European Journal of Gastroenterology & Hepatology最新文献

Purpose: To determine the efficacy of transcutaneous electrical nerve stimulation (TENS) on children with intractable constipation and compare treatment success between TENS application twice weekly and three times weekly.

Methods: We recruited otherwise healthy consecutive children aged 6-17 years old suffering from intractable constipation over a 6-month period. Anatomic causes and organic pathologies were ruled out. All children received TENS treatment for 20 min, during 4 weeks, three times a week in group 1 and twice a week in group 2 for 4 weeks. Patients were evaluated for defecation frequency, stool consistency, symptom relief, and fecal incontinence before, at the first week, at the end, and 4 weeks after treatment was discontinued.

Results: Twenty patients were enrolled in group 1 and 15 in group 2. Age, gender, and duration of constipation were indifferent among groups. After treatment, there was a significant increase in the number of weekly defecations ( P  < 0.001), improvement in fecal incontinence ( P  < 0.05), and painful defecation ( P  < 0.001) in both groups; however, each group's improvements did not persist 4 weeks after the treatment's discontinuation ( P  > 0.05). Meanwhile, twice weekly TENS was as effective as three-times weekly TENS ( P  > 0.05).

Conclusion: TENS treatment appears to improve weekly defecation, fecal incontinence, and pain in children with intractable constipation; however, effects are not sustained after discontinuation. The twice-weekly and three-times weekly protocols yielded comparable results; however, the study lacked sufficient power to conclusively demonstrate noninferiority.

Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) poses a growing global health challenge. This study evaluates the global burden of MASLD-related liver diseases-including MASLD with cirrhosis (MASLD-C) and liver cancer due to metabolic dysfunction-associated steatohepatitis (LC-MASH) from 1990 to 2021, with projections to 2045.

Methods and results: Using updated Global Burden of Disease 2021 data, we assessed the prevalence, incidence, deaths, and disability-adjusted life years (DALYs) for MASLD-C and LC-MASH globally. Trend analysis was conducted using average annual percentage changes and a Bayesian age-period-cohort model for forecasting. In 2021, MASLD-C had a prevalence of 1.27 billion and an incidence of 48.31 million; LC-MASH had 52 431 prevalent cases and 42 291 incident cases. Age-standardized prevalence rates rose from 12 084.69 to 15 017.46 per 100 000 for MASLD-C and from 0.40 to 0.66 for LC-MASH. MASLD-C accounted for 97 403 deaths and 2.67 million DALYs, while LC-MASH caused 40 925 deaths and 2.67 million DALYs. MASLD-C mortality slightly declined, while LC-MASH mortality rose. Middle SDI regions had the highest MASLD-C burden; high SDI regions showed the fastest LC-MASH growth. Forecasts suggest rising MASLD-C burden and LC-MASH incidence, despite declining LC-MASH age-standardized rates.

Conclusion: The increasing global burden of MASLD-C and LC-MASH underscores the urgent need for region-specific prevention and intervention strategies.

Hepatocellular carcinoma (HCC) is one of the most common and highly lethal tumors worldwide. Early metastasis is the main cause of postoperative recurrence and high mortality in patients with HCC. Vessels encapsulating tumor clusters (VETCs) are a distinct vascular metastatic pattern different from microvascular invasion, which has higher recurrence and mortality rates because of its unique metastatic mechanism; however, VETC is currently recognized only by the morphological manifestations of pathology, while in-depth understanding and discussion are insufficient. In future clinical practice, VETC patterns may have a nonnegligible role in the prediction of HCC, therapeutic decision-making, and are closely related to the long-term survival and management of patients. In addition, there is unlimited research potential regarding the mechanism of VETC patterns. This paper summarizes VETC-positive HCC based on pathogenesis, diagnosis, prognosis, and treatment, and discusses current limitations and future prospects.

Background: Atezolizumab plus bevacizumab is recommended as first-line systemic therapy for patients with advanced hepatocellular carcinoma (HCC). This study aimed to investigate the prognostic significance of early mild liver function deterioration in a real-world cohort.

Methods: This retrospective study included patients with HCC treated with atezolizumab plus bevacizumab as first-line between September 2020 and January 2024. We evaluated the evolution of liver function during the first 6 months of treatment, survival, and adverse events, and the impact of mild deterioration [change in albumin-bilirubin (ALBI) grade, without clinical ascites, encephalopathy, jaundice, or gastrointestinal bleeding] on overall survival (OS).

Results: Among 155 patients, 44 had a Child-Pugh score ⩾ B7, and 111 had ALBI grade ⩾ 2 at baseline. Median OS was 24.1 months. There was a significant deterioration in the ALBI score at cycle 2 ( P  = 0.001), 3 ( P  = 0.001), and 4 ( P  = 0.015), with no deterioration in the subsequent treatment. In multivariate analyses, baseline ALBI grade 3 (vs. 1), Eastern Cooperative Oncology Group 1 (vs. 0), macrovascular invasion, but not mild deterioration of liver function, were identified as independent prognostic predictors for OS.

Conclusion: Early mild liver function deterioration does not impact OS during first-line treatment with atezolizumab and bevacizumab.

Background: Prior studies have implicated diabetes as a risk factor for pancreatic cancer, yet the impact of diabetes progression on pancreatic cancer incidence remains unclear. We aim to assess pancreatic cancer risk across different stages of diabetes.

Methods: Employing a predefined search strategy, we conducted a literature review of electronic databases up to 29 February 2024. Extracting odds ratios (OR) and 95% confidence intervals (CIs) relevant to diabetes, we aimed to evaluate pancreatic cancer risk among diabetic patients and conduct subgroup analyses.

Results: Our systematic review comprised 29 observational cohort studies with 25 million participants. We observed a 2.13-fold higher likelihood of pancreatic cancer among diabetic individuals compared with nondiabetic counterparts. Specifically, males with diabetes exhibited a greater pancreatic cancer risk than females; however, regional disparities in pancreatic cancer risk among diabetic patients were NS. Regarding diabetes duration, pooled ORs (95% CI) for pancreatic cancer risk were 2.41 (2.07-2.81) for 1-4 years, 1.67 (1.50-1.85) for 4-10 years, and 2.01 (1.81-2.22) for over 10 years.

Conclusion: The results of this study confirm a significant association between diabetes and pancreatic cancer. Although there was no statistically significant difference in risk between different diabetes duration groups, diabetic patients overall face a higher risk of pancreatic cancer. Therefore, diabetic patients should undergo regular pancreatic cancer screening and take appropriate management measures to detect potential pancreatic cancer at an early stage.

Background and aim: Nonalcoholic fatty liver disease (NAFLD) is linked to colorectal cancer and adenoma. Lean NAFLD is associated with a higher colorectal cancer risk than non-lean NAFLD. NAFLD was modified as metabolic dysfunction-associated steatotic liver disease (MASLD). Certain adenoma features carry a high risk of metachronous lesions requiring early colonoscopy follow-up. The association between MASLD, lean MASLD, and colorectal adenomas with these features is unclear and is assessed in this study.

Methods: This cross-sectional study included patients greater than or equal to 18 years undergoing health checkups at Fu Jen Catholic University Hospital, Taiwan, between 2018 and 2023. Data collected included cardiometabolic markers, colonoscopy, liver ultrasonography, and a questionnaire. MASLD was hepatic steatosis plus greater than or equal to one cardiometabolic risk factor. Polyps with high risk of metachronous lesions were defined as having greater than or equal to one of the following features: greater than or equal to five adenomas, any adenoma greater than or equal to 10 mm, villous histology, high-grade dysplasia, or traditional serrated adenoma. Logistic regression was used to assess associations between patient groups and colorectal adenomas, adjusting for confounders.

Results: Among 5616 patients, 45.0% had MASLD, 2.4% hepatic steatosis without cardiometabolic abnormality, and 52.6% normal liver; 11.6% of MASLD were lean. Logistic regressions confirmed that MASLD was associated with colorectal adenomas [adjusted odds ratio (aOR) = 1.32] and adenomas with high-risk features (aOR = 1.46), all P values less than 0.05. Among patients with MASLD, lean MASLD was not associated with either outcome.

Conclusion: MASLD is associated with an increased prevalence of colorectal adenomas, including those with a high risk of metachronous lesions. Lean MASLD patients did not show higher adenoma rates.

Background: As the third leading cause of cancer-related mortality globally, liver cancer exhibits a rising metabolic risk profile, with high BMI emerging as a critical etiological driver.

Objective: To systematically quantify the global burden of liver cancer disease attributable to high BMI from 1990 to 2021 and project its epidemiological trajectory through 2036.

Methods: Using the Global Burden of Disease data for 2021, we analyzed mortality rates, disability-adjusted life years (DALYs), and age-standardized rates categorized by sex, age, time cohort, and sociodemographic index (SDI) strata. We employed spatiotemporal clustering to identify regional patterns of burden, and utilized autoregressive integrated moving average models to predict future trends.

Results: In 2021, high BMI accounted for 46 200 (95% uncertainty interval: 42 800-49 700) liver cancer deaths and 1.24 million (95% uncertainty interval: 1.15-1.33) DALYs globally, representing 3.5 and 3.2% increases from 1990, respectively. The burden of deaths and DALYs demonstrated significant sex differences (male to female ratio of 1.6 : 1 and 1.9 : 1, respectively), age-dependent progression (peak mortality at 90-94 years for men: 6.54 per 100 000; peak mortality at 95+ for women: 6.53 per 100 000), and SDI-associated increases ( R2  = 0.039, P  < 0.0001). Projections indicate that the age-standardized death rate will rise to 17.63 per 100 000 (95% uncertainty interval: 16.83-18.44) by 2036, representing a 120% increase from 2021 levels.

Conclusion: High BMI-associated liver cancer burden has intensified globally since 1990, disproportionately affecting males, aging populations, and high-SDI regions. Accelerated epidemiological transitions and persistent obesity trends suggest continued burden escalation without targeted metabolic intervention strategies.

Background and aims: Gastrointestinal endoscopy is a collaborative process requiring technical and nontechnical skills from both physicians and nurses. Role swapping during simulated procedures has the potential to enhance skill development and team dynamics. The study aimed to evaluate the impact of role swapping on technical and nontechnical skills, as well as on team collaboration and satisfaction, among endoscopists and nurses during simulated endoscopic procedures.

Methods: A pilot study was conducted with 22 participants (10 endoscopists and 12 nurses). Participants completed pre- and postsimulation assessments using validated self-rating scales: Non-Technical Skills for Surgeons (NOTSS), Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS), and customised technical skills questionnaires. Role swapping training sessions included onsite classes, randomised role-swapping simulations, and a 2-week postsimulation assessment. Wilcoxon nonparametric tests assessed differences between pre- and postsimulation scores.

Results: Role swapping significantly improved NOTSS and SPLINTS scores across key domains: communication, decision-making, situational awareness, and teamwork ( P  < 0.05). Endoscopists reported significant confidence gains in instrument preparation, medication dilution, and patient discharge ( P  < 0.05). Nurses demonstrated improvement in motor skills, mucosal inspection, and loop reduction handling during colonoscopy ( P  < 0.05). Both groups expressed high satisfaction with role swapping training.

Conclusion: Role swapping in simulated settings significantly enhances technical and nontechnical skills, fostering teamwork and mutual respect between physicians and nurses. This innovative approach could improve clinical practice and patient safety in real-world settings.

Background: Despite a rising prevalence of eosinophilic esophagitis (EoE), real-world data on current management challenges remain limited.

Objective: To evaluate demographic and clinical characteristics, treatment patterns, and health outcomes in patients with EoE.

Methods: Physicians from Canada, France, Germany, Spain, and the UK retrospectively reviewed records of patients (aged ≥12 years) who were newly diagnosed with EoE between January 2009 and December 2019. EoE diagnosis was confirmed by esophageal biopsy demonstrating a peak eosinophil count ≥15 eosinophils/high-power field (eos/hpf) within 90 days before or after the documented diagnosis (index). Included patients had ≥1 follow-up endoscopy with biopsy and known eosinophil count within 24 months. Data on demographics, clinical characteristics, treatment, and health outcomes were collected 12-month preindex to the last record entry/death.

Results: Overall, 415 patients [mean age (SD): 31.8 (14.6) years] were included. The mean (SD) diagnostic delay from symptom onset was 3.4 (4.8) years [median (range): 1.7 (0.7-4.0)]. The average eosinophil count was 41.4 eos/hpf; 80.2% of patients had endoscopic abnormalities of the esophagus at diagnosis. Post-EoE diagnosis, 77.1% of patients received proton-pump inhibitors, 68.2% swallowed topical corticosteroids, 48.4% made dietary modifications, and 18.8% had esophageal dilation. At diagnosis, 74.5% of patients had dysphagia and 46.0% had heartburn. After diagnosis, 63.5%, 62.2%, and 57.6% did not achieve histologic remission (<15 eos/hpf) at the first, second, and third endoscopy, respectively.

Conclusion: Patients with EoE experience a substantial disease burden, with a significant delay in diagnosis. Achieving optimal disease control remains an unmet need with conventional nonbiologic therapies.

Purpose: Using the Global Burden of Disease 2021 data, this study reports the global, regional, and national disease burden of liver cancer due to hepatitis B (LCDHB) from 1990 to 2021, stratified by age, sex, and sociodemographic index (SDI), and projects future burden to 2051.

Methods: We examined incidence, deaths, and disability-adjusted life years (DALYs) of LCDHB. Age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and age-standardized DALYs rates were analyzed (1990-2021). Spearman correlation assessed age-standardized rates-SDI relationships. The Bayesian age-period-cohort (BAPC) model projected the burden to 2051.

Results: Compared to 1990, the number of LCDHB incidences, deaths, and DALYs increased by 46.9, 41.2, and 33.9% in 2021; however, from 1990 to 2021, the ASIR, ASDR, and age-standardized DALYs rate all exhibited a declining trend. In 2021, the highest ASIR occurred in East Asia, High-income Asia Pacific, and Western sub-Saharan Africa. At the national and regional levels, Mongolia, the Republic of Paraguay, and the Commonwealth of the Bahamas showed peak ASIR. ASIR was higher in males and increased with age, peaking at 85-89 age group for both males and females in 2021. A reverse U-shaped correlation existed between age-standardized DALYs and SDI during 1990-2021. BAPC projections indicate declining global ASIR, ASDR, and age-standardized DALYs rates (2021-2051).

Conclusion: Despite rising incidence, deaths, and DALYs, LCDHB treatment challenges persist, especially for males and elderly populations. Our findings on epidemiological trends and demographic variations provide crucial insights for policymakers addressing this global health burden.