Gastroenterology Research最新文献

Background: The Hispanic population is the fastest-growing ethnic group in the USA and is projected to comprise 30% of the US population by 2050. Despite socioeconomic disadvantages and often presenting with more severe disease phenotypes, previous studies in chronic diseases have shown that Hispanics experience lower overall inpatient mortality compared with other ethnic groups - a phenomenon known as the "Hispanic Paradox". In alcoholic liver cirrhosis (ALC), this paradox is particularly evident: Hispanics frequently develop more advanced forms of alcoholic liver cirrhosis, yet survival outcomes are often similar or even superior to those of non-Hispanic populations. This study aims to assess the risk and burden of alcoholic liver cirrhosis in the Hispanic population and to compare the clinical phenotype of ALC with that observed in non-Hispanic populations.

Methods: This retrospective analysis used the Nationwide Inpatient Sample (NIS) database (2016 - 2019) to examine adults hospitalized with ALC. Patients with other causes of cirrhosis were excluded. Patients were stratified into Hispanic and non-Hispanic groups. Diagnoses, complications, and comorbidities were captured using the International Classification of Disease, 10th Revision (ICD-10) codes. The primary outcome was inpatient mortality; secondary outcomes included length of stay (LOS) and total hospitalization charges (TOTCHG). Statistical analyses were performed using Chi-square, t-tests, and Mann-Whitney U tests.

Results: Among patients hospitalized with alcoholic cirrhosis (n = 1,002,115), 17% were Hispanic. Hispanic patients were younger (mean age 54 vs. 57 years, P < 0.001), more often male (81% vs. 67%, P < 0.001), and had similar Charlson Comorbidity Index (CCI) scores. Despite slightly lower inpatient mortality (5.9% vs. 6.8%, P < 0.001), Hispanics experienced higher rates of complications, including esophageal varices (28% vs. 23%), variceal bleeding (10% vs. 7%), acute liver failure (27% vs. 25%), and hepatocellular carcinoma (4% vs. 2%) (P < 0.001 for all). Median TOTCHG was significantly higher ($46,494 vs. $38,881, P < 0.001) in Hispanic patients.

Conclusions: Hispanic patients with alcoholic cirrhosis (ALC) experience a higher burden of cirrhosis-related complications and increased healthcare utilization compared to other ethnic groups yet exhibit lower observed inpatient mortality. These disparities highlight the need for earlier detection, culturally tailored public health interventions, and improved access to preventive and specialty liver care to improve outcomes in this vulnerable population.

Background: Acute cholangitis (AC) is a serious condition caused by partial or complete obstruction of the common bile duct (CBD), leading to biliary tract infection. We aimed to evaluate whether teaching hospitals with trainees and non-teaching hospitals impact the outcome of AC in the United States.

Methods: This study utilized the National Inpatient Sample database to analyze adult hospitalizations (> 18 years old) with a primary diagnosis of AC in the USA from 2016 to 2020. A multivariate logistic regression along with Chi-square and t-tests was performed using SAS 9.4 software to analyze inpatient AC-associated mortality, inflation-adjusted total hospitalization costs (THC), and length of stay (LOS) in US teaching and non-teaching hospitals during the study period.

Results: This study included a total of 30,300 patients, out of whom 23,535 (about 78%) were managed in teaching hospitals and 6,765 (about 22%) were managed in non-teaching hospitals. Primary outcomes showed a significant increase in mortality for patients managed in teaching hospitals (2.77% vs. 2.08%, P = 0.01) in comparison to non-teaching hospitals, hospital LOS was slightly higher in teaching hospitals (5 days (interquartile range (IQR): 3 - 6) vs. 4 days (IQR: 3 - 8)) and so did hospital cost ($15,259 vs. $14,506) in comparison to non-teaching hospitals. Secondary outcomes showed that patients in teaching hospitals had higher incidence of septic shock (16.06% vs. 12.53%, P < 0.0001), intensive care unit (ICU) admissions (6.61% vs. 5.07%, P = 0.0002), and intubation (5.30% vs. 3.46%, P < 0.0001) in comparison to non-teaching hospitals.

Conclusion: Our study found higher mortality rates for AC patients in teaching hospitals compared to non-teaching hospitals. Teaching hospitals also had higher rates of septic shock, ICU admission, and intubation, with no difference in endoscopic retrograde cholangiopancreatography (ERCP) use. These differences could be due to several factors, such as greater resident and fellow autonomy in teaching hospitals and a potentially more proactive approach by physicians in non-teaching hospitals. Additionally, teaching hospitals often manage more complex, higher-acuity cases, which could contribute to worse outcomes.

Background: Rebleeding is a major challenge and a serious complication of non-variceal upper gastrointestinal bleeding (NVUGIB). Prophylactic transcatheter arterial embolization (P-TAE) has emerged as a potential management strategy for high-risk cases. This study aimed to evaluate the efficacy and safety of P-TAE compared with no embolization (NE) in the absence of angiographic evidence of bleeding or therapeutic arterial embolization (TAE).

Methods: The study systematically searched Medline and Embase databases from inception until November 15, 2024. The primary outcome was the overall rebleeding rate, while secondary outcomes included mortality, need for additional interventions, transfusion requirements, hospital/intensive care unit (ICU) stay, and procedure-related adverse events.

Results: The meta-analysis included 10 studies with a total population of 1,253 patients. Compared to NE, the pooled data indicated that P-TAE was not associated with significantly reduced rates of rebleeding (odds ratio (OR): 0.69, 95% confidence interval (CI): 0.39 - 1.22, P = 0.20) or all-cause mortality (OR: 0.70, 95% CI: 0.40 - 1.23). Although P-TAE trended towards lower rates of repeat interventions, blood transfusions, and shorter hospital stays, these differences were not statistically significant. Conversely, P-TAE and TAE had similar rates of rebleeding (OR: 1.08, 95% CI: 0.70 - 1.68, P = 0.05) and all-cause mortality (OR: 0.72, 95% CI: 0.34 - 1.51, P = 0.39). The analysis found no significant differences in adverse events or the need for repeat procedures between the two embolization approaches.

Conclusion: This review suggests that P-TAE may not significantly reduce rebleeding or mortality compared with standard therapy for high-risk NVUGIB. However, the current findings remain inconclusive, and further comprehensive research with larger sample sizes is required to conclusively substantiate these observations.

Background: Statins are reported to reduce colorectal cancer (CRC) risk in the general population, but their effect on individuals with inflammatory bowel disease (IBD) remains uncertain. We aimed to evaluate the relationship between statin use and CRC risk in patients with IBD.

Methods: A comprehensive review of the literature was conducted on PubMed, Web of Science, and EMBASE to evaluate the association between statin use and the development of CRC in patients with IBD. After deduplication, there were 324 studies screened, and those reporting odds ratios (ORs) or hazard ratios (HRs) for CRC risk in IBD patients using statins were included. The primary endpoints included the development of CRC (OR) and time to CRC (HR). A meta-analysis utilizing fixed or random-effects models, heterogeneity tests, and a funnel plot was performed in R (version 4.3.0) with alpha of 0.05.

Results: This meta-analysis included seven studies involving 59,596 patients: three for OR (11,116 patients) and four for HR (48,480 patients). The pooled OR was 0.22 (95% confidence interval (CI): 0.01 - 7.81), suggesting 78% lower odds of CRC in statin users, though not statistically significant (P = 0.21), with potential publication bias. The pooled HR was 0.77 (95% CI: 0.63 - 0.94), indicating a significant 23% reduction in CRC hazard for statin users (P < 0.05), with low publication bias.

Conclusion: Our meta-analysis showed that statin use is associated with a reduced risk of CRC in IBD, significant in HR-based but not in OR-based analysis. Large randomized controlled trials are needed to clarify the duration of statin use and their chemopreventive effects, independent of factors such as targeted therapy for chronic mucosal inflammation.

Primary intestinal lymphangiectasia (PIL) is a rare disease characterized by the loss of lymphatic fluid in the intestinal lumen and is a known cause of protein-losing enteropathy (PLE). Although uncommon, few cases of secondary hyperparathyroidism (SHPT) have been reported in patients with PIL. This study summarizes the characteristics of four cases diagnosed with PIL. Notably, all cases were confirmed to have hyperparathyroidism secondary to vitamin D deficiency and hypocalcemia. Recurrent diarrhea and limb convulsions were also observed in all patients, with one patient diagnosed with osteoporosis. Simultaneously, hypomagnesemia was detected in three cases. Treatment with vitamin D and calcium supplements relieved symptoms, elevated serum calcium levels, and decreased parathyroid hormone (PTH) levels. In patients with PIL, evaluation of 25-hydroxyvitamin D, calcium, and PTH levels is crucial. Bone diseases should be considered in patients with SHPT, and appropriate vitamin D3 and calcium supplementation is highly recommended.

Background: Northern Central America is unique in the Western Hemisphere, with a high incidence of gastric cancer, low/middle-income country (LMIC) status, and a substantial emigration to the United States. The two primary Helicobacter pylori (H. pylori) virulence factors related to carcinogenesis are cytotoxin-associated gene A (CagA) and vacuolating cytotoxin A (VacA). The prevalence of these factors may help delineate gastric cancer risk in the region. We aimed to characterize the H. pylori seroprevalence and virulence factors in two Central American Countries (Honduras and Guatemala).

Methods: Healthy volunteers from Western Honduras and Central-Western Guatemala were recruited and tested for antibodies against 13 H. pylori antigens using a novel multiplex serology assay. H. pylori seropositivity was defined as positivity for ≥ 4 antigens, and active infection was defined as positivity for a combination of 2/4 antigens: VacA, GroEl, HcpC, and HP1564, based upon the literature. Multivariate logistic regression models were used to estimate the odds ratios for the association between H. pylori and CagA positivity.

Results: A total of 1,143 healthy adults were tested using the H. pylori multiplex serology assay (444 in Guatemala and 699 in Honduras). Mean age was 54.2 ± 14.5 years, 46.2% were male, 60% were from rural settings, and 56% lived > 1,000 meters above sea level. H. pylori prevalence was 87%, and 83% with active infection. The CagA and VacA seropositivity rates were 82% and 75%, respectively. No significant differences were noted according to country, age group, sex, or rural/urban location. None of the socioeconomic variables were significantly associated with the presence of H. pylori or CagA.

Conclusions: A high prevalence of H. pylori, CagA, and VacA is observed in Honduras and Guatemala, with implications for Northern Central America and immigrants from the region. Innovative and resource-appropriate primary and secondary prevention programs are needed.

Background: Gastrointestinal (GI) tract malignancies represent a significant global health burden, being major contributors to cancer-related morbidity and mortality globally, with over 7.7 million cases reported. While aspirin is a well-studied chemopreventive agent for GI neoplasms, its use may be limited due to the underlying bleeding risk. Eflornithine (DFMO) is an inhibitor of the ornithine decarboxylase (ODC) which inhibits polyamine synthesis, and has shown promise as an alternative chemopreventive agent, particularly in animal studies and limited clinical trials.

Methods: Following PRISMA guidelines, we conducted a systematic review of studies evaluating DFMO alone or in combination for chemoprevention in premalignant GI lesions including chronic gastritis, atrophic gastritis, intestinal metaplasia, and dysplasia. The protocol was registered in Prospero (CRD42022309307). Randomized controlled trials (RCTs) and cohort studies in English or Spanish were included.

Results: Nine studies (six RCTs and three phase I-II trials) met inclusion criteria. Phase I-II trials involving Barrett's esophagus and gastric cancer did not report significant benefits. Phase III-IV trials combining DFMO with nonsteroidal anti-inflammatory drugs (NSAIDs) were associated with reductions in adenoma recurrence, size, and polyamine levels in high-risk GI cancer populations. Side effects included ototoxicity, reversible upon discontinuation, and mild GI events, both occurring at higher doses.

Conclusion: While aspirin remains a frontline chemopreventive agent for GI neoplasms, this review shows that phase III-IV trials suggest promising outcomes in combination with NSAIDs, warranting further investigation. Notably, DFMO's low cost and favorable toxicity profile may position it as a viable alternative, emphasizing the need for additional RCTs to delineate its efficacy and safety in GI cancer prevention. Further investigation into DFMO's optimal dosage, duration, and side effect management is essential to establish it as a safe and effective chemopreventive agent.

Background: Inflammatory bowel disease (IBD) has been associated with increased risk of developing pancreatitis. We analyzed data from the National Inpatient Sample (NIS) with the aim of evaluating the outcomes of acute pancreatitis (AP) in patients with co-existent Crohn's disease (CD) or ulcerative colitis (UC).

Methods: This was a cross-sectional study using the 2020 NIS database. Patients were included if they were more than 18 years old with a principal diagnosis of AP. Main outcome measurements of our study were in-hospital mortality, length of hospital stay, hospital total charges, incidences of hypovolemic shock, severe sepsis with and without shock, acute kidney failure (AKI), and the need for intensive care unit (ICU) care. Statistical analyses were performed on STATA version 18.0.

Results: There were 258,965 (0.8%) admissions with the primary diagnosis of AP among the 32 million discharges in 2020 NIS database. Among patients with AP, a total of 1,930 (0.75%) and 1,170 (0.45%) hospitalizations had co-existing CD and UC, respectively. The overall in-hospital mortality for AP was 1,560 (0.62%). Patients with UC hospitalized for AP had increased odds of in-hospital mortality (adjusted odds ratio (aOR): 3.62, 95% confidence interval (CI): 1.310 - 9.978, P = 0.013) while for patients with CD, there were no in-hospital mortality. Patients with CD had increased odds of developing comorbid AKI (aOR: 1.37, 95% CI: 1.005 - 1.880, P = 0.047) when they present with AP but not those with UC.

Conclusions: Patients hospitalized with AP had increased odds of in-hospital mortality and comorbid AKI when they have co-existent UC and CD, respectively.

Background: Achalasia is a rare motility disorder of the esophagus. The diagnosis involves clinical suspicion based on history details and results of high-resolution manometry (HRM) as recommended by the Chicago classification (CCv4.0). Interpreting data obtained through HRM can be complex especially for the novice user.

Methods: We propose therefore a color-based algorithm involving the "reversed red-green-blue (RGB)" rule as a simplified way to establish the diagnosis based on colors obtained through the HRM pressure sensors. The rule is based on the simple acknowledgment of the dominant color present in the mid-portion of the HRM figure such that, for type I (classic) achalasia, the blue color illustrates the minimal pressurization and absent peristalsis. In type II (pan-pressurized) achalasia, the green color illustrates pan-esophageal pressurization, while in type III (spastic) achalasia, red color illustrates the spastic contractions.

Results: This rule, which we present as a conceptual framework and has not yet been prospectively validated, provides an intuitive tool for clinicians dealing with HRMs diagnosing achalasia.

Conclusion: Further studies are required to assess the diagnostic accuracy of this rule, alongside the potential for incorporating such rules into artificial intelligence (AI)-based models for manometric diagnosis of esophageal motility disorders.