European Journal of Gastroenterology & Hepatology最新文献

Background and aim: Dysphagia is an alarming symptom often associated with upper gastrointestinal organic diseases. Its incidence has increased in the last decades, although updated clinical data related to patients presenting with dysphagia are lacking. Thus, in this study, we aimed to provide an update of the main characteristics of patients presenting with dysphagia to an outpatient clinic.

Methods: We retrospectively evaluated consecutive patients first referred to our outpatient clinic (June 2021-December 2022) for dysphagia as the main symptom. All patients underwent upper digestive endoscopy as the first diagnostic examination, with or without biopsies. According to clinician assessment, patients also underwent high-resolution manometry (HRM).

Results: During the study period, a total of 78 patients met the inclusion criteria. Endoscopy showed abnormal features in 25 patients (32.1%), and the most common findings were those associated with eosinophilic esophagitis ( n  = 8, 10.3%). Biopsies of the esophagus and/or cardia were obtained in 61 patients (78.2%), and 28 patients had abnormal histologic findings. Overall, the most common histological diagnosis was eosinophilic esophagitis, identified in 12 patients (15.3%), with 4/12 (33.3%) without endoscopic alterations suggestive of this diagnosis. HRM was performed in 34/78 patients (43.6%), and in these patients, achalasia was the most common diagnosis (7/34, 20.6%).

Conclusion: Among patients complaining of dysphagia referred to an outpatient gastroenterology clinic, eosinophilic esophagitis is the most common underlying cause of the symptom. Given its high frequency, biopsies should always be performed in patients with dysphagia, regardless of endoscopic findings.

Background and aims: Barrett's esophagus is the only known precursor lesion to esophageal adenocarcinoma (EAC). Barrett's esophagus and EAC are less common in African Americans than in non-Hispanic Whites. Studies in European populations have identified Barrett's esophagus-associated risk loci; however, none have examined loci in African Americans cohorts. We conducted a case-control targeted replication study to investigate previously identified Barrett's esophagus risk loci in an African Americans cohort in the All of Us (AoU) Research Program.

Methods: We abstracted phenomic and genomic data from 108 African Americans with Barrett's esophagus and 778 African Americans controls in the AoU database. We examined 16 single-nucleotide polymorphisms (SNPs) identified in individuals of European origin in the largest Barrett's esophagus genome-wide association study to date. We conducted a logistic regression, adjusting for age, sex, and global ancestry, to assess associations between SNPs and Barrett's esophagus/control status.

Results: Of 16 SNPs examined, logistic regression analysis showed three SNPs (rs42202, rs62217, and rs848092) were associated with Barrett's esophagus risk at Bonferroni-adjusted significance ( P < 3.1e-3) and in the same direction as previously reported. One SNP, rs2701111, met significance but showed a discordant association with Barrett's esophagus in African Americans. The association with the remaining 12 SNPs was not replicated. Effect sizes were generally larger for each SNP in our African Americans cohort.

Conclusion: This study evaluated 16 Barrett's esophagus-associated SNPs in African Americans and confirmed associations for only three Barrett's esophagus-associated variants shared across populations. The nonreplication of most loci and differences in association patterns suggest distinct genetic factors influence Barrett's esophagus in admixed populations. These findings underscore the need for discovery and replication in diverse populations.

Gastrointestinal angiodysplasia is frequently observed in patients with aortic stenosis and may present with bleeding and anemia. We conducted a systematic review and meta-analysis to estimate its prevalence in this population and to summarize outcomes after valve intervention. Following PRISMA 2020, we searched PubMed, Scopus, and Web of Science and registered the protocol in PROSPERO (CRD42024550839). Eligible observational studies reporting angiodysplasia, von Willebrand factor abnormalities, or both in aortic stenosis were appraised for quality and pooled using a random effects model; heterogeneity and publication bias were assessed with I ² and Egger's test. Eleven studies were included. The pooled prevalence of gastrointestinal angiodysplasia among patients with aortic stenosis was 6.3% (95% confidence interval: 4.51-8.38, I ² = 98.68, P  < 0.0001), with no evidence of publication bias. Across studies that reported longitudinal outcomes, aortic valve replacement or transcatheter aortic valve implantation was associated with a reduction in lesion burden and lower rates of gastrointestinal bleeding, anemia, transfusion, and readmission, although early postprocedural bleeding could occur and typically declined over follow-up. These findings indicate that angiodysplasia is a clinically relevant comorbidity in aortic stenosis and support proactive gastrointestinal evaluation in patients with anemia or unexplained bleeding. Standardized diagnostic criteria and prospective studies are needed to clarify long-term outcomes after valve therapy and to define screening and management pathways.

Objective: Percutaneous liver biopsy (PLB) is the gold standard for diagnosing liver diseases, yet postoperative bleeding remains the most common and severe complication, constraining its clinical application. Accurate prediction of postoperative bleeding risk is essential to enhance PLB safety.

Methods: This study first used multivariate regression analysis in a retrospective cohort to identify independent risk factors associated with postoperative bleeding after PLB. Based on these factors, a preoperative bleeding risk scoring system was further developed, and its performance was analyzed across subgroups defined by different clinical indications. Finally, the model and scoring system were prospectively validated in an external cohort to assess generalizability.

Results: Multivariable analysis identified lesion type, portosystemic shunt (PSS), and total bilirubin as independent risk factors, and a significant interaction between lesion type and PSS status was observed. The bleeding-prediction model was: logit(P) = -3.5 + (1.223 × lesion type) + (1.018 × PSS) + (0.454 × total bilirubin) + (1.523 × lesion type × PSS). The scoring system derived from these factors showed a marked increase in postoperative bleeding rate with rising scores and demonstrated good discrimination in both the standard-indication group (the area under the receiver operating characteristic curve = 0.892) and the super-indication group (the area under the receiver operating characteristic curve = 0.846). External validation further confirmed robust generalizability across populations.

Conclusion: The preoperative bleeding-prediction model and risk scoring system developed in this study can accurately predict postoperative bleeding after PLB, enhance PLB safety, and support optimization of preoperative assessment and postoperative management in clinical practice for diverse patient groups effectively.

Objectives: Surveillance colonoscopy is recommended for follow up of colorectal cancer and polyps. It has, however, a low yield in this setting and presents a significant strain on endoscopy capacity. Colon capsule endoscopy (CCE) is an alternative diagnostic. We aimed to determine the utility of this test in surveillance patients.

Methods: A retrospective analysis of a prospectively collated service evaluation data was conducted looking at all surveillance CCE patients in NHS Highland. The primary outcomes were the need for follow up endoscopy and capacity saved. Secondary outcomes included the CCE completion rate, and patient specific factors that contribute to an unsuccessful CCE or the need for a follow up endoscopy.

Results: One hundred forty-six patients underwent surveillance CCE between May 2023 and January 2025. Ninety-three (63.7%) required follow up endoscopy. Capacity saved was up to 35.2% of the time slots that would have otherwise been used if all had undergone colonoscopy. Opiate use was associated with CCE failure. Polyp, as opposed to cancer, surveillance and a history of multiple polyps on previous endoscopy were associated with increased follow up rate.

Conclusion: CCE resulted in endoscopy capacity savings in this surveillance cohort, but it should be used selectively in view of the high follow up investigation rate. The benefit may be improved with careful patient selection and the exclusion of patients on opiates, tricyclic antidepresants, or who have a history of polyposis.

Background: Inflammatory bowel disease (IBD) is associated with chronic inflammation and increased malignancy risk; however, data on the effects of cancer therapies on the clinical course of IBD are limited. We evaluated the effects of cancer therapies on IBD activity and oncologic outcomes.

Methods: This single-center, retrospective study was conducted at a tertiary care cancer center and included patients with IBD and malignancy who received cancer therapy 2015-2023. Patient characteristics and comparisons between patients who did and did not develop gastrointestinal adverse events (GI AEs) related to cancer therapy are presented.

Results: The cohort included 1153 patients, predominantly white (85.3%) and female (51.6%). GI AEs occurred in 296 (25.7%) patients. Those who developed GI AEs had more hematologic malignancies (21.6 vs. 14.6%; P = 0.005), stage III-IV cancer (55.1 vs. 45.6%; P < 0.0001), immune checkpoint inhibitor (ICI) use (19.6 vs. 10.7%; P < 0.0001) and active baseline IBD status before cancer therapy (20.0 vs. 14.5%; P = 0.025). Stage III-IV disease (hazard ratio: 2.9, P < 0.0001), GI AEs (hazard ratio: 1.3, P = 0.008), GI AE-related hospitalization (hazard ratio: 2.1, P < 0.0001), and ICI (hazard ratio: 2.0, P < 0.0001) were associated with decreased survival.

Conclusion: Concurrent management of IBD and cancer poses clinical challenges, particularly with the higher risk of GI AEs (25.7%) that is associated with active baseline IBD status and ICI use. These interactions may compromise treatment and survival. Further research is warranted to clarify the long-term impact of cancer therapies on IBD progression and outcomes.

Background: The connection between metabolic dysfunction-associated fatty liver disease (MAFLD) and sleep issues remains unclear. This study seeks to explore the relationship between sleep duration, associated disorders, and MAFLD.

Methods: A cross-sectional study utilized data from the National Health and Nutrition Examination Survey spanning from 2017 to March 2020. The MAFLD cohort was characterized by the presence of hepatic steatosis (controlled attenuation parameter ≥ 264) and metabolic dysfunction based on international guidelines. Exclusion for participants under 18 years old, those with incomplete elastography tests, heavy alcohol users, positive hepatitis C virus and hepatitis B virus status, or those lacking necessary data for MAFLD diagnosis or the sleep questionnaire. Logistic regression analysis was employed to identify significant risk factors for sleep abnormalities.

Results: The prevalence of MAFLD was found to be 41.4%. Participants diagnosed with MAFLD experienced shorter sleep duration, snoring, and snoring that included breathing difficulties, and increased daytime sleepiness. When controlling for age, sex, and ethnicity, MAFLD emerged as an independent risk factor for abnormal sleep duration [odds ratio (OR): 1.7, 95% confidence interval (CI): 1.5-2.1, P < 0.001], sleep troubles (OR: 1.4, 95% CI: 1.2-1.7, P < 0.001), daytime sleepiness (OR: 1.23, 95% CI: 1.05-1.4, P = 0.007), and snoring (OR: 1.2, 95% CI: 1.02-1.5, P = 0.02), as well as snoring associated with breathing difficulties (OR: 1.3, 95% CI: 1.05-1.7, P = 0.04).

Conclusion: MAFLD increases the risk of shorter sleep duration and various sleep disorders. Further research is required to elucidate the mechanisms mediating this association.

Background: Mild-moderate ulcerative colitis (UC) in clinical trials has been defined as an adapted Mayo Clinic score ≥4 with a Mayo endoscopic score (MES) of 2 and rectal bleeding score ≥1. This study aims to explore whether UC patients with lower endoscopic burden but active histology have similar outcomes to those with 'conventional' mild-moderate UC.

Methods: This was a post hoc analysis from the treat-through VARSITY study ( Clinicaltrial.gov : NCT02497469). Patients who completed induction (at week 14) with mild-moderate UC based on the conventional definition were compared to patients with histologically active MES 1 for achieving histo-endoscopic mucosal improvement (HEMI) at week 52, defined as MES ≤ 1 and Geboes highest grade <3.2. Secondary outcomes included endoscopic remission (ER) (MES = 0), histologic improvement (Geboes highest grade <3.2), and clinical remission (CR) (total Mayo score ≤2 and no subscore >1). Histologically active disease was defined as Geboes highest grade >3.2 (>50% of neutrophil crypt involvement in the epithelium).

Results: Week 52 outcomes were similar among patients with mild-moderate UC compared to those with histologically active disease and MES of 1. At week 52, a similar proportion of patients achieved HEMI [19/79 (24.1%) vs. 28/113 (24.8%), P  = 0.908], ER [23/79 (29.1%) vs. 35/113 (31.0%), P  = 0.782], histologic improvement [23/79 (29.1%) vs. 36/113 (31.9%), P  = 0.685], and CR [38/79 (48.1%) vs. 66/113 (58.4%), P  = 0.158].

Conclusions: Patients with histologically active MES 1 had comparable clinical and histologic outcomes at week 52 as those with conventional mild-moderate UC, suggesting that histology may better predict prognosis than symptoms or endoscopy alone.

Objective: There are no robust noninvasive tools to predict long-term liver-related events in well-compensated cirrhosis. We assessed the performance of noninvasive fibrosis tools in predicting decompensation, hepatocellular carcinoma (HCC), and liver-related mortality (LRM) within a mixed aetiology Child Pugh A cirrhosis cohort.

Design: Patients were followed in a single centre for 10 years. The primary outcome was decompensation (ascites, encephalopathy, or variceal bleeding). Secondary outcomes were HCC and LRM. All patients received baseline transient elastography for liver stiffness measurement (LSM) and blood tests to calculate Fibrosis-4 (FIB-4).

Results: In 114 patients, 31% decompensated during the follow-up period. 11% developed HCC. Increased LSM is associated with greater decompensation risk ( P  = 0.007). When controlling for FIB-4 and alcohol consumption, for each 1 kPa increase, the 10-year risk of decompensation increased by 2.2% [ P  = 0.009, hazard ratio: 1.022, 95% confidence interval (CI): 1.01-1.04]. Ten-year risk of decompensation was 20% for LSM < 21 kPa, 32% in the 21-35 kPa group, and 47% in the ≥35 kPa group ( P  = 0.019). After censoring for HCC, index LSM was associated with risk of death or liver transplant [odds ratio (OR): 1.029 (95% CI: 1-1.06) P  = 0.039]. FIB-4 is associated with HCC risk ( P  = 0.001) with an OR: 1.16 (95% CI: 1.01-1.32).

Conclusion: Ten-year risk of decompensation increased with increasing LSM in mixed aetiology compensated cirrhosis. LSM can be used to risk-stratify real-world patients, in order to reassure those at lowest risk and potentially focus resources on patients with higher scores and greatest decompensation risk.

Background: The treatment of liver cirrhosis requires a multidisciplinary approach at expert centers. Given the disease's complexity and serious consequences, care quality significantly impacts patient survival. Specialized care models at tertiary hospitals are thought to improve treatment outcomes and quality of life. This study evaluates whether proximity to an expert center influences care quality and patient outcomes and investigates the role of socioeconomic factors and social support in Germany.

Methods: A retrospective evaluation was conducted on 299 patients with liver cirrhosis treated at Medical Faculty Mannheim, Heidelberg University, with 43% at Child-Pugh B stage. The analysis considered various distances to the hospital (10 and 20 km by car, straight-line distance and public transportation usage) and correlated these with patient survival.

Results: The analysis showed that neither car travel distance (P = 0.221, P = 0.1894), straight-line distance (log-rank P = 0.221, cox regression P = 0.1894), nor public transportation usage (P = 0.363, P = 0.1845) up to over 50 km or more than 120 min traveling by public transportation significantly affected survival. Geographical accessibility and differing socioeconomic conditions did not impact treatment quality or survival rates. Known risk factors such as age (P = 0.007, P < 0.0001), gender (P = 0.019, P = 0.0207) and Child-Pugh stage (P = 0.003, P = 0.0155) significantly influenced survival.

Conclusion: Specialized care models at tertiary hospitals offer consistent high-quality care to rural populations not facing disadvantages in survival due to longer travel distances to expert hepatology centers. Socioeconomic backgrounds do not affect care quality in this care model.