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Introduction

Primary biliary cholangitis (PBC) is an immune-mediated cholestatic liver disease characterized by progressive destruction of the small intrahepatic bile ducts, leading to fibrosis and eventually cirrhosis. Previous studies demonstrated a high proportion of depression in patients with PBC. Accumulating evidences have shown that depression is associated with the severity of liver diseases and some extrahepatic autoimmune diseases (EHAIDs). Compared to general population, the prevalence of depressive symptoms in patients with cirrhosis is higher (18-58% vs. 10%). Moreover, cirrhotic patients with depression experience worse clinical outcomes. A diagnosis of depression before liver transplantation is related to reduced survival after transplantation. Antidepressant mirtazapine correlated with the reduced incidence of decompensated cirrhosis, liver transplantation and decreased mortality in patients with PBC. Therefore, it is important to screen for depression, and the effect of depression on patients with PBC remains to be fully elucidated.
Previous studies demonstrated that HLA alleles were closely related to PBC susceptibility. DRB1*08:03, DRB1*07:01, and DPB1*17:01 conferred an increased risk to PBC among Chinese populations. In another study, DRB1*07:01, 14:01 and 14:05 were the major predisposing alleles for PBC in China. Among Europeans, DRB1*08 was demonstrated to be a risk factor for PBC. HLA-DRB1 alleles were also associated with cirrhosis in patients with autoimmune hepatitis (AIH), autoimmune sclerosing cholangitis (ASC), and chronic hepatitis C. However, DRB1*11 and DRB1*13 were associated with a reduced risk of developing PBC. DRB1*11:01 was also demonstrated to be protective in post-traumatic stress disorder, bipolar affective disorders, and depression of early undifferentiated arthritis. In summary, it is helpful to explore the effect of HLA-DRB1 alleles on depression and further cirrhosis in patients with PBC.

Aims & Methods

A comorbid depression is common in patients with primary biliary cholangitis (PBC), of which the role in disease progression remains unclear. Genetic predisposition such as human leukocyte antigen (HLA)-DRB1 alleles are reported to be linked with both depression and PBC. For better management of PBC, it is pivotal to establish a risk model for cirrhosis that takes depression and HLA-DRB1 alleles into account. In this study, patients with PBC and healthy controls were evaluated for depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9). Patients with PBC were divided into a model (n = 141) and validation cohort (n = 51). Further, we designed our study to determine the role of depression in treatment response, as well as the effect of depression and HLA-DRB1 alleles on cirrhosis.

Results

In detail, depression was observed to be a common phenomenon in patients with PBC (76/141, 53.9%), and positively associated with levels of alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), and Immunoglobulin (Ig)M in serum. HLA-DRB1*03:01 allele, which was more common in PBC patients with depression than those without, increased the risk of cirrhosis in patients with PBC (odds ratio [OR], 5.676; p < 0.001). Importantly, our study showed that PHQ-9 score, HLA-DRB1*03:01 allele, and other factors (age and level of ALP), were determined as risk factors for cirrhosis in patients with PBC by logistic analysis. Consistent with the logistic regression model, the elevated PHQ-9 score (>= 3.5) was calculated as a discriminating risk factor for cirrhosis in decision tree model.

Conclusion

In conclusion, the depressive symptom was associated with poor treatment response and was a risk factor for cirrhosis in patients with PBC. These results highlight the important clinical significance of the identification and management of depression in patients with PBC.

DEPRESSION AS A RISK FACTOR FOR CIRRHOSIS IN PATIENTS WITH PRIMARY BILIARY CHOLANGITIS: A DECISION TREE-BASED RETROSPECTIVE COHORT STUDY

Liping Guo 1, Simin Zhou 1, Lu Zhou 1

1 Tianjin Medical University General Hospital, Tianjin, China

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Mistakes In Articles

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Alcohol consumption is the most prevalent aetiology for liver cirrhosis in Europe and the third leading risk factor for overall mortality.1,2 In fact, alcoholic liver cirrhosis accounts for almost half a million deaths a year worldwide, corresponding to 50% of all cases of cirrhosis, according to the World Health Organization (WHO).3 Alcoholic liver disease (ALD) is multifaceted, with several cofactors influencing its progression. Patients abusing alcohol can simultaneously have viral hepatitis B or C, or a genetic disease, such as alpha-1 antitrypsin deficiency or haemochromatosis.

Mistakes in alcoholic liver disease and how to avoid them

Helena Cortez-Pinto, Pedro Marques Da Costa

Topics

Hepatobiliary

Citation

Marques da Costa P and Cortez-Pinto H. Mistakes in alcoholic liver disease and how to avoid them. UEG Education 2017: 17; 10–14.

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Non-invasive tests are increasingly being used to improve the diagnosis and prognostication of chronic liver diseases across aetiologies. Herein, we provide the latest update to the EASL Clinical Practice Guidelines on the use of non-invasive tests for the evaluation of liver disease severity and prognosis, focusing on the topics for which relevant evidence has been published in the last 5 years.

EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Citation

Journal of Hepatology, Volume 75, Issue 3, 659 - 689

Published

2021

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Background

Variation exists in practice pertaining to bowel preparation before minimally invasive colorectal surgery. A survey of EAES members prioritized this topic to be addressed by a clinical practice guideline.

Objective

The aim of the study was to develop evidence-informed clinical practice recommendations on the use of bowel preparation before minimally invasive colorectal surgery, through evidence synthesis and a structured evidence-to-decision framework by an interdisciplinary panel of stakeholders.

Methods

This is a collaborative project of EAES, SAGES, and ESCP. We updated a previous systematic review and performed a network meta-analysis of interventions. We appraised the certainty of the evidence for each comparison, using the GRADE and CINeMA methods. A panel of general and colorectal surgeons, infectious diseases specialists, an anesthetist, and a patient representative discussed the evidence in the context of benefits and harms, the certainty of the evidence, acceptability, feasibility, equity, cost, and use of resources, moderated by a GIN-certified master guideline developer and chair. We developed the recommendations in a consensus meeting, followed by a modified Delphi survey.

Results

The panel suggests either oral antibiotics alone prior to minimally invasive right colon resection or mechanical bowel preparation (MBP) plus oral antibiotics; MBP plus oral antibiotics prior to minimally invasive left colon and sigmoid resection, and prior to minimally invasive right colon resection when there is an intention to perform intracorporeal anastomosis; and MBP plus oral antibiotics plus enema prior to minimally invasive rectal surgery (conditional recommendations); and recommends MBP plus oral antibiotics prior to minimally invasive colorectal surgery, when there is an intention to localize the lesion intraoperatively (strong recommendation). The full guideline with user-friendly decision aids is available in https://app.magicapp.org/#/guideline/LwvKej.

Conclusion

This guideline provides recommendations on bowel preparation prior to minimally invasive colorectal surgery for different procedures, using highest methodological standards, through a structured framework informed by key stakeholders.

Guideline registration number PREPARE-2023CN045.

Keywords: Bowel preparation, Colorectal surgery, Minimally invasive surgery, Laparoscopic surgery, Guidelines

EAES, SAGES, and ESCP rapid guideline: bowel preparation for minimally invasive colorectal resection

Stavros A. Antoniou

Publisher

European Association for Endoscopic Surgery and other interventional techniques

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology Surgery

Citation

Surg Endosc 37, 9001–9012 (2023)

Published

2023

UEG Mistakes In Articles

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By far the most common risk factors for the development of acute pancreatitis are excessive alcohol consumption and gallstone disease. Several mutations have been identified that, in combination with nongenetic factors or alone, can lead to pancreatitis. Certain drugs are known to be associated with the development of pancreatitis and smoking might also increase the probability of it developing. 80–85% of patients diagnosed with the disease will have mild disease and make an uneventful recovery with little more than adequate fluid therapy and analgesia needed to support them. The remaining patients, however, will suffer from moderately severe to severe acute pancreatitis, with the development of pancreatic necrosis, severe sepsis or abdominal compartment syndrome. These patients are at immediate danger of multiorgan failure and death and require multidisciplinary intensive care, organ support and often pancreatic interventions conducted by experienced investigators. Since it is difficult to predict outcomes and complications develop during the disease course, treatment in specialized centres that have a high case load is recommended.4

Mistakes in the management of acute pancreatitis and how to avoid them

Peter Simon, Markus M. Lerch, Julia Mayerle, Georg Beyer, Elisabeth Orgler-Gasche

Topics

Pancreas

Citation

Beyer G, et al. Mistakes in the management of acute pancreatitis and how to avoid them. UEG Education 2016: 16: 27–30.

Published

2024

UEG Standards and Guidelines

Consensus

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Summary

These recommendations refer to the current management in pancreatic ductal adenocarcinoma (PDAC), a neoplasia characterised by an aggressive course and extremely poor prognosis. The recommendations regard diagnosis, surgical, adjuvant and palliative treatment, with consideration given to endoscopic and surgical methods. A vast majority of the statements are based on data obtained in clinical studies and experts’ recommendations on PDAC management, including the following guidelines: International Association of Pancreatology/European Pancreatic Club (IAP/EPC), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network (NCCN) and Polish Society of Gastroenterology (PSG) and The National Institute for Health and Care Excellence (NICE). All recommendations were voted on by members of the Working Group of the Polish Pancreatic Club. Results of the voting and brief comments are provided with each recommendation.

Keywords: pancreatic ductal adenocarcinoma; recommendations; guidelines; treatment; diagnosis