Journal of Gastroenterology and Hepatology最新文献

{"title":"Increased Mortality Among Lean Versus Non-Lean Adults With MASLD: A Multicenter Study.","authors":"Leith Ghani, Majd B Aboona, Claire S Faulkner, Pooja Rangan, Moises Nevah Rubin, Ma Ai Thanda Han, Michael B Fallon, Vincent L Chen, Karn Wijarnpreecha","doi":"10.1111/jgh.17015","DOIUrl":"https://doi.org/10.1111/jgh.17015","url":null,"abstract":"<p><strong>Background and aim: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease worldwide. Since the adoption of the new terminology from the Delphi Consensus statement, there has not been a large multicenter cohort study of MASLD among lean versus non-lean individuals. This study aims to assess prevalence and incidence outcomes among lean and non-lean individuals with MASLD in a diverse patient cohort.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter study on patients with MASLD at the Banner and the University of Michigan Health systems from 2012 to 2023. Main outcomes included mortality and incidence of cirrhosis, cardiovascular disease (CVD), major adverse liver outcome (MALO), and cancer.</p><p><strong>Results: </strong>Seventy-five thousand nine hundred twenty-one patients were included in this cohort with 5% lean individuals. In this cohort, 4.99% were lean, 23.16% were overweight, 28.47% were obesity class I, and 43.39% were obesity class II-III; 58.49% were female; and 66.32% were non-Hispanic White, 22.23% Hispanic, 4.75% Black, 1.71% Native Americans (NAs), and 1.97% Asian/Pacific Islander. After adjusting for confounders, lean individuals had a higher mortality, higher incidence of CVD, and higher incidence of MALO.</p><p><strong>Conclusions: </strong>Lean individuals have a higher mortality, higher cardiovascular burden, and higher incidence of MALO compared to non-lean individuals. Further studies are warranted to explore lean patients with MASLD, and interventions are needed to decrease mortality in this patient population.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of Endoscopic Mucosal Resection Using an Over-the-Scope Clip for Duodenal Neuroendocrine Tumors: A Multicenter Retrospective Comparative Study.","authors":"Tomoaki Tashima, Osamu Dohi, Hideki Kobara, Tomonori Kawasaki, Hayato Fukui, Naoya Tada, Kunihisa Uchita, Satoshi Asai, Takashi Hirose, Takahiro Muramatsu, Tsubasa Ishikawa, Shomei Ryozawa","doi":"10.1111/jgh.17005","DOIUrl":"https://doi.org/10.1111/jgh.17005","url":null,"abstract":"<p><strong>Background and aim: </strong>Resection of non-ampullary duodenal neuroendocrine tumors presents technical challenges. This study investigated the efficacy and safety of endoscopic mucosal resection using an over-the-scope clip compared to endoscopic mucosal resection with a ligation device and endoscopic submucosal dissection.</p><p><strong>Methods: </strong>This retrospective multicenter study included 65 lesions (63 patients), categorized by resection method: endoscopic mucosal resection using an over-the-scope clip (n = 26), endoscopic mucosal resection using a ligation device (n = 17), and endoscopic submucosal dissection (n = 22). Patient characteristics, tumor details, and outcomes were systematically evaluated, with significance at p < 0.05.</p><p><strong>Results: </strong>Endoscopic mucosal resection using an over-the-scope clip had a significantly shorter procedure time than endoscopic submucosal dissection (16 min [7-30] vs. 60 min [28-119], p < 0.001) and recorded no perforations. Endoscopic mucosal resection using a ligation device was employed for smaller lesions, while endoscopic submucosal dissection had challenges in achieving clear margins. Hospitalization duration was the longest for the endoscopic submucosal dissection group (endoscopic mucosal resection using an over-the-scope clip: 4 [3-7] days, endoscopic mucosal resection using a ligation device: 5 [4-8] days, endoscopic submucosal dissection: 7 [4-15] days, p < 0.001). Endoscopic mucosal resection using an over-the-scope clip exhibited a unique advantage for full-thickness resection.</p><p><strong>Conclusions: </strong>Endoscopic mucosal resection using an over-the-scope clip allows for full-thickness resection with fewer complications. While effective, endoscopic mucosal resection using a ligation device is less reliable for achieving clear vertical margins, and endoscopic submucosal dissection, suitable for larger tumors, has a longer duration and higher complication rate.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality Upper Gastrointestinal Endoscopy in Australia and Aotearoa New Zealand: A Joint Position Statement.","authors":"Linda S Yang, Abir Halder, Bronte A Holt, Benedict Devereaux, Matthew Remedios, Neil Merrett, Marianne Lill, Zoe Raos, Malcolm Arnold, Nicholas G Burgess, Sneha John, Krish Ragunath","doi":"10.1111/jgh.17013","DOIUrl":"https://doi.org/10.1111/jgh.17013","url":null,"abstract":"<p><p>Quality standards for upper gastrointestinal (UGI) endoscopy are required to identify key quality indicators that are relevant to Australasian endoscopic practice and local patient populations. Such standards will promote equitable access to high-quality UGI endoscopy for appropriate indications across Australia and Aotearoa New Zealand. The Gastroenterological Society of Australia (GESA) Endoscopy Faculty's quality of UGI endoscopy working group conducted a review of published guidelines on quality standards in UGI endoscopy. A literature search was performed using the MEDLINE database, with further references sourced from bibliographies of published papers. Recommendations from international guidelines and available evidence were reviewed, and their relevance to the Australian clinical context was assessed. The working group then formulated a position statement on quality assurance in UGI endoscopy in Australian practice. A further iterative process involving the Endoscopy Guidance Group for New Zealand (EGGNZ) and the Royal Australasian College of Surgeons (RACS) culminated in the final recommendations for practice in Australia and Aotearoa New Zealand. The recommendations in this position statement are categorized into preprocedural, intraprocedural, and postprocedural. As UGI endoscopy examines several anatomical structures and is performed for a wider range of indications than colonoscopy, disease-specific intraprocedural recommendations for common benign and premalignant conditions of the UGI tract are also presented. This GESA initiative was undertaken in collaboration with the RACS and endorsed by GESA, RACS, the Royal Australasian College of Physicians, and EGGNZ, membership of which includes the New Zealand Society of Gastroenterology, the New Zealand Association of General Surgeons, and other local endoscopy stakeholders.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of Gastric Subepithelial Lesion of < 2 cm and Risk Factors for Tumor Growth.","authors":"Miyuki Iwasaki, Tomoaki Matsumura, Kenichiro Okimoto, Yuhei Ohyama, Yukiyo Mamiya, Hayato Nakazawa, Satsuki Takahashi, Ryosuke Horio, Chihiro Goto, Michiko Sonoda, Akane Kurosugi, Tatsuya Kaneko, Yuki Ohta, Takashi Taida, Keisuke Matsusaka, Yoshihito Ozawa, Koichi Hayano, Jun Kato, Hisahiro Matsubara, Naoya Kato","doi":"10.1111/jgh.17019","DOIUrl":"https://doi.org/10.1111/jgh.17019","url":null,"abstract":"<p><strong>Background and aim: </strong>Endoscopic resection of small gastric subepithelial lesions (SELs) has been recently reported. However, evidence of natural history of untreated small gastric SELs is lacking. This study aimed to investigate the long-term course of gastric SELs of < 2 cm as well as identify the enlargement rate and factors affecting it.</p><p><strong>Methods: </strong>A total of 1045 gastric SELs in 1033 patients were evaluated via endoscopic ultrasonography (EUS) from January 1994 to December 2023. Of these, this study included 125 SELs in 122 patients with an initial tumor diameter of < 2 cm and who underwent at least two EUS examinations. Tumor diameter was measured through EUS and considered enlarged when the longitudinal diameter increased > 1.25 times from the initial size. Multivariate Cox proportional hazards regression analysis was used to identify factors affecting tumor enlargement.</p><p><strong>Results: </strong>The average observation period was 4.0 ± 3.4 years. A total of 29 (23.2%) lesions were enlarged during the observation period, with a mean tumor doubling time of 4.1 ± 3.8 years and an augmentation rate of 5.7/100 person-years. The multivariate analysis indicated that the initial tumor size of ≥ 9.5 mm (hazard ratio [HR]: 3.99, 95% confidence interval [CI]: 1.33-11.94) and EUS finding changes (irregular border, cystic space, high echoic lesion, and/or heterogeneity), excluding calcifications (HR: 2.55, 95% CI: 1.09-5.97), were increasing factors.</p><p><strong>Conclusions: </strong>The augmentation rate of gastric SELs of < 2 cm was 5.7/100 person-years. These results provide valuable data for treatment decisions.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MDSCs in Chronic Liver Disease: Updates and Future Challenges.","authors":"Yi Lu, Ting Li, Liang Song, Qingling Fan, Danlin Wang, Punan Wang, Ying Han, Xinmin Zhou","doi":"10.1111/jgh.17008","DOIUrl":"https://doi.org/10.1111/jgh.17008","url":null,"abstract":"<p><p>Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of pathologically expanded immature myeloid cells originating from bone marrow precursors, characterized by their potent immunosuppressive activity through mechanisms such as T cell inhibition, cytokine dysregulation, and metabolic interference. These cells are critically implicated in diverse pathological contexts, including cancer progression, chronic infections, and inflammatory disorders. In chronic liver diseases, MDSCs contribute to the pathogenesis of multiple conditions, such as chronic viral hepatitis, alcoholic liver disease (ALD), nonalcoholic fatty liver disease (NAFLD), and autoimmune liver diseases (AILD). Emerging evidence highlights their dual roles in both exacerbating tissue injury and modulating immune responses, positioning MDSCs as pivotal regulators of disease progression and potential therapeutic targets. In this review, we summarize the biological roles of MDSCs in a variety of chronic inflammatory liver diseases and explore the therapeutic potential of targeting these diseases to provide new insight for the treatment of chronic liver diseases.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Epidemiology of Early-Onset Digestive System Malignancy: A Systematic Analysis for the Global Burden of Disease Study 2021","authors":"Jiayi Wang,&nbsp;Deming Li,&nbsp;Fangzhou Ye,&nbsp;Jian Li,&nbsp;Zhe Qing,&nbsp;Xiaohong Zhang,&nbsp;Huanqing Li,&nbsp;Li Feng","doi":"10.1111/jgh.17012","DOIUrl":"10.1111/jgh.17012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>The researches on the global burden of digestive system malignancy in young populations were limited. This study aimed to comprehensively investigate the burden of early-onset digestive system malignancy (often defined as cancers diagnosed below the age of 50) based on the Global Burden of Disease 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data of incidence, prevalence, deaths, disability-adjusted life years (DALYs), and risk factors for the five major early-onset digestive system malignancies, including early-onset esophageal cancer (EOEC), early-onset gastric cancer (EOGC), early-onset liver cancer (EOLC), early-onset pancreatic cancer (EOPC), and early-onset colorectal cancer (EOCRC), were extracted from GBD 2021. The average annual percent change (AAPC) was calculated using joinpoint regression analysis. The Bayesian age–period–cohort (BAPC) model was utilized to predict the burden up to 2030.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 1990 to 2021, the age-standardized incidence rate (ASIR) of early-onset digestive system malignancies, except for EOCRC (AAPC, 0.37), showed a decreasing pattern. Meanwhile, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of early-onset digestive system malignancy presented a downward trend. Notably, high-middle sociodemographic index (SDI) countries experienced higher disease burdens. Dietary risk factors, tobacco, alcohol consumption, and metabolic factors were the main risk factors. The ASIR of EOEC and EOCRC was projected to increase in 2030, whereas the trend for EOGC, EOLC, and EOPC was projected to decrease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early-onset digestive system malignancy presented notable heterogeneity across gender, geography, and cancer types. This emphasizes the urgency of addressing the public health challenge of early-onset digestive system malignancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 6","pages":"1525-1535"},"PeriodicalIF":3.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.17012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119837","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}

{"title":"Salvage Endoscopic Management for Basket Impaction Using Cholangioscopy and Electrohydraulic Lithotripsy.","authors":"Kuan-Hui Hsin, Hsu-Hua Tseng, Hsiu-Po Wang, Chieh-Chang Chen","doi":"10.1111/jgh.17010","DOIUrl":"https://doi.org/10.1111/jgh.17010","url":null,"abstract":"<p><strong>Background: </strong>Basket impaction is a serious complication of mechanical lithotripsy during endoscopic retrograde cholangiopancreatography, often necessitating surgical intervention. Risk factors include stones > 1.5 cm, multiple stones, extremely hard stones, or inadequate dilatation of the bile duct.</p><p><strong>Case report: </strong>We describe a 64-year-old woman with recurrent cholangitis and choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography for a 1.6-cm common bile duct stone. Initial balloon lithotripsy was unsuccessful, and subsequent mechanical lithotripsy resulted in basket impaction. Attempts with a rescue lithotripter handle were ineffective due to challenging ampullary angulation. Peroral cholangioscopy with the Boston Scientific SpyGlass DSII system was utilized, and electrohydraulic lithotripsy successfully fragmented the stone. The basket and stone fragments were subsequently removed without complications.</p><p><strong>Conclusions: </strong>This case underscores the value of cholangioscopy-assisted electrohydraulic lithotripsy as a salvage strategy for basket impaction, offering direct visualization and precise targeting to reduce the risk of tissue injury associated with blind or forceful interventions, thereby preventing the need for surgery. While cost and limited availability remain barriers, this minimally invasive technique provides a timely and effective alternative to surgical intervention, offering a critical salvage option for managing basket impaction.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ulcerative Lesion of the Ileocecal Region in a Patient With Immunodeficiency","authors":"Naohiko Kinoshita,&nbsp;Kazuki Kakimoto,&nbsp;Emiri Kaji,&nbsp;Noboru Mizuta,&nbsp;Keijiro Numa,&nbsp;Kei Nakazawa,&nbsp;Ryoji Koshiba,&nbsp;Yuki Hirata,&nbsp;Takako Miyazaki,&nbsp;Shiro Nakamura,&nbsp;Hiroki Nishikawa","doi":"10.1111/jgh.17006","DOIUrl":"10.1111/jgh.17006","url":null,"abstract":"&lt;p&gt;A male patient had atopic dermatitis at 1 month of age, and at 1 year of age, he contracted infectious mononucleosis and varicella. Since 2 years of age, the patient repeatedly had pneumococcal pneumonia and bacteremia, and each time, he was hospitalized and treated with antibiotics. At 2 years of age, hypodontia with conical teeth, sparse hair, and anhidrosis were noted, and a skin biopsy revealed the absence of eccrine sweat glands. A G524C (A175P) missense mutation in his IKBKG gene was confirmed and diagnosed as X-linked ectodermal dysplasia and immunodeficiency (XL-EDA-ID). Since 4 years of age, he has been receiving gamma globulin every 8 weeks as prophylaxis against infections.&lt;/p&gt;&lt;p&gt;At 21 years of age, the patient presented with right lower abdominal pain and diarrhea. Blood test results were as follows: leukocyte count, 11 800/μL (neutrophils, 59%; lymphocytes, 30.5%; and lymphocyte fraction: monocytes, 8.5% and eosinophils, 2.0%); HGB level, 12.0 g/dL; PLT count, 652 000/μL; Alb level, 3.1 g/dL; CRP level, 7.1 mg/dL; IgA, 1518 mg/dL; IgG, 1081 mg/dL; and IgM, 17 mg/dL. Tests for cytomegalovirus (CMV), C7-HRP, T-SPOT, antinuclear antibody, P-ANCA, C-ANCA, and HLA-B51 were negative; moreover, stool cultures showed no bacterial growth.&lt;/p&gt;&lt;p&gt;Colonoscopy revealed a large, deep ulcer extending from the terminal ileum to the ileocecal region with a deformed lumen (Figure 1a–d). Additionally, erythema, erosion, and shallow mucosal ulceration were observed in the terminal ileum (Figure 1e) and transverse colon (Figure 1f); however, the intervening mucosa was normal. Histopathological examination of the intestinal mucosa revealed edema and neutrophilic infiltration in the mucosal lamina propria (Figure 2a,b).&lt;/p&gt;&lt;p&gt;What is the most likely diagnosis?&lt;/p&gt;&lt;p&gt;The patient was diagnosed with nuclear factor-κB (NF-κB) essential modulator (NEMO) colitis.&lt;/p&gt;&lt;p&gt;Based on the endoscopic findings, CMV colitis and intestinal tuberculosis were considered differential diagnoses; however, the tests for C7HRP and T-SPOT were negative. Furthermore, no symptoms characteristic of Behçet's disease (recurrent oral ulceration, recurrent genital ulceration, eye lesions, or skin lesions) were observed. Histopathological examination showed only nonspecific inflammation and no crypt distortion or granuloma, which are characteristic of Crohn's disease or intestinal tuberculosis. Because tests for all these diseases were negative, NEMO colitis associated with XL-EDA-ID was diagnosed.&lt;/p&gt;&lt;p&gt;When infliximab, antitumor necrosis factor (TNF)α antibody, was administered for NEMO colitis, abdominal pain, diarrhea, and inflammatory response quickly resolved. In addition to the previously regular administration of intravenous immunoglobulin, infliximab was continued every 8 weeks. Five months after initiating infliximab administration, colonoscopy showed that all ulcerative lesions were scarred and mucosal healing had occurred. After more than 5 years, the patient has remained f","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 6","pages":"1345-1347"},"PeriodicalIF":3.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.17006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093636","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}

{"title":"Clinical Significance of Small-Bowel Mucosal Changes in Liver Cirrhosis Patients With Suspected Small-Bowel Bleeding: A Capsule Endoscopy Study.","authors":"Yuka Matsubara, Akiyoshi Tsuboi, Shuya Shigenobu, Issei Hirata, Takeshi Takasago, Hidenori Tanaka, Ken Yamashita, Yuichi Hiyama, Hidehiko Takigawa, Yoshihiro Kishida, Eisuke Murakami, Yuji Urabe, Masataka Tsuge, Toshio Kuwai, Shiro Oka","doi":"10.1111/jgh.17002","DOIUrl":"https://doi.org/10.1111/jgh.17002","url":null,"abstract":"<p><strong>Background and aim: </strong>Although the type and prevalence of small-bowel lesions in patients with liver cirrhosis have been reported, the clinical significance of their endoscopic features is unclear. We aimed to clarify their association with small-bowel bleeding in liver cirrhosis patients with suspected small-bowel bleeding.</p><p><strong>Methods: </strong>We retrospectively included 165 patients with liver cirrhosis (96 men; median age, 73 years) who underwent capsule endoscopy at our institution: 32 without portal hypertensive enteropathy (Grade 0), 101 with inflammatory-like abnormalities (Grade 1), and 32 with vascular lesions (Grade 2). The main outcome measures were the rates of small-bowel bleeding at the initial bleeding episode and rebleeding. Factors associated with Grade 2 portal hypertensive enteropathy were examined.</p><p><strong>Results: </strong>At the time of initial bleeding, 66% of patients with Grade 2 portal hypertensive enteropathy had small-bowel bleeding, compared with only 3% of those with Grades 0 or 1 portal hypertensive enteropathy. Furthermore, the cumulative rebleeding rate from small-bowel lesions 1 year after the initial bleeding was 33% in patients with Grade 2, compared to 0% in those with Grades 0 and 1. Colorectal angioectasia, Child-Pugh Grade C cirrhosis, and a history of blood transfusion were independent predictors of small-bowel vascular lesions.</p><p><strong>Conclusion: </strong>Our results suggest that patients with colorectal angioectasia, Child-Pugh Grade C cirrhosis, or a history of blood transfusion have a high risk of small-bowel bleeding and should, therefore, be examined via capsule endoscopy.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Carvedilol to Propranolol in Reduction of Hepatic Venous Pressure Gradient in Liver Cirrhosis: A Meta-Analysis","authors":"Amey Joshi,&nbsp;Hafsa Arshad Azam Raja,&nbsp;Poulami Roy,&nbsp;Fakhar Latif,&nbsp;Rahul George Reji,&nbsp;Novonil Deb,&nbsp;Ryan K. Mui,&nbsp;Ahmed Shady","doi":"10.1111/jgh.16999","DOIUrl":"10.1111/jgh.16999","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nonselective beta-blockers, such as propranolol and carvedilol, are used to prevent first decompensation in patients with clinically significant portal hypertension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a systematic literature search of English language articles from inception in PubMed, Medline, and Cochrane databases to compare the effect of carvedilol and propranolol on systemic and splanchnic hemodynamics. Mean differences were pooled using a random-effect model, and a <i>p</i>-value of &lt; 0.05 was considered statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seven RCTs with a total of 351 patients were involved in the final analysis. Reduction in hepatic venous pressure gradient was significantly greater in the carvedilol group (MD = −0.76, 95% CI = −1.45 to −0.08; <i>p</i> = 0.03). Decrease in systemic vascular resistance and mean arterial pressure was significantly greater in the carvedilol group ([MD = −190.55, 95% CI = −307.5 to −73.58; <i>p</i> = 0.001] and [MD = −3.65, 95% CI = −5.94 to −1.36; <i>p</i> = 0.002], respectively). Decrease in cardiac output was greater in the propranolol group (MD = 0.92, 95% CI = 0.45–1.38; <i>p</i> = 0.004). Decrease in hepatic blood flow and right atrial pressure appeared to be greater in the propranolol group; however, this did not reach statistical significance ([MD = 0.13, 95% CI = −0.06 to 0.32; <i>p</i> = 0.17] and [MD = 0.28, 95% CI = −0.27 to 0.83; <i>p</i> = 0.32], respectively). Decrease in mean pulmonary arterial pressure appeared to be greater in the carvedilol group; however, this was not statistically significant (MD = −0.75, 95% CI = −1.60 to 0.10; <i>p</i> = 0.08). There was no difference in incidence of rebleeding, shortness of breath, hepatic encephalopathy, and hypotension between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Carvedilol demonstrated a significantly greater reduction in HVPG, SVR, and MAP compared to propranolol, with no significant difference in adverse effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":"40 6","pages":"1409-1418"},"PeriodicalIF":3.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.16999","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093990","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}