Digestive and Liver Disease最新文献

Background: The association between serum HBV DNA levels and liver fibrosis in patients with chronic hepatitis B (CHB) remains controversial. We investigated this association in non-cirrhotic CHB patients.

Methods: A total of 5,880 non-cirrhotic treatment-naïve CHB patients with ALT ≤2 × ULN were retrospectively included. Liver fibrosis was evaluated using FIB-4, APRI, LSM, or liver histology.

Results: The CHB patients had a median age of 38.0 years and 57.6% were male. There was a non-linear, parabolic association between serum HBV DNA loads and non-invasive fibrosis tests (APRI, FIB-4, and LSM). Patients with moderate serum HBV DNA levels (around 6 log₁₀ IU/mL) had the highest APRI, FIB-4, and LSM values. After adjustment, the non-linear relationship between serum HBV DNA loads and non-invasive liver fibrosis indicators remained significant, especially in HBeAg-positive patients. Patients with moderate serum HBV DNA levels (around 6 log₁₀ IU/mL) had the highest proportion of significant liver fibrosis as determined by APRI, FIB-4, LSM, and liver biopsy.

Conclusions: A non-linear association was observed between serum HBV DNA levels and liver fibrosis in non-cirrhotic, treatment-naïve CHB patients with ALT ≤2 × ULN, with moderate HBV DNA levels (around 6 log₁₀ IU/mL) associated with a higher risk of fibrosis.

Introduction and aim: Guidelines recommend sampling 2-3 esophageal locations (4-6 biopsies) during EoE follow-up, but the optimal scheme is uncertain. We assessed whether two biopsies (distal, proximal) reliably classify activity versus three sites (distal, middle, proximal).

Methods: Retrospective analysis of EoE follow-up endoscopies (2020-2024, tertiary centers) with three-site histology. Active disease was defined as ≥15 eos/0.3 mm² in ≥1 site; sub-analyses used ≥6 and ≥1 eos/0.3 mm². We compared active/inactive classification for two-site (distal+proximal) versus three-site sampling.

Results: Among 634 histologic evaluations, 306 three-site sets and 293 two-site sets were positive at ≥15 eos/0.3 mm²; all 328 three-site negatives remained negative with two sites. Thus, omitting the middle site would miss 2.0 % of active disease. Two-site performance: accuracy 98.0 %, sensitivity 96 %, specificity 100 %, PPV 100 %, NPV 96 %, AUC 0.98 (95 % CI, 0.97-0.99), Cohen's κ 0.98. At ≥6 eos/0.3 mm², sensitivity 97 %, accuracy 98.6 %, AUC 0.98 (95 % CI, 0.98-0.99). At ≥1 eos/0.3 mm², sensitivity 99 %, AUC 0.99 (95 % CI, 0.98-0.99).

Conclusions: In EoE follow-up, two-site (distal+proximal) biopsies provide classification nearly equivalent to three-site sampling, with only a 2 % miss rate for active disease when the middle site is omitted. This approach may reduce procedure time, patient discomfort, and costs while maintaining excellent diagnostic performance.

Background: Behavioural economics (BE)-inspired messages within invitations for immunochemical faecal tests (FIT), or offering alternative tests such as sigmoidoscopy (FS) or CT-colonography (CTC), are strategies to re-engage non-respondents in subsequent colorectal cancer (CRC) screening rounds. This study evaluated their impact on screening participation.

Methods: In 2022-2023, a randomized controlled trial was conducted involving 20,225 non-respondents to the CRC Florence screening program. Individuals aged 54-70 were randomized into six groups: a control group receiving the standard invitation letter (SL); three groups receiving SL plus a feedback message (F), a social norm message (MN), or both (F+MN); and two groups offered FS or CTC as alternatives to FIT among invitees aged 58-60. The primary outcome was participation within 90 days. The trial was registered with ISRCTN (ISRCTN11841256).

Results: Participation was 5.7% in controls, and 7.4%, 6.7%, 6.6%, 2.0%, and 4.1% in the F, MN, F+MN, FS, and CTC groups. Invitees in the F group were more likely to participate (aOR=1.32; 95%CI:1.10-1.57), while FS invitees were less likely (aOR=0.39; 95%CI:0.27-0.54). CTC participation resembled controls aged 58-60 and was twice that of FS.

Conclusion: BE-inspired interventions can increase CRC screening participation, whereas more invasive alternative tests did not. Future studies should explore preferences for different screening tests to identify more acceptable modalities and optimise participation.

Background: Primary intestinal B-cell (IBCL) and T-cell (ITCL) lymphomas are rare and poorly characterized entities.

Aim: To compare clinical features and survival outcomes of IBCL and ITCL.

Methods: We conducted a multicentre, retrospective study including patients diagnosed with primary intestinal lymphoma between 2001 and 2024. Clinical and laboratory variables were analysed using univariate and multivariate logistic regression. Discriminatory accuracy was assessed through ROC analysis. Overall survival was estimated with Kaplan-Meier curves.

Results: Ninety-four patients (41 IBCL and 53 ITCL) were included. IBCL were more frequently diagnosed at Lugano stage I (90% vs 5.7%; p<0.01) and showed markedly lower lactate dehydrogenase and β2-microglobulin levels compared with ITCL (p<0.01). Coeliac disease (CD) was strongly associated with ITCL (p<0.01). In multivariable analysis, CD and biomarker levels independently differentiated IBCL from ITCL, with excellent model discrimination (AUROC 0.95). Median follow-up was 56 months for IBCL and 12 months for ITCL. IBCL demonstrated significantly greater survival (HR 0.21; log-rank p=0.01).

Conclusions: IBCL and ITCL exhibit distinct clinical and prognostic profiles, with IBCL showing more favourable clinical profile and better survival. Tailored diagnostic and therapeutic approaches that reflect the divergent behaviour of these lymphomas are urgently needed.