Irritable bowel syndrome (IBS) is a functional gut disorder with high prevalence.Because of various factors involved in its pathophysiology and disappointing results from conventional IBS medications,the treatment of ...Irritable bowel syndrome (IBS) is a functional gut disorder with high prevalence.Because of various factors involved in its pathophysiology and disappointing results from conventional IBS medications,the treatment of IBS is challenging and use of complementary and alternative medicines especially herbal therapies is increasing.In this paper,electronic databases including PubMed,Scopus,and Cochrane library were searched to obtain any in vitro,in vivo or human studies evaluating single or compound herbal preparations in the management of IBS.One in vitro,3 in vivo and 23 human studies were included and systematically reviewed.The majority of studies are about essential oil of Menta piperita as a single preparation and STW 5 as a compound preparation.Some evaluated herbs such as Curcuma xanthorriza and Fumaria officinalis did not demonstrate any benefits in IBS.However,it seems there are many other herbal preparations such as those proposed in traditional medicine of different countries that could be studied and investigated for their efficacy in management of IBS.展开更多
The distribution or NOS-BI In the myenterlc plexus or the rabbit small ho'vels was studied by using NOS--BI lmm unohlstoc hemlstry with cool emount stal nl ug method. The resul is Indicatedthat the NOS--BI-like lm...The distribution or NOS-BI In the myenterlc plexus or the rabbit small ho'vels was studied by using NOS--BI lmm unohlstoc hemlstry with cool emount stal nl ug method. The resul is Indicatedthat the NOS--BI-like lmmunoreactlvity was observed in all specimens or myenterlc plexus. These positive nerve fibers rorlned a regular, ladder-like meSkwork in the myenterlc plexus. The positive product deposited in the cytoplasm, and the majority of NOS-BI neurons had ckaracterlstlcs similar to theDoglel type 1. Thes. cells had many short and long Process. This study provided the morphologicalsupport for the bypotbesls that NO Is pro'duced by neurons and serves as a neurotransmitter in therabbit small bowels.展开更多
The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can i...The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can improve the results of colonoscopy,it may interfere with the gut microbiota.Bowel preparation for colonoscopy can lead to transient changes in the gut microbiota,potentially affecting an individual’s health,especially in vulnerable populations,such as patients with inflammatory bowel disease.However,measures such as oral pro-biotics may ameliorate these adverse effects.We focused on the bowel prepa-ration-induced changes in the gut microbiota and host health status,hypothesized the factors influencing these changes,and attempted to identify measures that may reduce dysbiosis,thereby providing more information for individualized bowel preparation for colonoscopy in the future.展开更多
In this article,we explored the role of adipose tissue,especially mesenteric adipose tissue and creeping fat,and its association with the gut microbiota in the pathophysiology and progression of Crohn’s disease(CD).C...In this article,we explored the role of adipose tissue,especially mesenteric adipose tissue and creeping fat,and its association with the gut microbiota in the pathophysiology and progression of Crohn’s disease(CD).CD is a form of inflammatory bowel disease characterized by chronic inflammation of the gastrointestinal tract,influenced by genetic predisposition,gut microbiota dysbiosis,and environmental factors.Gut microbiota plays a crucial role in modulating immune response and intestinal inflammation and is associated with the onset and progression of CD.Further,visceral adipose tissue,particularly creeping fat,a mesenteric adipose tissue characterized by hypertrophy and fibrosis,has been implicated in CD pathogenesis,inflammation,and fibrosis.The bacteria from the gut microbiota may translocate into mesenteric adipose tissue,contributing to the formation of creeping fat and influencing CD progression.Although creeping fat may be a protective barrier against bacterial invasion,its expansion can damage adjacent tissues,leading to complications.Modulating gut microbiota through interventions such as fecal microbiota transplantation,probiotics,and prebiotics has shown potential in managing CD.However,more research is needed to clarify the mechanisms linking gut dysbiosis,creeping fat,and CD progression and develop targeted therapies for microbiota modulation and fat-related complications in patients with CD.展开更多
BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improp...BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.展开更多
BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literatu...BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.展开更多
Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immu...Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immunological response,environmental exposure,particularly the gut microbiota,and genetic suscept-ibility represents the major determinants.The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans.The gut virome varies greatly among individuals and is influenced by factors including lifestyle,diet,health and disease conditions,geography,and urbanization.The majority of research has focused on the significance of gut bacteria in the progression of IBD,although viral populations represent an important component of the microbiome.We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.展开更多
BACKGROUND Excessive endoplasmic reticulum(ER)stress in intestinal epithelial cells can lead to damage to the intestinal mucosal barrier,activate the signal transducer and activator of transcription 3(STAT3)/nuclear f...BACKGROUND Excessive endoplasmic reticulum(ER)stress in intestinal epithelial cells can lead to damage to the intestinal mucosal barrier,activate the signal transducer and activator of transcription 3(STAT3)/nuclear factor kappa B(NF-κB)signaling pathway,and exacerbate the inflammatory response,thus participating in the pathogenesis of ulcerative colitis(UC).Mesalazine is a commonly used drug in the clinical treatment of UC.However,further studies are needed to determine whether mesalazine regulates the ER stress of intestinal epithelial cells,downregulates the STAT3/NF-κB pathway to play a role in the treatment of UC.AIM To study the therapeutic effects of mesalazine on spontaneous colitis in interleukin-10(IL-10)-/-mice.METHODS The 24-week-old IL-10-/-mice with spontaneous colitis were divided into the model group and the 5-amino salicylic acid group.Littermates of wild-type mice of the same age group served as the control.There were eight mice in each group,four males and four females.The severity of symptoms of spontaneous colitis in IL-10-/-mice was assessed using disease activity index scores.On day 15,the mice were sacrificed.The colon length was measured,and the histopathological changes and ultrastructure of colonic epithelial cells were detected.The protein expressions of STAT3,p-STAT3,NF-κB,IκB,p-IκB,and glucoseregulated protein 78 were identified using Western blotting.The STAT3 and NF-κB mRNA expressions were identified using real-time polymerase chain reaction.The glucose-regulated protein 78 and C/EBP homologous protein expressions in colon sections were detected using immunofluorescence.RESULTS Mesalazine reduced the symptoms of spontaneous colitis in IL-10 knockout mice and the histopathological damage of colonic tissues,and alleviated the ER stress in epithelial cells of colitis mice.Western blotting and quantitative real-time polymerase chain reaction results showed that the STAT3/NF-κB pathway in the colon tissue of model mice was activated,suggesting that this pathway was involved in the pathogenesis of UC and might become a potential therapeutic target.Mesalazine could down-regulate the protein expressions of p-STAT3,NF-κB and p-IκB,and down-regulate the mRNA expression of STAT3 and NF-κB.CONCLUSION Mesalazine may play a protective role in UC by reducing ER stress by regulating the STAT3/NF-κB signaling pathway.展开更多
BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patie...BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.展开更多
BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory condition requiring continuous treatment and monitoring.There is limited pharmacokinetic data on vedolizumab during maintenance therapy and the effect of thio...BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory condition requiring continuous treatment and monitoring.There is limited pharmacokinetic data on vedolizumab during maintenance therapy and the effect of thiopurines on vedolizumab trough concentrations is unknown.AIM To investigate the exposure-response relationship of vedolizumab and the impact of thiopurine withdrawal in UC patients who have achieved sustained clinical and endoscopic remission during maintenance therapy.METHODS This is a post-hoc analysis of prospective randomized clinical trial(VIEWS)involving UC patients across 8 centers in Australia from 2018 to 2022.Patients in clinical and endoscopic remission were randomized to continue or withdraw thiopurine while receiving vedolizumab.We evaluated vedolizumab serum trough concentrations,presence of anti-vedolizumab antibodies,and clinical outcomes over 48 weeks to assess exposure-response asso-ciation and impact of thiopurine withdrawal.RESULTS There were 62 UC participants with mean age of 43.4 years and 42%were females.All participants received vedolizumab as maintenance therapy with 67.7%withdrew thiopurine.Vedolizumab serum trough concentrations remained stable over 48 weeks regardless of thiopurine use,with no anti-vedolizumab antibodies detected.Pa-tients with clinical remission had higher trough concentrations at week 48.In quartile analysis,a threshold of>11.3μg/mL was associated with sustained clinical remission,showing a sensitivity of 82.4%,specificity of 60.0%,and an area of receiver operating characteristic of 0.71(95%CI:0.49-0.93).Patients discontinuing thiopurine required higher vedolizumab concentrations for achieving remission.CONCLUSION A positive exposure-response relationship between vedolizumab trough concentrations and UC outcomes suggests that monitoring drug levels may be beneficial.While thiopurine did not influence vedolizumab levels,its with-drawal may necessitate higher vedolizumab trough concentrations to maintain remission.展开更多
BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD....BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.展开更多
BACKGROUND Bullous pemphigoid(BP)is an autoimmune blistering skin disorder.It is associated with other autoimmune disorders and the use of certain drugs.We describe a case of BP in a patient with ulcerative colitis(UC...BACKGROUND Bullous pemphigoid(BP)is an autoimmune blistering skin disorder.It is associated with other autoimmune disorders and the use of certain drugs.We describe a case of BP in a patient with ulcerative colitis(UC)treated with mesalamine.CASE SUMMARY A 38-year-old male patient with UC and a history of multiple flares was maintained on mesalamine with good clinical response.One year after starting mesalamine,he sought medical care following the onset of a severe itchy rash of several weeks’duration with a recent appearance of skin bullae.A biopsy of the skin revealed subepidermal blistering dermatitis with focal eosinophilic spongiosis.Direct immunofluorescence studies revealed linear IgG and C3 immune reactant deposits at the dermoepidermal junction,consistent with the diagnosis of BP.Prednisone therapy alleviated his symptoms.However,tapering prednisone led to re-eruption of the bullae.CONCLUSION BP should be considered when patients with UC develop skin manifestations.Although BP is not one of the extraintestinal manifestations of UC,there may be an association between these two conditions.Whether treatment with mesalamine or other therapeutic agents plays a role in the development of BP remains unclear.展开更多
Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic ...Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.展开更多
Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions accou...Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.展开更多
Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical ...Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.展开更多
This pictorial review discusses the imaging approach to evaluate for proper placement or complications of pediatric gastrostomy tube(G-tube)placement and long-term use.G-tubes are crucial for long-term nutritional sup...This pictorial review discusses the imaging approach to evaluate for proper placement or complications of pediatric gastrostomy tube(G-tube)placement and long-term use.G-tubes are crucial for long-term nutritional support in patients facing challenges with oral intake.The article depicts the role of imaging such as contrast radiography,fluoroscopy,ultrasound,and computed tomography scans for confirming G-tube position and evaluating complications,in addition to basic anatomical considerations and placement techniques.Complications discussed include malposition,intraperitoneal placement,buried bumper syndrome,and tube malfunction.Specific imaging techniques and checklists are provided to guide clinicians in assessing G-tube placement accurately.The latter half of the review is a comprehensive exploration of pearls and pitfalls of imaging when employed to detect complications to avoid false positives and negatives.展开更多
BACKGROUND The relationship between exercise and gastrointestinal(GI)health is complex and bidirectional.While moderate exercise generally promotes gut health by enhancing motility,reducing inflammation,and supporting...BACKGROUND The relationship between exercise and gastrointestinal(GI)health is complex and bidirectional.While moderate exercise generally promotes gut health by enhancing motility,reducing inflammation,and supporting microbial balance,intense or prolonged physical activity may exacerbate GI symptoms,particularly in individuals with preexisting digestive disorders.A deeper understanding of this interplay is essential for optimizing both exercise performance and GI well-being.AIM To synthesize current evidence on exercise-related GI disorders,exploring the prevalence,mechanisms,risk factors,and management strategies associated with exercise-induced GI symptoms.METHODS Following PRISMA guidelines,comprehensive searches of databases,including PubMed,Scopus,Web of Science,and EMBASE were conducted.Studies were included if they focused on exercise-induced GI disorders,encompassed randomized controlled trials,cohort studies,case-control studies,and cross-sectional designs,and addressed symptoms across various exercise modalities.Data were extracted and analyzed to identify patterns and implications for clinical and athletic practice.RESULTS A total of 231 studies met the inclusion criteria,highlighting both the benefits and risks of exercise on GI health.Regular moderate-intensity exercise,including activities such as walking,cycling,and yoga has been associated with improved GI function in conditions like gastroesophageal reflux disease,irritable bowel syndrome,inflammatory bowel disease,and constipation.These benefits are attributed to enhanced intestinal motility,reduced systemic inflammation,and improved gut barrier integrity.Additionally,exercise plays a role in regulating the gut-brain axis,with practices like yoga and Tai Chi demonstrating particular effectiveness in alleviating functional GI disorders.Conversely,high-intensity or prolonged exercise may contribute to symptoms such as nausea,diarrhea,and abdominal pain due to mechanisms like splanchnic hypoperfusion and increased intestinal permeability.Individual factors,including fitness level,dietary habits,hydration status,and underlying GI conditions,significantly influence the body’s response to exercise.CONCLUSION Moderate-intensity exercise is a beneficial and well-tolerated intervention for promoting GI health,whereas highintensity activities require careful monitoring,particularly in individuals with pre-existing GI disorders.Personalized exercise and dietary strategies are essential for balancing the benefits of physical activity with the risk of GI distress.Further research is needed to explore the long-term effects of exercise on gut microbiota composition and overall digestive health.展开更多
Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due...Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.展开更多
Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease result...Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease resulting from pa-thogenic mutations causing impairment in the protective mechanism of the GIT.Around 10%-15%of patients with very early onset IBDs may have an underlying monogenic condition.Monogenic IBD is very different from complex forms of polygenic IBD in the underlying molecular basis of uncontrolled intestinal inflam-mation,age of onset,extraintestinal comorbidities as well as treatment modality.An in-depth understanding of this distinct form of IBD is essential for deciding an appropriate therapeutic approach as well as prognostication.In this review,we aim to discuss about the epidemiology,clinical presentation,diagnostic approach,therapeutic challenges and latest advances in patients with monogenic IBD.展开更多
The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodo...The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodological challenges hinder its immediate use in clinical practice.Notably,the current research was retrospective,lacks comparative studies with fecal calprotectin,and did not provide long-term predictive data.Further prospective studies are needed to improve the applicability of LRG.Moreover,integrating LRG with additional biomarkers and employing artificial intelligence techniques may improve its effectiveness in disease monitoring.Future research should address interobserver variability,assess LRG's cost-effectiveness,and standardize endoscopic healing definitions to ensure broader applicability.Advancing these areas is vital for establishing LRG's role in precision medicine strategies for the management of CD.展开更多
文摘Irritable bowel syndrome (IBS) is a functional gut disorder with high prevalence.Because of various factors involved in its pathophysiology and disappointing results from conventional IBS medications,the treatment of IBS is challenging and use of complementary and alternative medicines especially herbal therapies is increasing.In this paper,electronic databases including PubMed,Scopus,and Cochrane library were searched to obtain any in vitro,in vivo or human studies evaluating single or compound herbal preparations in the management of IBS.One in vitro,3 in vivo and 23 human studies were included and systematically reviewed.The majority of studies are about essential oil of Menta piperita as a single preparation and STW 5 as a compound preparation.Some evaluated herbs such as Curcuma xanthorriza and Fumaria officinalis did not demonstrate any benefits in IBS.However,it seems there are many other herbal preparations such as those proposed in traditional medicine of different countries that could be studied and investigated for their efficacy in management of IBS.
文摘The distribution or NOS-BI In the myenterlc plexus or the rabbit small ho'vels was studied by using NOS--BI lmm unohlstoc hemlstry with cool emount stal nl ug method. The resul is Indicatedthat the NOS--BI-like lmmunoreactlvity was observed in all specimens or myenterlc plexus. These positive nerve fibers rorlned a regular, ladder-like meSkwork in the myenterlc plexus. The positive product deposited in the cytoplasm, and the majority of NOS-BI neurons had ckaracterlstlcs similar to theDoglel type 1. Thes. cells had many short and long Process. This study provided the morphologicalsupport for the bypotbesls that NO Is pro'duced by neurons and serves as a neurotransmitter in therabbit small bowels.
文摘The term“gut microbiota”primarily refers to the ecological community of various microorganisms in the gut,which constitutes the largest microbial community in the human body.Although adequate bowel preparation can improve the results of colonoscopy,it may interfere with the gut microbiota.Bowel preparation for colonoscopy can lead to transient changes in the gut microbiota,potentially affecting an individual’s health,especially in vulnerable populations,such as patients with inflammatory bowel disease.However,measures such as oral pro-biotics may ameliorate these adverse effects.We focused on the bowel prepa-ration-induced changes in the gut microbiota and host health status,hypothesized the factors influencing these changes,and attempted to identify measures that may reduce dysbiosis,thereby providing more information for individualized bowel preparation for colonoscopy in the future.
基金Supported by the Postdoctoral Scholarship Grant,No.5552/2024 PROPG/PROPE N°06/2024.
文摘In this article,we explored the role of adipose tissue,especially mesenteric adipose tissue and creeping fat,and its association with the gut microbiota in the pathophysiology and progression of Crohn’s disease(CD).CD is a form of inflammatory bowel disease characterized by chronic inflammation of the gastrointestinal tract,influenced by genetic predisposition,gut microbiota dysbiosis,and environmental factors.Gut microbiota plays a crucial role in modulating immune response and intestinal inflammation and is associated with the onset and progression of CD.Further,visceral adipose tissue,particularly creeping fat,a mesenteric adipose tissue characterized by hypertrophy and fibrosis,has been implicated in CD pathogenesis,inflammation,and fibrosis.The bacteria from the gut microbiota may translocate into mesenteric adipose tissue,contributing to the formation of creeping fat and influencing CD progression.Although creeping fat may be a protective barrier against bacterial invasion,its expansion can damage adjacent tissues,leading to complications.Modulating gut microbiota through interventions such as fecal microbiota transplantation,probiotics,and prebiotics has shown potential in managing CD.However,more research is needed to clarify the mechanisms linking gut dysbiosis,creeping fat,and CD progression and develop targeted therapies for microbiota modulation and fat-related complications in patients with CD.
文摘BACKGROUND Internal hernia(IH)is a rare culprit of small bowel obstruction(SBO)with an incidence of<1%.It poses a considerable diagnostic challenge requiring a high index of suspicion to prevent misdiagnosis,improper treatment,and subsequent morbidity and mortality.AIM To determine the clinico-demographic profile,radiological and operative findings,and postoperative course of patients with IH and its association with SBO.METHODS Medical records of 586 patients with features of SBO presenting at a tertiary care centre at Lucknow,India between September 2010 and August 2023 were reviewed.RESULTS Out of 586 patients,7(1.2%)were diagnosed with IH.Among these,4 had congenital IH and 3 had acquired IH.The male-to-female ratio was 4:3.The median age at presentation was 32 years.Contrast-enhanced computed tomography(CECT)was the most reliable investigation for preoperative identification,demonstrating mesenteric whirling and clumped-up bowel loops.Left paraduodenal hernia and transmesenteric hernia occurred with an equal frequency(approximately 43%each).Intraoperatively,one patient was found to have bowel ischemia and one had associated malrotation of gut.During follow-up,no recurrences were reported.CONCLUSION IH,being a rare cause,must be considered as a differential diagnosis for SBO,especially in young patients in their 30s or with unexplained abdominal pain or discomfort post-surgery.A rapid imaging evaluation,preferably with CECT,is necessary to aid in an early diagnosis and prompt intervention,thereby reducing financial burden related to unnecessary investigations and preventing the morbidity and mortality associated with closed-loop obstruction and strangulation of the bowel.
文摘BACKGROUND Patients with inflammatory bowel disease are at a 2-8-fold higher risk of deve-loping venous thromboembolism(VTE)as compared to the general population.Although the exact pathogenesis is unclear,the literature suggests that increased risk of thromboembolic events in such patients occurs as a result of increased coagulation factors,inflammatory cytokines,and reduction in anticoagulants leading to a prothrombotic state.AIM To assess the prevalence,risk factors,management,and outcome of ulcerative colitis(UC)patients who develop VTE.METHODS This was a retrospective chart review done in The Gastroenterology Department of The Aga Khan University Hospital.Data was collected from medical records for all patients admitted with a diagnosis of UC from January 2012 to December 2022.RESULTS Seventy-four patients fulfilled the inclusion criteria.The mean±SD of age at presentation of all UC patients was 45 years±10 years whereas for those who developed VTE,it was 47.6 years±14.7 years.Hypertension and diabetes were the most common co-morbid seen among UC patients with a frequency of 17(22.9%)and 12(16.2%),respectively.A total of 5(6.7%)patients developed VTE.Deep venous thrombosis was the most common thromboembolic phenomenon seen in 3(60%)patients.All the patients with UC and concomitant VTE were discharged home(5;100%).CONCLUSION The prevalence of VTE with UC in Pakistani patients corresponds with the international literature.However,multi-centric studies are required to further explore these results.
文摘Inflammatory bowel disease(IBD)is a chronic inflammatory illness of the intes-tine.While the mechanism underlying the pathogenesis of IBD is not fully under-stood,it is believed that a complex combination of host immunological response,environmental exposure,particularly the gut microbiota,and genetic suscept-ibility represents the major determinants.The gut virome is a group of viruses found in great frequency in the gastrointestinal tract of humans.The gut virome varies greatly among individuals and is influenced by factors including lifestyle,diet,health and disease conditions,geography,and urbanization.The majority of research has focused on the significance of gut bacteria in the progression of IBD,although viral populations represent an important component of the microbiome.We conducted this review to highlight the viral communities in the gut and their expected roles in the etiopathogenesis of IBD regarding published research to date.
基金Supported by Xi’an Science and Technology Plan Project,No.23YXYJ0162Shaanxi Province Traditional Chinese Medicine Research and Innovation Talent Plan Project,No.TZKN-CXRC-16+2 种基金Project of Shaanxi Administration of Traditional Chinese Medicine,No.SZYKJCYC-2025-JC-010Shaanxi Province Key Research and Development Plan Project-Social Development Field,No.S2025-YF-YBSF-0391the Science and Technology Innovation Cultivation Program of Longhua Hospital affiliated to Shanghai University of Chinese Medicine,No.YD202220。
文摘BACKGROUND Excessive endoplasmic reticulum(ER)stress in intestinal epithelial cells can lead to damage to the intestinal mucosal barrier,activate the signal transducer and activator of transcription 3(STAT3)/nuclear factor kappa B(NF-κB)signaling pathway,and exacerbate the inflammatory response,thus participating in the pathogenesis of ulcerative colitis(UC).Mesalazine is a commonly used drug in the clinical treatment of UC.However,further studies are needed to determine whether mesalazine regulates the ER stress of intestinal epithelial cells,downregulates the STAT3/NF-κB pathway to play a role in the treatment of UC.AIM To study the therapeutic effects of mesalazine on spontaneous colitis in interleukin-10(IL-10)-/-mice.METHODS The 24-week-old IL-10-/-mice with spontaneous colitis were divided into the model group and the 5-amino salicylic acid group.Littermates of wild-type mice of the same age group served as the control.There were eight mice in each group,four males and four females.The severity of symptoms of spontaneous colitis in IL-10-/-mice was assessed using disease activity index scores.On day 15,the mice were sacrificed.The colon length was measured,and the histopathological changes and ultrastructure of colonic epithelial cells were detected.The protein expressions of STAT3,p-STAT3,NF-κB,IκB,p-IκB,and glucoseregulated protein 78 were identified using Western blotting.The STAT3 and NF-κB mRNA expressions were identified using real-time polymerase chain reaction.The glucose-regulated protein 78 and C/EBP homologous protein expressions in colon sections were detected using immunofluorescence.RESULTS Mesalazine reduced the symptoms of spontaneous colitis in IL-10 knockout mice and the histopathological damage of colonic tissues,and alleviated the ER stress in epithelial cells of colitis mice.Western blotting and quantitative real-time polymerase chain reaction results showed that the STAT3/NF-κB pathway in the colon tissue of model mice was activated,suggesting that this pathway was involved in the pathogenesis of UC and might become a potential therapeutic target.Mesalazine could down-regulate the protein expressions of p-STAT3,NF-κB and p-IκB,and down-regulate the mRNA expression of STAT3 and NF-κB.CONCLUSION Mesalazine may play a protective role in UC by reducing ER stress by regulating the STAT3/NF-κB signaling pathway.
基金Supported by the China Health Promotion Foundation Young Doctors'Research Foundation for Inflammatory Bowel Disease,the Taishan Scholars Program of Shandong Province,China,No.tsqn202306343National Natural Science Foundation of China,No.82270578.
文摘BACKGROUND Inflammatory bowel disease(IBD)is a global health burden that affects millions of individuals worldwide,necessitating extensive patient education.Large language models(LLMs)hold promise for addressing patient information needs.However,LLM use to deliver accurate and comprehensible IBD-related medical information has yet to be thoroughly investigated.AIM To assess the utility of three LLMs(ChatGPT-4.0,Claude-3-Opus,and Gemini-1.5-Pro)as a reference point for patients with IBD.METHODS In this comparative study,two gastroenterology experts generated 15 IBD-related questions that reflected common patient concerns.These questions were used to evaluate the performance of the three LLMs.The answers provided by each model were independently assessed by three IBD-related medical experts using a Likert scale focusing on accuracy,comprehensibility,and correlation.Simultaneously,three patients were invited to evaluate the comprehensibility of their answers.Finally,a readability assessment was performed.RESULTS Overall,each of the LLMs achieved satisfactory levels of accuracy,comprehensibility,and completeness when answering IBD-related questions,although their performance varies.All of the investigated models demonstrated strengths in providing basic disease information such as IBD definition as well as its common symptoms and diagnostic methods.Nevertheless,when dealing with more complex medical advice,such as medication side effects,dietary adjustments,and complication risks,the quality of answers was inconsistent between the LLMs.Notably,Claude-3-Opus generated answers with better readability than the other two models.CONCLUSION LLMs have the potential as educational tools for patients with IBD;however,there are discrepancies between the models.Further optimization and the development of specialized models are necessary to ensure the accuracy and safety of the information provided.
基金Supported by Takeda Australia,No.IISR-2016-101883.
文摘BACKGROUND Ulcerative colitis(UC)is a chronic inflammatory condition requiring continuous treatment and monitoring.There is limited pharmacokinetic data on vedolizumab during maintenance therapy and the effect of thiopurines on vedolizumab trough concentrations is unknown.AIM To investigate the exposure-response relationship of vedolizumab and the impact of thiopurine withdrawal in UC patients who have achieved sustained clinical and endoscopic remission during maintenance therapy.METHODS This is a post-hoc analysis of prospective randomized clinical trial(VIEWS)involving UC patients across 8 centers in Australia from 2018 to 2022.Patients in clinical and endoscopic remission were randomized to continue or withdraw thiopurine while receiving vedolizumab.We evaluated vedolizumab serum trough concentrations,presence of anti-vedolizumab antibodies,and clinical outcomes over 48 weeks to assess exposure-response asso-ciation and impact of thiopurine withdrawal.RESULTS There were 62 UC participants with mean age of 43.4 years and 42%were females.All participants received vedolizumab as maintenance therapy with 67.7%withdrew thiopurine.Vedolizumab serum trough concentrations remained stable over 48 weeks regardless of thiopurine use,with no anti-vedolizumab antibodies detected.Pa-tients with clinical remission had higher trough concentrations at week 48.In quartile analysis,a threshold of>11.3μg/mL was associated with sustained clinical remission,showing a sensitivity of 82.4%,specificity of 60.0%,and an area of receiver operating characteristic of 0.71(95%CI:0.49-0.93).Patients discontinuing thiopurine required higher vedolizumab concentrations for achieving remission.CONCLUSION A positive exposure-response relationship between vedolizumab trough concentrations and UC outcomes suggests that monitoring drug levels may be beneficial.While thiopurine did not influence vedolizumab levels,its with-drawal may necessitate higher vedolizumab trough concentrations to maintain remission.
文摘BACKGROUND Mucosal healing has become an important goal of Crohn’s disease(CD)treat-ments.Modulen,enriched with transforming growth factor-beta 2,and budeso-nide are commonly accepted treatments for mild-moderate CD.However,their effects on the small bowel(SB)mucosa remain underexplored.AIM To prospectively assess clinical and mucosal responses to Modulen vs budesonide in adults with CD,using SB capsule endoscopy.METHODS Thirty patients were divided into two groups:Modulen+home-based diet(21 patients)and budesonide(9 patients)for an eight-week intervention followed by four weeks of follow-up.Clinical,laboratory,and endoscopic responses were evaluated.The mucosal changes were assessed through SB capsule endoscopy.RESULTS Results indicated significant clinical improvement in the Modulen group with reduced CD activity index(P=0.041)and improved inflammatory bowel disease questionnaire score(P=0.016).Moreover,Modulen was associated with a signifi-cant SB mucosal improvement,evidenced by a decrease in Lewis score(P=0.027).No significant changes were observed in calprotectin or other laboratory parame-ters.Conversely,budesonide exhibited more modest clinical effects,but it improved calprotectin,hemoglobin,and C-reactive protein levels(P=0.051,P=0.014,and P=0.038,respectively).The capsule endoscopy did not reveal a significant mucosal response in the budesonide group.CONCLUSION Both interventions have a role in CD treatment.Yet,their effects differ and may complement each other:Modulen yields clinical and mucosal improvements,while budesonide primarily leads mainly to laboratory improvements.
文摘BACKGROUND Bullous pemphigoid(BP)is an autoimmune blistering skin disorder.It is associated with other autoimmune disorders and the use of certain drugs.We describe a case of BP in a patient with ulcerative colitis(UC)treated with mesalamine.CASE SUMMARY A 38-year-old male patient with UC and a history of multiple flares was maintained on mesalamine with good clinical response.One year after starting mesalamine,he sought medical care following the onset of a severe itchy rash of several weeks’duration with a recent appearance of skin bullae.A biopsy of the skin revealed subepidermal blistering dermatitis with focal eosinophilic spongiosis.Direct immunofluorescence studies revealed linear IgG and C3 immune reactant deposits at the dermoepidermal junction,consistent with the diagnosis of BP.Prednisone therapy alleviated his symptoms.However,tapering prednisone led to re-eruption of the bullae.CONCLUSION BP should be considered when patients with UC develop skin manifestations.Although BP is not one of the extraintestinal manifestations of UC,there may be an association between these two conditions.Whether treatment with mesalamine or other therapeutic agents plays a role in the development of BP remains unclear.
文摘Pediatric inflammatory bowel disease(PIBD)is a chronic inflammatory disorder of the gastrointestinal tract,with rising global incidence and prevalence.Over the past two decades,biologics have added to the therapeutic armamentarium and revolutionized the approach to treatment of inflammatory bowel disease.The available biologics include monoclonal antibodies which target inflammatory cytokines(anti-tumor necrosis factor alpha,anti-interleukin 12/23)or recruitment of leucocytes to the gastrointestinal tract(anti-alpha4beta7 integrin)and small molecules(Janus kinase inhibitors,sphingosine 1-phosphate-inhibitors)which modify the proinflammatory signaling.Considering their potential disease-modifying ability,recent pediatric guidelines from the West have advocated upfront use of biologics in appropriate clinical scenarios as a top-down approach rather than the conventional step-up approach.Although real-world studies are available regarding the clinical efficacy of biologics in PIBD,there is paucity of long-term outcome and safety data in children.Also,little information is available about the best approach in the newly industrialized-developing countries where PIBD is rising but at the same time,infections are prevalent and resources are limited.In this review,we summarize the efficacy and safety profile of biologics and small molecule drugs and discuss the challenges in the management of PIBD,especially in the developing world,and future directions.
文摘Bowel obstruction is a frequent reason for hospital admissions and can be categorized into small or large,partial or complete obstructions.While small bowel obstructions occur more often,large bowel obstructions account for 20%-25%of all cases,primarily aff ecting elderly patients.[1]Malignancy is the leading cause of large bowel obstruction and is responsible for 50%-60%of cases.Other causes include idiopathic,volvulus,infl ammatory,hernia,adhesion,intussusception,endometriosis,and functional colon disorders.[1]Colonic volvulus is the third most common cause of large bowel obstruction.Most cases of colonic volvulus occur in the sigmoid(60%-70%)and cecum(25%-40%)regions.[2]In contrast,transverse colon volvulus(TCV)is rare,accounting for less than 3%of large bowel obstructions.[3]This condition has a high mortality rate of 18%-33%,predominantly due to delayed diagnosis and the absence of characteristic radiological findings.[3-5]This case report presents a rare instance of TCV obstruction in a 19-year-old patient from Mankweng Academic Hospital.
基金Supported by The European Union-Next Generation EU,through the National Recovery and Resilience Plan of the Republic of Bulgaria,No.BG-RRP-2.004-0008。
文摘Inflammatory bowel disease(IBD)represents a significant disease burden marked by chronic inflammation and complications that adversely affect patients’quality of life.Effective diagnostic strategies involve clinical assessments,endoscopic evaluations,imaging studies,and biomarker testing,where early diagnosis is essential for effective management and prevention of long-term complications,highlighting the need for continual advancements in diagnostic methods.The intricate interplay between genetic factors and the outcomes of biological therapy is of critical importance.Unraveling the genetic determinants that influence responses and failures to biological therapy holds significant promise for optimizing treatment strategies for patients with IBD on biologics.Through an indepth examination of current literature,this review article synthesizes critical genetic markers associated with therapeutic efficacy and resistance in IBD.Understanding these genetic actors paves the way for personalized approaches,informing clinicians on predicting,tailoring,and enhancing the effectiveness of biological therapies for improved outcomes in patients with IBD.
文摘This pictorial review discusses the imaging approach to evaluate for proper placement or complications of pediatric gastrostomy tube(G-tube)placement and long-term use.G-tubes are crucial for long-term nutritional support in patients facing challenges with oral intake.The article depicts the role of imaging such as contrast radiography,fluoroscopy,ultrasound,and computed tomography scans for confirming G-tube position and evaluating complications,in addition to basic anatomical considerations and placement techniques.Complications discussed include malposition,intraperitoneal placement,buried bumper syndrome,and tube malfunction.Specific imaging techniques and checklists are provided to guide clinicians in assessing G-tube placement accurately.The latter half of the review is a comprehensive exploration of pearls and pitfalls of imaging when employed to detect complications to avoid false positives and negatives.
文摘BACKGROUND The relationship between exercise and gastrointestinal(GI)health is complex and bidirectional.While moderate exercise generally promotes gut health by enhancing motility,reducing inflammation,and supporting microbial balance,intense or prolonged physical activity may exacerbate GI symptoms,particularly in individuals with preexisting digestive disorders.A deeper understanding of this interplay is essential for optimizing both exercise performance and GI well-being.AIM To synthesize current evidence on exercise-related GI disorders,exploring the prevalence,mechanisms,risk factors,and management strategies associated with exercise-induced GI symptoms.METHODS Following PRISMA guidelines,comprehensive searches of databases,including PubMed,Scopus,Web of Science,and EMBASE were conducted.Studies were included if they focused on exercise-induced GI disorders,encompassed randomized controlled trials,cohort studies,case-control studies,and cross-sectional designs,and addressed symptoms across various exercise modalities.Data were extracted and analyzed to identify patterns and implications for clinical and athletic practice.RESULTS A total of 231 studies met the inclusion criteria,highlighting both the benefits and risks of exercise on GI health.Regular moderate-intensity exercise,including activities such as walking,cycling,and yoga has been associated with improved GI function in conditions like gastroesophageal reflux disease,irritable bowel syndrome,inflammatory bowel disease,and constipation.These benefits are attributed to enhanced intestinal motility,reduced systemic inflammation,and improved gut barrier integrity.Additionally,exercise plays a role in regulating the gut-brain axis,with practices like yoga and Tai Chi demonstrating particular effectiveness in alleviating functional GI disorders.Conversely,high-intensity or prolonged exercise may contribute to symptoms such as nausea,diarrhea,and abdominal pain due to mechanisms like splanchnic hypoperfusion and increased intestinal permeability.Individual factors,including fitness level,dietary habits,hydration status,and underlying GI conditions,significantly influence the body’s response to exercise.CONCLUSION Moderate-intensity exercise is a beneficial and well-tolerated intervention for promoting GI health,whereas highintensity activities require careful monitoring,particularly in individuals with pre-existing GI disorders.Personalized exercise and dietary strategies are essential for balancing the benefits of physical activity with the risk of GI distress.Further research is needed to explore the long-term effects of exercise on gut microbiota composition and overall digestive health.
文摘Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.
文摘Inflammatory bowel disease(IBD)is a group of chronic disorders that cause relapsing inflammation in the gastrointestinal tract(GIT).It results either from gene-environment interactions or as a monogenic disease resulting from pa-thogenic mutations causing impairment in the protective mechanism of the GIT.Around 10%-15%of patients with very early onset IBDs may have an underlying monogenic condition.Monogenic IBD is very different from complex forms of polygenic IBD in the underlying molecular basis of uncontrolled intestinal inflam-mation,age of onset,extraintestinal comorbidities as well as treatment modality.An in-depth understanding of this distinct form of IBD is essential for deciding an appropriate therapeutic approach as well as prognostication.In this review,we aim to discuss about the epidemiology,clinical presentation,diagnostic approach,therapeutic challenges and latest advances in patients with monogenic IBD.
文摘The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodological challenges hinder its immediate use in clinical practice.Notably,the current research was retrospective,lacks comparative studies with fecal calprotectin,and did not provide long-term predictive data.Further prospective studies are needed to improve the applicability of LRG.Moreover,integrating LRG with additional biomarkers and employing artificial intelligence techniques may improve its effectiveness in disease monitoring.Future research should address interobserver variability,assess LRG's cost-effectiveness,and standardize endoscopic healing definitions to ensure broader applicability.Advancing these areas is vital for establishing LRG's role in precision medicine strategies for the management of CD.
