Introduction

Chronic liver disease, particularly cirrhosis, leads to significant morphological and psychological endocrine changes, which can have an impact on patients' sexual health. Although sexual health is an important parameter of quality of life, it remains little studied in hepatology.

Aims & Methods

The aim of our work is to study the prevalence and degree of sexual dysfunction in male patients with chronic liver disease, and the associated risk factors.
This is a monocentric, comparative, descriptive and analytical study conducted during the year 2023.We included male patients followed for chronic hepatopathies (group 1 (G1)) as well as a control group of subjects followed in gastroenterology consultation presenting no hepatic pathology (group 2(G2)). Exclusion criteria were the existence of overt hepatic encephalopathy, cognitive disorders or active alcohol abuse, limiting the reliability of the survey.
Sexual health was assessed using the IIEF (International Index of Erectile Function) questionnaire, which covers five domains: erection, orgasm, desire, satisfaction with intercourse and overall satisfaction. Two software packages were used for statistical analysis: Jamovi version 2.3.28 and Microsoft Excel.

Results

Our study included 120 patients, 60 followed for chronic liver disease, and 60 without liver pathology (control group).
Mean age was 44.6 years (21-73 years).
In the group of patients with hepatopathies, we found:
34 (65%) cirrhotics, 24 (40%) of whom had a history of decompensation.
18 (30%) HBV, 11(18%) HCV, 5 (8%) NAFLD, 5 (8%) of undetermined cause, 5 (8%) portal hypertension, 4 (6.6%) portal thrombosis, 12 (19.8%) others.
Patients in the liver disease group had more erectile dysfunction, orgasmic dysfunction, disorders of desire, disorders of sexual satisfaction and disorders of overall satisfaction compared with the control group, with respectively 40/60 (66. 6%) vs 16/60 (26.6%) p 0.003; 35/60 (58.3%) vs 14/60 (23.3%) p 0.012; 41/60 (68.3%) vs 10/60 (16.6) p <.001; 38/60 (63.3%) vs 18/60 (30%) p <.001; and 45/60 (75%), vs 17/60 (28.3%) p <.001.
After statistical analysis, cirrhosis was the only statistically significant risk factor for sexual dysfunction in our study (OR 7.9 ;p 0.012).
Moreover, 100% of patients said they had never been asked about their sexual health during a consultation.

Conclusion

Sexual dysfunction is common in patients followed for liver disease, with cirrhosis as the main risk factor. Sexual dysfunction should be systematically screened, with a multidisciplinary approach to the management of these patients.

Introduction

Standard treatment of autoimmune hepatitis (AIH) typically includes a combination of azathioprine and corticosteroids. However, approximately 20% of patients do not respond well to this conventional therapy. In this scenario, mycophenolate mofetil (MMF) may be used as an alternative treatment for patients with intolerance or non-response to first-line options.

Aims & Methods

This study aims to evaluate the performance of MMF in intolerant or non-responders patients with AIH previously treated with conventional therapy. We performed a systematic review in PubMed, Embase, and Cochrane databases. We analyzed overall remission, remission at AZA intolerance, and remission at AZA non-response. We also compared the outcome of overall remission in patients with AZA intolerance vs. AZA non-response. Statistical analyses were performed using R language 4.3.1.

Results

21 studies and 646 patients were included. The pooled overall remission rate was 62.21 (95% CI 54.31, 70.10). We found an overall remission rate of 66.74 (95% CI 57.48, 76.00) in patients intolerant to AZA, and 27.80 (95% CI 11.56, 44.04) in AZA non-responders. The comparison of overall remission in both groups favored the intolerance group (OR 4.98; 95% CI 1.69, 14.72; p = 0.004).

Conclusion

MMF is effective in inducing remission in patients with AIH who failed the first-line treatment. The overall effect is more prominent in patients who failed conventional therapy due to intolerance. Non-response to AZA may be correlated to suboptimal response to MMF as well.

Introduction

The prevalence of musculoskeletal disorders (MSD) among gastroenterologists is estimated between 39 to 89%. Factors associated with MSDs among endoscopists include a high number of procedures (over 20/week), prolonged procedure times (over 16 hours/week), the age of the endoscopist (> 40 years vs ≤ 40 years), and female sex.
This study aimed to evaluate the prevalence of MSD among French gastroenterologists and identify risk factors of MSD

Aims & Methods

A computerized, anonymized questionnaire was e-mailed to all members of French society of endoscopy (SFED) over a one-month period. Demographic data were collected, as well as the level of endoscopic activity performed, the quantity and volume of endoscopies performed per week, the presence of pain associated with the practice of endoscopy, and an assessment of stress.

Results

485 gastroenterologists responded to the questionnaires, the majority were male (55%), with a median age of 48 years (IQR 37–60), and 45.6% practiced endoscopy for more than 20 years. 74.3% of respondents worked full-time, mostly in private practice (47% in private practice, 13% in mixed public-private practice). Endoscopy was performed for a median of 15 hours per week (IQR 10–18.8), with 24 procedures per week (IQR 15–30).
76.3% of participants had already experienced joint and/or musculoskeletal pain related to work. Pain complaints mainly concerned the lower back (55%), shoulders (36% left, 37% right%), neck (50%), and wrists (30% both side). More than half of the participants (55.9%) reported that the pain persisted after procedures, with 17.8% experiencing nocturnal pain and about a quarter reporting pain lasting more than 3 months.
The impact of MSD on workload was evaluated. 5.1% of the gastroenterologists reported loss of efficiency, 3,8% adapted their job, 2.4% decreased their activity, and 2.1% had work stoppage. 35% declared to have management of their MSD (28.1% painkiller, 23.2% reeducation, 3.5% surgery). To reduce discomfort, 74.7% of respondents reported using an adjustable-height examination table, and half adjusted the height and distance of the screen.
In multivariate analysis, factors associated with MSD were, femal sexe (OR 1.85 (1.15-3.01) p = 0.012, number of endoscopy (OR 1.05 (1.01-1.11) p=0.03, activity > 20 years (OR 2.42 (0.89, 6.47) p=0.079.) The risk of MSD was higher after 16.5 hours of endoscopy/ week (Se 35%, Sp 83%).

Conclusion

Musculoskeletal pain among French gastroenterologists is common and concerning. Therefore, it is essential to develop preventive programs to support their health and ensure the quality and safety of care.

Introduction

Acute esophageal variceal bleeding (EVB) typically requires initial treatment involving pharmacotherapy and endoscopy, particularly endoscopic variceal ligation (EVL). In cases of rebleeding, transjugular intrahepatic portosystemic shunt (TIPS) is recommended, but in regions with limited TIPS access, repeated endoscopic therapy is common. This study evaluates the outcomes of EVL in managing rebleeding and mortality in resource-constrained settings.

Aims & Methods

Patients experiencing acute EVB and undergoing EVL were followed for up to five years or until death. Treatment involved vasoactive drugs and EVL until variceal eradication was achieved. Primary endpoints included bleeding control effectiveness and the need for a second EVL session to manage rebleeding. Rebleeding and mortality rates at 6 weeks and 5 years were analyzed. Logistic regression analysis identified risk factors associated with rebleeding and mortality.

Results

Among 118 patients with acute EVB undergoing EVL, no treatment failures occurred within five days. Eighty-three percent were successfully controlled with one EVL session, while 17% required at least two sessions for recurrent bleeding. In the rebleeding group, no patients rebled within five days after the first EVL, but 75% rebled within 6 weeks. Second EVL was performed for these patients, with a failure rate of 25%. Recurrent EVBs were ultimately controlled by other endoscopic therapy. There was no significant difference in 6-week mortality between rebleeding (15%) and non-rebleeding (18%) groups (p=0.72). Factors associated with 6-week mortality included age, hepatocellular carcinoma, post-bleeding beta-blocker use, creatinine, bilirubin, albumin, Child-Pugh class, and MELD score (Table). Beta-blocker use was associated with preventing recurrent EVB within six months (OR 0.053, 95% CI: 0.004-0.687, p = 0.025). Over five years, the rebleeding group showed a higher mortality trend (90%) compared to the non-rebleeding group (68.8%), though not statistically significant (p=0.06).

Conclusion

In resource-limited settings, multiple attempts of EVL demonstrate success in controlling rebleeding. Long-term trends indicate higher mortality in rebleeding cases, although not statistically significant.

Disclosure

The authors declare that they have no conflict of interest.

Introduction

Esophageal varices (EV) are a critical complication of portal hypertension in patients with cirrhosis, and early detection is essential to prevent potentially life-threatening hemorrhage. The Baveno VII consensus recommends performing endoscopy in patients with transient elastography (TE) values exceeding 20 kPa and platelet counts below 150,000/mm³. While endoscopy remains the gold standard for diagnosis, non-invasive tests are gaining importance as a promising alternative for predicting EV(1) .The objective of our study is to predict the grade of varices in cirrhotic patients using a score derived from both their biological blood test results and clinical parameters.

Aims & Methods

The objective of our study was to predict the grade of varices in cirrhotic patients using a score derived from their biological blood test results and clinical parameters. This retrospective study involved patients recruited from Hôtel-Dieu de France, with data collected a few months prior to their gastroscopy for esophageal varices detection.
We calculated the ALBI-PLT score based on the method described by Inoue-Yuri et al.(2). The modified ALBI-PLT (mALBI-PLT) score was derived from the mALBI grade, assigning 1 point for grades 1 or 2a, and 2 points for grades 2b or 3. It also incorporated platelet counts, awarding 1 point for counts greater than 150,000/μL and 2 points for counts of 150,000/μL or lower. In addition to the mALBI-PLT score, we considered various variables, including blood test results and established predictive scores such as Child-Pugh, MELD-Na, FIB-4, and APRI.

Results

This study analyzed 108 cirrhotic patients (mean age: 63.94 years, 64.8% men, 33.03% had hepatocellular carcinoma (HCC)) out of 115 recruited, excluding cases with missing data. Key predictors of varice grades included lymphocyte count (L, β = −0.43, p = 0.011) and sodium (Na^10, β = −3.22 × 10^−22, p = 0.005) as significant negative associations. Positive associations were observed for the modified ALBI-platelet score (β = 0.43, p < 0.001), HCC (β = 0.51, p = 0.005), and gastrointestinal (GI) bleeding (β = 0.48, p = 0.013).
A derived formula for predicting varice grades is: VariceGrade = 3.49 − 0.43×ln(L) + 0.43×mALBI-PLT score − 3.22×10^−22×Na^10 + 0.51×HCC + 0.48×GI Bleeding.
The model showed strong specificity (94.5%) for identifying varices when the score was ≥ 1 and high sensitivity (97.8%) for excluding grade 3 varices when the score was ≤ 2.

Conclusion

This study introduces a non-invasive scoring system to accurately stratify esophageal varices severity, optimizing clinical decision-making and endoscopic screening in cirrhotic patients.

References

(1) de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C, Baveno VII Faculty. Baveno VII—Renewing consensus in portal hypertension. J Hepatol. 2022;76:959–974. doi: 10.1016/j.jhep.2021.12.022.
(2) Inoue-Yuri M, Enomoto H, Wakabayashi I, Yuri Y, Aizawa N, Ikeda N, Takashima T, Fujiwara A, Yoshioka R, Kawata S, Yoshihara K, Ota S, Nakano R, Shiomi H, Nishimura T, Nishiguchi S, Iijima H. Modification of the ALBI-PLT Score for the Prediction of High-risk Varices. In Vivo. 2022 May-Jun;36(3):1360-1366. doi: 10.21873/invivo.12839. PMID: 35478164; PMCID: PMC9087093.