Scandinavian Journal of Gastroenterology最新文献

Introduction: This systematic review and meta-analysis aimed to assess the safety and efficacy of oral microbiome therapy (OMT) for the treatment of recurrent Clostridioides difficile infection (CDI).

Methods: A comprehensive search was performed in PubMed, Cochrane library, Scopus and Embase. All randomized controlled trials (RCTs) meeting predefined inclusion criteria were included. Statistical analysis was performed using R software.

Results: Three RCTs comprising 469 patients were analyzed, of whom 250 (53%) received OMT and 219 (47%) received placebo. OMT significantly reduced CDI recurrence at week 8 compared to placebo (risk ratio [RR] 0.57; 95% confidence interval [CI] 0.33-0.99; p = 0.04). In exploratory efficacy analyses, no significant differences in recurrence were observed between groups when stratified by prior fidaxomicin use (RR 0.36; 95% CI 0.03-4.01; p = 0.40) or vancomycin use (RR 0.68; 95% CI 0.30-1.55; p = 0.35). Similarly, Firmicutes engraftment at week 1 (mean difference [MD] 41.78; 95% CI -10.55 to 94.11; p = 0.12) and week 8 (MD 34.06; 95% CI -2.49 to 70.61; p = 0.07) did not show statistically significant between-group differences. Safety outcomes and adverse events were comparable between OMT and placebo.

Conclusion: OMT seems to reduce CDI recurrence at week 8 compared with placebo while demonstrating a comparable safety profile, supporting its role as an effective, well-tolerated therapy for recurrent CDI. New studies are necessary to confirm these findings.

Registration: The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251022230.

Background: Coeliac disease (CeD) affects 1-2% of the western population. Diagnosis is based on serology and duodenal biopsy, but serology-based diagnosis in adults has been approved in Europe.

Objective: To evaluate the diagnostic performance of IgA anti-transglutaminase 2 (IgA-TG2) and IgG anti-deamidated gliadin peptides (IgG-DGP), and their combinations, compared with biopsy in a real-world secondary care setting.

Methods: Adult patients referred to secondary care endoscopy service at Oslo University Hospital for suspected CeD were invited to participate. CeD diagnosis followed European and Norwegian guidelines, requiring positive serology and mucosal damage.

Results: Among 312 evaluable patients, 215 were diagnosed with CeD between 2018 and 2024. Analysis of IgA-TG2 above threshold (>4 U/ml) showed 93% specificity and 94% sensitivity, while IgG-DGP (>20 U/ml) showed 88% specificity and 83% sensitivity. In ROC analyses, the AUC values were 0.98 and 0.95, respectively. Higher threshold (2x, 3x, 5x and 10x ULN) of IgA-TG2 increased specificity (99% to 100%) but lowered sensitivity (82% to 49%). Using IgG-DGP did not increase specificity but detected six missed CeD cases by IgA-TG2. Forty-two percent (n = 92) of cases could be diagnosed with a no-biopsy approach with 10x ULN IgA-TG2 at referral with 100% specificity.

Conclusion: Serology correlates strongly with histological changes, supporting diagnosis without gastroscopy. A 10x ULN threshold shows excellent specificity at the expense of sensitivity, thus lower thresholds may be preferable due to diminishing gains in specificity. IgG-DGP serves as a valuable complementary marker, that improves sensitivity and helps identify patients with weak IgA-TG2 responses.

Background: Inflammatory bowel disease (IBD) is often diagnosed during reproductive age, requiring adequate management during pregnancy. Physiological changes during pregnancy affect liver enzymes, complicating interpretation in a population prone to liver test abnormalities. This study aims to investigate liver enzyme trends throughout pregnancy in women with IBD.

Methods: A retrospective cohort study was conducted in three Dutch university hospitals. Pregnant women with IBD were included; liver enzyme levels were analyzed throughout pregnancy using Bayesian modeling. The association between liver enzymes and IBD disease activity, medication, pregnancy and adverse pregnancy outcomes was assessed, with estimated marginal means (EMMs) reported across trimesters and clinical subgroups.

Results: Liver enzyme levels exhibited significant trimester-specific variations in pregnant individuals with IBD. Levels of aminotransferases, γ-glutamyl transferase (γGT) and bilirubin generally declined, particularly in the second trimester, whereas alkaline phosphatase (ALP) levels increased markedly in the third trimester, mirroring physiological changes observed in healthy pregnancies. Adverse pregnancy outcomes were not associated with differences in liver enzyme levels. Several medications - particularly ustekinumab, vedolizumab, thiopurines, corticosteroids and amino salicylates - were associated with liver enzyme values or interacted with pregnancy, modulating the direction or magnitude of change. However, these effects were generally modest and remained within reference values.

Conclusions: In pregnant women with IBD, changes in liver enzyme levels reflect physiological gestational adaptations rather than pharmacologic effects. Although medication-specific interactions were detected, their clinical significance appears limited. Marked elevations in liver enzymes during pregnancy cannot routinely be attributed to IBD activity or medication and warrant urgent analysis.

Aim: Gastroesophageal reflux disease (GERD) is closely linked to esophageal motility dysfunction. While high-resolution manometry (HRM) remains the gold standard for evaluating esophageal motility, the conventional single water swallow (SWS) protocol may not fully capture motility abnormalities. This study investigates esophageal motility characteristics in GERD patients using solid food swallows (SFS) to better assess clinically relevant dysfunction.

Methods: Esophageal motility parameters were compared between GERD and non-GERD groups during both SWS and SFS. Correlations between SFS findings and dysphagia symptoms, endoscopic findings and reflux metrics were analyzed, followed by multivariate regression to identify independent GERD risk factors.

Results: Among 151 participants, 54 were diagnosed with GERD. Impaired SFS esophageal body motility was more prevalent in GERD versus non-GERD patients (p < 0.01). Moreover, the GERD group exhibited significantly higher rate of esophageal hypomotility during SFS compared to SWS (p < 0.001). With SFS testing, 35.2% (19/54) of GERD with normal SWS esophageal motility demonstrated Impaired SFS esophageal body motility. Multivariate analysis identified SFS esophageal body hypomotility (OR: 5.158, 95%CI: 2.439-10.909, p < 0.001) as independent GERD predictors. The prevalence of dysphagia symptom and esophagitis were higher in patients with esophageal hypomotility of SFS. Distal contractile integral of SFS positively correlated with mean nocturnal baseline impedance (r = 0.393), while inversely correlating with supine bolus clearance time (r=-0.326) and acid exposure (r=-0.403).

Conclusions: SFS unmask clinically significant esophageal dysmotility in GERD patients that SWS miss, revealing pathophysiology linked to prolonged acid exposure and mucosal injury. SFS-enhanced HRM protocols may improve GERD evaluation and risk stratification.

Background: This meta-analysis aimed to evaluate the association between distinct KRAS mutations and overall survival (OS) in pancreatic ductal adenocarcinoma (PDAC) patients.

Methods: A comprehensive literature search was conducted across major databases to identify studies reporting hazard ratios (HRs) and 95% confidence intervals (CIs) for OS associated with key KRAS mutations (G12D, G12R, and G12V) in PDAC patients, from inception until January 2025. Subgroup analyses were carried out based on disease stage (resectable and borderline resectable as early-stage disease and locally advanced and metastatic as late-stage disease) and treatment approaches (operation, chemotherapy, or combination of both).

Results: KRAS G12D mutation was significantly associated with poor OS (HR = 1.64, 95% CI: 1.28-1.99, p < 0.05). In subgroup analysis, G12D mutation was significantly associated with poor OS in those receiving chemotherapy (HR = 1.29, 95%CI: 1.18-1.39, p < 0.05) and in those with late-stage disease (HR = 1.29, 95%CI: 1.18-1.39, p < 0.05). G12R was significantly associated with improved OS in patients receiving chemotherapy (HR = 0.74, 95% CI: 0.56-0.99, p = 0.042). G12V had a significant association with improved OS in patients with early-stage disease (HR = 0.67, 95% CI: 0.52-0.86, p = 0.002).

Conclusions: The study highlights the heterogeneous prognostic impact of KRAS mutations in PDAC. These findings suggest that the prognostic relevance of KRAS mutations in PDAC may depend on clinical factors such as treatment modality and disease stage.

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.

Purpose: The sucrase-isomaltase (SI) gene encodes sucrase-isomaltase enzyme found on the intestinal brush-border that has a major function in the hydrolysis of sucrose, oligosaccharides, and starch. Mutations disrupting its function cause genetic sucrase-isomaltase deficiency (GSID). Variants leading to mild to moderate reductions in enzyme activity may mimic disorders of gut-brain interaction (DGBI), and differentiating the etiology is crucial for initiating appropriate treatment. In this study, we aim to determine the rate of GSID in individuals who underwent whole exome or clinical exome sequencing (WES/CES) for indications other than chronic gastrointestinal symptoms in a single-center cohort. We also focused on a second group, the pediatric DGBI patients, who underwent SI gene analysis, to evaluate the rate of GSID in pediatric DGBI patients and assess the clinical utility of SI gene testing in GSID diagnosis.

Methods: We retrospectively reviewed 980 patients who underwent WES/CES between 2017-2022, and 148 pediatric patients with DGBI evaluated between May 2021 and August 2022 who received SI gene analysis.

Results: The frequency of symptomatic GSID was found to be 0.3% among patients who underwent WES/CES, whereas it was 10% among pediatric DGBI patients. In DGBI patients carrying SI gene mutations, clinical improvement with a sucrose- and starch-free diet in combination with a sacrosidase response proved effective for establishing a diagnosis in all cases.

Conclusion: GSID has been frequently detected among pediatric DGBI patients. SI gene analysis combined with a sucrose-restricted diet and a sacrosidase challenge provides a reliable, non-invasive approach for definitive diagnosis.

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.