Introduction

The complications of Crohn's disease (CD) are many and varied. Among them are thromboembolic complications that can occur during the course of the disease or reveal it. The aim of our work is to study the epidemiological, clinical and evolutionary aspects of these complications.

Aims & Methods

This is a monocentric retrospective study spread over a period of 23 years (January 1998 to October 2021). It focused on patients hospitalized for CD and presenting with a venous thrombosis confirmed by imaging.

Results

Out of 1084 cases of Crohn's disease, 17 cases of venous thrombosis were recorded, representing a prevalence of 1.7%. The median age was 35 years [28-41] with a M/F sex ratio of 1.
According to the Montreal classification, 7 cases (41.2%) were L2, 6 cases (35.3%) were L3, 3 cases (17.6%) were L1 and 1 case (5.9%) was L4. Four patients (28.6%) had ano-perineal manifestations. The phenotypic profile was B1 in 10 cases (58.8%), B2 in 5 cases (29.4%) and B3 in 2 cases (11.8%).
Apart from 2 cases of deep vein thrombosis (DVT) that revealed CD, the other 15 cases occurred during a relapse of the intestinal disease after an average evolution of 40 months, of which two cases (11.8%) were already under heparinoprophylaxis.
These were 12 cases (70.6%) of DVT of the lower limbs associated in one case with pulmonary embolism, 2 cases of cerebral venous thrombosis (11.8%) associated in one case with pulmonary embolism, one case of ovarian vein thrombosis, one case of superior mesenteric vein thrombosis, and one case of port-sinusoidal thrombosis (porto-sinusoidal vascular disease).
Associated risk factors were identified: 4 cases (23.5%) of recent surgery associated in two cases with smoking, and in one case with diabetes, one case of pregnancy, one case of prolonged immobilisation and one case of hypertension.
Biologically, there was one case of protein S deficiency and one case of vitamin B12 deficiency. It should be noted that hypoalbuminemia was found in 13 cases (76.5%) and that homocysteinemia measured in 3 cases was normal.
Apart from one death, the evolution under specific treatment was favourable in 94.1% of cases.

Conclusion

Thromboembolic complications in CD are potentially serious and dominated by DVT of the lower limbs. They usually occur during the active phase of the disease, highlighting the importance of preventive treatment.

Introduction

Hepatocellular carcinoma (HCC) is an end stage liver disease with increasing morbidity and mortality worldwide. Development of the disease is dependent on various genetic, dietary and environmental factors. While alcohol-related liver disease (ALD/MetALD) remains a major contributor, metabolic dysfunction-associated steatotic liver disease (MASLD) is becoming increasingly relevant in clinical practice. There is increasing evidence for the role of bacteria, for instance, such as Bifidobacterium and Blautia, which were considered protective, while Streptococcus has been associated with disease progression. However, little is known about the alteration of microRNAs (miRNAs) in liver diseases and its interrelationship with microbial environment in view of etiological factors.

Aims & Methods

This study aimed to elucidate gastrointestinal miRNA alterations and explore their relationship with microbiome composition in patients with different stages of liver disease in terms of disease etiology. Multi-omics analyses were performed in a subset of well characterized patients (n=59) with liver disease and healthy controls. Systematic characterization included clinical, laboratory, demographic and imaging characterization and dietary preferences. Patients subclassification included fibrosis stage (no fibrosis, fibrosis, liver cirrhosis(LC)) and etiology (MetALD/ALD vs. MASLD). Fecal miRNAs were extracted using the Qiagen miRNeasy Kit and profiled via Agilent miRNA microarray. Microbiome analyses were performed amplifying the V1-V2 region of the 16S rRNA gene following Illumina sequencing.

Results

For miRNA analysis stringent criteria were applied to identify high quality miRNA targets. From approximately 4,000 candidates filtering resulted in selection of 202 high-quality miRNAs with reliably measurable concentrations. 28 of these miRNAs showed significantly positive alterations in concentration in patients with liver disease and 7 miRNAs significant negative alterations. Specifically, miR-642a-3p, miR-5006, miR-6781, and miR-6849 were elevated in feces in patients with LC. In contrast, miR-6869, miR-4467, and miR-5001 were present in lower concentration in LC patients. Notably, miR-4467 also showed strong negative associations with liver-specific laboratory markers, including gamma-glutamyl transferase (GGT) (r=-0.34; p=0.026) and M65, a marker of apoptosis (r=-0.42; p=0.005). Cross-sectional comparison of miRNA and microbiome data revealed miRNA alterations associated with specific microbial signatures. MiR-6795-5p, which was associated with liver stiffness (r = 0.39, p = 0.01), also correlated positively with the abundance of Streptococcus, a genus linked to disease progression (r=0.29; p=0.047). Conversely, miR-6869, miR-4467, and miR-5001 showed positive correlations with the potentially protective genera Blautia and Bifidobacterium (miR-6869: r_{Bifidobacterium}=0.35; p_{Bifidobacterium}=0.012; r_Blautia=0.37; p_Blautia=0.008; miR-4467: r_Blautia=0.41; p_Blautia=0.002; miR-5001: r_Blautia=0.38; p_Blautia=0.006).

Conclusion

Multi-omics analysis reveals distinct alterations in fecal miRNAs and gut microbiota across different stages of liver disease. Changes in microbial composition were associated with shifts in miRNA profiles, suggesting a functional link in maintaining intestinal homeostasis. These findings highlight the potential of integrated microbiome–miRNA signatures as novel diagnostic and therapeutic targets. Further studies are warranted to validate these associations and explore their clinical applications.

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

Intestinal point-of-care ultrasound, as standardized by the International Bowel Ultrasound Group (IBUS), has emerged as a valuable tool for diagnosing, monitoring, and managing patients with Inflammatory Bowel Disease (IBD). While IBUS emphasizes a structured intestinal assessment, some European centers adopt a more comprehensive approach, combining intestinal ultrasound with a complete abdominal examination.
The Karolinska Centre for Digestive Health, a tertiary referral institution providing specialized care to approximately 4,500 patients with IBD, established a dedicated Gastrointestinal Ultrasound Unit in October 2023. This unit offers advanced diagnostic services to both hospitalized patients and those treated on an outpatient basis.

Aims & Methods

This retrospective study aimed to assess the prevalence of secondary extraintestinal findings in IBD patients undergoing comprehensive abdominal ultrasound between October 4, 2023, and March 4, 2025. All patients underwent ultrasound assessments that included both intestinal and abdominal imaging. Patients referred for indications unrelated to intestinal ultrasound (IUS), as well as those undergoing repeat examinations, were excluded from the analysis to ensure data consistency.
All examinations were performed by a single gastroenterologist with 25 years of ultrasound experience. In cases where secondary extraintestinal findings were identified, patients’ electronic medical records were reviewed to determine whether these findings represented new diagnoses or previously known conditions.

Results

The study included 348 patients with IBD, 201 (58%) females and 147 (42%) males, with a mean age of 42.4 years. Among these, 260 (75%) were referred internally by our IBD Outpatient Clinic, 47 (13%) by the Gastroenterology Ward, 33 (10%) by private outpatient clinics, and the remainder from other healthcare sites. IUS revealed evidence of intestinal inflammation in 144 patients (42%), while findings were normal in 204 patients (58%).
Furthermore, 150 patients presented with a total of 195 secondary extraintestinal findings, of which 113 (58%) represented newly identified pathologies. Among all secondary findings, the majority, 104 (53%), were related to the hepatobiliary system, including 33 newly diagnosed cases of hepatic steatosis and 17 new cases of cholecystolithiasis. One patient demonstrated ultrasound features suggestive of primary sclerosing cholangitis (PSC) and is currently undergoing further evaluation. Additional findings involved the reproductive system (29/15%), urinary system (15/7%), spleen (32/16%), and pancreas (5/2%). Various other intra-abdominal findings were also identified (37/18%). Notably, one patient presented with a suspicious mass in the right iliac fossa, and another demonstrated ultrasound findings suggestive of a prostatic tumor; both cases were referred for further oncologic evaluation. Additionally, three patients were newly diagnosed with intraductal papillary mucinous neoplasm (IPMN), which was subsequently confirmed via magnetic resonance imaging, and all were enrolled in the national IPMN surveillance protocol.

Conclusion

A considerable proportion of patients with IBD were found to have previously unknown extraintestinal abdominal pathologies, underscoring the essential role of comprehensive ultrasound examination that combines both intestinal and abdominal assessment. Fortunately, only a minority of these findings resulted in changes to patient management.

Disclosure

Francesca Bresso has acted as national and/or local principal investigator for clinical trials for Janssen, Ferring, and AbbVie. Charlotte Hedin served as a speaker and/or advisory board member for AstraZeneca, AbbVie, Dr. Falk Pharma and the Falk Foundation, Galapagos, Janssen, Pfizer, Ferring, Takeda, and Tillotts Pharma and received grant support from Tillotts Pharma and Takeda. Stephan L. Haas has served as a speaker for Takeda, Santax Medico, Tillotts Pharma, Johnson & Johnson, and Mediahuset. The rest of the authors have nothing to declare.

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

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.