Gastroenterology and Hepatology from Bed to Bench

Aim: To evaluate the impacts of successful Helicobacter pylori (H. pylori) eradication on lipid profiles and cardiovascular disease (CVD) risk.

Background: Recent evidence suggests that H. pylori infection increases the risk of lipid impairment and CVD. However, the extent to which H. pylori eradication can reduce these risks remains inconclusive.

Methods: Searches were conducted across databases (PubMed, Scopus, and ScienceDirect), along with website and citation searching, to identify studies before March 15, 2025. Studies assessing the effect of H. pylori eradication on lipid profiles and CVD risk were included. Meta-analysis with subsequent subgroup, meta-regression, and sensitivity analysis was performed using RStudio.

Results: A total of 24 studies were included. Successful H. pylori eradication significantly improved LDL levels (MD: -2.46 mg/dL; -4.70 to -0.22; p = 0.03) and HDL levels (1.83 mg/dL; 0.51–3.16; p = 0.01). Meta-analyses of TC and TG changes yielded comparable results; however, meta-regression revealed that age was a significant covariate, revealing a trend toward significance in younger patients. Comparison analysis showed that significant results were only achieved in HDL changes between successful and unsuccessful eradication. Qualitatively, H. pylori eradication appeared to confer a beneficial effect on CVD risk, although this was likely indirect and influenced by patient-specific characteristics, including age and comorbidities.

Conclusion: H. pylori eradication was associated with modest improvements in lipid profiles, particularly HDL and LDL, and may contribute to reduced CVD risk, especially in younger individuals. Successful eradication may therefore be considered as one of the efforts to enhance lipid profiles and reduce CVD risk.

Aim: This systematic review and meta-analysis evaluated the impact of probiotics on postoperative complications and intestinal barrier integrity markers in patients with colorectal cancer (CRC) undergoing surgery.

Background: Postoperative complications pose a substantial challenge in CRC. Probiotics have been shown to alleviate these complications through various mechanisms, including improving intestinal barrier integrity.

Methods: Following PRISMA guidelines, a systematic search was conducted in MEDLINE, Web of Science, Cochrane Library, and Scopus up to February 1, 2026, to identify randomized controlled trials (RCTs) investigating the effects of probiotics on post-surgical complications, recovery parameters, and functional intestinal barrier biomarkers (lactulose/mannitol [L/M] ratio and transepithelial electrical resistance [TER]). Statistical analysis was performed using random-effects models in R. Effect sizes were expressed as risk differences (RD) for binary outcomes and standardized mean differences (SMD) for continuous outcomes. Heterogeneity was assessed using Cochran’s Q and I² statistics (PROSPERO: CRD420251172153).

Results: Eleven RCTs involving 1,234 CRC patients were included. Probiotic supplementation significantly reduced the risk of septicemia (RD=-0.158, p=0.029), surgical site infection (RD=-0.060, p=0.024), respiratory tract infection (RD=-0.079, p<0.001), central line infection (RD=-0.096, p=0.007), diarrhea (RD=-0.137, p=0.005), and abdominal distension (RD=-0.172, p=0.005). Functional intestinal barrier markers were significantly improved, evidenced by a decreased L/M ratio (SMD=-1.78, p=0.018) and increased TER (SMD=1.10, p<0.001). Furthermore, the duration of postoperative antibiotic use was significantly shortened (SMD=-0.45, p=0.001). No significant differences were observed for bacteremia, abscess, urinary infection, ileus, anastomotic leak, pyrexia, or hospital stay (p>0.05). Sensitivity analyses showed outcome variability, and substantial heterogeneity existed for pyrexia, septicemia, ileus, and the L/M ratio.

Conclusion: Probiotics reduced the risk of specific infectious and gastrointestinal complications and enhanced intestinal barrier function after CRC surgery, highlighting their potential as a safe and effective adjunct to improve postoperative outcomes.

Aim: This study aimed to synthesize evidence on the prevalence of Barrett’s esophagus (BE), estimate its global burden, and examine variation across studies.

Background: Accurate BE prevalence estimates are essential for developing effective screening and surveillance strategies.

Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and EMBASE from inception to January 2026. Full-text articles and reference lists were also screened manually. Studies reporting BE prevalence in general or clinical populations were included. Extracted data covered study design, population characteristics, diagnostic criteria, biopsy protocols, geographic region, and publication period. Study-level analyses assessed methodological variability and temporal trends. Linear regression and generalized additive models were used to project BE prevalence through 2050.

Results: Fifty-two studies, including approximately 8.4 million participants from 24 countries, were analyzed. The pooled mean prevalence of BE was 5.76%, with estimates ranging from 0.06% to 37.4%. Prevalence was higher in symptomatic endoscopy cohorts than in population-based cohorts (4.8% vs. 1.2%, p < 0.001). Studies requiring histologic confirmation of intestinal metaplasia reported lower estimates than those using broader definitions. Significant heterogeneity was observed by region and publication period. Seattle biopsy protocol reporting was documented in 38.5% of studies and improved after 2010. Forecast models projected BE prevalence of 12.8–13.2% by 2050 using linear modeling and 11.2–11.8% using GAM.

Conclusion: Reported BE prevalence varies widely, mainly due to differences in diagnostic criteria, study populations, and methodology. Standardized definitions, biopsy protocols, and reporting practices are needed to improve epidemiologic accuracy and guide screening.

Aim: With growing evidence linking food antigens to inflammation and symptoms, our objective was to review the evidence for the impact of dietary factors on Functional dyspepsia (FD) pathogenesis.

Background: FD is a common gastrointestinal disorder characterised by postprandial fullness, early satiety, epigastric pain, and burning.

Methods: A systematic search of MEDLINE, EMBASE, PsycINFO, Scopus, and Cochrane databases was conducted for studies published between January 2000 and December 2024. Eligible studies included adults (≥18 years) with FD diagnosed using the Rome criteria. Data were synthesised narratively, and the risk of bias was assessed using ROBIS, RoB 2.0, and ROBINS-I tools.

Results: Fourteen studies met inclusion criteria, evaluating seven key dietary categories: FODMAPs/wheat, prebiotics/probiotics, capsaicin, peppermint–caraway and cinnamon oils, herbal therapies, medications, and ginger-based interventions. High-FODMAP foods, gluten, and capsaicin were linked to symptom exacerbation, with some studies noting impaired epithelial barrier function, immune activation, or microbiota alterations. Interventions with anti-inflammatory or microbiota-modulating effects, including probiotics, peppermint–caraway oil, herbal formulations, and ginger-based supplements, were found to mitigate symptoms.

Conclusion: Our findings show that specific dietary components can be implicated in inducing inflammation and symptoms in FD. Stress and anxiety might be another triggering factor for FD; hence, we see the utility of antidepressants in some cases. Since the symptoms are related to inflammation in most cases, we propose using ‘inflammatory dyspepsia’ to represent the true presentation for those patients with inflammation detected in their gastrointestinal mucosa. Large-scale randomised trials are needed to confirm findings and refine dietary guidelines.

Aim: This study planned to examine the latent impacts of ARID1A in modulating autophagy in colorectal cancer (CRC), thereby providing new insights into the potential regulatory role of ARID1A in CRC.

Background: ARID1A, an essential component of the SWI/SNF complex, is considered a recognized tumor suppressor, which is frequently inactivated and down-regulated in various human cancers, including CRC. Nevertheless, its potential role in regulating cell autophagy, a crucial cellular homeostatic mechanism that plays a pro-death or pro-survival role in cancer, remained unknown in CRC.

Methods: The expression of ARID1A was evaluated using real-time quantitative PCR (qPCR) and western blotting in the HCT116 cell line. After the shRNA-mediated knockdown of ARID1A, cellular proliferation and autophagy flu x were evaluated using MTT assay, P62 and LC3 western blotting and also LysoTracker method, respectively. 

Results: The qPCR and western blot confirmed the ARID1A down-regulation after shRNA-mediated knockdown. The MTT assay of HCT116 cells revealed enhancement of cell proliferation following the ARID1A down-regulation. Based on the western blot results, aggregation of the p62 and LC3-II revealed autophagy flux inhibition after ARID1A down-regulation. In confirmation of this result, the LysoTracker staining showed lysosomal alkalinization, autophagosome aggregation and inhibition of autophagic flux following ARID1A down-regulation. Therefore, enhanced autophagosome presence and impaired autophagic flux induced by ARID1A down-regulation may be at least in part as a result of lysosomal environment imbalance.

Conclusion: This study reports autophagy inactivation as the possible mechanism by which ARID1A down-regulation promotes CRC. Therefore, autophagy inducers may represent promising therapeutic targets for ARID1A-deficient tumors.

Aim: To investigate the responsiveness of the Persian version of the Patient Assessment of Constipation Quality Of Life (PAC-QOL) and Wexner questionnaires in individuals with dyssynergia defecation (DD) following physiotherapy intervention.

Background: Dyssynergic defecation, a common functional disorder, impairs quality of life. While PAC-QOL and Wexner questionnaires are standard outcome measures, their responsiveness in Persian-speaking individuals with this condition remains unevaluated.

Methods: The responsiveness of the PAC-QOL and Wexner questionnaires were evaluated in 95 patients with dyssynergic defecation following physiotherapy intervention. All participants in the study were evaluated through quality of life outcome tools in the first physiotherapy session and again after 5 weeks of physiotherapy treatment (at least fifteen sessions, every other day). The Patient Assessment of Constipation Quality of Life (PAC-QOL) and Wexner constipation scoring system were selected as treatment outcomes measuring before and after sessions 15. Responsiveness was examined using anchor-based (Global Rating of Change [GRC]) and distribution-based indices, including the area under the ROC curve (AUC), minimal clinically important change (MIC), effect size (ES), standardized response mean (SRM), and Guyatt’s responsiveness index (GRI).

Results: Both questionnaires showed excellent responsiveness. The PAC-QOL achieved an AUC = 0.92 (95 % CI 0.87–0.99) and the Wexner an AUC = 0.97 (95 % CI 0.94–0.99). The corresponding MICs were 34.5 and 3.5. Internal responsiveness indices were large (PAC-QOL ES = 2.19; SRM = 1.63; GRI = 1.45 / Wexner ES = 2.03; SRM = 1.85; GRI = 1.60).

Conclusion: The Persian PAC-QOL and Wexner questionnaires are highly responsive and capable of detecting clinically meaningful changes in DD after physiotherapy. These tools can reliably monitor treatment outcomes in Persian speaking populations and inform clinical and research practice in Persian-speaking populations.

Aim: This study aimed to evaluate the leukocyte glucose index (LGI) as a discriminator between patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and those with type 2 diabetes mellitus (T2DM), and to examine its association with the triglyceride-glucose index (TyGI) in both conditions.

Background: LGI is derived from fasting plasma glucose (FPG) and leukocyte count, both of which may fluctuate under pathological conditions. LGI has been proposed as a predictor of disease severity and mortality.

Methods: This cross-sectional study was conducted from 1 January 2024 to 1 September 2024 at the College of Pharmacy, University of Sulaimani, Sulaimaniyah, Iraq. Patients with MASLD were randomly selected. The primary outcome was LGI, calculated from FPG and total leukocyte count.. The secondary outcome was TyGI.

Results: A total of 126 patients were included and divided into three groups. Group I included patients with risk factors related to MASLD (n = 25), Group II included patients with MASLD (n = 51), and Group III included patients with T2DM (n = 50). Baseline characteristics did not differ significantly between Groups I and II, whereas Group III differed significantly from both Groups I and II. The median LGI value was significantly higher in Group III (1.53) than in Group I (0.793) and Group II (0.744) (p < 0.001). Significant positive correlations were observed between LGI and TyGI in Group II (r = 0.489, p < 0.001) and Group III (r = 0.705, p < 0.001). An LGI cutoff value of 1.167 significantly discriminated T2DM from MASLD, with a sensitivity of 86.1% and a specificity of 77.6%.

Conclusion: LGI may help distinguish MASLD from T2DM and is significantly associated with TyGI in both conditions.

Aim: To evaluate the longitudinal effect of human development on the global burden of gallbladder and biliary tract cancers (GBTC) from 1990 to 2021.

Background: GBTCs are rare but highly fatal malignancies with substantial geographic heterogeneities in incidence and mortality. Socioeconomic development, quantified through Human Development Index (HDI), may influence GBTC burden, but its long-term impact has not been quantified using longitudinal data.

Methods: This ecological study analyzed Global Burden of Disease (GBD) 2021 estimates across 204 countries. Four age-standardized indicators were examined, incidence rate (ASIR), mortality rate (ASMR), years-of-life-lost rate (ASYLLR), and mortality-to-incidence ratio (MIR). Temporal trends and HDI effects were evaluated using a longitudinal multilevel Gamma generalized linear mixed model (GLMM) to account for regional clustering and global heterogeneity.

Results: Between 1990 and 2021, all four indicators declined in both development groups, with steeper reductions in more-developed countries. The ASMR and ASYLLR were initially higher in high-HDI regions but declined more rapidly, crossing below less-developed regions in the early 2000s. MIR showed a delayed but sharper decrease, falling below 1 in more-developed settings around 2010, while remaining above 1 in less-developed areas. The longitudinal GLMM confirmed significant HDI–time interactions (p < 0.001), indicating faster burden reduction with higher development levels.

Conclusion: Human development is strongly associated with accelerated declines in GBTC incidence, mortality, and fatal burden. The results highlight the critical role of socioeconomic progress, healthcare infrastructure, and early detection in reducing disparities, underscoring the importance of targeted investments in low- and middle-HDI countries to achieve more equitable global cancer control.

Aim: We analyzed global and regional trends from 1990 to 2021, examined the impact of the Human Development Index (HDI), and compared spatial clusters in 1990 and 2021.

Background: Alcohol-related cirrhosis is a major cause of liver-related mortality, but long-term patterns remain incompletely understood.

Methods: Age-standardized mortality rates (ASMRs) for alcohol-related cirrhosis were obtained from the Global Burden of Disease 2021 study for 1990–2021. Temporal trends were evaluated using joinpoint regression. Differences by country development status (more vs. less developed using an HDI 0.700 cutoff) were assessed with multilevel longitudinal modeling. Spatial clustering was identified with Local Moran’s I.

Results: Globally, the ASMR of alcohol-related cirrhosis declined from 5.40 to 4.08 per 100,000 between 1990 and 2021, a 24% reduction, with larger relative declines observed in females than in males. The average annual percentage change (AAPC) in ASMR was −0.89%, with the steepest decline in North Africa and the Middle East and an increase in Central and Eastern Europe and Central Asia. Multilevel analysis over 1990–2021 showed faster yearly declines in ASMR in more developed countries compared with less developed ones. Spatial analysis revealed a shift of hotspots from Latin America and Africa in 1990 to Eastern Europe and Central Asia in 2021.

Conclusion: Global alcohol-related cirrhosis mortality has declined but remains uneven, rising in Central and Eastern Europe and Central Asia and falling faster in more developed countries. Further progress needs targeted alcohol control and stronger health systems, especially in less-developed and hotspot regions where high-burden countries cluster.

Aim: This study aimed to assess the association between anxiety and gastric cancer via a bioinformatics approach.

Background: Gastric cancer is a major health burden in the world and a threat to human health. Several risk factors, such as genetics, Helicobacter pylori (H. pylori) infection, sex, age, race, unhealthy dietary habits and lifestyle, obesity, and alcohol consumption, are highlighted by researchers.

Methods: Significantly differentially expressed genes (DEGs) from the Gene Expression Omnibus (GEO) database related to gastric cancer were validated by the GeneCards database.  The validated DEGs were compared with gastric cancer central genes from the “Disease” database to explore critical DEGs. The critical DEGs were searched in the anxiety-related genes from GeneCards to find the common genes between anxiety and gastric cancer. The common genes were evaluated via The Cancer Genome Atlas (TCGA) and Kaplan-Meier Plotter analysis.

Results: Among 658 significant DEGs, CHEK2, SLC2A1, EZH2, STAT1, and MMP9 were identified as gastric cancer-related critical genes common with the dysregulated genes in anxiety. Up-regulation of these genes was confirmed via GEO and TCGA analyses.

Conclusion: It can be concluded that there is clear association between anxiety and gastric cancer. Anxiety shares dysregulated genes with gastric cancer It can be suggested that, there is a possible molecular link between them.

Aim: Analysis of stage transition in gastric cancer is the aim of this project.

Background: Gastric cancer, as a lethal digestive cancer, is classified based on tumor, node, and metastasis. Early detection of gastric cancer facilitates cancer management and treatment.

Methods: Data on gene expression changes at different stages of gastric cancer are extracted from the Gene Expression Omnibus (GEO) database and evaluated using the GEO2R program to identify significantly differentially expressed genes (DEGs). The queried DEGs were enriched via Gene Ontology to explore dysregulated pathways. The crucial DEGs were identified via directed protein-protein interaction (PPI) analysis.

Results: Analyses revealed that stage IA → stage IIA and stage IB → stage IIB transitions in gastric cancer are accompanied by considerable numbers of significant DEGs. MYC, “Nitric oxide metabolism in cystic fibrosis”, and “Hepatitis C and hepatocellular carcinoma” are the critical dysregulate gene and pathways in the stage IB → stage IIB transition. ACTG2, MYH11, CDKN2A, MS4A2, and FCER1A were pointed out as the critical genes in the IA → IIA stage transition.

Conclusion: In conclusion, inhibition of MYC was introduced as a crucial point in preventing the stage IB → stage IIB transition, and “Smooth muscle damage” was identified as a key process in stage IA → stage IIA transition. Experimental validation is recommended to find the applicable findings.

Aim: This study aimed to assess the trend and geographical distribution of colorectal cancer (CRC) in Fars province from 2011 to 2024, and its changes during COVID-19.

Background: Research has indicated that the risk of CRC varies significantly across different regions of the world.

Methods: From 2011 to 2024, data from 1,453 CRC patients who were registered in the Shiraz Colorectal Cancer Surgery (SCORCS) program were analyzed. Using R software (v4.2.0), we applied interrupted time series analysis to evaluate the impact of COVID-19 on CRC incidence and mortality. Spatial distribution was examined with ArcGIS (v10.4.1), and Moran's I test was used to determine high- and low-risk regions. A 5% significance level was applied to all analyses.

Results: In this study, 56.2% of the patients were men and 43.8% were women. Most patients (49%) were between 30 and 59 years old. Rectal cancer was slightly more common (57.7%) than colon cancer (41.8%), and only a very small number (less than 0.5%) had both. About half of the patients were classified as T3, and over 80% already had metastasis. At the pandemic onset, both outcomes showed a significant immediate increase, followed by a significant post-pandemic decline in slope. Among the studied areas, Kazerun and Jahrom had the highest incidence rate, while Zarqan and Kazerun showed the highest mortality rate.

Conclusion: This study shows that CRC incidence and mortality declined during COVID-19, likely due to restrictive policies. However, the high rates in some cities of Fars province highlight the need for targeted interventions to reduce the disease burden.

Aim: This study evaluated the prognostic value of Strasberg classification on 30-day bile duct patency and explored relevant clinical and procedural factors.

Background: Bile duct injury (BDI) is a serious complication of cholecystectomy that may influence early outcomes after endoscopic retrograde cholangiopancreatography (ERCP).

Methods: We retrospectively reviewed 33 patients with BDI treated with ERCP at Dr. Moewardi Hospital from January 2023 to May 2025. Data included demographics, laboratory results, cholecystectomy type, timing of diagnosis and repair, and injury severity (minor: A–C; major: D–E). The primary outcome was bile duct patency at 30 days, assessed by imaging and clinical indicators. Statistical analyses included chi-square, Fisher’s exact, Kaplan–Meier survival, and ROC curves.

Results: Patients had a mean age of 45.9 years; 54.5% were female, and 54.5% had laparoscopic cholecystectomy. Minor and major injuries were observed in 51.5% and 48.5%, respectively. 63.6% achieved bile duct patency by day 30. No significant associations were found between demographic, laboratory, procedural variables, and either injury severity or outcomes (all p>0.05). Kaplan–Meier analysis revealed significantly longer patency in minor injuries compared to major injuries (mean 25.88 vs. 20.88 days, p=0.030).

Conclusion: This study highlights Strasberg classification as an independent predictor of early bile duct patency after ERCP. Other common clinical factors did not significantly influence outcomes. These findings underscore the importance of Strasberg classification not only for injury assessment but also for guiding early postoperative management and monitoring. Larger prospective studies are needed to confirm these results and to optimize prognostic tools for BDI care.

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