Introduction

Since the advent of the BAVENO VII consensus, Transient elastography (Fibroscan) has taken on a key role in the assessment of clinically significant portal hypertension (CSPH) and the prediction of decompensation and death. A liver stiffness measurement (LSM) ≤ 15 kPa associated with platelets ≥ 150 G/L excludes CSPH (NPV > 90%), while a LSM > 25 kPa is very much in favor of CSPH (PPV > 90%). CSPH remains possible in non-obese patients with LSM between 20 and 25 kPa with platelets < 150 G/L or LSM between 15 and 20 kPa with platelets < 110 G/L) but with a 40% risk of error.

Aims & Methods

We conducted this study to evaluate the reliability of transient elastography (TE) and platelet count in the diagnosis of CSPH, and to determine the extent of adherence to the consensus recommendations in our center.
This is a monocentric and retrospective study made in the gastroenterology and hepatology department of Mohamed Taher Maamouri Hospital in Nabeul, Tunisia, in which we collated reports of Fibroscans performed from March 2023 to March 2024.
We excluded patients with etiologies other than viral, alcoholic, or non-obese non-alcoholic steatohepatitis (NASH).
Platelet count and upper gastrointestinal endoscopy (EGD) data (if performed) were collected.
Data were entered and analyzed using SPSS version 27 software, with a significance level of 0.05.

Results

One hundred and fifty-nine Fibroscans were performed, of which 127 were included.
Women accounted for 64.6%, with a M/F sex ratio of 0.55. Mean age was 55.13 years [20-83].
The indications for Fibroscan were distributed as follows: 53.5% (68 patients) for non-obese NASH, 33.1% (42 patients) for HBV, 11.8% (15 patients) for HCV and only 2 cases for chronic ethylism.
The mean LSM value was 6.45 kPa [2-41.5], with thresholds distributed as follows; LSM <5 kPa in 70 patients (55.1%), LSM between 5 and 10 kPa in 44 patients (34.6%), LSM between 10 and 15 kPa in seven patients (5.5%), LSM between 15 and 20 kPa in two patients (1.6%), LSM between 20 and 25 kPa in a single patient, and LSM >25 kPa in three patients (2.4%).
The mean platelet count was 220 G/L [20-440], with a count > 150 G/L in 111 patients (87.4%), a count between 110 and 150 G/L in 13 patients (10.2%) and a count < 110 G/L in 3 patients.
Of all patients, 24 FOGDs were performed. Signs of Portal hypertension (PH) were noted in only 5 cases, represented by grade I esophageal varices.
In analytical study, hepatic elastography and platelet count were significantly correlated with the presence of endoscopic PH (p=0.009). Indeed, among patients with signs of endoscopic PH, 60% had a LSM > 25 kPa, 20% had a LSM between 15 and 20 kPa with a platelet count < 110 G/L and only 20% had a LSM < 10 kPa.
Furthermore, the consensus recommendations for the indication or not of EGD were not respected in our center (p=0.004); of all endoscopies performed 87.5% (21 EGD) were not indicated, and we noted one case where EGD was indicated but not performed.

Conclusion

Our study highlighted the recommendations of the latest BAVENO VII consensus regarding the reliability of transient elastography and platelet count in the evaluation of CSPH (p=0.009). This must be taken into consideration by practitioners in order to implement adequate preventive measures and to rationalize the indication of EGD which remains an inconvenient procedure for our patients.

Introduction

Chronic fatigue (CF) is prevalent among patients with ulcerative colitis (UC) and Crohn's disease (CD), but the influence of the disease activity is not established.

Aims & Methods

The primary aim of this study was to evaluate the prevalence and probability of chronic fatigue (CF) in patients with CD and UC one year after diagnosis, stratified by different measures for disease remission (symptomatic, biochemical, endoscopic, and histological). Additionally, we aimed to evaluate factors associated with chronic fatigue among patients in endoscopic/radiological remission.

Patients ≥18 years with CD and UC were recruited from the Inflammatory Bowel Disease South-Eastern Norway (IBSEN III) study, a population-based, observational inception cohort. Fatigue was assessed using Fatigue Questionnaire (FQ), and CF was defined as a dichotomized score of ≥4 with a duration of ≥6 months. Only patients with complete FQ data, without history of colectomy, were eligible for inclusion. Binary logistic regression analyses were used to examine the probability of CF for various indicators of remission, including i) symptomatic remission (Harvey–Bradshaw index score <5 for CD and Simple Clinical Colitis Activity Index score <3 for UC), ii) biochemical remission (Fecal calprotectin ≤ 250 µg/g), iii) endoscopic/radiological remission (Mayo endoscopic score 0 in UC, and endoscopically verified absence of inflammation combined with normal intestinal MRI/CT in CD), and iv) histological remission (normal histology in all mucosal biopsies). Additionally, in patients with endoscopic/radiological remission, associations between CF and selected clinical factors were evaluated using binary logistic regression analysis.

Results

In total, 711/1416 patients with CD or UC diagnosis were included (CD: 33.8%, UC: 66.2%). Among them, 619 (87.1%) underwent colonoscopy, intestinal MRI/CT and/or fecal calprotectin testing. Prevalence of CF stratified by different indicators of remission is presented in table 1. In univariate binary logistic regression analysis regarding measures for disease remission, the probability of CF was only significantly reduced in patients with UC in symptomatic remission (OR: 0.48 (0.30, 0.77), p=0.003). Among patients with CD and UC in endoscopic/radiological remission (n=181), CF was independently associated with current biological treatment (OR: 2.92 (1.002, 8.49), p=0.05) and sleep disturbance (OR: 6.23 (2.03, 19.14), p=0.001) in multivariate logistic regression.

Conclusion

The probability of CF one year after diagnosis was not associated with either low fecal calprotectin level, normal endoscopic/radiological examinations, or normal histology. Among patients with UC, but not CD, symptomatic remission was associated with a reduced probability of CF. For patients in endoscopic/radiological remission, CF was independently associated with sleep disturbances and current biological treatment.

Disclosure

All authors report no conflict of interest.