Autoimmune pancreatitis is a special type of chronic pancreatitis that can lead to abnormal pancreatic exocrine function in patients. Autoimmune pancreatitis comorbid with pancreatic exocrine insufficiency has a complex pathogenesis， and there is limited research on this topic， leading to the lack of understanding of such patients in clinical practice. This article introduces the epidemiology of autoimmune pancreatitis， briefly describes the pathogenesis of pancreatic exocrine insufficiency caused by autoimmune pancreatitis， and summarizes the various detection methods for pancreatic exocrine function， nutritional assessments， lifestyle management， and drug therapy， in order to strengthen the understanding of autoimmune pancreatitis comorbid with pancreatic exocrine insufficiency and improve the clinical diagnosis and treatment of pancreatic exocrine insufficiency.

Intestinal fibrosis is a major complication of inflammatory bowel disease (IBD), leading to a high incidence of surgical interventions and significant disability. Despite its clinical relevance, no targeted pharmacological therapies are currently available. This review aims to explore the underlying mechanisms driving intestinal fibrosis and address unresolved scientific questions, offering insights into potential future therapeutic strategies. We conducted a literature review using data from PubMed up to October 2024, focusing on studies related to IBD and fibrosis. Intestinal fibrosis results from a complex network involving stromal cells, immune cells, epithelial cells, and the gut microbiota. Chronic inflammation, driven by factors such as dysbiosis, epithelial injury, and immune activation, leads to the production of cytokines like interleukin (IL)-1β, IL-17, and transforming growth factor (TGF)-β. These mediators activate various stromal cell populations, including fibroblasts, pericytes, and smooth muscle cells. The activated stromal cells secrete excessive extracellular matrix components, thereby promoting fibrosis. Additionally, stromal cells influence the immune microenvironment through cytokine production. Future research would focus on elucidating the temporal and spatial relationships between immune cell-driven inflammation and stromal cell-mediated fibrosis. Additionally, investigations are needed to clarify the differentiation origins of excessive extracellular matrix-producing cells, particularly fibroblast activation protein (FAP) + fibroblasts, in the context of intestinal fibrosis. In conclusion, aberrant stromal cell activation, triggered by upstream immune signals, is a key mechanism underlying intestinal fibrosis. Further investigations into immune-stromal cell interactions and stromal cell activation are essential for the development of therapeutic strategies to prevent, alleviate, and potentially reverse fibrosis.
Humans ; Fibrosis/metabolism* ; Inflammatory Bowel Diseases/pathology* ; Animals ; Transforming Growth Factor beta/metabolism* ; Intestines/pathology*

Pancreatic intraductal papillary mucinous neoplasm (IPMN) is a pancreatic cystic lesion with malignant potential, the management of which relies on accurate diagnosis, risk stratification, and surveillance. Endoscopic techniques, particularly endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP), play crucial roles in the diagnosis, risk assessment, and therapeutic decision-making for IPMN. However, their application still faces challenges including technical limitations, operator dependence, cost-effectiveness considerations, and controversies regarding long-term surveillance strategies.This article comprehensively reviewed the current applications and recent advancements in gastrointestinal endoscopy for managing IPMN, and discussed future directions for refining personalized, precision-based treatment approaches.

Objective:To compare the diagnostic efficacy of 22 G fine needle aspiration (FNA) needles and 22 G end-cutting fine needle biopsy (FNB) needles for solid pancreatic lesion using both cytological and histological examination.Methods:Clinical data of 116 patients who underwent endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/FNB) at the Digestive Endoscopy Center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from June 2022 to March 2023 were retrospectively analyzed. Sixty-three patients sampled with 22 G FNA needles were the FNA group, and 53 sampled with 22 G FNB needles were the FNB group. The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and cytological and histological diagnostic yield of FNA needles and FNB needles for solid pancreatic lesions were compared.Results:There were no significant differences in age, gender, lesion location, lesion size, or the number of passes between the FNA group and the FNB group ( P>0.05). There were no significant differences in the diagnostic accuracy [93.7% (59/63) VS 90.6% (48/53), P=0.730], sensitivity [93.0% (53/57) VS 90.2% (46/51), P=0.732], specificity [100.0% (6/6) VS 100.0% (2/2), P=1.000], positive predictive value [100.0% (53/53) VS 100.0% (46/46), P=1.000] and negative predictive value [60.0% (6/10) VS 28.6% (2/7), P=0.335] of combined cytology and histology in distinguishing benign and malignant lesions between the two groups. In the FNA group, the diagnostic accuracy of combined cytology and histology was higher than cytology alone [93.7% (59/63) VS 81.0% (51/63), P=0.008], and was higher than histology alone without statistical significance [93.7% (59/63) VS 87.3% (55/63), P=0.125]. In the FNB group, the diagnostic accuracy of combined cytology and histology was higher than cytology alone [90.6% (48/53) VS 69.8% (37/53), P=0.001], but not than histology alone [90.6% (48/53) VS 90.6% (48/53)， P=1.000]. For solid masses located in pancreatic body/tail, the diagnostic accuracy for malignancy by histology using FNB needles tended to be higher than that of FNA needles [100.0% (17/17) VS 81.3% (26/32), P=0.080]. Conclusion:Both FNA needles and FNB needles exhibit adequate diagnostic yield for solid pancreatic masses when combining cytology and histology. FNB needles may offer a higher histological diagnostic yield.

Due to the difficult eradication of Helicobacter pylori caused by gradual increase of antibiotic resistance, the widespread use of nonsteroidal anti‑inflammatory drugs, and the common use of antithrombotic therapy in the aging population, the diagnosis and treatment of peptic ulcer are more challenging than ever. To further explore a new model of diagnosis and treatment of peptic ulcer in accordance with our national conditions, the Editorial Board of Chinese Journal of Digestion organized an expert committee to develop a new version of the consensus based on "Standardized diagnosis and treatment of peptic ulcer (2016, Xi′an)". The consensus has 30 statements, divided into 9 parts, covering the definition, clinical manifestations, pharmacological treatment, treatment of complications, and prevention of peptic ulcer.

Objective:To observe the pathological changes of different intestinal parts and the changes of intestinal barrier function in mice with acute necrotizing pancreatitis (ANP) induced by sodium taurocholate.Methods:A total of 18 male C57BL/6 mice were randomly divided into sham operation group, ANP 24 h group and ANP 48 h group with 6 mice in each group. The ANP model was established by retrograde injection of 2 μl/g 5% sodium taurocholate into the pancreaticobiliary duct. The sham operation group only underwent intubation. The survival status was recorded. The pathology of pancreatic and intestinal tissues were observed using hematoxylin-eosin staining, and the pathological scores were evaluated. The activities of serum amylase and lipase were measured by automatic biochemistry analyzer. Serum D-lactate levels were detected by ELISA. The expression of tight-junction proteins ZO-1 and occludin in small intestinal tissue was detected by Western blotting.Results:The survival rates of sham operation group, ANP 24 h group and ANP 48 h group were 100%, 36.4% and 25.0%, respectively. The pancreatic pathological scores of sham operation group, ANP 24 h group and ANP 48 h group were (0.67±0.82), (10.58±0.64) and (8.81±1.55); the serum amylase activities were (479.14±86.42), (5998.72±2096.31) and (3055.43±2336.5)U/L; the serum lipase activities were (18.56±3.84), (558.20±559.65) and (112.58±94.91)U/L. The pancreatic pathological scores, serum amylase and lipase levels in ANP group were higher than those in sham operation group, and the increase in ANP 24 h group was more significant, and the difference was statistically significant (all P value <0.05). The upper small intestine pathological scores in different groups were (0.17±0.41), (2.11±1.41) and (1.61±0.80); The lower small intestine pathological scores were (0.17±0.41), (1.00±0.76) and (1.06±0.25); the colonic pathological scores were (0.33±0.52), (0.67±0.82) and (0.67±0.52), respectively. The serum D-lactic acid level was (388.92±126.30), (2159.11±386.12) and (307.69±141.18) μmol/L. The expression of ZO-1 was (0.87±0.08), (0.19±0.18) and (0.50±0.19); the expression of occludin was (0.98±0.04), (0.13±0.08) and (0.69±0.04). The pathological scores of upper and lower segments of small intestine in ANP 24 h group and ANP 48 h group were significantly higher than those in the sham operation group (all P value <0.05). There was no significant difference on colonic pathological score among the three groups. The serum D lactate level in the ANP 24 h group was significantly higher than that in the sham operation group ( P<0.05), but there was no significant difference between the ANP 48 h group and the sham operation group. The expression of ZO-1 and occludin was decreased in ANP group compared with that in the sham operation group ( P value <0.05). Conclusions:ANP mouse model was successfully induced by sodium taurocholate, and the intestinal pathological changes were mainly concentrated on the small intestine, especially upper part of small intestine. The dysfunction of intestinal barrier was significantly aggravated within 24 hours after modeling, and the intestinal barrier function gradually recovered after 48 hours.

Objective:To compare the efficacy and safety between WangShiBaoChiWan and mosapride in the treatment of functional dyspepsia (FD).Methods:From September 2019 to September 2020, patients with postprandial fullness and early satiation who met the Rome Ⅳ criteria for FD diagnosis were enrolled from 15 hospitals, including the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical College. The subjects were randomly divided into WangShiBaoChiWan (experimental) group and mosapride (control) group in the ratio of 1∶1. The treatment regimens were WangShiBaoChiWan+ mosapride simulator, WangShiBaoChiWan simulator+ mosapride, respectively with a treatment period of 2 weeks. The primary efficacy outcome was the improvement rates of main symptoms before and after treatment, the secondary efficacy primary efficacy outcome was the total clinical effective rate and the change of the single symptom score. And the safety indicator included adverse events. Independent sample t-test, paired t-test and chi-square test were used for statistical analysis. Results:A total of 251 FD patients were enrolled in the full analysis set, including 124 in the experimental group and 127 in the control group; 241 FD patients were in the per-protocol analysis set, including 117 in the experimental group and 124 in the control group. The analysis of per-protocol analysis set showed that the improvement rates of the main symptoms of the experimental group and the control group were (66±29)% and (60±30)%, respectively, and the difference was not statistically significant ( P>0.05). The improvement rate of the main symptoms of the experimental group reached 117% of that of the control group, which exceeded the expected non-inferiority standard of 80%. The total clinical effective rates of the experimental group and the control group were 76.07% (89/117) and 75.81% (94/124), respectively, and the difference was not statistically significant ( P>0.05). The results of full analysis set showed that the incidence of adverse events of the experimental group and the control group was 1.62% (2/124) and 1.57% (2/127), respectively, and the difference was not statistically significant ( P>0.05). There were no serious adverse events in the two groups. Conclusion:The improvement rate of the main symptoms of WangShiBaoChiWan is not inferior to that of mosapride in the treatment of FD, and it has good safety.

Chronic pancreatitis (CP) is a chronic progressive disease that causes varying degrees of functional damage on pancreatic endocrine and exocrine, seriously affecting the quality of life of the patients. Endoscopic retrograde cholangio-pancreatography (ERCP) with minimal trauma, high safety, and good efficacy has become a first-line treatment method for CP. ERCP is a first-line treatment method for pancreatic duct stones and pancreatic duct stricture, and complications of CP.

Phosphodiesterase-4 (PDE4) functions as a catalyzing enzyme targeting hydrolyzation of intracellular cyclic adenosine monophosphate (cAMP) and inhibition of PDE4 has been proven to be a competitive strategy for dermatological and pulmonary inflammation. However, the pathological role of PDE4 and the therapeutic feasibility of PDE4 inhibitors in chronic ulcerative colitis (UC) are less clearly understood. This study introduced apremilast, a breakthrough in discovery of PDE4 inhibitors, to explore the therapeutic capacity in dextran sulfate sodium (DSS)-induced experimental murine chronic UC. In the inflamed tissues, overexpression of PDE4 isoforms and defective cAMP-mediating pathway were firstly identified in chronic UC patients. Therapeutically, inhibition of PDE4 by apremilast modulated cAMP-predominant protein kinase A (PKA)-cAMP-response element binding protein (CREB) signaling and ameliorated the clinical symptoms of chronic UC, as evidenced by improvements on mucosal ulcerations, tissue fibrosis, and inflammatory infiltrations. Consequently, apremilast maintained a normal intestinal physical and chemical barrier function and rebuilt the mucosal homeostasis by interfering with the cross-talk between human epithelial cells and immune cells. Furthermore, we found that apremilast could remap the landscape of gut microbiota and exert regulatory effects on antimicrobial responses and the function of mucus in the gut microenvironment. Taken together, the present study revealed that intervene of PDE4 provided an infusive therapeutic strategy for patients with chronic and relapsing UC.

Background; Sucralfate is a commonly used gastric mucosal protector in clinical practice. It can be dissociated into aluminum hydroxide and sucrose sulfate under the action of gastric acid. As a topical agent, sucralfate is mainly excreted with feces, and the tiny amount of sucralfate absorbed in gastrointestinal tract is excreted with urine in the form of disaccharide sulfate. Aims; To study the effect and safety of a domestic made oral sucralfate suspensoid gel on blood aluminum concentration. Methods; Twenty-three healthy volunteers participated in this study from June 2021 to September 2021 at the Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. All subjects received sucralfate suspensoid gel daily (1 h before breakfast in the morning, and before bedtime in the evening, 1 g each time) for 2 weeks. Blood samples were collected on day 1 (before sucralfate administration) and day 15 (after medication completion) for determination of blood aluminum concentration. Any adverse events (including abnormal laboratory indicators) were recorded. Results: No significant difference was existed in mean blood aluminum concentration of the healthy subjects between time points before and after sucralfate administration [(47. 66 ± 15. 64) μg/L vs. (39. 12 ± 2 0. 42) μg/L, P > 0. 0 5]. All the blood aluminum values after medication were within the reference range (70 μ g/L), so did the blood routine, urine routine and blood biochemical indicators before and after medication. No severe adverse events were reported. Conclusions; The domestic made sucralfate suspensoid gel used in this study for 2 weeks has no adverse effect on blood aluminum concentration in healthy subjects. It is considered to be safe and reliable, and is worthy for clinical application.