Introduction

Portal hypertension is a major complication of advanced chronic liver disease (ACLD) and is associated with gastro-oesophageal varices, a leading cause of morbidity and mortality. The British Society of Gastroenterology (BSG) recommends oesophagogastroduodenoscopy (OGD) for variceal screening in all patients with cirrhosis, which could result in a high volume of unnecessary procedures. Given increasing demands on NHS services and the need for cost-effective resource allocation, strategies to reduce unnecessary endoscopy are critical.
The Baveno VI and VII consensus workshops propose non-invasive criteria to optimise variceal screening. Baveno VI suggests that patients with a liver stiffness measurement (LSM) less than 20 kPa and a platelet count greater than 150×10⁹/L can safely avoid OGD. Baveno VII further refines this by recommending non-selective beta-blocker (NSBB) therapy in patients with clinically significant portal hypertension (CSPH), defined as LSM greater than 25 kPa, thereby eliminating the need for screening endoscopy in this group. For patients not clearly stratified by Baveno VI or VII criteria, splenic stiffness measurement (SSM) offers an additional non-invasive tool to refine risk assessment. Incorporating SSM in this intermediate-risk group may further reduce the need for OGD, with recent data showing a high negative predictive value for ​ruling out high-risk varices.

Aims & Methods

We aim to quantify the reduction in endoscopy burden achieved by applying Baveno VI and VII criteria in ACLD patients.
A retrospective analysis was conducted on 1,703 patients who underwent 1,802 FibroScans between January 1, 2024, and December 31, 2024. Patients were stratified based on LSM and platelet counts into the following categories:
1. BSG Criteria: All patients with LSM ≥10 kPa requiring OGD.
2. Baveno VI Criteria: Patients with LSM <20 kPa and platelet count ≥150×10⁹/L, for whom OGD could be safely avoided.
3. Baveno VII Criteria: Patients with CSPH (LSM ≥25 kPa) recommended for NSBB therapy without the need for screening OGD.
4. Patients requiring OGD: Those not meeting Baveno VI criteria and without CSPH.

Results

Liver stiffness distribution:
• <10 kPa: 1,534 patients
• 10–14.9 kPa: 136 patients
• 15–19.9 kPa: 44 patients
• 20–24.9 kPa: 31 patients
• ≥25 kPa: 57 patients
Impact of Adopting Baveno VI and VII:
• BSG Guidelines: 274 patients (LSM ≥10 kPa) would require OGD.
• Baveno VI: 149 patients (LSM <20 kPa, platelets ≥150) could avoid OGD.
• Baveno VII: 57 patients (LSM ≥25 kPa) would be managed with NSBB, avoiding OGD.
• Total Reduction: 206 out of 274 patients (~75%) could avoid OGD.

Conclusion

Adopting Baveno VI and VII criteria would significantly reduce the need for variceal screening endoscopy in ACLD patients. By applying these thresholds, up to 75% of OGDs could be avoided, optimising NHS resources and reducing patient burden. These findings support the routine use of non-invasive risk stratification in ACLD management.

References

1. Tripathi D, Stanley AJ, Hayes PC, et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015;64(11):1680–1704. doi:10.1136/gutjnl-2015-309262
2. de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VI Consensus Workshop: Stratifying risk and individualizing care for portal hypertension. J Hepatol. 2015;63(3):743–752. doi:10.1016/j.jhep.2015.05.022
3. de Franchis R, Bosch J, Garcia-Tsao G, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959–974. doi:10.1016/j.jhep.2021.12.022

Introduction

Systemic sclerosis (SSc) is a rare and complex autoimmune disorder characterized by fibrosis of the skin and internal organs, as well as vasculopathy. The disease can be classified into two main subtypes: diffuse and limited. The diffuse subtype is more frequently associated with significant internal organ fibrosis. In the Asia-Pacific region, Thailand has the highest prevalence of systemic sclerosis, with an incidence of 24.4 per 100,000 population. Gastrointestinal involvement occurs in over 90% of patients with SScwith esophageal involvement being particularly common. Among these, gastroesophageal reflux disease (GERD) is present in approximately 80% of SSc patients. Erosive esophagitis (EE), a severe form of GERD characterized by the erosion of esophageal mucosa, is observed in about 80% of GERD cases. Its severity is classified according to the Los Angeles classification (grades A to D), with 30% of cases classified as severe (Los Angeles grades C and D). Proton pump inhibitors (PPIs) are currently the standard treatment for GERD and EE in SSc patients. However, fewer than 50% of patients demonstrate adequate response to PPIs therapy, highlighting the need for alternative treatments. Vonoprazan, a novel potassium-competitive acid blocker (PCAB), has emerged as a potent and longer-acting alternative to traditional PPIs. It has shown superior efficacy in treating severe erosive esophagitis in the general population. Previous cohort studies have demonstrated promising results with vonoprazan in improving symptoms and healing rates in SSc patients with refractory GERD up to 60% in refractory GERD; However, randomized controlled trials evaluating its efficacy in this population remain limited. This study aims to conduct a randomized controlled trial comparing the efficacy of vonoprazan and PPIs in treating erosive esophagitis in SSc patients.

Aims & Methods

The aim was to compare the efficacy of vonoprazan and lansoprazole in healing erosive esophagitis in patients with systemic sclerosis.
A randomized placebo-controlled trial was conducted in patients with systemic sclerosis (SSc) and refractory GERD who had erosive esophagitis confirmed by endoscopy. Participants were recruited from the systemic sclerosis clinic at Srinagarind Hospital, Khon Kaen University, from June 2024 to March 2025. Patients were randomized to receive either vonoprazan 20 mg once daily or lansoprazole 30 mg once daily for 8 weeks. The primary outcome was the percentage of healing at 8 weeks. Secondary outcomes included improvement in gastro-esophageal reflux disease (GERD) symptoms, as assessed by the Frequency Scale for the Symptoms of GERD (FSSG), GERD Questionnaire (GerdQ), and visual analogue scales (VAS) for heartburn and regurgitation.

Results

A total of 48 patients were enrolled in the study. The healing rates for vonoprazan and lansoprazole were 73.9% and 39.1%, respectively, resulting in an absolute risk reduction of 0.348 (95% CI: 0.081–0.614; p-value: 0.017). Subgroup analysis of patients with severe erosive esophagitis, defined as Los Angeles (LA) grades C-D, demonstrated that vonoprazan was superior to lansoprazole (75% vs. 33.3%; absolute risk reduction: 0.52; 95% CI: 0.167–0.873; p-value: 0.008). No significant difference was observed between the two treatments in patients with LA grades A-B.

Conclusion

Preliminary data suggests that vonoprazan was superior to lansoprazole in the healing of erosive esophagitis in systemic sclerosis patients, with this benefit being particularly evident in cases of severe erosive esophagitis (LA grades C-D).

References

1. Volkmann ER, Andréasson K, Smith V. Systemic sclerosis. Lancet. 2023 Jan 28;401(10373):304–18.
2. Foocharoen C, Ngamjarus C, Pattanittum P, Suwannaroj S, Pongkulkiat P, Onchan T, et al. Incidence and prevalence of systemic sclerosis in Thailand in year 2017-2020: a database from the Ministry of Public Health. Clin Rheumatol. 2023 Jul;42(7):1767–74.
3. Emmanuel A. Current management of the gastrointestinal complications of systemic sclerosis. Nat Rev Gastroenterol Hepatol. 2016 Aug;13(8):461–72.
4. McMahan ZH. Gastrointestinal involvement in systemic sclerosis: an update. Curr Opin Rheumatol. 2019 Nov;31(6):561–8.
5. Roth E, Bruni C, Petelytska L, Becker MO, Dobrota R, Jordan S, et al. Gastroesophageal reflux disease is associated with a more severe interstitial lung disease in systemic sclerosis in the EUSTAR cohort. Rheumatology. 2025 Jan 8;keaf016.
6. Denaxas K, Ladas SD, Karamanolis GP. Evaluation and management of esophageal manifestations in systemic sclerosis. Ann Gastroenterol. 2018;31(2):165–70.
7. Chunlertrith K, Noiprasit A, Foocharoen C, Mairiang P, Sukeepaisarnjaroen W, Sangchan A, et al. GERD questionnaire for diagnosis of gastroesophageal reflux disease in systemic sclerosis. Clin Exp Rheumatol. 2014;32(6 Suppl 86):S-98-102.

Introduction

A successful colonoscopy aims to thoroughly visualize the entire colon, including the terminal ileum, to maximize the detection of lesions and effectively screen for colorectal cancer. However, approximately 10% of colonoscopies are incomplete, often due to a combination of technical challenges and patient-related factors. The goal of our study is to identify and analyze the factors that contribute to incomplete colonoscopy procedures.

Aims & Methods

We conducted a retrospective descriptive and analytical study including all patients who underwent a colonoscopy between January 2019 and August 2024. Patients known to have chronic inflammatory bowel disease (IBD) were excluded from our study. An incomplete colonoscopy was defined as non-visualization of the caecum.

Results

Out of 1,518 colonoscopies performed, 105 (11.5%) were deemed incomplete. Factors associated with incomplete colonoscopy included older age (p=0.003), male sex (p=0.026), history of abdominal surgery (p<0.001), constipation (p=0.001), diarrhea (p=0.002), rectal bleeding (p=0.006), and poor bowel preparation (p=0.001). Multivariate analysis revealed that factors linked to incomplete colonoscopy included: a history of abdominal surgery (OR: 13.8, 95% CI: 4.2–45.1, p=0.001), poor preparation (OR: 224, 95% CI: 57–884, p=0.001), presence of diarrhea (OR: 0.2, 95% CI: 0.08–0.5, p=0.002), and constipation (OR: 0.33, 95% CI: 0.1–0.7, p=0.007).

Conclusion

In this study, 11.5% of colonoscopies were incomplete. The factors most strongly associated with incomplete procedures were a poor preparation, a history of abdominal surgery, and the presence of diarrhea or constipation.

Introduction

Gallstone disease affects approximately 6% of the global population. Adequate knowledge about gallstone disease among the public can facilitate early medical consultation and enable them to navigate healthcare pathways effectively. In the digital age, patients increasingly turn to the internet for health-related information, with over half of the global population relying on it for access to knowledge.

Aims & Methods

This study aimed to evaluate the quality, readability, usability, and reliability of patient-oriented websites providing information on gallstone disease, using validated assessment tools. The three most widely used search engines, Google, Yahoo, and Bing were searched employing keywords related to gallstone disease. The first 50 search results per keyword per engine were screened. Applying the inclusion and exclusion criteria, 52 websites were selected for detailed analysis. The information was assessed for readability using the Flesch Reading Ease Score (FRES), for usability and reliability using the LIDA tool, and for overall quality using the DISCERN instrument. Statistical analysis was performed using SPSS (v27), with significance set at p < 0.05.

Results

Among the 52 websites analyzed, only sixteen (30.8%) sites had obtained Health on the Net (HON) code certification. The median FRES score of the included websites was 60.5 out of 100 (range: 33-79.6), indicating readability appropriate for readers aged 13–15 years. The median LIDA usability and reliability scores were 40 out of 54 (range: 31–54) and 24.5 out of 51 (range: 10–51), respectively. The median DISCERN score was 69.8 out of 80 (range: 30-80) with 5.8% (n=3) of websites scoring below 50%. A low DISCERN score (≤ 50%) was found in three (5.8%) websites. The DISCERN score was found to be significantly associated with LIDA reliability and LIDA overall scores (p < 0.001), government run websites (p= 0.028) and HON code certification (p = 0.01). However, no significant association was found between DISCERN scores and LIDA usability or FRES. Most websites (86.5%) provided accurate clinical information, but only 76.9% discussed treatment complications.

Conclusion

The quality of online patient information on gallstone disease varied considerably, with only a minority meeting optimal standards for readability and certification. While clinical accuracy was generally satisfactory, gaps remain in presenting treatment risks and maintaining content currency. These findings emphasize the need for improved oversight and standardization of online health content to support patient education and informed decision-making.

References

1. Internet World Stats. Internet world stats: Usage and population statistics, http://www.internetworldstats.com/stats.htm (2013, accessed 16 June 2023).
2. Lee JS, Seo HS, Hong TH. YouTube as a source of patient information on gallstone disease. World J Gastroenterol 2014; 20: 4066–4070.
3. Raptis DA, Sinanyan M, Ghani S, et al. Quality assessment of patient information on the management of gallstone disease in the internet. HPB 2019; 21: 1632–1640.
4. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol 2016; 65: 146–181.

Disclosure

There is no conflict of interest