2 Minute Medicine ® - Gastroenterology

1. In this randomized controlled trial, treatment with pegozafermin improved fibrosis in patients with nonalcoholic steatohepatitis (NASH).  2. Treatment with pegozafermin led to increased rates of NASH resolution. Evidence Rating Level: 1 (Excellent) Study Rundown: NASH is a disease characterized by hepatic inflammation and excess fat accumulation with or without fibrosis of the liver. Pegozafermin is a long-acting recombinant fibroblast growth factor 21 analog pegylated with the use of site-specific glycosyltransferases...

1. Despite the decrease in colonoscopies performed at the start of the COVID-19 pandemic, there was no difference in the percentage of colorectal cancer (CRC) presentations at a later stage or with higher acuity, when comparing patients diagnosed with rectal adenocarcinoma pre-pandemic and during the pandemic. Evidence Rating Level: 2 (Good) Colonoscopies as part of colorectal cancer (CRC) screening are instrumental in the early diagnosis of CRC, and have been associated with a 75% reduction in mortality for those diagnosed with left-sided colon cancer, likely due to earlier detection...

1. This post-hoc analysis of the AMATERASU randomized clinical trial found that, for digestive tract cancer patients with positive p53-immunoreactivity, 2000 IU/day vitamin D3 supplementation resulted in significantly improved relapse-free survival at 5 years.  Evidence Rating Level: 1 (Excellent) Recent meta-analyses of randomized clinical trials have found that daily vitamin D3 supplementation benefited cancer mortality. In this posthoc subgroup analysis of the AMATERASU randomized, double-blind, placebo-controlled clinical trial, patients with digestive cancers were followed up for a median of 3...

1. The prevalence of Hepatitis C infection during pregnancy increased between 1998 and 2018, coinciding with the opioid epidemic.  2. Individuals of White race, lower socioeconomic status, and a history of substance use were more likely to be infected with Hepatitis C during pregnancy.  3. Hepatitis C Infection was associated with a greater risk of gestational hypertension, cesarean delivery, preterm labour, poor fetal growth, and fetal distress . Evidence Rating Level: 2 (Good) Study Rundown: Hepatitis C virus (HCV) is the most prevalent chronic bloodborne infection in the United States...

1. This retrospective study found that patients undergoing gastrectomy for gastric cancer (GC) had improved five-year survival, reduced five-year tumor recurrence, less metastasis, and poorer tumour differentiation if they had ≥ 16 negative lymph nodes (NLNs) resected during gastrectomy. 2. This serves as further evidence for proportion of NLNs as a prognostic factor in cancer treatment.  Evidence Rating Level: 2 (Good) Currently one of the most common malignancies worldwide and the third most deadly cancer, gastric cancer (GC) is an important topic of research...

1. In this randomized controlled trial, a high dose of GNT0003 gene therapy was associated with decreased serum bilirubin and need for phototherapy.  2. The most common adverse events associated with GNT0003 were headache and liver enzyme elevations. Evidence Rating Level: 1 (Excellent) Study Rundown: Crigler-Najjar syndrome is a rare recessive disorder resulting in loss of function of the uridine diphosphoglucuronate glucuronosyltransferase 1A1 (UGT1A1) enzyme, which conjugates bilirubin and aids its elimination...

1. Patients with primary hepatocellular carcinoma randomized to receive primary hepatectomy versus conventional hepatectomy had less operation time, fewer complications, higher immune function post-op, and lower rates of recurrence at 3 years, amongst other advantages. Evidence Rating Level: 1 (Excellent) For patients with primary liver cancer, precision hepatectomy is a novel surgical approach that aims to decrease invasiveness and improve hepatic protection: This is done by creating a virtual 3D reconstruction of an individual patient’s liver to guide the surgical plan...

1. Implementation of ‘Water First’, a program consisting of classroom lessons, water promotion, and water stations, was associated with a lower increase in overweight prevalence compared to the control group. 2. No significant change was seen in obesity prevalence in schools exposed to the intervention. Evidence Rating Level:  1 (Excellent) Study Rundown: Childhood obesity is a major risk factor for the development of chronic illnesses in adulthood. Given that sugar-sweetened beverages (SSBs) are linked to childhood overweight and obesity, this cluster-randomized control trial sought to examine if a school-based drinking water promotion program could address overweight prevalence in elementary school students by reducing SSB consumption...

1. Among those treated for Hepatitis C Virus (HCV) infection, leading causes of death included drug abuse, liver failure, and liver cancer, and all-cause mortality was higher for those treated for HCV compared to the general population.  Evidence rating level: 2 (Good) Interferon-free antiviral agents have changed the landscape of hepatitis C virus (HCV) infection since 2014. Compared to previous management options, current treatments are shorter in duration and more effective, leading to HCV cure in >95% of patients...

1. Double-balloon enteroscopy (DBE) has a high diagnostic yield for small-bowel strictures in Crohn’s disease (CD) patients, with no difference in accuracy depending on low or high symptom severity. Evidence Rating Level: 2 (Good) Strictures occur in an estimated 15-30% of Crohn’s Disease (CD) patients within the first 10 years after diagnosis. Several methods have been developed for evaluating small-bowel strictures, including computed tomography enterography (CTE) and double-balloon enteroscopy (DBE)...

1. Overall survival was significantly greater in the fruquintinib group versus placebo. 2. The majority of adverse events were mild-to-moderate and were slightly more common among patients receiving fruquintinib. Evidence Rating Level: 1 (Excellent) Study Rundown: Colorectal cancer is the third-most prevalent cancer in the world and the second leading cause of death worldwide. Patients with advanced, chemotherapy-refractory colorectal cancer generally do not respond to systemic therapy and so, an alternate form of treatment is needed...

1. In this retrospective study, it was found that inflammatory bowel disease (IBD) activity was associated with poorer sleep scores in pediatric patients. 2. Furthermore, pediatric patients with IBD demonstrated poorer overall sleep compared to controls, as evidenced by a later sleep time and shorter sleep duration in IBD patients. Evidence Rating Level: 2 (Good) Sleep disturbances are common among patients with inflammatory bowel disease (IBD), and there is a well-identified link between sleep disorders and conditions of the gastrointestinal tract...

1. In this randomized controlled trial, patients with ulcerative colitis taking mirikizumab had higher rates of clinical remission compared to those taking a placebo. 2. Opportunistic infections occurred more frequently in the mirikizumab group.  Evidence Rating Level: 1 (Excellent) Study Rundown: Recent clinical trials and approval of monoclonal antibody treatments for ulcerative colitis suggest interleukin-23 as a promising therapeutic target. Mirikizumab is a humanized monoclonal antibody that binds a subunit of interleukin-23...

1. For patients with refractory ascites, daily home-based low-volume paracentesis was associated with a greater risk of hyponatremia and acute kidney injury compared to repeated large-volume paracentesis. Evidence Rating Level: 3 (Average) Refractory ascites is a clinical sign of end-stage liver disease, with few effective treatment options. Most patients will undergo repeated large-volume paracentesis (LVP) with albumin infusions. Home-based small-volume paracentesis is becoming more common, though previous research suggests there may be increased risks of AKI, hyponatremia, and hospital admissions with this practice...

1. In this retrospective cohort study, patients younger than 50 with metastatic colorectal cancer (mCRC) had significantly shorter progression-free survival and overall survival rates compared with those aged 50 to 65 years old. 2. The younger cohort of patients also had unique treatment-related adverse events and distinct genomic profiles compared with their older counterparts. Evidence Rating Level: 2 (Good) Study Rundown: Colorectal cancer (CRC) is the third most common cancer and the second deadliest cancer worldwide...

1. For patients with rectal cancer undergoing anterior resection (AR), the rates of anastomotic leakage (AL) and re-operation did not change when diverting ileostomy (DLI) rates increased as an intended risk mitigation strategy. Evidence Rating Level: 2 (Good) The standard curative treatment for cancer of the middle and upper rectum is an anterior resection (AR). An anastomotic leakage (AL) is a complication of AR, with risk factors including male gender, excess alcohol, smoking, obesity, medical comorbidities, neoadjuvant therapy, and anastomotic height...

1. In this randomized controlled trial, early integration of palliative care among patients with upper gastrointestinal (GI) cancers undergoing curative-intent surgeries did not result in improvements in patient-reported quality of life and mental health measures Evidence Rating Level: 1 (Excellent) Study Rundown: GI cancers often require extensive surgeries and can lead to significant morbidity and mortality. Palliative care entails symptom management and psychosocial support to individuals with serious illness to optimize their quality of life, regardless of diagnosis, prognosis, or care goals...

1. In this randomized controlled trial, upadacitinib resulted in higher remission rates for patients with Crohn’s disease compared to a placebo. 2. Overall adverse event rates were similar between upadacitinib and placebo groups. Evidence Rating Level: 1 (Excellent) Study Rundown: Crohn’s disease is a chronic inflammatory bowel disease that relapses and is associated with many comorbidities and extra-intestinal symptoms. Although immunomodulatory therapies exist, it is well-established that patients with moderate-to-severe disease experience inadequate symptomatic and endoscopic control...

1. At 26 weeks, the mean change in HbA1c was comparable between the weekly insulin icodec and daily glargine U100 groups. 2. There was no significant difference in serious adverse events or hypoglycemic episodes between treatment groups. Evidence Rating Level: 1 (Excellent) Study Rundown: A basal-bolus insulin regimen is often required for glycemic control in patients with type 2 diabetes. However, the number of injections required may lead to issues with adherence. Insulin icodec is a novel basal insulin analogue that may be used in such patients, although evidence around its clinical efficacy is limited...

1. Infrequent, light, or moderate alcohol consumption was associated with a reduced risk of all-cause mortality. Evidence rating level : 2 (Good) It is well known that heavy alcohol consumption is connected to detrimental physical and social consequences. Researchers aimed to assess the association between light to moderate alcohol consumption and all-cause and cause-specific mortality. This prospective population-based cohort study collected data from the National Health Interview Survey, which includes self-reported alcohol consumption for 918,529 adults in the United States from 1997 to 2014...