Scandinavian Journal of Gastroenterology最新文献

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: 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: 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: The Charlson Comorbidity Index (CCI) and prognostic nutritional index (PNI) have proven to be valuable tools in predicting prognosis based on comorbidities and nutritional status in the context of surgical procedures and endoscopic resections. The age-Adjusted CCI (ACCI) has also shown utility in surgical settings, but its application to early gastric cancer (EGC) remains unexplored. Consequently, we aimed at clarifying the prognostic factors for EGC treated with endoscopic submucosal dissection (ESD).

Methods: Patients who underwent ESD for EGC at the First Affiliated Hospital of Dalian Medical University from January 2015 to February 2023 were included. The overall survival (OS) and prognostic predictive ability were evaluated based on patients and lesion characteristics.

Results: During a median follow-up period of 50 months, 15 patients died, but none from the gastric cancer. The 5-year survival rate was 90.0%. In univariate and multivariate analyses, a high ACCI (>4.5) was the only significant prognostic factor (Hazard ratio, 27.78; 95% confidence interval, 3.62-213.40; p < 0.01). The 5-year survival rates for patients with low ACCI (<4.5) and high ACCI were 98.9% and 72.9%, respectively (p < 0.01).

Conclusions: A high ACCI is a significant prognostic indicator for 5-year survival and the risk of mortality caused by other comorbidities. EGC suitable for ESD is unlikely to serve as a prognostic factor, and ACCI should be considered as an important reference when considering additional surgical procedures in high-ACCI patients after ESD with endoscopic curability (eCura) C-2 for EGC.

Objectives: This study aims to discover the role of lncRNA MIR17HG, referred to as MIR17HG, in cisplatin resistance for cholangiocarcinoma (CCA).

Methods: QRT-PCR was conducted to measure the expression of MIR17HG in cisplatin-resistant/sensitive CCA cells and clinical CCA specimens. Log-rank test was used to analyze the survival curve. Cck8-assay and flow cytometry were employed to detect the sensitivity of CCA cells to cisplatin and the apoptosis rate following different treatments, respectively. The next-generation sequencing was carried out to get gene transcripts after silencing MIR17HG in HCCC-9810 cells. The LncBase database was used to predict the target miRNA of MIR17HG, and MS2 RIP assay and dual luciferase assay were conducted to confirm their binding. MiRwalk database and the RNA sequencing data were utilized to screen the key genes regulated by MIR17HG/miR-138-5p axis and a dual luciferase assay was performed to confirm the binding site of miR-138-5p with AKAP9. Immunoblotting was further employed to give assistant evidence. Rescue experiments were performed to observe the function of miR-138-5p and AKAP9 in MIR17HG-induced cisplatin resistance.

Results: MIR17HG overexpression predicts cisplatin resistance and poor prognosis in CCA. MIR17HG could bind with miR-138-5p to release AKAP9, thereby inhibiting cisplatin-induced apoptosis and promoting cisplatin resistance in CCA. MIR17HG silencing in CCA cells leads to expression alteration of genes, which are enriched in platinum resistance-related pathways.

Conclusions: LncRNA MIR17HG regulates platinum resistance-associated genes and promotes cisplatin resistance partially via the miR-138-5p/AKAP9 axis by inhibiting cisplatin-induced apoptosis in CCA.

Background: The role of anticoagulation in asymptomatic cirrhotic patients with portal vein thrombosis (PVT) remains unclear. This study aims to evaluate the efficacy and safety of anticoagulation in this patient population.

Methods: We systematically searched PubMed, Web of Science, Cochrane Library, and Embase up to August 2024. The primary outcomes analyzed were PVT recanalization, progression of PVT, bleeding events, and mortality. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for dichotomous variables.

Results: Seventeen studies, including randomized controlled trials (RCTs) and observational studies, were included in the analysis. Compared to no intervention, anticoagulation significantly increased the PVT recanalization rate (OR = 3.89, p < .001) and decreased the PVT progression rate (OR = 0.28, p < .001) as well as overall mortality (OR = 0.66, p = .008). Importantly, anticoagulation did not significantly increase the bleeding rate (OR = 1.21, p = .41). Subgroup analysis revealed a greater benefit in PVT recanalization within the short-term treatment subgroup (≤ 6 months) compared to long-term treatment subgroup (> 6 months), and in the Asian subgroup compared to the European or United States of America (USA) subgroup. In the Warfarin subgroup, while the total bleeding rate increased significantly, there was no significant rise in major bleeding events. Additionally, a downward trend in variceal bleeding was observed in the Asian subgroup (OR = 0.44; 95% CI: 0.19-1.04; p = .06).

Conclusion: Anticoagulation is both safe and effective for asymptomatic cirrhotic patients with PVT. It not only treats PVT and reduces all-cause mortality, but also does so without significantly increasing the risk of bleeding events.

Objectives: The only treatment with curative potential for distal cholangiocarcinoma (dCCA) is radical surgery which can be complemented with adjuvant chemotherapy. The aim of the present study was to perform an independent external validation of a prognostic model for 3-year overall survival based on routine clinicopathological variables for patients treated with pancreatoduodenectomy for dCCA.

Materials and methods: All patients with a histopathological confirmed dCCA that underwent pancreatoduodenectomy in Sweden from 2009 through 2019 were identified in the Swedish National Registry for Pancreatic and Periampullary Cancer. Model performance was estimated using the C-index and calibration plots.

Results: In total 220 patients were included in the study. The median survival was 33 months (IQR 26-40) and 3-year survival rate 47% (95% CI 40-53%). The prognostic model had a C-index of 0.69 (95% CI 0.62-0.72). Calibration plots revealed overestimated risk of death across risk groups in the full cohort. Calibration was good in the subgroup of patients that did not receive adjuvant treatment.

Conclusions: The prognostic model showed reasonable discriminative ability but some miscalibration likely since the effect of adjuvant treatment is not included in the model. Given that the model was developed in cohorts treated prior to the current adjuvant standard of care the model can be used to estimate baseline risk prior to risk/benefit decision for adjuvant treatment as well as stratification for clinical trials but with a risk to underestimate 3-year overall survival for patients that receive adjuvant treatment.

Background: Cholecystectomy often disrupts autonomic balance, impacting recovery. Remote ischemic preconditioning (RIPC) may enhance ANS function and protect organs, but its role in cholecystectomy is unclear.

Methods: In this randomized controlled trial, 80 patients aged 45 to 65 years, scheduled for elective laparoscopic cholecystectomy, were randomly assigned to either the RIPC group or the control group. The primary outcomes were mean arterial pressure (MAP), heart rate variability (HRV), and the low-frequency to high-frequency ratio (LF/HF) measured at various time points during the perioperative period. Secondary outcomes included liver and kidney function markers, postoperative hospital stay, and 30-day mortality rates.

Results: RIPC group significantly improved HRV compared to the control group at 5 minutes post-anesthesia induction (42.5 ± 9.8 ms vs. 36.4 ± 10.1 ms, P = 0.02) and at the end of surgery (44.8 ± 10.5 ms vs. 37.1 ± 9.3 ms, P = 0.01). The LF/HF ratio was significantly lower in the RIPC group at 30 minutes into surgery (1.25 ± 0.35 vs. 1.67 ± 0.42, P = 0.04) and at the end of surgery (1.19 ± 0.31 vs. 1.71 ± 0.39, P = 0.03), indicating improved autonomic balance. There were no significant differences in MAP, liver function markers (ALT), or kidney function (SCr) between groups at any time point.

Conclusions: RIPC may improve ANS function and MAP stability during cholecystectomy, as shown by better HRV and lower LF/HF ratios. Though the impact on recovery was not significant.

Background and study aims: Diffuse infiltrative gastric cancer can be difficult to diagnose owing to a lack of endoscopic features in the superficial mucosa. Moreover, a forceps biopsy may not reveal a pathological diagnosis. We aimed to evaluate the diagnostic yield and safety of endoscopic mucosal resection (EMR) and 'open-lid submucosal biopsy', a technique wherein EMR followed by biopsy of the ulcer floor is performed for a pathological diagnosis.

Patients and methods: This retrospective observational study involved patients with suspected diffuse invasive gastric cancer on endoscopy and cross-sectional imaging in whom endoscopic forceps biopsy did not lead to a pathological diagnosis. Patients who underwent EMR and open-lid submucosal biopsy were included. The primary outcome was the total diagnostic yield. The secondary outcomes were the diagnostic yields of EMR and open-lid submucosal biopsy and incidence of complications.

Results: Between June 2011 and February 2022, EMR and open-lid submucosal biopsy for diagnostic purposes were performed on seven patients without complications. EMR was diagnostic in four (57%) cases of diffuse infiltrative gastric cancer. Open-lid submucosal biopsy was diagnostic in five (71%) cases. As the primary endpoint, the combination of EMR and open-lid submucosal biopsy led to a pathological diagnosis in six cases (86%). Secondary analysis revealed gastric adenocarcinoma in 9 of 22 (41%) EMR specimens, while open-lid submucosal biopsies were positive for adenocarcinoma in 14 of 60 specimens (23%).

Conclusions: The combination of EMR and open-lid submucosal biopsy was safe and showed good accuracy for the diagnosis of diffuse infiltrative gastric cancer.

Background: Gallstone disease is common, with a prevalence of 5%-22% in Western countries and 6.3%-12.1% in Chinese adults, increasing with age. Postsurgery recurrence is high and analyzing recurrence factors helps identify high-risk patients and preventive strategies. This study explores the differences in stone types and factors associated with postoperative recurrence.

Method: Data from 16,763 patients treated for gallstones at Shandong Third Hospital (2017-2023) were collected. Variables such as age, gender, stone type and size, comorbidities and biochemical results were analyzed using rank sum test, chi-square test, odds ratio (OR) and logistic regression.

Results: Among 16,763 patients, females were slightly more numerous, with ages predominantly in the 60-74 range. Gallbladder stones were the most common type, with a low recurrence rate. Recurrence was significantly associated with stone size, venous thrombosis, respiratory diseases, and cirrhosis. Different stone types varied in terms of complications, gender, age, and recurrence.

Conclusions: Different stone types varied by comorbidities, gender, age, and recurrence, influencing recurrence risk. While the direct effect of stone type on recurrence is unclear, comorbidities play a crucial role. Larger, multicenter studies are needed to improve treatment guidance.