Digestive and Liver Disease最新文献

Background: Transarterial chemoembolization (TACE) is widely used for hepatocellular carcinoma treatment but side effects hamper tolerance. Dexamethasone reduces TACE side effects in patients with viral hepatitis, but data regarding alcohol and metabolic liver diseases are lacking. We aimed to evaluate the efficacy of dexamethasone in preventing TACE-associated adverse events in European populations with predominantly alcoholic and metabolic cirrhosis.

Methods: All cirrhotic patients undergoing TACE in our center between 2017 and 2021 were included. Dexamethasone was added to our protocol from 2019. Using a quasi-experimental study design, patients before and after introduction of dexamethasone in our procedure were compared. Factors associated with TACE adverse events were assessed by univariate and multivariate analysis. A sensitivity analysis was performed using propensity scores for covariate adjustment.

Results: 234 patients undergoing 398 TACE procedure were included. Cirrhosis was predominantly of alcohol or metabolic etiology (86.7 %). Dexamethasone was administered in 99 procedures (24.9 %). Incidence of fever and encephalopathy at day 2 after TACE was lower in the Dexamethasone group (p < 0.001; p = 0.02 respectively). In multivariate analysis, dexamethasone was associated with lower occurrence of fever (OR=0.03; p < 0.001), lower analgesics use (OR=0.11; p = 0.002), milder liver and kidney function impairment (OR=0.98; p = 0.001 and OR=0.94; p < 0.001 for bilirubin and creatinine variation respectively). Propensity score-adjusted analyses yielded similar results.

Conclusion: Dexamethasone improves TACE tolerance in a population of predominantly metabolic and alcohol cirrhosis.

Background: Bowel preparation represents a significant issue to high-quality colonoscopy. Oral mannitol requires a single dose, is of low volume, and has a pleasant taste and rapid action.

Aims: This SATISFACTION study compared single-dose (same day) oral mannitol 100 g/750 mL with standard split-dose PEG-ASC2 L (MoviPrep®).

Methods: The primary endpoint was the proportion of patients with adequate bowel cleansing. Secondary endpoints included efficacy (adenoma detection rate, caecal intubation rate, time of evacuation), safety (intestinal gases concentration, haemato-chemical parameters, adverse events), and patient satisfaction.

Results: The study included 703 patients (352 treated with mannitol and 351 with PEG-ASC). Mannitol was not inferior to PEG-ASC for the primary endpoint (91.1 % and 95.5 %, respectively; p-value for the non-inferiority =0.0131). There was no significant difference for secondary efficacy endpoints. The acceptability profile was significantly better in the mannitol group for ease of use, taste, and willingness to reuse (p < 0.0001 for all). The concentration of intestinal gases (H₂, CH₄) was similar between groups and well below those potentially critical.

Conclusions: The SATISFACTION study indicated that low-volume, single-dose mannitol may satisfy an unmet clinical need since it was more acceptable to the patient and not inferior to the split-dose PEG-ASC for bowel cleansing efficacy.

Background: Fatty acid esters of hydroxy fatty acids (FAHFAs) present potential beneficial effects that could offer valuable insights into metabolic and inflammatory diseases. However, few FAHFAs have been studied, and their role is unclear.

Aims: To assess FAHFA levels in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) associated with morbid obesity (MO) to explore the potential significance of FAHFAs under these conditions.

Methods: Using ultra-precise liquid chromatography, FAHFA serum levels were measured in 219 women, including 53 with normal weight (NW) and 166 with MO. The MO group was classified by histological diagnosis into 35 normal liver (NL), 38 simple steatosis (SS) and 93 metabolic dysfunction-associated steatohepatitis (MASH) groups.

Results: Thirty-two FAHFA isoforms from 11 families were identified. Most FAHFAs presented low levels in MO, but tLAHOAs, LAHOA-1 and OAHOA-1 increased. In MASLD, elevated tLAHPO, LAHPO-2, PAHLA-3 and PAHLA-4 levels were observed. In MASH, increased POHLA-1, tLAHPOs, LAHPO-2 and LAHLA-3 and decreased PAHSA-1, tOAHOAs, OAHSA-2 and OAHSA-3 levels were reported.

Conclusion: This study reveals novel insights into FAHFAs in a cohort of women with MO with MASLD. In MASLD, we reported only increased levels of certain FAHFAs. In MASH, we found a different profile that could be characteristic.

Background: Antibiotic usage in early life has been proposed as a risk factor for inflammatory bowel disease, especially Crohn's disease. However, most studies were conducted in Western countries.

Aims: We evaluated the association between antibiotic usage and the incidence of inflammatory bowel disease in the Asian population.

Methods: This nationwide population-based retrospective cohort study included 2,941,889 South Korean infants born between 2007 and 2015, using the National Health Insurance Service database. We assessed whether antibiotic use was associated with the incidence of inflammatory bowel disease. Additionally, we conducted sensitivity analyses, considering protopathic bias and dietary variables. The Cox proportional hazards model was used.

Results: Among 2,941,889 infants, 2,566,390 (87 %) used antibiotics within a year after birth. Antibiotic usage within a year, number of antibiotic classes, and cumulative days of usage were shown to decrease the risk of ulcerative colitis. This association was particularly prominent with earlier antibiotic exposure. Penicillin was the only antibiotic class related to the reduced risk. The results were robust after adjusting for dietary variables and considering protopathic effect.

Conclusions: Antibiotic exposure during the first year of life, particularly at a younger age, is linked to a reduced risk of early-onset ulcerative colitis in South Korea.