European Journal of Gastroenterology & Hepatology最新文献

Background: Depressive symptoms are common in individuals with inflammatory bowel disease (IBD) and are associated with poor disease outcomes. Transcutaneous electrical acupuncture point stimulation (TEAS) is a noninvasive intervention with potential benefits for inflammation but remains untested in IBD. We developed a smartphone application for home-based TEAS self-administration and evaluated its feasibility, acceptability, and preliminary effects.

Methods: In a randomized feasibility study, IBD patients with Patient Health Questionnaire-9 (PHQ-9) scores ≥ 8 were recruited through Crohn's and Colitis UK. Participants were remotely trained to use the TEAS device, locate acupoints, and self-administer the treatment via the app. Group A completed 30-min daily sessions for 21 days from week 1, while Group B started in week 6. Outcomes [recruitment, retention, acceptability, depression, fatigue, pain, and quality of life (QoL)] were assessed at baseline, week 4, and week 9.

Results: Of the 109 individuals of interest, 57 were assessed, 37 were eligible, and 36 were randomized. In Group A, 83% (15/18) completed ≥ 18 sessions, compared to 50% (9/18) in Group B. The questionnaire completion rates were 92% ( n  = 33) at baseline, 83% ( n  = 30) at 4 weeks, and 67% ( n  = 24) at 9 weeks. Most participants (81%) recommended TEAS. Preliminary analysis showed reduced depressive symptoms and improved QoL postintervention and at the follow-up. Postintervention, the mean PHQ-9 score decreased from 13.9 to 7.7 in Group A and from 14.2 to 6.5 in Group B.

Conclusions: Home-based TEAS is feasible, acceptable, and has a clinical potential. A full-scale randomized controlled trial is needed to confirm its efficacy in the treatment of IBD-related depression.

Introduction: Endoscopic submucosal dissection (ESD) is a promising technique for early-stage gastrointestinal neoplasms; however, its use for periappendiceal lesions poses challenges because of anatomical complexities and the potential risk of appendicitis or perforation. As a result, these lesions are often managed surgically. This systematic review and meta-analysis evaluate the safety and efficacy of ESD for periappendiceal lesions.

Methodology: A systematic search across multiple databases was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies focused on adult populations undergoing ESD for periappendiceal lesions. The primary outcome was a technical success, and secondary outcomes included R0 resection, en-bloc resection, adverse events, and need for surgery. Data were reported using percentages with associated confidence intervals (CIs) and heterogeneity ( I ²).

Results: Six studies comprising 298 patients were included. Technical success was achieved in 98% (95% CI: 97-100%, I2  : 4.63%), with R0 resection and en-bloc resection rates of 84% (95% CI: 77-91%, I2  : 61.86%) and 92% (95% CI: 86-97%, I2  : 66.11%), respectively. The overall rates of polyp recurrence, appendicitis, and bleeding were 0.1% (95% CI: 0-2%, I2  : 0%), 3% (95% CI: 0-4%, I2  : 0%), and 1% (95% CI: 0-3%, I2  : 0%), respectively. Conversely, perforation exhibited a relatively high incidence of 11% (95% CI: 3-19%, I2  : 84.55%); however, the need for surgical intervention was 6% (95% CI: 1-10%, I2  : 74.12%).

Conclusion: ESD provides a safe and effective alternative to surgical resection for managing periappendiceal lesions.

Background: Patients with suspected common bile duct stones are classified as high risk (HR), intermediate risk (IR), or low risk (LR) based on the American Society for Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE), and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). This study validated common bile duct microlithiasis (CBDM) clinical risk stratification utility.

Methods: We retrospectively reviewed cases of suspected CBDM between November 2017 and May 2024. After liver function tests, ultrasound or computed tomography, all patients were stratified according to ASGE, ESGE, and SAGES into HR, IR, and LR.

Results: Among 269 HR patients, diagnostic accuracy was 61.71% [95% confidence interval (CI): 55.77-67.32] for ASGE, 60.59% (95% CI: 54.65-66.25) for ESGE, and 56.51% (95% CI: 50.53-62.30) for SAGES. In the IR group, CBDM confirmation by endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) revealed: under ASGE ( n = 108), E US detected CBDM in 52 (no stones: 13) vs. MRCP identified CBDM in 19 (negative: 46), yielding 36.5% sensitivity; for ESGE ( n = 93), EUS identified CBDM in 46 (no stones:9) vs. MRCP identified CBDM in 32 (negative: 25) at 69.6% sensitivity; per SAGES ( n = 69), in the 43 receiving both modalities, EUS detected CBDM in 37 (no stones: 6) vs. MRCP detected CBDM in 14 (negative: 29) with 37.8% sensitivity.

Conclusion: We validated ASGE, ESGE, and SAGES for CBDM prediction but found suboptimal. EUS demonstrates superior sensitivity over MRCP for IR evaluation.

Background: Cardiovascular disease (CVD) risk increases in patients with metabolic-associated fatty liver disease (MAFLD). While sleep duration is linked to CVD risk, it is unclear whether it differs between individuals with and without MAFLD.

Methods: Data from the National Health and Nutrition Examination Survey (2007-2020; n  = 10 386) were analyzed using multivariable logistic regression to examine the relationship between sleep duration and CVD. Subgroup analyses and a restricted cubic spline model assessed interactions and potential nonlinear associations, while Mendelian randomization (MR) was used to infer causality.

Results: Long sleep duration (≥9 h) was associated with an increased CVD risk in MAFLD patients [ P  = 0.005, odds ratio (OR) = 1.92, 95% confidence intervals (CI): 1.22-3.02], while short sleep duration (≤6 h) was linked to a higher CVD risk in non-MAFLD individuals ( P  = 0.030, OR = 1.63, 95% CI: 1.05-2.52). Subgroup analysis revealed that marital status modified this association in MAFLD patients. A U -shaped relationship was observed, with the lowest CVD risk occurring at 6.7 h of sleep for MAFLD patients and 7.9 h for non-MAFLD individuals. MR suggested a causal link ( P  = 0.03, OR = 1.42, 95% CI: 1.02-1.97), with the results remaining robust after adjusting for potential confounders.

Conclusion: Long sleep duration increases CVD risk in MAFLD patients, with a U -shaped relationship indicating the lowest risk at 6.7 h of sleep in MAFLD and 7.9 h in non-MAFLD individuals. MR analysis suggests a causal link between sleep duration and CVD.

Objective: Refractory celiac disease-type II (RCDII) is the more severe and adverse form of celiac disease; however, its association with other autoimmune diseases remains unclear. We conducted a phenome-wide association study (PheWAS) to examine the association between the polygenic risk score (PRS) for RCDII and autoimmune diseases.

Methods: To construct the PRS-RCDII, we extracted summary statistics for three non-human leukocyte antigen genetic variants, which were independently associated with RCDII ( r2 < 0.001; P < 5 × 10 -5 ) in a genome-wide association study. We then conducted a PRS-PheWAS in the UK Biobank to investigate the associations of PRS-RCDII with 27 autoimmune diseases, adjusting for age, sex, genetic batch, and genetic ancestry. False discovery rate (FDR < 0.05) correction was applied to account for multiple comparisons.

Results: Our study population comprised 373 022 UK Biobank participants (mean age: 57.2 years), of whom 202 865 (54.4%) were females. We constructed the PRS-RCDII, using three genetic variants, namely rs2041570 on chromosome 7p14.3 ( FAM188B ), rs7324708 on chromosome 13q22.1 ( KLF12 ), and rs205047 on chromosome 17p12 ( SHISA6 ). In the PRS-PheWAS, two phenotypes were initially associated with RCDII at a nominal P value threshold, ankylosing spondylitis and systemic sclerosis; however, after adjusting for multiple comparisons, only the association with ankylosing spondylitis remained statistically significant (odds ratio per 1 SD increase = 1.13; 95% confidence interval: 1.04-1.22; PFDR = 0.023). Sex-stratified and single-nucleotide polymorphism (SNP)-by-SNP analyses revealed no significant heterogeneity.

Conclusion: Our study identified an association between the genetic risk score for RCDII and ankylosing spondylitis, but not with other autoimmune diseases. This finding may have clinical importance for people with RCDII, although replication in future studies is needed.

Objective: Platelets play important roles in thrombosis, immunity, and inflammation. Recent studies have shown a relationship between platelet indices and nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH). However, the nature and direction of this causal relationship remain controversial. This study used two-sample Mendelian randomization (MR) to elucidate the potential causal relationships.

Methods: Genetic associations of platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) were obtained from the summary statistics of a genome-wide association study from the UK Biobank, those of NAFLD/NASH were sourced from the FinnGen database, and two different genome-wide association meta-analyses. Inverse variance weighting was conducted, with weighted median, Mendelian randomisation-Egger, and Mendelian randomisation Pleiotropy Residual Sum and Outlier methods used as sensitivity analyses. Estimates from the inverse variance weighting method were meta-analyzed. Reverse MR Analysis was conducted using NAFLD data.

Results: Increased genetically predicted PDW levels were consistently associated with increased NAFLD risk from all three sources (OR = 1.08, 95% CI = 1.01-1.15; P  = 0.020). Genetically predicted NAFLD was associated with increased MPV (OR = 1.008, 95% CI: 1.005-1.032; P  = 0.008). Increased levels of genetically predicted PDW were associated with an increased risk of NASH (OR = 1.603, 95% CI: 1.154-2.228; P  = 0.005). Decreased levels of genetically predicted PLT and PCT were associated with an increased risk of NASH (OR = 0.679, 95% CI: 0.487-0.947, P  = 0.023; OR = 0.587, 95% CI: 0.408-0.843; P  = 0.004).

Conclusion: Our results suggest that fluctuations in platelet indices are important in predicting the onset and progression of NAFLD/NASH.

Functional gastrointestinal disorders impact 40% of the global population, with irritable bowel syndrome (IBS) standing out due to its complexity, quality-of-life effects, and economic impact. Our meta-analysis explored the global prevalence of IBS, considering diagnostic criteria, subtypes, sampling methods, geographical variations, and risk factors. The literature search used databases like PubMed and Cochrane Library, focusing on IBS studies from 2006 to June 2024. Eligibility criteria included studies on individuals aged ≥18, based on Rome III/IV criteria, using random or convenience sampling. Data on IBS prevalence, subtypes, and sampling methods were extracted, and statistical analysis was performed using Open MetaAnalyst and the review manager. The study reviewed 96 articles on IBS prevalence using Rome III and IV criteria across 52 countries, revealing a global prevalence of 14.1%. Prevalence varied by subtype: IBS-C (26.1%), IBS-D (26.5%), IBS-M (31.4%), and IBS-U (8.3%). IBS-D was more prevalent under Rome III (26.2%), while IBS-C was more common under Rome IV (34.2%). First-world countries like the UK, China, and Japan had the highest prevalence. Females [odds ratios (OR): 1.49], stress (OR: 2.47), anxiety (OR: 2.93), and depression (OR: 2.24) were significantly more prevalent in IBS patients, while no significant differences were found in smoking, alcohol use, or education levels. This meta-analysis reveals regional and subtype variations in IBS prevalence, with psychological factors significantly impacting its development. The influence of sampling techniques and Rome III/IV criteria on prevalence estimates highlights the need for a multidisciplinary treatment approach, with important implications for IBS management.

Hepatocellular carcinoma (HCC) recurrence remains a significant clinical challenge, even among patients who undergo surgical treatment. Although statins exhibit anticancer properties through several biologically plausible mechanisms, robust clinical evidence supporting their role in preventing HCC recurrence is still limited. This meta-analysis aimed to evaluate the impact of statin use on the prognostic outcomes of patients undergoing either liver transplantation or surgical resection. This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and identified relevant studies from electronic databases, including PubMed, Cochrane Library, Scopus, EBSCOhost, and ProQuest. The quality of the included studies was appraised using the Newcastle-Ottawa Scale tool. A meta-analysis was performed by estimating the hazard ratio (HR) with a 95% confidence interval (CI). A total of 15 studies encompassing 37 160 patients were included, with most evaluating statin use after surgical resection. The overall quality assessment yielded a low risk of bias. Our findings highlight a significant benefit of statin use following either liver transplant or resection, showing a significant improvement in overall survival (HR, 0.50; 95% CI, 0.40-0.61; P < 0.001). Moreover, further analysis also revealed that statins were associated with improved recurrence-free survival of HCC (HR, 0.56; 95% CI, 0.49-0.65; P < 0.001). Our study suggests that statins exert a protective effect, reflected in improved survival and reduced HCC recurrence. These findings support the potential role of statins as an adjunctive therapy in HCC management, potentially improving long-term outcomes. Further research is needed to confirm survival outcomes and safety. p.

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.