BMC Gastroenterology最新文献

Background: Celiac disease (CD) affects the small intestine and can hinder nutrient absorption. It is found worldwide and common in certain groups of people including individuals with Type 1 Diabetes Mellitus (T1DM). However, the prevalence of CD in the West African region is not documented. This study aimed to investigate the prevalence and pattern of CD autoimmunity in Nigerian children and adolescents diagnosed with T1DM.

Methods: This was a cross-sectional descriptive study of children and adolescents with T1DM at the Paediatric Endocrinology Clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and anthropometrics. The subjects were screened for markers of CD autoimmunity using anti-tissue transglutaminase antibody (tTG) and anti-endomysial antibody (EMA). Endoscopy and duodenal biopsy were recommended for participants with elevated CD-specific antibodies.

Results: The study recruited a total of 104 children and adolescents with TIDM, out of which six participants (5.8%) had CD autoimmunity. All six participants were females, aged between 3 and 12 years, with a mean age of 9.2 ± 3.7 years. Participants with CD autoimmunity were more likely to have DM diagnosed before the age of 10 years compared to those without CD autoimmunity (83.3% vs. 37.7%, p = 0.149). Except for two participants, all individuals with CD autoimmunity experienced gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and bloating.

Conclusion: This study highlights the occurrence of CD autoimmunity in Nigerian children and adolescents with TIDM. Healthcare providers should consider screening for celiac disease in children and adolescents with T1DM, particularly in females and when gastrointestinal symptoms are present. Additionally, the findings from this study suggest that there is a high probability of a significant burden of CD, even within the general population in Nigeria. Therefore, it's important to maintain a high level of suspicion and to actively screen at-risk groups in clinical settings to ensure early diagnosis of CD.

Background: The serum albumin-to-serum creatinine ratio (sACR) is independently associated with the prognosis of multiple diseases. However, its relationship with in-hospital mortality of patients with severe acute pancreatitis (SAP) remains unclear.

Methods: Patients diagnosed with SAP between April 2016 and December 2023 were collected. These patients were categorized into low and high sACR groups based on an optimal cut-off value calculated using Youden's index. Multivariate logistic regression analysis was utilized to examine the relationship between sACR levels and the in-hospital mortality. Additionally, a limited restricted cubic spline (RCS) method was employed to evaluate the nonlinear relationship between sACR values and the risk of in-hospital mortality. The potential for unmeasured confounders between sACR levels and in-hospital mortality was also explored through the calculation of the E value.

Results: A total of 114 eligible patients were included in this sutdy. The multivariate logistic regression analysis indicated an independent association between sACR levels and in-hospital mortality (p < 0.001). The RCS analysis demonstrated a linear correlation between sACR values and the risk of in-hospital mortality (P for non-linearity > 0.05), where the risk increased as the sACR value decreased.

Conclusions: The research findings suggest that sACR levels are independently associated with in-hospital mortality of patients with SAP, providing a means for early identification of those at high risk of in-hospital mortality. This early identification may facilitate the optimizing and strengthening of treatments, ultimately leading to improved outcomes.

Background: Multiple studies have evaluated fecal microbiota transfer (FMT) in patients with ulcerative colitis (UC) using single-donor (SDN) and multidonor (MDN) products. Systematic review and meta-analysis were performed to compare the safety of SDN and MDN products.

Methods: Systematic searches were performed in Web of Science, Scopus, PubMed, and Orbit Intelligence to identify studies that compared FMT products manufactured using SDN or MDN strategies against control treatment in patients with UC. Fifteen controlled studies were selected for meta-analysis (11 randomized controlled trials and 4 controlled cohort trials). Safety of each treatment type was assessed using the counts of adverse events and serious adverse events using fixed- and random-effects models. Significance of the indirect difference between FMT preparations was assessed using a network approach. Benefit-risk ratios were calculated by multiplicative utility model, incorporating geometric mean of risk ratios (RRs) of efficacy and safety.

Results: Safety data was collected for a total of 587 patients (193 exposed to SDN products, 114 exposed to MDN products and 280 exposed to control treatment). The 12 studies showed similar overall safety event counts for MDN and SDN versus placebo (RRs: 0.90 and 1.09, respectively [P = 0.206 and P = 0.420, respectively]). Results indicated similar risk of safety events for MDN compared to SDN (RR: 0.83, P = 0.159). Positive benefit-risk ratios were demonstrated for MDN and SDN versus placebo (RRs: 1.70 and 1.16, respectively [P = 0.003 and P = 0.173, respectively]). MDN had a greater benefit-risk ratio compared to SDN (RR: 1.46, P = 0.072).

Conclusion: Similar safety profiles were observed for MDN and SDN strategies. Alongside previously described superior efficacy, treatment with MDN has greater benefit-risk ratio than SDN in patients with UC. Further development of MDN FMT treatment for UC should be considered.

Background: To analyze the clinical manifestations, endoscopic features, pathological features, endoscopic resection, and prognosis of esophageal granular cell tumors (GCTs).

Methods: The present study retrospectively analyzed and followed up the clinical data of 62 patients diagnosed with esophageal GCTs who underwent endoscopic resection at Zhongshan Hospital of Fudan University between July 2007 and March 2022. The clinicopathological features, endoscopic diagnosis, and treatment experience of esophageal GCT patients were summarized.

Results: Among the 62 patients with esophageal GCT, there were 34 males and 28 females, with an average age of 49.3 ± 11.7 years. Only 11 patients had symptoms, such as epigastric discomfort, regurgitation or dysphagia. One patient had multiple lesions, and the rest had single lesions, totaling 63 lesions. Most lesions (53/63) were located in the median and lower esophagus, the diameters ranged from 3 to 22 mm. The endoscopic morphology of the GCTs was molar, flat, hemispherical, or irregular submucosal protuberance. Endoscopic ultrasound (EUS) was performed in 38 cases, most cases (31/38) were hypoechoic, and 32 cases were appeared as homogeneous lesions. There were no complications during or after the endoscopic operations, and the en bloc resection rate was 100%. The negative rate of microscopic incisional margin was 63.5% (40/63). No patients developed recurrence during the follow-up period. The follow-up duration was 21-197 months (100.5 months for average).

Conclusion: Esophageal GCT is a rare disease with no obvious symptoms and a good prognosis. Endoscopic resection is a safe and effective method of diagnosis and treatment for esophageal GCTs. A microscopic positive tumor margin may not increase the rate of recurrence.

Background: Research indicates that prehabilitation is effective in optimizing physical status before surgery, although this method may be considered "aggressive" for frail elderly patients. This study aimed to evaluate whether multimodal prehabilitation decreases postoperative complications and improves functional recovery in frail elderly patients undergoing gastric cancer surgery, in comparison to usual clinical care.

Methods: This study was a single-center, single-blind, randomized controlled trial. Patients over 65 years old with a Fried Frailty Index of 2 or higher, scheduled for gastric cancer surgery, were considered for inclusion. Eligible participants were randomized in a 1:1 ratio to either the intervention or control group. The intervention group underwent a 3-week multimodal prehabilitation program prior to surgery, in addition to perioperative care guided by ERAS protocols. The control group received only the latter. The primary outcome was the comprehensive complications index (CCI) measured at 30 days after surgery. Secondary outcomes included 30-day overall complications, functional walking capacity as assessed by 6-minute walking distance (6MWD) at 4 weeks postoperatively, and 3-month postoperative quality of life. This study was registered at ClinicalTrials.gov (No. NCT06510088).

Results: Among the 112 eligible patients, the median age was 74 years, with 58 (52.7%) being female. No between-group difference was found in the primary outcome measure, 30-day CCI. The Median (Q1-Q3) CCI for the intervention and control groups was 0 (0-12.2) and 0 (0-22.6) (P = 0.082), while the mean (SD) CCI was 6.1 (15.8) and 9.8 (12.7), respectively (P = 0.291). Notably, the incidence of severe complications (CCI > 20) was significantly lower in the intervention group compared to the control group (11.1% vs. 25.9%, P = 0.046), particularly in terms of medical complications (12.3% vs. 29.3%, P = 0.025). Preoperatively, 27 patients (47.4%) in the intervention group exhibited an increase in the 6MWD of at least 20 m, compared to 16 patients (27.6%) in the control group (P = 0.028). At 4 weeks postoperatively, more patients in the intervention group returned to their baseline 6MWD levels (63.2% vs. 43.1%, P = 0.031). Secondary parameters of functional capacity in the postoperative period generally favored the multimodal prehabilitation approach.

Conclusions: In frail elderly patients undergoing elective gastric cancer surgery, a prehabilitation program did not affect the 30-day postoperative complication rate or CCI but reduced severe complications and improved perioperative functional capacity.

Trial registration: [ClinicalTrials.gov], [NCT06510088], [07/15/2024], [Retrospectively registered].

Background & aims: Sarcopenia is common in patients with liver disease and both sarcopenia and short telomeres are associated with mortality, however their relationship in patients with liver disease remains unknown.

Methods: A cohort of 16,072 adults from the National Health and Nutrition Examination Survey from 1999 to 2006 was analyzed. Liver disease was defined by aminotransferases and classified into etiology-based categories. Sarcopenia was defined by dual-energy x-ray absorptiometry. All analyses were conducted separately on each multiple imputation data set and combined via Rubin's rules. P-values for group comparisons were calculated by testing logistic regression parameter estimates. Cox proportional hazards regression was used for mortality analysis with mortality data available until 2015.

Results: Sarcopenia was present in 9.5% of patients with liver disease. Age, race, income, education, physical inactivity, and certain medical comorbidities were associated with sarcopenia. Patients with liver disease and sarcopenia had significantly shorter telomeres than patients with liver disease without sarcopenia when unadjusted for age. The interaction between telomere length and sarcopenia was significantly associated with all-cause mortality.

Conclusions: The implications of telomere length on all-cause mortality in patients with liver disease varied by age and sarcopenia status. Shorter telomeres appear to be more highly associated with increased mortality in older patients without sarcopenia.