United European Gastroenterology Journal最新文献

Background: Data about the clinical significance and outcome of patients with nodular regenerative hyperplasia are limited.

Objective: The aim of this study was to describe the clinical and histopathological characteristics of patients with nodular regenerative hyperplasia and compare our findings with the literature.

Methods: From January 2015 to March 2021, patients with a diagnosis of nodular regenerative hyperplasia were included. They were extracted from the database of the pathology department of Cliniques universitaires Saint-Luc. Clinical and histological data were retrospectively recorded and complications of portal hypertension and mortality were analyzed. We also performed a systematic review of the literature.

Results: Eighty-two histology-proven nodular regenerative hyperplasia were included. The mean age at diagnosis was 58 ± 14 years. At least one clinical sign of portal hypertension was present in 37 patients (45%), and liver tissue sampling was performed for 29 of them for evaluation of portal hypertension. Conversely, nodular regenerative hyperplasia was an incidental discovery in 27 patients (33%), mostly after liver resection for metastasis (n = 15) or protocol biopsy in liver-transplanted patients (n = 9). The 5-year liver-related mortality was 5%. The 5-year non-liver-related mortality was 20%. Patients diagnosed by clinical suspicion (n = 55) were compared to patients diagnosed incidentally (n = 27). Patients with an incidental diagnosis had more frequently a condition associated with nodular regenerative hyperplasia than patients diagnosed clinically (93% vs. 66%, p = 0.008) and they developed significantly lower liver-related complications (4% vs. 27%, p = 0.01). A systematic review allowed us to compare our patients with 10 case series in the literature.

Conclusion: The clinical spectrum of patients with nodular regenerative hyperplasia is heterogeneous, including patients with clinical liver manifestations and patients diagnosed incidentally who could remain free of liver-related complications. This suggests that nodular regenerative hyperplasia could be a histological epiphenomenon as well as a clinical entity.

Background: Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus. Chronic inflammation has been linked to cancer development. We aimed to study the potential association between EoE and later cancer diagnosis.

Methods: In this nationwide population-based cohort study, we identified 1580 individuals with EoE diagnosed between 1990-2017 through Sweden's 28 pathology departments. Up to five general population reference individuals were matched on age and sex (n = 7533). A Cox regression analysis estimated adjusted hazard ratios (aHRs) for cancer up until December 31, 2020. To reduce potential intrafamilial confounding, we also compared EoE individuals with their unaffected siblings.

Results: During a median follow-up of 7 years, 47 individuals with EoE (3.9/1000 person-years) developed cancer versus 183 (3.2/1000 person-years) reference individuals. This corresponded to a non-significant aHR of 1.11 (95% CI = 0.80-1.53). Incidence rates were independent of budesonide and proton-pump inhibitor use. Individuals with EoE however did have an increased risk of esophageal cancer where two EoE versus one reference individual were diagnosed (aHR = 25.20; 95% CI = 2.28-278.80), and also Barrett's esophagus risk was also increased in EoE (HR = 18.18; 95% CI = 6.75-48.95). Non-esophageal gastrointestinal (GI) cancer occurred in 11 EoE versus 24 reference individuals: aHR = 2.03 (95% CI = 0.99-4.18). We found no increased risk of cancers from the skin (EoE n = 10), lung (n = 0), breast (n = 4), or blood (n = 0). Sibling analyses supported these findings.

Conclusion: We did not find any overall association between EoE and cancer development. EoE was associated with esophageal cancer, but this was very rare with wide confidence interval and few cases therefore we urge caution with generalization of these findings.

Introduction: A rational discussion of the impact of Pain, Fatigue and Bowel Incontinence on the Quality of Life of People Living With Inflammatory Bowel Disease: A UK Cross- Sectional Survey.

Conclusion: To help Inflammatory Bowel Disease patients manage symptoms and improve quality of life by incorporating a multifaceted community health strategy that goes beyond routine symptomatic treatment.

Background: Patients with a history of metabolic and bariatric surgery (MBS) are susceptible to developing alcohol use disorder, potentially resulting in end-stage liver disease, with a paucity of data on the evolution of cirrhosis.

Aims: Our aim was to describe the demographics and mortality in hospitalizations over time in individuals diagnosed with cirrhosis due to alcohol-associated liver disease (ALD) in relation to prior MBS.

Methods: We included patients hospitalized at the Ghent University Hospital between 1/1/2010 and 01/09/2023 with cirrhosis due to ALD. Data were retrieved retrospectively from all hospitalizations.

Results: 46/275 (16.7%) of individuals with cirrhosis admitted with ALD had a history of MBS; they were predominantly female (76.1%), in contrast to the non-MBS population (29.7%) (p < 0.0001) and were significantly younger at the time of diagnosis (46 vs. 58 years, p < 0.0001). Liver disease evolved at a faster pace in the MBS group with a shorter time to first hospitalization (5 vs. 13 months, p = 0.036), and consecutive hospitalizations. The proportion with primary hospitalization due to acute-on-chronic liver failure (ACLF) was significantly larger in the MBS group (60.9% vs. 27.6%, p < 0.0001), and throughout the following hospitalizations, ACLF remained more prevalent in the MBS group. Modeled transplant-free survival was lower in the MBS group (p = 0.004), with ACLF as the main cause of death. The weekly amount of alcohol consumed during drinking periods and duration of use were significantly lower in the MBS group.

Conclusions: MBS patients hospitalized with ALD develop acute decompensation at a faster pace, with more overall ACLF hospitalizations, and higher cumulative mortality, despite being 12 years younger on average.

Clinical trial registration: Not applicable.

The incidence and prevalence of pancreatic neuroendocrine neoplasms are steadily increasing. These tumors are highly heterogeneous, with treatment options ranging from observation to surgery, and various medical therapies. The choice of treatment is influenced by factors such as tumor stage, grade (proliferative activity), and the presence of hormone-related syndromes. Endoscopic ultrasound (EUS) is becoming increasingly valuable for assessing pancreatic neuroendocrine neoplasms, offering detailed morphological, vascular, and functional information through techniques such as contrast enhancement and elastography. It also allows biopsies that are useful for both histopathological and molecular analyses. These tumors are highly heterogeneous, with treatment options ranging from observation to various medical therapies and surgery. Recent data suggest that small, non-functioning PanNENs with low proliferation rates may be safely monitored, whereas more aggressive or functioning tumors typically require surgery. EUS-guided ablation is a promising alternative for patients with functional pancreatic neuroendocrine neoplasms who are unsuitable for surgery, although randomized trials are needed. In non-resectable pancreatic neuroendocrine neoplasms, treatment options include somatostatin analogs, targeted therapies (e.g., everolimus, sunitinib), chemotherapy, and radioligand therapy. This review discusses key factors in planning personalized treatment strategies for pancreatic neuroendocrine neoplasms.

Crohn's Disease (CD) can affect any part of the gastrointestinal (GI) tract, including the upper GI tract (UGIT). However, the definitions and classifications of upper GI CD (UGICD) vary. We conducted a scoping review to explore how UGIT and UGICD are defined and to assess the heterogeneity of these definitions in published CD guidelines, aiming to inform future initiatives for harmonizing definitions. We conducted a search of MEDLINE and Embase for English-language guidelines on CD that mentioned upper GI-related terms in the titles, abstracts, or keywords from inception until 26 July 2024. Definitions of UGIT and UGICD were summarized descriptively. Of 1132 citations, only 19 records met our inclusion criteria. Only eight were identified as CD guidelines. None of them focuses on UGICD. Among these, five diagnostic guidelines explicitly mentioned "upper GI" in their abstracts. Only the joint European Crohn's and Colitis Organisation and European Society of Gastrointestinal and Abdominal Radiology guidelines clearly defined the UGIT. Most guidelines mentioned UGI terms related to upper endoscopy or biopsy only. It was unclear whether these guidelines typically included the esophagus, stomach, and duodenum in the definition of UGICD while excluding the distal small intestine. Although the latest guideline related to pediatric-onset IBD cited the 2011 Paris classification, none of the three guidelines published after that explicitly mentioned the proposed subdivided location of the upper disease. There is a lack of consistent reporting in defining UGICD according to disease location. It is unclear whether there is a consensus on excluding the small intestine beyond the duodenum. Additionally, there is no indication that the subdivided location of UGIT was considered in CD guideline development. Greater consistency in definitions would aid in diagnosis, clinical care, epidemiological research and inclusion into clinical trials. These findings underscore the need for developing a framework to standardize the classification of UGICD, especially for clinical trials.

Pancreatic ductal adenocarcinoma (PDAC) ranks among the leading causes of cancer-related deaths worldwide. Despite advances in precision oncology in other malignancies, treatment of PDAC still largely relies on conventional chemotherapy. Given the dismal prognosis and heterogeneity in PDAC, there is an urgent need for personalized therapeutic strategies to improve treatment response. Organoids, generated from patients' tumor tissue, have emerged as a powerful tool in cancer research. These three-dimensional models faithfully recapitulate the morphological and genetic features of the parental tumor and retain patient-specific heterogeneity. This review summarizes existing precision oncology approaches in PDAC, explores current applications and limitations of organoid cultures in personalized medicine, details preclinical studies correlating in vitro organoid prediction and patient treatment response, and provides an overview of ongoing organoid-based clinical trials.

Background: Janus kinase (JAK) inhibitors, filgotinib (FIL) and upadacitinib (UPA) have emerged as promising treatments for ulcerative colitis (UC). However, a comparative analysis of these JAK inhibitors, particularly in patients previously treated with tofacitinib (TOF), has not been performed.

Aims: To compare the efficacy and safety of FIL and UPA in patients with UC, including those previously exposed to TOF.

Methods: A multicentre retrospective cohort study was conducted to compare the effectiveness and safety of FIL and UPA in patients with UC whose treatment was initiated between March 2022 and December 2023. The co-primary outcomes were clinical response and remission at week 8. The secondary outcomes included treatment persistence and adverse events (AEs). Modified Poisson and Cox regression models with multivariable analysis to adjust for confounders and propensity score matching were conducted. Subgroup analyses stratified by previous exposure to TOF and biologics were also conducted.

Results: In total, 168 patients (98 treated with FIL and 70 treated with UPA) were enrolled in this study, with a median follow-up period of 181 days. The clinical response/remission rates at week 8 were 55.1/46.9% for FIL and 71.4/65.7% for UPA, respectively. UPA was associated with significantly higher rates of clinical response (adjusted risk ratio [RR] 1.40 [95% confidence interval [CI], 1.09 to 1.80]) and clinical remission (adjusted RR 1.54 [95% CI, 1.16 to 2.05]) compared with FIL. This result was consistent across subgroup analyses based on previous exposure to TOF or biologics, except for bio-naive patients. There was no significant difference in the treatment persistence. AEs were more frequent with UPA (45.7%) than with FIL (24.5%) (p = 0.0049). Propensity score matching confirmed the superior overall effectiveness of UPA.

Conclusions: UPA demonstrated better short-term effectiveness than FIL, with a higher incidence of AEs.

Background: Eosinophilic esophagitis (EoE) predominantly affects males across all ages; however, little is known about sex differences for other aspects of EoE.

Objective: To investigate associations between sex and clinical presentation, endoscopic features, treatment choice and response in EoE patients in real-world practice.

Methods: Cross-sectional analysis of the multicenter EoE CONNECT registry. The independent contribution of patients' sex and other relevant variables were statistically assessed by multivariate models.

Results: A total of 2976 patients (76% male) were evaluated. Males were diagnosed at a younger age compared to females (32.7 ± 14.8 vs. 34.8 ± 15.6 years, respectively; p = 0.002) with similar diagnostic delay. EoE symptoms varied significantly between sexes, with food impaction predominating in males and dysphagia, heartburn, regurgitation and abdominal and epigastric pain in females. However, female sex contributed to higher symptom severity at diagnosis as measured with Dysphagia Symptom Score (R² = 0.57; p = 0.013) and presented higher peak eosinophil count in esophageal biopsies (p = 0.005). Males showed increased risk of stricturing or mixed phenotypes (adjusted OR 1.43, 95%CI:1.05-1.96; p = 0.024). No association was found between patients' sex and first-line treatment modality: proton pump inhibitors (PPI) were preferred over topical corticosteroids in patients with inflammatory phenotypes instead of stricturing or mixed phenotypes, and in patients who did not present food impaction. Both topical corticosteroids and dietary interventions were preferred over PPI in pediatric patients regardless of sex.

Conclusions: Sex is associated with clinical and phenotypical presentation of EoE at diagnosis, with more fibrotic findings in males but higher symptom score in females.