Digestive Diseases最新文献

Introduction: Celiac disease (CD)-related antibody positivity in children with type 1 diabetes (T1D) may fluctuate and become negative spontaneously. There are uncertainties about the optimal tissue transglutaminase IgA (tTG-IgA) titre and timing of endoscopy in the diagnosis of CD, and this study aimed to contribute to the debate on the tTG-IgA threshold titre for endoscopy decisions in children with T1D.

Methods: The data of 991 children with T1D who had undergone serologic evaluation for CD were analysed retrospectively. The tTG-IgA positivity rate and the upper limit of normal (ULN) tTG-IgA positivity were assessed. Participants were grouped according to the frequency, course, and test results of tTG-IgA tests. Those with and without histopathologic diagnosis of CD by endoscopic biopsy were compared in terms of tTG-IgA screening time and tTG-IgA predictive values.

Results: In 10.2% (n:101) of all cases, tTG-IgA antibody was positive and endoscopic biopsy was performed in 68.3% (n:69) of these cases. Of all cases, 4.3% (n:43) were diagnosed with CD by endoscopic biopsy. A tTG-IgA titre of 7×ULN and above was found to be the best predictive value for the diagnosis of CD with 79.1% sensitivity, 80.8% specificity 87.2% positive predictive value, and 70% negative predictive value.

Conclusions: Approximately 10% of antibody positive cases showed fluctuating and low-titre positivity, and no CD was detected by endoscopic biopsy in the group with fluctuating antibody course. The results of our study suggest that endoscopy in children with tTG-IgA levels 7×ULN or above may prevent both false-positive results and missed cases.

Introduction: Colorectal cancer screening relies on effective bowel preparation before a colonoscopy. Walking has emerged as a potential adjunct strategy to achieve bowel cleansing prior to colonoscopy. We investigated the efficacy of walking as a potential adjunct strategy to bowel preparation methods.

Methods: Our search encompassed Embase, Medline, Cochrane, and Scopus databases. Search results underwent screening utilizing Covidence based on predefined criteria. Data extraction performed by independent reviewers involved general characteristics, baseline patient characteristics, and outcome measures. Risk of bias evaluation employed the RoB 2 tool for randomized controlled trials (RCTs). Statistical analysis utilized RevMan v5.3, employing mean differences and random-effects models. Statistical significance was indicated by p value <0.05. Heterogeneity was assessed with I2 tests.

Results: Our meta-analysis included four RCTs with a total of 1,218 patients. We found that walking did not yield a significant difference in total BBPS score compared to control groups. Walking led to statistically significant improvements in ascending, transverse, and descending colon BBPS scores. Walking did not significantly affect cecal intubation time or total procedure time. While there was no significant difference in the time to first diarrhea, the total number of diarrheal episodes was significantly impacted.

Conclusion: While walking did not significantly affect total BBPS scores, procedural timelines, or cecal intubation, it demonstrated significant improvements in ascending, transverse, and descending colon BBPS scores and diarrheal instances. These findings suggest that walking may have a beneficial effect on specific aspects of bowel preparation for colonoscopy, highlighting its potential as an adjunctive strategy in enhancing colonoscopy outcomes.

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: 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: Video capsule endoscopy (VCE) is a valuable noninvasive diagnostic tool for gastrointestinal disorders, but it carries a risk of capsule retention and subsequent bowel obstruction. The aim of the present study was to examine the manifestations, diagnostic approaches, treatment modalities, and outcome of patients with bowel obstruction due to VCE.

Methods: A comprehensive search was conducted in PubMed/Medline, Embase, Cochrane, and Scopus databases focusing on intestinal obstruction post-VCE.

Results: Out of 399 unique articles, 27 studies were included, involving 30 patients, with an average age of 54 ± 22.3 years and a female-to-male ratio of 1.9:1. Common indications for VCE included Crohn's disease, anemia, abdominal pain with diarrhea, and obscure gastrointestinal bleeding. The obstruction most often occurred in the small intestine, predominantly in the ileum (20 patients, 67%) and the duodenum (5 patients, 17%). Diagnostic methods included CT scans in 19 cases (66%) and X-ray imaging in 8 cases (28%). Treatment varied from conservative management to surgical intervention, and no cases of mortality or morbidity were reported.

Conclusions: This study highlights the importance of a multidisciplinary approach of such cases, concentrating on tailored therapeutic strategies to prevent and address complications related to VCE. Further research with larger cohorts is needed for a deeper understanding of risk factors and long-term outcomes.

Introduction: This study aimed 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 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% confidence interval [CI] = 1.07-1.44, p = 0.004), although it was low-quality evidence. This increased risk was observed in both ulcerative colitis (OR = 1.38, 95% CI = 1.04-1.83, p = 0.025) and Crohn's disease (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: The association between Helicobacter pylori (H. pylori) infection and digestive autoimmune diseases remains unclear, with inconsistent findings in previous observational studies. We conducted Mendelian randomization (MR) analysis to systematically explore the causal relationship and delve into the pathogenesis based on gut microbiota.

Methods: This study encompassed anti-H. pylori IgG levels and genome-wide association studies (GWASs) for multiple digestive autoimmune diseases, utilizing diverse MR methodologies to assess the causal relationship between H. pylori antibody levels and these diseases. Associations between H. pylori and ulcerative colitis (UC) were examined using genetic variants from MiBioGen associated with 194 gut microbiota traits. Additionally, a series of sensitivity analyses were performed to validate the results of the initial MR analyses.

Results: Our study showed a significant association between anti-H. pylori IgG levels and the incidence risk of UC (β = -0.001, p = 0.011). No causal associations were observed with the incidence risk of primary biliary cirrhosis, primary sclerosing cholangitis, celiac disease, and Crohn's disease (CD). Multiple gut microbiota were found to be correlated with H. pylori infection and UC. Particularly noteworthy is the negative correlation between the abundance of the genus.Anaerofilum and H. pylori antibody levels (β = -0.174, p = 0.048). Notably, genus.Anaerofilum exhibited a positive genetic correlation with an increased risk of UC (β = 0.0014, p = 0.0029).

Conclusion: MR analysis confirmed a causal association between anti-H. pylori IgG and UC, but not with CD. The genus.Anaerofilum may increase the risk of UC by inhibiting H. pylori infection.

Background: Helicobacter pylori eradication is increasingly challenged, due to high antibiotic resistance rates in H. pylori and treatment failure. Consequently, new treatment regimens are needed. Probiotic and gastrointestinal bacteria exert anti-H. pylori activity in vivo, thus being potential add-on candidates for future eradication strategies.

Summary: In this review, we summarised the currently available literature for in vivo inhibition of H. pylori. Included studies address anti-H. pylori effects in mouse and rat models caused by potentially beneficial bacteria. Research on literature was further extended to clinical eradication studies in humans. Several bacterial strains, mainly belonging to the Lactobacillus genus, inhibited H. pylori in vivo. In animal studies, probiotic bacteria and commensals reduced H. pylori colonisation and the inflammatory response. Certain probiotic species reduce H. pylori colonisation in humans.

Key messages: Probiotic and gastrointestinal commensals are beneficial in H. pylori eradication therapy. Their current role is the reduction of adverse events and H. pylori load.

Introduction: Total colectomy for ulcerative colitis (UC) is associated with postoperative morbidity, including venous thromboembolic events (VTE). In light of recent concerns about increased major adverse events associated with Janus kinase (JAK) inhibitor exposure, we aimed to evaluate the postoperative VTE risk as well as other complications in UC patients undergoing colectomy.

Methods: This single-center retrospective cohort study included all UC patients who underwent (procto)colectomy between 2013 and March 2022 and documented the 180-day postoperative non-infectious and infectious complications.

Results: One hundred seventy-five UC patients (43.4% women, median age 41.0 years) underwent colectomy. Forty-nine patients (28.0%) were operated in an urgent setting. In the 12 weeks prior to surgery, 53 (30.3%) patients had received anti-TNF agents, 40 (22.9%) anti-adhesion therapy, 16 (9.1%) anti-IL12/23, and 34 (19.4%) JAK inhibitors. Preoperatively, 26 patients (14.9%) received moderate-to-high doses of systemic corticosteroids. All except 2 patients received prophylactic low-molecular-weight heparin postoperatively. During the 180-day postoperative period, 2 patients developed thrombosis, all incidental findings on abdominal CT scan. No VTE was seen in the patients who underwent colectomy while on JAK inhibitor. Three out of 34 JAK inhibitor-treated patients (8.8%) developed a postoperative infectious complication, while the overall incidence of infectious complications was 17.1%.

Conclusion: Our findings suggest that the overall VTE risk in UC patients undergoing colectomy is low with adequate antithrombotic prophylaxis. JAK inhibitor use prior to surgery was not linked to increased short-term thromboembolic or infectious complications. However, the limited sample size warrants further study in larger cohorts.

Background: A standardized examination procedure and correct bowel wall assessment are the prerequisites for correct findings and for distinguishing normal findings from pathological diagnoses. PubMed was searched for the time period from January 01, 1990, to March 29, 2024, using a Boolean search.

Summary: The present work provides knowledge and details of the examination of the gastrointestinal tract in transcutaneous ultrasound with examination procedure, transducer selection, transducer guidance, knowledge of the identification of anatomical structures, and sonographic assessment. The sonographic reference values for the gastrointestinal tract were researched, compiled, and interpreted. In addition, citations and references of eligible studies were searched to identify further studies for inclusion.

Key messages: Knowledge of the sonographic appearance of the gastrointestinal tract and the standardized examination of the healthy gastrointestinal tract, including correct measurements, must be trained. Although age, body weight, and food ingestion influence the thickness of the intestinal wall, it does not normally exceed 2 mm in the duodenum, jejunum, ileum, and colon on US. However, in most clinical studies 3 mm was used as cutoff for pathology. When assessing the appendix, an outer diameter of < 6 mm is considered normal. However, an increase in this diameter may also occur in healthy, asymptomatic people and should be not used as the sole criterion for diagnosing appendicitis. GIUS is now established as valid clinical method to assess patients with digestive diseases. Accordingly, there is a great need for training opportunities and supervision of young doctors who want to enhance their knowledge and skills in GIUS.