BACKGROUND: The treatment of liver cirrhosis requires a multidisciplinary approach at expert centers. Given the disease's complexity and serious consequences, care quality significantly impacts patient survival. Speciali...BACKGROUND: The treatment of liver cirrhosis requires a multidisciplinary approach at expert centers. Given the disease's complexity and serious consequences, care quality significantly impacts patient survival. Specialized care models at tertiary hospitals are thought to improve treatment outcomes and quality of life. This study evaluates whether proximity to an expert center influences care quality and patient outcomes and investigates the role of socioeconomic factors and social support in Germany. METHODS: A retrospective evaluation was conducted on 299 patients with liver cirrhosis treated at Medical Faculty Mannheim, Heidelberg University, with 43% at Child-Pugh B stage. The analysis considered various distances to the hospital (10 and 20 km by car, straight-line distance and public transportation usage) and correlated these with patient survival. RESULTS: The analysis showed that neither car travel distance (P = 0.221, P = 0.1894), straight-line distance (log-rank P = 0.221, cox regression P = 0.1894), nor public transportation usage (P = 0.363, P = 0.1845) up to over 50 km or more than 120 min traveling by public transportation significantly affected survival. Geographical accessibility and differing socioeconomic conditions did not impact treatment quality or survival rates. Known risk factors such as age (P = 0.007, P < 0.0001), gender (P = 0.019, P = 0.0207) and Child-Pugh stage (P = 0.003, P = 0.0155) significantly influenced survival. CONCLUSION: Specialized care models at tertiary hospitals offer consistent high-quality care to rural populations not facing disadvantages in survival due to longer travel distances to expert hepatology centers. Socioeconomic backgrounds do not affect care quality in this care model.
BACKGROUND: Diffuse echogenicity of the pancreas (DEP) is a hallmark of endoscopic ultrasound (EUS) diagnosis of fatty pancreas. This study aimed to characterize different patterns of DEP seen on EUS and its correlation...BACKGROUND: Diffuse echogenicity of the pancreas (DEP) is a hallmark of endoscopic ultrasound (EUS) diagnosis of fatty pancreas. This study aimed to characterize different patterns of DEP seen on EUS and its correlation with clinical and laboratory values. METHODS: This retrospective study includes patients diagnosed with fatty pancreas on EUS at a US tertiary center from January 2015 to June 2022. Fatty pancreas distribution was divided into three patterns: (a) The diffuse echogenicity of the entire pancreas with discrete hypoechoic areas 'indicative of fatty sparing areas', (b) diffuse echogenicity of the entire pancreas without any hypoechoic areas of fat sparing, and (c) diffuse echogenicity of the entire pancreas extending beyond the pancreatic border, 'cotton candy appearance'. RESULTS: Overall, 238 patients were included (69.7% female). The average age of patients was 57.45 ± 12.93 years. The mean BMI was 31.27 ± 6.9 kg/m2. Concurrent diabetes and fatty liver were noted in 26.9 and 24.7% of the patients, respectively. The prevalence of exocrine pancreatic insufficiency (EPI) in those who underwent testing (n = 68) was 33.8%. Type II was the most observed type in our cohort (44.1%). Type I and III were seen in 26.1 and 29.8% of the cohort, respectively. The three types of fatty pancreas had similar clinical patterns, with comparable prevalence of diabetes (P = 0.9), fatty liver (P = 0.9), and EPI (P = 0.4). CONCLUSION: The three patterns of DEP identified in this study have similar clinical and laboratory findings. Recognizing these patterns can aid in better detection of fatty pancreas.
INTRODUCTION: Irritable bowel syndrome with constipation (IBS-C) is a common gastrointestinal disorder that significantly impacts quality of life. Tenapanor, a sodium/hydrogen exchanger inhibitor, shows promise in managi...INTRODUCTION: Irritable bowel syndrome with constipation (IBS-C) is a common gastrointestinal disorder that significantly impacts quality of life. Tenapanor, a sodium/hydrogen exchanger inhibitor, shows promise in managing IBS-C. This systematic review and meta-analysis aim to evaluate the efficacy and safety of tenapanor 50 mg compared with placebo. METHODS: This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted on 7 October 2024 across PubMed , Cochrane , Embase , Scopus , and Web of Science databases. We included randomized controlled trials (RCTs) focusing on adult IBS-C patients aged 18-75. Quality assessment was performed using the risk of bias 2 tool. Primary outcomes included responder rates for abdominal symptoms (pain, discomfort, bloating, cramping, fullness) and complete spontaneous bowel movements (CSBM). Secondary outcomes comprised treatment-related adverse events (AEs) and those leading to treatment discontinuation. Data analysis was conducted using R software. RESULTS: Three RCTs involving 1378 patients were included. Tenapanor significantly improved symptoms versus placebo, including bloating [relative risk (RR) = 1.32; 95% confidence interval (CI), 1.15-1.51], cramping (RR = 1.27; CI, 1.13-1.44), discomfort (RR = 1.37; CI, 1.21-1.56), fullness (RR = 1.37; CI, 1.20-1.58), pain (RR = 1.37; CI, 1.17-1.49), and CSBM (RR = 1.54; CI, 1.24-1.91). However, tenapanor was associated with higher rates of treatment-related AEs (RR = 2.3; CI, 1.72-3.06) and AEs leading to discontinuation (RR = 9.08; CI, 3.63-22.71). CONCLUSION: Tenapanor is effective in improving IBS-C symptoms but has a higher incidence of treatment-related AEs. Further studies are needed to evaluate its long-term safety.
BACKGROUND: For poorly differentiated early gastric cancer (PDEGC), the oncologic safety and outcomes of endoscopic resection vs. surgical resection remain controversial. This study aimed to evaluate the prognostic diffe...BACKGROUND: For poorly differentiated early gastric cancer (PDEGC), the oncologic safety and outcomes of endoscopic resection vs. surgical resection remain controversial. This study aimed to evaluate the prognostic difference of endoscopic resection and surgical resection for PDEGCs. METHODS: We retrospectively collected data of PDEGC cases from the Surveillance, Epidemiology, and End Results (SEER) database. A final cohort of 558 PDEGC cases with highly complete clinical and follow-up records available for analysis. Cox multivariate analysis and univariate analysis after propensity score matching (PSM) were used to evaluate the prognostic differences. Cancer-specific survival (CSS) and overall survival (OS) were chosen as the endpoints of this study. RESULTS: In multivariate analysis of the raw dataset, surgical resection was observed as a relative protective factor for CSS [hazard ratio: 0.61, 95% confidence interval (CI): 0.28-1.33, P = 0.215] and an independent protective factor for OS (hazard ratio: 0.56, 95% CI: 0.32-0.98, P = 0.042). Survival curves based on post-PSM dataset exhibited significant differences in analysis on both CSS ( Plog-rank = 0.034) and OS ( Plog-rank = 0.033). CONCLUSION: In this retrospective study on PDEGC utilizing the SEER database, our analysis suggests that endoscopic resection for PDEGC was associated with significantly worse CSS and OS compared with surgical resection. These findings reinforce the current guideline recommendations favoring surgical resection as the treatment of choice for PDEGC to achieve optimal oncological safety.
Tursi A, Piovani D, Brandimarte G
… +18 more, Di Mario F, Figlioli G, Dumitrascu DL, Chaves Oliveira E, Papagrigoriadis S, Stundiene I, Reichert MC, Regula J, Elisei W, Picchio M, Bassotti G, Bafutto M, Latella G, Maconi G, Bonovas S, Papa A, Danese S, DICA International Group
OBJECTIVE: The onset of acute diverticulitis (AD) is a significant concern, yet the optimal preventive strategy is unclear. METHODS: This multicentre, prospective cohort study included 1945 patients with newly diagnosed...OBJECTIVE: The onset of acute diverticulitis (AD) is a significant concern, yet the optimal preventive strategy is unclear. METHODS: This multicentre, prospective cohort study included 1945 patients with newly diagnosed colonic diverticula and scored according to Diverticular Inflammation and Complication Assessment (DICA) classification. At baseline, patients were assigned to one of five treatment strategies: no treatment, a high-fibre diet, mesalamine, rifaximin, or a combination of mesalamine and rifaximin. The primary outcome was the development of AD within 3 years. Energy balancing weighting and multivariable weighted Cox regression were used to estimate the causal treatment effects from nonrandomised data. RESULTS: During the follow-up period, 140 cases of AD were reported. The crude 3-year risk was: 3.3% (no treatment), 5.9% (high-fibre diet), 9.5% (mesalamine), 11.8% (rifaximin), and 17.1% (mesalamine plus rifaximin). Mesalamine was associated with a lower hazard risk of AD compared to rifaximin [hazard ratio (HR) = 0.42; 95% confidence interval (CI): 0.19-0.94] and combination therapy (HR = 0.37; 95% CI: 0.15-0.88). Rifaximin was associated with a higher hazard risk compared to no treatment. Mesalamine was most beneficial for patients classified as DICA 2, with a 77% (HR = 0.23; 95% CI: 0.08-0.62) and 84% (HR = 0.16; 95% CI: 0.05-0.53) lower hazard of AD compared to rifaximin and combination therapy, respectively. CONCLUSION: Mesalamine may be a better alternative in patients classified as DICA 2; however, its benefit over no treatment remains uncertain.
OBJECTIVES: VE202 is an oral, defined 16-strain bacterial consortium with properties that may diminish dysbiosis and alleviate symptoms of inflammatory bowel disease. This phase 1 study evaluated VE202 safety and tolerab...OBJECTIVES: VE202 is an oral, defined 16-strain bacterial consortium with properties that may diminish dysbiosis and alleviate symptoms of inflammatory bowel disease. This phase 1 study evaluated VE202 safety and tolerability and assessed strain colonization. METHODS: Thirty-one healthy adults received oral vancomycin 125 mg four times daily for 5 days to decrease gut microbial burden, followed by a single dose of VE202 at 1 × 10 9 or 1 × 10 10 colony-forming units (CFUs), or 14-days of the lower dose (1.4 × 10 10 total CFU). Adverse events were monitored through week 12, with follow-up at week 24. Stool was collected for VE202 strain detection and abundance during screening and pretreatment, day 2, day 4, day 7, day 14, week 4, week 8, week 12, and optionally at week 24. RESULTS: VE202 and vancomycin pretreatment were well tolerated. Among VE202 recipients, the most frequent adverse events (>20% of subjects) were abdominal discomfort, diarrhea, headache, and fatigue. Most treatment-related adverse events were gastrointestinal. Two serious adverse events were reported; these were not treatment-related and occurred weeks after dosing completion. VE202 strain detection and relative abundance in the vancomycin-perturbed gut occurred as soon as day 2, sustained through 2 weeks postdosing, then declined slowly but remained substantially above baseline through week 24. Colonization was dose- and duration-dependent, with 14-day dosing providing more durable VE202 colonization. CONCLUSION: VE202 was well tolerated. Following antibiotic pretreatment, rapid and durable gut colonization of VE202 strains was observed, most significantly in participants administered multiple doses (NCT03931447).
BACKGROUND: Mild-moderate ulcerative colitis (UC) in clinical trials has been defined as an adapted Mayo Clinic score ≥4 with a Mayo endoscopic score (MES) of 2 and rectal bleeding score ≥1. This study aims to explore wh...BACKGROUND: Mild-moderate ulcerative colitis (UC) in clinical trials has been defined as an adapted Mayo Clinic score ≥4 with a Mayo endoscopic score (MES) of 2 and rectal bleeding score ≥1. This study aims to explore whether UC patients with lower endoscopic burden but active histology have similar outcomes to those with 'conventional' mild-moderate UC. METHODS: This was a post hoc analysis from the treat-through VARSITY study ( Clinicaltrial.gov : NCT02497469). Patients who completed induction (at week 14) with mild-moderate UC based on the conventional definition were compared to patients with histologically active MES 1 for achieving histo-endoscopic mucosal improvement (HEMI) at week 52, defined as MES ≤ 1 and Geboes highest grade <3.2. Secondary outcomes included endoscopic remission (ER) (MES = 0), histologic improvement (Geboes highest grade <3.2), and clinical remission (CR) (total Mayo score ≤2 and no subscore >1). Histologically active disease was defined as Geboes highest grade >3.2 (>50% of neutrophil crypt involvement in the epithelium). RESULTS: Week 52 outcomes were similar among patients with mild-moderate UC compared to those with histologically active disease and MES of 1. At week 52, a similar proportion of patients achieved HEMI [19/79 (24.1%) vs. 28/113 (24.8%), P = 0.908], ER [23/79 (29.1%) vs. 35/113 (31.0%), P = 0.782], histologic improvement [23/79 (29.1%) vs. 36/113 (31.9%), P = 0.685], and CR [38/79 (48.1%) vs. 66/113 (58.4%), P = 0.158]. CONCLUSIONS: Patients with histologically active MES 1 had comparable clinical and histologic outcomes at week 52 as those with conventional mild-moderate UC, suggesting that histology may better predict prognosis than symptoms or endoscopy alone.
OBJECTIVES: Given the high rate of recurrence in Crohn's disease (CD), postoperative maintenance therapy is crucial for preventing disease recurrence. However, the relationship between infliximab trough levels and postop...OBJECTIVES: Given the high rate of recurrence in Crohn's disease (CD), postoperative maintenance therapy is crucial for preventing disease recurrence. However, the relationship between infliximab trough levels and postoperative endoscopic recurrence in CD patients has been insufficiently evaluated. METHODS: This study included consecutive postoperative CD patients treated with infliximab for the prevention of postoperative recurrence, with measurement of infliximab serum trough concentrations and colonoscopy performed within 3 months of sampling. Endoscopic recurrence was defined as a Simple Endoscopic Score for Crohn's Disease (SES-CD) score ≥3 or a Rutgeerts' score ≥2. RESULTS: The final cohort comprised 137 patients, with 70 in the 'no endoscopic recurrence' group and 67 in the 'endoscopic recurrence' group. Infliximab trough levels were significantly lower in patients with recurrence (3.4 vs. 5.9, P = 0.001), with an area under the curve of 0.69 and an optimal cutoff value of 3.15 μg/ml. In the subgroup of patients who have undergone ileocolonic resection, the nonrecurrence group showed significantly higher infliximab trough levels (5.8 vs. 2.4, P = 0.001). In addition, patients with a Rutgeerts' score of 0 had significantly higher trough infliximab levels compared with scores of 2 ( P = 0.001). Multivariate analysis confirmed that infliximab trough levels were inversely associated with endoscopic recurrence in the overall cohort, and this association remained significant in the ileocolonic resection subgroup. CONCLUSION: Our study demonstrates that lower infliximab trough levels are associated with postoperative endoscopic recurrence in CD patients, both in the overall surgical cohort and in the subgroup of patients who underwent ileocolonic resection.
BACKGROUND: Esophageal hypervigilance and symptom-specific anxiety are emerging as key factors influencing symptom severity in patients with dysphagia and gastro-esophageal reflux disease (GERD). We aimed to evaluate the...BACKGROUND: Esophageal hypervigilance and symptom-specific anxiety are emerging as key factors influencing symptom severity in patients with dysphagia and gastro-esophageal reflux disease (GERD). We aimed to evaluate the relative contributions of esophageal hypervigilance, alongside parameters of high-resolution manometry (HRM) and pH study, to esophageal symptom severity. METHODS: Consecutive patients attending HRM with or without a 24-hour pH study at a tertiary referral center were prospectively included from March 2022 to June 2024. Patients completed the following questionnaires: Esophageal Hypervigilance and Anxiety Scale (EHAS-7), Brief Esophageal Dysphagia Questionnaire, and Gastroesophageal Reflux Disease Questionnaire (GERDQ). Pearson's correlation was used to determine the interrelationships between questionnaire results, HRM, and pH study metrics. RESULTS: A total of 380 patients were included (median age 54; 63.2% female), with 226 undergoing pH studies. EHAS-7 showed stronger correlations with dysphagia symptom severity compared with manometry metrics in patients with normal manometry findings ( r = 0.306, P < 0.001), achalasia ( r = 0.429, P < 0.050), absent contractility and ineffective esophageal motility ( r = 0.611, P < 0.001), and distal esophageal spasm and hypercontractile esophagus ( r = 0.536, P = 0.048). Regression analysis showed EHAS-7 independently explained 14.1% of variance ( β = 0.382, P < 0.001) in dysphagia severity. In the pH study cohort, both EHAS-7 and pH study metrics had either weak or no correlations with the severity of patients' GERD symptoms. CONCLUSION: Esophageal hypervigilance and symptom-specific anxiety correlate more strongly with dysphagia symptom severity than HRM metrics in select patient groups, emphasizing its role in symptom perception.
OBJECTIVE: This study aimed to evaluate the demographic, clinical, and procedural characteristics of adult patients presenting to the emergency department (ED) due to gastrointestinal foreign body ingestion (FBI). METHOD...OBJECTIVE: This study aimed to evaluate the demographic, clinical, and procedural characteristics of adult patients presenting to the emergency department (ED) due to gastrointestinal foreign body ingestion (FBI). METHODS: This single-center retrospective observational study included adult patients who presented with FBI to a tertiary hospital ED between January 2020 and December 2023. Demographic data, foreign body characteristics, time to presentation, interventions, and clinical outcomes were analyzed. RESULTS: A total of 198 patients were evaluated. The median age was 38.5 years (interquartile range: 28-59), and 60.1% were male. Recurrent FBI was present in 21.2% and intentional ingestion in 26.3% of cases. Special clinical conditions were observed in 32.8%, including prisoners (18.7%), psychiatric patients (10.6%), and those with esophageal strictures (4.5%). The median time from ingestion to ED presentation was 2 hours (interquartile range: 1-3); significantly longer in the nonendoscopy group (3.5 hours; P < 0.001). Foreign bodies were most commonly located in the esophagus (35.9%) and stomach (42.9%). Among foreign bodies detected in the esophagus or above, 61.1% were removed endoscopically; in contrast, 79.5% of those located in the stomach or more distal gastrointestinal tract passed spontaneously ( P < 0.001). Foreign bodies >5 cm required surgery in 13.3% of cases and were associated with longer presentation times. Complications occurred in 17.7% ( n = 35) of patients, especially after bone-containing meat ingestion (28.6%, P = 0.001). CONCLUSION: Early presentation and timely intervention appear to reduce the risk of complications and the need for surgery. High-risk populations, such as incarcerated individuals and patients with psychiatric conditions, may benefit from individualized, multidisciplinary management strategies. These findings underscore the potential value of updating existing clinical guidelines to better address the unique challenges posed by these vulnerable groups.
Xu XL, Su JY, Zhang Y
… +17 more, Su Z, Liu SP, Chen SC, Ou JJ, Peng N, Chen CY, Shao JN, He X, Liu WX, Yang DL, Pan LX, Deng ZJ, Huo RR, Guo PP, Ma L, Ma YL, Zhong JH
BACKGROUND: Current guidelines for hepatocellular carcinoma (HCC) lack standardized adjuvant therapy recommendations, particularly for patients with high-risk of recurrence after curative resection. This multicenter retr...BACKGROUND: Current guidelines for hepatocellular carcinoma (HCC) lack standardized adjuvant therapy recommendations, particularly for patients with high-risk of recurrence after curative resection. This multicenter retrospective study aimed to evaluate the efficacy and safety of adjuvant sintilimab (a programmed death protein-1 inhibitor) in this underserved population. METHODS: Patients with high-risk recurrence factors after curative resection were enrolled from five medical centers. All patients received sintilimab (200 mg), with or without tyrosine kinase inhibitors (TKIs). The primary endpoint was recurrence-free survival (RFS), with secondary endpoints including overall survival (OS). RESULTS: A total of 101 patients were included. The median RFS was 32.1 months [95% confidence interval (CI): 12.9-51.1], with 1-, 2-, and 3-year RFS rates of 73.1, 58.3, and 49.4%, respectively. Median OS was not reached, with 1-, 2-, and 3-year OS rates of 90.1, 83.0, and 76.2%, respectively. No significant differences in RFS (hazard ratio: 0.75, 95% CI: 0.40-1.40) or OS (hazard ratio: 0.65, 95% CI: 0.26-1.62) were observed between patients with ( n = 34; 33.7%) or without TKIs ( n = 67; 66.3%). In addition, no significant difference in RFS (hazard ratio: 0.97, 95% CI: 0.50-1.86) or OS (hazard ratio: 0.54, 95% CI: 0.19-1.53) was found between patients receiving adjuvant therapy for up to 6 months versus longer than 6 months. CONCLUSION: These findings support the potential of 6 months sintilimab monotherapy or in combination with TKIs as an effective adjuvant therapy for patients with HCC at high risk of recurrence. Further large-scale randomized controlled trials should be warranted.
Viazis N, Toruner M, Papastergiou V
… +40 more, Mousourakis K, Christidou A, Tzouvala M, Zacharopoulou E, Palatianou M, Theocharis G, Geramoutsos G, Theodoropoulou A, Karmiris K, Velegraki M, Ferhat Çelik A, Akpinar A, Zampeli E, Papathanasiou E, Unal NG, Kapsoritakis A, Argyriou K, Christodoulou D, Katsanos K, Fousekis F, Karakan T, Koutroubakis IE, Drygiannakis I, Giouleme O, Kalogirou M, Vlachou E, Liatsos C, Kyriakos N, Tsironi E, Markopoulos P, Bamias G, Chalakatevaki K, Tsiolakidou G, Lamouri C, Tribonias G, Dimopoulou K, Kasapidis P, Paraskeva K, Telli P, Akyuz F
OBJECTIVES: To identify the rate and predictors of successful antitumor necrosis factor (TNF) dose deescalation in patients with inflammatory bowel disease (IBD). METHODS: This multicenter retrospective cohort study coll...OBJECTIVES: To identify the rate and predictors of successful antitumor necrosis factor (TNF) dose deescalation in patients with inflammatory bowel disease (IBD). METHODS: This multicenter retrospective cohort study collected data from consecutive IBD patients followed at referral centers in Greece and Turkey, who had received intensified anti-TNF regimens due to secondary loss of response. Clinical response, steroid-free clinical remission, biochemical response, or mucosal healing were evaluated at 3 and 6 months following dose escalation. Multivariate analysis was used to identify predictors of successful dose deescalation. RESULTS: A total of 1129 patients were included [Crohn's disease: n = 743; ulcerative colitis: n = 386; infliximab (IFX): n = 650; adalimumab (ADA): n = 471; and golimumab (GOL): n = 8]. The median interquartile range (IQR) duration of anti-TNF treatment before escalation was 13.0 (6.0-36.0) months. After a median (IQR) of 16.0 (8.0-36.0) months of intensified therapy, 283 (25.1%) patients were successfully deescalated to standard anti-TNF dosing, 340 (30.1%) remained on the intensified regimen, and 506 (44.8%) were switched to a different agent - either another anti-TNF ( n = 111, 21.9%) or a biologic with a different mechanism of action ( n = 395, 78.1%). Predictors of successful deescalation included the concomitant use of steroids and the type of anti-TNFa agent used (IFX vs. ADA/GOL). Negative predictors included the presence of extraintestinal manifestations, prior anti-TNF exposure (i.e. ADA followed by IFX and vice versa), and longer duration of anti-TNF therapy before escalation. CONCLUSION: One quarter of IBD patients requiring intensified anti-TNFa therapie were successfully deescalated to standard dosing, after a median of 16.0 (IQR: 8.0-36.0) months.
BACKGROUND: Acute variceal bleeding (AVB) comprises 70% of upper gastrointestinal bleeding in cirrhotic individuals, with first-episode mortality of 15-20%. A third of surviving patients rebleed within 6 weeks of initial...BACKGROUND: Acute variceal bleeding (AVB) comprises 70% of upper gastrointestinal bleeding in cirrhotic individuals, with first-episode mortality of 15-20%. A third of surviving patients rebleed within 6 weeks of initial presentation. Scores such as Child-Turcotte-Pugh (CTP), model for end-stage liver disease-sodium (MELD-Na), and complete Rockall score (CRS) predict such outcomes, but with limitations. The platelet-albumin-bilirubin (PALBI) score is an attractive, rapid scoring system for predicting 6-week adverse outcomes after AVB. AIM: To correlate 5-day and 6-week outcomes after AVB with the PALBI score against the MELD-Na, CTP, and CRS. METHODS: Two hundred fifty patients presenting with AVB over the 20-month study period were investigated. CTP, MELD-Na and PALBI, and CRS scores were calculated; patients were followed for 6 weeks. The areas under the receiver-operator characteristic curves (AUROCs) were compared. RESULTS: The most common etiology for cirrhosis was ethanol (52.8%). Sixty-five patients were PALBI-1 (26%), 46 PALBI-2 (18.4%), and 139 PALBI-3 (55.6%). Ninety-five rebleeding events (30%) and 30 mortalities (12%) were noted over the follow-up period. AUROCs for predicting adverse outcomes at 5 days were 0.888 for CTP, 0.833 for MELD-Na, 0.777 for CRS, and 0.720 for PALBI; and at 6 weeks, were 0.885 for CTP, 0.821 for MELD-Na, 0.709 for CRS, and 0.856 for PALBI. AUROCs were statistically significant ( P < 0.001). Compared to other scores, PALBI showed no statistically significant difference compared to the MELD-Na and CTP scores at week 6. CONCLUSION: PALBI score on admission is a good predictor of adverse outcomes within 6 weeks in patients who present with variceal bleed.
BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) poses a growing global health challenge. This study evaluates the global burden of MASLD-related liver diseases-including MASLD with c...BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) poses a growing global health challenge. This study evaluates the global burden of MASLD-related liver diseases-including MASLD with cirrhosis (MASLD-C) and liver cancer due to metabolic dysfunction-associated steatohepatitis (LC-MASH) from 1990 to 2021, with projections to 2045. METHODS AND RESULTS: Using updated Global Burden of Disease 2021 data, we assessed the prevalence, incidence, deaths, and disability-adjusted life years (DALYs) for MASLD-C and LC-MASH globally. Trend analysis was conducted using average annual percentage changes and a Bayesian age-period-cohort model for forecasting. In 2021, MASLD-C had a prevalence of 1.27 billion and an incidence of 48.31 million; LC-MASH had 52 431 prevalent cases and 42 291 incident cases. Age-standardized prevalence rates rose from 12 084.69 to 15 017.46 per 100 000 for MASLD-C and from 0.40 to 0.66 for LC-MASH. MASLD-C accounted for 97 403 deaths and 2.67 million DALYs, while LC-MASH caused 40 925 deaths and 2.67 million DALYs. MASLD-C mortality slightly declined, while LC-MASH mortality rose. Middle SDI regions had the highest MASLD-C burden; high SDI regions showed the fastest LC-MASH growth. Forecasts suggest rising MASLD-C burden and LC-MASH incidence, despite declining LC-MASH age-standardized rates. CONCLUSION: The increasing global burden of MASLD-C and LC-MASH underscores the urgent need for region-specific prevention and intervention strategies.
BACKGROUND AND AIM: Nonalcoholic fatty liver disease (NAFLD) is linked to colorectal cancer and adenoma. Lean NAFLD is associated with a higher colorectal cancer risk than non-lean NAFLD. NAFLD was modified as metabolic...BACKGROUND AND AIM: Nonalcoholic fatty liver disease (NAFLD) is linked to colorectal cancer and adenoma. Lean NAFLD is associated with a higher colorectal cancer risk than non-lean NAFLD. NAFLD was modified as metabolic dysfunction-associated steatotic liver disease (MASLD). Certain adenoma features carry a high risk of metachronous lesions requiring early colonoscopy follow-up. The association between MASLD, lean MASLD, and colorectal adenomas with these features is unclear and is assessed in this study. METHODS: This cross-sectional study included patients greater than or equal to 18 years undergoing health checkups at Fu Jen Catholic University Hospital, Taiwan, between 2018 and 2023. Data collected included cardiometabolic markers, colonoscopy, liver ultrasonography, and a questionnaire. MASLD was hepatic steatosis plus greater than or equal to one cardiometabolic risk factor. Polyps with high risk of metachronous lesions were defined as having greater than or equal to one of the following features: greater than or equal to five adenomas, any adenoma greater than or equal to 10 mm, villous histology, high-grade dysplasia, or traditional serrated adenoma. Logistic regression was used to assess associations between patient groups and colorectal adenomas, adjusting for confounders. RESULTS: Among 5616 patients, 45.0% had MASLD, 2.4% hepatic steatosis without cardiometabolic abnormality, and 52.6% normal liver; 11.6% of MASLD were lean. Logistic regressions confirmed that MASLD was associated with colorectal adenomas [adjusted odds ratio (aOR) = 1.32] and adenomas with high-risk features (aOR = 1.46), all P values less than 0.05. Among patients with MASLD, lean MASLD was not associated with either outcome. CONCLUSION: MASLD is associated with an increased prevalence of colorectal adenomas, including those with a high risk of metachronous lesions. Lean MASLD patients did not show higher adenoma rates.
Tumor necrosis factor-alpha (TNF-α) inhibitors, including infliximab, have redefined the treatment of inflammatory bowel diseases (IBD) such as ulcerative colitis (UC). Despite their efficacy, these agents are associated...Tumor necrosis factor-alpha (TNF-α) inhibitors, including infliximab, have redefined the treatment of inflammatory bowel diseases (IBD) such as ulcerative colitis (UC). Despite their efficacy, these agents are associated with rare but serious adverse events, including drug-induced interstitial lung disease (D-ILD). We report a case of infliximab-induced ILD in a 63-year-old male undergoing treatment for UC. The patient presented with fever, dyspnea, and a miliary hypersensitivity pattern on imaging. Infectious causes were excluded, and drug-induced pulmonary toxicity was diagnosed. Discontinuation of infliximab and appropriate management led to gradual clinical improvement. This case highlights the importance of early recognition and management of pulmonary complications associated with TNF-α inhibitors. Given that UC itself and other autoimmune diseases can predispose patients to ILD, we also explore the role of disease activity and additional risk factors, including prior exposure to 5-aminosalicylic acid-based medications. Endoscopic disease activity, fecal calprotectin levels, autoimmune markers (ANA, ENA, ANCA), and bronchoalveolar lavage results are provided to further elucidate the diagnostic process.
BACKGROUND AND AIMS: Nonceliac wheat sensitivity (NCWS) is characterized by gastrointestinal and extraintestinal symptoms triggered by gluten ingestion. Its symptomatology overlaps substantially with irritable bowel synd...BACKGROUND AND AIMS: Nonceliac wheat sensitivity (NCWS) is characterized by gastrointestinal and extraintestinal symptoms triggered by gluten ingestion. Its symptomatology overlaps substantially with irritable bowel syndrome (IBS) and functional dyspepsia (FD), leading to diagnostic challenges. Data on the prevalence and predictors of NCWS among patients with IBS or FD, especially those with refractory symptoms, are limited. We aimed to determine the prevalence, clinical predictors, and impact of a gluten-free diet (GFD) in this population using the Salerno Experts' Criteria. METHODS: In this prospective, multicenter trial, adults (18-65 years) with Rome IV-defined IBS or FD, refractory to standard therapy, were enrolled. Participants underwent a 6-week GFD; gluten responders subsequently underwent a double-blind placebo-controlled gluten challenge (DBPCGC) with crossover. Symptom trajectories, health-related quality of life (HRQOL), anxiety, and depression were assessed. Multivariable logistic regression identified predictors of NCWS. Trial registration number- CTRI/2021/10/037323. RESULTS: Of 252 screened patients, 177 were enrolled for a 6-week GFD (step I), and 154 patients completed this phase (mean age 41.9 ± 14.2 years, 53.2% males). Eighty-two (52.3%) patients responded to GFD, of whom 77 entered step II (DBPCGC). Thirty-one (20.1%) patients had significant symptom worsening on blinded gluten ingestion, suggesting the presence of NCWS. Female sex, FD-IBS overlap, headache, fatigue, and anxiety independently predicted NCWS. GFD was associated with significant HRQOL improvement. CONCLUSION: Approximately one-fifth of the patients with refractory IBS/FD fulfill the NCWS criteria. Therefore, screening for NCWS in patients with refractory IBS or FD is extremely important to limit unnecessary pharmacotherapy and enhance patient outcomes.
Katunin E, Pasternack C, Kurppa K
… +4 more, Salmi T, Huhtala H, Kaukinen K, Nurmi R
Eur J Gastroenterol Hepatol
· 2026 Apr · PMID 40991679
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OBJECTIVES: Alarm symptoms at coeliac disease (CeD) diagnosis predict a more severe disease presentation, but the long-term implications remain unclear. We studied the prevalence of alarm symptoms at diagnosis and their...OBJECTIVES: Alarm symptoms at coeliac disease (CeD) diagnosis predict a more severe disease presentation, but the long-term implications remain unclear. We studied the prevalence of alarm symptoms at diagnosis and their association with outcomes. METHODS: A mixed-method cohort study combined retrospective medical record review with data collection through patient interviews and blood sampling from 814 adult patients with CeD after a median of 9.7 years on a gluten-free diet (GFD). Validated questionnaires assessed symptoms and quality of life. Alarm symptoms included anaemia, weight loss, dysphagia, vomiting, melaena, and rectal bleeding. Patients were grouped by the presence or absence of alarm symptoms. RESULTS: 45% of the patients presented with alarm symptoms, primarily (95%) anaemia and weight loss. These patients were significantly more often female (83 vs. 71%; P < 0.001), had more severe clinical presentation ( P < 0.001; reported severe symptoms 41 vs. 2%) and more advanced mucosal damage ( P < 0.001; subtotal or total villous atrophy 72 vs. 57%) than those without these symptoms. On GFD, these patients experienced fewer persistent symptoms (asymptomatic 71 vs. 79%; P = 0.035) but more often had osteopenia/osteoporosis (15 vs. 9%; P = 0.008). The groups did not differ in the strictness of GFD, positivity of CeD autoantibodies, quality of life, fractures, or other comorbidities. CONCLUSION: Alarm symptoms were common at CeD diagnosis. After 9.7 years on a GFD, patients with alarm symptoms had a higher incidence of osteopenia/osteoporosis, but generally did not demonstrate poorer long-term outcomes compared to those without alarm symptoms.