Clinical Gastroenterology and Hepatology最新文献

Background/aims: Endoscopic ultrasound guided portosystemic pressure gradient measurement (EUS-PPG) is a novel technique to evaluate for portal hypertension (PH), a diagnosis that can prognosticate and guide therapy for patients. This study evaluated the safety and efficacy of EUS-PPG and correlation with clinical parameters and liver histology.

Methods: We conducted a multi-center, retrospective study of patients undergoing EUS-PPG from January 2020 to December 2022 for suspected liver disease or PH. Linear regression was used to examine the relationship between EUS-PPG and clinical parameters of PH and the chi square test, Fisher's exact test, and Wilcoxon Rank Sums test described correlation with liver biopsy histology and non-invasive markers of fibrosis (FIB-4, APRI). Logistic regression was performed to identify the strongest predictor of histologic cirrhosis.

Results: Across 8 centers, 385 patients were enrolled and 373 had successful EUS-PPG (technical success 97%). Higher median PPGs were observed in patients with than without esophageal varices (11.6mmHg vs 4.1), portal hypertensive gastropathy (10.5mmHg vs 3.3), and thrombocytopenia (7.6 mmHg vs 4.4) (p<0.001). Individuals with PH and clinically significant PH (PPG>10) were 6.7 and 3.8 times more likely to have cirrhosis on histology. EUS-PPG was the best overall predictor of biopsy proven cirrhosis (AUC 0.84) compared to FIB-4 (0.72), and APRI (0.54). There were 2 minor adverse events related to PPG (post procedural pain).

Conclusions: EUS-PPG measurement was technically feasible, safe and demonstrated strong correlation with clinical parameters of PH and liver histology. The strongest predictor of cirrhosis was EUS-PPG >5mm Hg which outperformed non-invasive markers of fibrosis.

Background and aims: Obesity and alcohol consumption are established risk factors for colorectal cancer (CRC). Recently, a multi-society consensus group has introduced a new classification for steatotic liver disease (SLD), which encompasses metabolic dysfunction-associated SLD (MASLD), MASLD and increased alcohol intake (MetALD), and alcohol-associated liver disease (ALD). However, the risk of developing CRC in each of these SLD subgroups is unknown. This nationwide cohort study investigated the risk of CRC in MASLD, MetALD, and ALD patients. The primary endpoint was the occurrence of CRC in each SLD subgroup.

Methods: We conducted a nationwide, population-based study that included 1,497,813 patients diagnosed with MASLD, MetALD, or ALD, alongside 4,885,536 individuals with no known liver disease as a comparison group. The primary outcome was the incidence of CRC and the risk of CRC was compared between MASLD, MetALD and ALD.

Results: The 5- and 10-year cumulative CRC incidence rates were 0.22% and 0.48% for MASLD, 0.32% and 0.73% for MetALD, and 0.43% and 0.97% for ALD, and 0.15% and 0.31% for the comparison group, respectively. The cumulative incidence of CRC was highest for ALD and significantly greater than that for MetALD, MASLD, and the comparison groups (both p < 0.001). Using the comparison group as the reference and adjusting for age, sex, smoking habit, number of colorectal examinations, diabetes mellitus, dyslipidemia, hypertension, and medication use, the adjusted hazard ratios (95% confidence interval) for CRC were 1.73 (1.59-1.87) for ALD, 1.36 (1.28-1.45) for MetALD, and 1.28 (1.22-1.35) for MASLD.

Conclusion: The risk of CRC differs significantly among patients with SLD, with the highest incidence observed in those with ALD, followed by MetALD and MASLD.

Background and aims: Wireless motility capsules (WMCs) can be used to assess gastrointestinal transit time to facilitate diagnosis and treatment of motility disorders. The Atmo Capsule is a novel WMC that measures gases (H₂, CO₂, O₂) and temperature. We aimed to compare and evaluate the performance characteristics of the Atmo Capsule and the SmartPill Capsule (discontinued reference standard WMC) for measurement of gastric emptying time (GET) and colonic transit time (CTT) , in patients with confirmed or suspected disordered gastrointestinal transit.

Methods: Patients with symptoms indicative of an upper and/or lower gastrointestinal motility disorder ingested the two WMCs in a random order. Gastrointestinal transit times were assessed using Spearman correlation and Bland-Altman analysis. Device agreement was assessed for delayed GET (≥ 5 hours) and CTT (≥ 59 hours).

Results: There were 213 participants from 12 sites, yielding 177 paired GET and 147 paired CTT measurements. The measurements for GET and CTT with the Atmo Capsule and SmartPill Capsule were strongly correlated (GET, R=0.73, P<0.01; CTT, R=0.69, P<0.01) and their observed biases were within 10% of the delayed transit margin. Both delayed GET (68/177) and CTT (56/147) were identified in 38% of participants with 84% agreement for identification of both delayed GET (sensitivity 78%, specificity 86%) and CTT (sensitivity 67%, specificity 93%). No serious adverse device effects were reported.

Conclusions: The performance characteristics of the Atmo capsule for measurements of GET and CTT, were equivalent to the reference standard WMC with a strong correlation and good device agreement. These results demonstrate that the Atmo Capsule is a valid method for evaluating gastrointestinal transit.