Journal of Gastroenterology and Hepatology最新文献

Gastrointestinal Cancer 胃肠癌

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16697

{"title":"Gastrointestinal Cancer","authors":"","doi":"10.1111/jgh.16697","DOIUrl":"https://doi.org/10.1111/jgh.16697","url":null,"abstract":"47University of California San Francisco (UCSF) criteria and liver dysfunction predict hepatocellular carcinoma (HCC) recurrence after surgery for HCC: A large multi-centre studyConner Blackmore1,2, Ian Lockart2,3, Yuen Kang Joseph Yeoh2, Ciara Flynn2, Gregory Dore3,4, Mark Danta2,3, Jacob George5,6,7,8, Basheer Alshiwanna1,2,9, Maryam Alavi4, Behzad Hajarizadeh4 and Miriam Tania Levy1,2,91Liverpool Hospital, Sydney, Australia; 2Faculty of Medicine, UNSW, Sydney, Australia; 3St Vincent's Hospital, Sydney, Australia; 4The Kirby Institute, Sydney, Australia; 5Storr Liver Centre, Sydney, Australia; 6Westmead Institute for Medical Research, Sydney, Australia; 7Westmead Hospital, Sydney, Australia; 8Faculty of Medicine, University of Sydney, Sydney, Australia; 9Ingham Institute for Applied Medical Research, Sydney, AustraliaBackground and Aim: Primary liver cancer is the third leading cause of cancer-related death worldwide, with hepatocellular carcinoma (HCC) accounting for 80% of primary liver cancers. Liver resection is a curative treatment for early HCC (more than 2cm or when inaccessible to locoregional ablation), however there is a paucity of literature on predicting the likelihood of HCC recurrence following resection. We evaluated factors related to recurrence following primary HCC resection with curative intent.Methods: We retrospectively reviewed the electronic medical records of patients with HCC who underwent primary resection at three tertiary referral hospitals in Australia between January 2008 and May 2022. Baseline and follow-up characteristics, including liver disease, patient, and tumour characteristics were collected. The incidence rate of HCC recurrence following curative resection, and the factors associated with recurrence risk was evaluated.Results: A total of 242 patients underwent surgical resection with a median follow up of 36.6 months (IQR: 13.8-60.5). The overall survival rate at 3 years was 54%, with total disease-free survival at 3 years 29%. Underlying HCC aetiology was hepatitis C virus (HCV) in 73 (30%), hepatitis B virus (HBV) in 98 (41%) and non-viral in 71 (29%). Clear histological margins and complete post-operative radiological response was achieved in 190 (79%) patients with 1 (0.4%) 90-day mortality. Recurrence occurred in 94 (39%) with median time to recurrence of 18.8 months (IQR: 8.6-35]). The incidence rate of recurrence was 10.5 per 100 person-years (95% CI: 8.6 – 12.9). Multivariate Cox regression analysis identified an increased risk of HCC recurrence was independently associated with: MELD score > 7 (aHR: 2.36; 95% C","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16697","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IBD Clinical IBD 临床

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16702

{"title":"IBD Clinical","authors":"","doi":"10.1111/jgh.16702","DOIUrl":"https://doi.org/10.1111/jgh.16702","url":null,"abstract":"13Comparative analysis of chronic kidney disease risk: Inflammatory bowel disease vs. autoimmune diseasesMing-che Chuang1, Cheng-Li Lin2, Fuu-Jen Tsai3,4 and Tsung-Yu Tsai1,4,51Center for Digestive Medicine, Department of Internal Medicine, China Medical University, Taichung, Taiwan (R.O.C.); 2Management Office for Health Data (DryLab), Clinical Trial Center (CTC),, China Medical University, Taichung, Taiwan (R.O.C.); 3Department of Medical Research, China Medical University Hospital, Taichung, Taiwan(R.O.C.); 4School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan (R.O.C.); 5School of Medicine, China Medical University, Taichung, Taiwan(R.O.C.)Background and Aim: Autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and type I diabetes mellitus, increase the risk of chronic kidney disease (CKD). Similarly, inflammatory bowel disease (IBD) patients also face an elevated risk of CKD, yet this is frequently disregarded due to an assumption that the occurrence and severity of kidney dysfunction are lower compared to other autoimmune diseases. However, the comparison of CKD risk between autoimmune diseases and IBD remains unknown. In this study, we aim to evaluate the risk of CKD between patients with autoimmune disease and IBD.Methods: Using the National Health Insurance database in Taiwan, we compared 11336 patients who were diagnosed with autoimmune disease with 2834 IBD patients during 2009-2019. Autoimmune diseases included as fellow: systemic lupus erythematosus, rheumatoid arthritis, psoriasis, systemic sclerosis, Sjogren's syndrome, Bechet’s disease, polymyositis, dermatomyositis, ankylosing spondylitis, autoimmune thyroiditis, and type 1 diabetes mellitus. We applied Cox regression analysis to estimate hazard ratios (HRs) for CKD in autoimmune disease and IBD.Results: The mean follow-up of patients with autoimmune disease and IBD was 6.06 and 5.99 years in this study (Table 1). We found that 346 events developed in 68669 person-year in patients with autoimmune disease compared with 78 events in 16988 person-year in patients with IBD (adjusted HR [aHR]: 1.09; 95% confidence interval [95% CI]: 0.85 to 1.39, p=0.51). However, we further divided IBD patients into ulcerative colitis group and Crohn's disease group and then evaluated the CKD risk with autoimmune disease separately. 29 events developed in patients with Crohn’s disease (aHR: 1.84; 95% CI, 1.25 to 2.69, p=0.002), and 49 events developed in patients with ulcerative colitis (aHR: 0.88; 95% CI: 0.65 to 1.18, p=0.39) (Table 2). The cumulative incidence of CKD was higher in patients with Crohn’s disease compared to the autoimmune disease patients (Figure 1).15","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16702","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hepatology Basic Science 肝病学基础科学

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16699

{"title":"Hepatology Basic Science","authors":"","doi":"10.1111/jgh.16699","DOIUrl":"https://doi.org/10.1111/jgh.16699","url":null,"abstract":"102Therapeutic targeting of α-specific PI3K improves chemotherapy efficacy by inhibiting hepatic stellate cell activation in liver cancerQi Ruan1,2, Lu Cao1, Haotian Yang1,3, Leslie Burke1, Kim Bridle1,3, Darrell Crawford1,3 and Xiaowen Liang1,2,31Gallipoli Medical Research, Brisbane, Australia; 2Fazer Institute, Brisbane, Australia; 3School of Medicine, Brisbane, AustraliaBackground and Aim: Transarterial chemoembolization (TACE), administrating high dose of cisplatin, is a standard treatment for unresectable primary liver cancer. However, Liver cancer remains clinically challenging due to chemotherapy resistance, which has been associated with cancer-associated fibroblasts (CAFs). Activated hepatic stellate cells (HSCs), the main origin of CAFs in the tumour microenvironment (TME), contribute to fibrogenesis and treatment resistance. Understanding the molecular mechanisms of HSC activation in response to chemotherapy would identify potential targets to enhance treatment efficacy in liver cancer.Methods: CAFs subpopulations and the expression of alpha-smooth muscle actin (αSMA) were analysed in human hepatocellular carcinomas (HCC) patients with or without TACE using a single cell RNA sequencing dataset and immunohistochemistry staining on tumour tissues. The effect of chemotherapeutic drugs on HSC activation was examined in vitro by mixed-cell spheroids and conditioned medium (CM) of cisplatin pretreated Huh7 and HuCCT1 cells (human HCC and intrahepatic cholangiocarcinoma (ICC) cell lines). A pFRET HSP33 plasmid was transfected in LX2 cells (human HSC line) to monitor intracellular ROS levels in different CM. RNA sequencing profiled differential gene expression in primary HSCs in Huh7 cell CM treated with or without cisplatin. In the preclinical models of HCC and ICC, activation markers of HSCs and PI3K signalling were investigated in the tumour tissues after cisplatin treatment. Finally, PI3K α-specific inhibitors, HS-173 and alpelisib, were tested to determine their effectiveness in inhibiting chemotherapy-induced HSC activation. Combination treatment of cisplatin and alpelisib was administered to the orthotopic HCC mouse model, with tumour volume, PI3K signalling, and collagen deposition assessed using western blot and Masson trichrome staining.Results: The proportion of CAFs shifted towards the enrichment in COL1A1+ and ACTA2+ subpopulations, and increased αSMA expression was observed in tumour tissues of liver cancer patients after TACE treatment. LX2 cells were significantly activated by cisplatin-pretreated Huh7 and HuCCT1 cells through the paracrine effects. Increased ROS level was found in LX2 cells cultured in CM of Huh7 cells pretreated with cisplatin, indicating ROS mediated HSC activation. ","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16699","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

IBD Basic Science IBD 基础科学

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16701

{"title":"IBD Basic Science","authors":"","doi":"10.1111/jgh.16701","DOIUrl":"https://doi.org/10.1111/jgh.16701","url":null,"abstract":"93The biogeography of the mucosa-associated microbiota is associated with the presence and symptom severity of inflammatory bowel disease, proton pump inhibitor usage, and visceral sensitivityPeter Sternes3, Ayesha Shah1,2, Camila Ayela Pintos3, Thomas Fairlie1, Natasha Koloski1, Seungha Kang2, Simon McIlroy3, Mark Morrison2, Gene Tyson3 and Gerald Holtmann1,21Princess Alexandria Hospital, Metro South Health, Woolloongabba, Australia; 2University of Queensland, Brisbane, Australia; 3Queensland University of Technology, Brisbane, AustraliaBackground and Aims: We aimed to assess and compare the biogeography of the mucosa associated microbiome (MAM) in patients with inflammatory bowel disease (IBD) and controls in different segments of the gastrointestinal tract, and explore the links between the MAM, gastrointestinal symptoms and use of proton pump inhibitors (PPI).Methods: We recruited 59 controls (without structural abnormalities and gastrointestinal symptoms),44 patients with ulcerative colitis (UC) and 31 with Crohn’s disease (CD). Biopsies from various segments of the upper and lower gastrointestinal tract were collected. Microbial composition was assessed via 16S rRNA gene amplicon analysis and the bacterial load of the mucosal biopsies were assessed via qPCR. The MAM was examined in the context of disease status, PPI usage, the severity of gastrointestinal symptoms, and the symptom response to a standardized nutrient challenge (SNC).Results: Microbial communities of the MAM in the upper and lower gastrointestinal tract are different. Compared to controls, IBD patients were characterised by relative and absolute depletion of numerous butyrate and/or propionate producing genera, with the largest differentiation being the depletion of Faecalibacterium in the lower GI tract of CD patients. PPI users had enrichment of Faecalibacteriumin the lower GI tract. The severity of gastrointestinal symptoms, as well as the symptom response to the SNC, were significantly associated with MAM composition in the GI tract.Conclusion: The absolute and relative composition of the MAM is variable across different segments of the GI tract and is different in patients with IBD and controls. Gastrointestinal symptoms are associated with quantitative changes of bacterial taxa along the GI tract.125Frequency of NUDT15 polymorphisms in a multicultural Australian IBD populationTessa Greeve1,2, Georgia Sun1 and Gregory Moore1,21Monash Health, Melbourne, Australia; 2Monash University, Melbourne, AustraliaBackground and Aim: Thiopurine ","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16701","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Luminal Basic Science 流明基础科学

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16703

{"title":"Luminal Basic Science","authors":"","doi":"10.1111/jgh.16703","DOIUrl":"https://doi.org/10.1111/jgh.16703","url":null,"abstract":"92Simethicone suppresses the growth of microbes cultured from the human duodenal mucosaThomas Fairlie1,2, Ayesha Shah1,2, Yenkai Lim2, Jing-Jie Teh2, Lauren Schooth2, Mark Morrison2 and Gerald Holtmann1,21Princess Alexandria Hospital, Metro South Health, Woolloongabba, Australia; 2University of Queensland, Brisbane, AustraliaBackground and Aim: Small intestinal dysbiosis (SID) is known to play an important role in the pathophysiology of various gastrointestinal and extraintestinal disorders, with recent studies linking select members of the duodenal microbiota with symptom severity in functional dyspepsia (FD). Simethicone is routinely used during endoscopy as an anti-foaming agent and at lower concentrations used to alleviate painful gut symptoms associated with excessive gas and/or bloating. Here, we assessed the effects from simethicone on the growth of a mixed culture of duodenal mucosa-associated microbiota (MAM).Methods: The consortia of duodenal MAM recovered from the biopsies of a non-FD asymptomatic control subject were anaerobically cultured using a duodenal habitat-simulating medium with no addition, or supplemented with a commercially available source of Simethicone to provide final concentrations of 0.2 mg/ml (lowest effective dose for antifoaming effects, 1 mg/mL, 2 mg/mL or 4 mg/mL. Three biological replicates with six technical replicates of the cultures (and uninoculated controls) were prepared using a 96-well microtitre plate format within an anaerobic chamber, then microbial growth (optical density change at 600 nm) at 37 °C was measured every 30 minutes for 18 hours using an automated microtiter plate also housed within the anaerobic chamber. The R package Growthcurver was applied to assess the growth kinetic profiles by calculating the area under the curve and statistical comparisons to control cultures calculated with a paired t-test.Results: Relative to control cultures, the growth kinetic profile (area under the curve) after 18 hours was unaffected by the addition of 0.2 mg/mL simethicone (P = 0.99), but progressively reduced by the addition of greater simethicone concentrations (Fig. 1). The reduction of growth kinetics with 2 mg/mL simethicone approached significance (P = 0.059) and were significantly reduced with 4 mg/mL simethicone (P = 0.023).139A whole blood interleukin-2 release assay offers a novel approach to detect and monitor pathogenic T cells to support epitope discovery and drug development in coeliac disease and beyondOlivia Moscatelli1, Amy Russell1, Lee Henneken2, Linda Fothergill1, Hugh Reid3, Jamie Rossjohn3, Melinda Hardy1, Vanessa Bryant1 and J","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nursing 护理

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16705

{"title":"Nursing","authors":"","doi":"10.1111/jgh.16705","DOIUrl":"https://doi.org/10.1111/jgh.16705","url":null,"abstract":"181A clinical nurse specialist comprehensive hepatology clinic: Streamlining service deliveryMarcelle Perrin, Crystal Connelly, Vanessa Sheehan and Ying ShenFiona Stanley Hospital, Murdoch, AustraliaBackground: Advances in curative therapies for Hepatitis have seen the core role of the hepatology specialist nurses broaden significantly. In addition, hepatology service demand is increasing across both inpatient and outpatient settings. Transitioning to a new health service provided an opportunity to implement an alternative model to streamline access to hepatology services. A team of Hepatology Clinical Nurse Specialists deliver a clinic service to all hepatology patients aimed at managing extensive waitlists and ensuring appropriate services are provided in the timeliest manner. There is limited literature available on nurse-led hepatology clinics that are not condition specific. This clinic is the only one of its kind in Western Australia and, to our knowledge, nationally.Service structure and implementation: The clinic is autonomously led by a team of three Clinical Nurse Specialists and aims to divert from the Consultant waitlist where appropriate, provide baseline hepatology assessment including investigations and liver scan to facilitate early intervention and inform timely delivery of care, and improve the hepatology patient experience. A guideline and suite of standard operating procedures were developed and endorsed by the health service. Medical governance review is provided at weekly multidisciplinary team meetings. Patients are initially referred from Consultants or General Practitioners (GP) or identified through a virtual assessment triage of waitlisted patients. Hepatology screening and assessment is undertaken by a Hepatology Clinical Nurse Specialist and patients are either discharged from the service to the care of their GP, remain on the Consultant waitlist for review, or engage in ongoing monitoring and education within the clinic.Service delivery outcomes: Since implementation in 2022, the clinic has provided over 5,000 occasions of care. In the preceding year the clinic has had 195 referrals, with the primary sources of patient referrals being GPs (45%) and specialists (40%). The largest proportions of the cohort present due to deranged liver function tests (40%), followed by steatosis (29%). Seventy three percent of individuals referred engaged with the clinic service. Post assessment and clinic visit patients are most commonly identified to be suffering steatotic liver disease and are provided counselling and education. Half of presenting patients are discharged from the service to the care of their GP, resulting in a significant reduction to the waitlist for Consultant review. Ongoing surveillance is maintained for 40% of the presenting cohort. The service generates over $400,000 in activity-based funding per year to","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Advanced Endoscopic Techniques 先进的内窥镜技术

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16696

{"title":"Advanced Endoscopic Techniques","authors":"","doi":"10.1111/jgh.16696","DOIUrl":"https://doi.org/10.1111/jgh.16696","url":null,"abstract":"16Early experience with endoscopic submucosal dissection at Austin HealthSitong Chen1, Sujievvan Chandran1,2,3, Leonardo Zorron Cheng Tao Pu2,3, Nicholas Dalkie3, Rhys Vaughan1,2,3 and Marios Efthymiou1,2,31Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia; 2Liver Transplant Unit, Austin Health, Heidelberg, Australia; 3Department of Gastroenterology and Hepatology, Austin Health, Melbourne, AustraliaBackground and Aim: Endoscopic submucosal dissection (ESD) is a minimally invasive endoscopic procedure which employs en-bloc dissection technique to remove premalignant or early malignant gastrointestinal lesions. In Japan, ESD is considered as first line treatment for early gastrointestinal neoplasms, yet the wide adoption of ESD in the West has been slow. Barriers include the technical difficulty of ESD, lower prevalence of early gastric cancer in the West, and the lack of training opportunities. We know that gastric location is the easiest location to start training in ESD whereas colorectal ESD is more challenging. The aim of this study was to assess the early experience with ESD at Austin Health.Methods: A retrospective analysis was conducted on 31 consecutive gastrointestinal lesions in 27 patients who underwent ESD from June 2020 to April 2023 at Austin Health, Melbourne Australia. Clinical and procedural data, complications, and the efficacy and efficiency of the ESD procedure were evaluated.Results: Twenty-seven patients (12 females and 15 males) were enrolled in the study, with a mean age of 72.0 years. Overall, thirty-one lesions were resected, including 16 gastric lesions, 6 oesophageal lesions and 9 colorectal lesions. The mean size of the lesions was 35.8mm and the mean resected base area was 12.0cm2. In the total cohort, en-bloc resection rate was 96.8%. Final ESD histology upstaged the initial diagnosis in four lesions based on pre-ESD pinch biopsies and imaging. Eleven malignant lesions were found in the final pathology. Six complications were reported in our study, including two cases of intraoperative perforation and four cases of delayed bleeding (all the complications were managed medically/endoscopically). The mean hospital stay was 1.6 days for all patients, and 19 patients were discharged after an overnight admission.Conclusion: ESD is an effective and safe treatment for gastrointestinal neoplasms in an Australian tertiary centre and our early treatment outcomes were comparable to recently published large study data. Outcomes are likely to progressively improve with further experience.30Intrathoracic cholecystitis managed with endoscopic gallbladder drainageAndrea Huang1,4","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16696","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hepatology Clinical 肝病学临床

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16700

{"title":"Hepatology Clinical","authors":"","doi":"10.1111/jgh.16700","DOIUrl":"https://doi.org/10.1111/jgh.16700","url":null,"abstract":"10Liver outcome score predicts long term clinical outcomes in primary biliary cholangitis: a multi-centre studyDujinthan Jayabalan1,2, Leon A Adams1,2, Yi Huang1, Luis Calzadilla Bertot1,2, Wendy Cheng3, Simon Hazeldine4, Briohny Smith1, Gerry MacQuillan1,2, Michael Wallace1,2, George Garas1,2 and Gary P Jeffrey1,21Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Australia; 2Medical School, University of Western Australia, Nedlands, Australia; 3Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia; 4Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Perth, AustraliaBackground and Aim: Few predictive models of survival exist for primary biliary cholangitis (PBC) patients. This study investigated the natural history and assessed the accuracy of models for predicting liver-related outcomes in PBC patients.Methods: PBC patients were identified from the state-wide Hepascore and Clinical Outcome (HACO) cohort. Patients with PBC overlap syndromes were excluded. Overall death or transplant, liver-related mortality (liver-related death or transplant), and liver-related decompensation were determined using a population-based data linkage system. Accuracy of baseline Liver Outcome Score (LOS), composed of albumin, GGT, hyaluronic acid, age, sex, Hepascore and MELD were examined for predicting clinical outcomes.Results: 157 PBC patients (13% male, median age 60.5 years, median MELD 6, median Hepascore 0.22, 34% cirrhotic at enrolment) were followed for a median of 4.0 years (range, 0.01-9.5 years). Twelve patients died, 8 had liver-related deaths and 3 underwent liver transplant. Ten patients decompensated and two developed hepatocellular carcinoma. 5-year transplant-free survival was 92% (95% CI: 85-96%) overall, 71% (95% CI: 48-86%) in cirrhosis and 97% (95% CI: 91-99%) in non-cirrhotics (p<0.0001). 5-year liver-related mortality free rate was 95% (95% CI: 89-98%) in all, 76% (95% CI: 53-89%) in cirrhosis and 100% (95% CI: 100-100%) in non-cirrhotics (p<0.0001). Median time-to-decompensation was 3.3 years (range, 0.2-8.6). 5-year liver-related decompensation-free rate was 89% (95% CI: 78-95%) in all, 53% (95% CI: 22-76%) in cirrhosis, 98% (95% CI: 89-99.8%) in non-cirrhotics (p<0.0001). Multivariate analysis found LOS predicts overall death or transplant in all patients (HR 2.14; (95% CI: 1.26-3.62), p=0.005, C-statistic 0.89) and in cirrhotics (HR 2.24; (95% CI: 1.11-4.50), p=0.024, C-statistic 0.85). LOS predicted liver-related mortality in all (HR 2.40; (95% CI: 1.11-5.19), p=0.027, C-statistic 0.93) and in cirrhosis (HR 2.06; (95% CI: 0.98-4.31), p=0.056, C-statistic 0.93). LOS p","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16700","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sustainability 可持续性

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16709

{"title":"Sustainability","authors":"","doi":"10.1111/jgh.16709","DOIUrl":"https://doi.org/10.1111/jgh.16709","url":null,"abstract":"65Using patient satisfaction scores to compare performance of nurse practitioner against doctors in direct access endoscopy clinicDavid Huynh, Aathavan Shanmuga Anandan, Ruth Ayers and Peter HendyMater Hospital Brisbane, Brisbane, AustraliaBackground and Aim: Physician shortages contribute to the growing presence of nurse practitioners (NP), driven by the expectation that NP can reduce outpatient wait times, leading to better patient outcomes. While Direct Assessment Endoscopy (DAE) aims to streamline access for simple cases, it still requires doctor involvement for consent and assessment. An NP-led care model presents an alternative, but concerns exist anecdotally about patient acceptance. We seek to assess patient expectations and acceptance of a newly introduced NP-led DAE clinic at Mater Health Brisbane (MHB).Methods: Patients attending DAE clinics at the MHB were surveyed across two months. Patients completed two survey sections: a pre- and post-consultation questionnaire using a 5-point Likert scale. The pre-consultation questions were set to determine if the patients had pre-conceived biases such as “expecting to see a doctor”. Post-consultation questions assessed ‘communication’, ‘experience’, ‘professionalism’, and ‘understanding’ of endoscopic procedures. Patients were blinded to whether they would see an NP or doctor for their endoscopic consultation. Scores were collated to compare NP against doctors.Results: 92 patients offered to participate in the survey with 71 (77%) patients completing questionnaires. 33 (46%) patients saw a doctor, and 38 saw an NP (54%). NP ratings were significantly higher than doctors regarding ‘professionalism and friendliness’ (see table 1). NP scores were numerically greater than doctors in ‘overall experience’, ‘understanding’, and ‘communication’. Of the total 71 patients, 61 had anticipated seeing a doctor. Of these 61 patients, 51% encountered an NP instead (n = 31). Of these 31 patients, 28 expressed no reservations about seeing either an NP or a doctor following the consultation. The average scores for doctors (Group A) regarding overall experience, professionalism, understanding, and communication were 4.0 (95% CI [3.5–4.5]), 4.2 (95% CI [3.8–4.7]), 4.5 (95% CI [4.3–4.7], and 4.5 (95% CI [4.3–4.7]), respectively. Conversely, patients with preconceived biases determined by all the patients wanting to see a doctor (Group B) reported average scores of 4.3 (95% CI [3.9–4.7]), 4.7 (95% CI [4.5–4.9]), 4.5 (95% CI [4.5–4.6]), and 4.5 (95% CI [4.4–4.8]) for the same attributes, respectively.Conclusion: Overall, NP results proved non-significantly higher in all metrics than doctors except ‘professionalism and friendliness’. We also showed that pre-existing biases did not significantly influence patients' overall experiences with NPs. This suggests that the integration of an NP into","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16709","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Luminal Clinical 流明临床

IF 3.7 3区医学

Journal of Gastroenterology and Hepatology Pub Date : 2024-09-13 DOI: 10.1111/jgh.16704

{"title":"Luminal Clinical","authors":"","doi":"10.1111/jgh.16704","DOIUrl":"https://doi.org/10.1111/jgh.16704","url":null,"abstract":"7Safety, efficacy and tolerability of an ultra-low volume bowel preparation (NER1006) – a real world experienceAnthony Sakiris, Arvinf Rajandran, Jane Lynch, Myles Rivlin and Sneha JohnGold Coast University Hospital, Gold Coast, AustraliaBackground and Aim: Endoscopic assessment with colonoscopy allows for the detection of polyps and adenomas which are precursors to colorectal adenocarcinoma. The quality of bowel preparation is of significant importance to the outcome of a colonoscopy as poor bowel preparation results in prolonged procedure times, the need for repeat procedures and missed lesions. A split-dose regimen of 3-4L Polyethylene Glycol (PEG) has historically been the recommended form of bowel preparation. NER1006 is a 1L split-dose PEG bowel preparation that is comparatively novel to Australia and has been adopted within our service since 2020. NER1006 provides enhanced osmotic activity from the high-dose ascorbate that is present in the second dose. Given its ultra-low volume, the aim of this study was to assess the safety, efficacy and tolerability of NER1006 in a real-world setting within our hospital network.Methods: This study was a retrospective analysis of prospectively collected data for colonoscopy procedures at two centres within our hospital health service. Patients who underwent a colonoscopy between July 2020 and February 2024 and received NER1006 as bowel preparation with a split-dose regime were analysed. The study population consisted of patients who returned a positive faecal occult blood test from the Australian National Bowel Cancer Screening Program (NBCSP) as well as symptomatic patients referred through our nurse-led Direct Access Colonoscopy clinic. The quality of the bowel preparation was quantified through the Boston Bowel Preparation Scale (BBPS). The Polyp Detection Rate (PDR), Adenoma Detection Rate (ADR), Sessile Serrated Lesion Detection Rate (SSLDR) and Advanced Adenoma Rate (AADR) were also calculated as quality indicators of colonoscopy. Adverse events related to NER1006 were classified as either minor or major. Major adverse events were defined as those requiring hospitalisation or those that prevented the patient from adequately completing their bowel preparation.Results: A total of 2920 colonoscopies were performed on 2874 patients. There were 1571 males, 1301 females and 2 indeterminate with a mean age of 57 years. 2827/2920 (97%) of the colonoscopies performed produced a BPPS score equal to or greater than 6 (good or excellent), with an average score of 7.90. Analysis revealed a 72% PDR, 55% ADR, 16% SSLDR and 25% AADR. There were 2 cases (0.07%) of major adverse events. One patient was unable to complete their bowel preparation due to vomiting and one patient presented with an acute kidney injury. There 98 cases (3.36%) of minor adverse events. Tachycardia (>100 bpm) was the most co","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16704","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142230955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0