European Journal of Gastroenterology & Hepatology最新文献

Objective: There are no robust noninvasive tools to predict long-term liver-related events in well-compensated cirrhosis. We assessed the performance of noninvasive fibrosis tools in predicting decompensation, hepatocellular carcinoma (HCC), and liver-related mortality (LRM) within a mixed aetiology Child Pugh A cirrhosis cohort.

Design: Patients were followed in a single centre for 10 years. The primary outcome was decompensation (ascites, encephalopathy, or variceal bleeding). Secondary outcomes were HCC and LRM. All patients received baseline transient elastography for liver stiffness measurement (LSM) and blood tests to calculate Fibrosis-4 (FIB-4).

Results: In 114 patients, 31% decompensated during the follow-up period. 11% developed HCC. Increased LSM is associated with greater decompensation risk ( P  = 0.007). When controlling for FIB-4 and alcohol consumption, for each 1 kPa increase, the 10-year risk of decompensation increased by 2.2% [ P  = 0.009, hazard ratio: 1.022, 95% confidence interval (CI): 1.01-1.04]. Ten-year risk of decompensation was 20% for LSM < 21 kPa, 32% in the 21-35 kPa group, and 47% in the ≥35 kPa group ( P  = 0.019). After censoring for HCC, index LSM was associated with risk of death or liver transplant [odds ratio (OR): 1.029 (95% CI: 1-1.06) P  = 0.039]. FIB-4 is associated with HCC risk ( P  = 0.001) with an OR: 1.16 (95% CI: 1.01-1.32).

Conclusion: Ten-year risk of decompensation increased with increasing LSM in mixed aetiology compensated cirrhosis. LSM can be used to risk-stratify real-world patients, in order to reassure those at lowest risk and potentially focus resources on patients with higher scores and greatest decompensation risk.

Background: Mild-moderate ulcerative colitis (UC) in clinical trials has been defined as an adapted Mayo Clinic score ≥4 with a Mayo endoscopic score (MES) of 2 and rectal bleeding score ≥1. This study aims to explore whether UC patients with lower endoscopic burden but active histology have similar outcomes to those with 'conventional' mild-moderate UC.

Methods: This was a post hoc analysis from the treat-through VARSITY study ( Clinicaltrial.gov : NCT02497469). Patients who completed induction (at week 14) with mild-moderate UC based on the conventional definition were compared to patients with histologically active MES 1 for achieving histo-endoscopic mucosal improvement (HEMI) at week 52, defined as MES ≤ 1 and Geboes highest grade <3.2. Secondary outcomes included endoscopic remission (ER) (MES = 0), histologic improvement (Geboes highest grade <3.2), and clinical remission (CR) (total Mayo score ≤2 and no subscore >1). Histologically active disease was defined as Geboes highest grade >3.2 (>50% of neutrophil crypt involvement in the epithelium).

Results: Week 52 outcomes were similar among patients with mild-moderate UC compared to those with histologically active disease and MES of 1. At week 52, a similar proportion of patients achieved HEMI [19/79 (24.1%) vs. 28/113 (24.8%), P  = 0.908], ER [23/79 (29.1%) vs. 35/113 (31.0%), P  = 0.782], histologic improvement [23/79 (29.1%) vs. 36/113 (31.9%), P  = 0.685], and CR [38/79 (48.1%) vs. 66/113 (58.4%), P  = 0.158].

Conclusions: Patients with histologically active MES 1 had comparable clinical and histologic outcomes at week 52 as those with conventional mild-moderate UC, suggesting that histology may better predict prognosis than symptoms or endoscopy alone.

Background: The treatment of liver cirrhosis requires a multidisciplinary approach at expert centers. Given the disease's complexity and serious consequences, care quality significantly impacts patient survival. Specialized care models at tertiary hospitals are thought to improve treatment outcomes and quality of life. This study evaluates whether proximity to an expert center influences care quality and patient outcomes and investigates the role of socioeconomic factors and social support in Germany.

Methods: A retrospective evaluation was conducted on 299 patients with liver cirrhosis treated at Medical Faculty Mannheim, Heidelberg University, with 43% at Child-Pugh B stage. The analysis considered various distances to the hospital (10 and 20 km by car, straight-line distance and public transportation usage) and correlated these with patient survival.

Results: The analysis showed that neither car travel distance (P = 0.221, P = 0.1894), straight-line distance (log-rank P = 0.221, cox regression P = 0.1894), nor public transportation usage (P = 0.363, P = 0.1845) up to over 50 km or more than 120 min traveling by public transportation significantly affected survival. Geographical accessibility and differing socioeconomic conditions did not impact treatment quality or survival rates. Known risk factors such as age (P = 0.007, P < 0.0001), gender (P = 0.019, P = 0.0207) and Child-Pugh stage (P = 0.003, P = 0.0155) significantly influenced survival.

Conclusion: Specialized care models at tertiary hospitals offer consistent high-quality care to rural populations not facing disadvantages in survival due to longer travel distances to expert hepatology centers. Socioeconomic backgrounds do not affect care quality in this care model.

Magnetically controlled capsule endoscopy (MCE) has emerged as a noninvasive alternative to esophagogastroduodenoscopy (EGD) for diagnosing gastric conditions. This review aimed to evaluate the diagnostic accuracy of MCE compared to EGD. A comprehensive search of multiple databases was conducted to identify studies assessing the diagnostic accuracy of MCE against the reference standard of EGD. Ten studies comprising 1667 diagnostic units were included. Pooled sensitivity, specificity, likelihood ratios, and the diagnostic odds ratio (DOR) were calculated using a random-effects model. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated using Deek's funnel plot asymmetry test. The pooled sensitivity and specificity of MCE were both 0.92 [95% confidence interval (CI): 0.84-0.96 and 0.69-0.98, respectively]. The area under the receiver operating characteristic curve was 0.96 (95% CI: 0.94-0.97), indicating excellent diagnostic performance. The pooled positive likelihood ratio was 11.3, and the negative likelihood ratio was 0.09. The DOR was 129 (95% CI: 18-941). Substantial heterogeneity was observed ( I2 = 97%). No publication bias was detected ( P  = 0.18). MCE demonstrates high diagnostic accuracy comparable to EGD for detecting gastric conditions, suggesting it could be an effective noninvasive alternative in specific clinical settings. However, significant interstudy variability in specificity warrants further investigation and standardization. Future research should focus on optimizing its clinical use and assessing its cost-effectiveness.

Background: The use of probiotics as a treatment for irritable bowel syndrome (IBS) is gaining attention, with recent studies indicating that certain probiotics or combinations may have mental health benefits for patients with IBS.

Aims: To systematically review and meta-analyze, using network meta-analysis (NWM), the comparative effectiveness and safety of probiotics with psychotropic potential on quality of life, depression, and anxiety in patients with IBS.

Methods: Relevant randomized controlled trials (RCTs) were analyzed, using a Bayesian NWM, to compare the performance of probiotics with mental health benefits in IBS treatment. Treatment effectiveness was assessed using surfaces under cumulative ranking (SUCRA) values.

Results: The analysis included 3154 participants assigned to nine different treatments: Bifidobacterium longum, Saccharomyces, Clostridium butyricum, Bifidobacterium lactis, Lactobacillus acidophilus, Lactobacillus casei strain Shirota, Lactobacillus plantarum, probiotic combinations, and placebo. B. longum and probiotic combinations were found to be significantly more effective than placebo. In terms of improving quality of life (QoL), B. longum was the most effective (SUCRA = 89.7%), while L. plantarum was the least effective (SUCRA = 14.9%). For alleviating depression and anxiety, the combination of probiotics (SUCRA = 95.6%) and L. acidophilus (SUCRA = 74.2%) showed the best results, respectively.

Conclusion: Some probiotics or combinations may offer benefits for patients with IBS in improving QoL, depression, and anxiety; however, as this is a developing field, additional research is necessary to fully understand the effectiveness, underlying mechanisms, and specific strains that may be advantageous. More high-quality RCTs are needed to substantiate these therapeutic possibilities.

Aim: The purpose of our study was to evaluate the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and its associated risk factors in patients with inflammatory bowel disease (IBD).

Methods: This was a retrospective chart review of patients who underwent treatment for IBD at Jordan University Hospital between January 2013 and 2022. Case finding methods and clinical chart reviews were used to evaluate the clinical profile of patients with IBD. Demographic, anthropometric, and biochemical data; endoscopic severity scores; and imaging were obtained.

Results: A total of 367 patients with IBD were included: 194 with Crohn's disease and 173 with ulcerative colitis. MASLD was diagnosed through imaging in 152 (41.4%) and compared with 215 (58.6%) patients without MASLD. Univariate analysis revealed several factors associated with MASLD in patients with IBD: age, number of relapses, longer IBD duration (all P  < 0.001), severity of Crohn's disease based on the simple endoscopic score for Crohn's disease ( P  = 0.05), Crohn's disease penetrating behavior based on the Montreal classification ( P  < 0.001), increased triglyceride level ( P  = 0.002), and the presence of diabetes mellitus and hypertension ( P  < 0.001). In the binary logistic regression analysis, increased number of relapses [ P  < 0.001, oddsratio (OR) = 1.526], penetrating disease behavior ( P  < 0.001, OR = 3.304), and presence of hypertension ( P  = 0.027, OR = 6.728) were independent risk factors associated with an increased risk of MASLD, while shorter disease duration was associated with a decreased risk of MASLD ( P  = 0.008, OR = 0.849).

Conclusion: A substantial proportion of patients with IBD experienced concurrent MASLD. Increased IBD duration and number of relapses, penetrating Crohn's disease behavior, and presence of hypertension were independent risk factors associated with MASLD.

Introduction: Inflammatory bowel disease (IBD) causes chronic inflammation in the gastrointestinal tract, particularly in the colon and small intestine. We aimed to compare the clinical characteristics and long-term outcomes of Arab Bedouin and Jewish IBD patients in the Negev.

Methods: This retrospective case-control study (1:2 matching, controlled for age and sex) included patients of Bedouin Arab (BA) or Jewish origin, aged 18 or older, diagnosed with Crohn's disease (CD) or ulcerative colitis (UC). Data on demographics, disease behavior, outcomes, and mortality were collected.

Results: One hundred sixty-seven CD patients and 159 UC patients were included. Fifty-eight (34.7%) of the CD patients and 53 (33.3%) of the UC patients were BA. BA CD patients had a higher proportion of ileal disease (56.9 vs. 35.8%, P  = 0.009), and lower healthcare utilization, including fewer emergency department visits (9.4 ± 8.7 vs. 16.2 ± 13.8, P  < 0.001) and fewer hospitalizations (5.18 ± 6 vs. 12.2 ± 12, P  < 0.001) than Jewish patients. Treatment disparities showed that AB patients were less likely to receive biological therapies (55.2 vs. 84.4%, P  < 0.001). Regarding UC, AB patients had a higher rate of proctitis than Jewish patients (56.6 vs. 29.2%, P  < 0.001) and a higher rate of extraintestinal manifestations 41.5 vs. 11.3%, P  < 0.001, respectively. In addition, BA UC patients had a lower rate of biological treatment but a higher rate of hospitalization and death.

Conclusion: The study underscores the need for tailored healthcare strategies for BA IBD patients, including improved healthcare access, financial and social support, and culturally sensitive educational initiatives.

Background: Current guidelines for hepatocellular carcinoma (HCC) lack standardized adjuvant therapy recommendations, particularly for patients with high-risk of recurrence after curative resection. This multicenter retrospective study aimed to evaluate the efficacy and safety of adjuvant sintilimab (a programmed death protein-1 inhibitor) in this underserved population.

Methods: Patients with high-risk recurrence factors after curative resection were enrolled from five medical centers. All patients received sintilimab (200 mg), with or without tyrosine kinase inhibitors (TKIs). The primary endpoint was recurrence-free survival (RFS), with secondary endpoints including overall survival (OS).

Results: A total of 101 patients were included. The median RFS was 32.1 months [95% confidence interval (CI): 12.9-51.1], with 1-, 2-, and 3-year RFS rates of 73.1, 58.3, and 49.4%, respectively. Median OS was not reached, with 1-, 2-, and 3-year OS rates of 90.1, 83.0, and 76.2%, respectively. No significant differences in RFS (hazard ratio: 0.75, 95% CI: 0.40-1.40) or OS (hazard ratio: 0.65, 95% CI: 0.26-1.62) were observed between patients with ( n  = 34; 33.7%) or without TKIs ( n  = 67; 66.3%). In addition, no significant difference in RFS (hazard ratio: 0.97, 95% CI: 0.50-1.86) or OS (hazard ratio: 0.54, 95% CI: 0.19-1.53) was found between patients receiving adjuvant therapy for up to 6 months versus longer than 6 months.

Conclusion: These findings support the potential of 6 months sintilimab monotherapy or in combination with TKIs as an effective adjuvant therapy for patients with HCC at high risk of recurrence. Further large-scale randomized controlled trials should be warranted.

Background and aims: The aims of the present study were to assess the histological evolution of patients with metabolic dysfunction-associated steatotic liver disease (MASLD) using paired liver biopsies, identify the factors associated with fibrosis and clinical disease progression, and determine the relationship between histological progression and clinical outcomes.

Methods: This was a single-center study. A total of 114 patients with MASLD who had at least two liver biopsies were included in the analysis.

Results: From baseline to follow-up biopsy, 44% of patients showed histological progression. Fibrosis progressed in 28 patients, regressed in 21, and showed no change in 65. The proportion of metabolic dysfunction-associated steatohepatitis (MASH) increased from 83% to 90%, with 95% of MASH patients remaining MASH and 70% of MASL patients fulfilling MASH criteria at follow-up biopsy. Among MASL patients with progression, 87% had lobular inflammation at baseline. During the median follow-up of 10 years, half of the patients with MASLD showed clinical progression, with 73% having MASH at baseline. No new metabolic abnormality developed in patients with MASL who maintained MASL status at follow-up. Multivariable logistic regression analysis showed that baseline hypertension (Odds Ratio [OR]: 2.611, p = 0.024) and high serum ALT levels (OR: 2.815, p = 0.049) were predictors of clinical progression in patients with MASLD.

Conclusions: Patients with MASLD, MASL, and MASH, exhibit disease progression. Hypertension and baseline abnormal liver injury test results are predictors of clinical disease progression in patients with MASLD.

Objectives: To identify the rate and predictors of successful antitumor necrosis factor (TNF) dose deescalation in patients with inflammatory bowel disease (IBD).

Methods: This multicenter retrospective cohort study collected data from consecutive IBD patients followed at referral centers in Greece and Turkey, who had received intensified anti-TNF regimens due to secondary loss of response. Clinical response, steroid-free clinical remission, biochemical response, or mucosal healing were evaluated at 3 and 6 months following dose escalation. Multivariate analysis was used to identify predictors of successful dose deescalation.

Results: A total of 1129 patients were included [Crohn's disease: n  = 743; ulcerative colitis: n  = 386; infliximab (IFX): n  = 650; adalimumab (ADA): n  = 471; and golimumab (GOL): n  = 8]. The median interquartile range (IQR) duration of anti-TNF treatment before escalation was 13.0 (6.0-36.0) months. After a median (IQR) of 16.0 (8.0-36.0) months of intensified therapy, 283 (25.1%) patients were successfully deescalated to standard anti-TNF dosing, 340 (30.1%) remained on the intensified regimen, and 506 (44.8%) were switched to a different agent - either another anti-TNF ( n  = 111, 21.9%) or a biologic with a different mechanism of action ( n  = 395, 78.1%). Predictors of successful deescalation included the concomitant use of steroids and the type of anti-TNFa agent used (IFX vs. ADA/GOL). Negative predictors included the presence of extraintestinal manifestations, prior anti-TNF exposure (i.e. ADA followed by IFX and vice versa), and longer duration of anti-TNF therapy before escalation.

Conclusion: One quarter of IBD patients requiring intensified anti-TNFa therapie were successfully deescalated to standard dosing, after a median of 16.0 (IQR: 8.0-36.0) months.