European Journal of Gastroenterology & Hepatology最新文献

Objective: This study aimed to investigate the characteristics and prognosis of recompensation in hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF).

Methods: A total of 136 patients with HBV-related ACLF were followed up until the end of the study. Patients were categorized into recompensation and non-recompensation groups based on whether recompensation occurred in the first year. The survival rate and incidence of recompensation were calculated using the Kaplan-Meier method.

Results: According to the BAVENO VII consensus criteria, 56 (41.18%) of these patients with ACLF regained recompensation in the 1-year follow-up. The recompensated group had less severe liver damage, higher alpha-fetoprotein, lower age, and lower model for end-stage liver disease score. Specifically, in terms of complications, the recompensated group showed a lower incidence compared with the non-recompensated group ( P  < 0.05). The 3-, 6-, 12-, 36-, and 60-month cumulative survival rates of ACLF were 44.9, 43.4, 43.4, 40.4, and 40.4% respectively. Among the patients who survived beyond 90 days, 57/61 (93.44%) patients showed recompensation of ACLF (with one patient recovering to recompensation after more than 1 year of follow-up), the 3-, 6-, 12-, and 24-month cumulative recompensation rates were 56.5, 90.9, 94.6, and 97.3%, respectively. Among the 57 patients with recompensation of ACLF, 87.7% maintained a stable condition, and 10.5% were diagnosed with hepatocellular carcinoma (HCC).

Conclusion: Milder necrosis, less inflammation, and more vigorous hepatic regeneration are conducive to recompensation and a better long-term prognosis in ACLF. However, the occurrence of HCC cannot be avoided and regular monitoring is necessary in the recompensation of ACLF.

Background: Some studies have found that high dietary inflammatory index (DII) increases stroke risk, but previous studies have mostly been conducted in the general population, and the exact relationship between DII and stroke in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is not clear.

Methods: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2009-2016) to investigate the association between the DII and stroke. DII was computed according to established methods. Participants were categorized into tertiles of DII (Q1-Q3). Multivariate weighted logistic regression analysis, smooth curve fitting, and subgroup analysis were employed to explore this relationship. Subgroup analyses were conducted based on demographic and clinical variables.

Results: A total of 2426 individuals were enrolled in our study. The overall prevalence of stroke in the study population was 4.66%. The smooth curve fitting analysis indicated a J-shaped relationship between DII and stroke among individuals with MASLD. In multivariate weighted logistic regression analysis, the odds ratio (OR) of DII is 1.17 (95% CI: 1.03-1.38) for stroke, with a turning point of 1.89. After the turning point, the OR (95% CI) was 1.22 (1.08-2.56). In subgroup analysis, DII still increased the risk of stroke independently.

Conclusion: Our study highlighted a J-shaped association between DII and stroke in adults with MASLD from USA.

There are no Food and Drug Administration (FDA)-approved treatment options for nonalcoholic steatohepatitis (NASH) which is a prevailing disease that leads to fibrosis, cirrhosis, or hepatocellular carcinoma. Hence, this systematic review and meta-analysis aims to determine the efficacy and safety of resmetirom, the first FDA-approved drug, for the treatment of NASH. A Grading of Recommendations, Assessment, Development, and Evaluation assessed systematic search of Cochrane Library , MEDLINE , Scopus , and Google Scholar database was conducted from inception till 31 March 2024. Meta-analyses were carried out in accordance with the PRISMA statement. Heterogeneity was determined to be significant if found above 50%. This meta-analysis encompasses three randomized clinical trials, including a total of 2231 patients. The findings show resmetirom's significant efficacy in several key outcomes, including improvement in fibrosis risk ratios, 1.67 [95% confidence intervals (CI), 1.26-2.20], reductions in liver fat content (95% CI, -39.58 to -23.5), and enhanced liver fibrosis score (95% CI, -0.37 to -0.13) along with improved levels of liver enzymes. Resmetirom was found to be associated with nausea and diarrhea. This is the first systematic review and meta-analysis to determine the safety and efficacy of resmetirom which showed significant positive results in fibrosis improvement, liver fat content, lipid profiles, and liver enzymes in comparison to placebo. Moreover, moderate side effects, such as diarrhea and nausea, were seen in few patients indicating a satisfactory safety profile.

Background/aims: Metabolic-associated steatotic liver disease (MASLD) has become the most common chronic liver disease, especially in people with type 2 diabetes mellitus (T2DM). Liver biopsy remains the gold standard method for diagnosis of MASLD subtypes, but prevalences may be under or overestimated when biopsy is performed with selection bias. The aims of this study were to define prevalence of MASLD subtypes by liver biopsy in T2DM participants not selected by abnormal exams, determine variables associated with metabolic-associated steatohepatitis (MASH), and analyze performance of aminotransferases and abdominal ultrasound in diagnosis.

Methods: T2DM participants from 18 to 70 years were considered for enrollment. Of the 396 participants, 85 were included and submitted to clinical, laboratory examinations, and ultrasound. Eighty-three performed liver biopsy evaluated by two independent pathologists. Factors independently associated to MASH and significant fibrosis were assessed by hierarchical multivariate logistic regression.

Results: Prevalence of MASLD was 92% (50% simple steatosis, 42% MASH) and kappa = 0.78. Steatosis was mild in 76% of participants with simple steatosis and severe in 65% of MASH (P < 0.001). Presence of MASH or fibrosis was associated with BMI and alanine aminotransferase (ALT) [threshold of 33.5 mg/dl in predicting MASH (area under the curve = 0.82, P = 0.001)].

Conclusion: Prevalence of MASLD by liver biopsy in T2DM regardless of ultrasound or ALT elevation is almost 100%, with 42% of MASH. MASH was associated to severe steatosis on histology. BMI and ALT were independently associated with MASH and ALT close to the upper limit of normal gave the best cutoff point for MASH detection.

Introduction: Gastroenterology training usually coincides with childbearing years and pregnancy and parenthood during training can impact trainees' work-life-family balance.

Aim: The aim was to assess the challenges that gastroenterology trainees in Europe encounter during pregnancy and parenthood.

Methodology: A questionnaire was distributed electronically, targeting doctors who were pregnant or had a pregnant partner during their gastroenterology training in the last 10 years.

Results: The study included 82 women and 22 nonpregnant partners. Fear of being perceived negatively was prevalent (n = 59, 72.0%) as well as concern that the pregnancy would negatively impact on training (n = 54, 65.9%). Participants reported several hazards that were not addressed during pregnancy, namely exposure to non-scavenged anesthetic gases (34.1%) and exposure to blood-borne illnesses (28.0%). Formal training programs' maternity leave policies were reported by only 34.1% (n = 28) of women and 45.5% (n = 10) of men. Satisfaction with the duration of parental leave was 85.1% (n = 63) for women and 50% (n = 11) for men. Women reported greater difficulty coping with early parenthood during gastroenterology training than men (women: n = 14, 18.4% vs. men: n = 10, 45.5%; P = 0.014) while worrying that having children would impair their career progress (women: n = 40, 52.6% vs. men: n = 8, 36.4%; P = 0.015).

Conclusion: This European study has demonstrated perceptions of negative stigma related to childbearing, concerns of unaddressed health hazards, dissatisfaction with parental leave policies and a desire for more discussion on a healthy work-family-life balance.

Background: Post-COVID entails persistent symptoms following a presumed or confirmed SARS-CoV-2 infection. This study aims to evaluate post-COVID general health symptoms reported by patients with IMIDs.

Methods: An online questionnaire was distributed to IMID patients on systemic therapy at dermatology, rheumatology, and gastroenterology departments in the Netherlands. General health symptoms were compared between patients with and without prior SARS-CoV-2 infection. Multivariable logistic regression was used to adjust for disease-related factors and known post-COVID risk factors. Self-reported prevalence of post-COVID symptoms was assessed by asking patients if they linked their symptoms to the previous SARS-CoV-2 infection.

Results: A total of 1518 patients were included, and 58% (n = 877) reported ≥1 SARS-CoV-2 infections. When assessing self-reported prevalence of post-COVID symptoms, 13.9% (122/877) linked their symptoms to a previous infection. Patients with a previous infection showed higher prevalence of symptoms than those without (56.2%, 43.9%; P < 0.001), and higher prevalence of fatigue (42%, 32%; P < 0.001). After adjusting for potential risk factors, previous infection was associated with symptoms (OR: 1.53; 95% CI: 1.23-1.91; P < 0.001), and fatigue (OR: 1.31; 95% CI: 1.04-1.64; P = 0.021). Subanalysis showed an association between self-reported COVID-19 severity and symptoms, while presumed SARS-CoV-2 variant (based on date of reported infection) and number of infections were not associated.

Conclusion: The self-reported prevalence of general health symptoms, particularly fatigue, is significantly higher in IMID patients with a previous SARS-CoV-2 infection. The cause of this increase requires further investigation and might provide insights into the pathogenesis of post-COVID, both relevant for IMID patients as well as the general population.

Endoscopic biliary sphincterotomy (EBS) is commonly performed during endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant biliary obstruction (MBO) before stent placement. Studies comparing adverse events between patients with MBO undergoing ERCP with and without EBS have reported conflicting results. We conducted an updated meta-analysis including randomized controlled trials (RCTs) only to evaluate the safety of EBS in these patients and its efficacy in decreasing the risk of post-ERCP pancreatitis (PEP). We reviewed several databases from inception to 10 January 2024 to identify RCTs that compared adverse events of biliary stenting with and without EBS in the patients with MBO. Our outcomes of interest were PEP, successful stent insertion, and adverse events such as cholangitis, bleeding, perforation, stent migration, and stent occlusion. We calculated pooled risk ratio with 95% confidence intervals (CIs) for all of the outcomes and used a random effect model to analyze the data. We included six RCTs with 1070 patients. There was no significant difference in rate of PEP between groups [risk ratio (95% CI): 0.50 (0.23-1.08)]. We found no significant difference in the rate of successful stent insertion between groups [risk ratio (95% CI): 1.01 (0.99-1.02)]. The rate of post-ERCP bleeding was significantly higher in EBS group [risk ratio (95% CI): 7.43 (2.45-22.53)]. We found no significant difference in rates of cholangitis, perforation, stent migration, and stent occlusion between groups. EBS does not decrease the risk of PEP in patients with MBO and is associated with increased risk of bleeding.

Background: Nonalcoholic fatty liver disease (NAFLD) has been identified as an emerging risk factor for hepatocellular carcinoma (HCC). Identifying non-cirrhotic NAFLD patients at risk for HCC is crucial. We aimed to investigate the utility of noninvasive tests (NITs) as predictors for HCC and to determine optimal and cost-effective NIT cutoffs for HCC surveillance in non-cirrhotic NAFLD patients.

Methods: Medline, EMBASE, and Scopus databases were searched for studies evaluating the relationship between NITs and HCC in this population. Random-effects models were used to estimate hazard ratios or risk ratios and 95% confidence interval (95% CI). Cutoffs of NITs for identifying high-risk patients for HCC were determined.

Results: This systematic review comprised 20 studies. A meta-analysis of 379 194 patients was conducted using six studies with individual patient data and five studies with aggregate data. Among NITs studied, fibrosis-4 index (FIB-4), aspartate aminotransferase to platelet ratio index (APRI), and NAFLD fibrosis score (NFS) were significantly associated with HCC, with pooled risk ratio (95% CI) of 9.21 (5.79-14.64), pooled hazard ratio of 12.53 (6.57-23.90), and 13.32 (6.48-27.37), respectively. FIB-4, APRI, and NFS of more than 2.06, 0.65, and 0.51 resulted in the highest area under the receiver operating characteristics of 0.83, 0.80, and 0.85, respectively. Surveillance in patients with FIB-4 ≥ 5.91 and NFS ≥ 2.85 would be cost-effective with an annual HCC incidence of ≥15 per 1000 patient-years.

Conclusion: FIB-4, APRI, and NFS are associated with HCC development in non-cirrhotic NAFLD patients. Different NIT cutoffs may be used to enroll high-risk NAFLD patients for HCC surveillance, according to resource availability in different settings.

Background: Musculoskeletal manifestations occur in half of the patients with inflammatory bowel disease (IBD) and contribute to a reduced quality of life (QoL) and increased work disability. We aimed to evaluate the natural disease course, characteristics, and risk factors of musculoskeletal manifestations in patients with IBD.

Methods: We performed a prospective longitudinal cohort study in patients with IBD with and without musculoskeletal manifestations with a 1-year follow-up. Primary outcome was the proportion of patients with resolution of musculoskeletal manifestations. Secondary outcomes included the proportion of patients with IBD that developed new musculoskeletal manifestations during follow-up; the correlation among IBD activity, baseline characteristics, and musculoskeletal disease course; and the difference in QoL between patients with and without musculoskeletal manifestations.

Results: In total, 243 patients with IBD were included (124 with and 119 without musculoskeletal manifestations). In the majority of patients (62.2%), musculoskeletal manifestations were of noninflammatory nature. Overall, peripheral and axial manifestations were persistent in 85.7 and 44.6% at 1 year, respectively. The QoL at baseline and at 1 year was lower in the group with musculoskeletal manifestations compared with patients without these manifestations. Female sex and age above 40 were associated with the presence of musculoskeletal manifestations.

Conclusion: Musculoskeletal manifestations in patients with IBD are mostly noninflammatory disorders, persist at 1 year of follow-up, and occur more frequently in patients of age above 40 and female sex. Overall, patients with musculoskeletal manifestations have lower QoL compared with patients without musculoskeletal manifestations.

Background: Excessive alcohol consumption is a major risk factor for liver disease, with significant variations in its impact across populations. BMI has been identified as a potential mediator in alcohol-related liver damage. This study aimed to examine the association between alcohol consumption and liver function and to explore the mediating role of BMI in a population from India, where both are rising public health concerns.

Materials and methods: A cross-sectional study was conducted using data from adult participants. Liver function was assessed using serum levels of gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP). Alcohol consumption was self-reported, and BMI was calculated AST from height and weight measurements. Multiple linear regression models were used to evaluate the relationship between alcohol consumption and liver enzymes while adjusting for BMI as a mediator. Statistical significance was set at P < 0.05.

Results: The results indicated that higher alcohol consumption was significantly associated with elevated levels of GGT, ALT, and AST. BMI was found to mediate this relationship, with individuals having higher BMI showing a greater increase in liver enzyme levels in response to alcohol consumption. However, no significant association was observed for ALP. BMI also independently correlated with higher levels of GGT, ALT, and AST.

Conclusion: This study highlights the mediating role of BMI in alcohol-induced liver dysfunction in the Indian population. Public health interventions focusing on both reducing alcohol intake and managing obesity may help mitigate the risk of liver disease in this high-risk population.