Saudi Journal of Gastroenterology最新文献

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.

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: The Spatz3® Intragastric Adjustable Balloon (SAB) offers a novel approach to weight loss in super obese patients [body mass index (BMI) ≥50 kg/m 2 ]. 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/m 2 , 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: 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.

Background: Inflammatory bowel disease (IBD) incidence and prevalence has been increasing worldwide. Limited data exists on the effectiveness of ustekinumab (UST) in children. We aimed to describe the effectiveness and safety of UST in pediatric patients with IBD.

Methods: A single-center retrospective study was conducted between January 2017 and February 2022. The study included patients ≤16 years of age who were treated with UST and followed up for ≥1 year. Clinical remission was defined as a score of the Pediatric Crohn's Disease (CD) and Pediatric Ulcerative Colitis (UC) Activity Indices ≤10 at week 52.

Results: Thirteen patients who had failed anti-tumor necrosis factor-α (anti-TNFα) therapy were included, eight (61.5%) with CD and five (38.5%) with UC. The median age was 13 years (interquartile range [IQR]: 11.5 to 14). UST treatment was initiated at a median age of 3 years (IQR: 2.3 to 7) after diagnosis. Ten patients (76.9%) achieved clinical remission. There were no statistically significant differences in characteristics between patients who achieved and did not achieve clinical remission. Biochemical remission (BioR) was achieved in six patients (46.2%). Body mass index (BMI) significantly improved, C-reactive protein (CRP) significantly decreased, and the need for corticosteroids significantly decreased in the remission group. Endoscopy conducted post-treatment in seven patients confirmed remission in six patients. Adverse events included two cases of infection and one of headache.

Conclusions: UST was effective as a secondary biologic therapy for the induction and maintenance of remission in patients with anti-TNFα refractory IBD. At one year, 84% of patients remained on UST with no severe adverse reactions reported.

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: To compare the long-term safety and efficacy of Adalimumab (ADA) and Infliximab (IFX) agents in biologic-naive patients with Ulcerative colitis (UC).

Methods: The key focus was on specific outcomes such as the requirement of hospitalization due to UC, colectomy, steroid administration, and severe infections that led to the discontinuation of therapy.

Results: Anti-TNF treatment was initiated in 208 of the 475 patients with ulcerative colitis. The final study population consisted of 86 biologic-naive patients with UC, including 41 treated with IFX and 45 treated with ADA. No significant differences in treatment details, baseline Mayo scores, risk factors, or demographic features were observed. The ADA group displayed a significantly increased need for steroids (44.4%) compared to the IFX group (14.6%). The UC-associated hospitalization, colectomy, and serious infections were similar between the ADA and IFX groups. Similar outcomes were observed with IFX or ADA as monotherapy or in combination with immunomodulators. The survival analysis revealed IFX had a longer time to secondary loss of response compared to ADA, however, without statistical significance (72.5% versus 46.7%, P = 0.057).

Conclusion: Our results hint at the likelihood of IFX and ADA presenting similar clinical outcomes as first-time agents in UC. Nonetheless, the need for steroids with ADA should be taken into consideration.