Journal of Gastroenterology and Hepatology最新文献

Background: We determined the outcomes of Helicobacter pylori (HP) eradication on fracture risk.

Methods: This was a retrospective cohort study of patients who had received clarithromycin-based triple therapy for HP infection or undergone upper endoscopy with no HP infection found (HP negative) between 2003 and 2012 in Hong Kong. Patients were divided into three groups: (i) HP-negative, (ii) successful HP eradication, and (iii) delayed/failed HP eradication, and were observed till fracture development, death, or end of study. Propensity score (PS) adjustment was performed to account for ≥ 20 covariates (age, sex, comorbidities, and time-varying medication use). Following the establishment of PS-matched cohorts, the hazard ratio (HR) of fracture with HP eradication outcome was calculated by a multivariable Cox model.

Results: Of 322 180 eligible patients, 250 978 (77.9%) were HP-negative, 61 892 (19.2%) had successful HP eradication, and 9310 (2.9%) delayed/failed eradication. During a median follow-up of 11.5 years (IQR: 8.8-14.2), 16 935 (5.3%) developed fracture (vertebra: 1825; hip: 8338; humerus: 2147; forearm: 4080; carpal/wrist: 545). Compared with the HP-negative group, the successful HP eradication group did not have a higher fracture risk (HR: 1.02; 95% CI: 0.89-1.16). However, a higher fracture risk was observed in the delayed/failed HP eradication group (HR: 1.37; 95% CI: 1.21-1.56). Among delayed/failed HP eradication patients with and without prior history of gastric ulcer, the HR was 2.21 (95% CI: 1.10-4.45) and 1.35 (95% CI: 1.19-1.54), respectively.

Conclusion: When compared with HP-negative individuals, only HP-positive patients with delayed/failed HP eradication had a higher fracture risk, particularly in those with a prior history of gastric ulcer. These results may suggest a potential protective association of successful HP eradication and subsequent fracture risk.

Background: Tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are guideline-endorsed first-line options for antiviral-naive chronic hepatitis B (CHB). We compared their associations with hepatocellular carcinoma (HCC) occurrence.

Methods: We assembled a multicenter cohort of 1364 treatment-naive CHB patients initiating either TAF (n = 322) or TDF (n = 1042) between 2012 and 2019. Confounding was addressed using 1:2 propensity score (PS) matching and inverse probability of treatment weighting (IPTW).

Results: The PS-matched analytic set comprised 966 patients (TAF 322; TDF 644). Over 60 months, nine HCC events occurred (two TAF and seven TDF events). Crude incidence rates were 0.17 and 0.27 per 100 person-years for TAF and TDF, respectively. Five-year cumulative risks were 0.6% (TAF) versus 1.0% (TDF). In multivariable models, TAF remained protective (adjusted hazard ratio [aHR]: 0.29, 95% confidence interval [CI]: 0.13-0.66; p < 0.01). Findings were directionally consistent across subgroups, with the strongest associations observed among patients without diabetes, those who were hepatitis B e antigen-positive, and those with baseline HBV DNA in the 5-8 log10 IU/mL range. In IPTW analyses, TAF was likewise associated with lower HCC risk (aHR: 0.31, 95% CI: 0.14-0.68; p < 0.01).

Conclusions: Compared with TDF, TAF use was associated with an approximately 71% reduction in HCC hazard. Larger cohorts with longer follow-up are warranted to corroborate these observations.

Introduction: Although sigmoid volvulus is a potentially life-threatening condition in elderly patients, its prognostic factors are not well-known. This study aimed to evaluate clinical outcomes and identify prognostic factors in patients with sigmoid volvulus.

Methods: This retrospective cohort study included 96 patients diagnosed with sigmoid volvulus by abdominal CT between January 2005 and January 2023 at two tertiary referral centers. After patients who underwent emergent surgery, refused endoscopic treatment, or experienced spontaneous decompression were excluded, 75 patients were analyzed. Logistic regression identified factors linked to endoscopic decompression failure, while Cox regression analyzed recurrence factors.

Results: Among the 75 patients who underwent endoscopic decompression, 60 (80%) showed improvement, whereas 15 (20%) did not. In the logistic regression analysis, younger (≤ 65 years) age (odds ratio [OR], 10.21; 95% confidence interval [CI], 2.21-47.09) and larger (≥ 85 mm) maximum cross-sectional diameter of distended colon (OR, 5.06; 95% CI, 1.12-22.87) were associated with failure of initial endoscopic treatment. Among the 60 patients who initially improved with endoscopic treatment, cumulative recurrence rates were 30% at 1 year and 36.7% at 3 years. In the Cox regression analysis, a larger (≥ 85 mm) maximum cross-sectional diameter of distended colon (hazard ratio [HR], 3.27; 95% CI, 1.25-8.59) and a greater (≥ 230 mm) longitudinal axis length of spiraled colon (HR, 5.18; 95% CI, 1.67-16.05) at diagnosis were related to volvulus recurrence.

Conclusions: Younger age (≤ 65 years) and severe colonic dilatation (≥ 85 mm) were associated with endoscopic decompression failure, while severe colonic dilatation (≥ 85 mm) and marked longitudinal elongation (≥ 230 mm) were independently related to recurrence. These findings may guide early surgical consultation for high-risk sigmoid volvulus patients and subsequent resection planning after successful decompression.

Objective: To develop a predictive model that integrates radiomics features from contrast-enhanced MRI with conventional radiologic features to identify early recurrence locations in nonviable hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE).

Methods: This multicenter retrospective study included HCC patients treated with TACE who were assessed as Liver Imaging Reporting and Data System Treatment Response Algorithm nonviable. All patients were followed for at least 1 year. A 1-cm peritumoral ring was divided into eight sectors for radiomics feature extraction to build a radiomics model. A fusion model was developed by combining radiomics features with two radiologic features (nonsmooth margin and peritumoral hyperintensity on T2-weighted imaging/diffusion-weighted imaging). Model performance was evaluated using receiver operating characteristic (ROC) curves. The DeLong test assessed differences in predictive performance.

Results: The study finally included 424 sectors from 53 patients and 192 sectors from 24 patients in the training and test cohort, respectively. The radiomics model achieved an area under the ROC curve (AUC) of 0.771 and 0.602 in the training and test cohorts, respectively. The radiologic model achieved AUCs of 0.787 and 0.736 in the training and test cohorts, respectively. The fusion model combining six radiomics features and two radiologic features achieved AUC of 0.843 and 0.774 in the training and test cohorts, respectively. The DeLong test showed that the fusion model outperformed the radiomics and radiologic models in the training cohort and was superior to the radiomics model in the test cohort (p < 0.05).

Conclusions: The fusion model combining radiomics and radiologic features shows good performance in predicting recurrence location and may support personalized follow-up and retreatment planning.

Background and aims: Patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) have a high short-term mortality. This study aims to explore the predictive value of KAT8 in ACLF.

Methods: In this study, a carbon tetrachloride/lipopolysaccharide/D-galactosamine-induced ACLF mouse model was established. In parallel, PBMCs were collected from a prospective cohort comprising patients with HBV-ACLF, chronic hepatitis B (CHB), HBV-related liver cirrhosis (LC), and healthy individuals (HI) to investigate the association between KAT8 expression and ACLF.

Results: In liver tissues from the ACLF animal model, the expression of KAT8 was significantly decreased. Meanwhile, in human PBMCs, KAT8 expression levels were significantly lower in the HBV-ACLF group than in HI, but higher than those in patients with CHB and HBV-related LC. Furthermore, survivors exhibited significantly higher KAT8 levels than non-survivors (all p < 0.001). KAT8 shows potential prognostic value for 28-day and 90-day mortality in HBV-ACLF, with AUROC values of 0.90 and 0.97, respectively.

Conclusions: KAT8 may serve as a valuable biomarker for the prognosis prediction of patients with HBV-ACLF.

Background and aims: Fatty pancreas disease (FPD), characterized by excessive intrapancreatic fat deposition (IPFD), is increasingly recognized as a manifestation of metabolic dysfunction. However, its epidemiology and clinical impact in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) remain unclear. We conducted a systematic review and meta-analysis to quantify the prevalence of FPD in MASLD and to compare clinical characteristics between patients with and without FPD.

Methods: A comprehensive search of the PubMed and Embase databases was conducted from inception to November 29, 2025, to identify observational studies reporting the prevalence and/or clinical impact of FPD in adults with MASLD. Pooled prevalence estimates were calculated using a generalized linear mixed model, and clinical features were compared using random-effects models.

Results: We identified 11 studies (n = 21 438 patients). The pooled prevalence of FPD in MASLD was 54.32% (95% CI 34.53 to 72.83), with high heterogeneity (I² = 99.6%). FPD prevalence was significantly lower in Asian studies (35.59%) than in non-Asian studies (75.05%) (p = 0.01). No differences in FPD prevalence were found when stratified by sample size, MASLD diagnosis, or IPFD assessment method. Patients with MASLD and FPD were found to be older, had a higher body mass index, and were more likely to have diabetes, hypertension, and metabolic syndrome.

Conclusions: Around half of patients with MASLD have concomitant FPD, which is associated with an adverse cardiometabolic phenotype. These findings support the need for integrated, longitudinal evidence to define the prognostic and therapeutic relevance of IPFD within a multiorgan ectopic fat framework of systemic metabolic dysfunction.