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.

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.

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.

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.

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.