Scandinavian Journal of Gastroenterology最新文献

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.

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/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: 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 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.