European Journal of Gastroenterology & Hepatology最新文献

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.

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.

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.

Background: Diffuse echogenicity of the pancreas (DEP) is a hallmark of endoscopic ultrasound (EUS) diagnosis of fatty pancreas. This study aimed to characterize different patterns of DEP seen on EUS and its correlation with clinical and laboratory values.

Methods: This retrospective study includes patients diagnosed with fatty pancreas on EUS at a US tertiary center from January 2015 to June 2022. Fatty pancreas distribution was divided into three patterns: (a) The diffuse echogenicity of the entire pancreas with discrete hypoechoic areas 'indicative of fatty sparing areas', (b) diffuse echogenicity of the entire pancreas without any hypoechoic areas of fat sparing, and (c) diffuse echogenicity of the entire pancreas extending beyond the pancreatic border, 'cotton candy appearance'.

Results: Overall, 238 patients were included (69.7% female). The average age of patients was 57.45 ± 12.93 years. The mean BMI was 31.27 ± 6.9 kg/m2. Concurrent diabetes and fatty liver were noted in 26.9 and 24.7% of the patients, respectively. The prevalence of exocrine pancreatic insufficiency (EPI) in those who underwent testing (n = 68) was 33.8%. Type II was the most observed type in our cohort (44.1%). Type I and III were seen in 26.1 and 29.8% of the cohort, respectively. The three types of fatty pancreas had similar clinical patterns, with comparable prevalence of diabetes (P = 0.9), fatty liver (P = 0.9), and EPI (P = 0.4).

Conclusion: The three patterns of DEP identified in this study have similar clinical and laboratory findings. Recognizing these patterns can aid in better detection of fatty pancreas.

Objective: The onset of acute diverticulitis (AD) is a significant concern, yet the optimal preventive strategy is unclear.

Methods: This multicentre, prospective cohort study included 1945 patients with newly diagnosed colonic diverticula and scored according to Diverticular Inflammation and Complication Assessment (DICA) classification. At baseline, patients were assigned to one of five treatment strategies: no treatment, a high-fibre diet, mesalamine, rifaximin, or a combination of mesalamine and rifaximin. The primary outcome was the development of AD within 3 years. Energy balancing weighting and multivariable weighted Cox regression were used to estimate the causal treatment effects from nonrandomised data.

Results: During the follow-up period, 140 cases of AD were reported. The crude 3-year risk was: 3.3% (no treatment), 5.9% (high-fibre diet), 9.5% (mesalamine), 11.8% (rifaximin), and 17.1% (mesalamine plus rifaximin). Mesalamine was associated with a lower hazard risk of AD compared to rifaximin [hazard ratio (HR) = 0.42; 95% confidence interval (CI): 0.19-0.94] and combination therapy (HR = 0.37; 95% CI: 0.15-0.88). Rifaximin was associated with a higher hazard risk compared to no treatment. Mesalamine was most beneficial for patients classified as DICA 2, with a 77% (HR = 0.23; 95% CI: 0.08-0.62) and 84% (HR = 0.16; 95% CI: 0.05-0.53) lower hazard of AD compared to rifaximin and combination therapy, respectively.

Conclusion: Mesalamine may be a better alternative in patients classified as DICA 2; however, its benefit over no treatment remains uncertain.

Aims: We investigated the independent association between dietary vitamin E intake among individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) and all-cause and cause-specific mortality in a representative sample of the USA.

Methods: We used the 2007-2014 US National Health and Nutrition Examination Survey with mortality follow-up through 2019 (median: 8.6 years). Cox regression models were used to assess the association between dietary vitamin E intake in MASLD and all-cause and cause-specific mortality.

Results: Among the 10 193 individuals with MASLD (mean age: 46.8 years and male: 48.0%), greater dietary vitamin E intake was correlated with a gradual reduction in the risk of all-cause mortality, which remained significant after adjustment for clinical and metabolic risk factors (hazard ratio: 0.68, 95% confidence interval: 0.50-0.94 for the fourth quartile compared with the first quartile; P for trend = 0.018). This association remained more pronounced in older populations, males, and non-Hispanic Whites than in their counterparts. Increased dietary vitamin E intake demonstrated trends associated with reduced cancer-related mortality.

Conclusion: Higher dietary vitamin E intake in MASLD was associated with a lower risk of all-cause mortality.