BMC Gastroenterology最新文献

Background: Depression is common in people living with Inflammatory Bowel Disease (IBD). Depression rates increase with active disease and are linked to poorer clinical outcomes. Previous studies investigating the relationship between contemporaneous IBD disease activity and depression are often poorly controlled, use small samples and/or rely on self-reported measures of disease activity. Depression and self-reported disease activity (SRDA) are linked to increased healthcare usage, however, objective inflammation is rarely statistically controlled. The primary aim was to understand how self-reported disease activity and inflammation are related to depression. Secondary aims included assessing the relative influence of self-reported disease activity, inflammation and depression on healthcare usage.

Methods: This was a cross-sectional analysis of baseline data collected as part of a randomised controlled trial (trial registration no: ISRCTN71618461) of a digital treatment for symptom self-management in IBD (n = 599). Bivariate associations of demographic and clinical variables with depression were conducted to identify relevant covariates. Multiple linear regressions assessed (i) the relationships between depression (Patient Health Questionnaire-9 (PHQ-9)), SRDA (IBD-Control) and intestinal inflammation (faecal calprotectin (FCP)) and (ii) whether these variables explained variance in healthcare usage and economic indicators.

Results: Depression was significantly predicted by SRDA (β = -0.82, p < 0.001) but not FCP, with the model explaining 37% of the variance in depression (F(2,596) = 175.1, p < 0.001). FCP was only weakly associated with SRDA (r = -0.16, p < 0.001). Depression was independently associated with visits to primary care (β = 0.19, p < 0.001), IBD secondary care (β = 0.13, p < 0.001), IBD-related A&E attendance (β = 0.10 p < 0.05) and the impact of IBD on productivity (β = 0.24 p < 0.001) in the last 3 months.

Conclusions: Depression was related to SRDA but not FCP. Depression was also associated with healthcare usage even when SRDA and inflammation were statistically controlled. Routinely assessing and treating depression in IBD alongside managing inflammation may improve symptoms for patients and reduce healthcare costs.

Background: Gastric cancer (GC) is a pressing global health concern, with prognosis intricately linked to the tumour stage and tumour microenvironment, especially, the presence of immune cells. Notably, CD8 + T cells play a pivotal role in the anti-tumour immune response, prompting investigations into their correlation with GC survival. This study aimed to investigate the intricate interplay between CD8 + T cells, particularly within the context of CXCR6, and survival outcomes in patients with GC.

Methods: Utilising datasets from The Cancer Genome Atlas, Gene Expression Omnibus, and Tumor Immune Dysfunction and Exclusion, the study employed xCell and Weighted Gene Co-expression Network Analysis to assess CD8 + T cell infiltration and identify key gene clusters. The prognostic significance of CXCR6 was evaluated via immunohistochemical staining of a GC tissue microarray.

Results: High CD8 + T cell infiltration correlated with improved survival in patients with GC. CXCR6 was identified as a prognostic gene and its expression was predominantly observed in CD8 + T cells. CXCR6 expression positively correlated with improved overall and disease-free survival. Furthermore, CXCR6 expression was associated with an immunoreactive microenvironment.

Conclusion: This study established that high CD8 + T-cell infiltration is related to CXCR6 expression, making it a key factor in predicting a favorable GC prognosis. The role of CXCR6 in shaping the tumour microenvironment and its potential utility in immunotherapy response prediction highlights its significance in GC management.

Background: Chronic liver disease is an on-going loss of liver structure and functions that lasts for at least six months. About 1.5 billion population suffered with this devastating disease worldwide.

Objectives: The aim of this study is to assess the treatment outcome and associated factors in patients with chronic liver disease at Bahir Dar, North West Ethiopia.

Method: A retrospective cross sectional study was conducted in both governmental and private hospitals of Bahir Dar city from January to August 2024. All patients with liver disease for at least six months and treated for their specific causes and/or complications were included. Descriptive statistics was employed to explain socio-demographic and relevant clinical characteristics. Binary logistic regression was employed to determine associated factors with poor treatment outcome. Texts, tables and charts used to present statistically and/or clinically significant results. A p-value of < 0.05 was considered statistically significant.

Result: A total of 213 medical records of chronic liver disease patients were reviewed. Most of the study participants (72.8%) were male and resided in rural area (63.8%). Viral hepatitis was the most frequent (60.0%) etiology followed by parasitic (23.0%) and alcohol misuse (11.5%). The percentage of patients with chronic liver disease who experienced poor treatment outcomes was 39.0% and 54.2% were not taking medications specifically tailored to their condition. Stages of chronic liver disease (AOR = 2.68; 95%CI: 1.50-4.76, p = 0.001), carcinoma status (AOR = 2.68; 95%CI: 1.07-6.68, p = 0.035) and treatment duration (AOR = 0.38; 95%CI: 0.15-0.98, p = 0.045) were independent predictors for poor treatment outcome.

Conclusion: The overall treatment outcome of chronic liver disease in our study was inadequate. Decompensated stages of cirrhosis, cellular carcinoma and shorter treatment duration were significant factors of treatment failure. Timely initiation of appropriate therapy is warranted to improve the treatment outcome of chronic liver disease patients.

Introduction: Gastrointestinal infections represent a worldwide public health problem. In Colombia, the incidence reaches 21.4 cases per 1,000 inhabitants. Given the limitations of traditional diagnostic methods in terms of sensitivity and specificity, the gastrointestinal panel (GIP) has emerged as a promising tool, allowing rapid detection of 22 pathogens. This study aimed to describe the clinical and microbiological characteristics of immunosuppressed and immunocompetent adult patients with diarrhea and the influence of the gastrointestinal panel in their treatment in a high-complexity hospital in Colombia.

Materials and methods: A cross-sectional observational study was carried out including 350 adult patients treated at the Fundación Valle del Lili hospital between 2021 and 2022. Demographic and clinical variables, GIP findings and treatment were analyzed by univariate and bivariate analysis. We compare immunocompromised and immunocompetent adult patients using Chi-square tests, Fisher's F test for qualitative variables, Student's t-test, and the Mann-Whitney U test for quantitative variables. A significance level of 5% was applied to demonstrate the significance of the variables in all the tests used.

Results: The results showed that 52% were men, with an average age of 52 years. 72.0% presented acute diarrhea, being inflammatory in 60.1%. 39.1% of the patients were immunosuppressed, mainly transplant recipients (31.3%). 53% of the GIPs were positive, with up to 5 pathogens per sample. Bacteria were detected in 80%, viruses in 14.4%, and parasites in 5.5%. The most frequent bacteria were enteropathogenic E. coli (43.0%), enteroaggregative E. coli (18.6%), and C. difficile (17.4%). Norovirus was the predominant virus (67.7%) and Cryptosporidium the most common parasite (41.7%). A higher frequency of Vibrio spp. was observed in non-immunosuppressed patients (p = 0.004) and of enterotoxigenic E. coli in immunosuppressed patients. 41.0% of patients received antibiotic/antiviral therapy, 83% empirically. GIP influenced the treatment of 56.7% of patients, with a 90.0% recovery rate.

Conclusion: This study confirms that GIP is a valuable diagnostic tool in the management of adult patients with diarrheal disease, particularly in immunocompromised patients. In our setting it is still a costly and difficult to access test, which makes it necessary to standardize the indications for its application. Future studies could evaluate its cost-effectiveness in our context.

Background: Upper gastrointestinal bleeding (UGIB) is a prevalent and severe complication of cirrhosis, often resulting from esophagogastric variceal bleeding (EVB). This condition poses significant life-threatening risks. Once bleeding occurs, the risk of recurrent episodes substantially increases, further compromising liver function and worsening patient outcomes. This study aims to identify risk factors for UGIB in cirrhotic patients using clinical examination data and to develop a non-invasive predictive model to improve diagnostic precision and efficiency.

Methods: Based on the inclusion and exclusion criteria, the study included 140 cirrhotic patients hospitalized at the First Affiliated Hospital of Nanjing Medical University between June 2022 and May 2023, who experienced UGIB within six months after discharge. These patients were compared with 151 cirrhotic patients hospitalized at the same hospital during the same period, who were discharged within six months without experiencing UGIB. General characteristics of the patients during hospitalisation, laboratory parameters on admission, and liver and spleen stiffness were retrospectively collected, and a retrospective case-control study was conducted. All patients were randomly assigned to the training and validation sets in a ratio of 7:3. Independent factors associated with UGIB were identified by univariate analysis, multivariate logistic regression analysis, and stepwise regression analysis, on the basis of which a predictive model was developed. The model's performance was assessed via receiver operating characteristic (ROC) curve and decision curve analysis (DCA) and was compared with established prognostic models, including the Child-Pugh and MELD scores.

Results: The study analyzed 291 patients with cirrhosis, of whom 208 were allocated to the training set and 83 to the validation set. Independent predictors were identified, and predictive models were constructed using multivariate logistic regression analysis, and stepwise regression analysis in the training set, followed by validation in the validation set. The stepwise regression analysis identified ascites, spleen stiffness, albumin, fibrinogen, total cholesterol, and total bilirubin as independent predictors of UGIB (P < 0.05). These variables were incorporated into the predictive model. The area under the curve (AUC) for UGIB prediction was 0.956 in the training set and 0.909 in the validation set, demonstrating strong predictive performance. Furthermore, comparative analysis using ROC and DCA demonstrated that the developed model outperformed established scoring systems, such as the Child-Pugh score and the MELD score.

Conclusion: Ascites, spleen stiffness, albumin, fibrinogen, total cholesterol and total bilirubin as independent predictors of UGIB in cirrhotic patients.

Introduction: Hypercoagulability contributes to the majority of deaths and organ failure associated with obstructive jaundice (OJ). However, the exact mechanism of the coagulopathy in OJ remains elusive. Our objectives were to demonstrate whether phosphatidylserine (PS) exposure on blood cells (BCs), microparticles (MPs), and endothelial cells (ECs) can account for the hypercoagulability and liver damage in OJ patients.

Methods: We evaluated OJ patients at two time point, which before (Day 0) and 7 days (Day 7) after the endoscopic retrograde cholangiopancreatography procedure (ERCP), and compared with healthy controls. Lactadherin was used to quantify PS exposure on BCs, MPs and ECs. Human umbilical vein endothelial cells (HUVECs) were incubated with serum of OJ patients and the expression of PS were evaluated. Meanwhile, healthy BCs and HUVECs were treated with 0, 25, 50 or 100µM unconjugated bilirubin (UCB) and PS exposure on cells were evaluated. Procoagulant activity was evaluated by purified coagulation complex assays, clotting time, and fibrin turbidity. In addition, we established a cholestatic mouse model by bile duct ligation to determine the potential role of PS in intrahepatic coagulation and liver damage.

Results: Using flow cytometry, we found that OJ patients exhibited elevated levels of PS + BCs and associated MPs compared to the controls. Furthermore, the number of PS + BCs and MPs in patients at Day 0 were significantly higher than in patients at Day 7. Similarly, we observed markedly elevated PS exposure on HUVECs cultured with serum from patients at Day 0 versus serum from patients at Day 7. In vitro assays, PS exposure on BCs and HUVECs progressively increased with the concentration of UCB. Moreover, PS + BCs and MPs contributed to greatly shortened coagulation time and markedly enhanced coagulation factor Xa, thrombin, and fibrin generation. This procoagulant activity could be blocked approximately 80%, by the addition of lactadherin. Moreover, cholestatic mice exhibited significantly increased levels of liver tissue necrosis, fibrin deposition, and thrombophilia compared to sham mice. The enhanced intrahepatic coagulation and liver injury could be reversed by inhibiting PS with lactadherin.

Conclusions: These results highlight the pathogenic activity of PS + cells and MPs in promoting a prothrombotic environment and liver damage in OJ. As such, lactadherin, a PS blockade, may be a viable therapeutic strategy for treating such patients.

Background: Restrictive eating behaviors are common among patients with inflammatory bowel disease (IBD), which may may develop nutritional and/or quality of life impairments into avoidant/restrictive food intake disorder (ARFID). The objective of this study is to estimate the prevalence and characteristics of ARFID in Chinese patients with IBD, and to investigate the current perceptions and dietary behaviors of patients with and without ARFID.

Methods: A cross-sectional study was conducted in gastroenterology clinics of four tertiary hospitals in China. Patients with IBD were asked to complete a structured questionnaire including demographic characteristics, dietary attitudes and behaviors. The diagnosis of ARFID was established using Chinese version of the Nine-Item Avoidant/Restrictive Food Intake Disorder Screen questionnaire.

Results: A total of 483 patients with IBD completed the questionnaires, and 20.3% met clinical criteria for ARFID. The average score of ARFID was 21.9 (interquartile range = 17.0-26.0). Multivariable binary logistic regression results showed that patients with Crohn's disease (OR = 0.483, 95%CI = 0.280-0.835; p = 0.009), being in an active disease state (OR = 0.220, 95%CI = 0.123-0.392; p < 0.001), holding dietary attitudes regarding symptom control (OR = 2.431, 95%CI = 1.299-4.548; p = 0.005), and reporting a specific dietary history (OR = 27.158, 95%CI = 3.679-200.456; p = 0.001) were significant more likely to suffer from ARFID.

Conclusions: ARFID is a common problem among patients with IBD. The incidence of ARFID is particularly high among patients with Crohn's disease, during relapse, and those who hold restrictive dietary attitudes or have a history of specific diets. Therefore, it is imperative to prioritize routine screening and early identification of ARFID, especially among high-risk populations, in future research and clinical practice.

Trial registration: ChiCTR2100051539, on 26 September 2021.

Background: Considering the role of leukotrienes in inflammatory pathways, and owing to the anti-leukotrienes effect of montelukast, in the present clinical trial, we aimed to assess the effect of montelukast on remission maintenance in patients with ulcerative colitis (UC).

Methods: In the present double-blind randomized controlled clinical trial, 222 volunteer UC patients on high-dose corticosteroid and montelukast were recruited. The patients received 10 mg of montelukast (98 patients) or placebo (124 patients) for 22 weeks. Simultaneously, the prednisolone dose was tapered. The patients were followed up eight more weeks post-interventions. The primary efficacy of the treatment was remaining in remission.

Results: 194 patients completed this study. During the study, relapse occurred in 108 patients, 32 patients in the montelukast group and 76 patients in the placebo group. There were significant differences between groups regarding the relapse-free period (intervention group mean: 27.25 95% CI: 26.17-28.32 weeks and placebo group mean: 20.88; 95% CI: 19.36, 20.40 weeks, P < 0.001). At the end of the intervention period and six weeks' post-intervention, the mean partial Mayo score, and inflammatory biomarkers were significantly lower in the montelukast group compared with the placebo group. The frequency of patients with high fecal calprotectin levels was significantly higher in the placebo group compared with the montelukast Group.

Conclusion: The findings indicated that compared with placebo, montelukast had a significant positive effect on remission maintenance in UC patients who were in the steroid-tapering phase of therapy.

Clinical trial registration number: IRCT20121212011738N3.

Background: The present study is an online survey to determine the quality of life and functional impairment caused by irritable bowel syndrome (IBS) and the healthcare experiences of IBS patients in Norway, which has not been done previously.

Methods: An author-developed, online questionnaire using Microsoft Forms program was applied. The questionnaire comprised 52 questions. The questionnaire was posted from 1 March to 17 April (a 48-day period) on the Norwegian Gastrointestinal Association website and in its magazine and social media posts.

Results: The questionnaire was completed by 2727 patients. Of these patients 327 were excluded because they have not been diagnosed by a medical doctor. IBS reduced the quality of life in 97% of affected patients, including the social life in 90% and the sexual life in 69%. The unemployment rate of IBS patients in Norway 38%, which is 10-fold higher than that of the general population, and 94% of IBS patients reported that IBS impaired their work/study performance. About half of the patients had to discuss their abdominal symptoms with their general practitioner (GP) more than 10 times and wait more than 1 years before being diagnosed. Only 34% and 48% were satisfied with the help they received from their GP and gastroenterologist, respectively. Only 18% and 43% of the IBS patients felt that their GP and gastroenterologist, respectively, were sufficiently knowledgeable about IBS. Only 21% of the IBS patients was satisfied with the treatment they received.

Conclusions: IBS markedly reduces the affected patient's quality of life and their working productivity. IBS patients are generally dissatisfied with the clinical management they receive from GPs and gastroenterologists.

Background: Choledocholithiasis has been reported to be associated with the occurrence of cholangiocarcinoma (CCA); however, the association has not yet been sufficiently demonstrated. This study aimed to evaluate the association between choledocholithiasis (common bile duct stones) and CCA.

Methods: This nationwide retrospective cohort study used the Health Insurance Review and Assessment database of individuals diagnosed with choledocholithiasis between 2008 and 2009 in South Korea. Individuals were stratified by age, and CCA was categorized into extrahepatic CCA (ECA) and intrahepatic CCA (ICA). The standardized incidence ratio (SIR) was calculated to compare CCA incidence between patients with choledocholithiasis and the general population.

Results: The study enrolled 20,808 patients with choledocholithiasis (52.35% men and 47.65% women; male-to-female ratio: 1.09:1). Over a 10-year follow-up period, CCA occurred in 548 (2.64%) patients, comprising 238 (1.14%) ECA cases and 310 (1.48%) ICA cases. The SIR was 25.23 (95% confidence interval [CI]: 21.98-28.85) for ECA and 24.64 (95% CI: 21.87-27.73) for ICA. Statistical significance persisted even after excluding cases within the first 2 years from the index date, with an SIR of 18.63 (95% CI: 16.23-21.28) for ICA and 12.73 (95% CI: 10.50-15.30) for ECA. The SIRs peaked in patients diagnosed with choledocholithiasis at the age of 70-79 years (SIR 16.61, 95% CI: 11.83-22.69) for ECA and 60-69 years (SIR 29.27, 95% CI: 23.53-36.03) for ICA.

Conclusion: Our study demonstrated a significant association between choledocholithiasis and cholangiocarcinoma, particularly those in their 70s for ECA and 60s for ICA. However, causation cannot be established due to the retrospective design.