United European Gastroenterology Journal最新文献

Background: While tumor necrosis factor (TNF) inhibitors can induce paradoxical reactions, sarcoidosis-like disease has hardly been reported so far. This study aimed to describe the epidemiological, diagnostic and therapeutic features of TNF inhibitor-induced sarcoidosis-like lesions in patients with inflammatory bowel disease.

Methods: We conducted a case series across 59 institutions affiliated with the Groupe d'Etude Therapeutique des Affections Inflammatoires du Tube Digestif. Diagnosis of TNF inhibitor-induced sarcoidosis was based on typical clinical and radiological signs, histological evidence of non-necrotizing granuloma, exclusion of alternative diagnoses, and a timeline consistent with drug exposure. A pharmacovigilance expert reviewed each case to confirm drug causality.

Results: We identified 14 cases of sarcoidosis-like lesions, including 9 patients with Crohn's disease, 4 ulcerative colitis, and 1 with unclassified inflammatory bowel disease. The implicated medications were infliximab (8), adalimumab (5), and golimumab (1), predominantly in first-time biotherapy users (71%). The median time from treatment initiation to sarcoidosis diagnosis was 27.5 months (range 3-91). Common clinical manifestations included dyspnea (71%), coughing (50%) and fever (50%). Ten patients discontinued TNF inhibitor therapy and started oral steroids, leading to complete symptom resolution in seven cases and improvement in two. Median time from steroid initiation to clinical remission of sarcoidosis was 84 days (range 11-134). After a median follow-up of 40 months, while no relapses occurred in 13 patients, one showed persistent sarcoidosis activity.

Conclusions: TNF inhibitor-induced sarcoidosis should be considered in inflammatory bowel disease patients with chronic respiratory symptoms or fever after exclusion of mycobacterial infection. Management involves discontinuation of TNF inhibitors and a course of steroids.

Background: Limited data are available on the management and outcomes of postoperative Crohn's disease (CD) in older patients. We aimed to describe the management of CD in the postoperative setting and assess surgical postoperative recurrence (POR) in this population.

Methods: This was a case-control study including all adult patients with CD from the ENEIDA registry who had undergone a first intestinal resection with ileo-colonic anastomosis. Patients were grouped according to their age at the time of the first surgery in older (over 60 years) subjects and controls (between 18 and 60 years of age).

Results: A total of 3982 (535 older subjects and 3454 controls) underwent a first intestinal resection for CD with an ileo-colonic anastomosis. Time from CD diagnosis to surgery was significantly longer in older patients (114 ± 128 vs. 93 ± 97 months; p < 0.001). Older patients also had a lower proportion of penetrating CD (25% vs. 39%; p < 0.0001) and perianal disease (14% vs. 25%; p < 0.0001). A significantly lower proportion of older patients started preventive therapies for POR (32% vs. 51%; p < 0.0001). The cumulative risk of surgical POR was 3.2%, 5.3% and 10.1% in the older group and 3.6%, 6.6% and 14.2% in the control group at three, five and 10 years, respectively (p = 0.093). In the multivariate logistic regression analysis, only prevention with thiopurines was associated with a lower risk of surgical POR.

Conclusions: Although postoperative preventive therapy with immunomodulators or biologicals is prescribed less often in older patients after a first intestinal resection, they develop surgical POR as often as younger adult patients.

Background: Chronic delta hepatitis represents a major health burden. Until recently, pegylated interferon-alfa-2a (PEG-IFNα) therapy was the only treatment option for patients infected with hepatitis D virus (HDV). The aim of this study was to evaluate 10-year long-term clinical and virological outcomes after 96 weeks of treatment with PEG-IFNα with or without tenofovir disoproxil fumarate (TDF).

Methods: We conducted a retrospective follow-up study of the Hep-Net-International-Delta-Hepatitis-Intervention-Study 2 (HIDIT-II trial). Patients had received 96 weeks of treatment with either PEG-IFNα-2a plus TDF or PEG-IFNα-2a alone. Patients were included if they had completed the 96-week treatment period and had at least one follow-up visit (PEG-IFNα-2a + TDF; n = 51, PEG-IFNα-2a alone; n = 56).

Results: Patients who received PEG-IFNα-2a + TDF were younger (37 vs. 42 years) and no significant differences were observed in other baseline characteristics between the two treatment arms. A total of 26 patients (24%) developed one or more liver-related endpoints after a mean time of 8.4 years. The incidence of endpoints was significantly lower in the combination group (14% vs. 34%, p = 0.02). The development of liver-related endpoints was also associated with non-response to therapy (HDV RNA and HBsAg), elevated HBV DNA at week 72, and baseline age, cirrhosis, platelets, INR, AST, GGT, bilirubin and albumin according to the Cox regression model.

Conclusions: The long-term follow-up of this large randomised clinical trial demonstrates that combination therapy with TDF and virological response to PEG-IFNα-2a (undetectable HDV RNA and HBsAg loss) were associated with better clinical outcomes.

Trial registration: NCT00932971, EudraCT 2008-005560-13.

United European Gastroenterology (UEG) has launched an initiative to promote physician well-being and prevent burnout. This current concept article is based on a survey of the National Societies Forum and National Societies Committee, a meta-analysis by Shiha et al., and a scoping review of evidence-based interventions. It identifies key systemic and individual drivers of burnout, outlines its consequences, and presents strategies for intervention-recognising that physician burnout threatens individual health, patient safety, and the sustainability of health care systems. Burnout in gastroenterology is driven by demanding workloads, complex procedures, and increasing administrative tasks. Addressing physician well-being must be viewed as a systemic challenge requiring coordinated efforts from individuals, hospitals, and scientific societies. National and specialist GI societies are pivotal. They must implement initiatives and advocate for systemic change through education, policy advocacy, and sustainable work design. Acknowledgement of burnout is a start. Progress requires commitment to well-being and continuing research.

Background: Ileal pouch-anal anastomosis (IPAA) is a standard surgical procedure for ulcerative colitis (UC) and familial adenomatous polyposis. However, pouch-related fistulae (PRF) are a significant complication. There is no consensus on the optimal treatment for PRF.

Objective: This study evaluated the effectiveness of autologous adipose tissue injection (AATI) as a treatment for PRF.

Methods: Twenty-one patients with IPAA and a total of 29 PRF were treated with AATI. Patients who did not achieve healing after the first treatment were offered repeated injections. Patients were followed for a median of 16 months after AATI. Outcomes including clinical healing, treatment complications, and recurrence of PRF were registered.

Results: After a single treatment with AATI, 48% of the fistulae were clinically healed. Repeated treatments increased the healing rate to 69%. An additional 14% responded to AATI by reduced secretion from PRF. The procedure was well tolerated with minimal complications.

Conclusion: AATI appears to be a safe, minimally invasive, and sphincter-saving treatment for PRF with promising healing rates. Further studies with larger cohorts are necessary to validate these findings.

Background: Bloating refers to the sensation of tension in the abdomen, reported in the presence or absence of visible abdominal distension. These and other gas-related symptoms are often reported by patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). However, the prevalence of bloating and visible abdominal distension as separate symptoms in these disorders is not well known. The aim of this study was to investigate the link between bloating, distension, and intestinal gas-related symptoms with IBS and FD, and their overall impact.

Methods: Data from a population-based internet survey of adults from the US, UK, and Mexico were used. This survey included Rome IV diagnostic questions for IBS and FD, questions to distinguish between ≥ weekly bloating and/or distension, and the Intestinal Gas Questionnaire (IGQ) to assess the impact of six gas-related symptoms.

Results: The analyses included 131 individuals with only IBS, 360 with only FD, 217 with IBS + FD and 4740 without IBS and FD (reference group). Individuals with IBS (64.9%), FD (50.6%), and especially IBS + FD (88.5%) reported bloating and/or distension more frequently than the reference group (13.7%). Bloating and distension as distinct and combined symptoms were strongly linked to IBS and FD even after correcting for confounding factors. Also, other gas-related symptoms had a higher impact on individuals with IBS and/or FD compared with the reference group.

Discussion: Bloating and visible abdominal distension can occur as concomitant or distinct impactful symptoms and are, together with other gas-related symptoms, strongly linked to IBS and FD. These findings may provide arguments to include bloating and distension as supportive criteria for IBS and FD diagnoses.

Background: Acute pancreatic injury can result from blunt or sharp force trauma, often leading to serious complications. While direct pancreatic trauma is associated with high rates of infection, organ failure, and mortality, little is known about the pancreas as a potential secondary target and remote trauma organ and thereby as a booster of systemic injury.

Methods: We employed a murine model of multiple trauma and hemorrhagic shock in which the pancreas was deliberately spared from the direct trauma impact. Four hours post-trauma, we determined systemic and local inflammatory responses, pancreatic tissue damage, pancreatic lipase (Pnlip in mice), and protease activity, and conducted proteomic profiling of the pancreas. For clinical translation, we performed a post hoc analysis of severely injured polytrauma patients, focusing on acute pancreatic involvement and its association with clinical parameters.

Results: Severe trauma in mice induced rapid systemic inflammation and significantly elevated plasma levels of Pnlip. Notably, pancreatic edema formation was observed in a subset of polytraumatized mice, accompanied by increased activity of matrix metalloproteinases Mmp2 and Mmp9. Proteomic analysis revealed an enrichment of inflammatory and cellular stress pathways in pancreatic tissue. Similarly, in polytraumatized patients, plasma pancreatic lipase (PNLIP in humans) and trypsin concentrations were elevated during the early posttraumatic period and correlated with injury patterns, systemic inflammation, coagulopathy, endotheliopathy, organ failure, and time in hospitals and intensive care units.

Conclusion: Our findings highlight the pancreas as a novel remote responder to severe tissue trauma, even in the absence of direct injury. This widely overlooked dimension of trauma pathophysiology has potential clinical implications. However, further research is essential (i) to unravel the mechanisms driving remote pancreatic enzyme release and (ii) to prove the causality between the pancreatic response and observed clinical parameters.