Canadian Journal of Gastroenterology and Hepatology最新文献

Objective: To preliminarily explore the feasibility and clinical implications of using gadoxetic acid disodium (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) for assessing the gallbladder ejection fraction (GBEF) in patients with cholecystolithiasis.

Methods: This retrospective analysis encompassed 81 patients with gallstones who underwent Gd-EOB-DTPA-enhanced MRI. Gallbladder volume was measured during fasting and at 1 h after a lipid-rich meal to calculate the GBEF. Two radiologists independently reviewed the images for GBEF, structural anomalies, and biliary patency.

Results: The mean GBEF was 62.29% ± 25.2%. Sixty patients demonstrated a GBEF > 50%, while 21 had a GBEF ≤ 50%. The imaging also facilitated the identification of gallbladder malformations (41/81) and abnormal pancreaticobiliary junctions (20/81). Bile flow into the gallbladder via the cystic duct and into the duodenum was observed in 66 patients.

Conclusion: This exploratory study suggests that Gd-EOB-DTPA-enhanced MRI is a feasible modality for simultaneous anatomical evaluation and functional assessment of the GBEF in cholecystolithiasis patients. It provides a comprehensive visualization of biliary dynamics. However, the findings are preliminary, and further validation against standard modalities with controlled study design is required to establish its accuracy and clinical utility.

This study is aimed at evaluating the incidence and clinical characteristics of spontaneous portosystemic shunts (SPSSs) in cirrhotic patients with oesophageal and gastric variceal bleeding (EGVB) and investigating the impact of SPSSs on the course of EGVB. A retrospective analysis of 1110 cirrhotic patients with EGVB was conducted to determine SPSS incidence and characteristics and evaluate the impact of SPSS size and endoscopic treatments. The SPSS incidence was 94.26% (411/436), with gastric renal shunts (78.89%) being the most common. SPSSs were categorized by diameter as follows: S-SPSS (≤ 5 mm), M-SPSS (5-8 mm), and L-SPSS (≥ 8 mm). A larger SPSS diameter was correlated with higher model for end-stage liver disease (MELD) scores, international normalized ratios (INRs), total bilirubin (TB) levels, and portal vein thrombosis. During the 12-month follow-up, the L-SPSS group had a lower rebleeding rate (3.38%) than the S-SPSS (14.64%) and M-SPSS (16.88%) groups. A larger SPSS diameter was associated with a 77% reduction in rebleeding risk (HR = 0.23, p = 0.016). In summary, a larger SPSS diameter is linked to worse liver function but reduced rebleeding risk in cirrhotic patients with EGVB.

Background: This study aimed to investigate the potential causal relationship between inflammatory bowel disease (IBD) and venous leg ulcers (VLU) using Mendelian randomization (MR).

Materials and methods: Independent genetic variants for IBD and VLU were selected as instruments from previously published genome-wide association studies (GWAS) in people of primarily European descent. MR analyses were carried out utilizing inverse-variance weighted (IVW), weighted median, MR Egger, simple mode, and weighted mode.

Results: Genetically predicted IBD was not associated with VLU, according to the IVW analysis (OR 0.95, 95% CI 0.88-1.03, p = 0.23). MR Egger (OR 0.93, 95% CI 0.76-1.12, p = 0.44), weighted mode (OR 1.06, 95% CI 0.87-1.29, p = 0.55), simple mode (OR 1.03, 95% CI 0.79-1.34, p = 0.83), and weighted median (OR 0.99, 95% CI 0.89-1.10, p = 0.90) all produced results in line with IVW. According to the IVW technique, UC (OR 1.02, 95% CI 0.95-1.10, p = 0.62) and CD (OR 0.97, 95% CI 0.90-1.04, p = 0.36) did not appear to be associated with VLU in subtype analyses.

Conclusion: The MR investigation found no genetic evidence to support a causal relationship between IBD and VLU. This finding clarifies that observed clinical associations are unlikely to be driven by shared genetics, and this genetic insight helps refine the clinical assessment of VLU in patients with IBD.

Background: Healthcare expenditures across the clinical trajectory of hepatitis B virus (HBV) infection are inadequately characterized, particularly among immigrants. Our aim is to quantify HBV-attributable short- and long-term costs among a population of newcomers to the province of Ontario.

Methods: We performed a cost-of-illness study with an incidence-based, matched cohort design, employing linked population-based laboratory and health administrative data, and permanent residence data from Immigration, Refugees and Citizenship Canada (IRCC). We identified newcomers diagnosed with HBV between January 1, 2004, and December 31, 2018, and dichotomized the study cohort into individuals with or without liver complications before diagnosis. We used propensity score matching and phase-of-care costing to quantify monthly attributable costs for each of six HBV phases and longitudinal costs for one, five, and ten years following diagnosis. Costs were quantified in 2021 Canadian dollars.

Results: Among n = 30,677 newcomers with HBV, 2.7 percent had complications before diagnosis. Mean monthly phase costs were higher for individuals with complications before diagnosis relative to those without for prediagnosis care ($439, 95% CI: $250-$645 vs. $22, 95% CI: $12-$34), initial care for HBV ($1545, 95% CI: $1196-$1945 vs. $331, 95% CI: $299-$369), continuing care for HBV ($537, 95% CI: $314-$760 vs. $73, 95% CI: $55-$92), and final care ($7271, 95% CI: $3749-$10,747 vs. $3430, 95% CI: $1813-$5061).

Conclusions: Findings emphasize the dynamic nature of HBV-attributable costs and highlight the importance of care following diagnosis and complication onset.

Background: Spontaneous portosystemic shunts (SPSSs) frequently develop in individuals with cirrhosis. However, their clinical impact on the hepatic venous pressure gradient (HVPG) and liver function remains complex and a subject of ongoing debate. This retrospective study evaluated the relationship between SPSS diameter, particularly ultra-large SPSS, and HVPG, liver dysfunction, and their predictive value in patients with cirrhosis.

Methods: A retrospective study was conducted on 90 cirrhotic patients. The patients were categorized into three groups: no SPSS (none or φ < 3 mm), small SPSS (3 ≤ φ < 8 mm), and large SPSS (φ ≥ 8 mm). The large SPSS group was further stratified into large (8 ≤ φ < 14.5 mm) and ultra-large (φ ≥ 14.5 mm) subgroups based on a receiver operating characteristic (ROC)-derived cutoff for hepatic encephalopathy (HE). Clinical parameters, HVPG, and vascular diameters were analyzed.

Results: The large SPSS group had higher total bilirubin and a higher incidence of HE than the no SPSS group. Within the large SPSS cohort, the ultra-large subgroup (≥ 14.5 mm) demonstrated significantly worse liver function (lower albumin, higher bilirubin, prolonged PT, increased INR, and poorer Child-Pugh/MELD scores), a higher proportion of Child-Pugh Class C, and elevated HVPG values (18.7 vs. 16.6 mmHg, p = 0.03) compared to the large subgroup. Critically, SPSS diameter showed a significant positive correlation with HVPG (R = 0.314, p = 0.013). The incidence of HE was also significantly higher in the ultra-large subgroup (55.52% vs. 11%, p = 0.001).

Conclusions: The portal pressure-lowering effect of SPSS does not correlate linearly with its diameter, exhibiting a threshold-dependent attenuation as shunt size exceeds 14.5 mm. This cutoff may serve as a predictor of increased risk for HE and liver dysfunction in cirrhosis, supporting its potential role in clinical risk stratification and decision-making for cirrhosis patients with SPSS.

Background: Delayed bleeding is a serious complication of endoscopic papillectomy (EP). The aim of this study was to evaluate the efficacy of preventing delayed bleeding of clip after EP.

Methods: Consecutive patients diagnosed with ampullary benign tumors who received EP from January 1^st 2013 to December 31^st 2024 were analyzed retrospectively. EP was performed with the snare polypectomy technique. Biliary duct stent and pancreatic duct stent were routinely placed. The resection site is closed completely by clips.

Results: Fifty major papilla benign tumors patients with a mean age of 55.9 ± 10.7 years were found. All of the lesions were En bloc removed in a single endoscopic procedure. The pancreatic duct stents and biliary duct stents were successfully placed in 47 (94%) and 49 patients (98%), respectively. Two patients had positive horizontal margin, 35 patients had negative horizontal margin, and in 13 patients, horizontal margin was compromised by cautery effect. None of the patients had vertical positive margin, 39 patients had vertical negative margin, and in 11 patients, vertical margin was compromised by cautery effect. Post-EP bleeding was observed in 2 patients (4%), which was classified as mild. Post-EP hyperamylasemia was observed in 13 patients (26%), and post-EP pancreatitis was observed in 7 patients (14%), 6 were mild pancreatitis and 1 was severe pancreatitis. Intraoperative perforation occurred in 1 patient, which was clamped with hemostatic clips. No cholangitis was observed. The mean follow-up duration was 378.1 ± 305.7 days. Histologically confirmed recurrence at the resection site was detected in 6 patients (12%).

Conclusions: This study demonstrated that preventive closure of the resection site by clips was technically feasible and effective in preventing delayed bleeding after EP, without increasing the risk of postprocedure pancreatitis and cholangitis.

This review article presents the anatomical and clinical variations in patients with pancreatic ductal adenocarcinoma (PDAC) arising from the head and body/tail regions. It discusses the distinctive risk factors for venous thromboembolism (VTE) formation and assesses various parameters for monitoring VTE and intervention strategies. Pancreaticoduodenectomy is typically performed for tumors in the head region of the pancreas, while distal pancreatectomy with splenectomy is performed for tumors arising from the body or tail of the pancreas. This article also reviews the stratified analysis of VTE risks in PDAC based on tumor origin, aiming to establish valuable VTE risk factor assessment tools and prophylactic anticoagulation strategies. Furthermore, it focuses on PDAC patients with tumors arising from distinct pancreatic anatomical locations to improve quality of life, reduce thrombotic risks, and optimize clinical outcomes.

The progression from compensated to decompensated cirrhosis has historically been considered irreversible. However, accumulating clinical evidence has given rise to the concept of "recompensation," which posits that a subset of patients with decompensated cirrhosis may regain a compensated state following successful etiological control, leading to a markedly improved prognosis. This review synthesizes current evidence on cirrhosis recompensation, examining its definition, mechanisms, and etiological specificities, while also addressing the prognosis and persistent challenges in this patient population. Further research is needed to refine the definition of recompensation and elucidate the underlying mechanisms and determinants.

Background: Nausea is a distressing symptom affecting ∼7% of the population. Pharmacologic options are limited and often ineffective for chronic nausea. Nonpharmacologic strategies, such as breathing exercises, have shown promise in reducing stress and GI symptoms, but their role in chronic nausea has not been studied. This study addresses this knowledge gap by comparing written diaphragmatic breathing (DB) instructions with a biofeedback device (CalmiGo) for their effect on nausea severity.

Methods: In a prospective study, we investigated the effects of breathing exercises using either written instructions for DB or a biofeedback respiratory practice device (CalmiGo) on self-reported severity of nausea. Participants were randomized to either intervention and asked to practice the exercises three times daily for 3 min each time for 6 Weeks. Nausea was evaluated at baseline and every week for 7 Weeks via online self-reported surveys.

Results: A total of 85 adults with nausea (n = 44, 51.7% severe nausea) were randomized to either DB (n = 36) or CalmiGo (n = 49). There was no difference between the two groups at baseline in demographic features, anxiety, depression, or nausea severity. Nausea improved at all-time points in both groups with a medium to large effect size. However, after applying false discovery rate correction, the improvement remained significant for DB only at weeks one to three and borderline significant at weeks four to five and Week 7. There was no difference in response rates between the two groups. Age, body mass index, baseline anxiety, and whether one was diabetic were predictive of improvement in nausea after 4 Weeks.

Conclusion: In a pilot study, we observed that brief breathing exercises improve nausea. Breathing exercises may be useful as a nonpharmacologic option in the management of nausea, although larger trials are needed to confirm these findings.

Purpose: Inflammation is implicated in the pathogenesis of gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs); however, the causal nature of this association remains unclear. This study sought to evaluate the causal relationships between GEP-NENs and inflammatory factors using a two-sample Mendelian randomization (MR) approach.

Methods: We performed a two-sample MR analysis to investigate the causal associations between 91 inflammatory proteins and 731 immune cell traits as exposures and the five subtypes of GEP-NENs as the outcomes. The analytical approach employed various methodologies, such as inverse variance weighting, MR-Egger, weighted mode, weighted median, and simple mode. To evaluate the robustness of the results, sensitivity analyses were conducted, which encompassed MR Egger regression, MR multiple gene residual and outlier detection, leave-one-out analysis, and Cochran's Q test. False discovery rate (FDR) correction was applied, and causal relationships at the gene level were deemed significant at p < 0.05 after FDR adjustment.

Results: After FDR correction, the findings revealed robust causal associations between genetically predicted HLA DR++ monocyte %leukocyte (OR = 3.09, 95% CI: 1.76-5.44, p < 0.001, FDR = 0.022), HLA DR on CD14+ CD16- monocyte (OR = 1.72, 95% CI: 1.34-2.22, p < 0.001, FDR = 0.010), and HLA DR on CD14+ monocyte (OR = 1.76, 95% CI: 1.36-2.29, p < 0.001, FDR = 0.010) and genetically predicted stomach NENs. Reverse analysis revealed that GEP-NENs had no major impact on inflammation.

Conclusion: These findings reveal the immune mechanisms underlying GEP-NENs and highlight potential therapeutic strategies targeting the immune microenvironment of GEP-NENs.