Clinics and research in hepatology and gastroenterology最新文献

英文中文

A series of pediatric patients with inflammatory bowel disease switching from intravenous to subcutaneous infliximab maintenance therapy 一系列儿童炎症性肠病患者从静脉注射切换到皮下英夫利昔单抗维持治疗。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.clinre.2025.102680

Anne Sophie Duquerois , Christine Martinez-Vinson , Thomas Loppinet , Lioara Restier , Pierre Poinsot , Aurélie Portefaix , Sophie Heissat , Noel Peretti , Nicolas Caron , Rémi Duclaux-Loras

Objective

Infliximab is approved for pediatric Crohn's disease (CD) and ulcerative colitis (UC), but is limited in children by its intravenous administration. We evaluated the effectiveness and safety of switching from intravenous to subcutaneous infliximab in pediatric patients with CD/UC.

Methods

Multicenter retrospective cohort study, from January to December 2022 in two pediatric centers, that included CD/UC patients in clinical remission and weighing ≥50 kg, treated with maintenance dose IV IFX. Primary endpoint: maintenance of clinical remission at six-months post-switch; PCDAI<10 for CD, PUCAI<10 for UC. Secondary endpoints included: IFX trough levels, anti-infliximab antibodies (AIAs), adverse events, and treatment persistence.

Results

Twenty-one patients were included: 11 (52.3 %) female, median 17 years of age (range: 13–18 years), 18 (85.7 %) CD and 3 (14.3 %) UC. The median (range) age at diagnosis was 12 (5–15) years; at inclusion (M0; switch) it was 16 (10–18) years. All received optimized IFX regimens (10mg/kg every 8 or 4 weeks). All were in clinical remission at M0 and maintained remission throughout the 6-month follow-up. None discontinued treatment. Median (range) serum IFX trough levels was 11.3μg/mL (4.7–39μg/mL; n = 13) at M0, 17.8μg/mL (8.5–20μg/mL; n = 10) at M3, and 20μg/mL (17.1–20μg/mL; n = 6) at M6. No patient developed AIAs. There was no serious adverse event; one patient (4.7 %) experienced a mild injection site reaction.

Conclusion

Switching from IV to SC IFX appears effective and safe in pediatric IBD patients. Pharmacokinetic studies are required for children <50 kg in order to determine the dosage of SC IFX that allows therapeutic trough values to be achieved.

目的：英夫利昔单抗被批准用于儿童克罗恩病（CD）和溃疡性结肠炎（UC），但在儿童静脉给药方面受到限制。我们评估了儿科CD/UC患者从静脉注射到皮下注射英夫利昔单抗的有效性和安全性。方法：多中心回顾性队列研究，于2022年1月至12月在两个儿科中心进行，纳入临床缓解且体重≥50kg的CD/UC患者，接受维持剂量IV IFX治疗。主要终点：转换后6个月的临床缓解维持；pcdai结果：21例患者包括：11例（52.3%）女性，中位年龄17岁（范围：13-18岁），18例（85.7%）CD， 3例（14.3%）UC。诊断时的中位（范围）年龄为12岁（5-15岁）；在纳入（M0; switch）时为16（10-18）年。所有患者均接受优化的IFX方案（每8周或4周10mg/kg）。所有患者在M0时临床缓解，并在6个月的随访中保持缓解。没有人停止治疗。血清中位（范围）IFX谷水平在M0时为11.3μg/mL (4.7-39μg/mL, n=13)， M3时为17.8μg/mL (8.5-20μg/mL, n=10)， M6时为20μg/mL （17.1-20μg/mL, n=6）。无患者发生AIAs。无严重不良事件发生；1例患者（4.7%）出现轻度注射部位反应。结论：对于儿童IBD患者，从静脉注射转向SC IFX似乎是有效和安全的。需要对儿童进行药代动力学研究

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引用次数: 0

Hepatitis D, a new declared enemy: a little-known carcinogen that must be urgently combated in sub-Saharan Africa D型肝炎，一个新的敌人：一种鲜为人知的致癌物，必须在撒哈拉以南非洲地区紧急抗击

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.clinre.2025.102679

Stanis DONNANG , Dujardin MAKEDA , Joshua EKOUO , Christian TAGUE , Hermann YOKOLO

引用次数: 0

Mortality reduction or selection bias? Interpreting outcomes of index admission cholecystectomy in acute cholangitis 死亡率降低还是选择偏差？急性胆管炎指数入院胆囊切除术的疗效分析。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.clinre.2025.102683

Parth Aphale, Himanshu Shekhar, Shashank Dokania

引用次数: 0

Results of a French screening campaign comparing clinical and molecular characteristics of interval colorectal cancers to cancers detected using a guaiac test 一项法国筛查活动的结果，比较间隔期结直肠癌和使用愈创木试验检测的癌症的临床和分子特征。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.clinre.2025.102678

Carole Vitellius , Benjamin Morvant , Estelle Pedrono , Diane Lambert , Mylène Monteil , Eric Lavoine , Anne-Sophie Banaszuk , Philippe Guardiola , François-Xavier Caroli-Bosc

Few studies have analyzed the biological characteristics of interval colorectal cancers (CRC) during a screening campaign. We included 98 patients of whom 46 had a screened cancer (SCG) and 52 an interval cancer (ICG). Microsatellite instability and gene mutation profiling were performed in 86 and 55 patients, respectively. ICG were diagnosed with more advanced diseases. A time interval between last negative test and CRC diagnosis (TIg2D) ≥ 18 months, in the ICG, was associated with an increased risk of metastasis at diagnosis. Old age, male gender, rectal cancer and TIg2D ≥ 18 months were associated with a worse outcome in ICG. Interval cancers remained associated with a worse survival in an adjusted Cox model. There was no significant difference in terms of mutation frequency between SCG and ICG. However, APC / CTNNB1 mutations were less frequent in rectum cancers of ICG. Furthermore, KRAS activating mutations were less frequent in the ICG when age at diagnosis was below 65 years or if patients had colon cancer. When compared to the SCG, the survival of ICG was significantly worse in patients with wild-type KRAS. These results suggest that men and elderly subjects could benefit from annual screening. Patients with rectum cancer and wild-type APC/CTNNB1/KRAS should be considered as high-risk subjects.

很少有研究分析间隔期结直肠癌（CRC）在筛查过程中的生物学特征。我们纳入了98例患者，其中46例为筛查性癌症（SCG）， 52例为间隔期癌症（ICG）。微卫星不稳定性和基因突变分析分别对86例和55例患者进行。ICG诊断为更晚期的疾病。在ICG中，最后一次阴性检测与CRC诊断（TIg2D）之间的时间间隔≥18个月与诊断时转移风险增加相关。年龄、男性、直肠癌和TIg2D≥18个月与ICG预后较差相关。在调整后的Cox模型中，间隔期癌症仍然与较差的生存率相关。SCG和ICG的突变频率无显著差异。然而，APC /CTNNB1突变在ICG直肠癌中较少发生。此外，当诊断年龄低于65岁或患者患有结肠癌时，ICG中KRAS激活突变的频率较低。与SCG相比，野生型KRAS患者的ICG生存率明显较差。这些结果表明，男性和老年人可以从每年的筛查中受益。直肠癌患者和野生型APC/CTNNB1/KRAS应视为高危人群。

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引用次数: 0

GGT-normal cholestasis associated with LSR deficiency: A potential new subtype of PFIC 与LSR缺乏相关的ggt正常胆汁淤积：PFIC的潜在新亚型。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-09-01 DOI: 10.1016/j.clinre.2025.102674

Ozlem Sumer Cosar , Hakan Ozturk , Gulsum Kayhan , Ayse Can , Sınan Sarı , Guldal Esendağlı , Buket Dalgıc

Introduction

Hereditary cholestatic liver diseases are a group of disorders caused by different gene mutations encoding proteins involved in bile production, transport, or secretion. New genetic disorders have been identified in cholestatic patients through an increased understanding of these proteins, evolving genetic technology and more widespread genetic testing. Recently, mutations in the Lipolysis-Stimulated Lipoprotein Receptor (LSR) gene have been identified as a novel cause of infantile intrahepatic cholestasis. To date, only two cases have been reported in the literature. Here, we present two children with GGT normal cholestasis with LSR-gene variants.

Methods

Two pediatric patients with GGT-normal cholestasis underwent genetic analysis, including whole-exome sequencing. Clinical, laboratory, and histopathological findings were reviewed, and genetic variants were evaluated.

Results

Both patients exhibited progressive cholestasis with normal GGT levels, and genetic analysis identified homozygous missense variants in the LSR gene. These cases' clinical presentation and disease course shared similarities with previously reported LSR-related cholestasis, suggesting a common pathogenic mechanism.

Conclusions

These findings further support the LSR gene as a novel cause of GGT normal cholestasis. Identifying additional cases provides crucial insights into the genotype-phenotype correlation, aiding in the early diagnosis and management of affected patients. Expanding the number of reported cases will contribute to a better understanding of disease progression and potential therapeutic strategies.

简介：遗传性胆汁淤积性肝病是一组由参与胆汁产生、运输或分泌的编码蛋白的不同基因突变引起的疾病。通过对这些蛋白质的进一步了解、不断发展的基因技术和更广泛的基因检测，在胆汁淤积症患者中发现了新的遗传疾病。最近，脂肪酶刺激脂蛋白受体（LSR）基因的突变已被确定为婴儿肝内胆汁淤积症的新原因。迄今为止，文献中仅报道了两例病例。在此，我们报告了两例伴有lsr基因变异的GGT正常胆汁淤积症患儿。方法：对2例ggt正常的儿童胆汁淤积症患者进行遗传分析，包括全外显子组测序。我们回顾了临床、实验室和组织病理学的发现，并对遗传变异进行了评估。结果：两例患者均表现出进行性胆汁淤积，GGT水平正常，遗传分析发现LSR基因存在纯合错义变异。这些病例的临床表现和病程与先前报道的lsr相关性胆汁淤积有相似之处，提示有共同的致病机制。结论：这些发现进一步支持LSR基因作为GGT正常胆汁淤积的新病因。确定其他病例提供了对基因型-表型相关性的重要见解，有助于受影响患者的早期诊断和管理。扩大报告病例的数量将有助于更好地了解疾病进展和潜在的治疗策略。

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引用次数: 0

Improving fecal sample collection in patients with inflammatory bowel disease: A comparative evaluation of two calprotectin devices. 改善炎症性肠病患者的粪便样本收集：两种钙保护素装置的比较评价。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-09-01 Epub Date: 2025-08-05 DOI: 10.1016/j.clinre.2025.102665

Giulia Pasi, Amale Antari, Damien Masson, Thomas Dejoie, Marie-Anne Vibet, Michael Collins, Hélène Caillon, Arnaud Bourreille, Catherine Le Berre

Background: Fecal calprotectin (FC) is a non-invasive biomarker that can be used to guide treatment decisions in inflammatory bowel diseases (IBD). Low compliance may hinder routine testing, with stool collection being the primary obstacle.

Aims: The objective was to compare an alternative collection device (sampling bottle) to a conventional container for stool sampling in terms of acceptability and compliance with FC testing in patients with IBD.

Methods: In this prospective study, patients were randomly assigned 1:1 to either the standard laboratory method (Bühlmann fCAL® turbo) or the ProciseFCP™ assay. Acceptability was assessed using qualitative and quantitative scales. Factors associated with FC acceptability, and compliance with FC testing, were analyzed. Only the stool sampling procedure was evaluated, not the satisfaction with the 'point-of-care' assay.

Results: In total, 156 patients were included. The ProciseFCP™ device was associated with higher acceptability than the standard container on the ordinal scale (primary outcome) (OR 2.69, p < 0.001). Using the visual analog scale (secondary outcome), a positive difference of 30.0 % (95 % CI: 19.7 to 44.7) was found in favor of the ProciseFCP™ arm, but this was not statistically significant (CI including the predefined threshold of a 30-point difference). Compliance was similar and high in both groups (80 %).

Conclusion: This study demonstrates that a sampling bottle offers a patient-friendly alternative to the conventional stool container, significantly enhancing patient's acceptability with stool collection. These findings support the integration of patient-centric innovations in diagnostic testing to improve the monitoring and management of IBD.

背景：粪便钙保护蛋白（FC）是一种非侵入性生物标志物，可用于指导炎症性肠病（IBD）的治疗决策。低依从性可能妨碍常规检查，粪便收集是主要障碍。目的：目的是比较一种替代收集装置（采样瓶）与传统的粪便采样容器在可接受性和依从性方面对IBD患者进行FC检测。方法：在这项前瞻性研究中，患者以1:1的比例随机分配到标准实验室方法（b hlmann fCAL®turbo）或ProciseFCPTM检测中。采用定性和定量量表评估可接受性。分析了与FC可接受性和FC测试依从性相关的因素。仅评估粪便取样程序，不评估对“即时”检测的满意度。结果：共纳入156例患者。ProciseFCPTM装置在常规量表上比标准容器具有更高的可接受性（主要结局）（OR 2.69, p < 0.001）。使用视觉模拟量表（次要结果），发现ProciseFCPTM组的阳性差异为30.0% (95% CI: 19.7至44.7)，但这没有统计学意义（CI包括预定义的30点差异阈值）。两组的依从性相似且较高（80%）。结论：本研究表明，采样瓶提供了一种患者友好的替代传统的粪便容器，显著提高患者对粪便收集的接受程度。这些发现支持以患者为中心的诊断检测创新的整合，以改善IBD的监测和管理。

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引用次数: 0

Inflation as a gut health crisis: The SAFEGUARD framework 作为肠道健康危机的通货膨胀：保障框架

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-08-20 DOI: 10.1016/j.clinre.2025.102673

Rushabh H. Doshi , Bhav Jain , Fatima Cody Stanford

引用次数: 0

Cardiac metastasis of colorectal cancer: a case report and review of literature 结直肠癌心脏转移1例报告及文献复习。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-08-14 DOI: 10.1016/j.clinre.2025.102669

Ambre Besson, Claire Gallois, Céline Lepere, Jeanne Netter, Julien Taieb, Widad Lahlou

引用次数: 0

Evaluation of a nutritional education guide designed for patients living with cirrhosis: A randomized controlled mixed-methods study 肝硬化患者营养教育指南的评价：一项随机对照混合方法研究。

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-08-13 DOI: 10.1016/j.clinre.2025.102672

Manila Sophasath , Mélanie Tremblay , Crystèle Hogue , Alexandre Brisset , Puneeta Tandon , Geneviève Huard , Christopher F. Rose , Chantal Bémeur

Background

Liver diseases are increasingly common in Canada, and patients with cirrhosis are at high risk for malnutrition due to difficulties in meeting energy and protein intake targets. This highlights the need for tailored nutritional interventions. This study evaluates the impact of the Nutrition in Cirrhosis guide on nutritional knowledge, quality of life (QoL), nutritional risk, and dietary intake, as well as patient satisfaction.

Methods

In this randomized controlled mixed-methods study, patients in the intervention group (Guide+) received and used the Guide for 6 months. Data was collected at baseline, 3 months and 6 months. Assessments included evaluation of nutritional knowledge (questionnaire based on the Guide), QoL (Chronic Liver Disease Questionnaire) and nutritional risk (Liver Disease Undernutrition Screening Tool). Satisfaction was evaluated with 3 focus groups including patients from the Guide+ group as well as a patient partner and thematic analysis was conducted.

Results

Thirty-nine patients were randomized into Guide+ (n=23) and Guide- (n=16) groups. The Guide+ group showed significantly greater improvement in nutritional knowledge (p=0.032) compared to Guide-. Knowledge scores increased from 74.3% at baseline to 84.0% after six months (p<0.001), while no significant change was observed in Guide- (p=0.143). Nutritional risk decreased significantly in Guide+ patients (47.8% to 21.7%, p=0.021) but remained unchanged in controls. No significant QoL changes were observed. Focus groups identified three main themes: navigational challenges, outcomes and feelings associated with the Guide.

Conclusion

The Nutrition in Cirrhosis guide effectively improved nutritional knowledge and reduced nutritional risk in cirrhosis patients. Patient feedback highlighted areas for improvement, affirming the guide’s value in supporting nutritional education.

背景：肝脏疾病在加拿大越来越普遍，肝硬化患者由于难以满足能量和蛋白质摄入目标而处于营养不良的高风险。这突出表明有必要采取有针对性的营养干预措施。本研究评估肝硬化营养指南对营养知识、生活质量（QoL）、营养风险、饮食摄入以及患者满意度的影响。方法：在这项随机对照混合方法研究中，干预组（Guide+）患者接受并使用指南6个月。在基线、3个月和6个月时收集数据。评估包括营养知识评估（基于指南的问卷）、QoL（慢性肝病问卷）和营养风险评估（肝病营养不足筛查工具）。通过3个焦点小组（包括Guide+组患者和患者伴侣）对满意度进行评估，并进行专题分析。结果：39例患者随机分为Guide+组（n=23）和Guide-组（n=16）。与Guide-组相比，Guide+组在营养知识方面有显著提高（p=0.032）。知识得分从基线时的74.3%提高到6个月后的84.0%。结论：肝硬化营养指南有效提高了肝硬化患者的营养知识，降低了营养风险。病人的反馈强调了需要改进的地方，肯定了指南在支持营养教育方面的价值。

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引用次数: 0

Portal hypertension in alcohol-associated hepatitis: harmless and the reflection of systemic inflammation? 酒精相关性肝炎门静脉高压症：是无害的还是全身性炎症的反映？

IF 2.4 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Clinics and research in hepatology and gastroenterology

Pub Date : 2025-08-13 DOI: 10.1016/j.clinre.2025.102668

Karim Gebara , Lionel Moulis , Joana Pissarra , Benjamin Rivière , Georges-Philippe Pageaux , José Ursic-Bedoya

Background and Aims

Portal hypertension is a prominent feature of alcohol-associated hepatitis. However, it is not established whether the severity of PH has a prognostic impact in AH. The aim of our study was to assess the impact of PH on 6-month transplantation-free survival (TFS).

Methods

A monocentric retrospective analysis was conducted on patients with symptomatic AH, proven histologically, admitted in our tertiary care hospital from January 2013 to December 2021.

Results

127 patients were included in the study, with a mean Discriminant Function and MELD score of 59.5 (±23.5) and 25.2 (±6.6), respectively. The only risk factor for severe PH at admission was the liver/spleen ratio. Patients were followed up for a median of 20 months. The median TFS was 16.8 months. Severe PH was not significantly associated with 6-month TFS, unlike the MELD score and nonresponse to corticosteroids. In addition, the leucocyte count was associated with persistent PH at 6 months.

Conclusions

In our study, severe PH had no impact on 6-month TFS. Further investigations on the prognostic value of PH and its natural history in AH are warranted.

背景和目的：门静脉高压是酒精相关性肝炎的一个显著特征。然而，目前尚不清楚PH的严重程度是否对AH的预后有影响。我们研究的目的是评估PH对6个月无移植生存（TFS）的影响。方法：对2013年1月至2021年12月在我院三级医院就诊的经组织学证实的有症状AH患者进行单中心回顾性分析。结果：127例患者纳入研究，平均判别函数和MELD评分分别为59.5（±23.5）和25.2（±6.6）。入院时严重PH的唯一危险因素是肝/脾比例。患者随访时间中位数为20个月。中位TFS为16.8个月。与MELD评分和对皮质类固醇无反应不同，严重PH与6个月TFS没有显著相关。此外，白细胞计数与6个月时的持续PH值有关。结论：在我们的研究中，严重PH对6个月的TFS没有影响。进一步研究PH值的预后价值及其在AH中的自然历史是必要的。

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