Gut and Liver最新文献

Background/aims: Helicobacter pylori is a well-known gastric carcinogen, and its eradication is an important therapeutic strategy to prevent the development of metachronous lesions following endoscopic submucosal dissection (ESD). However, the optimal timing for H. pylori eradication following ESD remains unclear.

Methods: In this multicenter, prospective, randomized trial, 191 patients undergoing ESD for gastric neoplasms were randomly assigned to either an early (3 to 5 days) or late (8 to 9 weeks) eradication group after ESD. The primary outcome was the rate of successful H. pylori eradication. Secondary outcomes included the tolerability and side effects of eradication therapy in both groups.

Results: A total of 149 patients were included in the per-protocol analysis (75 in the early eradication group and 74 in the late eradication group) after excluding patients who required surgery or were lost to follow-up. The early eradication group showed a significantly higher eradication rate compared to the late eradication group (early 80.0%, late 64.9%; p=0.045). However, the tolerability and side effects of the eradication therapy did not differ between the groups. In multivariate analysis, early initiation of eradication therapy after ESD was an independent predictor of successful eradication (odds ratio, 2.30; 95% confidence interval, 1.04 to 5.05; p=0.038).

Conclusions: Early attempts to eradicate H. pylori following ESD significantly increased eradication success rates without increasing the incidence of side effects. Therefore, early attempts to eradicate H. pylori after ESD may be the best option for successful eradication. (ClinicalTrials.gov identifier NCT02921399).

Background/aims: Malignant duodenal obstruction has become more common with the development of palliative therapies.The outcomes of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) are comparable to those of surgical gastrojejunostomy or duodenal stenting. However, EUS-GJ is technically challenging. Duodenal self-expandable metallic stent (SEMS) placement is popular; however, obstructions are common. Duodenal SEMS obstruction can be managed with the insertion of a second SEMS in a stent-in-stent manner. Therefore, we aimed to analyze the clinical outcomes of secondary duodenal SEMS placement in patients with malignant duodenal obstruction.

Methods: We retrospectively analyzed the data of patients who underwent secondary duodenal stent insertion for duodenal stent dysfunction between January 2016 and December 2021. The primary outcome was stent patency. The secondary outcomes were clinical success, factors associated with dysfunction, patient survival, and adverse events.

Results: A total of 109 patients were included. The mean age was 64.4±11.2 years, and 63 patients (57.8%) were male. Ninety-two patients (84.4%) had pancreaticobiliary cancer. Clinical success was achieved in 94 cases (86.2%). Twenty-three patients experienced stent dysfunction with 231 days of median stent patency (95% confidence interval [CI], 169 to not available). After a multivariable Cox hazard analysis of stent patency, the Eastern Cooperative Oncology Group performance status (hazard ratio [HR], 2.13; 95% CI, 1.20 to 3.81; p=0.010) and the first stent patency ≥6 months (HR, 0.33; 95% CI, 0.11 to 0.95; p=0.050) remained significant associated factors. Adverse events occurred in five patients (4.6%).

Conclusions: Secondary duodenal stent insertion is a viable option for first duodenal stent obstruction. Further comparative studies involving surgery or EUS-GJ for obstructed duodenal stents are warranted.

Background/aims: Few studies have compared the outcomes of catheter angiography and colonoscopy after positive computed tomography angiography (CTA) results in patients with severe lower gastrointestinal bleeding. This study aimed to evaluate differences in clinical outcomes between these approaches.

Methods: We analyzed data from 254 patients with positive CTA results of the lower gastrointestinal tract at Severance Hospital, South Korea (2014-2024). Clinical outcomes were compared between the catheter angiography group (n=108) and the colonoscopy group (n=146), and the predictive risk factors for rebleeding were examined.

Results: There were no significant differences in the confirmation yield (59.3% vs 47.9%), therapeutic yield (64.8% vs 56.2%), and mean hospitalization duration (20.1 days vs 21.3 days) between groups. However, the mean time to procedure (12.3 hours vs 19.2 hours) and rebleeding rate (36.1% vs 48.6%) were lower in the catheter angiography group. Logistic regression revealed that time to procedure predicted higher confirmation and therapeutic yields. Multivariate Cox regression showed that risk factors for rebleeding included receiving >5 units of packed red blood cells (hazard ratio [HR], 1.711; 95% confidence interval [CI], 1.025 to 2.857, p=0.040) and undergoing colonoscopy instead of catheter angiography (HR, 1.922; 95% CI, 1.242 to 2.974, p=0.003).

Conclusions: Following a positive CTA result, colonoscopy (compared to catheter angiography) and the need for more than 5 units of packed red blood cell transfusion were significant risk factors for rebleeding.

Background/aims: Antioxidants may offer protection against colorectal cancer, but their association with colorectal adenomas remains unclear due to variations in study design, population, and dietary factors. We investigated the relationship between dietary intake of β-carotene, vitamin A, and retinol and the prevalence of colorectal adenoma using food frequency questionnaires (FFQs) and colonoscopy data.

Methods: We recruited participants undergoing elective colonoscopy across eight medical institutions. FFQs were administered prior to colonoscopy, and nutrient intakes were categorized into quartiles. Multivariate logistic regression was used to estimate odds ratios (ORs) adjusting for potential cofounders. A meta-analysis of 11 observational studies, including our own, was also conducted.

Results: Among 720 eligible participants (mean age 52.44±14.30 years; body mass index 23.82±3.46 kg/m²), colorectal adenoma was identified in 266 (36.9%). Higher intake of β-carotene and vitamin A was associated with a significantly lower prevalence of colorectal adenoma (p for trend <0.05). Adjusted ORs for the highest versus lowest quartile were 0.43 (95% confidence interval [CI], 0.20 to 0.91) for β-carotene and 0.34 (95% CI, 0.15 to 0.76) for vitamin A. Conversely, higher retinol intake was linked to increased adenoma prevalence (OR, 2.16; 95% CI, 1.09 to 4.29), particularly among individuals with high-fat diets. Meta-analysis confirmed a protective association for β-carotene (OR, 0.60; 95% CI, 0.46 to 0.78), but not for vitamin A or retinol.

Conclusions: We demonstrated an inverse association between β-carotene and colorectal adenoma prevalence, whereas the effects of vitamin A and retinol appeared to vary depending on dietary context. These findings highlight the complex influence of dietary pattern and nutrient sources on colorectal adenoma risk.

Background/aims: Stratifying patients for gastric neoplasm risk before screening esophagogastroduodenoscopy (EGD) is challenging. The aim of this study was to develop a prediction model for assessing gastric neoplasm risk in a screening setting.

Methods: This retrospective cross-sectional study included 21,586 EGD patients from Seoul St. Mary's Hospital, Korea (2009 to 2019). Logistic regression analyses identified risk factors, and score-based prediction models were developed on the basis of these risk factors. These models were evaluated using the area under the curve (AUC) and the Hosmer?Lemeshow goodness of fit test. Internal validation was performed using bootstrapping (1,000 resamples) and a validation cohort.

Results: The study included 10,414 patients in the derivation cohort and 11,172 in the validation cohort. Gastric dysplasia and cancer were identified in 49 (0.47%) and 35 (0.34%) patients, respectively. Four models were developed, with Model 4 including age, sex, pepsinogen I/II ratio, anti-Helicobacter pylori immunoglobulin G antibody, smoking, body mass index, alcohol use, and family history of gastric cancer. Model 4 had the highest AUC (0.827) in the derivation cohort, while Model 2 achieved the highest AUC (0.788) after risk scores were assigned. Observed prevalence rates were 0.24%, 1.05%, and 4.08% for low-, medium-, and high-risk groups, respectively (p<0.001). In internal validation, Model 3 demonstrated the highest AUC (0.802), with consistent performance in the validation cohort, and all models passed the Hosmer-Lemeshow test (p>0.8).

Conclusions: The predictive models achieved an AUC of approximately 0.8. Further improvements with additional stratification factors are needed for better diagnostic performance in prescreening.

Background/aims: Acute mesenteric ischemia occurs mainly in elderly individuals; however, it can also affect young adults, and some of these patients experience a poor disease course because of delayed diagnosis and treatment. This study aimed to assess the clinical characteristics and outcomes of young adults with acute mesenteric ischemia.

Methods: We retrospectively reviewed young adult patients aged 20 to 39 years diagnosed with acute mesenteric ischemia between 2002 and 2022 at four tertiary medical centers in Korea. Their clinical characteristics were compared with those of young middle-aged adults aged 40 to 49 years.

Results: A total of 86 patients were included. The median age of the patients was 42 years, and 71% of the patients were male. Twenty-three percent of the patients had a history of abdominal procedures or surgery. The most common cause of acute mesenteric ischemia was mesenteric venous thromboembolism (33.7%), followed by mesenteric artery thromboembolism (30.2%), nonocclusive mesenteric ischemia (18.6%), and mesenteric artery dissection (17.4%). Patients aged 20 to 39 years were more frequently affected by mesenteric venous thromboembolism (44.0% vs 26.0%) and less frequently affected by mesenteric arterial thromboembolism (13.9% vs 42.0%) than patients aged 40 to 49 years (p=0.013). However, no significant differences were observed in terms of disease involvement, treatment method, or treatment outcome during follow-up (median, 769 days).

Conclusions: Young adults with acute mesenteric ischemia may exhibit clinical characteristics distinct from those of young middle-aged adults. Venous thromboembolism is prominent etiology of acute mesenteric ischemia in young adults.

Background/aims: Muscle volume loss (MVL) is associated with poor outcomes in patients with hepatocellular carcinoma (HCC). However, dynamic muscle atrophy during HCC treatment is also a critical concern. This study aimed to determine the clinical significance of MVL and severe muscle atrophy following lenvatinib treatment among patients with unresectable HCC.

Methods: This study included 302 patients with unresectable HCC who received first-line lenvatinib between July 2019 and December 2022. MVL was defined using the psoas muscle index, while severe muscle atrophy was classified as a ≥1.5% decrease in the psoas muscle index per month after lenvatinib initiation. To reduce the risk of selection bias, propensity score matching was performed.

Results: After propensity score matching, 168 patients were included, comprising 112 non-MVL and 56 MVL patients. The MVL group had significantly worse overall survival (9.9 months vs 15.0 months, p=0.021) and a higher incidence of treatment-related adverse events (82.8% vs 66.6%, p=0.03) than the non-MVL group. Among 128 patients with dynamic imaging assessments, those with severe muscle atrophy (n=76) had significantly shorter progression-free survival (4.1 months vs 10.9 months, p<0.001) and overall survival (11.1 months vs 25.9 months, p<0.001) than patients with mild atrophy. Multivariate analysis revealed that severe muscle atrophy was an independent risk factor for progression-free survival (hazard ratio [HR], 2.388; 95% confidence interval [CI], 1.519 to 3.756; p<0.001) and overall survival (HR, 2.130; 95% CI, 1.152 to 3.939; p=0.016), while MVL was not.

Conclusions: In real-world clinical practice, severe muscle atrophy is a stronger prognostic indicator than MVL among patients with unresectable HCC treated with first-line lenvatinib.

Background/aims: Noninvasive indexes can be used to diagnose and stage liver fibrosis caused by chronic hepatitis B (CHB). We aimed to evaluate whether changes in the liver stiffness measurement (LSM) and serum biomarkers can predict liver fibrosis regression in CHB patients based on triple liver biopsies.

Methods: This multicenter cohort study was based on triple liver biopsies and lasted for 260 weeks. Liver fibrosis regression was defined as Ishak decreased ≥1 stage or predominantly regressive by P-I-R classification with stable Ishak stage. Twelve noninvasive models were validated externally and yielded area under the receiver operating characteristic curve (AUROC) values ≥0.700 for predicting significant fibrosis in the training set.

Results: A total of 175 CHB patients were included (median age: 38 years, 76.6% male). A total of 69.2% (117/169) and 79.6% (78/98) patients achieved liver fibrosis regression at week 78 and week 260, respectively. The mixed effects model revealed significant group×time interactions between the regression and non-regression groups for aminotransferase to platelet ratio index (APRI; p=0.041), new algorithm attributed to age, alanine aminotransferase, gamma-glutamyl transferase algorithm (p=0.022), and King's score (p=0.016) from baseline to week 78 as well as for APRI (p=0.046) from baseline to week 260. The AUROC values for model changes were all <0.750 for predicting liver fibrosis regression. Additionally, the changes in the LSM and most noninvasive models were significantly correlated with the changes of Ishak-histology activity index score.

Conclusions: Changes in the LSM and noninvasive models were not strong predictors of liver fibrosis regression after 78 weeks and 260 weeks of treatment among CHB patients. It is critical to develop a dynamic noninvasive model for assessing liver fibrosis regression (ClinicalTrials.gov identifier NCT02849132).

Background/aims: Due to the very low incidence of human immunodeficiency virus (HIV) infection in South Korea, epidemiological data on hepatitis C virus (HCV)/HIV coinfection are limited. The aim of this study was to investigate the clinical characteristics and treatment outcomes of patients with HCV/HIV coinfection in South Korea.

Methods: We retrospectively collected data from patients diagnosed with HCV/HIV coinfection at 12 academic hospitals in South Korea from 2009 to 2020.

Results: A total of 124 patients were included in this study; most patients were males (n=112, 90.3%), and the mean age was 46.5±13.5 years. Among the study patients, 11 (8.9%) had cirrhosis, and seven (5.6%) tested positive for the hepatitis B surface antigen. During the follow-up period (mean period: 67.4 months), two patients (1.6%) developed hepatocellular carcinoma, and nine (7.3%) died. Of the 112 patients (90.3%) who underwent HCV genotype testing, most were infected with HCV genotype 2 (n=53, 47.3%) and genotype 1b (n=41, 36.6%). In particular, HCV genotype 1a was identified in 12.5% (n=14) of patients. Ninety-one patients (73.4%) received antiviral therapy, with 104 antiviral treatments administered overall. The sustained virologic response rate was significantly higher in patients treated with direct-acting antiviral agents (DAA) than in those receiving pegylated interferon-based treatment (89.0% vs 58.1%, p<0.001).

Conclusions: In South Korea, patients with HCV/HIV coinfection were predominantly male and younger and exhibited a higher prevalence of genotype 1a than those with HCV monoinfection. These patients demonstrated a significantly better treatment response to DAA treatment than to interferon-based therapy.

Background/aims: The aim of this study was to evaluate the efficacy of serum pepsinogen (sPG) tests for gastritis, gastric adenoma (GA), and gastric cancer (GC) using the enzyme‑linked immunosorbent assay-based GastroPanel kit and to investigate the correlation between Gastro-Panel- and Latex-enhanced Turbidimetric Immunoassay (L-TIA)-derived sPG results.

Methods: sPG I and II levels and PG I/II ratios were measured using both kits in 2,204 participants, including 1,109 controls, 316 GA, and 779 GC patients.

Results: The GastroPanel- and L-TIA-derived sPG results showed high concordance. An sPG I concentration of 70 ng/mL and a PG I/II ratio of 3 measured with the L-TIA kit corresponded to 100 ng/mL and 5.3 with the GastroPanel kit. sPG I decreased in the GA and GC groups, whereas sPG II was lower in the GA group, but higher in the GC group than that in control group. The PG I/II ratios significantly decreased in the GA and GC groups, especially for the intestinal type. The sensitivity and specificity of PG I/II ratio ≤5.3 using the GastroPanel kit for the detection of GA or GC were 51%-59% and 61%-66%, respectively, which were slightly higher than 51%-58% and 58%-63% using the L-TIA kit. The group with a PG I/II ratio ≤5.3 and Helicobacter pylori-negative status had the highest risk with an adjusted odds ratio of 3.36 for GA and 2.25 for GC, with more prominent increase in diffuse-type compared to intestinal-type.

Conclusions: The GastroPanel kit showed non-inferiority compared to the L-TIA kit.