Scandinavian Journal of Gastroenterology最新文献

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.

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: Perihilar cholangiocarcinoma (pCCA) is a rare malignancy originating from the bile duct bifurcation which is often diagnosed in an advanced stage. At presentation, most patients present with jaundice requiring biliary drainage. Palliative chemotherapy (pCTx) has a positive impact on survival and quality of life. The primary aim of this study was to investigate the impact of biliary drainage on pCTx initiation in patients with non-resected pCCA.

Methods: Individual patient data from all Dutch patients diagnosed with non-resected pCCA between 2015 and 2020 were retrieved from the Netherlands Cancer Registry. Primary outcome were factors associated with initiation of pCTx, analysed by multivariable competing risk regression analysis.

Results: A total of 1265 patients were included, of whom 242 patients (19.1%) received pCTx after a median interval of 72 days [IQR 43-110 days] after initial presentation. Patients who underwent biliary drainage did not receive pCTx more often. If performed, drainage at a referral hospital (HR:0.65, 95%CI: 0.42-0.99), ≥3 drainage procedures performed (HR:0.53, 95%CI: 0.32-0.88), and drainage performed ≥14 days after presentation (HR:0.70, 95%CI: 0.49-0.99) were associated with no pCTx. Median overall survival for those who received pCTx and those who did not was 12.8 months [95%CI: 11.7-14.2] and 2.7 months [95%CI: 2.4-3.1].

Conclusion: The need for biliary drainage did not affect the initiation of pCTx. When indicated, biliary drainage should be performed as quick as possible in an academic center to improve the rate of patients receiving pCTx.

Background: Iron deficiency is common in patients with inflammatory bowel disease (IBD) and may lead to a variety of distressing symptoms negatively impacting quality of life.

Aims: This prospective observational cohort study aimed to assess quality of life, measured using the Short Form-36 (SF-36) questionnaire before and after treatment with high-dose intravenous iron in patients with IBD and iron deficiency.

Materials and methods: Over a 15-month period, 130 patients with a well-established diagnosis of IBD (either ulcerative colitis (UC) or Crohns disease (CD)) and confirmed iron deficiency were consecutively assessed for study eligibility at two university hospitals in South-Eastern Norway. Of these, 112 patients were included in the per protocol set. Demographic characteristics were recorded at study inclusion. Clinical, and biochemical variables, as well as SF-36 questionnaires were collected just before and 5-7 weeks after treatment with intravenous iron.

Results: An improvement was observed in six of the eight SF-36 domains six weeks after treatment with intravenous iron. Females had lower scores compared to males at both visits, but there were no differences between UC and CD patients. Both sexes and the two diagnoses had a significant increase in vitality scores. Haemoglobin level was a significant predictor for improvement of quality of life.

Conclusions: Treatment with high dose intravenous iron improves quality of life in IBD patients and iron deficiency and particularly in those with anaemia. The most significant improvements were observed in vitality and energy levels, suggesting a clinically meaningful change.

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.

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.

Background: The incidence of early-onset colorectal cancer (EOCRC; ≤50 years) has been increasing globally. High BMI is a recognized predisposing factor for colorectal cancer, but its contribution to EOCRC is not yet fully understood. We conducted an updated systematic review and meta-analysis of cohort studies to clarify the association between BMI and EOCRC risk. Methods: Following PRISMA guidelines, PubMed, EMBASE, Scopus, Science Direct, and Web of Science were searched through August 2025. Eligible studies reported BMI measured prior to diagnosis and EOCRC outcomes. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using random-effects models. Subgroup analyses by sex, region, and age cut-offs were performed.

Results: Eleven cohort studies were included. In the primary analysis (EOCRC defined as <50 years), compared with normal weight, overweight/obesity (combined as BMI ≥25 kg/m²) was significantly associated with higher EOCRC risk (OR = 1.59, 95%CI: 1.25-1.93). Stratified analyses showed a modest increase with overweight (OR = 1.24, 95%CI: 1.07-1.40) and a stronger association with obesity (OR = 1.81, 95%CI: 1.08-2.55). Sensitivity analyses using ≤55 years as the cutoff confirmed robustness of results (OR = 1.63). Sex-specific analyses indicated greater risk among men (OR = 1.50) than women (OR = 1.16). Regional variations were observed, with the strongest associations in North America and Europe.

Conclusions: Our findings indicated that elevated BMI could be associated with increased risk of EOCRC, particularly among obese individuals and men. These findings highlight obesity as a modifiable risk factor and underscore the importance of weight management strategies in younger populations to mitigate the rising global burden of EOCRC.

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.