Introduction

Globally, hepatitis C virus (HCV) infection is still common among chronic kidney disease (CKD) patients despite the advent of serologic screening of blood by enzyme-linked immunoassays, routine use of erythropoietin for patients with anemia and CKD, and better adherence to infection control procedures to prevent the spread of HCV within dialysis units. A large body of epidemiological evidence regarding HCV infection among patients undergoing maintenance dialysis in the developed world has accumulated. prevalence rates have been shown to range between 1.4% and 28.3%. The prevalence rates observed in developing countries remain much higher with prevalence rates between 4.7% and 41.9%. Treatment of CKD patients with pegylated interferon plus ribavirin was challenging and with low response rates.
On its approval, sofosbuvir was not used among CKD patients with creatinine clearance < 30 ml/min, but recently its usage was approved after demonstrating its safety among these patients.

Aims & Methods

Our aim was to determine the response rate of sofosbuvir based regimens in CKD stage 4/5 and end stage renal disease (ESRD) patients on maintenance hemodialysis and to determine the predictors of treatment failure, including (IFNL4) SS469415590 gene polymorphism.
The study included 55 HCV pateints CKD stage 4/5 and ESRD on MHD. The sample size was calculated using G Power 3.1.9.4, 2018. Based on an effect size of direct acting antiviral therapy of HCV among patients with ESRD of 0.4, alpha error of 0.05, power of 80%, the minimum required sample size was calculated to be 52 patients.

Results

Sustained virologic response was achieved in 52.7% of cases. Among those who failed to achieve SVR, platelets and albumin was significantly lower (p < 0.001), INR and total bilirubin was significantly higher (p < 0.001). Both APRI and FIB-4 scores were significantly higher among those who failed to achieve SVR (p < 0.001). The favorable IFNL4 genotype (TT/TT) was present in 36.4% of the 55 patients. 58.6% of the TT/TT genotype patients achieved SVR compared to 41.4% of the non-TT/TT genotype patients (p= 0.001). On multivariate logistic regression analysis, higher FIB-4 Score was significantly associated with failure to achieve SVR. ROC curve analysis revealed that at a cut-off ≥ 2.63, pretreatment FIB-4 had a sensitivity of 88.46%, and negative predictive value (NPV) of 90%.

Conclusion

In CKD patients with stage 4 or stage 5, greater FIB-4 scores are linked to a higher chance of failing to achieve SVR after receiving sofosbuvir-containing regimens for chronic HCV infection.

Introduction

Short-septum Zenker’s diverticulum (ZD) is considered difficult-to-treat because the limited anatomical space which restricts the operating area. Recently, peroral endoscopic septotomy (POES) emerged as a novel third-space technique for addressing this condition.

Aims & Methods

This study aims to compare the effectiveness and safety of POES with traditional flexible endoscopic septotomy (FES) for the treatment of symptomatic patients with short-septum ZD (<25 mm). In this single-center, prospective study we included all consecutive patients referred to Humanitas Research Hospital with symptomatic short-septum ZD who were scheduled to undergo either FES or POES. The primary outcome was the rate of technical success and adverse events (AEs). The secondary outcome was the rate of clinical success at 12 months and recurrence requiring a retreatment. A sensitivity analysis was conducted using propensity score matching. Hazard Ratio (HR) and its associated 95%CI were used for a time-dependent analysis of recurrence.

Results

A total of 94 patients (63.8% male; mean age 72.7 + 10.7 years) underwent endoscopic treatment for a short-septum ZD (mean size 17.0 + 4.3 mm) were included. Among them, 41.5% (n=39) were treated with FES and 58.5% (n=55) with POES (p=n.s.). Overall, the mean procedural duration was 25.3 + 15.7 min, while the mean hospital stay was 0.3 days. Septotomies were performed under deep sedation in 91.5% of patients (n=86), while in 8.5% of them (n=8) the procedure was performed under general anesthesia. Technical success was achieved in 98.9% of patients (n=93), while AEs occurring in 5.3% of cases (n=5), with no statistical difference between groups (p=n.s.). Clinical success was observed in 91.5% of patients (n=86), while recurrence necessitating retreatment in 14.9% of cases (n=14) with no statistical difference between groups (p=n.s.).

Conclusion

Our findings suggest that POES is an effective and safe technique for the treatment of short-septum ZD, showing comparable outcomes to traditional FES.

References

Repici A, Spadaccini M, Belletrutti PJ, et al. Peroral endoscopic septotomy for short-septum Zenker's diverticulum. Endoscopy. 2020 Jul;52(7):563-568.

Introduction

Patients with acute-on-chronic liver failure (ACLF) have traditionally been considered with a tendecy for bleeding however, they frequently display a paradoxical prothrombotic state. ACLF is characterized systemic inflammation and an increased risk of both bleeding and thrombosis. Bleeding arises from decreased pro-coagulation factors and platelet sequestration due to portal hypertension, while thrombosis is exacerbated by endothelial dysfunction and elevated heparinoids, thrombomodulin, or von Willebrand factor.

Aims & Methods

The aim of this study was to evaluate platelet aggregation pattern in patients with ACLF compared to acute decompensated (AD) liver cirrhosis.
The study took place in between the 1^st of July 2024- 31^st of January 2025 and we prospectively included cirrhotic patients, divided in two groups: ACLF group and AD group. The exclusion criteria were people with compensated liver cirrhosis, antiaggregant or anticoagulant treatment and patients with hepatocellular carcinoma or other malignancies. We investigated platelet aggregability in whole blood, by using multiplate aggregometry. For analysis, platelet aggregometry was performed induced by: adenosine diphosphate (ADP), arachidonic acid (ASPI), prostaglandin E2 (PGE2) and thrombin receptor-activated peptide (TRAP-6) as agonist were determined. TRAP‑6 is a peptide that stimulates protease-activated receptor 1 (PAR1) on platelet membrane.

Results

In this study we included 52 patients – 25 patients with ACLF and 27 patients with AD. There were no differences regarding demographic parameters and liver disease etiology between the two study groups. Compared to AD group, patients with ACLF showed an enhanced maximal platelet aggregation with TRAP-6 (AUC 85±12 U vs 45±10 U, p<0.0001). In contrast, we did not detect any differences in platelet aggregation between the two groups after ADP, ASPI or PGE2 activations. We observe that PAR-1 stimulation induces the highest aggregation curve and area under the curve in patients with ACLF and AD, but ACLF patients show the strongest response, highlighting that the degree of liver decompensation influences aggregation results. Severe decompensation correlates with a stronger TRAP response, suggesting that there are more PAR-1 receptors on platelets of this patients.

Conclusion

Our results indirectly indicate that platelet reactivity is higher in patients with ACLF likely due to enhanced PAR-1 receptor activity. Severe decompensation correlates with a stronger TRAP response, suggesting that there are more PAR-1 receptors on platelets of this patients.

References

1. EASL Clinical Practice Guidelines on acute on liver failure; J. Hepatol. 2023
2. Napolitano et al. European Journal of Internal Medicine 2017
3. Tripodi et al. Hepatology 2006
4. Lisman et al. Hepatology 2006
5. Nassar et al. BIOMEDICINES 2023
6. Rogalski et al. Scandinavian Journal of Gastroenterology 2019
7. Zanetto et al. Liver International 2022
8. Vecerzan et al. Cureus 2024
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Clinical Case Summary

We present a rare case of protein losing gastropathy.A 60-year-old female presented to our clinic with 10 years history of intermittent dyspepsia with no alarm features and peripheral oedema for 6 months.Physical examination was unremarkable except mild bilateral pitting oedema.Pertinent investigations suggested normal albumin,urine analysis,renal&liver profiles and a normal echocardiogram.Subsequent testing with esophagogastroduodenoscopy(EGD) for dyspepsia showed hypertrophied mucosal folds predominantly in gastric corpus while sparing the antrum.Full thickness biopsies were taken and sent for histopathology with differentials of Lymphoma,adenocarcinoma,sarcoidosis and Menetrier’s disease.Stool antigen for Helicobacter Pylori(H.Pylori)thereafter,was positive while Contrast enhanced CT abdomen was consistent with mildly thickened gastric walls.Histological examination demostrated foveolar hyperplasia,elongated gastric pits and cystically dilated gastric glands without any features of malignancy.Hence a diagnosis of Menetrier’s disease(underlying H.Pylori) was made.
Patient then had H.Pylori eradication therapy as well as a diet rich in medium-chain fatty acids and proteins.H.Pylori eradication was confirmed.6 months follow up revealed partial resolution of her symptoms but no change in endoscopic findings.Patient could not undergo further treatment with biologics(cetuximab)due to financial constraints and octreotide for its local unavailability.She is now on a yearly endoscopic surveillance for future high risk of gastric malignancies.

References

​​Fig1A.Haematoxylin & Eosin staining shows foveolar & mucous cell hyperplasia,elongated gastric pits and lymphocytic infiltration.
Fig1B.Haematoxylin & ​Eosin staining shows cystic dilation of gastric glands
1.Pepa P, Uehara T, Wonaga A, Redondo A, Avagnina A, Mazzocchi O, Antelo P, Waldbaum C, Sorda J. Menetrier's disease. A diagnostic and therapeutic challenge. Medicina (B Aires). 2021;81(3):470-473. English. PMID: 34137712.
2.Gore M, Bansal K, Jadhav N. Menetrier Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [updated 2023 Jun 25].

Disclosure

No conflicts

Introduction

Colonic diverticulosis is a prevalent gastrointestinal condition that is often diagnosed incidentally. However, its association with chronic polyps and rectal hemorrhoids remains underexplored, particularly in the northern region of Saudi Arabia.

Aims & Methods

This study aimed to assess the relationship between colonic diverticulosis and colonic conditions while considering demographic and clinical factors. This retrospective observational study was conducted at a tertiary referral center over four years. Data from 4,014 patients who underwent colonoscopy were analyzed. Statistical tests, including chi-square and independent sample t-tests, were used to determine associations between diverticulosis, polyps, hemorrhoids, and bowel preparation adequacy.

Results

Diverticulosis was observed in 14.2% of the patients, with a higher prevalence among males (16.1%) than among females (12.1%) (p < 0.001). Patients with diverticulosis were significantly older (mean age 61.35 years) than those without diverticulosis (mean age 48.25 years) (p < 0.001). Hemorrhoids were more frequent in patients with diverticulosis (18.6%) than in those without diverticulosis (11.9%) (p < 0.001). A similar association was found between diverticulosis and polyps, with the polyp prevalence being higher in patients with diverticulosis (21.4%) than in those without (11.7%) (p < 0.001). Additionally, inadequate bowel preparation was more common among patients with diverticulosis (17.1%) than among those with adequate bowel preparation (13.6%) (p = 0.023).

Conclusion

This study highlights a significant association between colonic diverticulosis and the presence of polyps and hemorrhoids. Older age and male sex were identified as the key risk factors. These findings emphasize the importance of targeted screening and optimized bowel preparation in at-risk patients. Further research is required to explore the underlying pathophysiological mechanisms and to develop preventive strategies.
Keywords: Diverticulosis; Hemorrhoids; Chronic Polyps

References

1 Nallapeta NS, Farooq U, Patel K. Diverticulosis. StatPearls. Treasure Island (FL): StatPearls Publishing 2025.
2 Tursi A, Scarpignato C, Strate LL, et al. Colonic diverticular disease. Nat Rev Dis Primers. 2020;6:20. doi: 10.1038/s41572-020-0153-5

Introduction

In Germany, screening colonoscopy has been offered to all adults aged 55 or older since 2002. In parallel to screening colonoscopy, fecal occult blood testing is offered (Guaiac test until 2017, fecal immunochemical test afterwards) and, in addition, there is a high use of diagnostic colonoscopies. In view of this context, we aimed to quantify the effectiveness of screening colonoscopy in reducing colorectal cancer (CRC) incidence in Germany in men and women aged 55–69 years.

Aims & Methods

Using a German claims database (GePaRD, 20% population coverage) we included persons at average CRC risk aged 55–69 years and without a colonoscopy, polypectomy or fecal occult blood test before baseline. We emulated a target trial with two arms: Colonoscopy screening vs. no colonoscopy screening at baseline. We estimated adjusted cumulative CRC incidence over 11 years of follow-up stratified by sex (at the time of the conference, 14-year follow-up data will be available).

Results

Overall, we included 99,101 men (women: 99,288) in the screening arm and 583,861 men (women: 664,052) in the control arm. In men, the adjusted 11-year CRC risk was 1.89% in the screening group and 2.85% in the control group resulting in a relative risk of 0.66 (95% CI: 0.63–0.73). In women, the adjusted 11-year CRC risk was 1.31% in the screening group and 1.96% in the control group resulting in a relative risk of 0.67 (95% CI: 0.63–0.73).

Conclusion

Our study shows that screening colonoscopy in Germany is effective in preventing CRC both in men and women. In the interpretation of the strength of the effect (~33% incidence reduction), the high background prevalence of diagnostic colonoscopy should be considered. As previously shown, screening colonoscopy accounts for less than half of the overall 10-year prevalence of colonoscopy in persons aged 55-69 years in Germany.

Introduction

Acute variceal bleeding (AVB) is a common and life-threatening complication of cirrhosis and portal hypertension. Despite advances in therapeutic strategies, the 6-week mortality rate remains high, ranging from 10% to 20%. Current clinical guidelines recommend standard treatment for cirrhotic patients with AVB, including vasoactive agents, prophylactic antibiotics, and endoscopic intervention. However, real-world clinical practices are often influenced by physician awareness, institutional resources, and patient preferences. In late 2019, West China Hospital of Sichuan University established a multidisciplinary rapid-response pathway for the emergency management of high-risk upper gastrointestinal bleeding (UGIB). This initiative aimed to improve the treatment protocol, integrate endoscopic and interventional resources, and finally improve the outcomes.

Aims & Methods

The present study evaluates the impact of this rapid-response pathway on clinical outcomes in cirrhotic patients with AVB. This retrospective study included consecutive patients admitted for acute UGIB to West China Hospital between January 2016 and November 2022. Inclusion criteria were: (1) cirrhosis; and (2) presentation with hematemesis and/or melena within five days before admission. Exclusion criteria included: (1) non-variceal bleeding or an unconfirmed bleeding source on endoscopy; and (2) less than six weeks of follow-up. Patients were categorized into two groups based on the timing of rapid-response pathway implementation: Group A (2016–2019, pre-implementation) and Group B (2020–2022, post-implementation). Primary outcomes were 6-week mortality and 5-day treatment failure. Propensity score matching (PSM) was applied to adjust for baseline confounders: a 1:1 PSM was used to compare Group A and B.

Results

A total of 1,529 cirrhotic patients with AVB were included. Following 1:1 PSM, Groups A and B comprised 654 patients each. The most common etiology of cirrhosis is chronic hepatitis B virus infection. No significant intergroup differences were observed in Child-Pugh score, MELD score, MELD-Na score, prevalence of PVT, HCC, infection, ascites, or hepatic encephalopathy (all P > 0.05). Group B had a higher rate of prophylactic antibiotics, early endoscopic or interventional treatment use, and less balloon tamponade and intubation. Group B demonstrated significantly lower 6-week mortality compared to Group A [52 (8.0%) vs. 88 (13.5%), P = 0.001]. Multivariate Cox regression identified Child-Pugh score (HR = 1.203), MELD-Na score (HR = 1.040), PVT (HR = 1.733), HCC (HR = 2.398), and 5-day treatment failure (HR = 4.385) as independent risk factors for 6-week mortality. Similarly, Group B exhibited a significantly reduced 5-day treatment failure rate [64 (9.8%) vs. 137 (20.9%), P < 0.001]. While no significant differences in overall 6-week mortality or 5-day treatment failure were observed between the PVT and non-PVT groups, patients with coPVT had significantly higher 6-week mortality compared to non-PVT patients (HR = 4.81).

Conclusion

The implementation of a multidisciplinary rapid-response pathway significantly improved early intervention, endoscopy utilization, and TIPS procedures in cirrhotic patients with AVB. These changes were associated with marked reductions in both 6-week mortality and 5-day treatment failure. Key independent predictors of 6-week mortality included Child-Pugh score, MELD-Na score, HCC, PVT, and 5-day treatment failure.