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Association Between Bowel Wall Thickening and Long-Term Outcomes in Decompensated Liver Cirrhosis

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A Correction to this article was published on 23 April 2024

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Abstract

Introduction

Bowel wall thickening is commonly observed in liver cirrhosis, but few studies have explored its impact on the long-term outcomes of patients with cirrhosis.

Methods

Overall, 118 patients with decompensated cirrhosis were retrospectively enrolled, in whom maximum wall thickness of small bowel, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum could be measured in computed tomography (CT) images. X-tile software was employed to determine the best cut-off values of each segment of bowel wall thickness for predicting the risk of further decompensation and death. Cumulative rates of further decompensation and death were calculated by Nelson–Aalen cumulative risk curve analyses. Predictors of further decompensation and death were evaluated by competing risk analyses. Sub-distribution hazard ratios (sHRs) were calculated.

Results

Cumulative rates of further decompensation were significantly higher in patients with wall thickness of ascending colon ≥ 11.7 mm (P = 0.014), transverse colon ≥ 3.2 mm (P = 0.043), descending colon ≥ 9.8 mm (P = 0.035), and rectum ≥ 7.2 mm (P = 0.045), but not those with wall thickness of small bowel ≥ 8.5 mm (P = 0.312) or sigmoid colon ≥ 7.1 mm (P = 0.237). Wall thickness of ascending colon ≥ 11.7 mm (sHR = 1.70, P = 0.030), transverse colon ≥ 3.2 mm (sHR = 2.15, P = 0.038), and rectum ≥ 7.2 mm (sHR = 2.38, P = 0.045) were independent predictors of further decompensation, but not wall thickness of small bowel ≥ 8.5 mm (sHR = 1.19, P = 0.490), descending colon ≥ 9.8 mm (sHR = 1.53, P = 0.093) or sigmoid colon ≥ 7.1 mm (sHR = 0.63, P = 0.076). Small bowel, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum wall thickness were not significantly associated with death.

Conclusions

Colorectal wall thickening, but not small bowel wall, may be considered for the prediction of further decompensation in cirrhosis.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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References

  1. Yang X, Yu L, Yu W, et al. Intestinal wall thickness detected by multidetector spiral computed tomography enterography predicts the disease severity of Crohn’s disease. Scand J Gastroenterol. 2014;49(7):807–13.

    Article  PubMed  Google Scholar 

  2. Wu YW, Tang YH, Hao NX, Tang CY, Miao F. Crohn’s disease: CT enterography manifestations before and after treatment. Eur J Radiol. 2012;81(1):52–9.

    Article  PubMed  Google Scholar 

  3. Mills A, Mellnick VM, Itani M. Imaging of bowel wall thickening in the hospitalized patient. Radiol Clin North Am. 2020;58(1):1–17.

    Article  PubMed  Google Scholar 

  4. Pothoulakis I, Wikholm C, Verma V, et al. Predictors of colorectal carcinoma and inflammatory bowel disease in patients with colonic wall thickening. JGH Open. 2022;6(3):159–65.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2021;398(10308):1359–76.

    Article  PubMed  Google Scholar 

  6. Hwang JC, Ha HK, Yoon KH, et al. Colonic wall thickening in cirrhotic patients: CT features and its clinical significance. Abdom Imaging. 1999;24(2):125–8.

    Article  CAS  PubMed  Google Scholar 

  7. Balthazar EJ, Gade MF. Gastrointestinal edema in cirrhotics. Radiographic manifestations and pathogenesis with emphasis on colonic involvement. Gastrointest Radiol. 1976;1(3):215–23.

    Article  CAS  PubMed  Google Scholar 

  8. Yoshiji H, Nagoshi S, Akahane T, et al. Evidence-based clinical practice guidelines for Liver Cirrhosis 2020. J Gastroenterol. 2021;56(7):593–619.

    Article  PubMed  PubMed Central  Google Scholar 

  9. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53(3):397–417.

    Article  Google Scholar 

  10. Baba Y, Hokotate H, Inoue H, Nakajo M. Correlations between colonic wall thickening in patients with virally induced cirrhosis on CT and clinical status. J Comput Assist Tomogr. 2001;25(5):786–91.

    Article  CAS  PubMed  Google Scholar 

  11. Tarantino G, Citro V, Esposito P, et al. Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins. BMC Gastroenterol. 2009;9:21.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–9.

    Article  CAS  PubMed  Google Scholar 

  13. Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology. 2007;45(3):797–805.

    Article  PubMed  Google Scholar 

  14. Qi X, Li Y, Wang R, et al. Liaoning score for prediction of esophageal varices in cirrhotic patients who had never undergone endoscopy: a multicenter cross-sectional study in Liaoning Province, China. Adv Ther. 2019;36(8):2167–78.

    Article  CAS  PubMed  Google Scholar 

  15. Li Q, Wu Y, Zhu Q, et al. External validation of Liaoning score for predicting esophageal varices in liver cirrhosis: a Chinese multicenter cross-sectional study. Ann Transl Med. 2019;7(23):755.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Zheng K, Guo X, Yi F, Wang L, Mancuso A, Qi X. No association between ischemic stroke and portal vein thrombosis in liver cirrhosis. Biomed Res Int. 2020;2020:8172673.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Xu S, Guo X, Yang B, et al. Evolution of nonmalignant portal vein thrombosis in liver cirrhosis: a pictorial review. Clin Transl Gastroenterol. 2021;12(10):e00409.

    Article  PubMed  PubMed Central  Google Scholar 

  18. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C. Baveno VII—renewing consensus in portal hypertension. J Hepatol. 2022;76(4):959–74.

    Article  PubMed  Google Scholar 

  19. Marshak RH, Khilnani M, Eliasoph J, Wolf BS. Intestinal edema. Am J Roentgenol Radium Ther Nucl Med. 1967;101(2):379–87.

    Article  CAS  PubMed  Google Scholar 

  20. Guingrich JA, Kuhlman JE. Colonic wall thickening in patients with cirrhosis: CT findings and clinical implications. AJR Am J Roentgenol. 1999;172(4):919–24.

    Article  CAS  PubMed  Google Scholar 

  21. Harkins JM, Ahmad B. Anatomy, abdomen and pelvis, portal venous system (hepatic portal system). Treasure Island: StatPearls Publishing; 2022.

    Google Scholar 

  22. Chou CK, Mak CW, Tzeng WS, Chang JM. CT of small bowel ischemia. Abdom Imaging. 2004;29(1):18–22.

    Article  CAS  PubMed  Google Scholar 

  23. Shao L, Ling Z, Chen D, Liu Y, Yang F, Li L. Disorganized gut microbiome contributed to liver cirrhosis progression: a meta-omics-based study. Front Microbiol. 2018;9:3166.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Di-Ciaula A, Baj J, Garruti G, et al. Liver steatosis, gut-liver axis, microbiome and environmental factors. A never-ending bidirectional cross-talk. J Clin Med. 2020;9(8):2648.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ersöz G, Aydin A, Erdem S, Yüksel D, Akarca U, Kumanlioglu K. Intestinal permeability in liver cirrhosis. Eur J Gastroenterol Hepatol. 1999;11(4):409–12.

    Article  PubMed  Google Scholar 

  26. Thalheimer U, De Iorio F, Capra F, et al. Altered intestinal function precedes the appearance of bacterial DNA in serum and ascites in patients with cirrhosis: a pilot study. Eur J Gastroenterol Hepatol. 2010;22(10):1228–34.

    Article  PubMed  Google Scholar 

  27. Tripathi A, Debelius J, Brenner DA, et al. The gut-liver axis and the intersection with the microbiome. Nat Rev Gastroenterol Hepatol. 2018;15(7):397–411.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Csak T, Ganz M, Pespisa J, Kodys K, Dolganiuc A, Szabo G. Fatty acid and endotoxin activate inflammasomes in mouse hepatocytes that release danger signals to stimulate immune cells. Hepatology (Baltimore, Md). 2011;54(1):133–44.

    Article  CAS  PubMed  Google Scholar 

  29. Uesugi T, Froh M, Arteel GE, Bradford BU, Thurman RG. Toll-like receptor 4 is involved in the mechanism of early alcohol-induced liver injury in mice. Hepatology (Baltimore, Md). 2001;34(1):101–8.

    Article  CAS  PubMed  Google Scholar 

  30. Seki E, Schnabl B. Role of innate immunity and the microbiota in liver fibrosis: crosstalk between the liver and gut. J Physiol. 2012;590(3):447–58.

    Article  CAS  PubMed  Google Scholar 

  31. Scott RA, Williams HG, Hoad CL, et al. MR measures of small bowel wall t2 are associated with increased permeability. J Magn Reson Imaging. 2021;53(5):1422–31.

    Article  PubMed  Google Scholar 

  32. Gómez-Hurtado I, Such J, Sanz Y, Francés R. Gut microbiota-related complications in cirrhosis. World J Gastroenterol. 2014;20(42):15624–31.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Goulis J, Armonis A, Patch D, Sabin C, Greenslade L, Burroughs AK. Bacterial infection is independently associated with failure to control bleeding in cirrhotic patients with gastrointestinal hemorrhage. Hepatology (Baltimore, Md). 1998;27(5):1207–12.

    Article  CAS  PubMed  Google Scholar 

  34. Senzolo M, Fries W, Buda A, et al. Oral propranolol decreases intestinal permeability in patients with cirrhosis: another protective mechanism against bleeding? Am J Gastroenterol. 2009;104(12):3115–6.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We sincerely thank the participants of this study.

Funding

No funding or sponsorship was received for this study or publication of this article.

Author information

Author notes

  1. Xueying Wang and Min Ding contributed equally to this work.

Authors and Affiliations

  1. Liver Cirrhosis Study Group, Department of Gastroenterology, The General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China

    Xueying Wang, Min Ding, Weiwei Wang, Xiaojie Zheng & Xingshun Qi

  2. Postgraduate College, Jinzhou Medical University, Jinzhou, China

    Xueying Wang & Xingshun Qi

  3. Postgraduate College, China Medical University, Shenyang, China

    Min Ding, Xiaojie Zheng & Xingshun Qi

  4. Postgraduate College, Liaoning University of Traditional Chinese Medicine, Shenyang, China

    Weiwei Wang

  5. Clinical and Translational Hepatology, Rajagiri Hospital, The Liver Institute, Center of Excellence in GI Sciences, Aluva, India

    Cyriac Abby Philips

  6. Liver Research Unit, Medica Sur Clinic & Foundation, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico

    Nahum Méndez-Sánchez

  7. Emergency Medicine Department, General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), No. 83 Wenhua Road, Shenyang, 110840, Liaoning Province, China

    Hongxu Jin

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Contributions

Concept and design: Xingshun Qi; Data collection and revision: Xueying Wang, Min Ding, Xiaojie Zheng, and Xingshun Qi; Statistical analysis: Xueying Wang, Min Ding, Weiwei Wang, and Xingshun Qi; Drafting the manuscript: Xueying Wang, Min Ding, and Xingshun Qi; Critical comments and revision: Xueying Wang, Min Ding, Cyriac Abby Philips, Nahum Méndez-Sánchez, Hongxu Jin, and Xingshun Qi; Supervision: Hongxu Jin and Xingshun Qi. All authors have made an intellectual contribution to the manuscript and approved the submission.

Corresponding authors

Correspondence to Hongxu Jin or Xingshun Qi.

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Conflict of Interest

Xueying Wang, Min Ding, Weiwei Wang, Xiaojie Zheng, Cyriac Abby Philips, Nahum Méndez-Sánchez, Hongxu Jin, and Xingshun Qi have nothing to disclose.

Ethical Approval

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Medical Ethical Committee of the General Hospital of Northern Theater Command [Y (2023) 043]. The patient's informed consent was not required due to the retrospective nature of this study.

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The article is revised due to update in supplement file.

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Wang, X., Ding, M., Wang, W. et al. Association Between Bowel Wall Thickening and Long-Term Outcomes in Decompensated Liver Cirrhosis. Adv Ther 41, 2217–2232 (2024). https://doi.org/10.1007/s12325-023-02690-z

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  • DOI: https://doi.org/10.1007/s12325-023-02690-z

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