Arab Journal of Gastroenterology最新文献

Background and study aims

Balloon-occluded retrograde transvenous obliteration-assisted endoscopic cyanoacrylate injection (E-BRTO) temporarily treats gastric fundic varices draining through gastrorenal shunts (GRS) occluding the GRS with a balloon, then endoscopically injecting cyanoacrylate. We retrospectively examined the safety, feasibility, and efficacy of E-BRTO.

Patients and Methods

We enrolled 85 patients with hepatic cirrhosis plus gastric fundic varices with GRS; 34 underwent E-BRTO. The 51 patients who refused all secondary prophylactic treatments served as controls.

Results

Finally, 33 of the 34 patients underwent successful E-BRTO without major adverse events. Gastric varices were eradicated from all 33 patients in the E-BRTO group; the average follow-up time was 161.0 (74.0) weeks (mean [SD]). Four end-point events (12%) were recorded during the follow-up period. In the control group, 33 patients (65%) suffered repeat variceal bleeding, resulting in seven deaths. The cumulative rebleeding rates of the E-BRTO group on the 6th, 24th, 48th, 96th, 144th, 192nd, 240th, and 288th week were 0%, 3%, 9%, 9%, 13%, 13%, 13%, and 13%, while the cumulative rebleeding rates of the control group in the same period were 10%, 20%, 35%, 46%, 55%, 65%, 76%, and 76%.

Conclusions

E-BRTO was safe, feasible, and well tolerated by patients with hepatic cirrhosis plus gastric fundic varices with GRS. Over the long-term follow-up period, the E-BRTO group demonstrated a lower rate of repeat bleeding than the control group.

Background and study aim

Gastric endoscopic submucosal dissection (ESD) is a curative treatment for gastric neoplasm. A scheduled second-look endoscopy could be performed to prevent delayed post-ESD bleeding. However, no studies on the efficacy of second-look endoscopy for the prevention of early delayed post-ESD bleeding have been conducted. So, the aim of this study was to be the first to investigate the efficacy of immediate second-look endoscopy for the prevention of post-ESD bleeding.

Patients and methods

The 266 gastric ESD cases were included. Immediate second-look endoscopy was defined as repeated upper endoscopy soon after complete hemostasis of the ESD site and specimen fixation. Early and late delayed bleeding were classified as before or after 24 h after the ESD, respectively.

Results

The 262 ESD cases were enrolled and divided into three groups: the immediate second-look (n = 79), scheduled second-look (n = 86), and no second-look (n = 97). Post-ESD bleeding occurred in 19 cases (7.3%). Of these, 13 (68.4%) were early delayed post-ESD bleeding. The immediate second-look endoscopy had a lower incidence of early delayed post-ESD bleeding compared to the groups without immediate second-look endoscopy, (3.8% vs. 0.8%, p = 0.009). In a multivariate analysis, immediate second-look endoscopy significantly reduced early delayed post-ESD bleeding (OR 0.39, p = 0.022). The resected specimen area ≥ 1,000 mm² was an independent risk factor for early delayed post-ESD bleeding (OR 8.98, p = 0.010). However, the frequency of delayed post-ESD bleeding did not differ between the three groups.

Conclusion

Immediate second-look endoscopy after gastric ESD may prevent early delayed post-ESD bleeding under certain circumstances.

Objective: Biopsy remains the gold standard for the diagnosis of Non-alcoholic fatty liver disease (NAFLD). To investigate the diagnostic value of FibroScan based on biopsy and range of cut-offs for steatosis and fibrosis, we explored the grade of steatosis and fibrosis. Method: A simultaneous search was performed on cohort studies published earlier than October 8, 2020,in the PubMed, Web of Science, Sinomed, CNKI, VIP, and WanFang databases. Next,we screened qualified studies. The data were mainly analysed in RevMan and complemented in STATA. Results: The area under the receiver operating characteristic of FibroScan in identifying the stage of steatosis for ≥ S1 was 0.90 (sensitivity:89%; specificity:92%), that for ≥ S2 was 0.82 (sensitivity:89%;specificity:70%) and that for S3 was 0.79 (sensitivity:83%; specificity:63%).The area under the receiver operating characteristic of FibroScan in identifying the stage of fibrosis for ≥ F1 was 0.86 (sensitivity:81%;specificity:77%),that for ≥ F2 was 0.80 (sensitivity: 75%; specificity:82%), that for ≥ F3 was 0.94 (sensitivity:87%; specificity: 89%) and that for F4 was 0.97 (sensitivity: 94%; specificity:91%). Conclusion: FibroScan, a promising and cost-effective technique, can provide an accurate noninvasive approach for quantifying and staging hepatic steatosis and fibrosis in NAFLD, particularly for advanced fibrosis and cirrhosis. Further studies are needed to explore the relationship between steatosis and fibrosis based on the same group. Additionally, NASH is the key stage of NAFLD. Early diagnosis and intervention can help reduce the incidence of liver cirrhosis. However, no large study has investigated the significance of FibroScan in the diagnosis of NASH confirmed by pathology.

Background and study aim

During the natural course of HBeAg-negative chronic hepatitis B (CHB), fluctuations in hepatitis B virus (HBV) DNA and alanine aminotransferase (ALT) levels are often observed, making the classification of patients difficult. We aimed to describe spontaneous short-term HBV DNA level fluctuations and to assess the usefulness of qHBsAg in Tunisian patients with HBeAg-negative chronic HBV infection.

Patients and methods

We included 174 treatment-naive Tunisian patients with HBeAg-negative chronic HBeAg-negative HBV infection. A prospective 1-year follow-up was conducted with serial determinations of HBV DNA, ALT levels, and qHBsAg. The patients were classified into three groups: inactive carriers (G1), patients with negative HBeAg CHB (G2), and patients with an “indeterminate state” (G3). For the latter group, a liver biopsy was indicated.

Results

Only genotype D was detected. During follow-up, 21.6% and 19.5% of patients with a low initial (<2,000 IU/ml) and intermediate viral load (2,000–20,000 IU/ml) experienced a subsequent increase in their HBV DNA levels above 2,000 and 20,000 IU/ml, respectively. Significant variations in viral load were observed in 61.1% of patients at 6-month intervals. Among the 174 patients, 89 (51.1%) belonged to G1, 33 (19%) to G2, and 52 (29.9%) to G3. Fourteen patients have undergone a liver biopsy, of whom seven showed moderate to severe liver disease. Combination of HBV DNA < 2,000 IU/ml and qHBsAg < 832 IU/ml excluded CHB in 98.4% of cases. A cutoff point for qHBsAg < 100 IU/ml associated with an annual decline of > 0.5 log ₁₀ IU/ml is a good predictor marker of functional cure for hepatitis B.

Conclusions

This study highlights the large short-term fluctuations in HBV DNA in patients with HBeAg-negative chronic HBeAg-negative HBV infection with genotype D. Thus, using the cutoff value of 832 for qHBsAg combined with that of 2,000 for HBV DNA makes it possible to exclude CHB for most patients.

Backgrounds and study aims

The fibrosis-4 (FIB-4) is a non-invasive scoring system for estimating liver fibrosis severity as a biomarker of chronic liver disease. We aimed to estimate the prevalence and severity of chronic liver disease at the community level using FIB-4.

Patients and methods

This cross-sectional study was conducted using the Pars Cohort database collected in Valashar, Fars province, Iran. Participants were divided into three groups based on their FIB-4 scores: low risk of liver fibrosis (FIB < 1.45), intermediate cases (1.45 ≤ FIB-4 ≤ 3.25), and high risk of liver fibrosis (FIB-4 > 3.25).

Results

In total, 9269 individuals with a mean age of 52.65 years were enrolled in the study, of which 4278 (46.2 %) were male. Among all participants, 7853 (84.7 %) were in the low-risk, and 65 (0.7 %) were in the high-risk groups. In the final ordinal regression model, male gender, being a farmer or rancher, living in rural areas, history of opioid use, history of jaundice, no history of diabetes, history of depression, and positive HBs Ag were independently associated with higher FIB-4 scores.

Conclusion

Our study revealed that males, individuals residing in rural areas, and those engaged in farming and ranching occupations face a heightened risk of liver fibrosis. These findings emphasize the need for future programs for early detection and effective management of liver fibrosis in these at-risk populations.

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver disease, comprising hepatic steatosis, and non-alcoholic steatohepatitis. Periodontal disease (PD) may be a risk factor for the evolution of liver cirrhosis. This study aimed to evaluate the association between NAFLD and PD. We searched in Pubmed, Scopus, Cochrane, and Lilacs databases with descriptors (Non-alcoholic Fatty Liver Disease OR (non-alcoholic AND Fatty Liver AND disease) OR Nonalcoholic Steatohepatitis) AND (Periodontal Disease OR Gingivitis OR Periodontitis) from January 2021 to September 2021. We selected, by the abstract, cross-sectional, cohort (prospective and retrospective), and case-control studies that address periodontal disease in patients with Non-alcoholic Fatty Liver Disease, and aged ≥ 18 years. The search was without the restriction of language and publication time. The search resulted in 954 articles. After applying the selection criteria, five cross-sectional studies remained. A metanalysis combined the study estimates of periodontal disease in NAFLD, by using the random effects. The Odds Ratio (1.91; 95% CI 1.21–3.02; P = 0.006) indicates that the chance of presenting Periodontal disease is 91% higher in individuals with NAFLD when compared with individuals without NAFLD. There are few studies with appropriate methodology to produce sound evidence about the causal relationship between the use of NAFLD and PD, however, studies support the association. So, dental staff must be aware of this association for better management of periodontal disease in patients with NAFLD.

Bleeding disorders can exacerbate gastrointestinal bleeding in inflammatory bowel disease (IBD) at the time of diagnosis or flares. Factor VII (FVII) deficiency is a life-threatening rare congenital bleeding disorder in childhood. This study describes three adolescent patients with IBD accompanied by acquired FVII deficiency. This is the first case series of patients with IBD accompanied by FVII deficiency. We hypothesized that inflammation, accelerated consumption, disease severity, and weight loss can cause decreased FVII activity in patients diagnosed with IBD. To control intestinal bleeding, we must keep in mind factor deficiencies in IBD.

Background and study aims

Childhood functional constipation (FC) is gradually becoming an emerging public health problem. This study aimed to develop a personalized nomogram for the prediction of incident FC among Chinese children, and the diagnosis of FC was based on the Rome IV criteria.

Patients and methods

This cross-sectional study was conducted from Nov. 2020 to Jan. 2021 among children residing in Anhui province, China. An electronic questionnaire regarding the general demographic and clinical characteristics of all children was completed by their primary caregivers. The multivariate logistic regression analysis was applied to identify risk factors for FC. Moreover, a nomogram was constructed for FC based on the risk factors identified from the multivariate analysis.

Results

In this study, a total of 901 electronic questionnaires were collected, of which 832 (92.3%) questionnaires were properly completed and included in the final analysis. The prevalence of FC among Chinese children was 11.3% based on the Rome IV criteria. After controlling for potential confounding factors, the multivariate logistic regression analysis showed that inadequate sleep, picky eating, and positive family history of FC were identified as key risk factors of FC. The area under the receiver operating characteristic curve of the nomogram was 0.694 (95 %CI: 0.6412–0.7459). Further, a calibration curve drawn illustrated that the predicted probabilities reasonably approximately the actual prevalence of FC in this population.

Conclusion

Inadequate sleep, picky eating, and positive family history of FC were identified as risk factors of FC. An easy-to-use nomogram was constructed based on these three significant factors. Besides, this nomogram was validated to have acceptable discrimination and calibration capabilities. Hence, this nomogram may enable clinical professionals to predict the risk of FC among Chinese children and further provide optimized disease prevention and intervention for this population.

Background and study aims

We investigated the value of the serum cystatin C level as a potential predictor of acute kidney injury (AKI) in patients with acute pancreatitis (AP).

Patients and Methods

We retrospectively examined patients diagnosed with AP between January 2013 and December 2018. Patients were categorized into two groups based on their serum cystatin C levels after admission: the normal (n-Cys C group) and high serum cystatin C levels groups (h-Cys C group). Patients in the h-Cys C group demonstrated serum cystatin C levels ≥1.05 mg/L. Demographic parameters, laboratory data, and AP severity were compared between the two groups. Receiver operating curve (ROC) analysis was used to evaluate the efficacy of serum cystatin C in predicting persistent AKI.

Results

A total of 379 patients with AP were enrolled: 319 in the n-Cys C group and 60 in the h-Cys C group. Serum cystatin C levels were significantly higher in patients with severe acute pancreatitis (SAP) compared to moderate acute pancreatitis (MAP) (P< 0.05). The h-Cys C group had a higher BISAP score (P < 0.001). Incidences of organ failure and SAP were significantly higher in the h-Cys C group (P < 0.05). ROC analysis indicated that a serum cystatin C cutoff point of 1.055 mg/L optimally predicted persistent AKI (AUC = 0.711). For internal validation, we selected 545 AP patients, treated at our center from 2019 to 2022, including 54 AKI patients. ROC analysis in this validation group yielded a sensitivity of 100% and specificity of 90.9% (AUC = 0.916, 95% CI: 0.894–0.937).

Conclusion

Elevated serum cystatin C levels are sensitive indicators of adverse AKI prognosis in AP patients. The cystatin C level at admission can reflect a patient’s initial renal function status.

Background and study aims

Monitoring disease activity in ulcerative colitis (UC) is critical in preventing long-term complications. This study aims to develop a scoring system using non-invasive indicators to predict endoscopic activities for ulcerative colitis (UC) patients.

Patients and methods

All enrolled patients with UC admitted to Shanghai Xinhua Hospital between June 2017 and January 2021 were enrolled, and their clinical data were retrospectively collected and a number of serological biomarkers concentrations were analyzed. Patients were categorized into mild and moderate-to-severe disease groups. Univariate and multivariate logistic regression was used to predict moderate-to-severe endoscopic activities, which were then incorporated into a nomogram to establish a prediction scoring model.

Result

Overall, 231 patients were divided into a mild group (n = 111, 48.0%) and a moderate-to-severe group (n = 120, 52.0%). The following variables were independently associated with the disease severity and were subsequently included into the prediction model: Proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA), C-reactive protein (CRP), hemoglobin(Hb), IL-10, stool frequency ≥ 5 times/day and hematochezia. Incorporating these 6 factors, the nomogram showed good discrimination with C-index of 0.819 and reliable calibration. A scoring model was established with the area under the curve 0.818. Moreover, PR3-ANCA and CRP correlated with the duration of hospital stay.

Conclusion

We developed a predictive model for endoscopic disease activities by using noninvasive factors based on PR3-ANCA, CRP, Hb, IL-10, stool frequency and hematochezia. This prediction model might assist clinicians in managing patients with UC.