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Background and Aims: The resect‐and‐discard strategy for colorectal polyps based on accurate optical diagnosis remains challenges. Our aim was to investigate the feasibility of hyperspectral imaging (HSI) for identifying colorectal polyp properties and diagnosis of colorectal cancer in fresh tissues during colonoscopy. Methods: 144,900 two dimensional images generated from 161 hyperspectral images of colorectal polyp tissues were prospectively obtained from patients undergoing colonoscopy. A residual neural network model was trained with transfer learning to automatically differentiate colorectal polyps, validated by histopathologic diagnosis. The diagnostic performances of the HSI‐AI model and endoscopists were calculated respectively, and the auxiliary efficiency of the model was evaluated after a 2‐week interval. Results: Quantitative HSI revealed histological differences in colorectal polyps. The HSI‐AI model showed considerable efficacy in differentiating nonneoplastic polyps, non‐advanced adenomas, and advanced neoplasia in vitro, with sensitivities of 96.0%, 94.0%, and 99.0% and specificities of 99.0%, 99.0%, and 96.5%, respectively. With the assistance of the model, the median negative predictive value of neoplastic polyps increased from 50.0% to 88.2% (p = 0.013) in novices. Conclusion: This study demonstrated the feasibility of using HSI as a diagnostic tool to differentiate neoplastic colorectal polyps in vitro and the potential of AI‐assisted diagnosis synchronized with colonoscopy. The tool may improve the diagnostic performance of novices and facilitate the application of resect‐and‐discard strategy to decrease the cost. [ABSTRACT FROM AUTHOR]

A compelling correlation method linking microbial communities and host gene expression in tissues is currently absent. A novel pipeline is proposed, dubbed Transcriptome Analysis of Host‐Microbiome Crosstalk (TAHMC), designed to concurrently restore both host gene expression and microbial quantification from bulk RNA‐seq data. Employing this approach, it discerned associations between the tissue microbiome and host immunity in the context of Crohn's disease (CD). Further, machine learning is utilized to separately construct networks of associations among host mRNA, long non‐coding RNA, and tissue microbes. Unique host genes and tissue microbes are extracted from these networks for potential utility in CD diagnosis. Experimental validation of the predicted host gene regulation by microbes from the association network is achieved through the co‐culturing of Faecalibacterium prausnitzii with Caco‐2 cells. Collectively, the TAHMC pipeline accurately recovers both host gene expression and microbial quantification from CD RNA‐seq data, thereby illuminating potential causal links between shifts in microbial composition as well as diversity within CD mucosal tissues and aberrant host gene expression. [ABSTRACT FROM AUTHOR]

Background: Patient education contributes to improve public awareness of Helicobacter pylori. Large language models (LLMs) offer opportunities to revolutionize patient education transformatively. This study aimed to assess the quality of patient educational materials (PEMs) generated by LLMs and compared with physician sourced. Materials and Methods: Unified instruction about composing a PEM about H. pylori at a sixth‐grade reading level in both English and Chinese were given to physician and five LLMs (Bing Copilot, Claude 3 Opus, Gemini Pro, ChatGPT‐4, and ERNIE Bot 4.0). The assessments of the completeness and comprehensibility of the Chinese PEMs were conducted by five gastroenterologists and 50 patients according to three‐point Likert scale. Gastroenterologists were asked to evaluate both English and Chinese PEMs and determine the accuracy and safety. The accuracy was assessed by six‐point Likert scale. The minimum acceptable scores were 4, 2, and 2 for accuracy, completeness, and comprehensibility, respectively. The Flesch–Kincaid and Simple Measure of Gobbledygook scoring systems were employed as readability assessment tools. Results: Accuracy and comprehensibility were acceptable for English PEMs of all sources, while completence was not satisfactory. Physician‐sourced PEM had the highest accuracy mean score of 5.60 and LLM‐generated English PEMs ranged from 4.00 to 5.40. The completeness score was comparable between physician‐sourced PEM and LLM‐generated PEMs in English. Chinese PEMs from LLMs proned to have lower score in accuracy and completeness assessment than English PEMs. The mean score for completeness of five LLM‐generated Chinese PEMs was 1.82–2.70 in patients' perspective, which was higher than gastroenterologists' assessment. Comprehensibility was satisfactory for all PEMs. No PEM met the recommended sixth‐grade reading level. Conclusion: LLMs have potential in assisting patient education. The accuracy and comprehensibility of LLM‐generated PEMs were acceptable, but further optimization on improving completeness and accounting for a variety of linguistic contexts are essential for enhancing the feasibility. [ABSTRACT FROM AUTHOR]

Background & Aims: Short videos, crucial for disseminating health information on metabolic dysfunction‐associated steatotic liver disease (MASLD), lack a clear evaluation of quality and reliability. This study aimed to assess the quality and reliability of MASLD‐related videos on Chinese platforms. Methods: Video samples were collected from three platforms (TikTok, Kwai and Bilibili) during the period from November 2019 to July 2023. Two independent reviewers evaluated the integrity of the information contained therein by scoring six key aspects of its content: definition, epidemiology, risk factors, outcomes, diagnosis and treatment. The quality and reliability of the videos were assessed using the Journal of the American Medical Association (JAMA) criteria, the Global Quality Score (GQS) and the modified DISCERN score. Results: A total of 198 videos were included. The video content exhibited an overall unsatisfactory quality, with a primary emphasis on risk factors and treatment, while diagnosis and epidemiology were seldom addressed. Regarding the sources of the videos, the GQS and modified DISCERN scores varied significantly between the platforms (p =.003), although they had generally similar JAMA scores (p =.251). Videos created by medical professionals differed significantly in terms of JAMA scores (p =.046) compared to those created by nonmedical professionals, but there were no statistically significant differences in GQS (p =.923) or modified DISCERN scores (p =.317). Conclusions: The overall quality and reliability of the videos were poor and varied between platforms and uploaders. Platforms and healthcare professionals should strive to provide more reliable health‐related information regarding MASLD. [ABSTRACT FROM AUTHOR]

Background: The optimal dosage of tetracycline remains unclear for Helicobacter pylori eradication. Frequent dosing requirements may decrease patient adherence and increase the incidence of adverse events, potentially reducing treatment efficacy. This study aimed to compare the efficacy of different tetracycline dosages in rescue treatment for H. pylori infection. Methods: A total of 406 patients needing H. pylori rescue treatment were enrolled. Patients were randomized into two groups and received bismuth‐containing quadruple therapies as follows: esomeprazole 40 mg twice daily, bismuth 220 mg twice daily, amoxicillin 1000 mg twice daily, and tetracycline 500 mg either three (TET‐T group) or four (TET‐F group) times daily. At least 6 weeks after treatment completion, a 13C‐urea breath test was performed to evaluate H. pylori eradication. Results: The intention‐to‐treat (ITT) eradication rates were 91.13% (185/203) and 90.15% (183/203) (p = 0.733), the modified ITT (MITT) eradication rates were 94.87% (185/195) and 95.31% (183/192) (p = 0.841), and the per‐protocol (PP) eradication rates were 94.79% (182/192) and 95.21% (179/188) (p = 0.851) in the TET‐T group and TET‐F group, respectively. The eradication rates for the TET‐T group were not inferior to those of the TET‐F group in ITT, MITT, and PP analyses. The incidence of adverse effects was significantly lower in the TET‐T group than in the TET‐F group (23.65% vs. 33.50%, p = 0.028). No significant differences were observed in treatment compliance between the groups. Conclusions: The dose of tetracycline administered three times daily showed comparable efficacy to that administered four times daily, while significantly reducing the incidence of adverse events. The combination of tetracycline and amoxicillin in bismuth‐containing quadruple therapy achieved a high eradication rate in H. pylori rescue treatment. [ABSTRACT FROM AUTHOR]

Background: Potassium‐competitive acid blockers have demonstrated enormous potential in the eradication treatment of Helicobacter pylori infection, with tegoprazan being one of the representatives. The available data on the safety and efficacy of tegoprazan in dual therapy are limited. Materials and Methods: The multicenter, noninferiority, randomized‐controlled trial was conducted from May 2023 to March 2024. Treatment‐naive subjects were randomly assigned (1:1) to enter either the tegoprazan–amoxicillin (TA) group (tegoprazan 50 mg twice daily and amoxicillin 750 mg four times daily) or the esomeprazole–amoxicillin (EA) group (esomeprazole 20 mg and amoxicillin 750 mg all four times daily), with a duration for 14 days. The primary outcome was eradication rate as determined by 13C‐urea breath test, including per‐protocol (PP) analysis and intention‐to‐treat (ITT) analysis. Secondary outcomes were adverse events and compliance. Results: A total of 368 individuals were included in the randomization. The eradication rates in the EA group and the TA group were 84.2% and 85.8%, respectively, according to an ITT analysis (p = 0.77), and 88.5% and 88.2%, respectively, according to PP analysis (p = 1.00). The eradication rates for the TA group were not inferior to those of the EA group in both PP (p = 0.0023) and ITT analyses (p = 0.0009). There were no significant statistical differences in the incidence of adverse events and compliance between the two groups. The multivariate logistic regression analysis revealed that poor compliance increased the risk of eradication failure (p < 0.001). Conclusions: Dual therapy containing tegoprazan is safe and effective to be considered as a clinical first‐line treatment option, but further optimization involving antimicrobial susceptibility testing and adjustments in dosage and frequency is warranted. Trial Registration: ClinicalTrials.gov ID: NCT05870683. [ABSTRACT FROM AUTHOR]

Current global variations exist in Helicobacter pylori (H. pylori) eradication regimens. Triple therapy (TT), bismuth quadruple therapy (BQT), and high‐dose dual therapy (HDDT) currently represent the predominant regimens. These regimens diverge in terms of treatment duration, the utilization of susceptibility testing, acid‐inhibiting drug administration, and patient education. We conducted a comprehensive systematic literature review on these H. pylori treatment regimens. Our review aims to provide standardized treatment recommendations for H. pylori, reducing the risk of amalgamating findings from diverse eradication regimens. Recent research suggests that the optimal treatment duration for TT and BQT may be 14 and 10 days, respectively. Selecting the appropriate treatment duration for HDDT should rely on regional research evidence, and 14 days may be the optimal duration. The incorporation of susceptibility testing in TT is of paramount importance. In the case of BQT, the absence of susceptibility testing may be considered as an option, contingent upon cost and availability, and should be determined based on local antibiotic resistance patterns and the efficacy of empirical regimens. The type and dosage of acid‐inhibiting drug would affect the efficacy of these regimens. Acid‐inhibiting drugs should be selected and applied reasonably according to the population and therapies. Adequate patient education plays a pivotal role in the eradication of H. pylori. In regions with accessible local research evidence, the 10‐day empirical BQT regimen may be considered a preferred choice for H. pylori eradication. [ABSTRACT FROM AUTHOR]

Helicobacter pylori is a potential underlying cause of many diseases. Although the Carbon 13 breath test is considered the gold standard for detection, it is high cost and low public accessibility in certain areas limit its widespread use. In this study, we sought to use machine learning and deep learning algorithm models to classify and diagnose H. pylori infection status. We used hyperspectral imaging system to gather gastric juice images and then retrieved spectral feature information between 400 and 1000 nm. Two different data processing methods were employed, resulting in the establishment of one‐dimensional (1D) and two‐dimensional (2D) datasets. In the binary classification task, the random forest model achieved a prediction accuracy of 83.27% when learning features from 1D data, with a specificity of 84.56% and a sensitivity of 92.31%. In the ternary classification task, the ResNet model learned from 2D data and achieved a classification accuracy of 91.48%. [ABSTRACT FROM AUTHOR]

Objectives: To assess the region‐specific relative risk of cardia/non‐cardia gastric cancer (CGC/NCGC) associated with Helicobacter pylori (H. pylori) and quantify its contribution to gastric cancer burden using population attributable fraction (PAF). Methods: PubMed, EMBASE, Web of Science, and Cochrane Central databases were searched by two reviewers until April 20, 2022. The association between H. pylori infection and NCGC/CGC was assessed using pooled odds ratios (ORs) with 95% confidence intervals (CIs). PAF was calculated using the formula of H. pylori prevalence and the pooled OR. Results: One hundred and eight studies were included. A significant association was observed between H. pylori infection and NCGC in East Asia (OR, 4.36; 95% CI: 3.54–5.37) and the West (OR, 4.03; 95% CI: 2.59–6.27). Regarding CGC, a significant association was found only in East Asia (OR, 2.86; 95% CI: 2.26–3.63), not in the West (OR, 0.80; 95% CI: 0.61–1.05). For studies with a follow‐up time of ≥10 years, pooled ORs for NCGC and CGC in East Asia were 5.58 (95% CI: 4.08–7.64) and 3.86 (95% CI: 2.69–5.55), respectively. Pooled OR for NCGC was 6.80 (95% CI: 3.78–12.25) in the West. PAFs showed that H. pylori infection accounted for 71.2% of NCGC, 60.7% of CGC in East Asia, and 73.2% of NCGC in the West. Conclusions: Gastric cancer burden associated with H. pylori infection exhibits important geographical differences. Prolonged follow‐up period could overcome the underestimation of the magnitude of the association between H. pylori infection and CGC/NCGC. Customized strategies for H. pylori screening and eradication should be implemented to prevent gastric cancer. [ABSTRACT FROM AUTHOR]

Objectives: The lack of effective countertraction to expose the submucosal layer contributes to the technical complication and adverse events in endoscopic submucosal dissection (ESD). We aimed to evaluate the efficacy and safety of a novel endoscopic robot (flexible auxiliary single‐arm transluminal endoscopic robot [FASTER]) for ESD learning for novices. Methods: This was a prospective, cross‐over designed pilot study in ex vivo porcine stomach. Four ESD novices were randomized to either FASTER‐assisted ESD first (FC) group or a conventional ESD first (CF) group, performed 40 gastric ESDs using each technique, then crossed over to another technique. The performance and learning curve were compared between the two groups. Results: In the first phase, novices in the FC group demonstrated significantly better performance with shorter procedure time (25.6 ± 7.8 vs. 38.9 ± 13.4 min; P < 0.001) and submucosal dissection time (13.9 ± 5.5 vs. 23.1 ± 11.0 min; P < 0.001), higher direct‐vision dissection ratio (84.0 ± 7.9% vs. 43.5 ± 20.7%; P < 0.001), and lower muscular injury (2.5 vs. 40.0%; P < 0.001) and task load (4 vs. 5; P < 0.001). Fewer ESDs were required to gain early proficiency in the FC group. When crossed to the second phase, procedure time in the FC group was prolonged but the muscular injury rate did not increase significantly. In total, endoscopists in the FC group tended to have a lower task load (4 vs. 5; P = 0.008) and less muscular injury (10.0 vs. 21.3%; P = 0.05). Conclusion: Flexible auxiliary single‐arm transluminal endoscopic robot‐assisted learning reduces the technical difficulty of ESD for novices and the safety profile can sustain in following conventional ESD. These results indicated that FASTER has potential implications for ESD training in clinical practice. [ABSTRACT FROM AUTHOR]

Background and objective: Helicobacter pylori (H. pylori), a gram‐negative bacterium that colonizes the stomach, can cause chronic gastritis and peptic ulcers, as well as gastric cancer as a Class I carcinogen. However, the modes of H. pylori transmission are not clear. This review aims to clarify the transmission routes and patterns of H. pylori and identify efficacious prevention measures. Methods: Studies of H. pylori transmission were identified using PubMed, the Web of Science, and Cochrane Central; the retrieval deadline was October 2022. Results: The transmission routes of H. pylori are discussed, focusing on the five primary transmission routes, namely fecal–oral, oral–oral, gastric–oral, anal–oral, and genital–oral. We propose that H. pylori is contracted through multiple transmission routes. Additionally, we summarize the key transmission patterns of H. pylori, including person‐to‐person and animal‐to‐human transmission, as well as foodborne and occupational exposure. Conclusion: Fecal–oral appears to be the most common H. pylori transmission routes. Although the oral–oral pathway is also important, the evidence does not support that this route of transmission is universal. The gastric–oral route occurs primarily in children and patients who are prone to vomiting. Meanwhile, the anal–oral and genital–oral routes remain hypothetical. Person‐to‐person and foodborne infections represent the predominant transmission patterns of H. pylori, whereas strong environmental and occupational limitations are associated with animal‐to‐human and occupational exposure. [ABSTRACT FROM AUTHOR]

Background & Aims: Antibiotic resistance of Helicobacter pylori (H. pylori) is increasing worldwide, and bismuth quadruple therapy has been recommended as a first‐line regimen in many areas. This study aimed to investigate whether bismuth would improve the eradication rate (ER) of clarithromycin‐/metronidazole‐/levofloxacin‐resistant H. pylori strains and how much additional efficacy bismuth could achieve. Methods: PubMed, EMBASE, Web of Science, and Cochrane Central databases for randomized controlled trials were systematically searched by two independent reviewers until 15 January 2022. Pooled ERs of clarithromycin‐/metronidazole‐/levofloxacin‐resistant H. pylori strains were compared between bismuth‐containing and non‐bismuth therapies. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random‐effects model. Results: Eight studies enrolling 340 individuals were included. The RRs of pooled ERs compared between bismuth‐containing and non‐bismuth therapies were 1.83 for clarithromycin‐resistant strains (95% CI 1.16–2.89, pooled ER: 76.9% vs. 36.6%, p =.009, I2 = 0%), 1.39 for metronidazole‐resistant strains (95% CI 1.09–1.78, pooled ER: 86.8% vs. 60.9%, p =.008, I2 = 37%), 2.75 for dual clarithromycin/metronidazole‐resistant strains (95% CI 1.01–7.52, pooled ER: 76.9% vs. 18.2%, p =.05, I2 = 0%), and 1.04 for levofloxacin‐resistant strains (95% CI 0.56–1.93, pooled ER: 63.4% vs. 54.3%, p =.90; I2 = 60%). Bismuth significantly increased the ERs of clarithromycin‐, metronidazole‐, and dual‐resistant strains by 40%, 26%, and 59%, respectively. Subgroup analysis of treatment duration showed that the significantly higher eradication rate for antibiotic‐resistant strains in bismuth‐containing therapy than non‐bismuth therapy was only observed in 14‐day treatment regimens and not in 7‐day regimens (p =.02 and.17, respectively). Conclusions: Bismuth was most effective in improving the ERs of dual‐resistant H. pylori strains, followed by clarithromycin‐ and metronidazole‐resistant strains. Prolonged treatment duration might effectively improve the efficacy of bismuth in overcoming antibiotic resistance. [ABSTRACT FROM AUTHOR]

Wind energy harvesting from the ambient environment by triboelectric nanogenerator (TENG) is highly important for powering wireless sensing systems. However, the output of TENG is greatly affected by ambient humidity, which seriously limits the measurement accuracy and stability of sensors. Herein, a flutter‐driven TENG composed of an Al foil interlayer sealed by FEP membranes (FEP/Al/FEP) is proposed to isolate Al foil from the external environment. A self‐charge excitation circuit is used to inject charges into the Al foil interlayer to achieve high charge density on it, greatly reducing the dependence on triboelectrification. In addition, an elastic steel sheet connected to a fluttering membrane at the fixed end is designed to get high stability of vibration. Consequently, the interference of humidity and other external environmental factors of this new type of elastic‐assisted TENG (EA‐TENG) with self‐charge excitation is greatly reduced and the output performance is greatly enhanced compared with traditional flutter‐driven TENGs. To demonstrate a practical application, a wind speed monitoring and alarming system are designed, which realizes real‐time wind speed detection and wind speed threshold alarm. The moisture‐resistant and stable wireless wind speed sensing system in this study has great applications in building large‐scale sensor networks. [ABSTRACT FROM AUTHOR]

Background: Intra‐family transmission is an important Helicobacter pylori (H. pylori) infection route. Family‐based screening and treatment of H. pylori is a promising strategy. However, limited data are available on patient compliance with post‐screening recommendations for such a strategy. Materials and Methods: A prospective cohort study of families from six regions in Shandong, China, from July 2021 to February 2022 was conducted. Demographic characteristics, prior testing, and treatment for H. pylori, prior gastroscopy, symptoms, and family history were collected. Infection status of participants was determined using the 13C‐urea breath test. Infected participants were recommended to undergo eradication treatment, confirmation testing, and gastroscopy per expert consensus. Participants were monitored for 6 months to record recommendation compliance in a real‐world setting. Logistic regression models were used to analyze the factors influencing compliance with the recommendations. Results: The study included 1173 individuals from 386 families with the overall infection rate of 36.7%. The recommendation compliance for eradication treatment, confirmation testing, and gastroscopy was 69.3% (271/391), 32.5% (88/271), and 6.1% (19/309), respectively. Factors that increased the risk of lower compliance were male sex (odds ratio [OR], 1.917, 95% confidence interval [CI], 1.233–2.981), and living in a non‐urban area (OR, 1.954, 95% CI, 1.241–3.074), for treatment recommendations; having more than one infected family member (OR, 2.138, 95% CI, 1.237–3.698), and a lower family income (¥100,000–¥300,000 per year, OR, 7.247, 95% CI, 1.788–29.363; or <¥100,000 per year, OR, 7.294, 95% CI, 1.832–29.042), for confirmation testing recommendations; and being asymptomatic (OR, 3.009, 95% CI, 1.105–8.196), for gastroscopy recommendations. Conclusions: Post‐screening recommendation compliance for this family‐based H. pylori screening and treatment program was unsatisfactory. Further studies focusing on pre‐screening education are warranted to improve compliance. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori (H. pylori) infections are of serious concern due to the associated risk of gastric cancer. However, many patients have poor medication and therapy compliance, which makes it difficult to eradicate their infections. This points to the need for stronger educational interventions aimed at enhancing compliance, thus increasing the potential for treatment success. As such, this study conducted a meta‐analysis to clarify the effects of enhanced patient education (EPE) programs for H. pylori. Materials and Methods: We searched electronic databases (PubMed, EMBASE, Web of Science, and Cochrane Library) for randomized controlled trials (RCTs) on health education for patients infected with H. pylori from inception to June 2021. The primary outcome was the eradication rate of H. pylori, while the secondary outcomes included the incidence of individual adverse symptoms, treatment compliance, clinical symptom remission after treatment, and patient satisfaction. We used the fixed or random‐effects model to pool the risk ratio (RR), with 95% confidence interval. We also conducted sensitivity and subgroup analyses. Results: Our search returned seven relevant studies across a total of 1,433 patients. Compared with controls, EPE was significantly associated with improved H. pylori eradication rates (RR = 1.16, 95%CI: 1.04–1.29, p = 0.006) and patient compliance (RR = 1.48, 95%CI: 1.14–1.93, p = 0.003). A subgroup analysis also showed that EPE benefits were consistent across patients with different eradication programs, WeChat intervention plans, and intervention frequencies (p < 0.05). However, there were no significant differences in the total adverse effects, common side effects (diarrhea, nausea, abdominal pain, taste disorder, and skin rash), or discontinuation rate (p > 0.05). Conclusions: Patient education is inexpensive, safe, and convenient. In this context, our findings suggest that enhanced educational interventions have positive effects on both the H. pylori eradication rate and adherence among infected patients, and thus constitute promising complements to clinical treatment regimens. [ABSTRACT FROM AUTHOR]

Summary: Two phenazine compounds, diastaphenazine and izumiphenazine C, with complex structures and promising antitumour activity have been isolated from the plant endophytic actinomycete Streptomyces diastaticus W2. Their putative biosynthetic gene cluster (dap) was identified by heterologous expression and gene knockout. There are twenty genes in the dap cluster. dap14‐19 related to shikimic pathway were potentially involved in the precursor chorismic acid biosynthesis, and dapBCDEFG were confirmed to be responsible for the biosynthesis of the dibenzopyrazine ring, the nuclear structure of phenazines. Two transcriptional regulatory genes dapR and dap4 played the positive regulatory roles on the phenazine biosynthetic pathway. Most notably, the dimerization of the dibenzopyrazine ring in diastaphenazine and the loading of the complex side chain in izumiphenazine C could be catalysed by the cyclase homologous gene dap5, suggesting an unusual modification strategy tailoring complex phenazine biosynthesis. Moreover, metabolite analysis of the gene deletion mutant strain S. albus::23C5Δdap2 and substrate assay of the methyltransferase Dap2 clearly revealed the biosynthetic route of the complex side chain in izumiphenazine C. [ABSTRACT FROM AUTHOR]

Background and Aim: The increase in antibiotic resistance makes the eradication of Helicobacter pylori more difficult. Considering the limitations of the application of susceptibility‐guided therapy, it is important to find an effective empirical regimen. The aim of the study is to compare the efficacy, safety, and cost‐effectiveness of clarithromycin‐based bismuth‐containing quadruple therapy (C‐BQT) and furazolidone‐based bismuth‐containing quadruple therapy (F‐BQT) in naïve H. pylori positive patients. Methods: This was an open‐label, randomized controlled, crossover trial. The trial comprised two phases. In C‐F group, patients received C‐BQT in the first phase; those who were still positive for H. pylori infection after the first phase entered the second phase to receive F‐BQT as rescue treatment. In F‐C group, patients were treated with F‐BQT firstly and rescued with C‐BQT. Results: As first‐line treatments, the eradication rates of C‐BQT and F‐BQT were 89.7% (157/175) and 92.0% (161/175) (P = 0.458) in intention‐to‐treat analysis and 93.4% (156/167) and 95.8% (161/168) (P = 0.327) in per‐protocol analysis, respectively. The cumulative eradication rates of the C‐F group and the F‐C group were both 94.3% in intention‐to‐treat analysis (P = 1.000). Cost‐effectiveness indexes of F‐BQT and C‐BQT were 0.54 and 1.24 in first‐line treatments. Frequencies of adverse events in F‐BQT and C‐BQT had no differences (36.0% in C‐BQT vs 32.6% in F‐BQT, P = 0.499). Conclusions: Furazolidone‐based bismuth‐containing quadruple therapy should be preferred for its excellent cost‐effectiveness and acceptable safety. [ABSTRACT FROM AUTHOR]

Objectives: Enterochromaffin (EC) cells have been associated with functional gastrointestinal disorders such as IBS. Recently, we found that glial cell‐derived neurotrophic factor (GDNF)‐rearranged during transfection (RET) localized in EC cells in human colonic epithelia. Here, we examine the role of GDNF‐RET in the pathophysiology of diarrhoea‐predominant irritable bowel syndrome (IBS‐D). Materials and Methods: GDNF was assessed by ELISA and immunohistochemistry in biopsies from IBS‐D patients and healthy controls. Stress was induced by using a wrap‐restraint stress (WRS) procedure to serve as an acute stress‐induced IBS model. The function of GDNF‐RET axis to intestinal stem cell (ISC) homeostasis, and EC cell numbers were assessed in vivo and in vitro. Results: GDNF‐RET was expressed in EC cells in human colon. GDNF was significantly increased in IBS‐D patients. WRS mice showed increased GDNF‐RET levels in colon. WRS induced visceral hypersensitivity by expanding of ISC and differentiation of EC cell via GDNF‐RET. Furthermore, GDNF‐treated mice recapitulated the phenotype of WRS mice. In vitro, GDNF treatment amplified Wnt signal and increased serotonin levels in colonic organoids in a dose‐dependent manner. Conclusions: We identified GDNF‐RET was presented in colonic epithelium of patients with IBS‐D. GDNF‐RET played important roles in regulating ISC and EC cell differentiation. Our findings, thus, provide RET inhibitor as new therapeutic targets for treatment of patients with IBS‐D. [ABSTRACT FROM AUTHOR]

Background and Aim: Removal of neoplastic polyps is important for colorectal cancer prevention. The primary aim was to compare the complete resection rate of diminutive (≤ 5 mm) or small colorectal polyps (6–10 mm) using cold snare polypectomy (CSP) versus hot snare polypectomy (HSP). Methods: To April 2018, databases of Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science were searched for randomized controlled trials comparing CSP and HSP for diminutive or small colorectal polypectomy. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We used the Mantel–Haenszel method for binary endpoints and inverse variance method for continuous outcomes. Subgroup analysis was conducted to explore sources of heterogeneity. Results: Twelve trials involving 2481 patients and 4535 polyps were analyzed. Regarding complete resection rate, there was no statistical significance between CSP and HSP (odds ratio [OR] 0.86, 95% confidence interval [CI] 0.60–1.24). CSP shows more immediate bleeding cases than HSP in per‐lesion analysis while no statistical significance in bleeding needing treatment (OR 1.99, 95% CI 0.59–6.75). In terms of all adverse events, both per‐lesion and per‐patient analysis revealed no difference (OR 1.49, 95% CI 0.87–2.56 and 0.57, 0.11–2.97, respectively). As far as post‐polypectomy bleeding is concerned, there was also no statistical significance between CSP and HSP. Regarding procedure time, CSP was superior to HSP (standard mean difference −1.04, 95% CI −1.22 to −0.87). Conclusions: Cold snare polypectomy is a safe, efficient, and effective polypectomy technique for diminutive or small colorectal polyps. [ABSTRACT FROM AUTHOR]

Background and Aims N-methyl- d-aspartate receptor (NMDAR) in brain, spinal cord, and enteric nervous system is involved in visceral hypersensitivity. This study aimed to reveal the functional expression of NMDAR on mucosal cells in colon and to investigate the downstream signal pathway from colonic NMDAR activation to visceral hypersensitivity in irritable bowel syndrome (IBS). Methods The expression of mucosal NMDAR in IBS patients and healthy controls was assessed by immunohistochemistry and Western blot and correlated with abdominal pain/discomfort scores quantified by a validated questionnaire. Electromyography recording in response to colorectal distension was recorded to measure the colonic sensitivity of mice receiving NMDA administration intracolonically. Brain-derived neurotrophic factor (BDNF) expression and extracellular signal-regulated kinase (ERK) pathway activation were examined in human colonic epithelial HT29 cells after NMDA stimulation, with or without MK801 or U0126 pretreatment. Results A significant upregulation of mucosal NMDAR was observed in IBS patients compared with controls, which was significantly correlated with abdominal pain/discomfort scores. Intracolonic administration of NMDA in normal mice produced increased colonic sensitivity to colorectal distension and elevated expression of BDNF and activation of ERK. Activation of NMDAR in colonic epithelial HT29 cells in vitro induced increased BDNF secretion in cell supernatants and higher BDNF expression in cells, as well as elevated phosphorylated ERK. Conclusions This study demonstrated that the activation of mucosal NMDAR in colon may contribute to the visceral hypersensitivity in IBS, by increasing production of BDNF in an ERK-dependent pathway. [ABSTRACT FROM AUTHOR]

Abstract: Previous studies suggested that brain-derived neurotrophic factor (BDNF) might act as an important modulator in chronic pain states. However, no systematic study has used knock-out mice to clarify its effect on visceral sensitivity. In the present study, 2,4,6-trinitrobenzene sulfonic acid (TNBS) was administered to heterozygous (BDNF+/−) knock-out and wild-type (BDNF+/+) mice to induce colitis. Visceral response to colorectal distension (CRD) and bladder reactivity were recorded. Results demonstrated that in normal state, BDNF+/− and BDNF+/+ mice did not differ in the visceral response to CRD at <60mmHg pressure and the bladder reactivity; however, with ⩾60mmHg pressure, BDNF+/− mice showed a weaker visceral response to CRD. In inflammatory state of colitis, TNBS induced upregulation of BDNF in dorsal root ganglia of both genotypes while BDNF+/− mice showing significantly lower sensitivity in the colon at ⩾30mmHg and lower sensitivity in bladder than BDNF+/+ mice. The two genotypes showed no significant difference in inflammatory severity. Thus, BDNF deficiency results in developmental changes in colonic nociception in both control and inflammatory states, which are more significant in inflammatory state. For bladder reactivity, BDNF deficiency leads to lower sensitization in inflammatory state but has no effect in control state. Perspective: This article highlights the role of BDNF in colonic and referred bladder hyperalgesia in mice. The findings might help in determining novel pharmaceutical interventions targeted at BDNF to relieve abdominal pain. [Copyright &y& Elsevier]

Visceral hypersensitivity has been shown to be present in irritable bowel syndrome (IBS). The current study sought to compare the characteristics of visceral perception thresholds after rectal thermal and pressure stimuli between IBS patients and healthy subjects. A total of 46 patients with IBS were diagnosed using Rome II criteria. Thirteen healthy individuals participated in the study. Rectal visceral perception thresholds were examined in patients with IBS and in normal controls after thermal and pressure stimuli. Subjects were asked to report the sensation type, location, and spread. Compared with healthy subjects, IBS patients demonstrated significantly initially lower perception thresholds and defecation thresholds to rectal thermal and pressure stimuli, particularly in patients with diarrhea-predominant IBS. Ice stimuli on the abdominal wall had varied effects on symptoms in patients with IBS and did not affect perception thresholds. Visceral perception thresholds were decreased significantly after rectal thermal and pressure stimuli in patients with IBS. Visceral hypersensitivity may be one of the important pathogenic mechanisms in IBS. [ABSTRACT FROM AUTHOR]

Background & Aims: Developing countries are making efforts to improve health management. Practice deviating from the guideline means inefficient control. The study aims to investigate the management of Helicobacter pylori (H pylori) infection from a developing country perspective. Methods: An authoritative survey was conducted in 14th (2014) and 17th (2017) Congress of Gastroenterology China, respectively. The Maastricht V/Florence consensus report was invoked as the evaluation criterion. Results: A total of 4182 valid samples were included in this study. Most of the respondents (94%) updated knowledge by lectures. Respondents had a different awareness rate of H pylori‐related diseases, ranging from 45% to 95%. Up to 40% of the respondents did not follow the recommendations for the diagnosis. Choice accuracy of eradication regimens and antibiotic combinations was <70%. About 20% of the respondents did not pay attention to the confirmation after the eradication. The situation had been improved in 2017 when compared with that in 2014 (all P < .05). Multivariate logistic regression analysis revealed that influencing factors including nongastroenterologists, bachelor degree and below, the primary professional title, hospital location, and a small proportion of H pylori infection in daily practice related to the deviation of consensus (all P < .05). Conclusions: Although the management of H pylori infection has been improved in a developing country, there is still a gap between the real‐world practices and the consensus. Influencing factors should be taken into account in decision‐making, and the corresponding population should be strengthened with precision training during the promotion of the guideline. [ABSTRACT FROM AUTHOR]

Background: To investigate the effects of twice daily short‐message‐based re‐education (SMRE) before taking medicine for Helicobacter pylori (H pylori) eradication. Materials and Methods: Treatment‐naive patients with H pylori infection were prescribed 14‐day quadruple regimen consisting of lansoprazole 30 mg, colloidal bismuth pectin 200 mg, amoxicillin 1000 mg, and clarithromycin 500 mg twice daily. Patients were randomly allocated to SMRE group or control group. Patients in control group received oral and written instructions at outpatient clinic. In contrast, patients in the SMRE group received extra short messages including dosage and time of administration twice daily. Successful H pylori eradication was assessed using the 13C‐urea breath test 6 weeks after treatment. The compliance, adverse events, and patient satisfaction were also analyzed. Results: A total of 310 patients were enrolled in the intention‐to‐treat (ITT) and 283 in the per‐protocol (PP) analysis. For young patients, the eradication rates were significantly higher in SMRE group than those in control group in PP analysis (88.6% vs 71.2%, P = 0.036), while for patients of all age groups, the eradication rate improvements were not statistically significant. The eradication rates in SMRE group and control group were 74.2% and 67.7% (P = 0.211) in ITT analysis and 82.1% and 73.4% (P = 0.078) in PP analysis, respectively. The compliance in SMRE group was significantly better than that in control group (84.8% vs 72.8%, P = 0.011). Conclusions: Twice daily SMRE could improve the eradication rate in young population, as well as the compliance with treatment during H pylori eradication. [ABSTRACT FROM AUTHOR]