Advances in Digestive Medicine最新文献

Nucleotide analogs (NAs) reduced hepatocellular carcinoma (HCC) incidence in chronic hepatitis B (CHB) patients. Among low-viral-load (DNA of hepatitis B virus [HBV] were <2000 IU/mL) and non-cirrhotic CHB patients, the efficacy of NAs in the prevention of HCC remained elusive. The retrospective study recruited non-cirrhotic CHB patients with hepatitis B e-antigen (HBeAg) negative who were older than 50 years. Patients treated with or without NAs (2:1 age and sex match). HCC survey was performed during regular follow-up. A total of 63 patients were recruited for the current study (mean age, 63.5 years; 61.9% male). All patients were non-cirrhotic and with HBeAg negative. 68.3% of patients had fatty liver. Mean value of fibrosis-4 index (FIB-4) was 1.8. Overall, 65.1% of patients (41/63) were treated with potent NAs during the follow-up period. Compared to patients without NAs therapy, those with NAs therapy had higher HBV DNA levels (416.0 IU/mL vs. 212.0 IU/mL; p = .01). The HCC development was substantially lower in patients with NAs therapy, compared to those without NAs therapy (0% vs. 9.1%; log-rank p < .001). There was no HCC development in patients with NAs therapy, whereas two patients developed HCC within 2 years of follow-up in patients without NAs therapy. NAs could reduce the incidence of HCC in older (more than 50 years), non-cirrhotic, HBeAg-negative patients with low viral load.

The present research evaluated the impact of concurrent administration of metformin and l-carnitine with vitamin E on sonography grade as well as on the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients diagnosed with nonalcoholic fatty liver disease (NAFLD). This randomized controlled clinical trial was conducted on 68 non-metabolic patients diagnosed with NAFLD, confirmed by sonography and clinical examinations. Patients were randomly allocated to two groups: 34 individuals received 1 g of l-carnitine per day, the other 34 individuals received 1000 mg of metformin per day, both for a period of 6 months. All the studied patients received 800 IU of vitamin E daily for 6 months. The sonography grade of the fatty liver and the levels of ALT and AST in patients were evaluated at three time points: at the beginning of the trial and at 3 and 6 months after the study initiation. After 6 months of treatment, the administration of metformin and vitamin E resulted in a reduction in the sonography grade of patients diagnosed with NAFLD (p < .05). In contrast, there was no improvement in the sonography grade of patients who received l-carnitine and vitamin E. There were no notable alterations in the levels of liver enzymes (both ALT and AST) in either group (p > .05). The simultaneous use of metformin and vitamin E significantly improves the sonography grade of fatty liver, but not the level of liver enzymes in individuals with NAFLD.

Pancreatitis is the most common and devastating adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is mostly mild, but some can progress to more severe conditions with lethal outcomes. Although many risk factors and preventive measures for the occurrence of PEP have been established, there are insufficient studies to compare mild and moderate to severe PEP for the determination of predictors in the severity. This study looked at the eligibility of 4407 patients who had ERCP in a tertiary care hospital between January 2010 and December 2021. Of the 2512 eligible patients, 155 (6.2%) had a diagnosis of PEP, with 113 (4.5%) having a mild degree, 29 (1.2%) having a moderate degree, and 13 (0.5%) having a severe degree. Baseline profiles, intraprocedural data, and post-ERCP outcomes were compared between mild PEP (A) and moderate to severe PEP (B). Group B had a longer median time to resume oral intake or enteral feeding after ERCP (5 vs. 2 days; p = .01) and hospital day (18 vs. 6 days; p = .01) than group A. There was 1 PEP-related death in group B, but the mortality rate was not different between the two groups. The proportion of patients with a common bile duct diameter ≤10 mm (54.0% vs. 35.7%; p = .04), overall biliary cannulation time >10 min (61.9% vs. 38.1%; p = .01), and concurrent post-ERCP complications (16.7% vs. 3.5%; p = .01) was higher in group B than in group A. The main difference in concurrent post-ERCP complications was micro-perforation, which occurred in 11.9% of group B and 0.9% of group A (p = .01). Overall biliary cannulation time >10 min (odds ratio [OR]: 2.90; 95% confidence interval [CI] = 1.19–7.07; p = .02) and concurrent post-ERCP complications (OR: 5.60; 95% CI = 1.17–26.76; p = .03) were found to be independent predictors of moderate to severe PEP. Selective biliary cannulation time >10 min and concurrent post-ERCP complications are risk factors for moderate to severe PEP.

Prognostic factors for poor survival have been proposed in esophageal squamous cell carcinoma (SCC) patients receiving concurrent chemoradiotherapy (CRT). However, little is known about the association of pretreatment platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte (NLR) levels and treatment outcomes in elderly SCC patients. We conducted a retrospective study of elderly patients with esophageal SCC to find out clinical factors affecting survival. From January 2008 to December 2017, a total of 106 esophageal SCC patients with age more than 65 years old were enrolled. All included patients had undergone either concurrent CRT or radiotherapy (RT). Complete blood count, differential count, NLR, and PLR were obtained before treatment. Univariate and multivariate Cox regression analyses were used to assess the association between survival and patient, disease, and treatment characteristics. Seventy-five patients received CRT, while the remaining 31 patients were treated with RT alone. Multivariate analysis showed that CRT (p = .03, hazard ratio [HR] [95% confidence interval, CI] = 0.589 [0.365–0.95]), female (p = .011, HR [95% CI] = 0.216 [0.066–0.703]), ECOG performance status 0–I (p < .001, HR [95% CI] = 3.514 [2.049–6.026]), hemoglobin (Hb) ≥12 g/dL (p < .01, HR [95% CI] = 0.57 [0.37–0.878]) were independent factors for predicting better overall survival (OS). Independent factors for predicting better disease-specific survival (DSS) included ECOG performance status 0–I (p < .001, HR [95% CI] = 3.147 [1.802–5.497]), Clinical staging I–II (p = .023, HR [95% CI] = 2.124 [1.112–4.060]) and, NLR <5.3 (p = .029, HR [95% CI] = 1.706 [1.058–2.752]). Our study showed that CRT, gender, ECOG performance status, Hb level, were independent predictors of OS; whereas ECOG performance status, clinical staging and NLR were independent predictors of DSS. Pretreatment NLR >5.3 is an independent poor prognostic factor for DSS of elderly esophageal SCC patients. Because our study is a retrospective analysis, further prospective studies are needed to validify the findings in our study.

Percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) tubes are commonly used for long-term enteral feeding in older patients with swallowing difficulties. We conducted a nationwide cohort study (2002–2018) comparing complications between PEG and NG tubes using a 1:1 new-user design. Post-procedure outcomes included peritonitis, peptic ulcer, gastrointestinal bleeding, and aspiration pneumonia. The incidence rates per 1000 person-years for PEG versus NG groups were 3.52 versus 4.53 for peritonitis, 4.67 versus 8.62 for peptic ulcer, 7.65 versus 8.59 for GI bleeding, and 15.4 versus 9.04 for aspiration pneumonia. After adjusting for confounders, PEG was not associated with significant risks compared to NG. However, patients with chronic kidney disease (CKD) had a higher risk of aspiration pneumonia with PEG feeding (HR 3.03, 95% CI 1.02–8.99). Our findings suggest that PEG is the recommended approach for patients needing extended tube feeding support and careful patient selection and close monitoring, especially for CKD patients, are crucial post-PEG placement. These real-world data contribute to clinical decision-making on enteral access options, but further studies on interventions to reduce complications are needed.

A 53-year-old man with alcohol-associated liver disease presented with progressive abdominal enlargement over 3 days. Associated symptoms included abdominal fullness with pain upon coughing. Patient admitted to heavy consumption of 500 cc of 5% beer per day for the past 3 months. Physical examination and later sonography confirmed the presence of moderate ascites and his Child-Pugh score was 9 (Figure 1A). Gastroduodenoscopy revealed snake skin-like appearance in the stomach but no gastroesophageal varices. He was managed as decompensated liver disease secondary to alcoholic liver cirrhosis. After 5 days of admission, a spontaneous ecchymosis was observed over his right flank (Grey-Turner sign) but patient refused any ascitic tapping despite medical advice (Figure 1B). His blood test results are as follows: thrombocytopenia (platelet count: 60 × 1000/μL), macrocytic anemia (hemoglobin: 9.8 g/dL, mean corpuscular volume: 118.2 fL), twofold elevation of aspartate aminotransferase:alanine aminotransferase ratio (125/56 U/L), hyperbilirubinemia (total bilirubin: 5.3 U/L), markedly elevated gamma-glutamyl transferase (383 U/L), hypoalbuminemia (2.9 g/dL), and prothrombin time of 12.4 s. The Grey-Turner sign was not likely due to hemorrhagic pancreatitis since amylase (52 U/L) and lipase (56 U/L) tests were normal. Furthermore, patient did not have typical symptoms of pancreatitis with upper abdominal pain radiating to the back and improvement with bending forward. Since he was stable and improving, he was managed conservatively. After 2 weeks, with alcohol abstinence and medical therapy, the ecchymosis eventually disappeared, and likewise the ascites (Figure 2).

The classical Grey-Turner sign was first reported by Chauhan et al. for its association with portal hypertension.¹ We have previously reported the association of inguinal ecchymosis (Stabler's sign) with portal hypertension.² These two reports illustrated the causative link of cutaneous ecchymosis with portal hypertension. We postulated the same has happened to our patient in this case report, and in stable patient, spontaneous regression of ecchymosis could happen with treatment of portal hypertension. However, we recognize our limitation of ascitic tap which we did not perform to exclude hemorrhagic pancreatitis but the amylase and lactase tests were normal.

Yoen Young Chuah, Ping-Huei Tseng, Yeong Yeh Lee: Conceptualization. Yoen Young Chuah, Ping-Huei Tseng, Ping-I Hsu, Seng-Kee Chuah: Data curation; writing-original draft preparation. Yeong Yeh Lee: Supervision; validation. Yeong Yeh Lee: Writing—reviewing and editing.

The authors declare no conflicts of interest.

Informed consent was obtained from the patient for the publication of his information and image.

Invasive cytomegalovirus (CMV) diseases require accurate diagnosis. However, study evaluating the accuracy of hematoxylin and eosin (H&E) staining and the necessity of immunohistochemistry (IHC) staining in different CMV diseases of the gastrointestinal (GI) tract is limited. We analyzed specimens of the GI tract with H&E and IHC staining results from the pathology database. Patients were divided into suspected CMV infection (HEs) and no evidence of CMV infection (HEn) groups. We used IHC staining as the gold standard and analyzed sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) for H&E staining. Among 1448 specimens, the SE/SP (%) of H&E staining for the entire tract, esophagus, stomach, small intestine, and colon were 76.1%/82.1%, 76.1%/70%, 85.5%/71.7%, 60%/94.2%, and 75%/87%; the PPV/NPV (%) in the same order were 58%/91.3%, 39.3%/92%, 51.2%/93.5%, 69.2%/91.5%, and 68%/90.4%. In conclusion, for patients exhibiting high clinical suspicion, the application of IHC staining is essential in achieving an accurate diagnosis.