GastroHep最新文献

Individuals with coeliac disease are required to exclude all gluten from their diet to prevent small bowel inflammation and associated complications. Life-long adherence to a gluten-free diet is challenging because of the potential presence of gluten in common noncereal foods, cross-contamination, and potentially small amounts of gluten in cereal-based foods formally labelled as “gluten-free.” For people living with coeliac disease, current tests to monitor the efficacy of a gluten-free diet may not detect ongoing, low level, or intermittent unintentional gluten exposure. The iVYCHECK and iVYLISA assays by Biomedal detect gluten-derived peptides, which are resistant to digestion, known to be immunogenic and are excreted in urine and stool. The urine test is qualitative for recent short-term exposure while the faecal test is quantitative and reflects gluten exposure over a longer interval. Several studies have validated the performance of these assays in monitoring compliance to gluten-free diets. We sought to evaluate these assays in a community-based pathology service by comparing values obtained in individuals with no dietary restrictions compared with those following a gluten-free diet. We performed 124 assays in 21 subjects over 9 days. The quantitative faecal gluten immunogenic peptide assay was highly precise. Faecal gluten immunogenic peptide assays were moderately sensitive (66%) and highly specific (97%) while the urine assay had sensitivity of 100% and lesser specificity (48%). Both assays had very high negative predictive value (90%) for detection of clinically relevant levels of oral gluten, as verified by participant self-reported diet diary over a 9-day period. An episode of inadvertent gluten exposure in one individual on an otherwise gluten-free diet was associated with temporally high gluten immunogenic peptide levels in stool. The majority of participants regarded accidental gluten exposures as important to their health and rated monitoring for gluten contamination as their strongest reason for utilizing this assay. Our study was limited by use of self-report rather than independent tests of gluten intake or clinical disease markers; however, our findings do provide support for implementation of these assays to assist in monitoring efficacy of a gluten-free diet.

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.

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.

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.

Trial Registration: ClinicalTrials.gov identifier: UMIN000053561

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.