Clinical and Translational Gastroenterology最新文献

{"title":"Double Band Ligation-Assisted Endoscopic Submucosal Resection for Rectal Neuroendocrine Tumors: Comparison With Conventional Endoscopic Mucosal Resection With Ligation (With Video).","authors":"Yuan Gao, Liansong Ye, Xu Li, Long He, Bin Yu, Wei Liu, Yuwan Cao, Liuxiang Chen, Yi Mou, Ou Chen, Jia Xie, Jiang Du, Qiongying Zhang, Bing Hu","doi":"10.14309/ctg.0000000000000830","DOIUrl":"10.14309/ctg.0000000000000830","url":null,"abstract":"<p><strong>Introduction: </strong>Based on endoscopic mucosal resection with ligation (EMR-L), we developed double band ligation-assisted endoscopic submucosal resection (ESR) for complete resection of small submucosal rectal neuroendocrine tumors (NETs). Both procedures use a multiband device to perform resection, with the only difference being that ESR adds an additional band to obtain deeper resection margin. The aim of this retrospective study was to validate its feasibility, safety, and effectiveness compared with EMR-L.</p><p><strong>Methods: </strong>This retrospective study included consecutive patients with small (≤10 mm) suspected submucosal rectal NETs who underwent ESR (n = 45) or EMR-L (n = 26) between June 2018 and October 2023 at West China Hospital. En bloc resection rate, complete resection rate, procedure time, margin distance, and adverse events were compared between 2 groups.</p><p><strong>Results: </strong>En bloc resections were achieved in all patients. The complete resection rate of ESR was higher than EMR-L (100% vs 88.5%, P = 0.045). The vertical margin distance and lateral margin distance were significantly longer in ESR group than EMR-L group (vertical margin distance 782.31 ± 359.45 μm vs 363.84 ± 222.78 μm, P < 0.001; and lateral margin distance 4,205.75 ± 2,167.43 μm vs 3,162.94 ± 1,419.22 μm, P = 0.008, respectively). There were no significant differences in procedure time, adverse events, postprocedural hospital stay, or medical cost between 2 groups. In addition, there was no evidence of recurrence or metastasis during the follow-up.</p><p><strong>Discussion: </strong>ESR seems to be safe and effective for complete resection of small submucosal rectal NETs. Larger, multicenter, prospective studies are needed to further assess this technique.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447874","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":"Prevalence and Patterns of Opioid Use in Chronic Pancreatitis.","authors":"Anna Evans Phillips, Darwin L Conwell, Shuang Li, Jami L Saloman, Phil A Hart, Evan L Fogel, Santhi Swaroop Vege, Dana K Andersen, William E Fisher, Christopher E Forsmark, Stephen Pandol, Walter G Park, Mark D Topazian, Stephen K Van Den Eeden, Jose Serrano, Liang Li, Dhiraj Yadav","doi":"10.14309/ctg.0000000000000807","DOIUrl":"10.14309/ctg.0000000000000807","url":null,"abstract":"<p><strong>Introduction: </strong>Opioids are used to treat pain in chronic pancreatitis (CP), but little is known about current use patterns. The aim of this study was to characterize the utilization of opioids and associations with clinical characteristics in adult patients with CP.</p><p><strong>Methods: </strong>This cross-sectional analysis used baseline data from participants with definite CP enrolled in a cohort study in the United States (PROspective Evaluation of CP for EpidEmiologic and Translational StuDies). Data on demographics, pain medication use, healthcare utilization, disability, and pain patterns were systematically collected in case report forms while quality of life was assessed with patient-reported outcome instruments. Opioid use was classified according to strength (weak or strong) and frequency (scheduled or as-needed).</p><p><strong>Results: </strong>A total of 681 participants (n = 364, 53% male) were included: 299 (44%) were current opioid users (22% only weak opioids and 22% at least 1 strong opioid). Increasing frequency and severity of pain was associated with increase of weak, strong, as-needed, or scheduled opioids. Neuromodulators were used by ∼40% of participants; increasing use was associated with increasing frequency and severity of pain. On multivariate analysis, independent predictors associated with strength and frequency of current opioid use were pain patterns (odds ratios [ORs] 1.84-8.32 and ORs 1.92-8.52, respectively, P < 0.001) and prior celiac plexus block (OR 3.54, 95% confidence intervals 1.82-6.87 and OR 3.42, 95% confidence intervals 1.76-6.64, respectively). Participants using opioids had higher prevalence of disability, healthcare utilization, and poorer quality of life.</p><p><strong>Discussion: </strong>Opioid use in CP is common and associated with increased pain severity and constancy. These data provide foundational estimates for future trials that can elucidate the complex interactions between patient factors, pain, and interventions.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188486","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":"10.14309/ctg.0000000000000799","url":null,"abstract":"<p><strong>Introduction: </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 months 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, and 12 months 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-month follow-up. The median (interquartile range) 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 months. A significant negative correlation was found between GI symptoms and FE-1 levels during hospitalization ( ρ = -0.288; P = 0.015) and at 12 months ( ρ = -0.219; P = 0.046). Eighteen participants (18.6%) lost ≥10% body weight between hospitalization and 12 months, and had significantly lower median FE-1 levels at 12 months compared with the group without weight loss (166 vs 332 µg/g, P = 0.016).</p><p><strong>Discussion: </strong>This is the first study to prospectively assess GI-symptom burden and exocrine function post-AP. Lower exocrine pancreatic function at 12 months was associated with increased symptom burden and weight loss. These findings support further investigations to define and improve patient-reported outcomes post-AP. This study is registered with ClinicalTrials.gov , NCT03063398.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00799"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845210/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy Lifestyle and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Study of the Efficacy of Fatty Liver Regression.","authors":"Jingwei Wang, Jinli Zhao, Yueyuan Zhong, Chengyue He, Fen Hu","doi":"10.14309/ctg.0000000000000806","DOIUrl":"10.14309/ctg.0000000000000806","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is the primary cause of metabolic dysfunction-associated steatotic liver disease (MASLD). Healthy lifestyle management has potential value in the treatment of MASLD.</p><p><strong>Methods: </strong>A total of 150 patients with MASLD diagnosed at the Health Management Center of our hospital were enrolled and randomly divided into a traditional treatment (control group, n = 75) and a healthy lifestyle group (observation group, n = 75). All patients underwent a 3-month intervention. Data on general information, body composition, glucose metabolism, lipid metabolism, and inflammatory factors were analyzed.</p><p><strong>Results: </strong>The difference in the change in fatty liver grade was statistically significant ( P < 0.05). There were statistically significant differences in treatment efficiency for physical conditions ( P < 0.05), including body fat mass, body mass index, body weight, waist circumference, and waist-to-hip ratio. In addition, there were statistically significant differences in treatment efficiency for scales such as the Diet Rating Scale, Emotional Stress Scale, and Global Physical Activity Questionnaire ( P < 0.05). Differences in treatment efficiency for body fat parameters, including percentage of body fat, visceral fat area, aspartate aminotransferase, and diastolic blood pressure, were also statistically significant ( P < 0.05). After treatment, statistically significant differences were observed in interferon-γ, insulin, low-density lipoprotein cholesterol, triglycerides, and tumor necrosis factor-α ( P < 0.05).</p><p><strong>Discussion: </strong>Our study indicates that a healthy lifestyle can effectively promote the reduction of fatty liver grade in patients with MASLD, demonstrating positive effects in improving lipid metabolism and inflammatory responses in these patients.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00806"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892608","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":"The Associations Between Life's Essential 8 and Diarrhea and Constipation: Results From the 2005-2010 National Health and Nutrition Examination Survey.","authors":"Xin Yang, Shengjie Ding, Jinlu Guo, Shuang Peng, Zhiqing Duan, Shi Liu","doi":"10.14309/ctg.0000000000000801","DOIUrl":"10.14309/ctg.0000000000000801","url":null,"abstract":"<p><strong>Introduction: </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, used information from the National Health and Nutrition Examination Survey conducted between 2005 and 2010. Diarrhea and constipation were classified based on Bristol Stool Form Scale and stool frequency. LE8 score is composed of 4 health behaviors (diet, physical activity, nicotine exposure, and sleep health) and 4 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 groups. Weighted logistic regression and restricted cubic splines were used to analyze the relationship between the LE8 score and abnormal bowel health.</p><p><strong>Results: </strong>The study comprised 12,369 participants 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 (odds ratio: 0.60, 95% confidence interval: 0.39-0.93), whereas the association between LE8 scores and constipation was not statistically significant (odds ratio: 0.82, 95% confidence interval: 0.59-1.13). In addition, health behavior scores and health factor scores were associated with constipation.</p><p><strong>Discussion: </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":"e00801"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845204/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic Inflammatory Bowel Disease Diagnosed During Colorectal Cancer Population Screening in Catalonia: Characteristics and Natural History.","authors":"Eduard Brunet-Mas, Anna Selva, Francesc Bas-Cutrina, Anna Brujats, Berta Caballol, Rebeca Font, Bàrbara Gómez, Carlos Gonzalez-Muñosa, David Busquets, David Monfort, Diana Patrícia Vera, Elisabet Maristany, Gemma Cirera, Gisela Torres, Jesús Castro-Poceiro, Joel Lopez, Laura Gonzalez-Gonzalez, Lucia Màrquez-Mosquera, Marta Gallach, Maria Esteve, Gemma Tremosa, Sandra Torra, Virginia Robles-Alonso, Pilar Garcia-Iglesias, Iago Rodríguez-Lago, Xavier Calvet","doi":"10.14309/ctg.0000000000000740","DOIUrl":"10.14309/ctg.0000000000000740","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel disease (IBD) is usually diagnosed when symptomatic. Prognosis and evolution of preclinical IBD is largely unknown. However, colorectal cancer screening programs (CRCSP) detect a subset of patients with IBD with no symptoms. The aim of this study was to describe the natural history of asymptomatic IBD diagnosed through CRCSP.</p><p><strong>Methods: </strong>An observational, longitudinal, and retrospective study was performed at 22 centers in Catalonia between January 2010 and December 2019 including patients with asymptomatic IBD detected in the CRCSP. Demographic data and IBD characteristics, evolution, and treatment were recorded. Descriptive statistics and Kaplan-Meier analysis were used for the analysis. Data were given separately for IBD, Crohn's disease (CD), ulcerative colitis (UC), and IBD unclassified (IBDU).</p><p><strong>Results: </strong>One hundred eighty-eight patients were included: 103 UC (54.8%), 60 CD (31.9%), and 25 IBDU (13.3%). Sixty-six (35.1%) were women, and the average age was 59.9 ± 5.9 years. Sixty-four patients (34.0%) developed symptoms after a median follow-up of 35.6 months. Diarrhea was the most frequent symptom for CD and IBDU (25.4% and 11.5%, respectively) and blood in stools for UC (21.4%). The median time to first symptom was 11.6 months. Treatment was prescribed in 135 patients (72.2%); mesalazine was the most prescribed drug (123 patients; 65.4%). Thirteen patients (6.9%) required biological treatment. None underwent surgery.</p><p><strong>Discussion: </strong>Around one-third of asymptomatic patients with IBD developed symptoms after a medium follow-up of 3 years. Only 6.9% required biological treatment, and none required surgery. Overall, prognosis of asymptomatic IBD seems better.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00740"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892621","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":"Clinical Characteristics, Management, and Outcomes of Colitis-Associated Colorectal Cancer and the Comparison With 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":"10.14309/ctg.0000000000000798","url":null,"abstract":"<p><strong>Introduction: </strong>We explored the clinical characteristics, treatment, and outcomes of colitis-associated colorectal cancer (CAC) and compared with sporadic colorectal cancer in Taiwan.</p><p><strong>Methods: </strong>In this retrospective study spanning 1987-2022, CACs 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 patients with CAC (median age: 56 years; male: 66.2%). Distal colon was the most common tumor location (41.5%). Of patients with ulcerative colitis, 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 of 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%, whereas 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>Discussion: </strong>This is the largest Asian CAC 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 than sporadic rectal cancers.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00798"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845191/pdf/","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":"OA","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":"10.14309/ctg.0000000000000797","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to analyze gastrointestinal guidelines to assess the quality of evidence and strength of recommendation.</p><p><strong>Methods: </strong>We abstracted clinical practice guidelines and guidance statements from 4 American gastroenterology societies (American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and American Association for the Study of Liver Disease) and the US Multi-Society Task Force.</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>Discussion: </strong>This analysis highlights the need for high quality research in gastroenterology to support the development of stronger evidence-based guideline statements.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00797"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845212/pdf/","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":"OA","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.","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":"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. 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 with 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 (odds ratio: 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>Discussion: </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":"e00804"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845206/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of Fecal Polymerase Chain Reaction Testing in Clarithromycin-Resistant Helicobacter Pylori: A Systematic Review and Meta-Analysis.","authors":"Ahmed Al Qady, Wafa Aldhaleei, Mohamed Salih, Marriam Ali, Sasmith Menakuru, Kapil Dev Nayar, Zhen Wang, Fernando F Stancampiano, Dana Harris, Yan Bi","doi":"10.14309/ctg.0000000000000792","DOIUrl":"10.14309/ctg.0000000000000792","url":null,"abstract":"<p><strong>Introduction: </strong>The increasing prevalence of clarithromycin (CLA)-resistant Helicobacter pylori(H. pylori) strains poses a significant challenge in the management of H. pylori infections. This systematic review and meta-analysis investigates the diagnostic accuracy of polymerase chain reaction (PCR) in identifying CLA-resistant H. pylori strains in stool.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed, Embase, and Cochrane databases from database inception to April 30, 2023. Eligible studies evaluated the effectiveness of PCR stool tests in detecting CLA-resistant H. pylori strains in adults (>18-year-old). Studies of pediatric populations, alternative methods to PCR or stool samples, and reference tests other than gastric biopsy were excluded. The bivariate random-effects model was used to pool diagnostic accuracy from the included studies.</p><p><strong>Results: </strong>The analysis of 11 prospective diagnostic studies with a total of 866 patients showed a pooled sensitivity of 0.97 (95% CI: 0.9-0.99) and a pooled specificity of 0.98 (95% CI: 0.81-1.00). Subgroup analysis based on the used technique demonstrated consistent findings without notable variations. The diagnostic odds ratio was calculated at 1843.92 (95% CI: 134.28-25,321.3). The positive likelihood ratio was determined as 51.02 (95% CI: 4.61-564.5), while the negative likelihood ratio was found to be 0.03 (95% CI: 0.01-0.1).</p><p><strong>Discussion: </strong>PCR testing for clarithromycin-resistant H. pylori was highly sensitive and specific across studies with proven reliability in clinical practice, particularly in outpatient settings. Their implementation offers cost-effectiveness and the potential for tailored treatment strategies, holding promise for improved patient outcomes.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00792"},"PeriodicalIF":3.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766673","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}