Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2021

Causal mediation of plasma metabolomics in pancreatitis: A Mendelian randomization study

Pancreatitis frequently leads to hospital stay for digestive system disorders and is in high demand for treatment. To identify possible treatment targets, we utilized Mendelian randomization (MR) to investigate the potential causal effects of metabolites on the outcomes of pancreatitis and examined the intermediary roles of risk factors associated with pancreatitis. We gathered GWAS data on 1091 plasma metabolites and 319 metabolite ratios, along with risk factors and phenotypes associated with pancreatitis and its subtypes. Risk factors included H, T2DM, body mass index (BMI), HLP, cholelithiasis, and Inflammatory bowel disease (IBD). Phenotypic outcomes encompassed acute pancreatitis (AP), chronic pancreatitis, alcohol-induced acute pancreatitis, and alcohol-induced chronic pancreatitis. To test the robustness of the findings, we estimated causality using inverse-variance-weighted MR complemented by sensitivity analyses. Additionally, we performed reverse MR analysis to explore potential reverse causality. This study identified 53 plasma metabolites and 22 metabolite ratios predicted by genetics that were significantly associated with pancreatitis (P < .05). Additionally, 54 metabolite ratios and 193 metabolites were associated with pancreatitis risk factors, with 86 and 27 metabolites, respectively, showing significant associations. The MR analysis confirmed that BMI, IBD, and HLP as pancreatitis risk factors (P < .05). It was also revealed that BMI and IBD mediate the relationship between certain metabolite levels and pancreatitis. The identified metabolites and their ratios have the potential to serve as circulating biomarkers with promising applications in CP screening and prevention strategies.

Diet and Risk for Incident Diverticulitis in Women : A Prospective Cohort Study

BACKGROUND

Patients with diverticulitis often attempt to control their diet with a particular focus on avoiding nuts and seeds. However, whether dietary patterns or dietary intake of nuts and seeds are associated with diverticulitis risk is poorly studied, particularly in women.

OBJECTIVE

To determine whether select diets affect incident diverticulitis risk in women.

DESIGN

Prospective cohort study.

SETTING

Cohort study in the United States and Puerto Rico.

PARTICIPANTS

Women aged 35 to 74 years at enrollment who responded to food frequency and diverticulitis questionnaires and had no history of inflammatory bowel disease, cancer, or diverticulitis (n = 29 916).

INTERVENTION

Food frequency questionnaires were used to calculate dietary index scores and to assess intake of nuts, seeds, and corn.

MEASUREMENTS

Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) and 95% CIs for the associations between each dietary component or dietary index and diverticulitis risk.

RESULTS

1531 cases of incident diverticulitis for 415 103 person-years of follow-up were identified. Intake of peanuts, nuts, and seeds (aHR,1.07 [95% CI, 0.91 to 1.25]) and fresh fruits with edible seeds (aHR,1.06 [CI, 0.90 to 1.24]) was not associated with incident diverticulitis. There was a reduced risk for incident diverticulitis in women in the highest quartile of healthy diets compared with the lowest quartile: the Dietary Approaches to Stop Hypertension diet (aHR, 0.77 [CI, 0.65 to 0.90]), the Healthy Eating Index (aHR, 0.78 [CI, 0.66 to 0.91]), the Alternative Healthy Eating Index (aHR, 0.81 [CI, 0.69 to 0.95]), and the Alternative Mediterranean diet (aHR, 0.91 [CI, 0.78 to 1.06]).

LIMITATION

Confounding, selection bias, and measurement bias are possible.

CONCLUSION

Healthy diets were associated with a reduced risk for incident diverticulitis in women. Consumption of nuts and seeds was not associated with diverticulitis risk.

PRIMARY FUNDING SOURCE

National Institutes of Health.

Impact of Ethno-racial Factors on Clinical Outcomes and Health Care Utilization in Chronic Pancreatitis

BACKGROUND

Healthcare disparities adversely affect clinical outcomes in racial and ethnic minorities. Chronic pancreatitis (CP) is a complex disorder, and pressures for time and cost-containment may amplify the disparity for minorities in this condition. This study aimed to assess ethno-racial differences in the clinical outcomes of CP patients cared for at our institution.

METHODS

This is a study of CP patients with available ethno-racial information followed at our pancreas center. We reviewed their demographics, comorbidities, clinical outcomes, and resource utilization: pain, frequent flares (≥ 2/year), local complications, psychosocial variables, exocrine, and endocrine insufficiency, imaging, endoscopic procedures, and surgeries. The outcomes underwent logistic regression to ascertain association(s) with covariates and were expressed as odds ratio (95% confidence intervals).

RESULTS

Of the 445 CP patients, there were 23 Hispanics, 330 Non-Hispanic Whites, 47 Non-Hispanic Blacks, 16 Asian Americans, and 29 patients from Other/mixed races. Over a median follow-up of 7 years, no significant differences in the pain profile (p = 0.36), neuromodulator use (p = 0.94), and opioid use for intermittent (p = 0.34) and daily pain (p = 0.80) were observed. Frequent flares were associated with Hispanic ethnicity [2.98(1.20-7.36); p = 0.02], despite adjustment for smoking [2.21(1.11-4.41); p = 0.02)] and alcohol [1.88(1.06-3.35); p = 0.03]. Local complications (pseudocysts, mesenteric thrombosis, and biliary obstruction), exocrine and endocrine dysfunction, and healthcare resource utilization (cross-sectional imaging, endoscopic procedures, celiac blocks, or surgeries) were comparable across all ethno-racial groups.

CONCLUSIONS

Although no significant differences in clinical outcomes, and health resource utilization were noted across ethno-racial groups, Hispanic ethnicity had significant association with CP flares. This study calls for further investigation of an understudied minority population with CP.

Visceral Fat Quantified by a Fully Automated Deep-Learning Algorithm and Risk of Incident and Recurrent Diverticulitis

BACKGROUND

Obesity is a risk factor for diverticulitis. However, it remains unclear whether visceral fat area, a more precise measurement of abdominal fat, is associated with the risk of diverticulitis.

OBJECTIVE

To estimate the risk of incident and recurrent diverticulitis according to visceral fat area.

DESIGN

A retrospective cohort study.

SETTINGS

The Mass General Brigham Biobank.

PATIENTS

A total of 6654 patients who underwent abdominal CT for clinical indications and had no diagnosis of diverticulitis, IBD, or cancer before the scan were included.

MAIN OUTCOME MEASURES

Visceral fat area, subcutaneous fat area, and skeletal muscle area were quantified using a deep-learning model applied to abdominal CT. The main exposures were z -scores of body composition metrics normalized by age, sex, and race. Diverticulitis cases were identified using the International Classification of Diseases codes for the primary or admitting diagnosis from the electronic health records. The risks of incident diverticulitis, complicated diverticulitis, and recurrent diverticulitis requiring hospitalization according to quartiles of body composition metrics z -scores were estimated.

RESULTS

A higher visceral fat area z -score was associated with an increased risk of incident diverticulitis (multivariable HR comparing the highest vs lowest quartile, 2.09; 95% CI, 1.48-2.95; p for trend <0.0001), complicated diverticulitis (HR, 2.56; 95% CI, 1.10-5.99; p for trend = 0.02), and recurrence requiring hospitalization (HR, 2.76; 95% CI, 1.15-6.62; p for trend = 0.03). The association between visceral fat area and diverticulitis was not materially different among different strata of BMI. Subcutaneous fat area and skeletal muscle area were not significantly associated with diverticulitis.

LIMITATIONS

The study population was limited to individuals who underwent CT scans for medical indication.

CONCLUSIONS

Higher visceral fat area derived from CT was associated with incident and recurrent diverticulitis. Our findings provide insight into the underlying pathophysiology of diverticulitis and may have implications for preventive strategies. See Video Abstract .

GRASA VISCERAL CUANTIFICADA MEDIANTE UN ALGORITMO DE APRENDIZAJE PROFUNDO TOTALMENTE AUTOMATIZADO Y RIESGO DE DIVERTICULITIS RECURRENTE E INCIDENTAL

ANTECEDENTES:La obesidad es un factor de riesgo de la diverticulitis. Sin embargo, sigue sin estar claro si el área de grasa visceral, con medida más precisa de la grasa abdominal esté asociada con el riesgo de diverticulitis.OBJETIVO:Estimar el riesgo de diverticulitis incidente y recurrente de acuerdo con el área de grasa visceral.DISEÑO:Un estudio de cohorte retrospectivo.AJUSTE:El Biobanco Mass General Brigham.PACIENTES:6.654 pacientes sometidos a una TC abdominal por indicaciones clínicas y sin diagnóstico de diverticulitis, enfermedad inflamatoria intestinal o cáncer antes de la exploración.PRINCIPALES MEDIDAS DE RESULTADOS:Se cuantificaron, área de grasa visceral, área de grasa subcutánea y área de músculo esquelético, utilizando un modelo de aprendizaje profundo aplicado a la TC abdominal. Las principales exposiciones fueron puntuaciones z de métricas de composición corporal, normalizadas por edad, sexo y raza. Los casos de diverticulitis se definieron con los códigos ICD para el diagnóstico primario o de admisión de los registros de salud electrónicos. Se estimaron los riesgos de diverticulitis incidente, diverticulitis complicada y diverticulitis recurrente que requiriera hospitalización según los cuartiles de las puntuaciones z de las métricas de composición corporal.RESULTADOS:Una puntuación z más alta del área de grasa visceral se asoció con un mayor riesgo de diverticulitis incidente (HR multivariable que compara el cuartil más alto con el más bajo, 2,09; IC del 95 %, 1,48-2,95; P para la tendencia < 0,0001), diverticulitis complicada (HR, 2,56; IC del 95 %, 1,10-5,99; P para la tendencia = 0,02) y recurrencia que requiriera hospitalización (HR, 2,76; IC del 95 %, 1,15-6,62; P para la tendencia = 0,03). La asociación entre el área de grasa visceral y la diverticulitis no fue materialmente diferente entre los diferentes estratos del índice de masa corporal. El área de grasa subcutánea y el área del músculo esquelético no se asociaron significativamente con la diverticulitis.LIMITACIONES:La población del estudio se limitó a individuos sometidos a tomografías computarizadas por indicación médica.CONCLUSIÓN:Una mayor área de grasa visceral derivada de la tomografía computarizada se asoció con diverticulitis incidente y recurrente. Nuestros hallazgos brindan información sobre la fisiopatología subyacente de la diverticulitis y pueden tener implicaciones para las estrategias preventivas. (Traducción: Dr. Fidel Ruiz Healy ).

Fueling the fire: colonocyte metabolism and its effect on the colonic epithelia

Colonic permeability is a major consequence of dysbiosis and diseases affecting the colon, further contributing to inflammation and extraintestinal diseases. Recent advances have shed light on the association between colonocyte energy utilization and the mechanisms that support epithelial function and homeostasis. One unifying theme is the induction of colonocyte hypoxia, driven by the aerobic oxidation of microbial-derived butyrate, as a critical factor promoting multiple cellular processes that support intestinal barrier function, mucus secretion, and the maintenance of synergistic luminal microbes. Particular attention will be focused on experimental evidence supporting beta-oxidation via activation of peroxisome proliferators-activated receptor-γ (PPAR) and upregulation and activation of processes that promote barrier function by hypoxia-inducible factor (HIF) signaling. Growing evidence suggests that colonocyte energy utilization is tightly regulated and switches between beta-oxidation of butyrate and anaerobic glycolysis, the latter being associated with several disease states. As most of the primary literature associated with colonocyte energy utilization has focused on adult models, evidence supporting butyrate oxidation in the neonatal gut is lacking. Thus, this review details the current state of knowledge linking colonocyte substrate utilization to mechanisms supporting gut health, but also highlights the counterindications of colonic butyrate availability and utilization in developmental periods.

Social determinants of health are associated with liver transplant evaluation and listing in a safety-net referral cohort

Among safety-net hospital (SNH) patients, little is known about the care cascade to liver transplantation (LT) and the clinical and psychosocial factors that impact evaluation and listing. We obtained clinical and psychosocial data on all patients referred for LT at our SNH from 2016 to 2020. Univariate and multivariate Cox regression were performed to determine factors associated with evaluation and listing for LT. A total of 472 safety-net patients were referred. Seventy-six percent completed an evaluation, out of which 58% were listed. In adjusted models, metabolic-associated steatotic liver disease versus alcohol-associated liver disease as etiology increased odds of evaluation (OR: 6.89, 95% CI: 2.17-21.89) while lack of stable housing (0.30, 0.13-0.71) and <6 months of abstinence (0.22, 0.10-0.46) reduced odds of evaluation. Living in a house rather than rental (2.05, 1.19-3.52); having ample versus limited or no social support (7.86, 3.93-15.73); and having a MELD >25 (vs. ≤25) (3.71, 1.44-9.51) were associated with increased odds of listing while history of polysubstance abuse reduced odds of listing (0.40, 0.19-0.83). A sensitivity analysis including an existing multicenter cohort re-demonstrated the significance of residence, adequacy of social support, and MELD score in the probability of listing. Social determinants of health were key to successful evaluation and listing for LT among referred SNH patients and provided targets for intervention.

The role of the enteric nervous system in the pathogenesis of Clostridioides difficile infection

Clostridioides difficile is the leading cause of antibiotic-associated diarrhoea worldwide. In the USA, C. difficile infection (CDI) is the eighth leading cause for hospital readmission and seventh for mortality among all gastrointestinal disorders. Gastrointestinal dysmotility and/or diarrhoea occurs after the acute phase of CDI, but persistent gastrointestinal dysfunction post-infection supports contributions of neuroplasticity in the enteric nervous system (ENS), which has a key role in regulating intestinal motility and secretion, in the natural course of CDI. Here, our goal is to provide an up-to-date summary of how the ENS and extrinsic innervation of the gut are affected by CDI and how ENS responses contribute to CDI pathogenesis and outcomes. Enteric neurons and glia are targets of C. difficile toxins in humans and in preclinical model, and changes to the ENS and extrinsic innervation contribute to intestinal inflammation, damage and secretory diarrhoea. These findings suggest possible bidirectional interaction between CDI and the ENS. More studies focusing on understanding how various neurotransmitters and mediators released by the ENS and extrinsic neurons modulate immune responses to CDI could provide insight into novel pharmacological approaches to balance the host response, improve the management of CDI and prevent gastrointestinal dysfunction post-infection.

Analgesics use and risk of pancreatitis: result from the UK Biobank

BACKGROUND

Pancreatitis, an inflammatory pancreatic disorder, arises from various etiologies including alcohol, tobacco, and drug use. Although the initiation of pancreatitis has been strongly linked to several medications, the association between analgesic use and pancreatitis risk remains ambiguous in population-based studies.

METHODS

This prospective cohort study involved 324,982 participants from the UK Biobank. Multivariable-adjusted Cox proportional-hazards models were conducted to evaluate the longitudinal association between incident pancreatitis risk and analgesics use, encompassing opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, antimigraine preparations, and the mix. Subgroup and sensitivity analyses were conducted to assess the potential effects of baseline factors.

RESULTS

Over a median follow-up of 13.70 years, 2,303 cases of pancreatitis were identified. In the fully adjusted model, analgesics utilization increased the risk of pancreatitis (HR 1.13, 95% CI 1.04-1.23), acute pancreatitis (AP) (HR 1.11, 95% CI 1.01-1.22), and chronic pancreatitis (CP) (HR 1.25, 95% CI 1.00-1.56) (All the above p <0.05). Furthermore, participants who used opioids presented the highest risk of pancreatitis (HR 1.85, 95% CI 1.49-2.31, p <0.001), and the mixed group (HR 1.35, 95% CI 1.21-1.51, p <0.001) followed. Compared to the no analgesics group, the risk of both AP and CP also increased in the opioids and the mixed group. Subgroup analysis indicated that the impact of analgesics utilization on the pancreatitis risk may vary with certain covariates, such as age, cholelithiasis, etc. (p-interaction <0.05).

CONCLUSION

In this large population-based prospective cohort, analgesics utilization, particularly opioids and mixed analgesics, was linked to an increased risk of pancreatitis.

A biomechanical comparative study of passive stomach tissue from pigs and humans

The prevalence of gastric problems, which are associated with high economic costs and medical complexity, is soaring worldwide. In biomedical research, porcine models have been widely used to investigate the gastrointestinal tract in preclinical studies due to their similar functionality and macrostructure. Despite their widespread acceptance, there is insufficient research on whether porcine gastric tissue accurately reflects the biomechanics and microstructure of the human stomach. Hence, the present study aims to characterize the human stomach wall and investigate inter-species differences and similarities through a comparison with a preceding study. For this purpose, quasi-static mechanical tests were performed in several deformation modes, i.e., planar biaxial extension, radial compression, and simple shear. The cyclic experiments were complemented by stress-relaxation tests to examine the viscoelastic behavior. Samples from two main layers of the stomach, i.e., mucosa and muscularis, as well as the complete stomach wall were tested from all gastric regions, i.e., fundus, body, and antrum. Through this strategic testing approach, considerable softening effects and various region- and layer-specific variations in the mechanical behavior of the stomach wall were observed. Complementary histological investigations highlighted the heterogeneous stomach wall architecture and its influence on the mechanical tissue response. The present study revealed significant regional, layer-, and sex-specific differences in the human stomach of patients undergoing bariatric surgery. The male stomach wall was thicker, more extensible in the antrum, and stiffer under radial compression in the fundus compared to the female cohort. Furthermore, notable differences were observed between porcine and human tissue, such as a significantly softer tissue response to radial compression and simple shear of the human muscularis and the complete stomach wall due to a higher collagen and elastin content and smaller muscle bundles.

Avoiding the complications of endoscopic retrograde cholangiopancreatography

PURPOSE OF REVIEW

To review the literature within the past 5 years on risk factors and prophylactic measures for avoiding the complications of endoscopic retrograde cholangiopancreatography (ERCP), including post-ERCP pancreatitis (PEP), post-ERCP cholangitis, bleeding, and perforation.

RECENT FINDINGS

Despite advances in endoscopic technique and numerous clinical trials, complications of ERCP still occur frequently, particularly PEP. Recent findings are concentrated in the PEP domain and include the following: the discovery of pancreatic steatosis as a potential novel risk factor, machine learning models to predict PEP, combination prophylactic strategies including rectal NSAIDs, aggressive intravenous fluid hydration and pancreatic duct stents, potential novel pharmacotherapies, and enhanced endoscopic techniques for difficult biliary cannulation.

SUMMARY

Endoscopists should be familiar with the complications of ERCP and prophylactic strategies. PEP carries a significant morbidity and economic burden, but its occurrence is par for the course when performing ERCP. Future studies should concentrate on elucidating further the pathophysiology of PEP and predicting cases that result in severe complications (severe if hospitalization was greater than 10 days along with the presence of pseudocyst, pancreatic necrosis, need for percutaneous drainage or surgery, or death).

Burden and Cost of Gastrointestinal, Liver, and Pancreatic Diseases in the United States: Update 2024

BACKGROUND & AIMS

A contemporary report describing the burden and expenditures of gastrointestinal (GI) diseases can be helpful for policy makers, administrators, and researchers. Using the most recent data, we estimated the burden and costs associated with GI diseases in the United States.

METHODS

We generated estimates using data from the Rome Foundation Global Epidemiology Study 2017-2018 (symptoms), National Ambulatory Medical Care Survey 2019 and National Hospital Ambulatory Medical Care Survey 2019 (ambulatory visits), Nationwide Emergency Department Sample 2021 (emergency department visits), National Inpatient Sample 2021 (admissions), Kids' Inpatient Database 2019 (admissions), National Program of Cancer Registries 2001-2021 (cancer incidence), National Center for Health Statistics 2001-2021 (cancer mortality), Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research 2021 (non-cancer mortality), MarketScan Commercial Claims and Encounters data 2002-2021 (endoscopy), MarketScan Medicare Supplemental data 2002-2021 (endoscopy), United Network for Organ Sharing Registry 2023 (transplant), Medical Expenditure Panel Survey 2021 (expenditures), and National Institutes of Health (NIH) 2012-2025 (research).

RESULTS

In 2021, GI health care expenditures totaled $111.8 billion. A GI diagnosis or symptom led to 14.5 million emergency department visits and 2.9 million hospital admissions. There were 315,065 new GI cancers diagnosed. GI diseases caused 281,413 deaths. In 2022, an estimated 23.5 million GI endoscopies were performed. In 2023, the NIH supported $3.6 billion for GI research, which represents 7.4% of the NIH budget.

CONCLUSION

GI diseases are responsible for a considerable and growing burden of health care use and costs. Funding innovative GI science and supporting the practice of GI medicine are critical to meeting the burden of GI illness.

Metabolic dysfunction-associated steatotic liver disease is a risk factor for gallstones: A multicenter cohort study

AIM

Gallstone formation is associated with metabolic dysfunction. Recently, new definitions of steatotic liver disease (SLD) have been proposed, including metabolic dysfunction-associated SLD (MASLD) and moderate alcohol intake (MetALD). We investigated the effects of MASLD/MetALD on gallstone formation.

METHODS

This multicenter observational cohort study enrolled 8766 consecutive health-check examinees who underwent abdominal ultrasonography between 2008 and 2021 (total observation period 39,105.9 person-years). All patients were classified into non-SLD, MASLD, or MetALD groups. The effect of MASLD on gallstone development was evaluated using multivariate Cox regression analysis.

RESULTS

Age, male sex, and MASLD were identified as independent risk factors for gallstone development. MASLD was associated with a significantly higher risk of developing gallstones than non-SLD (hazard ratio [HR] 1.7112; 95% confidence interval [CI] 1.4294-2.0486; p < 0.0001) and MetALD (HR 1.3516, 95% CI 1.0130-1.8033, p = 0.0406). However, the risk of MetALD did not significantly differ between the SLD and non-SLD groups. Hypertension was the only significant independent cardiometabolic risk factor for gallstone development in the MASLD group (HR 1.4350, 95% CI 1.0545-1.9528; p = 0.0216). Random forest analysis and directed acyclic graphs identified hypertension as the most important direct factor affecting gallstone development in patients with MASLD.

CONCLUSIONS

MASLD was an independent risk factor for gallstone development, whereas MetALD presented a similar risk as non-SLD. Moderate alcohol consumption may reduce the risk of gallstone formation in patients with MASLD. Hypertension may be the most significant cardiometabolic risk factor for gallstone development in patients with MASLD.

The Readability, Actionability, and Accessibility of Hemorrhoid-Focused Online Patient Education Materials: Are We Adequately Addressing Patient Concerns?

BACKGROUND

Hemorrhoidal disease is highly prevalent in the United States and frequently queried online. Unfortunately, health education web pages often lack reliable information.

OBJECTIVE

To evaluate whether online hemorrhoid education materials in English and Spanish meet national recommendations for readability, actionability, and accessibility and provide critical clinical guidance on when to seek medical care.

DESIGN

Using 3 search engines (Bing, Google, and Yahoo), we selected the top 30 results for formal medical and colloquial English and Spanish search terms regarding hemorrhoids. We assessed readability using validated scoring systems for readability in English and Spanish to report median reading levels and assessed health literacy performance on a 6-point checklist in 3 categories: accessibility, actionability, and critical clinical guidance.

SETTINGS

University of California Los Angeles.

MAIN OUTCOME MEASURES

Readability and health literacy performance.

RESULTS

After removing duplicates, 90 to 95 web pages generated from formal English, Spanish, and colloquial English terms remained. There was minimal overlap of results from the formal and colloquial English searches. Median reading levels were first-year university for formal and colloquial English web pages and 11th grade for Spanish web pages. Regarding health literacy, 43.2%, 48.4%, and 18.2% of formal English, Spanish, and colloquial English websites, respectively, had minimal health literacy performance. Health literacy performance criteria that were met least often were printability and providing specific, actionable goals for patients to implement.

LIMITATIONS

Our study represents searches completed at 1 point in time using specific terms. Colloquial search terms were generated via a survey with convenience sampling and may not be representative of all possible searches used by patients seeking information on hemorrhoidal disease.

CONCLUSIONS

Most English and Spanish hemorrhoid-focused web pages failed to provide appropriate patient education, as they exceeded the recommended sixth-grade reading level, lacked actionable recommendations, were not accessible, and failed to provide critical clinical guidance. Online resources are essential for patients of all health literacy levels; improvement is critical to reducing health care disparities. See Video Abstract .

LA LEGIBILIDAD, VIABILIDAD Y ACCESIBILIDAD DE LOS MATERIALES EDUCATIVOS EN LNEA CENTRADOS EN LAS HEMORROIDES PARA PACIENTES ESTAMOS ABORDANDO ADECUADAMENTE LAS INQUIETUDES DE LOS PACIENTES

ANTECEDENTES:La enfermedad hemorroidal es muy prevalente en los Estados Unidos y se busca con frecuencia información en línea. Desafortunadamente, las páginas web de educación para la salud a menudo carecen de información confiable.OBJETIVO:Evaluar si los materiales educativos en línea sobre hemorroides en inglés y español cumplen con las recomendaciones nacionales de legibilidad, viabilidad y accesibilidad, y brindan orientación clínica crítica sobre cuándo buscar atención médica.DISEÑO:Utilizando tres motores de búsqueda (Bing, Google, Yahoo), seleccionamos los 30 resultados principales de términos de búsqueda médicos formales y coloquiales en inglés y español relacionados con hemorroides. Evaluamos la legibilidad utilizando sistemas de puntuación validados para la legibilidad en inglés y español para informar los niveles de lectura promedio y evaluamos el desempeño en alfabetización en salud en una lista de verificación de seis puntos en tres categorías: accesibilidad, viabilidad y orientación clínica crítica.ESCENARIO:Universidad de California en Los Ángeles.PRINCIPALES MEDIDAS DE RESULTADOS:Legibilidad y desempeño en alfabetización en salud.RESULTADOS:Después de eliminar los duplicados, quedaron entre 90 y 95 páginas web generadas a partir de términos en inglés formal, español e inglés coloquial. Hubo una superposición mínima de resultados de las búsquedas en inglés formal y coloquial. Los niveles de lectura promedio fueron de primer año de universidad para las páginas web en inglés formal y coloquial, y de undécimo grado para las páginas web en español. El 43,2 %, el 48,4 % y el 18,2 % de los sitios web en inglés formal, español e inglés coloquial, respectivamente, tuvieron un desempeño mínimo en alfabetización en salud. Los criterios de desempeño en alfabetización en salud que se cumplieron con menos frecuencia fueron la posibilidad de imprimir y proporcionar objetivos específicos y viables para que los pacientes los implementen.LIMITACIONES:Nuestro estudio representa búsquedas completadas en un momento dado utilizando términos específicos. Los términos de búsqueda coloquiales se generaron a través de una encuesta con muestreo por conveniencia y pueden no ser representativos de todas las búsquedas posibles utilizadas por los pacientes que buscan información sobre la enfermedad hemorroidal.CONCLUSIONES:La mayoría de las páginas web en inglés y español sobre hemorroides no proporcionaron una educación adecuada para los pacientes, ya que excedían el nivel de lectura recomendado para sexto grado, carecían de recomendaciones prácticas, no eran accesibles y no brindaban orientación clínica crítica. Los recursos en línea son esenciales para los pacientes de todos los niveles de alfabetización en salud; es fundamental mejorarlos para reducir las disparidades en la atención médica. (Traducción-Dr. Felipe Bellolio ).

Functional disability after clinically significant extracranial bleeding: a secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) Trial

BACKGROUND

Clinically significant extracranial bleeding, defined as bleeding at any site other than the brain or spinal cord requiring either a hospital admission >24 hours, red blood cell transfusion, surgery for hemostasis, or resulting in death, is a common side effect of antithrombotic agents. Compared to intracranial bleeding, the impact of clinically significant extracranial bleeding on long-term outcomes, including functional independence, has been poorly studied.

OBJECTIVES

To determine if clinically significant extracranial bleeding impacts the development of functional disability in healthy older adults.

METHODS

We performed a secondary analysis of the Aspirin in Reducing Events in the Elderly trial. The primary outcome of this study was incident dependence in the Katz Activities of Daily Living (ADLs), defined as being unable to perform or requiring assistance with any ADLs or being admitted to a long-term care facility.

RESULTS

A total of 18 982 participants were included in the analysis, of which 547 (2.9%) developed clinically significant extracranial bleeding during study follow-up. In adjusted analyses, clinically significant extracranial bleeding was significantly associated with the development of incident ADL dependence (hazard ratio [HR], 2.46; 95% CI, 1.97-3.07). This finding was similar for gastrointestinal (HR, 2.29; 95% CI, 1.72-2.08) and nongastrointestinal extracranial bleeds (HR, 2.68; 95% CI, 1.96-3.69). The association with increased risk of incident ADL dependence remained significant in secondary analysis of groups randomized to either aspirin (HR, 2.15; 95% CI, 1.57-2.94) or placebo (HR, 2.84; 95% CI, 2.09-3.86).

CONCLUSION

Clinically significant extracranial bleeding was associated with the development of incident ADL dependence in otherwise healthy older adults.

Investigation of the Association of Acute Pancreatitis Outcomes with Social Vulnerability Indicators

BACKGROUND AND AIM

Geospatial analyses integrate location-based sociodemographic data, offering a promising approach to investigate the impact of social determinants on acute pancreatitis outcomes. This study aimed to examine the association of Social Vulnerability Index (SVI) and its constituent 16 attributes in 4 domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation), with outcomes in patients with acute pancreatitis.

METHODS

This study included acute pancreatitis patients hospitalized between 1/1/2008 and 12/31/2021 and recorded their demographics and clinical outcomes. Physical addresses were geocoded to determine SVI, a composite variable which was ranked and divided into quartiles (I-IV: IV representing the highest vulnerability).

RESULT

In 824 eligible patients [age of 53.0 ± 10 years and 48.2% females], with 993 acute pancreatitis-related hospitalizations, we noted a significant association in patients residing in communities with higher SVI, a higher prevalence of no/federal/state insurance (P < .001) and underserved ethnic/racial background (P < .001). We observed a significant association of alcohol withdrawal in patients with residence in areas with higher SVI despite adjustment for age, body mass index, and comorbidities (odds ratios: 1.62 [95% CI: 1.19-2.22]; P = .003). However, we observed no association of SVI with severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.

CONCLUSIONS

We noted significantly higher alcohol withdrawal in patients residing in areas with higher SVI ranks, despite no differences in severity of acute pancreatitis, inpatient opioid use, length of stay, 30-day admission rate, and mortality.

Therapeutic efficacy of Xuebijing injection in treating severe acute pancreatitis and its mechanisms of action: A comprehensive survey

BACKGROUND

Severe acute pancreatitis (SAP) is a life-threatening condition associated with high mortality and limited therapeutic options. Current management strategies focus on infection prevention, immune regulation, and anticoagulation. Xuebijing Injection (XBJ), a widely used traditional Chinese medicine-derived intravenous preparation, has shown promising therapeutic effects in SAP. Herein, we sought to evaluate clinical and preclinical evidence on XBJ to reveal its potential mechanisms of action, and provide insights to guide future research and clinical applications.

METHODS

We conducted a comprehensive survey of studies on XBJ in the treatment of SAP across PubMed, Embase, Cochrane Library, CBM, CNKI, Wanfang and VIP databases from their inception to March 21st, 2024.

RESULTS

A total of 239 studies were included, comprising 12 animal experiments, 7 systematic reviews, 220 clinical trials. Mechanistic studies suggest that XBJ downregulates the expression of inflammatory mediators, improves immune function, and alleviates oxidative stress via multiple signaling pathways, including the TLR4/NF-κB, p38-MAPK, HMGB1/TLR, TLR4/NF-κB, FPR1/NLRP3, and JAK/STAT pathways. These effects contribute to reducing organ damage. Compared to standard treatment, XBJ has more effective at reducing mortality and complications, improving overall clinical outcomes, shortening ventilator use time, and hospital stay in SAP patients.

CONCLUSIONS

Preclinical evidence and clinical trial data indicated that XBJ can simultaneously regulate inflammatory responses, immune function, microcirculatory disorders, oxidative stress, and apoptosis. However, further research is required to elucidate the specific mechanisms of action, clinical characteristics and safety of XBJ.

Diverticulitis in Older Adults: A Review of Etiology, Diagnosis, and Management

BACKGROUND

Diverticulitis accounts for over 300,000 hospitalizations annually in the United States and its incidence increases with age. Among older adults, diverticulitis is the fourth leading cause for emergency surgery. Older adults with multimorbidity and geriatric syndromes are often excluded from clinical studies, leaving a gap in the evidence needed to guide management. Here, we provide a clinically oriented review of the diagnosis and management of older adults with diverticulitis through the lens of age-friendly care.

METHODS AND RESULTS

We reviewed the literature describing the epidemiology, diagnosis, management, and prevention of diverticulitis in older adults. Due to age-related physiologic changes, the presence of geriatric syndromes, and multimorbidity, older adults with diverticulitis often present with atypical symptoms, variable laboratory findings, and are at higher risk for complications than younger patients. Guidelines support a more aggressive approach to diagnosis in this population, with lower threshold for obtaining diagnostic imaging. Antibiotics remain a mainstay of treatment for uncomplicated disease, and surgical management should be focused on severity of disease and the balance between the likelihood of improving quality of life and risks and burden of treatment.

CONCLUSIONS

Diverticulitis is a common disease that has a unique presentation among older individuals with limited evidence to guide management. Diagnosis and treatment should focus on what matters most to the patient, providing the most meaningful outcome possible within the context of multimorbidity, patient goals, symptom burden, and anticipated treatment outcomes.

Efficacy of DaXianXiong Decoction in Preventing the Progression of Acute Pancreatitis Severity: Protocol for a Randomized Controlled Trial

BACKGROUND

Low- and middle-income countries are facing an increase in the incidence of acute pancreatitis (AP)-characterized by rapid onset, fast progression, high rate of severity, and high mortality. Progression of AP into severe AP (SAP) results in a series of complications such as organ dysfunction, local abscesses, pseudocysts, and necrosis. Although the treatment of AP is primarily supportive, including fluid resuscitation and organ support, there is still a lack of consensus on the optimal management regimen for fluid therapy, and strategies to promote gastrointestinal recovery remain limited. As no effective intervention measure has yet been developed, supportive therapy remains the primary approach for the early treatment of AP. DaXianXiong decoction is a widely used traditional Chinese medicine formulation; however, limited research has been conducted on its clinical efficacy.

OBJECTIVE

This study aims to evaluate the efficacy and safety of DaXianXiong decoction in preventing AP from progressing to SAP, assessing its impact on SAP incidence, clinical severity scores, inflammation markers, and gastrointestinal function, and providing evidence for AP management.

METHODS

This study is a randomized, double-blind, placebo-controlled, single-center clinical trial. The primary outcomes will include the incidence of SAP, modified computed tomography severity index score, APACHE II (Acute Physiology and Chronic Health Evaluation II) score, modified Marshall score, and levels of the inflammation factor. The secondary outcomes will include the effect of the gastrointestinal dysfunction treatment. Evaluations will be conducted at baseline; 24 hours after the intervention; and on days 3, 7, and 28 after the intervention in both groups. A total of 60 eligible patients will be randomly allocated in a 1:1 ratio to the intervention group and the control group. Both groups will receive standard Western medical treatment for pancreatitis. The intervention group will additionally receive DaXianXiong decoction, while the control group will receive a placebo similar to the decoction.

RESULTS

This study has been funded by the Performance Incentive Project of Scientific Research Institutions in Chongqing. The trial was registered in April 2024, and data analysis is expected to be completed by April 2025. The study results will be presented at both national and international conferences and published in peer-reviewed journals.

CONCLUSIONS

This trial will help us assess the effectiveness and safety of DaXianXiong decoction in patients with AP and provide clinical evidence on the efficacy and safety of DaXianXiong decoction in preventing the progression of AP to SAP. By evaluating its impact, the findings will contribute to the understanding of DaXianXiong decoction as an adjunct therapy in AP management and may offer a novel complementary treatment strategy for AP, potentially improving patient outcomes and reducing complications.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2300076885; https://www.chictr.org.cn/showproj.html?proj=207084.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/67392.

Association between a laboratory-based frailty index and mortality of critically ill patients with acute pancreatitis: a retrospective study

Background

Acute pancreatitis (AP) is associated with significant global mortality and morbidity. Frailty, which can be assessed through clinical indicators and life history, is known to impact adverse outcomes across different medical conditions. The frailty index derived from laboratory tests (FI-Lab) is a novel approach to the quantification of frailty. This study sought to investigate the relationship between the FI-Lab and mortality among critically ill patients with AP.

Methods

We utilized data on patients diagnosed with AP from the Medical Information Mart for Intensive Care-IV database. The FI-Lab was calculated using a specific set of laboratory parameters indicative of physiological disturbances. The primary outcomes examined were 30-day and 90-day mortality rates. Multivariate Cox regression was used for the statistical analysis, with adjustments for age, gender, Acute Physiology and Chronic Health Evaluation II scores, and other variables. Propensity matching scores were used to ensure the robustness of our findings.

Results

A total of 1,116 AP patients were included in the analysis (mean age = 58.4 years; 57.9% male). Each 0.1 increment of FI-Lab was found to increase the risks of 30-day and 90-day mortality by 30% (hazard ratio (HR) = 1.30, p < 0.001 for both). The propensity score matching (PSM) analysis validated these results. The FI-Lab demonstrated an association with acute kidney injury and the requirement for continuous renal replacement therapy. However, these associations were not significant after the PSM analysis.

Conclusion

An elevated FI-Lab was associated with higher mortality rates among critically ill AP patients. Randomized controlled trials are needed to confirm these findings and to explore their clinical implications.

Assessing the content and quality of GI bleeding information on Bilibili, TikTok, and YouTube: a cross-sectional study

Gastrointestinal (GI) bleeding is a significant clinical issue that is commonly discussed on social media platforms. Despite the widespread availability of health information videos, the quality and comprehensiveness of these videos vary greatly, posing potential risks to public health. This study evaluates the content and quality of GI bleeding-related videos on TikTok, Bilibili, and YouTube. A total of 300 GI bleeding-related videos were collected and analyzed from TikTok, Bilibili, and YouTube. The videos were categorized based on the uploader's background (health professionals vs. non-health professionals). Key metrics such as likes, comments, video duration, and quality scores (GQS, JAMA, and modified DISCERN) were compared. Simultaneously, the content of the videos was analyzed across six aspects: definition, symptoms, risk factors, tests, treatment, and outcomes. A total of 300 GI bleeding-related videos were analyzed, with 196 (65.3%) uploaded by health professionals and 104 (34.7%) by non-health professionals. TikTok videos received significantly more likes and comments but were shorter in duration compared to those on Bilibili and YouTube (p < 0.05). The overall quality and reliability of the videos were relatively low, with median DISCERN and GQS scores of 2 (IQR: 2-3) and 3 (IQR: 2-3), respectively. Videos from health professionals exhibited higher reliability and quality, with median DISCERN scores of 3 (IQR: 3-4) and GQS scores of 3 (IQR: 3-4). The overall quality and comprehensiveness of GI bleeding-related videos on social media platforms are unsatisfactory, with many low-quality videos still prevalent. Although videos from health professionals score higher in quality and reliability, their content comprehensiveness is not significantly better than those from non-health professionals. Efforts should be intensified to improve the content and quality of GI bleeding videos, raise public awareness, and promote patient self-management.

Global, regional, and national burden of disease analysis on paralytic ileus and intestinal obstruction in adults aged 65 and over from 1990 to 2021, with projections for 2030: a Global Burden of Disease Study 2021 analysis

OBJECTIVE

This study aimed to evaluate the burden and trends of paralytic ileus and bowel obstruction in individuals aged ≥ 65 years, offering insights into prevention, treatment, and healthcare policy.

METHODS

Data from the Global Burden of Disease Study 2021 were used to analyze paralytic ileus and intestinal obstruction by demographics, year, country/region, and Socio-Demographic Index (SDI). The statistical methods included Joinpoint regression, decomposition analysis, and Bayesian Age-Period-Cohort modeling.

RESULTS

In 2021, the global age-standardized incidence of paralytic ileus and intestinal obstruction among the elderly was 643.45 cases per 100,000 individuals. The corresponding prevalence was 24.05 per 100,000 individuals, with disability-adjusted life years (DALYs) of 294.01 per 100,000 person-years and a mortality rate of 20.55 per 100,000 individuals. Between 1990 and 2021, the age-standardized incidence and prevalence of paralytic ileus and intestinal obstruction in the elderly gradually increased, while age-standardized DALYs and mortality consistently declined. Despite similar trends observed across both genders, the disease burden increased with age and was more pronounced in males than in females. Furthermore, the age-standardized incidence and prevalence of these conditions increased with SDI, whereas mortality and DALYs decreased. By 2030, the incidence and prevalence are expected to continue increasing, whereas mortality and DALYs are expected to decrease.

CONCLUSIONS

Despite the consistent decrease in mortality and DALYs associated with paralytic ileus and bowel obstruction in the elderly population aged ≥ 65 years, their incidence and prevalence continue to increase annually. This underscores the importance of improving preventive measures, early screening, and treatment efforts to address this pressing public health challenge.

Association of Visceral Adiposity and Sarcopenia with Geospatial Analysis and Outcomes in Acute Pancreatitis

Background: Radiological imaging has improved our insight into how obesity and sarcopenia impacts acute pancreatitis via several measured variables. However, we lack understanding of the association between social determinants of health and these variables within the acute pancreatitis population. Methods: This study included patients at a single tertiary care center between 1 January 2008 and 31 December 2021. Measurements of visceral adiposity (VA), subcutaneous adiposity (SA), the ratio of visceral to total adiposity (VA/TA), and degree of sarcopenia via psoas muscle Hounsfield unit average calculation (HUAC) were obtained on CT scans performed at presentation. Using geocoded patient data, we calculated the social vulnerability index (SVI) from CDC metrics. Descriptive and regression analyses were performed utilizing clinical and radiological data. Results: In 484 patients with 592 acute pancreatitis-related hospitalization, median (IQR) VA was 176 (100-251), SA was 209.5 (138.5-307), VA/TA ratio was 43.5 (32.3-55.3), and HUAC was 51.3 (44.4-58.9). For our primary outcome, geospatial analyses showed a reverse association between VA and SVI with a coefficient of -9.0 (p = 0.04) after adjustment for age, health care behaviors (i.e., active smoking and drinking), and CCI, suggesting residence in areas with higher SVI is linked to lower VA. However, VA/TA, SA, and HUAC showed no significant association with SVI. The SVI subdomain of socioeconomic status had significant association with VA (-39.78 (95% CI: -75.88--3.70), p = 0.03) after adjustments. For our secondary outcome, acute pancreatitis severity had significant association with higher VA (p ≤ 0.001), VA/TA (p ≤ 0.001), and lower HUAC (p ≤ 0.001). When comparing single vs. recurrent hospitalization patients, there was significantly higher median VA with recurrences (VA-single acute pancreatitis: 149 (77.4-233) vs. VA-recurrent acute pancreatitis: 177 (108-256); p = 0.04). Conclusions: In this study we found that patients residing in more socially vulnerable areas had lower visceral adiposity. This paradoxical result potentially conferred a protective effect against severe and recurrent acute pancreatitis; however, this was not found to be statistically significant.

Prevalence and patterns of peptic ulcer disease in Africa: a systematic review and meta-analysis

BACKGROUND

Peptic ulcer disease (PUD) remains a significant yet poorly understood public health issue in Africa, despite its declining prevalence in Western countries. Studies from Africa report a highly variable burden, with the highest prevalence observed in West Africa and the lowest in Southern Africa. However, the overall burden of PUD in Africa, its patterns (duodenal ulcers, gastric ulcers, and coexisting ulcers), and its association with H. pylori infection remain unclear.

OBJECTIVE

This review aims to systematically analyze the pooled prevalence and patterns of PUD in Africa through a systematic review and meta-analysis.

DESIGN

A systematic review and meta-analysis was conducted following the PRISMA checklist. We searched PubMed, Hinari, and Google Scholar, supplemented by Google and Yahoo search engines. Observational studies reporting the prevalence and patterns of PUD among the African population were included. Two independent reviewers extracted data and assessed study quality. Pooled prevalence estimates were calculated using a random-effects model, with heterogeneity assessed via the Cochrane Q test and I2 statistic.

RESULTS

A comprehensive analysis of 58 studies revealed a pooled prevalence of PUD in Africa at 15.2%. The most common ulcer pattern was DU at 10.2%, followed by GU at 5.8%, while 0.6% of cases had both types. Regional variations were observed, with West Africa having the highest prevalence (19%), followed by East Africa (15%), North Africa (12%), and Southern Africa (8%). Among individual countries, Ghana reported the highest prevalence (27%), followed by Ethiopia (19%) and Tanzania (16%). Furthermore, the pooled prevalence of PUD was 14% before 2010 and 15% in 2011 and later. Additionally, 57.1% of patients tested positive for Helicobacter pylori infection, with its prevalence reaching 76.4% among those diagnosed with PUD. Substantial heterogeneity was observed across most analyses, with I2 values exceeding 95% and p-values < 0.001.

CONCLUSION

The analysis revealed a significant burden of PUD in Africa, with DU being more common than GU. Regional disparities were observed, with the highest prevalence in West and East Africa. Over the past two decades, the burden has remained relatively stable, reflecting a concerning trend. H. pylori infection was also frequently diagnosed in individuals undergoing endoscopic examination. However, substantial heterogeneity was noted across studies, highlighting variability in reported prevalence.

Evaluation of scoring systems and hematological parameters in the severity stratification of early-phase acute pancreatitis

BACKGROUND

Acute pancreatitis (AP) is an emergency gastrointestinal disease that requires immediate diagnosis and urgent clinical treatment. An accurate assessment and precise staging of severity are essential in initial intensive therapy.

AIM

To explore the prognostic value of inflammatory markers and several scoring systems [Acute Physiology and Chronic Health Evaluation II, the bedside index of severity in AP (BISAP), Ranson's score, the computed tomography severity index (CTSI) and sequential organ failure assessment] in severity stratification of early-phase AP.

METHODS

A total of 463 patients with AP admitted to our hospital between 1 January 2021 and 30 June 2024 were retrospectively enrolled in this study. Inflammation marker and scoring system levels were calculated and compared between different severity groups. Relationships between severity and several predictors were evaluated using univariate and multivariate logistic regression models. Predictive ability was estimated using receiver operating characteristic curves.

RESULTS

Of the 463 patients, 50 (10.80%) were classified as having severe AP (SAP). The results revealed that the white cell count significantly increased, whereas the prognostic nutritional index measured within 48 hours (PNI48) and calcium (Ca2+) were decreased as the severity of AP increased (P < 0.001). According to multivariate logistic regression, C-reactive protein measured within 48 hours (CRP48), Ca2+ levels, and PNI48 were independent risk factors for predicting SAP. The area under the curve (AUC) values for the CRP48, Ca2+, PNI48, Acute Physiology and Chronic Health Evaluation II, sequential organ failure assessment, BISAP, CTSI, and Ranson scores for the prediction of SAP were 0.802, 0.736, 0.871, 0.799, 0.783, 0.895, 0.931 and 0.914, respectively. The AUC for the combined CRP48 + Ca2+ + PNI48 model was 0.892. The combination of PNI48 and Ranson achieved an AUC of 0.936.

CONCLUSION

Independent risk factors for developing SAP include CRP48, Ca2+, and PNI48. CTSI, BISAP, and the combination of PNI48 and the Ranson score can act as reliable predictors of SAP.

Evaluation of the Electrocardiographic Tp-e, Tp-e/QT, and Tp-e/QTc Parameters in Patients with Non-Alcoholic Liver Disease

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease associated with significant morbidity, including cardiovascular complications. This study investigates the relationship between NAFLD and electrocardiographic parameters indicative of ventricular arrhythmia risk. Materials and Methods: We conducted a cross-sectional study enrolling 136 patients with NAFLD and 136 healthy controls. Electrocardiographic parameters-Tp-e interval, QT and corrected QT (QTc) intervals, and Tp-e/QTc ratio-were measured and compared between groups. Results: Patients with NAFLD exhibited significantly higher Tp-e, QTc, Tp-e/QT ratio, and Tp-e/QTc ratio (p < 0.001, for all) than controls. Subgroup analysis showed progressive increases in Tp-e and Tp-e/QT ratio correlating with NAFLD severity (p < 0.001 and p = 0.001, respectively, for grade 1 vs. grade 2; p < 0.001 and p = 0.001, respectively, for grade 1 vs. grade 3). ROC analysis indicated that the Tp-e interval was a strong predictor for identifying grade 2 or more NAFLD (AUC 0.887, p < 0.001). Conclusions: Our findings highlight the association of NAFLD with prolonged electrocardiographic intervals that may predispose patients to ventricular arrhythmias. These parameters can serve as valuable markers for cardiac risk stratification in patients with NAFLD, suggesting the need for vigilant cardiac follow-up in this population.

Prognostic value of the measurement at admission of the inferior vena cava in acute pancreatitis

BACKGROUND

Identifying new early predictive markers for the development of severe forms in acute pancreatitis remains a major challenge. The aim of this study was to evaluate the performance of inferior vena cava (IVC) measurement to predict severe acute pancreatitis.

METHODS

We conducted a single-center retrospective study including patients consecutively hospitalized for acute pancreatitis between 2014 and 2019 who had an abdominal scan within 24 h after admission, before any significant fluid resuscitation. We calculated the ratio of inferior vena cava diameters (IVCR) by dividing the transverse diameter by the anteroposterior. Admission parameters associated with the occurrence of severe acute pancreatitis (persistent organ failure or necrosis infection) were identified by multivariate logistic regression.

RESULTS

Of the 404 included patients, 64 (15.8%) progressed to severe pancreatitis. IVCR in these patients was significantly higher (2.2 ± 0.6 vs. 1.7 ± 0.9, p < .001). In multivariate analysis, IVCR was independently associated with severe pancreatitis (OR = 2.27 95% CI [1.38-3.72], p = .001), as well as visual analog scale, creatinine, albumin, and bicarbonates. The areas under the Receiver Operating Characteristic (ROC) curve of IVCR was 0.67, inferior to systemic inflammatory response syndrome (0.76; p = .03) and Bedside Index for Severe Acute Pancreatitis (BISAP) (0.80; p = .002) in predicting severe acute pancreatitis.

CONCLUSIONS

IVCR is associated with the development of severe acute pancreatitis.

MAFLD mediates the association between CHR and gallstones in the U.S. adults: evidence from NHANES 2021-2023

BACKGROUND

Gallstones, a global hepatobiliary disorder, are linked to systemic inflammation, lipid disturbances, and metabolic-associated fatty liver disease (MAFLD). This population-based study aims to investigate the association of the novel inflammation-lipid composite biomarker high-sensitivity C-reactive protein-to-HDL cholesterol ratio (CHR) with gallstones and evaluate whether MAFLD mediates this relationship.

METHODS

This cross-sectional analysis utilized data from the National Health and Nutrition Examination Survey (NHANES, 2021-2023) to assess the correlation between the CHR and gallstone prevalence through weighted logistic regression. To evaluate potential nonlinear relationships and assess heterogeneity across key demographics, restricted cubic splines (RCS) were employed to model the association, complemented by subgroup analyses stratified by age, sex, and other covariates. A mediation analysis was used for elucidating the mediating effects of MAFLD.

RESULTS

Among 4,078 participants, 432 (10.60%) had gallstones. After adjusting for confounders, each unit increase in CHR was associated with a 165% increased risk of gallstones (OR: 2.65, 95% CI: 1.43-4.93, P = 0.006). The RCS curve demonstrated a nonlinear association between the CHR and gallstones (Poverall < 0.001, Pnonlinear < 0.001). Mediation analysis indicated that MAFLD explained 27.1% of this association.

CONCLUSIONS

CHR is positively associated with gallstones, with MAFLD partially mediating this relationship. Managing CHR levels and preventing MAFLD may reduce gallstone incidence.

Operative vs Nonoperative Treatment of Acute Cholecystitis in Older Adults With Multimorbidity

Importance

Acute cholecystitis in older patients with multimorbidity is associated with a high risk of morbidity and mortality. Debate exists as to whether operative or nonoperative treatment is the most appropriate approach.

Objectives

To compare the effectiveness of operative and nonoperative treatment in older adults with multimorbidity who are hospitalized emergently with acute cholecystitis.

Design, Setting, and Participants

This was a nationwide retrospective comparative effectiveness research study conducted in the US from 2016 to 2018 that used both an inverse propensity weight analysis and an instrumental variable analysis. The study participants were Medicare beneficiaries with multimorbidity hospitalized emergently with acute cholecystitis. Previously validated qualifying comorbidity sets were used to identify multimorbidity. Data were analyzed from April 1, 2016, to December 31, 2018.

Exposures

Treatment assignment of operative or nonoperative treatment for acute cholecystitis.

Main Outcomes and Measures

The primary outcome was 30- and 90-day mortality. Secondary outcomes included readmission rates, emergency department (ED) revisit rates, and cost. A preference-based instrumental variable approach was used to isolate circumstances for which the decision to operate is in clinical equipoise. Our hypothesis was that operative treatment would be associated with decreased mortality compared with nonoperative management.

Results

Among the 32 527 included patients, the median age was 78.8 years (IQR, 72.4-85.2 years), and 21 728 patients (66.8%) underwent cholecystectomy. Of the 10 799 patients (33.2%) who received nonoperative treatment, 3462 (32.1%) received a percutaneous cholecystostomy tube. Among all patients, operative treatment was associated with a lower risk of 30-day mortality (risk difference [RD], -0.03; P < .001) and 90-day mortality (RD, -0.04; P < .001) compared with nonoperative treatment. Among patients for whom the treatment decision was in clinical equipoise, mortality was similar for the operative and nonoperative treatment groups; operative treatment was associated with a lower risk of 30-day readmissions (RD, -0.15; P < .001) and 90-day readmissions (RD, -0.23; P < .001) as well as a lower risk of 30-day ED revisits (RD, -0.09; P < .001) and 90-day ED revisits (RD, -0.12; P < .001). The risk-adjusted cost of operative treatment was higher at the index hospitalization (+$2870.84; P < .001) and lower at 90 days (-$5495.38; P < .001) and 180 days (-$9134.66; P < .001) compared with nonoperative treatment.

Conclusions and Relevance

The findings of this comparative effectiveness research study suggest that risk-adjusted operative treatment of acute cholecystitis in older patients with multimorbidity was associated with lower rates of 30- and 90-day readmissions and ED revisits compared with nonoperative treatment and a lower cost by 90 days. These findings further suggest that when uncertainty exists regarding the most appropriate treatment approach for this challenging population, strong consideration should be given to operative treatment.

Using vaporized hydrogen peroxide for anhydrous disinfection of gastrointestinal endoscopes

BACKGROUND

Current disinfection methods for gastrointestinal endoscopes consume a significant amount of water resources and produce a large volume of waste.

AIM

To achieve the objectives of efficiency, speed, and cost-effectiveness, this study utilized vaporized hydrogen peroxide (VHP) generated from sodium percarbonate granules to conduct an anhydrous disinfection test on gastrointestinal endoscopes.

METHODS

The experimental device rapidly converts sodium percarbonate granules into VHP, and performs disinfection experiments on gastrointestinal endoscope models, disposable endoscopes, and various types of reusable gastrointestinal endoscopes. Variables such as the intraluminal flow rate (FR), relative humidity (RH), exposure dosage, and organic burden are used to explore the factors influencing the disinfection of long and narrow lumens with VHP.

RESULTS

The device generates a certain concentration of VHP that can achieve high-level disinfection of endoscope models within 30 minutes. RH, exposure dosage, and organic burden significantly affect the disinfection efficacy of VHP, whereas the intraluminal FR does not significantly impact disinfection efficacy. All ten artificially contaminated disposable endoscopes achieved satisfactory disinfection results. Furthermore, when this device was used to treat various types of reusable endoscopes, the disinfection and sterilization effects were not significantly different from those of automatic endoscope disinfection machines (using peracetic acid disinfectant solution) (P > 0.05), and the economic cost of disinfectant required per endoscope was lower (1.5 China Yuan), with a shorter disinfection time (30 minutes).

CONCLUSION

The methods and results of this study provide a basis for further research on the use of VHP for the disinfection of gastrointestinal endoscopes, as well as for the development of anhydrous disinfection technology for gastrointestinal endoscopes.

Non-epinephrine monotherapy matches combination therapy in high-risk PUB patients

Currently, there is no clear indication in the guidelines whether non-epinephrine injection monotherapy requires the addition of epinephrine for hemostasis.The purpose of this study is to compare the hemostatic efficacy of non-epinephrine injection monotherapy with combination therapy including extra epinephrine injection for peptic ulcer bleeding (PUB) patients . We retrospectively analyzed PUB patients who underwent endoscopic non-epinephrine injection as a monotherapy or combined non-epinephrine injection with epinephrine injection treatment in our center from March 2014 to January 2023 and the patients were divided into MT group or CT group. Subsequently, a propensity score matching analysis (PSM) was performed and rebleeding rates were calculated according to Forrest classifications via a stratified analysis. A total of 548 eligible patients were included in this study. After PSM, for PUB patients with nonbleeding visible vessels(FIIa), the recurrent bleeding rates by Days 3, 7, 14, and 30 after PSM were 17.6%, 26.5%, 27.9%, and 27.9% in the MT group, respectively, and rates were 1.4%, 5.6%, 6.9%, and 6.9% in the CT group, respectively, with significant differences observed between the 2 groups (P = 0.001, P = 0.001, P = 0.001 and P = 0.001, respectively).However, for PUB patients with spurting bleeding, oozing bleeding, and adherent clots, there were no significant differences between the two groups. For PUB patients with spurting bleeding(FIa) and oozing bleeding (FIb) ulcers, non-epinephrine injection monotherapy and epinephrine injection combined therapy have similar hemostatic efficacy. However, for PUB patients with visible blood vessel (FIIa) ulcers, combined therapy has higher hemostatic efficacy than non-epinephrine injection monotherapy.

Managing complicated pancreatitis with more knowledge and a bigger toolbox!

Acute pancreatitis (AP) is a heterogeneous inflammation of the pancreas, most frequently attributable to gallstones or alcohol. AP accounts for an estimated 300 000 patients admitted each year in the USA, and an estimated US$2.6 billion/year in hospitalization costs. Disease severity is classified as mild, moderate, or severe, dependent on the presence or degree of concomitant organ failure. Locally, pancreatitis may be complicated by fluid collections, necrosis, infection, and hemorrhage. Infection of necrotizing pancreatitis (NP) is associated with a doubling of mortality risk. The modern management of AP is evolving. Recent data suggest a shift from normal saline to lactated Ringer's solution, and from aggressive to more judicious volume resuscitation. Similarly, while historical wisdom advocated keeping patients nothing by mouth to 'rest the pancreas', recent data convincingly show fewer complications and reduced mortality with early enteral nutrition, when tolerated by the patient. The use of antibiotics in NP is controversial. Current recommendations suggest reserving antibiotics for cases with highly suspected or confirmed infected necrosis, as well as in patients with biliary pancreatitis complicated by acute cholecystitis or cholangitis. Regarding the management of local complications, control of acute hemorrhage can be attained either endovascularly or via laparotomy. Abdominal compartment syndrome is associated with a mortality risk of 50%-75%. Routine monitoring of intra-abdominal pressure is recommended in patients at high risk. Pancreatic pseudocysts require intervention in symptomatic patients or those with infection or other complications. Endoscopic transmural drainage may be considered as the first step when technically feasible. Necrotizing pancreatitis without suspicion of infection is often managed medically, while the delay, drain, debride approach remains the standard of care for the vast majority of infected pancreatic necrosis. Robotic surgery, in appropriately selected patients, allows for a one-step approach, and merits further study to explore its initially promising results.

Long-term weight change patterns in American adulthood in relation to gallstones: evidence from NHANES

BACKGROUND

The aim of this study is to investigate the association between weight change patterns across adulthood and gallstones in the United States.

METHODS

The analysis is based on data from participants aged 40-70 years taken from the National Health and Nutrition Examination Survey 2017-2020. Weight status and weight change patterns were categorized based on body mass index at three time points. Weighted logistic regression was used to estimate the association of weight status at the three time points and weight change patterns over the three periods with gallstones.

RESULT

Compared with normal weight, obese status at age 25 was associated with an 86% increased risk of gallstones (OR 1.86, 95%CI 1.07-3.24). No significant associations were observed for underweight or overweight status. Weight status at baseline or 10 years before baseline showed no relation to gallstones. Notably, the stable obese pattern from age 25 to baseline was positively associated with gallstones (OR 1.94, 95%CI 1.03-3.65). A similar association was observed from age 25 to 10 years before baseline (OR 1.92, 95%CI 1.05-3.49). However, weight change patterns from 10 years before baseline to baseline were not significantly associated with gallstone risk. Subgroup analyses revealed stronger associations among females, diabetic individuals, and those with low physical activity.

CONCLUSION

The stable obese pattern starting from early adulthood is associated with an increased risk of gallstones in Americans. Preventing or controlling obesity in early adulthood may be helpful in the primary prevention of gallstones.

Thiamine, gastrointestinal beriberi and acetylcholine signaling

Research has highlighted numerous detrimental consequences of thiamine deficiency on digestive function. These range from impaired gastric and intestinal motility to aberrant changes in pancreatic exocrine function, gastric acidity and disturbances in gut barrier integrity and inflammation. Thiamine and its pharmacological forms, as a primary or adjunctive therapy, have been shown to improve symptoms such as nausea, constipation, dysphagia and intestinal dysmotility, in both humans and animals. This review aims to explore molecular mechanisms underlying the therapeutic action of thiamine in gastrointestinal dysfunction. Our analysis demonstrates that thiamine insufficiency restricted to the gastrointestinal system, i.e., lacking well-known symptoms of dry and wet beriberi, may arise through (i) a disbalance between the nutrient influx and efflux in the gastrointestinal system due to increased demands of thiamine by the organism; (ii) direct exposure of the gastrointestinal system to oral drugs and gut microbiome, targeting thiamine-dependent metabolism in the gastrointestinal system in the first line; (iii) the involvement of thiamine in acetylcholine (ACh) signaling and cholinergic activity in the enteric nervous system and non-neuronal cells of the gut and pancreas, employing both the coenzyme and non-coenzyme actions of thiamine. The coenzyme action relies on the requirement of the thiamine coenzyme form - thiamine diphosphate - for the production of energy and acetylcholine (ACh). The non-coenzyme action involves participation of thiamine and/or derivatives, including thiamine triphosphate, in the regulation of ACh synaptic function, consistent with the early data on thiamine as a co-mediator of ACh in neuromuscular synapses, and in allosteric action on metabolic enzymes. By examining the available evidence with a focus on the gastrointestinal system, we deepen the understanding of thiamine's contribution to overall gastrointestinal health, highlighting important implications of thiamine-dependent mechanisms in functional gastrointestinal disorders.

Patient-Reported Outcome Measures in Benign Esophageal Disorders

Patient-reported outcome (PRO) measures are essential tools for assessing a patient's subjective experience related to disease and health. PROs measure symptom severity and evaluate treatment efficacy across a range of conditions at a particular point in time. Although PROs focusing on esophageal symptoms and esophageal hypervigilance exist, disease-specific PROs for commonly encountered benign esophageal disorders such as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), and achalasia are limited. Most GERD-specific PROs fail to address the complete spectrum of GERD presentations and those that provide daily assessment are more suited for research. Similarly, many EoE-specific PROs were designed for clinical trials. Comprehensive instruments incorporating EoE symptoms, as well as endoscopic and histologic features of active inflammation and fibrostenotic changes are needed. The psychometric properties of the Eckardt Score used for achalasia have significant limitations, stemming primarily from the dominance of dysphagia in scoring. Newer achalasia-specific PROs attempt to overcome this by capturing nuanced patient experiences. Broader symptom PROs are often used to assess esophageal symptoms across the spectrum of benign esophageal disorders, including a PRO that assesses esophageal hypervigilance and symptom-specific anxiety. Future efforts should focus on creating user-friendly PROs that comprehensively evaluate not just clinical presentation but also the disease state, which will enhance clinical symptom follow-up, quality of life assessment, and research applications. Assessments of hypervigilance and visceral anxiety will complement these applications as these measures are both a PRO and an important moderator of symptom severity and quality of life.

Management of acute pancreatitis in the "no man's land"

Acute pancreatitis (AP) is an inflammatory disease that can represent a challenge for clinicians, in fact, the early determination of its severity in the first 72 h is crucial for prognosis, recognizing the etiology and carrying out risk stratification to determine a more specific therapy. No accurate early prognostic scores for disease severity have been published, so the severity of AP often cannot be properly defined in the first few hours of the disease. This initial phase represents a "no man's land", in which there is no certainty in the stratification of the damage, prognosis is difficult to establish, therapy must be started promptly, although there is still no effective medical therapy against pancreatic enzymatic activation. Therefore, it is very difficult at this stage to make the correct decisions to achieve the best outcome for the patient with AP. Literature search was carried out using the PubMed database by entering early management of acute pancreatitis [title] or therapy of acute pancreatitis [title] and selecting the most relevant articles for the diagnosis and therapy of acute pancreatitis in clinical practice. This document provides suggestions on managing the key clinical decisions for patients suffering from AP before disease severity is defined, to achieve the best outcomes for patients with AP.

Molecularly Imprinted Polymer Advanced Hydrogels as Tools for Gastrointestinal Diagnostics

Gastroenterology faces significant challenges due to the global burden of gastrointestinal (GI) diseases, driven by socio-economic disparities and their wide-ranging impact on health and healthcare systems. Advances in molecularly imprinted polymers (MIPs) offer promising opportunities for developing non-invasive, cost-effective diagnostic tools that enhance the accuracy and accessibility of GI disease detection. This research explores the potential of MIP-based sensors in revolutionizing gastrointestinal diagnostics and improving early detection and disease management. Biomarkers are vital in diagnosing, monitoring, and personalizing disease treatment, particularly in gastroenterology, where advancements like MIPs offer highly selective and non-invasive diagnostic solutions. MIPs mimic natural recognition mechanisms, providing stability and sensitivity even in complex biological environments, making them ideal for early disease detection and real-time monitoring. Their integration with advanced technologies, including conducting polymers, enhances their functionality, enabling rapid, point-of-care diagnostics for gastrointestinal disorders. Despite regulatory approval and scalability challenges, ongoing innovations promise to revolutionize diagnostics and improve patient outcomes through precise approaches.

In-hospital mortality in patients with lower gastrointestinal bleeding: development and validation of a prediction score

BACKGROUND

 Lower gastrointestinal bleeding (LGIB) is a common condition linked to increased morbidity, healthcare costs, and mortality. Currently, no prospectively validated prognostic model exists to predict mortality in patients with LGIB. Our aim was to develop and validate a risk score that could accurately predict in-hospital mortality of patients admitted for LGIB.

METHODS

 Patient data from a nationwide cohort study in 15 centers in Italy (2019-2020) were used to derive the risk score, the Acute Lower gastrointestinal Bleeding and In-hospital mortality (ALIBI) score; the model was then externally validated in a cohort of consecutive patients hospitalized for LGIB in 12 centers from six countries (Italy, Spain, France, Greece, Iran, and Brazil) from 2022 to 2024. The main outcome was in-hospital mortality; we also reported rebleeding rates and the in-hospital mortality rate stratified by risk score and timing of colonoscopy. RESULTS : Among 1198 patients in the derivation cohort, 105 (8.8%) re-bled and 41 (3.4%) died. Age, Charlson Co-morbidity Index, in-hospital onset, hemodynamic instability, and creatinine level were independent predictors of in-hospital mortality. The model demonstrated excellent discrimination (area under the receiver operating curve [AUROC] 0.81, 95%CI 0.75-0.87) and calibration. In the validation cohort (n = 752 patients), the model's good discrimination (AUROC 0.79, 95%CI 0.72-0.86) and calibration were confirmed. Patients were categorized as low (0-4 points; 1% mortality), intermediate (5-9 points; 4.6% mortality), or high risk (10-13 points; 19.1% mortality). CONCLUSION : A new validated score effectively predicts in-hospital mortality in patients with LGIB, aiding in their risk stratification and management.

Global, regional, and national burdens of PUD in women of reproductive age from 1992 to 2021: a trend analysis based on the global burden of disease study 2021

Background

Peptic ulcer disease (PUD) constitutes a significant global health concern, particularly in women of childbearing age (WCBA), who face elevated risks of severe pregnancy-associated complications. This investigation aimed to map the temporal dynamics and forecast the future incidence of PUD in this demographic to inform targeted prevention and control initiatives.

Methods

This analysis drew on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, extracting data on PUD incidence and mortality across seven age groups (15-49 years) in WCBA. Age-standardized incidence and mortality rates were calculated using the direct method of age standardization. Temporal trends from 1992 to 2021 were analyzed using joinpoint regression. The study further employed age-period-cohort analysis to discriminate the effects of these variables on incidence and mortality, and frontier analysis to evaluate potential reductions in burden by country based on developmental status. Nordpred modeling was used to project epidemiological trends up to 2044.

Results

In 2021, the global age-standardized incidence rates (ASIR) and death rates (ASDR) for PUD among WCBA were 24.18 per 100,000 (95% CI: 14.72-36.38) and 0.54 per 100,000 (95% CI: 0.42-0.66), respectively. The highest incidence rates were observed in Oceania, while the greatest mortality rates were recorded in South Asia. Over the period from 1992 to 2021, global age-standardized mortality rates showed a significant decline. Conversely, after an initial drop, age-standardized incidence rates began to rise, with considerable regional and country-specific variation. This increase was particularly marked in regions with high Socio-demographic Index (SDI). Frontier analyses indicate that countries or regions in the middle SDI quintiles possess significant untapped potential to enhance both access to and quality of healthcare. Despite predictions of declining age-standardized incidence and mortality rates, total case numbers are expected to continue rising modestly through 2044.

Conclusions

The study underscores substantial global disparities in PUD trends in WCBA, with increasing case numbers and regional inequalities. The findings highlight the need for focused attention on high SDI regions and older WCBA cohorts to refine disease management and prevention strategies, aiding in the mitigation of PUD's public health impact.

Redox signaling in the pancreas in health and disease

This review addresses oxidative stress and redox signaling in the pancreas under healthy physiological conditions as well as in acute pancreatitis, chronic pancreatitis, pancreatic cancer, and diabetes. Physiological redox homeodynamics is maintained mainly by NRF2/KEAP1, NF-κB, protein tyrosine phosphatases, peroxisome proliferator-activated receptor-γ coactivator 1α (PGC1α), and normal autophagy. Depletion of reduced glutathione (GSH) in the pancreas is a hallmark of acute pancreatitis and is initially accompanied by disulfide stress, which is characterized by protein cysteinylation without increased glutathione oxidation. A cross talk between oxidative stress, MAPKs, and NF-κB amplifies the inflammatory cascade, with PP2A and PGC1α as key redox regulatory nodes. In acute pancreatitis, nitration of cystathionine-β synthase causes blockade of the transsulfuration pathway leading to increased homocysteine levels, whereas p53 triggers necroptosis in the pancreas through downregulation of sulfiredoxin, PGC1α, and peroxiredoxin 3. Chronic pancreatitis exhibits oxidative distress mediated by NADPH oxidase 1 and/or CYP2E1, which promotes cell death, fibrosis, and inflammation. Oxidative stress cooperates with mutant KRAS to initiate and promote pancreatic adenocarcinoma. Mutant KRAS increases mitochondrial reactive oxygen species (ROS), which trigger acinar-to-ductal metaplasia and progression to pancreatic intraepithelial neoplasia (PanIN). ROS are maintained at a sufficient level to promote cell proliferation, while avoiding cell death or senescence through formation of NADPH and GSH and activation of NRF2, HIF-1/2α, and CREB. Redox signaling also plays a fundamental role in differentiation, proliferation, and insulin secretion of β-cells. However, ROS overproduction promotes β-cell dysfunction and apoptosis in type 1 and type 2 diabetes.

A little goes a long way: A comparison of enterolithotomy versus single-stage cholecystectomy in the management of gallstone ileus

INTRODUCTION

Gallstone ileus is an infrequent complication of cholelithiasis with no specific guidelines for its management. This study aims to compare the outcomes of patients with gallstone ileus managed with both enterolithotomy with cholecystectomy (EL-CCY) versus those managed with enterolithotomy (EL) only.

METHODS

In this retrospective analysis of 2011-2017 Nationwide Readmissions Database, all patients with an index admission diagnosis of gallstone ileus were included. Patients were stratified based on the type of intervention received for gallstone ileus into those who underwent EL-CCY and those who underwent EL alone and compared. Primary outcomes were in-hospital complications (surgical site infections, sepsis, pneumonia, cardiac arrest, deep vein thrombosis, intestinal obstruction) and mortality. Secondary outcomes were hospital length of stay, hospital costs, and readmissions rate and cause of readmissions. Multivariable logistic regression analysis was performed.

RESULTS

A total of 1,960 patients were identified. The mean age was 67 years and 67% were female. Two hundred eighty-nine patients (14.7%) were managed with EL-CCY, whereas 1,671 patients (85.3%) underwent EL only. Overall, the readmission rate was 4.8%, whereas mortality was 4.2%. There was no significant difference between groups in terms of index-admission complications (24.8% vs. 21.7%, p = 0.415), mortality (6.2% vs. 3.9%, p = 0.068), rates of readmission (3.5% vs. 5.1%, p = 0.22), and cause of readmission ( p > 0.05). Enterolithotomy and cholecystectomy group had significantly longer hospital length of stay (10 vs. 8 days, p < 0.001) and median hospital costs ($70,959 vs. $52,147, p < 0.001). On multivariable logistic regression analysis, female sex was a predictor of undergoing EL-CCY, whereas increasing age and higher grade of all-patient redefined diagnosis-related groups risk of mortality were independently associated with lower odds of undergoing EL-CCY.

CONCLUSION

Our findings suggest no difference between EL compared with EL-CCY in terms of complications, readmissions, and mortality. However, patients managed with EL-CCY had a longer hospital stay and higher hospital costs compared with EL. Further prospective studies are needed to validate these findings and develop management protocols for gallstone ileus.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.

Fluid Resuscitation in the Treatment of Acute Pancreatitis: Rate and Volume Controversies

The aim of the Research to Practice column is to enhance the research critique abilities of both advanced practice registered nurses and emergency nurses, while also aiding in the translation of research findings into clinical practice. Each column focuses on a specific topic and research study. In this article, we used a scenario of left upper quadrant pain to explore the study by de-Madaria et al., titled "Aggressive or moderate fluid resuscitation in acute pancreatitis".

Unlocking the power of probiotics, postbiotics: targeting apoptosis for the treatment and prevention of digestive diseases

Digestive diseases are becoming an increasingly serious health burden, creating an urgent need to develop more effective treatment strategies. Probiotics and postbiotics have been extensively studied for their potential to prevent and treat digestive diseases. Growing evidence suggests that programmed cell death, especially apoptosis, is a critical mechanism influencing the molecular and biological aspects of digestive diseases, contributing to disease progression. Understanding the mechanisms and signaling pathways by which probiotics and postbiotics regulate apoptosis could reveal new therapeutic targets for treating digestive diseases. This review focuses on the beneficial effects of probiotics and postbiotics in regulating apoptosis across a range of liver diseases, including non-alcoholic fatty liver disease, liver injury, cirrhosis, and liver cancer. It also explores their effects on gastrointestinal diseases, such as colorectal cancer, colitis, gastrointestinal injury, and infectious diarrhea. Furthermore, some probiotics help balance the gut microbiota, enhance intestinal barrier function, and regulate the immune system, all of which are closely associated with apoptosis. Moreover, emerging technologies, such as encapsulation methods, have been developed to stabilize probiotics, primarily based on experimental findings from rodent and human studies.

Association between sarcopenia and the prevalence of gallstone in US adults: a cross-sectional analysis of NHANES

BACKGROUD

Gallstones are a common disease that imposes a significant burden on public health resources. Sarcopenia is an age-related condition characterized by a decline in muscle mass, strength, and function. However, its relationship with gallstones remains unclear.

METHODS

This cross-sectional study included 2,167 US adults from the National Health and Nutrition Examination Survey. We used the multivariable logistic regression models and restricted cubic spline regression to to assess the relationship between sarcopenia and gallstones. Additionally, subgroup analyses and propensity score matching (PSM) were conducted to account for potential confounding factors.

RESULTS

We found a significant negative association between the sarcopenia index and the prevalence of gallstones (OR: 0.253, 95% CI: 0.132-0.471, P < 0.001). In Model 4, which integrated all covariates, sarcopenia was associated with approximately a 100% increased prevalence of gallstones compared to non-sarcopenia patients (OR: 1.995, 95% CI: 1.340-2.948, P < 0.001). The results of PSM also confirmed the association between sarcopenia and gallstones (OR: 1.982, 95% CI: 1.217-3.285, P = 0.007). Notably, this association was more pronounced in subgroups including females, non-Hispanic whites, married individuals, and higher education level.

CONCLUSION

In summary, our findings suggest a positive association between sarcopenia and the prevalence of gallstones in US adults. This suggests that we should increase the emphasis on gallstone disease screening in sarcopenia patients. However, this finding needs to be validated through further large-scale prospective studies.

The Predictive Value of Serum Sodium Levels and Inflammatory Markers in Differentiating Complicated and Uncomplicated Acute Diverticulitis: A Retrospective Cohort Study

Background and Objectives: This study aimed to investigate the role of serum sodium levels as an independent predictor of complications in acute diverticulitis and to evaluate their diagnostic value alongside inflammatory markers. Materials and Methods: A total of 134 patients diagnosed with acute diverticulitis between June 2018 and January 2024 at the Erol Olçok Training and Research Hospital were retrospectively analyzed. Complicated diverticulitis was defined based on the presence of an abscess, perforation, fistula, or obstruction classified as Hinchey stage II-IV. Serum sodium, CRP, and WBC levels were assessed for their predictive value. Statistical analyses included ROC analysis to determine optimal thresholds and logistic regression to evaluate independent predictors. Results: A total of 29.1% of the patients were classified as having complicated diverticulitis. Serum sodium levels were significantly lower in the complicated group (median: 133 mmol/L, p < 0.001), whereas CRP (median: 86.5 mg/L, p < 0.001) and WBC levels (median: 11.62 × 103/µL, p = 0.001) were higher. The ROC analysis identified <135.5 mmol/L as the optimal threshold for serum sodium, with a 94.9% sensitivity and 94.7% specificity, making it the strongest predictor. The logistic regression revealed that each unit decrease in serum sodium increased the risk of complications by 5.7 times (p < 0.001). Conclusions: Serum sodium levels are an independent and strong predictor of complications in acute diverticulitis. When used alongside CRP and WBC levels, diagnostic accuracy can be enhanced, leading to improved patient management.

Burden of Nonmalignant Liver and Pancreatic Diseases in the United States Population: Rates and Trends

Nonmalignant liver and pancreatic diseases are common in the United States and lead to significant morbidity, mortality, and health care utilization. We used national survey and claims databases to investigate rates and trends in the liver and pancreatic disease burden over the past decade in the United States. The Nationwide Emergency Department Sample, National Inpatient Sample, Vital Statistics of the United States: Multiple Cause-of-Death Data, Optum Clinformatics Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample and Medicaid files were used to estimate claims-based prevalence, medical care use, and mortality with an all-listed liver or pancreatic disease diagnosis. In the US population, liver disease contributed to 2.7 million emergency department visits, 2 million hospital stays, and 134,000 deaths in 2021. Pancreatitis was a less common but still significant cause of health care use contributing to 733,000 emergency department visits, 552,000 hospital stays, and 9000 deaths in 2021. For both conditions, male and American Indian/Alaska Native persons had a greater mortality and medical care use burden. During the study period, both medical care use and mortality rates with a liver disease diagnosis rose, concerningly reversing previously declining trends. For pancreatitis, medical care use rates stabilized or declined during recent years and the mortality rate declined through 2019 and then rose through 2021. The burden of nonmalignant liver and pancreatic diseases in the United States is substantial. The rise in liver disease mortality rates following the reversal of a previous downward trend is particularly concerning. Hence ongoing surveillance of liver disease and pancreatitis prevalence may better inform research programs.