Annals of Gastroenterology最新文献

Background: The global medical community has set a goal of reducing the prevalence of viral hepatitis by 2030, focusing on screening large segments of the population who are unaware of being infected. This study aimed to investigate the efficacy of screening hospitalized patients for viral hepatitis.

Method: All patients hospitalized in an internal medicine department between January 2021 and September 2023 underwent screening for hepatitis B and C (HBV/C).

Results: A total of 3914 patients were screened (mean age 69.8±16.9 years). A total of 112 (2.9%) patients had positive surface antigen, and 1281 (32.8%) patients had evidence of prior HBV infection (anti-HBc+), of whom the majority (952, 74.4%) also had concurrent positive anti-HBs antibodies. HBV DNA testing was performed in 65 patients (58%), with 60 patients (92.3%) showing detectable HBV DNA levels. Of these, 13 had chronic HBV infection, and 47 had chronic HBV hepatitis. Finally, 28 patients (71.8% of eligible patients) received treatment. During screening for HCV, 102 patients (2.7%) were anti-HCV(+), and 53 patients (52%) underwent HCV RNA testing. Twenty-nine patients showed detectable HCV RNA levels (54.7%), with 13 patients eventually receiving treatment (52% of eligible patients).

Conclusions: Screening for viral hepatitis can be easily and effectively performed in hospitalized patients. However, significant care should be taken to ensure that all patients undergo the entire screening process and receive treatment when eligible. Additionally, a substantial proportion of patients with previous HBV infection was recorded, which is of considerable importance in the era of immunosuppressive therapies.

Background: Elective umbilical hernia repair (UHR) is recommended for symptomatic patients who have decompensated cirrhosis with ascites. However, the exact timing, the type of surgery, and the factors affecting the outcomes are not clearly defined.

Methods: We prospectively collected data of patients with decompensated cirrhosis and ascites, who underwent UHR between January 2016 and July 2024. Complications and mortality were recorded during the early post-surgery period, at 30 days, at 3 months, and at 12 months after surgery. Our aim was to assess the short-term and long-term outcomes of decompensated cirrhotic patients who underwent either elective or emergency UHR.

Results: We included 19 patients (15 male), median model for end-stage liver disease score 15 (interquartile range [IQR] 11-39), who underwent UHR (16 emergent, 3 elective). Median survival time at 12 months after UHR was 5.5 months (IQR 0.3-86), whereas the mortality rates at 12 months were up to 68.42% (13/19 patients). No association was found between survival and type of surgery, type of anesthesia, preoperative use of diuretics, ascites grade or laboratory findings. Survival rates at 30 days (P=0.086), 3 months (P=0.022), and 12 months (P=0.031) postoperatively were better in patients who underwent emergent UHR.

Conclusions: UHR in decompensated cirrhotics is associated with high mortality. Several risk factors are implicated in the outcomes, with the severity of liver disease having a central role.

Background: Complex perianal fistulas in Crohn's disease (CD) represent a therapeutic challenge. Darvadstrocel has demonstrated efficacy in clinical trials, but evidence from real-life clinical practice is limited. This study evaluated the effectiveness and safety of darvadstrocel in real-life clinical practice, and assessed the economic impact associated with the outcome-based payment model (OBPM) linked to its funding within the Spanish National Health System.

Methods: An observational, descriptive, retrospective study was conducted on patients treated with darvadstrocel in the Servizo Galego de Saúde (SERGAS) between December 2019 and December 2024. Data were collected from the Therapeutic Value of Medicines Information System (VALTERMED), including demographic, clinical, safety and effectiveness variables at 6 and 12 months post-treatment. Descriptive statistics and Fisher's exact test were used for subgroup analyses.

Results: A total of 26 patients were included (50.0% female; median age: 38.4 years). Combined remission was achieved in 69.2% (n=18) at 6 months and 57.7% (n=15) at 12 months. No significant differences were observed among subgroups. No treatment-related adverse events were reported. Regarding sustainability, the OBPM resulted in SERGAS covering 81.5% of the total treatment costs, as the second payment installment was not made for non-responders.

Conclusions: Darvadstrocel demonstrated high effectiveness and safety in real-world clinical practice for patients with CD and complex perianal fistulas, with remission rates consistent with previous studies. The implementation of the OBPM linked to health outcomes proved to be a valuable tool for funding innovative therapies.

Endoscopic resection is the standard approach for removing colorectal adenomas. Despite technical advances, recurrence remains a concern. This unique review explores current endoscopic strategies for the management of local adenoma recurrence, evaluating efficacy, safety and limitations, based on available evidence.

Background: Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are immunemediated disorders whose coexistence is incompletely defined.

Methods: We conducted a cohort study using the TriNetX database, examining a cohort of patients with IBD and EoE over the period 2013-2022. We stratified the cohort by type of IBD, age, sex and race, to assess the incidence and risk factors for the development of EoE in patients with IBD. Additionally, we evaluated the 5-year risk of EoE-specific outcomes in patients with and without IBD.

Results: Among 234,582 IBD patients (mean age 45.4 years; 52.5% female; 74.8% White; 52.8% Crohn's disease [CD]), EoE incidence was 0.60% in ulcerative colitis (UC) and 0.83% in CD, highest in 30-34yearold White males. IBD increased EoE risk vs. matched nonIBD controls (adjusted odds ratio [aOR] 2.88, 95% confidence interval [CI] 2.59-3.19). Risk factors in UC were age <40 years (aOR 1.82, 95%CI 1.53-2.16) and male sex (aOR 1.83, 95%CI 1.56-2.15). In CD, age <40 years (aOR 2.71, 95%CI 2.35-3.13), male sex (aOR 1.81, 95%CI 1.58-2.06), obesity (aOR 1.41, 95%CI 1.13-1.75), and prior intestinal surgery (aOR 1.22, 95%CI 1.10-1.50) were significant. After PSM, concurrent IBD reduced the 5year composite risk of esophageal dilation and/or dupilumab use (aOR 0.39, 95%CI 0.29-0.52) compared with EoE alone.

Conclusions: IBD confers roughly 3fold higher odds of EoE. Younger age and male sex are universal risk factors; obesity and surgery are risk factors in CD. EoE complicating IBD is associated with fewer fibrostenotic sequelae than isolated EoE.

Background: Immune checkpoint inhibitors (ICI) target microsatellite instability-high (MSI-H) tumors with success. The incidence and characteristics of ICI-related colitis (IMC) in patients with MSI-H colorectal cancers (CRC) are unclear.

Methods: We performed a retrospective analysis of adult patients with CRC who received ICI between June 1, 2014, and December 31, 2022, including data on IMC observed up to 3 months after the last dose of ICI. Patients' demographics, oncologic profile, endoscopic features, treatment and clinical outcomes were evaluated.

Results: Of 474 patients with CRC receiving ICI during our study period, 18 developed IMC (3.8%). The majority were Caucasian (88.8%), male (61.1%), and their median age was 69.5 years. Of these patients, 50% received combination therapy with anti-PD-1/L1 and CTLA-4; 66.6% had MSI-H colorectal cancer, 11.1% had a second cancer-melanoma, while 61.2% and 66.7% had grade 1-2 colitis and diarrhea respectively. Endoscopic evaluation was used in 5 patients, of whom 2 had ulcerative inflammation necessitating selective immunosuppressive therapy with biologics. Therapy was withheld in 61.1% because of toxicity; 41.4% and 5.8% were noted to have median Common Terminology Criteria for Adverse Events grade 2 liver and pancreas toxicity respectively. The majority of our cohort received steroid therapy.

Conclusions: The lower severity of IMC, compared to toxicity in other ICI-treated cancers, may be influenced by the tumor microenvironment in MSI-H colorectal cancer after ICI exposure. Larger prospective studies are necessary to determine the role of tumor biology and the gut microbiome in the disease profile and severity of IMC.

Background: The current allocation system for liver transplantation (LT) is based on the sickest-first policy, using objective variables to ensure equal priority. However, under-prioritization of female patients for LT, compared to males, is well demonstrated and new scores have been proposed to overcome this systematic bias. This study evaluated the ability of these new scores to predict the long-term outcomes of patients with cirrhosis.

Methods: The clinical and laboratory characteristics of 694 consecutive candidates for liver transplantation from 2 liver transplant centers were recorded. The model for end-stage liver disease (MELD)-based scores (MELD, MELD-Sodium and MELD 3.0), as well as the Gender-Equity Model for liver Allocation (GEMA) and GEMA-Sodium, were used to assess the severity of liver disease. Patients were followed-up prospectively and their outcomes assessed.

Results: During a follow-up period of median length 12 months (range: 4-52), 28.5% of patients died, 21% of patients underwent LT, while 50.5% remained alive. Female patients had significantly lower MELD and MELD-Sodium scores compared to males, attributable to their significantly lower creatinine, while MELD 3.0, GEMA and GEMA-Sodium did not differ between the 2 sexes. In multivariate Cox regression analysis, GEMA-Sodium was the only factor independently associated with death/LT, and showed very good discriminative ability (hazard ratio 1.10, 95% confidence interval 1.073-1.128; P<0.001). These findings were confirmed in several subgroup analyses.

Conclusions: Our findings show for the first time the predictive ability of GEMA-Sodium for the long-term outcomes of LT candidates. However, further studies are needed to confirm these findings.

Background: Intestinal ultrasound (IUS) is accurate in detecting active ulcerative colitis (UC), but its role in repeated monitoring during biologic therapy remains to be established. This study aimed to assess correlations between IUS findings and the Mayo endoscopic score (MES), clinical and biochemical indices, and to evaluate the utility of IUS for monitoring infliximab (IFX) therapy and predicting outcomes.

Methods: In this prospective open-label study, patients with moderate-to-severe UC starting IFX were assessed at baseline and at week 14. Flexible sigmoidoscopy, IUS and measurement of fecal calprotectin levels were performed at both time points. Correlations between bowel wall thickness (BWT) and MES, C-reactive protein (CRP), calprotectin, and the Simple Clinical Colitis Activity Index (SCCAI) were analyzed across both visits.

Results: Thirty-two patients completed baseline evaluations and 21 completed follow up. Median age was 38 years; 53% were male. Disease extent was left-sided in 41% and extensive in 59%. BWT showed moderate correlations with MES (r=0.43, P=0.0015), and CRP (r=0.40, P=0.007), and a weak correlation with calprotectin (r=0.19, P=0.25). No significant differences in BWT, MES, CRP or calprotectin were observed at either time point. The only significant improvement was in SCCAI, from 7 (4.8-8) to 3 (1-5) (P=0.009). Baseline BWT and MES did not differ significantly between responders and non-responders.

Conclusions: BWT measured by IUS correlates with endoscopic and biochemical markers of disease activity. IUS may serve as a reliable, noninvasive alternative to endoscopy for monitoring treatment response in UC.

Background: Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a common surgical procedure for ulcerative colitis and familial adenomatous polyposis. IPAA strictures are a known complication, often requiring surgical intervention. Endoscopic interventions offer a less invasive alternative, but their safety and efficacy remain uncertain.

Methods: A comprehensive literature search was performed to identify pertinent studies. Outcomes assessed were technical success, clinical success (immediate and end of follow up), pouch failure rate and adverse events. Pooled estimates were calculated using random effects models with a 95% confidence interval.

Results: A total of 607 patients from 9 studies were included. Technical success, defined as the ability to pass the endoscope through the stricture, was achieved in 97.4% of patients. Immediate clinical success, defined as symptom improvement post-intervention, was seen in 44.5% of patients. Clinical success at the end of follow up was observed in 81.7% of patients. However, 6.8% of patients experienced pouch failure and ultimately 14.5% required surgical intervention for refractory strictures or complications. Endoscopic intervention-related serious adverse events occurred in 3.9% of patients, including perforation and major post-procedural bleeding.

Conclusions: Endoscopic interventions for IPAA strictures demonstrate high technical success rates, providing a less invasive option for managing this complication. While clinical success rates immediately post-procedure and at end of follow up are promising, a significant proportion of patients ultimately require surgical intervention for pouch failure or refractory strictures.