The Relationship Between Intramural Fat Accumulation and Sarcopenia on MR Enterography Exams in Patients with Crohn's Disease.

Research on magnetic resonance enterography (MRE) and sarcopenia for assessing Crohn's disease (CD) is growing. Our study examined the connections between the presence of sarcopenia, intramural fat accumulation (IFA), and clinical, laboratory, and MRE findings.This retrospective study was conducted on 112 patients with suspected or diagnosed CD who underwent 3-tesla MRE. The study examined the correlation between sarcopenia-related parameters and MRE findings. Results of MRE exams and clinical and laboratory results were statistically analyzed. The Kruskal-Wallis, Pearson chi-square, and Fisher-Freeman-Halton tests were used for comparison.It was determined that patients with active inflammation on a chronic basis had more IFA than the others (p<0.001). There were positive relationships between IFA and intramural edema (p<0.001). There were positive correlations between IFA and high b-values and negative correlations with apparent diffusion coefficient values (p<0.05). Positively significant relationships were found between IFA and wall thickness, affected segment length, disease duration, and sedimentation values (p<0.05). Strong correlations were found between sarcopenia and the CD activity index as well as wall thickness (p<0.001/p=0.003). There was no significant relationship between steroid usage and other variables.The presence of IFA is associated with chronic inflammation. There was no clear relationship between steroid use and IFA. Our findings support the idea that sarcopenia is related to the activity of CD. Further comprehensive research is required on these subjects. · The usage of MR enterography for the management of CD is increasing day by day due to its advantages.. · There is a paucity of evidence regarding the relationship between sarcopenia and MR enterography findings in patients with CD.. · Intramural fat accumulation (IFA) is a sign of chronicity in patients with CD.. · The presence of IFA seems to be associated with active inflammation on a chronic basis.. · There was no clear relationship between steroid use and IFA.. · Algin O, Günes YC, Cankurtaran RE et al. The Relationship Between Intramural Fat Accumulation and Sarcopenia on MR Enterography Exams in Patients with Crohn's Disease. Fortschr Röntgenstr 2024; DOI 10.1055/a-2330-8148.

Adverse Events in Endoscopic Retrograde Cholangiopancreticography for Choledocholithiasis: A Holistic Perspective.

Background and aims In this study, we aimed to investigate the frequency of adverse events (AEs) in patients undergoing endoscopic retrograde cholangiopancreticography (ERCP) for choledocholithiasis and the independent risk factors that may cause these conditions. We planned to evaluate all AEs including cardiopulmonary complications and the risk factors that may affect them holistically. Methods This study was designed as a retrospective cohort study conducted at a single tertiary center's gastroenterology clinic. The study included patients with naive papillae and undergoing ERCP for choledocholithiasis between May 2019 and June 2022. Risk factors that may lead to AEs were analyzed in terms of both patient-related factors and procedure-related factors. Patients with and without AEs after ERCP were compared. Results This study included 812 patients who underwent ERCP for choledocholithiasis. AE occurred in 149 (18.3%) of patients, and the most common complication was pancreatitis (n=112, 13.8%). In regression analysis, of the patient- and procedure-related factors, only difficult cannulation was a significant independent risk factor for AEs (odds ratio=3.85, 95% CI: 1.102-13.498, p=0.035). Conclusion This study showed that, of patient- and procedure-related factors, only difficult cannulation is an independent risk factor for ERCP-related AEs.

Reliability and Usefulness of ChatGPT for Inflammatory Bowel Diseases: An Analysis for Patients and Healthcare Professionals.

AIM: We aimed to evaluate the performance of Chat Generative Pre-trained Transformer (ChatGPT) within the context of inflammatory bowel disease (IBD), which is expected to become an increasingly significant health issue in the future. In addition, the objective of the study was to assess whether ChatGPT serves as a reliable and useful resource for both patients and healthcare professionals. METHODS: For this study, 20 specific questions were identified for the two main components of IBD, which are Crohn's disease (CD) and ulcerative colitis (UC). The questions were divided into two sets: one set contained questions directed at healthcare professionals while the second set contained questions directed toward patients. The responses were evaluated with seven-point Likert-type reliability and usefulness scales. RESULTS: The distribution of the reliability and utility scores was calculated into four groups (two diseases and two question sources) by averaging the mean scores from both raters. The highest scores in both reliability and usefulness were obtained from professional sources (5.00± 1.21 and 5.15±1.08, respectively). The ranking in terms of reliability and usefulness, respectively, was as follows: CD questions (4.70±1.26 and 4.75±1.06) and UC questions (4.40±1.21 and 4.55±1.31). The reliability scores of the answers for the professionals were significantly higher than those for the patients (both raters, p=0.032).  Conclusion: Despite its capacity for reliability and usefulness in the context of IBD, ChatGPT still has some limitations and deficiencies. The correction of ChatGPT's deficiencies and its enhancement by developers with more detailed and up-to-date information could make it a significant source of information for both patients and medical professionals.

Effects of Hot Pack Therapy on Post-Colonoscopy Pain: A Prospective, Randomized, Controlled Study.

BACKGROUND: Post-colonoscopy pain (PCP) is a negative condition that causes physical and psychological distress to patients and may lead to noncompliance with treatment and follow-up. The most common hypothesis for the cause of PCP is the inflation of the lumen with air to examine the mucosa. There are no previous studies that have examined the effects of thermal therapy in patients with PCP. AIMS: In this study, we aimed to investigate the effects of the Hot Pack (HP) method in patients with PCP. DESIGN: Randomized, controlled, prospective study. METHODS: Patients were randomized 1:1 into 2 groups of HP and control. In the HP group, hot packs of 40-45°C, kept in a hydrocollator heating unit for 30-35 minutes and wrapped in towels, were applied to the umbilical and hypogastric region of patients in the supine position for 30 minutes. Visual analog scale (VAS) scores were used to measure the pain after colonoscopy. Visual analog scores at 1, 6, and 24 hours were recorded and compared in both groups. RESULTS: There was a significant difference in the presence and severity of pain between the two groups at 1 and 6 hours after colonoscopy (p < .001 and p = .004, respectively). There was no significant difference in pain scores at 24 hours between two groups. CONCLUSIONS: This study showed that the application of HP to patients after colonoscopy is effective in reducing pain in the early period.

Sarcopenia and Myosteatosis Assessed by Magnetic Resonance Enterography May Predict Negative Outcomes in Patients with Crohn's Disease.

BACKGROUND: Limited research has examined the clinical consequences of sarcopenia and myosteatosis in Crohn's disease. This study aimed to determine the prevalence, risk factors, and effects of sarcopenia and myosteatosis on prognostic outcomes in Crohn's disease patients who underwent magnetic resonance enterography. MATERIALS AND METHODS: This retrospective observational study included 116 Crohn's disease patients who underwent magnetic resonance enterography between January 2015 and August 2021. Skeletal muscle index was the ratio of the cross-sectional area of skeletal muscles at the L3 vertebral level to the square of the neck in cross-sectional imaging. Sarcopenia was defined as skeletal muscle index <38.5 cm2/m2 in women and <52.4 cm2/m2 in men. Myosteatosis was considered positive if the ratio of the mean signal intensity of the psoas muscle to the mean signal intensity of the cerebrospinal fluid was above 0.107. RESULTS: Among the negative results in the post-procedure follow-up of the patients, a significant increase was observed in the sarcopenia group regarding abscess and the need for surgery (P < .05). Anti-tumor necrosis factor initiation was found to be significantly higher in the follow-up than in patients without myosteatosis (P = .029). In the multivariate model established with these variables, the presence of sarcopenia in the surgical follow-up was odds ratio = 5.34 (CI: 1.02-28.03, P = .047) and was found to be significantly associated with the increased risk. CONCLUSIONS: The presence of myosteatosis and sarcopenia detected in magnetic resonance enterography may be a harbinger of negative outcomes in Crohn's disease patients. Nutritional support should be provided to these patients with the potential to alter the course of the disease.

Evaluation of Tp-e interval and Tp-e/QTc ratio in patients with inflammatory bowel disease.

BACKGROUND: Inflammatory bowel disease (IBD), a multisystemic inflammatory disorder, has been associated with increased risk of cardiovascular problems, including complications such as conduction defects and arrhythmias. Therefore, the early assessment of the risk factors predisposing to ventricular arrhythmias is crucial, since it can improve clinical outcomes. The objective of the present study is to evaluate ventricular repolarization by using Tp­e interval and Tp-e/QTc ratio as candidate markers of ventricular arrhythmias in patients with IBD. METHODS: The presented study was designed as a single-center prospective cohort study. The study population consisted of 175 patients with IBD and 175 healthy volunteers. The Tp­e interval, corrected QT (QTc), and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram. These parameters were compared between groups. RESULTS: The groups were similar in terms of electrocardiographic findings such as heart rate, QRS interval, and QTc interval. However, Tp­e interval (87.0 ms, interquartile range, IQR 81.0-105.0 ms vs. 84.0 ms, IQR 74.0-92.0 ms; p < 0.001) and Tp-e/QTc ratio (0.21 ± 0.04 vs. 0.19 ± 0.05; p < 0.001) were significantly increased in IBD patient group compared to control group. Notably, a positive correlation was demonstrated between Tp­e interval, Tp-e/QTc ratio and disease duration (Spearman's Rho = 0.36, p < 0.001 for Tp­e; Spearman's Rho = 0.28, p < 0.001 for Tp-e/QTc). CONCLUSION: This study demonstrated that IBD patients are at increased risk of disrupted ventricular repolarization (increased Tpe, Tpe/QTc ratio). In addition, a positive correlation was demonstrated between Tp­e interval, Tp-e/QTc ratio, and disease duration. Therefore, IBD patients, especially those with long-standing diseases, should be more closely screened for ventricular arrhythmias.