European Journal of Gastroenterology & Hepatology最新文献

Background and aims: Nonceliac wheat sensitivity (NCWS) is characterized by gastrointestinal and extraintestinal symptoms triggered by gluten ingestion. Its symptomatology overlaps substantially with irritable bowel syndrome (IBS) and functional dyspepsia (FD), leading to diagnostic challenges. Data on the prevalence and predictors of NCWS among patients with IBS or FD, especially those with refractory symptoms, are limited. We aimed to determine the prevalence, clinical predictors, and impact of a gluten-free diet (GFD) in this population using the Salerno Experts' Criteria.

Methods: In this prospective, multicenter trial, adults (18-65 years) with Rome IV-defined IBS or FD, refractory to standard therapy, were enrolled. Participants underwent a 6-week GFD; gluten responders subsequently underwent a double-blind placebo-controlled gluten challenge (DBPCGC) with crossover. Symptom trajectories, health-related quality of life (HRQOL), anxiety, and depression were assessed. Multivariable logistic regression identified predictors of NCWS. Trial registration number- CTRI/2021/10/037323.

Results: Of 252 screened patients, 177 were enrolled for a 6-week GFD (step I), and 154 patients completed this phase (mean age 41.9 ± 14.2 years, 53.2% males). Eighty-two (52.3%) patients responded to GFD, of whom 77 entered step II (DBPCGC). Thirty-one (20.1%) patients had significant symptom worsening on blinded gluten ingestion, suggesting the presence of NCWS. Female sex, FD-IBS overlap, headache, fatigue, and anxiety independently predicted NCWS. GFD was associated with significant HRQOL improvement.

Conclusion: Approximately one-fifth of the patients with refractory IBS/FD fulfill the NCWS criteria. Therefore, screening for NCWS in patients with refractory IBS or FD is extremely important to limit unnecessary pharmacotherapy and enhance patient outcomes.

Objective: Most of the existing instruments assessing quality of care (QoC) are based on the perception of healthcare providers that may differ from that of healthcare users. We aimed to measure QoC through the patient's eyes in a Greek cohort of patients with inflammatory bowel disease (GR QUOTE-IBD) and to investigate putative sociodemographic and disease-related QoC predictors.

Methods: GR QUOTE-IBD questionnaire was delivered to patients at their regular follow-up visit, and adequate time was offered to fill it in. The outcome of the analysis was associated with epidemiological and disease-related characteristics. Statistical analysis was performed with SPSS (version 29, SPSS Inc., Chicago, Illinois, USA).

Results: GR QUOTE-IBD questionnaire was completed by 150 patients from three IBD clinics, 93 with Crohn's disease (CD), with a median disease duration of 10 years (range 0.6-43 years). Quality Index (QI) for total care was >9 in all three hospitals. Quality deficit QI <9 was found only for accessibility to IBD care in two of three clinics. Autonomy in decision-making was rated as the least important dimension of QoC from the patients' perspective. A positive association was found between CD diagnosis and QI scores for total care ( P  = 0.013). Steroid treatment over two times in lifetime was negatively associated with QI scores for total care ( P  = 0.019).

Conclusion: Total QoC from patients' perspective is high in Crete. CD and disease severity seem to affect patients' perceptions of IBD care. Gastroenterologists in Crete should improve accessibility to IBD care and empower patients' involvement in shared decision-making.

Objective: Quality of care in inflammatory bowel disease (IBD) patients is a major priority as it is associated with better outcomes. We assessed the adherence of Italian gastroenterologists to current international recommendations regarding quality performance measures for clinical and endoscopic IBD activities.

Methods: From March to July 2023, 179 Italian specialists participated in an online questionnaire-based survey concerning their demographic details, affiliations, clinical, and endoscopic practice. Data on the characteristics of the specialists' centres were also collected. Recommendations from European Crohn's and Colitis Organisation, Building Resources and Research in IBD Globally group, and European Society of Gastrointestinal Endoscopy for clinical and endoscopic standards were used as reference standards.

Results: Deviations from guidelines' recommendations included suboptimal availability of all specialties required for multidisciplinary teams, underuse of maintenance treatment with oral mesalamine in ulcerative colitis but still frequent use in Crohn's disease, suboptimal dosages of topical therapy, low attention to performing ileal biopsies in suspected IBD and to Paris and mucosal pattern classifications for lesion characterisation. No significant regional differences were observed, while significantly lower performances were reported for many responses coming from small centres or doctors less dedicated to IBD care.

Conclusion: In Italy, adherence to current standards of care for IBD is generally good, with some practices to be improved. There is a need to support small centres and doctors less engaged in IBD within integrated clinical care networks.

Background: As diabetes-associated hepatocellular carcinoma (DM-HCC) has surged in Japan, there is an urgent need for effective screening methods. The Fibrosis-4 (FIB-4) index is commonly used for screening, but its age component tends to yield false-positive results in older patients. This study aimed to evaluate the value of the newly developed Fibrosis-3 (FIB-3) index, which excludes age, for identifying high-risk groups for DM-HCC across all age groups.

Methods: This study included 174 patients with diabetes-associated Barcelona Clinic Liver Cancer stage 0 hepatocellular carcinoma (HCC) and 74 diabetic controls. The ability of the FIB-4 and FIB-3 indices to predict HCC risk was assessed using receiver operating characteristic (ROC) curves and multivariate logistic regression analyses.

Results: Both indices effectively identified high-risk groups for DM-HCC (area under the ROC curve: FIB-4, 0.909; FIB-3, 0.911). Notably, the FIB-4 index required age-adjusted cutoffs, whereas a single cutoff FIB-3 maintained its predictive ability across all age groups. Multivariate analysis confirmed FIB-3 as an independent predictor of HCC risk even after adjusting for factors such as BMI, liver function tests, and tumor markers.

Conclusion: The FIB-3 index is a promising tool for identifying high-risk groups for DM-HCC without age-dependent cutoffs, potentially enabling earlier diagnosis and better prognosis. Its ability to stratify risk consistently across age groups addresses the limitations of FIB-4.

Rectal cancer represents approximately 35% of colorectal cancer cases in the European Union. Early-stage tumors may be treated with less invasive techniques, such as endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM). This systematic review and meta-analysis evaluates the comparative efficacy and safety of ESD versus TEM for early-stage rectal cancer. A literature search was conducted in PubMed, Scopus, Embase, and Cochrane databases up to October 2024. Studies comparing ESD and TEM outcomes in adult patients with rectal tumors were included. Outcomes assessed included the rates of en-bloc resection, recurrence, overall complications, R0 resection rates, postoperative bleeding, reoperation rates, perforation rates, operative time, and length of hospital stay. Statistical analyses were performed using both fixed and random effects models. Seven retrospective studies involving 671 patients were included. Pooled analyses showed that ESD achieved higher en-bloc resection rates [odds ratio (OR) = 0.29, 95% confidence interval (CI): 0.10-0.83, P  = 0.02), lower tumor recurrence rates (OR = 0.29, 95% CI: 0.12-0.70, P  = 0.006) and lower overall complication rate (OR = 0.50, 95% CI: 0.31-0.81, P  = 0.005). No significant differences were observed in terms of R0 resection rates, operative time, postoperative bleeding, and reoperation rates. ESD achieves favorable outcomes over TEM for early-stage rectal cancer by achieving higher en-bloc resection rates, lower rates of recurrence, and complications. Despite ESD's technical complexity, its superior precision and lower complication profile make it a promising option for early-stage rectal cancer, though clinician expertise and available resources should guide treatment selection.

Objective: For hepatocellular carcinoma (HCC) with microvascular invasion (MVI), the choice of surgical resection (SR) and resection margins (RMs) remains to be determined. The aim of this study was to discuss the relationship between SR and RM and MVI-positive HCC.

Methods: PubMed, Embase, Web of Science, and Cochrane Library were searched up to 1 September 2024. The methodological quality of eligible articles was assessed using the Newcastle-Ottawa Scale (NOS). Effect models were selected to pool the HR and 95% CI of recurrence and overall survival (OS) based on the presence of heterogeneity to assess the impact of SR and RM in MVI-positive HCC.

Results: A total of 12 articles with 6747 cases were included. NOS scale indicated that the studies were of high quality. The results showed that narrow RM were a risk factor for postoperative recurrence and OS in MVI-positive HCC, with a pooled HR of 1.76 (95% CI: 1.49, 2.07) and 1.99 (95% CI: 1.58, 2.49), respectively; whereas nonanatomical resection (NAR) was another risk factor for postoperative recurrence and OS, with a pooled HR of 1.33 (95% CI: 1.15, 1.54) and 1.42 (95% CI: 1.15, 1.75), so wide RM and anatomical resection (AR) was beneficial for postoperative recurrence and long-term survival. In the subgroups, narrow RM were more than twice the risk factor for TTR compared with wide RM; and in the SR subgroup, studies from the Japanese had more than double the risk factor for postoperative recurrence and OS compared with China.

Conclusion: For HCC with MVI, treatment modalities recommending anatomical resection and wide margins will have beneficial effects on postoperative recurrence and long-term survival.

Background and aims: The impact of sex disparity on the patterns of recurrence after curative resection of hepatocellular carcinoma (HCC) remains controversial. The aim of this study was to comprehensively investigate the influence of sex differences in HCC recurrence following curative hepatectomy.

Methods: Patients who underwent curative-intent resection for HCC between July 2015 and June 2020 were identified from a multicenter database and analyzed retrospectively. Tumor recurrence was evaluated using Cox regression and Kaplan-Meier methods. Hazard curves representing the changes in risk of recurrence over time were evaluated. Propensity score matching and a competing risk model were used for sensitivity analysis.

Results: Of 1570 patients, 1334 (85.0%) were men, and 236 (15.0%) were women. Female patients showed significantly lower risk for HCC recurrence than males in the multivariate Cox regression analysis (hazard rate: 0.75, 95% confidence interval: 0.61-0.93, P  = 0.008). Landmark analysis showed that sex was an independent risk factor for late recurrence, but not for early recurrence. The hazard function curve for female patients was relatively flat [peak hazard rates (pHR): 0.0234], while males recurred with a peak at 3.0 months (pHR: 0.0302). A lower risk of HCC recurrence was also found in females in the sensitive analysis.

Conclusion: Male patients had a higher risk of HCC recurrence than females after surgery, and recurrence hazard rates for different sexes varied substantially with respect to both time and peak rates.

Objectives: VE202 is an oral, defined 16-strain bacterial consortium with properties that may diminish dysbiosis and alleviate symptoms of inflammatory bowel disease. This phase 1 study evaluated VE202 safety and tolerability and assessed strain colonization.

Methods: Thirty-one healthy adults received oral vancomycin 125 mg four times daily for 5 days to decrease gut microbial burden, followed by a single dose of VE202 at 1 × 109 or 1 × 1010 colony-forming units (CFUs), or 14-days of the lower dose (1.4 × 1010 total CFU). Adverse events were monitored through week 12, with follow-up at week 24. Stool was collected for VE202 strain detection and abundance during screening and pretreatment, day 2, day 4, day 7, day 14, week 4, week 8, week 12, and optionally at week 24.

Results: VE202 and vancomycin pretreatment were well tolerated. Among VE202 recipients, the most frequent adverse events (>20% of subjects) were abdominal discomfort, diarrhea, headache, and fatigue. Most treatment-related adverse events were gastrointestinal. Two serious adverse events were reported; these were not treatment-related and occurred weeks after dosing completion. VE202 strain detection and relative abundance in the vancomycin-perturbed gut occurred as soon as day 2, sustained through 2 weeks postdosing, then declined slowly but remained substantially above baseline through week 24. Colonization was dose- and duration-dependent, with 14-day dosing providing more durable VE202 colonization.

Conclusion: VE202 was well tolerated. Following antibiotic pretreatment, rapid and durable gut colonization of VE202 strains was observed, most significantly in participants administered multiple doses (NCT03931447).

Background: For poorly differentiated early gastric cancer (PDEGC), the oncologic safety and outcomes of endoscopic resection vs. surgical resection remain controversial. This study aimed to evaluate the prognostic difference of endoscopic resection and surgical resection for PDEGCs.

Methods: We retrospectively collected data of PDEGC cases from the Surveillance, Epidemiology, and End Results (SEER) database. A final cohort of 558 PDEGC cases with highly complete clinical and follow-up records available for analysis. Cox multivariate analysis and univariate analysis after propensity score matching (PSM) were used to evaluate the prognostic differences. Cancer-specific survival (CSS) and overall survival (OS) were chosen as the endpoints of this study.

Results: In multivariate analysis of the raw dataset, surgical resection was observed as a relative protective factor for CSS [hazard ratio: 0.61, 95% confidence interval (CI): 0.28-1.33, P = 0.215] and an independent protective factor for OS (hazard ratio: 0.56, 95% CI: 0.32-0.98, P = 0.042). Survival curves based on post-PSM dataset exhibited significant differences in analysis on both CSS (Plog-rank = 0.034) and OS (Plog-rank = 0.033).

Conclusion: In this retrospective study on PDEGC utilizing the SEER database, our analysis suggests that endoscopic resection for PDEGC was associated with significantly worse CSS and OS compared with surgical resection. These findings reinforce the current guideline recommendations favoring surgical resection as the treatment of choice for PDEGC to achieve optimal oncological safety.

Objectives: Clostridioides difficile infection (CDI) and colorectal cancer pose significant health risks in the US, and yet the potential link between them remains unexplored in humans. We aim to investigate the association between CDI and the risk of developing premalignant and malignant colonoscopic findings in adult patients in inpatient and outpatient settings.

Methods: This retrospective cohort study reviewed patient charts from four healthcare facilities, including two tertiary referral centers. A total of 448 adult patients who underwent C. difficile tests (CDT) during the approved timeframe and had colonoscopies completed at least 5 years after CDT were identified using the Clostridium difficile PCR test and International Classification of Diseases codes. Our primary outcome was the rate of premalignant and malignant polyps or masses documented on colonoscopy reports greater than or equal to 5 years from the initial CDT date. Overall lesion frequency, size, histology, and presence of ulcerations were secondary outcomes.

Results: There was no significant difference in the development of polyps and masses between the patients with CDT-positive and CDT-negative [odds ratio (OR) = 1.21, 95% confidence interval (CI) = 0.70-2.11). In addition, the presence of malignant and premalignant histology also did not differ. CDT-positive group had a greater frequency of ulcerative lesions compared to the CDT-negative even after stratification for smoking (OR = 6.15, 95% CI = 1.67-22.66).

Conclusion: Although no significant association was found between CDI and malignant or premalignant lesions, the study sheds light on the potential link between CDI and inflammatory pathologies such as ulcerative colorectal lesions. It could influence colorectal cancer screening strategies for patients with CDI.