Scandinavian Journal of Gastroenterology最新文献

Objective: To analyze the cost-effectiveness of screening Helicobacter pylori (H. pylori) and determine the optimal screening strategy in China.

Methods: A Markov model was used to assess the cost-effectiveness of 13 screen-and-treat strategies, varying starting ages (20, 30, 40) and screening frequencies (no screening, once per lifetime, every 2, 3, or 5 years until age 50). For each scenario, 1,000,000 individuals were simulated. Outcomes were costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and the number needed to treat (NNT) to prevent a gastric cancer. Deterministic and probabilistic sensitivity analyses tested the model's robustness.

Results: Compared with no screening, screening at 20, 30, and 40 years of age once per lifetime were all cost-effective, with ICERs of -$40.37, -$78.28, and -$135.69 per QALY gained, respectively. NNT of the three strategies were 72, 63, and 55. Screening with a high frequency was associated with higher cost and QALYs; in the probabilistic sensitivity analyses, no matter the initial screening age, screening every 2 years would be the optimal strategy.

Conclusion: Screening for H. pylori is a cost-saving and effective way to prevent gastric cancer in China. To prevent more gastric cancer, the population should take an H. pylori test from the age of 20 with a frequency of every 5 years in low gastric cancer incidence areas or age, with a frequency of every 2 years in high gastric cancer incidence areas or age.

Background: Upper gastrointestinal tract bleeding (UGIB) is an significant cause of admission to emergency departments and hospitalizations.

Aims: The aim of our study was to compare the pre-endoscopic risk scores used in the literature with our new score (AS score) in patients admitted to the emergency department due to upper gastrointestinal bleeding (UGIB).

Methods: A total of 541 patients admitted to the emergency department of a tertiary care hospital due to UGIB were included in the study. Pre-endoscopic risk scores and AS score were compared in terms of the need for hospitalization, need for intensive care, need for endoscopic treatment, and mortality.

Results: All of the scores analysed in the study were found to be effective in predicting the need for hospitalization, the need for intensive care, the need for endoscopic treatment, and mortality. The most effective score in predicting mortality was the AS score. In addition, the sensitivity of the AS score was higher than the other scores in predicting the need for intensive care.

Conclusions: The AS score is a new tool that may be useful in the management of patients admitted to the emergency department due to UGIB because of its advantages, such as not including laboratory parameters, being calculated in a very short time in the triage area at the time of patient presentation, and being integrated with the Charlson comorbidity index.

Background and aims: Patients with inflammatory bowel disease (IBD) have lower health-related quality of life (HRQoL) than the general population. The highest incidence and prevalence rates of IBD in the world are found in the Faroe Islands, however, the HRQoL of Faroese patients is unknown. This study aimed to determine their HRQoL at diagnosis and two years of follow-up in comparison with Danish patients.

Methods: All patients (15 years or older) were invited to answer the Short Form 12 questionnaire (SF-12) and Short Inflammatory Bowel Disease Questionnaire (SIBDQ) at diagnosis and follow-up. Faroese patients were included from 2010 to 2022, and Danish patients in 2010.

Results: 160 Faroese patients and 160 Danish patients completed questionnaires twice. For Faroese patients with IBD, the physical and mental component summary scores (SF-12) significantly improved from 46.6 and 44.0 to 49.4 and 47.7, respectively. Total SIBDQ scores also improved from 46.6 to 53.9. However, Faroese patients had significantly lower scores at diagnosis of social functioning, mental health, and mental component summary (SF-12) as well as lower emotional scores (SIBDQ) compared with Danish patients.

Conclusions: Faroese patients with IBD improved their HRQoL from diagnosis to follow-up, although greater improvements were observed for Danish patients. Increased awareness of the HRQoL of this patient group is warranted as Faroese patients had lower mental and emotional scores than Danish patients at diagnosis.

Background: Patients hospitalized with moderately severe or acute severe ulcerative colitis (UC) may experience metabolic disturbances, including alterations in insulin resistance due to inflammation and the administration of glucocorticoids (GCs). This pilot study aimed to evaluate insulin sensitivity in patients hospitalized for moderately severe to severe UC.

Method: Patients hospitalized for moderately-severely active UC at Örebro University Hospital, Sweden, were eligible for inclusion. Quantification of insulin sensitivity was performed using the hyperinsulinemic euglycemic clamp (HEC) methodology. Assessment of insulin sensitivity was performed during both the index flare and while patients were in steroid-free clinical, biochemical and endoscopic remission during follow-up. Additionally, healthy controls were evaluated using HEC for comparison.

Results: Five patients with moderately-severely active UC, treated with intravenous GCs for ≥2 days, were included and underwent HEC assessment. During the index flare, four patients received second-line treatment with infliximab due to non-response to GC, and one patient was subsequently referred for acute subtotal colectomy. At inclusion, all five patients exhibited significantly reduced insulin sensitivity, and levels appeared similar regardless of the outcome of the index flare. At remission during follow-up, the insulin sensitivity was restored to levels comparable to healthy controls (n = 5).

Conclusion: The study demonstrates that patients with moderately severe to severe UC experience significant insulin resistance, irrespective of the outcome of the flare. The reduced insulin sensitivity is likely driven by a combination of active inflammation and GC treatment, as insulin sensitivity returned to normal levels when patients achieved remission during follow-up.

Background: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder seen by both primary care providers (PCPs) and gastroenterologists, and further diagnostic testing is generally discouraged unless red-flag symptoms are present.

Aims: Examine if advanced serologic testing for chronic abdominal pain in IBS patients followed society-specific guidelines and evaluate the diagnostic accuracy of these tests.

Methods: The study involved a retrospective cross-sectional analysis of adults aged 18 and older who were seen at our institution between 2013 and 2018. Tests included: C1 esterase inhibitor, MEFV gene, urine porphobilinogen, anti-dsDNA, and heavy metal screening. Patients with preexisting rheumatological conditions or diagnoses such as hereditary angioedema, porphyria, familial Mediterranean fever, or lead poisoning were excluded. An appropriateness scale based on disease-specific guidelines was used to evaluate test suitability.

Results: Among 26,732 IBS patients, 143 underwent advanced laboratory testing, with 85.3% ordered by gastroenterologists. Only 12.5% of tests adhered to society-specific guidelines, and the positive test rate was 2.1%. The total cost of testing was $46,542, with $39,007 spent on tests deemed inappropriate.

Conclusions: The findings emphasize the effectiveness and importance of adhering to Rome IV criteria, as advanced testing often fails to improve diagnostic accuracy and increases unnecessary healthcare costs.

Background and aims: The enhanced liver fibrosis (ELF) test has good discrimination performance in detecting advanced liver fibrosis. The chronic liver disease (CLivD) risk score based on clinical data accurately predicts risk for future severe liver disease. Considering the ELF test as a surrogate marker for liver fibrosis, we analyzed predictors of elevated ELF (eELF) and its change.

Methods: The study cohort consisted of Finnish general population-based health surveys Health2000 and a follow-up study 10 years later Health2011 with 6084 and 2937 individuals, respectively with phenotype and ELF data. eELF was defined as ELF ≥ 9.8, and clinically relevant fibrosis progression as an ELF change ≥0.6. CLivD risk score was calculated at baseline. Analyses were age-adjusted.

Results: Obesity measures and diabetes predicted eELF at baseline. Only waist-hip ratio (WHR) could predict clinically relevant fibrosis progression over the follow-up consistently among men and women (OR 1.35 and 1.41, respectively). High-risk alcohol use was a significant risk factor for eELF only among men (OR 1.72, p = 0.049), and it did not predict fibrosis progression in either sex. Although elevated transaminases were associated with eELF, in most individuals with eELF they were within reference limits. Increased CLivD scores correlated with baseline and the change of ELF values over the 10-year follow-up independent of baseline ELF (p < 0.001).

Conclusions: Liver fibrosis progression is difficult to predict based on single risk factors or liver enzymes. ELF had limited value to predict fibrosis progression. The CLivD score, based on multiple risk factors, predicted both occurrence of baseline eELF and its progression over a 10-year follow-up.

Objectives: Comorbidity with other conditions is common in functional bowel disorders. We aimed to investigate the prescription patterns of commonly used drugs in patients with irritable bowel syndrome (IBS) and functional unspecific bowel disorder, compared to the general population.

Material and methods: Prescriptions of commonly used drugs in 2022 were compared between patients and the general population from the same age group and region in Sweden.

Results: Of 526 patients, 317 were followed up in 2022 (219 women and 98 men) and were compared to 51,001 women and 55,571 men in the general population. The median follow-up time from the first visit to 2022 was 8 years (25^th-75th percentile 6-11 years). Female patients were significantly more likely than controls to be prescribed PPIs, antibiotics, NSAIDs, paracetamol, opioids, muscle relaxants, antimigraine drugs, antidepressants and asthma medications. Male patients were significantly more likely than controls to be prescribed PPIs, opioids, antidepressants, and asthma medications. In the year prior diagnosis and through 2022, female patients showed a significant decline in the use of PPIs (38% vs.10%; p < 0.001), antibiotics (27.5% vs. 20.1%; p = 0.0426), NSAIDs (23.3% vs.14.6%; p = 0.012), opioids (20.6% vs. 7.5%; p < 0.001), and a significantly increase in the use of asthma medications (15.5% vs. 24.2%; p = 0.0088). Male patients showed a significant decline in the use of PPIs and NSAIDs.

Conclusion: Patients with functional bowel disorders are more likely to be prescribed medications for conditions other than IBS. Over time, there was a decline in the prescriptions of most drugs, except for antidepressants and asthma medications.

Background and aims: Prior studies indicate that serum calprotectin (SC) and plasma calprotectin (PC) can be used as biomarkers in Crohn's disease (CD). The aim of this study was to investigate the diagnostic accuracy of SC and PC in patients with a clinical suspicion of CD.

Method: This biobank study included patients from a prospective, blinded, multicenter study examining minimally invasive modalities for diagnosing CD. Patients had a standardized work-up including ileocolonoscopy, pan-enteric capsule endoscopy, and blood samples within a 2-week period. Plasma and serum were stored at - 80 °C until further analysis. A routine C-reactive protein (CRP) was measured on the same day. Pan-endoscopy served as reference standard.

Results: 126 patients entered the study, and 58 (46.0%) were diagnosed with CD. Patients with CD had a median PC of 0.37 mg/L (IQR 0.20-0.70) compared to 0.29 mg/L (IQR 0.16-0.41) in non-CD patients (p = 0.03). The median SC was 1.09 mg/L (IQR 0.80-1.80) and 0.93 mg/L (IQR 0.66-1.25), respectively (p = 0.01). Receiver operating characteristics curves showed an AUC of 0.63 (CI 0.53-0.73) for SC and 0.61 (CI 0.51-0.71) for PC for detection of CD, which was inferior to that of CRP (AUC = 0.76, CI 0.68-0.85) (p < 0.02). None of the biomarkers reflected the endoscopic severity of CD.

Conclusion: Although levels of PC and SC are elevated in patients with CD, diagnostic accuracies are inferior to CRP. SC and PC are not reliable as stand-alone blood-based biomarkers for diagnosing CD and selecting patients for endoscopy.

Background: The aim of screening for colorectal cancer (CRC) is to find the cancer in its early stages, thereby improving the prognosis of cancer patients by preventing cancer-related deaths. In Finland, the national CRC screening program was initiated in 2022, with fecal immunochemical test (FIT) being the primary screening test. The FIT-threshold used was 25 µg hemoglobin/g feces. The aim of this retrospective study was to evaluate the results of the first screening round that was implemented by the wellbeing services county of Southwest Finland.

Materials and methods: Participants were screened for CRC between March 1^st, 2022 and April 14^th, 2023. Participants aged 60-70 years had their health records scrutinized retrospectively.

Results: Out of 36 397 FIT-invitees 23 388 (64%) returned a FIT-sample. 1407 (6%) subjects gave a FIT-positive stool sample of which 1118 (79%) attended the recommended screening colonoscopy. A total of 63 (6%) CRCs were found. 31 (49%) CRCs were classified as early stage I tumors, 12 (19%) of which were solely suitable for endoscopic treatment. Endoscopically removable adenomas were detected in 709 (63%) of the colonoscopies, which resulted in a recommendation of a 3-year follow-up colonoscopy for 427 (38%) cases. There were 3 (0.27%) acute polypectomy related complications and 5 (0.45%) late post-colonoscopy complications.

Conclusions: This is the first study to show the prevalence of CRC amongst participants of the newly implemented Finnish national CRC-screening program. Nearly half of the patients with CRC were diagnosed in the early stage. The adenoma detection rate was high.

Background: Colorectal adenomas (CRA) exhibit high recurrence rates following endoscopic resection. Insulin resistance (IR) and chronic inflammation, increasingly prevalent due to unhealthy lifestyles, are key factors in CRA development. This study aimed to evaluate the predictive power of combining the inflammation score with the triglyceride-glucose (TyG) index for CRA recurrence.

Methods: We conducted a comprehensive analysis of the clinical characteristics of 847 CRA patients who underwent endoscopic resection. Postoperative recurrence of CRA was assessed using logistic regression analyses to determine odds ratios (ORs) and 95% confidence intervals (CIs). The receiver operating characteristic (ROC) curve analysis was utilized to predict the risk of CRA recurrence based on the inflammation score and TyG index.

Results: Among the 847 CRA included in the study, 126 experienced recurrences. Logistic regression analysis identified NLR (OR 2.641, 95% CI 1.982-3.549), TyG (OR 1.494, 95% CI 1.146-1.956), three or more adenomas (OR 2.182, 95% CI 1.431-3.322) and CRA larger than 10 mm (OR 1.917, 95% CI 1.267-2.921) as independent risk factors for CRA recurrence. ROC curves demonstrated the efficacy of NLR (AUC 0.701, 95% CI 0.652-0.750) and TyG (AUC 0.607, 95% CI 0.553-0.660) in predicting CRA recurrence. The combination of NLR, TyG and adenoma characteristics showed improved performance in predicting CRA recurrence (AUC 0.762, 95% CI 0.718-0.805).

Conclusions: Elevated NLR and TyG were associated with an increased risk of CRA recurrence. The integration of NLR and TyG with CRA characteristics significantly enhanced the predictive power for CRA recurrence.