Volume 89 - 2026 - Fasc.3 - Original articles
Significance of Portal Tract Histological Changes in Metabolic Dysfunction-Associated Steatohepatitis
Background: Metabolic dysfunction associated steatohepatitis (MASH) is a leading cause of advanced liver fibrosis globally. Current histological scoring (NAS-CRN) excludes portal-based features, despite emerging evidence suggesting their relevance. Aim: To study the prevalence of portal tract changes and their correlation with fibrosis in liver biopsies from patients with MASH.
Methods: In this retrospective and prospective cross-sectional study, 505 liver biopsies were analysed. Portal inflammation, interface hepatitis, ductular reaction, bile duct damage, and plasma cells were semi-quantitatively assessed. Fibrosis was quantified using whole slide digital images of Sirius red-stained slides, and hepatic progenitor cells (HPC) were measured by CK7 immunohistochemistry.
Results: Mean age was 45.1±12.5 years, with 65% males. Advanced fibrosis (F3–F4) was present in 69.1%. Portal inflammation was observed in 69.3% (predominantly mild). Moderate–severe portal inflammation, plasma cells, interface activity, ductular reaction, duct damage, and HPC were significantly associated with advanced fibrosis (all p≤0.005). Portal inflammation significantly correlated with ductular reaction, interface activity, plasma cell infiltration, bile duct damage, progenitor cells, and fibrosis fraction (all p≤0.005).
Conclusion: Portal inflammation and related features are strongly associated with advanced fibrosis in MASH, thereby suggesting multifactorial role in disease progression and supporting their inclusion in histological scoring systems and routine reporting.
Autoimmune Hepatitis: A Single-Center Experience on Treatment Response Rates and Their Association with Cirrhosis
Objective: This study aimed to evaluate treatment responses in patients with autoimmune hepatitis (AIH) and overlap syndromes and to investigate the association between treatment response and cirrhosis development.
Methods: Between 2010 and 2025, 469 patients diagnosed with AIH at a single center were screened. After exclusion of patients who did not meet international diagnostic criteria, 234 patients were included and categorized as AIH (n = 130) and AIH with overlap syndrome (AIH+OS; comprising AIH+PBC and AIH+PSC) (n = 104). Demographic characteristics, treatment responses, cirrhosis prevalence, and potential predictors of cirrhosis were recorded. Treatment responses were classified according to International Autoimmune Hepatitis Group criteria.
Results: Median ages were 57 (44–67) and 59 (47–67) years in the AIH and AIH+OS groups, respectively, with female predominance in both groups. Cirrhosis prevalence was similar between groups (36.2% vs. 38.5%; p = 0.689). Complete biochemical response rates were 75.4% in AIH and 72.1% in AIH+OS; insufficient response rates were 19.2% and 16.3%, and non-response rates were 5.4% and 8.7% (p = 0.546). Cirrhosis was more frequent in patients with non-response (93.8%) and insufficient response (76.2%) than in those with complete biochemical response (23.1%) (p < 0.001). Advanced fibrosis at diagnosis was the most common contributing factor (57.5%).
Conclusion: Treatment responses are comparable in AIH and overlap syndromes. Achieving a complete biochemical response is crucial to prevent cirrhosis. Patients with insufficient response, non-response, or advanced fibrosis at diagnosis require close monitoring due to poorer prognosis.
A daily scrum at the gastrointestinal oncology ward shortens the length of stay, a tertiary center experience
Background and aims: Multidisciplinary meetings among medical and paramedical staff can limit the length of stay (LOS) of oncology patients during repeated hospitalizations. We applied the scrum methodology to streamline our discharge planning. This framework originated in IT development to address operational challenges and to allow for rapid adaptation. We aimed to assess whether a daily scrum can impact LOS and the readmission rate.
Methods: We implemented a daily multidisciplinary meeting, called scrum at the 26 bed- Gastro-intestinal (GI) oncology ward of our tertiary center from October 2022 to July 2023. This daily multidisciplinary debriefing determines the exact medical and paramedical criteria for discharge. We compared outcomes during the intervention to a four-year pre-intervention baseline. We applied a linear model to evaluate whether the scrum reduced the LOS while correcting for case mix.
Results: We included a total of 664 GI oncology patients over a 10-month period. The adjusted mean LOS was 4.09 days. After correcting for case mix, LOS decreased significantly during the daily scrum period compared to the four-year pre-scrum baseline (-9.96%, p=0.011). Unplanned readmissions within 30 days from discharge did not increase.
Conclusion: Implementing a daily scrum significantly reduced the length of stay at our oncology ward. The scrum framework provides an effective strategy to optimize bed capacity. It minimizes unnecessary hospital days and reduces the risk of suboptimal patient care.
Incidence and Risk Factors of Post-Colonoscopy Infections in Liver Transplant Candidates: A Retrospective Cohort Study
Background and study aims: Liver transplant candidates, especially those with cirrhosis are more prone to infections, potentially precipitated by semi-invasive procedures like colonoscopy. Limited data exist on infection rates post-colonoscopy and risk factors in this population. We aimed to estimate the incidence of post-colonoscopy infections and explore potential associated risk factors in patients awaiting liver transplantation.
Patients and methods: This retrospective Belgian single-centre cohort study included 141 adult liver transplant candidates undergoing screening colonoscopy (2019-2023) with ≥24h post-procedural observation. Infection was defined as fever ≥38°C, leucocytosis (>12,000/μL), need for antibiotics, or bacteraemia within 72 hours. Demographic, clinical (MELD, Child-Pugh), and procedural variables were analysed. Variables with p<0.10 in univariate analysis were entered into a backward stepwise multivariable logistic regression model for hypothesis generation.
Results: The overall post-colonoscopy infection rate was 6.4% (9/141), increasing to 8.9% (9/101) among cirrhotic patients. Infections included bacteraemia, spontaneous bacterial peritonitis, and pneumonia. Univariate analysis linked higher Child-Pugh score and INR, ascites grade ≥2, and diverticulosis with infection. Multivariable analysis suggested trends for INR (p=0.051) and diverticulosis (p=0.07). No associations were found with bowel preparation adequacy, sedation type, polypectomy, or antibiotic/immunosuppressive use.
Conclusions: Liver transplant candidates, particularly those with advanced liver disease and diverticulosis, may have a substantial risk of infection following screening colonoscopy. Because all infectious events occurred in patients with cirrhosis, these preliminary findings highlight the need for larger, prospective studies that target this high risk cirrhotic subgroup to confirm risk factors and inform risk stratified management.
Transabdominal Intestinal Ultrasound for the Assessment of Ileal Disease Activity in Crohn’s Disease
Background and study aims: Transabdominal intestinal ultrasonography (IUS) is increasingly used to assess transmural inflammatory activity in Crohn’s disease (CD). This study evaluated the diagnostic performance of IUS for detecting ileal inflammatory activity in CD by comparing individual ultrasonographic parameters and composite activity scores with ileocolonoscopy.
Patients and methods: This single-center retrospective study included patients with CD with ileal involvement who underwent ileocolonoscopy and transabdominal IUS within a 7-day interval. Ileal endoscopic activity was assessed using the Simple Endoscopic Score for Crohn’s Disease (SES-CD), with a score ≥3 indicating active disease. Ultrasonographic evaluation included bowel wall thickness (BWT), color Doppler signal (CDS), their combined assessment, and composite scores: International Bowel Ultrasound Segmental Activity Score (IBUS-SAS), Simple Ultrasound Score for Crohn’s Disease (SUS-CD), and Bowel Ultrasound Score (BUSS). Endoscopic findings served as the reference standard.
Results: Fifty patients were analyzed. Increased BWT and the presence of CDS were significantly associated with higher ileal SES-CD scores. When evaluated individually, BWT and CDS demonstrated moderate sensitivity and high specificity for endoscopically active disease. Among composite scores, SUS-CD showed the highest sensitivity and overall accuracy, whereas IBUS-SAS and BUSS demonstrated high-specificity profiles. ROC analysis identified an optimal BWT cut-off of 3.69 mm, providing improved specificity compared with the conventional 3-mm threshold.
Conclusion: Transabdominal intestinal ultrasound shows high specificity for detecting ileal inflammation in Crohn’s disease. Individual ultrasonographic parameters and composite ultrasound activity scores may serve as useful noninvasive adjuncts to endoscopic assessment of ileal disease activity.
The effectiveness of transcutaneous nerve stimulation in treating children with functional constipation
Background and study aims: Functional constipation (FC) is a prevalent condition in paediatric populations and while standard therapies, including laxatives and toilet training are commonly used, a substantial proportion of children exhibit an inadequate response. This study aimed to evaluate the effectiveness of transcutaneous nerve stimulation (TENS) as a non-invasive treatment for FC in children.
Patients and methods: Children diagnosed with FC according to the Rome IV criteria and treated with TENS were included in this retrospective cohort study. Data were collected in two Belgian hospitals between 2018 and 2024. Primary outcome measures included stool frequency, stool retention behaviour, faecal incontinence, and stool size. Statistical analyses incorporated post hoc comparison with Bonferroni correction.
Results: A total of 36 children were included (median age 7.5 years, range 3–15 years; 61% male) of whom approximately one-third had a concomitant diagnosis of a neurodevelopmental disorder (NDD). Improvements were observed in faecal incontinence (p = 0.016), retentive behaviour (p = 0.001), stool frequency (<2 bowel movements/week) (p = 0.035), and abdominal pain (p = 0.006). After applying a Bonferroni correction, only the effect on retentive behaviour remained statistically significant. Side effects were limited to mild erythema in two patients, which did not necessitate discontinuation.
Conclusion: TENS appears to be a promising and well-tolerated treatment for children with FC and it may be considered as an early intervention within the therapeutic management pathway as the beneficial effects seem particularly evident in children with more severe forms