Journal of Digestive Diseases最新文献_第6页

Clinical Impact of Primary Sclerosing Cholangitis on Outcomes of Inflammatory Bowel Disease Hospitalization: A Propensity Score Matching Analysis of the Nationwide Inpatient Sample 原发性硬化性胆管炎对炎症性肠病住院治疗结果的临床影响：全国住院患者样本的倾向评分匹配分析

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2025-04-04 DOI: 10.1111/1751-2980.13339

Xing Yu, Juan Guo, Meng Li Xue, Cheng Dang Wang, Wei Wei Zheng

Objective

We aimed to evaluate the effect of primary sclerosing cholangitis (PSC) on hospitalization outcomes of inflammatory bowel disease (IBD) patients.

Methods

This retrospective study used data from the Nationwide Inpatient Sample (NIS) database from January 1, 2019, to December 31, 2020, including adults (≥ 18 years) admitted and diagnosed with IBD. Key outcomes included length of hospital stay (LOS), in-hospital mortality, hospitalization cost, and complications. The propensity score matching (PSM) analysis was used to balance characteristics between IBD patients with and without PSC, followed by logistic regression for analysis.

Results

After PSM analysis, 4950 patients (PSC: 990; non-PSC: 3960) were analyzed. IBD patients with PSC showed higher odds of any complication (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.80–2.39), including acute kidney injury (OR 1.31, 95% CI 1.10–1.55), septic shock (OR 1.84, 95% CI 1.33–2.54), liver cirrhosis (OR 18.19, 95% CI 14.23–23.25), and liver failure (OR 8.33, 95% CI 5.93–11.70) (all p < 0.05). These associations were consistently observed across subgroups with stronger associations in the Crohn's disease subgroup.

Conclusions

PSC significantly increases the risk of short-term complications in hospitalized IBD patients and the likelihood of chronic liver disease-related complications. These findings highlight the need for targeted management strategies for IBD patients with co-existing PSC.

目的：探讨原发性硬化性胆管炎（PSC）对炎症性肠病（IBD）患者住院结局的影响。方法：本回顾性研究使用了2019年1月1日至2020年12月31日全国住院患者样本（NIS）数据库的数据，包括入院并诊断为IBD的成年人（≥18岁）。主要结局包括住院时间（LOS）、住院死亡率、住院费用和并发症。使用倾向评分匹配（PSM）分析来平衡伴有和不伴有PSC的IBD患者的特征，然后进行逻辑回归分析。结果：经PSM分析，4950例患者(PSC: 990；非psc: 3960)进行分析。IBD合并PSC患者出现任何并发症的几率更高（比值比[OR] 2.08, 95%可信区间[CI] 1.80-2.39），包括急性肾损伤（OR 1.31, 95% CI 1.10-1.55）、感染性休克（OR 1.84, 95% CI 1.33-2.54）、肝硬化（OR 18.19, 95% CI 14.23-23.25）和肝功能衰竭（OR 8.33, 95% CI 5.93-11.70）（均为p）。PSC显著增加IBD住院患者短期并发症的风险和慢性肝病相关并发症的可能性。这些发现强调了IBD合并PSC患者需要有针对性的管理策略。

{"title":"Clinical Impact of Primary Sclerosing Cholangitis on Outcomes of Inflammatory Bowel Disease Hospitalization: A Propensity Score Matching Analysis of the Nationwide Inpatient Sample","authors":"Xing Yu, Juan Guo, Meng Li Xue, Cheng Dang Wang, Wei Wei Zheng","doi":"10.1111/1751-2980.13339","DOIUrl":"10.1111/1751-2980.13339","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to evaluate the effect of primary sclerosing cholangitis (PSC) on hospitalization outcomes of inflammatory bowel disease (IBD) patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study used data from the Nationwide Inpatient Sample (NIS) database from January 1, 2019, to December 31, 2020, including adults (≥ 18 years) admitted and diagnosed with IBD. Key outcomes included length of hospital stay (LOS), in-hospital mortality, hospitalization cost, and complications. The propensity score matching (PSM) analysis was used to balance characteristics between IBD patients with and without PSC, followed by logistic regression for analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After PSM analysis, 4950 patients (PSC: 990; non-PSC: 3960) were analyzed. IBD patients with PSC showed higher odds of any complication (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.80–2.39), including acute kidney injury (OR 1.31, 95% CI 1.10–1.55), septic shock (OR 1.84, 95% CI 1.33–2.54), liver cirrhosis (OR 18.19, 95% CI 14.23–23.25), and liver failure (OR 8.33, 95% CI 5.93–11.70) (all <i>p</i> < 0.05). These associations were consistently observed across subgroups with stronger associations in the Crohn's disease subgroup.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PSC significantly increases the risk of short-term complications in hospitalized IBD patients and the likelihood of chronic liver disease-related complications. These findings highlight the need for targeted management strategies for IBD patients with co-existing PSC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 1-2","pages":"52-61"},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Application of an Automated Deep Learning Program to A Diagnostic Classification Model: Differentiating High-Risk Adenomas Among Colorectal Polyps 10 mm or Smaller 自动深度学习程序在诊断分类模型中的应用：在10毫米或更小的结肠直肠息肉中区分高风险腺瘤。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2025-04-02 DOI: 10.1111/1751-2980.13340

Da Yeon Ham, Hyun Joo Jang, Sea Hyub Kae, Chang Kyo Oh, Sungjin Hong, Jae Gon Lee

Objective

This study aimed to develop a computer-aided diagnosis (CADx) model using an automated deep learning (DL) program to classify low- and high-risk adenomas among colorectal polyps ≤ 10 mm with standard white-light endoscopy.

Methods

Still images of colorectal adenomas ≤ 10 mm were extracted. High-risk adenomas were defined as high-grade dysplasia or adenomas with villous histology. Neuro-T version 3.2.1 (Neurocle Inc., Seoul, Republic of Korea), an automated DL software, was used for DL. Accuracy, precision, recall, and F1 score of the DL model were calculated. Endoscopy experts and trainees were invited to diagnose endoscopic images to compare their diagnostic accuracy with that of the DL model.

Results

A total of 2696 endoscopic images (2460 images of low-grade and 236 of high-grade adenomas) were used for training the DL model. In classifying high- and low-risk adenomas in the external validation dataset (398 images of low-grade and 41 images of high-grade adenomas), the model demonstrated 93.8% accuracy, 81.0% precision, 85.7% recall, and 83.3% F1 score overall. The area under the receiver operating characteristic curve for classifying high- and low-risk adenomas was 0.910 and 0.914, respectively. The expert endoscopists and trainees showed an overall accuracy of 95.1% and 79.7%, respectively, for discriminating high- and low-risk adenomas in the external validation dataset.

Conclusions

The CADx model established by the automated DL program showed high diagnostic performance in differentiating high- and low-risk adenomas among colorectal polyps ≤ 10 mm. The performance of the model was comparable to the experts and superior to the trainees.

目的：本研究旨在利用自动深度学习（DL）程序建立计算机辅助诊断（CADx）模型，在标准白光内镜下对≤10 mm的结直肠息肉进行低、高危腺瘤分类。方法：提取≤10 mm的结直肠腺瘤的静止图像。高危腺瘤定义为高度不典型增生或具有绒毛组织的腺瘤。使用自动化深度学习软件neurot version 3.2.1 （Neurocle Inc., Seoul, Republic Korea）进行深度学习。计算DL模型的准确率、精密度、召回率和F1分数。内窥镜专家和学员被邀请诊断内窥镜图像，比较他们的诊断准确性与DL模型。结果：共使用2696张内镜图像（低级别腺瘤2460张，高级别腺瘤236张）用于DL模型的训练。在外部验证数据集中（398张低级别和41张高级别腺瘤图像）对高、低风险腺瘤进行分类时，该模型的准确率为93.8%，精密度为81.0%，召回率为85.7%，F1总分为83.3%。受试者工作特征曲线下划分高风险和低风险腺瘤的面积分别为0.910和0.914。内窥镜专家和受训人员在外部验证数据集中区分高风险和低风险腺瘤的总体准确率分别为95.1%和79.7%。结论：采用自动DL程序建立的CADx模型对≤10 mm的结直肠息肉的高、低危腺瘤具有较高的诊断价值。该模型的性能与专家相当，优于学员。

{"title":"Application of an Automated Deep Learning Program to A Diagnostic Classification Model: Differentiating High-Risk Adenomas Among Colorectal Polyps 10 mm or Smaller","authors":"Da Yeon Ham, Hyun Joo Jang, Sea Hyub Kae, Chang Kyo Oh, Sungjin Hong, Jae Gon Lee","doi":"10.1111/1751-2980.13340","DOIUrl":"10.1111/1751-2980.13340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to develop a computer-aided diagnosis (CADx) model using an automated deep learning (DL) program to classify low- and high-risk adenomas among colorectal polyps ≤ 10 mm with standard white-light endoscopy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Still images of colorectal adenomas ≤ 10 mm were extracted. High-risk adenomas were defined as high-grade dysplasia or adenomas with villous histology. Neuro-T version 3.2.1 (Neurocle Inc., Seoul, Republic of Korea), an automated DL software, was used for DL. Accuracy, precision, recall, and F1 score of the DL model were calculated. Endoscopy experts and trainees were invited to diagnose endoscopic images to compare their diagnostic accuracy with that of the DL model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 2696 endoscopic images (2460 images of low-grade and 236 of high-grade adenomas) were used for training the DL model. In classifying high- and low-risk adenomas in the external validation dataset (398 images of low-grade and 41 images of high-grade adenomas), the model demonstrated 93.8% accuracy, 81.0% precision, 85.7% recall, and 83.3% F1 score overall. The area under the receiver operating characteristic curve for classifying high- and low-risk adenomas was 0.910 and 0.914, respectively. The expert endoscopists and trainees showed an overall accuracy of 95.1% and 79.7%, respectively, for discriminating high- and low-risk adenomas in the external validation dataset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CADx model established by the automated DL program showed high diagnostic performance in differentiating high- and low-risk adenomas among colorectal polyps ≤ 10 mm. The performance of the model was comparable to the experts and superior to the trainees.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 1-2","pages":"80-87"},"PeriodicalIF":2.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gastric Cardiac Carcinoma: Recent Progress in Clinicopathology, Prognosis, and Early Diagnosis 贲门癌：临床病理、预后及早期诊断的最新进展。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2025-03-20 DOI: 10.1111/1751-2980.13336

Qin Huang, Yu Qing Cheng, Kong Wang Hu, Yan Ding

Gastric cardiac carcinoma (GCC), also known as gastroesophageal junction (GEJ) carcinoma, is a slow-growing fatal cancer that arises in gastric cardiac mucosa in a region of about 2 cm above and 3 cm below the GEJ line. This carcinoma shows clinicopathologic and genomic features similar, but not identical, to gastric noncardiac carcinoma (GNCC). In contrast, GCC is much more complicated than esophageal adenocarcinoma (EA) in clinicopathology, genomics, and prognosis. GCC is heterogeneous geographically, accounting for 20%–50% of all gastric carcinomas in endemic regions in China. Compared with EA, GCC shows a much broader histopathologic spectrum and worse prognosis. Although detailed mechanisms of GCC pathogenesis remain elusive, advanced age, Helicobacter pylori infection, and gastroesophageal reflux disease are key risk factors. Intriguingly, goblet cell intestinal metaplasia may not be an essential initial step toward carcinogenesis in all GCC cases. At present, an accurate diagnosis of early GCC with prompt curative resection is the only realistic hope for dramatically improving patient outcomes. The recently developed liquid biopsy technology for serum cell-free DNA is a promising tool for the detection of early GCC, though many challenges remain and an in-depth investigation is required. Given the recent rapid advances in artificial intelligence, endoscopic technology, and a better understanding of endoscopists for subtle mucosal/vascular changes in early GCC, accurate detection of early GCC in a high proportion of cases would be possible.

胃贲门癌（GCC），又称胃食管交界处癌（GEJ），是一种生长缓慢的致死性癌症，发生于胃贲门粘膜上、下约2cm处。该癌的临床病理和基因组特征与胃非心脏癌（GNCC）相似，但不完全相同。相比之下，GCC在临床病理、基因组学和预后方面比食管腺癌（EA）复杂得多。GCC在地理上具有异质性，占中国流行地区所有胃癌的20%-50%。与EA相比，GCC表现出更广泛的组织病理谱和更差的预后。虽然GCC发病的具体机制尚不清楚，但高龄、幽门螺杆菌感染和胃食管反流病是关键的危险因素。有趣的是，杯状细胞肠化生可能不是所有GCC病例发生癌变的必要初始步骤。目前，准确诊断早期GCC并及时根治性切除是显著改善患者预后的唯一现实希望。最近开发的血清无细胞DNA液体活检技术是检测早期GCC的一种很有前途的工具，尽管仍然存在许多挑战，需要深入的研究。鉴于近年来人工智能和内镜技术的快速发展，以及内镜医师对早期GCC细微粘膜/血管变化的更好理解，在高比例的早期GCC病例中准确检测是可能的。

{"title":"Gastric Cardiac Carcinoma: Recent Progress in Clinicopathology, Prognosis, and Early Diagnosis","authors":"Qin Huang, Yu Qing Cheng, Kong Wang Hu, Yan Ding","doi":"10.1111/1751-2980.13336","DOIUrl":"10.1111/1751-2980.13336","url":null,"abstract":"<div>\u0000 \u0000 <p>Gastric cardiac carcinoma (GCC), also known as gastroesophageal junction (GEJ) carcinoma, is a slow-growing fatal cancer that arises in gastric cardiac mucosa in a region of about 2 cm above and 3 cm below the GEJ line. This carcinoma shows clinicopathologic and genomic features similar, but not identical, to gastric noncardiac carcinoma (GNCC). In contrast, GCC is much more complicated than esophageal adenocarcinoma (EA) in clinicopathology, genomics, and prognosis. GCC is heterogeneous geographically, accounting for 20%–50% of all gastric carcinomas in endemic regions in China. Compared with EA, GCC shows a much broader histopathologic spectrum and worse prognosis. Although detailed mechanisms of GCC pathogenesis remain elusive, advanced age, \u0000 <i>Helicobacter pylori</i>\u0000 infection, and gastroesophageal reflux disease are key risk factors. Intriguingly, goblet cell intestinal metaplasia may not be an essential initial step toward carcinogenesis in all GCC cases. At present, an accurate diagnosis of early GCC with prompt curative resection is the only realistic hope for dramatically improving patient outcomes. The recently developed liquid biopsy technology for serum cell-free DNA is a promising tool for the detection of early GCC, though many challenges remain and an in-depth investigation is required. Given the recent rapid advances in artificial intelligence, endoscopic technology, and a better understanding of endoscopists for subtle mucosal/vascular changes in early GCC, accurate detection of early GCC in a high proportion of cases would be possible.</p>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 1-2","pages":"22-30"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Long-Term Outcomes of Double-Balloon Enteroscopy Polypectomy for Large Small Bowel Polyps Detected During Surveillance Imaging in Patients With Peutz–Jeghers Syndrome 双气囊小肠镜息肉切除术治疗Peutz-Jeghers综合征患者在监测影像中发现的大小肠息肉的长期疗效。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2025-03-03 DOI: 10.1111/1751-2980.13335

Min Kyu Kim, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon

Objectives

Double-balloon enteroscopy (DBE) is effective for managing small bowel (SB) diseases. We aimed to evaluate the patient outcomes of DBE polypectomy in Peutz–Jeghers syndrome (PJS) with large SB polyps at surveillance imaging studies and to identify the risk factors for SB surgery.

Methods

Forty-five PJS patients who underwent regular SB surveillance imaging studies from 2005 to 2023 were retrospectively included. DBE was performed for polyps > 15 mm detected by imaging studies, and DBE polypectomy was conducted for those > 10 mm or symptomatic ones.

Results

Patients' average age at PJS diagnosis and surveillance initiation was 19.9 and 27.8 years, respectively. Thirty-one (68.9%) patients had laparotomy before surveillance. Each patient underwent 2.7 DBE procedures at a 31.0-month interval. An average of 7.8 and 4.4 polyps were removed during the first and second DBE procedures (p = 0.070). During 9 (8.2%) DBE procedures, complications, including two perforations requiring surgery, occurred. During the follow-up period, 11 patients required SB surgery, with a median time to surgery of 155 months. Patients with ≥ 5 polyps removed at initial DBE had a higher cumulative probability of SB surgery than those with < 5 polyps (hazard ratio [HR] 9.65, p = 0.031). Patients with ≥ 3 laparotomies before surveillance tended to have an increased surgery risk (HR 9.98, p = 0.078).

Conclusions

DBE polypectomy effectively manages large SB polyps detected by imaging surveillance in PJS over the long term. Early initiation of surveillance should be emphasized to minimize the risk of SB surgery.

目的：双气囊小肠镜检查（DBE）是治疗小肠疾病的有效方法。我们的目的是评估Peutz-Jeghers综合征（PJS）伴有大SB息肉的DBE息肉切除术患者的监测成像结果，并确定SB手术的危险因素。方法：回顾性分析2005年至2023年接受定期SB监测影像学检查的45例PJS患者。影像学检查发现息肉>015mm行DBE， >0mm或有症状者行DBE息肉切除术。结果：患者在PJS诊断和监测开始时的平均年龄分别为19.9岁和27.8岁。31例（68.9%）患者在监测前进行了剖腹手术。每名患者间隔31.0个月接受2.7次DBE手术。在第一次和第二次DBE手术中，平均切除了7.8个和4.4个息肉（p = 0.070）。在9例（8.2%）DBE手术中，发生并发症，包括2例需要手术的穿孔。随访期间，11例患者行SB手术，中位手术时间155个月。初始DBE切除≥5个息肉的患者比接受DBE切除术的患者有更高的SB手术的累积概率。结论：DBE息肉切除术有效地管理了PJS患者长期影像学监测发现的大SB息肉。应强调早期开始监测，以尽量减少SB手术的风险。

{"title":"Long-Term Outcomes of Double-Balloon Enteroscopy Polypectomy for Large Small Bowel Polyps Detected During Surveillance Imaging in Patients With Peutz–Jeghers Syndrome","authors":"Min Kyu Kim, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon","doi":"10.1111/1751-2980.13335","DOIUrl":"10.1111/1751-2980.13335","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Double-balloon enteroscopy (DBE) is effective for managing small bowel (SB) diseases. We aimed to evaluate the patient outcomes of DBE polypectomy in Peutz–Jeghers syndrome (PJS) with large SB polyps at surveillance imaging studies and to identify the risk factors for SB surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Forty-five PJS patients who underwent regular SB surveillance imaging studies from 2005 to 2023 were retrospectively included. DBE was performed for polyps > 15 mm detected by imaging studies, and DBE polypectomy was conducted for those > 10 mm or symptomatic ones.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients' average age at PJS diagnosis and surveillance initiation was 19.9 and 27.8 years, respectively. Thirty-one (68.9%) patients had laparotomy before surveillance. Each patient underwent 2.7 DBE procedures at a 31.0-month interval. An average of 7.8 and 4.4 polyps were removed during the first and second DBE procedures (<i>p</i> = 0.070). During 9 (8.2%) DBE procedures, complications, including two perforations requiring surgery, occurred. During the follow-up period, 11 patients required SB surgery, with a median time to surgery of 155 months. Patients with ≥ 5 polyps removed at initial DBE had a higher cumulative probability of SB surgery than those with < 5 polyps (hazard ratio [HR] 9.65, <i>p</i> = 0.031). Patients with ≥ 3 laparotomies before surveillance tended to have an increased surgery risk (HR 9.98, <i>p</i> = 0.078).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DBE polypectomy effectively manages large SB polyps detected by imaging surveillance in PJS over the long term. Early initiation of surveillance should be emphasized to minimize the risk of SB surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 1-2","pages":"44-51"},"PeriodicalIF":2.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Splenic Infarction After Sclerotherapy for Gastric Varices due to Anatomical Variation of Left Gastric Artery: A Case Report and Literature Review 胃左动脉解剖变异致胃静脉曲张硬化治疗后脾梗死1例报告并文献复习。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2025-03-02 DOI: 10.1111/1751-2980.13334

Shuai Jie Qian, Zhi Yin Huang, Yang Tai, Cheng Wei Tang, Hao Wu

Endoscopic sclerotherapy with cyanoacrylate has been recommended as the first-line therapeutic option for gastric varices with acute bleeding [1]. However, endoscopic injection of cyanoacrylate for treating gastric varices may cause splenic infarction [2], the etiology of which remains unclear. Here we reported a case of a 24-year-old man who presented with splenic infarction after endoscopic sclerotherapy with cyanoacrylate due to splenic arterial occlusion and compensatory dilatation of the left gastric artery (LGA) with collateral branch arteries.

A 24-year-old man was admitted to our hospital due to recurrent gastric variceal bleeding caused by inherited thrombophilia-related cavernous transformation of the portal vein. Inherited thrombophilia was diagnosed 3 years prior to his admission, with extensive arterial thrombosis involving the celiac trunk and its branches as well as venous thrombosis involving the portal vein, superior mesenteric vein, and splenic vein on abdominal computed tomography (CT) scan at diagnosis (Figure 1a). The patient was prescribed warfarin as the long-term anticoagulant therapy, although disease improvement was hardly observed, which was withdrawn 18 months later due to noncompliance of the patient. He was rushed to our Emergency Center due to massive hematemesis and hematochezia 8 months after cessation of treatment. At that admission, esophagogastroduodenoscopy (EGD) showed severe gastroesophageal varices (Figure 1b,c). And abdominal contrast-enhanced CT scan suggested a cavernous transformation of the portal vein (Figure 1a) and abundant collateral vessels. Considering the presence of prehepatic portal hypertension, two sessions of endoscopic band ligation combined with sclerotherapy were performed to treat hemorrhage and prevent rebleeding.

At admission, physical examination and laboratory tests of the patient revealed no remarkable abnormalities. The patient was then hospitalized for sclerotherapy to prevent rebleeding. During the procedure, severe gastric varices were observed (Figure 2a). Spurting hemorrhage occurred immediately after sclerosing agent cyanoacrylate (B. Braun, Melsungen, Germany) was injected (Figure 2b). Although emergency hemostasis was successfully performed by using a titanium clip (Figure 2c), the patient complained of persistent severe pain in the left upper quadrant of the abdomen and left waist accompanied by mild fever (37.4°C) at 30 h after the endoscopic treatment. Peripheral blood tests revealed an elevated white blood cell (WBC) count (15.5 × 10⁹/L; normal range 3.5–9.5 × 10⁹/L) and neutrophil percent (84.1%; normal range 40%–75%). A repeat abdominal contrast-enhanced CT scan revealed a large hypodense area of the spleen (Figure 2d). Splenic infarction due to arterial embolism was then diagnosed.

To investigate the reason why ectopic embolism of the artery occurred in this case, computed tomography angiography (C

氰基丙烯酸酯的内镜硬化疗法已被推荐为胃静脉曲张急性出血的一线治疗选择。然而，内镜下注射氰基丙烯酸酯治疗胃静脉曲张可能导致脾梗死[2]，其病因尚不清楚。我们在此报告一例24岁的男性患者，由于脾动脉闭塞和胃左动脉（LGA）伴侧支动脉代偿性扩张，经氰基丙烯酸酯内镜硬化治疗后出现脾梗死。一名24岁男性因遗传性血栓相关的门静脉海绵状变性引起胃静脉曲张出血而入院。患者在入院前3年被诊断为遗传性血栓病，诊断时腹部CT扫描显示广泛动脉血栓形成累及腹腔干及其分支，静脉血栓形成累及门静脉、肠系膜上静脉和脾静脉（图1a）。患者被开华法林作为长期抗凝治疗，但几乎没有观察到疾病的改善，18个月后由于患者的不遵守而停药。他在停止治疗8个月后因大量呕血和便血被紧急送往我们的急救中心。入院时，食管胃十二指肠镜（EGD）显示严重的胃食管静脉曲张（图1b，c）。腹部CT增强扫描显示门静脉海绵样转变（图1a）和丰富的侧支血管。考虑到肝前门静脉高压症的存在，我们进行了两次内镜下带状结扎联合硬化治疗，以治疗出血并防止再出血。入院时，体格检查和实验室检查未见明显异常。患者随后住院接受硬化治疗以防止再出血。手术过程中，观察到严重的胃静脉曲张（图2a）。注射硬化剂氰基丙烯酸酯（B. Braun, Melsungen, Germany）后立即发生喷射性出血（图2b）。虽然使用钛夹成功进行了紧急止血（图2c），但患者在内镜治疗后30 h仍主诉腹部左上腹和左腰持续剧烈疼痛，并伴有轻度发热（37.4℃）。外周血检查显示白细胞（WBC）计数升高(15.5 × 109/L；正常范围3.5 ~ 9.5 × 109/L)，中性粒细胞百分比(84.1%；正常范围40%-75%)。重复腹部增强CT扫描显示脾脏大面积低密度区（图2d）。然后诊断为动脉栓塞引起的脾梗死。为了探讨该病例发生动脉异位栓塞的原因，我们进行了三维重建的计算机断层血管造影（CTA），显示位于胃底连接LGA和脾动脉的几条异常扩大的动脉。脾内供血异常动脉闭塞（图3a），表明硬化剂通过增大的LGA动脉分支进入脾内动脉（图3b，c），导致脾梗死。患者给予口服抗生素及非甾体类抗炎药，症状逐渐好转。患者随访2年，脾梗死改善，写此信时无静脉曲张出血复发。静脉曲张出血是肝硬化门静脉高压和非肝硬化门静脉血栓形成相关的严重并发症[1,3]。氰基丙烯酸酯内镜硬化疗法被认为是胃静脉曲张出血的有效治疗选择[1,4]。氰基丙烯酸酯注射后异位栓塞虽然罕见，但已有文献记载，其描述为不同部位的血栓形成，包括肺、脑、冠状动脉、肾静脉、门静脉或脾静脉[2]。脾梗死最常见的原因是脾静脉阻塞与药物通过分流的迁移有关。氰基丙烯酸酯内镜硬化治疗中动脉栓塞性脾梗死的报道很少，在临床实践中应引起重视[5,6]。由于超声内镜（EUS）技术的发展，其在氰基丙烯酸酯注射指导下的应用在胃静脉曲张的治疗中备受关注，可以更仔细、准确地评估胃静脉曲张，并实时监测手术过程。与内镜下直接注胶相比，eus引导下的闭塞治疗取得了更有效的闭塞效果，并且出血复发和再干预率更低[8,9]。此外，EUS可以减少氰基丙烯酸酯用量，减少并发症的风险，并在与线圈联合使用时减少复发性出血[10,11]，特别是对于高危异位栓塞和自发性门系统分流的患者[12,13]。在我们的病例中，慢性门静脉和脾动脉血栓栓塞导致肝前门静脉高压、胃静脉曲张和脾缺血。作为脾动脉闭塞的代偿反应，LGA扩张并发展侧支动脉供应脾。这些扩张的动脉在内镜治疗中被误认为是胃静脉曲张，并被错误地注射了氰基丙烯酸酯。结果，氰基丙烯酸酯沿着LGA异常分支流入脾脏，引起脾梗死。据我们所知，氰基丙烯酸酯注射后由异常供应动脉引起脾梗死的报道很少。虽然粘膜静脉曲张血管多起源于粘膜下深部静脉，但当动脉有解剖变异时，尤其是合并血管疾病时，可能难以区分。对于重度胃静脉曲张患者，尤其对于多次内镜栓塞和硬化治疗的患者，可常规应用CTA，在硬化治疗前及时发现异常血管，避免出血和异位栓塞的风险。在术前CTA充分评估腹部血管状况后，也可考虑eus引导下注射氰基丙烯酸酯，以减少并发症的发生，提高高危患者的治疗效果。作者声明无利益冲突。

{"title":"Splenic Infarction After Sclerotherapy for Gastric Varices due to Anatomical Variation of Left Gastric Artery: A Case Report and Literature Review","authors":"Shuai Jie Qian, Zhi Yin Huang, Yang Tai, Cheng Wei Tang, Hao Wu","doi":"10.1111/1751-2980.13334","DOIUrl":"10.1111/1751-2980.13334","url":null,"abstract":"<p>Endoscopic sclerotherapy with cyanoacrylate has been recommended as the first-line therapeutic option for gastric varices with acute bleeding [<span>1</span>]. However, endoscopic injection of cyanoacrylate for treating gastric varices may cause splenic infarction [<span>2</span>], the etiology of which remains unclear. Here we reported a case of a 24-year-old man who presented with splenic infarction after endoscopic sclerotherapy with cyanoacrylate due to splenic arterial occlusion and compensatory dilatation of the left gastric artery (LGA) with collateral branch arteries.</p><p>A 24-year-old man was admitted to our hospital due to recurrent gastric variceal bleeding caused by inherited thrombophilia-related cavernous transformation of the portal vein. Inherited thrombophilia was diagnosed 3 years prior to his admission, with extensive arterial thrombosis involving the celiac trunk and its branches as well as venous thrombosis involving the portal vein, superior mesenteric vein, and splenic vein on abdominal computed tomography (CT) scan at diagnosis (Figure 1a). The patient was prescribed warfarin as the long-term anticoagulant therapy, although disease improvement was hardly observed, which was withdrawn 18 months later due to noncompliance of the patient. He was rushed to our Emergency Center due to massive hematemesis and hematochezia 8 months after cessation of treatment. At that admission, esophagogastroduodenoscopy (EGD) showed severe gastroesophageal varices (Figure 1b,c). And abdominal contrast-enhanced CT scan suggested a cavernous transformation of the portal vein (Figure 1a) and abundant collateral vessels. Considering the presence of prehepatic portal hypertension, two sessions of endoscopic band ligation combined with sclerotherapy were performed to treat hemorrhage and prevent rebleeding.</p><p>At admission, physical examination and laboratory tests of the patient revealed no remarkable abnormalities. The patient was then hospitalized for sclerotherapy to prevent rebleeding. During the procedure, severe gastric varices were observed (Figure 2a). Spurting hemorrhage occurred immediately after sclerosing agent cyanoacrylate (B. Braun, Melsungen, Germany) was injected (Figure 2b). Although emergency hemostasis was successfully performed by using a titanium clip (Figure 2c), the patient complained of persistent severe pain in the left upper quadrant of the abdomen and left waist accompanied by mild fever (37.4°C) at 30 h after the endoscopic treatment. Peripheral blood tests revealed an elevated white blood cell (WBC) count (15.5 × 10<sup>9</sup>/L; normal range 3.5–9.5 × 10<sup>9</sup>/L) and neutrophil percent (84.1%; normal range 40%–75%). A repeat abdominal contrast-enhanced CT scan revealed a large hypodense area of the spleen (Figure 2d). Splenic infarction due to arterial embolism was then diagnosed.</p><p>To investigate the reason why ectopic embolism of the artery occurred in this case, computed tomography angiography (C","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 1-2","pages":"88-91"},"PeriodicalIF":2.3,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Artificial intelligence in pancreaticobiliary endoscopy: Current applications and future directions 人工智能在胰胆内镜检查中的应用：当前应用和未来方向。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-12-30 DOI: 10.1111/1751-2980.13324

Huan Jiang, Lian Song Ye, Xiang Lei Yuan, Qi Luo, Nuo Ya Zhou, Bing Hu

Pancreaticobiliary endoscopy is an essential tool for diagnosing and treating pancreaticobiliary diseases. However, it does not fully meet clinical needs, which presents challenges such as significant difficulty in operation and risks of missed diagnosis or misdiagnosis. In recent years, artificial intelligence (AI) has enhanced the diagnostic and treatment efficiency and quality of pancreaticobiliary endoscopy. Diagnosis and differential diagnosis based on endoscopic ultrasound (EUS) images, pathology of EUS-guided fine-needle aspiration or biopsy, need for endoscopic retrograde cholangiopancreatography (ERCP) and assessment of operational difficulty, postoperative complications and prediction of patient prognosis, and real-time procedure guidance. This review provides an overview of AI applications in pancreaticobiliary endoscopy and proposes future development directions in aspects such as data quality and algorithmic interpretability, aiming to provide new insights for the integration of AI technology with pancreaticobiliary endoscopy.

胰胆道内窥镜检查是诊断和治疗胰胆道疾病的重要工具。但不能完全满足临床需求，存在操作难度大、漏诊、误诊风险大等挑战。近年来，人工智能（AI）提高了胰胆内镜的诊疗效率和质量。基于超声内镜（EUS）图像、超声内镜引导下细针穿刺或活检病理、内镜逆行胆管造影（ERCP）必要性、手术难度评估、术后并发症及患者预后预测、实时手术指导的诊断与鉴别诊断。本文综述了人工智能在胰胆管内窥镜中的应用，并从数据质量、算法可解释性等方面提出了未来的发展方向，旨在为人工智能技术与胰胆管内窥镜的融合提供新的见解。

引用次数: 0

Risk of comorbidity of autoimmune liver disease in patients with inflammatory bowel disease: A single-center case–control study in China 炎症性肠病患者自身免疫性肝病合并症的风险：中国一项单中心病例对照研究

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-12-28 DOI: 10.1111/1751-2980.13321

Meng Yuan Zhang, Tian Ming Xu, Ying Hao Sun, Xiao Tian Chu, Ge Chong Ruan, Xiao Yin Bai, Hong Lv, Hong Yang, Hui Jun Shu, Jia Ming Qian

Objective

To investigate the prevalence of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), and the impact of comorbidity of AIH, PBC, and PSC on hospitalization burden in patients with inflammatory bowel disease (IBD).

Methods

Inpatients admitted to Peking Union Medical College Hospital from January 1, 1998 to December 31, 2021 were included. Odds ratio (OR) and the corresponding 95% confidence interval (CI) were calculated to compare the risk of AIH, PBC, and PSC between IBD and non-IBD patients. Medical cost and length of hospitalization were compared between IBD patients with and without AIH, PBC, or PSC.

Results

Among the included 858 967 inpatients, there were 3059 patients with IBD. Additionally, there were 117 patients with AIH, 879 patients with PBC, and 35 patients with PSC, regardless of having IBD or not. Patients with IBD had a significantly higher risk of AIH (OR 4.87, 95% CI 1.20–19.71, p = 0.03) and PSC (OR 112.28, 95% CI 53.88–233.98, p < 0.01) than those without IBD. While there was no significant difference in the risk of PBC between patients with and without IBD (OR 1.60, 95% CI 0.67–3.86, p = 0.29). The medical cost of each hospitalization did not differ between IBD patients with and without AIH, PBC, or PSC.

Conclusions

IBD patients had a higher risk of AIH and PSC. Comorbidity of AIH, PBC, or PSC has no significant effect on the average cost of each hospitalization in IBD patients.

目的：探讨自身免疫性肝炎（AIH）、原发性胆管炎（PBC）和原发性硬化性胆管炎（PSC）的患病率，以及AIH、PBC和PSC合并症对炎症性肠病（IBD）患者住院负担的影响。方法：选取1998年1月1日至2021年12月31日北京协和医院住院患者。计算比值比（OR）和相应的95%置信区间（CI），比较IBD和非IBD患者之间AIH、PBC和PSC的风险。比较合并和不合并AIH、PBC或PSC的IBD患者的医疗费用和住院时间。结果：纳入的住院患者858967例中，IBD患者3059例。此外，有117例AIH患者，879例PBC患者和35例PSC患者，无论是否患有IBD。IBD患者发生AIH （OR 4.87, 95% CI 1.20 ~ 19.71, p = 0.03）和PSC （OR 112.28, 95% CI 53.88 ~ 233.98, p）的风险明显高于IBD患者。AIH、PBC或PSC的合并症对IBD患者每次住院的平均费用没有显著影响。

{"title":"Risk of comorbidity of autoimmune liver disease in patients with inflammatory bowel disease: A single-center case–control study in China","authors":"Meng Yuan Zhang, Tian Ming Xu, Ying Hao Sun, Xiao Tian Chu, Ge Chong Ruan, Xiao Yin Bai, Hong Lv, Hong Yang, Hui Jun Shu, Jia Ming Qian","doi":"10.1111/1751-2980.13321","DOIUrl":"10.1111/1751-2980.13321","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the prevalence of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC), and the impact of comorbidity of AIH, PBC, and PSC on hospitalization burden in patients with inflammatory bowel disease (IBD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Inpatients admitted to Peking Union Medical College Hospital from January 1, 1998 to December 31, 2021 were included. Odds ratio (OR) and the corresponding 95% confidence interval (CI) were calculated to compare the risk of AIH, PBC, and PSC between IBD and non-IBD patients. Medical cost and length of hospitalization were compared between IBD patients with and without AIH, PBC, or PSC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the included 858 967 inpatients, there were 3059 patients with IBD. Additionally, there were 117 patients with AIH, 879 patients with PBC, and 35 patients with PSC, regardless of having IBD or not. Patients with IBD had a significantly higher risk of AIH (OR 4.87, 95% CI 1.20–19.71, <i>p</i> = 0.03) and PSC (OR 112.28, 95% CI 53.88–233.98, <i>p</i> < 0.01) than those without IBD. While there was no significant difference in the risk of PBC between patients with and without IBD (OR 1.60, 95% CI 0.67–3.86, <i>p</i> = 0.29). The medical cost of each hospitalization did not differ between IBD patients with and without AIH, PBC, or PSC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>IBD patients had a higher risk of AIH and PSC. Comorbidity of AIH, PBC, or PSC has no significant effect on the average cost of each hospitalization in IBD patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 9-10","pages":"587-593"},"PeriodicalIF":2.3,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142893701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of the diagnostic efficacy between virtual portal pressure gradient and hepatic venous pressure gradient in patients with cirrhotic portal hypertension 虚门脉压梯度与肝静脉压梯度对肝硬化门脉高压诊断效果的比较。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-12-26 DOI: 10.1111/1751-2980.13319

Wei Ping Song, Shuo Zhang, Jing Li, Yu Yang Shao, Ji Chong Xu, Chang Qing Yang

Objectives

This study aimed to evaluate the performance of virtual portal pressure gradient (vPPG) and its associated hemodynamic parameters of 3-dimensional (3D) model in patients with cirrhosis.

Methods

Seventy cirrhotic patients who underwent both hepatic venous pressure gradient (HVPG) measurement and vPPG calculation were prospectively collected. The ideal-state model (ISM; n = 44) was defined by sinusoidal PH without hepatic vein shunt or portal vein thrombosis, whereas those not conforming to the criteria were classified as non-ISM (n = 26). Correlation analyses were conducted to determine the relationship between vPPG or its associated 3D hemodynamic parameters and HVPG. The diagnostic and predictive performance of vPPG and HVPG for cirrhotic-related complications was evaluated using the receiver operating characteristic (ROC) curve and Kaplan–Meier analysis.

Results

In the ISM group, vPPG-associated hemodynamic parameters including total branch cross-sectional area (S2), average branch cross-sectional area (S), and average portal vein model length (h) were correlated with HVPG (r = 0.592, 0.536, −0.497; all p < 0.001), whereas vPPG was strongly correlated with HVPG (r = 0.832, p < 0.001). In the non-ISM group, vPPG, S2, S, and h were not related to HVPG (all p > 0.05). In the ISM group, both vPPG and HVPG showed significant diagnostic and predictive capabilities for cirrhosis-related complications. While in the non-ISM group, the diagnostic accuracy and predictive efficacy of vPPG surpassed those of HVPG.

Conclusion

HVPG exhibited superior diagnostic and predictive efficacy for cirrhotic PH in the ISM, whereas vPPG showed enhanced performance in non-ISM.

目的：本研究旨在评价三维（3D）模型虚拟门静脉压力梯度（vPPG）在肝硬化患者中的表现及其相关血流动力学参数。方法：前瞻性收集70例肝硬化患者进行肝静脉压梯度（HVPG）测量和vPPG计算。理想状态模型(ISM；n = 44)以PH值为正弦值，无肝静脉分流或门静脉血栓形成，不符合标准者为非ism （n = 26）。通过相关分析确定vPPG或其相关三维血流动力学参数与HVPG的关系。采用受试者工作特征（ROC）曲线和Kaplan-Meier分析评估vPPG和HVPG对肝硬化相关并发症的诊断和预测性能。结果：ISM组vppg相关血流动力学参数总分支横截面积（S2）、平均分支横截面积(S)、门静脉模型平均长度(h)与HVPG相关(r = 0.592, 0.536, -0.497；p < 0.05)。在ISM组中，vPPG和HVPG均显示出对肝硬化相关并发症的诊断和预测能力。而在非ism组，vPPG的诊断准确性和预测效果优于HVPG。结论：HVPG在ISM中对肝硬化PH具有优越的诊断和预测功效，而vPPG在非ISM中表现出更强的性能。

{"title":"Comparison of the diagnostic efficacy between virtual portal pressure gradient and hepatic venous pressure gradient in patients with cirrhotic portal hypertension","authors":"Wei Ping Song, Shuo Zhang, Jing Li, Yu Yang Shao, Ji Chong Xu, Chang Qing Yang","doi":"10.1111/1751-2980.13319","DOIUrl":"10.1111/1751-2980.13319","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aimed to evaluate the performance of virtual portal pressure gradient (vPPG) and its associated hemodynamic parameters of 3-dimensional (3D) model in patients with cirrhosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seventy cirrhotic patients who underwent both hepatic venous pressure gradient (HVPG) measurement and vPPG calculation were prospectively collected. The ideal-state model (ISM; n = 44) was defined by sinusoidal PH without hepatic vein shunt or portal vein thrombosis, whereas those not conforming to the criteria were classified as non-ISM (n = 26). Correlation analyses were conducted to determine the relationship between vPPG or its associated 3D hemodynamic parameters and HVPG. The diagnostic and predictive performance of vPPG and HVPG for cirrhotic-related complications was evaluated using the receiver operating characteristic (ROC) curve and Kaplan–Meier analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the ISM group, vPPG-associated hemodynamic parameters including total branch cross-sectional area (S2), average branch cross-sectional area (S), and average portal vein model length (h) were correlated with HVPG (<i>r</i> = 0.592, 0.536, −0.497; all <i>p</i> < 0.001), whereas vPPG was strongly correlated with HVPG (<i>r</i> = 0.832, <i>p</i> < 0.001). In the non-ISM group, vPPG, S2, S, and h were not related to HVPG (all <i>p</i> > 0.05). In the ISM group, both vPPG and HVPG showed significant diagnostic and predictive capabilities for cirrhosis-related complications. While in the non-ISM group, the diagnostic accuracy and predictive efficacy of vPPG surpassed those of HVPG.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>HVPG exhibited superior diagnostic and predictive efficacy for cirrhotic PH in the ISM, whereas vPPG showed enhanced performance in non-ISM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 9-10","pages":"603-614"},"PeriodicalIF":2.3,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clinical decision support tool-guided, selective intensive induction strategy of ustekinumab in patients with Crohn's disease: A multicenter cohort study 临床决策支持工具指导下，ustekinumab在克罗恩病患者中的选择性强化诱导策略：一项多中心队列研究

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-12-22 DOI: 10.1111/1751-2980.13318

Qing Li, Jian Tang, Zhao Peng Huang, Li Shuo Shi, Xiao Ping Lyu, Xue Min Chen, Wen Ke Chen, An Ying Xun, Qin Guo, Miao Li, Xiang Gao, Kang Chao

Objectives

We aimed to evaluate the effectiveness and safety of clinical decision support tool (CDST)-guided initial selective intensive induction therapy (IIT) for patients with Crohn's disease (CD) who were treated with ustekinumab (UST) and to identify those most likely to benefit from IIT.

Methods

Patients with active CD were included in this multicenter retrospective study and were categorized as low-, intermediate-, and high-probability responders according to the UST-CDST. IIT was defined as intensive induction by two or three initial doses of weight-based intravenous UST administration. Patients treated with standard therapy (ST) served as controls. The primary end-point was corticosteroid-free clinical remission (CFCR) at Week 24. Secondary end-points included clinical remission, clinical response, endoscopic remission, endoscopic response, and C-reactive protein (CRP) normalization at Week 24. Propensity score adjustments was conducted to ensure comparability.

Results

A total of 296 patients were included. At Week 24, IIT was associated with higher rates of CFCR (72.3% vs 43.0%, p < 0.001), clinical remission (77.3% vs 47.1%, p < 0.001), clinical response (78.1% vs 60.1%, p = 0.001), endoscopic remission (26.1% vs 9.9%, p = 0.024), and endoscopic response (58.6% vs 36.9%, p = 0.018) in low–intermediate-probability responders compared with ST. CRP normalization was comparable between groups. No significant differences were found in any end-points in high-probability responders. No serious adverse events were observed.

Conclusion

The efficacy of IIT was superior to that of ST in patients with predicted poor response to UST, which may be regarded as a novel strategy for stratifying patients at baseline.

目的：我们旨在评估临床决策支持工具（CDST）引导的初始选择性强化诱导治疗（IIT）对接受ustekinumab （UST）治疗的克罗恩病（CD）患者的有效性和安全性，并确定最有可能从IIT中获益的患者。方法：活动性CD患者被纳入这项多中心回顾性研究，并根据UST-CDST分为低、中、高概率应答者。IIT被定义为通过两到三次初始剂量的基于体重的静脉给药来强化诱导。采用标准治疗（ST）的患者作为对照组。主要终点是第24周无皮质类固醇临床缓解（CFCR）。次要终点包括临床缓解、临床反应、内窥镜缓解、内窥镜反应和第24周c反应蛋白（CRP）正常化。进行倾向得分调整以确保可比性。结果：共纳入296例患者。在第24周，IIT与较高的CFCR发生率相关（72.3% vs 43.0%）， p结论：在预测对UST反应较差的患者中，IIT的疗效优于ST，这可能被视为基线患者分层的新策略。

{"title":"Clinical decision support tool-guided, selective intensive induction strategy of ustekinumab in patients with Crohn's disease: A multicenter cohort study","authors":"Qing Li, Jian Tang, Zhao Peng Huang, Li Shuo Shi, Xiao Ping Lyu, Xue Min Chen, Wen Ke Chen, An Ying Xun, Qin Guo, Miao Li, Xiang Gao, Kang Chao","doi":"10.1111/1751-2980.13318","DOIUrl":"10.1111/1751-2980.13318","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>We aimed to evaluate the effectiveness and safety of clinical decision support tool (CDST)-guided initial selective intensive induction therapy (IIT) for patients with Crohn's disease (CD) who were treated with ustekinumab (UST) and to identify those most likely to benefit from IIT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with active CD were included in this multicenter retrospective study and were categorized as low-, intermediate-, and high-probability responders according to the UST-CDST. IIT was defined as intensive induction by two or three initial doses of weight-based intravenous UST administration. Patients treated with standard therapy (ST) served as controls. The primary end-point was corticosteroid-free clinical remission (CFCR) at Week 24. Secondary end-points included clinical remission, clinical response, endoscopic remission, endoscopic response, and C-reactive protein (CRP) normalization at Week 24. Propensity score adjustments was conducted to ensure comparability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 296 patients were included. At Week 24, IIT was associated with higher rates of CFCR (72.3% vs 43.0%, <i>p</i> < 0.001), clinical remission (77.3% vs 47.1%, <i>p</i> < 0.001), clinical response (78.1% vs 60.1%, <i>p</i> = 0.001), endoscopic remission (26.1% vs 9.9%, <i>p</i> = 0.024), and endoscopic response (58.6% vs 36.9%, <i>p</i> = 0.018) in low–intermediate-probability responders compared with ST. CRP normalization was comparable between groups. No significant differences were found in any end-points in high-probability responders. No serious adverse events were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The efficacy of IIT was superior to that of ST in patients with predicted poor response to UST, which may be regarded as a novel strategy for stratifying patients at baseline.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"25 9-10","pages":"594-602"},"PeriodicalIF":2.3,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rare digestive disease: Mitochondrial neurogastrointestinal encephalomyopathy, review of the literature 罕见消化系统疾病：线粒体神经胃肠道脑肌病，文献综述。

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases

Pub Date : 2024-12-18 DOI: 10.1111/1751-2980.13317

Ying Hao Sun, Xiao Yin Bai, Tao Guo, Si Yuan Fan, Ge Chong Ruan, Wei Xun Zhou, Hong Yang

The median age of patients at diagnosis of mitochondrial neurogastrointestinal encephalomyopathy was 25 years. The most common neurological symptoms were leukoencephalopathy (83.1%), polyneuropathy (68.5%), and ptosis/ophthalmoparesis (61.8%). And the most common digestive symptoms were weight loss/cachexia (71.9%), abdominal pain (58.4%), diarrhea (57.3%), vomiting (53.9%), and constipation (13.5%).

诊断为线粒体神经胃肠道脑肌病的患者中位年龄为25岁。最常见的神经症状是白质脑病（83.1%）、多神经病变（68.5%）和上睑下垂/眼麻痹（61.8%）。最常见的消化系统症状为体重减轻/恶病质（71.9%）、腹痛（58.4%）、腹泻（57.3%）、呕吐（53.9%）和便秘（13.5%）。

引用次数: 0