Kathryn Jack, Rachel Jackson, William Lucien Irving
Background: Hepatitis D virus (HDV) infection is an important cause of chronic liver disease yet remains a poorly met clinical challenge. The current European and UK guidelines recommend that all patients with hepatitis B virus (HBV) are tested for HDV, but emerging UK data indicates that only approximately 20% have been tested. The World Health Organization viral hepatitis elimination strategy first requires the systematic testing of people with relevant risk factors, so there is a need to understand factors contributing to low anti-HDV rates of testing.
Methods: An audit was conducted to ascertain the perspectives of patients and healthcare professionals about identifying HDV infection. During a 4-month period, 39 hepatology healthcare professionals and 70 patients with chronic HBV were recruited. The attitudes of healthcare professionals about HDV testing were surveyed according to the seven constructs of the theoretical framework of acceptability (TFA). Patients were surveyed by telephone about their knowledge of HDV and their own testing status.
Results: Among the 39 healthcare professionals, only 66.6% and 53.8% were able to correctly cite EASL (European) HDV and NICE (UK) testing guidelines, respectively, although there were high levels of anti-HDV testing acceptability according to the TFA. Among the patients, 95.7% (67/70) had been tested for anti-HDV and all were seronegative. Only 23% (16/70) knew of the existence of HDV. There was extensive ethnic heterogeneity with 23 countries of birth and 24 different primary languages.
Conclusion: Some clinicians lack familiarity with clinical guideline recommendations for universal testing of all HBsAg-positive patients. Similarly, most patients lack knowledge about HDV. Staff and patient education are required to increase HDV diagnosis.
{"title":"Hepatitis D Virus Status Among People With Hepatitis B Virus Infection: A Disconnect Between Guidelines and Practice","authors":"Kathryn Jack, Rachel Jackson, William Lucien Irving","doi":"10.1155/2024/6622276","DOIUrl":"https://doi.org/10.1155/2024/6622276","url":null,"abstract":"<p><b>Background:</b> Hepatitis D virus (HDV) infection is an important cause of chronic liver disease yet remains a poorly met clinical challenge. The current European and UK guidelines recommend that all patients with hepatitis B virus (HBV) are tested for HDV, but emerging UK data indicates that only approximately 20% have been tested. The World Health Organization viral hepatitis elimination strategy first requires the systematic testing of people with relevant risk factors, so there is a need to understand factors contributing to low anti-HDV rates of testing.</p><p><b>Methods:</b> An audit was conducted to ascertain the perspectives of patients and healthcare professionals about identifying HDV infection. During a 4-month period, 39 hepatology healthcare professionals and 70 patients with chronic HBV were recruited. The attitudes of healthcare professionals about HDV testing were surveyed according to the seven constructs of the theoretical framework of acceptability (TFA). Patients were surveyed by telephone about their knowledge of HDV and their own testing status.</p><p><b>Results:</b> Among the 39 healthcare professionals, only 66.6% and 53.8% were able to correctly cite EASL (European) HDV and NICE (UK) testing guidelines, respectively, although there were high levels of anti-HDV testing acceptability according to the TFA. Among the patients, 95.7% (67/70) had been tested for anti-HDV and all were seronegative. Only 23% (16/70) knew of the existence of HDV. There was extensive ethnic heterogeneity with 23 countries of birth and 24 different primary languages.</p><p><b>Conclusion:</b> Some clinicians lack familiarity with clinical guideline recommendations for universal testing of all HBsAg-positive patients. Similarly, most patients lack knowledge about HDV. Staff and patient education are required to increase HDV diagnosis.</p>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"2024 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/6622276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ariana Tagliaferri, Nida Ansari, Gabriel Melki, Yana Cavanagh
Background: Primary and secondary prophylaxis for spontaneous bacterial peritonitis (SBP) should be reserved for high-risk cirrhotic patients, such as those with a history of SBP, gastrointestinal (GI) hemorrhage, high Child–Pugh score, or low ascitic fluid protein (AFP) with liver and renal failure. Due to a multitude of reasons, many patients who require prophylaxis do not receive it. We present a retrospective analysis and quality improvement project. High-risk cirrhotic patients were identified to see if antibiotic prophylaxis was initiated upon admission and the 1-year outcomes for those individuals.
Methods and Results: One hundred twenty-six patients were included in the study. The mean age was 57.38 years. A total of 59.5% (n = 75) of patients were current or former alcohol users. A total of 54.8% (n = 69) of patients met the criteria for SBP prophylaxis; however, only 26% (n = 18) received it (p ≤ 0.073). Ciprofloxacin and cephalosporins were the most used antibiotics. Although none of the analyses for readmissions produced statistical significance, there were clinically more patients readmitted for SBP when prophylaxis was not prescribed. No patients who received prophylaxis were hospitalized within 6 months following a discharge for SBP. Only two of the 18 patients who received prophylaxis died compared to 30 of the 51 patients who did not (p ≤ 0.001). Twenty-eight of the 32 who met the criteria but did not receive prophylaxis were deceased within 1 year following discharge (p ≤ 0.042). When stratified by basic demographics, mortality was significant in the nonprophylaxis groups for males (p ≤ 0.0001), 25–30 body mass index (BMI) group (p ≤ 0.003), and alcohol use (p ≤ 0.002).
Conclusion: We intend to educate providers on the appropriate time to intervene to reduce mortality and subsequent hospitalizations for those with advanced liver disease.
{"title":"The Use of Antibiotics for the Prophylaxis of Spontaneous Bacterial Peritonitis: A Retrospective Review and Quality Improvement Study","authors":"Ariana Tagliaferri, Nida Ansari, Gabriel Melki, Yana Cavanagh","doi":"10.1155/2024/9271718","DOIUrl":"https://doi.org/10.1155/2024/9271718","url":null,"abstract":"<p><b>Background:</b> Primary and secondary prophylaxis for spontaneous bacterial peritonitis (SBP) should be reserved for high-risk cirrhotic patients, such as those with a history of SBP, gastrointestinal (GI) hemorrhage, high Child–Pugh score, or low ascitic fluid protein (AFP) with liver and renal failure. Due to a multitude of reasons, many patients who require prophylaxis do not receive it. We present a retrospective analysis and quality improvement project. High-risk cirrhotic patients were identified to see if antibiotic prophylaxis was initiated upon admission and the 1-year outcomes for those individuals.</p><p><b>Methods and Results:</b> One hundred twenty-six patients were included in the study. The mean age was 57.38 years. A total of 59.5% (<i>n</i> = 75) of patients were current or former alcohol users. A total of 54.8% (<i>n</i> = 69) of patients met the criteria for SBP prophylaxis; however, only 26% (<i>n</i> = 18) received it (<i>p</i> ≤ 0.073). Ciprofloxacin and cephalosporins were the most used antibiotics. Although none of the analyses for readmissions produced statistical significance, there were clinically more patients readmitted for SBP when prophylaxis was not prescribed. No patients who received prophylaxis were hospitalized within 6 months following a discharge for SBP. Only two of the 18 patients who received prophylaxis died compared to 30 of the 51 patients who did not (<i>p</i> ≤ 0.001). Twenty-eight of the 32 who met the criteria but did not receive prophylaxis were deceased within 1 year following discharge (<i>p</i> ≤ 0.042). When stratified by basic demographics, mortality was significant in the nonprophylaxis groups for males (<i>p</i> ≤ 0.0001), 25–30 body mass index (BMI) group (<i>p</i> ≤ 0.003), and alcohol use (<i>p</i> ≤ 0.002).</p><p><b>Conclusion:</b> We intend to educate providers on the appropriate time to intervene to reduce mortality and subsequent hospitalizations for those with advanced liver disease.</p>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"2024 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/9271718","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141536738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background/Aims: This study is aimed at comparing the outcomes of upper gastrointestinal bleeding (UGIB) during emergency endoscopy between patients taking and not taking antithrombotic agents to inform antithrombotic management.
Methods: We conducted a retrospective analysis of 389 patients who underwent emergency endoscopy for UGIB from 2016 to 2021. The patients were categorized into group A (taking antithrombotic agents) and group NA (not taking antithrombotic agents). The clinical characteristics, types of antithrombotic agents, patient status upon admission, and causes of UGIB were examined. Treatment outcomes and adverse events were assessed by propensity score matching (PSM).
Results: Group A was significantly older and the primary antithrombotic agent was low-dose aspirin, with multiple antithrombotics taken by 38 patients (29.0%). Peptic ulcers were the most common cause of UGIB in both groups. PSM generated 83 matched pairs. The success rate of endoscopic hemostasis in group A was significantly higher than in group NA (96.4% vs. 84.3%, P = 0.02). Despite promptly resuming antithrombotic agent posthemostasis, there was no significant difference in the rebleeding rate or 30-day mortality.
Conclusion: The high success rate of endoscopic hemostasis and no difference in adverse events made the prompt resumption of antithrombotic medications after emergency endoscopy for UGIB acceptable.
{"title":"Management of Antithrombotic Agents During Emergency Endoscopy for Upper Gastrointestinal Bleeding: A Propensity Score Matching Analysis","authors":"Daisuke Yamaguchi, Satoshi Ishida, Kasumi Gondo, Tadahiro Nomura, Azuki Yamaguchi, Ryosuke Asahi, Yumi Mizuta, Goshi Nagatsuma, Shota Fukami, Shunichiro Kimura, Shun Fujimoto, Akane Shimakura, Amane Jubashi, Yuki Takeuchi, Kei Ikeda, Yuichiro Tanaka, Wataru Yoshioka, Naoyuki Hino, Tomohito Morisaki, Keisuke Ario, Seiji Tsunada","doi":"10.1155/2024/7561793","DOIUrl":"https://doi.org/10.1155/2024/7561793","url":null,"abstract":"<p><b>Background/Aims:</b> This study is aimed at comparing the outcomes of upper gastrointestinal bleeding (UGIB) during emergency endoscopy between patients taking and not taking antithrombotic agents to inform antithrombotic management.</p><p><b>Methods:</b> We conducted a retrospective analysis of 389 patients who underwent emergency endoscopy for UGIB from 2016 to 2021. The patients were categorized into group A (taking antithrombotic agents) and group NA (not taking antithrombotic agents). The clinical characteristics, types of antithrombotic agents, patient status upon admission, and causes of UGIB were examined. Treatment outcomes and adverse events were assessed by propensity score matching (PSM).</p><p><b>Results:</b> Group A was significantly older and the primary antithrombotic agent was low-dose aspirin, with multiple antithrombotics taken by 38 patients (29.0%). Peptic ulcers were the most common cause of UGIB in both groups. PSM generated 83 matched pairs. The success rate of endoscopic hemostasis in group A was significantly higher than in group NA (96.4% vs. 84.3%, <i>P</i> = 0.02). Despite promptly resuming antithrombotic agent posthemostasis, there was no significant difference in the rebleeding rate or 30-day mortality.</p><p><b>Conclusion:</b> The high success rate of endoscopic hemostasis and no difference in adverse events made the prompt resumption of antithrombotic medications after emergency endoscopy for UGIB acceptable.</p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: UMIN000053561</p>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"2024 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/7561793","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141489016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily Lim, Maxter Thai, Yoon-Kyo An, Peter Hendy, Mahmoud Alchlaihawi, Rupert Leong, Susan Connor, Watson Ng, Bonita Gu, Lena Thin, Miles Sparrow, Robert Gilmore, Kirstin Taylor, Olivia Sallis, Jane M. Andrews, Charlotte Daker, Richard B. Gearry, Gabrielle Wark, Simon Ghaly, Matt Begun, Krupa Krishnaprasad, Tianhong Wu, Leonie Ruddick-Collins, Veronika Schreiber, Satomi Okano, Graham Radford-Smith, Julien Schulberg, Daniel van Langenberg, Jakob Begun
Background: Endoscopic balloon dilatation (EBD) is an alternative therapy to avoid or delay surgery in stricturing Crohn’s disease (CD); however, certain factors determining outcomes remain poorly defined, and conflicting evidence exists in current studies. In one of the largest cohorts to date, we assess outcomes following EBD for stricturing CD for both anastomotic and de novo strictures.
Methods: A retrospective cohort study of CD patients undergoing EBD was conducted at 12 hospitals across Australia and New Zealand. Local databases were used to identify cases from February 1999 to November 2019. Data from patient endoscopy reports and medical records were used to determine patient medical details and EBD outcomes. Multivariable analysis was undertaken to identify factors associated with technical and long-term success.
Results: A total of 273 patients with stricturing CD were identified (48% female; 49.6% Montreal L3 disease). Of 695 EBD procedures (355 anastomotic, 340 de novo strictures), the majority (80.1% of strictures with identified length) was performed on short strictures (< 4 cm). Technical success, defined as the ability to traverse the stricture with a colonoscope after dilation, was achieved in 577 (83%) of endoscopic procedures, with success more likely with de novo strictures compared with anastomotic strictures (aOR: 3.21, P = 0.010). A significantly higher failure rate was noted with long strictures (aOR: 0.09, P < 0.001). A total of 74 patients (27%) required surgery within 5 years with stricture length, the only significant factor associated with increased surgery risk (aHR: 2.37, P < 0.01).
Conclusion: EBD is a highly effective and safe procedure in both de novo and anastomotic strictures < 4 cm that can prevent or delay the need for surgical treatment.
{"title":"High Technical Success Rate of Endoscopic Balloon Dilatation Reduces Surgical Requirement for Patients With Stricturing Crohn’s Disease","authors":"Emily Lim, Maxter Thai, Yoon-Kyo An, Peter Hendy, Mahmoud Alchlaihawi, Rupert Leong, Susan Connor, Watson Ng, Bonita Gu, Lena Thin, Miles Sparrow, Robert Gilmore, Kirstin Taylor, Olivia Sallis, Jane M. Andrews, Charlotte Daker, Richard B. Gearry, Gabrielle Wark, Simon Ghaly, Matt Begun, Krupa Krishnaprasad, Tianhong Wu, Leonie Ruddick-Collins, Veronika Schreiber, Satomi Okano, Graham Radford-Smith, Julien Schulberg, Daniel van Langenberg, Jakob Begun","doi":"10.1155/2024/3686618","DOIUrl":"https://doi.org/10.1155/2024/3686618","url":null,"abstract":"<p><b>Background:</b> Endoscopic balloon dilatation (EBD) is an alternative therapy to avoid or delay surgery in stricturing Crohn’s disease (CD); however, certain factors determining outcomes remain poorly defined, and conflicting evidence exists in current studies. In one of the largest cohorts to date, we assess outcomes following EBD for stricturing CD for both anastomotic and de novo strictures.</p><p><b>Methods:</b> A retrospective cohort study of CD patients undergoing EBD was conducted at 12 hospitals across Australia and New Zealand. Local databases were used to identify cases from February 1999 to November 2019. Data from patient endoscopy reports and medical records were used to determine patient medical details and EBD outcomes. Multivariable analysis was undertaken to identify factors associated with technical and long-term success.</p><p><b>Results:</b> A total of 273 patients with stricturing CD were identified (48% female; 49.6% Montreal L3 disease). Of 695 EBD procedures (355 anastomotic, 340 de novo strictures), the majority (80.1% of strictures with identified length) was performed on short strictures (< 4 cm). Technical success, defined as the ability to traverse the stricture with a colonoscope after dilation, was achieved in 577 (83%) of endoscopic procedures, with success more likely with de novo strictures compared with anastomotic strictures (aOR: 3.21, <i>P</i> = 0.010). A significantly higher failure rate was noted with long strictures (aOR: 0.09, <i>P</i> < 0.001). A total of 74 patients (27%) required surgery within 5 years with stricture length, the only significant factor associated with increased surgery risk (aHR: 2.37, <i>P</i> < 0.01).</p><p><b>Conclusion:</b> EBD is a highly effective and safe procedure in both de novo and anastomotic strictures < 4 cm that can prevent or delay the need for surgical treatment.</p>","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"2024 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/2024/3686618","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141298408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Timothy Wearne, Safaa Nadeem, Bruce Wilson, Kylie J. Mansfield, Caitlin Keighley
Background. Helicobacter pylori is considered the most widespread bacterial pathogen worldwide. Successful eradication protocols are well established, highlighting the importance of appropriate infection detection. Noninvasive testing (NIT) methods are commonly used to detect infection, with test selection dependent on access and previous infection. This study examined trends in NIT by age group and test selection for eradication screening as well as examining H. pylori area prevalence by socioeconomic status (SES) in the Illawarra Shoalhaven and surrounding region. Materials and Methods. This retrospective cohort quantitative study is based on 20,998 NIT including stool antigen test (SAT), urea breath test (UBT), or H. pylori serology via Southern.IML Pathology between 2018 and 2020. Test percentage positives per and total test percentages within age groups were calculated for each NIT. Positive sample postcode data was assigned to socioeconomic percentiles. Total test utilisation and prevalence were calculated and depicted as geospatial representations. Results. Overall: 58.5% UBT, 31% serology, and 10.5% SAT were performed, with 14.7% positive for any NIT. Highest percent positive age group: SAT 80-89yo (18.6%), UBT 0-9yo (20.8%), and serology 90–99yo (32.6%). Test majority per age group: SAT 0-9yo (67.4%), UBT 10-89yo (59.4%), and serology 90-99yo (48.3%). A trend was seen between increasing infection prevalence and increasing socioeconomic disadvantage ( , ). Prevalence rates visually correlated with total test utilisation. Conclusions. SAT was underutilised compared to UBT or serology. Serology was inappropriately used in older age groups, and the result validity was questioned following confirmed infection. SAT is a viable alternative for use in these settings. No significant correlation was seen between lower SES areas and higher H. pylori infection prevalence, but low-test utilisation suggests likely prevalence underestimation within the studied area and may indicate reduced accessibility to healthcare.
{"title":"The Suitability of Stool Antigen Testing in the Detection of Helicobacter pylori in a Regional and Rural Area of Australia","authors":"Timothy Wearne, Safaa Nadeem, Bruce Wilson, Kylie J. Mansfield, Caitlin Keighley","doi":"10.1155/2023/6642474","DOIUrl":"https://doi.org/10.1155/2023/6642474","url":null,"abstract":"Background. Helicobacter pylori is considered the most widespread bacterial pathogen worldwide. Successful eradication protocols are well established, highlighting the importance of appropriate infection detection. Noninvasive testing (NIT) methods are commonly used to detect infection, with test selection dependent on access and previous infection. This study examined trends in NIT by age group and test selection for eradication screening as well as examining H. pylori area prevalence by socioeconomic status (SES) in the Illawarra Shoalhaven and surrounding region. Materials and Methods. This retrospective cohort quantitative study is based on 20,998 NIT including stool antigen test (SAT), urea breath test (UBT), or H. pylori serology via Southern.IML Pathology between 2018 and 2020. Test percentage positives per and total test percentages within age groups were calculated for each NIT. Positive sample postcode data was assigned to socioeconomic percentiles. Total test utilisation and prevalence were calculated and depicted as geospatial representations. Results. Overall: 58.5% UBT, 31% serology, and 10.5% SAT were performed, with 14.7% positive for any NIT. Highest percent positive age group: SAT 80-89yo (18.6%), UBT 0-9yo (20.8%), and serology 90–99yo (32.6%). Test majority per age group: SAT 0-9yo (67.4%), UBT 10-89yo (59.4%), and serology 90-99yo (48.3%). A trend was seen between increasing infection prevalence and increasing socioeconomic disadvantage ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo>=</mo> <mn>0.161</mn> </math> , <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <msup> <mrow> <mi>R</mi> </mrow> <mrow> <mn>2</mn> </mrow> </msup> <mo>=</mo> <mn>0.0361</mn> </math> ). Prevalence rates visually correlated with total test utilisation. Conclusions. SAT was underutilised compared to UBT or serology. Serology was inappropriately used in older age groups, and the result validity was questioned following confirmed infection. SAT is a viable alternative for use in these settings. No significant correlation was seen between lower SES areas and higher H. pylori infection prevalence, but low-test utilisation suggests likely prevalence underestimation within the studied area and may indicate reduced accessibility to healthcare.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"2 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135568075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Electrogastrography and electroenterography are noninvasive methods for measuring gastric and intestinal electrical activities, respectively. Few studies have measured electroenterography in healthy humans; however, no studies have measured electrogastrography and electroenterography simultaneously. This study was performed to provide basic electrogastrography and electroenterography data for comparison with future studies in patients. Methods. Simultaneous preprandial and postprandial measurements of electrogastrography and electroenterography were taken for 30 min each in 50 healthy volunteers. Power spectrum analysis was performed to calculate dominant frequency, dominant power, and power ratio. Results. Gastric and small intestinal dominant frequencies were not significantly different between preprandial and postprandial periods. In preprandial and postprandial periods, normogastria was seen in 49 (98%) and 44 (88%) patients ( ), bradygastria in 1 (2%) and 6 (12%) patients ( ), and tachygastria in 0 (0%) patients, respectively. Dominant power was significantly increased in the stomach (828 [460–3203] μV2 vs. 1526 [759–2958] μV2, ) and small intestine (49 [27–86] μV2 vs. 68 [37–130] μV2, ). The power ratio was 1.6 (0.9–2.5) in the stomach and 1.4 (1.0–2.5) in the small intestine. Body mass index showed a negative correlation with the stomach and small intestinal dominant power in preprandial and postprandial periods ( , ; , ; , ; and , , respectively). T
背景。胃电图和肠电图分别是测量胃和肠电活动的无创方法。很少有研究测量健康人的肠电图;然而，没有研究同时测量胃电图和肠电图。本研究的目的是提供基本的胃电图和肠电图数据，以便与未来的患者研究进行比较。方法。对50名健康志愿者分别进行30分钟的餐前和餐后胃电图和肠电图测量。功率谱分析计算主导频率、主导功率和功率比。结果。胃和小肠的优势频率在餐前和餐后无显著差异。在餐前和餐后，正常胃痛49例(98%)和44例(88%)(p = 0.063)，胃缓1例(2%)和6例(12%)(p = 0.063)，胃过速0例(0%)。胃(828 [460-3203]μV2 vs. 1526 [759-2958] μV2, p = 0.016)和小肠(49 [27-86]μV2 vs. 68 [37-130] μV2, p <0.001)。胃的功率比为1.6(0.9 ~ 2.5)，小肠的功率比为1.4(1.0 ~ 2.5)。体重指数与胃和小肠在餐前和餐后的支配力呈负相关(r s = - 0.566, p <0.001;R s = - 0.534, p <0.001;R s = - 0.459, p <0.001;r s = - 0.529, p <分别为0.001)。布里斯托大便形态量表与小肠功率比呈正相关(r s = - 0.430, p = 0.002)。结论。胃和小肠的频率没有变化，但胃和小肠的功率显著增加。
{"title":"Visualized Quantitative Evaluation of Gastrointestinal Activity in Healthy Volunteers Using a Noninvasive Single-Channel Electroamplifier","authors":"Gen Aikawa, Misaki Kotani, Hideaki Sakuramoto, Akira Ouchi, Mitsuki Ikeda, Tetsuya Hoshino, Nobuyuki Araki, Yuki Enomoto, Nobutake Shimojo, Yoshiaki Inoue","doi":"10.1155/2023/6902635","DOIUrl":"https://doi.org/10.1155/2023/6902635","url":null,"abstract":"Background. Electrogastrography and electroenterography are noninvasive methods for measuring gastric and intestinal electrical activities, respectively. Few studies have measured electroenterography in healthy humans; however, no studies have measured electrogastrography and electroenterography simultaneously. This study was performed to provide basic electrogastrography and electroenterography data for comparison with future studies in patients. Methods. Simultaneous preprandial and postprandial measurements of electrogastrography and electroenterography were taken for 30 min each in 50 healthy volunteers. Power spectrum analysis was performed to calculate dominant frequency, dominant power, and power ratio. Results. Gastric and small intestinal dominant frequencies were not significantly different between preprandial and postprandial periods. In preprandial and postprandial periods, normogastria was seen in 49 (98%) and 44 (88%) patients ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo>=</mo> <mn>0.063</mn> </math> ), bradygastria in 1 (2%) and 6 (12%) patients ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo>=</mo> <mn>0.063</mn> </math> ), and tachygastria in 0 (0%) patients, respectively. Dominant power was significantly increased in the stomach (828 [460–3203] μV2 vs. 1526 [759–2958] μV2, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>p</mi> <mo>=</mo> <mn>0.016</mn> </math> ) and small intestine (49 [27–86] μV2 vs. 68 [37–130] μV2, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M4\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ). The power ratio was 1.6 (0.9–2.5) in the stomach and 1.4 (1.0–2.5) in the small intestine. Body mass index showed a negative correlation with the stomach and small intestinal dominant power in preprandial and postprandial periods ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M5\"> <msub> <mrow> <mi>r</mi> </mrow> <mrow> <mi>s</mi> </mrow> </msub> <mo>=</mo> <mo>−</mo> <mn>0.566</mn> </math> , <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M6\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ; <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M7\"> <msub> <mrow> <mi>r</mi> </mrow> <mrow> <mi>s</mi> </mrow> </msub> <mo>=</mo> <mo>−</mo> <mn>0.534</mn> </math> , <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M8\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ; <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M9\"> <msub> <mrow> <mi>r</mi> </mrow> <mrow> <mi>s</mi> </mrow> </msub> <mo>=</mo> <mo>−</mo> <mn>0.459</mn> </math> , <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M10\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ; and <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M11\"> <msub> <mrow> <mi>r</mi> </mrow> <mrow> <mi>s</mi> </mrow> </msub> <mo>=</mo> <mo>−</mo> <mn>0.529</mn> </math> , <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M12\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> , respectively). T","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135551756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Harris, R. Harris, D. Young, M. McDonnell, B. Clancy, J. Harvey, C. Araújo, I. Iria, J. Gonçalves, Susan Latter, J. Cummings
Background and Aims. Regulatory pathways compare biosimilars with originator molecules only and not with other biosimilars. With the development of multiple infliximab biosimilars, patients may be asked to transition between them. Data is emerging but there is still a gap in the evidence on switching between infliximab biosimilars. Our aim was to conduct a full evaluation of switching a cohort of IBD patients from one biosimilar (CT-P13) to another (SB2) in a real-world setting including clinical and patient experience and molecular and drug immunogenicity aspects of the process. Methods. Prospective, phase IV interventional study of patients on CT-P13 switched to SB2. Demographics, disease history, validated disease activity scores, PROMs, and laboratory measurements were collected. Semistructured qualitative interviews were also conducted. Results. 133 out of 158 patients agreed to participate. Mean disease duration was 9.2 years. There was no difference in mean haemoglobin, platelet count, albumin, and C-reactive protein before and after switching. Mean faecal calprotectin at baseline and at week 30/32 was 306 μg/g versus 210 μg/g. Mean pMCS and mHBI at baseline were 1.54 and 3.14 versus 1.18 and 2.91 at week 30/32, respectively. Thirty-five subjects discontinued. There were 16 serious adverse events. Thematic analysis identified six major themes that reflected the patient experience—trust, clinical status at the point of switching, past experience, general disposition, information provision, and concerns/anxiety. Conclusions. Switching from CT-P13 to SB2 is safe and effective. Certain factors must be considered in supporting patient decision-making. These results support the development of clear, streamlined, and well-monitored biosimilar switching programmes.
{"title":"Clinical Outcomes and Patient Experience of Biosimilar to Biosimilar Infliximab Switching in Patients with Inflammatory Bowel Disease: A Prospective, Single-Centre, Phase IV Interventional Study with a Nested Qualitative Study","authors":"C. Harris, R. Harris, D. Young, M. McDonnell, B. Clancy, J. Harvey, C. Araújo, I. Iria, J. Gonçalves, Susan Latter, J. Cummings","doi":"10.1155/2023/1248526","DOIUrl":"https://doi.org/10.1155/2023/1248526","url":null,"abstract":"Background and Aims. Regulatory pathways compare biosimilars with originator molecules only and not with other biosimilars. With the development of multiple infliximab biosimilars, patients may be asked to transition between them. Data is emerging but there is still a gap in the evidence on switching between infliximab biosimilars. Our aim was to conduct a full evaluation of switching a cohort of IBD patients from one biosimilar (CT-P13) to another (SB2) in a real-world setting including clinical and patient experience and molecular and drug immunogenicity aspects of the process. Methods. Prospective, phase IV interventional study of patients on CT-P13 switched to SB2. Demographics, disease history, validated disease activity scores, PROMs, and laboratory measurements were collected. Semistructured qualitative interviews were also conducted. Results. 133 out of 158 patients agreed to participate. Mean disease duration was 9.2 years. There was no difference in mean haemoglobin, platelet count, albumin, and C-reactive protein before and after switching. Mean faecal calprotectin at baseline and at week 30/32 was 306 μg/g versus 210 μg/g. Mean pMCS and mHBI at baseline were 1.54 and 3.14 versus 1.18 and 2.91 at week 30/32, respectively. Thirty-five subjects discontinued. There were 16 serious adverse events. Thematic analysis identified six major themes that reflected the patient experience—trust, clinical status at the point of switching, past experience, general disposition, information provision, and concerns/anxiety. Conclusions. Switching from CT-P13 to SB2 is safe and effective. Certain factors must be considered in supporting patient decision-making. These results support the development of clear, streamlined, and well-monitored biosimilar switching programmes.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87436901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Blanc, C. Laurendeau, M. de Zélicourt, M. Dhaoui, N. Kelkouli, F. Fagnani, P. Mathurin
Background. The prognosis of patients with hepatocellular carcinoma (HCC) not eligible to curative treatment is poor. Little information is available on treatment modalities and outcomes of these patients in everyday practice. The aim of this analysis was to describe the characteristics of patients with a newly diagnosed intermediate, advanced, or terminal (IAT) stage of HCC (ICD-10: C220) between 2015 and 2017, either present at diagnosis of HCC or having occurred after disease progression; treatment patterns, HCC aetiologies, and the associated survival were determined using the nationwide claims database. Methods. Patients with HCC were identified using the ICD-10 code C220. IAT stages, defined according to the terminology used in the Barcelona Clinic Liver Cancer classification, were indirectly identified by the presence of at least one of the following treatments: transarterial chemoembolization (TACE), transarterial radioembolization (TARE), HCC systemic therapy, best supportive care (BSC), or an ICD-10 code of metastatic HCC. Treatment patterns were described with an algorithm based on a ranking of palliative treatments identified. Survival was analysed by using Kaplan-Meier curves. Results. 19,649 eligible patients were identified. Their mean age was 70.5 years (SD: 11.0), and 82.5% were males. For 68.8% of patients, the IAT stage was present at HCC diagnosis. On the whole population, 5,114 patients (26.0%) were treated initially with a TACE or TARE, and 4,681 (23.8%) received a targeted systemic therapy at any moment during follow-up with sorafenib in 99.5% of cases. About 7,628 patients (45.6%) received only BSC. Survival since the diagnosis of the AIT stage of HCC differed according to the type of the first received palliative treatment. Median overall survival was 23.8, 9.6, 7.4, and 1.0 months in patients initially receiving TACE, TARE, systemic therapy, and BSC only, respectively. Conclusion. Over the period 2015-2017, hepatocellular carcinoma was still often diagnosed in France at late-stage disease with a very poor prognosis.
{"title":"Treatment Patterns and Survival in Patients with Intermediate, Advanced, or Terminal Stage of Hepatocellular Carcinoma in France over the Period 2015-2017: A Real-Life Study","authors":"J. Blanc, C. Laurendeau, M. de Zélicourt, M. Dhaoui, N. Kelkouli, F. Fagnani, P. Mathurin","doi":"10.1155/2023/5800168","DOIUrl":"https://doi.org/10.1155/2023/5800168","url":null,"abstract":"Background. The prognosis of patients with hepatocellular carcinoma (HCC) not eligible to curative treatment is poor. Little information is available on treatment modalities and outcomes of these patients in everyday practice. The aim of this analysis was to describe the characteristics of patients with a newly diagnosed intermediate, advanced, or terminal (IAT) stage of HCC (ICD-10: C220) between 2015 and 2017, either present at diagnosis of HCC or having occurred after disease progression; treatment patterns, HCC aetiologies, and the associated survival were determined using the nationwide claims database. Methods. Patients with HCC were identified using the ICD-10 code C220. IAT stages, defined according to the terminology used in the Barcelona Clinic Liver Cancer classification, were indirectly identified by the presence of at least one of the following treatments: transarterial chemoembolization (TACE), transarterial radioembolization (TARE), HCC systemic therapy, best supportive care (BSC), or an ICD-10 code of metastatic HCC. Treatment patterns were described with an algorithm based on a ranking of palliative treatments identified. Survival was analysed by using Kaplan-Meier curves. Results. 19,649 eligible patients were identified. Their mean age was 70.5 years (SD: 11.0), and 82.5% were males. For 68.8% of patients, the IAT stage was present at HCC diagnosis. On the whole population, 5,114 patients (26.0%) were treated initially with a TACE or TARE, and 4,681 (23.8%) received a targeted systemic therapy at any moment during follow-up with sorafenib in 99.5% of cases. About 7,628 patients (45.6%) received only BSC. Survival since the diagnosis of the AIT stage of HCC differed according to the type of the first received palliative treatment. Median overall survival was 23.8, 9.6, 7.4, and 1.0 months in patients initially receiving TACE, TARE, systemic therapy, and BSC only, respectively. Conclusion. Over the period 2015-2017, hepatocellular carcinoma was still often diagnosed in France at late-stage disease with a very poor prognosis.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88667599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jasmohan S. Bajaj, James H. Fischer, Patrick Yeramian, Edith A. Gavis, Andrew Fagan, Paolo Angeli, Guadalupe Garcia-Tsao, Jonathan M. Adams, Penelope Markham
{"title":"Corrigendum to “Safety, Tolerability, Pharmacokinetics, and Efficacy of Terlipressin Delivered by Continuous Intravenous Infusion in Patients with Cirrhosis and Refractory Ascites”","authors":"Jasmohan S. Bajaj, James H. Fischer, Patrick Yeramian, Edith A. Gavis, Andrew Fagan, Paolo Angeli, Guadalupe Garcia-Tsao, Jonathan M. Adams, Penelope Markham","doi":"10.1155/2023/9815951","DOIUrl":"https://doi.org/10.1155/2023/9815951","url":null,"abstract":"","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135006926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Haemochromatosis is a rare autosomal genetic disease that can cause multiple organ failure. In the past, this condition was not considered to affect pregnancy. The objectives of this study are to update the management of haemochromatosis in general as there are new treatments being investigated other than phlebotomy and to summarise the effects of the condition on pregnancy and vice versa. Methods. The initial search was in Ovid Medline® from 2002 to 2013. Review articles for haemochromatosis and case reports of its related complications in pregnancy were found. None of the reviews addressed pregnancy in detail. A second search in PubMed from 2014 to 2016 included studies regarding haemochromatosis and pregnancy and iron metabolism association with other metals and biomarkers, defining the mechanism of foetomaternal risks in maternal haemochromatosis. A third search at PubMed from 2017 to 2022 using key words haemochromatosis and pregnancy was done to look at the new data. Results. The results are qualitative indicating that even in the absence of abnormal iron parameters, haemochromatosis increases the risk of foetomaternal complications due to genetic predisposition, necessitating antenatal monitoring. Newer medications targeting the pathophysiology of the disease to eliminate it are being developed. The coabsorption of lead with iron causes increased risk of maternal preeclampsia, gestational hypertension, foetal congenital abnormalities, and growth problems. There is risk of neurodevelopmental delays, large for gestational age and childhood leukaemia in babies whose mothers and themselves have mutations for haemochromatosis. Conclusion. Previously, women with haemochromatosis were thought to have no higher risk of complications than the general population. However, there is evidence of foetomaternal complications. As a result, pregnancy with haemochromatosis necessitates additional monitoring for both mother and baby.
{"title":"Primary Hereditary Haemochromatosis and Pregnancy","authors":"A. Shamas","doi":"10.1155/2023/2674203","DOIUrl":"https://doi.org/10.1155/2023/2674203","url":null,"abstract":"Background. Haemochromatosis is a rare autosomal genetic disease that can cause multiple organ failure. In the past, this condition was not considered to affect pregnancy. The objectives of this study are to update the management of haemochromatosis in general as there are new treatments being investigated other than phlebotomy and to summarise the effects of the condition on pregnancy and vice versa. Methods. The initial search was in Ovid Medline® from 2002 to 2013. Review articles for haemochromatosis and case reports of its related complications in pregnancy were found. None of the reviews addressed pregnancy in detail. A second search in PubMed from 2014 to 2016 included studies regarding haemochromatosis and pregnancy and iron metabolism association with other metals and biomarkers, defining the mechanism of foetomaternal risks in maternal haemochromatosis. A third search at PubMed from 2017 to 2022 using key words haemochromatosis and pregnancy was done to look at the new data. Results. The results are qualitative indicating that even in the absence of abnormal iron parameters, haemochromatosis increases the risk of foetomaternal complications due to genetic predisposition, necessitating antenatal monitoring. Newer medications targeting the pathophysiology of the disease to eliminate it are being developed. The coabsorption of lead with iron causes increased risk of maternal preeclampsia, gestational hypertension, foetal congenital abnormalities, and growth problems. There is risk of neurodevelopmental delays, large for gestational age and childhood leukaemia in babies whose mothers and themselves have mutations for haemochromatosis. Conclusion. Previously, women with haemochromatosis were thought to have no higher risk of complications than the general population. However, there is evidence of foetomaternal complications. As a result, pregnancy with haemochromatosis necessitates additional monitoring for both mother and baby.","PeriodicalId":12480,"journal":{"name":"GastroHep","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87518214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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