Canadian Journal of Gastroenterology and Hepatology最新文献

Objective: This study aims to investigate the clinical pathological features of colorectal lateral spreading tumors (LSTs) with skirt features and the associated carcinogenic risk factors. Methods: A total of 390 cases of colorectal LSTs, treated via endoscopy at the Digestive Endoscopy Center of the 900th Hospital of the People's Liberation Army Joint Logistics Support Force between January 2021 and August 2023, were included. The cases were categorized into a skirt group (30 cases) and a group without a skirt (360 cases) based on the presence of skirt features. The clinical pathological characteristics, including age, gender, endoscopic features (lesion diameter, location, morphology), and histological types, were compared between the two groups. Additionally, the risk factors for carcinogenesis in LSTs with a skirt were analyzed. Results: Among the 390 LSTs cases, 30 (7.69%) exhibited skirt features, with 23 lesions located in the rectum (76.67%) and 26 lesions having a diameter of ≥ 20 mm (86.67%). Histological classification revealed 10 cases (33.33%) of adenomas with low-grade intraepithelial neoplasia (LGIN), 9 cases (30.00%) of adenomas with high-GIN (HGIN), and 11 cases (36.67%) of carcinoma. The proportions of female patients, rectal lesions, lesions with a diameter of ≥ 20 mm, mixed nodular lesions, and those classified as carcinoma were significantly higher in LSTs with a skirt group compared to LSTs without a skirt group. Rectal lesions (p=0.001, OR = 8.588, 95% CI: 2.428-30.379) and lesion diameters ≥ 20 mm (p=0.008, OR = 4.538, 95% CI: 1.477-13.940) were identified as independent predictors of skirt presence in colorectal LSTs. Age ≥ 60 years (p=0.002, OR = 22.667, 95% CI: 3.140-163.629) was found to be an independent risk factor for carcinogenesis in LSTs with a skirt. Conclusion: Compared with LSTs without a skirt, the results indicated that LSTs with a skirt are more commonly found in female patients, predominantly has a diameter of ≥ 20 mm, typically presents as a mixed nodular type, is frequently located in the rectum, and is often classified as carcinoma. The presence of rectal lesions and lesion diameter ≥ 20 mm increases the likelihood of skirt features in LSTs. Furthermore, advanced age (≥ 60 years) may elevate the risk of carcinogenesis in LSTs with a skirt, necessitating thorough preoperative assessments and complete resection during endoscopic removal of such lesions.

Objective: The objective of the present study was to evaluate the antacid and cytoprotective effects of root bark aqueous extract of Diospyros mespiliformis (RBAEDM). Materials and Methods: Thirty rats were grouped into six groups of five rats each, namely, three control groups (normal, negative and positive) and three test groups. These animals were treated with distilled water (normal and negative controls), verapamil (positive control) and the extract at doses of 100, 200 and 400 mg/kg (test groups). One hour after treatment, gastric ulcers were induced in all animals by immersion in water (22 ± 1°C) for 5 h except for the normal control. The ulcerated surface, mucus mass, in vivo oxidative stress parameters and nitrite levels were determined. In vitro antacid activity of the extract was evaluated on artificial gastric juice by the determination of pH, neutralization time and antacid capacity. Acute toxicity of extract was evaluated. Results: Treatment with RBAEDM showed a significant (p < 0.01, p < 0.001) decrease of ulcerated surface with a percentage of inhibition between 5.58% and 60.46%. The decrease in the ulcerated surface was accompanied by a significant (p < 0.001) increase in mucus production at 400 mg/kg. Treatment with RBAEDM also showed a significant (p < 0.001) decrease in malondialdehyde (MDA) levels and a significant increase in superoxide dismutase (SOD) level, catalase (CAT) activities, in addition to nitrite levels in stomachs. In artificial gastric juice, the RBAEDM caused a significant increase (p < 0.001) of neutralizing time and the number of neutralized H⁺ ions compared to distilled water. No change in behavioural parameters and no death was observed after administration of the extract at 2000 mg/kg. Conclusion: RBAEDM inhibited ulcer occurrence by the stimulation of mucus production, increase of antioxidant enzyme activity and NO production. Moreover, this study revealed that the studied extract could exert a strong anti-acid capacity in vitro due its ability for the neutralization of H⁺ ions. DL₅₀ of RBAEDM was greater than 2000 mg/kg.

Background and Aims: Patients experience more complications of portal hypertension as liver disease progresses, many of which can be managed by transjugular intrahepatic portosystemic shunt (TIPS) insertion. Controversy surrounds the association of age with TIPS-related complications. We sought to evaluate the effect of age on TIPS-associated outcomes, including hospital admissions. Methods: This retrospective, bicentric cohort study included patients who underwent TIPS insertion between January 1, 2006, and December 31, 2016. The primary outcome of the study was predictors of liver-related hospital admission within 12 months of TIPS insertion between patients < 70 years and ≥ 70 years old. Secondary outcomes included mortality at 12 months and MELD-Na score at 90 days following TIPS placement. Results: A total of 593 patients were included in the study-487 patients were less than 70 years old while 106 patients were 70 years of age or older. Near equal percentages of elderly and nonelderly patients were admitted with post-TIPS complications within 12 months of insertion (29.2% v. 29.0%, p=0.91). Pre-existing diagnoses of diabetes and/or hypertension, hepatic hydrothorax, as well as serum creatinine and/or serum sodium at the time of TIPS insertion were associated with TIPS-related admissions within the first 12 months of shunt insertion. Conclusion: TIPS placement in selected older patients can be safe. Age should not be a strict contraindication for TIPS insertion, but discussion regarding risks and benefits of the procedure should be individualized.

Background: The choice of resuscitation fluid remains debated for patients with septic shock. While patients with cirrhosis may benefit from albumin administration, the efficacy of albumin for resuscitation in cirrhotic patients with septic shock remains unclear. Methods: This is a historical cohort study of patients with cirrhosis admitted for septic shock to the intensive care unit (ICU) at a tertiary referral hospital from January 2007 to May 2017. Patients were stratified based on using albumin for fluid resuscitation within six hours of ICU admission. The primary outcome was the percentage of time during the first 48 h of ICU admission that patients were alive and shock-free. Linear regression was used to compare this outcome between groups, and a multivariable analysis was performed to account for baseline differences between study populations. Results: Of the 132 patients with cirrhosis admitted for septic shock, albumin was administered within the first six hours of ICU admission for 84 patients (64%). The albumin and nonalbumin groups had similar percentages of shock-free time during the first 48 h of ICU admission (9.0% vs. 20.2%, p = 0.073) and ICU length of stay (5.6 vs. 3.7 days, p = 0.093). No differences were observed in clinical outcomes of end-organ dysfunction, such as the need for kidney replacement therapy or mechanical ventilation. Conclusion: Administration of albumin during the first 6 h of ICU admission as an adjunctive resuscitation fluid to crystalloids was not associated with improved shock-free time in the ICU or clinical outcomes in patients with cirrhosis and septic shock.

Background: Nonalcoholic fatty liver disease (NAFLD) has a major impact on public health owing to its high morbidity and mortality due to its close relationship with several conditions, including metabolic syndrome, cirrhosis, and cancer. Therefore, this review aimed to systematically compile and summarize the scientific literature on early risk factors for NAFLD development. Methods: A systematic review of population-based cohort studies was conducted. Studies reporting the risk factors associated with nonalcoholic steatohepatitis (NASH) and NAFLD were screened. Results: The search yielded 987 unique records, of which 196 articles were selected after title and abstract screening. A total of 39 articles were read in full text after quality analysis using Downs and Black criteria; 10 of the studies were excluded due to heterogeneity or inconclusive results. Finally, 30 publications were included in this systematic review. The review revealed that clinical conditions such as obesity, weight change, psoriasis, polycystic ovary syndrome, diabetes, thyroid disorders, and elevated serum uric acid levels increase the risk of developing nonalcoholic fatty liver. In addition, lifestyle factors such as sedentary behavior, active or passive smoking, poor sleep quality, and consumption of carbonated beverages are associated with this condition. Conclusions: Evidence was found on the association between different clinical and lifestyle risk factors and NAFLD. This supports the need for preventive, diagnostic, and therapeutic strategies to improve the metabolic, hepatic, and oncological outcomes related to this condition.

CKD-495 is a newly developed drug extracted from Cinnamomum cassia Presl. This phase II study assessed the clinical benefits of CKD-495 in the treatment of acute and chronic gastritis. This study randomly assigned 250 patients with endoscopically-proven gastric mucosal erosion to five groups. The groups received either 75 mg or 150 mg of CKD-495, 100 mg of rebamipide, 60 mg of Artemisiae argyi folium 95% ethanol ext. (20 ⟶ 1) (Stillen; Dong-A ST Co., Ltd., Seoul, Korea), or placebo for 2 weeks, respectively. The primary endpoint was the erosion improvement rate, and the secondary endpoints were erosion cure rates, improvement rates of gastrointestinal symptoms, edema, redness, and hemorrhage. Drug-related adverse events were evaluated. The endoscopic erosion improvement rate was significantly higher in the 75 mg CKD-495 group than in the other groups in both the full analysis set (73% vs. 41%, 45%, 52%, 48% for the 75 mg CKD-495, 150 mg CKD-495, placebo, 60 mg Stillen, and 100 mg rebamipide groups, respectively) and the per-protocol set (PPS) (75% vs. 37%, 45%, 51%, 50%). The cure rate of gastric erosion was significantly higher in the 75 mg CKD-495 group than in the other groups. The improvement rates of hemorrhage erosion were significantly higher in the 150-mg CKD-495 group. No significant differences were observed in the safety profiles. No serious adverse events or drug reactions were observed. These results demonstrate that 75 mg of CKD-495 has excellent efficacy for the treatment of endoscopic and symptomatic improvements for acute and chronic gastritis. Trial Registration: ClinicalTrials.gov identifier: NCT03437785.

Introduction: Alcohol-associated liver disease (ALD) is one of the most common causes of cirrhosis. Pharmacotherapy for alcohol use disorder (AUD) can improve abstinence rates in patients with cirrhosis, however, there is limited data on how these therapies affect liver-related outcomes. Methods: A scoping review was completed using multiple electronic search databases. Articles exploring pharmacotherapy for AUD and outcomes for ALD were included. The primary outcome of this study was liver outcomes after receiving pharmacotherapy for AUD, including decompensated cirrhosis, mortality, progression of ALD, and need for liver transplantation. Results: A total of 2521 studies were screened and 3 were selected. A total of 45,948 patients were included, 43,863 (98%) of patients were male, and the mean age was 58.7. Only 2299 (5%) of patients received AUD pharmacotherapy. Receipt of AUD pharmacotherapy was found to be associated with decreased hepatic decompensation and mortality in 2 out of 3 studies. Conclusion: There are limited studies that explore AUD pharmacotherapy and ALD outcomes. Medications AUD may improve hepatic outcomes; however, further prospective studies need to be completed to explore this association.

Background: Triglyceride glucose (TyG) and its related index (TyG-body mass index, TyG-BMI) are recognized as markers for nonalcoholic fatty liver disease (NAFLD), but their associations with metabolic dysfunction-associated steatotic liver disease (MASLD) and significant liver fibrosis (SLF) risk are less studied. Therefore, this study explores the effectiveness of these indices in assessing MASLD and SLF risk in the U.S. population. Methods: Utilizing data from the National Health and Nutrition Examination Survey (NHANES), a cross-sectional study involving 5520 participants from the general population was performed. This research measured demographic, anthropometric, biochemical, comorbid, and lifestyle characteristics, all of which are considered risk factors for MASLD/SLF. Results: Upon controlling for confounding variables, only the TyG-BMI was found to have a consistent positive association with the risk of MASLD and SLF. Specifically, for each standard deviation increase, the odds ratio (OR) and 95% confidence interval (CI) were 4.44 (3.64-9.26, p for trend < 0.001) for MASLD and 2.48 (2.15-2.87, p for trend < 0.001) for SLF. Significant interactions were identified among age, sex, and the risk of MASLD associated with the TyG-BMI. The TyG-BMI also had a significant threshold effect on the risk of MASLD at a cutoff point of 180.71. Furthermore, the area under the receiver operating characteristic curve (AUC) revealed that the TyG-BMI better predicted the risk of MASLD and SLF (AUC 0.820, 95% CI 0.810-0.831; AUC 0.729, 95% CI 0.703-0.756, respectively). In addition, the integrated discrimination improvement (IDI), decision curve analysis (DCA), and net reclassification index (NRI) also demonstrated the satisfactory predictive ability of the TyG-BMI. Conclusions: Within this large dataset, the TyG-BMI was independently associated with both the MASLD score and the SLF in the MASLD cohort. Its predictive efficacy consistently surpassed that of TyG and other noninvasive models, indicating that TyG-BMI has potential for the early identification of MASLD and SLF risk.

Background and objectives: The efficacy of antiviral therapy in chronic hepatitis B (CHB) patients with normal alanine aminotransferase (ALT) is controversial. This study aimed to systematically review and analyze antiviral efficacy in ALT-normal CHB patients. Methods: PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to 17 May 2024 were searched for retrieving relevant studies with antiviral efficacy of ALT-normal CHB patients. Results: Of 4992 records screened, 10 studies met the criteria for inclusion and had a low risk of bias. The pooled proportions of undetectable HBV DNA, HBeAg loss, HBeAg seroconversion, HBsAg loss, and HBsAg seroconversion in ALT-normal CHB patients with antiviral therapy were 87%, 35%, 19%, 16%, and 10%, respectively. Subgroup analysis suggested that the virological and serological responses were better in patients receiving IFN-based therapy or with a longer follow-up time. Compared with no treatment, antiviral therapy was associated with significant higher rates of undetectable HBV DNA (RR: 65.62, 95% CI: 16.65-258.57, and p < 0.01), HBeAg loss (RR: 14.97, 95% CI: 3.31-67.65, and p < 0.01), HBsAg loss (RR: 14.22, 95% CI: 4.10-49.29, and p < 0.01), and HBsAg seroconversion (RR: 24.65, 95% CI: 3.06-198.60, and p < 0.01). The normal ALT group and elevated ALT group had comparable antiviral efficacy including proportions of undetectable HBV DNA, HBeAg loss, and HBeAg seroconversion (p > 0.05). Conclusions: CHB patients with normal ALT could benefit from antiviral therapy, and the virological and serological responses were comparable to that of ALT-elevated ones.

Introduction: Metabolic dysfunction-associated fatty liver disease (MAFLD) is highly prevalent among people living with severe obesity (body mass index [BMI] ≥ 35 kg/m²). However, it remains unknown how sex and adipose tissue distribution are related to MAFLD onset and progression into metabolic dysfunction-associated steatohepatitis (MASH) or advanced stages of fibrosis. Methodology: We retrospectively studied patients with severe obesity who were eligible for bariatric surgery. Demographic characteristics, biomarkers, and cardiometabolic comorbidities were reported. Anthropometric indices such as BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), neck circumference (NC), lipid accumulation product (LAP), visceral adiposity index (VAI), body adiposity index (BAI), abdominal volume index (AVI), and body roundness index (BRI) were measured or calculated. MAFLD, MASH, and stages of fibrosis (F1-F4) were established from perioperative liver biopsies. Standardized univariate and multivariate logistic regression analyses were used to examine the association between demographic variables, anthropometric indices, cardiometabolic conditions, and the risk of MASH or severe fibrosis (F2-F4). Results: A total of 2091 participants with severe obesity were included in the analyses; BMI 47.9 ± 7.3 kg/m², age 46.2 ± 11.2 years, and 68.4% females. Overall, MAFLD prevalence was 79.5%, with 44.5% having MASH and 24.4% having severe fibrosis (Stage 2 or higher). No anthropometric indices of adiposity were associated with MASH or fibrosis severity. In this population, female sex was a risk factor for severe fibrosis (OR: 1.27, 95% CI 1.01-1.59, p < 0.05). Conclusions: MAFLD and MASH are highly prevalent in individuals living with severe obesity, but no anthropometric indices or laboratory tests are good predictors of MAFLD or MASH in this population. When MAFLD is diagnosed, our results suggest that females with severe obesity might be at higher risk of advanced stages of fibrosis.