Clinical and Translational Gastroenterology最新文献

{"title":"Higher rates of delay in starting advanced inflammatory bowel disease therapies linked to insurance delays, intravenous infusions, and lack of pharmacy support.","authors":"Sara Gottesman, Karen Xiao, Hang P Nguyen, Elizabeth Hernandez, Emily Saweris, Priyanka Jaganathan, Faraz Jafri, Jonathan Davis, Kimhouy Tong, Zhouwen Tang, Jill K J Gaidos, Linda A Feagins","doi":"10.14309/ctg.0000000000000808","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000808","url":null,"abstract":"<p><strong>Background: </strong>Because biologic and small molecule therapy is expensive, payors have mandated pre-authorizations for these medications, often resulting in a lengthy approval process. The aims of this study are to assess the frequency of and risk factors for delays in starting advanced therapies assessing insurance, care team, and patient-related factors.</p><p><strong>Methods: </strong>Retrospective, multi-center study of adult inflammatory bowel disease patients with prescriptions for an advanced therapy in two geographically distinct academic gastroenterology practices; one with and the other without a dedicated pharmacist. A priori we defined a delay in starting therapy as >14 days between prescription and first dose. Logistic regression analysis was performed to assess for risk factors for delay.</p><p><strong>Results: </strong>A total of 388 patients were prescribed advanced therapies with 46.6% receiving their first dose within 14 days. Patients who were on time vs delayed were similar in baseline demographics, disease characteristics, and disease activity. After adjusting for confounders, three independent risk factors remained significant as predictors for delay; study site (OR=5.2, 95% CI 2.894, 9.333), intravenous drug delivery as opposed to subcutaneous or oral (OR=3.07, 95% CI 1.845, 5.099), and insurance denial (OR=2.72, 95% CI 1.082, 6.825).</p><p><strong>Conclusions: </strong>In a multicenter study, we found that a delay between prescription and administration of first dose of an advanced therapy is common, with >50% of patients having the first dose delayed by >2 weeks. Delays in starting therapy were significantly more likely if denied by insurance, given via IV induction, or at a study site without a dedicated pharmacist.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of a Survival Prediction Model for Patients With Pancreatic Cancer.","authors":"Paul D James, Fatema Almousawi, Misbah Salim, Rishad Khan, Peter Tanuseputro, Amy T Hsu, Natalie Coburn, Balqis Alabdulkarim, Robert Talarico, Anastasia Gayowsky, Colleen Webber, Hsien Seow, Rinku Sutradhar","doi":"10.14309/ctg.0000000000000774","DOIUrl":"10.14309/ctg.0000000000000774","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with pancreatic ductal adenocarcinoma (PDAC) face challenging treatment decisions following their diagnosis. We developed and validated a survival prognostication model using routinely available clinical information, patient-reported symptoms, performance status, and initial cancer-directed treatment.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with PDAC from 2007 to 2020 using linked administrative databases in Ontario, Canada. Patients were randomly selected for model development (75%) and validation (25%). Using the development cohort, a multivariable Cox proportional hazards regression with backward stepwise variable selection was used to predict the probability of survival. Model performance was assessed on the validation cohort using the concordance index and calibration plots.</p><p><strong>Results: </strong>There were 17,450 patients (49% female) with a median age of 72 years (interquartile range 63-81) and a mean survival time of 9 months. In the derivation cohort, 1,469 patients (11%) had early stage, 4,202 (32%) had advanced stage disease, and 7,417 (57%) had unknown stage. The following factors were associated with an increased risk of death by more than 10%: tumor in the tail of the pancreas; advanced stage; hospitalization 3 months before diagnosis; congestive heart failure or dementia; low, moderate, or high pain score; moderate or high appetite score; high dyspnea and tiredness score; and a performance status score of 60-70 or lower. The calibration plot indicated good agreement with a C-index of 0.76.</p><p><strong>Discussion: </strong>This model accurately predicted one-year survival for PDAC using clinical factors, symptoms, and performance status. This model may foster shared decision making for patients and their providers.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Associations Between Life's Essential 8 and Diarrhea and Constipation: Results from the 2005-2010 NHANES.","authors":"Xin Yang, Shengjie Ding, Jinlu Guo, Shuang Peng, Zhiqing Duan, Shi Liu","doi":"10.14309/ctg.0000000000000801","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000801","url":null,"abstract":"<p><strong>Background and aims: </strong>Few studies have investigated the association between Life's Essential 8 (LE8) and abnormal bowel health. We aimed to investigate the relationship between LE8 and diarrhea and constipation in the adult population of the United States.</p><p><strong>Methods: </strong>This cross-sectional study, based on population data, utilized information from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2010. Diarrhea and constipation were classified based on Bristol Stool Form Scale and stool frequency. LE8 score is composed of four health behaviors (diet, physical activity, nicotine exposure, and sleep health) and four health factors (body mass index, blood lipids, blood glucose, and blood pressure) and is classified into low (0-49), moderate (50-79), and high (80-100) cardiovascular health (CVH) groups. Weighted logistic regression and restricted cubic splines were employed to analyze the relationship between the LE8 score and abnormal bowel health.</p><p><strong>Results: </strong>The study comprised 12,369 subjects aged 20 years or older, among whom 1,279 (9.7%) had constipation and 1,097 (7.6%) had diarrhea. After adjusting for potential confounders, we observed negative associations between LE8 scores and diarrhea (OR: 0.60, 95% CI: 0.39-0.93), whereas the association between LE8 scores and constipation was not statistically significant (OR: 0.82, 95% CI: 0.59-1.13). Additionally, health behavior scores and health factor scores are associated with constipation.</p><p><strong>Conclusions: </strong>Higher LE8 levels are associated with a lower incidence of diarrhea, but not constipation.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary approach improves eradication rate and safety in refractory Helicobacter pylori infection: Multidisciplinary approach for H. pylori.","authors":"Na Dai, Yu-Qin Zhao, Wen-Juan Wu, Zheng-Lin Shen, Yan-Hua Xu, Xiao-Yang Wu, Gui-Zhen Zhang, Lan Wang, Qing-Hua Wang","doi":"10.14309/ctg.0000000000000804","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000804","url":null,"abstract":"<p><strong>Introduction: </strong>Helicobacter pylori (HP) infection is prevalent worldwide and contributes to various gastrointestinal diseases. Eradication therapy is crucial in managing HP infection, but antibiotic resistance has led to refractory cases, complicating treatment outcomes and increasing the risk of adverse events.</p><p><strong>Objectives: </strong>This study aimed to evaluate the effectiveness of a multidisciplinary approach, termed HP Multidisciplinary Team (MDT) Clinic, in improving eradication rates and safety in patients with refractory HP infection.</p><p><strong>Methods: </strong>Between November 2020 and November 2023, 153 patients with refractory HP infection were included, with 51 patients in the non-HP-MDT group and 102 patients in the HP-MDT group. The HP-MDT clinic provided personalized treatment plans, patient education, and follow-up. Genetic testing was conducted in selected cases to assess resistance patterns.</p><p><strong>Results: </strong>Patients attending the HP-MDT clinic showed significantly higher eradication rates compared to those in the non-HP-MDT group (80.39% vs. 50.98%, P<0.001). Logistic regression analysis confirmed that HP-MDT clinic attendance was independently associated with higher eradication rates (OR: 4.43, 95% CI: 2.02 to 9.71, P<0.001). Genetic testing revealed high rates of antibiotic resistance, particularly to clarithromycin (10/11, 90.91%) and metronidazole (11/11, 100%). Despite resistance, the HP-MDT approach achieved a high eradication rate of 92.31%. Adverse drug reactions occurred in 12.75% of patients in the HP-MDT group, predominantly mild gastrointestinal symptoms.</p><p><strong>Conclusion: </strong>The HP-MDT Clinic, integrating medical, pharmaceutical, and nursing expertise, significantly improved eradication rates and safety in patients with refractory HP infection. Personalized treatment plans, patient education, and genetic testing contributed to successful outcomes with minimal adverse events.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of the Second Forward View on the Detection Rate of Sessile Serrated Lesions in the Proximal Colon: A Single-Center Prospective Randomized Controlled Study.","authors":"Jiandi Wu, Qingqing Zhang, Xueyan Li, Tao Bai, Xiaohua Hou, Gangping Li, Jun Song","doi":"10.14309/ctg.0000000000000805","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000805","url":null,"abstract":"<p><strong>Objectives: </strong>The detection rate of proximal sessile serrated lesion (PSSLDR) is linked to the incidence and mortality of colorectal cancer. However, research on second forward view (SFV) examinations for PSSLDR remains limited. This first randomized controlled trial assessed the impact of the proximal SFV on the PSSLDR.</p><p><strong>Methods: </strong>Patients were randomized into two groups during proximal colonoscopy: standard colonoscopy (SC) and SFV. The SC group underwent a standard examination, whereas the SFV group underwent a second examination of the proximal colon (cecum to splenic flexure). The primary outcome was PSSLDR, with secondary outcomes, including the proximal polyp detection rate (PPDR), proximal adenoma detection rate (PADR), and lesion miss rate, compared between the two groups.</p><p><strong>Results: </strong>Among 246 patients (SC=124; SFV=122), SFV significantly improved the PSSLDR by 7.4% compared to SC (9.8% vs. 2.4%, P=0.017). SFV increased the PPDR by 20.2% (55.7% vs. 35.5%, P=0.002) and PADR by 12.7% (37.7% vs. 25%, P=0.039). Multivariate analysis revealed that sessile serrated lesions (SSLs) (OR=7.70, 95% CI [1.58, 37.59]), inflammatory polyps (OR=4.24, 95% CI [1.73, 10.39]), and lesion size (OR=0.76, 95% CI [0.60, 0.96]) were associated with proximal missed lesions. The overall polyp miss rate was 52.9%, with miss rates of 61.0% for polyps <5 mm, 80% for SSLs, and 42.2% for adenomas. Furthermore, 12.3% of patients experienced changes in surveillance intervals from SFV examination.</p><p><strong>Conclusions: </strong>SFV examination of the proximal colon significantly improved the PSSLDR by 7.4%, PPDR by 20.2%, PADR by 12.7%, while shortening the detection interval by 12.3%, making it a valuable and cost-effective addition to routine colonoscopy.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom burden after acute pancreatitis and its correlation with exocrine pancreatic function: A multicenter prospective study.","authors":"Joseph Bejjani, Stacey Culp, Melica Nikahd, Anna Evans Phillips, Vikesh Singh, Kristen M Roberts, Maisam Abu-El-Haija, Somashekar G Krishna, Mitchell L Ramsey, Ali Lahooti, Peter J Lee, Phil A Hart, Georgios I Papachristou","doi":"10.14309/ctg.0000000000000799","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000799","url":null,"abstract":"<p><strong>Background and aims: </strong>Gastrointestinal (GI) symptoms and weight loss develop during and after acute pancreatitis (AP), but remain understudied. In this prospective, multicenter study, we aim to assess GI symptom burden and weight loss and their correlation with exocrine function up to 12-mo post-AP.</p><p><strong>Methods: </strong>GI symptom burden, anthropometrics, and exocrine pancreatic function were systematically measured in adults (≥18 years) with AP at predefined intervals: hospitalization (enrollment), 3-months (3-mo), and 12-mo post-AP. Symptoms were evaluated using a 15-item tracker, including abdominal symptoms, stool characteristics, and activities of daily living; higher scores indicating greater symptom burden (range 0-45). Exocrine function was assessed with fecal elastase-1 (FE-1) levels.</p><p><strong>Results: </strong>GI symptoms were collected in 97 participants with 12-mo follow-up. The median (IQR) GI-symptom score was 7 (3-12) with 55 participants (57%) experiencing at least one symptom frequently (\"often\" or \"almost always\"). In multivariable linear regression, younger age, lower Charlson Comorbidity Index, smoking, recurrent AP, and alcoholic or idiopathic etiologies were associated with significantly higher GI-symptom burden at 12-mo. A significant negative correlation was found between GI symptoms and FE-1 levels during hospitalization ((ρ)=-0.288; p=0.015) and at 12-mo (ρ=-0.219; p=0.046). Eighteen participants (18.6%) lost ≥10% body weight between hospitalization and 12-mo, and had significantly lower median FE-1 levels at 12-mo compared to the group without weight-loss (166 vs. 332 µg/g, p=0.016).</p><p><strong>Conclusions: </strong>This is the first study to prospectively assess GI-symptom burden and exocrine function post-AP. Lower exocrine pancreatic function at 12-mo was associated with increased symptom burden and weight loss. These findings support further investigations to define and improve patient-reported outcomes post-AP.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Genetic Risk, Dysbiosis, and Treatment Stratification Using Host Genome and Gut Microbiome in Inflammatory Bowel Disease.","authors":"Ahmed Moustafa, Weizhong Li, Ericka L Anderson, Emily H MWong, Parambir S Dulai, William J Sandborn, William Biggs, Shibu Yooseph, Marcus B Jones, Craig J Venter, Karen E Nelson, John T Chang, Amalio Telenti, Brigid S Boland","doi":"10.14309/ctg.0000000000000796","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000796","url":null,"abstract":"","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Levels of evidence supporting recommendations in gastroenterology.","authors":"Miyabi Saito, Amy Yu, Nneka N Ufere, Andrew Chan, Bharati Kochar","doi":"10.14309/ctg.0000000000000797","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000797","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to analyze gastrointestinal guidelines to assess quality of evidence and strength of recommendation.</p><p><strong>Methods: </strong>We abstracted clinical practice guidelines and guidance statements from 4 American GI societies (ACG, AGA, ASGE and AASLD) and the United States Multi-Society Task Forc.</p><p><strong>Results: </strong>Of the 3,609 statements analyzed, only 13% were supported by high level of evidence. The number of statements published annually is increasing, but the level of evidence supporting recommendations is declining over time.</p><p><strong>Conclusions: </strong>This analysis highlights the need for high quality research in GI to support the development of stronger evidence-based guideline statements.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics, Management and Outcomes of Colitis-associated Colorectal Cancer and the Comparison to Sporadic Colorectal Cancer in Taiwan.","authors":"Hsin-Yun Wu, Meng-Tzu Weng, Jen-Wei Chou, Hsu-Heng Yen, Chun-Chi Lin, Feng-Fan Chiang, Chen-Shuan Chung, Wei-Chen Lin, Chen-Wang Chang, Puo-Hsien Le, Chia-Jung Kuo, Ching-Pin Lin, Wen-Hung Hsu, Chiao-Hsiung Chuang, Tzung-Jiun Tsai, I-Che Feng, Shu-Chen Wei, Tien-Yu Huang","doi":"10.14309/ctg.0000000000000798","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000798","url":null,"abstract":"<p><strong>Background: </strong>We explored the clinical characteristics, treatment, and outcomes of colitis-associated colorectal cancer and compared with sporadic colorectal cancer in Taiwan.</p><p><strong>Methods: </strong>In this retrospective study spanning 1987-2022, colitis-associated colorectal cancers diagnosed according to endoscopic and pathological reports from 14 tertiary centers were reported to our cohort. Clinical demographics, endoscopic findings, histological results, treatment modalities, and outcomes were analyzed. Sporadic colorectal cancer data were retrieved from the Cancer Registry Annual Report, Ministry of Health and Welfare, Taiwan.</p><p><strong>Results: </strong>We enrolled 65 colitis-associated colorectal cancer patients (median age: 56 years; male: 66.2%). Distal colon was the most common tumor location (41.5%). Of ulcerative colitis patients, 77.2% had extensive colitis and 76.5% had Mayo endoscopic subscores of ≥2. Moreover, 50% of lesions were nonpolypoid with indistinct borders in 66.7%. Signet-ring cell subtype consisted 12.3%. Surveillance colonoscopy adherence was 78.4%, yet 51.3% interval cancers occurred. Disease stage 0-4 distribution was 15%, 20%, 13.3%, 20%, and 31.7%, respectively. Endoscopic resection was feasible for 14%, while 67.7% required surgery. During follow-up (median: 21.5 months), we recorded 23.2% recurrence and 34.5% mortality. Lesions with indistinct borders were associated with adverse outcomes (adjusted odds ratio = 11.5 [1.35-98.16]). Colitis-associated rectal cancers, diagnosed later (p < 0.001), had worse outcomes than sporadic rectal cancers.</p><p><strong>Conclusions: </strong>This is the largest Asian colitis-associated colorectal cancer cohort study, emphasizing the need for stringent disease control, improving detection and reducing interval cancers. Signet-ring cell subtype was prevalent. Rectal colitis-associated cancers were diagnosed later with poorer outcomes then sporadic rectal cancers.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Misdiagnosis and Underdiagnosis of Hepatic Encephalopathy.","authors":"Patricia P Bloom","doi":"10.14309/ctg.0000000000000784","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000784","url":null,"abstract":"<p><strong>Abstract: </strong>Patients with cirrhosis are at risk of developing hepatic encephalopathy, which can present with a wide range of symptoms, including confusion, lethargy, inappropriate behavior, and altered sleep patterns. In addition to hepatic encephalopathy, patients with cirrhosis are at risk of developing mild cognitive impairment, dementia, and delirium, which have features closely resembling hepatic encephalopathy. Given the similar presentation of these conditions, misdiagnosis can and does occur. Mild cognitive impairment is common in individuals aged ≥50 years and can progress to dementia in those affected. Dementia and hepatic encephalopathy are both characterized by sleep disturbance and cognitive dysfunction, thus differentiating these conditions can be difficult. Furthermore, delirium can disrupt sleep patterns, and liver disease is recognized as a risk factor for its development. As hepatic encephalopathy is a cirrhosis-related complication, determining if a patient has undiagnosed cirrhosis is critical, particularly given the large number of patients with asymptomatic, compensated cirrhosis. Separately, underdiagnosis of minimal hepatic encephalopathy can occur even in patients with diagnosed liver disease, related, in part, to lack of testing. Given the availability of effective therapies available for managing symptoms and preventing future episodes, accurate diagnosis of hepatic encephalopathy is essential.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}