Acta gastro-enterologica Belgica最新文献

Extra-pulmonary tuberculosis can affect any part of the digestive system, including the esophagus. Esophageal involvement in tuberculosis is considered rare and its atypical manifestation can lead to delayed or misdiagnosis. Primary esophageal tuberculosis (ET) occurs when the esophagus is directly affected by tuberculosis while secondary ET arises from infiltration by surrounding structures. We report the case of a 44-year-old immunocompetent Tibetan patient who presented with dysphagia, in whom gastroscopy revealed a subepithelial lesion (SEL). The patient was diagnosed with secondary esophageal tuberculosis by tissue acquisition with endoscopic ultrasound (EUS) and successfully treated with tuberculostatic drugs. Esophageal tuberculosis must be considered when a subepithelial lesion of the esophagus is found, especially in patients originating from endemic areas.

Background and study aims: Chronic idiopathic diarrhea represents a diagnostic and therapeutic challenge to gastroenterologists. We aimed to explore the diagnostic and therapeutic yield of 72h stool collection combined with bile acid quantification, in chronic diarrhea patients, to differentiate bile acid malabsorption from other causes of diarrhea and thus enabling tailored treatment.

Patients and methods: We performed a retrospective study on 252 stool collections combined with bile acid quantification. Descriptive statistics, Pearson correlation analysis and ANOVA with post hoc between-group t-tests were used.

Results: Idiopathic bile acid diarrhea was present in up to one third of patients with diarrhea-predominant IBS and functional diarrhea. Steatorrhea was highly prevalent both in patients with a clinical suspicion of fat malabsorption (57%) as well as patients with non-specific diarrhea (23%). We show a significant difference in fecal bile acid and fat content in patients with vs. without predisposing risk factors for bile acid or fat malabsorption (e.g. cholecystectomy). The prevalence of steatorrhea was also significantly higher in patients with previous enteric resection or bariatric surgery. Bile acid diarrhea was significantly more frequent in patients with previous colonic resection, probably due to combined resection of a distal ileal segment during right hemicolectomy. We could not show higher rates of bile acid diarrhea post-cholecystectomy compared to the other groups.

Conclusion: Bile acid diarrhea and steatorrhea are prevalent findings in patients with chronic diarrhea. Using this 72h stool analysis with bile acid quantification can help clinicians in the complex management of chronic diarrhea.

Background and aims: Tofacitinib has expanded treatment options for moderate-to-severe ulcerative colitis (UC). Longterm real-world data on its efficacy and safety remain limited, particularly in multi-refractory populations. This study evaluated the real-world effectiveness and safety of tofacitinib in Belgian UC patients with prior exposure to anti-TNF and vedolizumab.

Patients and methods: This retrospective multicentric observational study included consecutive adult UC patients from 26 Belgian centers who initiated tofacitinib through an early access program (November 2018-August 2019). Data were prospectively collected. Primary endpoint was clinical remission (partial adapted Mayo score≤1) at the end of follow-up (predefined as week 52). Secondary endpoints included endoscopic outcomes, treatment retention rate, colectomy-free survival, and adverse events (AEs).

Results: Seventy-five patients (59% men, median age 44 years) were included, with a median treatment duration of 45 weeks (IQR:19-51). At baseline, 96% had prior anti-TNF and 97% antiintegrin exposure, while 56% were on concomitant steroids. Clinical remission was achieved by 43% at the end of follow-up. Endoscopic response and remission were observed in 37% and 9% of patients, respectively. Fecal calprotectin <250μg/g at week 16 predicted clinical remission at the end of follow-up (OR:0.03, p=0.01). Overall, 34 patients (45%) discontinued tofacitinib, primarily due to primary non-response (62%). AEs were reported in 33% of patients, with the most common being arthralgia, respiratory tract infections, and herpes zoster. No major cardiovascular events or opportunistic infections occurred.

Conclusion: In a real-world Belgian cohort of multi-refractory UC patients, tofacitinib demonstrated effectiveness in achieving clinical remission by the end of follow-up with no new safety signals identified. These findings support its use in this challenging patient population.

Background: Ketamine-induced sclerosing cholangitis is an under-recognized but emerging condition, associated with chronic recreational ketamine use (1,2). While the bladder dysfunction related to ketamine abuse is well-documented, its hepatobiliary complications are less known (3). The disease mechanism remains unclear. It is suspected that ketamine has an effect on N-methyl-D-aspartate receptors in the bile duct smooth muscle, which contributes to chronic inflammation, fibrosis, and strictures. Patients present with abnormal liver function tests, imaging abnormalities, and aberrant liver biopsy. Management requires cessation of ketamine use, symptomatic treatment and close monitoring to prevent progression to cirrhosis (4-8).

Cases: This case series presents two cases of ketamine-induced sclerosing cholangitis in female patients, a demographic not typically represented in existing literature.

Conclusion: A multidisciplinary approach involving gastroenterologists, urologists, and psychiatrists is necessary (5). Long-term studies are needed to better understand the pathophysiology and to approve treatment and management of this disease.

Background and study aims: A large amount of FODMAP-rich food is part of a balanced and recommended diet for the general population. This study aims to assess quantitatively FODMAP consumption in a sample of the Belgian adult population of healthy volunteers (HV) and irritable bowel syndrome (IBS) patients.

Patients and methods: Participants completed five-day food diaries. Food portions were translated into quantities (g or ml) with the help of the "Poids et Mesure" manual (CSS, 2005). Nutritional valorisations were conducted using validated nutritional tables (Souci Fachmann Kraut, Ciqual, Nubel) and data from published studies. Student t-test and Mann-Whitney U test were performed for comparisons. Statistical significance was fixed at 5%.

Results: Forty food diaries were analysed (20 HV, 60% F, mean age 40 (16); 20 IBS patients, 85% F, mean age 46.7 (20.0)). The mean total FODMAP consumption was moderate for HV and was significantly lower in IBS patients (15.3 (5.4) g/d vs. 8.4 (5.1) g/d; p=0.0002), specifically for lactose (p=0.0009) and fructans (p=0.0004). In both groups, lactose represented the highest proportion of FODMAP consumed, while galactans were the least consumed. Most of the HV were considered as moderate or high consumers of FODMAP (45% [9g/d; 15.9g/d]; 45% ≥16g/d), while IBS patients were mainly low consumers (65% <9g/d).

Conclusions: FODMAP consumption in the Belgian adult general population is moderate, with the highest proportion of lactose, while IBS patients consume significantly fewer FODMAP.

Background: Juvenile polyposis syndrome (JPS) is a rare autosomal dominant disorder characterized by the presence of multiple hamartomatous polyps in the gastro-intestinal (GI) tract with an increased risk for developing GI cancer. Two causative genes have been identified, of which SMAD4 germline mutations show more upper GI tract involvement and appears to be a more aggressive form. In addition, SMAD4 JPS is linked with hereditary haemorrhagic telangiectasia (HHT).

Case history: We present 4 patients in our tertiary care hospital with a challenging treatment of extensive gastric polyposis who all had a late diagnosis, some of them despite the early discovery of polyposis or colon tumors.

Conclusion: Diagnosing SMAD4 JPS can be challenging but is important for the management of patients. The malignant potential in the upper GI tract is underestimated in clinical practice. Germline genetic analysis should be awaited before performing surgical interventions.

Background and study aims: Liver transplantation (LT) is limited by organ shortage. Dynamic preservation (DP) techniques have rapidly become the standard of care in liver graft preservation, particularly for extended criteria donors (ECD). This study reviews the clinical applications and future potential of various DP techniques in LT.

Patients and methods: A literature review was conducted using Medline (PubMed) to identify relevant studies on DP techniques, including normothermic machine perfusion (NMP), hypothermic oxygenated perfusion (HOPE), and normothermic regional perfusion (NRP).

Results: A growing number of high-impact studies support the clinical implementation of MP techniques. NMP maintains the organ metabolically active, enabling real-time graft viability assessment through markers of function and injury. When initiated at the donor hospital, NMP helps reduce or even eliminate ischemia-reperfusion injury (IRI). HOPE, on the other hand, mitigates IRI by supporting mitochondrial recovery, with flavin mononucleotide serving as a reliable surrogate marker of graft function. Importantly, both NMP and HOPE allow for safely extended preservation times, improving LT logistics and avoiding the need for nighttime procedures. NRP restores oxygenated blood flow in donation after circulatory death donors, reducing biliary complications and improving graft outcomes compared to rapid organ recovery. Emerging strategies, such as controlled oxygenated rewarming, combine HOPE and NMP to sequentially optimize graft preservation and assessment.

Conclusions: DP has revolutionized liver preservation, providing superior outcomes compared to static cold storage, particularly for ECD. Clarity and consensus are needed regarding the definition of clinically relevant endpoints to broaden the applicability of study results on DP.

Background: Use of antiplatelets, anticoagulants, or aspirin/NSAIDs increases the risk of major gastrointestinal (GI) bleeding. This study aimed to analyze esophagogastroduodenoscopy (EGD) findings in patients treated with these drugs (drug-exposed) versus those who were not (non-exposed), who presented with signs suggestive of nonvariceal upper GI bleeding.

Patients and methods: This retrospective cohort study included patients aged over 16 years with signs suggestive of upper GI bleeding, no history of gastrointestinal malignancy, and no portal hypertension or varices, hospitalized at the General Hospital of Ioannina, Greece, from January 2019 to October 2023. Differences between the two patient groups were tested for significance with the chi-square test. Relative Risk (RR) and Odds Ratio (OR) were calculated to assess the association between drug exposure and endoscopic findings. A p-value less than 0.05 was consider ed statistically significant.

Results: A total of 405 patients (268 males; mean age 73.1 ± 16.8 years) were enrolled: 303 drug-exposed (193 males; mean age 77.6 ± 12.2) and 102 non-exposed (75 males; mean age 59.7 ± 20.9). Peptic ulcer disease (PUD) was the most common bleeding cause. Drug exposure was strongly associated with vascular lesions (angiodysplasias, Dieulafoy's lesion, GAVE) (RR: 12.12, 95% CI: 1.68-87.3, p = 0.01; OR: 13.62, 95% CI: 1.84-100.64, p = 0.002). Notably, 75% of angiodysplasia cases occurred in anticoagulant-treated patients, with 50% receiving DOACs.

Conclusion: Upper GI bleeding in patients on antiplatelets, anticoagulants, or NSAIDs/aspirin should prompt suspicion of pre-existing lesions, particularly PUD and angiodysplasias.

Hepatitis E is an increasingly recognized cause of acute hepatitis in the Western world and is often complicated by extrahepatic manifestations, particularly neurological ones such as neuralgic amyotrophy (NA). NA is a disease of the brachial plexus, characterized by sudden onset of severe pain and muscle weakness, typically affecting the shoulders and upper limbs and can even extend to the diaphragm. Recent data suggest that its presence is linked to a HEV infection in 10% of the cases. Due to its rarity, there are currently no established treatment guidelines. Here we present a case of a 44-year-old man who developed bilateral NA and phrenic nerve palsy as a consequence of an acute hepatitis E infection.

Neonatal cholestasis is a diagnostic challenge that warrants extensive investigation as there can be serious sequalae such as liver failure, cirrhosis, or other extrahepatic complications. To differentiate the etiology of cholestasis, a distinction can be made between high and low gamma-glutamyltransferase (GGT) cholestasis. Low GGT cholestasis points towards progressive familial intrahepatic cholestasis type 1-2 and 4-6, bile acid synthesis disorders, tight-junction protein type 2 deficiency and some forms of hypopituitarism. Classic galactosemia is generally not included in the differential diagnosis of low GGT cholestasis. Here, we demonstrate low GGT cholestasis in 9 consecutive patients with classic galactosemia at the University Hospitals of Leuven, Belgium. All neonatal cholestasis should be managed with prompt cessation of galactose intake, but in classic galactosemia it can be lifesaving. We now add that low GGT cholestasis increases the likelihood of galactosemia. Conversely, high GGT cholestasis could point to other causes, like biliary atresia, where there may be no need to stop breastfeeding. In galactosemia, we observe a rise in GGT after initiation of a galactose-free diet, which we suggest may be partially explained by the normalization of bile acid transporter glycosylation.