Clinics and research in hepatology and gastroenterology最新文献_第5页

Temporal trends in prevalence of liver cancer and etiology-specific liver cancer from 1990 to 2019 1990-2019 年肝癌和病因特异性肝癌患病率的时间趋势。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-21 DOI: 10.1016/j.clinre.2024.102451

Chunhua Yang , Jia Jia , Yue Yu , Hao Lu , Liwei Zhang

Background

Liver cancer (LC) remains a major cause of cancer death worldwide. Grasping prevalence trends is key to informing strategies for control and prevention. We analyzed the global, regional and national trends in LC prevalence and its major causes from 1990 to 2019.

Methods

We obtained LC age-standardized prevalence rate (ASPR) estimates from the Global Burden of Disease study 2019 and assessed trends using Joinpoint regression. LC cases were categorized into those due to hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol use, nonalcoholic steatohepatitis (NASH) and other causes.

Results

While the ASPR of LC has shown a global decrease, there are specific regions where an increase in ASPR has been observed, with the highest rates in America. HBV remained the leading cause of LC (41.45 %) but significant increases occurred for HCV, alcohol use and NASH. Prevalence correlated with socioeconomic development. High-income countries had higher LC rates from HCV and alcohol but lower HBV-related LC. In high-income nations, LC prevalence climbs; the converse holds in middle- and low-income countries.

Conclusions

Despite a global ASPR decrease, LC due to HCV, NASH, and alcohol is rising. Prevention strategies must prioritize HBV vaccination, HCV treatment, and alcohol regulation.

Impact

The study informs targeted LC control policies and emphasizes the importance of continued monitoring and regional cooperation to combat LC.

背景：肝癌（LC）仍然是全球癌症死亡的主要原因。把握流行趋势是制定控制和预防策略的关键。我们分析了 1990 年至 2019 年全球、地区和国家的肝癌流行趋势及其主要病因：我们从 2019 年全球疾病负担研究中获得了 LC 年龄标准化患病率 (ASPR) 估计值，并使用 Joinpoint 回归法评估了趋势。LC 病例分为乙型肝炎病毒 (HBV)、丙型肝炎病毒 (HCV)、饮酒、非酒精性脂肪性肝炎 (NASH) 和其他原因引起的 LC 病例：尽管全球肝癌发病率呈下降趋势，但在一些特定地区，肝癌发病率呈上升趋势，其中美国的发病率最高。HBV 仍是导致 LC 的主要原因（41.45%），但 HCV、酗酒和 NASH 的发病率显著上升。患病率与社会经济发展相关。高收入国家因丙型肝炎病毒（HCV）和酒精导致的低血糖发病率较高，但因 HBV 导致的低血糖发病率较低。在高收入国家，低血糖患病率呈上升趋势，而在中低收入国家则相反：结论：尽管全球 ASPR 有所下降，但 HCV、NASH 和酒精导致的 LC 仍在上升。预防策略必须优先考虑 HBV 疫苗接种、HCV 治疗和酒精管制：影响：该研究为有针对性的低血糖控制政策提供了信息，并强调了持续监测和区域合作对防治低血糖的重要性。

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引用次数: 0

Causal effects of smoking, alcohol consumption, and coffee intake on hepatobiliary and pancreatic diseases: A Mendelian randomization study 吸烟、饮酒和摄入咖啡对肝胆胰疾病的因果效应：孟德尔随机研究》。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-20 DOI: 10.1016/j.clinre.2024.102450

Bingbing Zhao , Jiajing Xue , Huaqin Zhang

Background

Hepatobiliary and pancreatic diseases, such as cirrhosis, hepatocellular carcinoma, cholelithiasis, and pancreatitis, are major global health challenges. Lifestyle factors like smoking, alcohol consumption, and coffee intake are commonly studied for their health impacts. However, observational studies often face issues with confounding factors and reverse causality, making it difficult to establish causal relationships.

Methods

This research uses Mendelian randomization (MR) to investigate the causal effects of smoking, alcohol use, and coffee intake on 10 hepatobiliary and pancreatic diseases. Genetic data from the Sequencing Consortium of Alcohol and Nicotine Use (GSCAN) and self-reported GWAS were used to derive instrumental variables (IVs). The outcomes were obtained from the FinnGen and UK Biobank cohorts. Univariable and multivariable MR analyses were conducted to assess the associations.

Results

Genetic predisposition to tobacco use was associated with increased risks of acute pancreatitis, alcoholic hepatitis, chronic pancreatitis, cirrhosis, gallstones, liver cancer, and pancreatic cancer. Alcohol consumption was linked to acute pancreatitis, chronic pancreatitis, alcoholic liver disease, hepatic cancer, and cholangitis. Coffee intake showed minimal associations, with a slight protective effect against non-alcoholic steatohepatitis.

Conclusions

This study confirms the harmful effects of inhaling tobacco and consuming alcohol on hepatobiliary and pancreatic diseases. It highlights the need for public health strategies to reduce tobacco use and heavy alcohol consumption. Coffee intake showed minimal effects, suggesting further research is needed to understand its relationship with hepatobiliary health.

背景：肝胆胰疾病，如肝硬化、肝细胞癌、胆石症和胰腺炎，是全球面临的主要健康挑战。吸烟、饮酒和咖啡摄入量等生活方式因素对健康的影响通常被研究。然而，观察性研究往往面临混杂因素和反向因果关系的问题，因此难以确定因果关系：本研究采用孟德尔随机法（MR）调查吸烟、饮酒和咖啡摄入对 10 种肝胆胰疾病的因果关系。来自酒精和尼古丁使用测序联盟（GSCAN）的基因数据和自我报告的 GWAS 被用来推导工具变量（IV）。研究结果来自 FinnGen 和英国生物库队列。为评估相关性，进行了单变量和多变量MR分析：结果：吸烟的遗传倾向与急性胰腺炎、酒精性肝炎、慢性胰腺炎、肝硬化、胆结石、肝癌和胰腺癌风险的增加有关。饮酒与急性胰腺炎、慢性胰腺炎、酒精性肝病、肝癌和胆管炎有关。咖啡摄入量的相关性很小，对非酒精性脂肪性肝炎有轻微的保护作用：这项研究证实了吸入烟草和饮酒对肝胆胰疾病的有害影响。结论：这项研究证实了吸入烟草和饮酒对肝胆胰疾病的有害影响，强调了减少吸烟和大量饮酒的公共卫生策略的必要性。咖啡摄入量的影响微乎其微，这表明需要进一步研究咖啡与肝胆健康的关系。

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引用次数: 0

Alkaline phosphatase and liver fibrosis at diagnosis are associated with deep response to ursodeoxycholic acid in primary biliary cholangitis 诊断时的碱性磷酸酶和肝纤维化与原发性胆汁性胆管炎患者对熊去氧胆酸的深度反应有关。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-20 DOI: 10.1016/j.clinre.2024.102453

Guilherme Grossi Lopes Cançado , Patrícia da Silva Fucuta , Nathalia Mota de Faria Gomes , Cláudia Alves Couto , Eduardo Luiz Rachid Cançado , Debora Raquel Benedita Terrabuio , Cristiane Alves Villela‑Nogueira , Michelle Harriz Braga , Mateus Jorge Nardelli , Luciana Costa Faria , Elze Maria Gomes Oliveira , Vivian Rotman , Maria Beatriz Oliveira , Simone Muniz Carvalho Fernandes da Cunha , Marlone Cunha da Silva , Liliana Sampaio Costa Mendes , Claudia Alexandra Pontes Ivantes , Liana Codes , Valéria Ferreira de Almeida e Borges , Fabio Heleno de Lima Pace , Maria Lucia Gomes Ferraz

Objective

Primary biliary cholangitis is a chronic and progressive autoimmune liver disease, whose prognosis can be improved by normalizing alkaline phosphatase and bilirubin. While ursodeoxycholic acid (UDCA) is first line standard of care, approximately 40 % of patients exhibit incomplete response. We aimed to identify prognostic markers for deep response to UDCA therapy at presentation.

Patient and methods

Data from the Brazilian Cholestasis Study Group cohort were analyzed retrospectively. Patients were assessed for deep response, defined as normal alkaline phosphatase and bilirubin, after 1 year of UDCA treatment. Additionally, the performance of the UDCA response score in predicting deep response was evaluated.

Results

A total of 297 patients were analyzed, with 57.2 % achieving an adequate response according to the Toronto criteria, while 22.9 % reached deep response. Cirrhosis (OR 0.460; 95 % CI 0.225–0.942; p = 0.034) and elevated baseline alkaline phosphatase levels (OR 0.629; 95 % CI 0.513–0.770; p < 0.001) were associated with reduced odds of deep response. The UDCA response score exhibited moderate discrimination power (AUROC = 0.769) but lacked calibration.

Conclusions

Baseline ALP and liver fibrosis emerge as the most important prognostic factors to predict normalization of alkaline phosphatase and bilirubin after UDCA. The UDCA response score was inadequate for predicting deep response in the Brazilian PBC population.

目的：原发性胆汁性胆管炎是一种慢性、进展性自身免疫性肝病，其预后可通过使碱性磷酸酶和胆红素恢复正常而得到改善。尽管熊去氧胆酸（UDCA）是一线标准疗法，但约 40% 的患者表现出不完全反应。我们的目的是确定对 UDCA 治疗深度反应的预后标志：我们对巴西胆汁淤积症研究小组队列中的数据进行了回顾性分析。患者在接受 UDCA 治疗 1 年后接受深度反应评估，深度反应的定义是碱性磷酸酶和胆红素正常。此外，还评估了 UDCA 反应评分在预测深度反应方面的性能：共对 297 例患者进行了分析，根据多伦多标准，57.2% 的患者达到了充分反应，22.9% 的患者达到了深度反应。肝硬化（OR 0.460; 95% CI 0.225-0.942; p=0.034）和基线碱性磷酸酶水平升高（OR 0.629; 95% CI 0.513-0.770; p结论：基线ALP和肝纤维化是预测UDCA治疗后碱性磷酸酶和胆红素恢复正常的最重要预后因素。UDCA反应评分不足以预测巴西PBC人群的深度反应。

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引用次数: 0

FXR contributes to obstructive jaundice-induced vascular hyporeactivity in mesenteric arteries by reconstituting BKCa channels FXR 通过重建 BKCa 通道，促进肠系膜动脉阻塞性黄疸诱导的血管低反应性。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-17 DOI: 10.1016/j.clinre.2024.102448

Jin-ping Li , Bing-lu Ye , Qiang Li , Le-le Zhang , Lei Zhuang , Ya-wei Yuan

Objective

Vascular hyporeactivity increases with the incidence of obstructive jaundice (OJ). Evidence suggests that OJ activates the farnesoid X receptor (FXR) as well as the large-conductance Ca²⁺-activated K⁺ (BK_Ca or MaxiK) channel. This study was designed to explore the role of the FXR in vascular hyporesponsiveness induced by cholestasis.

Methods

The OJ model rats were constructed by bile duct ligation (BDL) and treated with an FXR agonist or antagonist. Vasoconstriction of the mesenteric arteries (MAs) was assessed in vitro. Whole-cell patch clamp recordings were used to investigate BK_Ca channel function. Real-time quantitative polymerase chain reaction (RT-qPCR) and Western blot were used to detect mRNA and protein levels.

Results

A significant increase in vascular tone and responsiveness to norepinephrine (NE) was observed after the MaxiK channel blocker (IbTX) was administered. This effect was pronounced in BDL animals and can be mimicked by the FXR agonist GW4064 and inhibited by the FXR antagonist Z-guggulsterone (Z-Gu). GW4064 has a similar effect as cholestasis in promoting MaxiK currents in isolated arterial smooth muscle cells (ASMCs), while Z-Gu blunted this effect. The mRNA and protein expression of FXR and MaxiK-β1, but not MaxiK-α, were significantly increased in the BDL group in comparison to the sham. Furthermore, activation or inhibition of FXR promoted or inhibited the mRNA and protein expression of the MaxiK-β1 subunit, respectively.

Conclusion

Activation of FXR enhances the capability of the MaxiK channel to regulate vascular tone and leads to vascular hyporesponsiveness in the MAs of BDL rats, which may be mediated by the nonparallel upregulation of MaxiK-α and MaxiK-β1 subunit expression.

目的：血管低反应性会随着阻塞性黄疸（OJ）的发生而增加。有证据表明，OJ 会激活法尼类固醇 X 受体（FXR）以及大电导 Ca2+ 激活 K+ （BKCa 或 MaxiK）通道。本研究旨在探讨 FXR 在胆汁淤积诱导的血管低反应性中的作用：方法：通过胆管结扎（BDL）构建 OJ 模型大鼠，并用 FXR 激动剂或拮抗剂治疗。体外评估肠系膜动脉（MAs）的血管收缩。全细胞膜片钳记录用于研究 BKCa 通道的功能。采用实时定量聚合酶链反应（RT-qPCR）和 Western 印迹法检测 mRNA 和蛋白质水平：结果：给予 MaxiK 通道阻断剂（IbTX）后，观察到血管张力和对去甲肾上腺素（NE）的反应性明显增加。FXR 激动剂 GW4064 可模拟这种效应，而 FXR 拮抗剂 Z-guggulsterone (Z-Gu) 则可抑制这种效应。GW4064 在促进离体动脉平滑肌细胞（ASMCs）的 MaxiK 电流方面具有与胆汁淤积相似的效果，而 Z-Gu 则会减弱这种效果。与假性相比，BDL 组 FXR 和 MaxiK-β1 的 mRNA 和蛋白表达显著增加，但 MaxiK-α 的表达却没有增加。此外，FXR的激活或抑制分别促进或抑制了MaxiK-β1亚基的mRNA和蛋白表达：结论：FXR的激活增强了MaxiK通道调节血管张力的能力，并导致BDL大鼠MAs血管反应低下，这可能是由MaxiK-α和MaxiK-β1亚基表达的非平行上调介导的。

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引用次数: 0

Reply to comments on “Dependent functional status is an independent risk factor for 30-day mortality and morbidities following colectomy for volvulus: An ACS- NSQIP study from the United States” 对 "依赖性功能状态是结肠切除术后 30 天死亡率和发病率的独立风险因素：美国 ACS- NSQIP 研究"。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-17 DOI: 10.1016/j.clinre.2024.102449

Renxi Li

引用次数: 0

ARHGEF39 targeted by E2F1 fosters hepatocellular carcinoma metastasis by mediating fatty acid metabolism E2F1靶向的ARHGEF39通过介导脂肪酸代谢促进肝细胞癌转移

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-09 DOI: 10.1016/j.clinre.2024.102446

Yao Huang , Jianxing Zeng , Teng Liu , Qingyi Xu , Xianglin Song , Jinhua Zeng

Background

Hepatocellular carcinoma (HCC) stands as the prevailing manifestation of primary liver cancer. Previous studies have implicated ARHGEF39 in various cancer progression processes, but its impact on HCC metastasis remains unclear.

Methods

Bioinformatics analysis and qRT-PCR were employed to test ARHGEF39 expression in HCC tissues and cells, identified enriched pathways associated with ARHGEF39, and investigated its regulatory relationship with E2F1. The impact of ARHGEF39 overexpression or knockdown on cellular phenotypes in HCC was assessed through the implementation of CCK-8 and Transwell assays. Accumulation of neutral lipids was determined by BODIPY 493/503 staining, while levels of triglycerides and phospholipids were measured using specific assay kits. Expression of E-cadherin, Vimentin, MMP-2, MMP-9, and FASN were analyzed by Western blot. The interaction between ARHGEF39 and E2F1 was validated through ChIP and dual-luciferase reporter assays.

Results

Our study demonstrated upregulated expression of both ARHGEF39 and E2F1 in HCC, with ARHGEF39 being associated with fatty acid metabolism (FAM) pathways. Additionally, ARHGEF39 was identified as a downstream target gene of E2F1. Cell-based experiments unmasked that high expression of ARHGEF39 mediated the promotion of HCC cell viability, migration, and invasion via enhanced FAM. Moreover, rescue assays demonstrated that the promotion of HCC cell metastasis by high ARHGEF39 expression was attenuated upon treatment with Orlistat. Conversely, the knockdown of E2F1 suppressed HCC cell metastasis and FAM, while the upregulation of ARHGEF39 counteracted the repressive effects of E2F1 downregulation on the metastatic potential of HCC cells.

Conclusion

Our findings confirmed the critical role of ARHGEF39 in HCC metastasis and unmasked potential molecular mechanisms through which ARHGEF39 fostered HCC metastasis via FAM, providing a theoretical basis for exploring novel molecular markers and preventive strategies for HCC metastasis.

背景：肝细胞癌（HCC）是原发性肝癌的主要表现形式。以前的研究表明 ARHGEF39 与多种癌症进展过程有关，但其对 HCC 转移的影响仍不清楚：方法：采用生物信息学分析和qRT-PCR检测ARHGEF39在HCC组织和细胞中的表达，确定与ARHGEF39相关的富集通路，并研究其与E2F1的调控关系。通过CCK-8和Transwell试验评估ARHGEF39过表达或敲除对HCC细胞表型的影响。中性脂质的积累通过 BODIPY 493/503 染色法测定，甘油三酯和磷脂的水平则通过特定的检测试剂盒测定。通过 Western 印迹分析了 E-cadherin、Vimentin、MMP-2、MMP-9 和 FASN 的表达。通过 ChIP 和双荧光素酶报告实验验证了 ARHGEF39 与 E2F1 之间的相互作用：我们的研究表明，ARHGEF39和E2F1在HCC中均有上调表达，其中ARHGEF39与脂肪酸代谢（FAM）通路相关。此外，ARHGEF39还被确定为E2F1的下游靶基因。基于细胞的实验揭示了 ARHGEF39 的高表达通过增强 FAM 促进了 HCC 细胞的活力、迁移和侵袭。此外，拯救实验表明，高表达 ARHGEF39 对 HCC 细胞转移的促进作用在奥利司他的治疗下有所减弱。相反，E2F1的敲除抑制了HCC细胞的转移和FAM，而ARHGEF39的上调抵消了E2F1下调对HCC细胞转移潜力的抑制作用：我们的研究结果证实了ARHGEF39在HCC转移中的关键作用，并揭示了ARHGEF39通过FAM促进HCC转移的潜在分子机制，为探索HCC转移的新型分子标记和预防策略提供了理论依据。

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引用次数: 0

Familial NTCPD presenting with persistent hypercholanemia and co-existing with a series of novel heterozygous mutations 家族性 NTCPD 表现为持续性高胆管血症，同时伴有一系列新型杂合突变。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-05 DOI: 10.1016/j.clinre.2024.102444

Meifen Wang , Lin Zhou , Qian Zhang , Juan Li , Junchao Peng , Rui Chen , Qi Shao , Zhongrui Bi , Mingying Wang , Jiwei Li

引用次数: 0

Association of congenital hepatic fibrosis and Caroli's syndrome: Two illustrative cases 先天性肝纤维化与卡罗琳综合征的关联：两个典型病例

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-05 DOI: 10.1016/j.clinre.2024.102443

Meifen Wang , Xiaomei Liu , Chuanfu Qiao , Rui Chen , Jintao Duan , Rong Zeng , Jiwei Li

引用次数: 0

Thirty-day outcomes of non-emergent colectomy for inflammatory bowel disease in patients with chronic obstructive pulmonary disease 慢性阻塞性肺病患者因炎症性肠病接受非急诊结肠切除术的 30 天疗效。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-05 DOI: 10.1016/j.clinre.2024.102445

Renxi Li

Background

Inflammatory bowel disease (IBD) can have significant colonic involvement and carries a long-term risk of surgical resection. Chronic obstructive pulmonary disease (COPD) and IBD share multiple inflammatory pathways, suggesting a bidirectional relationship through proposed pulmonary-intestinal cross-talk. This study aimed to examine the association between COPD and 30-day outcomes following non-emergent colectomies for IBD.

Methods

Patients with IBD as the primary indication for colectomy were selected from National Surgical Quality Improvement Program (NSQIP) colectomy database 2012–2022. Emergency colectomy cases were excluded. A 1:3 propensity-score matching was used to balance the preoperative characteristics of COPD and non-COPD patients. Thirty-day postoperative outcomes were compared.

Results

Among 25,285 patients who underwent colectomy for IBD, 365 (1.44 %) had COPD. Patients with COPD were older and had more comorbidities. After propensity-score matching, all COPD patients were matched to 1,095 patients without COPD. COPD and non-COPD patients had comparable 30-day mortality (3.29 % vs 2.19 %, p = 0.25). However, COPD patients had higher pulmonary complications (14.79 % vs 7.21 %, p < 0.01) attributed to pneumonia (10.14 % vs 4.02 %, p < 0.01), sepsis (12.88 % vs 8.68 %, p = 0.02), prolonged postoperative nothing by mouth (NPO) or nasogastric tube (NGT) use (28.22 % vs 22.10 %, p = 0.02), discharge not to home (40.28 % vs 34.02 %, p = 0.04), and longer length of stay (p = 0.01).

Conclusion

Therefore, given their mortality rates, colectomy is an effective treatment for IBD patients with concurrent COPD, while their postoperative care should include close monitoring of pulmonary symptoms and timely interventions to prevent further complications. Future research should explore the long-term prognosis of COPD patients after colectomy for IBD.

背景：炎症性肠病（IBD）可严重累及结肠，并具有手术切除的长期风险。慢性阻塞性肺病（COPD）和 IBD 有着共同的多种炎症途径，这表明两者之间存在着肺-肠交叉作用的双向关系。本研究旨在探讨慢性阻塞性肺病与 IBD 非急诊结肠切除术后 30 天预后之间的关系：方法：从2012-2022年国家外科质量改进计划（NSQIP）结肠切除术数据库中筛选出以IBD为结肠切除术主要适应症的患者。急诊结肠切除术病例除外。采用1:3倾向分数匹配法平衡慢性阻塞性肺病和非慢性阻塞性肺病患者的术前特征。对术后 30 天的结果进行了比较：在 25,285 例因 IBD 而接受结肠切除术的患者中，有 365 例（1.44%）患有 COPD。患有慢性阻塞性肺病的患者年龄更大，合并症更多。经过倾向分数匹配后，所有慢性阻塞性肺病患者与 1,095 名非慢性阻塞性肺病患者进行了匹配。慢性阻塞性肺病患者和非慢性阻塞性肺病患者的 30 天死亡率相当（3.29% vs 2.19%，P=0.25）。然而，慢性阻塞性肺病患者的肺部并发症更高（14.79% vs 7.21%，P=0.25）：因此，考虑到他们的死亡率，结肠切除术对于并发慢性阻塞性肺病的 IBD 患者是一种有效的治疗方法，而他们的术后护理应包括密切监测肺部症状和及时干预，以防止进一步的并发症。未来的研究应探讨慢性阻塞性肺病患者在接受结肠切除术治疗 IBD 后的长期预后。

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引用次数: 0

Gastroesophageal reflux after per oral endoscopic myotomy for achalasia: Results of a monocentric cohort 贲门失弛缓症经口腔内窥镜肌切开术后的胃食管反流：单中心队列研究结果。

IF 2.6 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2024-08-05 DOI: 10.1016/j.clinre.2024.102440

Laurine Estermann , Sophie Testu , Jérôme Rivory , Florian Rostain , Thierry Ponchon , Mathieu Pioche , Sabine Roman , François Mion

Background and study aims

Peroral endoscopic myotomy (POEM) has become the first line treatment for achalasia, but controversies remain about the prevalence of gastro-esophageal reflux disease (GERD) after the procedure. The aim of this study was to evaluate post-POEM GERD by a retrospective analysis of a single center cohort.

Patients and methods

Achalasia patients aged 18 or above, who underwent POEM between 2012 and 2021, were included, provided they had an endoscopic control of reflux at least one year after POEM. GERD symptoms based on GerdQ questionnaire, and proton pomp inhibitors (PPI) consumption were also evaluated.

Results

Among a consecutive cohort of 422 patients treated by POEM, 254 patients were included. Endoscopic results were available after a mean follow-up of 1.9 ± 1.5 years. 71/254 patients (28 %) had erosive esophagitis (86 % Los Angeles Grade A or B). At the last follow-up (mean 4.5 ± 2.2 years), clinical success of POEM (Eckardt score ≤ 3) was achieved in 79.5 % of patients. 44.5 % of patients were on PPI. Mean GerdQ score was 2.2 ± 2.7, with only 13 patients (6.5 %) with a score ≥ 8.

Conclusion

In this cohort of achalasia patients with an endoscopic follow-up at least 1 year after POEM, GERD did not appear a major threat concern: clinical symptoms were mild in most cases, as was the degree of erosive esophagitis. Furthermore, at the time of last follow up, less than half of patients required treatment with PPI.

背景和研究目的：口周内镜下肌切开术（POEM）已成为治疗贲门失弛缓症的一线疗法，但关于术后胃食管反流病（GERD）的发病率仍存在争议。本研究旨在通过对单中心队列进行回顾性分析，评估手术后胃食管反流病的发病率：纳入年龄在 18 岁或以上、在 2012 年至 2021 年期间接受过 POEM 的胃食管反流患者，条件是他们在 POEM 术后至少一年内通过内镜控制了反流。根据GerdQ问卷对胃食管反流症状和质子泵抑制剂（PPI）使用情况进行了评估：结果：在接受 POEM 治疗的 422 名患者中，有 254 名患者接受了内窥镜检查。平均随访时间为（1.9 ± 1.5）年，内镜检查结果已出炉。71/254名患者（28%）患有侵蚀性食管炎（86%为洛杉矶A级或B级）。在最后一次随访（平均 4.5 ± 2.2 年）中，79.5% 的患者获得了 POEM 的临床成功（艾卡得分≤ 3）。44.5%的患者服用了 PPI。平均 GerdQ 得分为 2.2 ± 2.7，只有 13 名患者（6.5%）的 GerdQ 得分≥8：在 POEM 术后至少 1 年进行内镜随访的这批贲门失弛缓症患者中，胃食管反流病似乎并不是主要的威胁因素：大多数病例的临床症状和侵蚀性食管炎的程度都很轻微。此外，在最后一次随访时，只有不到一半的患者需要使用 PPI 治疗。

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引用次数: 0