Gastro hep advances最新文献

英文中文

Successful Example of Implementing Screening of Liver Fibrosis in Specialist Diabetes Care

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.10.017

Muna Tajudin , Hannes Hagström , Sophia Rössner

Background and Aims

Patients with type 2 diabetes (T2D) constitute a risk group for presence and severity of metabolic dysfunction–associated steatotic liver disease (MASLD). Yet, there are few published examples of collaborations between endocrinologists and hepatologists in caring for patients with T2D and MASLD. Here, we describe a pathway for screening of liver fibrosis in routine specialist diabetes care at a tertiary care hospital.

Methods

Patients with T2D seen at the Endocrinology department at Karolinska University Hospital, Stockholm, Sweden, during a structured intervention for T2D between October 2016 and September 2023 were eligible for inclusion. Liver stiffness measurements (LSM) and controlled attenuation parameter (CAP) as proxies for liver fibrosis and steatosis, respectively, were obtained utilizing vibration-controlled transient elastography (VCTE). An LSM cut-off to exclude advanced fibrosis was set to <8 kPa. Presence of MASLD was defined as a CAP value of CAP ≥ 294 dB/m.

Results

A total of 177 patients with a valid LSM were included. The median age was 60 years and 60% were women. The median LSM was 5.8 (interquartile range 4.6–8.1) kPa, and the median CAP was 306 (258–362) dB/m. In total, 27% had LSM ≥8 kPa and 11% had LSM ≥12 kPa. MASLD was present in 55%. The clinical score for aspartate aminotransferase, alanine aminotransferase, age, platelet count had a low sensitivity for identifying patients with VCTE measurements above 8 kPa (34%) and 12 kPa (37%).

Conclusion

This study provides an example of a productive partnership between endocrinologists and hepatologists using direct VCTE measurements, leading to the identification of a significant number of patients with presumed advanced fibrosis.

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引用次数: 0

Extramedullary Involvement of Myelofibrosis in the Colon: A Case Report

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.11.003

Krystal Mills , Naseema Gangat , Victor Chedid

Colitis refers to a range of inflammatory conditions of the colon and each condition requires a distinct diagnostic and therapeutic approach. Common differentials include inflammatory bowel disease, ischemic colitis, and infections. Endoscopic evaluation is often a critical adjunct in determining the underlying cause of colitis and concomitant biopsies further improve diagnostic accuracy. Work up of this clinical case revealed the diagnosis of extramedullary hematopoiesis presenting as colonic ulcers in a patient with myelofibrosis, which has not yet been described in the existing literature.

引用次数: 0

A Program Offering CT Colonography for Colorectal Cancer Screening Avoided Colonoscopy and Sedation Risks in Heart Transplant Candidates and Expedited Screening: A Retrospective Observational Study

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.10.014

Diane R.M. Somlo , Reece J. Goiffon , James M. Richter , Asishana A. Osho , Cordula Magee , Sonali Palchaudhuri

引用次数: 0

Functional and Structural Investigation of Myenteric Neurons in the Human Colon 人结肠肌群神经元的功能和结构研究。

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.08.016

Kristin Elfers , Alina Sophia Sehnert , Alexander Wagner , Ulrich Zwirner , Helena Linge , Ulf Kulik , Daniel Poehnert , Markus Winny , Benjamin Gundert , Heiko Aselmann , Gemma Mazzuoli-Weber

Background and Aims

The enteric nervous system independently controls gastrointestinal function including motility, which is primarily mediated by the myenteric plexus, therefore also playing a crucial role in functional intestinal disorders. Live recordings from human myenteric neurons proved to be challenging due to technical difficulties. Using the neuroimaging technique, we are able to record human colonic myenteric neuronal activity and investigate their functional properties in a large cohort of patients.

Methods

Activity from myenteric neurons in wholemount preparations of different sampling sites of fresh, human colonic tissue was recorded using neuroimaging with the voltage sensitive dye 1-(3-sulfanatopropyl)-4-[beta[2-(di-n-octylamino)-6-naphthyl]vinyl]pyridinium betaine. Neuronal responses were analyzed following stimulation with nicotine and serotonin (5-HT) for differences based on the donor’s age, the disorder indicative for surgery and the colonic region. Immunohistochemistry was performed to calculate the total neuronal numbers.

Results

Stimulation with nicotine and 5-HT elicited reproducible action potential discharge in a proportion of human myenteric neurons. The responses to 5-HT were significantly greater in tissues from older patients and from those with inflammatory disorders, while neuronal activity to nicotinergic stimulation was comparable in all patients. Neuronal numbers declined with rising patient’s age and was highest in the sigmoid colon.

Conclusion

Neuroimaging with 1-(3-sulfanatopropyl)-4-[beta[2-(di-n-octylamino)-6-naphthyl]vinyl]pyridinium betaine was successfully adapted to record reproducible responses from human colonic myenteric neurons upon pharmacological stimulation. Evidence exists for an impact of age and inflammation on the serotonergic neuronal signaling and for differences in neuronal numbers in the distinct colonic regions as well as a neuronal decrease with age.

背景与目的：肠神经系统独立控制胃肠功能，包括胃肠运动，而胃肠运动主要由肌肠丛介导，因此在功能性肠道疾病中也起着至关重要的作用。由于技术上的困难，从人类肌肠神经元的实时记录被证明是具有挑战性的。利用神经成像技术，我们能够记录人类结肠肌神经活动，并在一大群患者中研究它们的功能特性。方法：用电压敏感染料1-（3-磺胺基）-4-[β[2-（二-正辛基氨基）-6-萘基]乙烯基]甜菜碱神经显像记录新鲜人结肠组织不同取样部位的全量制剂中肌肠神经元的活性。在尼古丁和5-羟色胺（5-HT）刺激下分析神经元反应，以观察供体年龄、手术指示性疾病和结肠区域的差异。采用免疫组化方法计算神经元总数。结果：尼古丁和5-羟色胺刺激可引起部分人肌间神经元重复性动作电位放电。老年患者和炎症性疾病患者的组织对5-HT的反应明显更大，而所有患者对尼古丁能刺激的神经元活动是相似的。神经元数量随着患者年龄的增长而下降，其中乙状结肠的神经元数量最多。结论：1-（3-磺胺丙基）-4-[β[2-（二-正辛胺）-6-萘基]乙烯基]甜菜碱吡啶神经显像技术可用于记录人类结肠肌肠神经元在药物刺激下的可重复性反应。有证据表明，年龄和炎症对血清素能神经元信号的影响，以及不同结肠区域神经元数量的差异，以及神经元随着年龄的增长而减少。

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引用次数: 0

Provider Adherence to the 2020 US Multi-Society Task Force Guidelines for Surveillance After Colonoscopy With Polypectomy 提供者遵守2020年美国多社会工作组结肠镜息肉切除术后监测指南。

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.08.011

Benjamin E. Cassell , Katherine Scholand , Wyatt Tarter , Camille J. Hochheimer , Colleen Long , Gregory L. Austin

Background and Aims

The 2020 United States Multi-Society Task Force on Colorectal Cancer guidelines for surveillance after colonoscopy with polypectomy introduced significant changes in surveillance intervals. We sought to identify rates of adherence to these new guidelines at an academic medical center.

Methods

Average-risk screening colonoscopies where 1 to 4 polyps <10 mm were removed between January 1, 2020, and June 30, 2021 were included. To determine predictors of nonadherence, a multivariable logistic regression analysis was conducted and included patient and procedure-related variables. Bayesian changepoint analysis was applied to identify timing of change in adherence. Multinomial logistic regression was used to identify predictors of variability within the guidelines.

Results

One thousand twenty-six procedures were analyzed. Adherence to the guidelines was 85%. In procedures with 1 to 2 polyps, increasing size (odds ratio [OR] 0.84 per mm; 95% confidence interval [CI]: 0.75–0.93) and a mixture of tubular adenomas (TA) and hyperplastic polyps (OR 0.35; 95% CI: 0.21–0.59) were associated with nonadherence. Among procedures with 1 to 2 TAs, age (OR 0.86 per 5-year increase; 95% CI: 0.75–0.99), increasing size (OR 0.86 per mm; 95% CI: 0.75–0.99) and polyp number (OR 0.54; 95% CI: 0.33–0.90) were associated with nonadherence. Changepoint analysis identified a potential changepoint on September 2, 2020 (95% credible interval April 2, 2020–February 22, 2020). Larger TAs were less likely to receive a 10-year recommendation (OR 0.61, 95% CI 0.5–0.75).

Conclusion

Adherence rates to the 2020 surveillance guidelines were high with a potential changepoint identified on 2/9/20. Deviation from guidelines was associated with patient and procedure related variables.

背景和目的：2020年美国结直肠癌多协会工作组关于结肠镜息肉切除术后监测的指南对监测间隔进行了重大改变。我们试图在一个学术医疗中心确定遵守这些新指南的比率。方法：平均风险筛查结肠镜检查1至4个息肉结果：分析了1226例手术。遵守指南的比例为85%。在有1 - 2个息肉的手术中，增大息肉大小(比值比[OR] 0.84 / mm；95%可信区间[CI]: 0.75-0.93)和管状腺瘤（TA）和增生性息肉的混合物(OR 0.35；95% CI: 0.21-0.59)与不依从性相关。在1 - 2个ta的手术中，年龄（OR为0.86 / 5年）增加；95% CI: 0.75-0.99)，增大尺寸(OR 0.86 / mm；95% CI: 0.75-0.99)和息肉数量(OR 0.54；95% CI: 0.33-0.90)与不依从性相关。变更点分析在2020年9月2日确定了一个潜在的变更点（95%可信区间为2020年4月2日至2020年2月22日）。较大的ta获得10年推荐的可能性较小（OR 0.61, 95% CI 0.5-0.75）。结论：2020年监测指南的依从率很高，并在2020-02-9确定了一个潜在的改变点。偏离指南与患者和手术相关的变量有关。

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引用次数: 0

The Clinical Utility of Anorectal Manometry: A Review of Current Practices

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.10.002

Eleanor Aubrey Belilos , Zoë Post , Sierra Anderson , Mark DeMeo

Anorectal manometry (ARM) is a diagnostic test that utilizes pressure sensors to dynamically measure intraluminal anal and rectal pressures, thus providing an objective evaluation of anorectal functional parameters (tone, contractility, and relaxation), coordination and reflex activity, and sensation. ARM is a useful test for numerous indications including for the assessment and management of functional anorectal disorders such as fecal incontinence, functional defecatory disorders, and functional anorectal pain, preoperative assessment of anorectal function, and in facilitating/assessing response to biofeedback training. In addition, while many functional anorectal disorders present with overlapping symptoms (ie constipation, anorectal pain), ARM allows delineation of more specific disease processes and may guide treatment more effectively. In recent years the development of advanced manometric methodologies such as high-resolution anorectal manometry has also led to improved spatial resolution of data acquisition, further increasing the potential for the expansion of ARM. However, despite its ability to provide detailed information on anorectal and pelvic floor muscle function and synergy as well as the endorsements of several national and international organizations, ARM is still infrequently utilized in clinical practice. The purpose of this review is to address the current clinical applications and limitations of ARM for various disorders of the lower gastrointestinal tract. In so doing, we will provide clinicians with a framework for the use of ARM in clinical practice. This review will also discuss potential barriers to widespread adoption of ARM in clinical practice and propose possible solutions to these challenges.

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引用次数: 0

Medicaid and Medicare Utilization of Direct-Acting Antiviral Medications for Patients With Hepatitis C

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.10.024

Xiaohan Ying , Alexander Zhao , Nicole Ng , Russell Rosenblatt , Catherine Lucero , Arun B. Jesudian

引用次数: 0

In Vitro Acid Resistance of Pathogenic Candida Species in Simulated Gastric Fluid

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.100591

Eri Ikeda , Masaya Yamaguchi , Masayuki Ono , Shigetada Kawabata

Background and Aims

Although species in the fungal genus Candida are often commensal residents of the gastrointestinal (GI) tract, they can also cause high-mortality systemic candidiasis. Most pathogenic Candida species are dimorphic fungi that exist predominantly in filamentous forms in the invading tissues. Candida albicans is the most prominent pathogen among Candida species, but nonalbicans Candida species have also emerged as important pathogens. The stomach is the most acidic niche in the GI tract and is maintained at pH 1–2 in healthy individuals. The aim of the present study was to determine whether Candida species can survive in gastric fluid and to observe their morphology under varied pH conditions.

Methods

We investigated the in vitro survival of the pathogenic Candida species C. albicans, Candida glabrata, Candida parapsilosis, and Candida tropicalis in simulated gastric fluid.

Results

We first described that a portion of the 4 Candida species can survive under highly acidic conditions. Moreover, dimorphic Candida species, namely, C. albicans, C. parapsilosis, and C. tropicalis, exhibited yeast–hyphal transition in simulated gastric fluid with elevated pH. Pathogenic filamentous cells had lower acid resistance than yeast cells.

Conclusion

These findings may illuminate the migration to the lower GI tract by commensal fungi of the oral cavity.

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引用次数: 0

Epidemiology and Treatment Patterns of Fistulizing Crohn’s Disease in a Large, Real-World Australasian Cohort

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.100594

Jack McNamara , William Wilson , Joseph L. Pipicella , Simon Ghaly , Jakob Begun , Ian C. Lawrance , Richard Gearry , Jane M. Andrews , Susan J. Connor

Background and Aims

Fistulizing Crohn’s Disease (fCD) affects up to 50% of people with Crohn’s Disease over their lifetime. Despite this high prevalence, the burden of disease, treatment and natural history in the current biologic era are poorly described. This study explores demographic, disease and treatment factors in a real-world Australasian cohort.

Methods

A large real-world cohort of people with inflammatory bowel disease under routine care was interrogated in August 2023. Current fCD was defined as fistula(e) on most recent clinical, radiologic or endoscopic investigation; prior fCD was defined as the resolution of fistula(e) on most recent documentation.

Results

Of 3075 people with Crohn’s Disease, 7.4% had current and 10.1% prior fCD (n = 224 & 311). Most patients were in Australia (77%), where 19.3% had current or previous fCD compared to 11% in New Zealand (P < .001). Patients with current or previous fCD were younger compared to those without (P = .003 & P < .001). Males were more commonly affected (P = .021). Current or prior fCD were more likely to be on biologic therapy (P < .001), with anti-tumor necrosis factor agents most frequently utilized. Conversely, those without fCD were more likely on Ustekinumab or Vedolizumab compared to current and prior fCD groups. People with fistulizing disease had higher hospitalization rates, while the prior fCD cohort had longer hospital admissions and more frequently required surgical intervention.

Conclusion

People with fCD used more health-care resources, making this an important area for further research into care gaps to improve outcomes and optimal treatment approaches.

{"title":"Epidemiology and Treatment Patterns of Fistulizing Crohn’s Disease in a Large, Real-World Australasian Cohort","authors":"Jack McNamara , William Wilson , Joseph L. Pipicella , Simon Ghaly , Jakob Begun , Ian C. Lawrance , Richard Gearry , Jane M. Andrews , Susan J. Connor","doi":"10.1016/j.gastha.2024.100594","DOIUrl":"10.1016/j.gastha.2024.100594","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Fistulizing Crohn’s Disease (fCD) affects up to 50% of people with Crohn’s Disease over their lifetime. Despite this high prevalence, the burden of disease, treatment and natural history in the current biologic era are poorly described. This study explores demographic, disease and treatment factors in a real-world Australasian cohort.</div></div><div><h3>Methods</h3><div>A large real-world cohort of people with inflammatory bowel disease under routine care was interrogated in August 2023. Current fCD was defined as fistula(e) on most recent clinical, radiologic or endoscopic investigation; prior fCD was defined as the resolution of fistula(e) on most recent documentation.</div></div><div><h3>Results</h3><div>Of 3075 people with Crohn’s Disease, 7.4% had current and 10.1% prior fCD (n = 224 & 311). Most patients were in Australia (77%), where 19.3% had current or previous fCD compared to 11% in New Zealand (<em>P</em> < .001). Patients with current or previous fCD were younger compared to those without (<em>P</em> = .003 & <em>P</em> < .001). Males were more commonly affected (<em>P</em> = .021). Current or prior fCD were more likely to be on biologic therapy (<em>P</em> < .001), with anti-tumor necrosis factor agents most frequently utilized. Conversely, those without fCD were more likely on Ustekinumab or Vedolizumab compared to current and prior fCD groups. People with fistulizing disease had higher hospitalization rates, while the prior fCD cohort had longer hospital admissions and more frequently required surgical intervention.</div></div><div><h3>Conclusion</h3><div>People with fCD used more health-care resources, making this an important area for further research into care gaps to improve outcomes and optimal treatment approaches.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 4","pages":"Article 100594"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143237533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Distinct Clinical Characteristics and Predictors of Sporadic Mismatch Repair-Deficient Colorectal Cancer

Gastro hep advances

Pub Date : 2025-01-01 DOI: 10.1016/j.gastha.2024.09.013

Dan Li , Sheng-Fang Jiang , Theodore R. Levin , Ajay Goel , Douglas A. Corley

引用次数: 0

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