United European Gastroenterology Journal最新文献

This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt "fatty pancreas" as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta-cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high-quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence-based clinical practice in this emerging field.

Background: Crohn's disease (CD) and ulcerative colitis (UC) are progressive inflammatory bowel diseases that often result in bowel damage, imposing a significant burden on patients with insufficient disease control due to the limited efficacy of current treatments or complex disease management. There are limited data on how disease monitoring informs treatment decisions in daily clinical practice. The IBD-PODCAST study aimed to estimate the proportion of Crohn's disease and ulcerative colitis patients experiencing suboptimal disease control in a real-world setting.

Objectives: To evaluate disease monitoring practices and their impact on physicians' actions and treatment decisions for patients with suboptimal disease control.

Methods: A non-interventional cross-sectional study was conducted across 103 sites in 10 countries. Criteria for suboptimal disease control were based on STRIDE-II criteria, adapted by an expert panel.

Results: 2185 patients (Crohn's disease: n = 1,108, ulcerative colitis: n = 1077) with a mean (SD) age of 44.0 (14.8) years and disease duration of 12.4 (9.2) years were included. Suboptimal disease control was present in 52.2% of CD (n = 578) and 44.3% of UC patients (n = 477). Disease monitoring via imaging and/or endoscopy over a 12-month period was conducted in approximately 40% of the patients. In patients that were lacking annual monitoring via imaging/endoscopy and/or biochemical monitoring at index, an optimal disease status indicating no objective inflammation was observed in only 31.1% of CD and 36.4% of UC patients. In patients with suboptimal disease control, 391 CD (67.6%) and 324 UC (67.9%) had clinically relevant parameters. In around 50% of these patients, physicians took action.

Conclusions: Annual disease monitoring via imaging/endoscopy was performed in only 40% of inflammatory bowel disease patients. Physicians modified treatment in approximately half of patients with suboptimal disease control and clinically relevant parameters. The study emphasized the importance of consistent monitoring and taking action when targets are not met to improve the quality of life of patients with inflammatory bowel disease.

Background: Reproduction is a fundamental aspect of life. This study aimed to provide an international overview of gastroenterologists' approaches to managing inflammatory bowel disease (IBD) during preconception, pregnancy, lactation, and postpartum.

Methods: An anonymous 75-question survey was distributed to gastroenterologists in 36 countries, including European countries, the United States of America, Latin American countries, Australia, and New Zealand, focusing on clinical practices for managing pregnancy and breastfeeding in IBD patients.

Results: A total of 856 gastroenterologists participated, 61% were IBD specialists. In pregnant patients in remission, participants stated they would discontinue IBD therapy as follows: 19% for thiopurines, 41% for anti-TNF, 37% for vedolizumab, 31% for ustekinumab, and 96% for small molecules. Many gastroenterologists avoided initiating oral or rectal budesonide, anti-TNF, vedolizumab, or ustekinumab during disease flares. Despite existing safety concerns, one-third of gastroenterologists reported initiating thiopurines to manage disease flares during pregnancy. Only 50% of gastroenterologists had specialized follow-up programs for pregnant patients with IBD in remission. Thirteen percent of gastroenterologists believed that all drugs were safe during breastfeeding. For vaccinations, about 20% advised against non-live vaccines, and 50% avoided live-vaccines during the first 12 months for infants exposed to anti-TNF in utero. Few gastroenterologists had referral pathways to IBD-specialized obstetricians or paediatricians.

Conclusion: Our international survey suggests that management of IBD during pregnancy, lactation, and postpartum remains suboptimal, even among gastroenterologists specifically dedicated to IBD. Urgent educational efforts are needed to address these issues and improve care.

Background: Mucosal healing (MH) is a key treatment goal in Crohn's disease (CD). However, evidence on pan-enteric MH (PE-MH) in CD patients treated with vedolizumab remains limited. We aimed to assess vedolizumab efficacy in achieving PE-MH using PillCam Crohn's capsule.

Methods: This prospective, open-label observational study included CD patients with intestinal inflammation (SB-Lewis score [LS] ≥ 220 and/or colonic-Eliakim score [ES] > 0) who initiated vedolizumab and were followed with C-reactive protein (CRP), fecal calprotectin (FCP), and PillCam Crohn's capsule at baseline and after 14 and 52 weeks. In cases of exclusive SB involvement, colonic preparation and assessment were omitted. LS and ES were calculated when applicable. The primary outcome was PE-MH, defined as LS < 135 for SB-VCE assessment, and ES = 0 for PE-VCE assessment. Secondary outcomes included SB-MH (LS < 135), colonic-MH (ES = 0) and biochemical remission (FCP < 150 μg/g). An exploratory outcome for SB-MH was defined as a LS < 350, which has previously been shown to predict future flares in CD.

Results: Of the 60 screened patients, 44 were enrolled (median age: 29.0 [22.0-45.5] years; 43.2% male; Ileum [L1]-54.5%, Colon [L2]-41.0%, Ileo-colon [L3]-4.5%). At week 52, 7/44 (15.9%) patients reached PE-MH compared to baseline (risk difference [RD] 15.9%, 95% confidence interval [CI] 5.1%-26.7%, p = 0.016). 8/44 (18.2%) and 9/44 (20.5%) patients achieved SB-MH at week 52 and 14, respectively, compared to 2/44 (4.5%) at baseline. Using the less stringent SB-MH criterion (LS < 350), rates improved significantly at week 52 versus baseline (45.5% vs. 25.0%, p = 0.049). All study indices decreased during follow-up (baseline, week 14, week 52): CRP (11.8, 5.8, 5.0: p = 0.152), FCP (758, 418, 158: p = 0.004), LS (900, 225, 225, p < 0.001), and ES (18.0, 4.0, 4.0: p < 0.001). 14/44 (31.8%) patients reached biochemical remission (p = 0.049) at week 52 compared to 5/44 (11.4%) at baseline.

Conclusion: Vedolizumab treatment led to significant biochemical and endoscopic improvement, including SB-MH and PE-MH, through 52 weeks.

Background and aims: Endoscopic size estimation of large colorectal polyps influences treatment decisions and clinical outcomes; however, its precision remains unclear. This study aimed to assess the accuracy of endoscopic size estimation for colorectal lesions ≥ 20 mm utilizing data from an endoscopic submucosal dissection (ESD) cohort.

Methods: This post hoc analysis included only en bloc resected lesions treated by ESD. Patients with neuroendocrine tumors, recurrent lesions, colitis-associated dysplasia, or insufficient data were excluded. Size accuracy was defined as a margin of error < 5 mm. Outcomes included the frequency of size errors ≥ 10 mm and ≥ 20 mm, terminal digit preferences in estimated size, and predictors for lesions estimated endoscopically at 20 mm but pathologically ≥ 25 mm. The reference standard was pathological size.

Results: Among 1889 lesions (1809 patients), 61 lesions (60 patients) were excluded. Finally, 1828 lesions (1749 patients) were evaluated. The accuracy of endoscopic size estimation was 53.4%. Errors ≥ 10 and ≥ 20 mm occurred in 19.1% and 4.5% of lesions, respectively. Endoscopic size estimation showed a strong terminal digit preference for 0 (65.2%) and 5 (30.0%). Among 366 lesions estimated at 20 mm, 97 (26.5%) were pathologically ≥ 25 mm. Polypoid lesions [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.1-6.8] and laterally spreading tumors granular type (OR 2.0, 95% CI: 1.1-3.5) were predictors of underestimation.

Conclusions: Endoscopic size estimation of large colorectal lesions can be inaccurate and influenced by digit bias, underscoring the need for improved measurement techniques (UMIN000010136).

Objectives: Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition and ligation-assisted antireflux mucosectomy (ARMS-L) which is a modified ARMS procedure that combines mucosa ligation and endoscopic mucosectomy was evaluated as an effective and safe endoscopic procedure. Moreover, the long-term efficacy of ARMS-L requires further validation.

Methods: This prospective study included 189 patients with proton pump inhibitor (PPI)-dependent and cardioesophageal sphincter-relaxed GERD. Primary endpoint was the treatment efficacy (subjective and objective symptom): the total GERD-HRQL questionnaire score and the rate of PPI discontinuation at the follow-up. Secondary endpoints included improvements in GERD-Q scores, HRM, 24-h pH impedance monitoring, and AFS grade, as objective measures of hiatal disruption.

Results: All patients underwent ARMS-L successfully and the average duration of follow-up are 48 months. 70.3% (133/189) of patients achieved a ≥ 50% improvement in the total GERD-HRQL score. HRM parameters improved significantly, with LES resting pressure increasing from 6.3 to 6.6 mmHg and LES residual pressure from 5.9 to 7.2 mmHg. 24-h pH impedance monitoring showed significant improvement, with the DeMeester score decreasing from 27.23 to 8.63. 70.9% of patients stopped PPIs, and 29.1% used PPIs occasionally. The improvement in the DeMeester score was lower in patients with AFS grade 1 (from 24.13 to 9.74) compared with those with grade 2 (from 27.98 to 7.86) and grade 3 (from 28.86 to 8.90).

Conclusions: ARMS-L reduced GERD symptoms and improved the quality of life for a long time, particularly in PPI-dependent and cardioesophageal sphincter relaxed GERD patients.