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ELife Feb 2023Whether the positive associations of smoking and alcohol consumption with gastrointestinal diseases are causal is uncertain. We conducted this Mendelian randomization...
BACKGROUND
Whether the positive associations of smoking and alcohol consumption with gastrointestinal diseases are causal is uncertain. We conducted this Mendelian randomization (MR) to comprehensively examine associations of smoking and alcohol consumption with common gastrointestinal diseases.
METHODS
Genetic variants associated with smoking initiation and alcohol consumption at the genome-wide significance level were selected as instrumental variables. Genetic associations with 24 gastrointestinal diseases were obtained from the UK Biobank, FinnGen study, and other large consortia. Univariable and multivariable MR analyses were conducted to estimate the overall and independent MR associations after mutual adjustment for genetic liability to smoking and alcohol consumption.
RESULTS
Genetic predisposition to smoking initiation was associated with increased risk of 20 of 24 gastrointestinal diseases, including 7 upper gastrointestinal diseases (gastroesophageal reflux, esophageal cancer, gastric ulcer, duodenal ulcer, acute gastritis, chronic gastritis, and gastric cancer), 4 lower gastrointestinal diseases (irritable bowel syndrome, diverticular disease, Crohn's disease, and ulcerative colitis), 8 hepatobiliary and pancreatic diseases (non-alcoholic fatty liver disease, alcoholic liver disease, cirrhosis, liver cancer, cholecystitis, cholelithiasis, and acute and chronic pancreatitis), and acute appendicitis. Fifteen out of 20 associations persisted after adjusting for genetically predicted alcohol consumption. Genetically predicted higher alcohol consumption was associated with increased risk of duodenal ulcer, alcoholic liver disease, cirrhosis, and chronic pancreatitis; however, the association for duodenal ulcer did not remain statistically significant after adjustment for genetic predisposition to smoking initiation.
CONCLUSIONS
This study provides MR evidence supporting causal associations of smoking with a broad range of gastrointestinal diseases, whereas alcohol consumption was associated with only a few gastrointestinal diseases.
FUNDING
The Natural Science Fund for Distinguished Young Scholars of Zhejiang Province; National Natural Science Foundation of China; Key Project of Research and Development Plan of Hunan Province; the Swedish Heart Lung Foundation; the Swedish Research Council; the Swedish Cancer Society.
Topics: Humans; Mendelian Randomization Analysis; Genetic Predisposition to Disease; Duodenal Ulcer; Smoking; Alcohol Drinking; Esophageal Neoplasms; Liver Diseases, Alcoholic; Gastritis; Pancreatitis, Chronic; Genome-Wide Association Study; Polymorphism, Single Nucleotide
PubMed: 36727839
DOI: 10.7554/eLife.84051 -
The Lancet. Gastroenterology &... Jan 2023The intestinal barrier, which primarily consists of a mucus layer, an epithelial barrier, and a gut vascular barrier, has a crucial role in health and disease by... (Review)
Review
The intestinal barrier, which primarily consists of a mucus layer, an epithelial barrier, and a gut vascular barrier, has a crucial role in health and disease by facilitating nutrient absorption and preventing the entry of pathogens. The intestinal barrier is in close contact with gut microbiota on its luminal side and with enteric neurons and glial cells on its tissue side. Mounting evidence now suggests that the intestinal barrier is compromised not only in digestive disorders, but also in disorders of the central nervous system (CNS), such as Parkinson's disease, autism spectrum disorder, depression, multiple sclerosis, and Alzheimer's disease. After providing an overview of the structure and functions of the intestinal barrier, we review existing preclinical and clinical studies supporting the notion that intestinal barrier dysfunction is present in neurological, neurodevelopmental, and psychiatric disorders. On the basis of this evidence, we discuss the mechanisms that possibly link gut barrier dysfunction and CNS disorders and the potential impact that evaluating enteric barriers in brain disorders could have on clinical practice, in terms of novel diagnostic and therapeutic strategies, in the near future.
Topics: Humans; Autism Spectrum Disorder; Central Nervous System; Gastrointestinal Microbiome; Intestinal Diseases
PubMed: 36334596
DOI: 10.1016/S2468-1253(22)00241-2 -
Disease-a-month : DM Jul 2021Gallbladder disorders encompass a wide breadth of diseases that vary in severity. We present a comprehensive review of literature for the clinical presentation,... (Review)
Review
Gallbladder disorders encompass a wide breadth of diseases that vary in severity. We present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis-related disease, acute acalculous cholecystitis, functional gallbladder disorder, gallbladder polyps, gallbladder hydrops, porcelain gallbladder, and gallbladder cancer.
Topics: Cholecystitis; Cholelithiasis; Gallbladder; Gallbladder Diseases; Gallbladder Neoplasms; Humans
PubMed: 33478678
DOI: 10.1016/j.disamonth.2021.101130 -
Nature Reviews. Gastroenterology &... May 2020Gut microbiota dysbiosis has been repeatedly observed in obesity and type 2 diabetes mellitus, two metabolic diseases strongly intertwined with non-alcoholic fatty liver... (Review)
Review
Gut microbiota dysbiosis has been repeatedly observed in obesity and type 2 diabetes mellitus, two metabolic diseases strongly intertwined with non-alcoholic fatty liver disease (NAFLD). Animal studies have demonstrated a potential causal role of gut microbiota in NAFLD. Human studies have started to describe microbiota alterations in NAFLD and have found a few consistent microbiome signatures discriminating healthy individuals from those with NAFLD, non-alcoholic steatohepatitis or cirrhosis. However, patients with NAFLD often present with obesity and/or insulin resistance and type 2 diabetes mellitus, and these metabolic confounding factors for dysbiosis have not always been considered. Patients with different NAFLD severity stages often present with heterogeneous lesions and variable demographic characteristics (including age, sex and ethnicity), which are known to affect the gut microbiome and have been overlooked in most studies. Finally, multiple gut microbiome sequencing tools and NAFLD diagnostic methods have been used across studies that could account for discrepant microbiome signatures. This Review provides a broad insight into microbiome signatures for human NAFLD and explores issues with disentangling these signatures from underlying metabolic disorders. More advanced metagenomics and multi-omics studies using system biology approaches are needed to improve microbiome biomarkers.
Topics: Animals; Diabetes Mellitus, Type 2; Digestive System Diseases; Dysbiosis; Gastrointestinal Microbiome; Humans; Non-alcoholic Fatty Liver Disease; Obesity; Signal Transduction
PubMed: 32152478
DOI: 10.1038/s41575-020-0269-9 -
Frontiers in Cellular and Infection... 2022The prevalence of infection has exceeded 50% worldwide, and it is considered a high-risk factor for chronic gastritis, peptic ulcer, gastric adenocarcinoma,... (Review)
Review
The prevalence of infection has exceeded 50% worldwide, and it is considered a high-risk factor for chronic gastritis, peptic ulcer, gastric adenocarcinoma, gastroesophageal reflux disease and functional dyspepsia. drug resistance is a common problem worldwide. In recent years, the relationship between infection and gastrointestinal microecology has received much attention. infection changes the structure and composition of gastrointestinal microflora by regulating the gastrointestinal microecological environment, local pH value, cytokines and antimicrobial peptides, and immune response and then plays a crucial role in the occurrence and development of digestive system tumors, liver metabolism and extragastrointestinal diseases. The quadruple strategy of eradication can also aggravate gastrointestinal microflora disorder. However, probiotics can reduce intestinal flora changes and imbalances through different mechanisms, thus enhancing the efficacy of eradication therapy and reducing adverse reactions caused by eradication therapy. Therefore, this paper reviews the relationship between infection and gastrointestinal microecology and its clinical application, providing a basis for clinical treatment.
Topics: Dyspepsia; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer
PubMed: 36061875
DOI: 10.3389/fcimb.2022.938608 -
World Journal of Gastroenterology Jan 2020Esophageo-gastro-duodenoscopy (EGD) is an important procedure used for detection and diagnosis of esophago-gastric lesions. There exists no consensus on the technique of... (Review)
Review
BACKGROUND
Esophageo-gastro-duodenoscopy (EGD) is an important procedure used for detection and diagnosis of esophago-gastric lesions. There exists no consensus on the technique of examination.
AIM
To identify recent advances in diagnostic EGDs to improve diagnostic yield.
METHODS
We queried the PubMed database for relevant articles published between January 2001 and August 2019 as well as hand searched references from recently published endoscopy guidelines. Keywords used included free text and MeSH terms addressing quality indicators and technological innovations in EGDs. Factors affecting diagnostic yield and EGD quality were identified and divided into the follow segments: Pre endoscopy preparation, sedation, examination schema, examination time, routine biopsy, image enhanced endoscopy and future developments.
RESULTS
We identified 120 relevant abstracts of which we utilized 67 of these studies in our review. Adequate pre-endoscopy preparation with simethicone and pronase increases gastric visibility. Proper sedation, especially with propofol, increases patient satisfaction after procedure and may improve detection of superficial gastrointestinal lesions. There is a movement towards mandatory picture documentation during EGD as well as dedicating sufficient time for examination improves diagnostic yield. The use of image enhanced endoscopy and magnifying endoscopy improves detection of squamous cell carcinoma and gastric neoplasm. The magnifying endoscopy simple diagnostic algorithm is useful for diagnosis of early gastric cancer.
CONCLUSION
There is a steady momentum in the past decade towards improving diagnostic yield, quality and reporting in EGDs. Other interesting innovations, such as Raman spectroscopy, endocytoscopy and artificial intelligence may have widespread endoscopic applications in the near future.
Topics: Digestive System Diseases; Early Detection of Cancer; Endoscopy, Digestive System; Gastroenterology; Humans
PubMed: 32063692
DOI: 10.3748/wjg.v26.i4.433 -
United European Gastroenterology Journal Jul 2020The overall objective of these guidelines is to provide evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive...
The overall objective of these guidelines is to provide evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, abdominal pain, posterior pancreatic pain, and involvement of extra-pancreatic digestive organs, including IgG4-related cholangitis. Treatment with glucocorticoids should be weight-based and initiated at a dose of 0.6-0.8 mg/kg body weight/day orally (typical starting dose 30-40 mg/day prednisone equivalent) for 1 month to induce remission and then be tapered within two additional months. Response to initial treatment should be assessed at week 2-4 with clinical, biochemical and morphological markers. Maintenance treatment with glucocorticoids should be considered in multi-organ disease or history of relapse. If there is no change in disease activity and burden within 3 months, the diagnosis should be reconsidered. If the disease relapsed during the 3 months of treatment, immunosuppressive drugs should be added.
Topics: Adult; Body Weight; Child; Digestive System Diseases; Dose-Response Relationship, Drug; Drug Dosage Calculations; Europe; Evidence-Based Medicine; Gastroenterology; Glucocorticoids; Humans; Immunoglobulin G4-Related Disease; Immunosuppressive Agents; Induction Chemotherapy; Maintenance Chemotherapy; Severity of Illness Index; Treatment Outcome
PubMed: 32552502
DOI: 10.1177/2050640620934911 -
Radiologic Clinics of North America Sep 2022Focal hepatic lesions are frequently discovered incidentally on cross-sectional imaging or abdominal ultrasound, and in the general population, a vast majority of those... (Review)
Review
Focal hepatic lesions are frequently discovered incidentally on cross-sectional imaging or abdominal ultrasound, and in the general population, a vast majority of those incidental findings are benign entities. However, the formal diagnosis of benign liver lesions is not always straightforward and may require advanced imaging modalities, such as MRI with hepatobiliary contrast agent or contrast-enhanced ultrasound (CEUS). This review presents the typical features of the main benign liver lesions, including focal nodular hyperplasia (FNH), hepatocellular adenoma (HCA), hepatic cysts, hemangioma, angiomyolipoma, and pseudotumors, such as inflammatory pseudotumors or hepatic granulomas. However, beyond the specific and classical MRI features, some lesions may present atypical patterns. Moreover, arterial phase hyperenhancement, often present in benign liver lesions, can be seen in malignant lesions such as hepatocellular carcinoma. Hence, accurate analysis of clinical and biological contexts is mandatory to optimize our diagnostic performance. The objective of this investigation was, therefore, to review the specific presentations of benign liver tumors and to illustrate their diagnostic pitfalls.
Topics: Adenoma, Liver Cell; Carcinoma, Hepatocellular; Contrast Media; Diagnosis, Differential; Digestive System Diseases; Focal Nodular Hyperplasia; Humans; Liver; Liver Neoplasms; Magnetic Resonance Imaging
PubMed: 35989043
DOI: 10.1016/j.rcl.2022.05.005 -
The American Journal of Gastroenterology Jan 2024Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and frequent indication for liver transplantation worldwide. With harmful...
Alcohol-associated liver disease (ALD) is the most common cause of advanced hepatic disease and frequent indication for liver transplantation worldwide. With harmful alcohol use as the primary risk factor, increasing alcohol use over the past decade has resulted in rapid growth of the ALD-related healthcare burden. The spectrum of ALD ranges from early asymptomatic liver injury to advanced disease with decompensation and portal hypertension. Compared with those with other etiologies of liver disease, patients with ALD progress faster and more often present at an advanced stage. A unique phenotype of advanced disease is alcohol-associated hepatitis (AH) presenting with rapid onset or worsening of jaundice, and acute on chronic liver failure in severe forms conveying a 1-month mortality risk of 20%-50%. The model for end stage disease score is the most accurate score to stratify AH severity (>20 defined as severe disease). Corticosteroids are currently the only available therapeutic with proven efficacy for patients with severe AH, providing survival benefit at 1 month in 50%-60% of patients. Abstinence of alcohol use, a crucial determinant of long-term outcomes, is challenging to achieve in ALD patients with concurrent alcohol use disorder (AUD). As patients with ALD are rarely treated for AUD, strategies are needed to overcome barriers to AUD treatment in patients with ALD and to promote a multidisciplinary integrated care model with hepatology, addiction medicine providers, and social workers to comprehensively manage the dual pathologies of liver disease and of AUD. Liver transplantation, a definitive treatment option in patients with advanced cirrhosis, should be considered in selected patients with AH, who are unresponsive to medical therapy and have a low risk of relapse to posttransplant alcohol use. Level of evidence and strength of recommendations were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations system. This guideline was developed under the American College of Gastroenterology Practice Parameters Committee.
Topics: Humans; Liver Diseases, Alcoholic; Risk Factors; Hepatitis, Alcoholic; Liver Cirrhosis; Alcoholism
PubMed: 38174913
DOI: 10.14309/ajg.0000000000002572 -
BMC Medicine Nov 2022Previous studies suggested that moderate coffee and tea consumption are associated with lower risk of mortality. However, the association between the combination of...
BACKGROUND
Previous studies suggested that moderate coffee and tea consumption are associated with lower risk of mortality. However, the association between the combination of coffee and tea consumption with the risk of mortality remains unclear. This study aimed to evaluate the separate and combined associations of coffee and tea consumption with all-cause and cause-specific mortality.
METHODS
This prospective cohort study included 498,158 participants (37-73 years) from the UK Biobank between 2006 and 2010. Coffee and tea consumption were assessed at baseline using a self-reported questionnaire. All-cause and cause-specific mortalities, including cardiovascular disease (CVD), respiratory disease, and digestive disease mortality, were obtained from the national death registries. Cox regression analyses were conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).
RESULTS
After a median follow-up of 12.1 years, 34,699 deaths were identified. The associations of coffee and tea consumption with all-cause and cause-specific mortality attributable to CVD, respiratory disease, and digestive disease were nonlinear (all P nonlinear < 0.001). The association between separate coffee consumption and the risk of all-cause mortality was J-shaped, whereas that of separate tea consumption was reverse J-shaped. Drinking one cup of coffee or three cups of tea per day seemed to link with the lowest risk of mortality. In joint analyses, compared to neither coffee nor tea consumption, the combination of < 1-2 cups/day of coffee and 2-4 cups/day of tea had lower mortality risks for all-cause (HR, 0.78; 95% CI: 0.73-0.85), CVD (HR, 0.76; 95% CI: 0.64-0.91), and respiratory disease (HR, 0.69; 95% CI: 0.57-0.83) mortality. Nevertheless, the lowest HR (95% CI) of drinking both < 1-2 cup/day of coffee and ≥ 5 cups/day of tea for digestive disease mortality was 0.42 (0.34-0.53).
CONCLUSIONS
In this large prospective study, separate and combined coffee and tea consumption were inversely associated with all-cause and cause-specific mortality.
Topics: Humans; Cardiovascular Diseases; Prospective Studies; Risk Factors; Tea; Coffee; Mortality; Respiratory Tract Diseases; Digestive System Diseases; Adult; Middle Aged; Aged; United Kingdom
PubMed: 36397104
DOI: 10.1186/s12916-022-02636-2