Scandinavian Journal of Gastroenterology最新文献

Background: Severe alcohol-associated hepatitis (AH) remains a major challenge in clinical practice due to its limited treatment options and high short-term mortality. Although corticosteroids have long been the mainstay of treatment, their use has been declining because of concerns about side effects and contraindications.

Aim: We aimed to summarize the current standards for corticosteroid use in severe AH, with a specific focus on differentiating absolute from relative contraindications.

Methods: This narrative review integrates evidence from randomized clinical trials, observational cohort studies, and contemporary guideline statements pertaining to corticosteroid therapy in severe alcohol‑associated hepatitis.

Results: The majority of individuals with severe AH present with concomitant complications such as infection, acute kidney injury, or gastrointestinal bleeding. Emerging data indicates that, with the developments in diagnostic methods, treatment strategies, and supportive care, that were previously considered absolute contraindications are now being recognized as relative. Corticosteroid treatment can be administered safely once certain concomitant conditions have been stabilized or resolved. On the other hand, such severe presentations, as identified by markedly elevated Maddrey's discriminant function, MELD score, or acute-on-chronic liver failure (ACLF) grade, determine a poor response to corticosteroid treatment and high risk of complications.

Conclusions: In the setting of severe AH, while certain conditions require a temporary corticosteroid treatment delay, others necessitate alternative approaches. Individuals with a low likelihood of responding, early liver transplantation, extracorporeal therapy, microbiota-based therapeutics, or palliative care should be considered in the earlier settings.

Aims: To investigate predictive factors in patients with non-curable malignant hilar biliary obstruction (mHBO) and identify those with a life expectancy of 30 days or less, who would not benefit from palliative biliary drainage.

Materials and methods: A retrospective analysis of consecutive palliative patients undergoing percutaneous or endoscopic biliary drainage for mHBO at Groote Schuur and Tygerberg Hospitals, Cape Town, between 1 January 2015 and 1 January 2023. Demographic and baseline clinical parameters, laboratory test results, tumour characteristics and intervention type were compared in patients who survived ≤ 30 days to those who survived > 30 days after index intervention.

Results: A total of 294 patients were included in the study, of whom 135 survived ≤ 30 days and 159 > 30 days. Regression analysis using a Cox proportional hazard model showed that Eastern Cooperative Oncology Group performance status ≥ 2, strictures secondary to hepatocellular carcinoma, serum levels of albumin < 30 g/L and serum levels of total and conjugated bilirubin > 250 μmol/L predicted survival of ≤ 30 days.

Conclusions: These predictive factors should be considered by the multidisciplinary team regarding the decision to perform biliary drainage during end-of-life care or rather proceed to solely medical and symptomatic relief in patients with non-curable mHBO.

Objectives: The real-world clinical course of hepatocellular carcinoma (HCC) remains poorly understood. We aimed to describe the prognosis of Danish patients with HCC treated with curative-intent resection or ablation strategies.

Methods: This was a population-based, historical cohort study of all patients with HCC within two Danish regions (population 2 million). Information was extracted from patients' medical records. Patients diagnosed with HCC in 2013-2023 and treated first-line with resection/ablation with curative intent were included. We used multistate models, competing risk analyses, and cause-specific Cox models to describe the clinical course and examine risk factors for recurrence.

Results: The cohort comprised 296 patients [79% male; median age 69 years (IQR 62-76); 60% (n = 179) with cirrhosis (alcohol-related, n = 76; viral hepatitis-related, n = 57)] treated first-line with resection (40%; n = 117) or ablation (60%; n = 179). The risk of early recurrence (within 2 years) was 55% (95% CI 50-61) and similar for resection- and ablation-treated patients. Five years post resection/ablation, 10% of patients remained alive and recurrence-free. Alpha-fetoprotein was a strong predictor of recurrence, and a high Child-Pugh score and high comorbidity burden were predictors of death without recurrence. The 10-year probability of receiving systemic treatment was 24%. For the total cohort, the median survival time was 3.5 years (IQR 1.5-5.9) and the median recurrence-free survival time was 1.1 years (IQR 0.5-2.4).

Conclusion: This population-based real-world study demonstrated that current curative-intent treatment strategies for early HCC are insufficient for long-term disease control, and that we need more effective management and follow-up of patients with HCC.

Background: To evaluate the efficacy and safety of potassium-competitive acid blockers (P-CABs) versus proton pump inhibitors (PPIs) in the treatment of gastroesophageal reflux disease (GERD) through a meta-analysis, explores the preliminary pharmacoeconomic advantages.

Methods: Randomized controlled trials (RCTs) comparing P-CABs and PPIs for GERD treatment were identified from database, up to July 2025. After processing the studies and extracting the data. RevMan and Stata was used for data analysis. A preliminary pharmacoeconomic analysis was performed based on market survey data.

Results: A total of 10 RCTs (5133 participants) were included. P-CABs demonstrated better overall efficacy than PPIs [risk ratio (RR) = 0.72, P = 0.02]. Sensitivity analysis indicated higher applicability in Asian populations (RR = 0.69, P = 0.01). Subgroup analysis showed P-CABs had a significant advantage over lansoprazole (P < 0.001, RR = 0.50), but not over esomeprazole (P = 0.93). P-CABs were superior in the low-dose group, 2-week and 8-week treatment courses group. In the high-dose P-CABs group, 4-week treatment courses group, heartburn relief group and adverse event rates were comparable to PPIs. Pharmacoeconomic analysis revealed that CER_P-CABs ≈ 0.1 CNY/day (d)/1%cure rate (1%CR); CER_PPIs ≈ 0.01 CNY/d/1%CR; ICER = 3.125 CNY/d/1%CR.

Conclusions: P-CABs demonstrate relatively greater efficacy than PPIs, especially in Asian populations. However, in terms of symptom relief, mid-term efficacy and safety both classes show comparable effects. PPIs are more cost-effective in specific contexts. Due to the limited follow-up duration in the included studies, the conclusions are applicable only to short-term symptom control.

Objectives: Systemic mastocytosis (SM) is a rare hematopoietic disease, in which gastrointestinal (GI) problems are common. There are no valid instruments for assessing GI problems in patients with SM. As the symptoms often mimic irritable bowel syndrome (IBS), the objective was to assess the validity of instruments designed to measure IBS related GI problems in this group of patients.

Methods: The study was performed as an exploratory multimethod study. The Gastrointestinal Symptom Rating Scale (GSRS) and the Visceral Sensitivity Index (VSI) were found to be the most appropriate and were administered to 393 adults with SM. The response rate was 78%. Of these, 147 (48%) reported having GI-problems due to SM and were thus included in this study. Reliability was assessed using Cronbach's alpha, whereas construct validity was examined through exploratory factor analysis.

Results: Internal consistency measured with Cronbach's alpha coefficient was overall good/excellent for the GSRS total scale (α = 0.88) and subscales (α = 0.72-0.84) and for the VSI (α = 0.93). The exploratory factor analysis revealed four factors for the GSRS (indigestion, diarrhea, constipation, pain/reflux) and two factors for the VSI (worries related to internal GI symptoms, external factors related to GI problems).

Conclusions: Based on our results, we propose using the GSRS for measuring physical GI problems and the VSI for measuring psychosocial consequences and/or worries related to GI problems in the SM population. The instruments could be used to highlight GI problems in both clinical care and research.

Clinical trial.gov registration: Trial registration number: NCT06065007.

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.

Background and aims: Data are limited on how histology and noninvasive tests (NITs) for fibrosis severity in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) can predict future events. We aimed to confirm the prognostic capacity of liver fibrosis to predict major adverse liver outcomes (MALO), and to confirm previous findings of similar prognostic capacity between invasive and noninvasive fibrosis tests on long-term outcomes.

Methods: This longitudinal observational cohort study (1974-2020) used data from adults with biopsy-defined MASLD from three Swedish university hospitals linked to national registers. Risks for MALO and major adverse cardiovascular events (MACE) were estimated using multivariable adjusted Cox regression models.

Results: Median (mean) follow-up for the overall population (N = 959) was 11 (15) years; 103 (10.7%) developed MALO and 245/867 patients without baseline cardiovascular disease (28.3%) developed MACE. The risk of long-term MALO was significantly lower in patients at fibrosis stage F0, F1 and F2, compared with F4, but not between stages F3 and F4. No significant associations were observed between other histological features and incident MALO. Neither fibrosis stage nor histological features were significantly associated with incident MACE. Biopsy-defined fibrosis staging and Fibrosis-4 Index (FIB-4) scoring had similar predictive performance with unadjusted C-index (95% confidence interval) values for MALO of 0.77 (0.71-0.82) and 0.75 (0.69-0.80) and for cardiovascular-related outcomes 0.58 (0.53-0.60) and 0.65 (0.61-0.68), respectively.

Conclusions: These data confirm the importance of liver fibrosis as the main predictor of long-term MALO. FIB-4 may aid in risk assessment and in predicting outcomes in MASLD.

Background: Endoscopic biopsies are insufficient for the correct diagnosis of gastric lesions since there has been described a discrepancy rate between endoscopy biopsies and endoscopic resection specimens of 25-32%. The aim of this study was to evaluate factors associated with upstaging and downstaging of biopsy results following gastric endoscopic submucosal dissection (ESD).

Methods: Retrospective, cohort study including consecutive patients who underwent gastric ESD after an initial upper endoscopy with the diagnosis of a gastric lesion harboring dysplasia or adenocarcinoma, confirmed by forceps biopsy.

Results: A total of 215 patients were included, most patients were male (66.0%), with a mean age of 68 ± 8 years. Most lesions were located in the antrum (62.3%). Upstaging was observed in 70 patients (32.6%): 43 patients from low-grade dysplasia (LGD) to high-grade dysplasia (HGD); 9 from LGD to adenocarcinoma; and 18 patients from HGD to adenocarcinoma. Patients with upstaging had significantly larger lesions (18 vs 15 mm, p < 0.001) and had more frequently ulcerated lesions (10.0% vs 2.9%, OR 3.778, p = 0.045). Five patients (2.3%) had downstaging, from HGD to LGD. Patients with downstaging were significantly younger (61 ± 8 vs 68 ± 8 years, p = 0.035) and were more frequently active smokers (60.0% vs 14.3%, OR 9.000, p = 0.028).

Conclusion: The diagnostic discrepancy rate between the initial forceps biopsy and the ESD specimen was 34.9%. Patients with larger or ulcerated lesions were more likely to have an upstaging pathological result. Therefore, it is essential to perform a thorough evaluation of the lesions, including chromoendoscopy and magnification.