Acta gastro-enterologica Belgica最新文献

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over a quarter of the global population, with up to 30% developing Metabolic Dysfunction-Associated Steatohepatitis (MASH), a progressive form that can silently lead to fibrosis, cirrhosis, and liver cancer. Current diagnostic methods, including blood-based scores and imaging, are insufficient for early detection, leading to late-stage diagnoses in most patients. Liver biopsy remains the diagnostic gold standard but is invasive, costly, and prone to high inter- and intra-reader variability, limiting its utility in routine care and clinical trials. Our research highlights myosteatosis-fat infiltration in skeletal muscle-as a potential early, non-invasive marker of MASH. In preclinical models and clinical studies, myosteatosis correlated with the presence of MASH and distinguished it from isolated steatosis. Notably, reductions in myosteatosis following interventions such as bariatric surgery or dietary regimens were associated with histological improvements in MASH, suggesting a potential role in predicting treatment response. In larger cohorts, myosteatosis was identified as a strong predictor of all-cause mortality. In parallel, we utilized a VCAM- 1-targeted molecular imaging technique and demonstrated a high accuracy in detecting inflammation in preclinical MASH models. This technology is now advancing to clinical trials for validation in humans. Taken together, our data support that targeted medical imaging may enable early, non-invasive diagnosis and monitoring of MASH, reducing reliance on liver biopsy and improving patient outcomes.

Pelvic floor multidisciplinary team (MDT) discussion is emerging as a standard part of care for patients with pelvic floor disorders. Although its use is encouraged by guidelines, there is still a lack of solid evidence supporting its benefits. The aim of this study is to evaluate the impact of pelvic floor MDT discussions on the diagnostic approach and treatment of a patient population at Antwerp University Hospital. After reviewing 26 patient cases, the study demonstrated a change in technical investigations in 69% of cases and a change in diagnostics in 85% of cases. These findings indicate that pelvic floor MDT discussions have a significant impact on both the diagnostic and treatment approaches for pelvic floor disorders.

Background: Extensive validation of the Q-NRG indirect calorimeter in canopy mode, especially against reference devices, is lacking. The aim of this study was to test its agreement in canopy mode with the Deltratrac II, which has always been considered as the gold standard indirect calorimeter in daily practice.

Methods: Healthy volunteers underwent indirect calorimetry with two consecutive assessments, using Q-NRG and Deltatrac II, both in canopy mode, in a random order, after careful calibrations. Body position, fasting conditions and environment were standardized. Agreement between the two devices was evaluated by paired Student's t test, correlation coefficients, and Bland-Altman plots.

Results: Sixty-one adults (85.2% male, aged 25.7±8.4 y, BMI 23.3±2.9 kg/m2) were included. Measured energy expenditure was similar whether it was measured using Q-NRG or Deltatrac II: 1816±361 kcal/day or 1809±260 kcal/day (p=0.803), respectively. There was a significant positive correlation between the two measures (ρ=0.78, p= <0.01). The Q-NRG slightly overestimated the energy expenditure compared to the Deltatrac II measure: the bias ± limits of agreement was 7 ± 227 kcal/day.

Conclusion: In healthy volunteers breathing spontaneously, the Q-NRG in canopy mode performed similarly to the Deltatrac II for energy expenditure measurement. The present study confirms the previously demonstrated accuracy of the Q-NRG device, and supports its clinical use in canopy mode.

Visceral leishmaniasis (VL) is a severe vector-borne parasiti disease, endemic in various tropical countries but also in the Mediterranean Basin. We report the case of a 64-year-old immunocompetent male, who presented with jaundice, fever, splenomegaly, hyperferritinaemia and cytopenias after a recent trip to Portugal. Clinical and biochemical findings were consistent with the diagnosis of an acute cholestatic hepatitis and haemophagocytic lymphohistiocytosis (HLH), secondary to visceral Leishmania infantum which was later confirmed by bone marrow examination. Despite adequate therapy with liposomal amphotericin B, the disease and HLH relapsed. Retreatment with higher dosing was eventually successful. This case highlights the risk of acquiring VL in southern Europe and its possible unusual presentations, causing diagnostic delay, as well as its complex management that requires appropriate multidisciplinary communication.

Background and study aims: Selective internal radiation therapy (SIRT) has shown good results in unresectable liver metastases from neuroendocrine neoplasms (NELM) with a high disease control rate (DCR) reported. The aims of the study is to assess retrospectively the efficacy and safety of 10y of SIRT for NELM.

Patients and methods: Primary endpoint was objective response rate (ORR) and DCR by RECIST 1.1 at 2, 4 and 12 months (m). Secondary endpoints were overall survival (OS), liver progressionfree survival (liver-PFS), clinical response (NEN-related symptoms improvement) and safety.

Results: 50 consecutive patients with NELM who got SIRT from 2011 to 2021 in one center. The two major NEN primary sites were pancreas (46%) and small intestine (36%). Histological NEN grades were 10%, 46% and 44% for grades 1, 2 and 3 respectively. ORR and DCR were 16% and 80% at 2m, 22% and 92% at 4m and 32% and 82% at 12m. Survival rates at 1 and 2 y were 76% and 72% respectively. Prognostic factors for OS and liver-PFS were NEN histological grade (3 vs 1+2) (hazard ratio (HR) for OS: 4.33 [1.8-10.6], for liver-PFS: 3.91 [1.3-11.4]), and early (2m) DCR (HR for OS: 0.14 [0.1-0.4], for liver-PFS: 0.016 [0.003-0.08]). Clinical response occurred in 7 of the 10 symptomatic patients. One patient died from radioembolization-induced liver disease.

Conclusion: SIRT showed efficacy in NELM pts, with a high DCR and an good safety profile. G1-2 grade and early DCR were associated with a better OS and liver-PFS.

Background: Subcutaneous (SC) infliximab CT-P13 (IFX) has recently been registered for the treatment of moderate-to-severe inflammatory bowel disease (IBD). The SC route is an attractive option for patients. However, many open questions remain on how to safely switch patients from maintenance IV to SC administration.

Objective: to assess switching from IV to SC IFX therapy in IBD patients through clinical and biochemical evaluation.

Methods: Patients in durable remission on eight-weekly (or six-weekly) IV infliximab and therapeutic IFX trough levels were switched to SC therapy every two weeks. All patients were monitored prospectively every 3 months with patient reported outcomes (PRO), labs including IFX concentrations and faecal calprotectin every 6 months for minimum one-year follow up.

Results: 55 patients (21 UC, 34 CD) agreed to switch to SC therapy. The median follow up in CD patients was 15.5 months, respectively 20 months in UC patients. All patients remained in deep remission according to PRO2, CRP and calprotectin. IFX serum concentrations more than tripled 3 months after the switch (18.31 ± 10.53 μg/mL vs. 4.82 ± 3.06 μg/mL at the start) and remained stable during further follow up. Local pain and injection site reactions both transient were reported in 47% and 42% patients respectively but disappeared in > 50% when injecting in the abdomen or when changing pen to syringe.

Conclusion: Switching UC and Crohn patients in clinical remission and adequate trough levels from maintenance IV tot SC infliximab therapy was successful for at least one year. A proportion of patients experienced pain and or injection site reactions.

A 71-year old male patient with myelodysplastic syndrome presented with severe signs of portal hypertension. There was no underlying cirrhosis nor portal vein thrombosis. Despite liver stiffness being high, hepatic vein catheterisation failed to show an increased hepatic venous pressure gradient compatible with clinically significant portal hypertension. Finally, a liver biopsy showed enlarged fibrotic portal tracts with multiple dilated immature bile ducts compatible with congenital hepatic fibrosis - there was no macroscopic biliary disease. Mostly presenting in childhood or adulthood, congenital hepatic fibrosis is an uncommon cause of non-cirrhotic portal hypertension that can also have a late presentation. Treatment is supportive with management of portal hypertension (and its complications); liver transplantation is curative but is reserved for cases with liver failure or recurrent cholangitis (mostly in Caroli syndrome).

A Meckel's diverticulum (MD) is the most prevalent congenital anomaly of the gastro-intestinal tract and the life-long risk for complications is estimated to be around 4%, mostly resulting in bleeding, obstruction, diverticulitis or intussusception. Although rare, about 3.1-5.1% of the complications are due to malignant evolution of the MD. Case: We present a 50-year old patient with progressive subobstructive symptoms leading the diagnosis of a complicated MD. Peroperative findings were suggestive for malignancy and the histopathological samples confirmed the presence of a metastatic adenocarcinoma, arising from the MD. Conclusion: This case illustrates a rare, malignant complication of a MD. This finding is of utmost clinical importance because the diagnosis may be challenging and early detection may improve the outcome of these patients. The clinician should be aware that malignant evolution of a MD exists and should be excluded in complicated cases.

Background: Sarcopenia is common in patients with cirrhosis and lower limb muscle strength could represent a factor of morbidity. A systematic review with meta-analysis on knee extension muscle strength in patients with cirrhosis was performed.

Methods: Literature was reviewed in electronic databases from inception until March 2023. Two independent researchers applied the inclusion criteria to assess the eligibility of articles. Of the 28 retrieved articles; 21 of them met the eligibility requirements.

Results: Muscle strength was impaired in patients with cirrhosis versus age-matched control (standardized mean difference, SMD: 3.48, 95% CI 2.35-4.61, I² = 96.5%, p<0.001) and was negatively influenced by increasing disease severity, with Child-Pugh A and B superior to C (SMD: 2.62, 95% CI 0.54-4.71, p<0.014; SMD 0.71, 95% CI 0.29-1.13, p<0.001, respectively). Exercise training tended to increase (SMD: 1.21, 95% CI 0.16-2.59, p=0.085), while liver transplantation decreased knee extension strength (SMD: -0.45, 95% CI -0.88 -0.01, p=0.045).

Conclusion: The negative impact of liver cirrhosis on knee extension strength is worsened by the severity of the disease. Transplantation leads to impaired knee extension strength. Conversely, exercise training tends to be beneficial, making rehabilitation pre and post-transplantation an attractive strategy to prevent muscle mass and strength loss.