Clinical and Translational Gastroenterology最新文献

{"title":"Sirolimus for Colon Polyposis in PTEN Hamartoma Tumor Syndrome.","authors":"Peter P Stanich, Kebire Gofar, Maegan E Roberts, Hisham Hussan","doi":"10.14309/ctg.0000000000000871","DOIUrl":"10.14309/ctg.0000000000000871","url":null,"abstract":"<p><strong>Introduction: </strong>PTEN hamartoma tumor syndrome (PHTS) is a rare condition with a high rate of colon polyposis. Sirolimus may reduce colorectal polyps in PHTS. We designed a trial to assess the safety and impact of sirolimus on colon polyp burden in PHTS.</p><p><strong>Methods: </strong>We performed an open-label trial of sirolimus for 1 year in adults with a PTEN pathogenic variant and colon polyposis. The primary outcome was change in polyp burden and staging.</p><p><strong>Results: </strong>Five participants were enrolled, with 2 completing the planned study course. Baseline colonoscopies showed a mean polyp burden of 107 (range 31-184), with multiple histologic types. For the 2 patients completing the study, polyp burden decreased.</p><p><strong>Discussion: </strong>Sirolimus has promise for reduction of colon polyp burden in PHTS, but side effects may limit usage. Future treatment trials in rare polyposis syndromes would benefit from the involvement of multiple centers to allow for improved recruitment.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00871"},"PeriodicalIF":3.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233371","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":"Association of Primary Language With Treatment and Outcomes in Inflammatory Bowel Disease.","authors":"Laura C Sahyoun, Veronica Chavez, Jaya Vasudevan, Lawrence Kogan, Bhuvana Mukkamala, Maria Goretti Ochi, Thritha Anand, Zehra Ahmed, Zhouwen Tang, Linda A Feagins, Jill K J Gaidos","doi":"10.14309/ctg.0000000000000868","DOIUrl":"10.14309/ctg.0000000000000868","url":null,"abstract":"<p><strong>Introduction: </strong>As rates of inflammatory bowel disease (IBD) rise among non-English-speaking populations, it is imperative to better understand the impact of language barriers and cultural differences on disease management.</p><p><strong>Methods: </strong>The multicenter, retrospective, cohort study of adult patients with IBD who spoke a language other than English, matched 1:2 to English-speaking controls. Patients were enrolled at their first clinic visit and then followed up to 12 months. Advanced therapy (AT) was defined as a biologic or small molecule. Primary outcome was the rate of AT use between cohorts. Secondary outcomes included rates of AT initiation and corticosteroid-free clinical remission at 6 and 12 months.</p><p><strong>Results: </strong>One hundred forty-four patients with IBD (48 non-English speakers, 96 English speakers) were included in this study. Both cohorts had similar baseline disease activity based on physician global assessment; however, non-English-speaking patients had significantly higher rates of baseline elevated fecal calprotectin (91.7% vs 50%, P = 0.014). After multivariate analysis to adjust for baseline differences, we found no difference in prior or current AT use. Rates of initiation of AT were similar between the 2 groups at 6- and 12-month follow-up. Adjusted rates of corticosteroid-free clinical remission were not different at 6 and 12 months.</p><p><strong>Discussion: </strong>Primary language spoken did not significantly affect the rates of AT use or overall IBD disease activity in 2 academic practices. Future studies are warranted to understand the effect of language on medication adherence, patient satisfaction and understanding, and disease outcomes.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00868"},"PeriodicalIF":3.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233370","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":"Discordance Between Radiological and Clinical Findings Among Patients Presenting With Elevated Lipase and Abdominal Pain.","authors":"Venkata S Akshintala, Rishi Subrahmanyan, Anmol Singh, Atif Zaheer, Furqan Bhullar, Ayesha Kamal, Peter J Lee, Maisam A Abu El Haija, Mahya Faghih, Elham Afghani, Vikesh K Singh","doi":"10.14309/ctg.0000000000000861","DOIUrl":"10.14309/ctg.0000000000000861","url":null,"abstract":"<p><strong>Introduction: </strong>False-positive lipase elevation is a diagnostic challenge in acute pancreatitis (AP) but has not been systematically studied. We evaluated patients presenting with serum lipase elevation and correlated this with abdominal imaging findings, considered the gold standard for AP diagnosis.</p><p><strong>Methods: </strong>Patients with abdominal pain, serum lipase ≥3-fold the upper limit of normal (ULN), and abdominal imaging within 48 hours of their lipase check were identified. An independent expert pancreas radiologist blinded to clinical data reviewed the images for features of AP. For patients without imaging changes of AP, repeat imaging obtained within 30 days was reviewed. Among patients with elevated lipase but no imaging changes of AP, other etiologies of lipase elevation were identified. Patients were stratified by the degree of lipase elevation, and imaging findings were compared between groups.</p><p><strong>Results: </strong>Two hundred thirty-four patients had lipase ≥3-fold the ULN, abdominal pain, and underwent CT or MRI with intravenous contrast. 60.2% had AP findings on their initial imaging, and another 13% had AP or sequelae on imaging within 30 days. In patients without imaging findings of AP, the use of opioid analgesics was the most commonly suspected cause of lipase elevation (24.7%), followed by abdominal trauma/surgery (12.9%). Among lipase elevations, a cutoff of ≥6-fold the ULN had the highest accuracy (70.1%) for diagnosing AP.</p><p><strong>Discussion: </strong>Lipase elevation without imaging findings of AP is found in nearly one-fourth of patients and may suggest non-AP causes of lipase elevation. This has clinical implications, but increasing lipase cutoff to ≥6-fold ULN has only a modest increase in diagnostic accuracy, suggesting the need for a better biomarker for AP diagnosis.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00861"},"PeriodicalIF":3.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207827","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":"Effects of Ricinoleic Acid (Castor Oil) on Gut Permeability in Healthy Participants: Provocative Test for Treatments Aimed at Restoring Barrier Function.","authors":"David Yi Yang, Camille Lupianez-Merly, Kara J Jencks, Saam Dilmaghani, Irene Busciglio, Deborah Eckert, Michael Ryks, Roy Dyer, Brady A Vizenor, Yuxi Zhao, Anna Sapone, Michelle G Rooks, Jeremy D Gale, Michael Camilleri","doi":"10.14309/ctg.0000000000000865","DOIUrl":"10.14309/ctg.0000000000000865","url":null,"abstract":"<p><strong>Introduction: </strong>Altered intestinal permeability (IP) is implicated in multiple gastrointestinal and systemic disease conditions; an experimental model of perturbed IP in healthy subjects is needed. Traditional approaches to perturbing IP include use of nonsteroidal anti-inflammatory drugs.</p><p><strong>Methods: </strong>We conducted a single-center, randomized, placebo-controlled pilot study of dose-related effects of castor oil (CO) (and its ingredient ricinoleic acid) at 750, 1,500, or 3,000 mg daily doses on IP. Permeability was assessed using validated 13 C-mannitol and lactulose urine excretion at 0-2, 8-24, and 0-24 hours after oral administration.</p><p><strong>Results: </strong>Permeability analysis across all groups demonstrated significant difference among the groups for 0-2 hours 13 C-mannitol, 0-24 hours 13 C-mannitol, and borderline significant difference for 2-8 hours 13 C-mannitol ( P = 0.060) and 0-24 hours lactulose ( P = 0.056). Direct comparison of 3,000 mg CO vs placebo ( t test) demonstrated higher excretion of 13 C-mannitol and lactulose at 0-2, and 0-24 hours, and lactulose at 2-8 hours.</p><p><strong>Discussion: </strong>CO may perturb small intestinal and colonic permeability in healthy adults.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00865"},"PeriodicalIF":3.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157136","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":"Integrating Etiological Insights With Machine Learning for Precision Diagnosis of Obstructive Jaundice: Findings From a High-Volume Center.","authors":"Ningyuan Wen, Yaoqun Wang, Xianze Xiong, Jianrong Xu, Shaofeng Wang, Yuan Tian, Di Zeng, Xingyu Pu, Bei Li, Jiong Lu, Geng Liu, Nansheng Cheng","doi":"10.14309/ctg.0000000000000849","DOIUrl":"10.14309/ctg.0000000000000849","url":null,"abstract":"<p><strong>Introduction: </strong>Large-scale cohort studies exploring the etiology of obstructive jaundice (OJ) are scarce, with current serum-based diagnostic markers offering suboptimal performance. This study leverages the largest retrospective cohort of patients with OJ to date to investigate its disease spectrum and to develop a novel diagnostic system.</p><p><strong>Methods: </strong>This study involves 2 retrospective observational cohorts. The biliary surgery cohort (BS cohort, n = 349) served for initial data exploration and external validation of machine learning (ML) models. The large general cohort (LG cohort, n = 5,726) enabled an in-depth analysis of etiologies and the determination of relevant diagnostic indicators, in addition to supporting ML model development. Interpretable ML techniques were used to derive insights from the models.</p><p><strong>Results: </strong>The LG cohort highlighted a diverse disease spectrum of OJ, including cholangiocarcinoma (10.39% distal, 10.01% perihilar, and 5.59% intrahepatic), pancreatic adenocarcinoma (19.11%), and common bile duct stones (18.27%) as leading causes. Traditional serum markers such as carbohydrate antigen 19-9 and carcinoembryonic antigen lacked stand-alone diagnostic accuracy. Two ML-based models (collectively termed the ML of OJ based on common laboratory tests model) were developed: a classifier to differentiate benign from malignant causes (AUROC = 0.862) and a multiclass model to further stratify malignant and benign diseases (ACC = 0.777). Interpretable ML tools provided clarity on critical features, offering actionable insights and enhancing transparency in the decision-making process.</p><p><strong>Discussion: </strong>This study elucidates the etiological spectrum of OJ, meanwhile providing a practical and interpretable ML-based diagnostic tool. By leveraging large-scale clinical data, our model provides a rapid and reliable primary assessment for patients with OJ, enabling clinicians to identify potential etiologies and guide further diagnostic workup.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00849"},"PeriodicalIF":3.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157138","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 Enteric Microbiome in Early-Onset Colorectal Cancer: A Comprehensive Review of Its Role as a Biomarker of Disease.","authors":"Jesús M Luévano, Julia Liu, Thaddeus Stappenbeck","doi":"10.14309/ctg.0000000000000864","DOIUrl":"10.14309/ctg.0000000000000864","url":null,"abstract":"<p><p>Early-onset colorectal cancer (EoCRC), a distinct entity from late-onset colorectal cancer (LoCRC), continues to increase in incidence. Known risk factors for LoCRC have been explored to explain this trend, but do not account for it completely. The gastrointestinal microbiome has been associated with LoCRC and additional risk factors of disease; however, it is only now being investigated in the context of EoCRC. A better understanding of the microbiome's function in EoCRC could elucidate its role in the increasing incidence of EoCRC. This article reviews the state of literature related to studies specifically isolating microbiome-related changes in EoCRC compared with LoCRC and age-matched controls. Several studies reviewed in this article highlight the varied results of overall diversity and specific bacteria that are influenced by EoCRC, and the utility of these unique changes to predict for EoCRC. Although the microbiome can be useful in understanding EoCRC, to better predict for disease the microbiome must be studied in more diverse populations and with deeper, more functional characterization in a manner that allows for transference of findings among future studies. These studies indicate that the enteric microbiome holds significant potential as a biomarker for disease but has yet to fully meet an understanding necessary for direct clinical utilization.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00864"},"PeriodicalIF":3.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144157140","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":"Risk of Pancreatic Cancer in Cystic Fibrosis and Cystic Fibrosis Transmembrane Conductance Regulator Germline Variants: A Retrospective Cohort Study.","authors":"Nikita J Patel, Qiaoling Chen, Tiffany Q Luong, Bechien U Wu","doi":"10.14309/ctg.0000000000000857","DOIUrl":"10.14309/ctg.0000000000000857","url":null,"abstract":"<p><strong>Introduction: </strong>Screening guidelines for pancreatic cancer (PC) based on genetic risk do not include patients with cystic fibrosis (CF) or cystic fibrosis transmembrane conductance regulator (CFTR) gene variants. The objective of this study was to determine risk of PC in patients with CF or CFTR pathogenic/likely pathogenic gene variants.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of CF/CFTR pathogenic/likely pathogenic variants patients in an integrated healthcare system from 2008 to 2023. Index date was the initial encounter within the health system, with censoring at loss of membership, death, or study completion. PC incidence rate was based on person-time at risk. Age-adjusted and sex-adjusted standardized incidence rate ratio (SIR) for PC was calculated for CF/CFTR compared with the non-CFTR reference population. We further stratified PC risk by age and family history of PC.</p><p><strong>Results: </strong>A total of 12,682 patients with CF/CFTR were included with a median follow-up of 8.3 years (interquartile range 4.3-13.1). The cohort was 88% female, had median age at index of 25.8 (interquartile range 19.1-31.1) years, and was majority White and Hispanic. Eight total PC events occurred in the CF/CFTR group (incidence rate 7.3 per 100,000 person-years). The adjusted SIR for PC was 2.3 (95% confidence interval 1.2-4.7) for CF/CFTR variant patients. There was effect modification by age, with SIR (age ≥50 years) of 2.87 (95% confidence interval 1.37-6.01). Among CF/CFTR patients with family history of PC, 1 PC case was observed with SIR (age ≥50 years) of 13.</p><p><strong>Discussion: </strong>Patients with CF or CFTR gene variants had an almost 3-fold higher adjusted risk of PC than the general population after the age of 50 years. The risk may be further increased with a family history of PC.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00857"},"PeriodicalIF":3.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149441","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 and Endoscopic-Histological Features of Multifocal and Corpus-Restricted Atrophic Gastritis Patients With Non-Cardia Gastric Cancer or Dysplasia: A Multicenter, Cross-Sectional Study.","authors":"Edith Lahner, Bruno Annibale, Emanuele Dilaghi, Cristina Luciano Millado, Marco Vincenzo Lenti, Antonio Di Sabatino, Emanuela Miceli, Sara Massironi, Nicola Zucchini, Renato Cannizzaro, Stefano Realdon, Giuseppe Losurdo, Antonia Valeria Borraccino, Elisa Marabotto, Edoardo Giovanni Giannini, Andrea Pasta, Francesco Calabrese, Luca Mastracci, Roberta Elisa Rossi, Valentina Sciola, Antonella Contaldo, Antonio Pisani, Angela Dalia Ricci, Maria Savino, Gianluigi Giannelli, Mario Milco D'Elios, Chiara Della Bella, Damiano Martino, Fabiana Zingone, Fabio Farinati","doi":"10.14309/ctg.0000000000000862","DOIUrl":"10.14309/ctg.0000000000000862","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Helicobacter pylori (Hp)-related atrophic gastritis (AG) affects corpus and antral mucosa, resulting in multifocal AG (MF-AG); autoimmunity-driven AG is corpus-restricted (CR-AG). AG carries increased gastric dysplasia (GD) and gastric cancer (GC) risk, well established in MF-AG, but debated in CR-AG. This study aimed to assess clinical, endoscopic-histological characteristics of GD-GC in patients with MF-AG and CR-AG.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was the multicenter cross-sectional study across 11 Italian gastroenterology centers on data of non-cardia GD-GC in adult patients with MF-AG or CR-AG based on clinical, endoscopic, and histological charts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Eighty-four patients were included with MF-AG and CR-AG in 45 (53.6%) and 39 (46.4%), respectively. Low-grade GD, high-grade GD, and GC were diagnosed in 31 (36.9%), 6 (7.1%), and 47 (56.0%), respectively. GD-GC similarly occurred in patients with MF-AG and CR-AG: high-grade GD in 4 (8.9%) vs 2 (5.1%), low-grade GD in 17 (37.8%) vs 14 (35.9%), and GC in 24 (53.5%) vs 23 (59.0%) ( P &gt; 0.05). Compared with MF-AG, in patients with CR-AG, GD-GC were more commonly polypoid (51.6% vs 27.3%, P = 0.048) and more frequent in the corpus (55.3% vs 28.6%, P = 0.02), but occurred also in the antrum (34.2%) and incisura (10.5%). Surgery was more frequent in CR-AG than in MF-AG (48.6% vs 23.1%, P = 0.02). Corpus atrophy severity and intestinal metaplasia were not different ( P &gt; 0.05), histological Hp positivity was low in both (2.3% vs 2.9%, P = 0.87), but in Hp negatives, active inflammation was present in the antrum in 26.7% and 7.7% ( P = 0.02), and in the corpus in 31.1% and 21.5% ( P = 0.27).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Non-cardia GC and GD may occur in both MF-AG and CR-AG, displaying differences in topography and endoscopic presentation but similarities in nonlesional mucosa, differentiation, and staging. Surveillance should be considered in corpus AG, regardless of extension and supposed etiology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;La gastrite atrofica (AG) Helicobacter pylori (Hp)-relata interessa la mucosa dell'antro e del corpo-fondo dando luogo alla gastrite atrofica multifocale (MF-AG); la gastrite atrofica autoimmune invece è limitata al corpo-fondo risparmiando l'antro (CR-AG). L'AG è ad aumentato rischio per displasia (GD) e cancro gastrico (GC). Questo rischio è ben stabilito nella MF-AG, ma ancor adibattuto nella CR-AG. Questo studio ha come scopo di valutare le caratteristiche cliniche e endoscopico-istologiche di pazienti affetti da GD o GC in MF-AG e CR-AG.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Metodi: &lt;/strong&gt;E' stato condotto uno studio trasversale multicentrico in 11 centri gastroenterologici italiani su dati di pazienti adulti con GD o GC non cardiali in MF-AG o CR-AG basati su schede cliniche e referti endoscopici e istologici.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Risultati: &lt;/strong&gt;Sono stati inclusi 84 pazienti, di cui 45 (53.6%) con MF-AG e 39 (46.4%","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00862"},"PeriodicalIF":3.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126849","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":"Bile Acid Diarrhea Is Associated With an Increased Risk of Type 2 Diabetes and Cardiovascular Disease: A Nationwide Cohort Study.","authors":"Anne-Marie Ellegaard, Matilde Winther-Jensen, Line L Kårhus, Filip K Knop, Martin L Kårhus","doi":"10.14309/ctg.0000000000000863","DOIUrl":"10.14309/ctg.0000000000000863","url":null,"abstract":"<p><strong>Introduction: </strong>Bile acid diarrhea (BAD) is a socially debilitating disease characterized by diarrhea, fecal urgency, and fecal incontinence. It is caused by excessive amounts of bile acids in the colon and is estimated to affect up to 1% of the population. Among other actions, bile acids regulate systemic glucose and lipid metabolism, and BAD has been associated with a dysmetabolic prediabetic-like state. Here, we investigate the association between BAD and type 2 diabetes (T2D) and cardiovascular disease (CVD), respectively.</p><p><strong>Methods: </strong>By using nationwide Danish health registries, individuals with BAD were identified by referral to the diagnostic 75 selenium-homotaurocholic acid test followed by redemption of a prescription of a bile acid sequestrant within 365 days or a BAD diagnosis code (n = 5,954). A reference population of age-matched and sex-matched individuals was included for comparison (n = 59,540).</p><p><strong>Results: </strong>More individuals with BAD than controls developed T2D (8.8% vs 5.2%) and experienced CVD (22.7% vs 18.0%) after index date (i.e., BAD diagnosis or matching, respectively). Sensitivity analyses revealed earlier onset of T2D and CVD in the BAD population compared with matches but no difference between sexes. The cause-specific hazards for T2D and CVD were 1.79 and 1.34, respectively, in the BAD population compared with matches. All-cause mortality-but not CVD-related mortality-was increased among individuals with BAD compared with matches.</p><p><strong>Discussion: </strong>BAD is associated with increased risk and earlier onset of T2D and CVD, respectively, as well as disturbed glucose and lipid metabolism, indicating BAD as a high-risk condition requiring intensified monitoring and relevant preventive interventions.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00863"},"PeriodicalIF":3.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126843","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":"Predictors of 30-Day Unplanned Readmission in Necrotizing Pancreatitis: A 12-Year Experience From a Tertiary Care Center.","authors":"Gaurav Suryawanshi, Megan B Ghai, Nauroze Faizi, Stuart K Amateau, Nabeel Azeem, Shawn Mallery, Martin L Freeman, Guru Trikudanathan","doi":"10.14309/ctg.0000000000000848","DOIUrl":"10.14309/ctg.0000000000000848","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital readmission rate is a key hospital metric and represents a substantial burden to patients and the healthcare system. Necrotizing pancreatitis (NP) patients are at high risk of unplanned readmission. The aim of this study was to determine the incidence and predictors of 30-day unplanned readmission after index hospitalization for NP.</p><p><strong>Methods: </strong>Adult NP patients who were managed at a single tertiary referral center between 2009 and 2022 were identified from a prospective database and categorized into 2 groups based on 30-day unplanned readmission after index hospitalization. Patients with no follow-up who died during index admission or within 30 days of discharge were excluded. Baseline data on admission including demographic, clinical, interventional, imaging, and discharge characteristics were compared. Multivariable analysis was completed to identify independent predictors of 30-day readmission.</p><p><strong>Results: </strong>Among 505 patients with NP (male patients-347 [69%], median age-50 years [inter quartile range 37-63]) 191 (37.8%) had at least 1 unplanned readmission. The most common causes of readmission were abdominal pain (40%) and sepsis (27%). On multivariable analysis, independent predictors for early readmission were necrosis collection size ≥ 6 cm (adjusted odds ratio [aOR] 1.91 [1.11-3.30], P < 0.03), stay at outside hospital ≥ 14 days before transfer to tertiary center (aOR 2.89 [1.27-6.60], P < 0.01), and need for percutaneous feeding tube at the time of discharge (aOR 2.06 [1.01-4.21], P < 0.05).</p><p><strong>Discussion: </strong>Readmission after NP is common and associated with greater mortality at 6 months. Expedited transfer to tertiary center for timely intervention, assiduous follow-up of other high-risk patients (large collections and those who need enteral nutrition) could help avoid readmissions and optimize outcomes.</p>","PeriodicalId":10278,"journal":{"name":"Clinical and Translational Gastroenterology","volume":" ","pages":"e00848"},"PeriodicalIF":3.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126866","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}