JGH Open最新文献_第10页

Comparison of metronidazole versus clarithromycin in first-line vonoprazan-based triple therapy for Helicobacter pylori: A multicenter randomized trial in Japan 甲硝唑与克拉霉素在基于冯诺普拉赞的幽门螺杆菌一线三联疗法中的比较：日本的一项多中心随机试验

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-04-22 DOI: 10.1002/jgh3.13069

Soichiro Sue, Hiroyuki Oka, Yosuke Kunishi, Yuichi Suzuki, Shingo Suzuki, Takashi Kaneko, Kazuo Komatsu, Makoto Naito, Yoshio Kato, Tomohiko Sasaki, Hiroaki Kaneko, Kuniyasu Irie, Masaaki Kondo, Shin Maeda

Background and Aim

To date, no randomized trials have compared the efficacy of 7-day vonoprazan, amoxicillin, and metronidazole triple therapy (VAM) versus 7-day vonoprazan, amoxicillin, and clarithromycin triple therapy (VAC) as a first-line treatment for Helicobacter pylori eradication. This study was performed to compare the efficacy of VAM and VAC as first-line treatments.

Methods

This prospective multicenter randomized trial was performed in Japan and involved 124 H. pylori-positive patients without a history of eradication. Patients without antibiotic resistance testing of H. pylori were eligible. The patients were randomized to receive either VAC (vonoprazan 20 mg + amoxicillin 750 mg + clarithromycin 200 or 400 mg twice a day) or VAM (vonoprazan 20 mg + amoxicillin 750 mg + metronidazole 250 mg twice a day) for 7 days, with stratification by age and sex. Eradication success was evaluated using the ¹³C-urea breath test. We evaluated safety using patient questionnaires (UMIN000025773).

Results

The intention-to-treat and per-protocol eradication rates of VAM were 91.3% (95% confidence interval [CI], 82.0–96.7%) and 92.6% (95% CI, 83.7–97.6%), respectively, and those of VAC were 89.1% (95% CI, 77.8–95.9%) and 96.1% (95% CI, 86.5–99.5%), respectively. No significant difference was observed between VAM and VAC in either analysis (P = 0.76 and P = 0.70, respectively). Abdominal fullness was more frequent in patients who received VAM than VAC.

Conclusions

These findings suggest that VAM as a first-line treatment in Japan can be categorized as grade B (intention-to-treat cure rate of 90–95%) and have potential as a first-line national insurance -approved regimen.

背景和目的迄今为止，还没有随机试验比较过 7 天的冯诺普拉赞、阿莫西林和甲硝唑三联疗法（VAM）与 7 天的冯诺普拉赞、阿莫西林和克拉霉素三联疗法（VAC）作为根除幽门螺旋杆菌一线疗法的疗效。本研究旨在比较 VAM 和 VAC 作为一线疗法的疗效。方法该前瞻性多中心随机试验在日本进行，涉及 124 名无根除史的幽门螺杆菌阳性患者。未经幽门螺杆菌抗生素耐药性检测的患者均符合条件。患者被随机分配接受 VAC（沃诺普赞 20 毫克 + 阿莫西林 750 毫克 + 克拉霉素 200 或 400 毫克，每天两次）或 VAM（沃诺普赞 20 毫克 + 阿莫西林 750 毫克 + 甲硝唑 250 毫克，每天两次）治疗，为期 7 天，并按年龄和性别进行分层。使用 13C 尿素呼气试验评估根除成功率。我们使用患者调查问卷（UMIN000025773）对安全性进行了评估。结果 VAM 的意向治疗根除率和按协议根除率分别为 91.3%（95% 置信区间 [CI]，82.0-96.7%）和 92.6%（95% CI，83.7-97.6%），VAC 的意向治疗根除率和按协议根除率分别为 89.1%（95% CI，77.8-95.9%）和 96.1%（95% CI，86.5-99.5%）。在这两项分析中，VAM 和 VAC 之间均未观察到明显差异（P = 0.76 和 P = 0.70）。与 VAC 相比，接受 VAM 的患者更容易出现腹部饱胀。结论这些研究结果表明，在日本，VAM 作为一线治疗可被归类为 B 级（意向治疗治愈率为 90-95%），有可能成为国家保险批准的一线治疗方案。

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引用次数: 0

Value of quantitative microsurface structure analysis for evaluating the invasion depth of type 0–II early gastric cancer 微表面结构定量分析对评估 0-II 型早期胃癌侵袭深度的价值

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-04-16 DOI: 10.1002/jgh3.13055

Zhang-Xiu Jiang, Yun-Xiao Liang, Peng-Yu Huang, Jia-Juan Ning, Jing-Jing Qi

Background and Aim

The microsurface structure reflects the degree of damage to the glands, which is related to the invasion depth of early gastric cancer. To evaluate the diagnostic value of quantitative microsurface structure analysis for estimating the invasion depth of early gastric cancer.

Methods

White-light imaging and narrow-band imaging (NBI) endoscopy were used to visualize the lesions of the included patients. The area ratio and depth-predicting score (DPS) of each patient were calculated; meanwhile, each lesion was examined by endoscopic ultrasonography (EUS).

Results

Ninety-three patients were included between 2016 and 2019. Microsurface structure is related to the histological differentiation and progression of early gastric cancer. The receiver operating characteristic curve showed that when an area ratio of 80.3% was used as a cut-off value for distinguishing mucosal (M) and submucosal (SM) type 0–II gastric cancers, the sensitivity, specificity, and accuracy were 82.9%, 80.2%, and 91.6%, respectively. The accuracies for distinguishing M/SM differentiated and undifferentiated early gastric cancers were 87.4% and 84.8%, respectively. The accuracy of EUS for distinguishing M/SM early gastric cancer was 74.9%. DPS can only distinguish M-SM1 (SM infiltration <500 μm)/SM (SM infiltration ≥500 μm) with an accuracy of 83.8%. The accuracy of using area ratio for distinguishing 0–II early gastric cancers was better than those of using DPS and EUS (P < 0.05).

Conclusion

Quantitative analysis of microsurface structure can be performed to assess M/SM type 0–II gastric cancer and is expected to be effective for judging the invasion depth of gastric cancer.

背景和目的微表面结构反映了腺体的损伤程度，与早期胃癌的浸润深度有关。目的评估微表面结构定量分析对估计早期胃癌侵犯深度的诊断价值。方法采用白光成像和窄带成像（NBI）内镜观察纳入患者的病灶。计算每位患者的面积比和深度预测评分（DPS），同时用内镜超声（EUS）检查每个病灶。结果 2016 年至 2019 年间共纳入 93 例患者。微表面结构与早期胃癌的组织学分化和进展有关。接收器操作特征曲线显示，当以80.3%的面积比作为区分粘膜（M）和粘膜下（SM）0-II型胃癌的临界值时，敏感性、特异性和准确性分别为82.9%、80.2%和91.6%。区分M/SM分化型和未分化型早期胃癌的准确率分别为87.4%和84.8%。EUS区分M/SM早期胃癌的准确率为74.9%。DPS只能区分M-SM1（SM浸润<500 μm）/SM（SM浸润≥500 μm），准确率为83.8%。使用面积比鉴别 0-II 期早期胃癌的准确性优于使用 DPS 和 EUS（P < 0.05）。结论微表面结构的定量分析可用于评估 M/SM 0-II 型胃癌，并有望有效判断胃癌的侵犯深度。

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引用次数: 0

Trends in mortality from gastrointestinal, hepatic, and pancreatic cancers in the United States: A comprehensive analysis (1999–2020) 美国胃肠癌、肝癌和胰腺癌死亡率趋势：综合分析（1999-2020 年）

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-04-15 DOI: 10.1002/jgh3.13064

Hassam Ali, Rizwan Ishtiaq, Brandon Tedder, Joshua Zweigle, Romina Nomigolzar, Dushyant S Dahiya, Vishali Moond, Amir Humza Sohail, Pratik Patel, Debargha Basuli, Hans L Tillmann

Background and Aim

This study investigates temporal trends in gastrointestinal cancer-related mortality in the United States between 1999 and 2020, focusing on differences by sex, age, and race.

Methods

We investigated the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research multiple causes of death database (Years 1999–2020) for gastrointestinal cancer-related mortality with a focus on the underlying cause of death.

Results

A total of 3 115 243 gastrointestinal cancer-related deaths occurred from 1999 to 2020. The overall age-adjusted mortality rate decreased from 46.7 per 100 000 in 1999 to 38.4 per 100 000 in 2020. The average annual percent change (AAPC) for the study period was −0.9% (95% CI: −1.0%, −0.9%, P < 0.001), with no significant difference in AAPC between the sexes but some difference between races and related to individual cancers. African Americans and Asian Americans, and Pacific Islanders experienced a greater decrease in mortality compared with Whites. Mortality rates for American Indian and Alaskan Native populations also decreased significantly from 1999 to 2020 (P < 0.001). There were significant declines in esophageal, stomach, colon, rectal, and gallbladder cancer-related mortality but increases in the small bowel, anal, pancreatic, and hepatic cancer-related mortality (P < 0.001), with variation across different sexes and racial groups.

Conclusion

While overall gastrointestinal cancer-related mortality declined significantly in the United States from 1999 to 2020, mortality from some cancers increased. Furthermore, differences between sexes and racial groups underscore crucial differences in gastrointestinal cancer mortality, highlighting areas for future research.

背景和目的本研究调查了 1999 年至 2020 年美国胃肠道癌症相关死亡率的时间趋势，重点关注性别、年龄和种族的差异。方法我们调查了美国疾病控制和预防中心的广泛流行病学研究在线数据数据库（1999-2020 年）中与胃肠道癌症相关的死亡率，重点关注死亡的根本原因。结果 1999 年至 2020 年期间，共有 3 115 243 例胃肠道癌症相关死亡。经年龄调整后的总死亡率从 1999 年的每 10 万人 46.7 例降至 2020 年的每 10 万人 38.4 例。研究期间的年均百分比变化（AAPC）为-0.9%（95% CI：-1.0%，-0.9%，P < 0.001），性别间的 AAPC 无显著差异，但种族间存在一些差异，且与个别癌症有关。与白人相比，非裔美国人、亚裔美国人和太平洋岛民的死亡率下降幅度更大。从 1999 年到 2020 年，美国印第安人和阿拉斯加原住民的死亡率也显著下降（P < 0.001）。与食管癌、胃癌、结肠癌、直肠癌和胆囊癌相关的死亡率明显下降，但与小肠癌、肛门癌、胰腺癌和肝癌相关的死亡率却有所上升（P <0.001），不同性别和种族群体之间存在差异。结论从 1999 年到 2020 年，美国与胃肠道癌症相关的总死亡率显著下降，但某些癌症的死亡率却有所上升。此外，不同性别和种族群体之间的差异凸显了胃肠道癌症死亡率的关键性差异，突出了未来研究的领域。

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引用次数: 0

Clinical utility of C-reactive protein-to-albumin ratio in the management of patients with inflammatory bowel disease C 反应蛋白与白蛋白比值在治疗炎症性肠病患者中的临床实用性

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-04-15 DOI: 10.1002/jgh3.13059

Anke L Nguyen, Claudia Brick, David Liu, David J Gibson, Peter R Gibson, Miles P Sparrow

Background and Aim

C-reactive protein (CRP)-to-albumin ratio (CAR) is a novel score with prognostic value in inflammatory conditions. This study assessed the performance of CAR as an objective marker of disease activity and prediction of subtherapeutic infliximab trough levels in patients with inflammatory bowel disease (IBD).

Methods

A retrospective study was conducted on three different patient cohorts with IBD: patients who had (i) fecal calprotectin (FC) measurements; (ii) Mayo Endoscopic Scores; and (iii) infliximab trough levels available. The relative performances of CAR, albumin, and CRP were compared in predicting disease activity (based on FC or Mayo Endoscopic Score) and infliximab trough levels.

Results

In both the FC (n = 289) and endoscopy (n = 65) cohorts, albumin and CAR correlated with objective disease activity. CAR (area under the curve [AUC] 0.70) was only marginally better at detecting active disease, measured by FC, compared to CRP (AUC 0.68). A CAR >0.15 was able to detect Mayo 3 disease (AUC 0.83, sensitivity 81%, specificity 89%). Albumin (r = 0.38) and CAR (r = −0.42) correlated with infliximab trough levels (n = 204). The optimal CAR for detecting subtherapeutic infliximab trough levels was >0.08 (AUC 0.70, sensitivity 66%, specificity 64%). Both albumin and CAR were independent predictors of subtherapeutic infliximab trough levels but correlated poorly with infliximab trough levels longitudinally in the same patient.

Conclusion

CAR was only a modest discriminator of subtherapeutic infliximab levels and offers little more than CRP in detecting active disease. CAR has potential to detect severe Mayo 3 disease and could be calculated in patients admitted with suspected acute severe ulcerative colitis.

背景和目的 C反应蛋白（CRP）-白蛋白比值（CAR）是一种新的评分方法，在炎症性疾病中具有预后价值。本研究评估了CAR作为炎症性肠病（IBD）患者疾病活动性客观标志物的性能以及对亚治疗英夫利昔单抗谷值水平的预测。方法对三组不同的 IBD 患者进行了回顾性研究：(i) 粪便钙蛋白（FC）测量值；(ii) 梅奥内镜评分；(iii) 英夫利西单抗谷值。比较了 CAR、白蛋白和 CRP 在预测疾病活动性（基于 FC 或梅奥内镜评分）和英夫利昔单抗谷值水平方面的相对性能。结果在 FC 组（n = 289）和内镜组（n = 65）中，白蛋白和 CAR 与客观疾病活动度相关。与 CRP（AUC 0.68）相比，CAR（曲线下面积 [AUC] 0.70）在通过 FC 检测活动性疾病方面仅略胜一筹。0.15 的 CAR 可以检测出 Mayo 3 疾病（AUC 0.83，敏感性 81%，特异性 89%）。白蛋白（r = 0.38）和 CAR（r = -0.42）与英夫利昔单抗谷值水平相关（n = 204）。检测治疗下英夫利西单抗谷水平的最佳CAR为0.08（AUC为0.70，灵敏度为66%，特异性为64%）。白蛋白和CAR均可独立预测治疗下的英夫利西单抗谷值水平，但与同一患者英夫利西单抗谷值水平的纵向相关性较差。结论 CAR 对亚治疗英夫利昔单抗水平的鉴别作用不大，在检测活动性疾病方面的作用也不如 CRP。CAR 有可能检测出严重的梅奥 3 疾病，可用于计算入院的疑似急性严重溃疡性结肠炎患者。

{"title":"Clinical utility of C-reactive protein-to-albumin ratio in the management of patients with inflammatory bowel disease","authors":"Anke L Nguyen, Claudia Brick, David Liu, David J Gibson, Peter R Gibson, Miles P Sparrow","doi":"10.1002/jgh3.13059","DOIUrl":"https://doi.org/10.1002/jgh3.13059","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>C-reactive protein (CRP)-to-albumin ratio (CAR) is a novel score with prognostic value in inflammatory conditions. This study assessed the performance of CAR as an objective marker of disease activity and prediction of subtherapeutic infliximab trough levels in patients with inflammatory bowel disease (IBD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective study was conducted on three different patient cohorts with IBD: patients who had (i) fecal calprotectin (FC) measurements; (ii) Mayo Endoscopic Scores; and (iii) infliximab trough levels available. The relative performances of CAR, albumin, and CRP were compared in predicting disease activity (based on FC or Mayo Endoscopic Score) and infliximab trough levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In both the FC (<i>n</i> = 289) and endoscopy (<i>n</i> = 65) cohorts, albumin and CAR correlated with objective disease activity. CAR (area under the curve [AUC] 0.70) was only marginally better at detecting active disease, measured by FC, compared to CRP (AUC 0.68). A CAR >0.15 was able to detect Mayo 3 disease (AUC 0.83, sensitivity 81%, specificity 89%). Albumin (<i>r</i> = 0.38) and CAR (<i>r</i> = −0.42) correlated with infliximab trough levels (<i>n</i> = 204). The optimal CAR for detecting subtherapeutic infliximab trough levels was >0.08 (AUC 0.70, sensitivity 66%, specificity 64%). Both albumin and CAR were independent predictors of subtherapeutic infliximab trough levels but correlated poorly with infliximab trough levels longitudinally in the same patient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CAR was only a modest discriminator of subtherapeutic infliximab levels and offers little more than CRP in detecting active disease. CAR has potential to detect severe Mayo 3 disease and could be calculated in patients admitted with suspected acute severe ulcerative colitis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 4","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.13059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140552047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hypertriglyceridemia-induced acute necrotizing pancreatitis: Poor clinical outcomes requiring revisiting management modalities 高甘油三酯血症诱发急性坏死性胰腺炎：临床效果不佳，需要重新审视管理模式

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-04-13 DOI: 10.1002/jgh3.13061

Yazan Abboud, Meet Shah, Benjamin Simmons, Kranthi Mandava, John E M Morales, Fouad Jaber, Saqer Alsakarneh, Mohamed Ismail, Kaveh Hajifathalian

Hypertriglyceridemia-induced acute pancreatitis (HTG-AP) is the third most common cause of AP after gallstones and alcohol. Supportive measures, intravenous insulin, and plasmapheresis are possible treatment modalities for HTG-AP; however, definitive guidelines evaluating the best therapeutic approach are not clearly established. We present a rare case of a 42-year-old male without known comorbidities who was found to have HTG-AP. Despite early initiation of intravenous insulin and plasmapheresis and the initial decline in his triglycerides level, his condition was complicated by necrotizing pancreatitis and subsequent multi-organ failure. Future studies are warranted to evaluate the role of plasmapheresis in HTG-AP and its efficacy.

高甘油三酯血症诱发的急性胰腺炎（HTG-AP）是继胆结石和酒精之后导致急性胰腺炎的第三大常见原因。支持性措施、静脉注射胰岛素和血浆置换术是治疗高甘油三酯血症诱发急性胰腺炎的可行方法；然而，评估最佳治疗方法的明确指南尚未明确确立。我们介绍了一例罕见的病例，患者是一名 42 岁的男性，没有已知的合并症，却被发现患有 HTG-AP。尽管他很早就开始静脉注射胰岛素和血浆置换术，甘油三酯水平也开始下降，但坏死性胰腺炎和随后的多器官衰竭使他的病情变得复杂。今后有必要开展研究，评估血浆置换在 HTG-AP 中的作用及其疗效。

引用次数: 0

Etrolizumab as an induction and maintenance therapy for ulcerative colitis: A systematic review and meta-analysis of randomized controlled trials 依托利珠单抗作为溃疡性结肠炎的诱导和维持疗法：随机对照试验的系统回顾和荟萃分析

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-04-02 DOI: 10.1002/jgh3.13056

Othman Saleh, Mohamed T. Abuelazm, Islam Mohamed, Alaa Ramadan, Mohammad Assaf, Ahmad Alzoubi, Majd M. AlBarakat, Basel Abdelazeem

Background and Aim

Etrolizumab is a gut-targeted anti-β7 integrin monoclonal antibody. However, the evidence of etrolizumab efficacy and safety in ulcerative colitis remains inconclusive. Therefore, we aim to evaluate the safety and efficacy of etrolizumab as an induction and maintenance therapy for active moderate to severe ulcerative colitis.

Methods

We synthesized randomized controlled studies (RCTs) from MEDLINE, Scopus, EMBASE, PubMed, Web of Science, and Cochrane Library until April 2023. The risk ratio (RR) for dichotomous outcomes with the corresponding 95% confidence interval (CI) was used. The study protocol was registered in PROSPERO with ID: CRD42023437040.

Results

Five RCTs with 1849 participants were included. The etrolizumab group had a significant clinical response (RR: 1.28 with 95% CI [1.08, 1.51], P = 0.005), clinical remission rates during the induction phase (RR: 2.47 with 95% CI [1.48, 4.11], P = 0.0005), compared with the placebo group in ulcerative colitis; however, there was no statistically significant difference between the two groups, regarding the corticosteroids-free remission rate (RR: 1.92 with 95% CI [0.94, 3.92], P = 0.07). Moreover, endoscopic improvement, endoscopic remission, and histologic remission rates were observed more in the etrolizumab group during both the induction and maintenance phases. For safety outcomes, etrolizumab was significantly safer, but any adverse event was higher in the etrolizumab group than in the placebo.

Conclusion

Etrolizumab shows its effectiveness as both an induction and maintenance therapy for moderate or severe UC. The findings demonstrate its positive impact on clinical, endoscopic, and histologic remission rates. Regarding safety, other than any side effects, etrolizumab showed a good safety than a placebo.

背景和目的依托珠单抗是一种肠道靶向抗β7整合素单克隆抗体。然而，etrolizumab 对溃疡性结肠炎的疗效和安全性仍无定论。因此，我们旨在评估依托利珠单抗作为活动性中重度溃疡性结肠炎诱导和维持疗法的安全性和有效性。方法我们综合了截至 2023 年 4 月来自 MEDLINE、Scopus、EMBASE、PubMed、Web of Science 和 Cochrane Library 的随机对照研究（RCT）。采用二分法结果的风险比 (RR) 及相应的 95% 置信区间 (CI)。研究方案已在 PROSPERO 注册，ID：CRD42023437040。结果共纳入了 5 项 RCT，1849 名参与者。与安慰剂组相比，依托利珠单抗组有显著的临床应答（RR：1.28，95% CI [1.08，1.51]，P = 0.005），诱导期临床缓解率（RR：2.47，95% CI [1.48，4.11]，P = 0.然而，与安慰剂组相比，两组在无皮质类固醇缓解率（RR：1.92，95% CI [0.94，3.92]，P = 0.07）方面没有显著统计学差异。）此外，在诱导和维持阶段，依托利珠单抗组的内镜改善率、内镜缓解率和组织学缓解率都更高。在安全性方面，依托利珠单抗明显更安全，但依托利珠单抗组的任何不良事件均高于安慰剂组。结论依托珠单抗在中度或重度 UC 的诱导和维持治疗中均显示出其有效性。研究结果表明，依托珠单抗对临床、内镜和组织学缓解率均有积极影响。在安全性方面，除副作用外，依托珠单抗比安慰剂更安全。

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引用次数: 0

Impact of pemafibrate in patients with metabolic dysfunction-associated steatotic liver disease complicated by dyslipidemia: A single-arm prospective study 培马贝特对代谢功能障碍相关性脂肪肝并发血脂异常患者的影响：单臂前瞻性研究

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-04-02 DOI: 10.1002/jgh3.13057

Hiroki Ono, Masanori Atsukawa, Akihito Tsubota, Taeang Arai, Kenta Suzuki, Tetsuyuki Higashi, Michika Kitamura, Kaori Shioda-Koyano, Tadamichi Kawano, Yuji Yoshida, Tomomi Okubo, Korenobu Hayama, Norio Itokawa, Chisa Kondo, Mototsugu Nagao, Masato Iwabu, Katsuhiko Iwakiri

Background and Aim

This study aimed to clarify the efficacy and safety of 48-week pemafibrate treatment in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) complicated by dyslipidemia.

Methods

A total of 110 patients diagnosed with MASLD complicated by dyslipidemia received pemafibrate at a dose of 0.1 mg twice daily for 48 weeks.

Results

The participants were 54 males and 37 females, with a median age of 63 (52–71) years. Besides improvement in lipid profile, significant reductions from baseline to 48 weeks of treatment were found in liver-related enzymes, such as aspartate aminotransferase, alanine aminotransferase (ALT), gamma-glutamyl transpeptidase, and alkaline phosphatase (P < 0.001 for all). A significant decrease in the homeostasis model assessment-insulin resistance (HOMA-IR) was observed in patients with insulin resistance (HOMA-IR ≥ 2.5) (4.34 at baseline to 3.89 at Week 48, P < 0.05). Moreover, changes in ALT were weakly correlated with those in HOMA-IR (r = 0.34; p < 0.05). Regarding noninvasive liver fibrosis tests, platelets, Wisteria floribunda agglutinin-positive Mac-2-binding protein, type IV collagen 7s, and the non-alcoholic fatty liver disease fibrosis score significantly decreased from baseline to Week 48. Most adverse events were Grades 1–2, and no drug-related Grade 3 or higher adverse events were observed.

Conclusion

This study demonstrated that 48-week pemafibrate administration improved liver-related enzymes and surrogate marker of liver fibrosis in patients with MASLD. The improvement of insulin resistance by pemafibrate may contribute to the favorable effect on MASLD complicated by dyslipidemia.

背景和目的本研究旨在阐明对代谢功能障碍相关性脂肪性肝病（MASLD）并发血脂异常患者进行48周培马贝特治疗的有效性和安全性。方法共110名确诊为代谢功能障碍并发血脂异常的脂肪肝患者接受培马贝特治疗，剂量为0.1毫克，每天两次，共48周。结果参试者中男性 54 人，女性 37 人，中位年龄为 63（52-71）岁。除了血脂状况有所改善外，从基线到治疗 48 周期间，与肝脏有关的酶，如天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、γ-谷氨酰转肽酶和碱性磷酸酶也有显著下降（均为 0.001）。胰岛素抵抗（HOMA-IR ≥ 2.5）患者的稳态模型评估-胰岛素抵抗（HOMA-IR）明显下降（基线时为 4.34，第 48 周时为 3.89，P < 0.05）。此外，ALT的变化与HOMA-IR的变化呈弱相关性（r = 0.34; P <0.05）。在非侵入性肝纤维化检测方面，血小板、紫藤凝集素阳性 Mac-2 结合蛋白、IV 型胶原 7s 和非酒精性脂肪肝纤维化评分从基线到第 48 周显著下降。大多数不良反应为 1-2 级，未观察到与药物相关的 3 级或以上不良反应。结论本研究表明，服用培马贝特 48 周可改善 MASLD 患者的肝脏相关酶和肝纤维化代用指标。培马贝特对胰岛素抵抗的改善可能是对并发血脂异常的MASLD产生良好疗效的原因之一。

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引用次数: 0

Psychological factors may affect the quality of life in irritable bowel syndrome patients more than the gut itself? A multicenter cross-sectional study 心理因素对肠易激综合征患者生活质量的影响可能大于肠道本身？一项多中心横断面研究

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-03-26 DOI: 10.1002/jgh3.13045

Xiaotian Xie, Jing He, Shu Xu, Zhiyue Xu, Yanqin Long, Zhijun Duan, Jie Yang, Zhifeng Zhang, Jun Wu, Lianying Cai, Liexin Liang, Ning Dai, Jun Zhang, Tao Bai, Xiaohua Hou

Background and Aim

Both intestinal symptoms and comorbidities exist in irritable bowel syndrome (IBS) patients and influence their quality of life (QOL). More research is needed to determine how these variables impact the QOL of IBS patients. This study aimed to determine which specific factors had a higher influence on QOL and to further compare the effects of intestinal symptoms and comorbidities on QOL.

Methods

IBS patients were recruited from six tertiary hospitals in different regions of China. QOL, gastrointestinal symptoms, and comorbidities were assessed by different scales. Correlation analysis, multiple linear regression, and mediation model were used for statistics.

Results

Four hundred fifty-three IBS patients (39.7% women, mean age 45 years) were included and no significant differences in QOL were found across demographic characteristics. Abnormal defecation (r = −0.398), fatigue (r = −0.266), and weakness (r = −0.286) were found to show higher correlation with QOL. More than 40% of IBS patients were found to suffer from varying degrees of anxiety or depression, and anxiety (r = −0.564) and depression (r = −0.411) were significantly negatively correlated with QOL (P < 0.001). Psychological factors showed the strongest impact (β′ = −0.451) and play a strong mediating role in the impact of physiological symptoms on QOL. Anxiety was found to be the strongest factor (β′ = −0.421).

Conclusion

Compared with other symptoms, psychological symptoms, particularly anxiety, are more common and have a more negative influence on QOL. The QOL of IBS patients is also significantly impacted by abnormal defecation, abdominal distension, and systemic extraintestinal somatic symptoms. In the treatment of IBS patients with unhealthy mental status, psychotherapy might be prioritized.

背景和目的肠易激综合征（IBS）患者的肠道症状和合并症都会影响他们的生活质量（QOL）。需要进行更多的研究来确定这些变量如何影响肠易激综合征患者的 QOL。本研究旨在确定哪些特定因素对 QOL 影响较大，并进一步比较肠道症状和合并症对 QOL 的影响。方法从中国不同地区的六家三级医院招募 IBS 患者。采用不同的量表对患者的 QOL、胃肠道症状和合并症进行评估。采用相关分析、多元线性回归和中介模型进行统计。结果共纳入 453 名 IBS 患者（39.7% 为女性，平均年龄 45 岁），不同人口统计学特征的患者在 QOL 方面无显著差异。排便异常（r = -0.398）、疲劳（r = -0.266）和虚弱（r = -0.286）与 QOL 的相关性较高。超过 40% 的肠易激综合征患者患有不同程度的焦虑或抑郁，焦虑（r = -0.564）和抑郁（r = -0.411）与 QOL 呈显著负相关（P < 0.001）。心理因素的影响最大（β′ = -0.451），在生理症状对 QOL 的影响中起着很强的中介作用。焦虑是影响最大的因素（β′ = -0.421）。结论与其他症状相比，心理症状（尤其是焦虑）更为常见，对 QOL 的负面影响也更大。排便异常、腹胀和全身性肠外躯体症状也对肠易激综合征患者的 QOL 有很大影响。在治疗精神状态不健康的肠易激综合征患者时，可优先考虑心理治疗。

{"title":"Psychological factors may affect the quality of life in irritable bowel syndrome patients more than the gut itself? A multicenter cross-sectional study","authors":"Xiaotian Xie, Jing He, Shu Xu, Zhiyue Xu, Yanqin Long, Zhijun Duan, Jie Yang, Zhifeng Zhang, Jun Wu, Lianying Cai, Liexin Liang, Ning Dai, Jun Zhang, Tao Bai, Xiaohua Hou","doi":"10.1002/jgh3.13045","DOIUrl":"https://doi.org/10.1002/jgh3.13045","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Both intestinal symptoms and comorbidities exist in irritable bowel syndrome (IBS) patients and influence their quality of life (QOL). More research is needed to determine how these variables impact the QOL of IBS patients. This study aimed to determine which specific factors had a higher influence on QOL and to further compare the effects of intestinal symptoms and comorbidities on QOL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>IBS patients were recruited from six tertiary hospitals in different regions of China. QOL, gastrointestinal symptoms, and comorbidities were assessed by different scales. Correlation analysis, multiple linear regression, and mediation model were used for statistics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four hundred fifty-three IBS patients (39.7% women, mean age 45 years) were included and no significant differences in QOL were found across demographic characteristics. Abnormal defecation (<i>r</i> = −0.398), fatigue (<i>r</i> = −0.266), and weakness (<i>r</i> = −0.286) were found to show higher correlation with QOL. More than 40% of IBS patients were found to suffer from varying degrees of anxiety or depression, and anxiety (<i>r</i> = −0.564) and depression (<i>r</i> = −0.411) were significantly negatively correlated with QOL (<i>P</i> < 0.001). Psychological factors showed the strongest impact (<i>β′</i> = −0.451) and play a strong mediating role in the impact of physiological symptoms on QOL. Anxiety was found to be the strongest factor (<i>β′</i> = −0.421).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Compared with other symptoms, psychological symptoms, particularly anxiety, are more common and have a more negative influence on QOL. The QOL of IBS patients is also significantly impacted by abnormal defecation, abdominal distension, and systemic extraintestinal somatic symptoms. In the treatment of IBS patients with unhealthy mental status, psychotherapy might be prioritized.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 3","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.13045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140297210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hot avulsion versus argon plasma coagulation for the management of the non-ensnarable polyp: A multicenter, randomized controlled trial 热切法与氩等离子体凝固法治疗非鼻息肉：多中心随机对照试验。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-03-26 DOI: 10.1002/jgh3.13052

Chloe Attree, Ravinder Ogra, Ian F Yusoff, Alan C Moss, Angela Jacques, Gregor Brown, Sina Alexander, Marios Efthymiou, Spiro Raftopoulos

Background and Aim

Snare resection of nonlifting colonic lesions often requires supplemental techniques. We compared the success rates of neoplasia eradication using hot avulsion and argon plasma coagulation in colonic polyps when complete snare polypectomy had failed.

Methods

Polyps that were not completely resectable by snare polypectomy were randomized to argon plasma coagulation or hot avulsion for completion of resection. Argon plasma coagulation was delivered using a forward shooting catheter, using a nontouch technique (flow 1.2 L, 35 watts). Hot avulsion was performed by grasping the neoplastic tissue with hot biopsy forceps and applying traction away from the bowel wall while using EndoCut I or soft coagulation for avulsion. Surveillance colonoscopies were performed at 6, 12, and 18 months.

Results

From November 2013 to July 2017, 59 patients were randomized to argon plasma coagulation (28) or hot avulsion (31). The median age was 69 (60–75), with 46% being female. The median residual tissue size was 10 mm (6–12). The residual adenoma rate at 6 months (hot avulsion 6% vs argon plasma coagulation 21% P = 0.09) and 18 months was not different between the groups (6.6% vs 3.6% P = 0.25). One patient in the argon plasma coagulation arm was diagnosed with metastatic cancer of likely colorectal origin despite benign histology in the original polypectomy specimen, supporting the importance of tissue acquisition.

Conclusion

Both hot avulsion and argon plasma coagulation are effective and safe modalities to complete resection of non-ensnarable colonic polyps.

背景和目的：对非移位结肠病变的钳形切除通常需要辅助技术。我们比较了在完全钳形息肉切除术失败的情况下，使用热撕脱术和氩等离子体凝固术根除结肠息肉肿瘤的成功率：方法：对于无法通过套环息肉切除术完全切除的息肉，随机采用氩等离子体凝固法或热切法完成切除。氩等离子体凝固术使用前射导管，采用非接触技术（流量 1.2 升，功率 35 瓦）。热剥离是用热活检钳抓取肿瘤组织，在远离肠壁的地方施加牵引力，同时使用 EndoCut I 或软凝固技术进行剥离。6个月、12个月和18个月时进行监测结肠镜检查：从 2013 年 11 月到 2017 年 7 月，59 名患者随机接受了氩等离子体凝固术（28 例）或热剥离术（31 例）。中位年龄为 69 岁（60-75 岁），46% 为女性。中位残留组织大小为 10 毫米（6-12）。6 个月和 18 个月时的腺瘤残留率（热剥离 6% vs 氩等离子体凝固 21% P = 0.09）在两组之间没有差异（6.6% vs 3.6% P = 0.25）。氩等离子体凝固治疗组的一名患者被诊断为转移性癌症，很可能是结直肠癌，尽管原始息肉切除标本的组织学为良性，这证明了组织获取的重要性：结论：热剥离法和氩等离子体凝固法都是彻底切除不可切除结肠息肉的有效而安全的方法。

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引用次数: 0

A systematic review with meta-analysis: Efficacy and safety of potassium-competitive acid blocker compared with proton pump inhibitor in the maintenance of healed erosive esophagitis 系统回顾与荟萃分析：钾竞争性酸阻滞剂与质子泵抑制剂在维持侵蚀性食管炎痊愈中的疗效和安全性比较

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-03-22 DOI: 10.1002/jgh3.13053

Daniel M Simadibrata, Elvira Lesmana, Muhammad I A Pratama, Adrianus J Sugiharta, Afiah S Winarizal, Yeong Y Lee, Ari F Syam

Introduction

Proton pump inhibitor (PPI) is the mainstay therapy for the maintenance of healed erosive esophagitis (EE). It is unknown whether potassium-competitive acid blockers (PCABs) are more efficacious and safer than PPIs.

Methods

Only randomized controlled trials (RCTs) comparing PCABs to PPIs in the maintenance of healing rates of endoscopically proven healed EE and indexed in MEDLINE, EMBASE, and CENTRAL until 3 February 2024, were included. A fixed-effects model meta-analysis was performed to pool primary efficacy outcome (maintenance of healing rates at week 24) and safety data (any treatment-emergent adverse event or TEAE). The risk of bias was assessed using Cochrane's Risk of Bias 2 (RoB2) tool.

Results

Four RCTs with a total of 2554 patients were eligible for inclusion. All trials were of low risk of bias. Compared to lansoprazole 15 mg, the maintenance rates of healed EE at week 24 were significantly higher with vonoprazan 10 mg (RR 1.13; 95% CI 1.07–1.19) and vonoprazan 20 mg (RR 1.15; 95% CI 1.10–1.21). Likewise, compared to lansoprazole 15 mg, any TEAEs were significantly greater with vonoprazan 20 mg (RR 1.10; 95% CI 1.01–1.20) but not vonoprazan 10 mg.

Conclusion

Vonoprazan 10 and 20 mg were superior to lansoprazole 15 mg in the maintenance of the healing of EE. Any TEAEs were greater with vonoprazan 20 mg.

导言质子泵抑制剂（PPI）是维持侵蚀性食管炎（EE）痊愈的主要疗法。目前尚不清楚钾竞争性酸阻滞剂（PCAB）是否比 PPI 更有效、更安全。方法仅纳入 2024 年 2 月 3 日前在 MEDLINE、EMBASE 和 CENTRAL 索引中收录的、比较 PCAB 与 PPI 在维持内镜证实痊愈的 EE 愈合率方面效果的随机对照试验（RCT）。采用固定效应模型进行荟萃分析，以汇总主要疗效结果（第 24 周的愈合率维持率）和安全性数据（任何治疗突发不良事件或 TEAE）。偏倚风险采用 Cochrane 的偏倚风险 2 (RoB2) 工具进行评估。结果共纳入了四项 RCT，共 2554 名患者。所有试验的偏倚风险均较低。与兰索拉唑15毫克相比，冯诺普拉赞10毫克（RR为1.13；95% CI为1.07-1.19）和冯诺普拉赞20毫克（RR为1.15；95% CI为1.10-1.21）在第24周时的EE痊愈维持率明显更高。同样，与兰索拉唑 15 毫克相比，沃诺普拉赞 20 毫克（RR 1.10；95% CI 1.01-1.20）的 TEAEs 明显高于沃诺普拉赞 10 毫克（RR 1.10；95% CI 1.01-1.20）。结论在维持 EE 愈合方面，沃诺普拉赞 10 毫克和 20 毫克优于兰索拉唑 15 毫克。沃诺普拉赞 20 毫克的 TEAEs 更多。

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引用次数: 0