Clinics and research in hepatology and gastroenterology最新文献

{"title":"Suboptimal Use of Inpatient Palliative Care Consultation in Alcoholic Hepatitis Hospitalizations May Lead to Higher Readmissions.","authors":"Ali Jaan, Syeda Shahnoor, Abdul Moiz Khan, Umer Farooq, Qurat Ul Ain Muhammad, Kamran Qureshi","doi":"10.1016/j.clinre.2025.102554","DOIUrl":"https://doi.org/10.1016/j.clinre.2025.102554","url":null,"abstract":"<p><strong>Aims: </strong>Alcoholic hepatitis (AH), a clinical syndrome precipitated by chronic alcohol consumption, constitutes about 0.9% of total admissions in the United States. It presents a wide severity spectrum, from mild disease to severe cases associated with high mortality. Palliative care (PC) is a specialized medical approach focused on enhancing the quality of life for patients with serious or life-threatening illnesses. This study aims to investigate the national trends of palliative care (PC) utilization in AH hospitalizations and its impact on resource utilization.</p><p><strong>Methods: </strong>We identified adult AH hospitalizations from the Nationwide Readmission Database, further categorized based on PC utilization. Multivariate regression analysis was employed to evaluate the impact of PC on the 90-day readmission rate.</p><p><strong>Results: </strong>Among the 68,062 AH patients, 3,784 (5.56%) utilized PC services. PC utilization in AH hospitalizations was associated with a significantly lower 90-day readmission rate (adjusted hazard ratio (aHR) 0.45, P=0.02). 90-day readmission benefits with PC were persistent on analysis of severe (North American Consortium for the Study of End-Stage Liver Disease-Acute-on-Chronic Liver Failure [NACSELD-ACLF] score ≥1) AH population as well (aHR 0.46, P<0.01). Trend analysis of PC utilization in AH hospitalizations revealed a non-significant change from 5.39% in 2016 to 5.69% in 2020 (P=0.07).</p><p><strong>Conclusion: </strong>This study shows that PC utilization in AH hospitalizations reduces readmissions and healthcare burden. We advocate integrating PC into the comprehensive management of AH. Further research is needed to determine the optimal timing and components of PC interventions for AH patients.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102554"},"PeriodicalIF":2.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating transcriptome and metabolomics analyses of hepatocellular carcinoma to discover novel biomarkers and drug targets","authors":"Ting Yang,&nbsp;Si-Yu Wang","doi":"10.1016/j.clinre.2025.102546","DOIUrl":"10.1016/j.clinre.2025.102546","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) ranks sixth in incidence and third in mortality among all cancers. Chronic infection by hepatitis B and C viruses are the predominant risk factors for HCC, but other factors related to metabolic disorders including diabetes and obesity are also involved.</div></div><div><h3>Methods</h3><div>Ten male HCC patients with chronic HBV infection were included in this study. Primary HCC tissues were obtained from all study participants following liver resection. Normal tissues that were simultaneously collected served as the controls and were defined as tissue at least 5 cm from the tumor edge. Tissues were subjected to untargeted metabolomics and transcriptome analyses.</div></div><div><h3>Results</h3><div>We identified 31 and 41 differentially expressed metabolites (DEMs) in positive and negative ion modes, respectively. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that 15 DEMs were enriched in ABC transporters, nine in purine metabolism, eight in central carbon metabolism in cancer, and seven in biosynthesis of amino acids. Regarding the transcriptome analysis, 1,224 significantly up-regulated and 887 down-regulated RNAs were found. KEGG pathway analysis revealed that the most significantly enriched pathways were metabolic pathways. Integrated analysis showed seven pathways that were highly activated in HCC tissues including PI3K/Akt, ABC transporters, caffeine metabolism, carbon metabolism, biosynthesis of amino acids, arginine biosynthesis, alanine, aspartate, and glutamate metabolism.</div></div><div><h3>Conclusion</h3><div>Some DEMs could be biomarkers or therapeutic targets for HCC. Moreover, we found that MAGEB2 was significantly elevated in HCC tissues for the first time, and its association with HCC needs to be explored by functional studies.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 4","pages":"Article 102546"},"PeriodicalIF":2.6,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143403519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the learning curve of intestinal ultrasound in inflammatory bowel disease: A comparative study between novice, regular and expert","authors":"Léo Bove ,&nbsp;Jérémy Meyer ,&nbsp;Michael Collins ,&nbsp;Eric Frampas ,&nbsp;Arnaud Bourreille ,&nbsp;Catherine Le Berre","doi":"10.1016/j.clinre.2025.102548","DOIUrl":"10.1016/j.clinre.2025.102548","url":null,"abstract":"<div><h3>Background</h3><div>Intestinal ultrasound (IUS) has emerged as a valuable tool for monitoring inflammatory bowel disease (IBD), but its reliability depends on the technical skills of the operator.</div></div><div><h3>Aims</h3><div>This study aimed to assess the IUS learning curve of a novice briefly trained to get him familiarized with the ultrasound machine and normal/abnormal IUS images, and a gastroenterologist with formal general ultrasound training and regular IUS experience (&gt; 200 exams), using an expert radiologist as the gold standard.</div></div><div><h3>Methods</h3><div>The ULTRA-IBD study was a single-center, prospective study involving 50 consecutive IBD patients. Three successive IUS examinations were performed on each patient by the 3 operators. Inter-rater agreement on IUS disease activity was calculated using the intraclass correlation coefficient.</div></div><div><h3>Results</h3><div>The experienced gastroenterologist demonstrated consistently good agreement with the radiologist throughout the study, while the novice failed to go beyond poor agreement after 50 examinations, although a faster learning curve was observed in patients without history of IBD surgery.</div></div><div><h3>Conclusion</h3><div>These findings highlight the difficulty of the technical performance of IUS rather than its interpretation. Comprehensive ultrasound training beforehand and between 50 and 200 examinations of experience are necessary before embarking on IUS.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 3","pages":"Article 102548"},"PeriodicalIF":2.6,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative wide-field superficial en bloc R0 resection of a unique colorectal high-grade dysplasia: \"horizontal full-thickness resection\"","authors":"Vincent Zimmer","doi":"10.1016/j.clinre.2025.102552","DOIUrl":"10.1016/j.clinre.2025.102552","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 3","pages":"Article 102552"},"PeriodicalIF":2.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Class of MicroRNAs as Diagnostic Biomarkers and Therapeutic Strategies in Non-Alcoholic Fatty Liver Disease.","authors":"Faraz Mahdizadeh, Pouria Sobhi, Shokofeh Banaei","doi":"10.1016/j.clinre.2025.102547","DOIUrl":"https://doi.org/10.1016/j.clinre.2025.102547","url":null,"abstract":"<p><p>MicroRNAs (miRNAs), small and noncoding RNAs that regulate gene expression through hybridization to messenger RNA, play a crucial role in the prevention or progression of non-alcoholic fatty liver disease (NAFLD). There is an urgent demand for the improvement of diagnostic tools and effective pharmacotherapies for the treatment of NAFLD, which can advance to cirrhosis and liver cancer. MiRNAs act as regulatory factors and noninvasive diagnostic agents for NAFLD, enabling the staging of the disorder, prognosis, and identification of pharmaco-therapeutic targets. NAFLD causes alterations in the expression patterns of hepatocyte miRNAs, with some specific miRNAs related to the upgrade from NAFLD to non-alcoholic steatohepatitis (NASH). These miRNAs can activate certain signaling cascade and exacerbate or improve NAFLD, additionally, act as hepatocellular signals or second messengers that transmit information between the liver and other systems. This study provides a comprehensive review of the most important miRNAs and their involvement in the pathophysiology and cellular signaling pathways related to NAFLD.</p>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":" ","pages":"102547"},"PeriodicalIF":2.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of portal hypertension in patients with hepatocellular carcinoma","authors":"François Faitot","doi":"10.1016/j.clinre.2025.102551","DOIUrl":"10.1016/j.clinre.2025.102551","url":null,"abstract":"","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 3","pages":"Article 102551"},"PeriodicalIF":2.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of incidental hepatocellular carcinoma in liver transplantation: A growing concern","authors":"Alfredo Caturano ,&nbsp;Enes Erul","doi":"10.1016/j.clinre.2025.102550","DOIUrl":"10.1016/j.clinre.2025.102550","url":null,"abstract":"<div><div>Incidental hepatocellular carcinoma (iHCC) is a growing concern in liver transplantation, where tumors are unexpectedly discovered during histopathological examination of explanted livers. The prevalence of iHCC varies widely, with reported rates between 1.6 % and 40 %, influenced by differences in diagnostic practices and patient populations. Recent studies, including that by Kerstens et al., highlight the clinical significance of iHCC, revealing its association with alcohol-related liver disease and the limitations of current surveillance strategies. Conventional imaging techniques, such as ultrasound, often fail to detect small tumors, leading to delayed diagnosis. Advanced imaging modalities, including MRI, and emerging biomarkers, such as des-γ-carboxy prothrombin (DCP), are improving detection, but further research is needed to refine diagnostic protocols. The growing recognition of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) complicates the surveillance of iHCC, particularly as patients with MASLD often present with subtle or atypical clinical profiles. Personalized surveillance, incorporating advanced technologies like liquid biopsy and artificial intelligence, holds promise for improving early detection. Additionally, individualized post-transplant management strategies are crucial, given the lower survival rates observed in iHCC patients. As our understanding of iHCC evolves, a shift toward more tailored approaches in diagnosis, surveillance, and treatment is essential to improve outcomes and reduce the burden of incidental HCC in liver transplantation.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 3","pages":"Article 102550"},"PeriodicalIF":2.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fecal calprotectin, intestinal ultrasound, and their combination for the diagnosis of inflammatory bowel disease","authors":"Serge Dubian ,&nbsp;Clara Yzet ,&nbsp;Franck Brazier ,&nbsp;Thierry Yzet ,&nbsp;Vincent Hautefeuille ,&nbsp;Catherine Decrombecque ,&nbsp;Quentin Bocquillon ,&nbsp;Nicolas Richard ,&nbsp;Anthony Buisson ,&nbsp;Jonathan Meynier ,&nbsp;Mathurin Fumery","doi":"10.1016/j.clinre.2025.102549","DOIUrl":"10.1016/j.clinre.2025.102549","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to evaluate the diagnostic accuracy of fecal calprotectin (FC) and intestinal ultrasound (IUS), independently and in combination, as screening tools for adults with suspected IBD to reduce the number of unnecessary endoscopic procedures.</div></div><div><h3>Methods</h3><div>We conducted a retrospective monocentric study that included consecutive adult patients with (i) ileocolonoscopy for suspected IBD between January 2021 and June 2023 who had either (ii) IUS and/or (iii) a FC test within 6 weeks. Bowel wall thickness (BWT) and the color Doppler signal (CDS) were evaluated for all segments. The presence of lymphadenopathy, loss of stratification, stricture, and fistula were also recorded.</div></div><div><h3>Results</h3><div>In total, 119 patients with a median age of 32 years (IQR, 24.0–41.0) were included. The most common symptoms were abdominal pain (<em>n</em> = 88, 75 %) and chronic diarrhea (<em>n</em> = 89, 75 %). Among the 119 patients, 74 (62 %) had IUS, 101 (82 %) had a FC test, and 56 (47 %) had both. Forty patients (34 %) had a diagnosis of IBD, including 31 (26 %) with CD and 9 (8 %) with UC. By ROC curve analysis, the best threshold of FC to diagnose IBD was 117 ug/g (Se 97 %, Sp 73 %, PPV 67 %, NPV 98 %, AUC 0.88, 95 %CI [0.81; 0.94], <em>p</em> = 0.006). Using this threshold, only 3 % of patients were misclassified as non-IBD. Screening by measuring FC levels would result in a 48 % reduction in the number of adults requiring endoscopy. Abnomal IUS was significantly associated with a diagnosis of IBD (OR 5.6, 95 %IC [2.1;16.2], <em>P</em> = 0.0008). The association of a BWT&gt;3 mm and a positive CDS was associated with a Se, Sp, PPV, and NPV of 48 %, 100 %, 100 %, and 75 %, respectively, but 52 % of patients were misclassified as non-IBD. The combination of a BWT&gt;3 mm, CDS, and FC&gt;117 ug/g had a Se, Sp, PPV, and NPV of 44 %, 100 %, 100 %, and 69 %, respectively. For patients with a normal IUS and FC&lt;117 ug/g, 4 % were misclassified as non-IBD.</div></div><div><h3>Conclusions</h3><div>The combination of FC and IUS is a useful screening strategy to identify patients who truly require endoscopy for suspected IBD. Calprotectin is a highly effective test for ruling out IBD. Conversely, relying solely on IUS lacks the discriminative power to safely rule out IBD. However, it shows a high PPV and is a potent tool for diagnosing IBD.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 3","pages":"Article 102549"},"PeriodicalIF":2.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143254890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary hepatocellular carcinosarcoma: A case series and literature review","authors":"Haodong Qiao ,&nbsp;Huaibin Guo ,&nbsp;Ze Liang ,&nbsp;Lin Kang ,&nbsp;Wanxing Zhang","doi":"10.1016/j.clinre.2024.102520","DOIUrl":"10.1016/j.clinre.2024.102520","url":null,"abstract":"<div><h3>Introduction</h3><div>Hepatocellular carcinosarcoma (HCS) is a rare and aggressive liver tumor with limited clinical evidence due to its infrequency. This case series aimed to enrich the existing knowledge on the diagnosis and clinical management of HCS.</div></div><div><h3>Methods</h3><div>Four patients with HCS were evaluated, focusing on their symptoms, diagnoses, treatments, and outcomes. The imaging characteristics and tumorigenesis of HCS were also investigated, highlighting the role of p53 mutations.</div></div><div><h3>Results</h3><div>This case series found that timely surgery and localized chemotherapy are crucial in managing HCS. Despite the promising results of targeted therapy, its limitations were observed in some patients. The onset and progression of HCS were found to be significantly correlated with the presence of p53 mutations.</div></div><div><h3>Conclusions</h3><div>This case series underscores the need for further research to improve the diagnosis and treatment of HCS and emphasizes the importance of timely surgery and localized chemotherapy in mitigating tumor side effects and potentially prolonging survival.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 2","pages":"Article 102520"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatoscope 2DTE's image-based quality index enhances applicability and repeatability of liver stiffness measurement","authors":"Cindy SERDJEBI ,&nbsp;Juliette FOUCHER ,&nbsp;Adrien BESSON ,&nbsp;Joel GAY ,&nbsp;Adèle DELAMARRE ,&nbsp;Claude COHEN-BACRIE","doi":"10.1016/j.clinre.2025.102532","DOIUrl":"10.1016/j.clinre.2025.102532","url":null,"abstract":"<div><h3>Purpose</h3><div>Hepatoscope® is an ultraportable ultrasound system with 50 Hz two-dimensional transient elastography (2DTE) for liver stiffness measurement (LSM). It provides a quality index (QI) for individual stiffness values that is based on imaging features. This study evaluated the 2DTE intra- and inter-user repeatability in patients with chronic liver diseases (CLD) for novice and expert operators across various QI conditions. We compared the performances with other imaging and non-imaging elastography techniques.</div></div><div><h3>Methods</h3><div>This investigation was a prospective cross-sectional single-center study. One hundred CLD patients underwent LSMs with vibration-controlled transient elastography (VCTE™), two-dimensional shear wave elastography (2DSWE) and 2DTE. Expert and novice operators each performed two consecutive exams with 2DTE, blinded to any output. Intra-class correlation coefficient for intra-, and inter-user repeatability were calculated as well as applicability for various QI conditions, and Spearman's correlations against VCTE and 2DSWE were assessed.</div></div><div><h3>Results</h3><div>Computing LSM as the median of 10 stiffness values with a QI&gt;85 % yielded the best compromise between reliability and applicability. In this setting, expert and inter-operator repeatability showed significant improvement over the condition with no QI threshold (ICC = 0.81 and 0.79, respectively) and 95 % applicability. Novice repeatability was excellent with a more restrictive QI (ICC = 0.80). LSM with 2DTE demonstrated strong and moderate correlation with VCTE and 2DSWE (<em>r</em> = 0.63 and 0.55, respectively).</div></div><div><h3>Conclusion</h3><div>Hepatoscope 2DTE provides a promising and reliable alternative for non-invasive liver stiffness assessment in patients with CLD. The application of the image-based QI enhances LSM reliability and consistency across novice and expert operators.</div></div>","PeriodicalId":10424,"journal":{"name":"Clinics and research in hepatology and gastroenterology","volume":"49 2","pages":"Article 102532"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}