BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To ex...BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To explore the clinical characteristics,treatment patterns,and short-term outcomes in CEG patients in China.METHODS We recruited patients with chronic non-atrophic or mild-to-moderate atrophic gastritis with erosion based on endoscopy and pathology.Patients and treating physicians completed a questionnaire regarding history,endoscopic findings,and treatment plans as well as a follow-up questionnaire to investigate changes in symptoms after 4 wk of treatment.RESULTS Three thousand five hundred sixty-three patients from 42 centers across 24 cities in China were included.Epigastric pain(68.0%),abdominal distension(62.6%),and postprandial fullness(47.5%)were the most common presenting symptoms.Gastritis was classified as chronic non-atrophic in 69.9%of patients.Among those with erosive lesions,72.1%of patients had lesions in the antrum,51.0%had multiple lesions,and 67.3%had superficial flat lesions.In patients with epigastric pain,the combination of a mucosal protective agent(MPA)and proton pump inhibitor was more effective.For those with postprandial fullness,acid regurgitation,early satiety,or nausea,a MPA appeared more promising.CONCLUSION CEG is a multifactorial disease which is common in Asian patients and has non-specific symptoms.Gastroscopy may play a major role in its detection and diagnosis.Treatment should be individualized based on symptom profile.展开更多
Background:The incidence of well-differentiated gastric neuroendocrine tumors(G-NET)is increasing annually,and while they have a good prognosis and low mortality rate,their high recurrence rate makes treatment options...Background:The incidence of well-differentiated gastric neuroendocrine tumors(G-NET)is increasing annually,and while they have a good prognosis and low mortality rate,their high recurrence rate makes treatment options controversial.This study aims to determine the relationship between individualized treatment plans and the recurrence of G-NET.Methods:We performed a multicenter,retrospective study of 94 patients with highly differentiated G-NET and treated at Peking Union Medical College Hospital,Yantai Yuhuangding Hospital,and Beijing Zhong-Neng-Jian Hospital from November 2015 to September 2023.Risk factors for recurrence of G-NETs were investigated using chi-squared test and multifactorial logistic regression analysis.Results:After a median follow-up of 49 months,the overall recurrence rate among the 94 G-NET patients was 14%(13/94).The recurrence rates of endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),somatostatin analog(SSA)therapy,and surgery were 43%(6/14),10%(5/49),5%(1/22),and 11%(1/9),respectively.Post-treatment recurrence rates were significantly different(P=0.014)among four treatments(EMR,ESD,SSA,and surgery),and further subgroup comparisons revealed lower recurrence rates in the ESD and SSA groups than in the EMR group.From the second month onward,SSA therapy considerably reduced the gastrin levels from 1081.0(571.5,2472.8)pg/mL to 461.5(255.3,795.0)pg/mL(Z=-3.521,P<0.001).Both chi-squared test and multifactorial logistic regression analysis suggested that among the clinicopathological parameters studied,only the pre-treatment gastrin level(P=0.018 and 0.005)and the type of treatment(P=0.014 and 0.017)were significantly associated with G-NET recurrence.Conclusions:Individualized treatment strategies may reduce the risk of relapse after G-NET treatment.Long-term SSA therapy may be a secure and efficacious treatment option for type 1 G-NET with more than six lesions,and it substantially decreases the incidence of post-treatment recurrence.展开更多
Objective While the upregulation of cytochrome P450 family 24 subfamily A member 1(CYP24A1)gene expression has been reported in colon cancer,its role in tumorigenesis remains largely unknown.In this study,we aimed to ...Objective While the upregulation of cytochrome P450 family 24 subfamily A member 1(CYP24A1)gene expression has been reported in colon cancer,its role in tumorigenesis remains largely unknown.In this study,we aimed to investigate the involvement of CYP24A1 in Wnt pathway regulation via the nuclear factor kappa B(NF-κB)pathway.Methods The human colon cancer cell lines HCT-116 and Caco-2 were subjected to stimulation with interleukin-6(IL-6)as well as tumor necrosis factor alpha(TNF-α),with subsequent treatment using the NF-κB pathway-specific inhibitor ammonium pyrrolidinedithiocarbamate(PDTC).Furthermore,CYP24A1 expression was subjected to knockdown via the use of small interfering RNA(siRNA).Subsequently,NF-κB pathway activation was determined by an electrophoretic mobility shift assay,and the transcriptional activity ofβ-catenin was determined by a dual-luciferase reporter assay.A mouse ulcerative colitis(UC)-associated carcinogenesis model was established,wherein TNF-αand the NF-κB pathway were blocked by anti-TNF-αmonoclonal antibody and NF-κB antisense oligonucleotides,respectively.Then the tumor size and protein level of CYP24A1 were determined.Results IL-6 and TNF-αupregulated CYP24A1 expression and activated the NF-κB pathway in colon cancer cells.PDTC significantly inhibited this increase in CYP24A1 expression.Additionally,knockdown of CYP24A1 expression by siRNA could partially antagonize Wnt pathway activation.Upregulated CYP24A1 expression was observed in the colonic epithelial cells of UC-associated carcinoma mouse models.Anti-TNF-αmonoclonal antibody and NF-κB antisense oligonucleotides decreased the tumor size and suppressed CYP24A1 expression.Conclusion Taken together,this study suggests that inflammatory factors may increase CYP24A1 expression via NF-κB pathway activation,which in turn stimulates Wnt signaling.展开更多
The human gastrointestinal tract accommodates an entire micro-environment for divergent physiologic processes,the dysbiosis of this micro-ecology has a strong inter-action with the pathogenesis of inflammatory bowel d...The human gastrointestinal tract accommodates an entire micro-environment for divergent physiologic processes,the dysbiosis of this micro-ecology has a strong inter-action with the pathogenesis of inflammatory bowel disease(IBD).In the past few years,with the advances in the understanding of microbiome,its metabolites and further application of next generation sequencing,analysis of dynamic alteration of gut micro-environment was realized,which provides numerous information beyond simple microbiota structure or metabolites differences under chronic colitis status.The subsequent intervention strategies targeting the modulation of intestinal micro-environment have been explored as a potential therapy.In this review,we will summarize the recent knowledge about multi-dimensional dysbiosis,the inter-action between fungus and bacteria under inflamed mucosa,and the clinical application of probiotics and fecal microbiota transplantation as a promising therapeutic approach in IBD.展开更多
Celiac disease (CD),once considered a gastrointestinal condition,is now known as a systemic autoimmune disease initiated by exposure to dietary gluten mainly in human leukocyte antigen DQ2 (HLA-DQ2) or HLA-DQ8 carrier...Celiac disease (CD),once considered a gastrointestinal condition,is now known as a systemic autoimmune disease initiated by exposure to dietary gluten mainly in human leukocyte antigen DQ2 (HLA-DQ2) or HLA-DQ8 carriers.The classic presentations of CD include intestinal manifestations such as chronic diarrhea,bloating,abdominal pain,constipation,weight loss,or poor growth in children.Iron-deficiency,osteoporosis,and neuropathy attributable to vitamin B12 deficiency is also frequently seen in celiac patients.Immune responses spreading to tissues apart from the intestine cause dermatologic conditions such as dermatitis herpetiformis,and even increased risk of miscarriage in women.展开更多
Eosinophilic gastroenteritis(EGE)is a gastrointestinal disorder of unclear etiology that is characterized by eosinophilic infiltration of the stomach and small intestine,and consists of mucosal,muscular,and serosal su...Eosinophilic gastroenteritis(EGE)is a gastrointestinal disorder of unclear etiology that is characterized by eosinophilic infiltration of the stomach and small intestine,and consists of mucosal,muscular,and serosal subtypes.Eosinophilic infiltration of the gastrointestinal tract is a fundamental histopathological characteristic of EGE and is driven by several T-helper type 2(Th2)-dependent cytokines and induced by food allergy.Due to the lack of a diagnostic gold standard,EGE has a high rate of delayed diagnosis or misdiagnosis.However,several new diagnostic strategies have been developed,such as novel genetic biomarkers and imaging tests.Although dietary therapy and corticosteroids remain the common choices for EGE treatment,recent decades have seen the emergence of novel treatment alternatives,such as biologics that target particular molecules involved in the pathogenic process.Preliminary investigations and clinical trials have demonstrated the efficacy of biologics and provided additional insights for the era of refractory or corticosteroid-dependent EGE biologics.展开更多
Colorectal cancer(CRC)is the third most commonly diagnosed malignant tumor in the world.The past few years have seen a remarkable increase in both incidence and mortality of CRC in developing countries like China,posi...Colorectal cancer(CRC)is the third most commonly diagnosed malignant tumor in the world.The past few years have seen a remarkable increase in both incidence and mortality of CRC in developing countries like China,posing a serious threat to human health.It is currently believed that about 70%of colorectal cancers are derived from conventional adenomas and 30%are derived from serrated adenomas.[1]As reported,CRC incidence rates per 10,000 person-years were 20.0 for advanced adenoma and 9.1 for non-advanced adenoma.[2]Colonoscopy,as an important tool for CRC screening and follow-up,can prevent the development of CRC by detecting and removing precancerous lesions,thereby effectively reducing the incidence and mortality.Current guidelines for post-polypectomy surveillance mostly recommend a 3-to 10-year interval according to baseline risk stratification.[3]However,there is no such guideline in China yet and doctors tend to perform the next colonoscopy within 1 year,which is much shorter than current international recommendations.展开更多
To the Editor:Increasing attention is being paid to preventing ulcerative colitis(UC)-associated carcinogenesis.The intestinal microbiota plays an important role in maintaining the intestinal barrier and immune functi...To the Editor:Increasing attention is being paid to preventing ulcerative colitis(UC)-associated carcinogenesis.The intestinal microbiota plays an important role in maintaining the intestinal barrier and immune function.Probiotic mixture VSL#3,that was bought from Sigma-Tau pharmaceuticals(De Simone Formulation)in May 2015,is a mixture of Lactobacillus casei,L.plantarum,L.acidophilus,L.delbrueckii subsp.bulgaricus,Bifidobacterium longum,B.breve,B.infantis and Streptococcus salivarius andcontains 4.5 billion live bacterialcolonies.i Previous studies have shown that VSL#3 can help induce and maintain UC remission.The effects of probiotics on UC-associated carcinogenesis are difficult to observe clinically;therefore,mouse models are often used to study this disease.Previous studies have shown that azoxymethane(AOM)combined with dextran sulfate sodium(DSS)can quickly induce a UC-associated carcinogenesis model.展开更多
基金the National Key Clinical Specialty Construction Project,No.ZK108000CAMS Innovation Fund for Medical Sciences,No.2021-I2M-C&T-A-001 and No.2022-I2M-C&T-B-012.
文摘BACKGROUND Although chronic erosive gastritis(CEG)is common,its clinical characteristics have not been fully elucidated.The lack of consensus regarding its treatment has resulted in varied treatment regimens.AIM To explore the clinical characteristics,treatment patterns,and short-term outcomes in CEG patients in China.METHODS We recruited patients with chronic non-atrophic or mild-to-moderate atrophic gastritis with erosion based on endoscopy and pathology.Patients and treating physicians completed a questionnaire regarding history,endoscopic findings,and treatment plans as well as a follow-up questionnaire to investigate changes in symptoms after 4 wk of treatment.RESULTS Three thousand five hundred sixty-three patients from 42 centers across 24 cities in China were included.Epigastric pain(68.0%),abdominal distension(62.6%),and postprandial fullness(47.5%)were the most common presenting symptoms.Gastritis was classified as chronic non-atrophic in 69.9%of patients.Among those with erosive lesions,72.1%of patients had lesions in the antrum,51.0%had multiple lesions,and 67.3%had superficial flat lesions.In patients with epigastric pain,the combination of a mucosal protective agent(MPA)and proton pump inhibitor was more effective.For those with postprandial fullness,acid regurgitation,early satiety,or nausea,a MPA appeared more promising.CONCLUSION CEG is a multifactorial disease which is common in Asian patients and has non-specific symptoms.Gastroscopy may play a major role in its detection and diagnosis.Treatment should be individualized based on symptom profile.
基金supported by grants from National High-Level Hospital Clinical Research Funding(No.2022-PUMCH-C-055)National High-Level Hospital Clinical Research Funding(No.2022-PUMCH-D-002).
文摘Background:The incidence of well-differentiated gastric neuroendocrine tumors(G-NET)is increasing annually,and while they have a good prognosis and low mortality rate,their high recurrence rate makes treatment options controversial.This study aims to determine the relationship between individualized treatment plans and the recurrence of G-NET.Methods:We performed a multicenter,retrospective study of 94 patients with highly differentiated G-NET and treated at Peking Union Medical College Hospital,Yantai Yuhuangding Hospital,and Beijing Zhong-Neng-Jian Hospital from November 2015 to September 2023.Risk factors for recurrence of G-NETs were investigated using chi-squared test and multifactorial logistic regression analysis.Results:After a median follow-up of 49 months,the overall recurrence rate among the 94 G-NET patients was 14%(13/94).The recurrence rates of endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),somatostatin analog(SSA)therapy,and surgery were 43%(6/14),10%(5/49),5%(1/22),and 11%(1/9),respectively.Post-treatment recurrence rates were significantly different(P=0.014)among four treatments(EMR,ESD,SSA,and surgery),and further subgroup comparisons revealed lower recurrence rates in the ESD and SSA groups than in the EMR group.From the second month onward,SSA therapy considerably reduced the gastrin levels from 1081.0(571.5,2472.8)pg/mL to 461.5(255.3,795.0)pg/mL(Z=-3.521,P<0.001).Both chi-squared test and multifactorial logistic regression analysis suggested that among the clinicopathological parameters studied,only the pre-treatment gastrin level(P=0.018 and 0.005)and the type of treatment(P=0.014 and 0.017)were significantly associated with G-NET recurrence.Conclusions:Individualized treatment strategies may reduce the risk of relapse after G-NET treatment.Long-term SSA therapy may be a secure and efficacious treatment option for type 1 G-NET with more than six lesions,and it substantially decreases the incidence of post-treatment recurrence.
基金supported by grants from the National Natural Science Foundation of China(No.81370500 and No.81770559)CAMS Innovation Fund for Medical Sciences(No.CIFMS2021-I2M-C&T-A-001 and No.2016-I2M-3-005)the CAMS Initiative for Innovative Medicine(No.CAMS-a12M 2016-I2M-1-007).
文摘Objective While the upregulation of cytochrome P450 family 24 subfamily A member 1(CYP24A1)gene expression has been reported in colon cancer,its role in tumorigenesis remains largely unknown.In this study,we aimed to investigate the involvement of CYP24A1 in Wnt pathway regulation via the nuclear factor kappa B(NF-κB)pathway.Methods The human colon cancer cell lines HCT-116 and Caco-2 were subjected to stimulation with interleukin-6(IL-6)as well as tumor necrosis factor alpha(TNF-α),with subsequent treatment using the NF-κB pathway-specific inhibitor ammonium pyrrolidinedithiocarbamate(PDTC).Furthermore,CYP24A1 expression was subjected to knockdown via the use of small interfering RNA(siRNA).Subsequently,NF-κB pathway activation was determined by an electrophoretic mobility shift assay,and the transcriptional activity ofβ-catenin was determined by a dual-luciferase reporter assay.A mouse ulcerative colitis(UC)-associated carcinogenesis model was established,wherein TNF-αand the NF-κB pathway were blocked by anti-TNF-αmonoclonal antibody and NF-κB antisense oligonucleotides,respectively.Then the tumor size and protein level of CYP24A1 were determined.Results IL-6 and TNF-αupregulated CYP24A1 expression and activated the NF-κB pathway in colon cancer cells.PDTC significantly inhibited this increase in CYP24A1 expression.Additionally,knockdown of CYP24A1 expression by siRNA could partially antagonize Wnt pathway activation.Upregulated CYP24A1 expression was observed in the colonic epithelial cells of UC-associated carcinoma mouse models.Anti-TNF-αmonoclonal antibody and NF-κB antisense oligonucleotides decreased the tumor size and suppressed CYP24A1 expression.Conclusion Taken together,this study suggests that inflammatory factors may increase CYP24A1 expression via NF-κB pathway activation,which in turn stimulates Wnt signaling.
基金supported by a grant from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(No.2016-12M-3-001).
文摘The human gastrointestinal tract accommodates an entire micro-environment for divergent physiologic processes,the dysbiosis of this micro-ecology has a strong inter-action with the pathogenesis of inflammatory bowel disease(IBD).In the past few years,with the advances in the understanding of microbiome,its metabolites and further application of next generation sequencing,analysis of dynamic alteration of gut micro-environment was realized,which provides numerous information beyond simple microbiota structure or metabolites differences under chronic colitis status.The subsequent intervention strategies targeting the modulation of intestinal micro-environment have been explored as a potential therapy.In this review,we will summarize the recent knowledge about multi-dimensional dysbiosis,the inter-action between fungus and bacteria under inflamed mucosa,and the clinical application of probiotics and fecal microbiota transplantation as a promising therapeutic approach in IBD.
文摘Celiac disease (CD),once considered a gastrointestinal condition,is now known as a systemic autoimmune disease initiated by exposure to dietary gluten mainly in human leukocyte antigen DQ2 (HLA-DQ2) or HLA-DQ8 carriers.The classic presentations of CD include intestinal manifestations such as chronic diarrhea,bloating,abdominal pain,constipation,weight loss,or poor growth in children.Iron-deficiency,osteoporosis,and neuropathy attributable to vitamin B12 deficiency is also frequently seen in celiac patients.Immune responses spreading to tissues apart from the intestine cause dermatologic conditions such as dermatitis herpetiformis,and even increased risk of miscarriage in women.
基金National High Level Hospital Clinical Reseach Funding(No.2022-PUMCH-B-022)CAMS Innovation Fund for Medical Sciences(No.CIFMS2021-I2M-1-003)National key clinical specialty construction project(No.ZK108000)
文摘Eosinophilic gastroenteritis(EGE)is a gastrointestinal disorder of unclear etiology that is characterized by eosinophilic infiltration of the stomach and small intestine,and consists of mucosal,muscular,and serosal subtypes.Eosinophilic infiltration of the gastrointestinal tract is a fundamental histopathological characteristic of EGE and is driven by several T-helper type 2(Th2)-dependent cytokines and induced by food allergy.Due to the lack of a diagnostic gold standard,EGE has a high rate of delayed diagnosis or misdiagnosis.However,several new diagnostic strategies have been developed,such as novel genetic biomarkers and imaging tests.Although dietary therapy and corticosteroids remain the common choices for EGE treatment,recent decades have seen the emergence of novel treatment alternatives,such as biologics that target particular molecules involved in the pathogenic process.Preliminary investigations and clinical trials have demonstrated the efficacy of biologics and provided additional insights for the era of refractory or corticosteroid-dependent EGE biologics.
基金This work was supported by grants from the National Natural Science Foundation of China(No.81770559 and 81370500)。
文摘Colorectal cancer(CRC)is the third most commonly diagnosed malignant tumor in the world.The past few years have seen a remarkable increase in both incidence and mortality of CRC in developing countries like China,posing a serious threat to human health.It is currently believed that about 70%of colorectal cancers are derived from conventional adenomas and 30%are derived from serrated adenomas.[1]As reported,CRC incidence rates per 10,000 person-years were 20.0 for advanced adenoma and 9.1 for non-advanced adenoma.[2]Colonoscopy,as an important tool for CRC screening and follow-up,can prevent the development of CRC by detecting and removing precancerous lesions,thereby effectively reducing the incidence and mortality.Current guidelines for post-polypectomy surveillance mostly recommend a 3-to 10-year interval according to baseline risk stratification.[3]However,there is no such guideline in China yet and doctors tend to perform the next colonoscopy within 1 year,which is much shorter than current international recommendations.
基金The study was funded by grants from National Natural Science Foundation of China(Nos.81370500 and 81770559)。
文摘To the Editor:Increasing attention is being paid to preventing ulcerative colitis(UC)-associated carcinogenesis.The intestinal microbiota plays an important role in maintaining the intestinal barrier and immune function.Probiotic mixture VSL#3,that was bought from Sigma-Tau pharmaceuticals(De Simone Formulation)in May 2015,is a mixture of Lactobacillus casei,L.plantarum,L.acidophilus,L.delbrueckii subsp.bulgaricus,Bifidobacterium longum,B.breve,B.infantis and Streptococcus salivarius andcontains 4.5 billion live bacterialcolonies.i Previous studies have shown that VSL#3 can help induce and maintain UC remission.The effects of probiotics on UC-associated carcinogenesis are difficult to observe clinically;therefore,mouse models are often used to study this disease.Previous studies have shown that azoxymethane(AOM)combined with dextran sulfate sodium(DSS)can quickly induce a UC-associated carcinogenesis model.
