Gastroenterología y Hepatología (English Edition)最新文献

{"title":"Predictors of response to a dietary intervention in patients with irritable bowel syndrome","authors":"Facundo Pereyra ,&nbsp;Francisco Schlottmann ,&nbsp;Carolina Salvatori ,&nbsp;Sofía Barbagelata ,&nbsp;Leandro Steinberg ,&nbsp;Lisandro Pereyra","doi":"10.1016/j.gastre.2025.502231","DOIUrl":"10.1016/j.gastre.2025.502231","url":null,"abstract":"<div><h3>Background</h3><div>Different diets have emerged as potential therapeutic options for patients with irritable bowel syndrome (IBS).</div></div><div><h3>Objective</h3><div>To identify predictors of improvement after a low-FODMAP, low-starch and low-sucrose diet among patients with IBS.</div></div><div><h3>Methods</h3><div>We performed a descriptive cross-sectional study including patients with IBS according to Rome IV criteria undertaking a social-media based program with a two-week dietary intervention. Patients completed an online survey before and after the intervention including the presence of intestinal and extra-intestinal symptoms, the IBS-SSS (irritable bowel syndrome symptoms severity scale) and the PHQ-9 (patient health questionnaire-9). Clinical improvement was defined as a decrease of at least 50% in IBS-SSS post dietary intervention. Variables associated with symptomatic response were identified with logistic regression analysis. A clinical score to predict response was created and tested with a with a receiver operating characteristic (ROC) curve analysis.</div></div><div><h3>Results</h3><div>A total of 3583 patients with IBS were included. Mean IBS-SSS before and after dietary intervention was 295.5<!--> <!-->±<!--> <!-->52.32 and 240<!--> <!-->±<!--> <!-->48.66, respectively (<em>p</em> <!-->=<!--> <!-->0.01); 1178 (32.8%) patients showed clinical improvement. A mean basal IBS-SSS &gt;400 (OR 3.04), chronic headache (OR 1.96), and chronic fatigue (OR 1.81) were significantly associated with symptomatic response. Patients with arthralgia (OR 0.41) and/or fibromyalgia (OR 0.33) were less likely to improve. Each variable received the following individuals scores: IBS-SSS &gt;400: +2, chronic headache: +1.5, chronic fatigue: +1, arthralgia: −1, and fibromyalgia: −1. The ROC curve analysis of the proposed score showed an area under the curve of 0.72 (95% CI 0.69–0.76). A score ≥3 had a sensitivity of 72.64% and specificity of 60.56% for predicting symptomatic improvement.</div></div><div><h3>Conclusions</h3><div>There are clinical variables that could serve as reliable predictors of response to a low-FODMAP, low-sucrose, low-starch diet among patients with IBS. Further research is needed to understand the link between the presence of extra-intestinal symptoms and clinical improvement after dietary interventions for IBS.</div></div>","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 3","pages":"Article 502231"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why your doctor is not an algorithm: Exploring logical principles of different clinical inference methods using liver transplantation as a model","authors":"Mario Romero-Cristóbal ,&nbsp;Magdalena Salcedo Plaza ,&nbsp;Rafael Bañares","doi":"10.1016/j.gastre.2025.502215","DOIUrl":"10.1016/j.gastre.2025.502215","url":null,"abstract":"<div><div>The development of machine learning (ML) tools in many different medical settings is largely increasing. However, the use of the resulting algorithms in daily medical practice is still an unsolved challenge. We propose an epistemological approach (i.e., based on logical principles) to the application of computational tools in clinical practice. We rely on the classification of scientific inference into deductive, inductive, and abductive comparing the characteristics of ML tools with those derived from evidence-based medicine [EBM] and experience-based medicine, as paradigms of well-known methods for generation of knowledge. While we illustrate our arguments using liver transplantation as an example, this approach can be applied to other aspects of the specialty. Regarding EBM, it generates general knowledge that clinicians apply deductively, but the certainty of its conclusions is not guaranteed. In contrast, automatic algorithms primarily rely on inductive reasoning. Their design enables the integration of vast datasets and mitigates the emotional biases inherent in human induction. However, its poor capacity for abductive inference (a logical mechanism inherent to human clinical experience) constrains its performance in clinical settings characterized by uncertainty, where data are heterogeneous, results are highly influenced by context, or where prognostic factors can change rapidly.</div></div>","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 3","pages":"Article 502215"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and economic value of bulevirtide in the treatment of chronic hepatitis D","authors":"María Buti ,&nbsp;Jose Luis Calleja ,&nbsp;Miguel Ángel Rodríguez ,&nbsp;Raquel Domínguez-Hernández ,&nbsp;Helena Cantero ,&nbsp;Nataly Espinoza-Cámac ,&nbsp;Miguel Ángel Casado","doi":"10.1016/j.gastre.2025.502241","DOIUrl":"10.1016/j.gastre.2025.502241","url":null,"abstract":"<div><h3>Background/Aims</h3><div>Bulevirtide (Hepcludex®) is the first drug approved for the treatment of chronic hepatitis D (CHD), unlike the current off-label treatment (PEG-IFN-α), limited in clinical practice and associated with post-treatment relapses. In a hypothetical cohort of CHD patients in Spain, the study aim was to compare the efficiency of bulevirtide with PEG-IFN-α in terms of clinical events avoided and associated cost savings.</div></div><div><h3>Methods</h3><div>A validated economic model reflecting the natural history of the disease was used to project lifetime liver complications and costs for two hypothetical cohorts treated with bulevirtide or PEG-IFN-α. The model considered progression to complications such as decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), liver transplantation (LT), and death. The efficacy rates used at 24 and 48 weeks were defined as the combined response rate for bulevirtide and undetectable HDV RNA to PEG-IFN-α. The numbers of clinic events and associated costs were evaluated from the perspective of the National Healthcare System.</div></div><div><h3>Results</h3><div>In a hypothetical cohort of 3882 patients, bulevirtide reduced the numbers of complications events in comparison to PEG-IFN-α (152 DCC, 113 HCC, 11 LT, and 321 deaths over a lifetime). This was associated with a reduction of event-related costs of €11,837,044 (DCC €1,138,059; HCC €1,503,583; LT €7,834,291; and death €1,361,111).</div></div><div><h3>Conclusion</h3><div>In patients with CHD, bulevirtide could prevent a significant number of clinical events compared to PEG-IFN-α and contribute to cost savings through these reduction in liver complications. Further testing for hepatitis D virus is needed so that more patients can benefit from bulevirtide.</div></div>","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 3","pages":"Article 502241"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the transition from intravenous to subcutaneous vedolizumab in patients with inflammatory bowel disease","authors":"Carmen Amor Costa ,&nbsp;Cristina Suárez Ferrer ,&nbsp;Laura García Ramírez ,&nbsp;Eduardo Martín-Arranz ,&nbsp;Joaquín Poza Cordón ,&nbsp;José Luis Rueda García ,&nbsp;María Sánchez Azofra ,&nbsp;Irene González Diaz ,&nbsp;Clara Amiama Roig ,&nbsp;María Dolores Martín-Arranz","doi":"10.1016/j.gastre.2025.502201","DOIUrl":"10.1016/j.gastre.2025.502201","url":null,"abstract":"<div><h3>Aims</h3><div>The aim of the study is to evaluate the clinical and biochemical response of inflammatory bowel disease (IBD) patients treated with vedolizumab, 16 weeks after transitioning from intravenous (iv) to subcutaneous (sc).</div></div><div><h3>Methods</h3><div>An observational, prospective, single-center cohort study was performed. Patients with IBD and maintenance treatment with vedolizumab, stable for at least 4 mo, were offered to switch to sc formulation. At the same time of treatment administration a blood test was performed, with vedolizumab levels and fecal calprotectin.</div></div><div><h3>Results</h3><div>Forty-three patients were included, 12 of them (27.9%) chose to transition to sc formulation. All included patients remained in remission during follow-up. At week 16 (w16), no significant differences were found in terms of calprotectin levels in patients on iv treatment (mean 146.6 ± SD 45.9) vs. sc (159.26 ± 53.9) (p 0.9). Vedolizumab serum levels at w16 were higher in the sc group (22364.3 ± 5141.6) vs. iv (11425.9 ± 1514.2) (p 0.009). At w16, 9 (75%) of the patients in the SC group were highly satisfied with the medication and 11 (91.7%) considered it easy to administer. 4 patients (12.9%) in the iv group and 2 (16.6%) in the sc group presented mild adverse effects. The 2 cases (100%) of the sc group the adverse event was local inflammation at the injection site.</div></div><div><h3>Conclusion</h3><div>In our experience, vedolizumab sc is a convenient alternative to iv administration. Vedolizumab serum levels in patients who transitioned to sc were higher than iv formulation.</div></div>","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 3","pages":"Article 502201"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of small bowel capsule endoscopy in patients with Crohn’s disease","authors":"Miquel Marquès-Camí ,&nbsp;Nuria Torres-Monclús ,&nbsp;Lucía Madero ,&nbsp;Eduard Brunet-Mas ,&nbsp;Margalida Calafat ,&nbsp;Iria Baston-Rey ,&nbsp;Grupo Joven de GETECCU","doi":"10.1016/j.gastre.2025.502294","DOIUrl":"10.1016/j.gastre.2025.502294","url":null,"abstract":"","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 3","pages":"Article 502294"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The figure of the Advanced Practice Nursing professional in Digestive Endoscopy Units","authors":"Gema Cámara Viudez","doi":"10.1016/j.gastre.2025.502260","DOIUrl":"10.1016/j.gastre.2025.502260","url":null,"abstract":"","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 3","pages":"Article 502260"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes of endoscopic ultrasound-guided pancreatic duct interventions: A single tertiary center experience","authors":"Joan B. Gornals ,&nbsp;Albert Sumalla-Garcia ,&nbsp;Daniel Luna-Rodriguez ,&nbsp;Maria Puigcerver-Mas ,&nbsp;Julio G. Velasquez-Rodriguez ,&nbsp;Silvia Salord ,&nbsp;Sandra Maisterra ,&nbsp;Juli Busquets","doi":"10.1016/j.gastre.2024.502221","DOIUrl":"10.1016/j.gastre.2024.502221","url":null,"abstract":"<div><h3>Background and aims</h3><div>Endoscopic ultrasound-guided pancreatic duct intervention (EUS-PDI) is one of the most technically challenging procedures. There remains a knowledge gap due to its rarity. The aim is to report the accumulated EUS-PDI experience in a tertiary center.</div></div><div><h3>Methods</h3><div>Single tertiary center, retrospective cohort study of prospectively collected data during the study period, from January 2013 to June 2021.</div></div><div><h3>Results</h3><div>In total, 14 patients (85% male; mean age, 61 years, range 37–81) and 25 EUS-PDI procedures for unsuccessful endoscopic retrograde pancreatography (ERP) were included. Principal etiology was chronic pancreatitis with pancreatic duct obstruction (78%). EUS-guided assisted (colorant and/or guidewire, <em>rendezvous</em>) ERP was performed in 14/25 (56%); and transmural drainage in 11 procedures, including pancreaticogastrosmy in 9/25 (36%) and pancreaticoduodenostomy in 2/25 (8%). Overall technical and clinical success was 78.5% (11/14). Three (21%) patients required a second procedure with success in all cases. Two failed cases required surgery. Three (21%) adverse events (AEs) were noted (fever, <em>n</em> <!-->=<!--> <!-->1; perforation, <em>n</em> <!-->=<!--> <!-->1; pancreatitis, <em>n</em> <!-->=<!--> <!-->1). Patients underwent a median of 58 months (range 24–108) follow-up procedures for re-stenting. Spontaneous stent migration was detected in 50% of cases.</div></div><div><h3>Conclusions</h3><div>EUS-PDI is an effective salvage therapy for unsuccessful ERP, although 21% of patients may still experience AEs. In case of EUS-guided <em>rendezvous</em> failure, it can cross over to a transmural drainage.</div></div>","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 2","pages":"Article 502221"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Legal aspects related to the use of artificial intelligence in medical science","authors":"Carlos Alventosa Mateu ,&nbsp;Robert Giner Alventosa ,&nbsp;María Lorena Tobar Peñaherrera","doi":"10.1016/j.gastre.2024.502227","DOIUrl":"10.1016/j.gastre.2024.502227","url":null,"abstract":"","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 2","pages":"Article 502227"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The phenotypic landscape of primary biliary cholangitis and autoimmune hepatitis variants","authors":"Francesca Bolis ,&nbsp;Giorgio Cazzaniga ,&nbsp;Fabio Pagni ,&nbsp;Pietro Invernizzi ,&nbsp;Marco Carbone ,&nbsp;Alessio Gerussi","doi":"10.1016/j.gastre.2024.502225","DOIUrl":"10.1016/j.gastre.2024.502225","url":null,"abstract":"<div><div>Autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) stand as distinct diseases, yet occasionally intertwine with overlapping features, posing diagnostic and management challenges. This recognition traces back to the 1970s, with initial case reports highlighting this complexity.</div><div>Diagnostic scoring systems like IAIHG and simplified criteria for AIH were introduced but are inherently limited in diagnosing variant syndromes. The so-called Paris criteria offer a diagnostic framework with high sensitivity and specificity for variant syndromes, although disagreements among international guidelines persist.</div><div>Histological findings in AIH and PBC may exhibit overlapping features, rendering histology alone inadequate for a definitive diagnosis. Autoantibody profiles could be helpful, but similarly cannot be considered alone to reach a solid and consistent evaluation.</div><div>Treatment strategies vary based on the predominant features observed.</div><div>Individuals with overlapping characteristics favoring AIH ideally benefit from corticosteroids, while patients primarily manifesting PBC features should initially receive treatment with choleretic drugs like ursodeoxycholic acid (UDCA).</div></div>","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 2","pages":"Article 502225"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence for dysplasia detection during surveillance colonoscopy in patients with ulcerative colitis: A cross-sectional, non-inferiority, diagnostic test comparison study","authors":"Antonio López-Serrano ,&nbsp;Alba Voces ,&nbsp;José Ramón Lorente ,&nbsp;Francisco José Santonja ,&nbsp;Angela Algarra ,&nbsp;Patricia Latorre ,&nbsp;Pablo del Pozo ,&nbsp;José María Paredes","doi":"10.1016/j.gastre.2024.552210","DOIUrl":"10.1016/j.gastre.2024.552210","url":null,"abstract":"<div><h3>Background and study aim</h3><div>High-definition virtual chromoendoscopy, along with targeted biopsies, is recommended for dysplasia surveillance in ulcerative colitis patients at risk for colorectal cancer. Computer-aided detection (CADe) systems aim to improve colonic adenoma detection, however their efficacy in detecting polyps and adenomas in this context remains unclear. This study evaluates the CADe Discovery™ system's effectiveness in detecting colonic dysplasia in ulcerative colitis patients at risk for colorectal cancer.</div></div><div><h3>Patients and methods</h3><div>A prospective cross-sectional, non-inferiority, diagnostic test comparison study was conducted on ulcerative colitis patients undergoing colorectal cancer surveillance colonoscopy between January 2021 and April 2021. Patients underwent virtual chromoendoscopy (VCE) with iSCAN 1 and 3 with optical enhancement. One endoscopist, blinded to CADe Discovery™ system results, examined colon sections, while a second endoscopist concurrently reviewed CADe images. Suspicious areas detected by both techniques underwent resection. Proportions of dysplastic lesions and patients with dysplasia detected by VCE or CADe were calculated.</div></div><div><h3>Results</h3><div>Fifty-two patients were included, and 48 lesions analyzed. VCE and CADe each detected 9 cases of dysplasia (21.4% and 20.0%, respectively; <em>p</em> <!-->=<!--> <!-->0.629) in 8 patients and 7 patients (15.4% vs. 13.5%, respectively; <em>p</em> <!-->=<!--> <!-->0.713). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for dysplasia detection using VCE or CADe were 90% and 90%, 13% and 5%, 21% and 2%, 83% and 67%, and 29.2% and 22.9%, respectively.</div></div><div><h3>Conclusions</h3><div>The CADe Discovery™ system shows similar diagnostic performance to VCE with iSCAN in detecting colonic dysplasia in ulcerative colitis patients at risk for colorectal cancer.</div></div>","PeriodicalId":100569,"journal":{"name":"Gastroenterología y Hepatología (English Edition)","volume":"48 2","pages":"Article 552210"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143395013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}