BMC Gastroenterology最新文献

Background: Gastroesophageal varices are portosystemic collaterals formed due to portal hypertension. The primary consequence and leading cause of death in cases of gastroesophageal varices is bleeding. Although variceal hemorrhage mortality has decreased due to early diagnosis of gastroesophageal varices, prophylaxis, and therapy, these procedures are still difficult to perform in many underdeveloped nations. When the dose of nonselective b-blockers is optimized to the highest acceptable dosage to reach the therapeutic goal, the benefit of reducing the risk of variceal bleeding is greatest. B-blocker optimization is unknown in our nation and Africa.

Objective: To assess the optimization rate of non-selective B-blockers and associated factors among esophageal varices patients following at the University of Gondar referral hospital.

Methods: A hospital-based cross-sectional study was conducted at the University of Gondar referral hospital GI clinic, North West Ethiopia. A total of 150 patients were taken with consecutive sampling and the target populations of the study were all adult esophageal varices patients who were on non-selective B-blockers at the GI follow-up clinic. Data were collected with a structured questionnaire and both descriptive and analytical data analysis was performed. Frequency, tables, and graphs were used to represent the data.

Results: A total of 150 patients were included in the study. From these 30.7% of patients took optimal doses of non-selective B -blockers. Patients with poor drug adherence (AOR = 4.293, [95% CI = 1.191-15.484], p-value = 0.026) and hospital admission in the last 01 year (AOR = 2.915, [95%CI = 1.076-7.893], P-value = 0.035) were significantly associated with sub-optimization of non-selective B- blockers.

Conclusion: Only one-third of patients received the optimal dose of non-selective B-blockers. Poor drug adherence and previous admission in the last year were significantly associated with sub-optimal dosing of non-selective B-blockers.

Background: The aim of this study was to discover immune-nutritional indicators that can preoperatively predict short-term mortality in older patients undergoing emergency gastrointestinal surgery.

Methods: We retrospectively analyzed older patients older than 65 years of age who underwent various types of emergency gastrointestinal surgery under general anesthesia between January 2012 and December 2023. The immune-nutritional indicators were defined according to previous literature. The primary endpoint of this study was 90-day survival after surgery.

Results: A total of 4120 patients older than 65 years were included in this study. ROC curves and the decision curve analysis for eight factors predicting 90-day postoperative survival were well predicted by the mGPS (0.68, 95% CI: 0.66-0.70), PNI (0.68, 95% CI: 0.66-0.71) and CONUT score (0.68, 95% CI: 0.66-0.70). The models constructed by LASSO Cox and CoxBoost were used to score the risk for each patient, and the high LASSO Cox model risk score group had worse 90-day survival than the low score group, whereas patients in the low CoxBoost model score group had a worse prognosis. The AUC of the CoxBoost model was greater than that of the LASSO Cox model. A nomogram model was constructed using the variables screened by the LASSO Cox model with a C-index of 0.706.

Conclusions: Immune-nutritional factors could be a favorable predictor for older patients undergoing emergency gastrointestinal surgery.

Background: Pancreatic cancer is a common and deadly cancer, ranking as the 14th most common cancer worldwide and the 7th leading cause of cancer-related deaths. Advanced pancreatic malignancy frequently presents with biliary and gastric outlet obstruction and palliative open interventions are often required, especially in low-income countries where endoscopic surgical bypass methods are often unavailable. This study aimed to describe the demographic and clinical characteristics of patients undergoing biliodigestive bypass for pancreatic malignancy.

Methods: This was a hospital-based retrospective observational study at the tertiary hospital in northern Tanzania. We included 53 patients who underwent double or triple bypass surgery for pancreatic malignancy between January 2019 to December 2022 at Kilimanjaro Christian Medical Centre (KCMC), Tanzania. Data was collected from medical records, analyzing demographics, comorbidities, pre-surgery and surgery details, and post-surgery outcomes. Descriptive statistics were used to summarize continuous variables as mean with standard deviation and categorical variables as percentages.

Results: 53 patients were analyzed, with a mean age of 63.2 years and a male to female ratio of 1.03:1. Jaundice was the most common presentation (77.4%). Of the patients, 74.5% had comorbidities, and the majority (81.1%) were uninsured. 50.9% of patients had a length of hospital stay shorter than 5 days, and 88.3% resumed normal oral intake. Palliation failure was observed in 22.6% of patients. The median survival time for the entire cohort of patients was 65 days. Patients with palliation failure had a significantly shorter mean survival time than those without complications (14.17 vs. 90 days, p = 0.001).

Conclusion: Bypass surgery remains a treatment of choice for palliating symptoms in patients with advanced pancreatic cancer. This study highlights the importance of prompt diagnosis of pancreatic tumors, especially in low-income countries, to achieve better outcomes.

Background: Dual-energy computed tomography enterography (DECTE) has significantly improved gastrointestinal imaging quality. Double-balloon endoscopy (DBE) has enabled comprehensive visualization of the small intestinal mucosa. This study aimed to assess the diagnostic efficacy of small-intestine DECTE and DBE for small bowel Crohn's disease (CD).

Methods: This retrospective study was conducted between 1 July 2016 and 1 November 2023 at the First Affiliated Hospital of Soochow University. The study included 72 CD patients who underwent both DECTE and DBE, with 4 patients repeating both procedures within 3 months.

Results: The diagnostic rate of small bowel CD using DBE was 80.3%, which was higher than that using DECTE (65.8%, P = 0.044). The combined small bowel CD diagnostic rate was 89.5%, which was higher than that of DECTE alone (P < 0.001). The detection rate of stenosis using DBE was 46.1%, which was higher than that using DECTE (13.2%; P < 0.001). The combined detection rate of stenosis was 52.6%, which was higher than that of DECTE alone (P < 0.001). For ulcers, DBE had a higher detection rate (73.7%) than DECTE (7.9%; P < 0.001). The combined ulcer detection rate was 76.3%, which was higher than that of DECTE alone (P < 0.001). The detection rate of long ulcers (≥ 2 cm) and non-ileocecal ulcers by DBE were both 17.9%. For patients with abdominal pain, DBE had a diagnostic rate of 79.4%, higher than 63.5% of DECTE (χ2 = 3.889, P = 0.049). The combined diagnostic rate was 87.3%, which was higher than that of DECTE alone (χ2 = 9.626, P = 0.002). For patients with diarrhoea, the DBE's diagnostic rates were 86.8% and 68.4% for DECTE (P = 0.097). The combined diagnostic rate was 94.7%, higher than DECTE alone (χ2 = 7.092, P = 0.008). For patients with other symptoms, such as abdominal distension or vomiting, the DBE diagnostic rate was 79.4% compared with 61.8% for DECTE (P = 0.183). The combined diagnostic rate was higher than DECTE alone (χ2 = 6.620, P = 0.010). Furthermore, notable differences in C-reactive protein, erythrocyte sedimentation rate, faecal calprotectin, haemoglobin, platelet count, albumin, haematocrit, Crohn's Disease Activity Index scores, and Simple Endoscopic Score for Crohn's Disease scores were observed between ulcer-positive and ulcer-negative patients detected by DBE (P < 0.05), whereas DECTE did not show significant differences (P > 0.05).

Conclusions: DBE or the combined use of DECTE and DBE provides superior diagnostic performance for small bowel CD, particularly in detecting stenosis and ulcers, compared with DECTE alone. DBE can be used to identify long ulcers and non-ileocecal ulcers. Moreover, DBE helps diagnose small bowel CD across different clinical manifestations and assess disease activity in various inflammatory states.

Background: Reliable, non-invasive evaluation of liver fibrosis is essential for early disease management. Computed tomography (CT)-based extracellular volume (ECV) fraction and portal venous phase enhancement rate (VP-ER) have shown potential in quantifying mild-to-moderate fibrosis. This study investigates the diagnostic performance of ECV and VP-ER in differentiating non-significant (F0-F1) from significant (F2-F3) fibrosis in biopsy-confirmed patients.

Methods: Ninety-three patients (20-72 years, 56.9% male) undergoing liver biopsy and multiphasic CT scans were retrospectively enrolled. Patients with METAVIR F4 cirrhosis or incomplete imaging/pathological data were excluded. Hematocrit levels were obtained on the day of CT. ECV was calculated from differences in liver and aortic attenuation between delayed and enhanced phases, adjusted for hematocrit. VP-ER was derived as the ratio of liver attenuation in venous to portal venous phases multiplied by 100. Spearman's correlation, receiver operating characteristic (ROC) curves, and DeLong tests evaluated their performance. Multiple logistic regression assessed independent contributions of ECV and VP-ER to fibrosis status.

Results: Fifty-three patients had no significant fibrosis (F0-F1) and 40 had significant fibrosis (F2-F3). ECV demonstrated a moderate correlation with fibrosis grade (r = 0.531, p < 0.0001), while VP-ER showed a weaker yet statistically significant correlation (r = 0.363, p = 0.0003). ROC analyses yielded an area under the curve (AUC) of 0.698 for ECV (cut-off = 38%) and 0.763 for VP-ER (cut-off = 71%), with no significant difference between AUCs (p = 0.358). VP-ER accurately classified 70 patients, while ECV correctly predicted 65. Logistic regression revealed significant associations for both VP-ER (OR = 1.08; p = 0.007) and ECV (OR = 1.025; p = 0.0132), achieving 72.04% classification accuracy and an overall AUC of 0.756 (95% CI: 0.688-0.863).

Conclusion: ECV fraction and VP-ER demonstrated reliable, complementary capabilities for distinguishing non-significant fibrosis from significant fibrosis. Their combined use in routine multiphasic CT protocols may reduce dependence on invasive biopsy while offering robust sensitivity and specificity for early fibrosis assessment. Further studies including cirrhotic populations and larger cohorts are recommended.

Objective: Helicobacter pylori (H. pylori) has attracted much attention since its discovery. This bacterium has had a substantial impact on society, the economy, and public health. In recent years, with the continuous increase in drug resistance in H. pylori and the emergence of multidrug resistant strains, the existing diagnostic and treatment options are no longer able to meet clinical needs, so we need to understand the dynamically changing nature of drug resistance of H. pylori in our region. This study collected stool samples from community residents in Lianyungang to analyse the local H. pylori infection status, resistance to commonly used antibacterial agents, and risk factors to provide a reference for local clinical empirical treatment.

Methods: Human stool samples from Lianyungang residents were collected, the DNA of H. pylori in the positive samples was extracted, the sites of mutated genes were determined by PCR and nucleic acid mass spectrometry, and genotypes of cytotoxin-associated gene A (CagA) and vacuolating cytotoxin A (VacA) were tested. The resistance rates of local H. pylori strains to five antibacterial agents, levofloxacin, clarithromycin, furazolidone, amoxicillin, and tetracycline, were collected, and the risk factors for drug resistance were analysed statistically based on questionnaire results.

Results: A total of 221 residents with qualified stool samples were enrolled. The infection rate was 25.3%. DNA was extracted from 56 H. pylori samples. Among them, only 17 H. pylori strains were sensitive to all five antibiotics, and a total of five drug resistance patterns were detected. The main drug resistance patterns were single drug resistance to clarithromycin (30.4%) and double drug resistance to levofloxacin + clarithromycin (21.4%). The levofloxacin resistance mutations were mainly located at N87K and D91Y of the gyrA sequence, and the clarithromycin resistance mutations were mainly located at A2143G in the 23S rRNA sequence. Age, gastrointestinal symptoms, and previous history of H. pylori infection were risk factors for resistant H. pylori. A previous history of H. pylori infection was an independent risk factor for the development of drug resistance in H. pylori.

Conclusion: The H. pylori infection rate in the Lianyungang area is lower than the national rate, but the rates of resistance to levofloxacin and clarithromycin are quite high. Drug sensitivity testing is needed to provide more accurate individualized treatment and improve the eradication rate of H. pylori. Continuous monitoring of local antibiotic resistance patterns remains the first choice for empirical treatment.

Background: The prevalence of metastatic colorectal cancer (mCRC) is increasing and is linked to poor overall survival (OS). Previous studies have aimed to determine the predictive value of scores and laboratory tests for OS in mCRC patients, but their findings have been inconclusive. In this research, we focused on determining the prognostic significance of the fibrosis-4 (FIB-4) index, the aspartate aminotransferase (AST) to platelet (PLT) ratio index (APRI), the albumin-bilirubin (ALBI) score, and the gamma-glutamyl transpeptidase to PLT ratio (GPR) with respect to OS in treatment-naïve mCRC patients.

Methods: This retrospective study included treatment-naïve mCRC patients. The FIB-4 index, ALBI score, APRI, and GPR were calculated for each participant, and their mortality dates were recorded. The clinical importance of these scores for survival outcomes was evaluated via the Cox regression model, Kaplan-Meier method, and log-rank test.

Results: The study enrolled 123 untreated mCRC patients. Univariate Cox regression analysis demonstrated that sex and AST/PLT and ALT/PLT counts were not associated with OS (p > 0.05 for all). However, a higher FIB-4 index (p = 0.025), ALBI score (p < 0.001), GPR (p < 0.001), and AST/ALT ratio (p < 0.001) were all associated with poor OS. Additionally, multivariate Cox regression analysis indicated that age (95% CI: 1.009-1.053, p = 0.006), ALBI score (95% CI: 1.234-2.983, p = 0.004), GPR (95% CI: 1.442-2.701, p < 0.001), and AST/ALT (95% CI: 1.193-2.911, p = 0.006) were independent prognostic factors for OS.

Conclusion: The affordable and easily accessible ALBI score, GPR, and AST/ ALT have prognostic value in untreated patients with mCRC.

This study aimed to detect the causal effect of ulcerative colitis (UC) on heart failure. A bidirectional two-sample Mendelian randomization (MR) analysis was performed. The causal impact of UC on heart failure was determined via MR by performing a genome-wide association study in which 4 UCs descending from European ancestors were set as individual exposures. The inverse-variance weighted (IVW) method was used as the main method, and 4 other methods were set as assistant parameters. Susbequently, the MR results were combined with meta-analysis results. The MR Egger method was employed to investigate pleiotropy. The leave-one-out method was utilized for sensitivity analysis. Furthermore, a reverse-directional study was conducted. There was evidence of the causal effect of UC on heart failure in MR estimates using 4 UC datasets. The IVW method revealed that the odds ratio (OR) = 1.03, 95% confidence interval (CI) = 1.01-1.06, P = 0.0441 when the first UC dataset was used; OR = 1.03, 95% CI = 1.01-1.05, P = 0.0445 when the second UC dataset was used; OR = 2046, 95% CI = 1.37-3.05E + 06, P = 0.0409 when the third UC dataset was used; and OR = 8.12E + 04, 95% CI = 29.09-2.27E + 08, P = 0.0052 when the fourth UC dataset was used. A meta-analysis of 4 MR studies revealed that UC had a statistically significant causal effect on heart failure (OR = 1.03, 95% CI = 1.01-1.05; P = 0.0074). Reverse MR analysis revealed that heart failure did not have a causal effect on UC. There was no pleiotropy. This MR study demonstrated that UC had a causal effect on heart failure and that there was no reverse causal effect.

Background: To evaluate the association between serum uric acid (SUA) levels and metabolic dysfunction-associated steatotic liver disease (MASLD), defined as excessive fat accumulation in the liver accompanied by at least one cardiometabolic risk factor, reflecting metabolic abnormalities associated with the condition, in a Chinese adult population.

Methods: This study included 3829 participants aged ≥ 18 years who underwent abdominal transient elastography and had complete SUA data. SUA was categorized into low, medium, and high tertiles. Hepatic steatosis was defined as a controlled attenuation parameter (CAP) ≥ 248 dB/m. MASLD diagnosis followed the latest definitions by relevant liver disease associations. Logistic regression analyzed the association between SUA and MASLD. Restricted cubic spline regression assessed non-linear relationships.

Results: A total of 1737 participants were diagnosed with MASLD. SUA levels were higher in the MASLD group (5.79 ± 1.50 mg/dL) than in the non-MASLD group (5.03 ± 1.35 mg/dL). SUA was linearly related to MASLD (P for nonlinearity = 0.8451). Both medium and high SUA groups had increased MASLD risk compared to the low SUA group (P < 0.05). Each unit increase in SUA was associated with a 14% higher risk of MASLD (odds ratio [OR] = 1.14, P = 0.0004).

Conclusions: This study highlights the association between SUA levels and MASLD, suggesting that SUA may serve as a potential biomarker for MASLD risk assessment. Monitoring SUA levels could inform preventive strategies and facilitate early intervention, contributing to improved MASLD management.

Background: Gastrointestinal bleeding is a significant cause of morbidity and mortality among emergency unit patients. Several scoring systems are verified for predicting hospitalization and mortality such as Glasgow Blatchford Bleeding Score (GBS), AIMS65 score, Rockall score (RS), and International Bleeding Risk Score (INBS; ABC score). The aim of this study is to evaluate the efficacy and predictive value of these scoring systems.

Methods: Adult emergency unit patients with gastrointestinal bleeding were retrospectively enrolled. The age, gender, complaints at admission, vitals and examination results, laboratory findings, outcomes, blood transfusion status, and endoscopic interventions were all reported, and GBS, AIMS65, RS, and INBS (ABC) scores were calculated individually for all enrollies.

Results: A total of 311 patients were included. The median age of participants was 70 years (IQR (25-75%): 59-81), and 202 (65%) of them were male. The efficacy of all four scoring systems (GBS, AIMS65, RS, and INBS (ABC)) in predicting hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality was found to be statistically significant (p < 0.05 for all). ROC-AUC analysis was revealed that while GBS is the most beneficial in predicting hospitalization, INBS (ABC) has the best predictive value on mortality. Besides, the only scoring model with predictive value in determining the need for endoscopic intervention was RS (p < 0.05).

Conclusion: The present study showed that, among adult emergency unit patients with gastrointestinal bleeding, GBS, AIMS65, RS, and INBS (ABC) scores could successfully predict hospitalization, need of blood transfusion, determination of high- and low-risk patients, and mortality. However, the only scoring system that could be used to determine the need of endoscopic intervention is RS. Finally, we believe further studies with prospective enrollment would be beneficial for more accurate conclusions.