Colorectal cancer (CRC) ranks third in cancer incidence and stands as the second leading cause of cancer-related deaths globally. CRC tumorigenesis results from a cumulative set of genetic and epigenetic alterations, disrupting cancer-regulatory processes like cell proliferation, metabolism, angiogenesis, cell death, invasion, and metastasis. Key epigenetic modifications observed in cancers encompass abnormal DNA methylation, atypical histone modifications, and irregularities in noncoding RNAs, such as microRNAs and long noncoding RNAs. The advancement in genomic technologies has positioned these genetic and epigenetic shifts as potential clinical biomarkers for CRC patients. This review concisely covers the fundamental principles of CRC-associated epigenetic changes, and examines in detail their emerging role as biomarkers for early detection, prognosis, and treatment response prediction.

Background Colorectal polyps > 10 mm in size are often incompletely resected. Anchoring-endoscopic mucosal resection (A-EMR) is the technique of making a small incision at the oral side of the polyp using a snare tip after submucosal injection to avoid slippage during ensnaring. This study was performed to evaluate whether A-EMR could increase the complete resection rate for large colorectal polyps compared with conventional endoscopic mucosal resection (C-EMR). Methods Polyps with sizes of 10–25 mm were randomly allocated to either the A-EMR or the C-EMR groups. Results 105 and 106 polyps were resected using A-EMR and C-EMR, respectively. In the intention-to-treat population, the complete resection rate was 89.5 % in the A-EMR group and 74.5 % in the C-EMR group (relative risk [RR] 1.20, 95 %CI 1.04 to 1.38; P = 0.01). The en bloc resection rates for the A-EMR and C-EMR groups were 92.4 % vs. 76.4 % (RR 1.21, 95 %CI 1.06 to 1.37; P = 0.005) and R0 resection rates were 77.1 % vs. 64.2 % (RR 1.18, 95 %CI 0.98 to 1.42; P = 0.07), respectively. The median (interquartile range [IQR]) total procedure time was 3.2 (2.6–4.1) minutes in the A-EMR group and 3.0 (2.2–4.6) minutes in the C-EMR group (median difference 0.2 minutes, 95 %CI −0.22 to 0.73; P = 0.25). There was one episode of delayed bleeding and one perforation in the C-EMR group. Conclusions A-EMR was superior to C-EMR for the complete resection of large colorectal polyps. A-EMR can be considered one of the standard methods for the removal of colorectal polyps of 10 mm or more in size.

Background/Objective: Rifaximin is a nonabsorbable antibiotic used to treat irritable bowel syndrome (IBS). Recent studies on Helicobacter pylori eradication treatment have reported synergistic effects and low adverse effects when antibiotics are used in combination with probiotics; yet, such studies have not been conducted in IBS. Probiotics can enhance gut microbiota modulation, inhibition of pathogen adhesion to the gut epithelia, improvement in gut barrier function, anti-inflammatory effects, and improvement of gut immunity. Therefore, this study aimed to investigate the efficacy and safety of rifaximin in combination with probiotics compared to rifaximin monotherapy in patients with IBS. Methods: Patients with IBS were randomly allocated to receive rifaximin monotherapy or a combination of rifaximin and probiotics. The primary outcome was the response rate of the total IBS severity scoring system (IBS-SSS) score (>50-point decrease). Secondary outcomes were based on the response rate of the IBS quality of life (IBS-QOL) score and the IBS-SSS₁ subscore (>10-point decrease in both scores). Results: Among 70 patients, the responder rates for the total IBS-SSS score were 65.7% in the combination therapy group and 31.4% in the monotherapy group at weeks 4 and 8, respectively (p = 0.004). The responder rates for IBS-QOL were 65.7% versus (vs.) 37.1% and 65.7% vs. 34.2% at weeks 4 and 8, respectively (p = 0.017 and p = 0.009, respectively). The IBS-SSS₁ subscore responder rates were 65.7% vs. 40.0% at week 4 and 68.6% vs. 37.1% at 8 weeks (p = 0.031 and p = 0.017, respectively). Conclusions: Rifaximin combined with probiotics was superior to rifaximin monotherapy in patients with IBS. This combination therapy is considered an effective and safe treatment option for patients with IBS. However, further studies are needed to investigate the mechanisms of therapy and long-term outcomes.