Introduction

The burden of Hepatitis C Virus (HCV) remains a critical public health issue, particularly among People Who Inject Drugs (PWID), who represent a high-risk and often underserved population. Psychiatric care settings—where PWID often seek support for mental health and substance use disorders are key points for opportunistic HCV screening and linkage to care.

Results & Findings

We analyzed two periods: before (2021-2022) and after (2023-2024) integrated hepatology-psychiatry care in the context of HCV treatment. During the whole 4 year period we treated 125 HCV patients, more (n=98) after integrated hepatology-psychiatry care compared to the period before (n=27), p<0.05. Overall, 55.2% (n=69) of patients were PWIDs, predominantly in the period after (92.7%) compared to the period before (7.3%; p<0.05). Majority of treated patients (84%) received their first DAA treatment, 3.3% were retreated due to previous treatment failure, while the rest were retreated due to reinfection.
Of 125 patients, 93% (n=117) were tested and all achieved end of treatment (EOT) response. Among them 63 were PWIDs. Of six PWIDs who were not EOT tested, 5 were lost to follow-up and 1 patient died. In the follow up, 100 patients were tested for sustained viral response (SVR) and 97% achieved SVR. Out of 17 who were not SVR tested, 6 still have not reached SVR period and 11 patients did not show up (90% of them were PWIDs).

Summary & Discussion

Our data indicate that integrated hepatology-psychiatry collaborations can increase treatment in PWID populations. An integrated model of care should help in reducing loss to follow-up in this difficult to treat population.

Conclusion

This practice underscore the importance of cross-specialty nursing cooperation in bridging healthcare gaps and support the development of access models that address both medical and psychosocial needs in vulnerable groups.

References

Dale CH, Smith E, Biondi MJ. Nurse practitioners as primary care site champions for the screening and treatment of hepatitis C virus. J Am Assoc Nurse Pract. 2022 Jan 21;34(4):688-695. doi: 10.1097/JXX.0000000000000689.
Clark CH, Ghalib RH. Hepatitis C: role of the advanced practice nurse. AACNClin Issues. 1999 Nov;10(4):455-63. doi: 10.1097/00044067-199911000-00005.

Disclosure

Nothing to disclose.

Introduction

Deep remission in complex perianal fistulizing Crohn’s disease (PFCD) is defined by both clinical and radiological remission. As the ultimate therapeutic goal for this condition, deep remission requires thorough assessment. MRI is the gold standard for evaluating complex perianal involvement.

Aims & Methods

Our aim was to identify baseline MRI factors linked to deep remission in PFCD and assess its impact on clinical outcomes. All patients with complex PFCD treated with anti-TNF-α agents at the gastroenterology department underwent baseline MRI and clinical evaluation. Radiological assessment included the number and type of fistula tracts (per Parks classification), presence/size of pelvic collections, horseshoe tracts (encircling more than 75% of the anal circumference), and rectal wall thickening. The Van Assche score was calculated. Follow-up MRIs were obtained only after clinical remission to assess radiological remission.

Results

Out of 105 patients, 80 were included in the study (male-to-female ratio: 1.33), with a mean age of 32.35 years. On average, patients had 1.7 fistula tracts (range: 1–6), with trans-sphincteric fistulas accounting for 65% of cases. Specific subtypes included ano-vulvar tracts in 8 women (9.5%), rectovaginal in 5 patients (6%), and anorectal tracts extending to the scrotum in 2 men (2.4%). Pelvic collections were present in 14 individuals (16.7%), averaging 23.8 mm in size. Horseshoe-shaped tracts were identified in 19 patients (22.6%), and rectal wall thickening greater than 3 mm was seen in 49 (58.3%). The mean Van Assche MRI score was 14.9. All patients underwent seton placement. The majority (88.1%) received infliximab, while the remainder were treated with adalimumab. Clinical remission was achieved after a mean of 5.8 months. Radiological remission occurred in 24 patients (28.6%). Presence of horseshoe tracts (p=0.013) and Van Assche scores more than 14 (p=0.027) were significantly associated with failure to reach radiological remission. These factors were confirmed as independent predictors by multivariate analysis. Among those who initially achieved radiological remission, 13 experienced recurrence during an average follow-up of 65.8 months. Radiological remission was associated with improved outcomes: recurrence-free survival rates were 81.3% at 1 year, 62.7% at 3 years, and 50.1% at 5 years, compared to 62.2%, 35.8%, and 23.2%, respectively, in patients with clinical remission but without radiological remission.

Conclusion

Deep remission was achieved in about one-third of PFCD patients following clinical remission. Horseshoe fistulas and Van Assche score more than 14 predict failure to reach this goal, correlating with worse long-term outcomes. These findings support the Top-Class classification designating such cases as unsuitable for curative repair, emphasizing symptom control instead.

Introduction

Corpus atrophic gastritis (CAG) requires endoscopic-histological surveillance due to the risk of developing gastric neoplastic lesions (GNL). This study aimed to identify variables associated with GNL development at long-term follow-up using a feature ranking method based on a novel One-Class Support Vector Machine (SVM) model.

Aims & Methods

A dataset containing clinical, endoscopic, and histological variables from consecutive CAG patients (2001-2023) adhering to a surveillance program was considered. GNL presence at the longest available follow-up was recorded. Gastric biopsies and histological evaluations were conducted according to the updated Sydney system. CAG patients with any missing data or a GNL diagnosis at the baseline gastroscopy were excluded from the final analysis. A Fisher score-based feature ranking method and One-Class SVM were used to select the optimal subset of baseline variables associated with GNL development, aiming to achieve average sensitivity (Se) and specificity (Sp) above 80%.

Results

Overall, 355 CAG patients were initially considered. Of these, 36 were excluded due to the presence of GNL at baseline gastroscopy, and 216 for missing data. Thus, a total of 103 patients were considered and grouped into: CAG patients with [22 patients (F 68.1%), median age 68 (35-83) years] and without GNL at follow-up [81 patients (F 72.8%), median age 59(26-84) years]. After a median follow-up of 60 (12-192) months, 13 epithelial GNL (gastric adenocarcinoma or high/low-grade dysplasia) and nine type-1 gastric-neuroendocrine-tumors (T1gNET) were recorded. Parietal-cell-antibodies and pepsinogen-I < 30 μg/l were associated with both epithelial GNL and T1gNET. Antral inflammation and age > 60 were linked to epithelial GNL, while anti-thyroperoxidase-antibodies, smoking, and dyspeptic symptoms at CAG diagnosis were linked to T1gNET. Low-dose aspirin and H. pylori eradication therapy showed inverse associations with epithelial GNL and T1gNET, respectively.

Conclusion

This is the first study in which an AI model simultaneously considers clinical, endoscopic, and histological characteristics from a dataset of CAG patients, showing good sensitivity and specificity in identifying those variables associated with developing GNL. Nonetheless, we acknowledge the need for improved variable standardization and data balancing between groups to enhance model performance further.