Gastroenterologia y hepatologia最新文献

Introduction: Metabolic dysfunction is highly prevalent worldwide and is associated with metabolic dysfunction-associated steatotic liver disease and an increased risk of cardiovascular disease. However, it remains unclear whether non-invasive tests assessing liver disease severity can predict major adverse cardiovascular events (MACEs).

Objective: We aimed to explore the relationship between changes in fibrosis-4 scores (FIB-4) and MACEs in patients with metabolic dysfunction.

Patients and methods: We conducted a retrospective cohort study including participants from a primary care clinic between 2009 and 2021, focusing on adults with metabolic dysfunction - risk of MASLD. We used FIB-4 to track MACEs over a 10-year follow-up period. Adjusted binomial regression models evaluated associations between FIB-4 progression (change in at least one stage of risk) and MACEs.

Results: We included 695 patients with a median age of 63.5 years [IQR 56-74]; 34.6% were women. Among them, 29% had diabetes mellitus, 21.5% had prediabetes, 58.1% had hypertension, and 93.3% had dyslipidemia. Patients who developed MACEs were older, had a higher proportion of men, and showed greater prevalence of hypertension, dyslipidemia, and obesity. Both baseline and final FIB-4 scores were higher in patients with MACEs. Adjusted analysis showed that FIB-4 progression was associated with a 106% increased risk of myocardial infarction (RR=2.06, 95% CI: 1.34-3.15; p=0.001), but not with an increased risk of stroke (RR=1.13, 95% CI: 0.73-1.74; p=0.591). Conversely, reductions in FIB-4 were protective for MI.

Conclusions: Progression and reduction in FIB-4 scores are associated with an increased and decreased risk of myocardial infarction, respectively, in patients with metabolic dysfunction.

Objectives: Obesity has reached pandemic dimensions, representing a large health burden. Conservative therapy has recently been improved, but the most definitive therapy is still surgery. Gastric sleeve is one of the most frequent techniques. Preoperative guidelines sometimes recommend preoperative endoscopy. The aim of this study is to review the preoperative use of endoscopy in bariatric surgery and the possible importance of Helicobacter pylori therapy to avoid surgical complications.

Patients and methods: Retrospective case series of patients undergoing sleeve gastrectomy in two large hospitals. We have reviewed demographic data, associated pathologies, endoscopic findings prior to surgery, histopathological findings in the surgical resection specimen and rate of complications after surgery, as the outcome measure.

Results: 455 patients fulfilled criteria for the study. 69% were women and the mean age was 46.93 (SD: 10.6). 68.7% of the patients show at least one comorbid disease, mainly dyslipidemia, but only 7.2% showed three or more comorbidities. Endoscopy was performed in 41.5% of the patients and biopsy in 35.8%, with significant differences between both hospitals. H. pylori were detected in 53 of the patients undergoing endoscopy and eradicated before surgery. Helicobacter was present in 7% of the surgical resection specimens, 68.75% of whom had not undergone a preoperative endoscopy. The postsurgical complication rate was 23.5% in our series and H. pylori was present in 20% of these patients.

Conclusions: Our study confirms the relevance of Helicobacter eradication before bariatric surgery, as Helicobacter infection is significantly linked to the surgical outcome in our area.

Objective: We aimed to evaluate the implementation of a digital tool that assists physicians during breath tests (BTs) for small intestinal bacterial overgrowth (SIBO), measuring its impact on diagnostic accuracy, report quality, and physician workload. Tool usability was also assessed.

Patients and methods: We conducted a retrospective evaluation of all BTs done at our institution from January 2024 to September 2024. All BTs were performed using the same equipment and interpreted by the same four board-certified gastroenterologists. In May 2024, a digital tool (i.e. Smart Breath) was adopted to help performing and reporting all BTs. Accuracy and report quality were compared before and after implementation of such digital tool. Three blinded SIBO experts used current international guidelines to adjudicate diagnoses and assess report completeness based on 12 quality criteria. Usability of the digital tool and workload were evaluated with the System Usability Scale (SUS) and NASA Task Load Index (NASA-TLX).

Results: A total of 637 BTs were analyzed: 324 standard BT (before the implementation of Smart Breath) and 313 assisted by Smart Breath. Accuracy significantly improved after the implementation of Smart Breath (100% vs. 89.2% for SIBO; 100% vs. 90.1% for IMO; p<0.0001). Report completeness increased from a median of 6-12 quality elements (p<0.0001). The digital tool achieved a mean SUS score of 92.5 and workload scores decreased significantly across all NASA-TLX dimensions.

Conclusions: The implementation of a digital assistant for SIBO breath testing significantly improved diagnostic accuracy and report quality while reducing physician workload. Evidence-based digital tools may enhance the performance of complex diagnostic procedures in clinical practice.

Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, carries an increased risk of tuberculosis (TB), particularly in patients treated with immunosuppressive therapies such as anti-TNF agents. The risk is further elevated when combined with immunomodulators. Other drugs, including anti-integrins, IL-12/23 inhibitors, and JAK inhibitors (JAK-i), present a variable risk of TB reactivation. Given this risk, screening for latent tuberculosis infection (LTBI) is essential in IBD patients before initiating immunosuppressive therapy. Guidelines recommend performing this screening ideally at the time of IBD diagnosis or, alternatively, before advanced therapy. Diagnostic tests include the tuberculin skin test (TST) and interferon-gamma release assays (IGRA). In immunocompromised patients, false negatives may occur; therefore, dual testing is advised. Chest X-rays are reserved for cases with positive tests or clinical suspicion. In the presence of LTBI, chemoprophylaxis with isoniazid or rifampicin is recommended prior to initiating immunosuppression. If active TB is diagnosed, immunosuppressive therapy must be discontinued and standard antituberculous treatment initiated. The reintroduction of immunosuppressive therapy should be assessed on a case-by-case basis, prioritizing agents with lower reactivation risk. Finally, BCG vaccination is not recommended in IBD patients undergoing immunosuppressive treatment due to its nature as a live vaccine.

Introduction: Colombia is a country with a high prevalence of Hp infection and gastric cancer (GC). The objective of this study was to evaluate the diagnostic yield of endoscopic findings for the diagnosis of Hp infection and, based on these findings, develop a new prediction score applicable to the local population.

Methods: Endoscopic findings were evaluated, and photographs were taken according to K. Yao's 22 stations in all individuals who underwent gastroscopy between January 1 and August 2023. All patients underwent biopsy with the Sydney protocol and hematoxylin, eosin, and Giemsa staining. Univariate and bivariate analysis was performed, with logistic regression evaluating a new score applicable to the cohort.

Results: A total of 200 patients were included. The prevalence of Hp was 47.5%. The presence of nodular gastropathy and abnormalities in the regular arrangement of collecting venules (RAC) were the endoscopic findings with the highest PPV and NPV, respectively, while atrophy assessed with the Kimura-Takemoto score had a very poor correlation with Hp. The Kyoto score had an AUC of 0.71 and the modified Kyoto score had an AUC of 0.76, which is lower than the performance in the Asian population. With the findings with better correlation, a new endoscopic score called ROVIRA was created with a cut-off point ≥3 and an AUC of 0.91 for this cohort, which suggests that it could become a more accurate clinical tool to identify active infection.

Conclusion: Endoscopic findings are useful for predicting Hp infection, highlighting that the preserved RAC is sensitive to rule out Hp infection with a high NPV and on the other hand the nodularity or follicular pattern due to its good specificity. The new ROVIRA scale showed better performance than the Kyoto and modified Kyoto scores in this cohort, suggesting its potential as a clinical tool in Colombia or countries where, in addition to a high prevalence of gastric cancer, there is also a high prevalence of Hp. However, these data will require further validation.