Digestive and Liver Disease最新文献

Background and aims: Crohn's disease (CD) affecting the esophagus, stomach, and duodenum (upper CD [UCD]) is a rare phenotype, and data on its outcomes and treatment response are limited.

Methods: We conducted a multicenter retrospective study of adult patients diagnosed with UCD between January 2000 and December 2019, with ≥ 1 year of follow-up. Extensive CD (ECD) was defined as concomitant jejunal, ileal and/or colonic involvement.

Results: One hundred ninety-seven UCD patients were included with a median follow-up of 10.7 years (IQR 5.7-14.2). Only nine (4.6%) had isolated UCD. The inflammatory phenotype predominated, with aphthous ulcers as the main endoscopic lesion (42%). Systemic corticosteroids and thiopurines were the most frequently prescribed therapies after UCD diagnosis. At weeks 14 and 52, response and remission rates for UCD and ECD were similar for all treatments, except higher rates with thiopurines and infliximab in UCD at both time points (p < 0.05). Ten (5.1%) patients shifted phenotype over time (most from inflammatory to stricturing). Two patients developed neoplasia (one gastric MALT lymphoma, one esophageal carcinoma).

Conclusions: Upper gastrointestinal involvement in adult CD does not appear to alter immunosuppressive therapeutic needs compared with ECD requirements.

Chronic hepatitis Delta virus (HDV) infection represents the most severe form of viral hepatitis, characterized by accelerated progression to cirrhosis, end-stage liver disease, and hepatocellular carcinoma. For decades, Pegylated Interferon (PegIFNα) has been the only therapeutic option, with limited efficacy and poor tolerability. The approval of the HBV/HDV entry inhibitor Bulevirtide marked a turning point, by providing the first anti-HDV specific antiviral drug. This position paper, developed jointly by the Italian Association for the Study of the Liver (AISF) and the Italian Society of Infectious and Tropical Diseases (SIMIT), updates prior national guidance by providing practical recommendations for diagnosis, staging, and treatment of chronic HDV infection.

Background: Malignant hilar biliary obstruction (MHBO) is frequently unresectable, requiring palliative endoscopic drainage. While self-expandable metal stents (SEMSs) are preferred over plastic stents (PSs), evidence regarding stent patency and patient survival remains limited.

Methods: We conducted a meta-analysis of individual patient data (IPD) from randomized controlled trials (RCTs) comparing SEMSs and PSs in unresectable MHBO. Systematic searches were performed in PubMed, Scopus, Web of Science, and the Cochrane Library on June 15, 2025. The primary outcomes were stent patency and overall survival, analyzed using reconstructed Kaplan-Meier curves and stratified Cox models, with hazard ratios (HRs) assessed. Secondary outcomes included reintervention, technical and clinical success, and adverse events, assessed using random-effects risk ratios (RRs), with 95% confidence intervals (CI) RESULTS: Out of 2106 publications screened, five RCTs comprising 322 patients were included. SEMSs significantly improved stent patency (HR, 0.49; 95% CI, 0.35-0.68) and overall survival (HR, 0.60; 95% CI, 0.47-0.78) compared to PSs. Reintervention was lower with SEMSs (RR, 0.76; 95% CI, 0.59-0.97). No significant differences were found in technical and clinical success rates, or in adverse event rates, including pancreatitis, cholecystitis, and cholangitis.

Conclusions: In patients with unresectable MHBO, SEMSs offer superior stent patency and survival compared to PSs, with similar safety and procedural success. These findings reinforce previous guidelines recommending the preferential use of SEMSs for endoscopic palliation in MHBO.

Background: Studies from northern Europe indicate that patients with primary sclerosing cholangitis (PSC) are predominantly males and often have ulcerative colitis (UC) and increased risk of colorectal cancer (CRC).

Aim: To evaluate the epidemiological and clinical features and natural history of PSC in Greece, a southern European country.

Methods: In the HERACLIS-PSC study, consecutive patients with PSC-IBD followed at Greek inflammatory bowel disease (IBD) centers were included and compared to data from consecutive patients with PSC-only followed at a Greek liver center.

Results: Among PSC-IBD patients (n=112, males:56%), 62.5% had UC (pancolitis:76%), 35.7% Crohn's disease and 1.8% indeterminate colitis. PSC was diagnosed at a younger age in PSC-IBD than PSC-only patients (n=39; males:54%) (32±15 vs 40±15 years; p=0.007), while the two groups did not differ significantly in gender, extrahepatic bile duct involvement, or development of cirrhosis, cholangiocarcinoma or CRC, although CRC occurred only in PSC-IBD (n=8). Transplant-free survival was higher in PSC-IBD than PSC-only (5-/10-year:95%/87% vs 85%/77%; p=0.021), while older age at PSC diagnosis and cirrhosis development were independently associated with lower transplant-free survival.

Conclusion: In Greece, PSC-IBD patients are usually males with UC, in whom PSC is diagnosed at a younger age demonstrating better transplant-free survival, compared to PSC-only.