Background:Currently,there are no effective biomarkers for predicting the progression of gastric precancerous lesions or screening early gastric cancer in clinical practice.Aims:To explore the expressions of adenylate cyclase 7(ADCY7),G protein-coupled receptor GPR86,glutamate receptor,ionotropic,N-methyl D-aspartate 2D(GRIN2D)and regulator of G protein signaling 4(RGS4)in various gastric mucosal lesions and their predictive value for progression of gastric precancerous lesions.Methods:Expressions of ADCY7,GPR86,GRIN2D,and RGS4 were detected by immuno-histochemistry,real-time PCR and Western blotting in Correa cascade(chronic non-atrophic gastritis,chronic atrophic gastritis,low-and high-grade intraepithelial neoplasia,and mucosal and submucosal early gastric cancer)and cancerous and para-cancerous tissues,among which,the differences in expression levels of these four factors were analyzed.Results:There was an increasing tendency in expression levels of ADCY7,GPR86,GRIN2D,and RGS4 from gastritis,intra-epithelial neoplasia to early gastric cancer.Except for GRIN2D expression between intraepithelial neoplasia and early gastric cancer,significant differences could be observed in any two groups(all P<0.001).Both mRNA and protein expression levels of GRP86 and GRIN2D were significantly higher in cancerous tissue than in adjacent tissue>5 cm(all P<0.05).Protein expression of RGS4 was significantly higher in cancerous tissue than in adjacent tissue>5 cm,but its mRNA expression presented an opposite trend(all P<0.05).Significant difference between cancerous tissue and adjacent tissue>5 cm in ADCY7 expression was only existed at protein level(P<0.05).Conclusions:Alterations of the expression levels of ADCY7,GPR86,GRIN2D,and RGS4 in Correa cascade and cancerous and para-cancerous tissues suggest that they are involved in the occurrence and development of gastric precancerous lesions,and might be used as predictors for progression of gastric precancerous lesions.

Background:Recurrence after stone removal is common in patients with choledocholithiasis.Recent studies have indicated that dysbiosis in gut microbiota plays an important role in the formation of cholesterol gallstones.Aims:To explore the effect of probiotics supplementation on serum lipopolysaccharide(LPS)and the indicators of bile acid metabolism in patients with a high risk of cholesterol gallstone formation.Methods:Sixty choledocholithiasis patients undergoing ERCP lithotomy were recruited at the First Affiliated Hospital of Shihezi University from June 2021 to June 2023.Bile and stool samples were collected for bacterial culture.Then the patients were randomly allocated into two groups:patients in control group received conventional supportive therapy after calculus removal,while those in probiotics intervention group were given oral bifid triple viable enteric capsule 420 mg,twice a day for 6 months based on conventional therapy.Changes in serum levels of LPS,the cell wall component of Gram-negative bacteria,fibroblast growth factor 19(FGF19),the key molecule in bile acid metabolism,and cholesterol 7α-hydroxylase(CYP7A1),the rate-limiting enzyme of bile acid synthesis,were determined and compared between the two groups.Results:Escherichia coli and Klebsiella pneumoniae were the main pathogens in bile and stool of patients with choledocholithiasis.Six months after ERCP lithotomy,the serum levels of LPS and FGF19 were decreased,and the serum level of CYP7A1 was increased in both groups(all P<0.05),especially in probiotics intervention group(all P<0.05).Conclusions:Oral probiotics supplementation can reduce the serum LPS level and modulate the canonical pathway of enterohepatic circulation of bile acids--farnesoid X receptor(FXR)-FGF19 pathway in high-risk patients of cholesterol gallstone formation.These alterations reduce the cholesterol supersaturation in bile and inhibit the probability of cholesterol gallstone formation.

Background:Combined double-balloon enteroscopy(DBE)plays an important role in the diagnosis and treatment of patients with suspected small bowel bleeding(SSBB).Aims:To investigate the performance of combined DBE in patients with SSBB and their clinical features.Methods:A total of 94 patients with SSBB underwent combined DBE from June 2018 to April 2023 at the Third People's Hospital of Bengbu and the First Affiliated Hospital of Anhui Medical University were enrolled,and the clinical features were analyzed.Results:Fifty-four SSBB patients completed the combined DBE,and the combination rate was 57.4%.Ten patients(10.6%)stopped combined DBE due to discovery of bleeding lesions.Five patients(5.3%)stopped combined DBE due to intestinal stenosis.Twenty-five patients(26.5%)stopped combined DBE due to difficulty in insertion.Combined DBE rate in SSBB patients was correlated with the combination time and the number of previous DBE for endoscopists(P<0.05),but not the gender,age,bleeding manifestations,tobacco smoking and alcohol drinking,nutritional risk,abdominal operation history,perianal lesions,autoimmune diseases,preoperative anemia,preoperative albumin level,and enteroscopy approach(P>0.05).ROC curve showed that when the cut-off value of first insertion depth was 385 cm,the sensitivity and specificity for successful combined DBE in SSBB patients were 72.2%and 77.5%,respectively,and the area under ROC curve was 0.800(95%CI:0.705-0.875,P<0.001).Conclusions:The combined DBE rate in SSBB patients is correlated with the combination time and the number of previous DBE for endoscopists.80%of the SSBB patients are expected to complete the combined DBE when the first insertion depth is greater than 385 cm.

Background:With the increasing diversity of biological agents,the first-line biological agents for moderate-to-severe Crohn's disease(CD)and ulcerative colitis(UC)requires more precise positioning.Aims:To systematically evaluate the efficacy and safety of infliximab(IFX)and ustekinumab(UST)as first-line options for moderate-to-severe CD and UC.Methods:Randomized controlled trials(RCTs)on IFX and UST in treatment of moderate-to-severe CD and UC were retrieved from CNKI,Wanfang data,VIP,Chinese Science Citation Database and PubMed,Web of Science,Embase,ClinicalTrials,Cochrane Library from the date of database establishment to December 2023.An indirect meta-analysis was conducted to compare the efficacy and safety of IFX and UST in treatment of moderate-to-severe CD and UC.Results:Eleven RCTs were enrolled.No significant differences in clinical remission and maintenance rates of moderate-to-severe CD were found between IFX group and UST group(P>0.05),and no significant differences in serious adverse events and serious infection rates were found between these two groups(P>0.05).No significant differences in clinical remission and maintenance rates of moderate-to-severe UC were found between IFX group and UST group(P>0.05),and no significant differences in serious adverse events and serious infection rates were found between these two groups(P>0.05).Conclusions:Both IFX and UST can be served as first-line biological therapy for patients with moderate-to-severe CD.In view of the fact that IFX can increase the risk of tuberculosis,UST is recommended as first-line therapy for moderate-to-severe CD.For moderate-to-severe UC,IFX is an effective and safe first-line biological therapy,and UST can be served as an alternative.

Liver diseases in pregnancy comprise both gestational liver disorders and acute and chronic hepatic disorders occurring coincidentally in pregnancy.Whether pregnancy-related or not,liver diseases in pregnancy are associated with a significant risk of maternal and fetal morbidity and mortality.Thus,the European Association for the Study of the Liver invited a panel of experts to develop clinical practice guidelines aimed at providing recommendations,based on the best available evidence,for the management of liver diseases in pregnancy for hepatologists,gastroenter-ologists,obstetric physicians,general physicians,training specialists and other healthcare professionals who provide care for this patient population.

Background:When colonic adenoma involves diverticulum,inflammation in the diverticulum will increase the risk of adenomatous dysplasia.Therefore,patients with colonic diverticulum adenoma are at a higher risk of colon cancer,and the adenoma needs to be resected to avoid poor outcome and improve prognosis.Aims:To explore the efficacy and safety of endoscopic mucosal resection(EMR)in treatment of colonic diverticulum adenoma.Methods:Fourteen consecutive cases of colonic adenoma near or involving a diverticulum treated by EMR from Jun.2018 to Jan.2022 at the First People's Hospital of Hangzhou Lin'an District were collected,and their clinical characteristics and outcomes were analyzed.The primary outcome was complications,including bleeding,perforation,and electrocoagulation syndrome,while the secondary outcomes were the en bloc resection rate,complete resection rate and local recurrence rate.Results:Among the 14 patients with colonic diverticulum adenoma,13 were type A(near a diverticulum)while 1 was type B(involving a diverticulum).The diameter of the lesion was(0.76±0.25)cm,and the operation time was(19.67±5.33)minutes.The main histological type was tubular adenoma,and the pathological results was intraepithelial neoplasia in most of the cases.Delayed hemorrhage was observed in 1 patient(7.1%),and electrocoagulation syndrome in 1 patient(7.1%).No perforation event occurred.The en bloc resection rate and complete resection rate were 100%.Ten patients accepted reexamination of colonoscopy within 1 year after surgery,and no local recurrence was found.Conclusions:EMR is safe and effective for treatment of colonic diverticulum adenoma.However,patients using antiplatelet drugs and adenoma involving both appendiceal orifice and diverticulum should be alert to postoperative complications.

Ulcerative colitis is characterized by the alternation of recurrence and remission of mucosal inflammation.Both its diagnosis and efficacy evaluation require the combination of clinical,laboratory examination,endoscopy,and histology.Therefore,evaluation scales are important for ulcerative colitis.Many different scales have been developed to accompany the escalation of therapeutic goals from clinical remission and mucosal healing to histological remission.This article summarized the current commonly used scales from multiple perspectives,including clinical evaluation,endoscopic evaluation,histological evaluation,and patient-reported assessment,which aimed to help clinical practitioners understand the advantages and disadvantages of different scales more comprehensively and choose more appropriate assessment method.

Ulcerative colitis is a common disease of the digestive system in China,which seriously affects the quality of life of patients due to its disease characteristics,such as easy recurrence,repeated course of disease and carcinogenic tendency.Neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)are considered as new inflammatory biomarkers,which have been found to be related with ulcerative colitis.This article reviewed the clinical value of NLR and PLR in ulcerative colitis.

Inflammatory bowel disease(IBD)is a chronic inflammatory disease of the gastrointestinal tract that includes Crohn's disease and ulcerative colitis.IBD may be caused by complex interactions between genetic susceptibility,environmental factors,and alterations in the gut microbiota,resulting in dysregulated innate and adaptive immune responses.Recent studies have identified macrophages in the intestinal inflammatory response as having the plasticity to not only regulate inflammation,but also to promote tissue repair and healing.As aberrant macrophage polarization occurs during the development of IBD,the balance between the phenotype and function of pro-inflammatory M1 and anti-inflammatory M2 macrophages is regulated by extracellular and intracellular stimuli,and this process is therefore expected to be a potential target for new therapeutic approaches.This article reviewed the progress of research on macrophage polarization in IBD.

Autoimmune gastritis(AIG)is a kind of gastritis caused by autoimmune dysfunction.It is often manifested as pernicious anemia or neurological symptoms.Gastric corpus mucosal atrophy is usually observed under endoscopy,which may be accompanied by positive serum anti-parietal cell antibody and/or anti-intrinsic factor antibody.Studies have shown that AIG is a risk factor for gastric neuroendocrine tumors and gastric cancer.Therefore,endoscopic diagnosis and surveillance of AIG are very important.This article reviewed the progress of research on AIG and gastric tumor.