Clinical and Translational Gastroenterology最新文献

{"title":"International Validation of a Novel PEACE Scale to Improve the Quality of Upper Gastrointestinal Mucosal Inspection During Endoscopy.","authors":"Marcin Romańczyk, Madhav Desai, Michal F Kamiński, Seiichiro Abe, Asma A Alkandari, Torsten Beyna, Raf Bisschops, Krzysztof Budzyń, Monika Bugdol, Samir C Grover, C Prakash Gyawali, Haruhiro Inoue, Prasad G Iyer, Helmut Messmann, Krish Ragunath, Yutaka Saito, Sachin Srinivasan, Christopher Teshima, Rena Yadlapati, Cesare Hassan, Prateek Sharma","doi":"10.14309/ctg.0000000000000786","DOIUrl":"10.14309/ctg.0000000000000786","url":null,"abstract":"<p><strong>Introduction: </strong>The performance of a high quality esophagogastroduodenoscopy (EGD) is dependent on the mucosal cleanliness. Recently, the Polprep: Effective Assessment of Cleanliness in EGD (PEACE) scale was created to assess the degree of mucosal cleanliness during EGD. The aim of this study was to validate this scoring system in a cohort of international endoscopists.</p><p><strong>Methods: </strong>In total, 39 EGD videos, with different degrees of mucosal cleanliness were retrieved from a previously conducted prospective trial. All experts rated the cleanliness of the mucosa on each video using the PEACE scale. To evaluate agreement of all scores (0-3), intraclass correlation coefficient 2.1 was used. The agreement on adequate (scores 2 and 3) and inadequate (scores 0 and 1) cleanliness was assessed using kappa values.</p><p><strong>Results: </strong>Videos evaluating esophagus, stomach, and duodenum cleanliness were reviewed by 16 endoscopists. The PEACE scores demonstrated good agreement (intraclass correlation coefficient 0.82, 95% CI 0.75-0.89), especially for esophagus (0.84; 95% CI 0.71-0.95) and stomach (0.81; 95% CI 0.69-0.91), while agreement was moderate for the duodenum (0.69; 95% CI 0.51-0.87). The agreement was similar between Eastern (0.86; 95% CI 0.79-0.92) and Western experts (0.80; 95% CI 0.72-0.88). Similarly, agreement regarding adequate cleanliness was comparable between Eastern (0.70; 95% CI 0.55-0.85) and Western (0.74; 95% CI 0.64-0.84) endoscopists being overall 0.75 (95% CI 0.65-0.85).</p><p><strong>Discussion: </strong>The PEACE scoring system is a simple and reliable scale to assess the cleanliness during EGD. The score is now validated among international experts with high concordance, justifying its use in clinical practice.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11756887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Use of Environmental and Polygenic Risk Scores to Inform Colorectal Cancer Risk-Based Surveillance Intervals.","authors":"Rebecca Landy, Hormuzd A Katki, Wen-Yi Huang, Difei Wang, Minta Thomas, Flora Qu, Neal D Freedman, Erikka Loftfield, Jianxin Shi, Ulrike Peters, Li Hsu, Robert E Schoen, Sonja I Berndt","doi":"10.14309/ctg.0000000000000782","DOIUrl":"10.14309/ctg.0000000000000782","url":null,"abstract":"<p><strong>Introduction: </strong>United States Multi-Society Task Force colonoscopy surveillance intervals are based solely on adenoma characteristics, without accounting for other risk factors. We investigated whether a risk model including demographic, environmental, and genetic risk factors could individualize surveillance intervals under an \"equal management of equal risks\" framework.</p><p><strong>Methods: </strong>Using 14,069 individuals from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial who had a diagnostic colonoscopy following an abnormal flexible sigmoidoscopy, we modeled the risk of colorectal cancer, considering the diagnostic colonoscopy finding, baseline risk factors (e.g., age and sex), 19 lifestyle and environmental risk factors, and a polygenic risk score for colorectal cancer. Ten-year absolute cancer risks for each diagnostic colonoscopy finding (advanced adenomas [N = 2,446], ≥3 non-advanced adenomas [N = 483], 1-2 non-advanced adenomas [N = 4,400], and no adenoma [N = 7,183]) were used as implicit risk thresholds for recommended surveillance intervals.</p><p><strong>Results: </strong>The area under the curve for the model including colonoscopy findings, baseline characteristics, and polygenic risk score was 0.658. Applying the equal management of equal risks framework, 28.2% of individuals with no adenoma and 42.7% of those with 1-2 non-advanced adenomas would be considered high risk and assigned a significantly shorter surveillance interval than currently recommended. Among individuals who developed cancer within 10 years, 52.4% with no adenoma and 48.3% with 1-2 non-advanced adenomas would have been considered high risk and assigned a shorter surveillance interval.</p><p><strong>Discussion: </strong>Using a personalized risk-based model has the potential to identify individuals with no adenoma or 1-2 non-advanced adenomas, who are higher risk and may benefit from shorter surveillance intervals.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142817504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Vedolizumab With Exclusive Enteral Nutrition in Adult Patients With Moderate to Severe Crohn's Disease (Crohn Exclusive Enteral Nutrition Study).","authors":"Jing Wang, Zhishun Tang, Jiao Li, Anning Yin, Yaqing Xu, Liping Zou, Haixia Ren, Jian Kang, Juan Su, Qian Zhou, Yang Wang, Wei Wang, Jing Zhang, Huipeng Wan, Ping An","doi":"10.14309/ctg.0000000000000759","DOIUrl":"10.14309/ctg.0000000000000759","url":null,"abstract":"<p><strong>Introduction: </strong>Despite increasing studies confirming the efficacy of vedolizumab (VDZ) in Crohn's disease (CD), improving the responses to this biologic agent remains challenging in clinical practice. In this article, we investigated the efficacy of combined treatment of VDZ and 16-week exclusive enteral nutrition (EEN) in moderately to severely active CD.</p><p><strong>Methods: </strong>From October 2020 to October 2023, 81 patients with moderately to severely active CD treated with VDZ from 2 inflammatory bowel disease centers were retrospectively selected. Forty-one patients received treatment of VDZ with concomitant 16-week EEN (VDZ + EEN cohort), and 40 patients received VDZ treatment alone (VDZ cohort). Clinical and biological outcomes were evaluated. Endoscopic response and mucosal healing were assessed by colonoscopy at weeks 16 and 52.</p><p><strong>Results: </strong>There was no statistically significant difference between 2 groups at baseline for demographic and clinical characteristics. Compared with patients treated with VDZ alone, patients in the VDZ + EEN cohort achieved higher rates of clinical response (84.2% vs 40.0%), clinical remission (81.6% vs 30.0%), endoscopic response (91.4% vs 34.6%), including mucosal healing (85.7% vs 26.9%) at week 16. The superiority of VDZ + EEN treatment sustained in maintenance, with 76.7% (vs 33.3%) clinical response, 70.0% (vs 26.7%) clinical remission, 76.9% (vs 33.3%) endoscopic response, and 61.5% (vs 26.7%) mucosal healing at week 52. None of the patients experienced severe adverse events.</p><p><strong>Discussion: </strong>VDZ with concomitant 16-week EEN might be an effective and optimized approach with solid efficacy in the induction and maintenance treatment of active CD.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00759"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142016550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liraglutide and Colesevelam Change Serum and Fecal Bile Acid Levels in a Randomized Trial With Patients With Bile Acid Diarrhea.","authors":"Anne-Marie Ellegaard, Martin L Kårhus, Lukasz Krych, David P Sonne, Julie L Forman, Svend H Hansen, Lars Ove Dragsted, Dennis S Nielsen, Filip K Knop","doi":"10.14309/ctg.0000000000000772","DOIUrl":"10.14309/ctg.0000000000000772","url":null,"abstract":"<p><strong>Introduction: </strong>Both liraglutide and colesevelam improve bile acid diarrhea symptoms. Colesevelam binds excess amounts of diarrhea-causing bile acids in the colon, whereas the mode of action for liraglutide remains elusive. In this article, we examined the impact of colesevelam and liraglutide treatment on the concentrations of bile acids in serum and feces and the fecal microbiota composition to better understand the 2 drugs' modes of action.</p><p><strong>Methods: </strong>Bile acid species were analyzed in serum and fecal samples from a randomized, double-blind, double-dummy trial at baseline and after 3 and 6 weeks of orally administered colesevelam (1,875 mg twice daily, n = 26) or subcutaneously administered liraglutide (uptitrated by weekly increments of 0.6 mg from 0.6 to 1.8 mg daily, n = 26) in patients with 75 selenium-homotaurocholic acid test-verified, idiopathic, or postcholecystectomy bile acid diarrhea. Fecal microbiota composition was analyzed by 16S rRNA gene amplicon sequencing at the same time points.</p><p><strong>Results: </strong>Colesevelam increased the fecal concentrations of all bile acid species, whereas it decreased serum concentrations of secondary bile acids. Liraglutide induced a small increase in serum unconjugated bile acid concentrations without affecting fecal bile acid concentrations. No changes in fecal microbiota composition were observed with either treatment.</p><p><strong>Discussion: </strong>Colesevelam and liraglutide exhibit distinct effects on serum and fecal bile acid concentrations with colesevelam reducing serum concentrations of secondary bile acids and promoting fecal bile acid excretion, whereas liraglutide enhances serum concentrations of unconjugated bile acids, potentially through deceleration of small intestinal transit time allowing more time for passive absorption of bile acids.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":"15 11","pages":"e00772"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digesting Digital Health: A Study of Appropriateness and Readability of ChatGPT-Generated Gastroenterological Information.","authors":"Avi Toiv, Zachary Saleh, Angela Ishak, Eva Alsheik, Deepak Venkat, Neilanjan Nandi, Tobias E Zuchelli","doi":"10.14309/ctg.0000000000000765","DOIUrl":"10.14309/ctg.0000000000000765","url":null,"abstract":"<p><strong>Introduction: </strong>The advent of artificial intelligence-powered large language models capable of generating interactive responses to intricate queries marks a groundbreaking development in how patients access medical information. Our aim was to evaluate the appropriateness and readability of gastroenterological information generated by Chat Generative Pretrained Transformer (ChatGPT).</p><p><strong>Methods: </strong>We analyzed responses generated by ChatGPT to 16 dialog-based queries assessing symptoms and treatments for gastrointestinal conditions and 13 definition-based queries on prevalent topics in gastroenterology. Three board-certified gastroenterologists evaluated output appropriateness with a 5-point Likert-scale proxy measurement of currency, relevance, accuracy, comprehensiveness, clarity, and urgency/next steps. Outputs with a score of 4 or 5 in all 6 categories were designated as \"appropriate.\" Output readability was assessed with Flesch Reading Ease score, Flesch-Kinkaid Reading Level, and Simple Measure of Gobbledygook scores.</p><p><strong>Results: </strong>ChatGPT responses to 44% of the 16 dialog-based and 69% of the 13 definition-based questions were deemed appropriate, and the proportion of appropriate responses within the 2 groups of questions was not significantly different ( P = 0.17). Notably, none of ChatGPT's responses to questions related to gastrointestinal emergencies were designated appropriate. The mean readability scores showed that outputs were written at a college-level reading proficiency.</p><p><strong>Discussion: </strong>ChatGPT can produce generally fitting responses to gastroenterological medical queries, but responses were constrained in appropriateness and readability, which limits the current utility of this large language model. Substantial development is essential before these models can be unequivocally endorsed as reliable sources of medical information.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00765"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Chronic Pancreatitis Prognosis Score in an American Cohort.","authors":"Soo Kyung Park, Darwin L Conwell, Phil A Hart, Shuang Li, Kimberly Stello, Evan L Fogel, William E Fisher, Christopher E Forsmark, Stephen J Pandol, Walter G Park, Mark Topazian, Jose Serrano, Santhi Swaroop Vege, Stephen K Van Den Eeden, Liang Li, Dhiraj Yadav, Jami L Saloman","doi":"10.14309/ctg.0000000000000758","DOIUrl":"10.14309/ctg.0000000000000758","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic Pancreatitis Prognosis Score (COPPS) was developed to discriminate disease severity and predict risk for future hospitalizations. In this cohort study, we evaluated if COPPS predicts the likelihood of hospitalization(s) in an American cohort.</p><p><strong>Methods: </strong>The Chronic Pancreatitis, Diabetes, and Pancreatic Cancer consortium provided data and serum from subjects with chronic pancreatitis (N = 279). COPPS was calculated with baseline data and stratified by severity (low, moderate, and high). Primary endpoints included number and duration of hospitalizations during 12-month follow-up.</p><p><strong>Results: </strong>The mean ± SD COPPS was 8.4 ± 1.6. COPPS correlated with all primary outcomes: hospitalizations for any reason (number: r = 0.15, P = 0.01; duration: r = 0.16, P = 0.01) and pancreas-related hospitalizations (number: r = 0.15, P = 0.02; duration: r = 0.13, P = 0.04). The severity distribution was 13.3% low, 66.0% moderate, and 20.8% high. 37.6% of subjects had ≥1 hospitalization(s) for any reason; 32.2% had ≥1 pancreas-related hospitalizations. All primary outcomes were significantly different between severity groups: hospitalizations for any reason (number, P = 0.004; duration, P = 0.007) and pancreas-related hospitalizations (number, P = 0.02; duration, P = 0.04). The prevalence of continued drinking at follow-up ( P = 0.04) was higher in the low and moderate groups. The prevalence of anxiety at enrollment ( P = 0.02) and follow-up ( P < 0.05) was higher in the moderate and high groups.</p><p><strong>Discussion: </strong>Statistically, COPPS significantly correlated with hospitalization outcomes, but the correlations were weaker than in previous studies, which may be related to the outpatient nature of the PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies cohort and lower prevalence of high severity disease. Studies in other prospective cohorts are needed to understand the full utility of COPPS as a potential tool for clinical risk assessment and intervention.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00758"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning and Automatic Differentiation of Pancreatic Lesions in Endoscopic Ultrasound: A Transatlantic Study.","authors":"Miguel Mascarenhas Saraiva, Mariano González-Haba, Jessica Widmer, Francisco Mendes, Tamas Gonda, Belen Agudo, Tiago Ribeiro, António Costa, Yousef Fazel, Marcos Eduardo Lera, Eduardo Horneaux de Moura, Matheus Ferreira de Carvalho, Alexandre Bestetti, João Afonso, Miguel Martins, Maria João Almeida, Filipe Vilas-Boas, Pedro Moutinho-Ribeiro, Susana Lopes, Joana Fernandes, João Ferreira, Guilherme Macedo","doi":"10.14309/ctg.0000000000000771","DOIUrl":"10.14309/ctg.0000000000000771","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic ultrasound (EUS) allows for characterization and biopsy of pancreatic lesions. Pancreatic cystic neoplasms (PCN) include mucinous (M-PCN) and nonmucinous lesions (NM-PCN). Pancreatic ductal adenocarcinoma (P-DAC) is the commonest pancreatic solid lesion (PSL), followed by pancreatic neuroendocrine tumor (P-NET). Although EUS is preferred for pancreatic lesion evaluation, its diagnostic accuracy is suboptimal. This multicentric study aims to develop a convolutional neural network (CNN) for detecting and distinguishing PCN (namely M-PCN and NM-PCN) and PSL (particularly P-DAC and P-NET).</p><p><strong>Methods: </strong>A CNN was developed with 378 EUS examinations from 4 international reference centers (Centro Hospitalar Universitário São João, Hospital Universitario Puerta de Hierro Majadahonda, New York University Hospitals, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo). About 126.000 images were obtained-19.528 M-PCN, 8.175 NM-PCN, 64.286 P-DAC, 29.153 P-NET, and 4.858 normal pancreas images. A trinary CNN differentiated normal pancreas tissue from M-PCN and NM-PCN. A binary CNN distinguished P-DAC from P-NET. The total data set was divided into a training and testing data set (used for model's evaluation) in a 90/10% ratio. The model was evaluated through its sensitivity, specificity, positive and negative predictive values, and accuracy.</p><p><strong>Results: </strong>The CNN had 99.1% accuracy for identifying normal pancreatic tissue, 99.0% and 99.8% for M-PCN and NM-PCN, respectively. P-DAC and P-NET were distinguished with 94.0% accuracy.</p><p><strong>Discussion: </strong>Our group developed the first worldwide CNN capable of detecting and differentiating the commonest PCN and PSL in EUS images, using examinations from 4 centers in 2 continents, minimizing the impact of the demographic bias. Larger multicentric studies are needed for technology implementation.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00771"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamics of Splenic Transient Elastography in Patients With Alcohol Use Disorder.","authors":"Mian B Khalid, Hanna L Blaney, Anusha Vittal, Alexander H Yang, Bilal A Asif, Natasha Kamal, Elizabeth C Wright, Chris Koh, David George, David Goldman, Yvonne Horneffer, Nancy Diazgranados, Theo Heller","doi":"10.14309/ctg.0000000000000770","DOIUrl":"10.14309/ctg.0000000000000770","url":null,"abstract":"<p><strong>Introduction: </strong>Splenic stiffness (SS) measurement (SSM) is an evolving noninvasive assessment to evaluate portal hypertension. Studies with respect to SSM in patients with alcohol use disorder are limited.</p><p><strong>Methods: </strong>We studied patients seeking treatment for alcohol use disorder in an inpatient treatment protocol at the National Institutes of Health and parsed SSM into 3 groups based on degree of change.</p><p><strong>Results: </strong>The improved SS group had statistically higher initial SSM and a nonstatistically increased liver stiffness measurement compared with others.</p><p><strong>Discussion: </strong>SS is dynamic in a subset of patients immediately after alcohol cessation, and improved SS is associated with a normalization of platelet count.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00770"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal Tubule Secretory Clearance, Injury, and Kidney Viability in Cirrhosis.","authors":"Michael L Granda, Eric Luitweiler, David K Prince, Andrew S Allegretti, Cary Paine, Raimund Pichler, Lena Sibulesky, Scott W Biggins, Bryan Kestenbaum","doi":"10.14309/ctg.0000000000000775","DOIUrl":"10.14309/ctg.0000000000000775","url":null,"abstract":"<p><strong>Introduction: </strong>Cirrhosis affects all structures of the kidney, in particular the tubules, which are responsible for secretion of protein-bound metabolites and electrolyte/water homeostasis. Yet, prevailing assessments of kidney function focus solely on glomerular filtration rate (GFR), which may incompletely reflect these processes. We sought to characterize markers of tubular function, injury, and viability in patients with and without cirrhosis.</p><p><strong>Methods: </strong>We recruited outpatients undergoing liver transplantation evaluation for a collection of plasma and 24-hour urine, matching by GFR to control participants without cirrhosis. We measured urinary kidney injury molecule-1, a marker of proximal tubular injury, as well as epidermal growth factor (EGF), a marker of viability necessary for tubular epithelial cell proliferation after injury. We also estimated secretory clearance by measuring several highly secreted endogenous metabolites in urine and plasma.</p><p><strong>Results: </strong>We recruited 39 patients with cirrhosis (mean model for end-stage liver disease 17 ± 4, Child-Pugh 8 ± 2, estimated glomerular filtration rate 66 ± 20 mL/min/1.73 m 2 ) and 58 GFR-matched controls without cirrhosis (estimated glomerular filtration rate 66 ± 21 mL/min/1.73 m 2 ). Urinary kidney injury molecule-1 was 4.4-fold higher than controls (95% confidence interval: 2.9-6.5), and EGF averaged 7.41-fold higher than controls (95% confidence interval: 2.15-25.53). We found that of 8 solutes, 5 had significantly greater kidney clearance in cirrhosis (1.3-2.1-fold higher): indoxyl sulfate, p-cresol sulfate, pyridoxic acid, tiglylglycine, and xanthosine.</p><p><strong>Discussion: </strong>Cirrhosis was characterized by molecular signs of tubular injury in stable outpatients without acute kidney injury, accompanied by largely preserved tubular secretory clearance and greater signs of tubular viability. Within the limitations of the study, this suggests a phenotype of chronic ischemic injury but with initial preservation of tubular function in cirrhosis.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00775"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Network Meta-Analysis of Comparing Different Dosages of Potassium-Competitive Acid Blocker With Proton-Pump Inhibitor in Acid-Related Disorders.","authors":"Yujiao Wang, Xiaosong Dai, Xinxing Zhang","doi":"10.14309/ctg.0000000000000776","DOIUrl":"10.14309/ctg.0000000000000776","url":null,"abstract":"<p><strong>Introduction: </strong>Potassium-competitive acid blockers have emerged as a promising treatment of acid-related disorders. However, the optimal dosage for maximizing their efficacy remains unclear. The aim of this network meta-analysis was to compare the efficacy and safety of various dosages of potassium-competitive acid blockers and proton-pump inhibitors for treating acid-related disorders.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Cochrane Library, and Web of Science from inception to July 16, 2023. Data extraction was performed independently by 2 authors. The Cochrane Risk of Bias in Randomized Trials tool (RoB 2.0) was used for bias assessment. The efficacy and safety were compared using the odds ratio with 95% confidence intervals.</p><p><strong>Results: </strong>Twelve articles were included in the present meta-analysis. For gastric/duodenal ulcers, keverprazan 30 mg (K30) exhibited the highest surface under the cumulative ranking (SUCRA) value (92.8%) for healing rate. In terms of total adverse events, lansoprazole 30 mg (L30) exhibited the lowest SUCRA value (25.3%) in the treatment of gastric/duodenal ulcers. For the healing rate in erosive esophagitis, the maximum SUCRA value of vonoprazan 40 mg (V40) was 90.7% in the first subgroup (erosive esophagitis using vonoprazan, keverprazan, and lansoprazole) and the maximum SUCRA value of T50 was 72.1% in the second subgroup (erosive esophagitis using tegoprazan, fexuprazan, and esomeprazole). For the total adverse events in erosive esophagitis, L15 exhibited the lowest SUCRA value (12.2%) in the first group and E40 exhibited the lowest SUCRA value (24.4%) in the second group.</p><p><strong>Discussion: </strong>K30 may be the most effective dosage for increasing the healing rate of gastric/duodenal ulcers. For erosive esophagitis, V40 and T50 may be the preferred dosages.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00776"},"PeriodicalIF":3.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11596345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}