Minerva gastroenterology最新文献

Primary sclerosing cholangitis (PSC) is a rare liver disorder characterized by biliary ducts inflammation, fibrosis and consequently chronic cholestasis, which progressively lead to liver cirrhosis. The main feature of PSC is the frequent association with inflammatory bowel disease (IBD), with an estimated prevalence of around 70% of the cases. This strong relationship seems due to the presence of shared pathogenetic mechanisms, which seem to involve the intestinal barrier function, the human gut microbiota and the immune innated and adaptative response to antigens derived from the bowel. Of relevance, PSC-IBD have specific clinical and pathological features that differ from PSC and IBD as separate entities, explaining the diversity in outcomes among these categories, and therefore the distinct clinical management that is required. The aim of this review is to present recent data regarding the epidemiology, pathobiology and clinical features of PSC-IBD.

Human albumin solution is a commonly used therapeutic agent because of its ability to expand plasma volume and improve oncotic pressure in various clinical settings, such as in patients with cirrhosis and sepsis, whose management is a major challenge. Despite the lack of evidence for the superiority of human albumin solutions compared with crystalloids in improving major outcomes, short-term administration of human albumin solution appears to be more effective than both saline and plasmalyte in recovering systemic hemodynamics and achieving a lower daily net fluid balance in patients with cirrhosis and sepsis-induced hypotension. The use of 25% human albumin solution could also effectively manage ascites in patients with cirrhosis, reducing the volume of fluids administered and allowing a faster achievement of the plasma target concentration. This article aims to comprehensively review the indications for the use of human albumin solutions, examine the associated risks, and outline best practices for monitoring patients receiving this treatment, ensuring optimal patient outcomes while minimizing adverse effects.

Background: End-stage liver disease (ESLD) patients have frequent readmissions to the same facility or a different hospital (care fragmentation). Care fragmentation results in care delivery from an unfamiliar clinical team or setting, a potential source of suboptimal clinical outcomes. We examined the occurrence, trends, and association between care fragmentation and outcomes during readmissions for ESLD.

Methods: From the Nationwide Readmissions Database (January to September 2010-2014), we followed adult (age ≥18 years) hospitalizations for ESLD who were discharged alive for 90 days. During 30- and 90-day readmissions, we calculated the frequency, determinants, and clinical outcomes of care fragmentation (SAS 9.4).

Results: Of the 67,480 ESLD hospitalizations surviving at discharge from 2010-2014, 35% (23,872) and 52% (35,549) were readmitted in 30- and 90-days respectively. During readmissions, the frequencies of care fragmentation were similar (30-day: 25.4% and 90-day: 25.8%) and remained stable from 2010 to 2014 (P trends>0.5). Similarly, factors associated with care fragmentation were consistent across 30- and 90-day readmissions. These included ages: 18-44 years, liver cancer, receipt of liver transplantation, hepatorenal syndrome, prolonged length of stay, and hospitalization in non-teaching facilities. During 30- and 90-day readmissions, care fragmentation was associated with higher risk of mortality (adjusted mean ratio: 1.13[1.03-1.24] and 1.14 [1.06-1.23]; P values<0.0001), prolonged length of stay (4.6-days vs. 4.1-days and 5.2-days vs. 4.6-days; P values<0.0001), and higher hospital charges ($36,884 vs. $28,932 and $37,354 vs. $30,851; P values<0.0001).

Conclusions: Care fragmentation is high among readmissions for ESLD and is associated with poorer outcomes.

Background: Fecal immunochemical test (FIT) is a yearly alternative colorectal screening modality for average risk individuals unwilling or unable to undergo invasive colorectal cancer (CRC) screening due to cost and accessibility. This study aimed to determine whether FIT should be interpreted within the context of patient demographics and medical history.

Methods: Patients >50 years old who had a FIT followed by colonoscopy within 1 year were analyzed based on age, race, BMI, social and medical comorbidities. False positive (FP) and false negative (FN) FIT results within each patient demographic and medical history variable were determined by comparing with the gold standard of colonoscopy using χ² analysis.

Results: One thousand twenty-five patients were reviewed. 21.8% of FIT results were positive. Factors which differed in positive FIT rates were age (P=0.003), smoking (P<0.001), alcohol (P=0.001), and hypertension (P<0.001). The difference in rates of FP and FN FIT outcomes among each variable underwent further subanalysis. The FP was 66.8% and the FN rate was 12.8%. Higher FN outcomes were noted in those above 70, males and smokers, though the result was only statistically significant for males (P=0.009). Females were observed to have higher FP rates (P=0.019).

Conclusions: Females had higher FP FIT rates compared to males, indicating that sex may influence FIT outcomes and should be accounted for when interpreting FIT results. This information can be utilized to identify populations at higher risk of FP or FN FIT results to target CRC screening. Additionally, recalculating the FP and FN rates for each variable may help determine new FIT targets.

Introduction: By searching relevant literature, the recurrence rate, complication rate after video-assisted anal fistula treatment (VAAFT), and efficacy and safety of the treatment were analyzed.

Evidence acquisition: Articles that reported the outcomes of VAAFT up to December 2020 were searched in PubMed (Medline) and Cochrane Library, in accordance with the preferred reporting items for systematic review and meta-analysis (PRISMA) screening guidelines. Two researchers independently completed the whole process from screening and inclusion to quality evaluation and bias risk assessment, and the data was included in the RevMan 5.3 software for analysis. The main outcomes were demographic data of patients, detection rate, classification of internal opening of anorectal fistula, postoperative recurrence rate, and incidence of complications.

Evidence synthesis: A total of 10 articles were included (779 patients). The average age of the patients was 44 years old, average operation time was 60 min, and the average follow-up time was 22 months. The ratio of male to female was 2.4:1, the ratio of high anorectal fistula to low anorectal fistula was 6.6:1, the detection rate of internal openings was 98%, the weighted recurrence rate was 24%, and the weighted complication rate was 1%.

Conclusions: VAAFT is effective and safe in the treatment of anorectal fistulas.

This article was published in Volume 69, issue 1 of publishing year 2023, with a mistake in Table I. The correct Table I is the one included in this erratum.