Digestive Diseases最新文献

Introduction: This study aims to investigate the association between proton pump inhibitors (PPIs) exposure and adverse outcomes in patients with inflammatory bowel disease (IBD).

Methods: According to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE), we conducted a comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library databases for relevant cohort and case-control studies comparing the incidence of adverse outcomes between IBD patients exposed to PPIs and those not exposed, from the inception of the databases to April 2024. The primary adverse outcomes analyzed included hospitalization and surgery.

Results: Five studies, encompassing nearly 100,000 subjects, were included in this meta-analysis. The findings indicated that IBD patients exposed to PPIs had a significantly higher incidence of adverse outcomes compared to those not exposed (Odds ratio [OR]=1.24, 95%CI=1.07-1.44, p=0.004), although it was low-quality evidence. This increased risk was observed in both ulcerative colitis (UC) (OR=1.38, 95%CI=1.04-1.83, p=0.025) and Crohn's disease (CD) (OR=1.14, 95%CI=1.02-1.29, p=0.025). Additionally, the incidence of surgery was higher in IBD patients with PPI exposure (OR=1.31, 95%CI=1.02-1.68). However, the OR for hospitalization did not show a statistically significant difference (OR=1.43, p=0.244). Moreover, the use of glucocorticoids was more frequent among patients exposed to PPIs (OR=1.16, 95%CI=1.06-1.28, p=0.001).

Conclusion: PPI exposure may be associated with an increased risk of adverse outcomes in IBD patients, particularly a higher rate of surgery. Limited by various factors, the evidence is considered low quality.

Introduction Diagnostics of small bowel Crohn's disease (CD) can be difficult. Combined positron emission tomography-magnetic resonance enterography (PET-MRE) can be used to evaluate intestinal metabolism, but clinical use has been limited due to accessibility, costs, absence of standardized methods and diagnostic thresholds. Our aim was to show that combined PET-MRE can be used to diagnose active small bowel CD. Methods We performed a fusion PET-MRE-scan with [18F]-FDG-tracer to 30 patients with suspected small bowel CD in colonoscopy. Standardized uptake values (SUV) were measured from small bowel. The diagnosis was confirmed with small bowel capsule endoscopy. Clinicians chose appropriate medication to each patient blinded from SUV-results. Endoscopic, laboratory and MRE-findings were investigated in relation to SUV. Results Fusion PET-MRE outperformed MRE in diagnostic accuracy. Patients diagnosed with CD (N=24) had higher SUV than patients not diagnosed with CD (N=6) (3.34 vs. 1.84, p=0.022). A diagnostic cut-off at SUV at 2.5. could be used (AUROC=0.81). A higher SUV predicts need for immunosuppressive medication (p=0.0026) and biologics (p=0.0005). SUV correlates positively with SES-CD-score (Simple Endoscopic Score for Crohn's Disease), fecal calprotectin and CRP and negatively with Hb and serum albumin. Conclusion In future, [18F]-FDG PET-MRE can be used in diagnostics of small bowel CD as a safe alternative for capsule endoscopy. High SUV can predict a more progressive disease course and need for more advanced therapies.

Introduction: This study evaluates the efficacy and safety of various anesthetic and sedative regimens for Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures.

Methods: A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios.

Results: 42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR<0.01), dexmedetomidine plus fentanyl (RR<0.01), propofol plus nalbuphine (RR=0.01), Mg sulfate plus propofol (RR=0.01), and propofol plus fentanyl (RR=0.02), showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazolam plus pethidine plus dexmedetomidine (RR=0.01), propofol plus oxycodone (RR=0.09), and dexmedetomidine plus fentanyl (RR=0.2) exhibited lower rates of adverse events compared to propofol.

Conclusion: This study provides comprehensive evidence to guide clinical decision-making and optimize anesthetic management for ERCP procedures.

Introduction: Previous studies reported inconsistent results of the association between Helicobacter pylori (H. pylori) infection and nonalcoholic fatty liver disease (NAFLD).

Methods: A cohort study of 2063 adults without NAFLD at baseline, who participated in a repeated health check-up including a 13C urea breath test and abdominal ultrasonography, was conducted to evaluate the link between H. pylori infection and NAFLD development.

Results: During a mean follow-up period of 1.7 years, we did not found a significant association between H. pylori infection and NAFLD (Hazard ratio (HR) = 1.10 (0.86, 1.40), p = 0.4689). We also found that higher age, body mass index (BMI), systolic blood pressure (systolic BP), diastolic blood pressure (diastolic BP), fasting blood glucose, triglycerides, total cholesterol, low density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were risk factors, and high density lipoprotein cholesterol (HDL-C) was a protective factor for NAFLD development.

Conclusions: H. pylori infection might not be positively related to NAFLD development.

Introduction: Data on the economic burden of chronic hepatitis B infection in Japan are lacking. This study investigated healthcare resource utilization and costs of chronic hepatitis B infection and liver complications in Japan.

Methods: This non-interventional study used the Medical Data Vision database. For the first analysis, a population with prevalent chronic hepatitis B infection and absence of liver complications was identified and further stratified by nucleos(t)ide analog treatment history. In the second analysis, patients with prevalent chronic hepatitis B infection and incident liver complications were identified. Patients were followed for 1 year in the first analysis and 2 years in the second analysis. Numbers of all-cause outpatient, inpatient, emergency hospitalizations, medication use, and associated costs per person-year were described across patients without/with nucleos(t)ide analog treatment and in those without/with liver complications.

Results: For patients with chronic hepatitis B infection, 75,967 had no liver complications while 17,678 patients had liver complications. All-cause outpatient visits were the largest contributor to healthcare resource utilization and costs, for patients without and with liver complications, and were numerically higher for patients on nucleos(t)ide analog than not. Patients with liver complications had numerically higher all-cause healthcare resource utilization and total costs than patients without complications.

Conclusions: Japan has a high economic burden of chronic hepatitis B infection, particularly in patients with liver complications. Optimizing treatment to prevent complications may reduce this burden.

Introduction: Deciding which patients with suspected small bowel bleeding (SSB) would benefit most from small bowel capsule endoscopy (SBCE) is challenging. Our aim was to perform an external validation of the recently developed SSB Capsule Diagnostic (Dx) score that includes 3 variables (hospital admission with overt bleeding, hemoglobin <6.4 g/dL and age <54 years) and has been shown to be potentially useful in limiting the use of SBCE in SSB low-risk patients.

Methods: Retrospectively included all adult patients submitted to SBCE for SSB between November 2007 and December 2019. Patients' demographic, clinical and laboratorial data at the time of SBCE were recorded. Small bowel lesions were classified according to Saurin classification. The SSB Capsule Dx score was calculated, and its calibration and discrimination ability were assessed.

Results: We assessed 473 SBCEs for SSB. Patients' mean age was 61.2 ± 17.9 years and 65.8% were female. P2 lesions were present in 36.2% of SBCEs. There was a significant association between the score and P2 lesions (p < 0.001). Mean score was -0.21 ± 0.87 having a fair accuracy toward the outcome (C-statistic 0.700; 95% confidence interval, 0.652-0.749; p < 0.001). A cutoff value of 0 was found to have a high sensitivity (86.0%) and negative predictive value (84.9%) for the diagnosis of P2 lesions at SBCE.

Conclusion: Patients with a SSB Capsule Dx score <0 are unlikely to have a significant lesion on SBCE, thus its routine use in the clinical practice may be useful in the identification of low-risk SSB patients.

Introduction: Leucine-rich alpha-2 glycoprotein (LRG) is a useful serum biomarker for monitoring disease activity during remission in ulcerative colitis (UC). Because LRG levels differ among patients, it is necessary to assess them after profiling patients, especially in patients with refractory UC undergoing treatment with molecular-targeted drugs. This study aimed to analyze LRG levels that indicate mucosal healing according to clinical characteristics and molecular-targeted drugs.

Methods: Among 214 patients with UC treated with biologics or Janus kinase (JAK) inhibitors, this study evaluated 111 patients (174 measurements) who achieved mucosal healing based on colonoscopy performed within 2 months before and after LRG measurement and experienced no changes in disease status or treatment during the same period. We analyzed the relationship of LRG with clinical characteristics (including sex, age, body mass index, and disease type and duration) and molecular-targeted drugs.

Results: Compared with men, women had significantly higher LRG levels (9.5 μg/mL vs. 11.3 μg/mL, p < 0.001). In addition, LRG levels were significantly higher in older patients (12.0 μg/mL vs. 9.8 μg/mL, p < 0.01). LRG levels were the highest in patients treated with vedolizumab and lower in patients treated with JAK inhibitors (vedolizumab: 12.7 μg/mL; tofacitinib: 8.9 μg/mL; upadacitinib: 8.5 μg/mL; and filgotinib: 9.1 μg/mL; p < 0.0001).

Conclusion: Among the patients who achieved mucosal healing, LRG levels were significantly higher in women and older patients. LRG levels differed according to the molecular-targeted drug used and were higher with vedolizumab and lower with JAK inhibitors.

Introduction: Autotaxin is an adipokine known to affect energy metabolism and lipid homeostasis. We aimed to evaluate serum autotaxin levels in metabolic associated fatty liver disease (MAFLD) and other metabolic disorders in postmenopausal women.

Methods: Postmenopausal women who received an annual health examination were included. The metabolic and demographic characteristics of the subjects were collected, including age, gender, weight, height, blood pressure, and biochemical parameters. Serum autotaxin level was determined by ELISA.

Results: This cross-sectional includes 20 postmenopausal women and 20 age-paired healthy controls. MAFLD patients showed significant metabolic disturbance presented with increased BMI, blood pressure (P＜0.001) and decreased HDL-C (P＜0.05), as well as liver injury companied by elevated ALT (P＜0.05). Serum autotaxin levels were statistically higher in MAFLD (253.1±52.1 vs. 202.2±53.2 ng/mL; P < 0.01) and positively correlated with ALT (P＜0.001), GGT and BMI (P＜0.01), SBP and TG (P＜0.05). Higher autotaxin group demonstrated worsen metabolic states with greater proportion of MAFLD, higher BMI (P＜0.01) and ALT (P＜0.05). Logistic regression analysis revealed that serum autotaxin levels would positively independently predicted MAFLD (OR 1.049, 95% CI 1.001-1.098, P＜0.05) with AUC of 0.763. Serum level of autotaxin is significantly elevated in hyperuricemia group (257.3±60.9 vs. 214.5±49.4 ng/mL; P < 0.05), and positively correlated with uric acid level (P＜0.01). Serum autotaxin would also act as diagnosing parameter of hyperuricemia with AUC of 0.706.

Conclusions: Among postmenopausal women, serum autotaxin level is significantly elevated in MAFLD and related to multiple metabolic characteristics, especially hyperuricemia, which would thus serve as a potential non-invasive biomarker as well as a therapeutic target.

Introduction: The relationships between histopathology and imaging remain elusive, and investigating the underlying reasons for tumor microstructure leading to an imaging phenotype is of clinical importance. In the present study, a cross-sectional guided biopsy specimen was used to correlate prebioptic magnetic resonance imaging (MRI) with immunohistochemical staining of the histopathologic specimen using precise spatial biopsy localization.

Methods: Twenty-seven patients with mass-forming cholangiocarcinoma (CCA) were included in the present analysis. All patients were imaged with a 1.5 T clinical scanner at least 1 month prior to biopsy. The contrast-enhanced dynamic sequences were analyzed with quantified signal intensities. The bioptic specimens were obtained by cross-sectional guided biopsy and further analyzed for cell density, proliferation index (Ki67), tumor-infiltrating lymphocytes, tumor-stroma ratio (TSR), and collagen.

Results: There were no statistically significant correlations between MRI signal intensities and cell count, TSR, Ki67 index, and CD45 count. Only a moderate correlation was observed between relative signal intensities of the venous phase and the collagen-stained area (r = 0.40, p = 0.04).

Conclusion: DCE-MRI is not associated with histopathological features in CCA. The complex interactions of tumor and tumor microenvironment are not reflected in the MRI phenotype.

Introduction: Bilirubin (BIL) and creatinine (Cr) have long been recognized as potential early indicators of disease severity. A recent study found that the Cr-to-BIL ratio (CTR) was more sensitive and specific than either serum Cr or BIL alone. Our research focused on the clinical significance of CTR in evaluating the severity and prognosticating outcomes of acute pancreatitis (AP) in patients.

Methods: Patients diagnosed with AP at the First Affiliated Hospital of Guangdong Pharmaceutical University between July 1, 2016, and December 31, 2020 were included. The analysis then focused on examining the relationship between CTR levels and the severity of the illness, the occurrence of complications, and the prognosticating outcomes for individuals diagnosed with AP. A total of 286 AP patients were enrolled.

Results: Multivariate regression analyses indicated that AP patients with elevated CTR levels were more likely to develop severe AP. They exhibited higher MODS, Ranson, and APACHE-II scores, an increased incidence of organ failures (acute heart failure [AHF], acute kidney injury [AKI], and acute myocardial infarction), higher 30-day all-cause mortality rates, and a worse prognosis, often requiring more frequent use of vasoactive and diuretic agents compared to those with lower CTR levels. When CTR >14.05, AP patients had increased occurrence of AHF and AKI, higher 30-day all-cause mortality rates, more frequently using vasoactive agent and diuretic agent. Besides, the disease severity scores (MODS, Ranson, and APACHE-II) and hospital stays were markedly increased.

Conclusion: AP patients with elevated CTR levels are prone to more severe disease progression, increased complications, and poorer outcomes compared to those with lower CTR levels.