Introduction

Cirrhosis is characterized by structural and functional hepatic alterations. The associated metabolic imbalances and psycho-neurological factors contribute to the high prevalence of sexual disorders and erectile dysfunction among affected patients. The aim of our study was to identify factors associated with sexual dysfunction in cirrhotic patients.

Aims & Methods

We conducted a prospective cross-sectional study, collecting data from patients followed for cirrhosis at the gastroenterology department of Charles Nicolle Hospital in Tunis over a one-year period. Female sexual function was assessed using the FSFI questionnaire. Female sexual dysfunction was defined by an FSFI score below 26 (or below 20 in post menopausal women). Male sexual function was evaluated using the IIEF-15 questionnaire. Male sexual dysfunction was identified by an IIEF-15 score below 42.9. Erectile dysfunction was confirmed by an IIEF-5 score
below 26. An analytical statistical study was conducted, highlighting factors associated with sexual dysfunction in both female and male patient groups.

Results

We included 55 cirrhotic patients (24 women and 31 men), with a sex ratio (M/F) of 1.29 and a mean age at inclusion of 59.11 ± 12.16 years. Female sexual dysfunction was observed in 70.8% of female patients. Male sexual dysfunction was found in 61.3% of patients. Erectile dysfunction was reported in 74.1% of men. Our study showed that the factors associated with female sexual dysfunction were: low economic status (p = 0.007), the presence of arterial hypertension (p = 0.026), and hepatic disease severity attested by Child-Pugh class B/C and MELD score >15 (p = 0.049 and p = 0.018, respectively). In male patients, a higher prevalence of sexual dysfunction was found among smokers patients (p = 0.045; OR = 0.18; 95% CI [0.03; 1.05]) and them who consumed alcohol (p = 0.042; OR = 0.19; 95% CI [0.04; 0.94]). In multivariate analysis, only alcohol consumption was independently associated with male sexual dysfunction (p = 0.041; OR = 9.187). MELD score >15

Conclusion

In conclusion, our study highlights the high frequency of sexual disorders in cirrhotic patients and identifies several associated factors, notably the severity of liver disease, socioeconomic
status, and certain comorbidities. For these reasons, screening and appropriate management of sexual dysfunction is essential in cirrhotic patients especialy with advanced disease or comorbidities.

Introduction

Management of poscholecystectomy complications has been variably discussed. Various options exist but the recent trend has been towards the endoscopic retrograde approach favoring a simultaneous diagnostic and therapeutic potential.

Aims & Methods

Objetive: A single institution retrospective analysis of 203 with bile duct injuries (BDI) after laparoscopic cholecystectomy (LC). We studied the various endoscopic modalities to evaluate the efficacy of the approach.
Patients and Methods: From January 2005 to January 2025, a retrospective analysis was conducted of 5528 patients referred to the endoscopy department. During this period, 434 were referred after related BDI. These 434 (7,8%) are BDI. 231(53,2%) after open cholecystectomy and 203 (46,8%) after LC, formed the basis for this study. 154 (75,8%) were female and 49 (24,2%) were male, with an average age of 49,1years (range,13-88 years). The clinical presentation of the BDI: jaundice 134 (66,0%); pain 47 (23,1%); fever 79 (38,9%); persistent drainage 75 (36,9%); pruritus 74 (36,4%) and acute biliary pancreatitis 18 (8,8%). ERCP was used in all cases.

Results

There were 103 patients with stricture (26 total transaction and 77 partial) and 64 (31,6%) patients with leaks and 36 (17,7%) had a combination of leaks and stricture. Endoscopic diagnosis was feasible in all cases. Subsequently, 170 (83, 7% ) patients were considered for endotherapy and endoscopic treatment was interrupted in 17 patients, required surgical intervention, success healing was shown in 90% There 64 biliary fistulae: 40 of the cystic stump, 20 of the common hepatic and 2 of the right hepatic and 2 of the left hepatic; 36 (17,7%) biliary fistulae with stenosis (9 complete transaction and 27 partial transaction) and 103 stenosis (26 total transaction and 77 partial). The 35 total transaction required surgical treatment; however two were treated by endoscopies. There was success in the endoscopic treatment of biliary fistulae, which 64 esphincterotomy transpapilar (ETP) and four stents. 27 patients with biliary fistulae with stenosis were 6 ETP; 11 ETP with stents; 8 ETP, dilatation, stents and two ETP with dilatation and two patients need the surgical treatment. 71/77 (92,2%) patients with stenosis could be treated: 34 ETP, stents; 36 ETP, dilatation, stents; and 3 ETP, dilatation. Complications occurred in 6 (3, 5%), perforation (n = 1), mild pancreatites (n=3), and cholangitis (n=2) and 17 patients failed endoscopic treatment.

Conclusion

The ERCP in biliary complications of LC is feasible and with good results. It firms as coadjuvant treatment of the definitive surgery and in some situations being the method close for the definitive treatment.

Disclosure

No Conflict of Interest

Introduction

The coexistence of HBV and hepatic steatosis is frequent, but its impact on the progression of liver disease remains poorly characterized and much debated.

Aims & Methods

We aim by this study to determine the prevalence, associated factors, consequences of this association and response to treatment.
A retrospective analysis was conducted over 20 years from 2005 to 2025 on a single-center cohort of 124 patients with chronic HBV, of whom 16.1% (n=20) had steatosis (confirmed by imaging). Demographic, virological, metabolic and histological (fibrosis stage) characteristics were compared between the groups with and without steatosis. And statistical tests (Chi², Mann-Whitney, logistic regression) were used.
For the comparison, we defined:
- Group A: combining steatosis and HBV
- Group B: HBV without steatosis.

Results

The prevalence of steatosis in patients with HBV in our series was 16.1%, with a mean age of 52.1 years higher than that of patients with HBV without steatosis, (45.8 years), with a p-value of 0.02. Furthermore, in our work there was a clear female predominance, with a sex ratio of 3 F/H in group A vs 0.9F/H in group B with a p-value of 0.04.
In the history of our patients, we found that 30% of patients had high blood pressure in group A compared with 18% in group B, 10% had diabetes in group A compared with 8% in the other group, and there was no significant difference in smoking habits (15% compared with 12%). Statistical regression did not find any significant correlation in those signs. On the other hand, in the case of dyslipidemia, there was a slight predominance of group A (15% vs. 10%) with a p-value of 0.045.
The analysis of hepatic test didn’t show any big difference between results of GGT, PAL and ASAT but for ALAT there was a higher in patients with steatosis with a median of 62 vs 52,1 and a p-value of 0,02.
Our study also found no difference in serological results: 95% of patients with steatosis were Hbs Ag positive, with the presence of Hbc Ab in all patients at the time of diagnosis. These results were not very different from those of patients without steatosis (Hbs Ag positive in 96.8% and Hbc Ab positive in all patients). Only 10% of patients had a positive Hbe Ag in group A vs 7.2% in group B. The median viral load before treatment was 1870 UI/ml vs 2450 UI/ml with no real difference noted between the 2 groups, confirmed by statistical regression which found a p=0.82 value.
Our study found no real impact on liver disease, showing no worsening of fibrosis (30% F≥2 with steatosis vs 25% without, p=0.62*).
After analysis using the association Chi² test, our study found similar virological responses under treatment (83% in group A vs 78% in group B, p=0.75*).

Conclusion

In this cohort, steatosis in HBV patients (16.1%) was associated with age and female sex. Hepatic test showed a higher ALAT fold among patient with steatosis. However, higher viral load or more severe fibrosis was not demonstrated. Steatosis in HBV does not appear to have a negative influence on the course of the disease. These results suggest that the management of HBV with steatosis should primarily target virological control, without requiring any specific therapeutic adaptation.

Disclosure

no conflict of interest

Introduction

Diarrhea after cholecystectomy is a well-known complication that worsens the quality of life of the patient and may become a real challenge for the doctor.
Both changes in the bile acids spectrum (BAsS) and possible changes in microbiota and Small Intestinal Bacterial Overgrowth (SIBO) may have a major impact. What is primary in this circle is not fully understood.

Aims & Methods

The aim was to assess BAsS and SIBO in patients prior to cholecystectomy, three and twelve months after cholecystectomy.
Methods: Initially, the bile of the patients was obtained directly from the gallbladder after it was removed during the surgery. For the second and third time, the bile of the same patients after cholecystectomy was obtained in 3 and 12 months postoperatively, after the intubation of the duodenum under ultrasound control. The spectrum of BA was assessed using photocalorimetry. To assess the possible influence of SIBO, all the patients underwent a hydrogen breath test before cholecystectomy, and if SIBO was confirmed, they were not included in the study. Successive hydrogen breath tests were performed 3 and 12 months after cholecystectomy to all the patients who were included. The data were analyzed using parametric and non-parametric methods of evaluating the results through the Statistica program (StatSoft Inc, USA).

Results

14 patients, predominantly women (71.4%) were enrolled in the study. The spectrum of BA three months after cholecystectomy showed a tendency for secondary BA (deoxycholic acid) to predominate over primary BA (cholic acid) (P>0.05). After 12 months, the BAs pool returned to the baseline in most of the patients (P>0.05). SIBO was not registered in patients 3 months after cholecystectomy, but it was detected in 50% of cases (P>0.05) after 12 months.

Conclusion

The predominance of secondary BA in the early postoperative period probably indicates an increase in the number of bacteria, for the transformation of primary BA in the ileum, but the breath test is not sensitive enough to determine this.
Over time, if the equilibrium in a complex mechanism of BA homeostasis is not achieved (the amount of bile in the ileum, bacteria, FXR, etc.), this may lead to the SIBO development.

Introduction

While histo-endoscopic improvement is achieved with Upadacitinib (Upa) treatment of ulcerative colitis (UC), its effect on the inflammatory microenvironment (IME) has yet to be fully resolved. Unlocking quantitative insights of histologic features of the IME has the potential to reveal biomarkers for treatment selection. Here, we assessed machine learning (ML)-derived histologic IME features associated with endoscopic response (ER) using UC biopsies at baseline and induction in two Upa clinical trials.

Aims & Methods

IBD Explore¹ (PathAI, Boston, version 1.3), a suite of ML models previously trained to quantify tissue regions (e.g., epithelium) and cells (e.g., goblet cells), was deployed on hematoxylin and eosin (H&E)-stained whole-slide images (WSI) of baseline and induction biopsies from patients with UC (N=732) enrolled in two clinical trials (NCT02819635, NCT03653026). Human interpretable features (HIFs) were extracted from each WSI and associated with Upa treatment and ER measured at induction (week 8; Mayo Endoscopic score≤1). Analysis of Covariance (ANCOVA) was used to associate change from baseline (CBL) of HIFs with Upa treatment, and logistic regression was used to associate baseline HIFs with ER, using baseline clinical data and total Geboes scores as covariates. Multivariable classification models, using baseline HIFs, were also trained to predict ER in Upa treated patients. Models were trained using 5-fold cross-validation and evaluated on the held-out test set using average predictions across these folds.

Results

ML-derived HIFs (N=402) displayed a significant CBL after Upa treatment, and 193 HIFs were prognostic of ER. These HIFs included fraction of goblet cell mucin area, fraction of normal epithelium, density of goblet cells in epithelium, fraction of infiltrated epithelium relative to all epithelium, fraction of crypts with abscess (CA) + complete granulation tissue (CGT) area relative to mucosa, and density of neutrophils (Table 1). HIFs quantifying the fraction of eosinophils and neutrophils within 20 μm of goblet cells were both independently prognostic and Upa- dependent predictive of ER. Baseline HIFs were also prognostic, as a group, of ER in the treatment group (mean validation AUROC = 0.78, test-set AUROC = 0.84).

Conclusion

Here, using an ML-based approach to assess the UC IME, we identified a significant association between features relating to goblet cells, goblet cell mucin, and immune cells near goblet cells and Upa ER. These findings underscore the importance of granular IME characterization to better understand treatment mechanisms. These results also highlight the potential of histological biomarkers for predicting therapeutic outcomes. Further validation of these potential biomarkers in larger cohorts is necessary.

References

¹IBD Explore is for research use only. Not for use in diagnostic procedures.

Disclosure

PathAI authors are employees at PathAI and holders of company stock. ​
AbbVie authors are employees at AbbVie and holders of company stock