Acta gastro-enterologica Belgica最新文献

Background and objectives: Metabolic dysfunction-associated fatty liver disease (MAFLD) has been reported as a complication after pancreatic surgery. The aim of this study is to assess this phenomenon in a Belgian population, specifically in a period in time when less perioperative chemotherapy was given.

Methods: We performed a retrospective monocentric cohort study with 124 selected patients who underwent pancreatic surgery - pancreaticoduodenectomy (PD), distal pancreatectomy (DP) or total pancreatectomy - between 2005 and 2014. Steatosis was assessed radiologically, using Hounsfield units on liver and spleen. Data on imaging, liver function, weight and other relevant parameters were gathered preoperatively as well as 2 and 6 months, 1 and 2 years after surgery.

Results: Thirty-eight (31%) out of 124 patients developed liver steatosis at least at one point in time in the two years following surgery, with a prevalence of 21.0% at 2 months, 28.6% at 6 months, 16.4% at 1 year and 20.8 % at 2 years. A statistically significant association with preoperative AST and ALT values, administration of pancreatic enzyme supplementation as a surrogate for pancreatic exocrine insufficiency (PEI) and weight loss at 2 years was detected.

Conclusion: MAFLD is seen in 31% of patients with PD or DP pancreatic resection in this retrospective analysis of a monocentric Belgian cohort. Both early and late onset of MAFLD was observed, implying that long-term follow-up is necessary. Clinical impact as well as a direct correlation with patients' weight and oral enzyme supplements needs to be further investigated.

Background: Functional constipation (FC) is a geriatric syndrome that is common in the older adult's population and can seriously affect the quality of life and may be a frequent cause of hospital visits. In this study, we planned to investigate the relationship between FC and its related factors for in older outpatients.

Patients and methods: Participants aged 65 and over who applied to the geriatrics outpatient were included in the study. The diagnosis of FC was made according to the presence of the Rome IV criteria. Frailty was screened by the using FRAIL scale, ≥ 3 a score of were evaluated as frail. Participants quality of life was evaluated by Euro-Quality of Life Visual Analog Scale (EQ-VAS).

Results: The study included 602 participants. FC prevalence was found 28.7%. In univariate analyses, FC was found related to age, having a diagnosis of depression or Parkinson diseases, frailty, urinary incontinence, sleep disorders, number of chronic diseases, and EQ-VAS. In multivariate analyses, FC was not found to be associated by the frailty while the number of chronic diseases [OR=1.212, 95%CI (1.084-1.355), p=0.001] and EQ-VAS were found to be related [OR=0.988, 95%CI (0.978-0.997), p=0.012].

Conclusion: In the results of this study, FC was not found to be associated by frailty in older outpatients but it emerged as a syndrome that should be screened frequently in patients with a high number of chronic diseases and a low general quality of life.

Immune mediated inflammatory diseases (IMIDs) are a heterogenous group of inflammatory disorders of joint, skin, and gut characterized by both shared and distinct pathological pathways. This complexity has therapeutic implications, as not all IMIDs exhibit responsiveness to available biologicals. Moreover, cases have been documented where patients undergoing biologic therapy experience paradoxical occurrences of either a new IMID or a flare-up of a previously asymptomatic one. Treatment with anti- IL-17a has been approved for ankylosing spondylitis, psoriasis, and psoriatic arthritis, but was not found effective for the treatment of inflammatory bowel disease (IBD). This case series describes four patients with new onset IBD under treatment with an IL-17a inhibitor for a rheumatological or dermatological indication.

We describe two cases of pseudo-signet ring cells in gastric biopsies of otherwise asymptomatic adult patients. One male patient was diagnosed during follow-up of a previous intestinal type gastric adenocarcinoma and underwent surgery before recognition of this non-malignant entity. He suffered from a secondary anastomotic stenosis requiring dilatation. A second male patient was spared from surgery thanks to timely recognition by the pathologist and is still declared cancer-free until today. This extremely rare nonmalignant mimicker of cancerous signet ring cells, as seen in diffuse type gastric cancer can potentially mislead the clinician. The absence of any endoscopic abnormality should prompt a revision by an experienced pathologist, digestive oncologist and surgeon to avoid unnecessary interventions and morbidity.

Statins are generally known for their lipid-lowering properties and protection against cardiovascular events. However, growing evidence suggests that statins are a promising treatment for patients with chronic liver disease. Specifically, there is data supporting their role in reducing portal pressure and having a chemopreventive effect on hepatocellular carcinoma (HCC). Treatment options for HCC remain limited with portal hypertension (PH), thus statins could represent an inexpensive alternative, increasing survival of patients with HCC and PH. These drugs cannot be considered standard of care without a cardiac-metabolic indication to prescription in this patient group, although the potential beneficial effect should be indication for prompt use whenever considered appropriate. Our aim is to review the effects of statins on PH and on HCC, both in the pre-clinical and clinical setting in literature, discussing safety issues and limitations to the current body of evidence.

Pancreatic cancer is an aggressive malignancy with poor survival rates. Pancreatic surgery has improved outcomes in the last few decades, but still contains high morbidity rates. Pancreatic fistula, delayed gastric emptying, intra-abdominal infections and bleeding are well-known complications. We report a case of a 57-year old woman with a portogastric fistula complicated with high gastrointestinal bleeding and septic thrombophlebitis after pancreaticoduodenectomy for pancreatic adenocarcinoma.

Background & aims: Chronic hepatitis B is still a major cause of morbidity and mortality worldwide. In recent years, there has been increasing research on inexpensive, noninvasive, reproducible methods for detecting fibrosis in the liver. In this study, we examined the efficacy of 15 different noninvasive fibrosis markers for predicting significant liver fibrosis in chronic hepatitis B patients.

Methods: Patients who underwent liver biopsy for chronic hepatitis B between 01.01.2010 and 01.01.2022 were retrospectively analysed. The study population was divided into two groups according to significant fibrosis (F≥3). Receiver operating characteristic analysis was performed to examine the diagnostic performance of these noninvasive fibrosis markers for the prediction of significant fibrosis. Multiple logistic regression analysis was used create a model which predicts significant fibrosis better than the individual markers.

Results: In total, 234 chronic hepatitis B patients were enrolled in this study. Among the 15 noninvasive fibrosis markers, King's score was found to have the biggest AUC in predicting significant fibrosis (F≥3). Furthermore, a model containing King's score, GUCI and GPR has the ability of prediction of significant fibrosis better than every individual marker (cut-off of the model >0,3356, p<0.0001).

Conclusion: According to our study results, the model containing King's score, GUCI and GPR can be used to predict significant liver fibrosis in chronic hepatitis B patients followed-up in countries with limited sources.

Invasive varicella zoster infection is a rare but severe infectious disease, potentially affecting almost every organ system and presenting with a variety of symptoms. It is usually seen in immunocompromised patients, but also occurs in immunocompetent patients. Isolated intestinal manifestations without skin lesions are even more scarce. We present a case of a 78-year old immunocompromised man with an isolated intestinal Varicella Zoster reactivation. If not early diagnosed and treated, an invasive infection can lead to life-threatening complications. Therefore, awareness in both immunocompromised as immunocompetent patients is very important in the daily clinical practice.

Primary Biliary Cholangitis (PBC) is a chronic cholestatic liver disease typically diagnosed by elevated cholestatic liver enzymes and a positive anti-mitochondrial antibody (AMA) test. The clinical importance of AMA positivity in patients with normal cholestatic liver enzymes is unclear. The aim of this study was to determine the relationship between PBC and AMA positivity detected in individuals with normal cholestatic enzyme levels. The files of patients with AMA and/or AMA-M2 positivity between 2009 and 2018 and whose alkaline phosphatase (ALP) levels were below upper limit of normal (ULN) at initial admission were retrospectively analyzed. The ALP levels were normal in all patients. All patients had AMA positivity demonstrated by indirect immunofluorescence (IIF) or AMA-M2 positivity demonstrated by ELISA. A total of 16 patients underwent liver biopsy and seven (43.75%) showed changes consistent with those with PBC. A total of 12 patients were diagnosed with PBC and were treated and followed up with this diagnosis. People with AMA positivity and normal cholestasis enzyme levels are closely associated with PBC. Some of these patients were diagnosed with PBC as a result of biopsy and some were diagnosed by clinical and laboratory findings during follow-up.. The patients with an AMA titration of 1/20 were not associated with PBC. In our study, results similar to the studies confirmed by biopsies were obtained. In this regard, there is a need for prospective and retrospective studies with longer follow-up periods.