Introduction

The prevalence of type 2 diabetes has more than doubled in the past 20 years, and literature suggests that nearly 90% of diabetes cases are preventable if risk factors are eliminated early. One of these potential risk factors is hypertriglyceridemia. Given the high prevalence of hypertriglyceridemia (which can affect nearly one-third of the population), the link between the two conditions is of crucial importance. Therefore, we aimed to investigate the dose-dependent effect of hypertriglyceridemia on the development of diabetes mellitus.

Aims & Methods

We carried out a systematic search in three databases (MEDLINE, Embase, and CENTRAL) on the 9th of November, 2023 with no restriction. In the final analysis, we investigated adult population with different triglyceride levels (exposure) and our outcome of interest was the development of diabetes mellitus. We calculated pooled odds ratios (OR) with 95% confidence intervals (CIs) and assessed the risk of bias with the Quality In Prognosis Studies (QUIPS) tool. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42023471288.

Results

According to the meta-analysis result of eight cohorts with a total population number of 127431, those who had hypertriglyceridemia had more than a 2-fold higher risk (OR:2.17[CI 1.52-3.10]) of developing diabetes mellitus during the follow-up period than those whose triglyceride levels were below 1.7 mmol/L. Those who had borderline high triglyceride levels at baseline (1.7-2.3 mmol/L) had significantly higher odds of developing diabetes mellitus during follow-up (OR 1.45[CI 1.29-1.63]) according to the data of six cohorts with 36807 patients. Those whose baseline triglyceride levels were higher than 2.3 mmol/L also had significant and even higher odds of the development of diabetes mellitus (OR:2.16 [CI 1.74-2.67]) than patients with normal triglyceride levels, based on the results of 6 cohorts with data on 39068 patients.

Conclusion

Hypertriglyceridemia is a dose-dependent risk factor of diabetes mellitus.

Introduction

Approximately 40% of patients develop diabetes mellitus (DM) after acute pancreatitis (AP). Even a single episode of mild AP confers a two-fold increase in DM risk compared to the general population. Nonetheless, information on risk factors is limited.

Aims & Methods

We aimed to identify risk factors for developing PD or DM following AP.
We conducted a systematic search of three databases Up until September 4, 2023, to get direct, within-study comparisons of risk factors on the incidence of PD and DM in patients with AP. If it was not possible to distinguish the PD and DM incidence rates, we presented it as a composite outcome: PD/DM. The random-effects model was used in the meta-analysis to compute pooled odds ratios (OR) with 95% confidence intervals (CI).

Results

The 61 eligible studies reported on 79 risk factors. The meta-analysis included 50 studies, 76,797 participants and 34 risk factor and outcome pairs. We found that the odds of developing DM was significantly higher if the AP was severe or moderately severe (OR: 2.11; CI: 1.30-3.41), the etiology was alcoholic (OR: 1.82; CI: 1.09–3.04), organ failure occurred (OR: 3.19; CI: 0.55–18.64), the patient had recurrent AP (OR: 1.89; CI: 0.95–3.77), liver cirrhosis (OR: 2.48; CI: 0.18–34.25), chronic kidney disease (OR: 2.10; CI: 1.85–2.38), dyslipidemia (OR: 1.82; CI: 0.68–4.84) or was obese (OR: 1.85; CI: 1.43–2.38). A higher probability of developing PD/DM was linked to severe and moderately severe AP (OR: 4.32; CI: 1.76–10.60), pancreatic necrosis (OR: 5.53; CI: 1.59–19.21) and hypertriglyceridemic AP etiology (OR: 3.27; CI: 0.17–63.91).

Conclusion

A number of factors increase the risk of developing PD or DM following AP, including severe and moderately severe AP, alcoholic and hypertriglyceridemic etiologies, pancreatic necrosis, organ failure, recurrent acute pancreatitis and comorbidities of obesity, chronic kidney disease, liver disease, and dyslipidemia.

Introduction

Pancreatic exocrine insufficiency (PEI) is seen in primary pancreatic disease, but has also been seen in extrapancreatic conditions including celiac disease (CeD). The symptoms of PEI and CeD often overlap, which makes differential diagnosis challenging.

Aims & Methods

We aimed to investigate the prevalence of PEI in CeD in a systematic review and meta-analysis.
We searched five databases: PubMed, Embase, Cochrane, Web of Science Core Collection, and Google Scholar, up until October 21, 2024. The pooled prevalence of PEI in biopsy-confirmed CeD was estimated. The quality of studies was appraised, and results were reported according to the PRISMA guidelines.

Results

We identified and screened the titles and abstracts of 1432 publications, of which 60 were reviewed in full text and 12 were included in the analyses. The overall pooled weighted prevalence of PEI in CeD was 13.5% (95% CI 7.2–21.0). The prevalence was similar among children (14.2%; 95% CI 2.0–32.8) and adults (12.8%; 95% CI 7.8–18.7) with CeD. The prevalence in studies that used secretory testing to define PEI was 13.1% (95% CI 6.4–21.3) and in those requiring digestive tests 17.1% (95% CI 5.8–32.1). The weighted prevalence of PEI was however significantly higher among untreated CeD patients (21.7%) than patients on a gluten-free diet (6.9%) (p=0.03), in both adults and children.

Conclusion

One in eight individuals with CeD may suffer from PEI. The prevalence was particularly high in children with untreated CeD. PEI should be considered in patients who do not respond to a gluten-free diet.

References

1. Dominguez-Muñoz JE, Vujasinovic M, de la Iglesia D, et al. European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations. United European Gastroenterol J 2024.
2. Löhr JM, Dominguez-Munoz E, Rosendahl J, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J 2017;5:153-199.
3. Vujasinovic M, Tepes B, Volfand J, et al. Exocrine pancreatic insufficiency, MRI of the pancreas and serum nutritional markers in patients with coeliac disease. Postgrad Med J 2015;91:497-500.

Introduction

Within five years of having acute pancreatitis (AP), three in five people develop prediabetes (PD) or diabetes mellitus (DM). However, information on risk factors is limited.

Aims & Methods

We aimed to identify risk factors for developing PD or DM following AP. We systematically searched three databases up to 2021.11.18 extracting direct, within-study comparisons of risk factors on the rate of new-onset PD, DM or PD/DM in AP patients. Meta-analysis was performed using the random-effects model to calculate pooled odds ratios (OR) with 95% confidence intervals (CI).

Results

Of the 45 studies identified, 36 were included in the meta-analysis, covering 71,367 participants. The odds of developing DM was significantly higher after severe AP (OR: 2.65; CI: 1.23-5.71) than non-severe, alcoholic AP (OR: 1.95; CI: 1.03-3.67) compared to other aetiologies and if pseudocysts developed (OR: 2.50; CI: 1.00-6.28) versus their absence. The odds of developing PD/DM was significantly higher after severe AP (OR: 3.16; CI: 1.13-8.83) than non-severe, severe and moderate AP (OR: 4.66; CI: 2.24-9.68) versus mild and presence of necrosis (OR: 5.53; CI: 1.59-19.21) versus its absence. Compared to other aetiologies there was a tendency for PD/DM development in hypertriglyceridaemic AP (OR: 3.27; CI: 0.84-12.67) and significantly lower odds of developing DM (OR: 0.61; CI: 0.44-0.85) and PD/DM (OR: 0.72; CI: 0.55-0.94) with idiopathic and biliary aetiology, respectively.

Conclusion

Severe and moderately severe AP, local complications, alcoholic and hypertriglyceridaemic aetiologies may be linked to a higher odds of developing PD or DM.

Disclosure

No conflict of interest.

Introduction

Overweight and obesity present global health challenges, often managed through lifestyle changes and medications like glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which can cause gastrointestinal (GI) adverse events. However, research on their effects in non-diabetic populations is lacking.

Aims & Methods

This review addresses this gap by examining the impact of GLP-1 RAs on GI adverse events in non-diabetic overweight or obese individuals. We systematically reviewed the literature by conducting a search using PubMed and EMBASE, adhering to predefined inclusion and exclusion criteria, to assess GI adverse events linked with GLP-1 RAs in non-diabetic overweight or obese populations. We conducted a dose response meta-analysis to evaluate each adverse event associated with different GLP-1 RAs. The quality of the included studies was appraised utilizing the Cochrane Collaboration's assessment tool.

Results

Our systematic review and meta-analysis encompassed thirty-eight articles, incorporating data from a total cohort of 32,882 individuals. Predominant GI adverse effects observed included nausea, vomiting, diarrhea, constipation, and abdominal pain. Across all evaluated GLP-1 RAs, a notable elevation in nausea risk was noted, with orforglipron exhibiting the highest risk, succeeded by exenatide, tirzepatide, semaglutide, and liraglutide. Moreover, liraglutide, orforglipron, semaglutide, and tirzepatide were associated with heightened vomiting risk, while cagrilinitide and exenatide displayed no significant increase. Exenatide, cagrilinitide, and orforglipron demonstrated no significant association with diarrhea risk. Conversely, semaglutide and liraglutide correlated with an elevated risk of constipation, while cagrilinitide and exenatide did not exhibit a significant increase. Notably, certain GLP-1 RAs were linked to a heightened risk of abdominal pain, with liraglutide, semaglutide, and tirzepatide displaying significant increases, whereas orforglipron showed no significant elevation in abdominal pain risk.

Conclusion

In conclusion, GLP-1 RAs are associated with an increased risk of GI adverse effects, including nausea, vomiting, diarrhea, constipation, and abdominal pain. Importantly, distinct GLP-1 RAs exhibited varying degrees of risk for these adverse effects, underscoring the importance of tailored risk assessment and management strategies in clinical practice.

Disclosure

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Introduction

Exclusive enteral nutrition (EEN) is a well-established first-line treatment for inducing remission in paediatric Crohn's disease, however, its use in adult Crohn’s disease treatment remains limited. In adults, 22% of patients require surgery within the first five years after diagnosis¹, with postoperative complication rates reaching around 25%². This study investigates whether preoperative EEN can reduce postoperative complications in adults with Crohn’s disease undergoing elective surgery.

Aims & Methods

A systematic search was conducted on October 26, 2024, across three databases: PubMed, EMBASE, and the Cochrane Library. Studies were included if they involved at least two weeks of preoperative EEN and reported postoperative outcomes. The primary outcomes were anastomotic leakage, stoma formation, and abscess formation, while the secondary outcome was the length of hospital stay. The odds ratio (OR) and mean differences (MD) with their 95% confidence interval (CI) were calculated using a random-effect model.

Results

A total of 11 studies, including 2112 patients, were included in the analysis. EEN significantly reduced the odds of anastomotic leakage (OR=0.29, CI: 0.19-0.47), stoma formation (OR=0.39, CI: 0.09-1.73), and abscess formation (OR=0.41, CI: 0.23-0.72). However, there was no significant reduction in the length of hospital stay (MD: 0.88 days, CI: -1.85-0.09).

Conclusion

Preoperative EEN significantly reduces the risk of anastomotic leakage, stoma formation, and abscess formation, leading to improved postoperative outcomes. These findings support adding EEN into preoperative management for adult Crohn’s disease patients undergoing elective surgery to enhance recovery and minimize complications.

References

1. Burisch, J., et al.,(2019). Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study. Gut, 68(3), 423–433. https://doi.org/10.1136/gutjnl-2017-315568
2. Luglio, G., et al.,(2022). Post-operative morbidity in Crohn's disease: what is the impact of patient-, disease- and surgery-related factors?. International journal of colorectal disease, 37(2), 411–419. https://doi.org/10.1007/s00384-021-04076-5

Introduction

Intragastric balloon (IGB) is a minimally invasive intervention used for obese patients who do not achieve adequate weight loss with standard medical therapy (SMT), which includes lifestyle interventions with or without pharmacological treatment. It is also an option for individuals who do not meet the criteria for bariatric surgery or choose not to undergo it. Despite its growing use, there is little data on the short and long-term effectiveness of IGB compared to SMT in randomized controlled trials (RCTs).

Aims & Methods

This systematic review and meta-analysis aimed to compare the efficacy of IGB therapy for at least six months versus SMT in the treatment of obesity, assessing outcomes at 6, 9, and 12 months. A comprehensive literature search was conducted in the MEDLINE, EMBASE, and Cochrane Library databases. The primary outcome was the percentage of excess weight loss (%EWL), while secondary outcomes included absolute weight loss (AWL), percentage of total weight loss (%TWL), and body mass index reduction (BMIR). We calculated mean differences (MD) with 95% confidence intervals (CI) for continuous outcomes. Meta-regression was performed using baseline body mass index (BMI) as a covariate, and subgroup analyses were conducted based on IGB type, baseline BMI, and pharmacological therapy in the SMT group.

Results

A total of 15 RCTs, including 1,961 patients, were included. Compared to SMT, IGB therapy resulted in significantly greater %EWL at 6 months (MD 16.80%; 95% CI [9.22%; 24.38%]), 9 months (MD 14.36%; 95% CI [7.67%; 21.04%]), and 12 months (MD 13.10%; 95% CI [10.43%; 15.77%]). IGB was also superior in AWL, %TWL, and BMIR across all time points (Table 1). Subgroup analyses revealed that results remained consistent regardless of pharmacological therapy use in the SMT group (p=0.77). The Orbera balloon showed superior %TWL at 6 months (p<0.01) and AWL at 6 months (test for subgroup differences with p=0.01), while the Spatz3 balloon demonstrated better %TWL at 9 months (p<0.01). Studies with a baseline BMI >40 kg/m² had significantly greater %TWL at 6 months (p=0.04) and AWL at 6 months (p<0.01) than those with BMI ≤40 kg/m². Meta-regression analysis indicated that higher baseline BMI was associated with greater AWL and BMIR at 6 months.

Conclusion

IGB therapy was significantly more effective than SMT, even when pharmacological therapy was included, leading to superior weight loss outcomes at 6, 9, and 12 months.

Table 1. Summary of findings.

References

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8- Hollenbach, M, et al. Digestion. 2024.

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10- Konopko-Zubrzycka, et al. J Clin Endoc Metab. 2009.

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13- Ponce, J, et al. Surg Obes Relat Dis. 2015.

14- Sullivan, S, et al. Surg Obes Relat Dis. 2018.

15- Vicente, M, et al. Surgical Endoscopy. 2020.