Clinical and Translational Gastroenterology最新文献

{"title":"Nausea and Gastric Myoelectrical Activity Are Influenced by Hormonal Contraception in Chronic Gastroduodenal Disorders.","authors":"Alexandria H Lim, Chris Varghese, Gabrielle Sebaratnam, Gabriel Schamberg, Stefan Calder, Armen Gharibans, Christopher N Andrews, Charlotte Daker, Daphne Foong, Vincent Ho, Michelle R Wise, Gregory O'Grady","doi":"10.14309/ctg.0000000000000880","DOIUrl":"10.14309/ctg.0000000000000880","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic gastroduodenal disorders are more prevalent among young women, many of whom are hormonal contraception users. We aimed to evaluate the effects of hormonal contraception on symptom severity and gastric myoelectrical activity in people with chronic gastroduodenal disorders.</p><p><strong>Methods: </strong>This analysis was conducted on a large international cohort of patients who met Rome IV criteria for chronic nausea and vomiting syndrome or functional dyspepsia and had undergone body surface gastric mapping using Gastric Alimetry. Symptoms were continuously reported on 0-10 Likert scales using a validated symptom logging app.</p><p><strong>Results: </strong>One hundred twenty-seven people were included: 43 women using hormonal contraception, 30 not using hormonal contraception, 30 postmenopausal women, and 24 men. Hormonal contraception users had higher nausea than nonusers (3.80 [interquartile range 2.00-5.42] vs 2.25 [0.20-4.43]; P < 0.05), particularly when using combined oral contraceptives with hormone-free intervals compared with continuous use (5.20 [4.30-6.00] vs 2.40 [1.70-3.80], P = 0.02). Premenopausal women were more symptomatic than postmenopausal women and men ( P < 0.001). Principal Gastric Frequency was higher in hormonal contraception users (median 3.1 cpm vs 3.00 cpm, P < 0.001) and highest with progestogen-only formulations ( P < 0.02).</p><p><strong>Discussion: </strong>Women with gastroduodenal disorders on hormonal contraception experience increased nausea in comparison with nonusers, with substantial variation dependent on contraceptive type. Hormonal contraception users also demonstrated modified gastric electrophysiology. These results imply that nonhormonal contraceptive alternatives should be trialled as a means to reduce symptoms in gastroduodenal disorders.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494883","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":"Adherence to Multitarget Stool DNA Testing in Individuals Aged 45-49 Years With Average Risk for Colorectal Cancer.","authors":"Mallik Greene, Mark Camardo, A Burak Ozbay, Michael Dore, A Mark Fendrick, Paul Limburg","doi":"10.14309/ctg.0000000000000878","DOIUrl":"10.14309/ctg.0000000000000878","url":null,"abstract":"<p><strong>Introduction: </strong>Recommendations for colorectal cancer (CRC) screening have been updated to include individuals aged 45-49 years, addressing recent increases in CRC rates among young adults. The multitarget stool DNA (mt-sDNA) test is approved for average-risk individuals aged 45-49 years and is a noninvasive, at-home, stool-based option. This real-world study quantified mt-sDNA screening adherence rates for individuals aged 45-49 years.</p><p><strong>Methods: </strong>This was a retrospective analysis of individuals aged 45-49 years with average risk for CRC and no history of mt-sDNA testing. Individuals received an mt-sDNA test kit based on a point-of-care order. Adherence was defined as the return of a kit resulting in a valid test result within 1 year of prescription.</p><p><strong>Results: </strong>A total of 1,126,523 individuals were included. Most (58.6%) were female, and 62.2% received digital communications about the test through text message only. Overall, 68.9% returned their mt-sDNA kit within 1 year. Across provider types, adherence was highest for individuals who were prescribed the test by a gastroenterologist (75.5%); among payor types, adherence was highest for those enrolled in commercial insurance (70.9%). Adherence was lowest for individuals who did not receive any digital communications (54.9%) vs those who did. In a logistic regression analysis, digital communication and payor type were the strongest predictors of adherence.</p><p><strong>Discussion: </strong>In this large real-world study, 68.9% of individuals aged 45-49 years returned an mt-sDNA CRC screening test within 1 year. Increasing digital communication may improve mt-sDNA screening adherence.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494882","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":"Relationship of Intestinal Ultrasound with Clinical, Biochemical, And Endoscopic Disease Severity in Acute Severe Ulcerative Colitis: A Blinded, Prospective Study.","authors":"Phillip Gu, David Ziring, Puja V Khanna, Waseem Ahmed, Eric Vasiliauskas, Andres Yarur, Stephan Targan, Dermot Pb McGovern, Shervin Rabizadeh, Phillip Fleshner, Maria T Abreu, Gil Y Melmed","doi":"10.14309/ctg.0000000000000881","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000881","url":null,"abstract":"<p><strong>Background: </strong>The utility of intestinal ultrasound (IUS) for ASUC is understudied. We correlated IUS to clinical, biochemical, and endoscopic disease severity in ASUC.</p><p><strong>Method: </strong>In a blinded, prospective study of 20 ASUC subjects, we analyzed standard IUS parameters (bowel wall thickening, vascular flow, wall stratification) and UC IUS indices (IBUS-SAS, Milan-UC, UC-IUS) alongside modified Mayo symptoms scores, C-reactive protein (CRP), albumin, and UC endoscopic index of severity (UCEIS). Spearman correlations were performed (rs). Areas under the curve (AUC) determined utility of IUS for detecting severe endoscopic disease.</p><p><strong>Results: </strong>All IUS indices correlated with stool frequency (rs:0.45-0.58, p<0.001), CRP (rs:0.56-0.59, p<0.02), and UCEIS (rs:0.54-0.69, p<0.03). IBUS-SAS (AUC 0.91) and Milan-UC (AUC 0.93) outperformed IUS-UC (AUC 0.82) for detecting UCEIS>5. Loss of bowel wall stratification correlated strongest with CRP (rs: 0.8, p=3.61e-8) and UCEIS (rs: 0.50, p=0.047).</p><p><strong>Conclusion: </strong>IUS offers an accurate and non-invasive method to evaluate ASUC severity and treatment response.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144494885","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":"Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis at US Safety-Net Health Systems.","authors":"Robert J Wong, Patricia D Jones, Bolin Niu, Paulo Pinheiro, Mae Thamer, Onkar Kshirsagar, Yi Zhang, Ronnie Fass, George Therapondos, Amit G Singal, Mandana Khalili","doi":"10.14309/ctg.0000000000000877","DOIUrl":"10.14309/ctg.0000000000000877","url":null,"abstract":"<p><strong>Introduction: </strong>Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is associated with improved patient outcomes. We aim to evaluate real-world utilization of HCC surveillance among safety-net populations with cirrhosis.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adults with cirrhosis across 4 safety-net health systems from March 1, 2017, to February 28, 2022. Receipt of abdominal imaging with ultrasound, computed tomography, or magnetic resonance imaging and the corresponding ICD-9-CM / ICD-10-CM diagnosis codes at 6 months and 12 months were used to assess HCC surveillance.</p><p><strong>Results: </strong>Among 14,556 patients with cirrhosis (61.8% male, 73.0% non-White ethnic minorities, 54.4% with Medicaid or indigent care/uninsured), 70.9% and 78.1% received abdominal imaging agnostic to indication within 6 months and 12 months, respectively. When evaluating the receipt of abdominal imaging with a specific indication for HCC surveillance, 29.1% and 34.0% of patients received surveillance within 6 months and 12 months, respectively. On adjusted multivariable regression, greater odds of HCC surveillance were observed in older patients, ethnic minorities, and those with commercial insurance. Lower odds of HCC surveillance were observed in patients with indigent care (vs Medicare: odds ratio [OR] 0.85, 95% confidence interval [CI] 0.72-1.00), drug use (OR 0.63, 95% CI 0.55-0.71), and concurrent mental health/psychiatric diagnoses (OR 0.88, 95% CI 0.80-0.97).</p><p><strong>Discussion: </strong>Among a multicenter safety-net cohort of patients with cirrhosis, fewer than 30% received HCC surveillance within 6 months. While greater proportions received abdominal imaging agnostic to indication, the clinical benefit of these examinations for HCC surveillance may be limited because of concerns with abbreviated protocols, quality, and interpretation.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483376","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 Impact of Endoscopic Gastric Remodeling on Gastroesophageal Reflux Disease.","authors":"Pichamol Jirapinyo, David Leung, Walter W Chan, Christopher C Thompson","doi":"10.14309/ctg.0000000000000867","DOIUrl":"10.14309/ctg.0000000000000867","url":null,"abstract":"<p><strong>Introduction: </strong>Sleeve gastrectomy is associated with an increased incidence of gastroesophageal reflux disease (GERD). By contrast, the impact of endoscopic gastric remodeling (EGR) on GERD symptoms remains unclear.</p><p><strong>Methods: </strong>This prospective study included patients who underwent EGR and completed validated GERD-related patient-reported outcome questionnaires at baseline and 12 months postprocedure.</p><p><strong>Results: </strong>Fifty patients were included. At 12 months post-EGR, both GERD questionnaire and Reflux Symptom Index scores significantly improved. Proton-pump inhibitor use decreased from 38% at baseline to 20% at 12 months ( P = 0.047). The presence of a hiatal hernia at baseline was associated with greater symptom improvement.</p><p><strong>Discussion: </strong>EGR improves both typical and atypical GERD symptoms and reduces proton-pump inhibitor dependence. It may represent a preferable treatment option for patients with obesity and concomitant GERD.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316022","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":"Impact of Immune-Related Adverse Events on Survival in Patients With Gastrointestinal Cancer Treated With Immune Checkpoint Inhibitors: A Meta-Analysis.","authors":"Wenxing Yan, Lijuan Qin, Yingying Han, Xueli Jia, Juan Wu","doi":"10.14309/ctg.0000000000000875","DOIUrl":"10.14309/ctg.0000000000000875","url":null,"abstract":"<p><strong>Introduction: </strong>Immune-related adverse events (irAEs) stemming from off-target immune activation have been associated with improved survival outcomes in various cancers. Nonetheless, the influence of irAEs on survival among gastrointestinal (GI) cancer patients treated with immune checkpoint inhibitors (ICIs) remains ambiguous. The aim of this meta-analysis was to clarify the relationship between irAEs and survival outcomes in this patient cohort.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and Web of Science to identify relevant observational studies with longitudinal data. Studies reported on overall survival (OS) or progression-free survival (PFS) among patients with GI cancer treated with ICIs, comparing those with irAEs with those without. We calculated pooled hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model to account for heterogeneity.</p><p><strong>Results: </strong>Our analysis included 22 retrospective cohort studies comprising 2,935 patients; 1,142 (38.9%) experienced irAEs. The pooled analyses indicated a significant association between the occurrence of irAEs and improved OS (HR: 0.45, 95% CI 0.36-0.57, P < 0.001, I2 = 56%) and PFS (HR: 0.44, 95% CI 0.34-0.57, P < 0.001, I2 = 65%). Subgroup analyses supported the consistency of these findings across tumor location, study quality scores, follow-up duration, and analytical models, with no significant differences noted ( P for subgroup differences all >0.05).</p><p><strong>Discussion: </strong>The presence of irAEs in patients with GI cancer receiving ICIs correlates with significantly better OS and PFS. This suggests that irAEs may be a potential biomarker for predicting treatment response.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316021","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":"Association of High-Density Lipoprotein Cholesterol-Based Inflammatory Markers With MASLD and Significant Liver Fibrosis in US Adults: Insights From NHANES 2017-2020.","authors":"Shuangzhen Jia, Xiaolin Ye, Yan Kong, Zhaoxia Wang, Jie Wu","doi":"10.14309/ctg.0000000000000873","DOIUrl":"10.14309/ctg.0000000000000873","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic inflammation and lipid metabolism disturbances are important hallmarks of the onset and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to explore the association of lymphocyte-high-density lipoprotein-cholesterol ratio (LHR), monocyte-HDL-C ratio (MHR), neutrophil-HDL-C ratio (NHR), and platelet-HDL-C ratio (PHR) with MASLD and significant liver fibrosis using NHANES 2017-2020 data.</p><p><strong>Methods: </strong>LHR, MHR, NHR, and PHR were calculated based on complete blood count parameters and serum HDL-C. MASLD and liver fibrosis were diagnosed based on transient elastography. Multivariate logistic regression analyses were used to explore these associations, and receiver operating characteristic was used to compare the predictive power of these markers.</p><p><strong>Results: </strong>A total of 8,341 participants were included, and the prevalence of MASLD and significant liver fibrosis was 45.1% and 11.57%, respectively. In fully adjusted models, log-transformed LHR, MHR, NHR, and PHR were positively associated with the odds of MASLD (odds ratio 1.853, 1.685, 1.470, and 1.879, respectively) and significant liver fibrosis (odds ratio 1.570, 1.425, 1.396, and 1.384, respectively) (all P < 0.05). Most of these associations were nonlinear, and significant positive correlations existed only after their respective inflection points. The association of LHR with significant liver fibrosis was more pronounced in men. Receiver operating characteristic analysis showed that LHR/NHR was superior in predicting MASLD, whereas MHR/NHR distinguished significant liver fibrosis better than other markers.</p><p><strong>Discussion: </strong>LHR, MHR, NHR, and PHR were independently associated with MASLD and liver fibrosis in US adults and may serve as emerging predictors. Future cohort studies are needed to confirm these findings and explore clinical predictive value.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301231","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":"ASSOCIATIONS BETWEEN ESOPHAGEAL MOTILITY, REFLUX, AND LUNG MECHANICS AND FUNCTION ARE DISEASE SPECIFIC, BOTH BETWEEN AND WITHIN RESTRICTIVE AND OBSTRUCTIVE LUNG DISEASE.","authors":"Ali Alghubari, Caroline Olson, Jessica Bradley, Ramsah Cheah, Sadia Z Shah, Abdel-Rahman N Naser, Augustine S Lee, Kenneth R DeVault, Lesley A Houghton","doi":"10.14309/ctg.0000000000000874","DOIUrl":"https://doi.org/10.14309/ctg.0000000000000874","url":null,"abstract":"<p><strong>Introduction: </strong>Gastroesophageal reflux is common in respiratory disease, but the inter-play between gastrointestinal mechanisms that expose individuals to reflux and potentially aspiration, and lung mechanics and function remain incompletely understood. Our aim was to investigate this in patients with chronic obstructive pulmonary disease (COPD) and non-IPF interstitial lung disease (non-IPF ILD), and compare with our published findings in idiopathic pulmonary fibrosis (IPF).</p><p><strong>Methods: </strong>57 patients with COPD (aged: 34-75yrs) and 64 with non-IPF ILD (22-75yrs) who underwent high-resolution impedance manometry and 24-hour pH-impedance, together with pulmonary function assessment were compared with 35 IPF patients (51-84yrs).</p><p><strong>Results: </strong>COPD patients were less likely to exhibit ineffective esophageal motility (IEM) and/or absent contractility (p=0.009; p=0.028), and tended to exhibit esophagogastric junction outflow obstruction (EGJOO) and/or hyper-contractility (p=0.09, p=0.14) than IPF and non-IPF ILD patients. Notably, integrated relaxation pressure correlated with esophageal length index (ELI) (p=0.048) and inspiratory LESP (p=0.003), with latter two correlating with each other (p<0.001). EGJOO patients tended to have fewer proximal reflux events and reduced pulmonary function; the latter inversely correlating with ELI (p<0.05).Non-IPF ILD patients were less likely to exhibit EGJOO than COPD patients (p=0.27), and less likely to exhibit IEM (p=0.07) than IPF patients. However, those with IEM or EGJOO, exhibited greater proportions of reflux events reaching the proximal esophagus than those with normal motility (p<0.03), which in contrast to IPF, appeared not to associate with worse pulmonary function.</p><p><strong>Conclusions: </strong>Associations between esophageal motility, and lung mechanics and function, and consequently reflux, are very disease specific.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282718","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":"Endoscopic Full-Thickness Resection vs Submucosal Tunneling Endoscopic Resection for Gastric Submucosal Tumors.","authors":"Shuxi Liu, Zhukai Chen, Lingnan He, Aiping Xu, Zehua Zhang, Xiaojing Du, Shuangzhu Yang, Haibing Zhang, Li Zhang, Jingjing Lian, Meidong Xu, Tao Chen","doi":"10.14309/ctg.0000000000000869","DOIUrl":"10.14309/ctg.0000000000000869","url":null,"abstract":"<p><strong>Introduction: </strong>The new working submucosal tunnel space allows entry to deeper layers of the luminal wall or even entirely outside the gastrointestinal tract for the treatment of submucosal tumors. Based on this concept, we developed submucosal tunneling endoscopic resection (STER). Here, we compared the clinical outcomes between exposed endoscopic full-thickness resection (EFTR) and STER (nonexposed EFTR) and analyzed the efficacy and safety of Natural Orifice Transluminal Endoscopic Surgery (NOTES) based on STER for extra-gastrointestinal stromal tumors (EGISTs).</p><p><strong>Methods: </strong>Sixty consecutive patients with tumors in the lesser curvature of the stomach corpus were enrolled from July 2019 to December 2023. Data on clinicopathologic features, treatment results, and follow-up outcomes were collected and analyzed retrospectively.</p><p><strong>Results: </strong>Among the 60 patients, 31 patients underwent EFTR and 29 patients underwent STER. The EFTR group had a shorter procedure time ( P = 0.016) but a longer postoperative hospital stay ( P = 0.004) than the STER group. Tumor size > 2 cm and endoloop-clips suture were significantly associated with long-time procedure. NOTES based on STER was successful for EGISTs. Follow-up data from 6 to 60 months was collected with no loss. All patients were free from local recurrence and distant metastasis during the study period.</p><p><strong>Conclusions: </strong>Although the procedure time of STER is longer than that of EFTR, the postoperative hospital stay is shorter. Tumor size > 2 cm and use of endoloop-clips suture are significantly associated with long-time procedure. In addition, STER-based NOTES is a promising and safe methodology for the resection of EGISTs.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282719","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":"PAMORAs in Opioid-Induced Constipation: Are We Following the Guidelines?","authors":"Katie Liu, Ariana Chen, Pranav Rajaram, Grayson Buning, Allen A Lee, Prashant Singh","doi":"10.14309/ctg.0000000000000876","DOIUrl":"10.14309/ctg.0000000000000876","url":null,"abstract":"<p><strong>Introduction: </strong>Peripherally acting u-opioid receptor antagonists (PAMORAs) are a safe and efficacious medication for treating opioid-induced constipation (OIC). This study evaluates the utilization of PAMORAs in patients with laxative-refractory OIC.</p><p><strong>Methods: </strong>Patients diagnosed with OIC from 2018 to 2023 were retrospectively identified at a tertiary care center. As recommended by the guidelines, patients were considered eligible for PAMORAs if they had failed at least 2 laxatives. Data on PAMORA prescription, demographics, clinical characteristics, and specialty of the managing provider were collected and analyzed using logistic regression and χ 2 analysis.</p><p><strong>Results: </strong>Of 281 patients diagnosed with OIC, 204 (73%) were eligible for a PAMORA, of which only 58 (28%) were prescribed one. There were no differences in demographic or clinical characteristics between those who were offered PAMORAs vs not. There was a significant difference in prescribing patterns based on provider specialty ( P < 0.001). Although gastrointestinal (GI) specialists saw less than half of the eligible patients, they offered PAMORAs at the highest proportion of 59% compared with non-GI specialists (13-16%) or primary care providers (18%). Multivariable logistic regression analysis showed 12.7-fold increased odds of being offered a PAMORA if the provider was from the GI department compared with all non-GI providers ( P < 0.001).</p><p><strong>Discussion: </strong>PAMORAs are underutilized in patients with OIC. GI prescribers offer PAMORAs at a higher proportion than other departments, and being seen in GI independently increases the likelihood of a patient receiving a PAMORA. This suggests that underutilization may be due to a lack of awareness and further education about PAMORAs is warranted.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282720","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}