Scandinavian Journal of Gastroenterology最新文献

Background: Celiac disease (CD) is an underdiagnosed disease with a significant diagnostic delay. Previous studies have shown associations between CD and several skin diseases.

Objective: The objective of this article was to investigate the association between undiagnosed celiac seropositivity and prevalence of self-reported skin symptoms and diseases in adults.

Methods: In a Danish population-based cohort comprising 9656 participants, we identified individuals with undiagnosed celiac seropositivity, defined by celiac antibody positivity against immunoglobulin (Ig) A and/or IgG tissue transglutaminase (TTG) ≥7 U/mL and/or IgG deamidated gliadin peptide ≥10 U/mL, without a known diagnosis of CD in the National Patient Register. Information on skin symptoms and diseases were obtained from participant-completed questionnaires. The associations between skin symptoms and diseases and undiagnosed celiac seropositivity were analyzed by ꭓ² or Fisher's exact test and logistic regression were used to calculate odds ratios (OR) with 95% confidence intervals (CI).

Results: We excluded 13 participants with a previous CD diagnosis and 386 participants due to missing measurements of CD antibodies, resulting in a study population of 9257 participants. In this population, 0.76% (70/9257) had undiagnosed celiac seropositivity. There were no statistically significant differences in skin symptoms and diseases between participants with and without undiagnosed celiac seropositivity; the OR for any skin symptom or disease was 0.83 (95% CI: 0.41-1.67) among individuals with undiagnosed celiac seropositivity compared with individuals without.

Conclusion: In this cross-sectional study, we found no differences in self-reported skin symptoms and diseases between participants with and without undiagnosed celiac seropositivity.

Background: Antiplatelet and anticoagulant therapy are associated with a significant risk of upper gastrointestinal bleeding (UGIB), as is the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Concomitant treatment with proton pump inhibitors (PPIs) has been shown to reduce the risk of this complication.

Aims: To compare the use of risk medications and PPIs in a cohort of adult patients with bleeding peptic ulcers or erosions in the stomach or duodenum with the background population.

Materials and methods: We performed a prospective observational study including 543 patients with endoscopically verified bleeding ulcers and/or erosions at two large hospitals in Norway. Information on risk medications taken prior to study enrolment was collected prospectively through structured interviews with patients and with the review of their medical records, whereas for the background population the information was obtained from The Norwegian Prescription Database (NorPD).

Results: Overall, 434 (80%) of the patients used risk medications, compared to 34% in the background population (p < 0.001). Only 39 (8.9%) of the patients received PPIs as co-medication, and 150 (34.6%) tested positive for Helicobacter pylori (H. pylori) infection.

Conclusions: Among patients with bleeding ulcers and erosions, we found a high prevalence of risk medication use and an underutilization of prophylactic PPIs. H. pylori infection appears to play a minor role.

Clinical trial registration: Bleeding Ulcer and Erosions Study "BLUE Study", ClinicalTrials.gov Identifier: NCT03367897.

Objectives: Gastroenterology clinics often assess hepatic steatosis using CAP-FibroScan, while radiology departments increasingly apply UGAP instead of subjective B-mode ultrasound. This study compares CAP and UGAP feasibility and diagnostic performance across steatosis stages, using PDFF as reference.

Materials and methods: Healthy controls and a cohort with known steatosis and fibrosis were examined between September 2022 and October 2024. Presence of steatosis (≥S1) defined as ≥5% PDFF, and presence of fibrosis was evaluated with MRE. Participants with even sex distribution were examined in supine and 30° left decubitus position; for UGAP, with normal (4 N) and (30 N) probe force. Diagnostic performance was evaluated by the area under the receiver operating characteristic curve (AUROC).

Results: In the group of N = 97 CAP demonstrated 91% feasibility in supine and 80% in lateral position. UGAP showed 100% feasibility for all examination techniques. The whole group was divided according to steatosis stages of PDFF. When differentiating ≥ S1, CAP supine accuracy was AUC 0.81 (95%CI: 0.71-0.92), and UGAP supine/30N accuracy was 0.88 (95%CI: 0.88-0.95). Differentiating S0 and S1 vs. S2 and S3, the CAP AUC was 0.81 (95% CI: 0.72-0.90), and the UGAP supine/30 N AUC was 0.93 (95%CI: 0.88-0.99). When differentiating S0, S1, and S2 vs. S3, the CAP AUC was 0.90 (95%CI: 0.83-0.97), and the UGAP supine/4N AUC was 0.97 (95%CI: 0.94-1.00). UGAP increased performance in both sexes using increased probe force.

Conclusions: UGAP provides absolute feasibility and higher diagnostic performance. CAP should not be performed in left position.

Patients with primary biliary cholangitis (PBC) consistently report low quality of life (QoL), but determinants of decreased QoL remain unresolved. We aimed to investigate the role of inflammation, fibrosis, and treatment response on QoL in PBC patients.

Method: We included 165 patients with 3 years of follow-up (n = 130). Annual visits included liver biochemistry, the macrophage activation marker sCD163, transient elastography (TE), and two QoL questionnaires (PBC-40 and SF-36).

Results: Median age was 62 years and 94% were female. Median QoL was normal (SF-36 mental and physical component summary scores [MCS and PCS] of 51.8 [IQR 41.1-58.1] and 49.1 [IQR 42.6-55.5], respectively). QoL was decreased in 32% (95%CI: 24-40%) and 33% (95%CI: 25-42%) of patients for MCS and PCS, respectively. Fatigue was the most frequent severe symptom (22%), while 13% reported clinically significant pruritus. Patients with cirrhosis (F4; TE > 16.9 kPa) had lower PCS scores than F0-F1 at baseline (p = 0.069) and after 3 years (p = 0.0026), whereas MCS and PBC-40 domains were similar across fibrosis stages. Higher sCD163 levels were associated with lower PCS (β = -0.56 [95%CI: -1.11 to -0.01], p = 0.044), with a stronger association among UDCA non-responders (β= -0.65 [95%CI: -1.27 to -0.02], p = 0.043). QoL remained stable over 3 years, with a minor improvement in the emotional domain (p = 0.040).

Conclusion: In Danish PBC patients, one-third had impaired QoL, primarily due to fatigue. QoL was reduced in cirrhosis but preserved in earlier fibrosis stages. Higher sCD163 was independently associated with lower physical QoL, particularly among UDCA non-responders.

Objective: Current guidelines recommend using the presence of alarm features to help determine if an upper endoscopy is appropriate as an initial diagnostic tool in young adults with dyspepsia. The study aimed to assess whether young adults without alarm features had clinically significant findings on gastroscopy.

Methods: This was a retrospective study on patients 18-50 years who underwent their first gastroscopy at Landspitali University Hospital 2018-2022. Data was collected on symptoms and endoscopic findings. American Society for Gastrointestinal Endocopy (ASGE) from 2015 were used to determine adequate indication for gastroscopy. The following were considered adequate indications: suspected gastrointestinal bleeding and/or iron deficiency anemia, dysphagia, persistent vomiting, unintentional weight loss, a family history of upper gastrointestinal cancer, or suspicious findings on imaging.

Results: Among 748 patients, 515/748 (69%) had an adequate indication, 52% males and 233/748 (31%) without. Endoscopic findings in the group with adequate indications were: esophagitis (20%), gastric ulcers (4.1%), duodenal ulcers (4.1%), esophageal ulcers (2.1%), gastric cancer (1.0%) and esophageal cancer (0.2%). Clinically relevant findings were rare in the group without an adequate indication and only 4/233 (1.7%) had a duodenal ulcer, all due to an H.pylori infection and only 1 gastric ulcer (0.4%). No cancers were diagnosed among those without an adequate indication.

Conclusions: Patients without alarm features were less frequently diagnosed with clinically significant diseases on gastroscopy compared to patients presenting with alarm features. No cancers were diagnosed in those without an adequate indication and clinically significant findings were rare in that group.

Objectives: The number of advanced therapies for inflammatory bowel disease (IBD) has increased in recent years. Ustekinumab, an inhibitor of interleukin -12 and -23, was mostly used for later-line treatment, where its efficacy may be reduced. Recent expiration of its patent and the introduction of affordable biosimilars introduced interest of using ustekinumab earlier as a first-line option. However, data on the effectiveness in the first-line setting remain limited. The aim was to evaluate the efficacy and treatment persistence of ustekinumab when used as a first-line treatment in IBD.

Materials and methods: This retrospective longitudinal cohortstudy included 71 naïve patients to advanced therapy who initiated first-line treatment with ustekinumab. Data on demographics, patient clinical characteristics, treatment persistence, serum concentrations of ustekinumab, and clinical, biochemical, and endoscopic outcomes, were collected. A Kaplan-Meier curve was performed to assess treatment persistence.

Results: Median follow-up was 20.8 months (interquartile range 11.3-48.5). One-year treatment persistence with ustekinumab was 88%, with a rate of 92% in Crohn's disease (CD), and 82% in ulcerative colitis (UC). Biochemical remission was achieved in 77.6% of patients based on C-reactive protein (≤5 mg/ml) and in 71.1% based on fecal calprotectin (<100 mg/kg). Endoscopic remission (absence of ulcers in CD and endoscopic Mayo ≤1 in UC) was observed in 58.3% of patients.

Conclusions: First-line treatment with ustekinumab demonstrates high treatment-persistence and is associated with substantial rates of clinical, biochemical, and endoscopic remission in patients with IBD.

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.

Background: This study aimed to identify tumor lesion-related factors associated with possible missed gastric cancer (PMGC) during screening endoscopy, with particular focus on cases following Helicobacter pylori (HP) eradication.

Methods: We analyzed consecutive gastric cancer (GC) cases detected at 11 health check-up institutions in Akita prefecture, Japan. The study focused on 171 GC cases with at least one negative endoscopy within the preceding 2 years. Based on histological assessment, GCs with pT1b or deeper invasion were classified as PMGCs. Their clinical characteristics were compared with those of the remaining pT1a GCs. A backward stepwise logistic regression analysis was performed to identify tumor lesion-related factors associated with PMGC.

Results: Among 171 GC cases, 39 (22.8%) were classified as PMGC, while the remaining 132 served as controls. Overall, 108 cases (63.2%) occurred in individuals with prior HP eradication, and eradication status was not statistically associated with PMGC. Multivariable regression analysis limited to post-eradication cases revealed that upper third location and undifferentiated histology were significantly associated with PMGC, with odds ratios (95% confidence intervals) of 5.65 (1.88-16.90) and 8.35 (2.22-31.40), respectively.

Conclusions: Undifferentiated histology and upper third location were associated with missed diagnoses of GC during screening endoscopy in individuals with prior HP eradication. These findings are clinically relevant for improving the quality of endoscopic examinations in health check-up settings, especially given the increasing prevalence of post-eradication GC.