Scandinavian Journal of Gastroenterology最新文献

Introduction: Metastatic colorectal cancer (mCRC) represents a growing burden on healthcare, yet comprehensive data on treatment costs across different disease phases remain limited. This study aims to estimate hospital resource utilization and costs of treating mCRC patients according to international up-to-date guidelines.

Materials and methods: The RAXO study aimed at maximising metastasectomy with repeated centralized assessment of resectability (inclusion 2012-2018). Cost data from the six largest Finnish hospital districts (n = 941) in RAXO were collected from mCRC diagnosis to death or the end of 2021. All patient costs were characterized day-by-day to diagnostic, curative, remission, palliative SACT, treatment break, or end-of-life disease phases. The resource utilization and mean costs, in 2021 euros, were calculated per patient per month (PPPM).

Results: The mean PPPM cost for treating mCRC patients was 2323€, when 37% had curative-intent metastasectomy. On average, each month included 0.7 ward days, 1.9 outpatient and 0.1 emergency visits. Outpatient care accounted for 64% of costs, inpatient care for 34%, and emergency room visits for 2%. The higher costs during disease phases involving active tumour-directed treatments (2963€-3059€/PPPM) were balanced by lower costs during remission and treatment break (453€-560€/PPPM). Pharmacy, ward, operating room, and outpatient costs (39%/18%/15%/15%, respectively) were the main drivers for internal hospital billing.

Conclusions: Resource utilization, costs, and cost drivers varied 8-fold between disease phases. Outpatient care accounted for two-thirds, and inpatient care accounted for one-third of costs.

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.

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 and objective: Cancer-associated fibroblasts (CAFs) promote hepatocellular carcinoma (HCC) progression. Identifying their cellular origin and molecular determinants may help to inform molecular targeted therapy for HCC. Identifying the tissue distribution of CAFs in HCC to indirectly reflect their cellular origin may provide a histological basis for further exploration of their cellular origin and molecular determinants.

Methods and results: The tissue distribution of CAFs in 57 HCC tissues was determined by immunohistochemical staining of α-SMA, and α-SMA-positive CAFs were found to be widely located along the capillary network. Immunofluorescent double staining was used to examine the co-expression of CD31 in α-SMA-positive CAFs to identify whether the endothelial-to-mesenchymal transition (EndoMT) is involved in the origin, and obvious colocalization was observed. Visium and Visium HD spatial transcriptomics further revealed endothelial cells (ECs) exhibited remarkable co-expression of CAF-specific marker genes and revealed inferred developmental trajectories to CAFs; molecular determinants, including TIMP1, IGFBP7, THBS2, CD74, COL4A1, COL4A2, AEBP1, S100A6, KCTD12, CALD1, IGHG1, SERPINE1, MCL1, MGP, GSTP1, TAGLN, THBS1, and CTGF, were positively correlated with the spatial developmental trajectories of ECs to CAFs; and CTGF exhibited extensive interactions with other common positively correlated molecular determinants and was a highly connected node in the interaction network.

Conclusion: ECs that undergo EndoMT may be one of the potential cellular and mechanical origins of CAFs in HCC, and the development of EndoMT may be associated with CTGF.

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.

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.

Objectives: Gastroenterology clinics often assess hepatic steatosis using CAP-FibroScan, while radiology departments increasingly apply UGAP instead of subjective B-mode ultrasound. This study compares CAP and UGAP feasibility and diagnostic performance across steatosis stages, using PDFF as reference.

Materials and methods: Healthy controls and a cohort with known steatosis and fibrosis were examined between September 2022 and October 2024. Presence of steatosis (≥S1) defined as ≥5% PDFF, and presence of fibrosis was evaluated with MRE. Participants with even sex distribution were examined in supine and 30° left decubitus position; for UGAP, with normal (4 N) and (30 N) probe force. Diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUROC).

Results: In the group of N = 97 CAP demonstrated 91% feasibility in supine and 80% in lateral position. UGAP showed 100% feasibility for all examination techniques. The whole group was divided according to steatosis stages of PDFF. When differentiating ≥ S1, CAP supine accuracy was AUC 0.81 (95%CI: 0.71-0.92), and UGAP supine/30N accuracy was 0.88 (95%CI: 0.88-0.95). Differentiating S0 and S1 vs. S2 and S3, the CAP AUC was 0.81 (95% CI: 0.72-0.90), and the UGAP supine/30 N AUC was 0.93 (95%CI: 0.88-0.99). When differentiating S0, S1, and S2 vs. S3, the CAP AUC was 0.90 (95%CI: 0.83-0.97), and the UGAP supine/4N AUC was 0.97 (95%CI: 0.94-1.00). UGAP increased performance in both sexes using increased probe force.

Conclusions: UGAP provides absolute feasibility and higher diagnostic performance. CAP should not be performed in left position.

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.

Objective: Current guidelines recommend using the presence of alarm features to help determine if an upper endoscopy is appropriate as an initial diagnostic tool in young adults with dyspepsia. The study aimed to assess whether young adults without alarm features had clinically significant findings on gastroscopy.

Methods: This was a retrospective study on patients 18-50 years who underwent their first gastroscopy at Landspitali University Hospital 2018-2022. Data was collected on symptoms and endoscopic findings. American Society for Gastrointestinal Endocopy (ASGE) from 2015 were used to determine adequate indication for gastroscopy. The following were considered adequate indications: suspected gastrointestinal bleeding and/or iron deficiency anemia, dysphagia, persistent vomiting, unintentional weight loss, a family history of upper gastrointestinal cancer, or suspicious findings on imaging.

Results: Among 748 patients, 515/748 (69%) had an adequate indication, 52% males and 233/748 (31%) without. Endoscopic findings in the group with adequate indications were: esophagitis (20%), gastric ulcers (4.1%), duodenal ulcers (4.1%), esophageal ulcers (2.1%), gastric cancer (1.0%) and esophageal cancer (0.2%). Clinically relevant findings were rare in the group without an adequate indication and only 4/233 (1.7%) had a duodenal ulcer, all due to an H.pylori infection and only 1 gastric ulcer (0.4%). No cancers were diagnosed among those without an adequate indication.

Conclusions: Patients without alarm features were less frequently diagnosed with clinically significant diseases on gastroscopy compared to patients presenting with alarm features. No cancers were diagnosed in those without an adequate indication and clinically significant findings were rare in that group.

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.