BMJ Open Gastroenterology最新文献

{"title":"Granulomatous liver disease in Thailand: a 20-year retrospective clinicoradiopathological analysis.","authors":"Siwanon Nawalerspanya, Apichat Kaewdech, Naichaya Chamroonkul, Pimsiri Sripongpun","doi":"10.1136/bmjgast-2024-001675","DOIUrl":"10.1136/bmjgast-2024-001675","url":null,"abstract":"<p><strong>Objective: </strong>Granulomatous liver disease (GLD) is a rare condition with various aetiologies and is characterised by the formation of hepatic granulomas. A comprehensive evaluation of GLD from a broad perspective is lacking. We aimed to investigate the aetiology and the clinicoradiopathological characteristics of patients with GLD in recent decades in Thailand.</p><p><strong>Methods: </strong>This retrospective study was conducted at a tertiary care centre in Thailand. All patients who underwent liver biopsy between 2003 and 2023 were reviewed. Patients with a histopathological report of granulomas in liver specimens were included. Clinical presentations, radiological data, and laboratory data closest to the procedure date were also collected.</p><p><strong>Results: </strong>Of the 4384 liver biopsy specimens collected during the study period, 89 (2%) had GLD. Of these, 58.4% were men, with the following aetiologies: 61 (68.5%) infectious, 16 (18%) non-infectious, and 12 (13.5%) undetermined. Common presentations included abnormal liver test results (81.4%) and fever (56.1%). Among infectious granulomas, mycobacterial infections (tuberculosis: 28; non-tuberculous mycobacteria (NTM): 11) were predominant. Compared with other causes, NTM was associated with a significantly lower body mass index, more extragastrointestinal involvement, and lower serum albumin levels. Caseating-type granulomas were also observed in 16% of non-mycobacterial cases. Nearly 40% of patients with GLD demonstrated no focal lesions on liver imaging, whereas multifocal lesions were found in a third of patients.</p><p><strong>Conclusions: </strong>Infectious causes, especially mycobacterial infections, remain the primary aetiology of GLD in Thailand. Granuloma types are not pathognomonic of specific diseases, emphasising the need for extensive evaluation beyond liver biopsy to determine the underlying aetiology.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vision-language large learning model, GPT4V, accurately classifies the Boston Bowel Preparation Scale score.","authors":"Daniel Yan Zheng Lim, Yu Bin Tan, Jonas Ren Yi Ho, Sushmitha Carkarine, Tian Wei Valerie Chew, Yuhe Ke, Jen Hong Tan, Ting Fang Tan, Kabilan Elangovan, Le Quan, Li Yuan Jin, Jasmine Chiat Ling Ong, Gerald Gui Ren Sng, Joshua Yi Min Tung, Chee Kiat Tan, Damien Tan","doi":"10.1136/bmjgast-2024-001496","DOIUrl":"10.1136/bmjgast-2024-001496","url":null,"abstract":"<p><strong>Introduction: </strong>Large learning models (LLMs) such as GPT are advanced artificial intelligence (AI) models. Originally developed for natural language processing, they have been adapted for multi-modal tasks with vision-language input. One clinically relevant task is scoring the Boston Bowel Preparation Scale (BBPS). While traditional AI techniques use large amounts of data for training, we hypothesise that vision-language LLM can perform this task with fewer examples.</p><p><strong>Methods: </strong>We used the GPT4V vision-language LLM developed by OpenAI, via the OpenAI application programming interface. A standardised prompt instructed the model to grade BBPS with contextual references extracted from the original paper describing the BBPS by Lai <i>et al</i> (GIE 2009). Performance was tested on the HyperKvasir dataset, an open dataset for automated BBPS grading.</p><p><strong>Results: </strong>Of 1794 images, GPT4V returned valid results for 1772 (98%). It had an accuracy of 0.84 for two-class classification (BBPS 0-1 vs 2-3) and 0.74 for four-class classification (BBPS 0, 1, 2, 3). Macro-averaged F1 scores were 0.81 and 0.63, respectively. Qualitatively, most errors arose from misclassification of BBPS 1 as 2. These results compare favourably with current methods using large amounts of training data, which achieve an accuracy in the range of 0.8-0.9.</p><p><strong>Conclusion: </strong>This study provides proof-of-concept that a vision-language LLM is able to perform BBPS classification accurately, without large training datasets. This represents a paradigm shift in AI classification methods in medicine, where many diseases lack sufficient data to train traditional AI models. An LLM with appropriate examples may be used in such cases.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing brodalumab in the treatment of primary sclerosing cholangitis (SABR-PSC pilot study): protocol for a single-arm, multicentre, pilot study.","authors":"Amera Elzubeir, Juliet High, Matthew Hammond, Lee Shepstone, Martin Pond, Martine Walmsley, Palak Trivedi, Emma Culver, Guruprasad Aithal, Jessica Dyson, Douglas Thorburn, Leo Alexandre, Simon Rushbrook","doi":"10.1136/bmjgast-2024-001596","DOIUrl":"10.1136/bmjgast-2024-001596","url":null,"abstract":"<p><strong>Introduction: </strong>Primary sclerosing cholangitis (PSC) is a rare immune-mediated hepatobiliary disease, characterised by progressive biliary fibrosis, cirrhosis, and end-stage liver disease. As yet, no licensed pharmacological therapy exists. While significant advancements have been made in our understanding of the pathophysiology, the exact aetiology remains poorly defined. Compelling evidence from basic science and translational studies implicates the role of T helper 17 cells (Th17) and the interleukin 17 (IL-17) pro-inflammatory signalling pathway in the pathogenesis of PSC. However, exploration of the safety and efficacy of inhibiting the IL-17 pathway in PSC is lacking.</p><p><strong>Methods and analysis: </strong>This is a phase 2a, open-label, multicentre pilot study, testing the safety of brodalumab, a recombinant human monoclonal antibody that binds with high affinity to interleukin-17RA, in adults with PSC. This study will enrol 20 PSC patients across five large National Health Service tertiary centres in the UK. The primary outcome of the study relates to determining the safety and feasibility of administering brodalumab in early, non-cirrhotic PSC patients. Secondary efficacy outcomes include non-invasive assessment of liver fibrosis, changes in alkaline phosphatase values and other liver biochemical readouts, assessment of biliary metrics through quantitative MR cholangiography+, and quality of life evaluation on completion of follow-up (using the 5D-itch tool, the PSC-patient-reported outcome and PSC-specific Chronic Liver Disease Questionnaire).</p><p><strong>Ethics and dissemination: </strong>Ethical approval for this study has been obtained from the London Bridge Research Ethics Committee (REC23/LO/0718). Written informed consent will be obtained from all trial participants prior to undertaking any trial-specific examinations or investigations. On completion of the study, results will be submitted for publication in peer-reviewed journals and presented at national and international hepatology meetings. A summary of the findings will also be shared with participants and PSC communities.</p><p><strong>Trial registration number: </strong>ISRCTN15271834.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden of five major types of gastrointestinal cancer in the Eastern Mediterranean Region.","authors":"Saleh A Alessy, Eileen Morgan, Ali S Al-Zahrani, Mariam Zahwe, Heba Fouad, Freddie Bray, Ariana Znaor, Saleh A Alqahtani","doi":"10.1136/bmjgast-2024-001577","DOIUrl":"10.1136/bmjgast-2024-001577","url":null,"abstract":"<p><strong>Objective: </strong>We provide an overview of the latest estimates of five gastrointestinal (GI) cancers in the Eastern Mediterranean Region (EMR) countries to guide cancer control policy.</p><p><strong>Methods: </strong>We extracted the number of cases and deaths for oesophageal, gastric, liver, colorectal and pancreatic cancers from the GLOBOCAN database produced as estimated by the International Agency for Research on Cancer for the year 2022. Age-standardised incidence and mortality rates (ASR) per 100 000 person-years were estimated for the 22 EMR countries, cancer site and sex.</p><p><strong>Results: </strong>The estimated 173 000 new cancer cases and 139 000 deaths from the five GI cancers corresponded to 22.2% of the incidence and 28.7% of the mortality burden in the EMR. Across all cancers (for both sexes combined), colorectal cancer ranked third (6.9%; ASR 8.9), followed by liver cancer (6.2%; ASR 8.4) in terms of incidence, while liver cancer (9.6%; ASR 8.1) and gastric cancer (6.4%; ASR 5.5) were the third and fourth leading causes of cancer-related mortality in the region, respectively. Marked differences in cancer incidence and mortality rates were observed between the 22 countries, particularly the 10-fold variations seen in liver cancer incidence.</p><p><strong>Conclusion: </strong>GI cancers currently account for an important fraction of the cancer burden in the EMR; the present analysis seeks to inform tailored decision-making according to the country-specific GI cancer profiles.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of oral vancomycin therapy in children with atypical ulcerative colitis with or without confirmed primary sclerosing cholangitis: a real-world observational study.","authors":"Laura Räisänen, Fariha Balouch, Annette McLaren-Kennedy, Julia Elizabeth Clark, Peter Lewindon","doi":"10.1136/bmjgast-2024-001605","DOIUrl":"10.1136/bmjgast-2024-001605","url":null,"abstract":"<p><strong>Objectives: </strong>Atypical ulcerative colitis (UC) presenting reverse gradient colitis, backwash ileitis, or rectal sparing and/or positive atypical antineutrophil cytoplasmic antibody serology is often associated with primary sclerosing cholangitis (PSC) and can be resistant to conventional medical therapies (CMT) for inflammatory bowel diseases. We report short-term and long-term outcomes of oral vancomycin therapy (OVT) in children with atypical UC and confirmed PSC in imaging/biopsy (PSC-UC) or treatment-resistant atypical UC without detectable PSC (aUC-non-PSC).</p><p><strong>Methods: </strong>In this retrospective real-world observational study from a tertiary paediatric centre in Brisbane, Australia, 44 children with aUC (29 PSC-UC, 15 aUC-non-PSC) received 79 OVT courses between 2014 and 2023. Pre-post-OVT characteristics were compared and relapses/repeated courses were recorded.</p><p><strong>Results: </strong>Pre-OVT, all had active colitis by Paediatric Ulcerative Colitis Activity Index (PUCAI), Feacal Calprotectin (FC) and/or colonoscopy. Post-OVT, PUCAI reduced from 15 (IQR 5-33) to 0 (IQR 0-5); 85% of children with pre-OVT PUCAI ≥10 achieved clinical remission (100% PSC-UC vs 64% aUC-non-PSC, p=0.019). FC reduced from 995 (IQR 319-1825) to 44 (IQR 16-79) µg/g; 83% of children with pre-OVT FC ≥100 µg/g achieved biochemical remission (92% PSC-UC vs 64% aUC-non-PSC, p=0.063). Colonoscopy confirmed Mayo 0 healing in 62% (67% PSC-UC vs 54% aUC-non-PSC, p=0.443) and 46% achieved pan-colonic histological remission (54% PSC-UC vs 31% aUC-non-PSC, p=0.173). All pre-post-OVT changes in these four markers were significant in both groups. After ceasing first OVT, 25/44 relapsed within 8.2 (IQR 1.9-14.5) months. Recommencing OVT regained biomarker remission in 13/25. During 3.8 (IQR 2.0-5.3) years of follow-up, 79 OVT courses in conjunction with CMT maintained deep remission in 67%. Routine stool testing (n=138) detected no vancomycin-resistant Enterococcus (VRE).</p><p><strong>Conclusions: </strong>OVT induced and reinduced remission in children with atypical UC. Relapse often followed ceasing vancomycin, half responded to reinduction. No VRE was developed.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective evaluation of the impact of repeated whole prison testing for hepatitis C.","authors":"Naw April Phaw, Aung Min Thant, Craig Thompson, Ryan Jelley, Kate McQue, Jodi Aldridge, Caroline Allsop, Jenna Kerry, Francesca McCullough, Carolyn Miller, Manoj Valappil, Tony Jefferson, Colin Lawton, Lee Christensen, Stuart McPherson","doi":"10.1136/bmjgast-2024-001593","DOIUrl":"10.1136/bmjgast-2024-001593","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic hepatitis C virus (HCV) infection is prevalent in prisons. Universal reception HCV testing is recommended, but acceptance can be suboptimal. To detect and treat missed HCV infections, a high-intensity test and treat (HITT) programme was introduced to rapidly test entire prisons. It remains unknown whether regular HITTs will be required to maintain prison microelimination. We aimed to assess the outcomes of HITTs conducted in a prison 4 years apart with ongoing reception testing.</p><p><strong>Methods: </strong>A prospective observational evaluation of the impact of HITTs was conducted in January 2020 and February 2024 at Low Newton, a female prison. The outcomes of the reception testing were reviewed in the intervening period to determine the number of newly identified HCV infections.</p><p><strong>Results: </strong>HITTs were successful in testing almost all residents (305/307) in 2020 and (296/296) in 2024. The number of newly diagnosed HCV individuals fell from 6.6% in 2020 to 0.3% in 2024. One new HCV case was identified in the second HITT. In between the HITTs, 89% of receptions had HCV testing, increasing from 83% in 2020 to 95% in 2023. Overall, 81% (144/178) of active HCV infections received antiviral treatment, and 89% achieved sustained virological response. The proportion of active HCV infections between the HITTs was 7.2% through reception testing.</p><p><strong>Conclusion: </strong>A follow-up HITT after 4 years yielded only 0.3% active HCV infection in a high HCV prevalence prison and a reasonably good reception testing and treatment programme. Therefore, resources should be focused on optimising reception testing rather than undertaking repeated HITTs.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provocative tests of anal sphincter function correlate with symptoms and subtypes of faecal incontinence.","authors":"Alexander O'Connor, Donghua Liao, Matthew Davenport, Abhiram Sharma, Dipesh H Vasant, Niels Klarskov, Asbjørn Mohr Drewes, Edward Kiff, John McLaughlin, Karen Telford","doi":"10.1136/bmjgast-2024-001600","DOIUrl":"10.1136/bmjgast-2024-001600","url":null,"abstract":"<p><strong>Objectives: </strong>High-resolution anorectal manometry (HRAM) is the established investigation in faecal incontinence (FI). However, provocative tests (functional lumen imaging probe (FLIP) and anal acoustic reflectometry (AAR)) have been proposed as alternatives. This study uniquely explores all three methods in correlation with FI symptoms and subtypes.</p><p><strong>Methods: </strong>This was a prospective observational study of patients with FI attending a tertiary pelvic floor unit between August 2022 and January 2024. Patients underwent HRAM, FLIP and AAR with the order randomised. FI severity was assessed with the Vaizey score and quality-of-life with the Manchester Health Questionnaire.</p><p><strong>Results: </strong>40 patients (39 women, median age: 62 (range: 38-85)) were recruited with 27 (67.5%) reporting urge FI, 8 (20%) mixed and 5 (12.5%) passive incontinence. FLIP squeeze measurements correlated with the Vaizey score, including incremental squeeze pressure at 40 mL (r_s=-0.412; p=0.008) and 50 mL (r_s=-0.414; p=0.009) and the pressure-diameter volume loop at 50 mL (r_s=-0.402; p=0.011). Incremental squeeze opening pressure with AAR correlated with the Vaizey score (r_s=-0.339; p=0.032). There was no correlation between symptom severity and HRAM parameters, or any parameter and quality-of-life scores. Resting parameters with all three modalities were lower in passive FI: mean resting pressure (HRAM; p=0.010), yield pressure (FLIP; p=0.031) and opening pressure (AAR; p=0.006). With FLIP, there was a trend towards reduced squeeze function in the urge group (pressure-diameter volume loop at 50 mL; p=0.295).</p><p><strong>Conclusions: </strong>FLIP and AAR correlate better with FI symptoms compared with HRAM. Therefore, these provocative tests could be used to guide the management of FI in prospective studies.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in faecal haemoglobin values over sequential rounds of faecal immunochemical tests (FIT) in a surveillance population.","authors":"Gemma Mortell, Kate Wooldrage, Gwen A Murphy, Amanda J Cross","doi":"10.1136/bmjgast-2024-001651","DOIUrl":"10.1136/bmjgast-2024-001651","url":null,"abstract":"<p><strong>Objective: </strong>Colorectal cancer (CRC) screening enables resection of polyp precursor lesions, preventing cancer or detecting it earlier. Post-polypectomy, people can remain at increased CRC risk, prompting surveillance colonoscopy. Less invasive faecal immunochemical tests (FIT) could reduce the burden of surveillance colonoscopy. We investigated whether changes in FIT values over multiple rounds were associated with advanced colorectal neoplasia (ACN) detection.</p><p><strong>Methods: </strong>A cohort of men and women aged 60-72 years deemed intermediate risk by the 2002 UK adenoma surveillance guidelines and scheduled for three yearly colonoscopies were recruited (January 2012-December 2013) within the English Bowel Cancer Screening Programme and offered a quantitative FIT at 1, 2 and 3 years post-baseline colonoscopy for a prospective analysis within a diagnostic accuracy study. Participants positive (≥40 µg haemoglobin/g faeces) at 1 year or 2 years were offered early colonoscopy and excluded, otherwise, colonoscopy was offered at 3 years. Only those who completed three FIT rounds and attended the 3-year colonoscopy were included. Participants were grouped based on changes between FIT rounds, with changes defined as absolute differences ≥4 µg/g, and positivity at round 3.</p><p><strong>Results: </strong>Among 4412 participants, the largest group (n=2773) was the no change category, which had the lowest ACN detection rate (4.7%, 95% CI: 3.9 to 5.5). The serial increase group with a positive round 3 value (n=46) had the highest ACN detection rate (32.6%, 95% CI: 19.5 to 48.0).</p><p><strong>Conclusion: </strong>No change in FIT result across multiple rounds was associated with a low ACN detection rate, while a serial increase was associated with higher ACN detection rates. Further research should consider if sequential rounds of FIT could be used for stratifying individual risk.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal symptoms and bowel habits in 53 046 healthy Danish blood donors: a nationwide cross-sectional study.","authors":"Anne Karmisholt Grosen, Jens Kjærgaard Boldsen, Susan Mikkelsen, Simon Mark Dahl Baunwall, Jens Frederik Dahlerup, Khoa Manh Dinh, Mie Topholm Bruun, Bitten Aagaard, Christina Mikkelsen, Janna Nissen, Thorsten Brodersen, Mikkel Steen Petersen, Klaus Rostgaard, Henrik Hjalgrim, Erik Sørensen, Sisse Rye Ostrowski, Ole Birger Pedersen, Christian Lodberg Hvas, Christian Erikstrup","doi":"10.1136/bmjgast-2024-001518","DOIUrl":"https://doi.org/10.1136/bmjgast-2024-001518","url":null,"abstract":"<p><strong>Objective: </strong>To characterise gastrointestinal symptoms and bowel habits in healthy blood donors and explore symptom phenotypes and their associated factors.</p><p><strong>Methods: </strong>Between November 2020 and March 2023, 53 046 participants in the nationwide Danish Blood Donor Study completed a questionnaire including 13 gastrointestinal symptoms, defaecation pattern regularity, stool frequency, and stool consistency. We used a data-driven approach to explore symptom phenotypes and investigated associated factors by multinomial logistic regression.</p><p><strong>Results: </strong>Among the 53 046 participants (52% women), 68% (95% CI 67.5% to 68.3%) reported at least one of 13 gastrointestinal symptoms. The most frequent symptoms were bloating (40%), abdominal rumbling (40%), abdominal pain (17%), acid regurgitation (13%), heartburn (12%), diarrhoea (12%), nausea (12%), and constipation (10%). Half of the participants (50%) had a regular defaecation pattern (defined as generally the same stool consistency and stool frequency) consisting of Bristol Stool Form Scale 4 stools 1-3 times per day. Symptom phenotypes and their prevalence among 51 820 near-complete case participants were as follows: (1) no gastrointestinal symptoms (32%); (2) bloating and/or rumbling only (21%); (3) acid regurgitation and/or heartburn only (4%); (4) any other one or two symptoms (14%); (5) any three or four symptoms (18%); (6) any five or six symptoms (7%); (7) at least seven symptoms (3%). The acid regurgitation and/or heartburn only phenotype associated with obesity, and the remaining symptomatic phenotypes were associated with female sex, decreasing age, and an irregular defaecation pattern, even after excluding individuals with self-reported irritable bowel syndrome, lactose intolerance, or gluten intolerance.</p><p><strong>Conclusion: </strong>Most healthy adults, especially women younger than 50 years, experience gastrointestinal symptoms. Symptom phenotypes strongly correlate with sex, age, and bowel habits.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-related quality of life in patients with liver cirrhosis following adjunctive nurse-based care versus standard medical care: a pragmatic, multicentre, randomised controlled study.","authors":"Maria Hjorth, Daniel Sjöberg, Anncarin Svanberg, Riccardo Lo Martire, Elenor Kaminsky, Fredrik Rorsman","doi":"10.1136/bmjgast-2024-001694","DOIUrl":"10.1136/bmjgast-2024-001694","url":null,"abstract":"<p><strong>Objectives: </strong>Patients have difficulties in understanding how to manage their liver cirrhosis. This highlights a need for support in comprehending health-related information, which remains largely lacking within liver cirrhosis care. Involvement of registered nurses (RNs) in outpatient liver cirrhosis care has potential to improve quality of care and reduce patient mortality. However, the benefits of nursing care on patients' health-related quality of life (HRQoL) are scarcely studied. This study compared HRQoL in patients receiving either standard medical outpatient care or adjunctive, nurse-led care. The risk of malnutrition, decompensation events and mortality were also compared between the two study groups.</p><p><strong>Methods: </strong>This was a pragmatic, multicentre, randomised trial, which enrolled 167 patients with liver cirrhosis. The primary outcome measure, HRQoL, was assessed using the RAND-36 questionnaire. The physical component summary (PCS) and the mental component summary (MCS) scores of RAND-36 were compared, using linear mixed-effects models for repeated measures, at 12 and 24 months.</p><p><strong>Results: </strong>83 patients received standard medical care, and 84 patients received adjunctive, nurse-led care for 24 months. Due to unforeseen circumstances, the final study population of 167 participants was less than the intended 500. Group comparisons were non-significant of the PCS and MCS scores (-1.1, p=0.53 and -0.7, p=0.67, respectively), malnutrition (p=0.62) and decompensation events (p<i>=</i>0.46), after 24 months. However, mortality was three times higher in the control group compared with the intervention group (12 vs 4, p=0.04) after 24 months.</p><p><strong>Conclusions: </strong>In this study, adjunctive nurse-led care was not superior to standard medical outpatient care regarding HRQoL, risk of developing malnutrition or decompensation. However, RN involvement contributed to early identification of decompensation and reduced mortality.</p><p><strong>Trial registration number: </strong>NCT02957253.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}