Minerva gastroenterology最新文献

Coeliac disease (CD) is a chronic, immune-mediated enteropathy triggered by gluten ingestion in genetically predisposed individuals carrying HLA-DQ2 and/or -DQ8 alleles. Its diagnosis traditionally combines serology and confirmatory duodenal biopsy. IgA anti-tissue transglutaminase is the first-line test, supported by endomysial antibody. Duodenal histology remains the gold standard, though limitations include patchy involvement and variability in interpretation. Recent advances have proposed biopsy-sparing approaches, whereas applicability in adults remains debated. Moreover, CD is increasingly recognized in association with autoimmune conditions, including type 1 diabetes mellitus and autoimmune thyroid disease, underscoring the importance of proactive screening. However, distinguishing true CD from potential CD or false-positive serology requires careful clinical integration and, often, biopsy confirmation. Mass screening appears to demonstrate high yield and potential cost-effectiveness compared with case-finding. However, evidence is emerging and not yet definitive, and its implementation remains limited. For patients already on a gluten-free diet, gluten challenge protocols combined with HLA genotyping enhance diagnostic accuracy. Overall, while duodenal biopsy is still pivotal in most guidelines, evolving evidence supports a tailored, less invasive approach that integrates serology, genetics, histology, and novel diagnostics to improve early detection and management of CD.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a condition that can progress to cirrhosis and hepatocellular carcinoma. Non-invasive techniques are increasingly used to assess hepatic steatosis. This study aimed to evaluate the accuracy of the Quantification Attenuation Index (QAI) and define diagnostic cut-offs by comparing QAI to liver biopsy and controlled attenuation parameter (CAP).

Methods: This prospective study included adults with chronic liver disease undergoing B-mode ultrasound, QAI, and vibration-controlled transient elastography with CAP. Liver biopsy, performed when indicated, served as gold standard. Diagnostic performance was assessed by ROC analysis; agreement between QAI and CAP was assessed using Cohen's kappa.

Results: A total of 209 patients were included (median age 62 years; 57.4% male). MASLD was diagnosed in 63 patients, who showed significantly higher CAP (288 dB/m) and QAI (0.88 dB/cm/MHz) compared to other liver diseases (CAP 235 dB/m; QAI 0.70 dB/cm/MHz; P<0.001). Steatosis was histologically confirmed in 22/40 biopsied patients. ROC analysis using biopsy as reference identified a QAI cut-off of 0.67 dB/cm/MHz for distinguishing absence of steatosis (S0) from any degree of steatosis (≥S1) (AUROC 0.683; sensitivity 63%, specificity 73%) and a cut-off of 0.81 dB/cm/MHz for discriminating severe steatosis (S3) from lower grades (≤S2) (AUROC 0.925; sensitivity 100%, specificity 87%). The overall agreement between QAI and CAP was substantial (κ=0.767 and κ=0.734; P<0.001). QAI correlated better with biopsy (r=0.719, P<0.001) than CAP (r=0.540, P<0.001).

Conclusions: QAI is a reliable, non-invasive method for assessing hepatic steatosis, with good agreement with histology and with CAP.

Background: Non-alcoholic fatty liver disease (NAFLD), which has recently been renamed metabolic dysfunction-associated fatty liver disease (MAFLD) or metabolic dysfunction-associated steatotic liver disease (MASLD), is the most common chronic liver disease globally, including in the Arab world. This study investigates the research output and impact of NAFLD/MAFLD/MASLD in Arab countries until 2024.

Evidence acquisition: A bibliometric analysis of the literature related to NAFLD/MAFLD/MASLD until 2024 was conducted using Web of Science for 22 Arab countries. After selecting the literature from Arab countries in this field, we analyzed literature output and citation, journals publishing the literature, the most prolific researchers and institutions affiliated to Arab world, keywords registered in the database, and international research collaboration.

Evidence synthesis: Between 2006 and 2024, 18 Arab countries produced 1,252 publications related to NAFLD/MAFLD/MASLD with accelerating output since 2020. The largest number of papers and citations were achieved by Egypt, followed by Saudi Arabia, and United Arab Emirates. The research topics based on keywords indicated efforts in both basic and clinical medicine with the adoption of newer nomenclatures MAFLD/MASLD. More than half (710 papers, 57%) of the papers derived from multiple countries totaling up to 108, with the closest collaborations within Arab and neighboring countries.

Conclusions: Despite the recent increase, the number of NAFLD/MAFLD/MASLD publications in the Arab world still represents a small fraction of the overall global production. Enhanced local support, as well as regional and international collaboration, is crucial for improving research impact and addressing the rising prevalence of the disease in the Arab world.

Introduction: In the era of treat-to-target (T2T), there is an urgent need for surrogate non-invasive markers to monitor patients with inflammatory bowel diseases (IBD). Fecal calprotectin (FC), a non-invasive biomarker reflecting intestinal inflammation, holds potential for improving treatment monitoring. This narrative review aims to provide an overview of the role of FC in assessing responses to biological therapies and the new small molecules.

Evidence acquisition: A comprehensive literature review was performed using major databases, including PubMed, Embase, Scopus, Cochrane Library, and Web of Science, to identify studies that assessed the performance of FC in predicting treatment responses to advanced therapies in both adult and pediatric IBD populations. Performance was specifically evaluated in terms of area under the curve (AUC) values.

Evidence synthesis: Numerous studies demonstrated FC's association with treatment response to biologics and small molecules. While some studies reported strong predictive validity (AUC values up to 0.9), others demonstrated lower performance (AUC ranging from 0.6 to 0.9), depending on the specific outcomes assessed. Longitudinal monitoring of FC levels proved superior to single time point assessments. Pediatric patients with IBD showed similar FC patterns to adults.

Conclusions: This review supports the use of FC to assess treatment response in patients with IBD, both in clinical research and clinical practice. Comprehensive prospective studies, randomized controlled trials (RCTs), and meta-analyses with data standardizations will enhance the FC's future clinical application in IBD management, supporting the T2T strategy while minimizing the need for invasive procedures.

Acute severe ulcerative colitis is a potentially life-threatening condition that requires hospitalization with early and aggressive intervention to prevent complications. Mirikizumab (an anti-IL-23 monoclonal antibody) is recommended for the treatment of adult patients with moderate-to-severe ulcerative colitis. Currently, there is lack of evidence supporting its use in acute severe colitis, and no evidence has been produced on the use of this medication in pregnant women. A 30-year-old pregnant woman, with a 4-year history of corticosteroid-refractory pancolitis, who had failure to respond to multiple biological therapies, including infliximab, adalimumab, and vedolizumab, presented with acute severe ulcerative colitis and suspected threatened preterm rupture of membranes at 18 weeks' gestation. After administering five days of intravenous corticosteroids, the patient showed an unfavorable clinical and endoscopic response. Given the corticosteroid-refractory ASUC and the significant obstetric and neonatal risks associated with colectomy, Mirikizumab was initiated as a rescue therapy. Remarkably, within one day of receiving the first dose, the patient exhibited significant clinical improvement. One month after Mirikizumab initiation, the patient maintained clinical remission with improved markers. At 35 weeks and 4 days of gestation, the patient underwent an urgent cesarean section, delivering a preterm female infant. This is the first reported case regarding the efficacy and safety of Mirikizumab as a rescue therapy in a pregnant woman with severe acute ulcerative colitis. Further research is needed to confirm its efficacy in ASUC and the safety of this drug during pregnancy.