JGH Open最新文献_第2页

Ten-year outcomes of a prospective population-based incidence cohort of inflammatory bowel disease patients from Canterbury, New Zealand 新西兰坎特伯雷炎症性肠病患者前瞻性人群发病队列的十年结果

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-10-14 DOI: 10.1002/jgh3.70038

Angela J Forbes, Chris M A Frampton, Andrew S Day, Millie DeVries, Nina McVicar, Heidi Su, Richard B Gearry

Background and Aim

Inflammatory bowel disease (IBD) is a progressive condition where ongoing inflammation in the gastrointestinal tract can lead to complications such as strictures, and fistulae. The long-term outcomes of newly diagnosed patients under current medical therapy can be used to plan health service provision and guide patients.

Methods

Prospective population-based data on all incident patients diagnosed with IBD in Canterbury was gathered in 2014 (n = 205). The medical records of these patients were followed for medication use, disease progression, hospitalization, surgery and mortality, in the 10 years since their diagnosis. Survival analysis and cox regression determined characteristics associated with earlier time to these outcomes.

Results

Medical records of 184 IBD patients were able to be retrieved. Immunomodulators were used by 62% and biologics by 35%; hospitalization occurred for 42% and surgery for 15%. Montreal phenotype progression occurred for 21 and 7% of the cohort died. Younger age at diagnosis hazard ratio (HR) 2.1 (95% confidence interval [CI] 1.1–4.0) and Crohn's disease HR 1.7 (95% CI 1.1–2.6) was associated with immunomodulator use. Younger age was also associated with biologic use HR 2.9 (95% CI 1.2–6.9). Male gender was associated with surgery HR 2.8 (95% CI 1.2–6.4). Perianal disease at diagnosis (14.7%) was associated with immunomodulator use HR 2.58 (95% CI 1.44–4.59) and Montreal phenotype progression HR 2.93 (95% CI 1.10–7.77).

Conclusion

In the 10 years since diagnosis disease progression and treatment escalation occurred for most of this population-based cohort. Earlier intervention for patients with higher-risk characteristics may improve long-term outcomes reducing the burden on health systems.

背景和目的炎症性肠病（IBD）是一种进展性疾病，胃肠道的持续炎症可导致狭窄和瘘管等并发症。新确诊患者在当前药物治疗下的长期疗效可用于规划医疗服务和指导患者。方法收集了 2014 年坎特伯雷所有确诊 IBD 患者的前瞻性人群数据（n = 205）。对这些患者的病历进行了跟踪调查，以了解其确诊后 10 年内的用药情况、疾病进展、住院情况、手术情况和死亡率。生存分析和 cox 回归确定了与较早出现这些结果相关的特征。结果检索到 184 名 IBD 患者的医疗记录。62%的患者使用了免疫调节剂，35%的患者使用了生物制剂；42%的患者住院治疗，15%的患者接受了手术治疗。21例患者的表型出现蒙特利尔进展，7%的患者死亡。较年轻的诊断年龄危险比 (HR) 为 2.1（95% 置信区间 [CI]：1.1-4.0），克罗恩病的危险比为 1.7（95% 置信区间 [CI]：1.1-2.6），这与使用免疫调节剂有关。年轻也与使用生物制剂有关，HR 2.9（95% CI 1.2-6.9）。男性与手术相关，HR 2.8（95% CI 1.2-6.4）。确诊时的肛周疾病（14.7%）与使用免疫调节剂和蒙特利尔表型进展有关，HR 2.58 (95% CI 1.44-4.59)，HR 2.93 (95% CI 1.10-7.77)。结论在确诊后的 10 年中，该人群队列中的大多数患者都出现了疾病进展和治疗升级。对具有较高风险特征的患者进行早期干预可改善长期预后，减轻医疗系统的负担。

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引用次数: 0

Overlapping group between non-alcoholic fatty liver disease and metabolic associated fatty liver disease better for liver research 非酒精性脂肪肝和代谢相关性脂肪肝的重叠群体更有利于肝脏研究

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-10-13 DOI: 10.1002/jgh3.70039

Yu-Ming Cheng, Tsung-Han Hsieh, Chia-Chi Wang, Jia-Horng Kao

Aims

Metabolic associated fatty liver disease (MAFLD) was proposed to replace “non-alcoholic fatty liver disease (NAFLD) with new diagnostic criteria.” The group meeting these two diagnostic criteria is called “Overlapping Fatty Liver Disease (FLD).” Its clinical characteristics remain unknown.

Methods

This study included participants from the Taiwan Bio-Bank database, where NAFLD was defined as hepatic steatosis in liver ultrasound, with exclusion of other known chronic liver diseases. MAFLD was defined as the presence of hepatic steatosis plus metabolic dysfunction, defined as having any of following three criteria: overweight/obesity, type 2 diabetes mellitus (DM), or ≥2 metabolic risk abnormalities in lean/normal weight subjects. According to these two diagnostic criteria, three groups were identified: “overlapping FLD”, “NAFLD alone”, and “MAFLD alone.” NAFLD fibrosis score (NFS) >0.675 was defined as advanced liver fibrosis.

Results

Eight thousand thirty-eight NAFLD participants (age 55.86 ± 10.12; males 41.07%) were included in the final analysis. Of them, “overlapping FLD” was diagnosed in 7377 (91.8%) and “NAFLD alone” in 661 (8.2%) participants. “Overlapping FLD” patients were older and had a higher percentage of male, worse metabolic profiles, higher NFS, and the percentage of carotid plaques was higher than those with “NAFLD alone.” Multivariate analysis showed age, hypertension, DM, and BMI were positively associated with advanced liver fibrosis in “overlapping FLD” patients.

Conclusions

“Overlapping FLD” is better for liver research due to identifying a high-risk population among NAFLD patients. NAFLD definition introduces the heterogeneity through “NAFLD alone” group and MAFLD criteria overcome this limitation.

目的提出代谢相关性脂肪肝（MAFLD），以新的诊断标准取代 "非酒精性脂肪肝（NAFLD）"。符合这两个诊断标准的人群被称为 "重叠性脂肪肝（FLD）"。其临床特征尚不清楚。方法本研究纳入了台湾生物库数据库中的参与者，其中非酒精性脂肪肝的定义是肝脏超声检查发现肝脏脂肪变性，并排除其他已知的慢性肝病。MAFLD定义为肝脏脂肪变性和代谢功能障碍，代谢功能障碍定义为以下三个标准中的任何一个：超重/肥胖、2型糖尿病（DM）或瘦/正常体重受试者有≥2个代谢风险异常。根据这两个诊断标准，确定了三个组别："重叠FLD"、"单纯NAFLD "和 "单纯MAFLD"。非酒精性脂肪肝纤维化评分（NFS）为 0.675，即为晚期肝纤维化。结果 838 名非酒精性脂肪肝患者（年龄 55.86 ± 10.12；男性占 41.07%）被纳入最终分析。其中，7377 人（91.8%）被诊断为 "重叠 FLD"，661 人（8.2%）被诊断为 "单纯非酒精性脂肪肝"。与 "单纯非酒精性脂肪肝 "患者相比，"重叠FLD "患者年龄更大，男性比例更高，代谢状况更差，NFS更高，颈动脉斑块的比例也更高。多变量分析显示，年龄、高血压、糖尿病和体重指数与 "重叠FLD "患者的晚期肝纤维化呈正相关。结论 "重叠FLD "更有利于肝脏研究，因为它能在非酒精性脂肪肝患者中发现高危人群。非酒精性脂肪肝的定义通过 "单纯非酒精性脂肪肝 "组引入了异质性，而MAFLD标准克服了这一局限性。

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引用次数: 0

Evaluating the yield of digital single operator cholangioscopy in posttransplant biliary strictures after unsuccessful guidewire placement with ERCP 评估ERCP导丝置入失败后移植后胆道狭窄的数字化单人胆道镜检查效果。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-10-08 DOI: 10.1002/jgh3.13112

Jonathan Ng, Sujievvan Chandran, Kim Hay Be, Leonardo Zorron Cheng Tao Pu, Kevin Kyung Ho Choi, Payal Saxena, Arthur John Kaffes, Rhys Vaughan, Marios Efthymiou

Background and Aims

Strictures are the most common biliary complication after liver transplantation, and endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard in its management. Failure to cross the biliary anastomosis requires a repeated attempt with ERCP, referral for percutaneous transhepatic cholangiography (PTC) or surgery. We present our experience with the digital single operator cholangioscope (D-SOC) in achieving guidewire access in a liver transplant cohort with difficult biliary strictures who have failed conventional ERCP methods.

Methods

This was a retrospective study involving two adult liver transplant centers servicing the two most populated states in Australia. Deceased-donor liver transplant recipients undergoing D-SOC for biliary strictures who have failed conventional methods to achieve biliary access were included.

Results

Between July 2017 to April 2022, eighteen patients underwent D-SOC after failing to achieve guidewire placement through standard ERCP techniques. Thirteen out of eighteen (72%) had successful guidewire placement with index D-SOC. Five of eighteen patients (28%) had unsuccessful guidewire placement with D-SOC. In two of these patients, use of D-SOC informed further endoscopic management, with one avoiding PTC and the other avoiding surgery. Two of the five patients required PTC and one patient was left unstented. Three patients developed post D-SOC cholangitis.

Conclusions

D-SOC is effective at achieving guidewire access in post-liver transplant patients who fail conventional ERCP techniques and should be considered in the treatment algorithm as a step before PTC and surgery.

背景和目的：胆道狭窄是肝移植术后最常见的胆道并发症，内镜逆行胰胆管造影术（ERCP）被认为是治疗胆道狭窄的金标准。如果胆道吻合术失败，就需要反复尝试ERCP、转诊进行经皮经肝胆管造影（PTC）或手术。我们介绍了数字式单人胆道镜（D-SOC）在传统ERCP方法失败的疑难胆道狭窄肝移植患者中实现导丝通路的经验：这是一项回顾性研究，涉及澳大利亚人口最多的两个州的两个成人肝移植中心。研究对象包括因胆道狭窄而接受D-SOC手术的死亡供体肝移植受者，这些受者采用传统方法实现胆道通路失败：2017年7月至2022年4月期间，有18名患者因无法通过标准ERCP技术实现导丝置入而接受了D-SOC手术。18名患者中有13名（72%）通过指数D-SOC成功实现了导丝置入。18 位患者中有 5 位（28%）在使用 D-SOC 时导丝置入不成功。在其中两名患者中，D-SOC 为进一步的内窥镜治疗提供了依据，其中一人避免了 PTC，另一人避免了手术。五名患者中有两名患者需要进行 PTC，一名患者没有进行手术。三名患者在 D-SOC 术后出现了胆管炎：结论：D-SOC 能有效实现传统 ERCP 技术失败的肝移植术后患者的导丝通路，应作为 PTC 和手术前的一个步骤纳入治疗方案。

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引用次数: 0

Genotypes of carboxypeptidase A1 and gamma-glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of intraductal papillary mucinous neoplasm in Japan 在日本，羧肽酶 A1 和γ-谷氨酰转移酶 1 的基因型可能是诊断和预测导管内乳头状黏液瘤令人担忧的特征的有用工具。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-10-07 DOI: 10.1002/jgh3.70031

Shuhei Agawa, Seiji Futagami, Ken Nakamura, Mayu Habiro, Rie Kawawa, Yuto Shinagawa, Rina Motomiya, Kumiko Kirita, Teppei Akimoto, Takeshi Onda, Tomohide Tanabe, Nobue Ueki, Kazufumi Honda, Kok-Ann Gwee, Katsuhiko Iwakiri

Background and Aim

This study aimed to clarify whether several single-nucleotide polymorphisms (SNPs)-related chronic pancreatitis such as carboxypeptidase A1 (CPA1), carboxypeptidase B1 (CPB1), Gamma-glutamyltransferase 1 (GGT1), G-protein-coupled receptor Class C Group 6 Member A (GPRC6A), and serine protease inhibitor, Kazal type 1 (SPINK-1) genotypes were associated with clinical characteristics of patients with intraductal papillary mucinous neoplasm (IPMN) and worrisome features of IPMN.

Methods

We enrolled 100 patients with IPMN and 116 patients as a control. Serum p-amylase, lipase, trypsin, phospholipase A2 (PLA2), and elastase-1 levels were measured. An Olympus EUS (GF-UCT 260) was used to perform endosonography in 100 patients with IPMN. Total EUS score was evaluated using endosonography. DNA was isolated from the duodenal tissue using a commercial system and polymerase chain reaction (PCR) was performed on 7500 Fast PCR System.

Results

There were no associations between glucose tolerances, lipid levels and genotypes of CPA1, GGT1, GPRC6A, and SPINK-1 in patients with IPMN. CPA1 genotype was significantly associated with the pathophysiology of IPMN. Then, GGT1 genotype was also significantly associated with EUS total score and the size of cyst more than 20 mm and more than 30 mm as one of worrisome features of IPMN.

Conclusion

Genotypes of carboxypeptidase A1 and gamma-glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of IPMN.

背景和目的：本研究旨在阐明几种单核苷酸多态性（SNPs）相关的慢性胰腺炎，如羧肽酶A1（CPA1），羧肽酶B1（CPB1），γ-谷氨酰转移酶1（GGT1）、GPRC6A）和丝氨酸蛋白酶抑制剂卡扎尔 1 型（SPINK-1）的基因型与导管内乳头状粘液瘤（IPMN）患者的临床特征和 IPMN 的令人担忧的特征相关。研究方法我们招募了 100 名 IPMN 患者和 116 名对照组患者。测量血清中 p-淀粉酶、脂肪酶、胰蛋白酶、磷脂酶 A2 (PLA2) 和弹性蛋白酶-1 的水平。使用奥林巴斯 EUS（GF-UCT 260）对 100 名 IPMN 患者进行内窥镜检查。通过内镜检查评估 EUS 总分。使用商用系统从十二指肠组织中分离出DNA，并在7500快速PCR系统上进行聚合酶链反应（PCR）：结果：IPMN 患者的葡萄糖耐量、血脂水平与 CPA1、GGT1、GPRC6A 和 SPINK-1 基因型之间没有关联。CPA1 基因型与 IPMN 的病理生理学显著相关。此外，GGT1 基因型与 EUS 总分以及 IPMN 的一个令人担忧的特征--囊肿大小超过 20 毫米和超过 30 毫米也有显著相关性：结论：羧肽酶 A1 和γ-谷氨酰转移酶 1 的基因型可能是诊断 IPMN 和预测 IPMN 危险特征的有用工具。

{"title":"Genotypes of carboxypeptidase A1 and gamma-glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of intraductal papillary mucinous neoplasm in Japan","authors":"Shuhei Agawa, Seiji Futagami, Ken Nakamura, Mayu Habiro, Rie Kawawa, Yuto Shinagawa, Rina Motomiya, Kumiko Kirita, Teppei Akimoto, Takeshi Onda, Tomohide Tanabe, Nobue Ueki, Kazufumi Honda, Kok-Ann Gwee, Katsuhiko Iwakiri","doi":"10.1002/jgh3.70031","DOIUrl":"10.1002/jgh3.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>This study aimed to clarify whether several single-nucleotide polymorphisms (SNPs)-related chronic pancreatitis such as carboxypeptidase A1 (<i>CPA1</i>), carboxypeptidase B1 (<i>CPB1</i>), Gamma-glutamyltransferase 1 (<i>GGT1</i>), G-protein-coupled receptor Class C Group 6 Member A (<i>GPRC6A</i>), and serine protease inhibitor, Kazal type 1 (<i>SPINK-1</i>) genotypes were associated with clinical characteristics of patients with intraductal papillary mucinous neoplasm (IPMN) and worrisome features of IPMN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We enrolled 100 patients with IPMN and 116 patients as a control. Serum p-amylase, lipase, trypsin, phospholipase A2 (PLA2), and elastase-1 levels were measured. An Olympus EUS (GF-UCT 260) was used to perform endosonography in 100 patients with IPMN. Total EUS score was evaluated using endosonography. DNA was isolated from the duodenal tissue using a commercial system and polymerase chain reaction (PCR) was performed on 7500 Fast PCR System.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no associations between glucose tolerances, lipid levels and genotypes of <i>CPA1</i>, <i>GGT1</i>, <i>GPRC6A</i>, and <i>SPINK-1</i> in patients with IPMN. <i>CPA1</i> genotype was significantly associated with the pathophysiology of IPMN. Then, <i>GGT1</i> genotype was also significantly associated with EUS total score and the size of cyst more than 20 mm and more than 30 mm as one of worrisome features of IPMN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Genotypes of carboxypeptidase A1 and gamma-glutamyltransferase 1 may be useful tools for the diagnosis and the predictor of worrisome features of IPMN.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 10","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11458879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394142","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

Initial treatment efficacy and safety of durvalumab plus tremelimumab combination therapy in unresectable hepatocellular carcinoma in clinical practice 临床实践中杜瓦单抗加曲妥木单抗联合治疗不可切除肝细胞癌的初始疗效和安全性。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-10-04 DOI: 10.1002/jgh3.70033

Tetsu Tomonari, Joji Tani, Yasushi Sato, Hironori Tanaka, Akihiro Morishita, Koichi Okamoto, Yutaka Kawano, Masahiro Sogabe, Hiroshi Miyamoto, Tetsuji Takayama

Background and Aims

We aimed to evaluate the efficacy and safety of durvalumab plus tremelimumab (Dur + Tre) combination therapy in patients with unresectable hepatocellular carcinoma (uHCC) in clinical practice.

Methods

We retrospectively evaluated 37 patients with uHCC from our institutions between April 2023 and January 2024. Patients were divided into first- and later-line groups for analysis of antitumor efficacy, adverse events (AEs), and transition rate to second-line treatment according to the Response Evaluation Criteria in Solid Tumors (RECIST).

Results

The disease control rate (DCR) for the first-line group was 80.9%, which was significantly higher than that for the later-line group (50%). The incidence of immune-related AEs (irAEs) was 24.3%, with grade 3 or higher irAEs including increased transaminase (8.1%), diarrhea (8.1%), and adrenal insufficiency (2.7%). The rates of drug withdrawal and discontinuation owing to AEs were 23.8% and 19%, respectively, in the first-line treatment and 31.2% and 12.5%, respectively, in the later-line treatment, with no significant difference. Analysis of changes in liver reserve using the albumin–bilirubin (ALBI) score showed no obvious loss of liver reserve for up to 12 weeks. The transition rate from first- to second-line therapy after progressive disease (PD) was as high as 94.7%.

Conclusion

The efficacy and safety of Dur + Tre in clinical practice were comparable to those reported in a recent phase III trial. The first-line Dur + Tre therapy had a higher DCR than that of the later lines, and the transition rate to second-line therapy was considerably high, suggesting that Dur + Tre therapy would be more beneficial in first-line treatment.

背景与目的我们旨在评估临床实践中杜瓦单抗加曲妥木单抗（Dur + Tre）联合治疗不可切除肝细胞癌（uHCC）患者的有效性和安全性：我们回顾性评估了2023年4月至2024年1月期间我院的37例uHCC患者。根据实体瘤反应评价标准（RECIST），将患者分为一线组和二线组，分析抗肿瘤疗效、不良事件（AEs）和二线治疗转归率：结果：一线治疗组的疾病控制率（DCR）为80.9%，明显高于二线治疗组（50%）。免疫相关不良反应（irAEs）的发生率为24.3%，其中3级或以上的不良反应包括转氨酶升高（8.1%）、腹泻（8.1%）和肾上腺功能不全（2.7%）。一线治疗中因AEs导致的停药率和停药率分别为23.8%和19%，后线治疗中分别为31.2%和12.5%，无显著差异。使用白蛋白-胆红素（ALBI）评分分析肝脏储备的变化显示，在长达12周的时间里，肝脏储备没有明显下降。疾病进展期（PD）后从一线治疗到二线治疗的过渡率高达94.7%：结论：Dur + Tre 在临床实践中的疗效和安全性与最近一项 III 期试验报告的疗效和安全性相当。一线Dur + Tre疗法的DCR高于后几线疗法，而且转为二线疗法的比率相当高，这表明Dur + Tre疗法在一线治疗中更有益。

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引用次数: 0

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-10-03 DOI: 10.1002/jgh3.70008

Jennifer Gu, Leonardo Zorron Cheng Tao Pu, Jonathan Ng, Kim H Be, Rhys Vaughan, Sujievvan Chandran, Marios Efthymiou

Background and Aim

Data on post-endoscopic retrograde cholangiopancreatography (ERCP) adverse events and readmission rates in liver transplantation (LT) patients remain scarce. This study determined the 30-day procedure-related readmission rate following ERCP in an LT cohort at an Australian tertiary academic center.

Methods

All unplanned readmissions within 30 days following ERCP in orthotopic LT patients between December 2012 and August 2021 were retrospectively identified. Demographic data, procedure variables, and readmission characteristics were also collected.

Results

Forty-five procedure-related readmissions were identified (3.3%) from a total of 1369 ERCP procedures. This included 33 cases of cholangitis (2.4%), 7 cases of nonspecific abdominal pain (0.5%), 5 cases of mild post-ERCP pancreatitis (0.5%), and 3 cases of bleeding (0.2%). No procedure-related mortality was observed.

Conclusion

The procedure-related readmission rate following ERCP in this LT cohort was 3.3%, which is likely lower than comparable studies carried out on the overall population.

背景和目的：有关肝移植（LT）患者内镜逆行胰胆管造影术（ERCP）后不良事件和再入院率的数据仍然很少。本研究确定了澳大利亚一家三级学术中心的肝移植队列中ERCP术后30天内与手术相关的再入院率：方法：回顾性地确定了2012年12月至2021年8月期间所有正位LT患者ERCP术后30天内的计划外再入院情况。研究还收集了人口统计学数据、手术变量和再入院特征：结果：在1369例ERCP手术中，发现了45例（3.3%）与手术相关的再入院。其中包括33例胆管炎（2.4%）、7例非特异性腹痛（0.5%）、5例ERCP术后轻度胰腺炎（0.5%）和3例出血（0.2%）。没有观察到与手术相关的死亡率：该LT队列中ERCP术后与手术相关的再入院率为3.3%，可能低于针对总体人群开展的同类研究。

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引用次数: 0

Cronkhite–Canada syndrome tends to be accompanied by colorectal cancer: Report of seven cases 克朗凯特-加拿大综合征往往伴有结肠直肠癌：七个病例的报告。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-10-02 DOI: 10.1002/jgh3.70032

Masayuki Shimoyama, Hiroyoshi Iwagami, Kosuke Minaga, Takuji Akamatsu, Yoshito Uenoyama, Yukitaka Yamashita

Cronkhite–Canada syndrome (CCS) can be difficult to diagnose. To diagnose CCS, it is important to perform endoscopic examination for patients with chronic diarrhea, check for the presence or absence of polyposis, and evaluate inflammation in the mucosa between the polyps. This study reported seven cases of CCS. The age of the patients, which included four men and three women, ranged 48–72 years, and all patients were Asian. The most common symptom among these patients was chronic diarrhea. Three of the patients had rectal cancer. In two patients, the lesions were detected at an early stage and resected via endoscopic treatment. CCS is associated with a high risk of malignant gastrointestinal lesions, especially rectal cancers, and periodic surveillance endoscopy and careful observation are required.

克朗凯特-加拿大综合征（CCS）很难诊断。要诊断 CCS，必须对慢性腹泻患者进行内窥镜检查，检查是否存在息肉病，并评估息肉之间粘膜的炎症情况。本研究报告了 7 例慢性腹泻患者。患者年龄在 48-72 岁之间，其中男性 4 人，女性 3 人，均为亚洲人。这些患者最常见的症状是慢性腹泻。其中三名患者患有直肠癌。其中两名患者在早期发现病变，并通过内窥镜治疗进行了切除。CCS 与胃肠道恶性病变（尤其是直肠癌）的高风险相关，因此需要定期进行内镜监测和仔细观察。

引用次数: 0

Unveiling Resmetirom: A systematic review and meta-analysis on its impact on liver function and safety in non-alcoholic steatohepatitis treatment 揭开 Resmetirom 的神秘面纱：非酒精性脂肪性肝炎治疗对肝功能和安全性影响的系统回顾和荟萃分析。

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-10-01 DOI: 10.1002/jgh3.70025

Hashim Talib Hashim, Ahmed Qasim Mohammed Alhatemi, Sania Riaz, Mohammedbaqer Ali Al-Ghuraibawi, Arwa S. Alabide, Humza Saeed, Fatimah Abdullah Sulaiman, Mustafa Ali Abd Alhussain, Maythum Ali Shallan, Ahmed Dheyaa Al-Obaidi, Omar Saab, Hasan Al-Obaidi, Ali Talib Hashim, Nooraldin Merza

Background and Aim

The role of Resmetirom in non-alcoholic steatohepatitis (NASH) represents a promising therapeutic approach in addressing the growing global burden of liver disease. With NASH emerging as a leading cause of liver-related morbidity and mortality worldwide, there is an urgent need for effective treatments. Resmetirom, a selective thyroid hormone receptor-β agonist, offers potential benefits in improving liver histology and metabolic parameters in patients with NASH. This review examines the current evidence surrounding Resmetirom's role in NASH management.

Methods

A systematic review and meta-analysis was done by searching in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE (including MEDLINE InProcess) (OvidSP), Web of Science, Embase (OvidSP), and Scopus databases. ROB2 Cochrane tool was used for assessing risk of bias in randomized controlled trials (RCTs). In the analysis, we used RevMan Cochrane software.

Results

The study showed that patients who were treated with Resmetirom had significantly lower low-density lipoprotein-cholesterol (LDL-C) levels (mean difference [MD] −10.45; 95% confidence interval [CI] −15.86 to −5.83; P < 0.001) and alanine aminotransferase (ALT) levels (MD −7.18; 95% CI −12.67 to −1.68; P = 0.01) as compared with those in the placebo group. The risk of adverse events including diarrhea [risk ratio (RR) 1.81; 95% CI 1.40 to 2.35; P < 0.001] and nausea (RR 1.72; 95% CI 1.31 to 2.27; P < 0.001) was significantly increased for the Resmetirom group as compared with the placebo group.

Conclusion

Resmetirom presents a promising therapeutic option for NASH, offering potential benefits in reducing liver fat content and improving histological outcomes. The encouraging results from clinical trials suggest that Resmetirom may address an unmet need in NASH management, providing hope for patients with this progressive liver disease. Further research and long-term studies are warranted to validate its efficacy and safety profile in larger patient populations.

背景和目的：Resmetirom 在非酒精性脂肪性肝炎（NASH）中的作用代表了一种很有前景的治疗方法，可解决全球日益沉重的肝病负担。随着非酒精性脂肪性肝炎成为全球肝脏相关疾病发病率和死亡率的主要原因，迫切需要有效的治疗方法。Resmetirom是一种选择性甲状腺激素受体-β激动剂，在改善NASH患者的肝脏组织学和代谢参数方面具有潜在的益处。本综述研究了有关雷美替罗在NASH治疗中作用的现有证据：通过在 Cochrane Central Register of Controlled Trials (CENTRAL)、PubMed、MEDLINE (包括 MEDLINE InProcess) (OvidSP)、Web of Science、Embase (OvidSP) 和 Scopus 数据库中检索，进行了系统综述和荟萃分析。ROB2 Cochrane 工具用于评估随机对照试验（RCT）的偏倚风险。在分析中，我们使用了RevMan Cochrane软件：研究显示，与安慰剂组相比，接受雷美替罗治疗的患者低密度脂蛋白胆固醇（LDL-C）水平明显降低（平均差[MD] -10.45；95%置信区间[CI] -15.86至-5.83；P P = 0.01）。包括腹泻在内的不良事件风险[风险比（RR）为1.81；95% CI为1.40至2.35；P P 结论：Resmetirom 是治疗 NASH 的一种很有前景的选择，在降低肝脏脂肪含量和改善组织学结果方面具有潜在的益处。临床试验取得的令人鼓舞的结果表明，Resmetirom 可以满足 NASH 治疗中尚未满足的需求，为这种进展性肝病患者带来希望。为了在更大的患者群体中验证其疗效和安全性，有必要开展进一步的研究和长期研究。

{"title":"Unveiling Resmetirom: A systematic review and meta-analysis on its impact on liver function and safety in non-alcoholic steatohepatitis treatment","authors":"Hashim Talib Hashim, Ahmed Qasim Mohammed Alhatemi, Sania Riaz, Mohammedbaqer Ali Al-Ghuraibawi, Arwa S. Alabide, Humza Saeed, Fatimah Abdullah Sulaiman, Mustafa Ali Abd Alhussain, Maythum Ali Shallan, Ahmed Dheyaa Al-Obaidi, Omar Saab, Hasan Al-Obaidi, Ali Talib Hashim, Nooraldin Merza","doi":"10.1002/jgh3.70025","DOIUrl":"10.1002/jgh3.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>The role of Resmetirom in non-alcoholic steatohepatitis (NASH) represents a promising therapeutic approach in addressing the growing global burden of liver disease. With NASH emerging as a leading cause of liver-related morbidity and mortality worldwide, there is an urgent need for effective treatments. Resmetirom, a selective thyroid hormone receptor-β agonist, offers potential benefits in improving liver histology and metabolic parameters in patients with NASH. This review examines the current evidence surrounding Resmetirom's role in NASH management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis was done by searching in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE (including MEDLINE InProcess) (OvidSP), Web of Science, Embase (OvidSP), and Scopus databases. ROB2 Cochrane tool was used for assessing risk of bias in randomized controlled trials (RCTs). In the analysis, we used RevMan Cochrane software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study showed that patients who were treated with Resmetirom had significantly lower low-density lipoprotein-cholesterol (LDL-C) levels (mean difference [MD] −10.45; 95% confidence interval [CI] −15.86 to −5.83; <i>P</i> < 0.001) and alanine aminotransferase (ALT) levels (MD −7.18; 95% CI −12.67 to −1.68; <i>P</i> = 0.01) as compared with those in the placebo group. The risk of adverse events including diarrhea [risk ratio (RR) 1.81; 95% CI 1.40 to 2.35; <i>P</i> < 0.001] and nausea (RR 1.72; 95% CI 1.31 to 2.27; <i>P</i> < 0.001) was significantly increased for the Resmetirom group as compared with the placebo group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Resmetirom presents a promising therapeutic option for NASH, offering potential benefits in reducing liver fat content and improving histological outcomes. The encouraging results from clinical trials suggest that Resmetirom may address an unmet need in NASH management, providing hope for patients with this progressive liver disease. Further research and long-term studies are warranted to validate its efficacy and safety profile in larger patient populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 10","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11444049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366883","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

Exploring vision transformers for classifying early Barrett's dysplasia in endoscopic images: A pilot study on white-light and narrow-band imaging 探索用于对内窥镜图像中的早期巴雷特发育不良进行分类的视觉转换器：白光和窄带成像试验研究

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-09-25 DOI: 10.1002/jgh3.70030

Jin L Tan, Dileepa Pitawela, Mohamed A Chinnaratha, Andrawus Beany, Enrik J Aguila, Hsiang-Ting Chen, Gustavo Carneiro, Rajvinder Singh

Background and Aim

Various deep learning models, based on convolutional neural network (CNN), have been shown to improve the detection of early esophageal neoplasia in Barrett's esophagus. Vision transformer (ViT), derived from natural language processing, has emerged as the new state-of-the-art for image recognition, outperforming predecessors such as CNN. This pilot study explores the use of ViT to classify the presence or absence of early esophageal neoplasia in endoscopic images of Barrett's esophagus.

Methods

A BO dataset of 1918 images of Barrett's esophagus from 267 unique patients was used. The images were classified as dysplastic (D-BO) or non-dysplastic (ND-BO). A pretrained vision transformer model, ViTBase16, was used to develop our classifier models. Three ViT models were developed for comparison based on imaging modality: white-light imaging (WLI), narrow-band imaging (NBI), and combined modalities. Performance of each model was evaluated based on accuracy, sensitivity, specificity, confusion matrices, and receiver operating characteristic curves.

Results

The ViT models demonstrated the following performance: WLI-ViT (Accuracy: 92%, Sensitivity: 82%, Specificity: 95%), NBI-ViT (Accuracy: 99%, Sensitivity: 97%, Specificity: 99%), and combined modalities-ViT (Accuracy: 93%, Sensitivity: 87%, Specificity: 95%). Combined modalities-ViT showed greater accuracy (94% vs 90%) and sensitivity (80% vs 70%) compared with WLI-ViT when classifying WLI images on a subgroup testing set.

Conclusion

ViT exhibited high accuracy in classifying the presence or absence of EON in endoscopic images of Barrett's esophagus. ViT has the potential to be widely applicable to other endoscopic diagnoses of gastrointestinal diseases.

背景与目的基于卷积神经网络（CNN）的各种深度学习模型已被证明可改善巴雷特食管早期食管肿瘤的检测。源于自然语言处理的视觉转换器（ViT）已成为图像识别领域的最新技术，其性能优于 CNN 等前辈。本试验研究探讨了如何使用 ViT 对巴雷特食管内窥镜图像中是否存在早期食管肿瘤进行分类。方法研究使用了来自 267 名患者的 1918 张巴雷特食管图像的 BO 数据集。这些图像被分为增生不良（D-BO）和非增生不良（ND-BO）两类。我们使用预先训练好的视觉转换器模型 ViTBase16 来开发分类器模型。为了进行比较，我们根据成像模式开发了三种 ViT 模型：白光成像（WLI）、窄带成像（NBI）和组合模式。根据准确性、灵敏度、特异性、混淆矩阵和接收者工作特征曲线对每个模型的性能进行了评估。结果 ViT 模型的性能如下：WLI-ViT（准确率：92%，灵敏度：82%，特异性：95%）、NBI-ViT（准确率：99%，灵敏度：97%，特异性：99%）和组合模式-ViT（准确率：93%，灵敏度：87%，特异性：95%）。与 WLI-ViT 相比，在分组测试集上对 WLI 图像进行分类时，组合模式-ViT 显示出更高的准确性（94% 对 90%）和灵敏度（80% 对 70%）。结论 ViT 在对 Barrett 食管内窥镜图像中是否存在 EON 进行分类时表现出很高的准确性。ViT 有潜力广泛应用于其他消化道疾病的内窥镜诊断。

{"title":"Exploring vision transformers for classifying early Barrett's dysplasia in endoscopic images: A pilot study on white-light and narrow-band imaging","authors":"Jin L Tan, Dileepa Pitawela, Mohamed A Chinnaratha, Andrawus Beany, Enrik J Aguila, Hsiang-Ting Chen, Gustavo Carneiro, Rajvinder Singh","doi":"10.1002/jgh3.70030","DOIUrl":"https://doi.org/10.1002/jgh3.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Various deep learning models, based on convolutional neural network (CNN), have been shown to improve the detection of early esophageal neoplasia in Barrett's esophagus. Vision transformer (ViT), derived from natural language processing, has emerged as the new state-of-the-art for image recognition, outperforming predecessors such as CNN. This pilot study explores the use of ViT to classify the presence or absence of early esophageal neoplasia in endoscopic images of Barrett's esophagus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A BO dataset of 1918 images of Barrett's esophagus from 267 unique patients was used. The images were classified as dysplastic (D-BO) or non-dysplastic (ND-BO). A pretrained vision transformer model, ViTBase16, was used to develop our classifier models. Three ViT models were developed for comparison based on imaging modality: white-light imaging (WLI), narrow-band imaging (NBI), and combined modalities. Performance of each model was evaluated based on accuracy, sensitivity, specificity, confusion matrices, and receiver operating characteristic curves.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The ViT models demonstrated the following performance: WLI-ViT (Accuracy: 92%, Sensitivity: 82%, Specificity: 95%), NBI-ViT (Accuracy: 99%, Sensitivity: 97%, Specificity: 99%), and combined modalities-ViT (Accuracy: 93%, Sensitivity: 87%, Specificity: 95%). Combined modalities-ViT showed greater accuracy (94% <i>vs</i> 90%) and sensitivity (80% <i>vs</i> 70%) compared with WLI-ViT when classifying WLI images on a subgroup testing set.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ViT exhibited high accuracy in classifying the presence or absence of EON in endoscopic images of Barrett's esophagus. ViT has the potential to be widely applicable to other endoscopic diagnoses of gastrointestinal diseases.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 9","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142324619","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

Liver transplant recipients have worse metabolic body phenotype compared with matched non-transplant controls 与匹配的非移植对照组相比，肝移植受者的代谢体表型更差

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open

Pub Date : 2024-09-24 DOI: 10.1002/jgh3.70024

Chandra Bhati, Danielle Kirkman, Mikael F Forsgren, Hiba Kamal, Hiba Khan, Sherry Boyett, Olof Dahlqvist Leinhard, Jennifer Linge, Vaishali Patel, Samarth Patel, Susan Wolver, Mohammad S Siddiqui

Background and Aim

Quantification of body compartments, particularly the interaction between adipose tissue and skeletal muscle, is emerging as novel a biomarker of metabolic health. The present study evaluated the impact of liver transplant (LT) on body compartments.

Methods

Totally 66 adult LT recipients were enrolled in whom body compartments including visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (ASAT), muscle fat infiltration (MFI), fat-free muscle volume (FFMV), and liver fat (LF) were quantified via whole body magnetic resonance imaging (MRI). To provide non-LT comparison, each LT recipient was matched to at least 150 non-LT controls for same sex, age, and body mass index (BMI) from the UK Biobank registry.

Results

LT recipients (vs matched non-LT controls) had significantly higher subcutaneous (13.82 ± 5.47 vs 12.10 ± 5.10 L, P < 0.001) and visceral fat (7.59 ± 3.75 vs 6.72 ± 3.06 L, P = 0.003) and lower LF (5.88 ± 7.14 vs 8.75 ± 6.50%, P < 0.001) and muscle volume (11.69 ± 2.95 vs 12.12 ± 2.90 L, P = 0.027). In subgroup analysis, patients transplanted for metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis (vs non-MASH cirrhosis) had higher ASAT, VAT, and MFI. A trend toward higher LF content was noted; however, this did not reach statistical significance (6.90 ± 7.35 vs 4.04 ± 6.23%, P = 0.189). Finally, compared with matched non-LT controls, patients transplanted for MASH cirrhosis had higher ASAT and VAT; however, FFMV and MFI were similar.

Conclusion

Using non-LT controls, the current study established the higher-than-expected adiposity burden among LT recipients, which is even higher among patients transplanted for MASH cirrhosis. These findings provide data needed to design future studies developing radiomics-based risk-stratification strategies in LT recipients.

背景和目的对身体各部分，尤其是脂肪组织和骨骼肌之间的相互作用进行量化，正在成为新陈代谢健康的新型生物标志物。本研究评估了肝移植对身体各部分的影响。方法共有66名成年LT受者参加了研究，通过全身磁共振成像（MRI）对他们的身体各部分进行了量化，包括内脏脂肪组织（VAT）、腹部皮下脂肪组织（ASAT）、肌肉脂肪浸润（MFI）、无脂肪肌肉体积（FFMV）和肝脏脂肪（LF）。为了提供非 LT 对照，每个 LT 受试者都与英国生物库登记的至少 150 名性别、年龄和体重指数（BMI）相同的非 LT 对照进行了配对。结果 LT 受体（与匹配的非 LT 对照组相比）的皮下脂肪（13.82 ± 5.47 vs 12.10 ± 5.10 L，P < 0.001）和内脏脂肪（7.59 ± 3.75 vs 6.72 ± 3.06 L，P = 0.003）和较低的 LF（5.88 ± 7.14 vs 8.75 ± 6.50%，P <0.001）和肌肉体积（11.69 ± 2.95 vs 12.12 ± 2.90 L，P = 0.027）。在亚组分析中，因代谢功能障碍相关性脂肪性肝炎（MASH）肝硬化（与非MASH肝硬化相比）而移植的患者的ASAT、VAT和MFI较高。LF含量呈上升趋势，但未达到统计学意义（6.90 ± 7.35 vs 4.04 ± 6.23%，P = 0.189）。最后，与匹配的非 LT 对照组相比，因 MASH 肝硬化而接受移植的患者的 ASAT 和 VAT 较高；但 FFMV 和 MFI 相似。结论通过使用非 LT 对照组，本研究确定了 LT 受者的脂肪负荷高于预期，而因 MASH 肝硬化而接受移植的患者的脂肪负荷甚至更高。这些发现为今后设计基于放射组学的 LT 受者风险分级策略的研究提供了所需的数据。

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引用次数: 0