Pub Date : 2024-09-03DOI: 10.1016/j.cgh.2024.07.041
Mie Thu Ko, Tom Thomas, Emily Holden, Ian L P Beales, Leo Alexandre
Background and aim: Obesity is a risk factor for both Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). However, it is unclear whether obesity drives the malignant progression of BE. We aimed to assess whether obesity is associated with high-grade dysplasia (HGD) or cancer in patients with BE.
Methods: We searched MEDLINE and EMBASE from inception through April 2024 for studies reporting the effect of body mass index (BMI) on the progression of non-dysplastic BE or low-grade dysplasia (LGD) to HGD or EAC. A two-stage dose response meta-analysis was performed to estimate the dose-response relationship between BMI with malignant progression. Study quality was appraised using a modified Newcastle-Ottawa scale. The review was registered (PROSPERO ID CRD42017051046).
Results: Twenty studies reported data on 38565 patients (74.4% male) in total, of whom 1684 patients were diagnosed with HGD/cancer. Nineteen studies were considered moderate to high quality. Eight cohort studies reported data on 6647 male patients with baseline NDBE/LGD, of whom 555 progressed to HGD/EAC (pooled annual rate of progression 0.02%; 95% CI 0.01%-0.03%) and 1992 female patients with baseline NDBE/LGD with 110 progressors (pooled annual rate of progression 0.01%; 95% CI 0.01%-0.02%). There was no significant difference in pooled annual rate of progression between males and females (p=0.15). Each 5kg/m2 increase in BMI was associated with a 6% increase in the risk of malignant progression (adjusted OR 1.06; 95% CI 1.02-1.10; p<0.001; I2=0%).
Conclusion: Our meta-analysis provides some evidence that obesity as measured by BMI is associated with malignant progression of BE with a dose-response relationship. This finding requires confirmation in future high-quality cohort studies. Future risk prediction models could incorporate measures of obesity to potentially improve risk stratification in patients with BE.
背景和目的:肥胖是巴雷特食管(BE)和食管腺癌(EAC)的危险因素。然而,目前尚不清楚肥胖是否会导致BE恶性进展。我们旨在评估肥胖是否与 BE 患者的高级别发育不良(HGD)或癌症有关:方法:我们检索了从开始到 2024 年 4 月的 MEDLINE 和 EMBASE,以寻找报告体重指数 (BMI) 对非增生异常 BE 或低度增生异常 (LGD) 发展为 HGD 或 EAC 的影响的研究。研究人员进行了两阶段剂量反应荟萃分析,以估计BMI与恶性进展之间的剂量反应关系。研究质量采用修改后的纽卡斯尔-渥太华量表进行评估。综述已注册(PROSPERO ID CRD42017051046):20项研究共报告了38565名患者(74.4%为男性)的数据,其中1684名患者被诊断为HGD/癌症。19项研究被认为是中高质量的。八项队列研究报告了 6647 名基线 NDBE/LGD 男性患者的数据,其中 555 人进展为 HGD/EAC(汇总年进展率为 0.02%;95% CI 为 0.01%-0.03%);1992 名基线 NDBE/LGD 女性患者的数据,其中 110 人进展为 HGD/EAC(汇总年进展率为 0.01%;95% CI 为 0.01%-0.02%)。男性和女性的汇总年进展率没有明显差异(P=0.15)。BMI每增加5kg/m2,恶性进展的风险就会增加6%(调整后OR 1.06;95% CI 1.02-1.10;P2=0%):我们的荟萃分析提供了一些证据,表明以体重指数(BMI)衡量的肥胖与 BE 的恶性进展存在剂量反应关系。这一发现需要在未来的高质量队列研究中得到证实。未来的风险预测模型可纳入肥胖测量指标,以改善BE患者的风险分层。
{"title":"The association between obesity and malignant progression of Barrett's Esophagus: a systematic review and dose-response meta-analysis.","authors":"Mie Thu Ko, Tom Thomas, Emily Holden, Ian L P Beales, Leo Alexandre","doi":"10.1016/j.cgh.2024.07.041","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.07.041","url":null,"abstract":"<p><strong>Background and aim: </strong>Obesity is a risk factor for both Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). However, it is unclear whether obesity drives the malignant progression of BE. We aimed to assess whether obesity is associated with high-grade dysplasia (HGD) or cancer in patients with BE.</p><p><strong>Methods: </strong>We searched MEDLINE and EMBASE from inception through April 2024 for studies reporting the effect of body mass index (BMI) on the progression of non-dysplastic BE or low-grade dysplasia (LGD) to HGD or EAC. A two-stage dose response meta-analysis was performed to estimate the dose-response relationship between BMI with malignant progression. Study quality was appraised using a modified Newcastle-Ottawa scale. The review was registered (PROSPERO ID CRD42017051046).</p><p><strong>Results: </strong>Twenty studies reported data on 38565 patients (74.4% male) in total, of whom 1684 patients were diagnosed with HGD/cancer. Nineteen studies were considered moderate to high quality. Eight cohort studies reported data on 6647 male patients with baseline NDBE/LGD, of whom 555 progressed to HGD/EAC (pooled annual rate of progression 0.02%; 95% CI 0.01%-0.03%) and 1992 female patients with baseline NDBE/LGD with 110 progressors (pooled annual rate of progression 0.01%; 95% CI 0.01%-0.02%). There was no significant difference in pooled annual rate of progression between males and females (p=0.15). Each 5kg/m<sup>2</sup> increase in BMI was associated with a 6% increase in the risk of malignant progression (adjusted OR 1.06; 95% CI 1.02-1.10; p<0.001; I<sup>2</sup>=0%).</p><p><strong>Conclusion: </strong>Our meta-analysis provides some evidence that obesity as measured by BMI is associated with malignant progression of BE with a dose-response relationship. This finding requires confirmation in future high-quality cohort studies. Future risk prediction models could incorporate measures of obesity to potentially improve risk stratification in patients with BE.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1016/j.cgh.2024.08.003
{"title":"Correction.","authors":"","doi":"10.1016/j.cgh.2024.08.003","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.08.003","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1016/j.cgh.2024.08.024
Dennis Yang, Abdul Mohammed, Rena Yadlapati, Andrew Y Wang, Thurarshen Jeyalingam, Peter V Draganov, Ernesto Robalino Gonzaga, Muhammad K Hasan, Alexander Schlachterman, Ming-Ming Xu, Ahmed Saeed, Aziz Aadam, Reem Z Sharaiha, Ryan Law, Louis M Wong Kee Song, Monica Saumoy, John E Pandolfino, Makoto Nishimura, Michel Kahaleh, Joo Ha Hwang, Robert Bechara, Vani Ja Konda, John M DeWitt, Prashant Kedia, Nikhil A Kumta, Irteza Inayat, Stavros N Stavropoulos, Vivek Kumbhari, Uzma D Siddiqui, Salmaan Jawaid, Sherif Andrawes, Mouen Khashab, Joseph R Triggs, Neil Sharma, Mohamed Othman, Amrita Sethi, Alexandra J Baumann, Cyrus Priraka, Christy M Dunst, Mihir S Wagh, Mohammad Al-Haddad, C Prakash Gayawali, Sergey Kantsevoy, B Joseph Elmunzer
Background and aims: There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process.
Methods: A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus.
Results: A total of 23 statements achieved high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients, (2) a single dose of prophylactic antibiotics may be as effective as a short course, (3) a modified diet can be advanced as tolerated, (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak.
Conclusions: The results of this Delphi process established expert agreement on several important issues and provides a practical guidance on key aspects in the care of patients following POEM.
{"title":"NORTH AMERICAN EXPERT CONSENSUS ON THE POST-PROCEDURAL CARE OF PATIENTS AFTER PER-ORAL ENDOSCOPIC MYOTOMY USING A DELPHI PROCESS.","authors":"Dennis Yang, Abdul Mohammed, Rena Yadlapati, Andrew Y Wang, Thurarshen Jeyalingam, Peter V Draganov, Ernesto Robalino Gonzaga, Muhammad K Hasan, Alexander Schlachterman, Ming-Ming Xu, Ahmed Saeed, Aziz Aadam, Reem Z Sharaiha, Ryan Law, Louis M Wong Kee Song, Monica Saumoy, John E Pandolfino, Makoto Nishimura, Michel Kahaleh, Joo Ha Hwang, Robert Bechara, Vani Ja Konda, John M DeWitt, Prashant Kedia, Nikhil A Kumta, Irteza Inayat, Stavros N Stavropoulos, Vivek Kumbhari, Uzma D Siddiqui, Salmaan Jawaid, Sherif Andrawes, Mouen Khashab, Joseph R Triggs, Neil Sharma, Mohamed Othman, Amrita Sethi, Alexandra J Baumann, Cyrus Priraka, Christy M Dunst, Mihir S Wagh, Mohammad Al-Haddad, C Prakash Gayawali, Sergey Kantsevoy, B Joseph Elmunzer","doi":"10.1016/j.cgh.2024.08.024","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.08.024","url":null,"abstract":"<p><strong>Background and aims: </strong>There is significant variability in the immediate post-operative and long-term management of patients undergoing per-oral endoscopic myotomy (POEM), largely stemming from the lack of high-quality evidence. We aimed to establish a consensus on several important questions on the after care of post-POEM patients through a modified Delphi process.</p><p><strong>Methods: </strong>A steering committee developed an initial questionnaire consisting of 5 domains (33 statements): post-POEM admission/discharge, indication for immediate post-POEM esophagram, peri-procedural medications and diet resumption, clinic follow-up recommendations, and post-POEM reflux surveillance and management. A total of 34 experts participated in the 2 rounds of the Delphi process, with quantitative and qualitative data analyzed for each round to achieve consensus.</p><p><strong>Results: </strong>A total of 23 statements achieved high degree of consensus. Overall, the expert panel agreed on the following: (1) same-day discharge after POEM can be considered in select patients, (2) a single dose of prophylactic antibiotics may be as effective as a short course, (3) a modified diet can be advanced as tolerated, (4) all patients should be followed in clinic and undergo objective testing for surveillance and management of reflux. Consensus could not be achieved on the indication of post-POEM esophagram to evaluate for leak.</p><p><strong>Conclusions: </strong>The results of this Delphi process established expert agreement on several important issues and provides a practical guidance on key aspects in the care of patients following POEM.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.cgh.2024.07.037
Lucia Parlati, Charlotte Mouliade, Eric Nguyen Khac, Mathis Collier, Stylianos Tzedakis, Samir Bouam, Anoisia Courtois, Marion Corouge, Alexandre Louvet, Stanislas Pol, Philippe Sogni, Amine Benyamina, Jürgen Rehm, Philippe Mathurin, Vincent Mallet
Background and aims: There is limited understanding of the benefits of alcohol rehabilitation after alcohol hepatitis (AH).
Methods: We conducted a 2012-2021 national longitudinal study involving adult inpatients diagnosed with AH in France. We assessed the primary outcome of liver transplantation or death within one year after AH, including in its complicated form (CAH) defined as ≥ 2 hepatic or extrahepatic complications within 4 weeks after AH. The primary exposure was in-hospital alcohol rehabilitation within 3 months following AH. Patients who died (6.5%, n=5,282) or were censored (12.5%, n=10,180) ≤ 4 weeks after AH were excluded. We measured adjusted hazard ratios (aHR) and odds ratios (aOR) within the full cohort and propensity-matched samples.
Results: Among 65,737 patients (median age 52; IQR 44-60; 76% male), 12% died or underwent liver transplantation. In-hospital alcohol rehabilitation was noted for 25% of patients (15.2% among CAH patients) and was the primary discharge diagnosis for 13.3%. The one-year transplant-free survival rates were 94% (95% CI: 94% to 95%) for rehabilitated patients, compared to 85% (85% to 86%) for those without [aHR 0.62 (0.57 to 0.69) p < 0.001]. Among CAH patients, transplant-free survival was 78% (76% to 81%) with rehabilitation versus 70% (69% to 71%) without [aHR 0.82 (0.68 to 0.98) p = 0.025]. In propensity-matched samples, rehabilitation was linked to an aOR of 0.54 (0.49 to 0.55, p < 0.001) overall, and 0.73 (0.60 to 0.89, p = 0.002) among matched CAH patients.
Conclusions: In-hospital alcohol rehabilitation within 3-months after AH and CAH improve transplant-free survival rate but remain underutilized.
{"title":"Alcohol Rehabilitation Within 3 Months after Alcohol Hepatitis and Survival - A National Analysis.","authors":"Lucia Parlati, Charlotte Mouliade, Eric Nguyen Khac, Mathis Collier, Stylianos Tzedakis, Samir Bouam, Anoisia Courtois, Marion Corouge, Alexandre Louvet, Stanislas Pol, Philippe Sogni, Amine Benyamina, Jürgen Rehm, Philippe Mathurin, Vincent Mallet","doi":"10.1016/j.cgh.2024.07.037","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.07.037","url":null,"abstract":"<p><strong>Background and aims: </strong>There is limited understanding of the benefits of alcohol rehabilitation after alcohol hepatitis (AH).</p><p><strong>Methods: </strong>We conducted a 2012-2021 national longitudinal study involving adult inpatients diagnosed with AH in France. We assessed the primary outcome of liver transplantation or death within one year after AH, including in its complicated form (CAH) defined as ≥ 2 hepatic or extrahepatic complications within 4 weeks after AH. The primary exposure was in-hospital alcohol rehabilitation within 3 months following AH. Patients who died (6.5%, n=5,282) or were censored (12.5%, n=10,180) ≤ 4 weeks after AH were excluded. We measured adjusted hazard ratios (aHR) and odds ratios (aOR) within the full cohort and propensity-matched samples.</p><p><strong>Results: </strong>Among 65,737 patients (median age 52; IQR 44-60; 76% male), 12% died or underwent liver transplantation. In-hospital alcohol rehabilitation was noted for 25% of patients (15.2% among CAH patients) and was the primary discharge diagnosis for 13.3%. The one-year transplant-free survival rates were 94% (95% CI: 94% to 95%) for rehabilitated patients, compared to 85% (85% to 86%) for those without [aHR 0.62 (0.57 to 0.69) p < 0.001]. Among CAH patients, transplant-free survival was 78% (76% to 81%) with rehabilitation versus 70% (69% to 71%) without [aHR 0.82 (0.68 to 0.98) p = 0.025]. In propensity-matched samples, rehabilitation was linked to an aOR of 0.54 (0.49 to 0.55, p < 0.001) overall, and 0.73 (0.60 to 0.89, p = 0.002) among matched CAH patients.</p><p><strong>Conclusions: </strong>In-hospital alcohol rehabilitation within 3-months after AH and CAH improve transplant-free survival rate but remain underutilized.</p><p><strong>Funding: </strong>No external funding.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.cgh.2024.08.009
Prowpanga Udompap, Kan Liu, Itzhak Zachi Attia, Rachel E Canning, Joanne T Benson, Terry M Therneau, Peter A Noseworthy, Paul A Friedman, Puru Rattan, Joseph C Ahn, Douglas A Simonetto, Vijay H Shah, Patrick S Kamath, Alina M Allen
Background and aims: Accessible noninvasive screening tools for metabolic dysfunction-associated steatotic liver disease (MASLD) are needed. We aim to explore the performance of a deep-learning based artificial intelligence (AI) model in distinguishing the presence of MASLD using 12-lead electrocardiogram (ECG).
Methods: This is a retrospective study of adults diagnosed with MASLD in Olmsted County, Minnesota, between 1996 and 2019. Both cases and controls had ECGs performed within 6 years before and 1 year after study entry. An AI-based ECG model using a convolutional neural network was trained, validated, and tested in 70%, 10% and 20% of the cohort, respectively. External validation was performed in an independent cohort from Mayo Clinic Enterprise. The primary outcome was the performance of ECG to identify MASLD, alone or when added to clinical parameters.
Results: 3,468 MASLD cases and 25,407 controls were identified. The AI-ECG model predicted the presence of MASLD with an area under the curve (AUC) of 0.69 (original cohort) and 0.62 (validation cohort). The performance was similar or superior to age- and sex-adjusted models using body mass index (BMI) (AUC=0.71), presence of diabetes, hypertension or hyperlipidemia (AUC=0.68) or diabetes alone (AUC=0.66). The model combining ECG, BMI, diabetes, and alanine aminotransferase had the highest AUC (0.76 (original); 0.72 (validation)).
Conclusion: This is a proof-of-concept study that an AI-based ECG model can detect MASLD with a comparable or superior performance as compared to the models using a single clinical parameter but not superior to the combination of clinical parameters. ECG can serve as another screening tool for MASLD in the non-hepatology space.
{"title":"Performance of AI-Enabled Electrocardiogram in the Prediction of Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Prowpanga Udompap, Kan Liu, Itzhak Zachi Attia, Rachel E Canning, Joanne T Benson, Terry M Therneau, Peter A Noseworthy, Paul A Friedman, Puru Rattan, Joseph C Ahn, Douglas A Simonetto, Vijay H Shah, Patrick S Kamath, Alina M Allen","doi":"10.1016/j.cgh.2024.08.009","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.08.009","url":null,"abstract":"<p><strong>Background and aims: </strong>Accessible noninvasive screening tools for metabolic dysfunction-associated steatotic liver disease (MASLD) are needed. We aim to explore the performance of a deep-learning based artificial intelligence (AI) model in distinguishing the presence of MASLD using 12-lead electrocardiogram (ECG).</p><p><strong>Methods: </strong>This is a retrospective study of adults diagnosed with MASLD in Olmsted County, Minnesota, between 1996 and 2019. Both cases and controls had ECGs performed within 6 years before and 1 year after study entry. An AI-based ECG model using a convolutional neural network was trained, validated, and tested in 70%, 10% and 20% of the cohort, respectively. External validation was performed in an independent cohort from Mayo Clinic Enterprise. The primary outcome was the performance of ECG to identify MASLD, alone or when added to clinical parameters.</p><p><strong>Results: </strong>3,468 MASLD cases and 25,407 controls were identified. The AI-ECG model predicted the presence of MASLD with an area under the curve (AUC) of 0.69 (original cohort) and 0.62 (validation cohort). The performance was similar or superior to age- and sex-adjusted models using body mass index (BMI) (AUC=0.71), presence of diabetes, hypertension or hyperlipidemia (AUC=0.68) or diabetes alone (AUC=0.66). The model combining ECG, BMI, diabetes, and alanine aminotransferase had the highest AUC (0.76 (original); 0.72 (validation)).</p><p><strong>Conclusion: </strong>This is a proof-of-concept study that an AI-based ECG model can detect MASLD with a comparable or superior performance as compared to the models using a single clinical parameter but not superior to the combination of clinical parameters. ECG can serve as another screening tool for MASLD in the non-hepatology space.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.cgh.2024.07.039
Rawen Kader, Andreas V Hadjinicolaou, Nicholas E Burr, Bassett Paul, Omer F Ahmad, Pedersen Lasse, Chand Manish, Valori Roland, Stoyanov Danail, Laurence B Lovat
Background and aims: In 2018, the World Endoscopy Organization (WEO) introduced standardised methods for calculating post-colonoscopy colorectal cancer-3yr rates (PCCRC-3yr). This systematic review aimed to calculate the global PCCRC-3yr according to the WEO methodology, its change over time, and to measure the association between risk factors and PCCRC occurrences.
Methods: We searched five databases from inception until January 2024 for PCCRC-3yr studies that strictly adhered to the WEO methodology. The overall pooled PCCRC-3yr was calculated. For risk factors and time-trend analyses, the pooled PCCRC-3yr and odds ratio (OR) of subgroups were compared.
Results: Several studies failed to adhere to the WEO methodology. Eight studies from four Western European and two Northern American countries were included, totalling 220,106 detected-colorectal cancers (CRC) and 18,148 PCCRCs between 2002-2017. The pooled Western World PCCRC-3yr was 7.5% (95%CI 6.4%-8.7%). The PCCRC-3yr significantly (p<0.05) decreased from 7.9% (95%CI 6.6%-9.4%) in 2006 to 6.7% (95%CI 6.1%-7.3%) in 2012 (OR 0.79 (95%CI 0.72-0.87)). There were significantly higher rates for people with inflammatory bowel disease (PCCRC-3yr 29.3%, OR 6.17 (95%CI 4.73-8.06)), prior CRC (PCCRC-3yr 29.8%, OR 3.03 (95% CI 1.34-4.72)), proximal CRC (PCCRC-3yr 8.6%, OR 1.51 (95%CI 1.41-1.61), diverticular disease (PCCRC 3-yr 11.6%, OR 1.74 (95%CI 1.37-2.10)) and female sex (PCCRC-3yr 7.9%, OR 1.15 (95%CI 1.11-1.20)).
Conclusion: According to the WEO methodology, the Western World PCCRC-3yr was 7.5%. Reassuringly, this has decreased over time, but further work is required to identify the reasons for PCCRCs, especially in higher-risk groups. We devised a WEO methodology checklist to increase its adoption and standardise the categorisation of patients in future PCCRC-3yr studies.
{"title":"SYSTEMATIC REVIEW AND META-ANALYSIS: THE THREE-YEAR POST-COLONOSCOPY COLORECTAL CANCER RATE AS PER THE WEO METHODOLOGY.","authors":"Rawen Kader, Andreas V Hadjinicolaou, Nicholas E Burr, Bassett Paul, Omer F Ahmad, Pedersen Lasse, Chand Manish, Valori Roland, Stoyanov Danail, Laurence B Lovat","doi":"10.1016/j.cgh.2024.07.039","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.07.039","url":null,"abstract":"<p><strong>Background and aims: </strong>In 2018, the World Endoscopy Organization (WEO) introduced standardised methods for calculating post-colonoscopy colorectal cancer-3yr rates (PCCRC-3yr). This systematic review aimed to calculate the global PCCRC-3yr according to the WEO methodology, its change over time, and to measure the association between risk factors and PCCRC occurrences.</p><p><strong>Methods: </strong>We searched five databases from inception until January 2024 for PCCRC-3yr studies that strictly adhered to the WEO methodology. The overall pooled PCCRC-3yr was calculated. For risk factors and time-trend analyses, the pooled PCCRC-3yr and odds ratio (OR) of subgroups were compared.</p><p><strong>Results: </strong>Several studies failed to adhere to the WEO methodology. Eight studies from four Western European and two Northern American countries were included, totalling 220,106 detected-colorectal cancers (CRC) and 18,148 PCCRCs between 2002-2017. The pooled Western World PCCRC-3yr was 7.5% (95%CI 6.4%-8.7%). The PCCRC-3yr significantly (p<0.05) decreased from 7.9% (95%CI 6.6%-9.4%) in 2006 to 6.7% (95%CI 6.1%-7.3%) in 2012 (OR 0.79 (95%CI 0.72-0.87)). There were significantly higher rates for people with inflammatory bowel disease (PCCRC-3yr 29.3%, OR 6.17 (95%CI 4.73-8.06)), prior CRC (PCCRC-3yr 29.8%, OR 3.03 (95% CI 1.34-4.72)), proximal CRC (PCCRC-3yr 8.6%, OR 1.51 (95%CI 1.41-1.61), diverticular disease (PCCRC 3-yr 11.6%, OR 1.74 (95%CI 1.37-2.10)) and female sex (PCCRC-3yr 7.9%, OR 1.15 (95%CI 1.11-1.20)).</p><p><strong>Conclusion: </strong>According to the WEO methodology, the Western World PCCRC-3yr was 7.5%. Reassuringly, this has decreased over time, but further work is required to identify the reasons for PCCRCs, especially in higher-risk groups. We devised a WEO methodology checklist to increase its adoption and standardise the categorisation of patients in future PCCRC-3yr studies.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background & aims: Functional cure is an essential endpoint in the management of patients with chronic hepatitis B virus (HBV) infection. We evaluated the cumulative probability and predictors of functional cure in patients with chronic HBV infection after hepatitis B e antigen (HBeAg)-seroconversion.
Methods: We retrospectively analyzed 413 (249 males and 164 females) initially HBeAg-positive chronic HBV-infected patients, who were followed up for a mean of 26.36 ± 0.53 years. All underwent HBeAg-seroconversion during follow-up. A functional cure was defined as durable HBsAg and HBV DNA loss without antiviral treatment for more than 24 weeks.
Results: After 10,888 person-years of follow-up, the cumulative probability of functional cure was 14.53% (n = 60). There were 24 (40%) subjects with functional cure after antiviral therapy. The annual functional cure rate was 0.55% per perperson-year, and increased to 0.96% per person-year after HBeAg-seroconversion. In subjects with functional cure, the HBsAg and HBV DNA titers after HBeAg-seroconversion were positively correlated with the time to functional cure (P < .001 and < .001, respectively). Multivariate Cox proportional hazard analysis of the cohort revealed that HBeAg-seroconversion at < 18 years of age, high genetic barrier nucleos(t)ide analogue(s) therapy before HBeAg-seroconversion, and a serum HBsAg titer < 1,000 IU/mL at 18 months after HBeAg-seroconversion were significant predictors of functional cure (P < .001, .001, and .001, respectively).
Conclusions: In a cohort of chronic HBV-infected patients with long-term follow-up, HBeAg-seroconversion in childhood, high genetic barrier nucleos(t)ide analogue(s) therapy, and low HBsAg titers after HBeAg-seroconversion were significant predictors of functional cure.
{"title":"Predictors of functional cure of chronic hepatitis B virus infection - A long-term follow-up study.","authors":"Jia-Feng Wu, Chi-San Tai, Kai-Chi Chang, Yuh-Jue Chen, Chien-Ting Hsu, Huey-Ling Chen, Yen-Hsuan Ni, Mei-Hwei Chang","doi":"10.1016/j.cgh.2024.07.036","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.07.036","url":null,"abstract":"<p><strong>Background & aims: </strong>Functional cure is an essential endpoint in the management of patients with chronic hepatitis B virus (HBV) infection. We evaluated the cumulative probability and predictors of functional cure in patients with chronic HBV infection after hepatitis B e antigen (HBeAg)-seroconversion.</p><p><strong>Methods: </strong>We retrospectively analyzed 413 (249 males and 164 females) initially HBeAg-positive chronic HBV-infected patients, who were followed up for a mean of 26.36 ± 0.53 years. All underwent HBeAg-seroconversion during follow-up. A functional cure was defined as durable HBsAg and HBV DNA loss without antiviral treatment for more than 24 weeks.</p><p><strong>Results: </strong>After 10,888 person-years of follow-up, the cumulative probability of functional cure was 14.53% (n = 60). There were 24 (40%) subjects with functional cure after antiviral therapy. The annual functional cure rate was 0.55% per perperson-year, and increased to 0.96% per person-year after HBeAg-seroconversion. In subjects with functional cure, the HBsAg and HBV DNA titers after HBeAg-seroconversion were positively correlated with the time to functional cure (P < .001 and < .001, respectively). Multivariate Cox proportional hazard analysis of the cohort revealed that HBeAg-seroconversion at < 18 years of age, high genetic barrier nucleos(t)ide analogue(s) therapy before HBeAg-seroconversion, and a serum HBsAg titer < 1,000 IU/mL at 18 months after HBeAg-seroconversion were significant predictors of functional cure (P < .001, .001, and .001, respectively).</p><p><strong>Conclusions: </strong>In a cohort of chronic HBV-infected patients with long-term follow-up, HBeAg-seroconversion in childhood, high genetic barrier nucleos(t)ide analogue(s) therapy, and low HBsAg titers after HBeAg-seroconversion were significant predictors of functional cure.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.cgh.2024.08.020
Mohammad Zamani, Shaghayegh Alizadeh-Tabari, Veeral Ajmera, Siddharth Singh, Mohammad Hassan Murad, Rohit Loomba
Background and aims: Limited data exist regarding the estimate of the prevalence of advanced liver fibrosis and cirrhosis in the general population. Therefore, we conducted a systematic review and meta-analysis to evaluate the global prevalence and risk factors of advanced fibrosis and cirrhosis.
Methods: We searched Embase, PubMed, Scopus, and Web of Science from inception to 30 April 2024 with no language restriction. We included cross-sectional studies reporting the prevalence of advanced liver fibrosis and/or cirrhosis in a sample of at least 100 individuals aged ≥18 years from the general population. Subjects with cirrhosis were included in the advanced fibrosis group. The pooled prevalence proportions utilizing a random-effects model and 95% confidence intervals (CIs) were estimated using global data.
Results: A total of 46 studies fulfilled the eligibility criteria, comprising approximately 8 million participants from 21 countries. The pooled prevalence rates of advanced liver fibrosis and cirrhosis in the general population were 3.3% (95% CI: 2.4-4.2) and 1.3% (95% CI: 0.9-1.7) worldwide, respectively. A trend was observed for an increase in the prevalence of advanced fibrosis (p=0.004) and cirrhosis (p=0.034) after 2016. There were significant geographic variations in the advanced fibrosis and cirrhosis prevalence at continental and national levels (p<0.0001). Potential risk factors for cirrhosis were viral hepatitis, diabetes, excessive alcohol intake, obesity, and male sex.
Conclusions: The prevalence of advanced fibrosis and cirrhosis is considerable and increasing worldwide with significant geographic variation. Further research is needed to better understand the risk factors and how to mitigate them worldwide to address the growing global burden of cirrhosis.
{"title":"Global prevalence of advanced liver fibrosis and cirrhosis in the general population: a systematic review and meta-analysis.","authors":"Mohammad Zamani, Shaghayegh Alizadeh-Tabari, Veeral Ajmera, Siddharth Singh, Mohammad Hassan Murad, Rohit Loomba","doi":"10.1016/j.cgh.2024.08.020","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.08.020","url":null,"abstract":"<p><strong>Background and aims: </strong>Limited data exist regarding the estimate of the prevalence of advanced liver fibrosis and cirrhosis in the general population. Therefore, we conducted a systematic review and meta-analysis to evaluate the global prevalence and risk factors of advanced fibrosis and cirrhosis.</p><p><strong>Methods: </strong>We searched Embase, PubMed, Scopus, and Web of Science from inception to 30 April 2024 with no language restriction. We included cross-sectional studies reporting the prevalence of advanced liver fibrosis and/or cirrhosis in a sample of at least 100 individuals aged ≥18 years from the general population. Subjects with cirrhosis were included in the advanced fibrosis group. The pooled prevalence proportions utilizing a random-effects model and 95% confidence intervals (CIs) were estimated using global data.</p><p><strong>Results: </strong>A total of 46 studies fulfilled the eligibility criteria, comprising approximately 8 million participants from 21 countries. The pooled prevalence rates of advanced liver fibrosis and cirrhosis in the general population were 3.3% (95% CI: 2.4-4.2) and 1.3% (95% CI: 0.9-1.7) worldwide, respectively. A trend was observed for an increase in the prevalence of advanced fibrosis (p=0.004) and cirrhosis (p=0.034) after 2016. There were significant geographic variations in the advanced fibrosis and cirrhosis prevalence at continental and national levels (p<0.0001). Potential risk factors for cirrhosis were viral hepatitis, diabetes, excessive alcohol intake, obesity, and male sex.</p><p><strong>Conclusions: </strong>The prevalence of advanced fibrosis and cirrhosis is considerable and increasing worldwide with significant geographic variation. Further research is needed to better understand the risk factors and how to mitigate them worldwide to address the growing global burden of cirrhosis.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and aims: We examined the incidence and natural history of patients with very elderly-onset (herein, referred to as very late-onset) inflammatory bowel diseases (IBD) (age ≥70y at diagnosis), compared with patients diagnosed between ages 60-69y in Denmark.
Methods: In the Danish National Patient Register, between 1980-2018, we identified all individuals ≥60y with newly diagnosed Crohn's disease (CD) and ulcerative colitis (UC) and examined trends in incidence, cumulative risk of hospitalization, treatment patterns, IBD-related surgery, serious infection, cancer and cardiovascular and venous thromboembolic risks among very late-onset (70-79y or 80+ years) vs. late-onset (60-69y) IBD, using non-parametric competing risk analysis treating death as competing risk.
Results: We identified 3,459 patients with onset of CD at age ≥60y (47% ≥70y) and 10,774 patients with onset of UC aged ≥60y (51% ≥70y). Over the last three decades, incidence changes for very late-onset and late-onset IBD have followed the same patterns. Also, both for CD and UC, cumulative incidence of IBD-related hospitalization and corticosteroid use was comparable in very late-onset vs. late-onset patients. However, the burden of disease-modifying therapy, either immunomodulator or TNF antagonist use, and major IBD-related surgery was significantly lower in patients with very late-onset than in late-onset IBD. On the other hand, 5-year risk of serious infections and cardiovascular events was higher in patients with very late-onset IBD.
Conclusion: This nationwide cohort study shows that patients diagnosed with very late-onset (≥70y) IBD have a higher relative burden of disease- and aging-related complications, with limited use of steroid-sparing strategies and surgery, compared with late-onset IBD.
{"title":"Epidemiology of Elderly-Onset IBD: A Nationwide Population-based Cohort Study.","authors":"Siddharth Singh, Gry Juul Poulsen, Tania Hviid Bisgaard, Linéa Bonfils, Tine Jess","doi":"10.1016/j.cgh.2024.08.011","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.08.011","url":null,"abstract":"<p><strong>Background and aims: </strong>We examined the incidence and natural history of patients with very elderly-onset (herein, referred to as very late-onset) inflammatory bowel diseases (IBD) (age ≥70y at diagnosis), compared with patients diagnosed between ages 60-69y in Denmark.</p><p><strong>Methods: </strong>In the Danish National Patient Register, between 1980-2018, we identified all individuals ≥60y with newly diagnosed Crohn's disease (CD) and ulcerative colitis (UC) and examined trends in incidence, cumulative risk of hospitalization, treatment patterns, IBD-related surgery, serious infection, cancer and cardiovascular and venous thromboembolic risks among very late-onset (70-79y or 80+ years) vs. late-onset (60-69y) IBD, using non-parametric competing risk analysis treating death as competing risk.</p><p><strong>Results: </strong>We identified 3,459 patients with onset of CD at age ≥60y (47% ≥70y) and 10,774 patients with onset of UC aged ≥60y (51% ≥70y). Over the last three decades, incidence changes for very late-onset and late-onset IBD have followed the same patterns. Also, both for CD and UC, cumulative incidence of IBD-related hospitalization and corticosteroid use was comparable in very late-onset vs. late-onset patients. However, the burden of disease-modifying therapy, either immunomodulator or TNF antagonist use, and major IBD-related surgery was significantly lower in patients with very late-onset than in late-onset IBD. On the other hand, 5-year risk of serious infections and cardiovascular events was higher in patients with very late-onset IBD.</p><p><strong>Conclusion: </strong>This nationwide cohort study shows that patients diagnosed with very late-onset (≥70y) IBD have a higher relative burden of disease- and aging-related complications, with limited use of steroid-sparing strategies and surgery, compared with late-onset IBD.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.1016/j.cgh.2024.08.008
Dominique Roulot, Ségolène Brichler, Richard Layese, Louis d'ALTEROCHE, Nathalie Ganne-Carrie, Christiane Stern, Antonio Saviano, Vincent Leroy, Françoise Roudot-Thoraval, Victor de Ledinghen
Background & aims: Liver biopsy remains the gold standard for fibrosis staging in patients with chronic hepatitis delta (CHD). Here we comparatively evaluated the performance of transient elastography (TE) and biomarkers for the diagnosis of liver fibrosis in patients with CHD.
Methods: 230 HDV-infected RNA-positive patients from various centers who underwent liver biopsy and liver stiffness measurements (LSM) using Fibroscan®, within a period of 6 months maximum, were investigated retrospectively. AUROC and Youden index were used to establish cut-off values of LSM. TE was compared with other noninvasive tests (NITs): APRI, Fibrosis-4 and Delta-4 fibrosis scores.
Results: Histologic fibrosis stage distribution was: 20.4% for F0-F1; 27.0% for F2; 18.7% for F3 and 33.9% for F4. TE demonstrated good diagnostic performance for detecting cirrhosis and advanced fibrosis with AUROC of 0.88 and 0.86, values, which were significantly higher than those obtained with the other NITs (P = .004 and P < .001). With a cutoff value >12 kPa for cirrhosis, sensitivity was 70.5%, specificity 86.2%, positive predictive value (PPV) 72.4% negative predictive value (NPV) 85.1% and accuracy 80.9%. Using 10.4 kPa as cut-off value for F3, sensitivity was 70.2%, specificity 83.5%, PPV 82.5%, NPV 71.7% and accuracy 76.5%. In 89% of patients with LSM ≤ 6.2 kPa, liver biopsy disclosed only absent or minimal fibrosis.
Conclusion: TE demonstrated good diagnostic performance for advanced fibrosis and cirrhosis in CHD patients. Advanced fibrosis is highly probable for LSM values ≥10 kPa. LSM values < 6 kPa almost totally exclude significant fibrosis. Between 6 and 10 kPa, liver biopsy should be discussed.
{"title":"High diagnostic value of transient elastography for advanced fibrosis and cirrhosis in patients with chronic hepatitis delta.","authors":"Dominique Roulot, Ségolène Brichler, Richard Layese, Louis d'ALTEROCHE, Nathalie Ganne-Carrie, Christiane Stern, Antonio Saviano, Vincent Leroy, Françoise Roudot-Thoraval, Victor de Ledinghen","doi":"10.1016/j.cgh.2024.08.008","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.08.008","url":null,"abstract":"<p><strong>Background & aims: </strong>Liver biopsy remains the gold standard for fibrosis staging in patients with chronic hepatitis delta (CHD). Here we comparatively evaluated the performance of transient elastography (TE) and biomarkers for the diagnosis of liver fibrosis in patients with CHD.</p><p><strong>Methods: </strong>230 HDV-infected RNA-positive patients from various centers who underwent liver biopsy and liver stiffness measurements (LSM) using Fibroscan®, within a period of 6 months maximum, were investigated retrospectively. AUROC and Youden index were used to establish cut-off values of LSM. TE was compared with other noninvasive tests (NITs): APRI, Fibrosis-4 and Delta-4 fibrosis scores.</p><p><strong>Results: </strong>Histologic fibrosis stage distribution was: 20.4% for F0-F1; 27.0% for F2; 18.7% for F3 and 33.9% for F4. TE demonstrated good diagnostic performance for detecting cirrhosis and advanced fibrosis with AUROC of 0.88 and 0.86, values, which were significantly higher than those obtained with the other NITs (P = .004 and P < .001). With a cutoff value >12 kPa for cirrhosis, sensitivity was 70.5%, specificity 86.2%, positive predictive value (PPV) 72.4% negative predictive value (NPV) 85.1% and accuracy 80.9%. Using 10.4 kPa as cut-off value for F3, sensitivity was 70.2%, specificity 83.5%, PPV 82.5%, NPV 71.7% and accuracy 76.5%. In 89% of patients with LSM ≤ 6.2 kPa, liver biopsy disclosed only absent or minimal fibrosis.</p><p><strong>Conclusion: </strong>TE demonstrated good diagnostic performance for advanced fibrosis and cirrhosis in CHD patients. Advanced fibrosis is highly probable for LSM values ≥10 kPa. LSM values < 6 kPa almost totally exclude significant fibrosis. Between 6 and 10 kPa, liver biopsy should be discussed.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}