Article of the Year 2022
Incidence, Disease Course, and Medical Treatment of a Danish Population-Based Cohort of Very Early-Onset Inflammatory Bowel DiseaseRead the full article
GastroHep is an international, peer reviewed, high quality publication focussing on current and cutting edge research in academic and clinical gastroenterology and hepatology.
Her Hsin Tsai, the Chief Editor, is a fellow of the Royal College of Physicians and Fellow of the European Board of Gastroenterology, has been a consultant gastroenterologist in Hull and East Yorkshire Hospitals for over 23 years, is a fully practicing clinician and has over 40 publications.
John Wiley and Sons, Inc. and Hindawi collaborate on an Open Access publishing partnership.
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The Suitability of Stool Antigen Testing in the Detection of Helicobacter pylori in a Regional and Rural Area of Australia
Background. Helicobacter pylori is considered the most widespread bacterial pathogen worldwide. Successful eradication protocols are well established, highlighting the importance of appropriate infection detection. Noninvasive testing (NIT) methods are commonly used to detect infection, with test selection dependent on access and previous infection. This study examined trends in NIT by age group and test selection for eradication screening as well as examining H. pylori area prevalence by socioeconomic status (SES) in the Illawarra Shoalhaven and surrounding region. Materials and Methods. This retrospective cohort quantitative study is based on 20,998 NIT including stool antigen test (SAT), urea breath test (UBT), or H. pylori serology via Southern.IML Pathology between 2018 and 2020. Test percentage positives per and total test percentages within age groups were calculated for each NIT. Positive sample postcode data was assigned to socioeconomic percentiles. Total test utilisation and prevalence were calculated and depicted as geospatial representations. Results. Overall: 58.5% UBT, 31% serology, and 10.5% SAT were performed, with 14.7% positive for any NIT. Highest percent positive age group: SAT 80-89yo (18.6%), UBT 0-9yo (20.8%), and serology 90–99yo (32.6%). Test majority per age group: SAT 0-9yo (67.4%), UBT 10-89yo (59.4%), and serology 90-99yo (48.3%). A trend was seen between increasing infection prevalence and increasing socioeconomic disadvantage (, ). Prevalence rates visually correlated with total test utilisation. Conclusions. SAT was underutilised compared to UBT or serology. Serology was inappropriately used in older age groups, and the result validity was questioned following confirmed infection. SAT is a viable alternative for use in these settings. No significant correlation was seen between lower SES areas and higher H. pylori infection prevalence, but low-test utilisation suggests likely prevalence underestimation within the studied area and may indicate reduced accessibility to healthcare.
Visualized Quantitative Evaluation of Gastrointestinal Activity in Healthy Volunteers Using a Noninvasive Single-Channel Electroamplifier
Background. Electrogastrography and electroenterography are noninvasive methods for measuring gastric and intestinal electrical activities, respectively. Few studies have measured electroenterography in healthy humans; however, no studies have measured electrogastrography and electroenterography simultaneously. This study was performed to provide basic electrogastrography and electroenterography data for comparison with future studies in patients. Methods. Simultaneous preprandial and postprandial measurements of electrogastrography and electroenterography were taken for 30 min each in 50 healthy volunteers. Power spectrum analysis was performed to calculate dominant frequency, dominant power, and power ratio. Results. Gastric and small intestinal dominant frequencies were not significantly different between preprandial and postprandial periods. In preprandial and postprandial periods, normogastria was seen in 49 (98%) and 44 (88%) patients (), bradygastria in 1 (2%) and 6 (12%) patients (), and tachygastria in 0 (0%) patients, respectively. Dominant power was significantly increased in the stomach (828 [460–3203] μV2 vs. 1526 [759–2958] μV2, ) and small intestine (49 [27–86] μV2 vs. 68 [37–130] μV2, ). The power ratio was 1.6 (0.9–2.5) in the stomach and 1.4 (1.0–2.5) in the small intestine. Body mass index showed a negative correlation with the stomach and small intestinal dominant power in preprandial and postprandial periods (, ; , ; , ; and , , respectively). The Bristol Stool Form Scale correlated positively with the small intestinal power ratio (, ). Conclusion. There was no change in frequency in the stomach or small intestine, but power significantly increased in both the stomach and small intestine.
Clinical Outcomes and Patient Experience of Biosimilar to Biosimilar Infliximab Switching in Patients with Inflammatory Bowel Disease: A Prospective, Single-Centre, Phase IV Interventional Study with a Nested Qualitative Study
Background and Aims. Regulatory pathways compare biosimilars with originator molecules only and not with other biosimilars. With the development of multiple infliximab biosimilars, patients may be asked to transition between them. Data is emerging but there is still a gap in the evidence on switching between infliximab biosimilars. Our aim was to conduct a full evaluation of switching a cohort of IBD patients from one biosimilar (CT-P13) to another (SB2) in a real-world setting including clinical and patient experience and molecular and drug immunogenicity aspects of the process. Methods. Prospective, phase IV interventional study of patients on CT-P13 switched to SB2. Demographics, disease history, validated disease activity scores, PROMs, and laboratory measurements were collected. Semistructured qualitative interviews were also conducted. Results. 133 out of 158 patients agreed to participate. Mean disease duration was 9.2 years. There was no difference in mean haemoglobin, platelet count, albumin, and C-reactive protein before and after switching. Mean faecal calprotectin at baseline and at week 30/32 was 306 μg/g versus 210 μg/g. Mean pMCS and mHBI at baseline were 1.54 and 3.14 versus 1.18 and 2.91 at week 30/32, respectively. Thirty-five subjects discontinued. There were 16 serious adverse events. Thematic analysis identified six major themes that reflected the patient experience—trust, clinical status at the point of switching, past experience, general disposition, information provision, and concerns/anxiety. Conclusions. Switching from CT-P13 to SB2 is safe and effective. Certain factors must be considered in supporting patient decision-making. These results support the development of clear, streamlined, and well-monitored biosimilar switching programmes.
T-HAD Score: A Novel Diagnostic Model for Advanced Fibrosis in Nonalcoholic Fatty Liver Disease (NAFLD)
Background and Aims. The NAFLD disease spectrum includes simple steatosis, nonalcoholic steatohepatitis (NASH), advanced fibrosis, and cirrhosis. Progression from NASH, the forerunner of developing cirrhosis, portends a poor outcome as mortality is proportionately increased. This study sought to propose a new diagnostic model for advanced fibrosis in an Asian population cohort affected with NAFLD. Methods. Cross-sectional study conducted in the Department of Medical Gastroenterology, Medical College, Trivandrum. The study period was 2 years. After excluding secondary causes of hepatic steatosis, patients were subjected to vibration-controlled transient elastography or transient elastography (VCTE or TE) to assess hepatic fibrosis. Subjects were grouped into those with advanced fibrosis ( Kpa) and those without ( Kpa) based on the estimation of TE. A new scoring system was then developed. This was then validated in a cohort of 84 biopsy-proven patients.Results. 1617 NAFLD patients were included in the study. Independent predictors of advanced fibrosis in this cohort were hip circumference, triglycerides, aspartate aminotransferase (AST), and diabetes mellitus (duration more than 10 years). The coefficient of beta for these variables was calculated. T-HAD score was calculated using the following formula: . The AUROC of the T-HAD score was 0.929. The T-HAD score had a sensitivity of 90% and a specificity of 77% at a cut off of >2 for advanced fibrosis. We validated this score in another cohort of liver biopsy with advanced fibrosis. In the validation cohort, the T-HAD score had an AUROC of 0.926 in diagnosing advanced fibrosis (sensitivity of 89% and specificity of 71% at a cut off of >2). Conclusion. The T-HAD score based on data from the Asian population is a new diagnostic model which is beneficial in estimating the risk of advanced fibrosis. It is a simple yet effective tool that could be in-cooperated into day-to-day practice in a resource-limited setting.
Treatment Patterns and Survival in Patients with Intermediate, Advanced, or Terminal Stage of Hepatocellular Carcinoma in France over the Period 2015-2017: A Real-Life Study
Background. The prognosis of patients with hepatocellular carcinoma (HCC) not eligible to curative treatment is poor. Little information is available on treatment modalities and outcomes of these patients in everyday practice. The aim of this analysis was to describe the characteristics of patients with a newly diagnosed intermediate, advanced, or terminal (IAT) stage of HCC (ICD-10: C220) between 2015 and 2017, either present at diagnosis of HCC or having occurred after disease progression; treatment patterns, HCC aetiologies, and the associated survival were determined using the nationwide claims database. Methods. Patients with HCC were identified using the ICD-10 code C220. IAT stages, defined according to the terminology used in the Barcelona Clinic Liver Cancer classification, were indirectly identified by the presence of at least one of the following treatments: transarterial chemoembolization (TACE), transarterial radioembolization (TARE), HCC systemic therapy, best supportive care (BSC), or an ICD-10 code of metastatic HCC. Treatment patterns were described with an algorithm based on a ranking of palliative treatments identified. Survival was analysed by using Kaplan-Meier curves. Results. 19,649 eligible patients were identified. Their mean age was 70.5 years (SD: 11.0), and 82.5% were males. For 68.8% of patients, the IAT stage was present at HCC diagnosis. On the whole population, 5,114 patients (26.0%) were treated initially with a TACE or TARE, and 4,681 (23.8%) received a targeted systemic therapy at any moment during follow-up with sorafenib in 99.5% of cases. About 7,628 patients (45.6%) received only BSC. Survival since the diagnosis of the AIT stage of HCC differed according to the type of the first received palliative treatment. Median overall survival was 23.8, 9.6, 7.4, and 1.0 months in patients initially receiving TACE, TARE, systemic therapy, and BSC only, respectively. Conclusion. Over the period 2015-2017, hepatocellular carcinoma was still often diagnosed in France at late-stage disease with a very poor prognosis.
Primary Hereditary Haemochromatosis and Pregnancy
Background. Haemochromatosis is a rare autosomal genetic disease that can cause multiple organ failure. In the past, this condition was not considered to affect pregnancy. The objectives of this study are to update the management of haemochromatosis in general as there are new treatments being investigated other than phlebotomy and to summarise the effects of the condition on pregnancy and vice versa. Methods. The initial search was in Ovid Medline® from 2002 to 2013. Review articles for haemochromatosis and case reports of its related complications in pregnancy were found. None of the reviews addressed pregnancy in detail. A second search in PubMed from 2014 to 2016 included studies regarding haemochromatosis and pregnancy and iron metabolism association with other metals and biomarkers, defining the mechanism of foetomaternal risks in maternal haemochromatosis. A third search at PubMed from 2017 to 2022 using key words haemochromatosis and pregnancy was done to look at the new data. Results. The results are qualitative indicating that even in the absence of abnormal iron parameters, haemochromatosis increases the risk of foetomaternal complications due to genetic predisposition, necessitating antenatal monitoring. Newer medications targeting the pathophysiology of the disease to eliminate it are being developed. The coabsorption of lead with iron causes increased risk of maternal preeclampsia, gestational hypertension, foetal congenital abnormalities, and growth problems. There is risk of neurodevelopmental delays, large for gestational age and childhood leukaemia in babies whose mothers and themselves have mutations for haemochromatosis. Conclusion. Previously, women with haemochromatosis were thought to have no higher risk of complications than the general population. However, there is evidence of foetomaternal complications. As a result, pregnancy with haemochromatosis necessitates additional monitoring for both mother and baby.