Scandinavian Journal of Gastroenterology最新文献

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.

Background: Advanced fibrosis is the main risk factor for liver-related complications in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). The first line-test for evaluating presence of advanced fibrosis, Fibrosis-4 index (FIB-4), has limitations. Here, we investigated whether the diagnostic performance of FIB-4 could be improved by incorporating commonly analyzed metabolic biomarkers, including C-reactive protein (CRP), Hemoglobin A1c (HbA1c), the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), or uric acid.

Methods: This cross-sectional study included 276 adult (≥18 years) patients with MASLD from seven Swedish university hospitals. All patients underwent liver stiffness measurement (LSM) for assessment of advanced fibrosis, defined as LSM ≥12 kPa. The performance of FIB-4, CRP, HbA1c, HOMA-IR, and uric acid, alone and in combination, was assessed using logistic regression models. The area under the curve (AUC) was calculated.

Results: An LSM value of ≥12 kPa was found in 45 patients (16%). Combining FIB-4 with CRP, HbA1c, HOMA-IR, and uric acid yielded the highest AUC (0.810; 95% confidence interval [CI] = 0.732-0.889), which was not significantly better than the AUC for FIB-4 alone (0.774, 95%CI = 0.701-0.847).

Conclusions: Adding CRP, HbA1c, HOMA-IR, or uric acid to FIB-4 did not result in any statistically significant improvement in diagnostic performance, suggesting limited additional value of these biomarkers in identifying advanced fibrosis.

Background: Neurological and psychiatric morbidity has been associated with celiac disease but has been scarcely studied in dermatitis herpetiformis (DH), a cutaneous manifestation of celiac disease. Hence, this cohort study aimed to investigate neurological and psychiatric morbidity in patients with DH and celiac disease.

Methods: The study comprised 368 DH patients and 1,072 celiac disease patients without DH and their 1,099 and 3,197 refences, matched 1:3 on age, sex, calendar period and place of residence. Their neurological and psychiatric morbidity was studied using the Care Register for Health Care and international classification of diseases codes. Hazard ratios (HR) were calculated using Cox proportional hazard model.

Results: In DH the risk for any neurological disease was not statistically significantly increased (HR 1.27; 95% CI 0.94-1.71), but Alzheimer's disease and extrapyramidal diseases were found to be more common in DH when compared with their references. In contrast, in celiac disease excess risks for any neurological disease (HR 1.31; 95% CI 1.09-1.56) and particularly for migraine and headaches were detected. The risk for any psychiatric disease was found to be decreased in DH (HR 0.65; 95% CI 0.47-0.90), as were the risks for anxiety and substance abuse. In celiac disease, increased risks for any psychiatric disease (HR 1.20; 95% CI 1.01-1.42), depression, and anxiety disorders were noted.

Conclusions: The neurological and psychiatric morbidity of patients with DH and celiac disease patients without DH seems to differ, but the reasons for this varying disease burden remain yet unidentified.

Background and aims: Evidence for cold snare polypectomy (CSP) in treating 10-19 mm colorectal adenomas in patients with familial adenomatous polyposis (FAP) is limited. This study compared the efficacy and safety of CSP vs. hot snare polypectomy (HSP). Methods: This prospective non-inferiority randomized controlled trial predefined a non-inferiority margin of 4%. A total of 452 colorectal adenomas (10-19 mm) from 41 FAP patients were enrolled between May 2024 and May 2025 and randomized 1:1 to CSP (n = 220) or HSP (n = 232). The primary endpoint was histological complete resection (R0). Subgroup analyses were performed by lesion size (10-15 mm vs. 16-19 mm). Results: R0 resection rates were similar between CSP and HSP (92.3% vs. 92.7%, p = 0.76). CSP was associated with shorter procedure time (4.53 ± 1.18 vs. 6.53 ± 1.46 min, p < 0.01) and lower hospitalization costs (p < 0.01). Intra-procedural bleeding was more frequent with CSP, whereas delayed bleeding and post-polypectomy electrocoagulation syndrome were more common with HSP. At 6 months, recurrence was rare (one lesion in each group). No significant interaction by lesion size was observed. Conclusions: CSP is non-inferior to HSP for R0 resection of 10-19 mm colorectal adenomas in FAP patients and offers advantages in efficiency, safety and cost.

Background and aim: Steatotic liver disease is subdivided into metabolic dysfunction-associated steatotic liver disease (MASLD), alcohol-related liver disease (ALD), and metabolic dysfunction- and alcohol-related liver disease (MetALD) based on alcohol intake. However, the diagnostic thresholds for alcohol consumption between subgroups are debatable. We aimed to determine whether low to moderate alcohol consumption compatible with the diagnosis of MASLD is associated with worsened cardiometabolic parameters and severity of liver injury.

Methods: We conducted a cross-sectional analysis using data from the 2017-2018 cycle of the National Health and Nutrition Examination Survey. Demographic variables, cardiometabolic parameters, and liver health indicators were compared between groups and within MASLD individuals stratified by level of alcohol consumption.

Results: Of 3,628 study participants, 1,498 (41.2%) met the criteria for MASLD diagnosis. Anthropometric parameters, including body mass index and waist circumference, as well as liver injury parameters such as liver stiffness and transaminase values, were significantly higher in individuals with MASLD compared to those without MASLD, despite similar reported alcohol consumption in both groups. However, there was no significant difference in the severity of liver injury or presence of cardio-metabolic risk factors when MASLD individuals were subdivided into 0, 1, and 2 alcoholic drinks per day for males, and 0 and 1 drinks for females.

Conclusions: Low to moderate alcohol consumption did not increase the liver injury or cardiometabolic risk among MASLD individuals. Further longitudinal cohorts are warranted using narrower ranges for alcohol consumption to ensure that the alcohol consumption thresholds in MASLD properly stratify risk.

Objectives: To investigate whether pancreatic steatosis is associated with the presence of pancreatic cysts among individuals with diabetes.

Material and methods: 158 individuals [mean age 66 ± 10 years, 81 (51%) female] with diabetes [135 (85%) had type 2 diabetes] participated in the study involving Magnetic Resonance Imaging (MRI), blood tests and anthropometric measurements. Pancreatic steatosis was estimated qualitatively by a radiologist as well as using the pancreatic fat fraction.

Results: Of 158 study participants, 78 (49%) had pancreatic cysts. The individuals with pancreatic cysts were older than those without cysts (69 ± 7 years vs. 63 ± 12 years, p = 0.002). Compared to the individuals without pancreatic cysts, those with pancreatic cysts had more often pancreatic steatosis (46 (59%) vs. 31 (39%), p = 0.011) and a higher pancreatic fat fraction (13% ± 10% vs. 9% ± 8%, p = 0.021). Likewise, the Odds Ratio (OR) for the presence of pancreatic cysts was 1.043 [95% confidence interval 1.007-1.082, p = 0.020] for pancreatic fat fraction and 2.272 [1.202-4.297, p = 0.012] pancreatic steatosis. The statistically significant association remained even after correction for multiple possible confounding factors (OR 1.045 [1.003-1.089, p = 0.035], and OR 2.588 [1.182-5.667, p = 0.017], respectively).

Conclusions: Pancreatic steatosis and older age are independently associated with the presence of pancreatic cysts in patients with diabetes. Despite some potential mechanistic links, prospective studies are needed to examine the possible causality.

Background and aims: Infliximab and adalimumab are first-line biological therapies in ulcerative colitis. Meta-analyses of randomized control trials indicate infliximab being more effective but observational studies indicate similar effect. Our aim was to compare short- and long-term efficacy of infliximab and adalimumab in bio-naive patients with ulcerative colitis in a real-world setting during the modern era of therapeutic drug monitoring and dose optimization.

Methods: We performed a retrospective multicentre observational cohort study. Patients initiating infliximab or adalimumab at four out-patient IBD-clinics between 2018 and 2022 were included.

Results: 105 patients were treated with infliximab and 166 with adalimumab. Steroid-free clinical remission at 12 months was reached in 43% (n = 37) of patients with infliximab and 35% (n = 55) with adalimumab (aOR: 1.41 (0.81-2.45), p = 0.22). Clinical remission at 3 months was more common with infliximab than adalimumab (68 vs. 57%, aOR 1.83 (1.07-3.14), p < 0.05) but no difference was observed regarding clinical response at 3 months, clinical remission at 12 months, and biochemical remission at 3 months and at 12 months. In the subpopulations with mild and moderate disease activity, infliximab and adalimumab were equal regarding clinical remission at 3 months and steroid-free clinical remission at 12 months. In patients with severe disease activity, infliximab had higher remission rates than adalimumab at 3 months; 70% (n = 32) vs. 46% (n = 26) (p < 0.05).

Conclusions: Adalimumab and infliximab achieved similar rates of long-term remission in bio-naive patients with ulcerative colitis. However, infliximab was superior in induction of remission and in patients with severe disease.

Background: Barrett's esophagus (BE) is a premalignant condition associated with gastroesophageal reflux disease (GERD) and an increased risk of esophageal adenocarcinoma (EAC). While Helicobacter pylori (H. pylori) has been proposed as a potential protective factor against BE, evidence remains conflicting, and clinical implications are uncertain. We aimed to investigate the association between H. pylori infection and BE in a largescreening cohort from Central Europe.

Methods: We analyzed data from 4,074 asymptomatic participants who underwent upper endoscopy at a single center as part of a colorectal cancer screening between 2007 and 2020. BE was defined by endoscopic evidence and histologic confirmationof specialized intestinal metaplasia. H. pylori status was determined histologically;endoscopic classification of H. pylori-associated gastritis was not used due to non standardized assessment. Multivariable logistic regression examined the association, adjusting for demographic, metabolic, and lifestyle confounders; univariable models were descriptive.

Results: BE prevalence was 1.2%, and H. pylori infection was present in 18.8% of participants, consistent with Austrian estimates (∼20%). No significant association was found between H. pylori infection and BE (adjusted OR 0.70, 95% CI 0.31-1.58, p = 0.395). Male sex (adjusted OR 3.45, 95% CI 1.66-7.20, p = 0.001) and active smoking (adjusted OR 2.15, 95% CI 1.02-4.54, p = 0.045) were the strongest independent predictors. Interaction analyses revealed no effect modification by age, sex, metabolic syndrome, or proton pump inhibitor use.

Conclusions: In this cohort, current H. pylori infection was not significantly associated with prevalent BE, and the adjusted effect estimate did not suggest a meaningful relationship.

Objective: To determine the incidence of rebleeding after initial endoscopic hemostasis for peptic ulcer bleeding. Furthermore, to investigate the risk factors for rebleeding, outcomes of this patient group and to assess the effect of prophylactic transarterial embolization (pTAE) in a setting without on-site interventional radiology.

Material and methods: This single-center retrospective cohort study included patients treated for peptic ulcer bleeding from 2020-2023 at Zealand University Hospital, Denmark. Follow-up was one year. A high-risk subgroup was defined as patients with duodenal ulcer, hemodynamic instability, and Forrest score Ia-IIb. Mortality risk was analyzed using Kaplan-Meier estimation. Patients undergoing pTAE were transferred to a tertiary center.

Results: A total of 174 patients were included. Rebleeding occurred in 28% and was associated with low BMI, smoking, duodenal ulcer, high-risk Forrest classification, and hypotension at admission. Rebleeding was linked to longer hospital stay and higher rates of adverse events, but no significant difference in mortality. The high-risk subgroup had significantly higher rebleeding rates and 90- and 365-day mortality. Ten patients (6%) underwent pTAE after initial endoscopic hemostasis with rebleeding and mortality rates equal to the non-pTAE group. Among 49 patients with rebleeding, 25% underwent pTAE after a second successful endoscopic intervention and had lower one-year mortality compared to those without pTAE (17% vs. 43%).

Conclusion: Rebleeding after initial successful endoscopic hemostasis for peptic ulcer bleeding was frequent and associated with adverse clinical outcomes, but not increased mortality. Patients undergoing pTAE after rebleeding had lower mortality, but the limited number of pTAE patients precluded firm conclusions on the effect.

Objectives: Hepatocellular carcinoma (HCC) is the 13th most common cancer in the U.S., causing approximately 30,000 deaths annually. Incidence has risen substantially over recent decades. This study examines trends in age-adjusted HCC incidence from 2004 to 2021.

Materials and methods: Incidence data for HCC (ICD-10 C22.0) from 2004 to 2021 were obtained from the Surveillance, Epidemiology and End Results (SEER) registry, representing 48% of the U.S. population. Rates were age-adjusted to the 2000 U.S. standard population and stratified by sex, race/ethnicity, age, and stage at diagnosis. Annual percentage changes (APCs) were calculated using Joinpoint regression with statistical significance set at p < 0.05.

Results and conclusion: From 2004 to 2015, overall HCC incidence increased (APC 3.16; p < 0.01), followed by a significant decline from 2015 to 2021 (APC -1.24; p < 0.01). Racial/ethnic subgroup trends varied: Hispanics, Non-Hispanic Blacks, and American Indian/Alaska Native populations showed rising incidence until 2015 with subsequent declines, while changes among Non-Hispanic Whites were less pronounced. After 2015, incidence declined among females (APC -0.27) and males (APC -1.85). Age-specific trends showed decreasing rates among individuals aged 35-49 and 50-64 years, with declines in those 65+ beginning in 2019. Localized-stage HCC incidence decreased after 2015, while regional trends fluctuated and distant-stage incidence continued to rise. Stage-specific patterns also differed by race. HCC incidence has declined overall since 2015, potentially reflecting improved hepatitis C therapy and risk-factor management. However, persistent or rising rates in specific demographic groups and increasing distant-stage diagnoses highlight ongoing disparities and the need for enhanced screening and early detection strategies.