Introduction

Functional dyspepsia (FD) is a commonly occurring functional gastrointestinal disorder, increases the number of clinical consultations and tests, significantly decrease quality of life and has a significant socioeconomic impact. FD is subdivided into postprandial distress syndrome (PDS), which is characterized by the presence of postprandial fullness and/or early satiety, and epigastric pain syndrome (EPS), which is characterized by the presence of epigastric pain and/or epigastric burning. Different pathophysiological mechanisms have been suggested to underlie the symptoms presented in these syndromes. Evidence suggests alterations in gastrointestinal motility, visceral hypersensitivity, permeability may play a role.

Aims & Methods

In this study, we aimed to studied the differences in gastric motility between healthy controls and PDS, and between healthy controls and EPS using cine magnetic resonance imaging (MRI). This study was a prospective interventional study. From January 2021 to May 2022, patients diagnosed with FD according to the ROME IV diagnostic criteria but who were non-adherent to prescribed medications that affect intestinal peristalsis, including laxatives, bowel regulators, and gastric peristalsis regulators, were studied prospectively. Cine MRI was performed before and after the test meal. Gastric short diameter, amplitude, contraction frequency, peristaltic wave height, peristaltic wave velocity, and gastric motility index (GMI) were evaluated in each group, and comparisons were made between the PDS group and healthy controls and between the EPS group and healthy controls.

Results

The numbers of subjects (controls/PDS/EPS) were 49 (18/22/9) patients. The mean(±standard deviation) age was 46.9±21.3 (32.9±14.1/59.1±20.4/45.1±18.8) years. The male-to-female ratio was 24:25 (12:6/9:13/3:6). The mean BMI was 22.0±3.3 (23.1±14.1/20.4±2.1/22.3±2.8). In the pre-prandial state, there were no significant differences in any of the findings in the PDS or EPS groups compared to the healthy controls. In the post-prandial state, there was no significant difference in maximum short diameter between the PDS group and healthy controls. However, the PDS group compared to the healthy controls showed increased amplitude of the fornix [PDS/controls) 12.1±4.3/7.3±5.1 (p=0.002)] and reduced contraction frequency [2.7±0.5/2.9±0.3 (p=0.003)], peristalsis wave height [9.2±2.5/14.9±4.0 (p<0.001)], and GMI 16.8±6.1/24.5±7.1 (p=0.001)]. The EPS group compared to the healthy controls showed no significant differences in maximum short diameter and amplitude, but had reduced contraction frequency [EPS/controls: 2.6±0.2/2.9±0.3 (p=0.027)], peristalsis wave height [9.5±3.2/14.9±4.0 (p=0.001)], and GMI [15.9±6.3/24.5±7.1 (p=0.009)].

Conclusion

In the pre-prandial state, analysis of gastric peristalsis using cine MRI showed no differences between the PDS group and healthy controls or between the EPS group and healthy controls. In the post-prandial state, both the EPS and PDS groups showed significant decreases in contraction frequency, peristaltic wave height, and GMI compared to the healthy controls, indicating reduced gastric peristalsis. Furthermore, the amplitude of the fornix was increased in the PDS group compared to the healthy controls, suggesting that it is possible to evaluate post-prandial gastric adaptive relaxation by cine MRI.

Introduction

Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis. Indeed, several risk stratification scores have been developed to anticipate early detection in order to better codify their management, including the Toronto Hepatocellular Carcinoma Risk Index (THRI). It is a simple and validated tool that has been developed to predict the risk of HCC in patients with cirrhosis and is mainly based on the following parameters: etiology, age, sex and platelet count.
The objective of this study was to evaluate the reliability of the THRI score in predicting the occurrence of hepatocellular carcinoma.

Aims & Methods

We conducted a monocentric retrospective study collecting all cirrhotic patients over an 8-year period [2008-2015]. Clinico-biological data, disease severity, and long-term outcomes were collected.
THRI was calculated for all patients, and were classified according to HCC risk into three levels : low HCC risk (<120), intermediate HCC risk (between 120 and 240), and those with high HCC risk (>240).
A statistical study using the SPSS tool was carried out. The performance of this score was evaluated with the area under the receiver operating characteristics curve (AUROC).

Results

We included 120 cirrhotic patients with an M/F sex ratio equal to 0.5. The mean age was 57 years [14-85]. The most frequent aetiology of cirrhosis were viral C (49%) and viral B (31%). The mean overall survival was approximately 6 years after diagnosis.
Twenty-five patients developed HCC during follow-up (20.8%). Patients who developed HCC had a higher THRI score than those who did not develop HCC : 264.8 ± 48.6 versus 232.3 ± 64.8, respectively with p-value = 0.008
Patients with a low risk of HCC were 5 (4.2%), none of whom had developed HCC. Fifty-eight patients (48.3%) were at intermediate risk, 12% of them (N=7) had developed HCC. The remaining 57 patients (47.5%) were at a high risk and 31.6% of them (N=18) developed HCC during their follow-up.
The AUROC for the THRI to predict HCC was 0.649 ([95% CI 0.533–0.765]. The cutoff THRI value in predicting the occurrence of HCC was 235.5 with a sensitivity of 72% and a specificity of 50%.

Conclusion

According to our study, the THRI score appears to be an effective tool for predicting the occurrence of HCC in cirrhotic patients. Its good sensitivity allows to identify the high-risk HCC population for early screening.

Introduction

Aims & Methods

Results

Conclusion