Gut and Liver最新文献

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.

Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used diagnostic and therapeutic procedure for pancreaticobiliary diseases. However, its relatively invasive nature necessitates a thorough understanding of potential adverse events and appropriate preventive strategies. Post-ERCP pancreatitis (PEP), the most common ERCP-related adverse event, occurs in approximately 10% of cases. While often mild, severe cases can rapidly progress and lead to clinical deterioration and mortality. The pathogenesis of PEP involves direct tissue injury, impaired ductal drainage, inflammatory mediator release, and individual susceptibility. These insights have informed the currently employed prevention and management strategies. PEP risk factors include both patient- and procedure-related variables, underscoring the need for precise risk stratification and individualized procedural planning. Evidence-based preventive strategies-such as rectal nonsteroidal anti-inflammatory drugs, prophylactic pancreatic stent placement, aggressive intravenous hydration, guidewire-assisted cannulation, and other pharmacologic agents-have demonstrated efficacy in reducing PEP incidence. Future developments, including optimal combination strategies and machine learning-based risk prediction models, may further improve outcomes. Significantly reducing the burden of PEP requires integrating mechanistic insight and risk stratification with timely, evidence-based prevention and management.

Background/aims: To assess the safety and efficacy of early oral refeeding (ERF) versus delayed refeeding (DRF) in patients with mild post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).

Methods: Eligible patients were randomly assigned in a 1:1 ratio to the ERF or DRF group. Eligible patients were randomly assigned in a 1:1 ratio to the ERF or DRF group. In the ERF group, feeding began 24 hours after the diagnosis of PEP; in the DRF group, feeding commenced once normal bowel sounds returned and pain had decreased to a visual analog scale score of <2. The diet was advanced from clear fluids to soft foods according to patient tolerance. Refeeding was temporarily halted if the visual analog scale score reached ≥5 points or if intake was refused due to pain. Resumption required normal amylase/lipase levels, pain relief, and bowel movement restoration. Discharge criteria included patient well-being >24 hours post-diet. The primary outcome was PEP hospitalization duration, and secondary outcomes were the incidence of severe acute pancreatitis, readmission rate (<30 days), and PEP-related mortality rate.

Results: A total of 80 patients (40 in each ERF and DRF group) were enrolled across nine referral centers. Baseline characteristics, procedural parameters and initial PEP severity were not significantly different between the two groups. Four ERF and three DRF patients had refeeding interruptions. ERF significantly reduced PEP hospitalization duration compared to DRF (2.93±1.59 days vs 3.78±1.97 days: relative risk, 0.75; 95% confidence interval, 0.59 to 0.97; p=0.026). Rates of severe acute pancreatitis, readmission, and mortality/morbidity related to PEP were similar between the two groups.

Conclusions: ERF effectively shortens hospitalization in mild PEP patients without increasing safety risks (ClinicalTrials.gov identifier NCT04750044).

Background/aims: The World Health Organization aims to eliminate hepatitis C virus (HCV) by 2030; however, linkage to care rates remain suboptimal. To address this, an in-hospital HCV alarm system integrated into electronic medical records (EMRs) was implemented to increase confirmatory testing and referral rates.

Methods: This retrospective study analyzed patients with positive anti-HCV antibody results at a tertiary hospital in Korea, comparing the pre-alarm period (August 2020-July 2022) with the post-alarm period (July 2022-May 2024). HCV RNA testing rates, liver clinic visits, and direct-acting antiviral (DAA) prescriptions were assessed. Multivariate logistic regression was performed to identify factors associated with the lack of HCV RNA testing implementation.

Results: Among 941 patients who tested positive for anti-HCV antibodies, the proportion of patients who underwent HCV RNA testing significantly increased from 49.4% in the pre-alarm period to 67.8% in the post-alarm period (p<0.001). The rate of referral to liver specialists also showed an increasing trend (89.4% vs 93.2%), while DAA initiation rates remained similar (68.4% vs 72.0%). Multivariate analysis revealed that older age, surgical or emergency department admission, and non-liver-related testing indications were independent predictors of the lack of HCV RNA testing implementation.

Conclusions: Implementation of an in-hospital HCV alarm system significantly increased HCV RNA testing rates, enhancing early diagnosis and linkage to care. While referral rates remained high, persistently low testing rates in emergency departments highlight the need for targeted interventions. A cost-effective, EMR-integrated alarm system may be a feasible strategy to support national HCV elimination efforts.

Background/aims: Type 2 diabetes mellitus (T2DM) is linked to an elevated risk of gastrointestinal bleeding (GIB), but the effects of diabetes duration and severity remain unclear. We investigated these associations in a nationwide Korean cohort.

Methods: This retrospective cohort study used the Korean National Health Insurance database from individuals who underwent national health screening between 2009 and 2015. Participants were classified as having normal glucose, impaired fasting glucose (IFG), new-onset diabetes, diabetes <5 years, or diabetes ≥5 years. GIB was defined by fulfilling all three: hospitalization, red blood cell transfusion, and ICD-10 GIB codes. Because hemoglobin A1c data were unavailable, insulin treatment served as a surrogate for diabetes severity. Kaplan-Meier and Cox proportional hazards models were applied to estimate cumulative incidence and adjusted hazard ratios (aHRs), adjusting for medications and comorbidities.

Results: Upper GIB risk increased progressively with diabetes duration: aHR 1.081 (95% confidence interval [CI], 1.008 to 1.159) for IFG; 1.265 (1.128 to 1.418) for new-onset diabetes; 1.561 (1.392 to 1.751) for diabetes <5 years; and 1.738 (1.578 to 1.915) for diabetes ≥5 years. Elevated risk was also observed among those receiving insulin. In contrast, diabetes duration was not significantly related to lower GIB: aHR 0.949 (95% CI, 0.830 to 1.085) for IFG; 1.150 (0.902 to 1.468) for new-onset diabetes; 1.202 (0.944 to 1.531) for diabetes <5 years; and 0.984 (0.792 to 1.224) for diabetes ≥5 years.

Conclusions: Longer duration and greater severity of T2DM are associated with increased risk of upper GIB, whereas no significant association was found for lower GIB.