JGH Open最新文献

Introduction

Cirrhosis progresses from compensated to decompensated phases, often marked by portal hypertension and complications like ascites, variceal hemorrhage, and hepatic encephalopathy. The ammonia-to-urea (A-to-U) ratio, reflecting urea cycle efficiency, may offer superior diagnostic performance compared to plasma ammonia levels alone. This study compared the diagnostic accuracy of the A-to-U ratio and plasma ammonia levels for identifying portal hypertension.

Methods

We conducted a derivation (2019–2020) and validation (2020–2022) study in patients with chronic liver disease. In the derivation study, outcomes included imaging findings of portal hypertension and clinically significant portal hypertension (CSPH) per BAVENO VII criteria. Validation outcomes encompassed CSPH, gastroesophageal varices, and portal hypertensive gastropathy.

Results

In the derivation study (n = 180), the A-to-U ratio, but not plasma ammonia, showed high diagnostic accuracy for detecting imaging findings suggestive of portal hypertension and CSPH (A-to-U ratio > 1.53 mg/g; diagnostic odds ratio [dOR], 4.04 [95% CI, 1.98–8.24; p < 0.0001] and dOR, 5.71 [95% CI, 2.87–11.37; p < 0.0001], respectively), and this association with CSPH remained significant after adjustment for renal function. In the validation study (n = 232), an A-to-U ratio > 1.53 mg/g had a dOR of 9.42 (95% CI, 4.63–19.21; p < 0.0001) for the diagnosis of CSPH. An A-to-U ratio > 1.53 mg/g showed independent associations with esophageal varices (dOR 4.44; 95% CI, 1.44–13.72; p = 0.01) and portal hypertensive gastropathy (dOR 9.33; 95% CI 2.65–32.92; p = 0.0005), whereas the BAVENO VII criteria did not.

Discussion

Our study suggests that an A-to-U ratio > 1.53 mg/g may serve as a useful noninvasive tool for identifying CSPH, gastroesophageal varices, and portal hypertensive gastropathy in patients with chronic liver disease.

Background

Global evidence has observed that individuals with inflammatory bowel disease (IBD) are at a heightened risk of experiencing psychiatric disorders, which often coincide with a decrease in their quality of life.

Objective

To assess the prevalence of anxiety and depression symptoms and associated factors among patients with IBD.

Methods

An institutional-based cross-sectional study was conducted at Tikur Anbesa Specialized Hospital and Adera Medical Center. Categorical variables were presented using frequency and percentage and compared between groups using the chi-square test. The normal distribution of the continuous variables was assessed using the Shapiro–Wilk test. Mean and standard deviation were calculated for normally distributed data, while the median and interquartile range were calculated for skewed data. We used univariate and multivariate binary logistic regression analysis to examine the factors associated with depression and anxiety; results were reported as adjusted odds ratios (OR) with 95% confidence intervals and p value < 0.05 considered statistically significant.

Results

The prevalence of anxiety and depression was 5.1% and 7.1%, respectively, in IBD. Moderate disease activity (AOR = 16.1 (1.7, 156.7), p = 0.015) and severe disease activity (AOR = 49.8 (2.1, 1144.02), p = 0.014) had a statistically significant association with increased rates of depressive symptoms. Moderate disease activity (AOR = 9.9, 95% CI: 0.9, 106.2, p = 0.058) had a positive association. Severe disease activity (AOR = 45.3, 95% CI: 2.0, 1018.0, p = 0.016) has a significant associated factor with having anxiety symptoms.

Conclusion

The prevalence of anxiety and depressive symptoms in this study was generally low but can increase due to important factors such as disease activity, smoking, unemployment, a short duration after diagnosis, and having ulcerative IBD.

Aims

Many patients develop Fontan-associated liver disease (FALD) after undergoing the Fontan procedure—a surgical treatment for congenital heart disease such as single ventricle—owing to changes in venous pressure and cardiac output. Liver biopsy is the gold standard for diagnosing FALD, but has limitations. Magnetic resonance elastography (MRE) is a popular non-invasive method for evaluating liver stiffness and fibrosis in FALD; however, no unified view exists. This study aimed to assess the usefulness of MRE in evaluating the pathophysiology of FALD, including its correlation with cardiovascular parameters and histological findings.

Methods and Results

This retrospective cohort study included 22 patients with FALD who underwent MRE at Yokohama City University Hospital. Patients with other liver diseases or a history of heavy alcohol consumption were excluded. Liver biopsies were assigned a congestive hepatic fibrosis score (CHFS). Liver stiffness was measured using MRE, and hemodynamic data were obtained using cardiac catheterization. The correlation between MRE-based liver stiffness and clinical, laboratory, and pathological findings was analyzed.

Patients' median age was 21.5 years, and the Fontan procedure was performed 16.3 years (mean) ago. Biochemical findings showed elevated gamma-glutamyl transpeptidase (GGT) levels. Mean liver stiffness measured using MRE was high (5.3 kPa), which significantly correlated with CHFS stage of liver fibrosis, and also correlated with GGT levels, fibrosis 4 index, and central venous pressure.

Conclusion

MRE seems a promising non-invasive tool for liver fibrosis evaluation in FALD. However, it may also reflect hepatic congestion. Further studies are needed to establish its clinical utility and standard cutoff values.

Objective

To compare the timing intervals of surveillance colonoscopies after resection for colorectal cancer with recommendations in the Australian Clinical Practice Guidelines for Surveillance Colonoscopy.

Study Design

A retrospective, observational study.

Data Sources

Adults who had a resection for colorectal cancer from the Costs of Surviving Cancer—Queensland Study (COS-Q), which is a retrospective population-based cohort study of all individuals diagnosed with a primary cancer from 2005 to 2015.

Results

In total, 7265 patients that underwent resection of colorectal cancer were included for analysis. Most patients had a pre-operative colonoscopy (6636, 87.6%) while 899 patients (12.4%) had no pre-operative colonoscopy. 82.1% of patients had their first surveillance colonoscopy as recommended by the Guidelines. In contrast, after the first post-operative surveillance colonoscopy without polypectomy, 978 of 1015 (96.4%) had a second surveillance colonoscopy early by at least 6 months. Thirty seven (1.7%) had the surveillance colonoscopy on time or later than recommended. Being female or having a pre-operative colonoscopy was associated with an early second surveillance colonoscopy (odds ratio 2.2, p < 0.05). Early surveillance colonoscopies incurred costs up to AU$3.78 million.

Conclusions

Most post-resection surveillance colonoscopies for patients with colorectal cancer are performed earlier than recommended. Since colonoscopies in patients at low risk of cancer recurrence were generally performed too early, there is evidence of the potential overuse of healthcare resources and the opportunity to improve hospital efficiency.

Introduction

Potential delays in patient care during weekends have not been studied in liver transplantation (LT) for acute liver failure (ALF). We evaluated the impact of listing after a weekend on waitlist (WL) and post-LT outcomes in ALF patients.

Methods

In a retrospective cohort study of adult ALF patients from February 2002 to May 2023 in the United Network for Organ Sharing (UNOS) database, the primary exposure was listing after a weekend. Multinomial regression and Cox models assessed WL outcomes and post-LT mortality, respectively, adjusting for potential confounders. Inverse probability censoring weighting addressed censoring bias.

Results

Among 6600 adults listed for LT, 840 (13%) were listed after a weekend. The median number of days from admission to waitlisting was 2 (IQR1–3). Accounting for potential confounders, patients listed after a weekend had a lower likelihood of spontaneous survival (SS; relative risk ratio 0.74, 95% CI 0.61–0.90, LT as reference). Post-LT mortality at 1 year was higher in patients listed after a weekend (HR 1.25, 95% CI: 1.01–1.54). IPW cohort outcomes corroborated these findings.

Conclusions

Among adults with acute liver failure, listing for liver transplantation after a weekend was associated with lower rates of spontaneous survival and higher one-year post-transplant mortality. Identifying system-level factors contributing to delays in transplant evaluation over weekends may help improve the timeliness and efficiency of care.

Objective

To compare the efficacy of polyethylene glycol electrolyte (PEG) combined with lactulose versus PEG alone in bowel preparation quality for colonoscopy.

Methods

The protocol for this systematic review was registered with PROSPERO (CRD420251035139). Comprehensive literature searches were conducted across multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP. RevMan 5.4 software was employed to assess differences between the two groups regarding the rates of excellent bowel preparation, willingness to undergo repeat examination, incidence of adverse reactions, and adenoma detection rates.

Results

Sixteen eligible studies, encompassing 2468 participants, were included in the analysis. Meta-analysis demonstrated that the combination of PEG and lactulose was significantly more effective than PEG alone in bowel cleansing (OR = 3.57, 95% CI: 2.75–4.63, p < 0.001, I² = 0% for efficacy; SMD = 0.38, 95% CI: 0.26–0.50, p < 0.001, I² = 45% for BBPS scores; SMD: Standard Mean Difference; BBPS: Boston Bowel Preparation Scale). This combination also led to a lower incidence of adverse events, including vomiting (OR = 0.54, 95% CI: 0.36–0.82, p = 0.004), abdominal pain (OR = 0.54, 95% CI: 0.36–0.80, p = 0.003), and abdominal bloating (OR = 0.53, 95% CI: 0.38–0.75, p < 0.001), compared with PEG alone. Furthermore, PEG plus lactulose significantly improved the detection rate of intestinal adenomas (OR = 2.57, 95% CI: 1.74–3.79, p < 0.001). However, no significant differences were observed in the incidence of nausea (OR = 0.69, 95% CI: 0.88–0.99, p = 0.05) or willingness to repeat the examination (OR = 1.31, 95% CI: 0.51–3.36, p = 0.58).

Conclusion

The combination of PEG and lactulose significantly enhances bowel cleansing efficacy, increases adenoma detection rates, and reduces the incidence of adverse reactions. This regimen is recommended for bowel preparation prior to colonoscopy.

Background

Multiple myeloma (MM) is a common plasma cell malignancy; however, extramedullary multiple myeloma (EMM) is an aggressive phenotype in which malignant plasma cells proliferate outside of the bone marrow.

Aims

Extramedullary plasmacytomas (EMP) are uncommon and gastrointestinal involvement is exceedingly rare.

Case Presentation

Here, we present a case of multifocal secondary colonic EMP in a patient with relapsed refractory multiple myeloma (RRMM) and review literature demonstrating other cases of secondary colonic EMP.

Background and Objective

Seladelpar is an oral, once-daily medication that improves cholestasis through its selective peroxisome proliferator-activated receptor (PPAR-δ) agonism. It shows promising efficacy in treating primary biliary cholangitis (PBC) patients.

Methods

A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Cochrane, Scopus, and WOS until July 19th, 2025. Dichotomous outcomes were reported using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI).

Results

Three RCTs with 499 patients were included. Seladelpar was significantly associated with an increased ALP normalization (RR: 21.12 with 95% CI [4.14, 107.58], p < 0.01), biochemical response (RR: 3.06 with 95% CI [2.00, 4.70], p < 0.01), and decreased pruritus NRS score change (MD: −1.47 with 95% CI [−2.73, −0.21], p = 0.02). Seladelpar was also significantly associated with a decreased incidence of pruritus (RR: 0.54 with 95% CI [0.31, 0.94], p = 0.03) but with an increased incidence of headache (RR: 3.37 with 95% CI [1.11, 10.23], p = 0.03). However, there was no significant difference between seladelpar and placebo regarding the incidence of any adverse events (RR: 0.96 with 95% CI [0.87, 1.06], p = 0.43).

Conclusion

Seladelpar improved liver biomarkers of cholestasis and reduced pruritus in patients with PBC without significantly increasing the adverse effects. This makes seladelpar a promising addition to the treatments available for PBC.

Trial Registration: PROSPERO: CRD42024521208

Objective

Previous studies examining the impact of Ramadan fasting on patients with metabolic dysfunction-associated fatty liver disease (MAFLD) have yielded mixed results. Therefore, assessing the health benefits of such fasting in patients with MAFLD through a systematic review and meta-analysis (SR/MA) is important.

Methods

A systematic search was conducted on MEDLINE, Scopus, Web of Science, Google Scholar, and ClinicalTrials.gov from their inception to March 5, 2025, to identify relevant studies involving adults with MAFLD fasting during Ramadan. The primary outcome was liver-related parameters, while additional outcomes included changes in anthropometric and metabolic parameters during the peri-Ramadan period. Statistical analysis was performed using R software, and the results were presented as mean differences (MD) with 95% confidence intervals (CI).

Results

Eight studies (10 reports), mostly with serious risk of bias, involving 603 subjects revealed that Ramadan fasting was associated with reductions in alanine transaminase (ALT [MD −4.11 U/L]), aspartate transaminase (AST [MD −4.24 U/L]), FIB4 index (MD −0.09), and nonalcoholic fatty liver disease fibrosis score (MD −0.22) from baseline in fasting individuals. However, the changes in ALT and AST were similar in studies comparing fasting and non-fasting groups. Fasting individuals experienced significantly greater weight loss (MD −1.44 kg), as well as reductions in body mass index (MD −0.66 kg/m²) and waist circumference (MD −0.91 cm), compared to those who did not fast. Individuals who fasted experienced a glycemic benefit characterized by a reduction in glycated hemoglobin (MD −0.4%). However, changes in mean body fat percentage and HOMA-IR were similar in both the fasting and non-fasting groups. Individuals who fasted experienced reductions in both systolic and diastolic blood pressure, along with improved lipid parameters.

Conclusion

This SR/MA of small existing data suggests that fasting during Ramadan improves certain MAFLD-related outcomes. Larger, multinational studies with wider global representation are needed to improve clinical practice decisions.