Digestive and Liver Disease最新文献

This correspondence discusses Silva et al.'s study on colorectal cancer (CRC) screening adherence and preferences, highlighting its contributions to understanding screening education, method choices, and barriers. While acknowledging the study's insights, we identify critical limitations, including insufficient consideration of socioeconomic disparities in screening access and participation. Lower socioeconomic groups often face barriers such as financial constraints, time limitations, and healthcare mistrust, which may skew adherence outcomes. Additionally, the study overlooks post-screening psychological impacts (e.g., anxiety from false positives) on long-term compliance. We propose integrating socioeconomic analyses, psychological interventions, and technological innovations (e.g., AI-driven tools for personalized reminders and counseling) to enhance screening equity and adherence. Future research should prioritize these dimensions to optimize CRC screening strategies globally.

Paediatric endoscopy has been an integral part of the diagnostic evaluation and management of gastroenterology and hepatology diseases in children. This area of clinical medicine has made meteoric advancements since it was first introduced conserving it's traditional roles of gastroscopy and colonoscopy but broadening significantly it's clinical utility and diagnostic accuracy with new and emerging technology. This article aims to explore and review the current utility and emerging applications of diagnostic and therapeutic endoscopy for the practicing paediatric gastroenterologist and hepatologist.

Background: Data on nonmedical switching from one anti-Tumor Necrosis Factor (TNF)-α biosimilar to another in inflammatory bowel disease (IBD) are relatively sparse. We aimed to study the effects of nonmedical switch from infliximab biosimilar CT-P13 to SB2 and from adalimumab biosimilar ABP 501 to SB5.

Methods: In this observational study, consecutive IBD patients receiving nonmedical switch were prospectively followed-up for 12 months. The primary outcome was treatment persistence; other outcomes included: secondary effectiveness outcomes, safety, immunogenicity, inflammatory makers levels and psychometric assessments.

Results: A total of 119 and 76 patients were enrolled in the SB2 and SB5 cohorts. Persistence on treatment at 12 months was 84.0 % in the SB2 cohort and 78.9 % in the SB5 cohort. No clinically meaningful changes in other secondary effectiveness outcomes were recorded. Rates of 0.38 and 0.63 adverse events of interest per 100 patient-years were observed in the SB2 and SB5 cohorts. The pharmacokinetics and immunogenicity of either drug were unaffected by nonmedical switch; similarly, levels of inflammatory cytokines remained largely unchanged. No changes in psychometric assessments were recorded.

Conclusion: Nonmedical switch of infliximab and adalimumab biosimilars does not significantly affect treatment effectiveness, safety and pharmacokinetics, nor does it have major psychological implications for patients.

Background: Primary sclerosing cholangitis (PSC) is a progressive liver disease with no treatment apart from liver transplantation (LT). After LT, patients can develop recurrent PSC (rPSC). The United-Kingdom (UK-PSC) and Amsterdam-Oxford (AOPSC) scores are used as prognostic models for PSC outcomes.

Aim: We aimed to assess these scores as predictive tools for graft loss and overall mortality in rPSC.

Methods: We evaluated 67 people who developed rPSC. Using Cox regression models, we quantified associations between UK-PSC and AOPSC scores and graft loss and overall mortality. Cut-offs were established using receiver operator characteristic analysis and the highest Youden index.

Results: Fifty-one individuals (76.1%) were males, with a mean age of 40±15 years. Both UK-PSC and AOPSC scores were independently associated with graft loss (hazard ratio [HR] 2.43 (p < 0.001) and HR 3.45 (p < 0.001), respectively), but only the UK-PSC score was independently associated with overall mortality (HR 2.63 (p = 0.009)). Individuals with UK-PSC ≥-4.2 (6.1 ± 0.8 vs. 14.7 ± 1.0 years; p = 0.001) and AOPSC ≥2.4 (5.4 ± 1.3 vs. 12.0 ± 1.1 years; p < 0.001) had shorter graft survival.

Conclusion: UK-PSC score at rPSC predicts both graft loss and overall mortality, while AOPSC scores using either age at rPSC or at diagnosis along with severe cholestasis predict graft loss in people with rPSC. These easy-to-administer tools can be utilized in clinical practice to identify high-risk rPSC patients and guide decisions about monitoring/interventions.

Aim: The incidence of acute kidney injury (AKI) following hepatectomy ranges from 0.9 % to 21.6 %. Postoperative AKI is associated with increased mortality, prolonged hospital stays, and more healthcare costs. Previous predictive models either neglected intraoperative factors or were excessively complicated for application. Based on estimated blood loss, minimum heart rate, and minimum mean arterial pressure, the Surgical Apgar Score (SAS) has been validated as an indicator of major complications and outcomes following surgeries. Furthermore, previous studies have linked hematocrit levels to the incidence of AKI. Our aim was to determine whether the modified SAS, calculated using both SAS and hematocrit, could accurately predict AKI following hepatectomy.

Methods: This retrospective study ultimately enrolled 960 patients who underwent hepatectomy. The study included a total of 28 preoperative and intraoperative variables. Univariate and multivariate logistic regression analyses were performed to determine the predictive ability of the modified SAS.

Results: We demonstrated significant associations between the modified SAS and the incidence of AKI (OR 0.65, 95 % CI 0.54-0.78, p < 0.001). A lower total score increases the likelihood of postoperative AKI, with a cutoff value set at 9.

Conclusions: The modified SAS appears to be a valid predictive factor for AKI following hepatectomy.

Background & aims: The initial intravenous dose of ustekinumab (UST) for treating Crohn's disease (CD) is recommended based on body weight ranges for clinical convenience. However, patients whose body weight nears the upper threshold may receive a relatively lower dose (<6 mg/kg) based on current dosage calculations. We aimed to investigate whether the body weight-range based dosing calculation method for UST may lead to suboptimal therapeutic doses and then impact effectiveness, particularly in patients with borderline weight.

Methods: A multi-center, observational, real-world cohort study was conducted in four centers. Patients with CD who received UST based on body weight-range dosing calculation were retrospectively enrolled. Participants were classified into two groups according to the initial induction dosage: the relatively higher dose (RHD) induction group (≥6 mg/kg) and the relatively lower dose (RLD) induction group (<6 mg/kg). Steroid-free remission, clinical remission, specific objective response and remission at week 24 were compared in the two groups using propensity score weighting. UST drug concentration was measured at week 24±4.

Results: A total of 438 patients were included, with 176 patients in the RHD group and 262 patients in the RLD group. The RHD group demonstrated superior outcomes compared to the RLD group in achieving steroid-free remission (66.2 % vs. 54.9 %, P = 0.020, OR = 1.605, 95 % CI 1.082-2.395), clinical remission (66.7 % vs. 56.4 %, P = 0.032, OR = 1.546, 95 % CI 1.041-2.311) at week 24. In objective evaluation, the RHD group showed higher rates in ultrasound response (64.9 % vs. 52.1 %, P = 0.041, OR = 1.700, 95 % CI 1.027-2.844) and radiologic remission (25.1 % vs. 13.4 %, P = 0.022, OR = 2.163, 95 % CI 1.117-4.205). The drug concentration was significantly higher in the RHD group compared to the RLD group at week 24 [2.06 (1.36-3.17) µg/ml vs. 1.12 (0.25-1.52) µg/ml, P < 0.001]. Additionally, the RHD group required fewer treatment optimizations than the RLD group, but with no statistical difference (20.6 % vs. 24.9 %, P = 0.291, OR = 0.780, 95 % CI 0.488-1.231). The rate of adverse events was similar between the two groups (4.0 % vs 3.4 %, P = 0.767).

Conclusions: This study suggested that the current dose calculation method may result in inadequate induction doses of UST for CD patients whose body weight is close to the upper threshold, potentially impacting the effectiveness of induction.

Lay summary: A multi-center study suggests that the current body weight-range based dosing of ustekinumab for Crohn's disease may lead to insufficient induction doses for patients near the upper weight threshold, negatively impacting treatment effectiveness.