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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
    Silva, Mário J.; Valente, João; Capela, Tiago; Russo, Pedro; Calinas, Filipe
    Epidemiology of hepatitis B in Portugal
    imageThe epidemiology of hepatitis B in Portugal is insufficiently characterized. We aimed to review the epidemiology of hepatitis B in Portugal since 1980. A literature review was performed in MEDLINE, Scielo, Web of Science, and the Portuguese Scientific Repository for studies containing ‘Hepatitis B’ and ‘Portugal’ published from 1980 to June 2016. The initial search was complemented by abstract books from national gastroenterology and hepatology meetings and reports from the Service for Intervention on Addictive Behaviours and Dependences, the Portuguese Blood Institute, and Directorate-General of Health. Further studies were identified in references of retrieved papers and https://www.google.pt . Ninety references were included. Hepatitis B surface antigen (HBsAg) prevalence was up to 2% in the general population and decreased in the last decades: 1.13–2.0% in studies carried out in 1980–1989 and 0.02–1.45% in studies carried out in 1990–2014. Among pregnant women, HBsAg prevalence was 1.35% in those on primary care, but 6.2% among risk parturients. Among drug abusers, HBsAg prevalence decreased from 10–19.6% in the decades of 1980–1990 to 4.8% in 2014. Higher HBsAg prevalence rates were observed among populations of African or Asian origin. Individuals with hepatitis B were mostly men, mean age 36.9–49 years. The most frequent viral genotype was D. Genotype E is more prevalent in patient cohorts from Central-Southern Portugal (10–62%) than those from Northern Portugal (1–4.1%). The proportion of inactive carriers varied from 24.2 to 73%. The prevalence of cirrhosis varied from 5.8 to 23.7%. Portugal is a low-endemicity country for hepatitis B. Nevertheless, prevalence is high among specific subgroups that may benefit from specifically designed healthcare programs.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Fric, Premysl; Škrha, Jan; Šedo, Aleksi; Bušek, Petr; Laclav, Martin; Bunganic, Bohuš; Zavoral, Miroslav
    Precursors of pancreatic cancer
    imagePancreatic cancer (PC) behaves very differently in comparison with other malignancies. Its incidence has been increasing continuously; mortality has not decreased, the diagnosis is frequently late, radical surgery is performed only in 15–20% of patients, and chemotherapy is only palliative. PC occurs in three different forms. Sporadic PC accounts for 90% of all PCs. Its most frequent form is the pancreatic ductal adenocarcinoma. The remaining 10% constitute two minority groups: familial PC (7%) and PC as a manifestation of a genetic cancer syndrome (3%). PCs are preceded by a precancerous lesion (precursor). At present, six different precursors are known. They have different histomorphological characteristics and malignant potential. The recognition and correct interpretation of individual precursors influences adequate clinical decision-making. The publication surveys the present knowledge of individual precursors and their role in the early pancreatic carcinogenesis.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Sellier, Pierre O.; Maylin, Sarah; Berçot, Béatrice; Chopin, Dorothée; Lopes, Amanda; Simoneau, Guy; Evans, John; Delcey, Véronique; Bénifla, Jean-Louis; Simon, François; Bergmann, Jean-François
    Prospective interventional study of tenofovir in pregnancy to prevent vertical transmission of hepatitis B in highly viremic women
    imageBackground: The risk of vertical transmission of hepatitis B virus (HBV) increases as maternal HBV DNA increase, despite serovaccination to newborns. Methods: From 1 July 2012 to 1 January 2016, all pregnant women in Lariboisiere Hospital, Paris, France, with HBV DNA of 5 log10 IU/ml and above were administered tenofovir from week 28 of pregnancy until delivery. HBV DNA was measured at months 1, 2 of tenofovir and at delivery. The newborns were serovaccinated, tested for hepatitis B surface antigen, hepatitis B core antibody (HBcAb)±HBV DNA, and hepatitis B surface antibody (HBsAb) when aged 9 months, and then 24 months. This study was registered in http://www.ClinicalTrials.gov (NCT02039362). Results: Thirty-one women gave birth to 37 newborns. Maternal HBV DNA at baseline was 8.23 log10 IU/ml and above in 12 pregnancies. The mean (median) HBV DNA were 4.4±1.2 (4.8), 3.3±1.7 (3.8), and 2.1±1.9 (2.0) log10 IU/ml at months 1, 2 of tenofovir and at delivery, respectively. Twenty-seven newborns were followed up: none of the 19 children aged 9 months or older was positive for hepatitis B surface antigen when aged 9 months; 14 children tested positive for HBcAb (probably transferred maternal antibodies, not found when aged 24 months) and for HBsAb without HBV DNA. Four of the 19 children showed HBsAb without HBcAb, the last being doubtful for HBcAb and HBsAb without HBV DNA. Eight newborns aged less than 9 months were not tested. Conclusion: Tenofovir from week 28 of pregnancy to highly viremic HBV women plus serovaccination to newborns could prevent chronic and past infection.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Voulgaris, Theodoros; Vlachogiannakos, John; Ioannidou, Panagiota; Papageorgiou, Maria-Vasiliki; Zampeli, Evi; Karagiannakis, Dimitrios; Georgiou, Anastasia; Papazoglou, Afroditi; Karamanolis, George; Papatheodoridis, George V.
    Adherence to follow-up and treatment recommendations in Greek and immigrant patients with chronic hepatitis B in Greece
    imageBackground/Aim: Immigrants have multiple barriers to access to health care systems. We evaluated the adherence to follow-up and treatment recommendations of chronic hepatitis B virus (HBV) Greek and immigrant patients. Methods: In total, 1001 consecutive adult patients with chronic HBV infection who visited our clinics for the first time between 2002 and 2011 were included. All patients born outside Greece were considered immigrants. Diagnosis was considered to be complete if patients could be classified into HBeAg-positive chronic hepatitis B (CHB), inactive carriers, HBeAg-negative CHB, or decompensated cirrhosis. Results: Of the patients, 56% were Greeks and 44% were immigrants. Greeks visited our clinics at a significantly older mean age (50 vs. 35 years, P<0.001) and more frequently with advanced liver disease (11.4 vs. 6.4%, P=0.007). During the first year, Greeks more frequently had several tests and eventually a complete diagnosis (68 vs. 55%, P<0.001). Greeks were more frequently in the phase of HBeAg-negative CHB and less frequently in the phase of inactive carrier or HBeAg-positive CHB, but age was the main determinant for these differences in multivariate analysis. Treatment was initiated more frequently by Greeks than immigrants with treatment indications (86 vs. 65%, P<0.001). Only 30–33% of treated and 4–10% of untreated patients remained under follow-up at year 5, without significant differences between Greeks and immigrants. Conclusion: Adherence to follow-up recommendations is rather poor for all chronic HBV patients. Immigrants are lost more frequently during the first year, but only small proportions of treated and particularly untreated Greek or immigrant patients remain under long-term follow-up.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Lapi, Francesco; Capogrosso Sansone, Alice; Mantarro, Stefania; Simonetti, Monica; Tuccori, Marco; Blandizzi, Corrado; Rossi, Alessandro; Corti, Giampaolo; Bartoloni, Alessandro; Bellia, Alfonso; Baiocchi, Leonardo; Cricelli, Iacopo; Cricelli, Claudio
    Hepatitis C virus infection: opportunities for an earlier detection in primary care
    imageBackground/aim: In the era of direct-acting antiviral medications, which can cure the hepatitis C virus (HCV) infection, the actual epidemiology of this condition in the general population is still unclear. We therefore aimed to estimate the prevalence rate of HCV and assess the determinants for incident cases of HCV in primary care in Italy. Methods: We identified outpatients aged at least 15 years registered in the Italian Health Search IMS Health Longitudinal Patient Database from 1 January 2002 to 30 June 2013. The annual trend of HCV prevalence was estimated. The candidate determinants for the risk of incident HCV infection included geographical area of residence, sex, age, infections by the HIV, hepatitis B virus (HBV), or other forms of hepatitis, and abuse of illicit substances or drugs. Results: The eligible cohort included 826 300 patients (53.5% women, mean age 48.1±19.1 years). The prevalence rate of HCV increased over the 11-year study period, ranging from 0.24 to 0.50%, with a small increase in men versus women. Patients aged more than 24 years had a higher risk than those aged 14–24 years, with up to a five-fold increase among patients aged 65–74 years. Being resident of Southern/Islands Italy, concurrent diagnosis HBV or HIV, and drug or illicit substance abuse were significant determinants for HCV infection. Conclusion: Our study shows that the prevalence of HCV in Italy has doubled over the last decade. Patients with certain demographics and clinical characteristics are more prone to be infected by HCV. In this scenario, general practitioners may play a crucial role in screening, early identification, and therapy of high-risk patients.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Ordieres, Carlos; Navascués, Carmen A.; González-Diéguez, María L.; Rodríguez, Mercedes; Cadahía, Valle; Varela, María; Rodrigo, Luis; Rodríguez, Manuel
    Prevalence and epidemiology of hepatitis D among patients with chronic hepatitis B virus infection: a report from Northern Spain
    imageBackground: The incidence of hepatitis delta virus (HDV) infection has decreased during the last decades. However, an increasing trend has been reported recently. Patients and methods: We carried out a case–control study to analyze changes in its prevalence in 1215 chronic hepatitis B virus (HBV) patients, diagnosed consecutively in a tertiary center, between 1983 and 2012. According to the year of diagnosis, patients were distributed into two groups: A [1983–1997 (n=786)] and B [1998–2012 (n=429)]. Results: The prevalence of anti-HDV was 8.2% (9.4% in group A and 6.1% in group B) (P=0.04). Multivariate regression revealed that intravenous drug use [odds ratio (OR) 261.0; 95% confidence interval (CI), 28.7–2368.5; P<0.001], blood transfusion (OR 28.0; 95% CI, 2.7–295.9; P=0.03), anti-HIV(+) (OR 4.8; 95% CI, 1.6–14.5; P=0.004), and high alanine aminotransferase (OR 14.4; 95% CI, 3.4–60.6; P<0.001) were associated independently with the presence of anti-HDV in group A, whereas in group B, it was associated with immigration (OR 20.0; 95% CI, 4.7–84.9; P<0.001), intravenous drug use (OR 683.5; 95% CI, 52.7–8855.7; P<0.001), promiscuous sexual activity (OR 22.6; 95% CI, 2.2–228.5; P=0.008), and high alanine aminotransferase (OR 3.4; 95% CI, 1.1–10.0; P=0.02). Conclusion: Although a significant decrease in the prevalence of HDV infection has been observed, it is still above 5%. Immigration and sexual transmission have emerged as new risk factors for HDV infection.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Karaphillis, Erica; Goldstein, Ryan; Murphy, Sharif; Qayyum, Rehan
    Serum alanine aminotransferase levels and all-cause mortality
    imageBackground and objectives: Studies have examined the relationship between serum alanine aminotransferase (ALT) and mortality with inconsistent results. Our aims were to examine the association of normal range serum ALT with mortality, to explore a nonlinear relationship between ALT and mortality, and to investigate whether age modifies this relationship. Study: We used the continuous National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010. Vital status of the participants was obtained by probabilistic matching between NHANES and the National Death Index. Cox proportional models were used to examine the relationship with and without adjustment for age, sex, race, BMI, hypertension, diabetes, alcohol use, serum triglycerides, prescription drug use, and glomerular filtration rate, and accounting for the sampling methodology of NHANES. Nonlinear relationship was examined using spline (single knot at 17 U/l) regression. Interaction terms were used to examine effect modification by age. Results: Higher serum ALT was associated with lower all-cause mortality [adjusted hazard ratio (HR)/ALT increment=0.98, 95% confidence interval (CI)=0.97–0.99]; however, this relationship was nonlinear and present only until 17 U/l (adjusted HR/ALT increment=0.93, 95% CI=0.91–0.95) and not thereafter. Age modified the relationship between ALT and mortality; elderly patients (>64 years) had a 6% lower adjusted mortality risk than younger (<35 years) participants (HR/ALT increment=0.94, 95% CI=0.91–0.96; interaction P<0.001). Conclusion: Increase in serum ALT within the normal range is initially associated with lower mortality, but has no effect after 17 U/l. The elderly show a significantly larger decrease in mortality with an increase in ALT than younger individuals. The mechanisms underlying this relationship need further exploration.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Tanwar, Sudeep; Trembling, Paul M.; Hogan, Brian J.; Srivastava, Ankur; Parkes, Julie; Harris, Scott; Grant, Paul; Nastouli, Eleni; Ocker, Mathias; Wehr, Klaus; Herold, Christoph; Neureiter, Daniel; Schuppan, Detlef; Rosenberg, William M.
    Noninvasive markers of liver fibrosis: on-treatment changes of serum markers predict the outcome of antifibrotic therapy
    imageAim: The utility of noninvasive serum markers to longitudinally monitor liver fibrosis is not established. Methods: A total of 70 patients with chronic hepatitis C who had previously failed antiviral therapy were randomized to receive pegylated interferon with or without silymarin for 24 months. Enhanced Liver Fibrosis (ELF) tests (hyularonic acid, terminal peptide of procollagen III, tissue inhibitor of matrix metaloproteinase-1) were performed on patient sera obtained before, during and at the end of the study (0, 12, 24 months) and liver histology obtained before and at the end of the study. Results: At 24 months, absolute changes in Ishak fibrosis stage and ELF ranged from −4 to +4 and from −2.41 to +2.68, respectively. Absolute changes in ELF at 12 months were significantly associated with changes in both ELF and histology at 24 months. A model combining both baseline ELF and change of ELF at 12 months could predict the 24-month ELF (R2=0.609, P<1×10–11), a decrease in ELF at 24 months [area under the curve (AUC): 0.80–0.85] and an increase in ELF at 24 months (AUC: 0.81–0.85). Furthermore, a model combining both baseline histologic stage and ELF together with the change of ELF at 12 months could predict 24-month histology (R2=0.601, P<1×10–11, AUC: 0.88–0.92), histologic fibrosis regression (AUC: 0.81–0.84) and progression (AUC: 0.86–0.91). Conclusion: Our observations suggest that a change in the serum marker ELF predicts changes in liver fibrosis over a longer period. These data support the use of ELF as a surrogate marker of liver fibrosis evolution in monitoring antifibrotic treatments, thus permitting ‘response-guided’ therapy by the early identification of patients who will benefit from prolonged treatment.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Deng, Xiao-Long; Ma, Rui; Zhu, Hong-Xia; Zhu, Jun
    Short article: A randomized-controlled study of sitagliptin for treating diabetes mellitus complicated by nonalcoholic fatty liver disease
    imageBackground: This study aimed to evaluate the efficacy and safety of sitagliptin for treating Chinese patients with type 2 diabetes mellitus (T2DM) with nonalcoholic fatty liver disease (NAFLD). Methods: In total, 72 Chinese T2DM patients with NAFLD were divided randomly into two groups of 36 patients each group. All 72 patients were assigned to receive either sitagliptin or diet and exercise for 52 weeks between January 2013 and December 2015. The outcomes’ measurements included serum levels of hemoglobin A1c, fasting plasma glucose, aspartate aminotransferase, and alanine aminotransferase. Results: Seventy patients completed the study. Sitagliptin showed greater efficacy than the diet and exercise in decreasing the hemoglobin A1c and fasting plasma glucose levels at weeks 13, 26, 39, and 52. In addition, no significant changes in the average aspartate aminotransferase and alanine aminotransferase levels were found during the 52-week follow-up in both the sitagliptin and the control groups. Conclusion: The results of this study indicate that sitagliptin is an effective and safe treatment for patients with T2DM and NAFLD.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Bruyneel, Marie; Sersté, Thomas; Libert, Walter; van den Broecke, Sandra; Ameye, Lieveke; Dachy, Bernard; Mulkay, Jean-Pierre; Moreno, Christophe; Gustot, Thierry
    Improvement of sleep architecture parameters in cirrhotic patients with recurrent hepatic encephalopathy with the use of rifaximin
    imageBackground and aim: Sleep disorders are frequently reported in patients with cirrhosis and hepatic encephalopathy (HE). This study assessed the effect of rifaximin on sleep architecture parameters in patients with recurrent HE. Patients and methods: This sequential, prospective, and exploratory study involved all patients with cirrhosis and recurrent HE admitted between June 2014 and September 2015. HE was assessed according to the West-Haven Classification. Patients underwent 24-h polysomnography (PSG) and 7-day actigraphy. Rapid eye movement (REM) sleep was considered to be an indicator of good sleep quality. Patients completed questionnaires assessing the quality of sleep and sleepiness. After a 28-day course of rifaximin, the same assessment was repeated. Results: Fifteen patients were included (nine men, mean age: 57±11 years). Child–Pugh scores ranged from B7 to C15. Before rifaximin, the mean HE score was 2.7±0.7. Data from PSG analysis indicated long total sleep time (TST): 571±288 min, and limited REM sleep: 2.5% TST (0–19). Seven-day actigraphy showed an impaired number of steps: 1690/24 h (176–6945). Questionnaires indicated that patients experienced impaired sleep quality and excessive daytime sleepiness. After rifaximin, HE scores decreased to 1.7±0.6 (P<0.001). REM sleep increased to 8.5% TST (0–25) (P=0.003). No changes were observed for TST, number of steps, and on questionnaires. Conclusion: Patients with recurrent HE suffer from poor sleep quality and excessive daytime sleepiness. On 24-h PSG, rifaximin improves objective sleep architecture parameters with no changes in the subjective quality of sleep and sleepiness.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Unger, Lukas W.; Herac, Merima; Staufer, Katharina; Salat, Andreas; Silberhumer, Gerd; Hofmann, Michael; Trauner, Michael; Rasoul-Rockenschaub, Susanne; Soliman, Thomas; Reiberger, Thomas; Berlakovich, Gabriela A.
    The post-transplant course of patients undergoing liver transplantation for nonalcoholic steatohepatitis versus cryptogenic cirrhosis: a retrospective case–control study
    imageBackground: Nonalcoholic fatty liver disease (NAFLD) can be considered the hepatic manifestation of the metabolic syndrome with nonalcoholic steatohepatitis (NASH) as its progressive form. With increasing prevalence of the metabolic syndrome, NASH cirrhosis is becoming a leading cause for liver transplantation. Some cases of orthotopic liver transplantation (OLT) due to cryptogenic cirrhosis (CC) might show typical features of NASH cirrhosis. Therefore, our aim was to assess recurrence of liver fibrosis in patients transplanted for NASH versus CC after OLT. Patients and methods: Patients transplanted for CC or NASH between 1 January 2004 and 30 September 2015 were included. The histological NAFLD activity score and the NAFLD fibrosis score (NFS) were assessed. Results: In total, 15 and 12 patients underwent OLT because of NASH and CC, respectively. The case load for OLT because of NASH was constantly increasing (n=2 in 2004–2007 vs. n=9 in 2012–2015) whereas decreasing for CC (n=6 in 2004–2007 vs. n=2 in 2012–2015). Patient characteristics at OLT were similar, except for an older age and a higher BMI in NASH patients (59.1±2.2 vs. 51.8±2.9 years, P=0.05; 27.7±1.2 vs. 24.3±0.8 kg/m2, P=0.035). Although post-OLT plasma lipid levels and incidence of de-novo hypertension, diabetes, and hyperlipidemia were similar between groups, the post-transplant NFS re-increased in the NASH group (but not in the CC: −0.1317 vs. −1.3645 at 12 months post-OLT, P=0.0400). Post-transplant survival was similar in NASH and CC patients. Conclusion: According to the NFS, some NASH patients show recurrence of fibrosis as early as 6–12 months after OLT.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Negm, Osama; Abou Saif, Sabry; El Gharib, Mohamed; Yousef, Mohamed; Abd-Elsalam, Sherief
    Role of low-molecular-weight heparins in prevention of thromboembolic complication after transarterial chemoembolization in hepatocellular carcinoma
    imageBackground and aim: Portal vein thrombosis (PVT) is a common complication after transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). This is the first clinical study to evaluate the role of low-molecular-weight heparins (LMWHs) with TACE in HCC for the prevention of thromboembolism complications (PVT). Patients and methods: This study was carried out on 40 patients with HCC requiring TACE who presented to the Tropical Medicine Department, Tanta University and Interventional Radiology Department of Ain-Shams University Hospitals starting from April 2015. Patients were divided in two groups: group I included 20 patients with HCC treated by TACE only. Group II included 20 patients with HCC treated by TACE and an adjuvant dose of LMWH. Radiological assessment of efficacy of procedure and detection of PVT as a complication was performed using ultrasound abdomen and pelvis and triphasic spiral computed tomography with contrast. Results: This study was carried out on 40 patients with HCC requiring TACE who presented to the Tropical Medicine Department of Tanta University and Interventional Radiology Department of Ain-Shams University Hospitals. The incidence of PVT after TACE was higher in group I than group II, with seven cases in group I and only one case in group II. Conclusion: LMWH with TACE in HCC is strongly recommended for prevention of thromboembolism complications (PVT). However, larger randomized-controlled studies are needed to confirm these obvious findings.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Zeitz, Jonas; Bissig, Marina; Barthel, Christiane; Biedermann, Luc; Scharl, Sylvie; Pohl, Daniel; Frei, Pascal; Vavricka, Stephan R.; Fried, Michael; Rogler, Gerhard; Scharl, Michael
    Patients’ views on fecal microbiota transplantation: an acceptable therapeutic option in inflammatory bowel disease?
    imageBackground: Fecal microbiota transplantation (FMT) represents a new therapeutic option that has been studied in two randomized-controlled trials in ulcerative colitis patients. Our study aimed to identify patients’ views on the use of this novel therapeutic approach. Methods: Using an anonymous questionnaire, we obtained data from 574 inflammatory bowel disease (IBD) patients on their knowledge and willingness to undergo FMT. Results: A large proportion of IBD patients (53.5%) are unaware that FMT is a therapeutic option in Clostridium difficile infection and potentially IBD. More responders preferred FMT (31.5%) to a study with a new medication (28.9%), although the difference was not significant (P=0.37), and the preferred way of transplantation was colonoscopy (49.7%). In all, 38.3% preferred a family member as a donor, but there was fear about the procedure (41.5% mentioned fear of infectious diseases, 26.5% expressed disgust). The knowledge of successful FMT treatment in other patients was important for 82.2% of responders and for 50.7%, a discussion with a specialist would likely change their opinion about FMT. Conclusion: FMT represents a therapeutic procedure that is of interest for IBD patients. As FMT has been receiving increasing interest as an alternative treatment in IBD and more studies on FMT in IBD are being carried out, it is important to learn about the knowledge, attitude, and preferences of patients to provide better education to patients on this topic. However, there are reservations because of the fact that data on the benefits of FMT in IBD are controversial and several limitations exist on the use of FMT in IBD.

    Date de mise en ligne : Jeudi 01 janvier 1970
    van Deen, Welmoed K.; Spiro, Arlen; Burak Ozbay, A.; Skup, Martha; Centeno, Adriana; Duran, Natalie E.; Lacey, Precious N.; Jatulis, Darius; Esrailian, Eric; van Oijen, Martijn G.H.; Hommes, Daniel W.
    The impact of value-based healthcare for inflammatory bowel diseases on healthcare utilization: a pilot study
    imageBackground and objectives: Value-based healthcare (VBHC) is considered to be the solution that will improve quality and decrease costs in healthcare. Many hospitals are implementing programs on the basis of this strategy, but rigorous scientific reports are still lacking. In this pilot study, we present the first-year outcomes of a VBHC program for inflammatory bowel disease (IBD) management that focuses on highly coordinated care, task differentiation of providers, and continuous home monitoring. Methods: IBD patients treated within the VBHC program were identified in an administrative claims database from a commercial insurer allowing comparisons to matched controls. Only patients for whom data were available the year before and after starting the program were included. Healthcare utilization including visits, hospitalizations, laboratory and imaging tests, and medications were compared between groups. Results: In total, 60 IBD patients treated at the VBHC Center were identified and were matched to 177 controls. Significantly fewer upper endoscopies were performed (−10%, P=0.012), and numerically fewer surgeries (−25%, P=0.49), hospitalizations (−28%, 0=0.71), emergency department visits (-37%, P=0.44), and imaging studies (−25 to −86%) were observed. In addition, 65% fewer patients (P=0.16) used steroids long term. IBD-related costs were 16% ($771) lower than expected (P=0.24). Conclusion: These are the first results of a successfully implemented VBHC program for IBD. Encouraging trends toward fewer emergency department visits, hospitalizations, and long-term corticosteroid use were observed. These results will need to be confirmed in a larger sample with more follow-up.

    Date de mise en ligne : Jeudi 01 janvier 1970
    van Gennep, Sara; Sahami, Saloomeh; Buskens, Christianne J.; van den Brink, Gijs R.; Ponsioen, Cyriel Y.; D’Hoore, André; de Buck van Overstraeten, Anthony; van Assche, Gert; Ferrante, Marc; Vermeire, Séverine; Bemelman, Willem A.; D’Haens, Geert R.A.M.; Löwenberg, Mark
    Comparison of health-related quality of life and disability in ulcerative colitis patients following restorative proctocolectomy with ileal pouch-anal anastomosis versus anti-tumor necrosis factor therapy
    imageBackground and aims: Health-related quality of life (HRQL) and disability were compared in ulcerative colitis (UC) patients who underwent restorative proctocolectomy versus patients who received treatment with anti-tumor necrosis factor (anti-TNF) agents. Patients and methods: UC patients who underwent restorative proctocolectomy or started anti-TNF treatment between January 2010 and January 2015 were included at two tertiary referral centers. A matched cohort was created using propensity score matching for the covariates disease duration, Montreal classification, age, and sex. HRQL and disability were assessed using the Colorectal Functional Outcome (COREFO), Inflammatory Bowel Disease Disability Index (IBD-DI), EuroQol-5D-3L, and Short Form 36 (SF-36) questionnaires. Results: In total, 297 patients were included, of whom 205 (69%) patients responded. Fifty-nine pouch patients were matched to 59 anti-TNF-treated patients. Pouch patients reported better general health scores (P=0.042) compared with the anti-TNF group (SF-36). No differences were found for the EuroQol-5D-3L and IBD-DI between the two groups. Pouch patients had significantly higher COREFO scores compared with anti-TNF-treated patients for ‘stool frequency’ (P<0.001), ‘antidiarrheal medication use’ (P<0.001), and ‘stool-related aspects’ (P=0.004), of which the latter was because of a higher perianal skin irritation frequency (P<0.001). Conclusion: UC patients who underwent restorative proctocolectomy reported a higher bowel movement frequency and more perianal skin irritation compared with anti-TNF-treated patients, but this did not affect overall disease-specific disability outcomes. Patients in the surgery group reported better outcomes for generic health compared with those in the anti-TNF group.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Van Erp, Sanne J.H.; Verheul, Marije K.; Levarht, E.W. Nivine; van der Reijden, Johan J.; van der Heijde, Désirée; van Gaalen, Floris A.; Hommes, Daniel W.; Norman, Gary L.; Shums, Zakera; Mahler, Michael; Verspaget, Hein W.; Trouw, Leendert A.; van der Meulen-de Jong, Andrea E.
    Short article: Absence of serological rheumatoid arthritis biomarkers in inflammatory bowel disease patients with arthropathies
    imageObjective: Biomarkers that are associated with future progression to rheumatoid arthritis (RA) and joint destruction have been discovered previously in patients with arthralgia. The present study examined these RA biomarkers in inflammatory bowel disease (IBD) patients with arthropathies. Patients and methods: Sera from 155 IBD patients with and 99 IBD patients without arthropathies were analyzed for immunoglobulin (Ig) M rheumatoid factor (RF), IgA-RF, anti-cyclic citrullinated peptide 2, anti-cyclic citrullinated peptide 3.1, and anti-carbamylated protein antibody positivity using enzyme-linked immunosorbent assays. The prevalence of the autoantibodies in the IBD patients was compared with the prevalence in RA patients. Results: No differences were found in biomarker positivity between IBD patients with and without arthropathies. Significantly more biomarker positivity (P<0.001) was observed in RA patients compared with IBD patients with arthropathies. Also, smoking turned out to be significantly associated with positivity for IgM-RF or IgA-RF. Conclusion: Our findings suggest that there is no apparent clinical value in the detection of RA biomarkers in serum of IBD patients to help identify arthropathies.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Mohammad Alizadeh, Amir H.; Abbasinazari, Mohammad; Hatami, Behzad; Abdi, Saeed; Ahmadpour, Forozan; Dabir, Shideh; Nematollahi, Aida; Fatehi, Samira; Pourhoseingholi, Mohammad A.
    Comparison of rectal indomethacin, diclofenac, and naproxen for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis
    imageBackground and aim: NSAIDs are commonly utilized for the prevention of post endoscopic retrograde cholangiopancreatography pancreatitis (PEP). However, not much is known about the most effective drug in preventing this complication. This study aims to clarify which drug (indomethacin, diclofenac, or naproxen) is most effective for the prevention of post endoscopic retrograde cholangiopancreatography (ERCP). Materials and methods: In a double-blind, randomized study, patients received a single rectal dose of one of the three drugs 30 min before undergoing ERCP: diclofenac (100 mg), indomethacin (100 mg), or naproxen (500 mg). The primary outcome measured was the development of pancreatitis. The levels of serum amylase, lipase, lipoxin A4, and resolvin E1 were measured before ERCP, and at 24 h after the procedure. Results: Three hundred and seventy-two patients completed the study. The overall incidence of PEP was 8.6%, which occurred in five of the 124 (4%) patients who received diclofenac, seven of the 122 (5.8%) patients who received indomethacin, and 20 of the 126 (15.9%) patients who received naproxen. There were no significant differences in amylase and lipase levels among the three groups (P=0.183 and 0.597, respectively). Unlike patients in the naproxen group, patients in the diclofenac and indomethacin groups showed a significant increase in lipoxin A4 and resolvin E1 (P=0.001 and 0.02, respectively). Conclusion: Diclofenac and indomethacin patient groups had a lower incidence of PEP than the naproxen group.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Falt, Premysl; Šmajstrla, Vít; Fojtík, Petr; Hill, Martin; Urban, Ondrej
    Carbon dioxide insufflation during colonoscopy in inflammatory bowel disease patients: a double-blind, randomized, single-center trial
    imageObjective: Bowel distension by insufflated air causes abdominal discomfort after colonoscopy. Carbon dioxide (CO2) instead of air insufflation during colonoscopy can reduce postprocedural discomfort in diagnostic and screening cases. Discomfort after colonoscopy and CO2 insufflation have never been studied in inflammatory bowel disease (IBD) patients, characterized by younger age, structural changes of the colon, and need for repeated and frequently uncomfortable colonoscopies. Our trial was designed to evaluate postprocedural discomfort associated with CO2 compared with air insufflation in unsedated or minimally sedated patients with known IBD. Methods: In a double-blind, randomized, single-center study, 64 patients were randomized to either CO2 insufflation (CO2) or air insufflation colonoscopy (Air). Abdominal pain, bloating, and flatulence scores during 24 h after colonoscopy were recorded using a continuous scale of 0–10 (0=none, 10=maximum discomfort). The primary endpoint used for power calculation was bloating score at 1 h after colonoscopy. Results: Pain, bloating, and flatulence scores at end, 1, and 3 h after colonoscopy were significantly lower in CO2 than in Air arm (P<0.001). Scores at 6, 12, and 24 h were comparable. Procedural parameters such as cecal and terminal ileum intubation rate, intubation and total time, pain during insertion, need for repositioning, and abdominal compression were not different between arms. No complications were recorded in the study. Conclusion: Compared with air, CO2 insufflation significantly reduces abdominal pain, bloating, and flatulence scores during at least 3 h after colonoscopy in IBD patients, achieving comparable intraprocedural outcomes.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Sonnenberg, Amnon
    Cry wolf and inflate medical urgency to expedite consult resolution through gastrointestinal endoscopy
    imageBackground and aims: To expedite a consult resolution, referring physicians sometimes inflate the urgency and need for endoscopic workup. The aim of the present decision analysis was to study the impact of inflationary indication on the expected benefits to gastroenterologists and referring physicians. Methods: The study aims were pursued in terms of game theory and medical decision analysis using decision trees. Different outcomes associated with true versus false urgent indication in immediate versus delayed endoscopy were ranked according to different preference schemes of gastroenterologists versus referring physicians. Results: The decision analysis shows that inflating the urgency of indication for endoscopy reduces the benefit from the perspective of gastroenterologists and referring physicians alike. Raising the level of false urgent indications results in a lost opportunity for immediate endoscopy among patients with true urgent indications and, thus, diminishes the overall benefit of endoscopy. By comparison, all other influences play only a marginal role. For referring physicians, the small benefit of expediting nonurgent endoscopies by exaggerated claims does not compensate for the concomitant loss of truly needed endoscopy slots. For gastroenterologists, a small benefit derived from delaying endoscopies in patients with false urgent endoscopies rapidly wears off as inflationary indications become common practice. Conclusion: An underlying communication problem between referring physicians and gastroenterologists needs to be resolved by educating referring physicians about the operative exigencies of endoscopy units and about the true appearance of alarm symptoms in common digestive diseases.

    Date de mise en ligne : Jeudi 01 janvier 1970
    Ferrarese, Alberto; Tikhonoff, Valerie; Casiglia, Edoardo; Burra, Patrizia; Senzolo, Marco
    Beneficial role of terlipressin in decompensated cirrhotics with spontaneous bacterial peritonitis
    imageNo abstract available

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