Gastroenterology and Functional Medicine

The adherence gap: Rural dwelling, low level of education, and missed opportunities for optimal hepatitis B control

Wed, 04 Dec 2024 00:00:00 +0800

Background and Objectives: Long-term antiviral use can suppress hepatitis B virus (HBV) DNA, normalize liver function tests, reverse fibrosis and cirrhosis, and improve histological changes. Understanding adherence and the factors affecting it is crucial for managing chronic hepatitis B virus (CHB) patients, achieving sustained suppression with low drug resistance risk, and developing strategies to address poor adherence. This study aims to assess antiviral medication adherence and factors associated with adherence among HBV patients on treatment at the gastroenterology clinic in Tikur Anbessa Specialized Hospital (TASH). Methods: A cross-sectional study was conducted in 149 HBV patients undergoing therapy at TASH from May 2023 to February 2024. The medication adherence level was assessed using Morisky’s 8-item medication adherence questionnaire. Data was entered into Epi Info 7 for database construction and exported to SPSS version 26. Different statistical analyses were used, including frequencies of variables and descriptive statistics. An ordinal logistic regression analysis was used to identify factors associated with medication adherence levels. The proportional odds model (POM) assumptions were checked using chi-square and parallel line tests. Results: The study found that only 32.2% participants had high adherence, 39.6% had medium adherence, and 28.2% had low adherence. Rural dweller (a POR: 2.4; 95%CI: 1.09 to 5.20), low educational level (a POR: 3; 95%CI: 1.27 to 7.13), being unmarried (a POR: 2.52; 95%CI: 1.15 to 5.50), not being counseled about medication adherence by treating physicians (a POR: 3.2; 95%CI: 1.61 to 6.50), and an abnormal liver function tests (a POR: 2.31; 95%CI: 1.08 to 4.92) were significantly associated with medium or low medication adherence level. Conclusion: The study reveals low medication adherence rates among participants, with only a minority demonstrating high adherence. Factors such as rural dwellings, low educational level, being unmarried, lack of counseling, and abnormal liver function tests were significantly associated with medium or low adherence. Targeted interventions are needed to improve adherence, especially for individuals in rural areas with lower education levels and who are unmarried. Efforts should be made to integrate medication adherence discussions into routine healthcare visits and raise physician awareness about counseling patients on adherence are crucial.

Are we beyond the peak of celiac disease incidence in Olmsted County, Minnesota, USA?

Fri, 27 Dec 2024 00:00:00 +0800

Background and Objectives: The incidence of celiac disease (CD) has increased over the past few decades. Recent reports suggest the incidence has peaked and plateaued in many countries. We aimed to demonstrate the CD incidence trend since 2000 in a well-defined US population. Methods: Using the Rochester Epidemiology Project (REP), we reviewed electronic health records for patients of Mayo Clinic and Olmsted Medical Center between 2000 and 2021. We identified patients diagnosed with CD during the study period and resided in Olmsted County, Minnesota. Incidence rates (per 100,000 person-years) were calculated by age, sex, and calendar year and adjusted to the 2020 US population. Results: Among 622 patients diagnosed with CD during the study period, 179 (29%) were children and 395 (64%) were female. Median age at diagnosis among pediatric and adult patients was 9.2 years and 42.2 years, respectively. Overall CD incidence rate increased and peaked at 24.9 in 2015 through 2017. Incidence plateaued in the later part but remained higher at the end of the study period. The increased incidence rate was influenced primarily by children younger than 11 years, whose incidence almost tripled during the study period. A clear decreasing trend was noted only among adults older than 64 years. Conclusion: Although the overall CD incidence rate is plateauing in Olmsted County, it continued to increase among children. This could indicate a shift to increase awareness and earlier diagnosis.

Analysis of blood immune biomarkers and fecal microbiome in subjects with and without malignant solid tumors: report from a feasibility study

Thu, 01 Aug 2024 00:00:00 +0800

Background and Objectives: Cytokines and other immune regulatory molecules are critical for mounting an effective immune response against cancer. The gastrointestinal (GI) microbiome plays a significant role in the pathogenesis of cancer and the response to immunotherapy. The central hypothesis guiding this project was that specific immune biomarkers and microbiome profiles will serve as predictors of effective vs. ineffective immunotherapy in patients with malignant diseases. This pilot feasibility study aims to establish baseline immune markers and microbiome profiles in subjects with newly diagnosed malignant solid tumors (n = 10), healthy subjects without diagnosed malignant disease (n = 10), and in existing patients treated with immunotherapy (n = 10). Methods: Parallel blood and stool samples were collected and used in the biomarker and microbiome analysis. The biomarkers in the two groups were analyzed by Principal Component Analysis, heat map with clustering, and differential expression based on P value, and Significance Analysis of Microarrays (SAM). The microbiome analysis was performed using long read 16S rRNA encoding gene sequencing with data visualization and analysis in R. Significant differences in alpha and beta diversity were evaluated between the groups. Results: Several biomarkers that were differentially expressed were identified. Significant taxa differences at the class (Clostridia), order (Clostridiales, Lactobacillillales), family (Eubacteriaceae, Lactobacillaceae), genus and species were identified. Furthermore, a limited analysis of samples from existing patients on immunotherapy who were responders (n = 4) vs. stable non-responders (n = 5) identified differentially expressed immune biomarkers and significant bacterial taxa differences. Conclusion: This study has established the feasibility for conducting a future larger study at the local community cancer center to evaluate whether immune and microbiome markers can predict effective vs. ineffective responses to immunotherapy and whether either or both molecular and microbial markers may have therapeutic potential.

Evaluating the clinical course of hepatitis A in children: A year in review in a tertiary care setting

Rafia Rashid, Salahuddin Mahmud, Madhabi Baidya, Syed Shafi Ahmed — Thu, 28 Nov 2024 00:00:00 +0800

Background and Objectives: This study aimed to evaluate the clinical course of pediatric hepatitis A virus (HAV) infections over one year in a tertiary care setting in Bangladesh focusing on clinical presentations and complications. Methods: A retrospective review of medical records was conducted in 32 children aged 1–18 years diagnosed with acute hepatitis A, confirmed by positive anti-HAV immunoglobulin M (IgM). Clinical presentations, liver function tests (LFTs), coagulation profiles, and complete blood counts (CBC) were analyzed. Patients with chronic liver disease or other forms of viral hepatitis were excluded. Descriptive statistics were used for analysis. Results: The majority of patients (62.5%) were aged 6–10 years. Common clinical features included jaundice (94%), hepatomegaly (84%), fever (78%), and vomiting/nausea (56%). Ascites (20%), encephalopathy (10%), and sepsis (10%) were the most frequent complications. LFT results showed significantly elevated alanine aminotransferase (SGPT) levels in 68.75% of patients, with values exceeding 1000 IU/dL. Aspartate aminotransferase (SGOT) levels were elevated in 9.38% of patients. Coagulation abnormalities, such as elevated prothrombin time (PT) and international normalized ratio (INR), were observed in a substantial proportion of patients, with hypoalbuminemia present in one-third of cases. Ultrasound findings indicated cholestasis in 12.5% of patients. Conclusion: Pediatric hepatitis A is generally mild but can lead to complications such as ascites, encephalopathy, and sepsis. Early diagnosis, awareness of atypical presentations, and regular monitoring are essential, especially in high-endemic areas like Bangladesh.

Correlation between radiological response after locoregional treatment and histopathological findings in patients undergoing liver transplant for hepatocarcinoma

Thu, 01 Aug 2024 00:00:00 +0800

Background and Objectives: Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm has been developed to evaluate response after locoregional treatment (LRT) in patients with hepatocellular carcinoma (HCC). The aim of the study was to corroborate if the post-treatment radiological findings described using LR-TR correspond to the final histopathological results, and survival in relation to different LR-TR groups in patients underwent LRT before liver transplantation (LT). Methods: A retrospective single-center study was performed. Data of patients undergoing LT and LRT due to HCC between January 2010 and December 2022 were collected. Results: Four hundred and four patients were transplanted, of which 103 (25.5%) had HCC. Ninety-seven patients (93.2%) received LRT. 53% of treated patients had a complete response on pathological examination. Re-evaluation imaging was performed in 88 patients. 59% were classified as non-viable LR-TR, 32.5% as viable LR-TR, and 8.5% as equivocal LR-TR. Regarding the correlation between the degree of tumor necrosis and the post-treatment LR-TR category, 37% of patients evaluated as viable LR-TR had a “complete response” compared to 62.9% with “no complete response”. For those evaluated as non-viable LR-TR, 59.2% had a “complete response” compared to 40.8% with a “no complete response” (P = 0.123). There were no statistically significant differences in overall and disease-free survival between the viable LR-TR, non-viable LR-TR, and equivocal LR-TR groups (P = 0.3484 and P = 0.4152, respectively). Conclusion: We have not been able to establish whether radiological response correlates with anatomopathological outcomes, as well as survival in these groups. More prospective studies are needed to validate these findings.

Assessment of dyspepsia in the era of endoscopic ultrasonography

Mohamed Gamal Talkhan, Mohammed Omar Khalifa Elsayed — Fri, 27 Dec 2024 00:00:00 +0800

Dyspepsia is one of the commonest indications for referral to gastroenterology and endoscopy assessment. It includes a wide range of differential diagnosis and variety of pathologies that needs further assessment in depth. Initial evaluation should focus on the identification and treatment of potential causes of symptoms such as peptic ulcer disease and medication side effects but also on recognizing those at risk for more serious conditions such as cancer or premalignant lesions. Dyspepsia is common in clinical practice with frequent relapses that often requires multiple investigations to assess intraluminal and extraluminal aetiologies. The basic gastroscopy represents a widely used tool for dyspepsia assessment for specific indications. Endoscopic ultrasonography (EUS), introduced into gastroenterological diagnostics more than 20 years ago, has undergone extensive evaluation of its diagnostic capability, probably to a larger extent than most other endoscopic and other imaging techniques in gastroenterology. The introduction of EUS in the recent era added the benefit of better visualization, assessment of layers and lesions and sampling for histological and pathological guidance. In this article, we aim to review the diagnostic yield in different causes of dyspepsia. We will also shed some light on role of EUS in staging of specific causes of dyspepsia including gastric, pancreatic, biliary and subepithelial lesions.

Systemic treatment for advanced hepatocellular carcinoma of non-viral causes

Esther Una Cidon, Pilar Alonso Martinez — Fri, 27 Dec 2024 00:00:00 +0800

As the most frequent primary hepatic malignancy and the third cause of cancer-related death, hepatocellular carcinoma (HCC) occurs primarily in cases of underlying chronic liver disease, being infection with hepatitis B and C the main cause. However, there are other relevant risk factors that contribute as well, such as non-alcoholic fatty liver disease (NAFLD) and its progressive subtype non-alcoholic steatohepatitis (NASH), obesity and diabetes among others. Currently there are several agents available for the systemic treatment of HCC and the guidelines support atezolizumab plus bevacizumab as the first-line therapy. However, some data show that non-viral HCC might benefit less from the treatment with immunotherapy. This article reviews the systemic treatment for advanced HCC focusing more on the results for non-viral causes.