BACKGROUND: Alcohol consumption is associated with increased risk for development of atrial fibrillation. Outcomes of patients with atrial fibrillation in the context of acute alcohol-associated hepatitis have yet to be...BACKGROUND: Alcohol consumption is associated with increased risk for development of atrial fibrillation. Outcomes of patients with atrial fibrillation in the context of acute alcohol-associated hepatitis have yet to be investigated. METHODS: We performed a retrospective study of patients with alcohol-associated hepatitis from the National Inpatient Sample (2016-2019), comparing those with and without concurrent atrial fibrillation. Subgroup analysis with and without cirrhosis was alone performed. Statistical analysis performed using STATA 16.1 and multivariate logistic and linear regression. RESULTS: Among 475 600 patients with alcohol-associated hepatitis, 27 675 (5.8%) had atrial fibrillation. Patients with atrial fibrillation had a nearly two-fold increased in-hospital mortality (6.9%) compared with those without atrial fibrillation (3.9%) [adjusted odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.20-1.53] and higher odds of developing acute kidney injury (OR = 1.23, 95% CI = 1.15-1.32). They also had longer hospital stays and higher total hospital charges (7.5 vs. 6.0 days and $20 005 vs. $14 714, respectively). Among patients with alcohol-associated hepatitis and atrial fibrillation, 33% also had cirrhosis (n = 9190), and these patients had an even higher mortality rate (11.3%) than those with alcohol-associated hepatitis and atrial fibrillation alone (4.7%). Acute coronary syndrome, chronic kidney disease, and obesity were independently associated with increased mortality. CONCLUSION: Patients with alcohol-associated hepatitis who have atrial fibrillation have an increased risk of in-hospital mortality and underlying cirrhosis compounds this risk. Early recognition of the effect of concomitant atrial fibrillation and alcohol-associated hepatitis could provide an opportunity for intervention.
BACKGROUND AND AIMS: Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation and high short-term mortality. We investigated whether the albumin-bilirubin (ALBI) score, model for end-stage liver dis...BACKGROUND AND AIMS: Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation and high short-term mortality. We investigated whether the albumin-bilirubin (ALBI) score, model for end-stage liver disease (MELD) score, and platelet-albumin-bilirubin (PALBI) score independently predict major ACLF complications. METHODS: This retrospective cross-sectional study enrolled 2104 ACLF patients (2017-2024) fulfilling Asian Pacific Association for the Study of the Liver 2019 criteria. ALBI, MELD, and PALBI were calculated within 48 h of admission. Multivariable logistic regression, restricted cubic spline, and receiver operating characteristic (ROC) analyses assessed associations with ascites, hepatic encephalopathy, hepatorenal syndrome (HRS), coagulopathy, splenomegaly, and spontaneous bacterial peritonitis. RESULTS: All three scores increased significantly with worsening Child-Pugh class (P < 0.001). Per SD increase, ALBI predicted all six complications with adjusted odds ratios (ORs) ranging from 1.98 to 8.73. MELD showed similar predictive ability (ORs: 2.58-7.26). PALBI quartiles 2 and 3 remained significantly associated with HRS (P = 0.007 and P = 0.011, respectively). Restricted cubic spline revealed nonlinear dose-response relationships (P-nonlinearity < 0.005). ROC area under the curve values were consistently higher for MELD than ALBI and PALBI. Subgroup analyses confirmed stability across age, sex, BMI, smoking, and alcohol use. CONCLUSION: ALBI, MELD, and PALBI scores simply and reliably identify ACLF complications, helping clinicians intensify monitoring and tailor therapy for high-risk patients.
BACKGROUND AND AIMS: Outcomes of endoscopic balloon dilatation (EBD), endoscopic stent placement (ESP), and endoscopic stricturotomy for Crohn's disease-related strictures vary across studies. We conducted an indirect me...BACKGROUND AND AIMS: Outcomes of endoscopic balloon dilatation (EBD), endoscopic stent placement (ESP), and endoscopic stricturotomy for Crohn's disease-related strictures vary across studies. We conducted an indirect meta-analysis to synthesize and compare outcomes. METHODS: Data were extracted from multiple online databases. Primary outcomes of interest were: clinical success and technical success. Secondary outcomes of interest were: rate of adverse events, the rates of repeat endoscopic procedures, and surgery. Pooled proportions along with 95% confidence interval (CI) and odds ratio (OR) of each outcome were calculated. RESULTS: We analyzed 39 studies: 25 on EBD (n = 1353), nine on ESP (n = 159), and five on endoscopic stricturotomy (n = 102). Pooled outcomes for EBD, ESP, and endoscopic stricturotomy, respectively, were: technical success (88, 93, and 95%), clinical success (62, 59, and 49%), adverse events (7, 25, and 17%), repeat procedures (17, 7, and 56%), and surgery (13, 25, and 9%). Compared with EBD, endoscopic stricturotomy showed significantly higher repeat endoscopy rates (OR = 6.165, 95% CI: 2.328-6.328, P < 0.05). Both endoscopic stricturotomy and ESP had higher adverse event rates than EBD (endoscopic stricturotomy: OR = 2.610, 95% CI: 1.095-6.221; ESP: OR = 4.214, 95% CI: 2.070-8.579; both P < 0.05). Differences in clinical and technical success, repeat procedures with ESP, and surgery were NS. CONCLUSION: Clinical and technical success were not significantly different between EBD, ESP, and endoscopic stricturotomy for Crohn's disease-related strictures. However, adverse events and repeat procedures were higher in ESP and endoscopic stricturotomy when compared with EBD.
Miyake Y, Tanaka K, Nagata C
… +30 more, Furukawa S, Andoh A, Yokoyama T, Yoshimura N, Mori K, Ninomiya T, Yamamoto Y, Takeshita E, Ikeda Y, Saito M, Ohashi K, Imaeda H, Kakimoto K, Higuchi K, Nunoi H, Mizukami Y, Suzuki S, Hiraoka S, Okada H, Kawasaki K, Higashiyama M, Hokari R, Miura H, Miyake T, Kumagi T, Kato H, Hato N, Sayama K, Hiasa Y, Japan Ulcerative Colitis Study Group
OBJECTIVES: A meta-analysis showed that serum folate concentrations, but not vitamin B12 concentrations, are lower in patients with ulcerative colitis compared to healthy controls. However, no epidemiological study has i...OBJECTIVES: A meta-analysis showed that serum folate concentrations, but not vitamin B12 concentrations, are lower in patients with ulcerative colitis compared to healthy controls. However, no epidemiological study has investigated the association between dietary intake of folate, vitamin B12, vitamin B6, vitamin B2, and vitamin B1 and the risk of ulcerative colitis. This study examines this association using data from a multicenter, hospital-based, case-control study. METHODS: The study included 384 cases of ulcerative colitis diagnosed within the past 3 years and 665 controls. Data were collected through a self-reported questionnaire. Dietary information was obtained using a 169-item semi-quantitative food frequency questionnaire. Adjustment was made for sex, age, pack-years of smoking, alcohol consumption, history of appendicitis, family history of ulcerative colitis, education level, and BMI. RESULTS: Higher dietary intakes of folate and vitamin B1 were independently associated with a decreased risk of ulcerative colitis after adjusting for confounding factors. The adjusted odds ratio for extreme quartiles was 0.60 [95% confidence interval (CI): 0.39 - 0.91, P for trend = 0.009) for folate and 0.54 (95% CI: 0.36 - 0.81, P for trend = 0.004) for vitamin B1. Dietary intake of vitamins B12, B6, or B2 was not independently associated with ulcerative colitis risk. CONCLUSION: This is the first study to demonstrate significant inverse relationships between dietary intake of folate and vitamin B1 and the risk of ulcerative colitis. Our results should be interpreted as exploratory and require validation through further, more focused studies.
AIM: Microvascular invasion (MVI) is a key predictor of recurrence in hepatocellular carcinoma (HCC), but it is diagnosed pathologically after surgery. We aimed to develop and validate a simplified preoperative nomogram...AIM: Microvascular invasion (MVI) is a key predictor of recurrence in hepatocellular carcinoma (HCC), but it is diagnosed pathologically after surgery. We aimed to develop and validate a simplified preoperative nomogram using routine markers and tumor burden score (TBS). METHODS: This retrospective study included 512 patients with HCC who underwent radical hepatectomy between June 2018 and 2023 (309 MVI-negative and 203 MVI-positive). Predictors were selected by univariate analysis and least absolute shrinkage and selection operator regression. Multivariable logistic regression was used to construct the model. Discrimination, calibration, and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. An interactive dynamic nomogram was developed from the final model. RESULTS: The nomogram incorporated dichotomized aspartate aminotransferase (≥29.5 U/L), platelet count (≥127.5 × 109/L), and alpha-fetoprotein (≥400 ng/ml), and TBS modeled as a continuous variable with restricted cubic splines. The model showed good discrimination (AUC = 0.720), good agreement between predicted and observed probabilities, and meaningful net benefit when the threshold probability exceeded 20%. CONCLUSION: This simplified dynamic nomogram provides a practical noninvasive tool for preoperative MVI risk assessment and may support individualized decision-making in patients with HCC.
BACKGROUND: Lactose intolerance is a common cause of functional gastrointestinal symptoms. Traditional diagnostic strategies primarily focus on detecting malabsorption despite symptoms often occurring without it. OBJECTI...BACKGROUND: Lactose intolerance is a common cause of functional gastrointestinal symptoms. Traditional diagnostic strategies primarily focus on detecting malabsorption despite symptoms often occurring without it. OBJECTIVES: This study examined the role of malabsorption and nonmalabsorptive mechanisms in the development of symptoms in patients with lactose intolerance. DESIGN: We analyzed 1015 patients undergoing standardized 50-g lactose hydrogen (H2) breath testing with simultaneous symptom assessment using the adult Carbohydrate Perception Questionnaire. Malabsorption was defined as an H2 increase greater than 20 ppm, and intolerance as a ≥ 20- and 35-mm increase in symptom scores. Breath test parameters and symptom patterns were compared across four groups: symptomatic malabsorbers (S+/M+), asymptomatic malabsorbers (S-/M+), symptomatic nonmalabsorbers or symptomatic absorbers (S+/M-), and asymptomatic nonmalabsorbers or asymptomatic absorbers (S-/M-). Linear and multiple regressions and receiver operating characteristic (ROC) analyses evaluated associations between H2 kinetics and symptoms. RESULTS: Symptoms occurred frequently both with and without malabsorption: 267 (S+/M+) and 236 (S+/M-). S+/M+ patients showed higher maximal H2 (98 vs. 59 ppm), larger area under the ROC curve (AUC) H2, and faster H2 accumulation than S-/M+ (all P < 0.001). Symptom burdens were higher in S+/M+ than S+/M- (133 vs. 72 mm; P < 0.001). However, H2 increases explained only 22% of symptom variance. In regression models, flatulence, pain, and diarrhea independently predicted malabsorption, while bloating and nausea did not. ROC performance was modest for both H2 (AUC: 0.66) and symptoms (AUC: 0.70). CONCLUSION: Lactose-induced symptoms arise through two partially independent mechanisms: a malabsorptive colonic fermentation pathway and a nonmalabsorptive pathway. Breath testing alone is insufficient to identify clinically relevant lactose intolerance; integrating physiological and symptom-based measures provides a more accurate mechanistic understanding.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and can progress to cirrhosis and hepatocellular carcinoma. Treatment options are still lacking. We assessed the efficacy of sodium-glu...Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and can progress to cirrhosis and hepatocellular carcinoma. Treatment options are still lacking. We assessed the efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in MASLD. An updated systematic review and meta-analysis of randomized controlled trials in PubMed, Embase, and Cochrane comparing SGLT2i with placebo or active drugs were conducted. Primary outcomes were controlled attenuation parameter (CAP) and liver stiffness by elastography, and fibrosis-4 (FIB-4) score; secondary outcomes were liver enzymes, metabolic and anthropometric measures, and MRI-PDFF. A subgroup without diabetes mellitus (DM) was analyzed. Twenty-nine randomized clinical trials were included (n = 2443). SGLT2i use significantly reduced liver stiffness [mean difference (MD): -0.47 kPa; 95% confidence interval (CI): -0.88 to -0.07; P = 0.022; I2=75%], CAP (MD: -12.24 dB/m; 95% CI: -20.12 to -4.35; P = 0.002; I2=1%), and FIB-4 (MD: -0.22; 95% CI: -0.38 to -0.06; P = 0.008; I2=84%). Improvements were consistently observed in liver enzymes, including alanine aminotransferase, aspartate aminotransferase, and gamma-glutamyl transferase. In addition, reductions were noted in body weight, visceral adipose tissue, waist circumference, glycated hemoglobin, and homeostatic model assessment of insulin resistance. In the subgroup analysis of patients without DM (n = 257), SGLT2i also significantly reduced aspartate aminotransferase and gamma-glutamyl transferase, as well as anthropometric parameters. SGLT2i improves hepatic, metabolic, and anthropometric parameters in MASLD, including liver stiffness, steatosis, and FIB-4; benefits also occur in non-DM individuals, warranting further trials.
BACKGROUND: Hepatocellular adenoma (HCA) is a benign liver tumour with variable biological behaviour and a recognised risk of haemorrhage and malignant transformation. Evidence on long-term natural history in mixed-manag...BACKGROUND: Hepatocellular adenoma (HCA) is a benign liver tumour with variable biological behaviour and a recognised risk of haemorrhage and malignant transformation. Evidence on long-term natural history in mixed-management cohorts remains limited. This study reports clinical features, radiological behaviour and outcomes from a large tertiary centre. METHODS: A retrospective review was undertaken of all radiologically or histologically confirmed HCAs over a 17-year period. Diagnosis was based primarily on cross-sectional imaging, with biopsy reserved for atypical lesions. Patients were managed with surveillance, resection or transplantation. RESULTS: From 2005 to 2022, 164 patients were identified, predominantly female (86.6%) with a median age of 36 years. Risk factors were present in 78.7%, most commonly oral contraceptive exposure and metabolic syndrome; syndromic disease accounted for 7.3%. Most tumours were incidental (70.7%); rupture occurred in three patients (1.8%). Histology (n = 86) showed inflammatory HCA as the most common subtype (40.7%), followed by hepatocyte nuclear factor 1a-mutated (24.4%) and β-catenin-mutated (8.1%). Surveillance was the main strategy (76.2%), with radiological regression in 18%. Resection was undertaken in 23.8% and transplantation in 5.5%. Malignant transformation occurred in six cases (3.7%), all within β-catenin-mutated or inflammatory adenomas. CONCLUSION: Most HCAs were safely managed with surveillance, while malignant transformation was rare and restricted to high-risk molecular subtypes, supporting a conservative, risk-stratified approach.
BACKGROUND: Fenofibrate has shown biochemical benefit in primary biliary cholangitis (PBC) patients with a suboptimal response to ursodeoxycholic acid (UDCA), but its long-term efficacy on survival remains unknown. METHO...BACKGROUND: Fenofibrate has shown biochemical benefit in primary biliary cholangitis (PBC) patients with a suboptimal response to ursodeoxycholic acid (UDCA), but its long-term efficacy on survival remains unknown. METHODS: In this retrospective-prospective cohort study, we enrolled 160 PBC patients with a suboptimal response to UDCA and followed up on these patients to obtain laboratory results and adverse events. Finally, we evaluated long-term survivals analyzed with Kaplan-Meier plotting and log-rank test. RESULTS: The fenofibrate add-on therapy group showed more significant improvements in alkaline phosphatase (ALP) and gamma-glutamyl transferase levels compared with UDCA monotherapy group after 1 year of treatment, resulting in a normalization rate of 60.9% for ALP and 45.3% for both ALP and total bilirubin. Importantly, compared with UDCA monotherapy group, the fenofibrate add-on therapy group had a better transplant-free survivals of 5 (89.7 vs 75.3%) and 10 years (87.0 vs 47.6%), with a hazard ratio of 0.3282 (95% confidence interval: 0.1334-0.8073, P < 0.05). Twenty-one cases (25.6%) developed adverse events, with liver injury being the most frequent one (17.1%). CONCLUSION: Fenofibrate add-on therapy improved not only biochemical responses but also long-term transplant-free survival in PBC patients with suboptimal response to UDCA. However, liver injury needs to be closely monitored and properly managed.
INTRODUCTION: Early detection of gastric dysplastic lesions and early gastric cancer (EGC) is crucial to enable prompt treatments, such as endoscopic submucosal dissection (ESD). Understanding the distribution and charac...INTRODUCTION: Early detection of gastric dysplastic lesions and early gastric cancer (EGC) is crucial to enable prompt treatments, such as endoscopic submucosal dissection (ESD). Understanding the distribution and characteristics of these lesions can enhance the efficiency of endoscopic examinations. This study aimed to analyze the locations and characteristics of dysplasia and EGCs in the stomach. METHODS: Retrospective study reviewing pathologically diagnosed gastric dysplasia and EGCs treated by ESD. Lesions were grouped by location (proximal-cardia, fundus, and body; distal-incisura and antrum) and compared regarding several clinicopathological variables. A predictive model - Search At the Top (SAT) score - was created using three pre-endoscopic variables: male sex (2 points), excessive alcohol consumption (1 point), and smoking (1 point). The score was evaluated for its ability to predict proximal lesions. RESULTS: A total of 215 patients were included (66.5% male; mean age 68 ± 8 years), with 225 lesions analyzed: 50.7% low-grade dysplasia, 30.7% high-grade dysplasia, and 18.6% adenocarcinoma. Most lesions were located in the distal stomach (73.3%) and along the lesser curvature (39.6%).Proximal lesions were more often associated to male sex (P = 0.001), younger age (P = 0.027), alcohol consumption (P = 0.003), and smoking (P = 0.008).The SAT-score showed moderate discriminative performance (area under the curve = 0.674) and identified high-risk patients (score ≥3) with 3.5-fold increased odds of having proximal lesions (odds ratio = 3.459; P < 0.001). CONCLUSION: Most gastric dysplastic lesions and EGCs were located in the distal stomach and along the lesser curvature. Proximal gastric lesions were more frequent in younger male patients with alcohol and tobacco exposure. These location-specific characteristics can enhance the diagnostic performance of endoscopic screening and surveillance, potentially leading to improved patient outcomes.