Digestive Diseases and Sciences最新文献

Objective: Timed-barium esophagogram (TBE) is established test for assessing bolus clearance in achalasia post-treatment. However, radiation exposure is an important disadvantage. Esophageal bolus transit can be evaluated by HRIM. Previous studies comparing Impedance bolus height (IBH) using saline and TBE showed fair correlation. We compared bolus clearance by TBE versus HRIM using yogurt (viscosity matched to barium-calculated using Ostwald viscometer) in patients treated for achalasia.

Methods: HRIM was performed using solid-state system (MMS, Netherlands). Twenty patients (age 45.1 years; 8 men) treated with pneumatic dilatation (Rigiflex, Boston Scientific) were evaluated with TBE (200 ml Barium) and HRIM (200 ml yoghurt) two weeks after dilation. Both tests were performed in upright position. Barium column height and impedance bolus height (IBH) were measured at 0, 1 and 5 min. Analysis of IBH was performed with spatial impedance variation plot overlayed on esophageal pressure topography. All patients gave consent, and protocol was approved by the IRB.

Results: At baseline, 5, 11 and 4 patients had type I, II and III achalasia, respectively. Eckardt score showed an improvement of 5 (range 1-9) points. The mean column height as measured by IBH and TBE at 5 min was similar (4.6 [range 0-12.5] cm vs. 4.25 [0-16] cm). Pearson correlation between the TBE column and IBH was 0.73 at 5 min. Bland Altman plot for bolus clearance as measured by TBE and HRIM showed good agreement between the modalities.

Conclusions: There is good agreement between HRIM (performed using yoghurt) and TBE for evaluation of bolus clearance after therapy in achalasia patients. Single HRIM study done with viscosity matched liquid to barium can give information about bolus clearance and motor function in treated achalasia patients, avoiding radiation exposure.

Purpose: Achalasia is an uncommon primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and esophageal body peristalsis, with a rising prevalence among the elderly due to global population aging. This review summarizes the current evidence on the clinical presentation, diagnostic algorithm, and management of achalasia in geriatric patients.

Methods: A literature search was conducted focusing on age-related differences in symptoms, endoscopic and functional testing, and outcomes of available therapeutic modalities.

Results: Clinical presentation of achalasia differs among younger and geriatric patients, with the latter presenting less pronounced symptoms. Geriatric patients experience a higher risk of malnutrition and aspiration and exhibit more often advanced disease stages, including sigmoid esophagus. High-resolution manometry represents the gold standard for diagnosis, and upper gastrointestinal endoscopy should precede it in order to exclude causes of mechanical obstruction. The treatment remains non-causative and encompasses botulinum toxin injection, pneumatic dilation, peroral endoscopic myotomy, and laparoscopic Heller's myotomy with fundoplication.

Conclusion: Considering the evolving potential of minimally invasive techniques, advanced age should not be regarded as a contraindication for the definitive treatment of achalasia, and evidence-based, age-specific recommendations should be developed for optimizing clinical outcomes.

Background: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease with inflammatory bowel disease (IBD) present in 60-80% of affected individuals. We aimed to investigate whether concurrent IBD worsens outcomes in PSC patients.

Methods: We conducted a retrospective cohort study using the TriNetX database to identify patients (≥ 18 years) with PSC. Patients were then divided into two groups: PSC with IBD (PSC-IBD cohort) and PSC without IBD (isolated PSC cohort). Propensity score matching (PSM) was used to control for covariates between both cohorts. The primary outcome was the risk of developing liver-related decompensation (combined ascites, hepatic encephalopathy, and variceal hemorrhage). Secondary outcomes included colorectal cancer (CRC), hepatobiliary malignancy, liver transplantation, and overall mortality. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CIs).

Results: We identified 6,690 patients with PSC, including 3,012 patients (45%) with isolated PSC and 3,678 patients (55%) with PSC-IBD. After PSM, 1,714 pairs were well-balanced. Over an average of 5-year follow-up, PSC-IBD patients had a higher risk of liver-related decompensation (HR 1.26, 95% CI 1.09-1.46, p = 0.001), cholangiocarcinoma (HR 1.38, 95%CI 1.08-1.76, p = 0.008), and liver transplantation (HR 1.50, 95%CI 1.28-1.78, p < 0.001) compared to those with isolated PSC, with no difference in overall mortality. CRC was more common in IBD-PSC patients (HR 3.91, 95%CI 2.46-5.21, p < 0.001). Subgroup analysis revealed that patients with ulcerative colitis had more severe liver disease than Crohn's disease patients.

Conclusion: Concurrent IBD was associated with adverse clinical outcomes in patients with PSC, including an increased risk of liver-related decompensation and cholangiocarcinoma.

Severe acute pancreatitis (SAP) is associated with a broad spectrum of local and systemic complications, among which gastrointestinal bleeding (GIB), although relatively uncommon, confers a disproportionately high mortality risk. The underlying pathogenic mechanisms remain incompletely elucidated and are distinctly multifactorial, involving acute gastric mucosal lesions, stress-induced ulcers, esophageal and gastric varices, and pseudoaneurysm formation and rupture. This review aims to systematically synthesize current evidence on the pathogenesis of SAP-associated GIB, thereby informing the development of targeted intervention strategies, improving the precision of individualized therapeutic decision-making, and ultimately providing a robust theoretical basis to optimize patient outcomes.

Objective: Post-ERCP pancreatitis (PEP) is the most common complication of ERCP. Identifying simple and accessible biomarkers to predict PEP risk may enhance patient safety and guide clinical decisions.

Material and methods: This retrospective, single-center study included 613 adult patients who underwent ERCP between January 2017 and December 2024. Demographic data, comorbidities, procedural details, and preoperative laboratory parameters were collected from institutional electronic health records. The primary outcome was the development of PEP, defined by standard diagnostic criteria.

Results: Post-ERCP pancreatitis occurred in 52 patients (8.5%). Demographic characteristics and comorbidities, including age, sex, body mass index, diabetes mellitus, and hypertension, were not significantly associated with PEP. Pancreatic duct cannulation was significantly more frequent among patients with PEP (53.8% vs. 24.8%, p < 0.001) and remained an independent risk factor in multivariable analysis (aOR: 3.05, 95% CI: 1.65-5.64, p < 0.001). Patients who developed PEP had higher preoperative neutrophil-to-lymphocyte ratio (NLR) (3.7 ± 1.9 vs. 2.9 ± 1.5, p = 0.001) and C-reactive protein (CRP) levels (18.5 ± 11.2 vs. 11.4 ± 8.3 mg/L, p = 0.001). In adjusted analysis, both NLR (aOR: 1.14, 95% CI: 1.02-1.28, p = 0.02) and CRP (aOR: 1.04, 95% CI: 1.01-1.08, p = 0.008) remained statistically significant but modest independent predictors of PEP. ROC analysis demonstrated limited discriminative ability for both NLR (AUC: 0.64) and CRP (AUC: 0.66), with moderate sensitivity and specificity.

Conclusion: Elevated preoperative NLR and CRP levels, together with pancreatic duct cannulation, were independently associated with an increased risk of post-ERCP pancreatitis. Although these inflammatory markers demonstrated statistically significant associations, their predictive strength was modest. Therefore, NLR and CRP should be interpreted as supportive parameters rather than standalone predictors and may contribute to pre-procedural risk stratification when integrated with established clinical and procedural risk factors. Further prospective, multicenter studies are warranted to validate these findings and clarify their role in clinical practice.

Background: Gallbladder cancer (GBC) while rare worldwide has a high prevalence in India. Pathogenesis is unclear and outcomes poor. No suitable models are available to study GBC pathogenesis and drug response. The aim of this study was to establish a biobank comprising patient derived organoids (PDOs) from a wide variety of gallbladder diseases including GBC and other rare pathologies.

Methods: PDOs were developed from surgically resected gallbladders 15 normal; 58 inflamed; 12 xanthogranulomatous cholecystitis (XGC); 5 pre-invasive neoplasm (PIN); and 13 invasive malignant gallbladder pathologies. Marker expressions, functional activity, histological and gene expression analyses were performed to validate the models. Banked PDOs were retrieved and drug assays performed to assess line-specific responses.

Results: Protocol optimization achieved 58% (69/119) and 52% (10/19) success in organoid generation and expansion for all and invasive malignant pathologies, respectively-highest globally for GBC organoids reported to date. Organoids maintained tight junction integrity; P-gp pump and enzymatic activity; preserved tissue-specific gene and protein marker expression; histological features and genetic variations. Besides cryopreserved organoids from 62 patients, primary gallbladder tissue and high-quality DNA, RNA and protein derivatives have been banked. In gene expression analyses of tissue, XGC samples clustered with malignant subtypes, separate from benign pathologies. Derived XGC organoids showed a similar clustering. Enriched Hallmark pathways in XGC support neoplastic changes. Drug response assays demonstrate PDO line-specific response heterogeneity.

Conclusion: The developed biobank of PDOs from different gallbladder pathologies provides a promising resource to study gallbladder diseases, investigate the pathogenesis of GBC and study drug responses.