European Journal of Gastroenterology & Hepatology最新文献

Backgrounds: People with metabolic dysfunction-associated steatotic liver disease (MASLD) frequently report fatigue. This symptom is associated with hepatic inflammation and fibrosis. FibroScan-aspartate aminotransferase (FAST) score is a noninvasive measurement tool that can be used to assess the severity of MASLD. We aimed to investigate the independent factors associated with patient-reported outcomes (PROs) including fatigue, and their FAST scores.

Methods: We enrolled 116 patients with MASLD. PROs were assessed by the Chronic Liver Disease Questionnaire for nonalcoholic fatty liver disease (CLDQ-NAFLD), which consists of six domains including fatigue. Each domain score that was less than 6 was classified into the impairment group. A cutoff value of 0.67 in the FAST score was used to categorize a high or low FAST score. Independent factors associated with impaired PROs and fatigue were analyzed using logistic regression analysis and a graphical model.

Results: For factor total, in the logistic regression analysis, the high FAST score was only identified as a negative independent factor for impaired total CLDQ-NAFLD (odds ratio: 5.9, 95% confidence interval: 1.11-31.20, P  = 0.034). The graphical model revealed that FAST score, BMI, and age directly interact with impaired total CLDQ-NAFLD. For fatigue, there was no statistically significant factor in the logistic regression analysis. The graphical model revealed that the FAST score, BMI, estimated glomerular filtration rate, and age directly interact with fatigue.

Conclusion: We found that the FAST score directly interacted with total CLDQ-NAFLD and the domain of fatigue. The FAST score may be a useful tool to assess impaired CLDQ-NAFLD.

Several studies have reported associations between metabolic dysfunction-associated steatotic liver disease (MASLD) and the risk of various cancers. However, studies focusing specifically on the association between MASLD and thyroid cancer are relatively limited, and the conclusions drawn, thus, far remain inconclusive. In response, we conducted a meta-analysis of relevant cohort studies to clarify the association between MASLD and the risk of thyroid cancer. We systematically searched the Web of Science, Embase, Cochrane Library, and PubMed databases for articles published before 24 September 2024. We utilized the R software (version 4.4.1) for the comprehensive execution of all statistical analyses. Our meta-analysis included eight cohort studies (six retrospective and two prospective), comprising 18 925 396 participants. The pooled results of the eight cohort studies indicate that MASLD is linked to an increased risk of thyroid cancer (HR = 1.46; 95% CI: 1.14-1.86; I ² = 69%; P  < 0.01). A random-effects model was employed due to moderate heterogeneity ( I ² > 50%). Subgroup analyses revealed that the association between MASLD and thyroid cancer risk was stronger in the Chinese population (HR = 2.24; 95% CI: 1.32-3.81; I ² = 51%) and among overweight individuals (HR = 1.29; 95% CI: 1.02-1.63; I ² = 90%). No significant differences were identified between male and female subgroups. This meta-analysis demonstrates that MASLD increases the risk of developing thyroid cancer.

Acute kidney injury (AKI) is associated with poor prognosis. New biomarkers, like neutrophil gelatinase-associated lipocalin (NGAL), are helpful for early warning of AKI. This study aims to investigate the accuracy of NGAL in evaluating the perioperative AKI of liver transplantation. The four databases, PubMed, Web of Science, Embase, and Cochrane Library, were searched for relevant studies published from database inception to August 2023. Results were pooled using random-effects models, and heterogeneity was examined. A total of 16 case-control studies with 1271 patients were included. The results showed that both preoperative [standardized mean difference (SMD) = 0.53; 95% confidence interval (CI): 0.15, 0.91; P < 0.001] and postoperative NGAL levels (SMD = 0.63; 95% CI: 0.24, 1.03; P < 0.001) were higher in the AKI group compared with the non-AKI group. Subgroup analysis by continents showed higher preoperative NGAL levels in AKI patients in the European population (SMD = 1.63; 95% CI: 0.55, 0.27; P = 0.003), but no differences in Asian, African, North American, and South American. Subgroup analysis by continents revealed higher postoperative NGAL levels in the European (SMD = 1.63; 95% CI: 0.55, 0.27; P = 0.002) and Asian populations (SMD = 0.42; 95% CI: 0.04, 0.81; P = 0.039). Higher postoperative NGAL levels in plasma and urine were observed in AKI patients compared with non-AKI patients [plasma (SMD = 1.29; 95% CI: 0.21, 2.38; P = 0.011), urine (SMD = 0.88; 95% CI: 0.18, 1.59; P = 0.035)], while there was no difference in African, North American, South American, and serum NGAL. NGAL level may be an important biomarker for early detection of AKI in the perioperative period of liver transplantation.

Background and aim: Endoscopic mucosal resection (EMR) of superficial nonampullary duodenal epithelial tumors (SNADETs) is challenging, and to date, only a few studies assessed the clinical outcomes of EMR in the duodenum. The aim of this study was to evaluate the efficacy and safety of EMR for the treatment of SNADETs >10 mm.

Patients and methods: This is a single-center retrospective study reporting data from a cohort of consecutive patients undergoing EMR of large (>1 cm) SNADETs between January 2017 and December 2021.

Results: A total of 81 patients with 83 lesions underwent EMR (70 conventional EMR, 13 underwater EMR). The median size was 20 mm (range: 10-60 mm). The mean procedure time was 45 ± 30 min, and the en-bloc resection rate was 47%. In all patients, SNADETs were successfully removed (i.e. technical success). Delayed bleeding occurred in 5 (6%) of EMRs. One delayed perforation occurred, which was managed surgically. Recurrence rate was 20% with a median follow-up period of 20.5 months. Recurrence was detected at the first endoscopic follow-up in 88% of cases, and all recurrences were successfully treated endoscopically. Lesion size (P = 0.04), previous endoscopic resection (P = 0.05), and piecemeal resection (P = 0.05) were independent risk factors of local recurrence after EMR on multivariate-adjusted analysis.

Conclusion: Large duodenal adenomas can be effectively managed by EMR. However, duodenal EMR of large lesions carries a significant risk of early recurrence, with a nonnegligible risk of adverse events. Lesion dimension, piecemeal resection, and previous endoscopic resection were associated with a higher recurrence rate. Close endoscopic follow-up is recommended given the high incidence of early recurrence, which can be successfully treated endoscopically.

Background: Alpha-fetoprotein (AFP) is the most commonly used and crucial tumor marker in clinical diagnosis and prognosis guidance for hepatocellular carcinoma (HCC). However, approximately 30% of HCC patients do not exhibit abnormal serum AFP levels at the time of diagnosis. This study aims to investigate the clinical characteristics and prognosis differences between AFP-negative and AFP-positive patients with HCC.

Methods: Clinical data on patients diagnosed between 2010 and 2015 from the Surveillance, Epidemiology, and End Results Program were collected and analyzed. All patients with HCC were reported as AFP-negative or AFP-positive based on AFP test results. Overall survival (OS) and cancer-specific survival (CSS) were compared between the AFP-negative and AFP-positive patients. Logistic regression analysis and multivariable Cox regression analysis were performed to identify the association of AFP with tumor size, lymph node metastasis, distant metastasis, and CSS.

Results: Of 7090 patients, 2074 (29.3%) and 5016 (70.7%) were AFP-negative and AFP-positive patients, respectively. The 5-year OS and CSS rates in AFP-negative patients were significantly better than AFP-positive patients (36.4 vs. 20.7% and 46.7 vs. 27.2%, both P < 0.001). Logistic regression analysis revealed that the AFP level was an independent risk factor of tumor size [odds ratio (OR), 1.821; 95% confidence interval (CI), 1.625-2.040; P < 0.001], N stage (OR, 1.922; 95% CI, 1.528-2.417; P< 0.001) and M stage (OR, 2.435; 95% CI, 1.980-2.995; P < 0.001). On multivariable Cox-regression analyses, AFP-positive was associated with decreased CSS (hazard ratio, 1.452; 95% CI, 1.355-1.557; P < 0.001).

Conclusion: Abnormal serum AFP was significantly associated with worse prognosis, larger tumor size, more lymph node metastasis, and distant metastasis. Patients with AFP-positive may need more individualized treatment decision and further optimization of HCC management strategies.

Background: Blood transfusion is usually required for cirrhotic patients with bleeding which is related to high risk of mortality. Identifying cirrhotic patients at high risk of bleeding and needing blood transfusions would benefit these patients, yet this remains an unmet need.

Objectives: This study aims to enhance blood transfusion management for patients with cirrhosis by developing a predictive model to assess the risk of transfusion.

Methods: We enrolled a cohort of 711 patients diagnosed with cirrhosis at The First Affiliated Hospital of Nanjing Medical University and divided into training set (n = 537) and validation set (n = 174). Each participant underwent a comprehensive clinical assessment. Data on prothrombin time (PT), platelet counts, and inflammatory markers were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. The nomogram was constructed. Model performance was evaluated through receiver operating characteristic curve analysis.

Results: The study successfully identified PT, platelet counts, and the mentioned inflammatory markers as significant predictors of the need for transfusion. The resulting nomogram demonstrated high predictive accuracy, with area under the curve values of 0.85 in the training set and 0.83 in the validation set.

Conclusion: The developed nomogram for predicting the need for blood transfusion in patients with cirrhosis shows promising effectiveness for clinical application. This tool can significantly contribute to optimizing transfusion practices, potentially improving patient care and outcomes through more personalized and efficient transfusion strategies.

Objective: We aimed to collect data on gastroenterology and hepatology training from the viewpoint of trainees and trainers.

Methods: A national online survey was distributed among trainees and specialists at certified training institutions between February and May 2024.

Results: Overall, 226 respondents - 98 trainees, 78 trainers, 50 program directors, and department heads responded, with a national coverage of 70% of trainees and 85% of specialty-department heads. A training curriculum was reported by 56% of trainees and 84% of curriculum organizers, regular feedback and training progress meetings by 11% of trainees (57% if considered without assessment of training progress), but 88% of curriculum organizers. Training was rated as very good or good by 65% of trainees, 79% of trainers, and 100% of department heads. Quality of functional diagnostics, endoscopy, and ultrasound training was rated as very good or good by trainees in 16, 61, and 54%, by trainers in 27, 79, and 58%, and by department heads in 74, 89, and 85%. Much agreement was found concerning the wish for external rotations (trainees 65%, trainers 70%, and department heads 89%) and a new postcertification advanced-endoscopy training and accreditation.

Conclusion: Department heads seem to overestimate the quality of their training programs. Consequently, we found large discrepancies in the perception of specialty training that should stimulate efforts to standardize training and boost necessary train-the-trainer programs. Diagnosis of functional gastrointestinal disorders and abdominal ultrasound skills are areas with the largest room for improvement. Increased flexibility of hospital providers will be crucial for significant improvement of external training possibilities.

Background and aims: Tofacitinib has been approved for the treatment of patients with moderate-to-severe ulcerative colitis independently of prior therapies. We aimed to assess the efficacy and safety of tofacitinib in biologic-naive patients.

Methods: This was a retrospective analysis of prospectively collected data extracted from the notes of patients with moderate-to-severe ulcerative colitis naive to advanced therapies, who were treated with tofacitinib [10 mg twice daily (b.i.d.) for 8 or 16 weeks followed by a 5 mg b.i.d. maintenance dose] in six Greek Hospitals, who had a follow-up of at least 26 weeks after treatment initiation.

Results: Overall, 48 patients were included. Clinical response was seen in 30 (62.5%) and 32 (66.6%) patients at week 8 and 16, respectively. Clinical remission, corticosteroid-free clinical remission, biochemical response, and endoscopic remission at week 26 was observed in 26 (54.2%), 26 (54.2%), 28 (60.8%), and 29 (60.4%) patients, respectively. No major adverse events or infections were recorded.

Conclusion: In this retrospective ongoing cohort study, tofacitinib demonstrated clinical response at weeks 8 and 16 in more than 60% and steroid-free clinical remission at week 26 in more than 50% of biologic-naive patients with moderate-to-severe ulcerative colitis with a good safety profile, indicating that tofacitinib is an effective first-line treatment for this group of patients.

Introduction: Upper gastrointestinal bleeding (UGIB) is a critical condition with an incidence of 80-150 cases per 100 000 annually and a mortality rate of 2-15%. Endoscopy is crucial for diagnosis and treatment. Prokinetic agents like metoclopramide are studied for their potential to improve visualization by promoting gastric motility. This meta-analysis evaluates the efficacy of intravenous metoclopramide in enhancing endoscopic visualization and clinical outcomes in UGIB patients.

Materials and methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review and meta-analysis using PubMed, Embase, Cochrane Library, and Scopus up to July 2024. We included randomized controlled trials involving UGIB patients who received intravenous metoclopramide vs placebo. Primary outcome was endoscopy visualization score (EMV). Meta-analysis was conducted using RevMan 5.4. This review was registered in PROSPERO RD42024552979.

Results: Five studies with 515 patients were included. The pooled analysis for overall EMV scores indicated significant improvement in metoclopramide group [standardized mean difference 0.47 (95% confidence interval, CI: 0.12-0.82)]. Repeat endoscopy showed no significant difference 0.70 (95% CI: 0.38-1.29). The mean difference for hospital stay was minimal and not significant [mean difference -0.06 (95% CI: -0.24 to 0.12)]. The mean number of red blood cell transfusions was slightly higher but not significant [mean difference 0.04 (95% CI: -0.14 to 0.22)].

Conclusion: Intravenous metoclopramide before endoscopy in UGIB patients improved EMV scores, while the other clinical outcomes were not significant. These findings suggest potential benefits of metoclopramide in UGIB, highlighting the need for further research with larger studies to confirm its effectiveness.

Background: First-degree relatives of gastric cancer (GC) patients are known to have an increased risk of developing GC. However, guidelines in low-intermediate incidence regions often lack specific recommendations for managing both asymptomatic and symptomatic relatives at risk.

Aim: This study aimed to evaluate the differences in relevant histological findings (e.g. Helicobacter pylori infection, gastric precancerous and neoplastic conditions) between asymptomatic patients undergoing esophagogastroduodenoscopy due to first-degree relatives with GC and patients with symptoms or other clinical indications and presence of first-degree relatives with GC. The secondary aim was to identify the patient's risk factors of relevant histological findings.

Methods: This single-center retrospective study included patients undergoing esophagogastroduodenoscopy with biopsies with the indication for first-degree relatives with GC from January 2008 to September 2022. They were analyzed in two groups based on whether they had additional symptoms or clinical indications for esophagogastroduodenoscopy.

Results: Overall, 283 patients were included (54.5% asymptomatic vs. 45.5% symptomatic). Histological findings that led to changes in patient management were identified in 32% of cases. No significant differences in histological findings between the two groups were observed (P = 0.077). A subanalysis revealed that patients with male relatives affected by GC had a higher incidence of relevant histological findings than those with female family members with GC (P = 0.013) with an odds ratio of 3.10.

Conclusion: First-degree relatives of GC patients may be at risk for H. pylori infection and gastric precancerous conditions regardless of symptoms or other indications, and a proactive endoscopic screening could be considered even in countries with low GC incidence.