Digestive Diseases and Sciences最新文献

Purpose: Short bowel syndrome with intestinal failure (SBS-IF) requires lengthy parenteral support (PS) infusions to maintain nutrition and hydration, and may also involve treatment with glucagon-like peptide 2 (GLP-2) analog injections. SBS-IF and its treatment have significant health-related quality-of-life (HRQoL) impacts on patients. While existing patient-reported outcome (PRO) questionnaires measure HRQoL impacts of SBS, differences in intestinal anatomy or treatment type have their own impacts to patients that warrant assessment. This qualitative research supports the content validity of three new questionnaires to measure these specific impacts on patients with SBS-IF (i.e., questionnaires are measuring what is important in ways that are understandable to patients).

Methods: Qualitative research activities, including a targeted literature review, meetings with clinical experts, and patient interviews, were conducted to understand the patient experience of SBS-IF and its treatment and to inform the development and evaluation of questionnaires to measure HRQoL impacts related to patients with jejunostomy ('stoma'); patients with colon-in-continuity and no stoma ('CIC'); and PS infusions and GLP-2 analog injections for both groups of patients.

Results: From the publications (n = 26), and meetings with experts (n = 8), three draft questionnaires were constructed for impacts specific to SBS-IF with stoma, impacts specific to SBS-IF with CIC, treatment impacts related to PS infusions and GLP-2 analog injections. Qualitative patient interviews (n = 23) confirmed the questionnaires' relevance and comprehensibility; minor revisions were subsequently made to the questionnaires based upon participants' suggestions.

Conclusion: This research provides content validity evidence for the three questionnaires to measure HRQoL impacts of SBS-IF, PS infusions, and GLP-2 analog injections among patients with SBS-IF.

Purpose: Recent literature has highlighted emerging inadequacies in the gastroenterology workforce. Currently, few studies have assessed the training pathway for pediatric gastroenterology. This study analyzes the number of applicants, training positions, and unfilled training positions for pediatric gastroenterology training in the United States (US).

Methods: This was a cross-sectional study of all applicants for pediatric gastroenterology fellowship training from 2009 to 2025. Match outcomes were calculated using National Resident Matching Program data and annual trends were assessed with linear regression. Comparisons were made with Chi-squared tests. Alpha was set at 0.05.

Results: Over the study period, growth in the number of training positions (103% increase, P < 0.001) and programs (75.0% increase, P < 0.001) exceeded growth in the number of applicants (29.3% increase, P = 0.015). As a result, the applicant-to-training position ratio decreased (1.37 to 0.87, P < 0.001) while the number of unfilled training positions increased (475% increase, P = 0.049). Annual match rates increased (68.3% to 93.4%, P < 0.001) over the study period while the representation of US allopathic medical school graduates (67.9% to 48.5%, P = 0.048) decreased. Match rates for US allopathic medical school graduates exceeded those for non-US allopathic medical school graduates (90.9% vs 72.5%, P < 0.001). The percentage of applicants who matched at their first-(40.2% to 51.9%, P = 0.039) and second-(8.5% to 16.0%, P = 0.041) choice fellowships increased over the study period while the percentage of unmatched applicants decreased (31.7% to 6.6%, P < 0.001).

Conclusion: Growth in the supply of pediatric gastroenterology training positions has exceeded demand, which has led to an increase in unfilled training positions. Future surveillance of match outcomes is needed to ensure an adequate pediatric gastroenterologist workforce.

Background: The primary indication for ERAT is acute uncomplicated appendicitis; however, in recent years, the successful treatment of appendiceal abscesses in adults has been reported in several cases. Further investigations are warranted to establish the feasibility of ERAT for the management of appendiceal abscesses.

Aims: This study aimed to evaluate the efficacy and safety of endoscopic retrograde appendicitis therapy (ERAT) for the treatment of acute periappendiceal abscess in adults.

Methods: This retrospective study included 30 adult patients with acute periappendiceal abscess who underwent ERAT at the Digestive Center of Suining Central Hospital between July 2021 and March 2025. The success rate (technical and clinical), procedure time, intervention time, visual analog scale (VAS) score, length of hospital stay, complications, and absorption condition of the abscesses 3 months after the procedure were recorded and analyzed.

Results: The technical success rate of ERAT was 80%, and the clinical success rate was 83.3%. The median procedure time was 14.5 (interquartile range [IQR], 11.8-16.5) minutes. The median ERAT intervention duration was 7.0 (IQR, 4.8-10.0) days. The postoperative VAS score was significantly decreased (P < 0.001), and the average length of hospital stay was 6.7 ± 2.4 days. Three months after the procedure, the abscesses were completely absorbed in 87.0% of the patients and partially absorbed in 13.0% of the patients. Two patients developed postoperative complications, namely, abscess dissemination and transient high fever.

Conclusion: In adult patients with acute periappendiceal abscess, ERAT may be an alternative and effective treatment option in the early stage.

Background: The prevalence of type 2 diabetes mellitus (T2DM) and its associated hepatic steatosis has surged with the obesity epidemic. The influence of T2DM on the natural history of primary biliary cholangitis (PBC) remains poorly characterized.

Aims: This study aims to assess the prevalence of T2DM in a PBC cohort and evaluate its impact on hepatic steatosis, liver fibrosis, and clinical outcomes.

Methods: A retrospective analysis was performed. The presence of hepatic steatosis was defined by a controlled attenuation parameter (CAP) ≥ 285 dB/m, and clinically significant liver fibrosis was defined by a liver stiffness measurement (LSM) ≥ 8.5 kPa assessed using vibration-controlled transient elastography (VCTE). The cohort was further stratified into four subgroups: PBC with T2DM (PBC/T2DM), PBC without T2DM (PBC/non-T2DM), PBC with hepatic steatosis (PBC/steatosis), and PBC without hepatic steatosis (PBC/no steatosis). Group comparisons were performed using t-tests, chi-squared analyses, and Kaplan-Meier survival curves.

Results: 562 patients with PBC were identified. The prevalence of T2DM was 14.8%. 158 (28%) patients had VCTE measurements. The PBC/T2DM sub-cohort was more likely to have concomitant hepatic steatosis compared to PBC/non-T2DM (54% vs 28%, p-value 0.010). The prevalence of clinically significant fibrosis was similar between these two groups (69% vs 52%, p-value 0.097). All-cause mortality rates were similar between PBC/T2DM vs PBC/non-T2DM (p-value 0.960) and PBC/steatosis vs PBC/no steatosis (p-value 0.895).

Conclusion: T2DM is a risk factor for the development of hepatic steatosis in patients with PBC; however, it does not increase the likelihood of clinically significant liver fibrosis or all-cause mortality.

Background: Fatigue is common in Crohn's disease (CD) and ulcerative colitis (UC), but the pathogenesis remains poorly understood.

Aims: This study aimed to assess changes in fatigue prevalence during the first year after diagnosis and examine the association between disease course and substantial fatigue (SF) at the 1-year follow-up.

Methods: Adults with newly diagnosed CD or UC were recruited from the population-based IBSEN III cohort. Fatigue was assessed at diagnosis and the 1-year follow-up using the Fatigue Questionnaire. Associations between SF at the 1-year follow-up and disease-related factors were quantified using multivariate logistic regression adjusted for sex, age and comorbidities.

Results: In total, 596 patients were included (CD: 196, UC: 400). SF was present at both baseline and after one year of disease for 46.9% (n = 92/196) and 40.5% (n = 162/400) of patients with CD and UC, respectively. In CD, development of endoscopically non-passable stricture and/or surgically treated stricture within first year of disease (OR = 4.52, 95%CI [1.61;12.68]), self-reported flares since diagnosis (OR = 2.55, 95%CI [1.26;5.16]), female sex (OR = 3.12, 95%CI [1.53;6.37]) and comorbidities (OR = 4.05, 95%CI [1.89;8.69]) were independently associated with SF at the 1-year follow-up. In UC, SF was associated with current biological treatment (OR = 5.14, 95%CI [1.56;16.96]), increasing Mayo endoscopic score at the 1-year follow-up (OR = 1.54, 95%CI [1.01;2.35]), self-reported flares since diagnosis (OR = 2.66, 95%CI [1.24;5.72]) and female sex (OR = 2.20, 95%CI [1.06;4.57]).

Conclusions: Fatigue frequently persists through the first year after IBD diagnosis. Clinical factors reflecting a more severe disease course were associated with SF one year after diagnosis in both CD and UC.