Digestive and Liver Disease最新文献

Background: Pancreatic adenocarcinoma (PDAC) presents with nonspecific symptoms, leading to long diagnostic delays and time-to-treatment. Data on the effects of diagnostic delay and time-to-treatment on the prognosis of PDAC patients are limited, dated and heterogeneous.

Aims: To investigate whether diagnostic delay, time-to-treatment, or diagnostic delay + time-to-treatment (overall delay) impact overall survival (OS) and whether they differ in patients followed up at a tertiary referral center compared to community hospitals.

Methods: This was a single-center prospective cohort of consecutive patients with PDAC, recording demographics, presenting symptoms, stage, treatments, and survival.

Results: A total of 282 patients were included. Diagnostic delay>49 days was significantly associated with a higher risk of death in univariate (HR 1.627; 95 % CI 1.15-2.28; p = 0.005) but not in multivariate analysis, whereas overall delay>104 days was significantly associated with a higher risk of death in both univariate (HR 1.83; 95 %CI 1.29-2.61; p = 0.0008) and multivariate (HR, 1.63; 95 % CI, 1.13-2.34; p = 0.008) analyses. Patients who were entirely cared for in tertiary center presented a significantly shorter median time-to-treatment (49 vs. 56 days; p = 0.048) than those in community hospitals.

Conclusion: Prolonged diagnostic and overall delays seem to impair the survival of patients with PDAC. While diagnostic delay might be reduced with higher awareness of specific warning symptoms, the overall delay can be reduced through specific and faster dedicated therapeutic pathways in referral centers.

Nonalcoholic fatty liver disease (NAFLD) manifests as chronic hepatic steatosis, occurring variably across people due to racial and genetic diversity. It represents a stage in the development of chronic liver disease, marked by fat accumulation, inflammatory responses, oxidative stress in the endoplasmic reticulum, and fibrosis as primary concerns. Understanding its underlying mechanisms remains a challenging and pivotal area of study. In the past, acute liver injury-related diseases were commonly treated with methods such as liver transplantation. However, the emergence of artificial liver has shifted focus to stem cell therapies. Unlike conventional drugs, stem cell therapies are continuously evolving. Despite being classified as drugs, stem cells demonstrated significant efficacy after multiple injections. Mesenchymal stem cells, unlike other types of stem cells, do not have the risk of tumor formation and low immunogenicity, reducing the hypersensitivity reactions associated with liver transplantation. Increasingly, studies suggest that mesenchymal stem cells hold promise in the treatment of chronic liver injury diseases. This review focuses on investigating the role of mesenchymal stem cells in chronic metabolic liver diseases, such as non-alcoholic fatty liver disease, and delves into their specific functions.

Background/purpose: Immune checkpoint inhibitor (ICIs) therapy can cause immune checkpoint inhibitor-related pancreatic injury (ICI-PI). This study aimed to elucidate the clinical characteristics of ICI-PI and explore treatment approaches.

Methods: We retrospectively analyzed data from patients with malignancies treated with ICIs at Nagoya University Hospital between September 2014 and June 2023. ICI-PI and pancreatitis were identified and classified using the Common terminology Criteria for Adverse Events (CTCAE) ver.5.0, and the patients with ICI-PI with/without pancreatitis were analyzed.

Results: This study included data from 930 patients treated with ICIs. Of these, eight (0.85 %) and 10 (1.08 %) patients were diagnosed with ICI-PI without and with pancreatitis, respectively. Five of the 10 patients received standard pancreatitis treatment, while three received additional glucocorticoid therapy. One patient experienced recurrent pancreatitis and developed a pancreatic pseudocyst, which improved after high-dose glucocorticoid treatment. ICI rechallenge was pursued in five patients. Two patients received ICIs without an interval.

Conclusions: ICI-PI with pancreatitis is rare but has become more prevalent with the increasing use of ICIs. Future prospective multicenter studies are needed to confirm these findings and develop standardized diagnostic and treatment protocols.

Background and aims: Glucagon-like peptide-1 receptor agonists (GLP1-RA) are associated with increased residual gastric content (RGC); however, there is debate about their impact on RGC-related clinical outcomes, particularly aspiration.

Methods: PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched for studies published up to January 4, 2025, comparing GLP1-RA with control groups (non-GLP1-RA) in patients undergoing endoscopy. The outcomes of interest included the risk of RGC, pulmonary aspiration, interrupted and repeated endoscopic procedures, and delays in gastric transit time during capsule endoscopy. For the meta-analysis, a random-effects model was used to calculate the pooled odds ratio (OR) and mean difference (MD) with 95 % confidence intervals (CIs).

Results: Thirty-nine studies composed of a total of 1,253,498 subjects, were included. The pooled analysis demonstrated that the GLP1-RA group had a significantly increased risk of RGC (OR 4.86, 95 % CI 3.85-6.14; adjusted OR 5.24, 95 % CI 3.49-7.87), pulmonary aspiration (OR 2.29, 95 % CI 1.36-3.87), interrupted endoscopic procedures (OR 3.22, 95 % CI 1.65-6.29), repeated endoscopy (OR 2.16, 95 % CI 1.14-4.11), and delays in gastric transit time during capsule endoscopy (MD 45.51, 95 % CI 1.33-89.68).

Conclusions: GLP1-RA use increased the risk of RGC, pulmonary aspiration, interrupted and repeated endoscopy and gastric transit time, reducing the safety and completion of upper endoscopy.

Background/objectives: The clinical utility of body composition in predicting the severity of acute pancreatitis (AP) remains unclear. We aimed to measure body composition using artificial intelligence (AI) to predict severe AP in hospitalized patients.

Methods: We performed a retrospective study of patients hospitalized with AP at three tertiary care centers in 2018. Patients with computer tomography (CT) imaging of the abdomen at admission were included. A fully automated and validated abdominal segmentation algorithm was used for body composition analysis. The primary outcome was severe AP, defined as having persistent single- or multi-organ failure as per the revised Atlanta classification.

Results: 352 patients were included. Severe AP occurred in 35 patients (9.9%). In multivariable analysis, adjusting for male sex and first episode of AP, intermuscular adipose tissue (IMAT) was associated with severe AP, OR = 1.06 per 5 cm², p = 0.0207. Subcutaneous adipose tissue (SAT) area approached significance, OR = 1.05, p = 0.17. Neither visceral adipose tissue (VAT) nor skeletal muscle (SM) was associated with severe AP. In obese patients, a higher SM was associated with severe AP in unadjusted analysis (86.7 vs 75.1 and 70.3 cm² in moderate and mild, respectively p = 0.009).

Conclusion: In this multi-site retrospective study using AI to measure body composition, we found elevated IMAT to be associated with severe AP. Although SAT was non-significant for severe AP, it approached statistical significance. Neither VAT nor SM were significant. Further research in larger prospective studies may be beneficial.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a newer class of glucose-lowering drugs with established cardiovascular benefit. However, their impact on bowel preparation quality remains controversial.

Aims: This article aimed to assess the association between GLP-1 RA use and colonoscopy quality indicators.

Methods: Electronic searches of PubMed and Embase were conducted up to January 2025. Clinical trials comparing colonoscopy quality indicators between GLP-1 RA users and controls were included. Non-English literature, meeting abstracts, and unpublished data were excluded. The primary outcome was the rate of inadequate bowel preparation; secondary outcomes included BBPS scores and adenoma/polyp detection rate (ADR/PDR).

Results: Six trials were included, involving 8778 GLP-1 RA users and 8290 controls. GLP-1 RA users had a higher rate of inadequate bowel preparation (risk difference = 0.06, 95 % CI 0.05-0.08, p < 0.001, I² = 39 %). Total BBPS scores were lower among GLP-1 RA users (mean difference = -0.31, 95 % CI -0.39--0.23, p < 0.001, I² = 0 %). Two studies reported increased ADR/PDR in GLP-1 RA users; one showed a neutral result.

Conclusion: GLP-1 RA is associated with inadequate bowel preparation. Further research is needed to establish the optimal GLP-1 RA washout period before colonoscopy.

Liver transplantation in people living with HIV is a well-established procedure. However, HIV infection has been suggested to be associated with higher post-transplant HCC recurrence rates and overall decreased survival, although this is based on limited real-life data. From September 2023, we conducted a survey in all Italian Liver Transplant Centers to investigate real-life data regarding numbers, listing indications, percentages of post-transplant HCC recurrence, and de novo malignancies in HIV-positive subjects. By the end of 2022, 365 subjects had received liver transplants across 13 Italian Transplant Centers. After 2009, HCC emerged as the primary indication for transplantation, accounting for 54.6 % of cases. Downstaging or bridging procedures were performed in 69.3 % of patients. Starting from 2018, the Metroticket 2.0 HCC listing criteria were utilized to prevent futile procedures. Estimated survival rates at 1, 3, and 5 years were 84.1 %, 72.9 %, and 64.4 %, respectively. During a median follow-up of 5.5 years, the HCC recurrence rate was 18.9 %, and post-transplant diagnosis of malignancies other than HCC (de novo tumors) was unexpectedly reported in 12.1 % of subjects. As reported by the survey, post-transplant HCC recurrences and survival rates at years 1 and 3 align with HIV-uninfected patients, while the 5-year survival rate is reduced.

Background: Treat-to-target therapy in inflammatory bowel disease requires longitudinal assessment of disease activity and intestinal ultrasound (IUS) is a promising non-invasive and cheap technology to provide objective read-outs. Vascularization of the bowel wall is one key parameter on IUS. While this is conventionally done with Color doppler imaging, it is currently unclear whether microvascular flow imaging techniques might improve the diagnostic performance of IUS.

Aims: To explore the utility of superb microvascular imaging (SMI) for assessing disease activity in Crohn's disease (CD).

Methods: We performed a prospective single-center cross-sectional cohort study including 56 patients with CD. IUS was performed on the terminal ileum or sigmoid colon within 30 days of colonoscopy and the International Bowel Ultrasound (IBUS) group Segmental Activity Score (SAS) as well as SMI signals were determined and correlated to established endoscopic, clinical and biochemical read-outs of disease activity.

Results: SMI scores showed superior correlation to endoscopic disease activity than Doppler imaging scores. While this did not further improve the diagnostic performance of the composite IBUS-SAS, SMI scores as a single parameter excellently predicted segmental endoscopic disease activity.

Conclusions: SMI is a highly promising tool to improve or simplify the non-invasive assessment of disease activity in CD that should further be investigated in real-world and multi-center trials.