Journal of gastrointestinal and liver diseases : JGLD最新文献

Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) with the prevalence of around 25% is the most prevailing cause of chronic liver disease. In this study, we aimed to investigate the association of the rs16928751 or +795 G>A variant in adiponectin receptor 2 gene (ADIPOR2) with MASLD.

Methods: Genomic DNA was isolated from the whole blood of 130 patients with biopsy-confirmed MASLD, and 130 controls according to the phenol-chloroform extraction and ethanol precipitation approach. Then the polymorphic marker of +795 G>A was genotyped by using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).

Results: The +795 G>A variant met the Hardy-Weinberg equilibrium (p > 0.05) in both control and patient groups; hence, the samples had good population representativeness. The genotype count of ADIPOR2 gene +795 G>A differed significantly between these two groups. The +795 G>A "AA" genotype in comparison to the "GG" was more frequent in the patients with MASLD (p=0. 037; OR=2.24, 95%CI: 1.20-6.47).

Conclusions: To our knowledge, this study is the first one that found a significant association between the +795 G>A variant of the ADIPOR2 gene and biopsy-confirmed MASLD; nonetheless, it needs to be corroborated by further research in different populations.

Background and aims: Acute pancreatitis (AP) presents with variable severity, and early identification of patients at risk for poor outcomes remains challenging. Red cell distribution width (RDW) is a widely available marker with potential prognostic value.

Methods: We analyzed 682 patients from the RO-API/BUC-API registry admitted with AP between 2015 and 2023. RDW measured at 24±6 hours post-admission was assessed for associations with severity (per Revised Atlanta Classification) and in-hospital mortality. ROC analysis and logistic regression were applied.

Results: Median RDW was significantly higher in non-survivors and patients with severe disease. RDW ≥13.85% predicted mortality [area under the curve (AUC)=0.67], and ≥14.35% predicted severe AP (AUC=0.67). RDW remained an independent predictor after adjusting for potential confounders.

Conclusions: RDW at 24 hours could be a useful early biomarker for predicting severity and mortality in AP.

Background and aims: Viral hepatitis C remains one of the leading causes of virus-related morbidity and mortality worldwide, being the main etiological cause of cirrhosis and hepatocarcinoma which transforms it into a global health problem. It investigated the prevalence and risk factors for hepatitis C virus (HCV) infection in Romania.

Methods: This prospective study was conducted between 2021 and 2023 by an extensive national Romanian screening program LIVE(RO)2 of 320,000 participants, most of whom being a part of deemed vulnerable populations. All participants agreed to an informed written consent and potential risk factors for HCV transmission were investigated by questionnaire.

Results: Out of the 320,000 screened individuals, 3,859 were infected with HCV meaning 1.21% prevalence (95%CI: 1.17-1.24). HCV-infected individuals were meanly aged at 65.8 ± 12.93 years, significantly higher as compared to non-infected participants (54.03 ± 16.41 years, p<0.0001). The main risk factors associated with HCV chronic infection included male gender, being aged between 30-49 or 60-69 years old, low level of education, being unvaccinated, unemployed, not married, with personal history of blood or blood products transfusion, hemodialysis, surgical interventions, tattooing, being in contact with family members with hepatitis, with hospitalizations, imprisoned, and performing unprotected sexual contacts or with partners diagnosed with sexually transmitted infectious diseases.

Conclusions: The prevalence of HCV infection in Romania is 1.21%. Additional to providing supplemental healthcare support to vulnerable populations, the current study contributes in Romania's national HCV elimination objectives.

Background and aims: Differential diagnosis between irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) represents a major challenge in modern gastroenterology due to overlapping symptoms, limitations of traditional diagnostic methods, and the complexity of their pathophysiology. This review examines the application of artificial intelligence (AI) and machine learning (ML) methods to improve accuracy and efficiency in the differential diagnosis between IBS and IBD.

Methods: The review encompasses seven recent studies employing various AI/ML techniques, utilizing clinical, genetic, microbiomic, and imaging data.

Results: AI-based models exhibit high sensitivity and specificity, with remarkable performance by algorithms such as logistic regression, random forest, neural networks, and support vector machines. Highlighted biomarkers include long non-coding RNA molecules, DNA methylation profiles, and diverse compounds from gut microbiota.

Conclusions: Although AI/ML methods show significant potential for distinguishing IBS from IBD, existing studies present limitations, including small sample sizes, data heterogeneity, and generalizability challenges. The development of standardized protocols and extensive multicenter studies is recommended to clinically validate these models, facilitating their integration into current medical practice.

Esophagojejunal (EJ) anastomoses are integral to gastrointestinal reconstructive surgeries following procedures such as gastrectomy, particularly in cases of cancer or Roux-en-Y reconstruction. However, the traditional surgical EJ anastomosis approach can pose challenges with notable risks such as anastomotic leakage, stricture, or fistula formation. Endoscopic interventions have been employed for managing these adverse outcomes through stent placement, but a primarily endoscopic EJ anastomosis technique has not yet been described. This retrospective case series details five patients who underwent delayed endoscopic EJ anastomosis, with each patient under differing circumstances of instability necessitating this emergent alternative to standard surgical reconstruction. This approach involved the placement of a lumen-apposing metal stent between the esophagus and jejunum. Successful endoscopic EJ anastomosis was achieved in all cases, with hospital stays ranging from 6-13 days. Adverse events included stent migration, dysphagia, and stricture. Subsequent management strategies for these adverse events included stent removal and exchange, balloon dilation, triamcinolone injection, and appropriate follow-up. Follow-up evaluations revealed successful outcomes with no mortalities or anastomotic leaks. Primarily endoscopic EJ anastomosis for delayed reconstruction emerges as an advanced, minimally invasive alternative in complex patients deemed unsuitable for conventional surgical reconstruction secondary to instability or critical conditions. Within the literature, this is the first human case series description of an endoscopic EJ anastomosis with stent placement between the esophagus and jejunum. This novel technique offers the potential in improving patient outcomes which warrants further investigation to optimize these endoscopic techniques and assess its long-term efficacy across a larger patient cohort.

Background and aims: Small bowel neuroendocrine neoplasms (SB-NENs) are a rare type of tumor that is clinically challenging and is often diagnosed in advanced stages. This retrospective study aimed to characterize the clinical presentation, diagnostic workup, and therapeutic strategies, as well as to evaluate the prognosis of patients managed in a tertiary care center in Bucharest, Romania, over five years.

Methods: We conducted an observational, retrospective cohort study on 42 cases of SB-NEN evaluated at our center between January 1, 2020, and March 31, 2025. Data regarding clinicopathological characteristics, treatments, and disease evolution were summarized. Overall survival was estimated at 1, 3, and 5 years.

Results: Computed tomography was the most frequently used imaging method for diagnosis (52.4%). Surgery was the most adopted method for obtaining the pathological specimen, used in 70.7% of cases. The majority of tumors were well-differentiated (85.6%). The overall survival distribution showed a median survival time of 94 months. The cumulative proportion of patients surviving at 1 year was 97.6%, at 3 years was 89.3% and at 5 years was 75.7%. There was a significant difference in overall survival stratified by tumor grading (p=0.006), indicating that this was a significant prognostic factor; the metastatic status and large tumors showed a trend toward statistical significance, but they did not meet the conventional threshold (p=0.068 and 0.103, respectively).

Conclusions: SB-NEN showed favorable outcomes, with surgery improving survival even in some metastatic cases. Lower tumor grade was associated with a better prognosis, while somatostatin analogues (SSA) therapy showed no survival benefit. Patients with large tumors and metastatic disease also showed a trend towards reduced survival.