Saudi Journal of Gastroenterology最新文献

Abstract: There is an increasing recognition of the need for a specialized hepatohematology program in countries with a high prevalence of sickle cell disease. This program would be tailored specifically for patients with sickle cell disease, addressing the unique challenges they face, including the management of liver and biliary complications, and hematological issues associated with their condition. By integrating hepatology and hematology expertise, we can improve knowledge of liver SCD-related diseases, and patient outcomes, enhance care coordination, and provide comprehensive management strategies for this vulnerable population. While the primary focus of this program is on SCD-related liver disease, there may be opportunities shortly to expand its scope to include patients with various hematological liver diseases.

Background: This study aimed to identify the predictors of liver decompensation and mortality in patients with HCC treated with trans arterial radioembolization (TARE).

Methods: A retrospective analysis of 140 HCC patients who underwent TARE was conducted. Kaplan‒Meier and multivariate Cox regression analyses were performed to identify the key predictors of mortality and liver decompensation, defined as a total bilirubin level greater than 50 μmol/l or an upgrade in the Child‒Pugh class within three months of the first TARE procedure.

Results: The cohort comprised 69.3% males with a mean age of 71.3 ± 11.9 years. Most patients (73.6%) had Child-Pugh class A cirrhosis and 34.3% had BCLC stage B disease. Liver decompensation was recorded in 55 patients (39.2%) within three months of the first TARE procedure. A total of 80 patients (57.1%) died during the follow-up period. The median survival was significantly longer in those without liver decompensation (3.2 vs. 0.7 years, P < 0.001). Multivariate analysis revealed that male gender (adjusted odds ratio [aOR] 5.889, P = 0.009), cirrhosis (aOR 6.82, P = 0.047), and baseline international normalized ratio (INR) (aOR 316.664, P = 0.013) were independent predictors of liver decompensation. Cox regression analysis revealed several significant predictors of increased mortality including ascites (HR 2.012, 95% CI, 1.122-3.61; P = 0.019), portal vein invasion (HR 1.695, 95% CI, 1.057-2.718; P = 0.029), and diabetes mellitus (HR 1.823, 95% CI, 1.017-3.265; P = 0.044). Conversely, non-multifocal HCC (HR 0.593, 95% CI, 0.369-0.955; P = 0.031), treatment of the liver lobe other than the right lobe (HR, 0.482; 95% CI 0.236-0.986, P = 0.046), and age ≥60 years (HR 0.288, 95% CI, 0.139-0.597; P = 0.001) were associated with a reduced risk of mortality.

Conclusion: This study identified the key predictors of liver decompensation and mortality in patients with HCC undergoing TARE, potentially improving patient selection and management strategies.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) presents a significant global health challenge, with the Arab region exhibiting a markedly higher prevalence. We aim to evaluate MASLD research output, collaboration patterns, and funding impact in the Arab region over the last decade.

Methods: We conducted a bibliometric analysis of MASLD research in 22 Arab countries (2014-2023) using Clarivate Analytics' InCites. Data on MASLD prevalence were extracted from the Global Burden of Disease, while population and economic data from the World Bank. We assessed MASLD-related publications, prevalence, collaboration patterns, and citation and funding impact.

Results: Between 2014 and 2023, Arab countries contributed 844 publications (3.3% of global MASLD research). We identified positive correlations between MASLD-related publications and gross domestic product (GDP) (rs = 0.825, P < 0.001), age-standardized prevalence (rs = 0.627, P = 0.002), and population size (rs = 0.509, P = 0.016). International collaborations accounted for 48.7% of these publications, with a citation impact of 15.7 compared to the global average of 23.7. Arab-funded MASLD-related publications constituted 19.4% of MASLD publications in the Arab world versus 42.3% globally funded. Citation impacts were similar between Arab-funded (30.6) and globally funded publications (30.3). Of the top 10 countries globally with the highest GDP, 47.8% of the MASLD publications received funding, yielding a citation impact of 33.5.

Conclusion: Despite the high MASLD prevalence, Arab countries exhibit lower research output, impact, and funding compared to global levels. Increased regional collaboration and investment in MASLD research are critical to addressing this disparity.

Background: The Spatz3® Intragastric Adjustable Balloon (SAB) offers a novel approach to weight loss in super obese patients [body mass index (BMI) ≥50 kg/m2]. This study evaluates the safety, effectiveness, and predictors of success of SAB in this population.

Methods: A retrospective study was conducted at King Abdullah Medical City, Makkah, Saudi Arabia, involving 94 patients with SAB implantation. Weight loss metrics (%EWL, %TBWL), complications, and predictors of adverse events were analyzed.

Results: Eleven patients required early SAB removal due to severe symptoms. Complications included gastrointestinal bleeding (3.2%), gastric ulcer/erosion (27.7%), and deflation (5.3%). Significant weight loss was observed at 6 and 12 months. The mean absolute weight loss was 22.03 kg at 12 months, with %EWL of 19.27%. Early weight loss at 3 months predicted long-term success. SAB adjustments did not significantly impact outcomes. Post SAB, 57% of patients proceeded to laparoscopic sleeve gastrectomy (LSG) with rare postoperative complications (2.9%).

Conclusion: SAB is safe and effective for patients with BMI ≥50 kg/m2, achieving significant weight loss at 12 months. Early weight loss predicts long-term success, and subsequent LSG can be performed without significant complications. Further research should explore long-term outcomes and comparative analyses.

Background: There is currently a lack of nomograms specifically designed for predicting the risk of death in diabetic patients with severe acute pancreatitis (SAP). The objective of this study was to develop a nomogram tailored to diabetic patients with SAP to predict overall survival.

Methods: Diabetic patients diagnosed with SAP between January 1, 2018 and December 31, 2023 were included in the study. Risk factors were identified through least absolute shrinkage and selection operator regression analysis. Subsequently, a novel nomogram model was developed through multivariable logistic regression analysis. The predictive performance of the nomogram was evaluated using metrics such as the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA).

Results: A total of 206 patients were included in the analysis, with 171 in the survival group and 35 in the deceased group. Multivariate logistic regression indicated that age, platelet, total bilirubin, and potassium were independent prognostic factors for the survival of diabetic patients with SAP. The nomogram demonstrated a performance comparable to sequential organ failure assessment (P = 0.570). Additionally, the calibration curve showed satisfactory predictive accuracy, and the DCA highlighted the clinical application value of the nomogram.

Conclusion: We have identified key demographic and laboratory parameters that are associated with the survival of diabetic patients with SAP. These parameters have been utilized to create a precise and user-friendly nomogram, which could be an effective and valuable clinical tool for clinicians.

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is the main method to prevent the rebleeding of esophagogastric varices. Many studies have demonstrated that pre-emptive TIPS (p-TIPS) is superior to medicine combined with endoscopic standard therapy in the efficacy of high-risk patients, but very few relevant studies reported whether p-TIPS is more effective than elective TIPS. This study aims to compare the efficacy and prognosis of p-TIPS and elective TIPS for the treatment of esophagogastric variceal bleeding (EGVB) patients with cirrhosis.

Methods: In this retrospective study, clinical data of 92 patients with cirrhosis who accepted TIPS treatment after EGVB of cirrhosis were collected. According to the different times of TIPS, the patients were divided into the p-TIPS group and the elective TIPS group. The following information is documented: clinical manifestations and laboratory examination at 1, 3, and 6 months after the operation, survival state, the rates of rebleeding at 6 weeks and 6 months, and postoperative complications and serious adverse events during follow-up.

Results: The Child-Pugh score (P = 0.002) and MELD score (P = 0.006) in the p-TIPS group were significantly lower than those in the elective TIPS group in the 6th month after treatment. The rate of no gastric coronary vein embolization in the p-TIPS group was higher than in the elective TIPS group (P = 0.034). The hospitalized days (P < 0.001) and hospitalized costs (P < 0.001) were significantly lower in the p-TIPS group than in the elective TIPS group. No significant differences were observed between the two groups concerning rebleeding, overt hepatic encephalopathy, ascites, complications, and serious adverse events, occurrence.

Conclusion: The p-TIPS contributes to liver function recovery and enhances patient survival benefits at 6-months postoperation in the treatment of EGVB compared with elective TIPS, without increasing the incidence of complications and adverse events.

Background: Patients with multiple organ metastases from hepatic alveolar echinococcosis have a high mortality rate. However, predictors of multi-organ metastasis have not been identified. We aimed to develop a nomogram that predicts multi-organ metastasis in patients with hepatic alveolar echinococcosis.

Methods: We retrospectively screened patients with hepatic alveolar echinococcosis who were treated between January 2016 and December 2021 at Qinghai Provincial People's Hospital, China. The outcome of the nomogram was multi-organ metastasis of hepatic alveolar echinococcosis. We collected patients' basic characteristics, disease course, imaging, and blood laboratory results. The Least Absolute Shrinkage Selection Operator (LASSO) analysis selected the predictors preliminarily. A predictive model was constructed by multivariate logistic regression and presented as a nomogram. The performance of the nomogram was measured by the receiver operating characteristic (ROC) curve, calibration diagram, and decision curve analysis (DCA). The model was internally validated by calculating the performance of the validation cohort.

Results: A total of 353 patients were enrolled in this study. Ninety five (26.9%) patients presented with multi-organ metastases. All participants were randomized into a development cohort (n = 249) and a validation cohort (n = 104). Predictors in this nomogram were the course of the disease, the long diameter of the lesion, multiple intrahepatic lesions, and medication. The ROC curve of the training set was 0.907 (95% CI: 0.870, 0.943). A similar ROC curve was achieved at the validation set (0.927, 95% CI: 0.876, 0.979). The calibration curve demonstrated that the prediction outcome was correlated with the observed outcome.

Conclusion: The nomogram can predict the risk of multi-organ metastasis in patients with hepatic alveolar echinococcosis, and help clinicians develop or adjust a reasonable diagnosis and treatment plan in time.

Background: The emergence of tumor necrosis factor inhibitors (anti-TNF) has considerably changed the management of inflammatory bowel disease (IBD) in patients who do not respond to traditional therapies. This study assesses the prevalence of anti-TNF drug levels (DLs) and antibodies (ATAbs) in patients with IBD in Saudi Arabia and explores their associations with IBD type and prior anti-TNF failure.

Methods: This cross-sectional study included patients aged 14-75 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC), treated with anti-TNF medications at King Fahad Medical City over January 2016 to December 2022. Data were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, Pearson's Chi-squared test, and multinomial logistic regression.

Results: Among 392 patients with IBD (median age, 31 years), 75.8% were diagnosed with CD and 24.2% with UC. Anti-TNF levels were subtherapeutic in 27.0% patients, therapeutic in 21.5%, and supratherapeutic in 51.5%. ATAbs were negative in 73.1% patients, weakly positive in 9.8%, and positive in 17.1%. Subtherapeutic anti-TNF levels were significantly associated with positive ATAbs (P < 0.001). Prior anti-TNF therapy failure was observed in 37.2% cases, with 15.3% showing immunogenicity. No significant demographic differences were noted across ATAbs groups.

Conclusion: We highlight the prevalence of subtherapeutic and supratherapeutic anti-TNF levels among patients with IBD in Saudi Arabia and their association with ATAbs. The findings underscore the importance of monitoring anti-TNF DLs and ATAbs to optimize treatment outcomes in IBD management. Future research should focus on the longitudinal impact of these factors and explore genetic predictors of treatment response.