Digestive Diseases and Sciences最新文献

Background and aim: This study examines patient traits linked to LT listings for AH.

Methods and results: 1325 of 41,558 ALD (3.2%) in US (2012-21) listed for AH vs. non-AH were younger (43 vs. 53 years), had higher BMI (29 vs. 28) and MELD (34 vs. 22). Factors associated with AH listing included black or other race, diabetes mellitus, excellent performance status, and higher MELD scores. Conversely, age < 50, Hispanic race, and lower education correlated with lower odds for AH listing. The proportion of AH listings increased from 1.1% (2002-2011) to 4.1% (2012-2021), with over twofold increase (OR 2.10, 95% CI: 1.69-2.61). Logistic regression models controlling baseline factors showed that the odds of AH listing in 2012-2021 vs. 2002-2011 were 5.27 for age ≤ 35, 4.76 for MELD ≥ 35, and 4.08 for excellent performance status. AH candidates had lower 90-day waitlist mortality (0.71, 95% CI: 0.60-0.83) and higher receipt of LT (1.49, 95% CI: 1.21-1.88). Among 16,190 LTs, the graft quality for AH and non-AH recipients was similar.

Conclusion: Listing for AH among ALD candidates is increasing in younger patients with high MELD scores and excellent functional status. Establishing standardized criteria for LT in AH patients is essential to optimize graft utilization.

Background/aims: Bowel preparation quality is a critical indicator of colonoscopy performance. This study investigated the relationship between different adequate preparation levels and the detection rates of SSLs.

Methods: We retrospectively analyzed 9,854 individuals with adequate bowel preparation (Aronchick scale) undergoing index colonoscopy. The primary outcome was SSL detection rate (SSLDR), and secondary outcomes include adenoma detection rate (ADR). Multivariable logistic regression and sensitivity analyses were performed to identify independent predictors.

Results: SSLDR was significantly higher in the "good" preparation group compared to the "excellent" group (8.4% vs. 4.7%, P < 0.001). In the multivariable analysis including fecal occult blood test results, symptomatic presentation (OR 10.22; 95% CI, 5.49-19.02), high-performing endoscopist expertise (OR 3.78; 95% CI, 2.34-6.11), and longer withdrawal time (OR 1.15 per minute; 95% CI, 1.12-1.19) were identified as strong independent predictors of SSL detection. Conversely, positive FOBT results (OR 0.46; 95% CI, 0.30-0.68) and synchronous adenoma detection (OR 0.39; 95% CI, 0.28-0.52) were inversely associated with SSL detection. Sensitivity analysis of the full cohort confirmed these procedural predictors and the robust inverse relationship with synchronous adenomas (OR 0.42; P < 0.001). ADR was also independently higher in the good preparation group (OR 1.38; 95% CI, 1.12-1.69, P < 0.001).

Conclusions: Excellent bowel preparation did not translate into a higher SSLDR compared to good preparation. Instead, SSL detection may be primarily driven by endoscopist expertise, inspection time, and the clinical context of the patient.

Objectives: Chronic pancreatitis (CP) is an irreversible condition with multiple comorbidities. Pancreatic stellate cells (PCSs) are crucial in the fibrotic process in CP. PSCs have a regulating vitamin D receptor. The aim was to assess if a daily higher dose of vitamin D can prevent the progression to CP in patients after the first episode of acute pancreatitis (AP).

Methods: This was a single-centre randomized placebo -controlled trial. Patients were randomized after the first episode of AP to either a daily 100 µg high-dose vitamin D (HDVD) or a 10 µg low-dose vitamin D (LDVD) groups. Follow-up included magnetic resonance imaging (MRI), laboratory tests and QoL questionnaires (QLQ-C30 and Pan26). The development of parenchymal changes possibly related to fibrosis after AP in MRI.

Results: Sixty-nine patients were recruited. There was a high dropout (51%), therefore the final analysis included all patients who completed the three or two years of trial: in total 34 patients. No definitive CP cases occurred in HDVD group, while one was observed in LDVD group (p = 0.367). Less CP related findings developed during the trial in the HDVD compared to the LDVD group (n = 4 vs n = 13, p = 0.016). The HDVD patients had a significantly lower pain score than the LDVD group (p = 0.019). Vitamin D levels were significantly higher in HDVD group compared to LDVD group without adverse effects.

Conclusions: HDVD after AP was linked to fewer early CP-related changes during 2-3 years of follow-up. These preliminary findings warrant confirmation in larger trials with longer observation. Long-term interventional trials are challenging in this patient group.

Trial registration number: ClinicalTrials.gov: NCT02965898.

Purpose: Mitochondrial dysfunction has been implicated in ulcerative colitis (UC), but human data evaluating mucosal bioenergetics alongside inflammatory responses remain limited. The contribution of metabolism to irritable bowel syndrome (IBS) is also unclear. This study aimed to characterise ex vivo colonic metabolic and inflammatory profiles across healthy control (HC), IBS, UC in remission, and active UC cohorts, and to assess associations with clinical characteristics including disease duration and progression.

Methods: Sigmoid biopsies from HC, IBS, UC in remission, and active UC were prospectively collected and underwent Seahorse analysis to quantify oxidative phosphorylation (OCR) and glycolysis (ECAR). Explant-conditioned media was analysed for ten cytokines and normalised to tissue protein. Group comparisons, principal component analysis, correlations, and multivariable regression were performed.

Results: Twenty-four participants were included (HC n = 6, IBS n = 6, UC remission n = 6, active UC n = 8). OCR was significantly lower in UC remission (78.3 pmol O2/min/µg protein; p = 0.024) and active UC (67.1 pmol O2/min/µg protein; p = 0.004) compared with HC (571.7 pmol O2/min/µg protein). OCR:ECAR ratios were similarly reduced in UC remission (2.1; p = 0.013) and active UC (2.7; p = 0.008) versus HC (18.7). Active UC demonstrated markedly elevated IL-4, IL-6, IFN-γ, and IL-1β compared with HC. ECAR was independently associated with UC disease duration (β = 0.03; p = 0.043). IBS showed no significant metabolic or cytokine differences relative to HC.

Conclusion: UC is characterised by impaired oxidative phosphorylation, enhanced cytokine secretion, and greater glycolytic activity with longer disease duration. These findings support progressive mucosal metabolic alteration as a feature of chronic UC.

Background: Patients with decompensated cirrhosis have high prevalence of frailty that increases morbidity and mortality. This study was done to determine the impact of six months of Rifaximin therapy on frailty in patients with decompensated cirrhosis.

Methods: 100 patients with frailty as assessed by Liver frailty Index (LFI > 4.5) at baseline were randomized 1:1 to receive standard medical therapy (SMT) plus Rifaximin (rSMT, intervention) versus SMT (control) alone. The primary outcome was an improvement in frailty at 6 months. Secondary outcome measures included improvement in CTP and MELD, inflammatory markers, hospitalization, and survival.

Results: Frailty improved significantly in the intervention arm as compared to the control arm (4.7(4.5-5.0) to 4.2(4.1-4.5), (P < 0.00) vs 4.7(4.6-5.0) to 4.7(4.4-5.2), (P = 0.70) at 6 months. The disease severity as assessed by CTP and MELD, scores showed a significant improvement in the rSMT group as compared to the SMT group (P < 0.05). The delta change in MELD score was -2.3 ± 2.9 versus 1.7 ± 5.4 (P < 0.00) in the intervention arm as compared to control arm. Inflammatory markers showed significant improvement, with a higher delta change in IL-6 in the intervention arm (-10 [-15.7/-4.4] vs -5 [-10.2/-0.5]; P = 0.01). The patients in rSMT arm had lesser number of hospitalizations 8(16%) vs 26(52%); P < 0.00) over the course of 6 months. The mortality in rSMT and SMT arms was 10% (n = 5), and 22% (n = 11), respectively though there was no significant difference in the overall survival (P = 0.11).

Conclusion: Rifaximin therapy in decompensated cirrhosis has a significant impact on improving frailty and disease severity, with a reduction in hospitalization rate.

Clinical trial registry number: CTRI/2023/01/048824.