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Coronavirus disease 2019 (COVID-19) most commonly presents with respiratory symptoms, including cough, shortness of breath, and sore throat. However, digestive symptoms also occur in patients with COVID-19 and are often described in outpatients with less severe disease. In this study, we sought to describe the clinical characteristics of COVID-19 patients with digestive symptoms and mild disease severity. We identified COVID-19 patients with mild disease and one or more digestive symptoms (diarrhea, nausea, and vomiting), with or without respiratory symptoms, and compared them with a group presenting solely with respiratory symptoms. We followed up patients clinically until they tested negative for COVID-19 on at least 2 sequential respiratory tract specimens collected ≥24 hours apart. We then compared the clinical features between those with digestive symptoms and those with respiratory symptoms. There were 206 patients with low severity COVID-19, including 48 presenting with a digestive symptom alone, 69 with both digestive and respiratory symptoms, and 89 with respiratory symptoms alone. Between the 2 groups with digestive symptoms, 67 presented with diarrhea, of whom 19.4% experienced diarrhea as the first symptom in their illness course. The diarrhea lasted from 1 to 14 days, with an average duration of 5.4 ± 3.1 days and a frequency of 4.3 ± 2.2 bowel movements per day. Concurrent fever was found in 62.4% of patients with a digestive symptom. Patients with digestive symptoms presented for care later than those with respiratory symptoms (16.0 ± 7.7 vs 11.6 ± 5.1 days, P < 0.001). Nevertheless, patients with digestive symptoms had a longer duration between symptom onset and viral clearance (P < 0.001) and were more likely to be fecal virus positive (73.3% vs 14.3%, P = 0.033) than those with respiratory symptoms. We describe a unique subgroup of COVID-19 patients with mild disease severity marked by the presence of digestive symptoms. These patients are more likely to test positive for viral RNA in stool, to have a longer delay before viral clearance, and to experience delayed diagnosis compared with patients with only respiratory symptoms.

Age is the dominant risk factor for infectious diseases, but the mechanisms linking age to infectious disease risk are incompletely understood. Age-related mosaic chromosomal alterations (mCAs) detected from genotyping of blood-derived DNA, are structural somatic variants indicative of clonal hematopoiesis, and are associated with aberrant leukocyte cell counts, hematological malignancy, and mortality. Here, we show that mCAs predispose to diverse types of infections. We analyzed mCAs from 768,762 individuals without hematological cancer at the time of DNA acquisition across five biobanks. Expanded autosomal mCAs were associated with diverse incident infections (hazard ratio (HR) 1.25; 95% confidence interval (CI) = 1.15–1.36; P  = 1.8 × 10 −7 ), including sepsis (HR 2.68; 95% CI = 2.25–3.19; P  = 3.1 × 10 −28 ), pneumonia (HR 1.76; 95% CI = 1.53–2.03; P  = 2.3 × 10 −15 ), digestive system infections (HR 1.51; 95% CI = 1.32–1.73; P  = 2.2 × 10 −9 ) and genitourinary infections (HR 1.25; 95% CI = 1.11–1.41; P  = 3.7 × 10 −4 ). A genome-wide association study of expanded mCAs identified 63 loci, which were enriched at transcriptional regulatory sites for immune cells. These results suggest that mCAs are a marker of impaired immunity and confer increased predisposition to infections. The burden of mosaic chromosomal alterations in blood-derived DNA, a type of clonal hematopoiesis, is associated with an increased risk for diverse types of infections, including sepsis and pneumonia.

Microplastics (MPs) and nanoplastics (NPs), formed as a result of plastic product degradation, pose a global environmental threat by penetrating biological systems and inducing systemic pathological changes. This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, aims to analyze the molecular and cellular mechanisms of the toxic effects of MPs and NPs on the human cardiovascular, nervous, reproductive, urinary, and digestive systems. The primary mechanisms include oxidative stress, inflammation, mitochondrial dysfunction, apoptosis, autophagy, ferroptosis, and impaired barrier functions. In the cardiovascular system, MPs and NPs contribute to endothelial dysfunction, disorders of lipid metabolism, and fibrosis; in the nervous system, they promote neuroinflammation, pathological protein aggregation, and psychiatric disorders; in the reproductive system, they lead to hormonal imbalance and reduced fertility; in the kidneys, they cause inflammation, and fibrosis and lead to deterioration of kidney function; and in the gastrointestinal tract, they contribute to dysbiosis and metabolic disorders. The literature search was conducted in the PubMed, Web of Science, and Scopus databases without limitations on date, language, or access. Studies were selected based on criteria of transparency, statistical validity, sample representativeness, and correctness of data interpretation. The review emphasizes the necessity of an interdisciplinary approach to developing prevention and treatment strategies, including reduction in exposure, antioxidant and immunomodulatory therapy, and restoration of barrier functions and microbiota. The data obtained reveal research gaps and identify directions for further study.

Despite the significant progress that has been made in the diagnosis and treatment of digestive system diseases, these conditions continue to pose a serious public health concern worldwide. There is an ongoing need for strategies that are precise, efficient and minimally invasive. Nanozymes, engineered nanomaterials that exhibit catalytic functions, have attracted considerable interest in this context. However, clinical application of nanozymes remains limited primarily due to their diversity, targetability, biocompatibility and early-stage clinical translation. The present review presented a comprehensive analysis of nanozymes in digestive system diseases. The main enzyme-like activities of nanozymes are summarized to guide further material selection and characteristic exploration. Preclinical applications are highlighted with mechanisms and theranostic effects discussed alongside their potential limitations. Emerging combination therapies, including photodynamic therapy, sonodynamic therapy and biotherapy, are reviewed. Finally, the current challenges of nanozymes and possible future developments are discussed.

Background Anxiety and depression are prevalent among elderly inpatients and may significantly influence clinical outcomes, particularly in patients with chronic diseases. However, limited research has explored these psychological conditions in elderly patients with digestive system diseases in the Southwest China region. Objective This study aimed to evaluate the associations between depression symptoms and clinical outcomes in elderly inpatients with digestive system diseases in Southwest China. Anxiety symptoms were examined as an associated variable and further analyzed in exploratory subgroup assessments. Methods A retrospective cohort study was conducted using data from 1,290 elderly inpatients aged 60 years or older hospitalized with a primary diagnosis of digestive system disease between January 2018 and December 2022 at a tertiary care hospital in Southwest China. Anxiety and depression symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), with a score ≥ 8 indicating clinically relevant symptoms. Clinical outcomes included prolonged hospital stay (≥ 14 days), hospitalization costs, complications during hospitalization, 30-day readmission, and in-hospital mortality. Multivariable logistic regression models were used to examine the associations, and subgroup analyses stratified by gender and age were performed. Results Anxiety symptoms were observed in 33.2% of patients, while 37.4% exhibited depression symptoms. Depression was significantly associated with longer hospital stays (14.2 ± 6.3 vs. 11.3 ± 5.2 days, P  < 0.001), higher hospitalization costs (¥12,300 vs. ¥10,800, P  < 0.001), and increased complication rates, including infections (29.5% vs. 20.8%, P  < 0.001) and gastrointestinal bleeding (19.1% vs. 11.6%, P  < 0.001). Subgroup analyses revealed that anxiety symptoms were strongly associated with prolonged hospital stays, particularly among female patients aged ≥ 70 years (adjusted OR: 2.35, 95% CI: 1.68–3.30, P  < 0.001). Multivariable analysis identified poor sleep quality, cognitive impairment, and digestive system tumors as variables independently associated with anxiety symptoms. Conclusion Anxiety and depression symptoms are prevalent among elderly inpatients with digestive system diseases in Southwest China and are associated with adverse clinical outcomes, including prolonged hospital stay, increased healthcare costs, and higher complication rates. Female patients and those aged ≥ 70 years are particularly vulnerable. Early psychological assessment and targeted interventions may improve clinical outcomes in this population.

Cystic fibrosis associated liver disease (CFLD) is the third largest cause of mortality in CF. Our aim was to define the burden of CFLD in the UK using national registry data and identify risk factors for progressive disease. A longitudinal population-based cohort study was conducted. Cases were defined as all patients with CFLD identified from the UK CF Registry, 2008-2013 (n = 3417). Denominator data were derived from the entire UK CF Registry. The burden of CFLD was characterised. Regression analysis was undertaken to identify risk factors for cirrhosis and progression. Prevalence of CFLD increased from 203.4 to 228.3 per 1000 patients during 2008-2013. Mortality in CF patients with CFLD was more than double those without; cirrhotic patients had higher all-cause mortality (HR 1.54, 95% CI 1.09 to 2.18, p = 0.015). Median recorded age of cirrhosis diagnosis was 19 (range 5-53) years. Male sex, Pseudomonas airway infection and CF related diabetes were independent risk factors for cirrhosis. Ursodeoxycholic acid use was associated with prolonged survival in patients without cirrhosis. This study highlights an important changing disease burden of CFLD. The prevalence is slowly increasing and, importantly, the disease is not just being diagnosed in childhood. Although the role of ursodeoxycholic acid remains controversial, this study identified a positive association with survival.

A Man with Recurrent Fever and Liver LesionsA 73-year-old man was admitted because of 22 months of recurrent fever and progressive hypodensities in the liver. A liver-biopsy specimen showed nonnecrotizing granulomas. A diagnosis was made.

Tight junctions (TJ) are intercellular adhesion complexes on epithelial cells and composed of integral membrane proteins as well as cytosolic adaptor proteins. Tight junction proteins have been recognized to play a key role in health and disease. In the liver, TJ proteins have several functions: they contribute as gatekeepers for paracellular diffusion between adherent hepatocytes or cholangiocytes to shape the blood-biliary barrier (BBIB) and maintain tissue homeostasis. At non-junctional localizations, TJ proteins are involved in key regulatory cell functions such as differentiation, proliferation, and migration by recruiting signaling proteins in response to extracellular stimuli. Moreover, TJ proteins are hepatocyte entry factors for the hepatitis C virus (HCV)—a major cause of liver disease and cancer worldwide. Perturbation of TJ protein expression has been reported in chronic HCV infection, cholestatic liver diseases as well as hepatobiliary carcinoma. Here we review the physiological function of TJ proteins in the liver and their implications in hepatobiliary diseases.

Opisthorchiasis caused by food-borne trematode Opisthorchis felineus is a substantial public health problem, with 17 million persons infected worldwide. This chronic disease is associated with hepatobiliary inflammation, cholangiocyte dysplasia, cholangiofibrosis, intraepithelial neoplasia, and even cholangiocarcinoma among chronically infected individuals. To provide first insights into the mechanism by which O. felineus infection causes precancerous liver lesions, we investigated the level of oxidative stress (lipid peroxidation byproducts and 8-hydroxy-2'-deoxyguanosine) as well as the time course profiles of chronic inflammation and fibrogenesis markers in the dynamics of opisthorchiasis from 1 month to 1.5 years postinfection in an experimental model based on golden hamsters Mesocricetus auratus. For the first time, we showed that O. felineus infection provokes time-dependent accumulation of oxidative hepatobiliary lesions in the injured liver of hamsters. In particular, over the course of infection, lipid peroxidation byproducts 4-hydroxynonenal and malondialdehyde were upregulated; these changes in general correlate with the dynamics of hepatic histopathological changes. We detected macrophages with various immunophenotypes and elevated levels of CD68, COX2, and CD163 in the O. felineus-infected animals. Meanwhile, there was direct time-dependent elevation of TNF-α (R = 0.79; p < 0.001) and CD163 protein levels (R = 0.58; p = 0.022). We also provide quantitative data about epithelial hyperplasia marker CK7 and a marker of myofibroblast activation (α smooth muscle actin). Our present data provide first insights into the histopathological mechanism by which O. felineus infection causes liver injuries. These findings support the inclusion of O. felineus in Group 1 of biological carcinogens.