Scandinavian Journal of Gastroenterology最新文献

Aim: Gastroesophageal reflux disease (GERD) is closely linked to esophageal motility dysfunction. While high-resolution manometry (HRM) remains the gold standard for evaluating esophageal motility, the conventional single water swallow (SWS) protocol may not fully capture motility abnormalities. This study investigates esophageal motility characteristics in GERD patients using solid food swallows (SFS) to better assess clinically relevant dysfunction.

Methods: Esophageal motility parameters were compared between GERD and non-GERD groups during both SWS and SFS. Correlations between SFS findings and dysphagia symptoms, endoscopic findings and reflux metrics were analyzed, followed by multivariate regression to identify independent GERD risk factors.

Results: Among 151 participants, 54 were diagnosed with GERD. Impaired SFS esophageal body motility was more prevalent in GERD versus non-GERD patients (p < 0.01). Moreover, the GERD group exhibited significantly higher rate of esophageal hypomotility during SFS compared to SWS (p < 0.001). With SFS testing, 35.2% (19/54) of GERD with normal SWS esophageal motility demonstrated Impaired SFS esophageal body motility. Multivariate analysis identified SFS esophageal body hypomotility (OR: 5.158, 95%CI: 2.439-10.909, p < 0.001) as independent GERD predictors. The prevalence of dysphagia symptom and esophagitis were higher in patients with esophageal hypomotility of SFS. Distal contractile integral of SFS positively correlated with mean nocturnal baseline impedance (r = 0.393), while inversely correlating with supine bolus clearance time (r=-0.326) and acid exposure (r=-0.403).

Conclusions: SFS unmask clinically significant esophageal dysmotility in GERD patients that SWS miss, revealing pathophysiology linked to prolonged acid exposure and mucosal injury. SFS-enhanced HRM protocols may improve GERD evaluation and risk stratification.

Background: This meta-analysis aimed to evaluate the association between distinct KRAS mutations and overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC) patients.

Methods: A comprehensive literature search was conducted across major databases to identify studies reporting hazard ratios (HRs) and 95% confidence intervals (CIs) for OS associated with key KRAS mutations (G12D, G12R, and G12V) in PDAC patients, from inception until January 2025. Subgroup analyses were carried out based on disease stage (resectable and borderline resectable as early-stage disease and locally advanced and metastatic as late-stage disease) and treatment approaches (operation, chemotherapy, or combination of both).

Results: KRAS G12D mutation was significantly associated with poor OS (HR = 1.64, 95% CI: 1.28-1.99, p < 0.05). In subgroup analysis, G12D mutation was significantly associated with poor OS in those receiving chemotherapy (HR = 1.29, 95%CI: 1.18-1.39, p < 0.05) and in those with late-stage disease (HR = 1.29, 95%CI: 1.18-1.39, p < 0.05). G12R was significantly associated with improved OS in patients receiving chemotherapy (HR = 0.74, 95% CI: 0.56-0.99, p = 0.042). G12V had a significant association with improved OS in patients with early-stage disease (HR = 0.67, 95% CI: 0.52-0.86, p = 0.002).

Conclusions: The study highlights the heterogeneous prognostic impact of KRAS mutations in PDAC. These findings suggest that the prognostic relevance of KRAS mutations in PDAC may depend on clinical factors such as treatment modality and disease stage.

Objectives: Patients with inflammatory bowel disease (IBD) are at increased risk of thromboembolic events (TEEs), particularly during hospitalisation. While extended thromboprophylaxis is standard in the post-partum and the post-surgical settings, its employment in IBD patients is uncommon. Current international guidelines recommend that extended outpatient prophylaxis is considered only for high-risk post-discharge ambulatory IBD patients. To determine the incidence of inpatient and post-discharge TEEs in hospitalised IBD patients over a 13-year period and to identify associated risk factors.

Method: We conducted a retrospective cohort study at a tertiary centre using hospital inpatient coding (HIPE) and radiology databases from 2012-2024. Discharges with a primary or secondary IBD diagnosis were cross-referenced with TEE-related imaging studies during admission and within 180 days post-discharge. Logistic regression was used to evaluate the associations between patient factors and TEEs.

Results: Among 1,601 discharges involving 954 individual patients (54% female; median age 44 [IQR: 32-59]), 117 admissions (7.3%) had TEE-directed imaging. Ten inpatient TEEs were identified (0.6%). Age ≥50 years was significantly associated with inpatient TEE (OR: 6.3; 95% CI: 1.57-41.82; p = 0.02). Male gender, ulcerative colitis subtype, and inpatient surgery were not significant predictors. Post-discharge imaging within 180 days occurred in 63 discharges (3.9%), with six post-discharge TEEs detected (0.4%). No significant predictors of post-discharge TEE were identified.

Conclusions: Both inpatient and post-discharge TEEs were infrequent in hospitalised IBD patients. These findings do not support routine use of extended thromboprophylaxis after discharge in unselected patients. A risk-stratified approach remains appropriate pending further prospective data.

Purpose: The sucrase-isomaltase (SI) gene encodes sucrase-isomaltase enzyme found on the intestinal brush-border that has a major function in the hydrolysis of sucrose, oligosaccharides, and starch. Mutations disrupting its function cause genetic sucrase-isomaltase deficiency (GSID). Variants leading to mild to moderate reductions in enzyme activity may mimic disorders of gut-brain interaction (DGBI), and differentiating the etiology is crucial for initiating appropriate treatment. In this study, we aim to determine the rate of GSID in individuals who underwent whole exome or clinical exome sequencing (WES/CES) for indications other than chronic gastrointestinal symptoms in a single-center cohort. We also focused on a second group, the pediatric DGBI patients, who underwent SI gene analysis, to evaluate the rate of GSID in pediatric DGBI patients and assess the clinical utility of SI gene testing in GSID diagnosis.

Methods: We retrospectively reviewed 980 patients who underwent WES/CES between 2017-2022, and 148 pediatric patients with DGBI evaluated between May 2021 and August 2022 who received SI gene analysis.

Results: The frequency of symptomatic GSID was found to be 0.3% among patients who underwent WES/CES, whereas it was 10% among pediatric DGBI patients. In DGBI patients carrying SI gene mutations, clinical improvement with a sucrose- and starch-free diet in combination with a sacrosidase response proved effective for establishing a diagnosis in all cases.

Conclusion: GSID has been frequently detected among pediatric DGBI patients. SI gene analysis combined with a sucrose-restricted diet and a sacrosidase challenge provides a reliable, non-invasive approach for definitive diagnosis.

Background: Perihilar cholangiocarcinoma (pCCA) is a rare malignancy originating from the bile duct bifurcation which is often diagnosed in an advanced stage. At presentation, most patients present with jaundice requiring biliary drainage. Palliative chemotherapy (pCTx) has a positive impact on survival and quality of life. The primary aim of this study was to investigate the impact of biliary drainage on pCTx initiation in patients with non-resected pCCA.

Methods: Individual patient data from all Dutch patients diagnosed with non-resected pCCA between 2015 and 2020 were retrieved from the Netherlands Cancer Registry. Primary outcome were factors associated with initiation of pCTx, analysed by multivariable competing risk regression analysis.

Results: A total of 1265 patients were included, of whom 242 patients (19.1%) received pCTx after a median interval of 72 days [IQR 43-110 days] after initial presentation. Patients who underwent biliary drainage did not receive pCTx more often. If performed, drainage at a referral hospital (HR:0.65, 95%CI: 0.42-0.99), ≥3 drainage procedures performed (HR:0.53, 95%CI: 0.32-0.88), and drainage performed ≥14 days after presentation (HR:0.70, 95%CI: 0.49-0.99) were associated with no pCTx. Median overall survival for those who received pCTx and those who did not was 12.8 months [95%CI: 11.7-14.2] and 2.7 months [95%CI: 2.4-3.1].

Conclusion: The need for biliary drainage did not affect the initiation of pCTx. When indicated, biliary drainage should be performed as quick as possible in an academic center to improve the rate of patients receiving pCTx.

Background: Iron deficiency is common in patients with inflammatory bowel disease (IBD) and may lead to a variety of distressing symptoms negatively impacting quality of life.

Aims: This prospective observational cohort study aimed to assess quality of life, measured using the Short Form-36 (SF-36) questionnaire before and after treatment with high-dose intravenous iron in patients with IBD and iron deficiency.

Materials and methods: Over a 15-month period, 130 patients with a well-established diagnosis of IBD (either ulcerative colitis (UC) or Crohns disease (CD)) and confirmed iron deficiency were consecutively assessed for study eligibility at two university hospitals in South-Eastern Norway. Of these, 112 patients were included in the per protocol set. Demographic characteristics were recorded at study inclusion. Clinical, and biochemical variables, as well as SF-36 questionnaires were collected just before and 5-7 weeks after treatment with intravenous iron.

Results: An improvement was observed in six of the eight SF-36 domains six weeks after treatment with intravenous iron. Females had lower scores compared to males at both visits, but there were no differences between UC and CD patients. Both sexes and the two diagnoses had a significant increase in vitality scores. Haemoglobin level was a significant predictor for improvement of quality of life.

Conclusions: Treatment with high dose intravenous iron improves quality of life in IBD patients and iron deficiency and particularly in those with anaemia. The most significant improvements were observed in vitality and energy levels, suggesting a clinically meaningful change.

Background and aims: Long-term outcomes for Crohn's disease (CD) patients treated with infliximab (IFX) remain suboptimal. We developed and validated a clinical decision support tool (CDST) to predict sustained remission in CD patients treated with infliximab (IFX).

Methods: This multicenter observational study analyzed 746 CD patients across three cohorts. Sustained clinical remission (CREM) was defined as steroid-free Crohn's Disease Activity Index (CDAI) <150 at week 104. Using logistic regression, predictors were weighted by inverse variance. The CDST was internally validated (Cohort I, n = 113) and externally validated (Cohort II, n = 367).

Results: Key predictors of CREM included: prior biologic exposure (-18 points), penetrating disease (B3 phenotype, -7 points), albumin (+0.5/gL), younger age (-0.3/year), and absence of antibody to infliximab formation (ATI, +17 points). The model demonstrated strong discrimination (AUC 0.791 [95% CI 0.708-0.875]) and calibration (Brier score: 0.191). External validation AUC was 0.611 (95% CI 0.546-0.675), indicating modest generalizability. Risk stratification via CDST categorized patients into low- (<6 points), intermediate- (6-25), and high-risk (>25) groups. A cutoff of 25 points predicted 2-year CREM with 60% (95%CI 53.2%-66.5%) sensitivity and 52% (95% CI 41.2%-1.8%) specificity.

Conclusions: We developed and validated a CDST to identify CD patients likely to achieve sustained remission on IFX therapy. By stratifying patients into distinct risk profiles, it guides personalized therapy initiation and monitoring.

Background: The prevalence of inflammatory bowel disease (IBD) is rising, while the incidence varies between countries.

Objective: To determine changes in prevalence and incidence of IBD in a Norwegian general population.

Design: This study was based on the Trøndelag Health Study (HUNT), a series of population-based health surveys in Nord-Trøndelag County, Norway, conducted since the 1980s. All adult residents aged 20 years and above were invited. The total number of unique participants in HUNT is 123,000. Those diagnosed with IBD were identified and verified by linkage to hospital records. Annual age-standardized prevalence and incidence rates were calculated from 1990 to 2022.

Results: The prevalence of IBD was 0.22% in 1990, increasing to 1.6% in 2022. An increase in ulcerative colitis (UC) accounted for the largest rise, from 0.16% to 1.12%. The prevalence of Crohn's disease (CD) rose from 0.06% to 0.27%. IBD unclassified (IBDU) was rarely diagnosed in the early years of the study but accounted for 0.19% in 2022. The incidence of IBD showed an average annual increase of 0.72% in the observation period. This was mainly due to an increase in UC in women, while the incidence was relatively stable in men. The incidence of IBD was highest, but stable, for those under 30 years, while the incidence rose in the older age groups, mostly in those above 70 years.

Conclusion: In this Norwegian adult population, the prevalence of IBD has been high and rising over the last 30 years. It is the highest prevalence of IBD reported in Europe.

Objectives: The clinical significance of HBeAg/HBeAb coexistence in pediatric chronic hepatitis B (CHB) remains unclear. This study assessed antiviral efficacy and predictors of functional cure in HBeAg/HBeAb-positive children/adolescents treated with PEG-IFNα-2a or entecavir (ETV).

Methods: We retrospectively analyzed 54 CHB patients (<18 years) treated from 2016-2022, stratified by treatment (PEG-IFNα-2a vs. ETV), age (≤7 vs. >7 years), and 48-week HBsAg seroconversion status. Biochemical and virological responses were assessed at 4, 12, 24 and 48 weeks. Cumulative incidence was calculated via Kaplan-Meier analysis, and predictive performance was evaluated using ROC curves and DeLong tests.

Results: ETV demonstrated superior ALT (24 weeks: 54.2% vs 16.0%, X²=7.873, p = 0.005; 48 weeks: 64.0% vs 20.8%, X²=9.317, p = 0.002) and AST normalization rate (24 weeks: 45.8% vs 16.0%, X²=5.131, p = 0.024; 48 weeks: 64.0% vs 12.5%, X²=13.680, p < 0.001), and faster HBV DNA decline (4 weeks: 5.16 vs 6.72 log₁₀IU/mL, Z=-2.843, p = 0.004; 12 weeks: 3.00 vs 5.06 log₁₀IU/mL, Z=-1.895, p = 0.058) than PEG-IFNα-2a. However, PEG-IFNα-2a achieved greater HBsAg reduction (late phase, all p < 0.01) and higher HBsAg serological response (48 weeks: 36.0% vs 12.0%, X²=3.947, p = 0.047) and seroconversion (48 weeks: 28.0% vs 12.0%, X²=2.000, p = 0.157). Younger patients (≤7 years) had higher HBsAg seroconversion rates (48 weeks: 28.1% vs 5.6%, X²=3.668, p = 0.055). Early qHBsAg levels (weeks 12/24) strongly predicted functional cure (AUC > 0.90).

Conclusions: ETV was more effective for short-term viral suppression and hepatic inflammation reduction, while PEG-IFNα-2a promoted HBsAg decline and functional cure. Younger age and early qHBsAg levels were key predictors of treatment success.