Journal of gastrointestinal and liver diseases : JGLD最新文献

Background and aims: Despite the reduction of the gender gap in medicine, uneven gender distribution has remained in several medical fields, including gastroenterology. We aimed to evaluate differences in clinical and academic training between male and female gastroenterologists.

Methods: We distributed a web-based survey to physicians who have completed their training and are currently working in the field of gastroenterology in five Balkan countries: Serbia, Republic of North Macedonia, Montenegro, Greece and Romania.

Results: The questionnaire was sent to 1220 physicians. A total of 229 questionnaires were filled out and 214 were included in the analysis. The overall response rate was 18.8%. Almost half of respondents were women (n=97, 45.3%). The proportion of male physicians having children was higher compared to females, which was of statistical significance (88.0% vs. 64.9%, p<0.05). Women have in general reported beginning endoscopic training as well as mastering endoscopic procedures later in clinical training, when compared to males. On average, males reported higher median time in performing endoscopies per week, as well as higher grades in self-assessment scales in colonoscopy performance.

Conclusions: Gender inequity exists during the gastroenterology clinical training. Women are especially vulnerable during the training period because training years coincide with the expected childbearing age and are therefore less likely to have children compared to their male colleagues.

Background and aims: Non-selective beta-blockers are widely used for the management of portal hypertension and prevention of variceal bleeding in patients with liver cirrhosis. While studies have demonstrated carvedilol's superiority in reducing portal pressure compared to propranolol, limited real-world data directly compare their efficacy in preventing decompensation.

Methods: We conducted a retrospective cohort study using the TriNetX database on patients from several healthcare organizations in the US Collaborative Network. Cohorts were defined as adult patients with compensated cirrhosis who were prescribed either carvedilol or propranolol. Propensity score matching was applied to balance demographic, clinical, and laboratory characteristics. The first decompensation event, all-cause hospitalization, and all-cause mortality were defined as outcomes.

Results: After matching, each cohort included 12,890 patients. The mean age was 59.6 years. Comorbidities and laboratory findings were well-balanced between the two groups. Patients receiving carvedilol had a significantly lower risk of developing new decompensating events within five years, including ascites, variceal bleeding, hepatic encephalopathy, and hepatorenal syndrome. Spontaneous bacterial peritonitis was not significantly different between the groups. Post-matching analysis showed marginally reduced all-cause mortality in the carvedilol group at five years.

Conclusions: In this real-world study, carvedilol demonstrated superior efficacy compared with propranolol in reducing key decompensatory events in patients with compensated cirrhosis, likely due to its enhanced ability to lower portal pressure. However, the mortality benefit probably requires further studies to unfold.

Chemoresistance is a major obstacle in the treatment of gastric cancer and can contribute to poor treatment and prognosis in GC patients. Autophagy is a highly conserved degradation process, and its dysregulation is closely associated with various diseases. More and more people have realized the dual role of autophagy in the treatment resistance of GC. The activation of autophagy can enhance the chemotherapy sensitivity of GC cells, but in some cases, it increases the chemoresistance. The regulation of autophagy on GC drug resistance is reflected by its impact on cell apoptosis and metastasis. Multiple factors are involved in the regulation of autophagy in GC, among which, non-coding RNAs are one of the important regulatory factors. Natural or synthetic compounds targeting autophagy can help improve the sensitivity of GC cells to chemotherapy. The combined application of nanomaterials and autophagy regulators has shown great potential in the preclinical treatment of GC. This review summarizes the recent research about the molecular mechanisms of targeted autophagy therapy for drug resistance, the role of autophagy modulators in the treatment of GC, and the potential of developing small-molecule modulators and natural compounds as autophagy modulators for the treatment of GC.

End-stage liver disease is linked to cardiovascular complications that can manifest as hyperdynamic circulation and may progress to overt heart failure in the context of cirrhotic cardiomyopathy (CCM). The incidence of CCM is significantly elevated among individuals with cirrhosis. However, due to the absence of overt symptoms at rest and the preservation of left ventricular systolic function, the diagnosis is frequently overlooked. The severity of CCM correlates directly with the degree of liver disease and is associated with poorer prognostic outcomes in both pre- and post-transplantation. Diagnosis is important because CCM is a major contributor to perioperative cardiovascular complications (including pulmonary edema and death) after liver transplant. These complications arise from the rapid escalation of systemic vascular resistance, which unmasks the subclinical left ventricular systolic dysfunction. Another clinical context in which CCM becomes evident is following transjugular intrahepatic portosystemic shunt placement. The abrupt increase in preload from blood redistribution can precipitate cardiac decompensation. The purpose of this review is to increase clinical recognition of this specific phenotype of heart failure with preserved ejection fraction. It aims to synthetize the pathophysiological mechanisms, definition, and diagnostic of CCM, also to highlight its clinical significance in the cirrhotic population and explore the possible therapeutic options. A literature review was performed using Pubmed and focused on the relevant and recent articles and trials concerning CCM. Based on literature data and on institutional experience, we propose an algorithm for cardiac assessment in cirrhosis to improve CCM diagnosis and ensure better outcomes.

Background and aims: Patients with autoimmune pancreatitis (AIP) sometimes show characteristic ophthalmologic findings, such as dacryoadenitis and dry eye. However, the ocular findings in AIP patients thus far have not fully been analyzed, especially in patients treated long term with corticosteroids (CS). We aimed to study the current and previous history of ocular diseases in AIP patients and changes of the common ophthalmologic findings during the CS treatment.

Methods: We retrospectively analyzed the history of ophthalmologic diseases in 105 AIP patients and further examined the changes in the ophthalmologic findings and associated factors occurring during CS treatment in 63 patients.

Results: Several common ophthalmic diseases, including cataract (33.3%) and glaucoma (6.3%), were recognized in approximately one-third of the AIP patients at their initial diagnosis. Behcet uveitis was seen in the past histories of two AIP patients. During 70 months of CS treatment, exacerbation of cataract was recognized in 31.7%, and new onset of glaucoma in 7.9%. Univariate and multivariate analyses demonstrated the cumulative CS amount as a significant risk of cataract exacerbation (p<0.05) and diffuse pancreatic swelling at the initial diagnosis as a risk of Mikulicz's disease (p<0.01).

Conclusions: An ophthalmologic check at the initial diagnosis and monitoring during CS treatment is required for patients with AIP. Promising steroid-sparing agents are expected to lessen the adverse ophthalmologic events caused by CS.

Aim: This study evaluates the diagnostic performance of the novel blood-based device, LIVERFASt to detect fibrosis stages in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), including those with type 2 diabetes (T2DM), compared to FIB-4 in a subgroup analysis.

Methods: LIVERFASt is computed with 10 blood biomarkers and four anthropometric measures and provides a quantitative score (0.00-1.00) to stage cirrhosis (F4), advanced fibrosis (≥F3), and clinically significant fibrosis (≥F2). Three cohorts of patients (two retrospective and one prospective) from tertiary centers in Europe and the U.S. with histological-proven biopsy were used to assess LIVERFASt and FIB-4 diagnostic performance using area under the receiver operating curve (AUROC), sensitivity (Sn), specificity, and predictive values (PV) for varying fibrosis prevalence levels.

Results: 497 MASLD adult patients were included (median age 56 years, 56.7% female, 50.3% T2DM, 44.1% advanced fibrosis, and 20.1% cirrhosis). In the pooled analysis, the AUROCs for fibrosis stages F4, ≥F3, and ≥F2 were: 0.868, 0.846, 0.748, as well as for the T2DM subgroup (n=250): 0.846, 0.798, 0.736, respectively. For 35% advanced fibrosis prevalence, the positive/negative PVs were 77.2%/81.3% for the overall cohort and 65.52%/79.81% for the subgroup with tT2DM, respectively. At high (90%) to low (1%) advanced fibrosis prevalences, the positive and negative PVs ranged from 93% to 4.28% and from 43.06% to 99.73%, respectively. For F4 and ≥F3 fibrosis stages, LIVERFASt outperformed FIB-4: AUROC 0.870 vs 0.851 and 0.874 vs 0.821 (p<0.01), with Sn 74.07 vs 48.15 and 65.54 vs 37.29, respectively.

Conclusions: LIVERFASt is a highly sensitive and clinically useful diagnostic test for staging fibrosis in MASLD patients, including those with T2DM and has a higher Sn for detecting advanced fibrosis when compared with FIB-4.