Immune‐mediated inflammatory disease (IMID) patients including psoriasis, inflammatory arthritides and bowel diseases have a higher risk of developing cardiovascular (CV) diseases compared to the general population. The increased CV risk may be promoted by tumour necrosis factor (TNF)‐α‐mediated immunological processes, which are present both in the pathomechanism of IMIDs and atherosclerosis. Our objective was to comprehensively investigate the effect of TNF inhibitors (TNFi) on CV risk compared with conventional therapies in IMIDs. The systematic literature search was conducted in three databases (MEDLINE, EMBASE, Cochrane Library) on 14 November 2022. Randomized controlled trials, cohort and case–control studies were eligible for inclusion. Outcomes consisted of the incidence of CV events, with major adverse cardiovascular events (MACE) as a main endpoint. A random‐effects meta‐analysis was performed by pooling fully adjusted multivariate hazard ratios (HR) and incidence rate ratios (IRR) with a 95% confidence interval (CI) comparing TNFis with conventional systemic non‐biologicals (CSNBs). Of a total of 8724 search results, 56 studies were included overall, of which 29 articles were eligible for the meta‐analysis, and 27 were involved in the systematic review. Including all IMIDs, the TNFi group showed a significantly reduced risk of MACE compared with the CSNB group (HR = 0.74, 95% confidence interval (CI) 0.58–0.95, p = 0.025; IRR = 0.77, 95% CI 0.67–0.88, p < 0.001). Subgroup analysis of Pso, PsA patients by pooling IRRs also confirmed the significantly decreased risk of MACE in TNFi‐treated patients compared with CSNB groups (IRR = 0.79, 95% CI 0.64–0.98). The observational nature of most included studies leading to high heterogeneity represents a limitation. Based on the results, TNFis may reduce the risk of CV events compared to CSNBs. Therefore, earlier use of TNFis compared to conventional systemic agents in the therapeutic sequence may benefit CV risk in IMID patients.

Background and study aims: Endoscopic biliary stent placement is a minimally invasive intervention for patients with biliary strictures. Stent patency and function time are crucial factors. Suprapapillary versus transpapillary stent positioning may contribute to stent function time, so a meta-analysis was performed in this comparison. Methods: A comprehensive literature search was conducted in the CENTRAL, Embase, and MEDLINE databases to find data on suprapapillary stent placement compared to the transpapillary method via endoscopic retrograde cholangiopancreatography in cases of biliary stenosis of any etiology and any stent type until December 2020. We carried out a meta-analysis focusing on the following outcomes: stent patency, stent migration, rate of cholangitis and pancreatitis, and other reported complications. Results: Three prospective and ten retrospective studies involving 1028 patients were included. Suprapapillary stent placement appeared to be superior to transpapillary stent positioning in patency (weighted mean difference = 50.23 days, 95% CI: 8.56, 91.98; p = 0.0.018). In a subgroup analysis of malignant indications, suprapapillary positioning showed a lower rate of cholangitis (OR: 0.34, 95% CI: 0.13, 0.93; p = 0.036). Another subgroup analysis investigating metal stents in a suprapapillary position resulted in a lower rate of pancreatitis (OR: 0.16, 95% CI: 0.03, 0.95; p = 0.043) compared to transpapillary stent placement. There was no difference in stent migration rates between the two groups (OR: 0.67, 95% CI: 0.17, 2.72; p = 0.577). Conclusions: Based on our results, suprapapillary biliary stenting has longer stent patency. Moreover, the stent migration rate did not differ between the suprapapillary and transpapillary groups.

Concomitant medications may alter the effect of biological therapy in inflammatory bowel disease. The aim was to investigate the effect of proton pump inhibitors on remission rates in patients with inflammatory bowel disease treated with the gut-selective vedolizumab. Patients from the Hungarian nationwide, multicenter vedolizumab cohort were selected for post hoc analysis. Primary outcomes were the assessment of clinical response and endoscopic and clinical remission at weeks 14 and 54. Secondary outcomes were the evaluation of the combined effect of concomitant steroid therapy and other factors, such as smoking, on remission. A total of 108 patients were identified with proton pump inhibitor data from 240 patients in the original cohort. Patients on steroids without proton pump inhibitors were more likely to have a clinical response at week 14 than patients on concomitant PPI (95% vs. 67%, p = 0.005). Non-smokers with IBD treated with VDZ were more likely to develop a clinical response at week 14 than smokers, particularly those not receiving PPI compared with patients on co-administered PPI therapy (81% vs. 53%, p = 0.041, and 92% vs. 74%, p = 0.029, respectively). We found that the use of PPIs in patients treated with VDZ may impair the achievement of response in certain subgroups. Unnecessary PPI prescriptions should be avoided.

Both acute kidney injury and chronic kidney disease are risk factors for many outcomes of gastrointestinal bleeding (GIB). These are associated with higher mortality, longer hospitalisation, and greater need for transfusion in case of overt GIB. Our study aimed to further evaluate the role of kidney function in several clinical outcomes of GIB patients. The Hungarian Gastrointestinal Bleeding Registry collected data on all-cause GIB between 2019 and 2022. A multi-level data-validation system provided high-quality data, which was retrospectively analysed. Numerous primary (in-hospital mortality, discharge, need for endoscopic intervention, in-hospital rebleeding, length of hospitalisation, need for emergency surgery, need for endoscopic examination and need for intensive care unit) and secondary (detection of Helicobacter pylori (H. pylori), recognition of cancer as the source of bleeding, need for any kind of transfusion or clotting factor, anticoagulation therapy) outcomes were observed. Descriptive statistical tools were used to summarize our data. Among others, estimated glomerular filtration rate (eGFR) (ml/min/1.73 m²) was used as continuous variable, mean, standard deviation, median, interquartile range and minimum/maximum values were calculated. Reduced kidney function was associated with in-hospital mortality (eGFR: 42.63 ± 28.78 ml/min/1.73 m² vs. 57.08 ± 26.62 ml/min/1.73 m², p < 0.001), need for red blood cells (RBC) transfusion (eGFR: 51.98 ± 27.90 ml/min/1.73 m² vs. 60.11 ± 25.06 ml/min/1.73 m², p < 0.001) and clotting factor supplementation (eGFR: 47.40 ± 27.41 ml/min/1.73 m² vs. 56.68 ± 27.02 ml/min/1.73 m², p < 0.001). Better eGFR values at admission were associated with discharge home after proper treatment, compared to any other outcome of the admission (eGFR: 58.12 ± 25.56 ml/min/1.73 m² vs. 50.23 ± 29.69 ml/min/1.73 m², p < 0.001), H. pylori positivity (eGFR: 59.63 ± 25.24 ml/min/1.73 m² vs. 52.76 ± 25.44 ml/min/1.73 m², p = 0.021) and the need for endoscopic intervention (eGFR: 58.65 ± 26.61 ml/min/1.73 m² vs. 54.31 ± 27.64 ml/min/1.73 m², p = 0.008). At admission, patients with better eGFR than 36.64 ml/min/1.73 m² were discharged to their homes, mortality was higher with eGFR worse than 25.96 ml/min/1.73 m², more RBC transfusion was needed if eGFR was lower than 49.61 ml/min/1.73 m². Regulation of anticoagulation was examined extensively. Impaired kidney function at admission results higher in-hospital mortality in overt all-cause GIB and increases the need of RBC transfusion.

Background: Acute gastrointestinal bleeding (GIB) remains a major clinical emergency with substantial morbidity, mortality, and healthcare burden. We aimed to provide a comprehensive characterization of all GIB subtypes, including iatrogenic bleeding, which is underrepresented in previous studies. Methods: In this ambidirectional cohort study, 1021 consecutive adults with overt GIB were enrolled from two Hungarian tertiary centers. Standardized data collection included demographics, comorbidities, medication use, bleeding source, and in-hospital outcomes: mortality, rebleeding, intensive care unit (ICU) admission, length of hospitalization (LoH), endoscopic evaluation and haemostatic intervention, red blood cell transfusion, and surgical intervention. Group comparisons were performed using appropriate statistical tests, and survival was analysed using Kaplan–Meier curves (R v4.4.2; p < 0.05). Results: Non-variceal upper GIB was the most common subtype (51.0%), followed by lower GIB (29.7%), variceal GIB (8.9%), small bowel bleeding (2.3%), and iatrogenic bleeding (7.5%). Overall, in-hospital mortality was 10.6%, highest in variceal bleeding (22%). Rebleeding occurred in 5.3% of cases, most frequently in variceal bleeding. ICU admission was required in 8.9% of patients, again, most common in variceal bleeding (21.6%). The median LoH was 7 days (IQR 4–10), significantly shorter in cases of intraprocedural iatrogenic bleeding. Endoscopy was performed in 91% of cases, with haemostatic intervention in 57%. Surgery was required in 3.4% of patients. Conclusions: Gastrointestinal bleeding represents a heterogeneous clinical entity with distinct outcome profiles across subtypes. Variceal bleeding was associated with the most unfavorable outcomes, whereas intraprocedural iatrogenic bleeding had a favorable course. These findings support subtype-specific clinical management and warrant validation in larger multicenter cohorts.

Background: Antral contractility and antroduodenal motility are major physiologic determinants of gastric emptying (GE). Delayed GE has been demonstrated in patients with reflux disease. In our previous study, using ultrasonography, we have investigated the role of the proximal stomach in the GE of patients with erosive oesophagitis (EO) or with Barrett's oesophagus (BO). The aim of the present study was the assessment of the antral contractility and its role in GE in these two subsets of patients with reflux disease. Patients and methods: Twenty-one patients BO, 17 patients with moderate EO (10 LA-A; 7 LA-B), and 19 control persons (CP) without history of reflux symptoms or dyspepsia were enrolled into the study. After an overnight fast the subjects ingested 500ml of a low calorie content semisolid test meal. The GE was characterized by the reduction of the residual gastric content calculated from the change of cross-sectional areas determined at predefined time points over a period of 240min after ingestion of the test meal. The frequency of antral contractions was counted for 3min at each time point. The amplitude of contractions was calculated from the maximal reduction of the antral area for each contraction. The motility index (MI) was expressed as the multiplication of the mean amplitude and frequency of the contractions. Results: GE was significantly slower in patients with BO and EO than in CP. In patients with BO a significant decrease of the MI was observed in the first 90 minutes of the study, whereas significant reduction of MI occurred only in the first 45 minutes in patients with EO. A negative correlation was observed between the GE and MI in the first 45min of the study in both groups of patients with reflux disease. Conclusions: Impaired antral motility and delayed GE are demonstrated in patients with BO and EO. Antral dysmotility was more pronounced in patients with BO. A possible role of increased biliary reflux in patients with BO warrants further investigation. Grant support: ETT 340/01 and TÁMOP-4.2.1/B-09/1/KONV-2010–0005