OBJECTIVE: To examine whether irritable bowel syndrome (IBS) is associated with a higher long-term risk of clinically diagnosed autonomic dysfunction. METHODS: A retrospective propensity score-matched cohort study was co...OBJECTIVE: To examine whether irritable bowel syndrome (IBS) is associated with a higher long-term risk of clinically diagnosed autonomic dysfunction. METHODS: A retrospective propensity score-matched cohort study was conducted using the Korean National Health Insurance Service-National Sample Cohort (2012-2023). IBS was defined using the ICD-10 code K58, and the index date was set as the first qualifying diagnosis. Autonomic dysfunction was defined as the first occurrence of outcome-defining ICD-10 G90 codes after the index date. Each IBS case was matched 1:2 to controls using demographic, lifestyle, metabolic, and socioeconomic covariates from the closest health screening. We estimated incidence rates, incidence rate ratios (IRRs), and hazard ratios (HRs) using Cox proportional hazards models. Sensitivity analyses considered IBS subtypes and alternative outcome code sets, including a definition excluding G90.2. RESULTS: The final cohort included 142,391 individuals with IBS and 284,782 matched controls. Mean follow-up was 4.28 and 4.29 years, respectively. The incidence rate of autonomic dysfunction was 2.20 per 1000 person-years in the IBS group and 1.09 in controls (IRR 2.02). In fully adjusted models, IBS was associated with increased risk (HR 2.16, 95% CI 1.90-2.46). Findings were similar across subgroup and sensitivity analyses. CONCLUSIONS: IBS was associated with a substantially higher long-term risk of clinically diagnosed autonomic dysfunction in this nationwide matched cohort.
OBJECTIVE: Hepatitis C virus (HCV) infection poses a global health threat with many undiagnosed cases despite advances in diagnosis and treatment. The LiverTAI project in Spain utilized electronic health records (EHRs) t...OBJECTIVE: Hepatitis C virus (HCV) infection poses a global health threat with many undiagnosed cases despite advances in diagnosis and treatment. The LiverTAI project in Spain utilized electronic health records (EHRs) to study factors associated with HCV infection, aiming to develop a predictive model for identifying unconfirmed HCV cases in the hospital setting. PATIENTS AND METHODS: Clinical data from EHRs of six hospitals in Spain were analyzed using machine learning and natural language processing through EHRead®. Patients were categorized as HCV positive, negative, or unknown. A semi-supervised learning framework allowed to incorporate labeled and unlabeled patient data extracted from clinical narratives. Propensity score matching was applied to reduce bias. Seven classification algorithms were used to predict HCV status based on 117 selected features, including demographics, risk factors, comorbidities, and clinical events. Model performance was confirmed through independent geographic validation. RESULTS: Among 2,440,358 screened patients, 44,235 were included in the training set, and 11,286 in the validation set. The Extreme Gradient Boosting model showed the best performance (AUC-ROC 0.794), followed by the logistic regression model (AUC-ROC 0.779). Key predictors included HCV risk factors (age, male sex, HIV, drug use), liver-related issues (cirrhosis, hepatocellular carcinoma), and extrahepatic conditions (neuropsychiatric, cardiovascular, immune-related disorders, cancer, and inflammatory processes). CONCLUSIONS: LiverTAI identified new patients with potential HCV infection in routine hospital EHRs, providing a proof of concept for risk-stratified opportunistic screening. The model supports more efficient in-hospital testing strategies, though further prospective validation is required to confirm generalizability and clinical utility.
OBJECTIVE: Radiation exposure during ERCP lacks validated cut-off values as quality indicators (QIs). We propose using fluoroscopy time (FT) and radiation dose (RD) cut-off points as surrogate measures of radiation expos...OBJECTIVE: Radiation exposure during ERCP lacks validated cut-off values as quality indicators (QIs). We propose using fluoroscopy time (FT) and radiation dose (RD) cut-off points as surrogate measures of radiation exposure to identify low-risk procedures. PATIENTS AND METHODS: Retrospective study of 1328 consecutive ERCPs. We constructed a composite reference standard outcome (ERCP complications and ASGE grade 3 procedures). We performed receiver operating characteristic (ROC) curves to identify optimal FT and RD thresholds for the composite outcome. Secondary objectives evaluated differences between FT and RD, across trainees and experts, and by ERCP complexity grade. RESULTS: The optimal cut-off value for FR and RD was >4.32min (AUC 0.672, 95% CI 0.65-0.7; p<0.001, Youden Index 0.3) and >32.5mGy (AUC 0.683, 95% CI 0.657-0.708; p<0.001, Youden Index 0.28), respectively; their negative predictive values were 89.2 and 88.7% respectively. CONCLUSIONS: FT and RD are reproducible QIs for ERCP that may help identify low-risk procedures and may function as new academic and standardized objectives.
OBJECTIVES: To describe the sociodemographic and clinical profile of individuals with a positive fecal immunochemical test result in the population-based colorectal cancer screening program who refused the screening colo...OBJECTIVES: To describe the sociodemographic and clinical profile of individuals with a positive fecal immunochemical test result in the population-based colorectal cancer screening program who refused the screening colonoscopy at the reference center, with no colonoscopy recorded thereafter, and to identify the reasons for such a refusal. PATIENTS AND METHODS: A descriptive, observational, cross-sectional, retrospective study including 128 participants who refused a colonoscopy at Clínic Barcelona after obtaining a positive fecal immunochemical test result through the population-based colorectal cancer screening program in 2022-2023. Data obtained from medical record reviews were described. RESULTS: Individuals who refused colonoscopy had a mean age of 60.35±5.25 years, 90.63% were Spanish nationals, and 85.16% had a high socioeconomic status. The median number of participations in the colorectal cancer screening program was 3. Most participants had no prior history of cancer (64.06%), no family history of colorectal cancer (64.84%), and no symptoms suggestive of colorectal cancer (71.09%). The main reasons for refusal were a preference to undergo colonoscopy in a center outside the screening program (21.09%) and multimorbidity, severe disease, or a condition requiring medical clearance to undergo the procedure (20.31%). CONCLUSIONS: Most people who declined the screening colonoscopy had a high socioeconomic status and one fifth preferred to undergo the procedure in an external center. The clinical profile of approximately one fifth of the subjects also corresponded to individuals with severe comorbidities, who required an individualized assessment of the risk-benefit balance of the procedure.
The hepatitis delta virus (HDV), whose infection depends on the presence of the hepatitis B virus (HBV), is associated with one of the chronic viral hepatitis that most rapidly progresses to advanced liver disease, inclu...The hepatitis delta virus (HDV), whose infection depends on the presence of the hepatitis B virus (HBV), is associated with one of the chronic viral hepatitis that most rapidly progresses to advanced liver disease, including liver cirrhosis and/or hepatocellular carcinoma. In this context, screening for HBV/HDV infection is key to the early diagnosis of hepatitis D, improving the prognosis of infected individuals through a strategy that has proven to be effective and efficient. This document reviews the epidemiology and current situation of hepatitis D in Spain, including the main barriers to its detection and diagnosis. The aim is to define recommendations for the diagnosis of hepatitis D, determined by a multidisciplinary experts panel. Regarding screening, recommendations are established in relation to: 1) settings and populations where screening is indicated; 2) optimization of HDV detection (reflex testing and point-of-care testing); and 3) the frequency for the test to be repeated. Regarding diagnosis, the following aspects are addressed: 1) how to diagnose HDV infection (double reflex test); 2) what characteristics are present in the tests currently available to determine HDV-RNA; and 3) possible solutions to overcome the current barriers in the diagnosis of the infection. These recommendations contribute to improving the prognosis for hepatitis D and, additionally, represent a step toward eliminating viral hepatitis by 2030, a goal set by the World Health Organization.
OBJECTIVE: To describe clinical features, endoscopic and histological findings, and follow up in patients with Human intestinal spirochetosis (HIS) from a Chilean academic health center. PATIENTS AND METHODS: A retrospec...OBJECTIVE: To describe clinical features, endoscopic and histological findings, and follow up in patients with Human intestinal spirochetosis (HIS) from a Chilean academic health center. PATIENTS AND METHODS: A retrospective review was conducted on HIS cases diagnosed in an academic health network in Santiago de Chile between 2018 and 2022. Clinical, endoscopic, histopathological, therapeutic, and follow-up information was collected. RESULTS: Sixteen colonic samples were identified (0.05% of all colonoscopies'biopsies). The median age was 40 years, 75% were male, and 33% had an antecedent of HIV infection. All patients reported symptoms: diarrhea (67%), abdominal pain (40%), and gastrointestinal bleeding (27%). The majority (69%) had a normal-appearing mucosa upon endoscopy, and the finding of spirochetes occurred predominantly in step biopsies (75%). Histopathological analysis revealed normal mucosal architecture in 88% of cases. Post-colonoscopy follow-up was achieved for 10 patients, 4 of whom received antibiotics with subsequent symptom resolution in the three with post-treatment follow-up. All followed-up patients who did not receive antibiotics reported symptom resolution. CONCLUSION: HIS is infrequent and predominantly colonic. Most cases are men, have a history of a sexually transmitted infection, present with gastrointestinal symptoms, and often have a normal colonoscopy. Most samples do not exhibit significant histopathological changes beyond superficial bacterial colonization.
Gil-Lasa I, Bujanda L, Sarasqueta C
… +33 more, Daca-Alvarez M, Zaffalon D, Saez de Gordoa K, Ibañez-Sanz G, Sanjuan X, Herreros-de-Tejada A, Salces I, Aguilera L, Ponce M, Pizarro Á, Barquero D, Puig I, Diez Redondo P, Martínez de Juan F, Jair Morales V, Alburquerque M, Machlab S, Ferrandez A, Peñas B, Díaz-González A, Sargatal L, Jover R, Hernandez L, Pérez Pedrosa A, Musulen E, Hernandez G, Trelles M, Ono A, Lopez Vicente J, Portillo I, Cuatrecasas M, Pellisé M, EpiT1 Consortium
OBJECTIVE: Preoperative endoscopic tattooing in patients with T1 colorectal cancer may increase lymph node retrieval. The aim of our study was to evaluate the use of preoperative tattooing in surgically treated T1 colore...OBJECTIVE: Preoperative endoscopic tattooing in patients with T1 colorectal cancer may increase lymph node retrieval. The aim of our study was to evaluate the use of preoperative tattooing in surgically treated T1 colorectal cancer and to identify its impact on lymph node recovery. PATIENTS AND METHODS: We included all cases of pT1 colorectal cancer treated with oncologic surgery from a retrospective, multicenter Spanish cohort study (EpiT1 Consortium). The use of preoperative tattooing and its influence on lymph node recovery outcomes were analyzed. RESULTS: A total of 1700 patients with pT1 colon cancer undergoing oncologic resection were included. Of these, 63.6% (1082/1700) had received preoperative tattooing. The median number of nodes retrieved was 14 in both groups (p=0.12). The rate of adequate lymph node recovery (≥12 nodes) was similar between tattooed and non-tattooed patients (60.8% vs. 61.9%, p=0.67), with no differences depending on tumor location. There were also no differences in the rate of positive nodes between tattooed and non-tattooed patients (10.4% vs. 9.5%, p=0.61) nor by tumor location. CONCLUSION: The use of endoscopic tattooing does not appear to increase the total lymph node retrieval or the detection of positive lymph nodes during surgery.
BACKGROUND: Ulcerative colitis (UC) remains challenging to diagnose, monitor, and treat due to heterogeneous disease presentation and lack of reliable non-invasive markers. Current diagnostic tools, including endoscopy a...BACKGROUND: Ulcerative colitis (UC) remains challenging to diagnose, monitor, and treat due to heterogeneous disease presentation and lack of reliable non-invasive markers. Current diagnostic tools, including endoscopy and routine laboratory tests, are limited by invasiveness, cost, and low sensitivity. AIM: This review evaluates emerging biomarkers and multi-omics strategies in UC, highlighting their potential role in disease diagnosis, prognosis, and therapeutic response prediction. METHODS: A comprehensive literature analysis was conducted, focusing on faecal, serological, genetic, epigenetic, microbial, and metabolite-based biomarkers, as well as recent advances in transcriptomics, proteomics, and metabolomics. Integration with machine learning approaches was also assessed for their clinical applicability. RESULTS: Faecal calprotectin and lactoferrin remain reliable non-invasive markers for mucosal inflammation, while serological markers such as CRP and ESR show limited specificity. Genetic variants (IL23R, NOD2) and epigenetic regulators, particularly microRNAs, demonstrate potential for disease stratification. Dysbiosis and altered microbial metabolites further correlate with disease severity and treatment response. Multi-omics integration offers a systems-level view of UC, enabling biomarker panels that improve diagnostic precision and predict therapeutic outcomes. Machine learning tools enhance biomarker-based models, but clinical translation is constrained by variability, validation gaps, and regulatory hurdles. CONCLUSION: Emerging biomarkers, especially when integrated across omics platforms and supported by artificial intelligence, provide promising avenues for precision medicine in UC. However, standardisation, external validation, and regulatory qualification remain essential for their successful clinical implementation.
Gallardo Arriero V, Calvo Moya M, de Lucas Téllez de Meneses R
… +6 more, González Partida I, Botella Mateu B, Matallana Royo V, Bella Castillo P, González Rodríguez M, Vera Mendoza M
OBJECTIVE: Inflammatory Bowel Disease (IBD) negatively impacts patients' quality of life. This study aims to evaluate the psychological impact and quality of life in patients with IBD. PATIENTS AND METHODS: A cross-secti...OBJECTIVE: Inflammatory Bowel Disease (IBD) negatively impacts patients' quality of life. This study aims to evaluate the psychological impact and quality of life in patients with IBD. PATIENTS AND METHODS: A cross-sectional study was conducted involving IBD patients treated at HUPHM. Validated questionnaires were used to assess patients' mental health. Clinical activity was evaluated using the Harvey-Bradshaw Index and the Partial Mayo Score. Clinical data were also collected. RESULTS: A total of 272 patients were included. Seventy-eight percent experienced some degree of psychological impairment, and 68% reported a negative impact on their quality of life. Anxiety showed a median score of 11 (IQR: 10-13) and stress a median of 24 (IQR: 16-31), representing the most frequent psychological disturbances. Quality of life and fatigue results reflected significant impairment, with fatigue being more prevalent in women (52%, p=0.027) and associated with higher stress levels (p=0.0013) and poorer quality of life (p=0.014). Patients with Crohn's disease exhibited worse quality of life compared to those with ulcerative colitis (median score: 46 [IQR: 34-55] vs. 49 [IQR: 41-55], p=0.04). In the occupational domain, patients with work disability showed greater psychological impairment and poorer quality of life (p=0.001). Finally, patients without prior surgery demonstrated better quality of life (p=0.032). CONCLUSIONS: The high prevalence of psychological comorbidities in IBD highlights the need for approaches that incorporate psychological assessment and intervention.
OBJECTIVES: To evaluate temporal trends and regional differences in the use of advanced therapies for ulcerative colitis (UC) within Brazil's public healthcare system. PATIENTS AND METHODS: Retrospective population-based...OBJECTIVES: To evaluate temporal trends and regional differences in the use of advanced therapies for ulcerative colitis (UC) within Brazil's public healthcare system. PATIENTS AND METHODS: Retrospective population-based study using Brazilian Department of Informatics of the Unified Health System (DATASUS) data (2019-2023). Patients with an ICD-10 code for UC were included. Monthly dispensing rates of infliximab, vedolizumab, and tofacitinib were analyzed. RESULTS: By 2023, 195,807 UC patients were identified. Administrative prevalence increased from 26.37 to 62.47 per 100,000 inhabitants. Nationwide use of advanced therapies rose significantly. Vedolizumab showed the highest Annual Average Percent Change (AAPC) (+8.5%), followed by tofacitinib (+4.8%) and infliximab (+1.02%). The Southeast demonstrated the greatest growth, whereas the Northeast showed a significant decline across all therapies. CONCLUSION: UC prevalence increased markedly in Brazil, with persistent regional disparities in advanced therapy use.
Gimeno-García AZ, Hernández A, Hernández Negrin D
… +12 more, Rodríguez E, Lorenzo G, Mon J, Romero R, Jiménez A, Felipe V, Adrián Z, de la Barreda R, Ortega J, Cedrés Y, Hernández-Guerra M, Nicolás-Pérez D
BACKGROUND: Compared with conventional colonoscopy, computer-assisted adenoma detection (CADe) colonoscopy and Endocuff-Vision (EV) have been shown to increase the adenoma detection rate (ADR). However, the evidence for...BACKGROUND: Compared with conventional colonoscopy, computer-assisted adenoma detection (CADe) colonoscopy and Endocuff-Vision (EV) have been shown to increase the adenoma detection rate (ADR). However, the evidence for whether their combination further increases the ADR compared with that of EV alone is limited. The aim was to compare the combination of CADe and EV, with EV alone. METHODS: In all, 696 patients were randomized 1:1 to receive either CADe (ENDO-AID [OIP-1]) plus EV or EV alone at a tertiary care hospital. The primary outcome was the ADR. The secondary outcomes included the advanced ADR and the number of adenomas per colonoscopy (APC). Both intention-to-treat (ITT) and per-protocol (PP) analyses were conducted for the primary outcome. RESULTS: In the ITT analysis, the ADR was 54.6% and 51.1% in the combination and EV groups, respectively (OR 1.15, 95% CI (0.85-1.55)). In the PP analysis, the ADRs were 58.7% and 56.6%, respectively (OR 1.09, 95% CI (0.79-1.52)), for the combination and EV groups. The ADR in the proximal colon was significantly greater in the combination group than in the EV group (39.6% vs. 30%; P=0.015). The APC value was significantly greater in the combination group than in the EV group (mean: 1.7, SD: 2.34 vs. mean: 1.31, SD: 1.92; P=0.029), which was primarily due to increased detection of flat diminutive adenomas. CONCLUSIONS: Compared with EV alone, colonoscopy assisted by both ENDO-AID (OIP-1) and EV does not significantly increase the ADR. However, this combination may be beneficial for the detection of proximal and diminutive flat adenomas (NCT05141773).