Gastroenterologia y hepatologia最新文献

英文中文

Follicular pancreatitis mimicking pancreatic cancer: A diagnostic challenge

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502463

Yu Lu , Qiu Wu , Tao Yin

引用次数: 0

Prevalence and prognosis of cirrhotic cardiomyopathy in hospitalized patients with decompensated cirrhosis 失代偿期肝硬化住院患者肝硬化心肌病的患病率及预后。

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502518

Judith Cortada , Francesca Castaldo , Jordi Sánchez-Delgado , José Ferrusquía-Acosta , Meritxell Casas , Mireia Miquel , Mario Sutil-Vega , Mercedes Vergara , Cristina Solé

引用次数: 0

Exploring infliximab serum level variability in inflammatory bowel disease: Comprehensive analysis of patient subgroups and treatment outcomes 探讨炎症性肠病中英夫利昔单抗血清水平变异性：对患者亚组和治疗结果的综合分析“炎症性肠病中英夫利昔单抗水平变异性”。

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502472

Carles Iniesta-Navalón , Lorena Rentero-Redondo , Rosa Gómez-Espín , Manuel Ríos Saorín , Isabel Nicolás de Prado , Juan José Gascón-Cánovas

Background and aims

Inflammatory bowel disease (IBD) features diverse clinical presentations and progressions, impacting IFX exposure. Understanding IFX serum concentration changes is crucial for tailored monitoring in specific patient groups. The main objective of this study was to analyze ITL trajectories in patients with IBD to identify distinct groups and subgroups, revealing heterogeneity in treatment responses.

Methods

A retrospective cohort study was conducted involving IBD patients treated with infliximab in a regional reference hospital in Spain. Latent class linear mixed models were applied to identify subgroups based on serum infliximab measurements over time. To analyze the factors associated with IFX discontinuation, we employed both logistic regression and Cox regression models.

Results

The study included 165 IBD patients, and a total of 799 ITL samples were analyzed. The selected model included three clusters, with a random intercept and a random effect on both time and natural cubic spline time in the linear mixed model. Cluster 1 (20.6%) had lower IFX exposure, with 93.9% experiencing treatment discontinuation, compared to 45.1% in Cluster 2 (43.0%) and 43.3% in Cluster 3 (36.4%) (p < 0.001). Treatment discontinuation was observed in 91 individuals (55.2%) out of the total patients. In the multivariate analysis, the presence of cluster 1 was a significant predictor (OR: 7.25, 95% CI: 1.45–36.12). Bayesian dose adjustment was found to significantly reduce the risk of IFX discontinuation (OR: 0.19, 95% CI: 0.46–1.96).

Conclusions

The lack of TDM during induction and a lower proportion of adjustments made through Bayesian methods were associated with a subgroup demonstrating suboptimal pharmacokinetic profiles and reduced drug persistence. These findings highlight the clinical relevance of model-informed TDM in optimizing IFX exposure and minimizing treatment discontinuation in IBD.

背景和目的：炎症性肠病（IBD）具有不同的临床表现和进展，影响IFX暴露。了解IFX血清浓度变化对于特定患者群体的量身定制监测至关重要。本研究的主要目的是分析IBD患者的ITL轨迹，以确定不同的组和亚组，揭示治疗反应的异质性。方法：对西班牙一家地区参考医院接受英夫利昔单抗治疗的IBD患者进行回顾性队列研究。潜伏类线性混合模型用于根据血清英夫利昔单抗随时间的测量来确定亚组。为了分析与IFX停药相关的因素，我们采用了logistic回归和Cox回归模型。结果：本研究纳入165例IBD患者，共分析ITL样本799份。所选择的模型包括三个簇，在线性混合模型中具有随机截距和对时间和自然三次样条时间的随机效应。第1组（20.6%）有较低的IFX暴露，93.9%经历了治疗中断，而第2组（43.0%）和第3组（36.4%）的这一比例分别为45.1%和43.3%。结论：诱导过程中缺乏TDM和通过贝叶斯方法进行调整的比例较低与亚组表现出次优的药代动力学特征和药物持久性降低有关。这些发现强调了模型知情TDM在优化IFX暴露和最小化IBD治疗中断方面的临床相关性。

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引用次数: 0

Fallo intestinal. Rehabilitación y tratamiento: nociones básicas para gastroenterólogos 肠衰竭。康复与治疗：胃肠病学家的基本概念。

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502603

Cristina Olmedo Moreno , Francisco López Romero-Salazar , María Maíz Jiménez , Carmelo Loinaz Segurola , Yago González Lama

引用次数: 0

Fecal elastase-1 and 13C-mixed triglyceride breath test vs. coefficient of fat absorption to diagnose exocrine pancreatic insufficiency after pancreatic surgery 粪便弹性酶-1和13c -混合甘油三酯呼气试验与脂肪吸收系数诊断胰腺手术后外分泌胰功能不全的比较

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502492

Paula Sirera-Sirera , Núria Lluís , Fèlix Lluís , Pedro Zapater , Pablo López-Guillén , José M. Ramia-Ángel , Rahma Amrani , Trinidad Castillo-García , José Andreu-Viseras , Karina Cárdenas-Jaén , Lucía Guilabert , Sara Pérez-Brotons , Emma Martínez-Moneo , Nerea Gendive-Martin , Iván González Hermoso , Enrique de-Madaria , María José Ferri

Objective

Exocrine pancreatic insufficiency (EPI) is common after pancreatic surgery. In patients with chronic pancreatitis, our previous results supported the use of fecal elastase-1 (FE-1) over the ¹³C-mixed triglyceride breath test (¹³C-MTBT) for the diagnosis of EPI. However, it is poorly established how the performance of these two tests compares to the diagnosis of EPI after pancreatic surgery.

Patients and methods

FE-1 and ¹³C-MTBT were compared with the gold standard coefficient of fat absorption (CFA). Area under ROC curve (AUC) and best cutoffs were used to assess presence of EPI. Patient characteristics were evaluated by extent of pancreatic resection.

Results

The AUC (95% confidence interval) was 0.724 (0.578–0.871) for FE-1 and 0.640 (0.482–0.799) for ¹³C-MTBT in the diagnosis of EPI. A pairwise comparison of the FE-1 and ¹³C-MTBT AUCs showed no statistically significant difference (P = .20). The best cut-off point was 65.5 μg/g for FE-1 and 22.5% for ¹³C-MTBT. According to contingency analysis, both the FE-1 threshold of 65.5 μg/g (P = .005) and the ¹³C-MTBT threshold of 22.5% (P = .015) showed statistical significance for diagnosing EPI.

Conclusion

FE-1 was more accurate for diagnosing EPI after pancreatic surgery, but the differences were not statistically different.

目的：外分泌性胰腺功能不全（EPI）是胰腺手术后常见的症状。在慢性胰腺炎患者中，我们之前的结果支持使用粪便弹性酶-1 （FE-1）而不是13c -混合甘油三酯呼吸试验（13C-MTBT）来诊断EPI。然而，目前尚不清楚这两项测试的表现如何与胰腺手术后EPI的诊断相比较。患者和方法：将FE-1、13C-MTBT与脂肪吸收金标准系数（CFA）进行比较。ROC曲线下面积（AUC）和最佳截止点（best cutoff）用于评估EPI的存在。通过胰腺切除程度评估患者特征。结果：FE-1诊断EPI的AUC（95%置信区间）为0.724 (0.578 ~ 0.871)，13C-MTBT诊断EPI的AUC（95%置信区间）为0.640（0.482 ~ 0.799）。FE-1与13C-MTBT auc两两比较，差异无统计学意义（P= 0.20）。FE-1的最佳截断点为65.5µg/g， 13C-MTBT的最佳截断点为22.5%。经权变分析，FE-1阈值65.5µg/g （P= 0.005）和13C-MTBT阈值22.5% （P= 0.015）对EPI的诊断均有统计学意义。结论：FE-1对胰腺术后EPI的诊断更准确，但差异无统计学意义。

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引用次数: 0

Unveiling the hidden risk: Herbal and dietary supplement consumption in liver disease patients 揭示隐藏的风险：肝病患者的草药和膳食补充剂消费。

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502520

Elia Canga , Anna Pocurull , Montserrat Rodriguez-Reyes , Cristina Collazos , Laura Martín , Zoe Mariño , Sabela Lens , Xavier Forns

Introduction

The use of herbal products and dietary supplements (HDS) carries a potential risk of liver toxicity. Data on HDS consumption among patients attending liver disease clinics remain unexplored.

Objective

To determine the frequency, types and reasons for HDS consumption in patients attending a specialized liver disease outpatient clinic.

Methods

Prospective study including consecutive patients attending the hepatology outpatient clinic at the Hospital Clínic of Barcelona from June 2023 to October 2023. Following a standard medical visit, a trained nurse conducted a structured interview to assess HDS consumption.

Results

A total of 150 patients were included, with a median age of 59 (IQR: 49–67) and male predominance (56%, n = 84). Only 12 patients (8%) reported HDS consumption during a standard medical interview, while the number increased to 92 (61%) after nurse-led structured interview. The primary reasons for dietary supplements use included vitamin supplementation (43%), fitness improvement (10.5%) and hair/nail health (10.5%). For herbal products, the most common reason for use was pleasure (73%). Reported HDS products with potential hepatotoxicity (levels A and B) were green tea (n = 16), turmeric with black pepper (n = 11), aloe (n = 2), greater celandine (n = 1) and black cohosh (n = 1).

Conclusion

HDS use is highly prevalent among patients with liver disease, but a structured interview is crucial to detect their consumption, as they usually forget spontaneous reporting. Importantly, a significant proportion of these products carry a risk of hepatic toxicity, underscoring the need for increased patient education and clinical vigilance.

使用草药产品和膳食补充剂（HDS）有潜在的肝毒性风险。在肝病门诊就诊的患者中HDS消费的数据仍未被探索目的：确定在肝病专科门诊就诊的患者中HDS消费的频率、类型和原因。方法：前瞻性研究包括2023年6月至2023年10月在巴塞罗那医院Clínic肝病科门诊就诊的连续患者。在一次标准的医疗访问之后，一名训练有素的护士进行了一次结构化的访谈，以评估HDS的消耗情况。结果：共纳入150例患者，中位年龄59岁（IQR:49 ~ 67），男性居多（56%,n=84）。在标准的医疗访谈中，只有12名患者（8%）报告了HDS的消费，而在护士主导的结构化访谈后，这一数字增加到92名（61%）。使用膳食补充剂的主要原因包括补充维生素（43%）、改善健康（10.5%）和头发/指甲健康（10.5%）。对于草药产品，最常见的使用原因是愉悦（73%）。据报道，具有潜在肝毒性的HDS产品（A级和B级）有绿茶（n=16）、姜黄黑胡椒（n=11）、芦荟（n=2）、白屈菜素（n=1）和黑升麻（n=1）。结论：HDS的使用在肝病患者中非常普遍，但结构化访谈对于检测他们的消费至关重要，因为他们通常会忘记自发报告。重要的是，这些产品中有很大一部分具有肝毒性风险，强调需要加强患者教育和临床警惕。

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引用次数: 0

Análisis de los factores de riesgo de complicación tras la reconstrucción de ileostomía de protección en los pacientes intervenidos por cáncer rectal 直肠癌术后保护性回肠造口重建并发症的危险因素分析。

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502495

Manuel González Bermúdez , María Lourdes García Jiménez , Sergio Rodríguez Rojo , Jose Antonio Romero González , Pablo Concheiro Coello , Javier Aguirrezabalaga González , José Francisco Noguera Aguilar

Objective

To estimate the incidence of complications following ileostomy reversal and to identify associated risk factors.

Patients and methods

A retrospective cohort study was conducted, including patients who underwent rectal cancer surgery with a protective ileostomy. The minimum follow-up period was one year. A univariate analysis was performed to identify potential risk factors for complications, and variables with P<0.1 were included in a multivariate analysis.

Results

Between January 1, 2015, and December 31, 2023, a total of 220 patients underwent surgery. Thirteen percent did not undergo ileostomy reversal. Thus, 193 patients were included in the final analysis. The median time to ileostomy reversal was 292 days. Postoperative complications occurred in approximately 27.5% of cases. Among the potential risk factors, albumin levels < 4 g/dl, open surgical approach for rectal pathology, absence of efferent loop stimulation, and side-to-side anastomosis were associated with P<.1 in univariate analysis. In the multivariate analysis, only low albumin levels and the open surgical approach for rectal pathology remained significantly associated with an increased risk of complications.

Conclusion

Modifiable factors such as the use of a laparoscopic approach for rectal surgery, stimulation of the efferent loop, and optimization of preoperative nutritional status may help reduce the incidence of postoperative complications.

目的：评估回肠造口术逆转术后并发症的发生率，并探讨相关危险因素。患者和方法：进行回顾性队列研究，包括接受直肠癌手术并保护性回肠造口术的患者。最低随访期为一年。进行单因素分析以确定并发症的潜在危险因素，p < 0.1的变量被纳入多因素分析。结果：2015年1月1日至2023年12月31日，共220例患者接受手术治疗。13%的患者没有接受回肠造口术逆转。因此，193例患者被纳入最终分析。回肠造口逆转的中位时间为292天。术后并发症发生率约为27.5%。在潜在的危险因素中，白蛋白水平< 4 g/dL、直肠病理开放手术入路、缺乏传出环刺激和侧对侧吻合在单因素分析中与p < 0.1相关。在多变量分析中，只有低白蛋白水平和直肠病理开放手术入路与并发症风险增加显著相关。结论：采用腹腔镜直肠手术入路、刺激传出袢、优化术前营养状况等可调整因素有助于减少术后并发症的发生。

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引用次数: 0

Empleo de ustekinumab como tratamiento de elección en paciente con colitis inmunomediada corticodependiente y secundaria a pembrolizumab Ustekinumab作为免疫介导皮质依赖性结肠炎和继发性Pembrolizumab患者的选择性治疗。

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502469

Alejandro García Martínez, María Regla Gallego Gallegos

引用次数: 0

Spontaneous cholecysto-cutaneous fistula in a patient with peritoneal carcinomatosis 腹膜癌并发自发性胆囊-皮肤瘘1例。

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502447

Miriam Bragado Pascual, Rosanna Villanueva Hernández, M. Pilar Delgado Alvarez, Luis Ricardo Gotuzzo Altez, Juan Manuel Blanco Esteban

引用次数: 0

Valor pronóstico del índice de Lille precoz en los pacientes con hepatitis asociada al alcohol grave 早期里尔评分对重度酒精相关性肝炎患者的预后价值。

IF 1.9 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Gastroenterologia y hepatologia

Pub Date : 2025-12-01 DOI: 10.1016/j.gastrohep.2025.502517

Ana Suárez-Saro Fernández , Mónica Barreales Valbuena , Cristina Martín-Arriscado Arroba , Elena Gómez Domínguez , Álvaro Hidalgo Romero , Inmaculada Fernández Vázquez

Objective

To evaluate the effectiveness of the Lille Index (LI) on day 2 (LI2) and day 4 (LI4) in predicting short-term mortality in patients with severe alcohol-associated hepatitis (SAH) and to assess its concordance compared to the Lille Index on day 7 (LI7).

Patients and methods

This retrospective, observational, single-center study included SAH patients admitted between 2016 and 2023. SAH was defined as a Maddrey score ≥32 and/or a MELD score ≥21. The predictive ability of LI2, LI4, and LI7 for 28-, 90-, and 180-day mortality was analyzed using AUC, Cox regression (Hazar Ratio (HR)), and Kaplan-Meier curves.

Results

Among 65 SAH patients, 62 received corticosteroids. Median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% CI: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (P>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (68.33% vs. 70.97%, P=.752) and LI4 vs. LI7 (73.33% vs. 70.97%, P=.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7 was 93.33%.

Results

Among 65 SAH patients, 62 received corticosteroids. The median follow-up was 722 days. LI2 was associated with a 28-day mortality HR of 33.1 (95% CI: 3.8-287.3), similar to LI7 (HR: 13.2; 95% CI: 2.2-81.2). AUCs for 28-day mortality were 0.818 for LI2, 0.794 for LI4, and 0.809 for LI7 (P>.05). The proportion of patients classified by prognosis was similar for LI2 vs. LI7 (P=.752) and LI4 vs. LI7 (P=.771). Concordance between LI2 and LI7 was 85%, and between LI4 and LI7, 93.33%.

Conclusions

LI2 and LI4 were comparable to LI7 in predicting short-term mortality in SAH. Earlier calculation, particularly LI2, could anticipate clinical decisions in poor prognosis patients, such as corticosteroid discontinuation or evaluation for liver transplantation in selected cases.

目的：评价Lille指数（LI）第2天（LI2）和第4天（LI4）预测严重酒精相关性肝炎（SAH）患者短期死亡率的有效性，并与Lille指数第7天（LI7）比较其一致性。患者和方法：这项回顾性、观察性、单中心研究纳入了2016年至2023年住院的SAH患者。SAH定义为Maddrey评分≥32和/或MELD评分≥21。采用AUC、Cox回归（Hazar Ratio， HR）和Kaplan-Meier曲线分析LI2、LI4和LI7对28、90和180天死亡率的预测能力。结果：65例SAH患者中，62例接受糖皮质激素治疗。中位随访时间为722天。LI2与28天死亡率相关，HR为33.1 (95% CI: 3.8-287.3)，与LI7相似(HR: 13.2；95% ci: 2.2-81.2)。LI2的28天死亡率auc为0.818，LI4为0.794，LI7为0.809 （p < 0.05）。LI2与LI7按预后分类的患者比例相似（68.33% vs. 70.97%, p=0.752）， LI4与LI7按预后分类的患者比例相似（73.33% vs. 70.97%, p=0.771）。LI2与LI7的一致性为85%，LI4与LI7的一致性为93.33%。结果：65例SAH患者中，62例接受糖皮质激素治疗。中位随访时间为722天。LI2与28天死亡率相关，HR为33.1 (95% CI: 3.8-287.3)，与LI7相似(HR: 13.2；95% ci: 2.2-81.2)。LI2的28天死亡率auc为0.818，LI4为0.794，LI7为0.809 （p < 0.05）。LI2与LI7、LI4与LI7按预后分类的患者比例相似（p=0.752）。LI2与LI7的一致性为85%，LI4与LI7的一致性为93.33%。结论：LI2和LI4在预测SAH短期死亡率方面与LI7相当。早期计算，特别是LI2，可以预测预后不良患者的临床决策，例如在选定的病例中停用皮质类固醇或评估肝移植。

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