Clinical Gastroenterology and Hepatology最新文献

{"title":"Direct-to-Consumer Pharmacies and \"Direct\" Drug Channels: Practice Implications for Gastroenterology and Hepatology.","authors":"Siddharth Singh, Kartik Dapke, Marina Ivanov","doi":"10.1016/j.cgh.2026.04.021","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.04.021","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing incidence and prevalence of Microscopic Colitis in Sweden: A nationwide population-based cohort study.","authors":"David Bergman, Soran Rabin Bozorg, Anders Forss, Jiangwei Sun, Carole A Marxer, Darrell S Pardi, Jonas F Ludvigsson","doi":"10.1016/j.cgh.2026.03.019","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.03.019","url":null,"abstract":"<p><strong>Background: </strong>There are few population-based studies on the incidence and prevalence of microscopic colitis (MC).</p><p><strong>Objective: </strong>To assess incidence and prevalence of MC in Sweden.</p><p><strong>Design: </strong>Nationwide population-based cohort study including all incident cases of biopsy-confirmed MC and all biopsied cases with normal mucosa from 1995 to 2021. Incidence rates (IRs) were age-standardized to the 2021 Swedish population. Age-specific IRs were plotted by sex. Poisson regression estimated trends and female-to-male incidence rate ratios (IRRs). A combined model of MC and normal mucosa evaluated whether changes in MC incidence exceeded background biopsy trends. Point prevalence on 31 December 2021 was derived by dividing MC cases with population denominators. Lifetime risk was computed using a competing-risk cumulative incidence estimator.</p><p><strong>Results: </strong>We identified 22,519 incident MC cases (71% women) from 1995 to 2021. The mean age-standardized IR across the study period was 8.8 (95% confidence interval(CI)=7.1-10.5) cases per 100,000 person-years and rose steeply from 1995 until 2007 (+17% per year, 95% CI=1.15-1.19), then increased more modestly (+3%, 1.02-1.04). The incidence of MC increased faster than that of normal mucosa, the mean difference was 4.33% per year (95% CI 3.19-5.48). The prevalence of MC was 170 per 100,000 inhabitants in 2021. Lifetime risk was 1 in 54 for women and 1 in 133 for men.</p><p><strong>Conclusion: </strong>In Sweden, incidence and prevalence of MC continued to rise through 2021. The steeper slope of MC incidence in relation to normal mucosa indicates either a true rise in disease occurrence or an ongoing diagnosis of prevalent cases related to an increased awareness of MC.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147833665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Schatzki's Rings: Recognition, Significance, and Management.","authors":"Francesca Forattini, Rena Yadlapati","doi":"10.1016/j.cgh.2026.03.028","DOIUrl":"10.1016/j.cgh.2026.03.028","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"American Gastroenterological Association Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review.","authors":"Waqar Qureshi, Sook Hoang, Jeanetta Frye, Satish Sc Rao","doi":"10.1016/j.cgh.2026.04.008","DOIUrl":"10.1016/j.cgh.2026.04.008","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Description: &lt;/strong&gt;Hemorrhoids are a common problem. The diagnosis and treatment can be challenging. Gastroenterologists have much to offer these patients. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review is to provide best practice advice (BPA) covering the diagnosis and treatment of hemorrhoid disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. These BPA statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these BPA statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BPA 1: The diagnosis and treatment of hemorrhoids is within the purview of the gastroenterologist. The diagnosis and grading of hemorrhoids is easily made by taking a history from the patient and examining the patient. Symptoms caused by hemorrhoids include bleeding, itching, discomfort, and/or prolapse. Hemorrhoids only cause significant pain when acutely thrombosed. Sharp pain on defecation is most likely anal fissure. BPA 2: Dietary and lifestyle modifications, including increasing fiber intake and avoiding straining or prolonged time on the toilet, are reasonable first-line therapies for symptomatic hemorrhoids. The use of sitz baths for symptom improvement in symptomatic hemorrhoids is often advised, but scientific data is limited. BPA 3: Topical treatments, including anesthetics, astringents (witch hazel), corticosteroids, and vasoactive agents, can be considered for treatment of symptomatic hemorrhoids, but there is little data to support efficacy. Topical steroids should not be used for more than 2 weeks at a time. BPA 4: Anoscopy should be performed, whenever possible, on every new patient with suspected hemorrhoids, prior to treatment, to ensure accurate diagnosis. BPA 5: Both hemorrhoid banding and infrared coagulation are safe, effective, and easy to perform in the office setting. Infrared coagulation and rubber band ligation have similar benefits in the short term. Rubber band ligation has longer-term benefits for treatment of prolapsing hemorrhoids and recurrent bleeding. Hemorrhoid banding or infrared coagulation should be employed prior to surgical hemorrhoidectomy for grades 1 to 3 hemorrhoids. BPA 6: As part of informed consent for hemorrhoid therapies, the patient must be made aware of the small possibility of pelvic sepsis as a complication. Patients should be counseled about the risk and instructed to present to the emergency department immediately for evalu","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Pharmacology Meets Expectancy: Lessons From Two Negative Trials in Disorders of Gut-Brain Interaction.","authors":"Prashant Singh, Anthony Lembo","doi":"10.1016/j.cgh.2026.04.018","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.04.018","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of stopping thiopurines under anti-TNF therapy in inflammatory bowel disease: A population-based study.","authors":"Jeongkuk Seo, Seonok Kim, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Jeong-Sik Byeon, Seung-Jae Myung, Ye-Jee Kim, Byong Duk Ye","doi":"10.1016/j.cgh.2026.04.017","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.04.017","url":null,"abstract":"<p><strong>Background and aims: </strong>The impact of stopping thiopurines after escalating to treatment with an anti-tumor necrosis factor (TNF) agent in patients with inflammatory bowel disease (IBD) is currently unclear. We aimed to assess the impact of stopping versus continuing thiopurines after initiating anti-TNF therapy.</p><p><strong>Methods: </strong>In this retrospective cohort study, we analyzed data from the Korean National Health Insurance claims database of 6,235 patients with ulcerative colitis (UC) or Crohn's disease (CD) on thiopurines, who started anti-TNF treatment between 2007 and 2020. Patients were classified based on thiopurine discontinuation within 90 days of initiating anti-TNF therapy. The primary outcome was a composite of new corticosteroid use, IBD-related hospitalization, or intestinal surgery.</p><p><strong>Results: </strong>Among the eligible patients, 1,900 (30.5%) had UC and 4,335 (69.5%) had CD; 429 (22.6%) patients with UC and 913 (21.1%) patients with CD discontinued thiopurines within 90 days. In the UC group, multivariable analysis demonstrated a modest increase in the risk of new corticosteroid use (adjusted hazard ratio [aHR], 1.18; 95% confidence interval [CI], 1.04-1.35) and the composite outcome (aHR, 1.20; 95% CI, 1.05-1.37) among patients who discontinued thiopurines. In contrast, no independent association was observed between thiopurine discontinuation and adverse clinical outcomes in the CD group. These results remained consistent in sensitivity analyses using a 6-month landmark (UC composite outcome: aHR 1.20; 95% CI 1.04-1.38).</p><p><strong>Conclusions: </strong>Discontinuing thiopurines after initiating anti-TNF therapy was associated with a modest increase in the risk of adverse clinical events in patients with UC. This warrants careful risk-benefit assessment before stopping thiopurines after escalation to anti-TNF therapy.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic use and later risk of celiac disease: A nationwide case-control and sibling analysis.","authors":"Maria Ulnes, Jonas Söderling, Benjamin Lebwohl, Peter H R Green, Jonas F Ludvigsson, Karl Mårild","doi":"10.1016/j.cgh.2026.04.009","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.04.009","url":null,"abstract":"<p><strong>Background and aims: </strong>Antibiotic exposure has, albeit inconsistently, been linked to future celiac disease (CD), but may reflect healthcare-seeking behavior or treatment of undiagnosed CD. We examined prior antibiotic use in individuals with biopsy-verified CD, vs. their matched general population comparators, and siblings. We also compared associations with individuals with normal mucosa.</p><p><strong>Methods: </strong>This nationwide Swedish study (2007-2023) assessed antibiotic use up until one year before diagnosis/matching in 27,789 individuals with biopsy-verified CD, 133,451 comparators, and 33,112 siblings. Secondary analyses included individuals with histologically normal mucosa (n=225,548) vs. matched comparators (n=1,089,796). Odds ratios (aORs) were adjusted for comorbidities, socioeconomic status, and healthcare use.</p><p><strong>Results: </strong>Earlier antibiotic exposure was more common in CD (69%) than in comparators (63%; aOR=1.24 [95%CI=1.21-1.28]). Restricted analyses to antibiotics ≥5 years before CD diagnosis yielded an aOR of 1.15 (95%CI=1.11-1.19). The association increased with the number of dispensations (aOR=1.21 [95%CI=1.17-1.25] for 1-2; 1.35 [95%CI=1.30-1.41] for ≥3 vs. none). The association between CD and prior antibiotics persisted in sibling comparisons (any use, aOR=1.29 [95%CI=1.24-1.35]). An even stronger association with antibiotics was seen among individuals with normal mucosa (aOR=1.50 [95%CI=1.48-1.51]), with a particularly elevated risk in those with ≥3 earlier dispensations (aOR=1.80 [95%CI=1.78-1.83]).</p><p><strong>Conclusion: </strong>Individuals with CD were more often exposed to antibiotics before diagnosis than their general population comparators. However, an even stronger association with antibiotic use was seen in those with normal mucosa, suggesting that heightened surveillance rather than causality may contribute to the observed patterns. Although antibiotic stewardship remains important, CD concerns should not deter appropriate antibiotic use.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of complicated upper gastrointestinal bleeding with direct oral anticoagulants: an Asian population-based analysis.","authors":"Louis H S Lau, Xiang Xiao, Terry C F Yip, Bonaventure Y M Ip, Rashid N Lui, Hon-Chi Yip, Shannon M Chan, Philip W Y Chiu, James Y W Lau, Vincent W S Wong, Grace L H Wong, Francis K L Chan","doi":"10.1016/j.cgh.2026.04.016","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.04.016","url":null,"abstract":"<p><strong>Background and aims: </strong>Asian data on complicated upper gastrointestinal bleeding (UGIB) risks among direct oral anticoagulants (DOACs) are limited.</p><p><strong>Methods: </strong>An industry-independent, population-based, retrospective cohort study was performed in Hong Kong during 2011-2020. Subjects with new exposure to apixaban, dabigatran, edoxaban or rivaroxaban were included. Baseline demographics, comorbidities, drugs and laboratory results were balanced between DOACs by inverse probability of treatment weighting (IPTW). Subjects were followed for 2 years with non-UGIB deaths considered as competing risks. Subdistribution hazard ratios (S-HR) were generated by Fine-Gray model. False discovery rate (FDR) was controlled by the Benjamini-Hochberg procedure for multiplicity. The primary outcome was complicated UGIB, defined as any UGIB-related death, or UGIB with a hemoglobin drop >2g/dL; blood transfusion; emergent endoscopic procedure; radiological/surgical intervention; or rebleeding within 30 days.</p><p><strong>Results: </strong>58,229 subjects with new DOACs exposure were included (22,359 apixaban, 20,639 dabigatran, 2,068 edoxaban, 13,163 rivaroxaban). Compared with apixaban, edoxaban (S-HR=1.891, 95%CI=1.091-3.275, p=0.025, FDR-adjusted p=0.039) and rivaroxaban (S-HR=1.441, 95%CI=1.047-1.983, p=0.026, FDR-adjusted p=0.039), but not dabigatran, were associated with significantly higher risks of complicated UGIB, with a number-needed-to-harm of 244 for edoxaban and 427 for rivaroxaban, respectively. In subgroup analysis, apixaban was associated with a lower bleeding risk in subjects with age ≥80 or estimated glomerular filtrate rate <60mL/min/1.73m². Low-dose apixaban was associated with a lower bleeding risk among all low-dose DOACs.</p><p><strong>Conclusion: </strong>This Chinese population-based observational study demonstrated a lower 2-year risk of complicated UGIB in apixaban users compared to edoxaban and rivaroxaban, but not dabigatran, among subjects without prior anticoagulant exposure.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serious infection in inflammatory bowel diseases patients treated with vedolizumab, ustekinumab, JAK inhibitors, anti-TNF or aminosalicylates.","authors":"Anaïs Bertrand, Aurélien Amiot, Antoine Martin, Franck Carbonnel, Antoine Meyer","doi":"10.1016/j.cgh.2026.04.015","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.04.015","url":null,"abstract":"<p><strong>Background and aims: </strong>Advanced therapy including biologics and JAKi are commonly used to treat inflammatory bowel diseases (IBD). We aimed to assess the risk of serious infection in IBD patients treated with advanced therapies.</p><p><strong>Methods: </strong>Nationwide French cohort including IBD patients aged >15 years, initiating treatment between 2014 and 2024: vedolizumab, ustekinumab, JAKi, anti-TNF, or aminosalicylates. We assessed serious infection according to treatment exposure. Propensity score weighting accounted for indication bias.</p><p><strong>Results: </strong>309,025 treatments were initiated in 219,229 patients: 27,514 initiated vedolizumab, 28,054 ustekinumab, 6439 JAKi, 93,444 anti-TNF, and 153,574 aminosalicylates. Median age was 41 years [IQR:29-55], 52.0% were women, and 45.3% had Crohn's disease. A total of 15,081 serious infections occurred over a median follow-up of 1.0 years. Compared with aminosalicylates, aHR for serious infections were 1.05 (95%CI: 0.98-1.11) for ustekinumab, 1.29 (95%CI: 1.24-1.34) for anti-TNF, 1.38 (95%CI: 1.30-1.46) for vedolizumab, and 1.63 (95%CI: 1.45-1.84) for JAKi. Compared with anti-TNF, aHR were 0.81 (95%CI: 0.76-0.86) for ustekinumab, 1.07 (95%CI: 1.01-1.13) for vedolizumab, and 1.27 (95%CI: 1.12-1.43) for JAKi. Patterns were consistent across IBD type. Anti-TNF and vedolizumab were particularly associated with skin, upper respiratory tract, and central nervous system infections. JAKi were particularly associated with herpesvirus infections, and anti-TNF with mycobacterial infections. Concomitant corticosteroids and thiopurine/methotrexate increased the risks of serious infection by 2.06 (95%CI: 1.98-2.14) and 1.11 (95%CI: 1.06-1.16), respectively.</p><p><strong>Conclusion: </strong>Among patients with IBD, the risk of serious infection is highest with JAKi, lowest with ustekinumab and intermediate with anti-TNF and vedolizumab.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AN OPEN-LABEL TRIAL OF EFFECTS OF VARENICLINE IN NON-CONSTIPATION IRRITABLE BOWEL SYNDROME AND PAIN","authors":"Ayah Matar MD, Irene Busciglio BS, Deborah Eckert BSN RN, David R. Linden PhD, W. Scott Harmsen MS, Michael Camilleri MD DSc","doi":"10.1016/j.cgh.2026.03.045","DOIUrl":"https://doi.org/10.1016/j.cgh.2026.03.045","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"22 1","pages":""},"PeriodicalIF":12.6,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147744167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}