1,721,036 research outputs found
Navigating the Second Victim Experience in Gastrointestinal Endoscopy and Colonoscopy.
No full textThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2025 The Author(s). JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and
John Wiley & Sons Australia, Ltd
Impact of poorly controlled type II diabetes mellitus on chemoresistance in colorectal cancer.
No full textType 2 diabetes mellitus (T2DM) significantly elevates the risk of colorectal cancer (CRC) and complicates its treatment by promoting chemoresistance. Poor glycemic control has been linked to exacerbated CRC progression and diminished chemotherapy efficacy, impacting patient outcomes through various mechanisms such as oxidative stress, activation of metabolic pathways, and altered protein modifications that hinder apoptosis and enhance tumor survival. Clinical evidence shows that T2DM patients experience higher rates of chemoresistance and reduced disease-free survival and overall survival compared to non-diabetic patients. Specifically, those with poor glycemic control exhibit increased chemoresistance and poorer survival metrics. Antidiabetic treatments, including metformin, acarbose, and gliclazide, show promise in improving chemotherapy response and glycemic management, potentially enhancing patient outcomes. Addressing this challenge requires a comprehensive, multidisciplinary approach involving oncologists, endocrinologists, and surgeons to optimize patient care. Integrated strategies that prioritize glycemic control are essential for reducing chemoresistance and improving survival in CRC patients with T2DM
Postgraduate gastroenterology training and continuing medical education in Africa: challenges, opportunities, and future directions.
No full textCopyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0(CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Africa faces a critical shortage of gastroenterologists amidst a growing burden of digestive diseases. Despite an alarming rise in gastrointestinal (GI) conditions - including peptic ulcers, GI cancers, and infectious colitis - postgraduate training in gastroenterology remains underdeveloped. This narrative review examines the structural, educational, and systemic challenges facing GI training across the continent, drawing from peer-reviewed literature, institutional surveys, and global health databases. Findings reveal substantial heterogeneity in training program length, curriculum standards, and procedural exposure. Advanced techniques like endoscopic retrograde cholangiopancreatograph and endoscopic ultrasound remain inaccessible to most trainees, while simulation facilities and didactic teaching are often limited. Faculty shortages, lack of protected research time, and minimal access to conferences further compromise academic development and contribute to workforce attrition. Despite these challenges, several innovative approaches offer hope. Low-cost simulation models, tele-education, and hybrid conference formats are improving access to training. Regional centers of excellence and North-South collaborations - such as partnerships between African institutions and the British Society of Gastroenterology (BSG) - have demonstrated success in building local capacity. The expansion of digital platforms, diaspora engagement, and public-private partnerships presents further opportunities. Recommendations include implementing competency-based assessments, supporting faculty development, creating regional accreditation bodies, and investing in infrastructure. Addressing systemic inequities in conference access and leveraging geospatial surveillance tools could also enhance disease mapping and policy planning. Ultimately, strengthening gastroenterology education in Africa requires coordinated regional and international action to develop sustainable, context-sensitive training ecosystems. This review provides a roadmap for achieving equitable specialist training and improving digestive health outcomes across the continent
Asundexian: a systematic review of safety, efficacy, and pharmacological insights in thrombosis.
No full text© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/Background: Asundexian, a novel oral Factor XIa (FXIa) inhibitor, targets the intrinsic coagulation pathway to prevent thrombosis while potentially reducing bleeding risk compared to direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs). This systematic review synthesizes clinical evidence on its safety, efficacy, and pharmacological properties in managing arterial and venous thrombotic events.
Methods: Following PRISMA guidelines, we searched PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Web of Science for clinical trials and observational studies on asundexian until January 2025. Inclusion criteria included studies reporting safety, efficacy, and pharmacokinetics/pharmacodynamics (PK/PD) outcomes. Two reviewers independently screened studies and extracted data, with quality assessed using the Cochrane Risk of Bias 2 tool.
Results: Eleven trials (n > 21,000, phases 1-3) were included. Asundexian suppressed FXIa activity, with phase 2 trials (e.g., PACIFIC-AF, PACIFIC-STROKE) showing reduced bleeding compared to apixaban. However, the phase 3 OCEANIC-AF trial was terminated early due to inferior efficacy in atrial fibrillation, with higher stroke/systemic embolism rates (2.5%) versus apixaban. PK/PD data support once-daily dosing with minimal drug interactions. Safety concerns include potential abnormal uterine bleeding, with limited data.
Conclusion: Asundexian shows promise in reducing bleeding but lacks efficacy in high-risk settings like atrial fibrillation. Ongoing trials are needed to define its role in specific thrombotic conditions
Stroke incidence, presentation, and outcomes in malaria: a review of current evidence.
Full text link© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.Malaria, a global health challenge, remains a leading cause of morbidity and mortality, particularly in sub-Saharan Africa, Southeast Asia, and South America. While traditionally associated with fever and systemic complications, the neurological impact of malaria, including stroke, has become a significant concern. This review aims to examine the incidence, clinical presentation, and outcomes of stroke in individuals with malaria, highlighting the role of malaria in both ischaemic and haemorrhagic strokes. A literature search identified nine studies published between 1999 and 2024, comprising case reports and case series involving malaria-related strokes in patients aged 2 to 47 years. Most cases involved Plasmodium falciparum, with a notable association between this parasite and haemorrhagic strokes. Plasmodium vivax, while less commonly implicated, was associated with ischaemic strokes, especially in younger patients. Diagnostic challenges, including misdiagnosis, were frequently encountered due to the overlap of neurological symptoms with cerebral malaria, emphasizing the need for a high index of suspicion. The pathophysiology of malaria-related strokes is multifactorial, with both mechanical obstruction of cerebral vessels and hypercoagulable states contributing to stroke development. Treatment generally involves a combination of anti-malarial therapy and supportive care, including management of complications such as raised intracranial pressure or seizures. Outcomes vary, with ischaemic stroke patients showing better recovery than those with haemorrhagic strokes. However, mortality remains high, particularly in cases with severe complications like cerebral venous thrombosis. Early diagnosis and intervention are crucial for improving survival and minimizing long-term neurological impairment. Further research is needed to refine diagnostic approaches, elucidate the underlying mechanisms, and optimize management strategies for stroke in patients with malaria
Transcatheter Tricuspid Valve Interventions: a Narrative Review of Current Evidence and Future Directions
No full textPurpose of Review
The review aims to delineate the developing role of transcatheter tricuspid valve interventions (TTVIs) whilst considering the current state of the evidence, preprocedural workup, developments, and outcomes based on current literature.
Recent Findings
TTVIs have made significant improvements in reducing TR and improving functional status in patients, especially in high-risk surgical cohorts. Innovations in device technology, such as the EVOQUE and LuX valves, have widened the scope of this intervention, offering tailored solutions for a wide range of anatomical and clinical challenges. Comparative analyses have indicated higher procedural success rates and improved patient outcomes compared to traditional surgical interventions.
Summary
TTVIs are redefining the management of tricuspid valve dysfunction by offering an effective and less invasive alternative to surgery. Despite promising short-term outcomes, questions of long-term durability require further research. Further innovation as well as larger clinical trials, will ensure this technique becomes a cornerstone in tricuspid valve management.
Opinion Statement
Transcatheter tricuspid valve interventions (TTVIs) represent a growing milestone in addressing tricuspid valve disorder, especially in high-risk surgery patients. These minimally invasive therapies overcome the disadvantages of traditional surgical/medical treatments by offering new and safer options with lower perioperative morbidity/mortality rates. Already accrued clinical data indicate that these procedures are feasible and safe, facilitating functional improvement and reduction in current tricuspid regurgitation. Nevertheless, several challenges remain. Anatomical and hemodynamic variability and the need to individualize treatment should be contemplated, thus emphasizing the need for pre-procedural planning for optimal outcomes. In addition, complications such as valve migration, leaflet tethering, and conduction disturbances underline the necessity for meticulous procedural multidisciplinary evaluation. Furthermore, long-term durability remains an area requiring further exploration. We recommend integrating TTVIs into a comprehensive structural program. In order to ensure efficacy and define guidelines, future research should continue to focus on randomized trials to validate these findings and to allow broader clinical adoption
The role of heart rate variability in cardiac surgery: applications and innovations
No full text© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Background
Heart rate variability, the physiological variation in time intervals between successive heartbeats, is a valuable marker used to index the functionality of the cardiac Autonomic Nervous System in healthy individuals and patients with cardiovascular and non-cardiovascular disorders. In cardiac surgery, heart rate variability can be a crucial tool for the operative management of patients. This manuscript reviews the role of heart rate variability in surgery, its current applications, and emerging trends in clinical settings.
Main body
Clinically, heart rate variability is used to evaluate surgical risk by identifying patients with impaired autonomic function who may be predisposed to complications such as arrhythmias or hemodynamic instability. During surgery, heart rate variability monitoring provides real-time insights into autonomic responses to anesthesia, fluid management, and surgical stress. Postoperatively, heart rate variability is instrumental in detecting early signs of sepsis, myocardial dysfunction, and autonomic dysregulation, thereby guiding timely interventions. Despite its clinical potential, heart rate variability analysis faces challenges, including variability in measurement techniques, limited standardization of interpretation, and the influence of confounding factors such as medications and mechanical ventilation. Additionally, real-time integration into surgical workflows remains underdeveloped.
Conclusions
Emerging trends in heart rate variability in cardiac surgery include the use of artificial intelligence for automated heart rate variability analysis, wearable biosensors for continuous monitoring, and tailored therapeutics. There are also new advances in machine-learning algorithms for heart rate variability interpretation, which are promising for enhancing ischemia detection and refining real-time decision-making during high-risk cardiac procedures. Thus, future research should focus on refining heart rate variability–based predictive models and integrating heart rate variability metrics into multimodal perioperative management strategies to improve surgical outcomes
Neurological complications post aortic arch surgery: a state of art review.
No full text© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Aortic arch surgery is a complex and high-risk operation undertaken to correct aneurysms, dissections, and traumatic aortic injuries. Despite notable improvement in surgical technique, perioperative care, and neuroprotection, the risk of neurological complications remains a predominant cause of concern. Such complications, which include permanent and transient neurological deficits, spinal cord damage, intellectual dysfunction, and seizures, are caused by conditions like cerebral hypoperfusion, embolism, reperfusion injury, and systemic inflammatory responses. The review seeks to summarize available evidence to cover the incidence, risk factors, mechanisms, prevention, and management of neurological complications in aortic arch surgery. It also evaluates the effectiveness of preventative strategies such as selective antegrade cerebral perfusion, hypothermia, intraoperative monitoring, and new pharmacologic approaches (i.e., hypertonic saline dextran, thiopental) in reducing neurological risk. Despite advances, there are important gaps in the management of long-term complications, reflecting the need for ongoing innovation in surgical and perioperative care. This review is a summary to assist clinicians in decreasing adverse outcomes in this high-risk group of patients
Vonoprazan Versus Lansoprazole in the Healing and Maintenance Phase of Erosive Esophagitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
No full textBackground: Vonoprazan (VPZ), a potassium-competitive acid blocker, has emerged as an alternative to traditional proton-pump inhibitors like Lansoprazole (LPZ) for the treatment of erosive esophagitis (EE). Vonoprazan provides stronger acid suppression compared to PPIs; however, evidence regarding its effectiveness and safety in treating EE remains limited. We conducted a systematic review and meta-analysis to evaluate the comparative effectiveness and safety of VPZ versus LPZ in the healing and maintenance phases of EE.
Methods: A comprehensive literature search was conducted across PubMed, Embase and Cochrane Library to identify eligible randomized controlled trials (RCTs) published till 12 December 2024 that evaluated efficacy and safety of VPZ and LPZ in patients with EE. Outcomes included endoscopic healing rates, recurrence rates, and treatment-emergent adverse events (TEAEs). Pairwise meta-analyses and network meta-analyses (NMA) were performed using Review Manager 5.4.1 and Bayesian models.
Results: This meta-analysis included 7 RCTs with 4,903 patients. In the healing phase, VPZ showed significantly higher endoscopic healing rates than LPZ at Week 2 (RR: 1.09; 95% CI: 1.04-1.13; p < 0.0001, I2 = 0%) and among patients with severe EE (LA classification C/D) at both Week 2 (RR: 1.26; 95% CI: 1.15-1.38; p < 0.00001, I2 = 0%) and Week 8 (RR: 1.13; 95% CI: 1.03-1.24; p = 0.007, I2 = 67%). No significant differences were observed in TEAEs, severe adverse events, or treatment discontinuation. In the maintenance phase, VPZ 20 mg reduced recurrence rates compared to LPZ 15 mg (RR: 0.41; 95% CI: 0.17-0.85) without differences in TEAEs.
Conclusions: VPZ demonstrates greater efficacy in healing and maintaining remission in EE, particularly in severe cases, with a safety profile comparable to LPZ. These findings support VPZ as an effective alternative to PPIs. However, long-term studies are warranted
Balloon Pulmonary Angioplasty Versus Riociguat in Inoperable Chronic Thromboembolic Pulmonary Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
No full textChronic thromboembolic pulmonary hypertension (CTEPH) results from unresolved pulmonary emboli that lead to persistent obstruction of the pulmonary vasculature, elevated pulmonary arterial pressure, and subsequent right-heart strain. About half of CTEPH patients cannot have surgery to remove blockages and need other treatments-either balloon pulmonary angioplasty (BPA), a procedure that widens vessels, or riociguat, a medication that relaxes them. We followed PRISMA guidelines and searched PubMed, Embase, Cochrane CENTRAL, and ClinicalTrials.gov for randomized trials from January 2018 to April 2025 that directly compared BPA and riociguat in adults with inoperable CTEPH. We pooled data from 3 trials (262 patients total: 134 BPA, 128 riociguat) using random-effects models and checked consistency with I² and leave-one-out tests. Compared to riociguat, BPA reduced mean pulmonary arterial pressure by 12.23 mm Hg (95% CI, 15.32-9.15; I² = 82%), pulmonary vascular resistance by 208.58 dyn·s/cm⁵ (95% CI, 299.85-117.32; I² = 87%), right atrial pressure by 2.18 mm Hg (95% CI, 3.13-1.23; I² = 66%), and NT-proBNP by 989.61 pg/mL (95% CI, 1456.66-522.55; I² = 0%) (all P < 0.0001). Riociguat led to a larger increase in cardiac output (0.47 L/min; 95% CI, 0.37-0.58; I² = 0%; P < 0.00001). Removing the Kawakami trial eliminated heterogeneity (I² = 0%). Both treatments were similarly safe. In summary, BPA delivers stronger pressure and biomarker improvements, while riociguat better boosts heart output. Combining or sequencing these treatments deserves further study in larger trials
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