European Journal of Gastroenterology & Hepatology最新文献

Background and aims: Antiviral treatment (AVT) reduces hepatitis B virus (HBV) reactivation and hepatocsellular carcinoma (HCC) development; however, the impact of AVT timing - before versus after HCC diagnosis - on prognosis remains unclear. This study aimed to evaluate the current status, changes, and clinical outcomes of AVT before HCC diagnosis in Korea.

Methods: Data were extracted from the Korean National Health Insurance Service for patients newly diagnosed with HBV-related HCC from 2008 to 2018. Patients were categorized into an early cohort (2008-2013) and a late cohort (2014-2018). AVT trends were analyzed using Joinpoint regression, and clinical outcomes were compared between groups.

Results: Among 82 609 patients (early cohort: n = 45 804; late cohort: n = 36 805), the proportion receiving AVT before HCC diagnosis increased from 22.4% in 2008 to 46.8% in 2018. AVT after diagnosis also rose from 16.3 to 21.3%. Overall survival rates in the late cohort were significantly improved compared with the early cohort (P < 0.001). More than half of the patients with HCC who received transplantation or local ablation treatment had received AVT before HCC diagnosis. AVT before HCC diagnosis was associated with reduced mortality rate (adjusted hazard ratio = 0.592; 95% confidence interval: 0.580-0.604; P < 0.001). Elderly patients (≥80 years) consistently had a lower AVT rate before HCC diagnosis compared with other age groups (P < 0.05).

Conclusion: The AVT rate before HCC diagnosis significantly increased over the past 10 years in Korea. Further efforts are needed to improve the AVT rate in elderly patients with HBV-related HCC.

Background: Proton pump inhibitors (PPIs) are widely prescribed for acid-related disorders; however, concerns have emerged regarding their misuse, particularly in patients with liver cirrhosis. This study aimed to assess the appropriateness of PPI prescriptions in patients with cirrhosis and to identify factors contributing to their overutilization in this patient population.

Methods: In this cross-sectional study, 1000 patients with cirrhosis receiving PPIs were enrolled. Data on demographics, clinical parameters, and endoscopic findings were collected, and indications for PPI therapy were assessed according to established guidelines.

Results: Among patients with cirrhosis, 60.5% were prescribed PPIs, with pantoprazole being the most prescribed (55.7%). Inappropriate PPI use was observed in 53.6% of the patients, mainly because of lacking an approved indication (78.54%) or exceeding the recommended treatment duration (21.46%). Causes contributing to misuse included prolonged PPI use postendoscopic band ligation (29.1%), extended treatment for functional dyspepsia (21.46%), failure to discontinue PPIs upon hospital discharge (17.54%), using PPIs for preventing portal hypertensive gastropathy (PHG) or variceal bleeding (16.42%), and stress ulcer prophylaxis in non-ICU patients (15.86%). Multivariate analysis identified independent predictors of inappropriate PPI use, including Child classification C, Mayo End-Stage Liver Disease score greater than 18, hepatocellular carcinoma, and previous variceal bleeding, whereas hematemesis was identified as an independent predictor of appropriate use.

Conclusion: This study underscores the prevalent inappropriate prescription of PPIs in patients with liver cirrhosis, particularly in those with advanced liver disease or a history of variceal bleeding. Enhancing prescribing practices and adhering to evidence-based guidelines are essential to mitigate the risks associated with PPI misuse in patients with cirrhosis.

Background and aims: There is a paucity of data on which bowel preparation (BP) to use in an inflammatory bowel disease (IBD) outpatient setting, in particular after the introduction of 1L-PEG-ASC. Thus, we aimed to evaluate the most effective BP between 1L-PEG-ASC and 2L-PEG and to identify risk factors for inadequate BP in this IBD population.

Methods: This is a multicentric, retrospective, cross-sectional study including IBD patients aged >16 years, who underwent outpatient split-dose colonoscopy between January 2021 and December 2022. Boston Bowel Preparation Scale (BBPS) was used to determine the adequacy of BP. Multivariable logistic regression was fitted to compare BP adequacy between 1L-PEG-ASC and 2L-PEG.

Results: Overall, 506 patients (F 42.9%, mean age 48.9 ± 15.2 years) were included and BP was adequate in 440 (87.0%). 1L-PEG-ASC was associated with a higher rate of adequate BP compared to 2L-PEG (89.8% vs. 83.8%, P  = 0.048) and higher BBPS score [median 8, interquartile range (IQR): 7-9 vs. 6, IQR: 6-8, P  < 0.001]. Male sex ( P  = 0.03), previous ileal/colonic surgery ( P  = 0.01), and stricturing Crohn's disease (CD) ( P  = 0.01) were associated with inadequate BP. At multivariable analysis, 1L-PEG-ASC was a predictor of adequate BP [odds ratios (OR) = 1.70, 95% confidence interval (CI): 1.00-2.90, P  < 0.05]; whereas male sex (OR = 0.51, 95% CI: 0.29-0.90, P  = 0.02) and previous ileal/colonic surgery (OR = 0.40, 95% CI: 0.21-0.77, P  < 0.01) were confirmed as risk factors for inadequate BP.

Conclusion: Results from this large real-world cohort highlight the efficiency of 1L-PEG-ASC in providing better BP compared to 2L-PEG. However, further studies are needed to validate our retrospective results and confirm the superiority of 1L-PEG-ASC. Male sex and previous ileal/colonic surgery and stricturing CD were related to poor BP.

Background: Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cystic lesions with variable risk for malignant transformation. This observational study assessed the long-term natural history of IPMNs, focusing on risk stratification based on imaging and histological features.

Methods: We retrospectively reviewed 93 patients with IPMN confirmed by MRI and endoscopic ultrasound (EUS) or both. All patients had a minimum follow-up of 5 years. Demographic, clinical, imaging, procedural, and outcome data were collected. IPMN characteristics including cyst size, duct size, duct involvement, and location were evaluated at baseline. The primary outcome was progression to high-grade dysplasia or invasive carcinoma. Secondary outcomes included the need for surgery, cyst progression, and IPMN-related mortality.

Results: The cohort included 93 patients (65.6% female, mean age 70.9 ± 9.9 years). The majority (92.5%) had branch duct IPMN. The mean cyst size was 1.53 ± 1.57 cm, and the duct size was 2.69 ± 1.79 mm. High-grade dysplasia was found in 9.7%. Surgical resection was significantly associated with cyst size >2.6 cm ( P  = 0.031), duct dilation >5.3 mm ( P  = 0.004), and main/mixed duct involvement ( P  < 0.001). Additionally, cyst wall thickening (60%) and mural nodule (67%) were significantly associated with surgical resection. One patient progressed to invasive carcinoma. No IPMN-related deaths were reported.

Conclusion: IPMNs evaluated and monitored with MRI/EUS demonstrate indolent behavior over extended follow-up. Surgical resection should be considered based on duct type, cyst size, and presence of dysplasia. Long-term surveillance remains essential for appropriate risk stratification.

Purpose: To explore the factors influencing noncurative resection (NCR) in patients with rectal neuroendocrine neoplasms (R-NENs) on the basis of endoscopic ultrasonography (EUS) findings and to construct and validate a nomogram prediction model based on these factors.

Methods: This retrospective cohort study included 244 patients with pathologically confirmed R-NEN who underwent endoscopic submucosal dissection (ESD) at the Affiliated Hospital of Qingdao University between March 2016 and June 2023. The patients' EUS and clinical features were collected to identify independent factors influencing NCR following ESD. A nomogram prediction model was constructed, and its performance was evaluated with receiver operating characteristic (ROC) curve analysis.

Results: A larger tumor diameter, irregular borders, and submucosal involvement on EUS were identified as independent risk factors for NCR following ESD in patients with R-NENs. A nomogram model integrating these three predictors effectively predicted the occurrence of NCR. ROC curve analysis was used to compare the clinical predictive efficacy of the independent influencing factors and their combination. The results revealed that the area under the curve for the combination of factors was 0.791, with a sensitivity of 68.6% and specificity of 86.0%, indicating good clinical diagnostic value. The Hosmer-Lemeshow goodness-of-fit test ( P  = 0.178) indicated satisfactory model calibration.

Conclusion: The nomogram model achieved good predictive performance. This model can assist endoscopists in dynamically assessing the risk of NCR in real time, but its clinical applicability requires verification.

The management of Crohn's disease during pregnancy presents significant challenges. Active Crohn's disease can be treated with corticosteroids or biologics. While these treatments are generally considered safe during pregnancy, they are not without potential side effects, leading to patient hesitancy in initiating therapy despite guidance from inflammatory bowel disease specialists. We present the case of a 34-year-old woman who was diagnosed with Crohn's disease 3 weeks before getting pregnant and who opted not to use medication during her pregnancy. For the initial 26-28 weeks, she received conservative treatment. Following a deterioration in her symptoms and an increase in calprotectin levels, she commenced the Crohn's disease exclusion diet (CDED) combined with partial enteral nutrition (PEN). This led to significant symptomatic improvement and a decrease in faecal calprotectin levels. At 40 weeks of gestation, she gave birth to a healthy baby. This case underscores the potential efficacy of CDED and PEN as dietary management strategies for Crohn's disease even during pregnancy, although further research is warranted to compare these approaches with conventional treatments. In addition, it emphasises the critical role of preconception counselling regarding medication safety and effective disease management during pregnancy.

Objective: To assess the hepatitis C virus (HCV) prevalence, incidence, and associated determinants among men who have sex with men (MSM) without HIV in Amsterdam, the Netherlands.

Methods: We used data from the Amsterdam Cohort Studies (2012-2021) to calculate the prevalence of past/current HCV infection at the first study visit and incidence rate of primary HCV infection during follow-up. We identified determinants associated with incident HCV infection using univariable Bayesian exponential survival models. Phylogenetic analysis was conducted to compare HCV sequences of MSM without HIV to those from MSM with HIV and those using HIV pre-exposure prophylaxis.

Results: A total of 926 MSM were included. At first visit, 2/926 (0.2%) had a past/current HCV infection. Among 891 participants contributing to 6083.30 person-years of follow-up, three incident HCV infections were observed (incidence rate = 0.05/100 person-years). These infections were observed between 2014 and 2018, and all participants had never used HIV pre-exposure prophylaxis. Incident infections were associated with receptive condomless anal sex, having 1-10 sexual partners vs. none, recent injecting drug use (IDU), ever IDU, and fisting, albeit there was substantial uncertainty for all determinants (i.e. 95% credible intervals included one). Phylogenetic analysis revealed that one HCV-RNA sequence was closely related to HCV sequences from MSM with HIV.

Conclusion: While HCV infection is uncommon among MSM without HIV, the risk of infection seems to increase among those with specific behaviors. HCV screening for MSM without HIV should be focused on those reporting these behaviors.

Objectives: Sarcopenia, characterized by the loss of skeletal muscle mass and function, is increasingly recognized as a critical factor influencing clinical outcomes in patients with chronic pancreatitis (CP). This study aims to evaluate the prevalence, hospitalization burden, and survival outcomes associated with sarcopenia in CP patients.

Methods: We used the National Inpatient Sample 2016-2020 to identify patients with CP and stratified them into two groups based on the presence of sarcopenia. Data were collected on patient demographics, hospital characteristics, and comorbidities. The outcomes assessed were inhospital mortality, sepsis, shock, acute kidney injury, and resource utilization. Multivariate regression analysis was used to assess the relationship between sarcopenia and clinical outcomes.

Results: Of the included patients, 18.3% (165 900) had sarcopenia. Patients with sarcopenia had higher odds of inhospital mortality [adjusted odds ratio (aOR): 3.29, 95% confidence interval (CI): 3.06-3.54, P  < 0.001], sepsis (aOR: 1.58, 95% CI: 1.49-1.69, P  < 0.001), acute kidney injury (aOR: 1.46, 95% CI: 1.42-1.51, P  < 0.001), and ICU admission (aOR: 2.6, 95% CI: 2.47-2.74, P  < 0.001). Sarcopenic patients also had longer hospital stays (+3.87 days, P  < 0.001) and increased hospitalization costs (+$40 285.15, P  < 0.001).

Conclusions: Sarcopenia is a strong, independent predictor of adverse clinical outcomes in CP patients, including increased mortality and healthcare costs. Early detection and management through nutritional and rehabilitative interventions should be integral components of CP care.

Up now, several medications were proposed for the treatment of autoimmune hepatitis (AIH); however, because of the unclear pathophysiology of AIH, the most optimal treatment option needs to be elucidated. This systematic review sought to investigate the safety and efficacy of rituxiamb (RTX) in patients with AIH. A total of 27 studies were included in the present study. A total of 80 patients had the eligibility criteria, of which the majority of them were female (63 female and 17 male). Of the 80 patients, nine patients were pediatrics. The induction of remission and maintenance therapy were the most common indications for RTX in AIH. Of the 80 patients, we found complete remission in 55% of patients ( n = 44) and partial remission in 11% of patients ( n = 11). Of the nine pediatric patients, we found complete remission in 77% of patients ( n = 7) and partial remission in 22% of patients ( n = 2). Unclear response was also reported in 31% of patients ( n = 25), which included four studies. 375 mg/m 2 × 4 followed by 1000 mg × 2 was the most commonly applied RTX dosage used for treatment of AIH. RTX therapy was associated with infectious complications in six patients; however, one episode of cancer, death, mild conjunctivitis, and large bowel perforation were also reported. RTX is an anti-CD20 mAb and was shown to be effective for the treatment of AIH, but there is no consensus regarding the therapeutic role of RTX in AIH.