BMJ Open Gastroenterology最新文献

Objective: Colorectal cancer (CRC) screening programmes have been implemented worldwide, but the evidence of the economic consequences of screening programmes relies on data from short-term trials. The aim of this paper was to describe the costs of CRC screening in a population-based screening programme, using administrative real-world data. Specifically, we aimed to estimate the annual costs of the screening programme and the total costs of the full programme over five consecutive screening rounds.

Methods: The CRC screening programme of Stockholm-Gotland, Sweden, targeted all resident men and women aged 60-69 years for biennial screening. The screening strategy was faecal occult blood testing (FOBT) sent to individuals' home addresses, with a positive test result leading to an invitation to diagnostic colonoscopy. The cost description was conducted with a retrospective, bottom-up costing design from a healthcare perspective using (1) a prevalence-based approach and (2) an incidence-based approach, with two different study samples.

Results: Annual healthcare costs were estimated using a sample of 124 608 individuals who were affected by the screening programme in 2017. Annual healthcare costs of the screening programme summed up to €273 758 per 10 000 people, equivalent to €27.4 per eligible individual. The sum of costs for colonoscopy procedures was more than two times as high as the costs for FOBT. The costs of the full screening programme were estimated using a cohort of 92 689 individuals who were invited to five consecutive rounds of screening between 2009 and 2021. Total healthcare costs over five screening rounds were €960 654 per 10 000 people, equivalent to €96.1 per individual.

Conclusion: The costs of diagnostic colonoscopies for a minority of participants were driving the costs of the CRC screening programme. The ongoing population-based screening programme and high-quality individual level data with long-term follow-up provide the opportunity to thoroughly describe the costs of CRC screening.

Introduction: Acute and chronic pancreatitis (CP) are inflammatory conditions of the pancreas that cause local and systemic complications. The epidemiology of these conditions are not well-known in India.

Methods and analysis: We describe the protocol and procedures of a multicentre study for delineating the epidemiology of pancreatitis in India. We plan to cover 110 000 people across 10 geographically distributed sites in 10 states of India to estimate the burden and risk factors of CP. Trained investigators will make house visits and screen for abdominal pain requiring hospitalisation or pre-diagnosed CP. The screened positive participants will be reviewed by a gastroenterologist to confirm the diagnosis of CP based on radiological imaging. For each case, four controls will be selected and data on risk factors for CP (tobacco, alcohol, family history, metabolic causes) and blood for genetic markers will be collected. Information on the cost of treatment and quality of life will be collected from patients with CP. For estimating incidence of acute pancreatitis (AP), hospital-based sentinel surveillance will be conducted in 10 districts across these 10 states. All hospitals in the district will be contacted to provide a line list of admissions due to acute abdomen including AP for 2 years. The spread of acute abdomen cases will be used to define the catchment area and estimate the denominator population. The line-listed cases with AP living in the catchment area will form the numerator to calculate the incidence. The study will provide critical information for planning pancreatitis-related services in the country.

Ethics and dissemination: The institutional ethics committee (IECs) at all the participating sites have given their approval for the study. All the participants whose data will be collected will be included after written informed consent. The results may be presented at national or international conferences and will be reported in peer-reviewed publications.

Objective: Reflux oesophagitis (RO) is one of the most common diseases encountered by gastroenterologists and primary care physicians. However, few epidemiological studies have investigated the association of medication use and RO. This study aimed to investigate the prevalence of RO and its risk factors, particularly with respect to medication use.

Methods: This retrospective, cross-sectional study included consecutive patients who underwent oesophagogastroduodenoscopy (OGD) and were assessed using questionnaires at the National Center for Global Health and Medicine (Shinjuku, Tokyo, Japan) between October 2015 and December 2021. The questionnaire collected data on patient characteristics, medical history, smoking and alcohol consumption, and medications that patients were taking at the time of OGD.

Results: Among the 13 993 eligible patients, the prevalence of RO was 11.8%. Multivariate logistic regression analysis indicated that male sex (OR=1.52 (95% CI 1.35 to 1.72), p<0.001); obesity (OR=1.57 (95% CI 1.40 to 1.77), p<0.001); smoking (OR=1.19 (95% CI 1.02 to 1.38), p=0.026); alcohol consumption (OR=1.20 (95% CI 1.07 to 1.35), p=0.002); diabetes (OR=1.19 (95% CI 1.02 to 1.39), p=0.029); hiatal hernia (OR=3.10 (95% CI 2.78 to 3.46), p<0.001); absence of severe gastric atrophy (OR=2.14 (95% CI 0.39 to 0.56), p<0.001); and the use of calcium channel blockers (CCBs) (OR=1.22 (95% CI 1.06 to 1.40), p=0.007), theophylline (OR=2.13 (95% CI 1.27 to 3.56), p=0.004), and non-steroidal anti-inflammatory drugs (NSAIDs) (OR=1.29 (95% CI 1.03 to 1.61), p=0.026) were independent predictors of RO.

Conclusion: RO was present in 11.8% of patients. Use of CCBs, theophylline, and NSAIDs were independent predictors of RO.

Objectives: This study aimed to evaluate the real-world effectiveness of tofacitinib for treating moderate-to-severe ulcerative colitis (UC).

Design: Systematic review and meta-analysis.

Data sources: PubMed, EMBASE and Cochrane CENTRAL databases were searched from inception up to 18 July 2023. Reference lists of included studies were manually searched to identify potentially relevant studies not found in the databases.

Eligibility criteria: Eligible studies included real-world observational studies, reported in English, on patients with moderate-to-severe UC treated with tofacitinib, defined by the Partial Mayo Score. Excluded were clinical trials, reviews, letters, conference abstracts, case reports and studies involving patients with mixed Crohn's disease.

Data extraction and synthesis: Two independent reviewers extracted data and recorded it in Excel. Quality assessment was performed using the Newcastle-Ottawa scale. Meta-analysis was performed using random-effects models due to high heterogeneity across studies.

Results: 19 studies containing a total of 2612 patients were included. Meta-analysis revealed that clinical response rates were 58% at week 8, 61% at weeks 12-16, 51% at weeks 24-26 and 51% at week 52. Clinical remission rates were 39% at week 8, 43% at weeks 12-16, 40% at weeks 24-26 and 43% at week 52. Corticosteroid-free clinical remission rates were 33% at week 8, 37% at weeks 12-16, 32% at weeks 24-26 and 40% at week 52.

Conclusion: This meta-analysis of real-world studies indicates that treatment of UC with tofacitinib is associated with favourable clinical response and remission rates in the induction and maintenance phases.

Introduction: The evolving landscape of inflammatory bowel disease (IBD) necessitates refining colonoscopic surveillance guidelines. This study outlines methodology adopted by the British Society of Gastroenterology (BSG) Guideline Development Group (GDG) for updating IBD colorectal surveillance guidelines.

Methods and analysis: The 'Grading of Recommendations, Assessment, Development and Evaluation' (GRADE) approach, as outlined in the GRADE handbook, was employed. Thematic questions were formulated using either the 'patient, intervention, comparison and outcome' format or the 'current state of knowledge, area of interest, potential impact and suggestions from experts in the field' format. The evidence review process included systematic reviews assessed using appropriate appraisal tools. An extensive list of potential outcomes was compiled from literature and expert consultations and then ranked by GDG members. The top outcomes were identified for evidence synthesis in three key areas: utility of surveillance in IBD, quality of bowel preparation and use of advanced imaging techniques in colonoscopy for IBD. Risk thresholding exercises determined specific risk levels for different surveillance strategies and intervals. This approach enabled the GDG to establish precise thresholds for interventions based on relative and absolute risk assessments, directly informing the stratification of surveillance recommendations. Significance of effect sizes (small, moderate, large) will guide the final GRADE assessment of the evidence.

Ethics and dissemination: Ethics approval is not applicable. By integrating clinical expertise, patient experiences and innovative methodologies like risk thresholding, we aim to deliver actionable recommendations for IBD colorectal surveillance. This protocol, complementing the main guidelines, offers GDGs, clinical trialists and practitioners a framework to inform future research and enhance patient care and outcomes.

Objective: Glucose metabolism status (GMS) is linked to non-alcoholic fatty liver disease (NAFLD). Higher levels of advanced glycation end products (AGEs) are observed in people with type 2 diabetes mellitus (T2DM) and NAFLD. We examined the association between GMS, non-invasive tests and AGEs, with liver steatosis and fibrosis.

Methods: Data from The Maastricht Study, a population-based cohort, were analysed. Participants with alcohol overconsumption or missing data were excluded. GMS was determined via an oral glucose tolerance test. AGEs, measured by skin autofluorescence (SAF), were assessed using an AGE Reader. Associations of GMS and SAF with the fibrosis-4 score (FIB-4), Forns index (FI) and fatty liver index (FLI) were investigated using multivariable linear regression, adjusted for sociodemographic, lifestyle and clinical variables.

Results: 1955 participants (56.6%) were analysed: 598 (30.6%) had T2DM, 264 (13.5%) had pre-diabetes and 1069 (54.7%) had normal glucose metabolism. Pre-diabetes was significantly associated with FLI (standardised regression coefficient (Stβ) 0.396, 95% CI 0.323 to 0.471) and FI (Stβ 0.145, 95% CI 0.059 to 0.232) but not FIB-4. T2DM was significantly associated with FLI (Stβ 0.623, 95% CI 0.552 to 0.694) and FI (Stβ 0.307, 95% CI 0.226 to 0.388) but not FIB-4. SAF was significantly associated with FLI (Stβ 0.083, 95% CI 0.036 to 0.129), FI (Stβ 0.106, 95% CI 0.069 to 0.143) and FIB-4 (Stβ 0.087, 95% CI 0.037 to 0.137).

Conclusion: The study showed that adverse GMS and higher glycaemia are positively associated with steatosis. FI, but not FIB-4, was related to adverse GMS concerning fibrosis. This study is the first to demonstrate that SAF is positively associated with steatosis and fibrosis.

Objective: Previous studies have shown that the incidence of peptic ulcer disease (PUD) exhibits seasonal variations. This study aimed to investigate the seasonal variation in PUD incidence in Taiwan, which spans both tropical and subtropical regions, using a nationwide database.

Methods: A cross-sectional study was conducted using real-world claims data from Taiwan, which includes a representative sample of 2 million individuals. Patients hospitalised with a primary diagnosis of PUD between 2001 and 2019 were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes for gastric ulcers (GUs), duodenal ulcers (DUs) and unspecified peptic ulcers. Descriptive statistics were used to present the seasonal variations in PUD incidence. Patients' gender, age, PUD type, geographical region and non-steroidal anti-inflammatory drugs (NSAIDs) usage across the four seasons (spring, summer, fall, winter) were compared using Pearson's χ² test.

Results: Among the 13 022 patients, new-onset PUD cases varied annually, peaking at 771 cases in 2004 and reaching a low of 614 cases in 2018. PUD incidence was higher in males than in females, and more common in elderly individuals aged ≥65 (59.5%). GU had the highest prevalence (56.1%), followed by DU (36.3%) and unspecified ulcers (7.7%). PUD incidence peaked in winter (26.8%), followed by spring (25.1%), fall (24.2%) and summer (23.9%). This seasonal trend was consistent across gender and age groups, with no significant impact on latitude, NSAID usage or PUD type.

Conclusion: Across the tropical and subtropical regions of Taiwan, seasonal variation in PUD incidence is observed with the highest rates occurring in winter, regardless of age or sex. However, NSAID usage tends to obscure this trend. The seasonal variation in DU incidence showed no significant differences between north and south Taiwan, suggesting that factors other than temperature may affect DU incidence compared with their effect on GU incidence.

Objectives: Acute severe ulcerative colitis (ASUC) poses challenges to patient management owing to its high surgical rate. This study aimed to identify predictors of colectomy in patients with ASUC.

Design: This is a systematic review and meta-analysis.

Data sources: PubMed and Web of Science were searched up to April 2024.

Eligibility criteria: Studies on the predictors of colectomy in adult patients with ASUC were eligible.

Data extraction and synthesis: Two reviewers independently extracted the data using a prespecified data collection sheet. A qualitative synthesis was performed in tabular form. Random-effect meta-analyses were conducted using OR and 95% CI.

Results: Forty-two studies were included in the systematic review. The reported variables can be categorised into biomarkers, auxiliary examination findings, demographic and clinical characteristics, and drug factors. Through meta-analysis, albumin (OR 0.39 (95% CI 0.26 to 0.59) per 1 g/dL increment, I²=0.0%), high C reactive protein level (2.63 (1.53 to 4.52), I²=29.6%), high erythrocyte sedimentation rate level (2.92 (1.39 to 6.14), I²=0.0%), low haemoglobin level (2.08 (1.07 to 4.07), I²=56.4%), fulfilling the Oxford criteria (4.42 (2.85 to 6.84), I²=0.0%), extensive colitis (1.85 (1.24 to 2.78), I²=47.5%), previous steroids (1.75 (1.23 to 2.50), I²=17.7%) or azathioprine (2.25 (1.28 to 3.96), I²=0.0%) use, and sarcopenia (1.90 (1.04 to 3.45), I²=0.0%) were identified as valuable predictors for colectomy within 1 year. The ulcerative colitis endoscopic index of severity (OR 2.41 (95% CI 1.72 to 3.39), I²=1.5%) was the only predictor found to predict colectomy over 1 year.

Conclusion: Identification of these predictors may facilitate risk stratification of patients with ASUC, drive personalised treatment and reduce the need for colectomy.

Objective: Liver disease is a growing cause of premature death in the UK. The National Health Service in England (NHS England) has funded regional early detection programmes through Community Liver Health Check pilots. 'Alright My Liver?' is Bristol and Severn's pilot service offering early detection of liver disease through screening events serving populations at risk, including people with a history of drug or alcohol use, type 2 diabetes and obesity. The service offers point-of-care testing for liver disease and a supported follow-up process.

Methods: Semistructured interviews were conducted with 14 service users and six service providers over a 6-month period using diversity sampling. Topic guides encouraged discussion of experiences of the service as well as barriers and facilitators to accessing the service. Data were analysed using thematic analysis, and positive and negative comments pertaining to the service were collated in a 'table of changes' to inform optimisation.

Results: Three main themes were identified: (1) motivations for engagement, (2) experience of the service and (3) health impacts. Key motivations for engagement were screening as a novel opportunity, a response to immediate health concerns or as reassurance. Service users commented on its convenience and that staff interactions were warm and informative. Some felt that follow-up could be more intensive. Impacts varied depending on perceived risk factors and screening results but generally involved stating a commitment to healthy lifestyle changes, including reducing alcohol use.

Conclusion: Targeted screening for liver disease in high-risk groups through this pilot service was deemed an appropriate and accessible intervention, with important optimisations identified.

Introduction: Pancreatic portal hypertension (PPH) is a rare complication of acute pancreatitis (AP) that can lead to severe gastrointestinal bleeding. The risk factors associated with PPH, as well as the overall prognosis, warrant further investigation. This study aims to develop and validate a nomogram to predict PPH in patients with AP.

Methods: Consecutive patients with AP from 2015 to 2023 were retrospectively included in the study. Demographic data, clinical manifestations within the first week of AP onset, and initial contrast-enhanced CT findings were used to develop the predictive model. Univariate and multivariate Cox regression analyses were performed to identify risk factors for PPH. Based on the results of the multivariate analysis, a nomogram was developed. The patients were randomly divided into training and validation sets at a 7:3 ratio. The accuracy and discriminative power of the predictive model were assessed using the area under the curve (AUC) from the receiver operating characteristic curve and the calibration curve.

Results: Of the 1473 patients with AP, 107 (7.3%) developed PPH within 6 months (range: 2-22 months) during follow-up. Multivariate regression analysis showed that body mass index (BMI) (HR, 1.10; 95% CI 1.04 to 1.16; p=0.001), moderately severe grade (HR, 9.36; 95% CI 4.58 to 19.13; p<0.001), severe grade (HR, 12.95; 95% CI 6.22 to 26.94; p<0.001), diabetes (HR, 2.26; 95% CI 1.47 to 3.47; p<0.001), acute fluid accumulation (HR, 2.13; 95% CI 1.31 to 3.47; p=0.002), and necrosis (HR, 3.64; 95% CI 2.30 to 5.78; p<0.001) were independent risk factors for PPH. A nomogram for predicting PPH was developed, with the predictive curves showing an AUC of 0.859 at 6 months and 0.846 at 9 months. In the validation set, the AUC at both time points was 0.812.

Conclusion: In summary, we identified BMI, moderately severe or severe AP, diabetes, acute fluid accumulation, and necrosis as risk factors for AP-related PPH. Using the largest cohort of patients with AP to date, we developed a highly accurate nomogram with strong discriminative ability for predicting PPH. Future studies with larger sample sizes are necessary to confirm our findings and conduct external validation.