Journal of clinical gastroenterology最新文献

Background: Digestive diseases affect patient health while highlighting challenges in socioeconomic development and health care system accessibility and efficiency. This analysis offers insights into digestive disease control by examining the burden, identifying risk factors, and forecasting trends to 2030.

Methods: Using the Global Burden of Disease (GBD) 2021 data to assess the burden of 17 digestive diseases, we analyzed incidence, prevalence, mortality, and disability-adjusted life years (DALYs). We analyzed the historical trends and their burden attributable to Level 1 and 2 risk factors. We conducted a Bayesian age-period-cohort (BAPC) analysis to forecast trends to 2030.

Results: In 2021, enteric infections were the primary contributors to age-standardized incidence, mortality, and DALYs rates within digestive diseases, while cirrhosis accounted for the highest prevalence rate. The DALYs attributable to risk factors were estimated at 4.01 million for males and 1.01 million for females. The leading Level 2 risk factor was poor sanitation. Alcohol use, tobacco, and high BMI are shared risk factors contributing to DALYs. We project a decline in incidence rate among females to 2030, accompanied by a rise in prevalence.

Conclusions: Although mortality and DALYs will decrease, digestive diseases such as enteric infections and cirrhosis remain critical challenges, particularly in low- and middle-income countries. Governments must prioritize the management of risk factors and strengthen pandemic preparedness to alleviate future strain.

Objective: To evaluate the clinical and endoscopic characteristics of esophageal mucosal white plaques (EMWPs) and to investigate potential underlying etiologies.

Methods: A total of 162 patients presenting with EMWPs were included as the case group. An equal number of patients without EMWPs served as the control group. Clinical symptoms, endoscopic findings, and fungal examination results were compared between the groups to identify potential contributing factors.

Results: EMWPs were most frequently observed in the middle and lower segments of the esophagus (87.1%). Compared with the control group, patients in the case group exhibited significantly higher frequencies of psychological stress (P=0.036), heartburn (P<0.001), acid regurgitation (P<0.001), retrosternal pain (P<0.001), pharyngitis (P=0.017), and globus sensation (P=0.042). Endoscopic examination revealed significantly higher detection rates of reflux esophagitis (P<0.001), hiatal hernia (P<0.001), duodenogastroesophageal reflux (P<0.001), antral hyperemia (P=0.019), and fundic hyperemia (P<0.001) in the case group. Helicobacter pylori (H. pylori) infection was significantly less prevalent among patients with EMWPs compared with controls (P=0.001). Among 142 patients who underwent fungal examination, no significant differences were identified between those with positive and negative results regarding reflux esophagitis, H. pylori infection, or ulcerative disease.

Conclusion: EMWPs primarily involve the middle and lower esophageal segments and are associated with symptoms, such as heartburn, acid regurgitation, retrosternal pain, pharyngitis, and globus sensation. The lower prevalence of H. pylori infection, along with elevated rates of psychological stress and reflux-related findings, indicates a possible association with gastroesophageal reflux disease and stress-related factors.

Background and aims: Gastrostomy is a widely utilized modality for long-term enteral nutrition, performed mainly through endoscopic or radiologic approaches, as they are less invasive than surgical approach. While both techniques are effective, their complications and outcomes remain under investigation. This study aims to compare the incidence of adverse events of percutaneous endoscopic gastrostomy (PEG) and interventional radiological-guided gastrostomy (IR-G) using large multicenter database.

Methods: Study cohorts were identified using TriNetX US Collaborative Network database. Current procedural terminology (CPT) codes were utilized to identify two cohortss: PEG versus IR-G. Propensity score matching was conducted based on demographics and relevant comorbidities. Outcomes were assessed within 30 days of the procedure and included adverse events following gastrostomy.

Results: Total of 160,064 patients were included in our study. After propensity score matching, 51,107 patients were included in each group. Compared with PEG, IR-G group had significantly higher odds of gastrostomy infections (1.07% vs. 0.88%; aOR 1.21; 95% CI: 1.07-1.37; P < 0.01), gastrostomy malfunctions (5.16% vs. 3.06%; aOR 1.72; 95% CI: 1.58-1.80; P < 0.01), and overall gastrointestinal (GI) bleeding (1.23% vs. 1.09%; aOR 1.13; 95% CI: 1.01-1.28; P = 0.04); however, no statistical differences were observed for gastrostomy-related hemorrhage. The odds of aspiration pneumonia were lower in IR-G group patients (2.85% vs. 3.19%; aOR 0.89; 95% CI: 0.82-0.96; P < 0.01). Overall mortality rates were higher in the IR-G group patients (10.06% vs. 9.19%; aOR 1.11; 95% CI: 1.05-1.14; P < 0.01). Complications such as perforations and peritonitis were not significantly different between the 2 groups.

Conclusions: Percutaneous endoscopic gastrostomy placement is associated with lower risk of gastrostomy malfunctions, infections, and overall GI bleeding compared with radiological-guided gastrostomy placement, highlighting superior safety outcomes. When feasible and expertise is available, endoscopic approach should be used as the primary method for gastrostomy tube placement.

Background: The incidence of inflammatory bowel disease (IBD) is rising in newly industrialized nations, yet nationally representative data from Türkiye are limited. We characterized recent epidemiologic trends, clinical features, and geographic distribution of newly diagnosed IBD across Türkiye.

Methods: This retrospective multicenter cohort included adults (≥18 y) with newly diagnosed IBD at 24 gastroenterology centers spanning all 7 Turkish regions (2010-2022). Demographics, disease behavior/extent, smoking status, family history, and province of residence were collected. Temporal and regional patterns were analyzed using χ2 tests and segmented regression.

Results: Among 3463 patients, 51.1% had UC, 44.0% CD, and 0.7% IC. Males comprised 57.7%; median age at diagnosis was 30 years for CD and 32 years for UC. Annual IBD diagnoses more than doubled from 2010 to 2021. The UC-to-CD ratio increased from 0.94:1 (2010-2016) to 1.29:1 (2016-2022, P < 0.001). CD most often showed inflammatory behavior (55.5%) and ileocolonic involvement (37.1%); UC frequently presented as pancolitis (39.3%). Smoking (24.2% vs 10.9%) and family history (6.8% vs 4.5%) were more common in CD than UC (both P <0.01). Choropleth mapping revealed a west-to-east gradient, with Marmara and Aegean regions bearing the highest burden. Multivariable analysis showed UC diagnosis was independently associated with state-hospital care, residence in Central Anatolia or the Black Sea, and age ≥60 years.

Conclusion: Incident IBD in Türkiye has risen steadily, with UC now exceeding CD. Patients predominantly present in early adulthood. Regional and hospital-level differences highlight the need for a national registry and targeted resource allocation.

Objective: Risk of Helicobacter pylori (H. pylori)-related gastroduodenal diseases is influenced by the degree of chronic gastritis, while other microbes reside in gastric mucosa may be relevant to this process. This study aimed to characterize the microbiome composition in the gastric mucosa, especially with an attempt to its correlation with histologic and serological degrees of H. pylori-related gastritis.

Methods: Among 182 cancer-free patients, bacterial communities of the gastric mucosa in the antrum were examined using 16S rRNA sequencing. The result was correlated with clinicopathological characteristics, histologic and serological degrees of H. pylori-related gastritis.

Results: Bacterial alpha diversity measures were significantly lower in H. pylori clinical test positives compared with that in the negatives. Lower bacterial alpha diversity measures were also associated with degree of histologic gastritis in the antrum, while rather higher bacterial alpha diversity measures were correlated with degree of serological gastritis. The multiple regression analysis demonstrated that histologic gastritis (active gastritis, atrophy) was significantly associated with lower Shannon index (t=-4.37, P<0.0001), an indicator for bacterial alpha diversity. Inversely, serological gastritis (serum pepsinogen 3+) was also associated with higher Shannon index (t=2.98, P<0.0001). In the specific bacteria, higher abundances of Bacillus, Actinobacillus, and Streptococcus were associated with degree of serological gastritis.

Conclusions: Our findings showed paradoxical change in the microbiome structure in the development of severe gastric atrophy that may be associated with progression of gastric atrophy and gastric cancer risk.The study was not registered as the clinical trial because of the retrospective observational study.

Background: Distinguishing between inflammatory and fibrotic strictures is crucial for guiding treatment strategies in Crohn's disease. This study aims to identify the optimal approach for differentiating intestinal strictures in Crohn's disease by combining endoscopic and radiologic examinations.

Methods: This study enrolled patients who underwent surgery for Crohn's disease intestinal strictures from March 2023 to December 2024. On the basis of operative histopathology, the strictures were classified into inflammatory, mixed and fibrotic types. Preoperative evaluations included computed tomography enterography (CTE), magnetic resonance enterography (MRE), and standardized endoscopic scoring. Clinical parameters, serum biomarkers, and imaging characteristics were analyzed to identify predictors of stricture subtypes.

Results: A cohort of 39 patients with 40 surgical intestinal strictures (7 inflammatory, 8 mixed, and 25 fibrotic) underwent comprehensive evaluation. Stricture detection rates were 55.77% for CTE and 61.54% for MRE. Differentiation accuracy was 55.0%for endoscopy, 53.8%for CTE, and 67.7% for MRE. Endoscopic evaluation demonstrated superior diagnostic performance for inflammatory strictures (P=0.007). The combination of endoscopy and MRE showed the highest AUC (0.770; P=0.020) in differentiating mixed strictures, and demonstrated equivalent sensitivity and no significant difference in specificity (P=0.442) compared with endoscopy combined with the others. For fibrotic strictures, MRE exhibited the highest sensitivity (80.0%) but limited overall accuracy (P=0.072). The combination of endoscopy with MRE improved the AUC (0.783; P=0.003) while achieving a statistically significant enhancement in specificity (P=0.011). Albumin was significantly negatively correlated with inflammatory strictures. The moderate SES-CD scores were independently associated with fibrotic strictures in multivariate analysis.

Conclusions: Integrating endoscopy with MRE significantly improves the diagnostic accuracy for distinguishing stricture subtypes in CD. These findings support the utility of combined imaging-endoscopic protocols for preoperative stratification of intestinal strictures.

Background: Lactulose is an osmotic laxative used to treat hepatic encephalopathy (HE) in cirrhotic patients. However, lactulose may cause hypernatremia (HN).

Methods: We identified all patients admitted with cirrhosis and HE at our institution (January 1, 2018 to December 31, 2023). To compare HE patients with and without HN, we used propensity matching to control for the severity of HE and underlying liver disease. The primary endpoint was mortality, and secondary endpoints included total and rectal lactulose dose (g) and length of stay (LOS).

Results: Among 6742 patients admitted with cirrhosis, 1651 (25%) had a primary diagnosis of HE; 347 patients had HN (21%), and 106 patients (6%) developed a sodium≥150 mEq/L (HN group) during hospitalization. Cirrhosis was most commonly caused by alcohol or MASH and the median MELD was 24. Admission sodium was 137 mEq/L and peak, 152 mEq/L (medians); all patients received lactulose. The average daily lactulose dose to peak sodium level was higher in the HN group than in matched HE controls (87 g vs. 38 g, P<0.001). 67 (63%) patients in the HN group received rectal lactulose (median sodium 154 mEq/L). Rectal lactulose was the strongest independent predictor of HN (OR=7.12, P<0.001), and doses ≥485 g (rectal ± oral lactulose) over 5 days were associated with increased HN risk (OR:7.89, P<0.001). Overall, 64 HE patients (60%) with HN died during hospitalization, compared with 37 (35%) without HN (P<0.001).

Conclusion: Lactulose-induced HN in patients with HE was associated with a remarkably high mortality rate. Rectal lactulose in HE patients may be unsafe.

Background and aims: Prolonged inhibition of gastric acid secretion may constitute a risk factor for colon polyps (CP) and colorectal cancer (CRC). We hypothesized that esophageal diseases treated with antisecretory medications may be associated with an increased frequency of CP and CRC.

Methods: In a case-control studies using the University of Pennsylvania Health System (UPenn) electronic database, we examined the occurrence of eosinophilic esophagitis (EoE), nonerosive reflux disease (NERD), erosive esophagitis (EE), or Barrett's esophagus (BE), in patients with CP or CRC. For comparisons of cases (with CP or CRC) and control subjects (without CP or CRC), we calculated odds ratios (OR) with their 95% CI, using multivariate logistic regressions to adjust for the confounding influences of demographic characteristics (age, sex, and race/ethnicity).

Results: The UPenn database contained 89,100 individual patients who underwent a colonoscopy and EGD between January 2000 and December 2024. Among these, 35,841 were diagnosed with CP and 3,228 with CRC. A total of 2137 patients were diagnosed with EoE, 18,223 with EE, 57,397 with NERD, and 6614 with BE. CPs were significantly associated with EoE (OR: 1.17, 95% CI: 1.07-1.28), EE (OR: 1.71, 95% CI: 1.65-1.77), NERD (OR: 1.76, 95% CI: 1.71-1.81), and BE (OR: 1.80, 95% CI: 1.71-1.90). CRC was significantly associated with BE (OR: 1.22, 95% CI: 1.08-1.33), but no other types of esophageal disease.

Conclusions: The occurrence of any type of reflux disease is associated with an increased risk for colonic neoplasia. Long-term inhibition of gastric acid secretion by antisecretory medication may constitute a risk factor for the occurrence of colon polyps and possibly colorectal cancer.

Background: Heart rate variability (HRV) can detect the onset of inflammation in ulcerative colitis (UC), a condition in which fatigue is an often-overlooked symptom that significantly affects patients' quality of life. Here, the capability of a novel validated wearable vital signs patch measuring HRV to assess disease activity and fatigue severity was explored in UC patients.

Study: In a cross-sectional pilot study, HRV was remotely monitored for 72 hours using a noninvasive wearable device in patients with active and quiescent UC. Associations were explored between 2 time-domain, 3 frequency-domain, and 2 nonlinear HRV metrics and fatigue [multidimensional fatigue inventory (MFI)], anxiety and depression [hospital anxiety and depression scale (HADS)], quality of life (SF-12), clinical symptoms [simple clinical colitis activity index (SCCAI)], and biochemical disease activity [fecal calprotectin (Fcal), C-reactive protein (CRP), hemoglobin, HNP1-3 and S100A8/A9].

Results: A total of 24 patients were included, of which 18 (75%) reported fatigue (MFI ≥60). No significant differences in HRV metrics were observed between clinically active and quiescent UC or between more and less fatigued UC patients. Two HRV metrics were associated with biochemical disease activity and all HRV metrics were significantly influenced by age, sex, and antidepressant use. There was a strong correlation between fatigue and depression.

Conclusions: Although the wearable vital signs patch could not distinguish between active and quiescent UC or detect fatigue severity based on HRV differences, associations were found between HRV and biochemical markers of inflammation, underscoring the need for further research using larger patient cohorts.