Harnessing autophagy: A potential breakthrough in digestive disease treatment

Autophagy,a conserved cellular degradation process,is crucial for various cellular processes such as immune responses,inflammation,metabolic and oxidative stress adaptation,cell proliferation,development,and tissue repair and remodeling.Dysregulation of autophagy is suspected in numerous diseases,including cancer,neurodegenerative diseases,digestive disorders,metabolic syndromes,and infectious and inflammatory diseases.If autophagy is disrupted,for example,this can have serious consequences and lead to chronic inflammation and tissue damage,as occurs in diseases such as Chron's disease and ulcerative colitis.On the other hand,the influence of autophagy on the development and progression of cancer is not clear.Autophagy can both suppress and promote the progression and metastasis of cancer at various stages.From inflammatory bowel diseases to gastrointestinal cancer,researchers are discovering the intricate role of autophagy in maintaining gut health and its potential as a therapeutic target.Researchers should carefully consider the nature and progression of diseases such as cancer when trying to determine whether inhibiting or stimulating autophagy is likely to be beneficial.Multidisciplinary approaches that combine cutting-edge research with clinical expertise are key to unlocking the full therapeutic potential of autophagy in digestive diseases.

Applications of gastric peroral endoscopic myotomy in the treatment of upper gastrointestinal tract disease

Gastric peroral endoscopic myotomy(G-POME)is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tun-nel around the pyloric sphincter.In 2013,Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy,prov-iding a new direction for the treatment of gastroparesis.With the recent and rapid development of G-POME therapy technology,progress has been made in the treatment of gastroparesis and other upper digestive tract diseases,such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture,with G-POME.This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.

Role of gut microbiota via the gut-liver-brain axis in digestive diseases

The gut-brain axis is a bidirectional information interaction system between the central nervous system(CNS) and the gastrointestinal tract, in which gut microbiota plays a key role. The gut microbiota forms a complex network with the enteric nervous system, the autonomic nervous system, and the neuroendocrine and neuroimmunity of the CNS, which is called the microbiota-gut-brain axis. Due to the close anatomical and functional interaction of the gut-liver axis, the microbiota-gut-liver-brain axis has attracted increased attention in recent years. The microbiota-gut-liver-brain axis mediates the occurrence and development of many diseases, and it offers a direction for the research of disease treatment. In this review, we mainly discuss the role of the gut microbiota in the irritable bowel syndrome, inflammatory bowel disease, functional dyspepsia, non-alcoholic fatty liver disease, alcoholic liver disease, cirrhosis and hepatic encephalopathy via the gut-liver-brain axis, and the focus is to clarify the potential mechanisms and treatment of digestive diseases based on the further understanding of the microbiota-gut-liver-brain axis.

Prevalence of depression and anxiety in patients with chronic digestive system diseases: A multicenter epidemiological study

AIM To investigate the prevalence of depression and anxiety in patients with chronic digestive system diseases.METHODS A total of 1736 patients with chronic digestive systemdiseases were included in this cross-sectional study, including 871 outpatients and 865 in-patients. A selfdesigned General Information for Patients of the Department of Gastroenterology of General Hospitals questionnaire was used to collect each patient's general information, which included demographic data(including age, sex, marital status, and education) and disease characteristics(including major diseases, disease duration, principal symptoms, chronic pain, sleep disorder, and limited daily activities).RESULTS The overall detection rate was 31.11%(540/1736) for depression symptoms alone, 27.02%(469/1736) for anxiety symptoms alone, 20.68%(359/1736) for both depression and anxiety symptoms, and 37.44%(650/1736) for either depression or anxiety symptoms. Subjects aged 70 years or above had the highest detection rate of depression(44.06%) and anxiety symptoms(33.33%). χ2 trend test showed: the higher the body mass index(BMI), the lower the detection rate of depression and anxiety symptoms(χ2trend = 13.697, P < 0.001; χ2trend = 9.082, P = 0.003); the more severe the limited daily activities, the higher the detection rate of depression and anxiety symptoms(χ2trend = 130.455, P < 0.001, χ2trend = 108.528, P < 0.001); and the poorer the sleep quality, the higher the detection rate of depression and anxiety symptoms(χ2trend = 85.759, P < 0.001; χ2trend = 51.969, P < 0.001). Patients with digestive system tumors had the highest detection rate of depression(57.55%) and anxiety(55.19%), followed by patients with liver cirrhosis(41.35% and 48.08%). Depression and anxiety symptoms were also high in subjects with comorbid hypertension and coronary heart disease. CONCLUSION Depression and anxiety occur in patients with tumors, liver cirrhosis, functional dyspepsia, and chronic viral hepatitis. Elderly, divorced/widowed, poor sleep quality, and lower BMI are associated with higher risk of depression and anxiety.

Artificial intelligence:Emerging player in the diagnosis and treatment of digestive disease

Given the breakthroughs in key technologies,such as image recognition,deep learning and neural networks,artificial intelligence(AI)continues to be increasingly developed,leading to closer and deeper integration with an increasingly data-,knowledge-and brain labor-intensive medical industry.As society continues to advance and individuals become more aware of their health needs,the problems associated with the aging of the population are receiving increasing attention,and there is an urgent demand for improving medical technology,prolonging human life and enhancing health.Digestive system diseases are the most common clinical diseases and are characterized by complex clinical manifestations and a general lack of obvious symptoms in the early stage.Such diseases are very difficult to diagnose and treat.In recent years,the incidence of diseases of the digestive system has increased.As AI applications in the field of health care continue to be developed,AI has begun playing an important role in the diagnosis and treatment of diseases of the digestive system.In this paper,the application of AI in assisted diagnosis and the application and prospects of AI in malignant and benign digestive system diseases are reviewed.

Danish cohort of monozygotic inflammatory bowel disease twins: Clinical characteristics and inflammatory activity

AIM: To describe the establishment of a Danish inflammatory bowel diseases (IBD) twin cohort with focus on concordance of treatment and inflammatory markers.METHODS: We identified MZ twins, likely to be discordant or concordant for IBD, by merging information from the Danish Twin Register and the National Patient Register. The twins were asked to provide biological samples, questionnaires, and data access to patient files and public registries. Biological samples were collected via a mobile laboratory, which allowed for immediate centrifugation, fractionation, and storage of samples. The mean time from collection of samples to storage in the -80&#x02005;&#x000b0;C mobile freezer was less than one hour. The diagnoses where validated using the Copenhagen diagnostic criteria.RESULTS: We identified 159 MZ IBD twin pairs, in a total of 62 (39%) pairs both twins agreed to participate. Of the supposed 62 IBD pairs, the IBD diagnosis could be confirmed in 54 pairs. The cohort included 10 concordant pairs, whereof some were discordant for either treatment or surgery. The 10 concordant pairs, where both pairs suffered from IBD, included eight CD/CD pairs, one UC/UC pair and one UC/IBDU pair. The discordant pairs comprised 31 UC, 5 IBDU (IBD unclassified), and 8 CD discordant pairs. In the co-twins not affected by IBD, calprotectin was above 100 &#x003bc;g/g in 2 participants, and above 50 &#x003bc;g/g in a further 5 participants.CONCLUSION: The presented IBD twin cohorts are an excellent resource for bioinformatics studies with proper adjustment for disease-associated exposures including medication and inflammatory activity in the co-twins.

A study of TCM master Yan Zhenghua’s medication rule in prescriptions for digestive system diseases based on Apriori and complex system entropy cluster

Objective:To explore Yan Zhenghua’s drug selection rule for treating digestive system diseases using data mining.Methods:The 609 medical records of digestive system diseases treated by Yan Zhenghua were collected and the herbs in these recipes were examined using a data mining technique.The correlativity between herb pairs and association rules was studied using an Apriori algorithm and the correlativity among multi-herbs was studied using a complex system entropy cluster technique.Results:Yan Zhenghua’s treatment of digestive system diseases featured 15 herbs prescribed at least 159 times each,22 herb pairs prescribed at least 155 times each,and eight frequently used herb core combinations.A confidence greater than 0.91 and a support level greater than 20%were achieved using the modified mutual information method.Conclusion:The data mining results conformed to findings from clinical practice.The data mining method is a valuable technique with which to study the experience of famous,elderly traditional Chinese medicine physicians.

A systematic review and meta-analysis to compare the effects of Chinese herbal pieces and granule in different diseaseherbal pieces

Objective:Compared to Chinese herbal piecesherbal pieces,the quality of TCM granule is stable and controllable,it is also a convenient alternative to decocting herbs.However,whether they are as clinically effective as Chinese herbal piecesherbal pieces is still controversial.In this study,a systematic review and meta-analysis were performed to assess the clinical efficacy of TCM granules and Chinese herbal piecesherbal pieces.Methods:A search of online databases for eligible articles was performed,including PubMed,Embase,Cochrane Library,Web of Science,China National Knowledge Internet,WanFang,and Chongqing VIP Information,searching from the inception of these databases to 2020.The Cochrane Handbook 5.1.0 was used to independently identify the trials,extract data,and assess the risk of bias.The meta-analysis was performed via RevMan 5.3 software.Results:A total of 98 eligible articles were included.After classification and statistical analysis of the related diseases,a meta-analysis was performed on 8 types of illnesses(cold,hypertension,migraine,osteoporosis,and diseases of the digestive system,such as gastritis,gastric ulcer,colitis,epigastric pain)included in 66 randomized controlled trials to compare the clinical efficacy and adverse events of TCM granules and Chinese herbal pieces.Meta-analysis showed that compared with Chinese herbal piecesherbal pieces,TCM granules had similar effectiveness and safety in treating cold,hypertension,and osteoporosis,but a higher response rate in migraines and a better effect in reducing migraine duration and higher response rate on diseases of the digestive system.Conclusion:Compared with the traditional decoctions,TCM formula granules had the same efficacy and safety,moreover,they had higher efficacy and safety in treating migraines and digestive system diseases.

An investigation of the influence of intestinal flora in external traditional Chinese medicine therapy

External therapy,which has been used for millennia to treat disease,has now become the newest member of complementary and alternative therapies.A growing number of clinical studies and animal experiments have shown that external therapy exerts a positive effect on the intestinal flora.In this paper,we review the research related to external therapy on various systemic diseases and focus on changes in the intestinal flora.We found that studies on external therapy are dominated by acupuncture and tuina,primarily aimed at the treatment of digestive and neurological diseases.However,the deeper mechanism of regulation of the intestinal flora by external therapy has not yet been experimentally confirmed.

Non-clostridium difficile induced pseudomembranous colitis

Pseudomembranous colitis is severe inflammation of the inner lining of the colon due to anoxia,ischemia,endothelial damage,and toxin production.The majority of cases of pseudomembranous colitis are due to Clostridium difficile.However,other causative pathogens and agents have been responsible for causing a similar pattern of injury to the bowel with the endoscopic appearance of yellow-white plaques and membranes on the mucosal surface of the colon.Common presenting symptoms and signs include crampy abdominal pain,nausea,watery diarrhea that can progress to bloody diarrhea,fever,leukocytosis,and dehydration.Negative testing for Clostridium difficile or failure to improve on treatment should prompt evaluation for other causes of pseudomembranous colitis.Bacterial infections other than Clostridium difficile,Viruses such as cytomegalovirus,parasitic infections,medications,drugs,chemicals,inflammatory diseases,and ischemia are other differential diagnoses to look out for in pseudomembranous colitis.Complications of pseudomembranous colitis include toxic megacolon,hypotension,colonic perforation with peritonitis,and septic shock with organ failure.Early diagnosis and treatment to prevent progression are important.The central perspective of this paper is to provide a concise review of the various etiologies for pseudomembranous colitis and management per prior literature.

Animal experimental study on magnetic anchor technique-assisted endoscopic submucosal dissection of early gastric cancer

BACKGROUND Gastric cancer(GC)has high morbidity and mortality.Moreover,because GC has no typical symptoms in the early stages,most cases are already in the advanced stages by the time the symptoms appear,thus resulting in poor prognosis and a low survival rate.Endoscopic submucosal dissection(ESD)can realize the early detection and diagnosis of GC and become the main surgical method for early GC.However,ESD has a steep learning curve and high technical skill requirements for endoscopists,which is not conducive to its widespread implementation and advancement.Therefore,a series of auxiliary techniques have been derived.AIM To evaluate the safety and efficacy of magnetic anchor technique(MAT)-assisted ESD in early GC.METHODS This was an ex vivo animal experiment.The experimental models were the isolated stomachs of pigs,which were divided into two groups,namely the study group(n=6)with MAT-assisted ESD and the control group(n=6)with traditional ESD.Comparing the total surgical time,incidence of surgical complications,complete mucosal resection rate,specimen size,and the scores of endoscopist’s satisfaction with the procedure reflected their feelings about convenience during the surgical procedure between the two groups.The magnetic anchor device for auxiliary ESD in the study group comprised three parts,an anchor magnet(AM),a target magnet(TM),and a soft tissue clip.Under gastroscopic guidance,the soft tissue clip and the TM were delivered to the pre-marked mucosal lesion through the gastroscopic operating hole.The soft tissue clip and the TM were connected by a thin wire through the TM tail structure.The soft tissue clip was released by manipulating the operating handle of the soft tissue clip in a way that the soft tissue clip and the TM were fixed to the lesion mucosa.In vitro,ESD is aided by maneuvering the AM such that the mucosal dissection surface is exposed.RESULTS The total surgical time was shorter in the study group than in the control group(26.57±0.19 vs 29.97±0.28,P<0.001),and the scores of endoscopist’s satisfaction with the procedure were higher in the study group than in the control group(9.53±0.10 vs 8.00±0.22,P<0.001).During the operation in the study group,there was no detachment of the soft tissue clip and TM and no mucosal tearing.The magnetic force between the AM and TM provided good mucosal exposure and sufficient tissue tension for ESD.The mucosal lesion was completely peeled off,and the operation was successful.There were no significant differences in the incidence of surgical complications(100%vs 83.3%),complete mucosal resection rate(100%vs 66.7%,P=0.439),and specimen size(2.44±0.04 cm vs 2.49±0.02,P=0.328)between the two groups.CONCLUSION MAT-ESD is safe and effective for early GC.It provides a preliminary basis for subsequent internal animal experiments and clinical research.

Gastrointestinal tract and viral pathogens

Viral gastroenteritis is the most common viral illness that affects the gastro-intestinal(GI)tract,causing inflammation and irritation of the lining of the stomach and intestines.Common signs and symptoms associated with this condition include abdominal pain,diarrhea,and dehydration.The infections commonly involved in viral gastroenteritis are rotavirus,norovirus,and adenovirus,which spread through the fecal-oral and contact routes and cause non-bloody diarrhea.These infections can affect both immunocompetent and immunocompromised individuals.Since the pandemic in 2019,coronavirus gastroenteritis has increased in incidence and prevalence.Morbidity and mortality rates from viral gastroenteritis have declined significantly over the years due to early recognition,treatment with oral rehydration salts,and prompt vaccination.Improved sanitation measures have also played a key role in reducing the transmission of infection.In addition to viral hepatitis causing liver disease,herpes virus,and cytomegalovirus are responsible for ulcerative GI disease.They are associated with bloody diarrhea and commonly occur in im-munocompromised individuals.Hepatitis viruses,Epstein-Barr virus,herpesvirus 8,and human papillomavirus have been involved in benign and malignant diseases.This mini review aims to list different viruses affecting the GI tract.It will cover common symptoms aiding in diagnosis and various important aspects of each viral infection that can aid diagnosis and management.This will help primary care physicians and hospitalists diagnose and treat patients more easily.

Chemical components and protective effects of Atractylodes japonica Koidz.ex Kitam against acetic acid-induced gastric ulcer in rats

BACKGROUND Atractylodes japonica Koidz.ex Kitam.(A.japonica,Chinese name:Guan-Cangzhu,Japanese name:Byaku-jutsu),a perennial herb,which is mainly distributed in northeast area of China,it’s often used to treat digestive system diseases such as gastric ulcer(GU).However,the mechanism of its potential protective effects against GU remains unclear.AIM To investigate the protective effects of A.japonica on acetic acid-induced GU rats.METHODS The chemical constituents of A.japonica were determined by ultra performance liquid chromatography tandem mass spectrometry(UPLC-MS/MS)analysis.The rat model of GU was simulated by acetic acid method.The pathological changes of gastric tissues were evaluated by hematoxylin-eosin stain,the levels of epidermal growth factor(EGF),EGF receptor(EGFR),nuclear factor kappa-B(NF-κB),interleukin-1β(IL-1β),IL-10,Na^(+)-K^(+)-ATPase(NKA)in serum and gastric tissues were determined by enzyme-linked immunosorbent assay,and the mRNA expressions of EGFR,NF-κBp65,IkappaBalpha(IκBα)and Zonula Occludens-1(ZO-1)in gastric tissues were determined by real-time reverse transcription polymerase chain reaction,and the efficacy was observed.Then,plasma metabolomic analysis was performed by UPLC-MS/MS to screen the specific potential biomarkers,metabolic pathways and to explore the possible mechani-sms.RESULTS 48 chemical constituents were identified.Many of them have strong pharmacological activity,the results also revealed that A.japonica significantly improved the pathological damage of gastric tissues,increased the expression levels of IL-10,IκBαrelated to anti-inflammatory factors,decreased the expression levels of IL-1β,NF-κB,NF-κBp65,related to proinflammatory factors,restored the levels of factors about EGF,EGFR,ZO-1 associated with ulcer healing and the levels of factors about NKA associated with energy metabolism.Metabolomic analysis identified 10 potential differential metabolites and enriched 7 related metabolic pathways.CONCLUSION These findings contribute to the understanding of the potential mechanism of A.japonica to improve acetic acidinduced GU,and will be of great importance for the development and clinical application of natural drugs related to A.japonica.

Research Progress of Necroptosis in Digestive Diseases

Digestive system diseases refer to organic and functional disorders of the digestive system,which are prone to recurrence and frequently accompanied by multiple complications.Necroptosis is a regulated mode of cell death mediated by death receptors,dependent on receptor protein activation,and could be specifically inhibited by necrostatin-1.Necroptosis is involved in pathological and physiological processes of various diseases,and plays an important role in the growth and development of organisms and the homeostasis of organ tissues.This paper reviewed the research advancement of necroptosis in digestive system disorders,and discussed the relationship between necroptosis and digestive system diseases,aiming to provide theoretical basis for the cure of these diseases.

A few suggestions to World Journal of Gastroenterology

To the Editor, It is of great pleasure to learn that WJG has developed into one of the important journals to the field of gastronenterology studies worldwide. Thank you for providing such an excellent platform for scholars to exhibit their hard work and fruitful ressults. It is also a very good chance for western scholars to learn of the advances dig estive disease studies performed inside China.Hopefully,more and more scholars around the world will come to realize that WJG is a journal worth reading.I visit the WJG website now and then to catch up with gastrointestinal research advances inside China. I have two small suggestions here for your reference. First is a layout issue. In the articles some of the lines are loose and some are tight, it is unappealing to look at and difficult to read. I finally realized that you didn't truncate the words by syllable where it is mecessary. This is usually done in other international journals. Microsoft Word software has an auto word-wrap function.Sometimes,my friends here would ask me to explain something printed on the wrap of made-in-China things which was written in "Chinglish" and with obvious mistakes. That embarrassed me so much. Next time, when I introduce WJG to my friends or olleagues, are they going to say :"Oh! Look at those lines?" Second, the of is too slow.How about speeding it up?

Mineral Medicine: Chinese Medical Stone

A simple experiment of rat gastric ulcer was carried out to study the medical effect of Chinese Medical Stone which is a kind of Mineral Medicine of mines in China on gastric ulcer in rats.The purpose of this study was to investigate the effect of the Chinese Medical Stone on the prevention and treatment of experimental gastrointestinal disease,especially gastric ulcer.

Application of deep learning in lower gastrointestinal diseases

Deep learning has made tremendous progress in diagnosis assistance and prognosis prediction along with the accumulation of abundant medical data and the improvement of computer algorithms.Many studies have focused on applying deep learning to diseases of the lower gastrointestinal tract.Studies on deep learning and digestive system diseases mainly focus on cancer and inflammatory diseases,while few studies focus on other diseases.In order to better understand the emerging interdisciplinary,this paper reviews the ways in which deep learning may help doctors make a diagnosis or establish a prognosis,revealing that further randomized controlled studies and deeper cooperation between artificial intelligence engineers and doctors will be required.

《Chinese Journal of Digestive Diseases》进入Medline检索

《Chinese Journal of Digestive Diseases》南中华医学会消化病学分会、中华医学会上海分会和Blackwell Publishing Asia合作出版，创刊于2000年，国际标准刊号：ISSN1443—9611。在总编辑萧树东教授领导的编委会的不懈努力下，

《Chinese Journal of Digestive Diseases》进入Medline检索

《Chinese Journal of Digestive Diseases》由中华医学会消化病学分会、中华医学会上海分会和 Blackwell Publishing Asia 合作出版,创刊于2000年,国际标准刊号:ISSN1443-9611。在总编辑萧树东教授领导的编委会的不懈努力下,《Chinese Journalof Digestive Diseases》已正式被国际著名检索系统 Medline 收录。欢迎广大消化科、外科及相关学科的临床、科研、教学工作者积极来稿,征稿范围包括:论著、综述等。来稿要求:稿件一式二份(附软盘),并说明作者的联系方式.Email 地址。