European Journal of Gastroenterology & Hepatology最新文献

The pancreas is a compound organ specialized in digestion and absorption of nutrients and in glucose homeostasis. Indeed, the exocrine component produces digestive enzymes and bicarbonates involved in the duodenal and jejunal digestion, whereas endocrine cells, mainly located in the islets of Langerhans, produce glucose-regulating hormones. These two different pancreatic functions are strictly and directly regulated by mechanisms that are still not completely understood. Not only pancreatic secretions but also the interaction between exocrine and endocrine pancreatic function have relevance on nutritional status, and there is increasing evidence that nutritional status impacts the prognosis of both inflammatory and pancreatic neoplastic diseases of the pancreas. Signs of malnutrition need to be investigated and identified in patients with pancreatic diseases to optimize the medical management and, potentially, to improve the clinical outcome. Considering the central role of the pancreas in the nutrition state, in this review, we aimed to report the current knowledge on pancreatic exocrine and endocrine functions and their relationship with diet, and the modifications and the impact on prognosis of the inflammatory and neoplastic diseases of the pancreas.

Background: Despite advancements in endoscopic technology, the concordance between endoscopic findings and histopathological diagnoses in gastritis remains inconsistent. This study aimed to evaluate the correlation between endoscopic and histopathological findings, identify predictors of pathological outcomes, and assess the role of biopsies in routine clinical practice.

Methods: A retrospective analysis of 4927 gastroscopies with biopsy over 6 years was performed. Demographics, endoscopic features, and histopathological findings were analyzed. Logistic regression identified predictors of Helicobacter pylori infection and precancerous conditions, with predictive accuracy assessed using receiver operating characteristic (ROC) analysis. Endoscopic patterns were categorized according to structured classification systems, with severity and anatomical distribution systematically documented.

Results: Normal biopsies were found in 28.6%, H. pylori in 33.6%, and histologically confirmed precancerous conditions - including atrophy, intestinal metaplasia, and low-grade dysplasia - in 13.5% of cases. Nodular gastropathy [odds ratio (OR) = 1.54, P  = 0.0006] and erosive raised gastropathy (OR = 1.31, P  = 0.037) predicted H. pylori infection, while atrophic-appearing gastropathy (OR = 8.42, P  < 0.001) and erosive raised gastropathy (OR = 2.47, P  < 0.001) strongly predicted precancerous lesions. Erythematous gastropathy was inversely associated with H. pylori and precancerous conditions. Predictive accuracy was moderate for H. pylori [area under the ROC curve (AUC) = 0.60] and good for precancerous conditions (AUC = 0.74).

Conclusion: While certain endoscopic features and patient demographics may assist in identifying individuals at higher risk of significant pathology, their predictive value remains modest. These findings may contribute to future efforts aimed at risk stratification; however, histological assessment remains essential, and prospective validation is warranted before altering current biopsy practices.

Background: The dynamics of alanine aminotransferase (ALT) remain poorly described in the general population owing to the unavailability of widely accepted cutoffs to define abnormal levels and insensitivity of dichotomized ALT values.

Methods: With data from the National Health and Nutrition Examination Survey 1988-1994 ( n = 11 854), 1999-2004 (12 280), 2005-2010 (14 204), 2011-2016 (14 145), and 2017-2020 (7047), we examined the age- and sex-standardized distribution of log-transformed serum ALT and tested the elevated ALT prevalence trend among American adults aged 19 years and older.

Results: The ALT geometric mean increased from 15.89 U/L (95% confidence interval = 15.43-16.37) in 1988-1994 to 21.97 U/L (21.75-22.20) in 1999-2004. The means remained around 22 U/L between 2004 and 2016 and then decreased to 19.19 U/L (18.85-19.54) in 2017-2020 ( P for quadratic trends <0.001). However, the 95 th percentile of the bell-distribution remained around 49 U/L by the end of the study after jumping from 38.39 U/L (35.73-41.06) in 1988-1994 to 48.86 U/L (47.34-50.39) in 1999-2004. Correspondingly, the elevated ALT prevalence doubled from 1988-1994 to 1999-2004 and remained unchanged through 2020, independent of the cutoffs used.

Conclusions: The ALT mean level decreased in recent years, but the right end of the bell-shaped distribution was stagnant, and the elevated ALT prevalence levels remained persistently high. The reductions in ALT levels likely corresponded to population-wide reductions in fructose consumption. The prevalent elevated ALT requires effective clinical interventions.

Background: Acute variceal bleeding (AVB) comprises 70% of upper gastrointestinal bleeding in cirrhotic individuals, with first-episode mortality of 15-20%. A third of surviving patients rebleed within 6 weeks of initial presentation. Scores such as Child-Turcotte-Pugh (CTP), model for end-stage liver disease-sodium (MELD-Na), and complete Rockall score (CRS) predict such outcomes, but with limitations. The platelet-albumin-bilirubin (PALBI) score is an attractive, rapid scoring system for predicting 6-week adverse outcomes after AVB.

Aim: To correlate 5-day and 6-week outcomes after AVB with the PALBI score against the MELD-Na, CTP, and CRS.

Methods: Two hundred fifty patients presenting with AVB over the 20-month study period were investigated. CTP, MELD-Na and PALBI, and CRS scores were calculated; patients were followed for 6 weeks. The areas under the receiver-operator characteristic curves (AUROCs) were compared.

Results: The most common etiology for cirrhosis was ethanol (52.8%). Sixty-five patients were PALBI-1 (26%), 46 PALBI-2 (18.4%), and 139 PALBI-3 (55.6%). Ninety-five rebleeding events (30%) and 30 mortalities (12%) were noted over the follow-up period. AUROCs for predicting adverse outcomes at 5 days were 0.888 for CTP, 0.833 for MELD-Na, 0.777 for CRS, and 0.720 for PALBI; and at 6 weeks, were 0.885 for CTP, 0.821 for MELD-Na, 0.709 for CRS, and 0.856 for PALBI. AUROCs were statistically significant ( P  < 0.001). Compared to other scores, PALBI showed no statistically significant difference compared to the MELD-Na and CTP scores at week 6.

Conclusion: PALBI score on admission is a good predictor of adverse outcomes within 6 weeks in patients who present with variceal bleed.

Background and aim: Dysphagia is an alarming symptom often associated with upper gastrointestinal organic diseases. Its incidence has increased in the last decades, although updated clinical data related to patients presenting with dysphagia are lacking. Thus, in this study, we aimed to provide an update of the main characteristics of patients presenting with dysphagia to an outpatient clinic.

Methods: We retrospectively evaluated consecutive patients first referred to our outpatient clinic (June 2021-December 2022) for dysphagia as the main symptom. All patients underwent upper digestive endoscopy as the first diagnostic examination, with or without biopsies. According to clinician assessment, patients also underwent high-resolution manometry (HRM).

Results: During the study period, a total of 78 patients met the inclusion criteria. Endoscopy showed abnormal features in 25 patients (32.1%), and the most common findings were those associated with eosinophilic esophagitis ( n  = 8, 10.3%). Biopsies of the esophagus and/or cardia were obtained in 61 patients (78.2%), and 28 patients had abnormal histologic findings. Overall, the most common histological diagnosis was eosinophilic esophagitis, identified in 12 patients (15.3%), with 4/12 (33.3%) without endoscopic alterations suggestive of this diagnosis. HRM was performed in 34/78 patients (43.6%), and in these patients, achalasia was the most common diagnosis (7/34, 20.6%).

Conclusion: Among patients complaining of dysphagia referred to an outpatient gastroenterology clinic, eosinophilic esophagitis is the most common underlying cause of the symptom. Given its high frequency, biopsies should always be performed in patients with dysphagia, regardless of endoscopic findings.

Background and aims: Barrett's esophagus is the only known precursor lesion to esophageal adenocarcinoma (EAC). Barrett's esophagus and EAC are less common in African Americans than in non-Hispanic Whites. Studies in European populations have identified Barrett's esophagus-associated risk loci; however, none have examined loci in African Americans cohorts. We conducted a case-control targeted replication study to investigate previously identified Barrett's esophagus risk loci in an African Americans cohort in the All of Us (AoU) Research Program.

Methods: We abstracted phenomic and genomic data from 108 African Americans with Barrett's esophagus and 778 African Americans controls in the AoU database. We examined 16 single-nucleotide polymorphisms (SNPs) identified in individuals of European origin in the largest Barrett's esophagus genome-wide association study to date. We conducted a logistic regression, adjusting for age, sex, and global ancestry, to assess associations between SNPs and Barrett's esophagus/control status.

Results: Of 16 SNPs examined, logistic regression analysis showed three SNPs (rs42202, rs62217, and rs848092) were associated with Barrett's esophagus risk at Bonferroni-adjusted significance ( P < 3.1e-3) and in the same direction as previously reported. One SNP, rs2701111, met significance but showed a discordant association with Barrett's esophagus in African Americans. The association with the remaining 12 SNPs was not replicated. Effect sizes were generally larger for each SNP in our African Americans cohort.

Conclusion: This study evaluated 16 Barrett's esophagus-associated SNPs in African Americans and confirmed associations for only three Barrett's esophagus-associated variants shared across populations. The nonreplication of most loci and differences in association patterns suggest distinct genetic factors influence Barrett's esophagus in admixed populations. These findings underscore the need for discovery and replication in diverse populations.

Objective: Percutaneous liver biopsy (PLB) is the gold standard for diagnosing liver diseases, yet postoperative bleeding remains the most common and severe complication, constraining its clinical application. Accurate prediction of postoperative bleeding risk is essential to enhance PLB safety.

Methods: This study first used multivariate regression analysis in a retrospective cohort to identify independent risk factors associated with postoperative bleeding after PLB. Based on these factors, a preoperative bleeding risk scoring system was further developed, and its performance was analyzed across subgroups defined by different clinical indications. Finally, the model and scoring system were prospectively validated in an external cohort to assess generalizability.

Results: Multivariable analysis identified lesion type, portosystemic shunt (PSS), and total bilirubin as independent risk factors, and a significant interaction between lesion type and PSS status was observed. The bleeding-prediction model was: logit(P) = -3.5 + (1.223 × lesion type) + (1.018 × PSS) + (0.454 × total bilirubin) + (1.523 × lesion type × PSS). The scoring system derived from these factors showed a marked increase in postoperative bleeding rate with rising scores and demonstrated good discrimination in both the standard-indication group (the area under the receiver operating characteristic curve = 0.892) and the super-indication group (the area under the receiver operating characteristic curve = 0.846). External validation further confirmed robust generalizability across populations.

Conclusion: The preoperative bleeding-prediction model and risk scoring system developed in this study can accurately predict postoperative bleeding after PLB, enhance PLB safety, and support optimization of preoperative assessment and postoperative management in clinical practice for diverse patient groups effectively.

Objective: The main objective of this study is to investigate the prognostic value of serum protein induced by vitamin K absence or antagonist-II (PIVKA-II) in predicting postoperative outcomes for hepatocellular carcinoma (HCC) patients after surgical resection.

Methods: Serum PIVKA‑II levels were compared between early‑stage (stage I+II) and advanced‑stage (stage III+IV) HCC patients. Correlations between PIVKA‑II and clinicopathological features were examined. Kaplan‑Meier curves were plotted to assess overall survival (OS) and recurrence‑free survival (RFS) by PIVKA‑II levels. Receiver operating characteristic (ROC) analysis compared the predictive performance of PIVKA‑II and α ‑fetoprotein (AFP), with DeLong 's test evaluating differences in area under the curve. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors for postoperative survival and recurrence.

Results: Serum PIVKA‑II levels were significantly elevated in HCC patients compared with controls (P < 0.01), and were higher in advanced‑stage than early‑stage HCC (P < 0.01). PIVKA‑II correlated significantly with tumor diameter, tumor node metastasis classification, lymph node infiltration, distant metastasis, differentiation, and complication incidence (all P < 0.05). Patients with high PIVKA‑II (≥100 mAU/ml) had shorter median OS and RFS than those with low levels (<100 mAU/ml) (P < 0.01). PIVKA‑II outperformed AFP in predicting 5‑year survival and recurrence (P < 0.05), and combined use improved predictive accuracy (P < 0.05). Multivariate Cox regression identified PIVKA‑II ≥100 mAU/ml as an independent prognostic factor for both OS and RFS (P < 0.05).

Conclusion: Our study confirms that serum PIVKA-II can serve as a prognostic predictor for HCC patients after surgical treatment.