European Journal of Gastroenterology & Hepatology最新文献

Objective: Despite national and international guidelines on Helicobacter pylori management, limited evidence exists on how these recommendations are applied in routine clinical practice. This nationwide survey, conducted by the Italian Association of Hospital Gastroenterologists and Endoscopists and the Italian Federation of General Practitioners (FIMMG), aimed to identify the empirical first- and second-line treatments most commonly recommended in Italy.

Methods: Members of societies were invited via email to anonymously complete an original 20-item questionnaire. Ten therapeutic regimens were proposed, with treatment durations classified as 7, 10, or 14 days. Respondents reported the type of proton-pump inhibitor (PPI) used, total daily dose (mg/day), and whether probiotics and/or lactoferrin were recommended. PPI doses were standardized according to acid inhibition potency and categorized as low, standard, or high.

Results: Among the 1262 respondents [358 gastroenterologists (GEs) and 904 general practitioners (GPs)], the first-line regimen most frequently prescribed was the triple therapy with PPI, clarithromycin and amoxicillin (35.2%; 12% of GEs vs. 44.4% of GPs; P < 0.0001), followed by bismuth quadruple therapy - three-in-one capsule (BQT-TSC: 31.2%; 51.4 vs. 23.3%, P < 0.001), and sequential therapy (21.7%; 26.8 vs. 19.7%, P < 0.001). For second-line, BQT-TSC was the most prescribed regimen (53.1%; GEs versus GSs: not statistically significant). 10-day courses and low-dose PPIs predominated, and approximately 1/3 of respondents recommended probiotics.

Conclusion: Empirical regimen selection, PPI dosing, and probiotic use frequently diverged from guideline recommendations. These findings highlight the need to align clinical practice with evidence-based standards to improve eradication rates, optimize cost-effectiveness, and preserve healthcare resources.

Background: Sarcopenia is linked to adverse outcomes in patients undergoing liver transplantation (LT), including higher post-transplant complication rates and mortality rates. The current study aims to assess the impact of sarcopenia on outcomes in LT recipients.

Methods: The National Inpatient Sample Database 2016-2020 was used to identify LT recipients. Patients were categorized into two groups based on the presence or absence of sarcopenia. Data were collected on patient demographics, etiology of liver disease, and decompensation of liver disease. The outcomes studied include in-hospital mortality, shock, acute kidney injury (AKI), ICU stay, and LT-related complications. The impact of sarcopenia was assessed using multivariate logistic/linear regression analysis.

Results: Of the 170 650 LT recipients included in the analysis, 24 525 (14.4%) had sarcopenia. After adjusting for confounding factors, sarcopenia was associated with a higher odds of in-hospital mortality [adjusted odds ratio (aOR), 2.16; 95% confidence interval (CI), 1.83-2.56; P < 0.001], shock (aOR, 2.18; 95% CI, 1.92-2.48; P < 0.001), AKI (aOR, 1.4; 95% CI, 1.32-1.49; P < 0.001), ICU stay (aOR, 2.23; 95% CI, 1.98-2.52; P < 0.001), LT-related complications (aOR, 1.47; 95% CI, 1.23-1.75; P < 0.001), longer length of stay (adj. coefficient, 4.71 days; 95% CI, 4.31-5.10; P < 0.001), and total hospitalization charges (adj. coefficient-$56 359.88; 95% CI, $49 737.17-$62 982.58; P < 0.001).

Conclusion: We noted that sarcopenia is associated with worse outcomes and higher resource utilization in LT recipients, highlighting the need for early detection and targeted interventions.

Background: Inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC) are recognized as interconnected immune disorders, necessitating comprehensive genetic analysis.

Methods: The research employed genome-wide association study (GWAS) data pertinent to IBD and PSC. Initially, linkage disequilibrium score regression alongside SUPERGNOVA was utilized to assess their genetic correlation. The genetic overlap between these two conditions was subsequently evaluated using the conditional/conjunctional false discovery rate (cond/conjFDR) approach. Shared loci pertinent to IBD and PSC were discerned through both conjFDR and multitrait analysis of GWAS (MTAG) techniques. Finally, transcriptome-wide association studies were executed at the tissue level to investigate enriched tissues and expressed genes.

Results: A substantial overall correlation was identified at the genome-wide level between IBD (including Crohn's disease and ulcerative colitis) and PSC. Locally, correlations were prominent as both diseases exhibited enrichment across various chromosomes, with chromosome 9 being particularly noteworthy. The conditional quantile-quantile plot derived from the conjFDR analysis indicated genetic overlap between the two diseases. Using an integrated approach involving conjFDR and MTAG analyses, 15, 12, and 6 shared loci were detected for IBD, Crohn's disease, and ulcerative colitis with PSC, respectively. Furthermore, concurrent enrichment of IBD and PSC was found in seven tissues (spleen, terminal ileum of the small intestine, whole blood, lung, Epstein-Barr virus-transformed lymphocytes, transverse colon, and adipose visceral omentum).

Conclusion: This study provides genetic evidence for the comorbidity of IBD and PSC, enhancing our understanding of the pathophysiological aspects of both diseases.

Background and aims: Accurate prognostication critical for managing liver cirrhosis. Existing tools [Child-Pugh, model for end-stage liver disease (MELD), MELD-sodium (MELD-Na), Albumin-Bilirubin (ALBI), and platelet ALBI (PALBI)] have limitations, including subjectivity, complexity, and reliance on logarithmic transformations. Simplified easy-ALBI (EZ-ALBI), a prognostic factor in hepatocellular carcinoma, is understudied in cirrhosis. The present study aimed to evaluate its prognostic value in cirrhosis, compare it with established scores, assess its consistent long-term performance, and define its clinical utility for risk stratification.

Methods: This retrospective study enrolled 501 cirrhotic patients (June 2018-June 2020), with a median follow-up of 42.3 months (interquartile range: 28.6-56.8 months); follow-up was terminated on 30 June 2025. EZ-ALBI was compared with Child-Pugh, MELD-Na, ALBI, and PALBI using correlation, survival (Kaplan-Meier), Cox regression, and receiver operating characteristic analyses.

Results: EZ-ALBI strongly correlated with ALBI (r = 0.9460, P < 0.001). EZ-ALBI grade 3 was associated with shorter survival (29.9 vs. 65.5 months, P < 0.001) and served as an independent prognostic factor (hazard ratio = 3.944, 95% confidence interval: 1.772-8.777, P < 0.05). Its prognostic accuracy was consistent across 6-60 months (areas under the curves: 0.738-0.832), long-term performance (36-60 months) was comparable to MELD, MELD-Na, and ALBI, and outperformed Child-Pugh and PALBI in specific periods.

Conclusion: The EZ-ALBI score is a simple, objective, and reliable prognostic tool for patients with liver cirrhosis, with consistent predictive value across follow-up periods, supporting its clinical utility for risk stratification. Notably, EZ-ALBI's simplicity (no logarithmic transformations) significantly enhances its practicality for bedside risk stratification, a key advantage in clinical practice.

Tumor necrosis factor-alpha (TNF-α) inhibitors, including infliximab, have redefined the treatment of inflammatory bowel diseases (IBD) such as ulcerative colitis (UC). Despite their efficacy, these agents are associated with rare but serious adverse events, including drug-induced interstitial lung disease (D-ILD). We report a case of infliximab-induced ILD in a 63-year-old male undergoing treatment for UC. The patient presented with fever, dyspnea, and a miliary hypersensitivity pattern on imaging. Infectious causes were excluded, and drug-induced pulmonary toxicity was diagnosed. Discontinuation of infliximab and appropriate management led to gradual clinical improvement. This case highlights the importance of early recognition and management of pulmonary complications associated with TNF-α inhibitors. Given that UC itself and other autoimmune diseases can predispose patients to ILD, we also explore the role of disease activity and additional risk factors, including prior exposure to 5-aminosalicylic acid-based medications. Endoscopic disease activity, fecal calprotectin levels, autoimmune markers (ANA, ENA, ANCA), and bronchoalveolar lavage results are provided to further elucidate the diagnostic process.

Tegoprazan, a novel potassium-competitive acid blocker, has emerged as a potential alternative to proton pump inhibitors (PPIs) for the treatment of erosive esophagitis (EE), especially in light of long-term safety concerns associated with PPIs. This study aimed to assess the efficacy and safety of tegoprazan compared to PPIs in patients with EE. A systematic review and meta-analysis were conducted following preferred reporting items for systematic reviews and meta-analyses guidelines, including three randomized controlled trials with a total of 658 patients diagnosed with EE. The primary outcomes were cumulative endoscopic healing rates across 4-8 weeks and at 4 and 8 weeks, while secondary outcomes included any adverse events, drug-related treatment-emergent adverse events (TEAEs), and serious adverse events (SAEs). Tegoprazan demonstrated noninferior healing rates at 4 weeks [relative risk (RR) = 1.05, 95% confidence interval (CI): 0.96-1.16; P  = 0.28; I ² = 51%] and 8 weeks (RR = 1.01, 95% CI: 0.96-1.06; P  = 0.73; I ² = 0%) compared to PPIs. There was no statistically significant difference in the overall incidence of adverse events or SAEs (RR = 1.19, 95% CI: 0.92-1.53; P  = 0.19; I ² = 24%). However, a significantly higher rate of drug-related TEAEs was observed in the tegoprazan group (RR = 1.23, 95% CI: 1.03-1.48; P  = 0.02; I ² = 0%). In conclusion, tegoprazan is an effective treatment option for EE, with comparable efficacy to PPIs, though further studies are warranted to evaluate its long-term safety before routine clinical use.

Currently, symptomatic gastrointestinal (GI) angiodysplasia is treated with argon plasma coagulation (APC) via endoscopic procedures, supplemented with octreotide or thalidomide treatment. However, suboptimal response and side effects are often seen. Bevacizumab, an angiogenesis inhibitor, may provide an alternative systemic therapy for patients with refractory GI angiodysplasia. A 75-year-old male patient with cirrhosis and portal hypertension due to metabolic dysfunction-associated steatotic liver disease presented with recurrent anemia and overt GI bleeding. Initial endoscopic findings showed a combination of portal hypertensive gastropathy and GI angiodysplasia. Anemia persisted despite repeated APC and octreotide. After transjugular intrahepatic portosystemic shunt, portal hypertensive gastropathy resolved; however, GI angiodysplasia remained and caused refractory symptomatic anemia and overt bleeding. Finally, we resorted to off-label bevacizumab in the absence of other viable treatment options. The patient initially responded to treatment but has needed top-up dosing, the effect of which remains to be evaluated. In conclusion, we describe our initial experience with off-label bevacizumab in the treatment of refractory GI angiodysplasia. Based on our experience and literature, bevacizumab may be a viable option for patients with refractory GI angiodysplasia, which should be further evaluated in future studies before it can be implemented in clinical practice.

Objectives: Single paracentesis is the standard treatment for large ascites. An alternative is the placement of a transient ascites drainage. This study aimed to evaluate the efficacy and safety of transient ascites drainage in patients with large ascites.

Methods: Patients with symptomatic ascites who underwent transient ascites drainage between January 2017 and February 2022 were enrolled in this study. The amount of drained ascites and the duration of the drainage stay were recorded. Drainage-associated acute complications have been documented. Risk factors for complications were analyzed.

Results: A total of 224 ascites drains were inserted into 177 patients. The mean cumulative volume of drained ascites was 14 284 ml (±9987). The duration of drainage varied between 0 and 42 days and averaged 8.57 days (±6.51). The technical success rate of drain placement was 98.21% (220/224). The most common drainage-associated complications were acute kidney injury in 31/224 (13.84%), bacterial peritonitis 16/185 (8.65%), and drainage-associated fistula [21/224 (9.38%)]. There were significant differences between the groups with and without drainage-associated peritonitis in the duration of drainage stay [13.63 (±8.13) vs. 8.06 (±6.20) days; P  = 0.001). The frequency of peritonitis with a length of drainage stay of up to 7 days was 1.92%, with a length of stay greater than 7 days 17.28% ( P  < 0.001).

Conclusion: Transient ascites catheters are effective for the drainage of large-volume ascites. The technical success rate was high, and the procedure itself was safe; however, owing to the high rate of drainage-associated peritonitis, a longer duration of drainage should be avoided.

Background: Nonalcoholic fatty liver disease (NAFLD) is defined by liver fat accumulation exceeding 5% in individuals who do not consume significant amounts of alcohol. This condition can advance to more severe outcomes, including fibrosis, cirrhosis, and liver cancer. Although numerous factors contribute to the progression of NAFLD, the influence of psychological elements, especially anxiety, remains inadequately explored.

Methods: This study applied Mendelian randomization (MR) using genome-wide association data from 4761 NAFLD cases and 373 227 controls to investigate the causal relationship between psychological factors and NAFLD. We conducted both multivariable and mediation MR analyses to determine how anxiety influences NAFLD through pathways involving gut microbiota and metabolites. Furthermore, we examined datasets related to anxiety and NAFLD from the Gene Expression Omnibus, identified differentially expressed genes, and conducted enrichment analyses on the genes shared between these two conditions.

Results: The MR analysis established a direct causal relationship between genetically predicted anxiety and the development of NAFLD (β=0.229, 95% confidence interval = 1.11-1.41, P  = 0.0002). This association was confirmed by multivariable MR, independent of BMI and type 2 diabetes. Mediation MR revealed that specific metabolites and fatty acid-related gut microbiota mediate the relationship between anxiety and NAFLD. Additionally, enrichment analysis confirmed the involvement of fatty acids in genes common to both anxiety and NAFLD.

Conclusion: This study suggests that genetically predicted anxiety contributes to the development of NAFLD by influencing specific gut microbiota and metabolites, underscoring the vital role of mental health in mitigating NAFLD risk.