Scandinavian Journal of Gastroenterology最新文献

Background/objectives: A nationwide survey, covering all surgical departments, was conducted in a country with easily accessible tax-funded healthcare. The survey aimed to provide insight into 'real-world' intraductal papillary mucinous neoplasia (IPMN) surveillance, including the proportion of patients monitored, adherence to guidelines and details of follow-up.

Methods: At all hospitals caring for IPMN patients in Sweden (n = 46), an upper-gastrointestinal surgeon received a survey by mail with clinically oriented questions, including a mix of Likert scale, multiple-choice and open-ended questions. Up to three reminders were sent.

Results: Forty-five hospitals responded. In median 116 (10-1500) patients with IPMN were followed at each hospital. At the hospital with the largest volume 14 physicians were involved in IPMN surveillance. In 9/45 hospitals, other professionals, such as registered nurses and secretaries, were actively involved in surveillance. All hospitals were aware of the national care program for IPMN, and all but three adhered to it. Nevertheless, uncertainty persisted about whether resources are being used wisely in branch duct (BD)-IPMN surveillance (yes/no/unsure; university hospital 2/4/0, county hospital 0/20/3 and district hospital 3/7/1). Comorbidity, older age, patient's own decision, and a combination of age and stable radiological findings were reasons for ending surveillance. Twenty-eight of 45 responders believed that surveillance will be changed in 5 years and almost all, 42/45 in 10 years.

Conclusions: Adherence to the national care program for IPMN was very good, although a majority questioned the current follow-up of BD-IPMN from a resource perspective. There is a strong belief that new knowledge will change the guidelines in the near future.

Background: Collagenous sprue (CS) is a rare sprue-like enteropathy with villous atrophy and a subepithelial collagen band. Published evidence is fragmented.

Methods: We conducted a systematic scoping review with a pooled, descriptive patient-level analysis to summarize presentation, evaluation, management and outcomes in reported adult CS. We searched PubMed/MEDLINE, Embase, Web of Science, CINAHL and Scopus from inception through 1 December 2025. We included adult cases with biopsy-confirmed CS, defined as small-bowel villous atrophy with a subepithelial collagen band.

Results: Of 777 records, 50 publications met inclusion criteria and contributed 99 unique patients with extractable data. Median age was 65 years and 62% were women. Symptoms were prolonged (median 36 weeks) with prominent diarrhea (median 6.5 stools/day) and frequent malnutrition and edema. Laboratory findings reflected severe malabsorption (median albumin 2.9 g/dL; potassium 2.6 mEq/L; hemoglobin 11.95 g/dL). Exposure to medications associated with sprue-like enteropathy was common when reported (30/38, 79%), most often angiotensin receptor blockers. Histology showed a median collagen band thickness of 19.2 μm and total villous atrophy in 54%. Treatment commonly combined nutritional rehabilitation (often parenteral nutrition), gluten-free diet, withdrawal of suspected medications and corticosteroids. Symptom improvement was often rapid (median 7 days). Histologic improvement occurred in 74% (37/50) with follow-up biopsies. Relapse occurred in 31% (4/13). Mortality among patients with known vital status was 23% (12/53).

Conclusions: CS is profoundly morbid but frequently improves with early recognition, medication review and withdrawal, aggressive nutritional support and steroid-based therapy, although relapse and mortality remain substantial.

Objectives of the article: Spondyloarthritis (SpA) affects 10-30% of patients with inflammatory bowel disease (IBD). An early diagnosis is essential as a delayed diagnosis of SpA increases the risk of disability and reduces quality of life. However, few screening tools for patients with IBD exist and none are available in Danish. To support early identification of spondyloarthritis symptoms in Danish patients with IBD, this study aimed to translate and cross-culturally adapt the Identification of Spondyloarthritis Questionnaire (IBIS-Q) into Danish and to assess face validity of the Danish version.

Materials and methods: Following Beaton et al.'s six step forward-backward translation guideline, the IBIS-Q was translated and cross-culturally adapted into Danish. This was done through an iterative process with an expert committee of translators, clinicians, methodologists and with inclusion of the IBIS-Q developers. Face validity was assessed through semi-structured interviews with 24 adults with and without arthritis-related symptoms.

Results: Participants generally found the questionnaire easy to understand, and face validity was confirmed. The semantic equivalence of painful and sore in a Danish context was a central topic of discussion within the expert committee. However, only minor modifications were made, including the addition of an introductory paragraph and changing the questionnaire's title.

Conclusions: Following an international, standardised guideline, the IBIS-Q was successfully translated and cross-culturally adapted into Danish, and face validity was confirmed. The IBIS-Q is the first available questionnaire to assess Danish patients with IBD for SpA symptoms. Psychometric validation of the measurement properties of IBIS-Q is recommended prior to implementation.

Background and study aim: Sex disparities in medicine have been shown to have clinical implications for patient outcomes. Previous studies have highlighted worse outcomes for female patients treated by male physicians in cardiology and surgery. This study aims to assess the effect of sex discordance between patients and endoscopists on colonoscopy outcomes.

Methods: Data from a gastrointestinal (GI) endoscopy database was used. All colorectal cancer (CRC) screening colonoscopies performed between January 2016 and December 2020 in 17 Dutch hospitals were analyzed. Primary outcomes included cecal intubation rate (CIR), adenoma detection rate (ADR), polyp detection rate (PDR) and patient discomfort measured by the Gloucester Comfort Scale (GCS). Associations between sex discordance (male-male, male-female, female-female and female-male) and outcomes were estimated using logistic mixed-effects models, accounting for various covariates and random effects.

Results: We included 44,944 CRC-screening colonoscopies performed by 115 endoscopists, 53.4% were sex-concordant procedures. Predicted probabilities for CIR, ADR, PDR and discomfort were in male patients with male endoscopists 0.98, 0.65, 0.75, 0.01 vs. 0.98, 0.67, 0.77, 0.02, respectively, in male patients with female endoscopists. In female patients with female endoscopists these outcomes were 0.98, 0.54, 0.67, 0.04 vs. 0.98, 0.55, 0.66, 0.03, respectively, in female patients with male endoscopists.

Conclusions: Although subjective discomfort scores were slightly higher for female endoscopists, both for male and female patients, our results show that endoscopist sex has a negligible impact on CRC-screening colonoscopy outcomes.

Background: Data on mortality among people who inject drugs with hepatitis C virus (HCV) infection remain limited, particularly in settings with a high OAT coverage. We aimed to assess all-cause and liver-related mortality and to evaluate associations between key exposures and mortality among people who inject drugs with HCV infection.

Methods: We included individuals evaluated for HCV treatment in a low-threshold clinic for people who inject drugs in Oslo, Norway, between 2013-2020 and linked data to the Norwegian Cause of Death Registry. Mortality was analysed using person-time, Poisson regression models to assess crude and adjusted IRRs, and Kaplan-Meier survival curves for subgroup comparison.

Results: Among 506 individuals (27.8% female, median age 49.1 years, 77.0% recent injecting drug use, 15.9% liver cirrhosis, 77.8% HCV treatment uptake), 39 (7.7%) deaths were recorded. All-cause mortality was 2.11/100 PY (95% CI 1.50-2.88). Liver-related mortality was 1.07/100 PY (95% CI 0.22-3.12) among those with liver cirrhosis and 0.16/100 PY (95% CI 0.03-0.47) overall. Drug-induced deaths accounted for the largest proportion of deaths (28.2%). HCV treatment was associated with lower all-cause mortality (adjusted IRR 0.22 [95% CI 0.06-0.76]; p = 002), while liver cirrhosis was associated with increased mortality (adjusted IRR = 2.78 [95% CI 1.00-7.65]; p = 0.049).

Conclusion: Liver-related mortality among people who inject drugs with HCV cirrhosis was low. Mainly driven by drug-related deaths, all-cause mortality was higher among individuals with untreated HCV infection and among those with liver cirrhosis, underscoring the need for strategies that integrate HCV treatment with overdose prevention and access to broader healthcare.

Objective: This study investigates the impact of the presence and severity of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) on prognosis and metastasis in patients with colorectal cancer (CRC).

Methods: This retrospective observational study included 242 CRC patients who underwent PET-CT imaging at a tertiary university hospital in Turkey between 2014 and 2019. Hepatosteatosis presence and severity were assessed via non-contrast CT. Demographic data, BMI, comorbidities, smoking history, family history, cancer stage, metastasis status, laboratory results, and FIB-4 scores were recorded. Relationships between hepatosteatosis and survival, metastases, and lab findings were analyzed.

Results: The mean age was 62.4 ± 11.6 years; 64.5% were female. Hepatosteatosis was present in 125 patients (51.7%), with 90 having mild-to-moderate and 35 having severe hepatosteatosis. BMI was significantly lower in patients without hepatosteatosis (p < 0.002). Rates of liver and extrahepatic metastases at diagnosis were significantly higher in patients with hepatosteatosis compared to those without (p < 0.05). Additionally, stage 4C cancer was more common among patients with hepatosteatosis (p < 0.05).

Conclusions: This study, the first to explore CRC metastases in MASLD patients, shows a significant association between MASLD and liver metastases. CRC patients with MASLD had higher rates of advanced-stage disease and liver metastases at diagnosis, correlating with shorter survival and poorer prognosis. These findings underscore the importance of early screening and monitoring in CRC patients with MASLD.

Introduction: Major gastrointestinal bleeding (MGB) is a critical complication of sepsis that is associated with a poor prognosis. We aimed to identify independent predictors of MGB in a large multicenter cohort of septic patients to facilitate clinical risk stratification.

Materials and methods: This retrospective study analyzed data collected from four tertiary hospitals in China between 2016 and 2023. Data on patient demographics, comorbidities, infection sources, admission laboratory parameters and treatments were collected. The primary outcome was MGB within 28 d, defined as overt bleeding with a hemoglobin drop >20 g/L or transfusion requirement.

Results: Of 10,249 eligible patients, 205 (2.0%) developed MGB. In-hospital mortality was significantly higher in the MGB group compared to the non-MGB group (44.0% vs. 17.0%, p < 0.001). Multivariable analysis identified independent risk factors for MGB: renal dysfunction (aOR 1.61), malignancy or immunosuppression (aOR 1.55), gastrointestinal infection (aOR 1.50), elevated blood urea nitrogen (BUN; aOR 1.03) and older age (aOR 1.01). Conversely, urinary tract infection (aOR 0.29) and higher baseline hemoglobin (HGB) levels (aOR 0.99) were associated with a lower risk. The predictive model achieved an area under the curve (AUC) of 0.702.

Conclusions: Although MGB occurred in only 2.0% of septic patients, it was associated with substantially higher mortality. Older age, renal dysfunction, elevated BUN and gastrointestinal sources were key drivers of risk, while urinary tract infection was associated with a lower risk. These findings underscore the importance of early risk stratification and targeted preventive strategies in high-risk patients to mitigate bleeding events and improve survival.

Background and aims: Primary sclerosing cholangitis (PSC) lacks validated surrogate endpoints, impeding the development of new therapies. This study assessed the association between cholestatic biochemical markers and clinical symptoms to evaluate their construct validity as surrogate endpoints.

Method: Cholestatic biochemical markers and clinical symptoms measured by the simple cholestatic complaint score were collected from non-end-stage PSC patients that participated in the DILSTENT trial. Associations between each biochemical marker and clinical symptom were explored using a univariable and multivariable mixed-effect ordinal logistic regression analysis. Measures of associations were expressed as odds-ratio (OR).

Results: Data from 65 patients were included. Alkaline phosphatase (ALP), bilirubin and Aspartate Aminotransferase (AST) levels were significantly associated with pruritus levels (OR 1.01 (p < 0.001); OR 1.02 (p = 0.02); OR 1.01 (p = 0.01), respectively) in univariable analysis. Bilirubin was significantly associated with abdominal right upper quadrant pain (OR 1.01, p = 0.02. Only ALP remained significantly associated with pruritus in multivariable analysis (OR 1.01, p < 0.001)).

Conclusion: This study shows a significant association between ALP and pruritus, the most prominent cholestatic symptom. Our results corroborate the hypothesis that ALP has construct validity as cholestatic marker, thereby supporting its role as potential surrogate endpoint for clinical trials.

Background/aim: Endoscopic submucosal dissection (ESD) for early gastric cardiac cancer (EGCC) faces anatomical challenges. This study aims to develop and validate a predictive model for ESD difficulty in EGCC, providing a basis for matching difficulty levels with endoscopists' experience.

Methods: This multicenter retrospective study included 514 EGCC patients from five tertiary hospitals (2017-2025). Patients from the 900th Hospital were randomized to training (n = 206) and internal validation (n = 164) cohorts; four other hospitals formed an external cohort (n = 144). Predictors with high collinearity (VIF ≥ 5) were excluded. Predictor selection was performed using LASSO regression, followed by multivariable logistic regression. Model performance was assessed using ROC curves, calibration plots, and decision curve analysis (DCA).

Results: The clinical scoring model incorporated four factors: Paris type III lesion (3 points), maximum diameter ≥3 cm (1 point), submucosal invasion (5 points), and lesion located on the anterior wall of the cardia (3 points). Model performance demonstrated an AUC of 0.784 (95% CI, 0.695-0.876) in the training cohort, 0.762 (95% CI, 0.653-0.884) in internal validation, and 0.740 (95% CI, 0.636-0.845) in external validation. Difficulty stratification was defined as: easy (0, 1, or 3 points), intermediate (4, 5, or 6 points), and difficult (8 or 11 points).

Conclusion: This validated system optimizes endoscopist matching, reducing costs and recurrence in EGCC ESD.

Background: Coeliac disease (CeD) affects 1-2% of the western population. Diagnosis is based on serology and duodenal biopsy, but serology-based diagnosis in adults has been approved in Europe.

Objective: To evaluate the diagnostic performance of IgA anti-transglutaminase 2 (IgA-TG2) and IgG anti-deamidated gliadin peptides (IgG-DGP), and their combinations, compared with biopsy in a real-world secondary care setting.

Methods: Adult patients referred to secondary care endoscopy service at Oslo University Hospital for suspected CeD were invited to participate. CeD diagnosis followed European and Norwegian guidelines, requiring positive serology and mucosal damage.

Results: Among 312 evaluable patients, 215 were diagnosed with CeD between 2018 and 2024. Analysis of IgA-TG2 above threshold (>4 U/ml) showed 93% specificity and 94% sensitivity, while IgG-DGP (>20 U/ml) showed 88% specificity and 83% sensitivity. In ROC analyses, the AUC values were 0.98 and 0.95, respectively. Higher threshold (2x, 3x, 5x and 10x ULN) of IgA-TG2 increased specificity (99% to 100%) but lowered sensitivity (82% to 49%). Using IgG-DGP did not increase specificity but detected six missed CeD cases by IgA-TG2. Forty-two percent (n = 92) of cases could be diagnosed with a no-biopsy approach with 10x ULN IgA-TG2 at referral with 100% specificity.

Conclusion: Serology correlates strongly with histological changes, supporting diagnosis without gastroscopy. A 10x ULN threshold shows excellent specificity at the expense of sensitivity, thus lower thresholds may be preferable due to diminishing gains in specificity. IgG-DGP serves as a valuable complementary marker, that improves sensitivity and helps identify patients with weak IgA-TG2 responses.