United European Gastroenterology Journal最新文献

{"title":"Endoscopic Techniques for Colorectal Neoplasia Surveillance in Inflammatory Bowel Disease: A Systematic Review and Network Meta-Analysis.","authors":"Chih-Wen Huang, Hsu-Heng Yen, Yang-Yuan Chen","doi":"10.1002/ueg2.70017","DOIUrl":"https://doi.org/10.1002/ueg2.70017","url":null,"abstract":"<p><strong>Background and aims: </strong>Dye-based chromoendoscopy (DCE) has been the preferred method for colonoscopy surveillance in patients with inflammatory bowel disease (IBD). However, with advances in endoscopy, virtual chromoendoscopy (VCE) techniques have emerged. This network meta-analysis evaluates the effectiveness of different endoscopy techniques for IBD patient surveillance.</p><p><strong>Methods: </strong>Sixteen randomized controlled trials involving 2514 patients were included in the analysis, comparing endoscopy techniques in IBD patient surveillance: DCE, high-definition white light endoscopy (WLE), standard-definition WLE, i-scan, narrow band imaging (NBI), flexible spectral imaging color enhancement (FICE), and autofluorescence imaging (AFI). We assessed the per patient neoplasia detection rate, positive predictive value (PPV), and withdrawal time between different endoscopy techniques. Moreover, subgroup analysis was conducted to investigate the neoplasia detection rate according to endoscopy techniques using various biopsy protocols.</p><p><strong>Results: </strong>Comparing neoplasia detection rates revealed that only DCE (OR: 2.56 [1.17-5.59]) significantly increased the neoplasia detection rate compared with standard-definition WLE. The subsequent rankings were high-definition WLE, NBI, FICE, i-scan, and AFI. Moreover, the PPVs of DCE, VCE, and high-definition WLE showed no significant difference compared with that of standard-definition WLE. However, DCE required a significantly longer withdrawal time. Subgroup analysis showed that DCE with random biopsy or target biopsy and high-definition WLE with target biopsy had superior neoplasia detection rates than standard-definition WLE with random biopsy.</p><p><strong>Conclusion: </strong>DCE significantly outperforms standard-definition WLE in neoplasia detection rates, with random biopsy providing additional benefits. Although DCE does not lower PPV, it requires more withdrawal time. If DCE-based surveillance is not feasible, high-definition WLE with targeted biopsy should be considered as other VCE techniques offer no significant advantages.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Acute and Sub-Acute Gluten Exposure on Gastrointestinal Symptoms and Psychological Responses in Non-Coeliac Gluten Sensitivity: A Randomised Crossover Study.","authors":"Julie Iven, Annelies Geeraerts, Tim Vanuytsel, Jan Tack, Lukas Van Oudenhove, Jessica R Biesiekierski","doi":"10.1002/ueg2.70014","DOIUrl":"https://doi.org/10.1002/ueg2.70014","url":null,"abstract":"<p><strong>Background/aims: </strong>Non-coeliac gluten sensitivity (NCGS) is a controversial entity, characterised by symptom improvement with gluten exclusion in the absence of coeliac disease. We primarily investigated the effects of acute and sub-acute gluten on psychological and mood profiles, with secondary outcomes examining gastrointestinal symptoms and biological markers in healthy controls (HC) and individuals with NCGS.</p><p><strong>Methods: </strong>A randomised, single-blind, crossover study used acute (16 g gluten or whey in yoghurt) and sub-acute (gluten-containing (16 g) or gluten-free muffins per day for 5 days) challenges. (Extra)intestinal symptoms, intestinal permeability, high-sensitive C-reactive protein and cortisol awakening response were assessed. Responses over time were analysed using generalised linear mixed models.</p><p><strong>Results: </strong>Twenty HCs (15% men, mean age 30 years) and 16 individuals with NCGS (31% men, mean age 33 years) participated. No significant group-by-nutrient interactions were observed. Negative affect scores were higher and positive affect scores were lower in NCGS compared to HC (p = 0.01 and p = 0.04, respectively). Participants experienced higher tension scores after gluten compared with placebo (p = 0.01 acute; p = 0.05 sub-acute) regardless of the group. After acute administration, fatigue scores increased in NCGS (p = 0.03) compared with HC regardless of nutrient intake. After sub-acute administration, abdominal pain scores (p < 0.001) and bloating (p = 0.001) increased in NCGS compared with HC regardless of nutrient intake. No differences were found for biological markers.</p><p><strong>Conclusions: </strong>These findings reveal that NCGS is characterised by baseline differences in affect, and higher acute fatigue and subacute gastrointestinal symptoms that are not gluten-specific. This may be explained by nocebo effects, warranting research into novel mechanisms and re-evaluating the NCGS definition.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov no: NCT03798262; NCT03798249.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enteroscopic Balloon Dilation in Small Bowel Stricturing Crohn's Disease: Long-Term Outcomes and Risk Factors for Surgery in a Single-Center Prospective Observational Study.","authors":"Sung Noh Hong, Ji Eun Kim, Eun Ran Kim, Dong Kyung Chang, Young-Ho Kim","doi":"10.1002/ueg2.12775","DOIUrl":"https://doi.org/10.1002/ueg2.12775","url":null,"abstract":"<p><strong>Background and aims: </strong>The long-term outcomes of enteroscopic balloon dilation for small bowel strictures in patients with Crohn's disease are not well understood. Although Crohn's strictures can be classified into web-like, ulcerated, and spindle-shaped strictures based on endoscopic findings, the outcomes of enteroscopic balloon dilation according to the shape of Crohn's strictures have not been analyzed. The primary outcome was to evaluate the cumulative surgery-free rate, and the secondary outcome was to evaluate the risk factor for subsequent surgery after enteroscopic balloon dilation.</p><p><strong>Methods: </strong>This prospective, longitudinal, observational study enrolled patients with Crohn's disease who underwent enteroscopic balloon dilation for small bowel strictures using single-balloon enteroscopy between 2015 and 2023 at Samsung Medical Center, Seoul, Korea.</p><p><strong>Results: </strong>A total of 150 consecutive patients who underwent 235 enteroscopic balloon dilations were included in this study with a mean follow-up of 42.4 ± 19.1 months. Thirty-one patients (20.7%) underwent surgery after enteroscopic balloon dilation, and the cumulative 1-, 3-, and 5-year surgery-free rates were 86.7%, 80.4%, and 76.6%, respectively. The cumulative surgery-free rates of enteroscopic balloon dilation for web-like, ulcerated, and spindle-shaped strictures were 96.3%, 91.0%, and 73.3% at 1 year, 96.3%, 84.9%, and 63.0% at 3 years, and 96.3%, 78.3%, and 63.0% at 5 years, respectively (p = 0.001). Multivariate Cox regression analysis identified spindle-shaped stricture (vs. web-like stricture: hazard ratio [HR], 13.33; 95% confidence interval [CI], 1.48-120.24, p = 0.021), ulcerated stricture (vs. web-like stricture: HR, 8.50; 95% CI, 1.05-69.03, p = 0.045), and conventional therapy only (vs. biologic therapy: HR, 2.51; 95% CI, 1.11-5.71; p = 0.028) as risk factors for surgery after enteroscopic balloon dilation. The major complication rate of enteroscopic balloon dilations was 2.7% (4/150) on per-patient analysis and 1.7% (4/235) on per-procedure analysis.</p><p><strong>Conclusions: </strong>Enteroscopic balloon dilation for small bowel strictures in patients with Crohn's disease may be an effective and safe alternative to surgery. Enteroscopic balloon dilation for web-like strictures showed favorable outcomes and biologic therapy following enteroscopic balloon dilation may be helpful to avoid surgery.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Education, Socioeconomic Status, and Household Size Dependent Variables Influencing the Developmental Origins of Inflammatory Bowel Disease?","authors":"Richard Kellermayer","doi":"10.1002/ueg2.70018","DOIUrl":"https://doi.org/10.1002/ueg2.70018","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Impact of COVID-19 on Disorders of Gut-Brain Interaction: Incidence, Symptom Burden, and Psychological Comorbidities.","authors":"Giovanni Marasco, Keren Hod, Luigi Colecchia, Cesare Cremon, Maria Raffaella Barbaro, Giulia Cacciari, Francesca Falangone, Anna Kagramanova, Dmitry Bordin, Vasile Drug, Egidia Miftode, Pietro Fusaroli, Salem Youssef Mohamed, Chiara Ricci, Massimo Bellini, M Masudur Rahman, Luigi Melcarne, Javier Santos, Beatriz Lobo, Serhat Bor, Suna Yapali, Deniz Akyol, Ferdane Pirincci Sapmaz, Yonca Yilmaz Urun, Tugce Eskazan, Altay Celebi, Huseyin Kacmaz, Berat Ebik, Hatice Cilem Binicier, Mehmet Sait Bugdayci, Munkhtsetseg Banzragch Yağcı, Husnu Pullukcu, Berrin Yalınbas Kaya, Ali Tureyen, İbrahim Hatemi, Elif Sitre Koc, Goktug Sirin, Ali Riza Calıskan, Goksel Bengi, Esra Ergun Alıs, Snezana Lukic, Meri Trajkovska, Dan Dumitrascu, Antonello Pietrangelo, Elena Corradini, Magnus Simren, Jessica Sjolund, Navkiran Tornkvist, Uday C Ghoshal, Olga Kolokolnikova, Antonio Colecchia, Jordi Serra, Giovanni Maconi, Roberto De Giorgio, Silvio Danese, Piero Portincasa, Antonio Di Sabatino, Marcello Maggio, Elena Philippou, Yeong Yeh Lee, Daniele Salvi, Alessandro Venturi, Claudio Borghi, Marco Zoli, Paolo Gionchetti, Pierluigi Viale, Vincenzo Stanghellini, Giovanni Barbara","doi":"10.1002/ueg2.70005","DOIUrl":"https://doi.org/10.1002/ueg2.70005","url":null,"abstract":"<p><strong>Background: </strong>The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has highlighted the potential exacerbation of gastrointestinal symptoms in patients with disorders of gut-brain interaction (DGBIs). However, the distinct symptom trajectories and psychological burden in patients with post-COVID-19 DGBIs compared with patients with pre-existing irritable bowel syndrome (IBS)/functional dyspepsia (FD) and non-DGBI controls remain poorly understood.</p><p><strong>Objectives: </strong>To examine the long-term gastrointestinal symptom progression and psychological comorbidities in patients with post-COVID-19 DGBI, patients with pre-existing IBS/FD and non-DGBI controls.</p><p><strong>Methods: </strong>This post hoc analysis of a prospective multicenter cohort study reviewed patient charts for demographic data and medical history. Participants completed the Gastrointestinal Symptom Rating Scale at four time points: baseline, 1, 6, and 12 months, and the Hospital Anxiety and Depression Scale at 6 and 12 months. The cohort was divided into three groups: (1) post-COVID-19 DGBIs (2) non-DGBI, and (3) pre-existing IBS/FD, with the post-COVID-19 DGBIs group compared to the latter two control groups.</p><p><strong>Results: </strong>Among 599 eligible patients, 27 (4.5%) were identified as post-COVID-19 DGBI. This group experienced worsening abdominal pain, hunger pain, heartburn, and acid regurgitation, unlike symptom improvement or stability in non-DGBI controls (p < 0.001 for all symptoms, except hunger pain, p = 0.001). While patients with pre-existing IBS/FD improved in most gastrointestinal symptoms but worsened in constipation and incomplete evacuation, patients with post-COVID-19 DGBI exhibited consistent symptom deterioration across multiple gastrointestinal domains. Anxiety and depression remained unchanged in patients with post-COVID-19 DGBI, contrasting with significant reductions in controls (non-DGBI: p = 0.003 and p = 0.057; pre-existing IBS/FD: p = 0.019 and p = 0.007, respectively).</p><p><strong>Conclusions: </strong>COVID-19 infection is associated with the development of newly diagnosed DGBIs and distinct symptom trajectories when compared with patients with pre-existing IBS/FD. Patients with post-COVID-19 DGBI experience progressive gastrointestinal symptom deterioration and persistent psychological distress, underscoring the need for tailored management strategies for this unique subgroup.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Implementing Endoscopic Artificial Intelligence: The Impact of Real-World Imaging Conditions on Barrett's Neoplasia Detection.","authors":"M R Jong, T J M Jaspers, C H J Kusters, J B Jukema, R A H van Eijck van Heslinga, K N Fockens, T G W Boers, L S Visser, J A van der Putten, F van der Sommen, P H de With, A J de Groof, J J Bergman","doi":"10.1002/ueg2.12760","DOIUrl":"https://doi.org/10.1002/ueg2.12760","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic deep learning systems are often developed using high-quality imagery obtained from expert centers. Therefore, they may underperform in community hospitals where image quality is more heterogeneous.</p><p><strong>Objective: </strong>This study aimed to quantify the performance degradation of a computer aided detection system for Barrett's neoplasia, trained on expert images, when exposed to more heterogeneous imaging conditions representative of daily clinical practice. Further, we evaluated strategies to mitigate this performance loss.</p><p><strong>Methods: </strong>We developed a computer aided detection system using 1011 high-quality, expert-acquired images from 373 Barrett's patients. We assessed its performance on high, moderate and low image quality test sets, each containing images from an independent group of 117 Barrett's patients. These test sets reflected the varied image quality of routine patient care and contained artefacts such as insufficient mucosal cleaning and inadequate esophageal expansion. We then applied three methods to improve the algorithm's robustness to data heterogeneity: inclusion of more diverse training data, domain-specific pretraining and architectural optimization.</p><p><strong>Results: </strong>The computer aided detection system, when trained exclusively on high-quality data, achieved area under the curve (AUC), sensitivity and specificity scores of 83%, 85% and 67% on the high quality test set. AUC and sensitivity were significantly lower with 80% (p < 0.001) and 62% (p = 0.002) on the moderate-quality and 71% (p > 0.001) and 47% (p = 0.002) on the low-quality test set. Incorporating robustness-enhancing strategies significantly improved the AUC, sensitivity and specificity to 92% (p = 0.004), 88% (p = 0.84) and 81% (p = 0.003) on the high-quality test set, 93% (p = 0.006), 86% (p = 0.01) and 83% (p = 0.09) on the moderate-quality test set and 84% (p = 0.001), 78% (p = 0.002) and 77% (p = 0.23) on the low-quality test set.</p><p><strong>Conclusion: </strong>Endoscopic deep learning systems trained solely on high-quality images may not perform well when exposed to heterogeneous imagery, as found in routine practice. Robustness-enhancing training strategies can increase the likelihood of successful clinical implementation.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Kidney Disease Increases Risk of Delayed Post-Polypectomy Bleeding: A Large-Scale Propensity Score-Matched Analysis.","authors":"Hye Kyung Hyun, Nak-Hoon Son, So Hyeon Gwon, Hyun Chul Lim, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim, Tae-Hyun Yoo, Shin-Wook Kang, Hae-Ryong Yun, Cheal Wung Huh","doi":"10.1002/ueg2.70013","DOIUrl":"https://doi.org/10.1002/ueg2.70013","url":null,"abstract":"<p><strong>Background: </strong>The association between delayed post-polypectomy bleeding and chronic kidney disease remains unclear.</p><p><strong>Objective: </strong>This study investigated whether patients with chronic kidney disease are at an increased risk of delayed post-polypectomy bleeding.</p><p><strong>Methods: </strong>This cohort study included patients who underwent colonoscopy and polypectomy in Korea between 2005 and 2022. We assessed various covariates, including patient-, polyp-, and procedure-related factors, using propensity score matching and inverse probability of treatment weighting to determine the impact of chronic kidney disease on delayed post-polypectomy bleeding risk.</p><p><strong>Results: </strong>Out of 21,562 patients, 16,591 with 41,014 polyps were included in the analysis. Of these, 2057 (12.4%) had chronic kidney disease, with 894 in early-stage (stages 1 and 2) and 1163 in advanced-stage (stages 3-5). There were 14,534 individuals without chronic kidney disease. After propensity score matching, the risk of delayed post-polypectomy bleeding in patients with chronic kidney disease was significantly higher than that in the non-chronic kidney disease group (OR 1.80, CI 1.12-2.89, p = 0.01). The risk increased with chronic kidney disease stage (OR 2.38, 95% CI 1.01-5.64 for early stage; OR 2.80, 95% CI 1.20-6.51 for advanced stage, all p < 0.05). The results remained robust after inverse probability analysis.</p><p><strong>Conclusions: </strong>Chronic kidney disease is an independent risk factor for delayed post-polypectomy bleeding, even in the early stages. The risk correlates with the chronic kidney disease stage. Meticulous attention is imperative during polypectomy for all patients with chronic kidney disease, including those in the early stages.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European Consensus on Malabsorption-UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN: Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective.","authors":"Marco Vincenzo Lenti, Heinz Florian Hammer, Ilja Tacheci, Rosa Burgos, Stephane Schneider, Anastasiou Foteini, Aleksejs Derovs, Jutta Keller, Ilse Broekaert, Marianna Arvanitakis, Dan Lucian Dumitrascu, Oscar Segarra-Cantón, Željko Krznarić, Juris Pokrotnieks, Gonçalo Nunes, Johann Hammer, Loris Pironi, Marc Sonyi, Cristina Maria Sabo, Juan Mendive, Adrien Nicolau, Jernej Dolinsek, Denisa Kyselova, Lucrezia Laterza, Antonio Gasbarrini, Teodora Surdea-Blaga, Jorge Fonseca, Christos Lionis, Gino Roberto Corazza, Antonio Di Sabatino","doi":"10.1002/ueg2.70011","DOIUrl":"https://doi.org/10.1002/ueg2.70011","url":null,"abstract":"<p><p>Malabsorption is a complex and multifaceted condition characterised by the defective passage of nutrients into the blood and lymphatic streams. Several congenital or acquired disorders may cause either selective or global malabsorption in both children and adults, such as cystic fibrosis, exocrine pancreatic insufficiency (EPI), coeliac disease (CD) and other enteropathies, lactase deficiency, small intestinal bacterial overgrowth (SIBO), autoimmune atrophic gastritis, Crohn's disease, and gastric or small bowel resections. Early recognition of malabsorption is key for tailoring a proper diagnostic work-up for identifying the cause of malabsorption. Patient's medical and pharmacological history are essential for identifying risk factors. Several examinations like endoscopy with small intestinal biopsies, non-invasive functional tests, and radiologic imaging are useful in diagnosing malabsorption. Due to its high prevalence, CD should always be looked for in case of malabsorption with no other obvious explanations and in high-risk individuals. Nutritional support is key in management of patients with malabsorption; different options are available, including oral supplements, enteral or parenteral nutrition. In patients with short bowel syndrome, teduglutide proved effective in reducing the need for parenteral nutrition, thus improving the quality of life of these patients. Primary care physicians have a central role in early detection of malabsorption and should be involved into multidisciplinary teams for improving the overall management of these patients. In this European consensus, involving 10 scientific societies and several experts, we have dissected all the issues around malabsorption, including the definitions and diagnostic testing (Part 1), high-risk categories and special populations, nutritional assessment and management, and primary care perspective (Part 2).</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Further Insights Into the Educational and Career Impact of Pediatric-Onset IBD.","authors":"Yize Ying, Wensheng Pan","doi":"10.1002/ueg2.70016","DOIUrl":"https://doi.org/10.1002/ueg2.70016","url":null,"abstract":"","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and Monitoring Pathways Using Non-Invasive Tests in Patients With Alpha-1 Antitrypsin Deficiency-Associated Liver Disease: Results From an Expert Delphi Panel.","authors":"Virginia C Clark, Mark A Price, Jon Russo, Rohit Loomba, Alice M Turner, Pavel Strnad","doi":"10.1002/ueg2.70009","DOIUrl":"https://doi.org/10.1002/ueg2.70009","url":null,"abstract":"<p><strong>Background and aims: </strong>The severe alpha-1 antitrypsin deficiency (AATD) genotype Pi*ZZ increases the risk of liver disease (AATD-LD) and lung disease. While non-invasive tests (NITs) are widely used for fibrosis stage and monitoring of all liver diseases, the consensus for use in AATD-LD is limited. A Delphi panel study was conducted to address this need.</p><p><strong>Method: </strong>Healthcare providers who managed at least two patients with AATD-LD in the past two years participated. Two iterative surveys were developed and administered. The second survey clarified the results from the first and provided deeper feedback. As follow-up, a real-time consensus-building exercise focused on survey topics without consensus. Controlled feedback was anonymous.</p><p><strong>Results: </strong>A total of 20 AATD experts (hepatology [n = 9], pulmonology [n = 6], transplant hepatology [n = 3], gastroenterology [n = 1], and hepatology and transplant hepatology [n = 1]) completed the study. A strong consensus was achieved around the use and evaluation of NITs for risk stratification and monitoring. All panelists agreed that vibration-controlled transient elastography (VCTE) is the preferred NIT for the initial assessment of AATD-LD owing to its accessibility and reliability. Magnetic resonance elastography and enhanced liver fibrosis tests were also considered valuable. Most (85%) agreed that VCTE < 8 kPa could indicate no or mild fibrosis and VCTE ≥ 8 kPa could indicate clinically significant fibrosis, which may correspond to fibrosis stage ≥ F2 on the METAVIR scale. Most (85%) agreed that VCTE ≥ 13 kPa may indicate cirrhosis.</p><p><strong>Conclusion: </strong>Utilizing the Delphi technique, this study identified a clinically applicable framework for the diagnosis and monitoring of AATD-LD. A high level of agreement emerged regarding preferred NITs and their usage, risk stratification and monitoring in the context of AATD-LD management. The results provide a foundation for future efforts into NIT validation and the development of clinical guidelines for AATD-LD.</p>","PeriodicalId":23444,"journal":{"name":"United European Gastroenterology Journal","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}