Muscle performance and fatigue in compensated chronic liver disease

Abstract

Background: A common and debilitating symptom in patients with chronic liver disease is fatigue (CLD). Muscle dysfunction has been suggested to be a key mechanism of fatigue in CLD.

Objective: We aimed to evaluate fatigue and the potential association with muscle performance and physical activity in outpatients with CLD.

Methods: Two-hundred seventy outpatients with CLD were included, (52?±?15 years, mean?±?SD; 151 females) with autoimmune hepatitis (n?=?49), primary biliary cholangitis (n?=?45), primary sclerosing cholangitis (n?=?46), chronic hepatitis B (n?=?57) or C (n?=?73). Patients with a Child-Pugh >6 were excluded. The questionnaire Fatigue Impact Scale (FIS) was used to evaluate fatigue, and physical activity was evaluated through a self-reported level of physical activity. Muscle function was assessed with four muscle tests, walking speed, handgrip strength, standing heel-rise test (SHT) and ‘Timed Up and Go’ test (TUG).

Results: The median total FIS score was 30 (40% had FIS > 40, considered high-fatigue). Diminished muscle performance was observed in the SHT (% of predicted value: 53?±?26%) and with maximum grip strength (85?±?20%). The FIS score was significantly different between groups of CLDs (p?=?.004). In multivariate analysis the TUG (p?=?.001), SHT (p?=?.005), antidepressants (p?p?=?.001) were associated with fatigue (R²?=?29%). Subjects with higher levels of physical activity had lower FIS (p?Conclusions: In patients with CLD, fatigue was associated with low muscle performance and reduced level of physical activity, which could be a potential therapeutic target.     

Perinatal and familial risk factors for irritable bowel syndrome in a Swedish national cohort

Objective: Studies of the importance of perinatal factors for the development of irritable bowel syndrome (IBS) are sparse. We conducted a large national cohort study to examine perinatal and familial risk factors for IBS.

Material and methods: A national cohort of 1,963,685 persons who were born in Sweden in 1973–1992 (identified from the Swedish Birth Registry) were followed up for adult (18 years and older) IBS incidence in the Swedish Patient Register through 2010 (maximum age 38 years). There were 24,633 IBS cases in 46,784,296 person-years of follow-up.

Results: After adjusting for potential confounders, significant risk factors for IBS included caesarean (HR?=?1.10, 95% confidence interval [CI] 1.05–1.11, p?p?=?.02), being second in birth order (HR?=?1.04, 95%CI 1.01–1.08, p?=?.01), foetal growth ≥1 SD (HR?=?1.06, 95%CI 1.00–1.11, p?=?.05), young maternal age (<20 years) (HR=?1.09, 95%CI 1.02–1.17, p?=?.02), maternal marital status (divorced/widowed) (HR?=?1.12, 95%CI 1.08–1.17, p?p?=?.01), maternal education of 12–14 years (HR?=?1.06, 95%CI 1.01–1.11, p?=?.03), parental history of IBS (HR?=?1.54, 95%CI 1.42–1.66, p?p?p?=?.02). Protective factors were male sex (HR?=?0.36, 95%CI 0.35–0.37, p?p?=?.03).

Conclusions: In this large cohort study, several perinatal and familial factors were associated with an increased risk of IBS independently, suggesting that perinatal and familial factors may play an important long-term role in the aetiology of IBS.     

Psychiatric symptoms among patients with acute abdominal pain

Abstract

Background: Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments.

Objective: Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, ‘Length of stay’ (LOS) and perceived health.

Method: The patients (N?=?137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups.

Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p?<?.001), especially regarding anxiety (p?<?.001) and depression (p?=?.002). Patients with organic dyspepsia reported significantly more total (p?=?.016), extragastrointestinal (p?=?.026) (chest pain; p?=?.017, dizziness; p?=?.004, palpitations; p?=?.005, insomnia; p?=?.005 and worries; p?=?.001), and summarized anxiety and depression symptoms (p?=?.001–0.002) besides poorer general health (p?<?.001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p?=?.002) but similar to the specific abdominal disorders group.

Conclusion: Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care.     

Factors associated with failure of Enhanced Recovery After Surgery (ERAS) in colorectal and gastric surgery

Abstract

Background: The Enhanced Recovery After Surgery (ERAS) pathway is widely applied in the perioperative period of stomach and colorectal surgery, and can decrease the length of hospital stay of the patients without compromising the safety of the patients. However, some patients are removed from this pathway for various reasons. Here we found some factors that taking the patients out from the procedures.

Methods: A retrospective analysis of collected data of 550 patients over a 3-year period was conducted, with 292 in the ERAS group and 258 in the conventional care group. Then various basic elements were analyzed to explore the reasons for the failure to complete the ERAS program.

Results: Total length of hospital stay after surgery was significantly shorter in the ERAS group, and a similar incidence of complication rates were observed in the two groups. In this study, the significant factors that associated with complications were advanced age (OR 2.18; p?=?.031), history of abdominal surgery (OR 2.03; p?=?.04), incomplete gastrointestinal obstruction (OR 3.42; p?p?=?.004) and intraoperative neostomy (OR 2.37; p?=?.006).

Conclusions: We found that advanced age (>80?years old), history of abdominal surgery, gastrointestinal obstruction and stoma formation were the risk factors. We anticipated to design a risk assessment system upon the high-risk patients from the present ERAS pathway, and make a modified ERAS pathway for those patients.     

Does transient elastography correlate with liver fibrosis in patients with PSC? Laennec score-based analysis of explanted livers

Background and aims: Previous studies demonstrated a close correlation between transient elastography (TE) and liver histology in chronic liver diseases. Data on the accuracy of TE in primary sclerosing cholangitis (PSC) remains scarce. Here, we investigated the association between TE, serum marker of liver injury and histology of explanted livers in PSC patients.

Methods: Thirty patients were prospectively recruited. TE (Fibroscan^®) and blood sampling were performed during evaluation for liver transplantation (LT); the second blood sampling was performed on the day of LT. Fibrosis of explanted livers according to the seven-point Laennec staging system and liver collagen contents were measured.

Results: TE correlated with Laennec stages of fibrosis (p?=?.001), collagen contents (p?p?=?.034) in explanted livers. It also correlated with serum indices of liver injury, namely AST, bilirubin as well as FIB-4 and APRI scores (all p?p?=?.035) or collagen contents (p?=?.005), was significantly associated with TE. Finally, patients with cirrhosis had increased liver stiffness (p?=?.002) and the TE cut-off of 13.7?kPa showed the best predictive value (AUC?=?.90, 95% CI: 0.80–1.00, p?Conclusions: TE correlates with liver fibrosis and markers of liver injury in patients with PSC. However, liver fibrosis seems to be the strongest predictor of liver stiffness assessed with TE. Hence, we postulate that TE is a reliable tool for non-invasive monitoring of PSC.     

Acute biliary pancreatitis: focus on recurrence rate and costs when current guidelines are not complied

Background: International guidelines recommend cholecystectomy within 2–4 weeks after mild to moderate acute biliary pancreatitis (ABP) to prevent recurrence. We aimed to investigate the compliance to guidelines concerning early cholecystectomy and the associated costs.

Methods: Admissions for ABP 2011–2013 were retrospectively reviewed. Classification was made according to the revised Atlanta classification. Treatment, time to surgery and recurrence, as well as cost analysis for both in-hospital costs and loss of production (LOP) were performed.

Results: In total, 254 patients were included. Some 202 of the ABP patients (80%) underwent definitive treatment during their first attack of ABP (68% cholecystectomy, 17% endoscopic retrograde cholangiopancreatography (ERCP), 15% both interventions) and 186 (73%) were treated within 1 month of discharge. Patients with ERCP alone were significantly older than cholecystectomy cases (p?<?.001), but no significant difference was observed between those who underwent ERCP or no treatment (p?=?.071). Mild ABP had intervention earlier (p?<?.001). In all, 52 patients (20%) had no intervention, out of which 15 were readmitted due to pancreatitis, compared to 3 patients of those treated at the initial admission (p?<?.001). The mean cost for hospital care and LOP in mild ABP was €6882?±?3010 and €9580?±?7047 for moderate ABP (p?=?.001). The cost for a recurrent episode was €16,412?±?22,367.

Conclusion: By improved compliance to current guidelines concerning the management of ABP, recurrence rate and associated costs can potentially be reduced.     

Are prematurity and environmental factors determinants for developing childhood-onset systemic lupus erythematosus?

Objective: The objective of this study is to evaluate the influence of exposure to air pollutants and inhalable environmental elements during pregnancy and after birth until childhood-onset systemic lupus erythematosus(cSLE) diagnosis.

Methods: This case–control study comprised 30 cSLE patients and 86 healthy controls living in the Sao Paulo metropolitan area. A structured and reliable questionnaire (kappa index for test-retest was 0.78) assessed demographic data, gestational and perinatal-related-factors, and exposure to inhalable elements during pregnancy and after birth (occupational exposure to inhalable particles and/or volatile vapor, and/or tobacco, as well as, the presence of industrial activities or gas stations near the home/work/daycare/school). Tropospheric pollutants included: particulate matter (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃) and carbon monoxide (CO).

Results: The median current age was similar between cSLE patients and healthy controls [16.0 (5–21) versus 15.0 (4–21) years, p?=?.32], likewise the frequency of female gender (87% versus 78%, p?=?.43). The frequencies of prematurity (30% versus 6%, p?=?.001), maternal occupational exposure during pregnancy (59% versus 12%, p?p?p?=?.008) were significantly higher in cSLE patients compared with controls. In a multivariate analysis regarding the gestation period, maternal occupational exposure (OR 13.5, 95% CI 2.5–72.4, p?=?.002), fetal smoking (OR 8.6, 95%CI 1.6–47, p?=?.013) and prematurity (OR 15.8, 95%CI 1.9–135.3, p?=?.012) remained risk factors for cSLE development. Furthermore, exposure to secondhand smoking during pregnancy and after birth (OR 9.1, 95%CI 1.8–42.1, p?=?.002) was also a risk factor for cSLE development.

Conclusions: Prematurity and environmental factors were risk factors for developing cSLE.     

Amalgamation of systemic inflammatory response syndrome score with C-reactive protein level in evaluating acute pancreatitis severity in children

Background and aim: Systemic inflammatory response syndrome (SIRS) has to do with how the body reacts to injury. Herein, we analyzed the clinical features of acute pancreatitis (AP) in children with SIRS complication and investigated the role of SIRS score combined with C-reactive protein (CRP) level in assessing AP severity in children.

Methods: This retrospective cohort study involved 111 children hospitalized with AP at the Children's Hospital of Zhejiang University School of Medicine between January 2012 and August 2017. Presence of SIRS, demographic data, clinical information and laboratory test results on admission were statistically examined.

Results: Out of the 111 AP cases, 45 were diagnosed with SIRS. Differences in CRP, interleukin-6 (IL-6), age, temperature, heart rate (HR), white blood cell (WBC), neutrophil count (NC), body mass index (BMI), duration of onset of disease symptoms as well as cases requiring intensive care unit (ICU) treatment were significantly higher in patients with SIRS than those without SIRS (p?p?p?=?.02) and fever (OR?=?3.56, p?=?.007). SIRS was an independent predictor for AP severity (OR?=?10.820, p?=?.005). The optimal cut-off value of CRP was 27.5?mg/L for severe AP classification according to receiver operating characteristic (ROC) (area under curve was 0.733).

Conclusion: Amalgamation of SIRS criterion with CRP level potentially plays an important role in assessing AP severity in children.     

Clinical characteristics of patients with liver cirrhosis and spontaneous portosystemic shunts detected by ultrasound in a tertiary care and transplantation centre

Abstract

Objectives: The clinical relevance of spontaneous portosystemic shunts detected by ultrasound is insufficiently investigated. The aim of this retrospective study was to assess the frequency and clinical relevance of spontaneous portosystemic shunts in patients with liver cirrhosis.

Methods: We evaluated portosystemic shunts, liver cirrhosis and spleen size by ultrasound in 982 patients with liver cirrhosis and correlated these with laboratory results, clinical data and the incidence of clinical endpoint deaths, liver transplantation and the development of HCC during the follow-up period (mean 1.26?±?1.53 years [range 0–7.2 years]).

Results: Portosystemic shunts were detected in 34% of the patients. These patients had a higher rate of alcohol-related cirrhosis (37% vs. 30%, p?=?.003), a higher MELD score (p?p?p?p?p?=?.041) and suffered more frequently from Child B/C stages (p?=?.03), hepatorenal syndrome (p?=?.03), massive ascites (p?=?.001) and spontaneous bacterial peritonitis (p?=?.011).

Conclusions: Patients with portosystemic shunts that are detected by ultrasound should be monitored carefully as these patients are associated with advanced liver disease and multiple clinical risk factors.     

Clinical and virological implications of A1846T and C1913A/G mutations of hepatitis B virus genome in severe liver diseases

Objective: Mutations occurring within different genes of hepatitis B virus (HBV) genome may have different clinical implications. This study aimed to observe the clinical and virological implications of the A1846T and C1913A/G mutations of HBV genome in the development and treatment outcome of severe liver diseases, which has not been previously determined.

Materials and methods: A total of 438 cases of patients with liver diseases were retrospectively reviewed, including 146 with mild chronic hepatitis B infection (CHB-M), 146 with severe chronic hepatitis B infection (CHB-S), and 146 with acute-on-chronic liver failure (ACLF). Partial or full-length HBV genome was directly sequenced. Replicons containing A1846T, C1913A or other mutant sequences, or the wild-type counterparts were constructed respectively, and then transfected into HepG2 cells for phenotype analysis.

Results: There was significant difference in the detection rates of A1846T (30.82%, 40.41% and 55.48%, respectively) and C1913A/G (15.52%, 28.77%, and 35.62%, respectively) among patients with CHB-M, those with CHB-S, and those with ACLF (p?p?=?.041). In vitro experiment revealed that A1846T mutant resulted in 3.20-fold and 1.85-fold increase of replication capacity and promoter activity, respectively compared with wild type counterpart (p?p?Conclusion: Occurrence of A1846T and C1913A is positively associated with clinical presentations of severe liver disease. A1846T mutation is significantly associated with poor prognosis of ACLF.     

Percutaneous endoscopic gastrostomy: dealing with the issue of dislodgement

Abstract

Introduction: Percutaneous Endoscopic Gastrostomy (PEG) is accepted as an efficient method to provide long-term enteral nutrition. PEG accidental dislodgement (device exteriorization confirmed by expert evaluation) rate is high and can lead to major morbidity.

Objective: To identify independent risk factors for PEG accidental dislodgement.

Methods: Retrospective, single-center study, including consecutive patients submitted to PEG procedure, for 38 consecutive months. Every patient had 12?months minimum follow-up after PEG placement. Univariate analysis selected variables with at least marginal association (p?<?.15) with the outcome variable, PEG dislodgement, which were included in a logistic regression multivariate model. Discriminative power was assessed using area under curve (AUC) of the receiver operating curve (ROC).

Results: We included 164 patients, 67.7% (111) were female, mean age was 81?years. We report 59 (36%) PEG dislodgements, of which 13 (7.9%) corresponded to early dislodgements. The variables with marginal association were hypoalbuminemia (p?=?.095); living at home (p?=?.049); living in a nursing home (p?=?.074); cerebrovascular disease (CVD) (p?=?.028); weight change of more than 5?kg, either increase or decrease (p?=?.001); psychomotor agitation (p?<?.001); distance inner bumper-abdominal wall (p?=?.034) and irregular appointment follow-up (p?=?.149). At logistic multivariate regression, the significant variables after model adjustment were CVD OR 4.8 (CI 95% 2.0–11.8), weight change OR 4.7 (CI 95%1.6–13.9) and psychomotor agitation OR 18.5 (CI 95% 5.2–65.6), with excellent discriminative power (AUC ROC 0.797 [CI95% 0.719–0.875]).

Conclusion: PEG is a common procedure and accidental dislodgement is a frequent complication. CVD, psychomotor agitation and weight change >5?kg increase the risk of this complication and should be seriously considered when establishing patients’ individual care requirements.     

Outpatient management of acute uncomplicated diverticulitis results in health-care cost savings

Purpose: Outpatient management without antibiotics has been shown to be safe for selected patients diagnosed with acute uncomplicated diverticulitis (AUD). The aim of this study was to evaluate the impact on admissions, complication rates and health-care costs of the policy of outpatient treatment without using antibiotics.

Methods: The medical records of all patients diagnosed with AUD in the year before (2011) and after (2014) the implementation of outpatient management without antibiotics in Västmanland County were reviewed. Health-care cost analysis was performed using the Swedish cost-per-patient model.

Results: In total, 494 episodes of AUD were identified, 254 in 2011 and 240 in 2014. The proportion of patients managed as outpatients was 20% in 2011 compared with 60% in 2014 (p?p?p?p?=?.469).

Conclusions: The new policy of outpatient management without antibiotics in routine health care almost halved the total health-care cost without an increase in the complication rate.     

Relevance of antiphospholipid antibody profile in the clinical outcome of ITP: a single-centre study

Objectives: The relevance of detecting antibodies against anticardiolipin, β2-glycoprotein I (β2gpI) or lupus anticoagulant (LA), collectively called antiphospholipid autoantibodies (APA), in subjects with immune thrombocytopenia (ITP) is still a debated issue. In particular, whether APA profile may affect the clinical course of ITP is unknown.

Methods: In this study, we report our experience in a cohort of ITP patients with APA with specific interest to the relevance of different antiphospholipid antibody profiles in clinical outcome and response to treatment.

Results: Thirty-seven out of 159 patients (23.2%) fulfilling ITP criteria had a platelet count ≤50?×?10⁹/L and tested positive at APA at ITP onset. Twenty-three (62.1%) patients received at least one line of treatment for ITP. Fourteen subjects (37.8%) showing triple positivity for APA showed a significantly lower median platelet count compared to other APA patients (p?=?.006). Among these ITP subjects with triple positivity, 85.7% needed a treatment because of low platelet count compared to 47.8% ITP patients with non-triple-positive APA (p?=?.0094). ITP/APA subjects who received immunosuppressors had a higher rate of thrombosis (p?=?.024) as well as thrombosis developed in subjects who were on steroid therapy at a significantly higher dosage than subjects who did not develop thrombotic episodes (p?<?.001). When considering treatment, CR and SR rate were significantly higher in ITP/triple-positive patients compared to non-triple-positive subjects (p?=?.021 and p?=?.005).

Conclusions: The profile of APA may affect the outcome of patients with ITP.     

Persistent SIRS and acute fluid collections are associated with increased CT scanning in acute interstitial pancreatitis

Background: The use of computed tomography (CT) in acute pancreatitis (AP) continues to increase in parallel with the increasing use of diagnostic imaging in clinical medicine.

Aim: To determine the factors associated with obtaining >1 CT scan in acute interstitial pancreatitis (AIP).

Methods: Demographic and clinical data of all adult patients admitted between 1/2010 and 1/2015 with AP (AP) were evaluated. Only patients with a CT severity index (CTSI)?≤?3 on a CT obtained within 48?h of presentation were included.

Results: A total of 229 patients were included, of whom 206 (90%) had a single CT and 23 (10%) had >1 CT during the first week of hospitalization. Patients undergoing >1 CT had significantly higher rates of acute fluid collection (AFC), persistent SIRS, opioid use ≥4 days, and persistent organ failure compared to those undergoing 1 CT (p?p?=?.01) and an AFC on initial CT (OR?=?3.5, 95% CI 1.4–9, p?=?.009) were independently associated with obtaining >1 CT.

Conclusion: An AFC on initial CT and persistent SIRS are associated with increased CT imaging in AIP patients. However, these additional CT scans did not change clinical management.     

Kidney biopsy in AA amyloidosis: impact of histopathology on prognosis

In AA amyloidosis, while kidney biopsy is widely considered for diagnosis by clinicians, there is no evidence that the detailed investigation of renal histopathology can be utilized for the prognosis and clinical outcomes. In this study, we aimed to obtain whether histopathologic findings in kidney biopsy of AA amyloidosis might have prognostic and clinical value.

This is a retrospective cohort study that included 38 patients who were diagnosed with AA amyloidosis by kidney biopsy between 2005 and 2013.The kidney biopsy specimens of patients were evaluated and graded for several characteristics of histopathological lesions and their relationship with renal outcomes.

Segmental amyloid deposition in the kidney biopsy was seen in 29%, global amyloid deposition in 71, diffuse involvement of glomeruli in 84.2%, focal involvement in 7%, glomerular enlargement in 53%, tubular atrophy in 75% and interstitial fibrosis in 78% of patients. Histopathologically, glomerular enlargement, interstitial fibrosis, tubular atrophy, interstitial inflammation and global amyloid deposition were significantly associated with lower estimated glomerular filtration rate (eGFR) (p?=?.02, p?p?=?.001, p?=?.009, p?=?.002, respectively) in univariate analysis. In multivariate analysis, tubular atrophy was the only predictor of eGFR (p?=?.019 B?=??20.573). In the follow-up at an average of 27?months, 18 patients developed end-stage renal disease (ESRD). Among them, global amyloid deposition was the only risk factor for the development of ESRD (p?=?.01, OR?=?18.750, %95?CI=?2.021–173.942).

This is the first study showing that the histopathological findings in kidney biopsy of AA amyloidosis might have a prognostic and clinical value for renal outcomes.     

Novel fork-tip needles versus standard needles for EUS-guided tissue acquisition from solid masses of the upper GI tract: a matched cohort study

Background: There are very few available data on the novel SharkCore? needles for EUS-FNB.

Aim: Comparison of the performance of the SharkCore? needles with the standard EUS-FNA needles for the diagnosis of solid upper GI masses.

Patients and methods: Single-center, retrospective cohort study in an academic tertiary referral hospital. Patients were matched 1:1 for the site of the lesion and the presence or absence of rapid on-site evaluation (ROSE).

Results: A total of 102 patients were included. There was no statistically significant difference in the mean number of passes (3.3?±?1.3 versus 3.4?±?1.5; p?=?.89). Similar results were observed at the subgroup with ROSE (4.3?±?1.3 versus 3.7?±?1.5; p?=?.26). More histological specimens were obtained with the SharkCore? needles compared to standard needles (59 versus 5%; p?<?.001). Diagnostic test characteristics were not significantly different (sensitivity: 91.5 versus 85.7; specificity: 100 versus 100%; accuracy: 92.2 versus 85.4% for SharkCore? versus standard needles, p?>?.05 in all cases). At multivariable analysis, there was no statistically significant difference in the mean number of passes in all patients (p?=?.23) and in the ROSE subgroup (p?=?.66). However, the SharkCore? needle obtained significantly more histological material than the standard needle (odds ratio 66; 95% confidence interval: 11.8, 375.8, p?<?.001). There was no significant difference in complication rates (p?=?.5).

Limitations: Retrospective study, single-center.

Conclusion: The SharkCore needles were similar to standard FNA needles in terms of the number of passes to reach diagnosis, but obtained significantly more histological specimen.     

Clinical factors associated with positive capsule endoscopy findings in patients with obscure gastrointestinal bleeding: a single-center study

Background: Capsule endoscopy (CE) is a useful tool for patients with obscure gastrointestinal bleeding (OGIB), but positive finding rate differs among trials, which may be attributable to the difference in patients’ background.

Objectives: To evaluate the predictive factors associated with positive findings on CE.

Methods: Consecutive patients with OGIB who underwent CE between March 2004 and May 2015 at a single university hospital were enrolled. Patients’ clinical factors and CE data were reviewed retrospectively, and we evaluated the relationship between clinical factors and positive findings by univariate and multivariate logistic regression analyses.

Results: Five hundred and seventy-eight patients were included in the analysis. Positive CE findings were obtained in 284 patients (49.1%). In multivariate analysis, low hemoglobin level (odds ratio (OR), 1.142 per 1?g/dL decrease; p?<?.001), Charlson comorbidity index (CCI) score (OR, 1.170 per 1 point increase; p?=?.002), and non-steroidal anti-inflammatory drug (NSAID) use (OR, 1.640; p?=?.044) were associated with an increased prevalence of positive findings. As for components of CCI, malignant tumor (OR, 1.839; p?=?.017) was associated with the positive findings.

Conclusions: OGIB patient with a low-hemoglobin level, complex and severe comorbidities, and NSAID use should receive CE.     

Clinical characteristics and long-term prognosis of elderly-onset Crohn’s disease

Objectives: This study aimed to evaluate the clinical characteristics and clinical course of Asian elderly-onset Crohn’s disease (EOCD) patients in a large well-defined cohort of South Korean IBD patients.

Materials and methods: From the Asan inflammatory bowel disease registry, we identified 29 EOCD patients (diagnosed with CD in age of 60 years or over) out of 2989?CD patients (1.0%). After excluding two patients with unclear data, 27 EOCD were matched with 108 young-onset CD (YOCD) and 108 middle age-onset CD (MOCD) for the interval from symptom onset to diagnosis (±3 years) and follow-up duration (±3 years).

Results: Females were predominant in the EOCD group (59.3%) compared to MOCD (31.5%) and YOCD (29.6%) groups (p?=?.012). In EOCD group, terminal ileal location was the most common (63.0%) at diagnosis, whereas ileocolonic location in other groups (57.4% in MOCD and 78.7% in YOCD, respectively) (p?vs. 28.7% in MOCD vs. 49.1% in YOCD, p?vs. 87.0% in MOCD vs. 89.8% in YOCD, p?p?=?.583).

Conclusions: EOCD may have a better clinical course than MOCD and YOCD, as demonstrated by the similar risk for intestinal resection despite the less frequent use of thiopurines.     

Acute pancreatitis in elderly patients: a single-center retrospective evaluation of clinical outcomes

Introduction: Acute pancreatitis (AP) incidence in the elderly population has increased in the last years. However, the role of age as influencing factor on the AP clinical course is still debated.

Methods: We reviewed clinical records of consecutive patients admitted with diagnosis of AP. Patients were divided in elderly (≥65 years) and non-elderly (<65 years). Primary endpoint was comparison of overall mortality. Secondary endpoint included ICU admission, in-hospital length of stay (LOS) and surgical procedures.

Results: We enrolled 352 elderly and 532 non-elderly patients. A higher mortality rate (7.4% vs 1.9%; p?<?.001), ICU admission rate (18.9% vs 6.3%; p?<?.001) and prolonged length of hospital stay (9 (6–14) vs 7 (5–11.7) days; p?=?.01) were registered in the ≥65 years group. Multivariate analysis identified age (OR: 3.5; 95% CI:1.645–7.555; p?=?.001), a higher Ranson score at admission (OR: 5.52; 95% CI:1.11–27.41; p<.001) and necrotic pancreatitis (OR: 8.6; 95% CI:2.46–30.27; p?=?.001) as independent predictors of mortality. Conversely age and necrotic pancreatitis were independent risk factors for higher LOS and ICU admission.

Conclusions: Patients with AP and age ≥65 years have a higher mortality, ICU admission and prolonged LOS. Early recognition and prompt treatment are key elements to improve outcomes in this population.     

Effects of anti-inflammatory therapy on bursting pressure of colonic anastomosis in murine dextran sulfate sodium induced colitis

Abstract

Background: In suspected Crohn’s disease (CD), non-diagnostic ileocolonoscopies are often followed by small bowel capsule endoscopy (SBCE). Adequate pre-selection of patients for SBCE is a key to optimize allocation of resources. We aimed to establish a rational approach for the CD diagnostic workflow, based on biochemical profile of patients with suspected CD, targeting an optimization of patients’ selection for SBCE.

Methods: Multicenter cohort study includes consecutive patients with suspected undergoing SBCE after non-diagnostic ileocolonoscopy. Minimum follow-up period after the capsule enteroscopy was six months. The outcome was confirmation of CD diagnosis. Univariate analysis and logistic regression were performed.

Results: In included 220 patients, 62.3% of women were with a mean age of 41?years [26–54]. A confirmed diagnosis of CD was established in 98 patients (44.5%). The initial univariate analysis identified variables above the threshold of marginal statistical association toward CD diagnosis (p?p?=?.128) and low serum Iron (OR 0.990 p?=?.025) as the independent variables with consistent correlation with CD diagnosis. Those two variables present a suitable discriminative power (AUC?=?0.669, p?Conclusion: In suspected CD, low serum iron and elevated CRP had a statistically significant association with CD diagnosis, being helpful to identify patients with higher CD probability before SBCE. However, the lack of a proper validation of the model leads us to currently recommend SBCE to all patients with suspected CD and negative ileocolonoscopy, as no specific biochemical profile can be used to confidently exclude small bowel CD.