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Les derniers abstracts de la revue European Journal of Gastroenterology & Hepatology - Current Issue :


    Date de mise en ligne : Jeudi 01 janvier 1970
    Kamal, Faisal; Khan, Muhammad Ali; Khan, Zubair; Cholankeril, George; Hammad, Tariq A.; Lee, Wade M.; Ahmed, Aijaz; Waters, Bradford; Howden, Colin W.; Nair, Satheesh; Satapathy, Sanjaya K.
    Rifaximin for the prevention of spontaneous bacterial peritonitis and hepatorenal syndrome in cirrhosis: a systematic review and meta-analysis
    imageProphylactic antibiotics have been recommended in patients with a previous history of spontaneous bacterial peritonitis (SBP). Recently, there has been interest in the use of rifaximin for the prevention of SBP and hepatorenal syndrome (HRS). We conducted a meta-analysis to evaluate this association of rifaximin. We searched several databases from inception through 24 January 2017, to identify comparative studies evaluating the effect of rifaximin on the occurrence of SBP and HRS. We performed predetermined subgroup analyses based on the type of control group, design of the study, and type of prophylaxis. Pooled odds ratios (ORs) were calculated using a random effects model. We included 13 studies with 1703 patients in the meta-analysis of SBP prevention. Pooled OR [95% confidence interval (CI)] was 0.40 (95% CI: 0.22–0.73) (I2=58%). On sensitivity analysis, adjusted OR was 0.29 (95% CI: 0.20–0.44) (I2=0%). The results of the subgroup analysis based on type of control was as follows: in the quinolone group, pooled OR was 0.42 (95% CI: 0.14–1.25) (I2=55%), and in the no antibiotic group, pooled OR was 0.40 (95% CI: 0.18–0.86) (I2=64%). However, with sensitivity analysis, benefit of rifaximin was demonstrable; pooled ORs were 0.32 (95% CI: 0.17–0.63) (I2=0%) and 0.28 (95% CI: 0.17–0.45) (I2=0%) for the comparison with quinolones and no antibiotics, respectively. Pooled OR based on randomized controlled trials was 0.41 (95% CI: 0.22–0.75) (I2=13%). For the prevention of HRS, the pooled OR was 0.25 (95% CI: 0.13–0.50) (I2=0%). Rifaximin has a protective effect against the development of SBP in cirrhosis. However, the quality of the evidence as per the GRADE framework was very low. Rifaximin appeared effective for the prevention of HRS.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Jensen, Berit E.S.; Hansen, Jane M.; Larsen, Kasper S.; Junker, Anders B.; Lassen, Jens F.; Jensen, Svend E.; Schaffalitzky de Muckadell, Ove B.
    Randomized clinical trial: the impact of gastrointestinal risk factor screening and prophylactic proton pump inhibitor therapy in patients receiving dual antiplatelet therapy
    imageObjective: Dual antiplatelet therapy reduces the risk of ischemic complications after acute coronary syndrome, but increases the risk of bleeding including upper gastrointestinal bleeding (UGIB). The aim of this study was to examine the effect of screening for risk of UGIB and prophylactic proton pump inhibitor (PPI) treatment in dual-antiplatelet-treated patients at risk of UGIB and to assess the significance of dual antiplatelet therapy compliance for cardiovascular events. Patients and methods: In a register-based randomized-controlled trial, 2009 patients were included at the time of first percutaneous coronary intervention and randomized to either screening or control. Screened high-risk patients were prescribed pantoprazole 40 mg during the 1-year after percutaneous coronary intervention. Results: The incidence of UGIB was 0.8 versus 1.3% in screened patients and controls, respectively (P=0.381). Significantly fewer screened patients (5.4%) than controls (8.0%) underwent upper gastrointestinal endoscopy (P=0.026). Screened patients (2.9%) had significantly fewer events of unstable angina pectoris than controls (4.7%) (P=0.036) and a higher compliance to dual antiplatelet therapy (88.3 vs. 85.0%) (P=0.035), but no statistically difference was observed in the incidences of myocardial infarction and all-cause mortality (1.0 vs. 1.5%) (P=0.422). Conclusion: Screening for risk factors for UGIB and subsequent prophylactic PPI treatment did not significantly reduce the incidence of UGIB. Prescription of PPI was associated with a higher compliance with dual antiplatelet therapy and decreases the risk of recurrent cardiovascular events.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Pech, Laurianne; Cercueil, Jean-Pierre; Jooste, Valérie; Krause, Denis; Facy, Olivier; Bouvier, Anne-Marie
    Current use of MRI in patients with liver metastatic colorectal cancer: a population-based study
    imageBackground: Liver MRI is recommended as the preoperative imaging strategy in liver metastatic colorectal cancers. Objective: The aim of the study was to assess for the first time the use of liver MRI in a French population-based cancer registry. Patients and methods: All liver-only metastatic colorectal cancers resected for their primary tumour diagnosed between 2009 and 2013 were included. Nonconditional logistic regression was used to search for associations between the MRI order and the characteristics of patients and tumours. Results: The primary tumour and liver metastases were resected for cure in 30% (69/233) of cases, and in 72% of these liver MRI was performed before resection of the liver metastases. Preoperative MRI ordering was not significantly higher in patients younger than 70 years when compared with that in older patients. Among patients who did not undergo resection of their liver metastasis, 22% had undergone a liver MRI. After adjustment for comorbidities, the probability of having undergone an MRI was higher for patients managed in the university hospital (P=0.004) and lower in those managed in nonuniversity hospitals (P=0.002) compared with the mean of odds for all facilities. Patients more than or equal to 70 years were 2.4 times less likely than younger patients to undergo an MRI (P=0.043). Conclusion: Liver MRI was underused in patients with colorectal liver-only synchronous metastasis undergoing curative resection for metastases and in elderly patients.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Kang, Xiaoyu; Zhao, Lina; Liu, Na; Wang, Xiangping; Zhang, Rongchun; Liu, Zhiguo; Liang, Shuhui; Yao, Shaowei; Tao, Qin; Jia, Hui; Pan, Yanglin; Guo, Xuegang
    Activities in a social networking-based discussion group by endoscopic retrograde cholangiopancreatography doctors
    imageBackground: Online social networking is increasingly being used among medical practitioners. However, few studies have evaluated its use in therapeutic endoscopy. Here, we aimed to analyze the shared topics and activities of a group of endoscopic retrograde cholangiopancreatography (ERCP) doctors in a social networking-based endoscopic retrograde cholangiopancreatography discussion group (EDG). Materials and methods: Six ERCP trainers working in Xijing Hospital and 48 graduated endoscopists who had finished ERCP training in the same hospital were invited to join in EDG. All group members were informed not to divulge any private information of patients when using EDG. The activities of group members on EDG were retrospectively extracted. The individual data of the graduated endoscopists were collected by a questionnaire. Results: From June 2014 to May 2015, 6924 messages were posted on EDG, half of which were ERCP related. In total, 214 ERCP-related topics were shared, which could be categorized into three types: sharing experience/cases (52.3%), asking questions (38.3%), and sharing literatures/advances (9.3%). Among the 48 graduated endoscopists, 21 had a low case volume of less than 50 per year and 27 had a high volume case volume of 50 or more. High-volume graduated endoscopists posted more ERCP-related messages (P=0.008) and shared more discussion topics (P=0.003) compared with low-volume graduated endoscopists. A survey showed that EDG was useful for graduated endoscopists in ERCP performance and management of post-ERCP complications, etc. Conclusion: A wide range of ERCP-related topics were shared on the social networking-based EDG. The ERCP-related behaviors on EDG were more active in graduated endoscopists with an ERCP case volume of more than 50 per year.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Raju, Suneil A.; Sanders, David S.; Akram, Rahim; Glover, Rebecca; Al-Rifaie, Ammar; Peever, Elise; Purves, Josh; Scanu, Emily; Kurien, Matthew
    United European Gastroenterology Week scientific abstracts and their progression to full publication
    imageObjective: Abstracts presentations at scientific meetings enable rapid dissemination of novel research. The percentage of abstracts that proceed to full publication from differing medical specialties is highly variable. This study aims to evaluate the outcomes of abstracts presented at the United European Gastroenterology Week (UEGW). Materials and methods: All abstracts presented at UEGW between 2009 and 2011 were assessed. Cross-referencing of the first author, senior author and at least one keyword of the abstract was performed using PubMed and EMBASE databases. Abstracts and possible resultant full publications were then examined in tandem to ensure that they represented the same study. Data were also collected on lag time to publication, journal impact factors, country of the author and factors influencing subsequent publication. Results: A total of 6785 abstracts (1438 oral and 5347 poster presentations) were presented during the period assessed. Of these, 2099 (30.9%) proceeded to full publication in indexed journals. Oral abstract presentations were most likely to proceed to full publication compared with poster presentations (odds ratio: 1.38, 95% confidence interval: 1.22–1.56) and were more likely to achieve publication in higher impact journals (median impact factor 4.78 vs. 2.89, P<0.0005). The median lag time to full publication was 15 (IQR: 7–15) months. The Netherlands had the highest United European Gastroenterology abstract conversion rate to full publication (46.8%). Conclusion: This is the first study to assess the publication rates of UEGW. Findings are favourable with similar studies from other societies.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Fernandes, Samuel R.; Marques da Costa, Pedro; Vítor, Sofia; Carvalho, Joana R.; Santos, Patrícia; Moura, Carlos M.; Cortez-Pinto, Helena; Ramalho, Fernando; Velosa, José
    Predicting short-term and long-term mortality of hospitalized Portuguese patients with alcoholic hepatitis
    imageBackground: Alcohol abuse can result in a spectrum of liver injury that ranges from mild fatty infiltration to alcoholic hepatitis (AH), cirrhosis, and hepatocellular carcinoma. The present study aimed to evaluate current scoring systems in predicting short-term and long-term mortality because of AH. Patients and methods: Records of 170 consecutive patients with AH admitted to a tertiary center between January 2005 and October 2015 were reviewed. Clinical and biochemical parameters were retrieved for the assessment of AH scores for the day of admission (D1) and for the seventh day of hospitalization (D7). Endpoints included admission to the ICU, and 30-day, 90-day, and 1-year mortality. Results: The Maddrey discriminant function and the Model of End-Stage Liver Disease (MELD) were modest predictors of the need for ICU admission. In-hospital, 30-day, 90-day, and 1-year mortality were 15.9, 18.2, 21.8, and 30.0%, respectively. There was a numerical, albeit nonsignificant, trend for higher accuracy using D7 scores, especially the MELD, in predicting 30-day and 1-year mortality. Overall, all scores showed high negative predictive values (30 day: 91.2–98.7% and 1 year: 78.8–93.7%), but modest positive predictive values (30 day: 30.6–70.8% and 1 year: 42.1–61.2%). Survival rates were the highest among patients showing a decrease in the MELD, Glasgow Alcoholic Hepatitis Score, and Age, serum Bilirubin, International normalized ratio, and serum Creatinine score over the first week of admission. Discussion: AH scores were comparable in identifying patients at low risk of mortality up to 1 year following admission. Reassessment of the MELD, Glasgow Alcoholic Hepatitis Score, and Age, serum Bilirubin, International normalized ratio, and serum Creatinine score scores after 1 week further improved mortality prediction.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Miotto, Noelle; Mendes, Leandro C.; Zanaga, Letícia P.; Goncales, Eduardo S.L.; Lazarini, Maria S.K.; Pedro, Marcelo N.; Gonçales, Fernando L. Jr; Stucchi, Raquel S.B.; Vigani, Aline G.
    Predictors of early discontinuation of interferon-free direct antiviral agents in patients with hepatitis C virus and advanced liver fibrosis: results of a real-life cohort
    imageAim: The aim of this study was to determine risk factors for premature treatment discontinuation among patients with hepatitis C and advanced fibrosis with advanced fibrosis treated with interferon (IFN)-free direct antiviral agents (DAA)-based therapy. Patients and methods: We included all patients with chronic hepatitis C virus infection and advanced liver fibrosis in whom treatment was initiated with IFN-free DAA therapy at a university hospital from December 2015 through June 2016. We prospectively collected data from medical records using standardized questionnaires and evaluated them using Epi Info 7.1.2.0. The primary outcome was treatment interruption and associated factors. Results: In total, 214 patients were included in this study; 180 patients were treated with sofosbuvir (SOF)+daclatasvir±ribavirin (RBV), 31 received SOF+simeprevir±RBV, and three were treated with SOF+RBV. Treatment discontinuation rate was 8.9% (19 patients) and cirrhotic decompensation was the main reason [8 (42.1%)]. Among patients with Child B or C cirrhosis (31), 10 (32.2%) prematurely interrupted treatment. The risk factors for treatment discontinuation in univariate analysis were older age (P=0.0252), higher comorbidity index (P=0.0078), higher model for end-stage liver disease (P<0.0001), higher fibrosis index based on the 4 factores (P=0.0122), and lower hemoglobin (P=0.0185) at baseline. Multivariate analysis showed that older age (odds ratio: 1.1, 95% confidence interval: 1.02–1.19) and higher model for end-stage liver disease (odds ratio: 1.27, 95% confidence interval: 1.03–1.56) were associated with premature treatment interruption. Conclusion: Older age and advanced liver disease were related to treatment interruption. Identification of risk factors associated with treatment discontinuation is important to recognize patients who should be followed up closely during treatment, ando those whom possibly may not benefit from immediate DAA treatment or should be followed up closely during treatment.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Barrault, Camille; Lison, Hortensia; Roudot-Thoraval, Françoise; Garioud, Armand; Costentin, Charlotte; Béhar, Véronique; Medmoun, Mourad; Pulwermacher, Georges; Hagège, Hervé; Cadranel, Jean-François
    One year of baclofen in 100 patients with or without cirrhosis: a French real-life experience
    imageBackground: Several studies have suggested the efficacy of baclofen in reducing alcohol consumption, leading to a temporary recommendation for use in France. Aim: Our aim was to report our experience in using baclofen in alcohol-dependant patients with or without liver cirrhosis. Patients and methods: Consecutive patients from two liver and alcohol units were recruited over a 3-year period and received increasing doses of baclofen associated with social, psychological, and medical care. Results: One hundred patients were treated, of whom 65 were cirrhotic. After 1 year, 86 patients were still being followed up. At a mean dosage of 40 mg/day (extremes: 30–210), the median daily alcohol consumption reduced from 80 to 0 g/day (P<0.001). Twenty patients drank a small amount of alcohol of up to 30 g/day and 44 patients were completely abstinent. These declarative results were associated with a significant improvement in alcohol-related biological markers in this ‘low-consumption’ group of 64 patients: the median γ-glutamyl transferase decreased from 3.9 to 2.0 UNL (P<0.001), the mean aspartate transaminase decreased from 2.6 to 1.2 UNL (P<0.001), and the mean corpuscular volume decreased from 101 to 93 µm3 (P<0.001). In cirrhotic patients, bilirubinemia decreased significantly from 22 to 11 µmol/l (P=0.026), prothrombin time increased from 68 to 77% (P<0.001), and albuminemia increased from 34.1 to 37.4 g/l (P<0.001). Twenty patients reported grades 1–2 adverse events. No liver or renal function deterioration occurred in cirrhotic patients. Conclusion: In our cohort, baclofen associated with a global care was very well tolerated even in cirrhotic patients. The marked reduction in alcohol consumption in 64 patients translated into a significant improvement in biological markers and in liver function tests. Baclofen could be very useful, especially in cases of severe alcoholic liver disease.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Pogorzelska, Joanna; Lapinska, Magda; Kalinowska, Alicja; Lapinski, Tadeusz W.; Flisiak, Robert
    Helicobacter pylori infection among patients with liver cirrhosis
    imageBackground and aim: Inflammatory changes in the stomach caused by Helicobacter pylori indirectly and directly affect liver function. Moreover, the bacteria may worsen the course of the liver cirrhosis. The study aimed at evaluating the incidence of H. pylori infection among patients with liver cirrhosis, depending on the etiology and injury stage, scored according to Child–Pugh classification. Stage of esophageal varices and endoscopic inflammatory lesions in the stomach were evaluated, depending on the presence of H. pylori infection. Patients and methods: The study included 147 patients with liver cirrhosis: 42 were infected with hepatitis C virus, 31 were infected with hepatitis B virus, 56 had alcoholic liver cirrhosis, and 18 had primary biliary cirrhosis. Diagnosis of H. pylori infection was performed based on the presence of immunoglobulin G antibodies in serum. Results: H. pylori infection was found in 46.9% of patients. The incidence of H. pylori infection among patients with postinflammatory liver cirrhosis was significantly higher (P=0.001), as compared with patients with alcoholic liver cirrhosis. Ammonia concentration was significantly higher in patients infected with H. pylori, compared with noninfected individuals (129 vs. 112 μmol/l; P=0.002). Incidence of H. pylori infection in patients without esophageal varices was significantly lower compared with patients with esophageal varices (14 vs. 60%; P<0.001). Conclusion: H. pylori infection is significantly more frequent among patients with postinflammatory liver cirrhosis (infected with hepatitis C virus or hepatitis B virus) than in patients with alcoholic liver cirrhosis or primary biliary cirrhosis. H. pylori infection correlates with elevated concentration of blood ammonia and the incidence of esophageal varices.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Zhou, Yu-Jie; Zheng, Ji-Na; Zhou, Yi-Fan; Han, Yi-Jing; Zou, Tian-Tian; Liu, Wen-Yue; Braddock, Martin; Shi, Ke-Qing; Wang, Xiao-Dong; Zheng, Ming-Hua
    Development of a prognostic nomogram for cirrhotic patients with upper gastrointestinal bleeding
    imageBackground and aim: Upper gastrointestinal bleeding (UGIB) is a complication with a high mortality rate in critically ill patients presenting with cirrhosis. Today, there exist few accurate scoring models specifically designed for mortality risk assessment in critically ill cirrhotic patients with upper gastrointestinal bleeding (CICGIB). Our aim was to develop and evaluate a novel nomogram-based model specific for CICGIB. Patients and methods: Overall, 540 consecutive CICGIB patients were enrolled. On the basis of Cox regression analyses, the nomogram was constructed to estimate the probability of 30-day, 90-day, 270-day, and 1-year survival. An upper gastrointestinal bleeding–chronic liver failure–sequential organ failure assessment (UGIB–CLIF–SOFA) score was derived from the nomogram. Performance assessment and internal validation of the model were performed using Harrell’s concordance index (C-index), calibration plot, and bootstrap sample procedures. UGIB–CLIF–SOFA was also compared with other prognostic models, such as CLIF–SOFA and model for end-stage liver disease, using C-indices. Results: Eight independent factors derived from Cox analysis (including bilirubin, creatinine, international normalized ratio, sodium, albumin, mean artery pressure, vasopressin used, and hematocrit decrease>10%) were assembled into the nomogram and the UGIB–CLIF–SOFA score. The calibration plots showed optimal agreement between nomogram prediction and actual observation. The C-index of the nomogram using bootstrap (0.729; 95% confidence interval: 0.689–0.766) was higher than that of the other models for predicting survival of CICGIB. Conclusion: We have developed and internally validated a novel nomogram and an easy-to-use scoring system that accurately predicts the mortality probability of CICGIB on the basis of eight easy-to-obtain parameters. External validation is now warranted in future clinical studies.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Shalimar, ; Gamanagatti, Shivanand R.; Patel, Arpan H.; Kedia, Saurabh; Nayak, Baibaswata; Gunjan, Deepak; Ranjan, Gyan; Paul, Shashi B.; Acharya, Subrat K.
    Long-term outcomes of transjugular intrahepatic portosystemic shunt in Indian patients with Budd–Chiari syndrome
    imageBackground/aim: Transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in Budd–Chiari syndrome (BCS) based on current data. Our objective was to evaluate outcomes and assess prognostic factors in BCS patients undergoing TIPS. Patients and methods: In this retrospective analysis of a propectively maintained database, all consecutive BCS patients undergoing TIPS from September 2010 to February 2017 were included. Complete response after TIPS was defined as resolution of symptoms (ascites/pedal edema) with no requirement of diuretics at the end of 4 weeks. The Cox proportional hazard regression model was used to assess predictors of outcome and complications. Results: Eighty patients with BCS who underwent TIPS were included; 40 (50%) were male. The mean age at onset of symptoms was 24.2±8.7 years. The median (range) follow-up was 660 (2–2400) days. The 1-, 3-, and 5-year rates for TIPS stent patency were 89, 81, and 81%, respectively. Cumulative encephalopathy-free rates were 91, 86, and 86%, respectively, and survival rates were 93, 89, and 84%, respectively. Eight (10.0%) patients died during follow-up, five within the first year (three of these five had incomplete response). On univariate analysis, serum bilirubin, response to intervention, serum creatinine, Child class, model for end-stage liver disease, and All India Institute of Medical Sciences-hepatic venous outflow tract obstruction score were significantly different between survivors and nonsurvivors. On multivariate analysis, response to therapy after TIPS (hazard ratio: 8.37; 95% confidence interval: 1.60–43.82) was independently associated with mortality. The 1-year survival was 97% in patients with complete response, compared with 59% in those with incomplete response (P<0.004). Conclusion: Incomplete symptom response after TIPS is associated with poor outcome and can be used for selection of patients for liver transplantation.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Bröker, Mirelle E.E.; Gaspersz, Marcia P.; Klompenhouwer, Anne J.; Hansen, Bettina E.; Terkivatan, Turkan; Taimr, Pavel; Dwarkasing, Roy; Thomeer, Maarten G.J.; de Man, Robert A.; IJzermans, Jan N.M.
    Inflammatory and multiple hepatocellular adenoma are associated with a higher BMI
    imageAim: To identify patient and lesion characteristics associated with the occurrence of single or multiple hepatocellular adenoma (HCA). Patients and methods: Using a tertiary centre database, we retrospectively collected information on patient and lesion characteristics, management and follow-up of all patients with HCA included between 2001 and 2016. Patients were classified into three groups; patients with a single HCA, 2–9 HCA and at least 10 HCA. Results: A total of 458 patients were diagnosed with HCA, including 121 (26.4%) with single HCA, 235 (51.3%) with 2–9 HCA and 102 (22.3%) with at least 10 HCA. Significant differences in the mean BMI were found, with the highest BMI in patients with more than 10 HCA (P<0.05). The mean BMI was significantly higher in patients with inflammatory HCA compared with steatotic HCA (31 vs. 26, respectively, P<0.05). Steatotic HCA were more often single lesions (22/55, 40%), whereas patients with inflammatory HCA were often diagnosed with multiple lesions (122/166, 73%). Conclusion: Our series show a significantly higher BMI and frequency of inflammatory HCA in patients with multiple HCA compared with single HCA.


    Date de mise en ligne : Jeudi 01 janvier 1970
    Singh, Prashant; Makharia, Govind K.
    Avoiding biopsy for initial diagnosis for celiac disease: are we there yet?
    No abstract available


    Date de mise en ligne : Jeudi 01 janvier 1970
    Holmes, Geoffrey K.T.; Hill, Peter G.
    Coeliac disease: further evidence that biopsy is not always necessary for diagnosis
    No abstract available


    Date de mise en ligne : Jeudi 01 janvier 1970
    Fan, Yaofu; Cao, Wen; Di, Hongjie; Liu, Chao
    Assessment of liver fibrosis with acoustic radiation force impulse in patients with chronic hepatitis C
    No abstract available


    Date de mise en ligne : Jeudi 01 janvier 1970
    Sieczkowska, Agnieszka; Landowski, Piotr; Zagozdzon, Pawel; Kaminska, Barbara; Lifschitz, Carlos
    The association of proton pump inhibitor therapy and small bowel bacterial overgrowth in children
    No abstract available


    Date de mise en ligne : Jeudi 01 janvier 1970
    Paper alert
    No abstract available