world. Then we analyzed the research trends and hotspots in H. pylori eradication regimens in different regions at different periods. RESULTS:A total of 780 clinical trials were included, which were mainly conducted in Asia (682), followed by Europe (59), Africa (20), North America (16), South America (7), Oceania (2). The most active countries were China (343), Iran (140), South Korea (63), and Japan (73). "Bismuth-containing quadruple therapy (BQT)" was the most studied regimen (159, 20.38 %). Additionally, clinical trials focused on potassium-competitive acid blockers (P-CABs)-based therapy, probiotics, and high-dose dual therapy (HDDT) were constantly increasing. BQT received the most attention in China (26.53 %) and Iran (22.14 %), while it was tailored therapy in South Korea (23.29 %). P-CABs-based therapy was the main reseach hotspot in Japan (61.90 %). CONCLUSION:How to eradicate H. pylori infection has been a heated research topic. BQT, P-CABs-based therapy, probiotics, and HDDT attracted the most attention in recent years.

BackgroundThe performance of existing image-based training models in evaluating bowel preparation on colonoscopy videos was relatively low, and only a few models used external data to prove their generalization. Therefore, this study attempted to develop a more precise and stable AI system for assessing bowel preparation of colonoscopy video.MethodsWe proposed a system named ViENDO to assess the bowel preparation quality, including two CNNs. First, Information-Net was used to identify and filter out colonoscopy video frames unsuitable for Boston bowel preparation scale (BBPS) scoring. Second, BBPS-Net was trained and tested with 5,566 suitable short video clips through three-dimensional (3D) convolutional neural network (CNN) technology to detect BBPS-based insufficient bowel preparation. Then, ViENDO was applied to complete withdrawal colonoscopy videos from multiple centers to predict BBPS segment scores in clinical settings. We also conducted a human-machine contest to compare its performance with endoscopists.ResultsIn video clips, BBPS-Net for determining inadequate bowel preparation generated an area under the curve of up to 0.98 and accuracy of 95.2%. When applied to full-length withdrawal colonoscopy videos, ViENDO assessed bowel cleanliness with an accuracy of 93.8% in the internal test set and 91.7% in the external dataset. The human-machine contest demonstrated that the accuracy of ViENDO was slightly superior compared to most endoscopists, though no statistical significance was found.ConclusionThe 3D-CNN-based AI model showed good performance in evaluating full-length bowel preparation on colonoscopy video. It has the potential as a substitute for endoscopists to provide BBPS-based assessments during daily clinical practice.

Aim: Different researches showed controversial results about the 'off-hours effect' in nonvariceal upper gastrointestinal bleeding (NVUGIB). Materials & methods: A total of 301 patients with NVUGIB were divided into regular-hours group and off-hours group based on when they received endoscopic hemostasis, and the relationship of the clinical outcomes with off-hours endoscopic hemostasis was evaluated. Results: Patients who received off-hours endoscopy were sicker and more likely to experience worse clinical outcomes. Off-hours endoscopic hemostasis was a significant predictor of the composite outcome in higher-risk patients (adjusted OR: 4.63; 95% CI: 1.35-15.90). However, it did not associate with the outcomes in lower-risk patients. Conclusion: Off-hours effect may affect outcomes of higher-risk NVUGIB patients receiving endoscopic hemostasis (GBS ≥12).

目的:比较分析非静脉曲张性上消化道出血(NVUGIB)床边急诊内镜与择期内镜治疗的临床特点和疗效.方法:回顾性收集304例NVUGIB并接受内镜止血治疗患者的病例资料,其中接受床边急诊内镜的152例患者纳入急诊内镜组,接受择期内镜止血的152例患者纳入择期内镜组,比较分析2组患者的一般情况、病情严重程度、疗效等.结果:2组患者的一般情况、病因构成、止血方式无明显差异(P均＞0.05),与择期内镜组比较,急诊内镜组患者血红蛋白量和血小板计数低,凝血时间延长,AIMS65评分及内镜前Rockall(pRS)评分较高(P均＜0.01),输血率高(60.4％vs 47.4％,P＜0.01),输血量多(P＜0.01),再出血率高(12.2％vs 3.9％,P＜0.01),住院时间更长(P＜0.01).2组患者止血成功率都在80％以上,并发症发生率和死亡率无明显统计学差异(P＞0.05).结论:对于NVUGIB患者,需行床边急诊内镜止血者失血情况严重,凝血功能差,其输血量、再出血率、住院时间均较高或较长,但死亡率与择期内镜止血治疗者相近.

目的 基于国内外临床试验注册数据库汇总分析目前幽门螺杆菌(Helicobacter pylori,H.pylori)感染临床试验注册资料,探讨我国H.pylori感染注册临床试验的特点及发展趋势,为今后开展H.pylori感染相关临床试验提供参考.方法 利用关键词检索国内外各临床试验注册中心数据库所有与H.pylori感染相关的临床试验,提取资料并汇总分析.结果 截至2021年8月10日,共纳入国内外804项H.pylori感染相关注册临床试验,注册数量总体上呈逐年上升趋势.其中我国316项,主要分布于经济文化水平相对发达的地区,研究类型以干预性研究为主(233项,73.7％),多为单中心研究(79.8％),样本量集中在101～500例(59.5％).干预性研究主要有四联治疗(49项)、PPI+抗生素二联治疗(30项)、三联治疗(19项)、个体化治疗(19项)、益生菌+抗H.pylori治疗(19项).结论 我国H.pylori感染相关注册临床试验数量增长迅速,以干预性研究和单中心研究为主,今后需进一步推动高质量临床试验的开展.

[目的]了解武汉综合性医院消化科及心内科医务人员对"第5次全国幽门螺杆菌感染处理共识报告"(下简称"共识")的认知情况.[方法]于2019年3月对武汉5家综合性医院消化科及心内科医务人员共613例进行问卷调查.调查问卷结合"共识"拟定,包括幽门螺杆菌(Helicobacter pylori,Hp)相关性疾病、检测和根除适应证、根除方法等.[结果]共收回有效问卷604份,应答率为98.5％.消化科医生、心内科医生、消化科护技和心内科护技对"共识"的知晓率分别为 93.3％(112/120)、16.8％(19/113)、38.4％(78/203)、22.6％(38/168)(x2=243.60,P＜0.01).消化科医生对于Hp根除适应证的知晓率均明显高于心内科医生、消化和心内科护技人员(P＜0.05).78.8％(93/118)消化科医生推荐含铋剂四联的根除Hp方案,高于心内科医生(52.3％,56/107)、消化科护技(58.7％,118/201)、心内科护技(33.9％,56/165)(P＜0.05).对于阿莫西林、甲硝唑等药物耐药率问题,消化科医生认知率也还不足,但高于其他医务人员(P＜0.01).39.2％(47/120)消化科医生认为无消化道症状也会主动选择查Hp,21.7％(26/120)消化科医生在家人有Hp感染时会选择分餐.[结论]武汉综合性医院消化科医生比其他医务人员更了解"共识",但对"共识"内容的掌握仍有待继续加强.

含铋剂的四联治疗是目前国内外共识推荐根除幽门螺杆菌( H. pylori)感染的一线治疗方案，但其仍有用药品种多、不良反应率高、治疗成本高等局限性，因此，二联治疗又重新引起关注。标准剂量阿莫西林和质子泵抑制剂(PPI)二联治疗在早期的探索中未能取得令人满意的结果，但大剂量二联治疗的多项临床研究均取得了令人满意的根除率，其不良反应较含铋剂四联治疗少，患者依从性较高，且治疗成本更低。本文综述大剂量阿莫西林和PPI二联治疗方案对 H. pylori的根除效果及其作用机制研究进展，并介绍含新型抑酸剂的二联治疗方案的应用现状。