Scandinavian Journal of Gastroenterology最新文献

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.

Background: Borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) constitute a heterogeneous disease spectrum with variable tumour biology and treatment responses, making clinical decision-making challenging. Improved prognostic markers are needed to guide individualised treatment strategies. This study aims to determine whether quality of life (QoL) at the time of diagnosis is associated with survival in patients diagnosed with BRPC and LAPC.

Methods: Between 2018 and 2020, a total of 230 consecutive patients with BRPC and LAPC were included in a population-based study. Patients completed the EORTC QLQ-C30 questionnaire at the time of diagnosis. Clinical data were collected prospectively. The association between QoL and survival was assessed using Cox regression models.

Results: Baseline QoL data were available for 143 (62%) patients. Median overall survival from time of diagnosis was 14 (95% CI 11.1-16.9) months. Multivariate analyses showed that emotional functioning, financial impact and constipation were significantly associated with survival. Constipation was the strongest prognostic factor (HR 1.95, 95% CI 1.28-2.96, p < 0.001). Patients with a high constipation score had a median overall survival of 10 months (95% CI, 7.2-12.8) compared to 16 months (95% CI, 11.9-20.0) for those with a low score (p = 0.009).

Conclusions: In patients with BRPC and LAPC, several baseline QoL domains, especially constipation, are significant prognostic indicators. Routine QoL assessment may facilitate personalised, patient-centred care that improves both clinical outcomes and QoL during treatment.

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.

Objectives: This study aimed to investigate the efficacy and safety of bowel preparation by linaclotide (Lina) combined with compound polyethylene glycol (PEG) in patients aged over 60 years.

Methods: A multi-center, endoscopist-blind, randomized controlled trial involved 527 patients aged over 60 years scheduled for colonoscopy at two hospitals in Chongqing from January 2022 to December 2023. Participants were randomly assigned to one of three groups: Lina + 2 litres of PEG (L-PEG), 3 L-PEG, or 2 L-PEG. The primary endpoint was the Boston Bowel Preparation Scale (BBPS), with secondary outcomes including the adequate bowel preparation rate (ABPR), adenoma/polyp detection rate (ADR), cecal intubation rate (CIR), cecal intubation time (CIT), willingness to repeat the colonoscopy, bowel preparation costs, and adverse reactions.

Results: The total BBPS scores, ABPR and CIT in the Lina + 2 L-PEG group and the 3 L-PEG group were superior to those in the 2 L-PEG group(p < 0.05). Compared with the 3 L-PEG group, the Lina + 2 L-PEG group and the 2 L-PEG group demonstrated a higher willingness to repeat the colonoscopy, lower costs, and a lower percentage of mild adverse events(p < 0.05). No statistically significant differences were observed among the groups in terms of ADR and CIR.

Conclusions: The bowel preparation efficacy of Lina + 2 L-PEG is comparable to that of 3 L-PEG, yet superior to that of 2 L-PEG. Moreover, Lina + 2 L-PEG is associated with fewer adverse reactions, a lower cost, and a higher willingness to repeat the colonoscopy among patients aged over 60 years.

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.