Scandinavian Journal of Gastroenterology最新文献

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most prevalent chronic liver disease globally, strongly linked to obesity, insulin resistance, and metabolic syndrome. Inflammation plays a central role in MASLD progression, with interferon gamma-induced protein 10 (IP-10/CXCL10) emerging as a key chemokine implicated in immune cell recruitment, hepatic injury, and fibrosis. However, its level in obese non-diabetic MASLD patients remains underexplored. This study aimed to evaluate serum IP-10 levels in obese, non-diabetic MASLD patients and explore their association with anthropometric, metabolic, and hepatic parameters.

Patients and methods: We conducted a case-control study, including 120 participants, divided into 60 obese non-diabetic MASLD patients (diagnosed clinically and radiologically) and 60 age- and sex-matched healthy controls. Serum IP-10 was measured by ELISA. Correlations with anthropometric indices, biochemical markers, insulin resistance, and hepatic steatosis (HSI) and fibrosis stiffness (FIB-4) scores were analysed. Diagnostic accuracy of IP-10 was assessed using ROC curve analysis.

Results: Serum IP-10 levels were significantly higher in MASLD patients compared to controls. IP-10 correlated positively with BMI, waist circumference, ALT, AST, fasting insulin, HOMA-IR, and hepatic steatosis stage, and negatively with HDL-C. ROC analysis showed that an IP-10 cutoff > 830.1 pg/mL discriminated obese MASLD with an AUC of 0.805, sensitivity of 61.7%, and specificity of 86.7%.

Conclusion: Serum IP-10 is significantly elevated in obese non-diabetic MASLD patients and strongly associated with metabolic derangements, insulin resistance, and hepatic steatosis. These findings suggest that IP-10 may serve as a promising early non-invasive risk stratification tool or an adjunctive biomarker for MASLD.

Patients with primary biliary cholangitis (PBC) consistently report low quality of life (QoL), but determinants of decreased QoL remain unresolved. We aimed to investigate the role of inflammation, fibrosis, and treatment response on QoL in PBC patients.

Method: We included 165 patients with 3 years of follow-up (n = 130). Annual visits included liver biochemistry, the macrophage activation marker sCD163, transient elastography (TE), and two QoL questionnaires (PBC-40 and SF-36).

Results: Median age was 62 years and 94% were female. Median QoL was normal (SF-36 mental and physical component summary scores [MCS and PCS] of 51.8 [IQR 41.1-58.1] and 49.1 [IQR 42.6-55.5], respectively). QoL was decreased in 32% (95%CI: 24-40%) and 33% (95%CI: 25-42%) of patients for MCS and PCS, respectively. Fatigue was the most frequent severe symptom (22%), while 13% reported clinically significant pruritus. Patients with cirrhosis (F4; TE > 16.9 kPa) had lower PCS scores than F0-F1 at baseline (p = 0.069) and after 3 years (p = 0.0026), whereas MCS and PBC-40 domains were similar across fibrosis stages. Higher sCD163 levels were associated with lower PCS (β = -0.56 [95%CI: -1.11 to -0.01], p = 0.044), with a stronger association among UDCA non-responders (β= -0.65 [95%CI: -1.27 to -0.02], p = 0.043). QoL remained stable over 3 years, with a minor improvement in the emotional domain (p = 0.040).

Conclusion: In Danish PBC patients, one-third had impaired QoL, primarily due to fatigue. QoL was reduced in cirrhosis but preserved in earlier fibrosis stages. Higher sCD163 was independently associated with lower physical QoL, particularly among UDCA non-responders.

Background: Antiplatelet and anticoagulant therapy are associated with a significant risk of upper gastrointestinal bleeding (UGIB), as is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Concomitant treatment with proton pump inhibitors (PPIs) has been shown to reduce the risk of this complication.

Aims: To compare the use of risk medications and PPIs in a cohort of adult patients with bleeding peptic ulcers or erosions in the stomach or duodenum with the background population.

Materials and methods: We performed a prospective observational study including 543 patients with endoscopically verified bleeding ulcers and/or erosions at two large hospitals in Norway. Information on risk medications taken prior to study enrolment was collected prospectively through structured interviews with patients and with the review of their medical records, whereas for the background population the information was obtained from The Norwegian Prescription Database (NorPD).

Results: Overall, 434 (80%) of the patients used risk medications, compared to 34% in the background population (p < 0.001). Only 39 (8.9%) of the patients received PPIs as co-medication, and 150 (34.6%) tested positive for Helicobacter pylori (H. pylori) infection.

Conclusions: Among patients with bleeding ulcers and erosions, we found a high prevalence of risk medication use and an underutilization of prophylactic PPIs. H. pylori infection appears to play a minor role.

Clinical trial registration: Bleeding Ulcer and Erosions Study "BLUE Study", ClinicalTrials.gov Identifier: NCT03367897.

Background/objectives: Endoscopic procedures-related musculoskeletal injuries (ERMI) are a major problem in gastroenterologists. ERMI arises from increased workload, extended times of advanced endoscopic procedures, and repetitive overuse. There has been no study for ERMI among gastroenterologist in Türkiye. This study aimed to assess the frequency, causes, and risk factors associated with ERMI among gastroenterologists in Türkiye.

Methods: A 26-item electronic survey was sent to 1,100 Turkish Gastroenterology Association physician members and to 253 gastroenterology fellows still in training. Demographic characteristics, prevalence of ERMI, workload parameters and possible risk factors were evaluated by univariate and multivariate analyses.

Results: The survey was completed by 132 gastroenterologists, 78% of respondent were male, with a mean professional experience of 11 years. Overall, 72% reported experiencing at least one ERMI during their career, and 63.2% reported injuries involving multiple joints. The most commonly affected areas were the neck, left thumb and right wrist. Significant differences in ERMI were observed based on gender, affiliated institution, and total weekly number of procedures. Regarding injury severity, sex and glove size were significant factors. In logistic regression analysis, female sex increased the risk of ERMI by 5.7 times, and performing ERCP procedures increased the risk by 2.4 times.

Conclusions: ERMI is highly prevalent among gastroenterologists in Türkiye and represents a significant occupational health problem with implications on work loss. Preventive strategies such as reducing the volume of procedures, increasing the frequency of breaks, and making ergonomic adjustments in procedure rooms are necessary to reduce the risk of ERMI.

Background: Celiac disease (CD) is an underdiagnosed disease with a significant diagnostic delay. Previous studies have shown associations between CD and several skin diseases.

Objective: The objective of this article was to investigate the association between undiagnosed celiac seropositivity and prevalence of self-reported skin symptoms and diseases in adults.

Methods: In a Danish population-based cohort comprising 9656 participants, we identified individuals with undiagnosed celiac seropositivity, defined by celiac antibody positivity against immunoglobulin (Ig) A and/or IgG tissue transglutaminase (TTG) ≥7 U/mL and/or IgG deamidated gliadin peptide ≥10 U/mL, without a known diagnosis of CD in the National Patient Register. Information on skin symptoms and diseases were obtained from participant-completed questionnaires. The associations between skin symptoms and diseases and undiagnosed celiac seropositivity were analyzed by ꭓ² or Fisher's exact test and logistic regression were used to calculate odds ratios (OR) with 95% confidence intervals (CI).

Results: We excluded 13 participants with a previous CD diagnosis and 386 participants due to missing measurements of CD antibodies, resulting in a study population of 9257 participants. In this population, 0.76% (70/9257) had undiagnosed celiac seropositivity. There were no statistically significant differences in skin symptoms and diseases between participants with and without undiagnosed celiac seropositivity; the OR for any skin symptom or disease was 0.83 (95% CI: 0.41-1.67) among individuals with undiagnosed celiac seropositivity compared with individuals without.

Conclusion: In this cross-sectional study, we found no differences in self-reported skin symptoms and diseases between participants with and without undiagnosed celiac seropositivity.

Introduction: Sarcopenia is an age-related geriatric syndrome. We aimed to investigate the association between sarcopenia and adverse events after endoscopic submucosal dissection (ESD) for gastrointestinal early-stage cancer and precancerous lesions.

Patients and methods: We enrolled 180 patients with gastrointestinal lesions who underwent ESD in the First Hospital of Hebei Medical University between April 2020 and November 2023 and divided them into the sarcopenia group (31 patients) and the non-sarcopenia group (149 patients). Their clinical information, ESD-related postoperative complications were then compared.

Results: The median age was higher (p < 0.05) and body mass index (BMI), albumin (ALB) level, and prognostic nutritional index (PNI) were lower (all p < 0.05) in the sarcopenia group compared to the non-sarcopenia group. The percentage of those with Common Terminology Criteria for Adverse Events (CTCAE) ≥ grade 1 was higher in the sarcopenia group (p < 0.01). Univariate logistic regression analysis showed that ALB, PNI and sarcopenia are risk factors for CTCAE ≥ 1 (both p < 0.05). Multivariate analyses indicated that sarcopenia (OR = 2.961; 95% CI: 1.220-7.188; p < 0.05) was a significant independent risk factor.

Conclusions: Sarcopenia is an independent risk factor for adverse events after ESD for gastrointestinal early cancer and precancerous lesions. Early preoperative identification and improvement of sarcopenic status by clinicians are therefore critical for enhancing ESD safety and optimizing patient recovery trajectories.

Objectives: The number of advanced therapies for inflammatory bowel disease (IBD) has increased in recent years. Ustekinumab, an inhibitor of interleukin -12 and -23, was mostly used for later-line treatment, where its efficacy may be reduced. Recent expiration of its patent and the introduction of affordable biosimilars introduced interest of using ustekinumab earlier as a first-line option. However, data on the effectiveness in the first-line setting remain limited. The aim was to evaluate the efficacy and treatment persistence of ustekinumab when used as a first-line treatment in IBD.

Materials and methods: This retrospective longitudinal cohortstudy included 71 naïve patients to advanced therapy who initiated first-line treatment with ustekinumab. Data on demographics, patient clinical characteristics, treatment persistence, serum concentrations of ustekinumab, and clinical, biochemical, and endoscopic outcomes, were collected. A Kaplan-Meier curve was performed to assess treatment persistence.

Results: Median follow-up was 20.8 months (interquartile range 11.3-48.5). One-year treatment persistence with ustekinumab was 88%, with a rate of 92% in Crohn's disease (CD), and 82% in ulcerative colitis (UC). Biochemical remission was achieved in 77.6% of patients based on C-reactive protein (≤5 mg/ml) and in 71.1% based on fecal calprotectin (<100 mg/kg). Endoscopic remission (absence of ulcers in CD and endoscopic Mayo ≤1 in UC) was observed in 58.3% of patients.

Conclusions: First-line treatment with ustekinumab demonstrates high treatment-persistence and is associated with substantial rates of clinical, biochemical, and endoscopic remission in patients with IBD.

Background: Post-colectomy enteritis is a rare but potentially life-threatening complication of colectomy in patients with ulcerative colitis. The current evidence is limited to case reports and small retrospective case series, suggesting that this condition is likely underdiagnosed and often recognized only in advanced stages.

Objective: We performed a comprehensive bibliographic search in Medline (via PubMed) up to April 2025 to collect available data on its clinical presentation, management, and outcome.

Results: Although its pathogenesis remains poorly understood, the disease typically presents with severe diarrhea, abdominal pain, and systemic inflammatory signs requiring prompt intervention. First-line therapy consists of high-dose intravenous corticosteroids, whereas biologic therapy may be needed in refractory or severe cases. Management remains largely empirical, and delayed diagnosis may contribute to increased morbidity and mortality. Implementing a structured diagnostic and therapeutic approach could improve early recognition and treatment, while further studies are required to clarify underlying mechanisms, optimize management strategies, and define the relationship between this condition and other forms of small bowel involvement in ulcerative colitis.

Conclusions: Raising awareness of post-colectomy enteritis among clinicians is crucial to prevent misdiagnosis and to reduce the burden of this rare but severe post-surgical complication.

Background: Perforated peptic ulcer (PPU) remains a life-threatening emergency. Laparoscopic repair is favored over open surgery, but intracorporeal suturing is demanding. Interrupted hand-tied sutures are traditional; knotless barbed sutures may simplify closure and shorten operative time.

Objectives: To evaluate the efficacy and safety of knotless barbed versus interrupted sutures in laparoscopic PPU repair.

Methods: PubMed, Scopus, the Cochrane Library, Web of Science and Google Scholar were searched until 22 July 2025. Eligible comparative studies included adults undergoing laparoscopic gastroduodenal PPU repair using continuous knotless barbed sutures ± omental patch versus interrupted absorbable sutures ± omental patch. Outcomes were operative time, postoperative complications, leak, hospital stay, perforation size and wound complications. Random-effects models yielded mean differences (MDs) or risk ratios (RRs) with 95% confidence intervals (CIs) and heterogeneity (I²).

Results: Four retrospective cohorts (n = 575; 192 barbed, 383 interrupted) met criteria. Barbed sutures reduced operative time (MD -25.49 min; 95% CI -40.35 to -10.62; p = 0.0008; I² = 43%). No differences were observed for postoperative complications (RR 0.91; 95% CI 0.54-1.53; p = 0.72; I² = 2%), leak (RR 0.53; 95% CI 0.14-2.04; p = 0.35; I² = 0%), hospital stay (MD -0.73 days; 95% CI -2.85 to 1.39; p = 0.50; I² = 0%), perforation size (MD -0.06 cm; 95% CI -0.17 to 0.05; p = 0.26; I² = 0%) or wound complications (RR 0.99; 95% CI 0.28-3.47; p = 0.99; I² = 0%).

Conclusions: In laparoscopic PPU repair, knotless barbed sutures improve operative efficiency without increasing adverse events. Given the small, retrospective evidence base and low certainty, randomized trials with standardized techniques are warranted.

Prospero number: CRD420251119990.

Clinical trial number: Not applicable.

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.