Clinical and Translational Gastroenterology

INTRODUCTION: Treatment guidelines for colorectal cancer (CRC) suggest 2 classifications for histological differentiation-highest grade and predominant. However, the optimal predictor of lymph node metastasis (LNM) in T1 CRC remains unknown. This systematic review aimed to evaluate the impact of the use of highest-grade or predominant differentiation on LNM determination in T1 CRC. METHODS: The study protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO, registration number: CRD42023416971) and was published in OSF ( https://osf...

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INTRODUCTION: Wide-area transepithelial sampling with 3-dimensional computer-assisted analysis (WATS 3D ) has been shown to increase the detection rate of dysplasia (and intestinal metaplasia) in patients with Barrett's esophagus (BE). The purpose of this study was to evaluate the interobserver variability and accuracy of diagnosing BE-associated dysplasia in WATS 3D specimens among gastrointestinal (GI) pathologists without prior experience with this technology. METHODS: Five GI pathologists underwent a 4-hour in-person (at microscope) and virtual training session and then evaluated digital images of discrete cellular foci from 60 WATS 3D cases with BE (20 nondysplastic BE [NDBE], 20 low-grade dysplasia [LGD], and 20 high-grade dysplasia/esophageal adenocarcinoma [HGD/EAC])...

BACKGROUND: Chronic pancreatitis (CP) is a progressive fibroinflammatory disorder lacking therapies and biomarkers. Neutrophil gelatinase-associated lipocalin (NGAL) is a proinflammatory cytokine elevated during inflammation that binds fatty acids (FAs) like linoleic acid. We hypothesized that systemic NGAL could serve as a biomarker for CP and, with FAs, provide insights into inflammatory and metabolic alterations. METHODS: NGAL was measured by immunoassay and FA composition was measured by gas chromatography in plasma ( n = 171) from a multicenter study, including controls ( n = 50), acute and recurrent acute pancreatitis (AP/RAP) ( n = 71), and CP ( n = 50)...

INTRODUCTION: High-resolution anoscopy (HRA) is the gold standard for detecting anal squamous cell cancer (ASCC) precursors. Preliminary studies on the application of artificial intelligence (AI) models to this modality have revealed promising results. However, the impact of staining techniques and anal manipulation on the effectiveness of these algorithms has not been evaluated. We aimed to develop a deep learning system for automatic differentiation of high (HSIL) versus low-grade (LSIL) squamous intraepithelial lesions in HRA images in different subsets of patients (non-stained, acetic acid, lugol, and after manipulation)...

INTRODUCTION: Adenoma detection rate (ADR) is an accepted benchmark for screening colonoscopy. Factors driving ADR and its relationship with sessile serrated lesions detection rate (SSLDR) over time remain unclear. We aim to explore patient, physician, and procedural influences on ADR and SSLDR trends. METHODS: Using a large healthcare system in northern California from January 2010 to December 2020, a total of 146,818 screening colonoscopies performed by 33 endoscopists were included...

OBJECTIVES: There is a lack of reliable predictors of disease behavior progression in patients with Crohn's disease (CD). Real-time shear-wave elastography (SWE) is a novel method for evaluating tissue stiffness. However, its value for assessing CD has not yet been investigated. We aimed to explore the value of SWE and other ultrasound parameters at diagnosis in predicting CD behavior progression. METHODS: We retrospectively collected data from CD patients with the non-stenotic non-penetrating disease (B1 phenotype based on the Montreal classification)...

Isolated case reports and case series have linked the use of sevelamer to severe intestinal inflammation and perforation among patients with end stage renal disease (ESRD). In this study we highlight 12 cases of biopsy proven sevelamer-induced gastrointestinal disease (SIGD) from a large urban community hospital over the course of five years. We describe baseline characteristics, sites and types of injury, histological findings, timing and dosing of sevelamer initiation compared to symptom onset, and in a smaller subset, endoscopic resolution post drug cessation...

BACKGROUND AND AIMS: In non-alcoholic fatty liver disease, the diagnostic efficacy of CAP was not very accurate in evaluating liver fat content. The aim of this study was to develop a score, based on CAP and conventional clinical parameters, to improve the diagnostic performance of CAP regarding liver fat content. METHODS: A total of 373 participants from two independent Chinese cohorts were included and divided into derivation (n = 191), internal validation (n = 75), and external validation (n = 107) cohorts...

INTRODUCTION: Field factors play more important roles in predicting the outcomes of patients compared with tumor factors in early-stage hepatocellular carcinoma (HCC). However, the prognostic ability of non-invasive serum marker scores for hepatic fibrosis and liver functional reserve on very early-stage HCC is still not yet determined. We aimed to investigate the performance of these serum marker scores in predicting the prognoses of patients with very early-stage HCC. METHODS: A total of 446 patients with the very early-stage HCC from 2012 to 2022 were retrospectively enrolled...

OBJECTIVE: The aim of this study is to investigate the epigenetic regulation and underlying mechanism of NRIP3 in colorectal cancer (CRC). METHODS: Eight cell lines (SW480, SW620, DKO, LOVO, HT29, HCT116, DLD1, and RKO), 187 resected margin samples from colorectal cancer tissue, 146 colorectal adenomatous polyp cases, and 308 colorectal cancer samples were used. Methylation specific PCR, western blotting, RNA interference assay, and a xenograft mouse model were employed...

OBJECTIVES: Emerging evidence suggests a high burden of psychosocial comorbidities in patients with EoE, although factors associated with this burden have not been explored. We aimed to increase understanding of the psychosocial burden of EoE and assess factors that are associated with disease burden. METHODS: We conducted a cross-sectional study of EoE patients (n=87) recruited from a single center, multidisciplinary pediatric EGID clinic (2019-2021). Participants (ages 8-18) completed validated assessments during routine clinic visit to assess EoE symptoms (PEESSv2...

INTRODUCTION: Barrett's esophagus (BE) is a precursor to esophageal adenocarcinoma. Physicians infrequently adhere to guidelines for managing BE, leading to either reduced detection of dysplasia or inappropriate re-evaluation. METHODS: We conducted a three-arm randomized controlled trial with 2 intervention arms to determine the impact of a tissue systems pathology (TSP-9) test on the adherence to evidence-based guidelines for simulated patients with BE. Intervention 1 received TSP-9 results, and intervention 2 had the option to order TSP-9 results...

INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) has a poor 5-year survival rate. PDAC surveillance is recommended in high-risk individuals (HRI) with strong PDAC family history or a pathogenic germline variant (PGV) in a PDAC-susceptibility gene. We aimed to explore a potential correlation between genetic status, extent of family history, pancreatic findings, and surveillance implications in heterogeneous PDAC HRIs. METHODS: 239 HRIs from 202 families were tested genetically and underwent prospective pancreatic surveillance for 6 years...

BACKGROUND: Artificial intelligence (AI) could minimize the operator-dependent variation in colonoscopy quality. Computer-aided detection (CADe) has improved adenoma detection rate (ADR) and adenomas per colonoscopy (APC) in randomized controlled trials (RCTs). There is a need to assess the impact of CADe in real-world settings. METHODS: We searched MEDLINE, EMBASE, and Web of Science for non-randomized, real-world studies of CADe in colonoscopy. Random-effects meta-analyses were performed to examine the effect of CADe on ADR and APC...

INTRODUCTION: Our understanding of the epidemiology of inflammatory conditions of the pouch and effectiveness of treatment is largely based on selected populations. We created a state-level registry to evaluate the incidence of pouchitis and the effectiveness of treatments utilized in an initial episode of pouchitis. METHODS: In a state-level retrospective cohort of all patients undergoing proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) between January 1, 2018 and December 31, 2020, we evaluated the incidence of pouchitis and compared the proportion of patients developing recurrent pouchitis and chronic antibiotic dependent pouchitis (CADP) according to initial antibiotic therapy...

INTRODUCTION: We previously reported the results of tofacitinib induction therapy in the prospective multi-site US real-world TOUR registry. We now assessed patient-reported outcomes (PRO's) and predictors of success during tofacitinib maintenance therapy. METHODS: TOUR included 103 patients with refractory ulcerative colitis (UC); 67% had failed ≥ 2 biologics. Patients reported the simple clinical colitis activity index (SCCAI), PRO Measurement Information Systems measures (PROMIS) for anxiety, depression, social satisfaction, and adverse events between weeks 8 and 52 using a web-based system...

BACKGROUND AND AIMS: Biochemical alterations in the esophagus of patients with eosinophilic esophagitis (EoE) is poorly understood. We used Raman spectroscopy via a pediatric endoscope to identify key Raman features reflective of the esophageal biochemical composition to differentiate between children with EoE from non-EoE controls, and between children with active (aEoE) and inactive EoE (iEoE). METHODS: Spectral measurements were obtained using a customized pediatric endoscope-compatible fiberoptic Raman probe in real-time during an esophagogastroduodenoscopy...

BACKGROUND AND AIMS: Liver fibrosis results from chronic liver injury and inflammation, often leading to cirrhosis, liver failure, portal hypertension and hepatocellular carcinoma. Progress has been made in understanding the molecular mechanisms underlying hepatic fibrosis; however, translating this knowledge into effective therapies for disease regression remains a challenge, with considerably few interventions having entered clinical validation. The roles of exosomes during fibrogenesis and their potential as a therapeutic approach for reversing fibrosis have gained significant interest...

BACKGROUND AIMS: Perturbations in aromatic (AAA) and branched-chain amino acids (BCAA) are seen in decompensated liver disease. The aim of this study was to evaluate the dynamic, post-prandial relationship between hepatitis C virus (HCV) induced liver disease and amino acid concentrations in patients with compensated liver disease. METHODS: HCV-infected patients underwent a baseline liver biopsy to determine Ishak Fibrosis and evaluate the liver transcriptome. Patients ate a standard meal and underwent peripheral vein sampling at defined intervals...