European Journal of Gastroenterology & Hepatology最新文献

Objective: Programmed cell death protein 1 and programmed death-ligand 1 (PD-L1) inhibitors are increasingly implicated in cases of drug-induced liver injury (DILI). While previous studies have established a correlation between chronic liver diseases and DILI, investigations into the association between steatotic liver disease (SLD) and DILI remain limited. This study aimed to evaluate the clinical characteristics and risk factors associated with PD-(L)1 inhibitor-related DILI, with particular emphasis on the impact of SLD on DILI incidence.

Methods: Clinical data from patients with extrahepatic malignancies who received PD-(L)1 inhibitors between January 2020 and December 2024 were retrospectively analysed. Causality between liver injury events and PD-(L)1 inhibitors was assessed using the updated Roussel Uclaf Causality Assessment Method.

Results: Among the 958 patients treated with PD-(L)1 inhibitors, 62 (6.5%) developed PD-(L)1 inhibitor-related DILI. A total of 364 (38.0%) had SLD, of whom 310 (32.4%) were classified as metabolic dysfunction-associated steatotic liver disease (MASLD), 18 (1.9%) as MASLD with increased alcohol consumption, and 36 (3.8%) as MASLD with chronic hepatitis virus infection. Multivariate analysis demonstrated that patients with SLD had a 5.6-fold increased risk of developing DILI (95% confidence interval: 3.42-9.12, P < 0.001); however, no association was observed between MASLD and an increased DILI risk. Notably, DILI risk was significantly higher in patients with steatosis combined with chronic hepatitis virus infection or heavy alcohol consumption.

Conclusion: Hepatic steatosis is associated with an increased risk of PD-(L)1 inhibitor-related liver injury in patients with extrahepatic malignancies, particularly in the presence of multiple underlying aetiologies.

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.

Background: Gastric cancer epidemiology evolved rapidly in the last century, shifting from being one of the main causes of cancer-related death to the sixth in high-income countries.

Methods: We conducted a narrative review on gastric cancer epidemiology. Our review focused on trends of gastric cancer and its relationship with Helicobacter pylori infection; cardia and noncardia gastric cancer risk factors; early onset gastric cancer; second primary cancers in patients with gastric cancer; and implementation of gastric cancer prevention strategies. In addition, we provided results of a case-only analysis of recently diagnosed gastric cancer from a middle-risk population.

Results: Literature consistently describes the ongoing declining trend of gastric cancer rates and the overall increase in in absolute number of incident cases because of a change in population. The evolving distribution of risk factor prevalence impacts the epidemiology of gastric cancer, with an increase in early onset and in cardia gastric cancer. A negative correlation was observed between H. pylori prevalence and the proportion of cardia gastric cancer. The analysis of 117 gastric cancer cases observed between 2016 and 2020 in Bologna, Italy, showed that smoking and epigastric pain were significantly associated with increased risk of early-onset gastric cancer after accounting for confounders.

Conclusion: Multifaceted strategies are needed to address challenges in gastric cancer control, early diagnosis, and clinical management in a changing epidemiological landscape. Prevention remains the cornerstone to reduce the gastric cancer burden.