Acta gastro-enterologica Belgica最新文献

Background: Inflammatory bowel disease (IBD) impacts patients' quality of life (QoL), and hence, there is a need to assess this through patient-reported outcomes (PRO). Intestinal ultrasound (IUS) is a non-invasive tool for monitoring IBD activity, but little is known about its correlation with PRO. This study explored the cross-sectional relationship between PRO, assessed by the IBD Questionnaire-32 (IBDQ-32), and IUS parameters in patients with ulcerative colitis (UC).

Methods: This prospective study included 37 Colombian patients with UC. IUS parameters such as bowel wall thickness (BWT), colour Doppler signal (CDS), and mesenteric fat hypertrophy were assessed, followed by IBDQ-32 completion. Two IUS-experienced gastroenterologists, blinded to the IBDQ- 32, performed the assessments.

Results: In UC, lower IBDQ-32 scores were significantly correlated with increased BWT (p=0.050), presence of CDS (p=0.022), higher Limberg score (p=0.032), and mesenteric fat hypertrophy (p=0.040). The gastrointestinal and systemic symptom dimensions of the IBDQ-32 showed significant correlations with both BWT (p=0.013 and p=0.013) and CDS (p=0.002 and p=0.003), respectively.

Conclusions: In UC, IUS parameters are significantly correlated with quality of life, reinforcing the value of IUS as a point-of-care tool.

Background and study aims: Anal fissure is a prevalent condition characterized by severe pain resulting from a tear in the epithelial layer surrounding the anus. This systematic review aims to assess the effectiveness of both surgical and conservative approaches in the management of anal fissures.

Methods: A systematic review was conducted, encompassing randomized controlled trials (RCTs), quasi-experimental, and clinical studies published between 2019 and 2024. A comprehensive literature search was performed in Medline, PubMed, and other databases using keywords such as 'anal fissure,' 'sphincterotomy,' and 'topical treatment.' The study adhered to the PICOS framework and followed the PRISMA guidelines. Quality assessment was conducted using the Joanna Briggs Institute (JBI) criteria, and a total of 38 studies were included in the analysis.

Results: Of 38 included studies, 27 investigated conservative treatments and 11 evaluated surgical approaches. Conservative methods - particularly topical diltiazem and nifedipine, botulinum toxin injections, and pelvic floor therapy - were effective in pain reduction and healing for many patients and had mostly mild adverse effects. Surgical LIS demonstrated superior long-term healing in refractory cases.

Conclusions: Both surgical and conservative approaches serve as complementary strategies in the management of anal fissures. Surgical methods, particularly LIS, provide an effective treatment option with high success rates, while conservative approaches are beneficial in the early stages and for specific patient populations.

Endotipsitis is a rare but serious infection of TIPSS, with no established diagnostic criteria or treatment guidelines. It presents significant diagnostic challenges, particularly in immunocompromised patients such as liver transplant recipients. We report the case of a patient who underwent liver transplantation followed shortly thereafter by TIPSS placement due to refractory ascites (PSVD of the liver graft). He presented 10 years after with decompensation of cirrhosis and fever. Despite negative blood cultures, FDG PET-CT revealed intense hypermetabolism along the TIPSS suggesting endotipsitis. He was treated initially with antibiotics and required ultimately a liver retransplantation. This case is notable for its occurrence in a transplant recipient, the absence of bacteremia, and the extremely delayed onset after TIPSS placement, the longest interval reported to date. Diagnosis was made through PET-CT, highlighting its critical role when conventional investigations are inconclusive.

Background: Colonoscopy is a complex, operator dependent, practical skill. Attainment of key performance indicators (KPIs) by endoscopists depends primarily upon training. Local factors can lead to unstructured training, contingent upon the observed practice of trainers who may not be consciously competent (understand colonoscopy, can identify and deconstruct problems). We sought to demonstrate the feasibility and impact of a virtuallive colonoscopy-training course.

Methods: Trainees underwent a one-day training course (intervention) by physically remote, consciously-competent endoscopists, consisting of interactive theoretical and live sessions, where trainees performed colonoscopy in their local endoscopy unit receiving real-time instructions via a teleconference monitor. KPIs (Caecal intubation rate[CIR], adenoma detection rate[ADR], withdrawal time[WT], Gloucester Comfort Score[GCS] and Visual Analog Scale[VAS]) were assessed on trainee-performed colonoscopies for 3 weeks prior and 4 weeks after the intervention. Qualitative trainee and trainer feedback was obtained.

Results: 6 trainees (mean 654 prior colonoscopies) participated performing 60 colonoscopies (33 pre-, 27 post-intervention). Favourable trends in CIR (91% vs 96%, p=0.386), ADR (39% vs 63%, p=0.069) were observed as well as endoscopist-reported GCS>3 (18% vs 11%, p=0.495) and nurse-reported GCS>3 (22% vs 8%, p=0.131). There was good agreement between trainee- and nurse reported GCS and patient reported VAS. Trainees and trainers reported favourable qualitative experiences.

Conclusions: This is the first demonstration of colonoscopy training remotely via teleconference with a positive impact on KPIs. This approach has the potential to create standardized colonoscopy training experiences removing the barriers of travel and allowing exposure to consciously-competent trainers.

Background: Acute pancreatitis (AP) in children is an uncommon but increasingly recognized medical condition, with dyslipidemias, especially severe hypertriglyceridemia, being a rare etiology. The correlation between primary lipid disorders and AP is rarely documented in pediatrics.

Objective: To outline three pediatric cases of acute pancreatitiscomplicated severe hypertriglyceridemia, emphasizing the challenges in diagnosis, treatment approaches, and outcome.

Cases: Case 1: A 40-day-old infant with consanguineous parents who was exclusively breastfed showed signs of vomiting and distension in the abdomen. Laboratory analyses indicated triglycerides at 15.6 g/L and lipase at six times the upper limit of normal. Imaging confirmed Balthazar stage C pancreatitis. Management through fasting and intravenous fluids showed clinical improvement. Case 2: A 2-month-old baby had a fever and was vomiting. The lipid panel showed triglycerides at 25.24 g/L, which is a sign of familial hypertriglyceridemia (type IV). The lipase level was high at 498 IU/L, and an ultrasound showed infiltration around the pancreas. Supportive management improved symptoms, but high triglyceride levels required changes in diet and the introduction of fibrates at 2 years of age. Case 3: A 12-year-old with a history of dyslipidemia and recurrent pancreatitis was hospitalized for an episode. Triglycerides rose to 35 g/L, and the lipase level was high. A CT scan showed Balthazar stage C pancreatitis. Treatment included fasting, a special diet, fibrates, and omega-3. The patient had five recurrent episodes over 24 months, despite a brief improvement, primarily as a result of inadequate dietary adherence.

Conclusion: These cases reflect that, even though severe hypertriglyceridemia is uncommon in children, it should be considered when making a differential diagnosis of acute pancreatitis, especially if lactescent serum is observed. Age-related dietary limitations and long-term adherence make management challenging.

Background and study aims: Knowledge about the impact of smoking in Celiac disease is limited. We aimed to assess clinical differences between smoking and non-smoking patients with celiac disease.

Patients and methods: We conducted a cross-sectional questionnaire-based study among patients with Celiac disease distributed through a common interest group. Patients answered questions regarding the clinical manifestation of disease, adherence to a gluten-free diet and symptom development over time. Patients were asked whether they smoked at the time of diagnosis. Comparisons to the Swiss General Population were performed using data from the Swiss federal statistic office with data from the health survey 2012.

Results: Data on smoking status was available from 1537 individuals. We found a significantly lower proportion of smokers among questionnaire respondents compared to the Swiss general population in the same time frame (8.5% vs 28.2%, p < 0.01). Compared to non-smokers, smokers had a higher age at diagnosis (39 years vs 32 years, p < 0.01) and more frequently reported diarrhea as an initial symptom (67% vs 56%, p =0.013). Smokers tended to adhere less strictly to a gluten-free diet than non-smokers (69% strict adherence vs. 77% p =0.052). Six and twelve months after diagnosis, the proportion of patients with symptomatic improvement was not different between smokers and non-smokers.

Conclusions: We found a lower rate of smokers in this large group of celiac disease patients compared to the general population. Differences in presenting symptoms and higher age at diagnosis suggest that smoking might influence disease onset and/or presentation in an early phase.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but may induce rare immune-related adverse events including pancreatitis (ICI-PI-), which occurs in 2-4% of cases. Such ICI-PI may necessitate treatment discontinuation. We report the rare case of a 51-year-old female with Lynch syndrome treated with pembrolizumab for metastatic urothelial carcinoma. A pancreatic mass was identified during follow-up by PET/CT. Pathology from endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) could not exclude adenocarcinoma. Surgical resection revealed pathology consistent with type II autoimmune pancreatitis (AIP) in a case which represent by definition , a type III ICI-PI. We explore diagnostic criteria focusing on clinical, serological, histological as well as medical imaging features and management.

Hepatitis E virus (HEV) is the commonest cause of acute viral hepatitis in Western countries, especially genotypes 3 and 4. Chronic cases are reported in immunosuppressed patients, which includes patients who have undergone solid organ or stem cell transplantation, patients who are being treated for cancer or autoimmune diseases. Chronic HEV can eventually lead to liver fibrosis, and exceptional cases requiring liver transplantation for decompensated liver cirrhosis have been reported. The mechanisms leading to chronic HEV and its incidence in the immunosuppressed population is still unclear due to the paucity of well-designed prospective studies. According to studies conducted in various European countries, the HEV seroprevalence in immunocompromised patients ranges up to 40% and HEV RNA viremic prevalence between 0,5 to 2%. In this review, we provide a description of the epidemiology, risk factors and natural history of chronic HEV in relation to various types of underlying immunosuppressive conditions and discuss the different treatment options available.

We report a case of a 56-year-old male with alcohol-associated liver cirrhosis presenting with septic and obstructive shock due to spontaneous bacterial peritonitis and pericarditis with tamponade. Imaging revealed ascites, pleural and pericardial effusion requiring drainage. Escherichia coli with identical resistance patterns was cultured from all drained fluids. Scintigraphy confirmed a peritoneal-pericardial connection. After initial treatment, fluid recurrences prompted evaluation for transjugular intrahepatic portosystemic shunt (TIPS) placement, which was unfortunately complicated by severe bleeding, ultimately leading to multi-organ failure and death. This case highlights the exceptional occurrence of pericardial effusion and spontaneous bacterial pericarditis as well as peritonitis as a complication of decompensated cirrhosis, with confirmed connection between the pericardium and the abdominal cavity by nuclear tracer study, as well as microbiological evidence. Based on an overview of all published cases management includes diuretics, paracentesis and in refractory cases, TIPS. Liver transplantation remains the definitive treatment.