BACKGROUND/OBJECTIVES: Modifiable factors may influence prognosis in patients with cirrhosis and portal hypertension-related bleeding (PHB). This study characterized metabolic and hematological profiles during and after...BACKGROUND/OBJECTIVES: Modifiable factors may influence prognosis in patients with cirrhosis and portal hypertension-related bleeding (PHB). This study characterized metabolic and hematological profiles during and after PHB and evaluated their impact on liver-related events and mortality. PATIENTS AND METHODS: Observational, single-center, retrospective cohort study including patients with cirrhosis admitted for PHB and followed for 1 year. Epidemiological, clinical, analytical, and hemodynamic data were collected. Anemia was defined according to World Health Organization criteria, and the hypoalbuminemia threshold was established using receiver operating characteristic (ROC) curves and the Youden index. Risk factors for liver-related events and death were assessed using Cox regression and cumulative incidence functions with competing risks. RESULTS: Forty-eight patients were included (60.4% men; 35.5% alcohol-related cirrhosis), with a median age of 63 years (IQR 55-74). During one-year follow-up, hepatic encephalopathy (HE) was the most frequent liver-related event (21%). Hypoalbuminemia was independently associated with an increased risk of hepatic encephalopathy at 6 months (sHR 5.70, 95% CI 1.36-23.8, p=0.017) and at 1 year (sHR 7.28, 95% CI 1.08-48.8, p=0.041). One-year survival was significantly lower in patients with HE (60% vs. 100%, p<0.001), hypoalbuminemia (60% vs. 96.7%, p=0.005), and anemia (80% vs. 100%, p=0.016). Patients receiving red blood cell transfusion during PHB showed better liver function at 1 year (median MELD 9 [IQR 7-10] vs. 10 [IQR 9.8-12.5], p=0.017). CONCLUSIONS: Anemia and hypoalbuminemia are potentially modifiable factors associated with increased risk of HE and mortality within 1 year after PHB. Whether correction of anemia and nutritional status improves prognosis remains to be determined.
UNLABELLED: Chronic hepatitis caused by the hepatitis D virus (HDV) represents one of the most aggressive forms of viral liver disease, associated with accelerated progression to cirrhosis and an increased risk of hepato...UNLABELLED: Chronic hepatitis caused by the hepatitis D virus (HDV) represents one of the most aggressive forms of viral liver disease, associated with accelerated progression to cirrhosis and an increased risk of hepatocellular carcinoma. Its management is not yet well standardized, which justifies the exploration of digital tools to improve the care of these patients. OBJECTIVE: To evaluate the user experience, perceived usefulness, and usability of the NORA mobile application in patients with HBV and/or HDV infection, as well as to analyze the determinants of non-use from a patient-centered perspective. PATIENTS AND METHODS: Cross-sectional observational study conducted in outpatient hepatology clinics. A total of 52 patients were included (19 users, 11 non-users, and 22 new users). Sociodemographic, clinical, and app usage variables were collected. Usability was assessed using the Mobile App Usability Questionnaire (MAUQ). RESULTS: Users rated the application positively (MAUQ 5.07 ± 1.43), particularly highlighting the quality-of-life and education modules, while biometric modules were the least used. The main improvements proposed included expanded educational content (57.9%), improved data visualization (31.6%), and greater communication with the healthcare team (21.1%). Lack of motivation was the main barrier among non-users (72.7%). Expectations exceeded actual use in most modules, suggesting areas for improvement. Adoption was associated with detectable HDV RNA and recent follow-up. CONCLUSIONS: NORA is a well accepted tool among users and is perceived as useful for the follow-up of patients with HDV. Optimizing aspects related to education, communication, and functionality could further enhance its impact in telemedicine. However, the methodological limitations of the study prevent any conclusions from being drawn regarding its clinical impact.
INTRODUCTION: Biliopancreatic diseases are prevalent, complex, and associated with significant morbidity and mortality. Despite their clinical importance, training in these conditions remains poorly defined across Europe...INTRODUCTION: Biliopancreatic diseases are prevalent, complex, and associated with significant morbidity and mortality. Despite their clinical importance, training in these conditions remains poorly defined across Europe. We aimed to assess self-perceived knowledge in biliopancreatic diseases among Spanish gastroenterology trainees and early-career specialists, and to identify training-related factors associated with higher competence. PATIENTS AND METHODS: A nationwide cross-sectional online survey was conducted among final-year residents and specialists completing residency between 2018 and 2024 under the auspices of the Spanish Association of Gastroenterology(AEG) and the Spanish Association of Pancreatology(AESPANC). Participants reported demographics and training characteristics. General self-perceived knowledge was rated on a 0-10 scale, and knowledge of 45 pancreatic and biliary conditions was assessed using a 5-point Likert scale. RESULTS: Of 216 respondents (60.5% women; mean age 32.3 years), 28.8% were residents and 71.2% specialists. Median general knowledge scores were 7/10 for both pancreatic and biliary diseases. Highest competence was reported in common conditions (acute pancreatitis, biliary colic, cholecystitis, cholangitis), lowest scores were observed for chronic pancreatitis, autoimmune pancreatitis, cystic fibrosis, pancreatic cystic lesions, and benign biliary disorders. Factors associated with higher self-perceived knowledge included presence of pancreatology specialists, larger case volumes, outpatient clinic exposure, participation in multidisciplinary committees, structured teaching, and formal competency assessment. CONCLUSIONS: Training in biliopancreatic diseases among Spanish gastroenterology trainees is heterogeneous, with significant gaps in clinically relevant domains. Structured clinical exposure, mentorship, formal evaluation, and targeted teaching are key factors. These findings highlight the need to standardise and strengthen pancreatology training pathways to improve patient care.
OBJECTIVE: Different diagnostic frameworks for fatty liver disease include the exclusion-based non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) and the inclus...OBJECTIVE: Different diagnostic frameworks for fatty liver disease include the exclusion-based non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) and the inclusion-based metabolic dysfunction-associated fatty liver disease (MAFLD) criteria. Their implications remain debated, especially in high viral hepatitis and alcohol use settings. This study evaluated diagnostic concordance and compared fibrosis detection across frameworks in a Vietnamese cohort. PATIENTS AND METHODS: In this cross-sectional study of 360 adults, liver fibrosis and steatosis were assessed using transient elastography. Significant fibrosis was defined as LSM ≥ 7.0 kPa (F2), with F3 (≥ 8.7) and F4 (≥ 11.5). Steatosis was classified by CAP (S1-S3). Patients were classified categorized as NAFLD, MASLD, and MAFLD. Univariable and multivariable logistic regression were performed to identify factors associated with significant fibrosis. RESULTS: Among participants, 76.67% (n=276) met all three definitions, while 15.83% (n=57) fulfilled only MAFLD criteria. The MAFLD group demonstrated higher liver stiffness than non-MAFLD group (median 5.0 vs. 4.1 kPa; p=0.004). In multivariable analysis, NAFLD and MASLD were inversely associated with significant fibrosis (OR=0.418, p=0.045; OR=0.418, p=0.046, respectively). MAFLD showed a positive but non-significant association (OR=1.347, p=0.791), reflecting inclusion of dual-etiology patients (e.g., metabolic dysfunction with viral hepatitis or alcohol use) who are excluded under NAFLD/MASLD criteria. CONCLUSION: The observed inverse association between NAFLD/MASLD and significant fibrosis likely reflects the exclusion of patients with coexisting metabolic dysfunction and viral or alcohol-related liver disease. MAFLD, by contrast, retains these dual-etiology cases and captures a more heterogeneous risk profile.
OBJECTIVE: Insulin resistance (IR) and obesity are reported to impair physiological processes in the intestinal system, but associations between triglyceride glucose-body mass index (TyG-BMI), a marker of IR and obesity,...OBJECTIVE: Insulin resistance (IR) and obesity are reported to impair physiological processes in the intestinal system, but associations between triglyceride glucose-body mass index (TyG-BMI), a marker of IR and obesity, and chronic diarrhea (CD) remain unclear. Thus, this study explored such relationship to provide novel insights for CD management. PATIENTS AND METHODS: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010. Univariate and multivariable logistic regression analyses were performed on weighted data to examined potential associations between TyG-BMI and CD. Additionally, subgroup analyses and interaction tests were performed. RESULTS: This research encompassed 5354 participants, including 416 with CD. In univariate logistic regression analyses, participants with high TyG-BMI had a significantly higher risk of CD (per 10 units, OR=1.041, 95% CI: 1.027-1.055). This connection was consistent (per 10 units, OR=1.038, 95% CI: 1.019-1.057) after adjusting for all confounding covariates. The smoothed curve fitting analysis and threshold effect analysis revealed a stronger positive association between TyG-BMI and chronic diarrhea at lower TyG-BMI levels (<247.15, per 10 units: OR=1.098, 95% CI: 1.040-1.161 vs >247.15: OR=1.024, 95% CI: 1.002-1.048). Furthermore, subgroup analyses and interaction tests suggested that the correlation between TyG-BMI and CD was more pronounced in those aged 20 to 44 years (per 10 units, OR=1.072, 95% CI: 1.043-1.103) or non-Hispanic whites (per 10 units, OR=1.068, 95% CI: 1.041-1.097). CONCLUSIONS: This cross-sectional study revealed that TyG-BMI is positively associated with the risk of CD in US adults, especially in those aged 20-44 years or non-Hispanic whites. This association may provide new management strategies for CD.
Acute severe ulcerative colitis (ASUC) is a potentially life-threatening medical emergency that requires hospitalization, close multidisciplinary monitoring, and prompt, protocolized decision-making. Despite therapeutic...Acute severe ulcerative colitis (ASUC) is a potentially life-threatening medical emergency that requires hospitalization, close multidisciplinary monitoring, and prompt, protocolized decision-making. Despite therapeutic advances, ASUC remains associated with high morbidity and mortality, substantial healthcare resource utilization, and a significant risk of colectomy. This position statement from the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) provides updated, evidence-based recommendations for the diagnosis and management of ASUC in clinical practice. Its development involved a comprehensive review of the literature, including clinical trials, observational studies, and the most recent international guidelines. Diagnosis must be rapid and standardized, with particular emphasis on the systematic exclusion of infections, especially Clostridioides difficile and cytomegalovirus. Intravenous corticosteroids remain the first-line treatment, and response should be assessed at 72hours using validated criteria. In steroid-refractory patients, infliximab and cyclosporine are equally effective rescue therapies, and the choice between them should be individualized according to patient characteristics and comorbidities. JAK inhibitors are emerging as a promising option in selected cases, although current evidence is still limited. Supportive measures, including optimization of nutritional status, thromboprophylaxis, and continuous close monitoring, constitute essential components of care. Early surgical assessment is also crucial in patients who fail to respond to medical therapy or who develop complications. The management of ASUC requires a structured, interdisciplinary approach delivered in specialized centers, integrating early diagnosis, optimization of medical therapy, and timely surgical decision-making. This consensus aims to harmonize clinical practice and contribute to improving outcomes in patients with ASUC.
Pérez Pérez J, Prieto Doblado M, Pérez Martín S
… +5 more, Fernández Jiménez B, Izquierdo García A, Amores Atance M, Carlos Laguia D, Ponferrada Díaz Á
OBJECTIVE: To investigate the correlation between bowel wall thickness (BWT) measured by intestinal ultrasound (IUS) and endoscopic disease activity in patients with Crohn's disease (CD), and to compare its diagnostic pe...OBJECTIVE: To investigate the correlation between bowel wall thickness (BWT) measured by intestinal ultrasound (IUS) and endoscopic disease activity in patients with Crohn's disease (CD), and to compare its diagnostic performance with established inflammatory biomarkers. METHODS: Consecutive patients with CD who underwent both IUS and ileocolonoscopy within 7 days between March 2022 and August 2025 were included. Endoscopic disease activity was assessed using the Simple Endoscopic Score for Crohn's Disease (SES-CD). The diagnostic performance of BWT, fecal calprotectin (FC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) was evaluated at SES-CD ≥3 and ≥7. RESULTS: A total of 62 patients were included. BWT correlated moderately-to-strongly with SES-CD (r=0.626, P<0.01). At SES-CD≥3, both BWT (AUC=0.929) and FC (AUC=0.944) outperformed CRP (AUC=0.811) and ESR (AUC=0.732; all P<0.05), with no significant difference between BWT and FC (P=0.656). At SES-CD≥7, BWT (AUC=0.894), FC (AUC=0.950), and CRP (AUC=0.905) all showed superior performance to ESR (AUC=0.730; all P<0.05), and no significant differences were observed among BWT, FC, and CRP (all P>0.05). CONCLUSION: BWT measured by IUS was moderately-to-strongly correlated with SES-CD and showed diagnostic performance comparable to FC, supporting its potential role as a reliable, non-invasive marker of endoscopic disease activity for routine monitoring of CD. .