IntroductionChanges in nomenclature and in the criteria for histological diagnosis of the serrated lesions have occurred over the years. Some of these lesions, the sessile serrated lesions (SSLs), progress to adenocarcinoma via suppression of the MLH1 gene, an important carcinogenic pathway.ObjectiveEvaluate the frequency of reclassification in histological diagnosis from hyperplastic polyps (HPs) to SSL after reappraisal using the 2019 World Health Organization (WHO) classification, to determine the occurrence of previously undiagnosed dysplasia and to study the expression of the MLH1 protein in SSLs and SSLDs.MethodologyLesions with histological diagnosis of HP, SSL, and SSLD resected by colonoscopies performed between 2005 and 2015 located in the proximal colon were studied. All HPs were submitted for histological review by two pathologists (Examiners 1 and 2), and a third experienced pathologist (Examiner 3) made the final decision when the other examiners did not agree. Interobserver agreement was analyzed. MLH1 protein expression was assessed by immunohistochemistry in lesions diagnosed as SSL and SSLD before and after reappraisal. These lesions were reviewed again for missed dysplasia.ResultsA total of 308 lesions were assessed being 287 with the initial diagnosis of HP and 21 SSL. Thirty‐eight (13.3%) lesions with an initial diagnosis of HP had their diagnosis reclassified to SSL. No dysplasia was found. There was a moderate agreement (Kappa 0.52) between Examiners 1 and 2 regarding the diagnosis of SSL. Between Examiners 1 and 3, there was no agreement (Kappa −0.19), and between Examiners 3 and 2, the agreement was poor (Kappa 0.13). All 38 lesions analyzed by immunohistochemistry had MLH1 expression.ConclusionChanges in diagnosis from HP to SSL occurred in 13.3%. No dysplasia or lack of MLH1 expression was observed.

[This corrects the article DOI: 10.1155/2021/8828326.].

PurposeThis study was aimed at investigating the influence of age on patients with autoimmune gastritis (AIG).MethodsA total of 56 patients diagnosed with AIG at our hospital between January 2019 and December 2021 were included in this study. The participants were categorized into the elderly group (≥ 60 years old) and the nonelderly group. We analyzed the baseline characteristics, gastroscopy findings, and various laboratory examination parameters to see if age significantly influences the clinical manifestation of AIG patients.ResultsDuring the study period, 32 and 24 patients were included in the elderly and nonelderly groups. Regarding baseline characteristics and symptoms, the nonelderly group showed a higher prevalence of acid reflux (12.5% vs. 6.3%, p < 0.05), a higher proportion of asymptomatic patients (8.3% vs. 3.1%, p = 0.046), and a higher prevalence of iron deficiency anemia (37.5% vs. 12.5%). Regarding laboratory examinations, the nonelderly group had a lower mean corpuscular volume (78.8 ± 7.9 vs. 89.2 ± 8.1 fL, p = 0.024), decreased serum ferritin levels ((24.8 ± 10.9 vs. 48.4 ± 13.1 ng/mL, p = 0.024), elevated serum vitamin B12 (92.3 ± 18.2 vs. 76.8 ± 12.9 pmol/L, p = 0.037), and a higher incidence of positive thyroid peroxidase antibody (28.2% vs. 12.5%, p = 0.024). However, the gastroscopy findings, including the incidence of proliferative polyps, neuroendocrine tumors, gastric intraepithelial neoplasia, and cancers, showed no significant difference between the two groups (p > 0.05).ConclusionNonelderly patients with AIG exhibit distinct clinical features compared to elderly patients. Large sample sizes with multiple centers involved in studies are required to verify our findings.

BackgroundWhile preoperative neoadjuvant chemotherapy (NT) followed by surgery has gained acceptance in the management of locally advanced gastric cancer (LAGC), there remains a paucity of studies examining the efficacy of total neoadjuvant chemotherapy (TNT) for LAGC. This study was aimed at addressing this gap by comparing the outcomes of patients with clinical stage T4a-bN + M0 proximal gastric cancer treated with TNT and NT. The investigation sought to provide valuable insights into the effectiveness of the TNT regimen in this specific clinical context.MethodsRetrospective analysis was conducted on the clinical data of patients diagnosed with proximal LAGC who underwent perioperative docetaxel, oxaliplatin, and fluorouracil (FLOT) chemotherapy followed by laparoscopic radical gastrectomy at Longyan First Hospital affiliated with Fujian Medical University. The study, spanning from January 2017 to December 2019, included 26 patients in the TNT group and 32 patients in the NT group. Comparative assessments were made regarding the outcomes of chemotherapy and surgery, as well as the 3-year disease-free survival (DFS) and overall survival (OS) between the two groups.ResultsThe TNT group demonstrated superiority over the NT group in terms of operation time and intraoperative blood loss. While no significant difference was observed in total postoperative complications between the two groups, the TNT group exhibited a more pronounced downstaging in T stage and a higher rate of pathological complete regression. The 3-year OS rate was notably higher in the TNT group at 61.5%, compared to 46.9% in the NT group. Similarly, the 3-year DFS rate favored the TNT group at 53.8%, surpassing the rate of 34.4% in the NT group.ConclusionsThe TNT approach for LAGC had the potential to enhance tumor regression and increase the completion rate of chemotherapy. This strategy demonstrated a positive trend in long-term outcomes and introduced a novel treatment model.

BackgroundDiet is a modifiable risk factor for gallstone formation and influence the risk of gallstone disease (GSD). The present study was designed with the aim of investigating the association between different dietary protein and the risk of GSD.MethodsThis case–control study was conducted on 189 patients diagnosed with GSD and 342 controls. Intake of total protein and its subgroups was measured based on food frequency questionnaire. Using multiple logistic regression models, crude and multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.ResultsTotal protein intake can have protective effects against GSD and its beneficial effect was more in moderate consumption (ORT2 vs.T1 = 0.2, 95% CI 0.1–0.4) than high consumption (ORT3 vs.T1 = 0.39, 95% CI 0.23–0.66) (p for trend < 0.001). The relationship between dairy protein intake and the risk of GSD was U-shaped, so that moderate intake was associated with a reduced risk (ORT2 vs.T1 = 0.76) and higher intake was associated with an increased risk of the disease (ORT3 vs.T1 = 1.5) (p for trend = 0.027). Vegetable protein as a protective factor and animal protein as a risk factor showed a significant relationship with the risk of GSD.ConclusionDietary protein intake, especially vegetable protein, may protect against GSD, while animal protein may be a predisposing factor. Dairy protein protects against GSD when consumed in moderation, but higher intakes may increase the risk of GSD.

BackgroundAdaptation of the small intestine and/or colon significantly impacts the prognosis of short bowel syndrome. This study investigated colonic adaptation in a mouse model of ileal resection, with a focus on bile acid absorption.MethodsThe ileal resection mouse model (ileal resection group, 8–10-week-old male C57BL/6J mice) was created by resecting 15 cm of the ileum, corresponding to approximately 50% of the small intestine, while preserving the cecum. The sham group underwent intestinal transection and reanastomosis at a site matched in distance from the ligament of Treitz to that used for the resection group. Postoperatively, between Days 1–7 and 7–14, mice received the elemental diet ELENTAL® (0.5 kcal/mL) and a standard solid diet ad libitum, respectively. The mice were euthanized on Day 14. We assessed postoperative body weight; histopathological characteristics of the colon; bile acid metabolism-related gene expression, including Asbt for luminal bile acid uptake, Fabp6 for cytosolic transport, Ostb for bile acid excretion into the circulation, and Fxr, the primary intracellular bile acid receptor regulating the genes; and fecal and serum bile acid concentrations.ResultsSignificantly lower changes in body weight and longer colon length were observed in the ileal resection group than in the sham group; however, no histological differences were observed in colonic mucosal height. Furthermore, a significantly increased Asbt expression was detected in the ileal resection group. No significant differences were observed in bile acid concentrations in the feces and serum in both groups.ConclusionOur results suggest a colonic adaptation to prevent impairment of bile acid absorption following ileal resection.

BackgroundIrritable bowel syndrome (IBS), a gastrointestinal motility disorder affecting millions of patients worldwide, has a substantial impact on healthcare economics and patient quality of life. However, fully satisfactory therapeutic options remain lacking. The identification of pathogenic proteins supported by causal genetic evidence enables the exploration of potential therapeutic targets for IBS.MethodsA Mendelian randomization (MR) study was performed to discover potential treatment targets linked to IBS. Summary data for IBS (outcome) were acquired from the two largest independent cohorts: sample sizes of 486,601 (53,400 cases and 433,201 controls) and 101,884 (24,735 cases and 77,149 controls), respectively. Instrumental variables were derived from cis-expression quantitative trait loci (cis-eQTL) data of druggable genes, obtained through the eQTLGen Consortium database. Colocalization analysis was employed to assess whether IBS risk and gene expression were influenced by shared SNPs. An IBS mouse model was additionally utilized to confirm the therapeutic potential of drug targets.ResultsFour drug targets (P2RY14, SLC5A6, ATRAID, and IL1RL1) displayed notable MR findings in two separate datasets. Purinergic receptor P2Y14 (P2RY14) and all-trans retinoic acid–induced differentiation factor (ATRAID) exhibited robust evidence of colocalization with IBS. We further showed an abnormal increase in expression of P2RY14 and a significant decrease in ATRAID level in the colon tissue of IBS mice.ConclusionThis study proposes two potential therapeutic targets for IBS: P2RY14 and ATRAID. Drugs aimed at targeting these two genes have a greater chance of success in clinical trials, potentially facilitating the prioritization of IBS drug development and lowering associated costs.

Background and AimsTo develop a noninvasive clinical diagnostic model based on serological markers for nonalcoholic steatohepatitis (NASH) and to verify its predictive efficacy.MethodsA total of 82 biopsy-proven patients with nonalcoholic fatty liver disease (NAFLD) were included in the study. Patients were classified into nonalcoholic fatty liver (NAFL) and NASH groups based on the results of liver biopsies. The study utilized the LASSO regression model for variable selection, followed by logistic regression analysis to create a prediction model. A nomogram was then developed to illustrate this model. To validate the model, bootstrapping was applied for internal validation, and the accuracy, consistency, and clinical utility of the prediction model were evaluated.ResultsThe NASH group had significantly higher levels of red blood cell count, lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine aminotransferase (ALT), while levels of high-density lipoprotein (HDL) cholesterol were significantly lower in the NASH group (p < 0.05). Logistic regression analysis indicated that AST and ceruloplasmin were independent risk factors associated with NASH. A nomogram based on serological markers, including ceruloplasmin, HDL, AST, red blood cell count, thyroid-stimulating hormone (TSH), and total bile acid (TBA), was established to predict NASH with excellent discrimination (AUROC 0.813).ConclusionsAST and ceruloplasmin are independent risk factors associated with NASH. The CHART2 prediction model based on serological markers demonstrates good accuracy, consistency, and clinical utility. The model could serve as a noninvasive approach to identifying patients with NASH, which might reduce the need for liver biopsy.

Background: Small intestinal bacterial overgrowth (SIBO) is suggested in irritable bowel syndrome (IBS). Our primary aim was to define a discriminating threshold for a positive lactulose hydrogen breath test (LHBT) in SIBO. As a secondary aim, IBS was subdivided into SIBO and non-SIBO groups.Methods: LHBT performed in 206 subjects, 74 healthy subjects, 39 SIBO patients with intestinal lesions, 77 IBS patients, and 16 nonhydrogen producers. Using scintigraphy and LHBT, orocecal transit time was set to 80 min. Peak hydrogen levels were compared between the groups. Values are mean and 95% confidence interval.Results: Using an 80-min orocecal cutoff time, LHBT in healthy subjects had peak values of 8 (6–9) ppm and SIBO 38 (31–45) ppm (p < 0.0001). The diagnostic cutoff 20 ppm verified a sensitivity of 77% and specificity of 88% and positive and negative predictions of 77% and 88%. With the same cutoff for IBS, the mean peak value was 21 (16–26) ppm (p < 0.0001 vs. healthy) with a sensitivity of 39% and a specificity of 78% and positive and negative predictions of 77% and 84%. Separating IBS at 20 ppm, the low-hydrogen group had a peak value of 6 (5–7) ppm (ns vs. healthy), and the high-hydrogen group had a peak of 44 (38–49) ppm (p < 0.0001 vs. healthy). After antibiotics, IBS with low hydrogen remained unchanged, whereas those with high hydrogen were reduced to control (p < 0.01).Conclusion: With cutoff at 20 ppm, LHBT differentiates SIBO in patients with early high breath hydrogen peaks, subdividing IBS into non-SIBO and SIBO groups; the latter may benefit from antibiotic treatment.

Gastroesophageal reflux disease (GERD) is primarily managed with acid suppressors, while laparoscopic fundoplication is considered the gold-standard surgical treatment for patients who have a suboptimal response to medical therapy, despite its limited acceptance. However, there have been alternative endoscopic treatment techniques available, including radiofrequency therapy, transoral fundoplication, and mucosal resection or mucosal ablation for this subgroup of patients, among which antireflux mucosectomy (ARMS) stands out as a relatively novel and minimally invasive option. The objective of this article is to provide gastroenterologists with a more comprehensive understanding of the technical features, current application status, clinical outcomes, and future perspectives regarding ARMS in the management of GERD. It is expected that ARMS will have a place in the standard endoscopic treatment of GERD. In the meantime, long-term multicenter, large-sample studies are required to provide a more convincing evaluation.