Digestive Diseases最新文献

{"title":"STW 5-II for Treatment of Functional Gastrointestinal Disorders: Mechanism and Clinical Efficacy.","authors":"Antonio Tursi, Beatrice Marinoni, Antonino Carlo Privitera, Lorenzo Privitera, Silvio Danese","doi":"10.1159/000544695","DOIUrl":"10.1159/000544695","url":null,"abstract":"<p><strong>Background: </strong>Functional dyspepsia (FD) is currently defined as episodic or recurrent epigastric pain or discomfort in the absence of organic diseases, lasting at least 4 weeks. FD is estimated to affect 7.2% of the worldwide population. Due to the underlying complex pathogenetic mechanisms, the therapy for FD is generally prescribed to treat the main symptoms experienced by the patient.</p><p><strong>Summary: </strong>Recently, a new herbal formulation has been proposed for treating FD. This plant-based preparation, called STW 5-II, is a fixed combination of six hydroethanolic herbal extracts from bitter candy tuft, peppermint leaf, chamomile flower, licorice root, caraway fruit, and melissa leaf. STW 5-II has been shown to be more effective than placebo in several controlled studies and clinical scenarios, allowing for its recent introduction into several European markets.</p><p><strong>Key messages: </strong>This review aimed to describe the mechanisms of action of this herbal drug, its current and potential clinical indications, and to explore future perspectives for its use.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-7"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467288","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":"Gastrointestinal Ultrasound: Measurements and Normal Findings - What Do You Need to Know?","authors":"Kathleen Möller, Pascal Fischer, Odd Helge Gilja, Heike Gottschall, Christian Jenssen, Alois Hollerweger, Claudia Lucius, Jennifer Meier, Gerhard Rogler, Benjamin Misselwitz, Christoph F Dietrich","doi":"10.1159/000544043","DOIUrl":"10.1159/000544043","url":null,"abstract":"<p><strong>Background: </strong>A standardized examination procedure and correct bowel wall assessment are the prerequisites for correct findings and for distinguishing normal findings from pathological diagnoses. PubMed was searched for the time period from January 01, 1990, to March 29, 2024, using a Boolean search.</p><p><strong>Summary: </strong>The present work provides knowledge and details of the examination of the gastrointestinal tract in transcutaneous ultrasound with examination procedure, transducer selection, transducer guidance, knowledge of the identification of anatomical structures, and sonographic assessment. The sonographic reference values for the gastrointestinal tract were researched, compiled, and interpreted. In addition, citations and references of eligible studies were searched to identify further studies for inclusion.</p><p><strong>Key messages: </strong>Knowledge of the sonographic appearance of the gastrointestinal tract and the standardized examination of the healthy gastrointestinal tract, including correct measurements, must be trained. Although age, body weight, and food ingestion influence the thickness of the intestinal wall, it does not normally exceed 2 mm in the duodenum, jejunum, ileum, and colon on US. However, in most clinical studies 3 mm was used as cutoff for pathology. When assessing the appendix, an outer diameter of < 6 mm is considered normal. However, an increase in this diameter may also occur in healthy, asymptomatic people and should be not used as the sole criterion for diagnosing appendicitis. GIUS is now established as valid clinical method to assess patients with digestive diseases. Accordingly, there is a great need for training opportunities and supervision of young doctors who want to enhance their knowledge and skills in GIUS.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-36"},"PeriodicalIF":2.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432474","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":"Decoding the Gut-Brain Axis: A Journey toward Targeted Interventions for Disorders-of-Gut-Brain Interaction.","authors":"Gerald Holtmann, Md Moniruzzaman, Ayesha Shah","doi":"10.1159/000543845","DOIUrl":"10.1159/000543845","url":null,"abstract":"<p><strong>Background: </strong>The gut-brain axis is a bidirectional communication pathway connecting the gastrointestinal tract and the brain. Disorders of gut-brain interaction (DGBI) manifest as highly prevalent gastrointestinal disorders such as irritable bowel syndrome (IBS) or functional dyspepsia (FD).</p><p><strong>Summary: </strong>The initial focus of DGBI research was on the effects of psychological stress on digestive functions like gastrointestinal motility, or secretion of gastric acid and pancreatic enzymes. Concepts related to DGBI have expanded in recent decades. Activation of mucosal or systemic immune functions has been observed in DGBI, and it is established that the gastrointestinal microbiome can alter mucosal integrity and permeability, leading to pro-inflammatory cytokine release that affects brain function. Pharmacologic treatments (e.g., tricyclic antidepressants) and non-pharmacologic interventions (e.g., cognitive behavioral therapy) are now standard for DGBI patients. Advances in culture-independent methods to study gastrointestinal microbes reveal new insights into DGBI and gut microbiota appear to play a crucial role in modulating the gut-brain axis and regulating various bodily functions.</p><p><strong>Key messages: </strong>DGBI are highly prevalent. Research in this field has evolved from studying the effects of psychological stress to recognizing the significant role of the gut microbiome and its metabolites in mucosal integrity and immune responses.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405628","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":"Association between the Achievement of Textbook Outcomes in Liver Surgery and Overall Survival in Perihilar Cholangiocarcinoma Patients following Major Hepatectomy: A Multicenter Study.","authors":"Shi-Yun Zhong, Shu-Yang Gao, Yan Jiang, Yu-Le Luo, Yi Gong, Ting Yu, Xing-Chao Liu, Hai-Ning Fan, Shu-Jie Pang, Jie Bai, Hai-Su Dai, Zhi-Yu Chen, Yan-Qi Zhang, Zhi-Peng Liu, Hua-Qiang Wang","doi":"10.1159/000543439","DOIUrl":"10.1159/000543439","url":null,"abstract":"<p><strong>Introduction: </strong>Major hepatectomy is the mainstay of curative-intent resection for perihilar cholangiocarcinoma (pCCA) patients. Textbook outcomes in liver surgery (TOLS) are a new composite parameter for evaluating the short-term outcomes of surgery; however, their association with overall survival (OS) is unknown. Therefore, this study aimed to investigate the association between TOLS and OS in pCCA patients following major hepatectomy.</p><p><strong>Methods: </strong>Consecutive pCCA patients who underwent major hepatectomy between 2014 and 2020 at 5 hospitals were included in this analysis. TOLS were defined as no intraoperative grade ≥2 incidents, no postoperative grade B/C bile leakage, no postoperative grade B/C liver failure, no postoperative major morbidity, no readmission within 90 days due to surgery-related major morbidity, no mortality within 90 days after hospital discharge, and R0 resection. The Kaplan-Meier method was used to compare OS rates between patients who achieved TOLS and those who did not. Cox regression analysis was used to identify independent risk factors for poor OS.</p><p><strong>Results: </strong>In total, 399 patients were included in this study, 214 (53.6%) of whom achieved TOLS. After excluding patients who died within 90 days, the 5-year OS rate of patients who achieved TOLS was significantly greater than that of patients who did not achieve TOLS (5-year OS rate: 26.2% vs. 17.3%, p = 0.001). TOLS were independently associated with OS for pCCA patients following major hepatectomy.</p><p><strong>Conclusions: </strong>TOLS were achieved in approximately half of the pCCA patients following major hepatectomy, and the patients who achieved TOLS had better survival.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"179-189"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946456","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":"Antibody Response to SARS-CoV-2 before and after the Third Vaccination in Patients with Inflammatory Bowel Disease.","authors":"Johanna Maria Classen, Anna Muzalyova, Christoph Römmele, Sandra Nagl, Alanna Ebigbo, Elisabeth Schnoy","doi":"10.1159/000542353","DOIUrl":"10.1159/000542353","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapy might have an increased risk of developing a severe course of SARS-CoV-2 infection. The aim of this study was to investigate the development of antibodies in immunosuppressed patients with IBD compared to a healthy control group and to determine the effect of immunomodulators on the level of anti-SARS-CoV-2 IgG antibody levels before and after a third vaccination against SARS-CoV-2.</p><p><strong>Methods: </strong>This is a single-center study with a retrospective observational design. Seventy-one IBD patients matched by propensity score to 71 healthy employees (control group) were included. Blood was taken from both groups at predetermined times before and after the third booster vaccination.</p><p><strong>Results: </strong>All patients with IBD (n = 71, 100%) received immunomodulatory therapy. The mean antibody level before the third vaccination was 1,352.88 U/mL (SD = 1,011.489) in the IBD group and was not lower compared to the control group (p = 0.088). Gender, age, and disease duration had no significant impact on the development of antibody levels. Patients with TNF-alpha blockers had significantly lower antibody titers (p = 0.011) compared to the control group. Patients with integrin inhibitor therapy had significantly higher antibody titers (p = 0.003) than the controls. After the third vaccination, an increase in antibody titers was recorded in all patients in the IBD group.</p><p><strong>Conclusion: </strong>We recorded an antibody titer in all patients with IBD that was not significantly lower compared to healthy controls despite immunomodulatory therapy. The booster vaccination led to an increase in antibody levels in all patients with IBD.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"19-27"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767291","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":"Comparative Efficacy and Safety of Anesthetic and Sedative Regimens for Endoscopic Retrograde Cholangiopancreatography: A Network Meta-Analysis.","authors":"Yufang Liu, Jifeng Xiao, Tian Chen, Dongdong Shi, Yan Qiao, Xingzhi Liao","doi":"10.1159/000542380","DOIUrl":"10.1159/000542380","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This study evaluates the efficacy and safety of various anesthetic and sedative regimens for endoscopic retrograde cholangiopancreatography (ERCP) procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR &lt;0.01), dexmedetomidine plus fentanyl (RR &lt;0.01), propofol plus nalbuphine (RR = 0.01), Mg sulfate plus propofol (RR = 0.01), and propofol plus fentanyl (RR = 0.02) showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazolam plus pethidine plus dexmedetomidine (RR = 0.01), propofol plus oxycodone (RR = 0.09), and dexmedetomidine plus fentanyl (RR = 0.2) exhibited lower rates of adverse events compared to propofol.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study provides comprehensive evidence to guide clinical decision-making and optimize anesthetic management for ERCP procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This study evaluates the efficacy and safety of various anesthetic and sedative regimens for endoscopic retrograde cholangiopancreatography (ERCP) procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR &lt;0.01), dexmedetomidine plus fentanyl (RR &lt;0.01), propofol plus nalbuphine (RR = 0.01), Mg sulfate plus propofol (RR = 0.01), and propofol plus fentanyl (RR = 0.02) showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazola","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"84-95"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616219","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":"Combined [18F]-Fluorodeoxyglucose Positron Emission Tomography-MR Imaging: A Promising Tool for Diagnostics of Small Bowel Crohn's Disease.","authors":"Juho Mattila, Johanna Kallio, Eliisa Löyttyniemi, Pirjo Nuutila, Jukka Koffert","doi":"10.1159/000542379","DOIUrl":"10.1159/000542379","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Diagnostics of small bowel Crohn's disease (CD) can be difficult. Combined positron emission tomography-magnetic resonance enterography (PET-MRE) can be used to evaluate intestinal metabolism, but clinical use has been limited due to accessibility, costs, absence of standardized methods, and diagnostic thresholds. Our aim was to show that combined PET-MRE can be used to diagnose active small bowel CD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a fusion PET-MRE scan with [18F]-FDG tracer to 30 patients with suspected small bowel CD in colonoscopy. Standardized uptake values (SUVs) were measured from small bowel. The diagnosis was confirmed with small bowel capsule endoscopy. Clinicians chose appropriate medication to each patient blinded from SUV results. Endoscopic, laboratory, and MRE findings were investigated in relation to SUV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fusion PET-MRE outperformed MRE in diagnostic accuracy. Patients diagnosed with CD (N = 24) had higher SUV than patients not diagnosed with CD (N = 6) (3.34 vs. 1.84, p = 0.022). A diagnostic cut-off at SUV at 2.5 could be used (AUROC = 0.81). A higher SUV predicts need for immunosuppressive medication (p = 0.0026) and biologics (p = 0.0005). SUV correlates positively with Simple Endoscopic Score for Crohn's Disease (SES-CD), fecal calprotectin, and CRP and negatively with Hb and serum albumin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In future, [18F]-FDG PET-MRE can be used in diagnostics of small bowel CD as a safe alternative for capsule endoscopy. High SUV can predict a more progressive disease course and need for more advanced therapies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Diagnostics of small bowel Crohn's disease (CD) can be difficult. Combined positron emission tomography-magnetic resonance enterography (PET-MRE) can be used to evaluate intestinal metabolism, but clinical use has been limited due to accessibility, costs, absence of standardized methods, and diagnostic thresholds. Our aim was to show that combined PET-MRE can be used to diagnose active small bowel CD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a fusion PET-MRE scan with [18F]-FDG tracer to 30 patients with suspected small bowel CD in colonoscopy. Standardized uptake values (SUVs) were measured from small bowel. The diagnosis was confirmed with small bowel capsule endoscopy. Clinicians chose appropriate medication to each patient blinded from SUV results. Endoscopic, laboratory, and MRE findings were investigated in relation to SUV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fusion PET-MRE outperformed MRE in diagnostic accuracy. Patients diagnosed with CD (N = 24) had higher SUV than patients not diagnosed with CD (N = 6) (3.34 vs. 1.84, p = 0.022). A diagnostic cut-off at SUV at 2.5 could be used (AUROC = 0.81). A higher SUV predicts need for immunosuppressive medication (p = 0.0026) and biologics (p = 0.0005). SUV correlates positively with Simple Endoscopic Score for Crohn's Disease (SES-C","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"104-114"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11817859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616204","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":"Helicobacter pylori Infection and Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Stergios A Polyzos, Nikoletta Pyrrou, Jannis Kountouras","doi":"10.1159/000544122","DOIUrl":"10.1159/000544122","url":null,"abstract":"","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"253-256"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406025","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":"Useful Bowel Preparation with Ultralow-Volume (500 mL) Polyethylene Glycol for Colonoscopy: A Retrospective Study.","authors":"Yusuke Mizuno, Takaya Shimura, Takayuki Nukui, Konomu Uno, Ruriko Nishigaki, Yuki Kojima, Takuya Kanno, Makiko Sasaki, Shigeki Fukusada, Naomi Sugimura, Mamoru Tanaka, Keiji Ozeki, Eiji Kubota, Hiromi Kataoka","doi":"10.1159/000543858","DOIUrl":"10.1159/000543858","url":null,"abstract":"<p><strong>Introduction: </strong>Adequate bowel preparation is indispensable for high-quality colonoscopy. We have developed an ultralow-volume (500 mL) polyethylene glycol (PEG) combined with other laxatives (sennoside, sodium picosulfate, and lactulose) and applied this regimen clinically to all patients with colonoscopy for 3 decades. This study aimed to assess the effectiveness of this ultralow-volume bowel preparation regimen.</p><p><strong>Methods: </strong>This single-center, retrospective study analyzed data from consecutive outpatients who underwent colonoscopy between January 2022 and December 2022. All the patients took sennoside (24 mg) two nights before, sodium picosulfate (75 mg) one night before, and 500 mL of PEG with lactulose (58.5 g) on the day of examination. Cleaning efficacy was evaluated using the Boston Bowel Preparation Scale (BBPS). Adequate bowel preparation was defined as a total BBPS score ≥6, with all colon segments scoring ≥2.</p><p><strong>Results: </strong>Out of 862 patients with colonoscopy, 773 were eligible for this study, and the median age was 66 years. The adequate bowel preparation rate was 91.8% (710/773). Notably, the BBPS full score \"9\" was observed in 50.5% (390/773). The median cecal intubation time and examination time were 8 and 20 min, respectively. Only 3 patients vomited as a side effect. In the multivariate analysis, age ≥70 years, diabetes mellitus, and diverticula were significantly independent risk factors for inadequate bowel preparation.</p><p><strong>Conclusions: </strong>Our established ultralow-volume (500 mL) PEG is safe and useful as a bowel preparation method.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"246-252"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122469","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 Overlap between Type 1 Diabetes and Celiac Disease in Children and the Role of Tissue Transglutaminase-IgA Positivity in Endoscopy Decision.","authors":"Elif Eviz, Sinan Sari, Nuray Uslu Kizilkan, Esra Doger, Gul Yesiltepe Mutlu, Ödül Eğritaş, Cigdem Arikan, Aysun Bideci, Buket Dalgic, Sukru Hatun","doi":"10.1159/000543168","DOIUrl":"10.1159/000543168","url":null,"abstract":"<p><strong>Introduction: </strong>Celiac disease (CD)-related antibody positivity in children with type 1 diabetes (T1D) may fluctuate and become negative spontaneously. There are uncertainties about the optimal tissue transglutaminase IgA (tTG-IgA) titre and timing of endoscopy in the diagnosis of CD, and this study aimed to contribute to the debate on the tTG-IgA threshold titre for endoscopy decisions in children with T1D.</p><p><strong>Methods: </strong>The data of 991 children with T1D who had undergone serologic evaluation for CD were analysed retrospectively. The tTG-IgA positivity rate and the upper limit of normal (ULN) tTG-IgA positivity were assessed. Participants were grouped according to the frequency, course, and test results of tTG-IgA tests. Those with and without histopathologic diagnosis of CD by endoscopic biopsy were compared in terms of tTG-IgA screening time and tTG-IgA predictive values.</p><p><strong>Results: </strong>In 10.2% (n:101) of all cases, tTG-IgA antibody was positive and endoscopic biopsy was performed in 68.3% (n:69) of these cases. Of all cases, 4.3% (n:43) were diagnosed with CD by endoscopic biopsy. A tTG-IgA titre of 7×ULN and above was found to be the best predictive value for the diagnosis of CD with 79.1% sensitivity, 80.8% specificity 87.2% positive predictive value, and 70% negative predictive value.</p><p><strong>Conclusions: </strong>Approximately 10% of antibody positive cases showed fluctuating and low-titre positivity, and no CD was detected by endoscopic biopsy in the group with fluctuating antibody course. The results of our study suggest that endoscopy in children with tTG-IgA levels 7×ULN or above may prevent both false-positive results and missed cases.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"225-234"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946460","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}