European Journal of Gastroenterology & Hepatology最新文献

Introduction: Irritable bowel syndrome with constipation (IBS-C) is a common gastrointestinal disorder that significantly impacts quality of life. Tenapanor, a sodium/hydrogen exchanger inhibitor, shows promise in managing IBS-C. This systematic review and meta-analysis aim to evaluate the efficacy and safety of tenapanor 50 mg compared with placebo.

Methods: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted on 7 October 2024 across PubMed, Cochrane, Embase, Scopus, and Web of Science databases. We included randomized controlled trials (RCTs) focusing on adult IBS-C patients aged 18-75. Quality assessment was performed using the risk of bias 2 tool. Primary outcomes included responder rates for abdominal symptoms (pain, discomfort, bloating, cramping, fullness) and complete spontaneous bowel movements (CSBM). Secondary outcomes comprised treatment-related adverse events (AEs) and those leading to treatment discontinuation. Data analysis was conducted using R software.

Results: Three RCTs involving 1378 patients were included. Tenapanor significantly improved symptoms versus placebo, including bloating [relative risk (RR) = 1.32; 95% confidence interval (CI), 1.15-1.51], cramping (RR = 1.27; CI, 1.13-1.44), discomfort (RR = 1.37; CI, 1.21-1.56), fullness (RR = 1.37; CI, 1.20-1.58), pain (RR = 1.37; CI, 1.17-1.49), and CSBM (RR = 1.54; CI, 1.24-1.91). However, tenapanor was associated with higher rates of treatment-related AEs (RR = 2.3; CI, 1.72-3.06) and AEs leading to discontinuation (RR = 9.08; CI, 3.63-22.71).

Conclusion: Tenapanor is effective in improving IBS-C symptoms but has a higher incidence of treatment-related AEs. Further studies are needed to evaluate its long-term safety.

Background: Previous studies have suggested that infection with Epstein-Barr virus (EBV) plays a role in the etiology of Hodgkin lymphoma, multiple sclerosis, systemic lupus erythematosus (SLE), Crohn's disease, and ulcerative colitis. We investigated whether a history of infectious mononucleosis, a well-known marker of early EBV exposure, is also associated with these diagnoses.

Methods: In case-control studies, we examined the concurrence of infectious mononucleosis, Hodgkin lymphoma, multiple sclerosis, SLE, Crohn's disease, and ulcerative colitis in the same patients, using the University of Pennsylvania Health System (UPHS) electronic database. Patients diagnosed with infectious mononucleosis, Hodgkin lymphoma, multiple sclerosis, Crohn's disease, or ulcerative colitis were identified by their corresponding International Classification of Diseases, 10th Revision. We compared the observed concurrence of each two diagnoses with their expected frequencies in the overall UPHS population by calculating odds ratios and their corresponding 95% confidence intervals.

Results: The UPHS database from 2000 to 2024 contained a total of 3 955 827 unique patients. Among these individuals, 10 462 were diagnosed with infectious mononucleosis, 5552 with Hodgkin lymphoma, 16 777 with multiple sclerosis, 18 475 with Crohn's disease, and 22 830 with ulcerative colitis. A prior history of infectious mononucleosis carried a 1.8-7.1-fold increased risk for concurrent Hodgkin lymphoma, multiple sclerosis, SLE, Crohn's disease, or ulcerative colitis. Moreover, anyone of the five diagnoses Hodgkin lymphoma, multiple sclerosis, SLE, Crohn's disease, ulcerative colitis was significantly associated with the concurrence of any other diagnosis from the same group.

Conclusion: The six diagnoses, infectious mononucleosis, Hodgkin lymphoma, multiple sclerosis, SLE, Crohn's disease, and ulcerative colitis tended to cluster in the same patient population. These results support the hypothesis that these diagnoses share a common etiology, most likely related to EBV infection during early lifetime.

Objective: This study aimed to evaluate the demographic, clinical, and procedural characteristics of adult patients presenting to the emergency department (ED) due to gastrointestinal foreign body ingestion (FBI).

Methods: This single-center retrospective observational study included adult patients who presented with FBI to a tertiary hospital ED between January 2020 and December 2023. Demographic data, foreign body characteristics, time to presentation, interventions, and clinical outcomes were analyzed.

Results: A total of 198 patients were evaluated. The median age was 38.5 years (interquartile range: 28-59), and 60.1% were male. Recurrent FBI was present in 21.2% and intentional ingestion in 26.3% of cases. Special clinical conditions were observed in 32.8%, including prisoners (18.7%), psychiatric patients (10.6%), and those with esophageal strictures (4.5%). The median time from ingestion to ED presentation was 2 hours (interquartile range: 1-3); significantly longer in the nonendoscopy group (3.5 hours; P < 0.001). Foreign bodies were most commonly located in the esophagus (35.9%) and stomach (42.9%). Among foreign bodies detected in the esophagus or above, 61.1% were removed endoscopically; in contrast, 79.5% of those located in the stomach or more distal gastrointestinal tract passed spontaneously (P < 0.001). Foreign bodies >5 cm required surgery in 13.3% of cases and were associated with longer presentation times. Complications occurred in 17.7% (n = 35) of patients, especially after bone-containing meat ingestion (28.6%, P = 0.001).

Conclusion: Early presentation and timely intervention appear to reduce the risk of complications and the need for surgery. High-risk populations, such as incarcerated individuals and patients with psychiatric conditions, may benefit from individualized, multidisciplinary management strategies. These findings underscore the potential value of updating existing clinical guidelines to better address the unique challenges posed by these vulnerable groups.

Background: Esophageal hypervigilance and symptom-specific anxiety are emerging as key factors influencing symptom severity in patients with dysphagia and gastro-esophageal reflux disease (GERD). We aimed to evaluate the relative contributions of esophageal hypervigilance, alongside parameters of high-resolution manometry (HRM) and pH study, to esophageal symptom severity.

Methods: Consecutive patients attending HRM with or without a 24-hour pH study at a tertiary referral center were prospectively included from March 2022 to June 2024. Patients completed the following questionnaires: Esophageal Hypervigilance and Anxiety Scale (EHAS-7), Brief Esophageal Dysphagia Questionnaire, and Gastroesophageal Reflux Disease Questionnaire (GERDQ). Pearson's correlation was used to determine the interrelationships between questionnaire results, HRM, and pH study metrics.

Results: A total of 380 patients were included (median age 54; 63.2% female), with 226 undergoing pH studies. EHAS-7 showed stronger correlations with dysphagia symptom severity compared with manometry metrics in patients with normal manometry findings (r = 0.306, P < 0.001), achalasia (r = 0.429, P < 0.050), absent contractility and ineffective esophageal motility (r = 0.611, P < 0.001), and distal esophageal spasm and hypercontractile esophagus (r = 0.536, P = 0.048). Regression analysis showed EHAS-7 independently explained 14.1% of variance (β = 0.382, P < 0.001) in dysphagia severity. In the pH study cohort, both EHAS-7 and pH study metrics had either weak or no correlations with the severity of patients' GERD symptoms.

Conclusion: Esophageal hypervigilance and symptom-specific anxiety correlate more strongly with dysphagia symptom severity than HRM metrics in select patient groups, emphasizing its role in symptom perception.

Objectives: Given the high rate of recurrence in Crohn's disease (CD), postoperative maintenance therapy is crucial for preventing disease recurrence. However, the relationship between infliximab trough levels and postoperative endoscopic recurrence in CD patients has been insufficiently evaluated.

Methods: This study included consecutive postoperative CD patients treated with infliximab for the prevention of postoperative recurrence, with measurement of infliximab serum trough concentrations and colonoscopy performed within 3 months of sampling. Endoscopic recurrence was defined as a Simple Endoscopic Score for Crohn's Disease (SES-CD) score ≥3 or a Rutgeerts' score ≥2.

Results: The final cohort comprised 137 patients, with 70 in the 'no endoscopic recurrence' group and 67 in the 'endoscopic recurrence' group. Infliximab trough levels were significantly lower in patients with recurrence (3.4 vs. 5.9, P = 0.001), with an area under the curve of 0.69 and an optimal cutoff value of 3.15 μg/ml. In the subgroup of patients who have undergone ileocolonic resection, the nonrecurrence group showed significantly higher infliximab trough levels (5.8 vs. 2.4, P = 0.001). In addition, patients with a Rutgeerts' score of 0 had significantly higher trough infliximab levels compared with scores of 2 (P = 0.001). Multivariate analysis confirmed that infliximab trough levels were inversely associated with endoscopic recurrence in the overall cohort, and this association remained significant in the ileocolonic resection subgroup.

Conclusion: Our study demonstrates that lower infliximab trough levels are associated with postoperative endoscopic recurrence in CD patients, both in the overall surgical cohort and in the subgroup of patients who underwent ileocolonic resection.

Background and studys purpose: Endoscopic band ligation is commonly used in gastroenterology but limited in colorectal polyps (CRPs) treatment due to narrow cap diameters. Endoscopic mucosal resection and endoscopic submucosal dissection (ESD) are effective but carry higher bleeding risks in patients with concomitant comorbidities. Considering the narrowest part of the colon, the rectosigmoid junction measures approximately 2.5 cm, we developed a custom endoscopic wide band resection (EWBR) cap with a 24 mm external diameter for CRPs <25 mm, particularly in high-risk patients. This study evaluates the efficacy and safety of EWBR.

Patients and methods: We prospectively collected and analyzed the outcomes of 32 patients with CRPs treated using EWBR and 34 matched patients treated with ESD between November 2020 and December 2024.

Main results: The groups were similar in age, gender, and lesion size (all P  > 0.05). Comorbidities were significantly more common in the EWBR group (78.6 vs. 8.8%; P  < 0.001). EWBR was associated with shorter procedure time (14.2 vs. 35 min; P  < 0.001), lower rates of prolonged bleeding that extended the procedure (3.1 vs. 52.9%; P  < 0.001), smaller hemoglobin decreases (0.55 vs. 1.17 g/dl; P  = 0.002), and shorter hospital stays (1.03 vs. 2.11 days; P  = 0.001). Only one patient (3.1%) in the EWBR group developed asymptomatic minor strictures. No recurrences were observed in either group.

Conclusion: EWBR is a safe and effective alternative for CRPs <25 mm, especially in high-risk patients. It reduces procedure time, bleeding, and hospital stay, making it a promising therapeutic option.

Objectives: Identifying patients at high-risk for endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events (AEs) is important for postendoscopic discharge management. This study assesses two strategies, a urinary trypsinogen-2 (UT-2) dipstick combined with a risk-factor-based ERCP discharge tool, for identifying patients at increased risk of developing AEs.

Methods: Between August 2018 and March 2021, 268 patients were enrolled in a multicenter prospective cohort. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the UT-2 dipstick, the discharge tool, and combined strategies were assessed for predicting ERCP-related AEs.

Results: Twenty-four (10.5%) AEs occurred in the eligible 228 patients, of which 14 (6.1%) were post-ERCP pancreatitis. The discharge tool and UT-2 dipstick combination outperformed the individual strategies for all AEs with a sensitivity of 66.7% (95% CI, 44.7-84.4%), specificity of 78.5% (95% CI, 72.2-83.9%), PPV of 26.6% (95% CI, 19.8-34.8%) and NPV of 95.3% (95% CI, 91.9-97.3%). For post-ERCP pancreatitis alone, the strategies combined had a sensitivity of 64.3% (95% CI, 35.1-87.2%), specificity of 76.2% (95% CI, 69.9-81.7%), PPV of 14.9% (95% CI, 10.0-21.7%) and NPV of 97.0% (95% CI, 94.2-98.5%).

Conclusion: Although the combination of UT-2 dipstick and discharge tool outperforms the two strategies separately in predicting post-ERCP AEs, we would not recommend implementation of either strategy given the low sensitivity when applied separately or combined.

Background/aims: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a global health burden increasing liver-related mortality. Existing cross-sectional studies lack causal evidence between the triglyceride glucose (TyG) index and MAFLD. Utilizing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 and Mendelian randomization, this study aimed to investigate the causal association between the TyG index and MAFLD.

Methods: On the basis of the 2017-2020 NHANES data, baseline characteristics of MAFLD cases and the control group were comparatively analyzed. Multivariate logistic regression evaluated the association between the TyG index and MAFLD, with restricted cubic splines (RCS) employed for nonlinear relationship assessment. A two-sample Mendelian randomization analysis examined potential causal relationships, while comprehensive sensitivity analyses validated the robustness of the principal findings.

Results: Cross-sectional analysis revealed a significant positive linear association between the TyG index and MAFLD risk. After multivariable adjustment, the odds ratio (OR) was 2.30 [95% confidence interval (CI) = 1.71-3.10, P  < 0.001]. RCS analysis further confirmed a monotonic linear relationship between the TyG index and MAFLD risk. The test for nonlinearity was nonsignificant ( P  = 0.07), confirming a linear dose-response. Mendelian randomization analysis indicated that a genetically predicted 1-unit increase in TyG index was associated with 64% higher MAFLD risk (OR = 1.64, 95% CI = 1.07-2.50, P  = 0.02).

Conclusion: This study using cross-sectional data and Mendelian randomization confirms the TyG index as an independent causal risk factor for MAFLD, highlighting the need for early monitoring and intervention to inform precision prevention strategies.

Background: Severe alcohol-associated hepatitis (sAH) has a high short-term mortality, with limited treatment options. Fecal microbiota transplantation (FMT) has shown benefits in small, uncontrolled studies.

Aim: Perform a systematic review and meta-analysis to provide updated evidence on the efficacy and safety of FMT in sAH patients.

Method: Electronic databases were searched till 4 December 2023 for studies comparing FMT with standard of care (SOC) in sAH patients. Sensitivity analysis (leave-one-out method) and subgroup analyses were performed. Pooled risk ratio (RR) was used to compare the survival outcomes.

Results: Eight studies with 444 patients (FMT: 218; SOC: 226) met the eligibility criteria and were included in this meta-analysis. The 28- and 90-day survival range was higher in the FMT group (75-100% and 53-87%) compared to the SOC group (48-80% and 25-56%). The random-effects model showed a statistically significant increase in survival in the FMT arm at 28 days [RR (95% confidence interval) 2.30 (1.24-4.28), P  = 0.01] and 90 days [2.53 (1.34-4.77), P  < 0.001]. However, there was no statistically significant change in survival at the 6-month [1.89 (0.89-4.05), P  = 0.10] and the 12-month time [1.86 (0.68-5.08), P  = 0.23]. Sensitivity analysis showed no major changes in the overall effect sizes, and subgroup analysis showed that the survival benefit was restricted only to the retrospective studies. No serious treatment-related adverse events were reported.

Conclusion: FMT is a safe and efficacious treatment option that improves short-term survival in sAH patients, without major adverse events. A multicentre randomized controlled trial with an adequate sample size is required to confirm these findings.