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":"266-272"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","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":"Pathological Resection Depth in Cold Snare Polypectomy and Underwater Endoscopic Mucosal Resection for Superficial Nonampullary Duodenal Epithelial Tumors.","authors":"Takayuki Nukui, Takaya Shimura, Shingo Inaguma, Naomi Sugimura, Shigeki Fukusada, Ruriko Nishigaki, Yuki Kojima, Takuya Kanno, Makiko Sasaki, Mamoru Tanaka, Keiji Ozeki, Eiji Kubota, Satoru Takahashi, Hiromi Kataoka","doi":"10.1159/000544939","DOIUrl":"10.1159/000544939","url":null,"abstract":"<p><strong>Introduction: </strong>Cold snare polypectomy (CSP) and underwater endoscopic mucosal resection (UEMR) are used for small superficial nonampullary duodenal epithelial tumors (SNADETs). This study aimed to compare the resection depth of SNADETs removed by CSP versus UEMR.</p><p><strong>Methods: </strong>Data from SNADETs resected with CSP or UEMR between April 2018 and July 2023 at Nagoya City University Hospital were collected retrospectively. An independent pathologist, blinded to clinical information, evaluated the resected specimens and categorized resection depth into four groups: mucosa only (M), incomplete muscularis mucosae with defects (iMM), complete muscularis mucosae without submucosa (cMM), and complete muscularis mucosae with submucosa (SM).</p><p><strong>Results: </strong>Among 109 SNADETs, 78 were resected with CSP and 31 with UEMR. The percentages of M, iMM, cMM, and SM for CSP were 23.1%, 50.0%, 5.1%, and 21.8%, respectively, while for UEMR they were 0%, 6.5%, 6.5%, and 87.1%. The UEMR group had a higher SM resection rate and significantly greater median submucosal depth than the CSP group (783 μm [range, 0-2,220] vs. 0 μm [range, 0-1,226]; p < 0.001). In the multivariate analysis, UEMR was an independent and significant factor for achieving SM resection.</p><p><strong>Conclusion: </strong>UEMR achieved a significantly higher SM resection rate than CSP for all types of SNADETs. Clinically diagnosed duodenal high-grade dysplasia and adenocarcinoma should be treated with UEMR rather than CSP.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"273-279"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523003","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":"Tenapanor Improves Abdominal Symptoms Irrespective of Changes in Complete Spontaneous Bowel Movement Frequency in Adults with Irritable Bowel Syndrome with Constipation.","authors":"Darren M Brenner, Gregory S Sayuk, Brooks D Cash, Lucinda A Harris, Nitin K Ahuja, Jill K Deutsch, Yang Yang, Suling Zhao, David P Rosenbaum, Anthony J Lembo","doi":"10.1159/000543166","DOIUrl":"10.1159/000543166","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Tenapanor is a first-in-class, minimally absorbed intestinal sodium/hydrogen exchanger isoform 3 inhibitor approved by the US Food and Drug Administration for adults with irritable bowel syndrome with constipation (IBS-C). Pooled data from the phase 2b (NCT01923428) and phase 3 T3MPO-1 (NCT02621892) and T3MPO-2 (NCT02686138) studies examined the effects of tenapanor on abdominal symptoms independent of tenapanor's effect on complete spontaneous bowel movement (CSBM) frequency in adults with IBS-C.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This post hoc analysis was performed for patients with no CSBMs in ≥6 of the first 12 weeks of treatment (no-CSBM subgroup). The three-item abdominal score (AS3; the average of weekly abdominal pain, bloating, and discomfort scores) measured abdominal symptom response in tenapanor versus placebo. The overall change from baseline and response rate (improvement of ≥2 points or a reduction of ≥30%) in AS3 and individual abdominal scores during the 12 weeks were assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the pooled safety analysis set (N = 1,382), 641 patients were classified as no-CSBM patients and 640 were included in the efficacy analysis. Among the no-CSBM subgroup, tenapanor-treated patients experienced a greater improvement in AS3 in week 12 versus placebo-treated patients (least squares mean change, -1.74 vs. -1.29; p = 0.007), and the AS3 responder rate was higher for tenapanor (40.2% vs. 29.6%; p = 0.008). Similar improvements were displayed across individual abdominal symptom scores. Diarrhea was the most common adverse event in tenapanor-treated patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Tenapanor was observed to improve abdominal symptoms independent of its effect on bowel symptoms in adults with IBS-C.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Tenapanor is a first-in-class, minimally absorbed intestinal sodium/hydrogen exchanger isoform 3 inhibitor approved by the US Food and Drug Administration for adults with irritable bowel syndrome with constipation (IBS-C). Pooled data from the phase 2b (NCT01923428) and phase 3 T3MPO-1 (NCT02621892) and T3MPO-2 (NCT02686138) studies examined the effects of tenapanor on abdominal symptoms independent of tenapanor's effect on complete spontaneous bowel movement (CSBM) frequency in adults with IBS-C.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This post hoc analysis was performed for patients with no CSBMs in ≥6 of the first 12 weeks of treatment (no-CSBM subgroup). The three-item abdominal score (AS3; the average of weekly abdominal pain, bloating, and discomfort scores) measured abdominal symptom response in tenapanor versus placebo. The overall change from baseline and response rate (improvement of ≥2 points or a reduction of ≥30%) in AS3 and individual abdominal scores during the 12 weeks were assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the pooled safety analysis set (N = 1,382), 641 patients were classified as no-CSBM patients and 640 were included i","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"146-157"},"PeriodicalIF":2.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863280","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":"Iron and Vitamin B12 Deficiency in Patients with Autoimmune Gastritis and Helicobacter pylori Gastritis: Results from a Prospective Multicenter Study.","authors":"Malgorzata Osmola, Nicolas Chapelle, Marie-Anne Vibet, Edith Bigot-Corbel, Damien Masson, Caroline Hemont, Adam Jirka, Justine Blin, David Tougeron, Driffa Moussata, Dominique Lamarque, Regis Josien, Jean-François Mosnier, Jérôme Martin, Tamara Matysiak-Budnik","doi":"10.1159/000535206","DOIUrl":"10.1159/000535206","url":null,"abstract":"<p><strong>Introduction: </strong>Iron and vitamin B12 deficiencies are common in patients with atrophic gastritis, but there are limited data on the prevalence of these deficiencies in different types of atrophic gastritis.</p><p><strong>Methods: </strong>This multicenter, prospective study assessed micronutrient concentrations in histologically confirmed autoimmune gastritis (AIG, n = 45), Helicobacter pylori-related non-autoimmune gastritis (NAIG, n = 109), and control patients (n = 201). A multivariate analysis was performed to determine factors influencing those deficiencies.</p><p><strong>Results: </strong>The median vitamin B12 concentration was significantly lower in AIG (367.5 pg/mL, Q1, Q3: 235.5, 524.5) than in NAIG (445.0 pg/mL, Q1, Q3: 355.0, 565.0, p = 0.001) and control patients (391.0 pg/mL, Q1, Q3: 323.5, 488.7, p = 0.001). Vitamin B12 deficiency was found in 13.3%, 1.5%, and 2.8% of AIG, NAIG, and control patients, respectively. Similarly, the median ferritin concentration was significantly lower in AIG (39.5 ng/mL, Q1, Q3: 15.4, 98.3 ng/mL) than in NAIG (80.5 ng/mL, Q1, Q3: 43.6, 133.9, p = 0.04) and control patients (66.5 ng/mL, Q1, Q3: 33.4, 119.8, p = 0.007). Iron deficiency and iron deficiency adjusted to CRP were present in 28.9% and 33.3% of AIG, 12.8% and 16.5% of NAIG, and 12.9% and 18.4% of controls, respectively. Multivariate analysis demonstrated that AIG patients had a higher risk of developing vitamin B12 deficiency (OR: 11.52 [2.85-57.64, p = 0.001]) and iron deficiency (OR: 2.92 [1.32-6.30, p = 0.007]) compared to control patients. Factors like age, sex, and H. pylori status did not affect the occurrence of vitamin B12 or iron deficiency.</p><p><strong>Conclusion: </strong>Iron and vitamin B12 deficiencies are more commonly observed in patients with AIG than in those with NAIG or control patients. Therefore, it is essential to screen for both iron and vitamin B12 deficiencies in AIG patients and include the treatment of micronutrient deficiencies in the management of atrophic gastritis patients.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"145-153"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416657","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":"Liver Stiffness Determined by Transient Elastography Is a Simple and Highly Accurate Predictor for Presence of Liver Cirrhosis in Clinical Routine.","authors":"Peter Lemmer, Lydia Christina Rohr, Marie Henning, Kerem Bulut, Paul Manka, Ali Canbay, Jan-Peter Sowa","doi":"10.1159/000538426","DOIUrl":"10.1159/000538426","url":null,"abstract":"<p><strong>Introduction: </strong>Early detection of patients with advanced chronic liver disease is critical for the prevention of complications and inclusion in surveillance programs for hepatocellular carcinoma. In daily clinical care, it remains challenging to differentiate early cirrhosis from lower fibrosis grades without performing a liver biopsy. The aim of the present study was to assess the performance of different non-invasive detection tools to differentiate cirrhosis from lower fibrosis grades.</p><p><strong>Methods: </strong>Data of 116 patients (51 male, 65 female) with chronic liver disease of various origins undergoing liver biopsy was analyzed. Routine laboratory values, liver stiffness measurement (LSM) by transient elastography, and histological liver assessment were collected.</p><p><strong>Results: </strong>Robust and significant correlations with the histological fibrosis stage were identified for LSM (r = 0.65), the FAST score (0.64), the FIB-4 (0.48), serum aspartate aminotransferase (AST) concentration (0.41), NFS (0.33), international normalized ratio (INR; 0.30), methacetin breath test results (-0.40), and serum albumin concentration (-0.29) by spearman rank correlation. Receiver operating characteristic curves were built for these parameters to separate patients with cirrhosis from those with any other fibrosis stage. The highest AUC was achieved by LSM (0.9130), followed by the FAST score (0.8842), the FIB-4 (0.8644), the NFS (0.8227), INR (0.8142), serum albumin (0.7710), and serum AST (0.7620). The most promising clinical applicability would be an LSM value of 12.2 kPa, achieving 95.7% sensitivity and 75.3% specificity.</p><p><strong>Conclusion: </strong>LSM and FAST score seem to be robust non-invasive measurements for liver fibrosis. LSM and FAST scores may have the potential to reliably detect patients with liver cirrhosis in clinical routine settings.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"265-275"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287112","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":"Feasibility and Safety of Endoscopic Control for Patients with Serrated Polyposis Syndrome.","authors":"Michiko Nakaoka, Hideyuki Chiba, Mikio Kobayashi, Naoya Okada, Jun Arimoto, Jun Tachikawa, Keiichi Ashikari, Hiroki Kuwabara","doi":"10.1159/000534968","DOIUrl":"10.1159/000534968","url":null,"abstract":"<p><strong>Introduction: </strong>Despite advances in endoscopic treatment, patients with serrated polyposis syndrome (SPS) occasionally require surgery due to numerous or unresectable polyps, recurrence, and treatment-related adverse events.</p><p><strong>Methods: </strong>We retrospectively evaluated 43 patients with SPS undergoing diagnosis and treatment at Omori Red Cross Hospital from 2011 to 2022. Resection of all polyps ≥3 mm in size was planned during the clearing phase; endoscopic control was defined as complete, endoscopic polyp removal. During the surveillance phase, patients underwent annual colonoscopy and resection of newly detected polyps ≥3 mm in size.</p><p><strong>Results: </strong>Thirty-eight patients (88%) achieved endoscopic control, two (5%) required surgery after endoscopic treatment because of colorectal cancer (CRC), and three (7%) have not yet achieved endoscopic control and are planning treatment. Endoscopic control was achieved with a median of four colonoscopies at 8 months. Ten polyps (median value) were resected per patient during the clearing phase. Three polyps ≥50 mm in size, six located in the appendiceal orifice, and seven with severe fibrosis could be resected by endoscopic submucosal dissection (ESD). All patients underwent treatment with a combination of cold snare polypectomy (CSP), endoscopic mucosal resection/hot polypectomy, and/or ESD. No case required surgery due to difficulty with endoscopic treatment. Delayed bleeding was observed in 2 cases (0.3%). Twenty-one patients underwent colonoscopies during the surveillance phase. Fifty-three polyps were resected using CSP; no CRC, sessile serrated lesions with dysplasia, or advanced adenoma were detected.</p><p><strong>Conclusion: </strong>SPS can be effectively, efficiently, and safely controlled with appropriate endoscopic management.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"31-40"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648646","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":"Metabolic Dysfunction-Associated Fatty Liver Disease on Distinct Microbial Communities at the Bacterial Phylum Level.","authors":"Haruki Uojima, Yoshihiko Sakaguchi, Kazuyoshi Gotoh, Takashi Satoh, Hisashi Hidaka, Akira Take, Kazue Horio, Shunji Hayashi, Chika Kusano","doi":"10.1159/000534284","DOIUrl":"10.1159/000534284","url":null,"abstract":"<p><strong>Introduction: </strong>Limited data are available on the correlation between microbial communities and metabolic dysfunction-associated fatty liver disease (MAFLD). This study aimed to evaluate the influence of MAFLD on diverse microbial communities.</p><p><strong>Methods: </strong>We recruited 43 patients with a nonviral liver disease. Enrolled patients were divided into two groups according to MAFLD criteria. The fecal microbial composition was evaluated using the variable V3-V4 region of the 16S ribosomal RNA region, which was amplified using polymerase chain reaction. First, we assessed the influence of MAFLD on distinct microbial communities at the bacterial phylum level. Next, the correlation between the microbial communities and diversity in patients with MAFLD was evaluated.</p><p><strong>Results: </strong>Among the enrolled participants, the non-MAFLD and MAFLD groups consisted of 21 and 22 patients, respectively. Sequences were distributed among ten bacterial phyla. The relative abundance of Firmicutes was significantly higher in the MAFLD group than in the non-MAFLD group (p = 0.014). The microbial diversity was not significantly influenced by the presence of MAFLD (Chao-1 index: p = 0.215 and Shannon index: p = 0.174, respectively); nonetheless, the correlation coefficient between the abundances of Firmicutes and microbial diversity was higher in the non-MAFLD group than in the MAFLD group.</p><p><strong>Conclusion: </strong>The presence of MAFLD increased the relative abundances of Firmicutes at the bacterial phylum level, which may cause the discrepancy between the abundances of Firmicutes and diversity in patients with MAFLD.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"61-69"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41106173","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":"Hospital Admission, Medical, and Surgical Procedures for Acute Diverticulitis Are More Appropriate when Using a Diagnostic and Therapeutic Assistance Pathway: An Experience from a Referral Center.","authors":"Walter Elisei, Pierluigi Marini, Roberto Faggiani, Stefano Manfroni, Gabriele Ricci, Noemi Di Fuccia, Valerio Papa, Antonio Tursi","doi":"10.1159/000540216","DOIUrl":"10.1159/000540216","url":null,"abstract":"<p><strong>Introduction: </strong>Our aim was to assess the impact of the Diagnostic and Therapeutic Assistance Pathway (PDTA) developed for acute diverticulitis (AD) on the management of patients with AD and referring to the emergency room (ER) in a referral center.</p><p><strong>Methods: </strong>This retrospective study includes all patients diagnosed with AD and referring to the ER between January 1, 2021, and December 31, 2022 (after approval of PDTA), compared to the same period of 2015-2019. Length of stay in ER, medical and surgical management, and length in hospital stay (in days) were also measured according to the type of disease (uncomplicated vs. complicated).</p><p><strong>Results: </strong>ER admission due to AD during the period 2015-2019 was 240 ± 13 cases per year, while it was 290 cases in 2022 (p = 0.05). After adopting the PDTA, the rate of length of stay in ER >24 h for AD was significantly reduced (p = 0.01); the median rate of hospital admission for AD was significantly reduced (p < 0.05); the rate of medical treatment of uncomplicated disease was increased (p = 0.01), while the rate of surgical management was decreased (p = 0.05); the rate of medical treatment of complicated disease was increased (p = 0.01), while the rate of surgical management was decreased (p = 0.001); the hospital stay was significantly reduced in both uncomplicated (p = 0.05) and complicated (p = 0.05) AD.</p><p><strong>Conclusions: </strong>The development and the routine use of a PDTA dedicated to AD have significantly improved the management of these patients, reducing the ER stay, the surgical procedures, and the overall hospital stay.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"522-528"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141554406","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":"Assessment of Cirrhotic Patients by the EncephalApp Fails to Predict Low-Grade Hepatic Encephalopathy.","authors":"Rebecca Maria Neye, Gerald Kircheis, Daria Stratmann, Norbert Hilger, Stefan Lüth","doi":"10.1159/000538924","DOIUrl":"10.1159/000538924","url":null,"abstract":"<p><strong>Introduction: </strong>An early detection of low-grade hepatic encephalopathy (HE) is of high importance. The aim of the study was to compare a neuropsychological with a psychophysical test on the basis of the psychometric hepatic encephalopathy score (PHES) regarding effectiveness in diagnosing minimal HE (MHE).</p><p><strong>Methods: </strong>In our prospective controlled observational study, we examined a total of 103 patients with liver cirrhosis for HE. The PHES, CFF, and EncephalApp were performed in all patients. Graduation was based on the result of the PHES. Patients without evidence for HE 1&amp;2 according to the mental state (West-Haven criteria) with a PHES <-4 value points and no clinical symptoms were defined as having MHE. Patients were considered as HE0 when in the PHES none of the psychometric subtest results was abnormal or with a PHES ≥-4 value points. Patients with clinical symptoms were considered HE 1&amp;2 patients. Different cut-off values were determined, and their specificity and sensitivity were calculated.</p><p><strong>Results: </strong>Ninety-six of the involved patients had liver cirrhosis and 25 acted as a healthy control group. The ROC analysis for the classification resulted in an AUC of 0.806, with the highest Youden index for the cut-off time >224 s, for which the sensitivity was 82% and the specificity 75%. Cases of withdrawals were seen in 10.74% of all tested patients.</p><p><strong>Conclusion: </strong>The EncephalApp distinguishes well between HE0 and MHE but has its limitations in grading higher forms of HE. Diagnosis using only the EncephalApp is not sufficient.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"567-575"},"PeriodicalIF":2.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310332","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":"Onset Time and Characteristics of Postprocedural Bleeding after Endoscopic Resection of Colorectal Lesions: A Multicenter Retrospective Study.","authors":"Qiyun Xiao, Maximilian Eckardt, Awsan Mohamed, Helmut Ernst, Alexander Behrens, Nils Homann, Thomas Hielscher, Georg Kähler, Matthias Ebert, Sebastian Belle, Tianzuo Zhan","doi":"10.1159/000534109","DOIUrl":"10.1159/000534109","url":null,"abstract":"<p><strong>Introduction: </strong>Postprocedural bleeding is a major adverse event after endoscopic resection of colorectal lesions, but the optimal surveillance time after endoscopy is unclear. In this study, we determined onset time and characteristics of postprocedural bleeding events.</p><p><strong>Methods: </strong>We retrospectively screened patients who underwent endoscopic resection of colorectal lesions at three German hospitals between 2010 and 2019 for postprocedural bleeding events using billing codes. Only patients who required re-endoscopy were included for analysis. For identified patients, we collected demographic data, clinical courses, characteristics of colorectal lesions, and procedure-related variables. Factors associated with late-onset bleeding were determined by univariate and multivariate logistic regression analysis.</p><p><strong>Results: </strong>From a total of 6,820 patients with eligible billing codes, we identified 113 cases with postprocedural bleeding after endoscopic mucosal (61.9%) or snare resection (38.1%) that required re-endoscopy. The median size of the culprit lesion was 20 mm (interquartile range 14-30 mm). The median onset time of postprocedural bleeding was day 3 (interquartile range: 1-6.5 days), with 48.7% of events occurring within 48 h. Multivariate logistic regression analysis demonstrates that a continued intake of antiplatelet drugs (OR: 3.98, 95% CI: 0.89-10.12, p = 0.025) and a flat morphology of the colorectal lesion (OR: 2.98, 95% CI: 1.08-8.01, p = 0.031) were associated with an increased risk for late postprocedural bleeding (&gt;48 h), whereas intraprocedural bleeding was associated with a decreased risk (OR: 0.12, 95% CI: 0.04-0.50, p = 0.001).</p><p><strong>Conclusion: </strong>Significant postprocedural bleeding can occur up to 18 days after endoscopic resection of colorectal lesions, but was predominantly observed within 48 h. Continued intake of antiplatelet drugs and a flat polyp morphology are associated with risk for late postprocedural bleeding.</p>","PeriodicalId":11294,"journal":{"name":"Digestive Diseases","volume":" ","pages":"78-86"},"PeriodicalIF":2.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41182297","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}