Clinical Gastroenterology and Hepatology最新文献

{"title":"Elsewhere in the AGA Journals","authors":"","doi":"10.1016/S1542-3565(24)01109-1","DOIUrl":"10.1016/S1542-3565(24)01109-1","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages A17-A18"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141095","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":"Blue Notes","authors":"Charles J. Kahi MD, MS, AGAF","doi":"10.1016/j.cgh.2024.11.004","DOIUrl":"10.1016/j.cgh.2024.11.004","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 193-194"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037496","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":"Continuing the Commitment to Diversity, Equity, and Inclusion Within AGA Journals","authors":"Sandra M. Quezada, Folasade P. May","doi":"10.1016/j.cgh.2024.11.003","DOIUrl":"10.1016/j.cgh.2024.11.003","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 195-199.e3"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037497","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":"Update on the Epidemiology and Management of Microscopic Colitis","authors":"Anne F. Peery ,&nbsp;Hamed Khalili ,&nbsp;Andreas Münch ,&nbsp;Darrell S. Pardi","doi":"10.1016/j.cgh.2024.08.026","DOIUrl":"10.1016/j.cgh.2024.08.026","url":null,"abstract":"<div><div>Microscopic colitis is an inflammatory bowel disease that commonly presents with debilitating chronic watery diarrhea. Recent epidemiologic studies and randomized trials of therapeutics have improved the understanding of the disease. Medications, such as nonsteroidal anti-inflammatories, proton pump inhibitors, and antidepressants, have traditionally been considered as the main risk factors for microscopic colitis. However, recent studies have challenged this observation. Additionally, several epidemiologic studies have identified other risk factors for the disease including older age, female sex, smoking, alcohol use, immune-mediated diseases, and select gastrointestinal infections. The diagnosis of microscopic colitis requires histologic assessment of colon biopsies with findings including increased in intraepithelial lymphocytes with or without expansion of the subepithelial collagen band. The pathophysiology is poorly understood but is thought to be related to an aberrant immune response to the luminal microenvironment in genetically susceptible individuals. Antidiarrheal medications, such as loperamide or bismuth subsalicylate, may be sufficient in patients with mild symptoms. In patients with more severe symptoms, treatment with budesonide is recommended. Maintenance therapy is often necessary and several potential treatment strategies are available. Biologic and small molecule treatments seem to be effective in patients who have failed budesonide. There is an unmet need to further define the pathophysiology of microscopic colitis. Additionally, trials with novel therapies, particularly in patients with budesonide-refractory disease, are needed.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 3","pages":"Pages 490-500"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281221","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":"Neoplastic Progression Risk in Females With Barrett’s Esophagus: A Systematic Review and Meta-Analysis of Individual Patient Data","authors":"Pauline A. Zellenrath ,&nbsp;Laurelle van Tilburg ,&nbsp;Roos E. Pouw ,&nbsp;Rena Yadlapati ,&nbsp;Yonne Peters ,&nbsp;Michael B. Ujiki ,&nbsp;Prashanthi N. Thota ,&nbsp;Norihisa Ishimura ,&nbsp;Stephen J. Meltzer ,&nbsp;Noam Peleg ,&nbsp;Won-Tak Choi ,&nbsp;John V. Reynolds ,&nbsp;Alexandros D. Polydorides ,&nbsp;Arjun D. Koch ,&nbsp;Judith Honing ,&nbsp;Manon C.W. Spaander","doi":"10.1016/j.cgh.2024.06.053","DOIUrl":"10.1016/j.cgh.2024.06.053","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Females with Barrett’s esophagus (BE) have a lower risk of neoplastic progression than males, but sufficiently powered risk analyses are lacking. This systematic review and meta-analysis of individual patient data (IPD) aimed to provide more robust evidence on neoplastic progression risk in females.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature search of 3 electronic databases (Medline, Embase, Google Scholar) from inception until August 2023. Eligible studies (1) reported original data on progression from nondysplastic BE, indefinite for dysplasia, or low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma; and (2) included female and male patients. IPD were quality controlled by 2 independent reviewers. The primary outcome was the association between sex and neoplastic progression risk, adjusted for risk factors using multivariable Cox regression analysis. Secondary outcomes were sex differences in time to progression and annual progression rate.</div></div><div><h3>Results</h3><div>IPD were obtained from 11 of 66 eligible studies, including 2196 (31%) females. Neoplastic progression risk was lower in females (hazard ratio for males vs females, 1.44; 95% confidence interval, 1.13–1.82) after adjusting for age, smoking, medication use, hiatal hernia, BE length, and baseline pathology. The annual progression rate was 0.88% in females vs 1.29% in males. Time to progression was similar in both sexes: 3.7 years (interquartile range, 2.1–7.7 years) in females and 4.2 years (interquartile range, 2.0–8.1 years) in males.</div></div><div><h3>Conclusion</h3><div>Although females had a lower neoplastic progression risk, sex differences were smaller than previously reported, and time to progression was similar for both sexes. Future research should focus on other factors than sex to identify low- and high-risk BE patients.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 225-235.e8"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspirin-Related Chemoprevention of GI Cancers and Bleeding-Related Mortality in Helicobacter Pylori–Eradicated Patients","authors":"Yi Bao,&nbsp;Yanming Xu","doi":"10.1016/j.cgh.2024.05.032","DOIUrl":"10.1016/j.cgh.2024.05.032","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Page 380"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300130","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":"The Cost of Inflammatory Bowel Disease Care: How to Make it Sustainable","authors":"Johan Burisch ,&nbsp;Jennifer Claytor ,&nbsp;Inmaculada Hernandez ,&nbsp;Jason Ken Hou ,&nbsp;Gilaad G. Kaplan","doi":"10.1016/j.cgh.2024.06.049","DOIUrl":"10.1016/j.cgh.2024.06.049","url":null,"abstract":"<div><div>The rising global prevalence of inflammatory bowel diseases (IBDs), such as Crohn’s disease and ulcerative colitis, underscores the need to examine current and future IBD care costs. Direct health care expenses, including ambulatory visits, hospitalizations, and medications, are substantial, averaging $9,000 to $12,000 per person annually in high-income regions. However, these estimates do not fully account for factors such as disease severity, accessibility, and variability in health care infrastructure among regions. Indirect costs, predominantly stemming from loss in productivity due to absenteeism, presenteeism, and other intangible costs, further contribute to the financial burden of IBD. Despite efforts to quantify indirect costs, many aspects remain poorly understood, leading to an underestimation of their actual impact. Challenges to achieving cost sustainability include disparities in access, treatment affordability, and the absence of standardized cost-effective care guidelines. Strategies for making IBD care sustainable include early implementation of biologic therapies, focusing on cost-effectiveness in settings with limited resources, and promoting the uptake of biosimilars to reduce direct costs. Multidisciplinary care teams leveraging technology and patient-reported outcomes also hold promise in reducing both direct and indirect costs associated with IBD. Addressing the increasing financial burden of IBD requires a comprehensive approach that tackles disparities, enhances access to cost-effective therapeutics, and promotes collaborative efforts across health care systems. Embracing innovative strategies can pave the way for personalized, cost-effective care accessible to all individuals with IBD, ensuring better outcomes and sustainability.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 3","pages":"Pages 386-395"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Culturally Sensitive and Inclusive IBD Care","authors":"Victor Chedid ,&nbsp;Laura Targownik ,&nbsp;Oriana M. Damas ,&nbsp;Sophie Balzora","doi":"10.1016/j.cgh.2024.06.052","DOIUrl":"10.1016/j.cgh.2024.06.052","url":null,"abstract":"<div><div>As the prevalence of inflammatory bowel disease (IBD) increases within historically disadvantaged communities, it is imperative to better understand how intersectionality—defined as the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism)—intersects and social determinants of health influence the patient’s experiences within the medical system when navigating their disease. Culturally sensitive care is characterized by the ability to deliver patient-centered care that recognizes how the intersectionality of an individual’s identities impacts their disease journey. An intentional consideration and sensitivity to this impact play important roles in providing an inclusive and welcoming space for historically disadvantaged individuals living with IBD and will help address health inequity in IBD. Cultural competence implies mastery of care that understands and respects values and beliefs across cultures, while cultural humility involves recognizing the complexity of cultural identity and engaging in an ongoing learning process from individual patient experiences. Heightening our patient care goals from cultural competence to cultural sensitivity allows healthcare professionals and the systems in which they practice to lead with cultural humility as they adopt a more inclusive and humble perspective when caring for patient groups with a diverse array of identities and cultures and to avoid maintaining the status quo of implicit and explicit biases that impede the delivery of quality IBD care. In this article, we review the literature on IBD care in historically disadvantaged communities, address culturally sensitive care, and propose a framework to incorporating cultural humility in IBD practices and research.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 3","pages":"Pages 440-453"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342788","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":"Prevalence and Costs of Eosinophilic Esophagitis in the United States","authors":"Hannah L. Thel ,&nbsp;Chelsea Anderson ,&nbsp;Angela Z. Xue ,&nbsp;Elisabeth T. Jensen ,&nbsp;Evan S. Dellon","doi":"10.1016/j.cgh.2024.09.031","DOIUrl":"10.1016/j.cgh.2024.09.031","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Eosinophilic esophagitis (EoE) has been continually increasing in prevalence, but current estimates are lacking. We aimed to determine updated estimates of the prevalence and medical costs associated with EoE in the United States (U.S.).</div></div><div><h3>Methods</h3><div>We used two large administrative databases, MarketScan and Medicare, and International Classification of Disease codes to calculate annual prevalence of EoE, as well as age- and sex-stratified estimates, standardized to the U.S. population. Health care utilization, including medications and endoscopic procedures, was quantified, and annual EoE-associated costs were estimated.</div></div><div><h3>Results</h3><div>We identified 20,435 EoE cases in MarketScan in 2022 and 1913 EoE cases in Medicare in 2017. This translated to prevalences of 163.08 cases/100,000 and 64.83 cases/ 100,000 in MarketScan and Medicare, respectively. There was a 5-fold increase in prevalence in both databases since 2009. In MarketScan, prevalence was higher among males (204.45/100,000 vs 122.06/100,000 among females); for both sexes, peak prevalence was from 40 to 44 years of age. Standardized to the U.S. population, the prevalence of EoE was 142.5/100,000, extrapolating to 472,380 cases. Total EoE-associated health care costs were estimated to be $1.32 billion in 2024 dollars after accounting for inflation.</div></div><div><h3>Conclusions</h3><div>The prevalence of EoE continues to increase, with a rate of 1 in 617 in 2022 in those &lt;65 years of age, and 1 in 1562 in 2017 those ≥65 years. Standardized to the U.S. population, the overall prevalence was approximately 1 in 700. EoE-associated annual costs were estimated to be $1.3 billion in 2024 dollars, representing a substantial financial burden.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 272-280.e8"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564004","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":"Role of Early On-Treatment Serum HBV RNA Declines in Predicting Hepatocellular Carcinoma Risk in Patients With Chronic Hepatitis B","authors":"Shi Liu ,&nbsp;Grace Lai-Hung Wong ,&nbsp;Rong Fan ,&nbsp;Junqi Niu ,&nbsp;Hong Ma ,&nbsp;Wanying Liang ,&nbsp;Xingyu Lu ,&nbsp;Jianping Xie ,&nbsp;Jia Shang ,&nbsp;Dongying Xie ,&nbsp;Yali Liu ,&nbsp;Bin Zhou ,&nbsp;Qing Xie ,&nbsp;Jie Peng ,&nbsp;Hongbo Gao ,&nbsp;Huiying Rao ,&nbsp;Jinjun Chen ,&nbsp;Jifang Sheng ,&nbsp;Sheng Shen ,&nbsp;Song Yang ,&nbsp;Jian Sun","doi":"10.1016/j.cgh.2024.07.024","DOIUrl":"10.1016/j.cgh.2024.07.024","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Hepatocellular carcinoma (HCC) risk prediction models established in patients with chronic hepatitis B receiving nucleos(t)ide analogue (NA) rarely include viral factors because of mediocre predictability of traditional viral markers. Here, we investigate the role of serum hepatitis B virus (HBV) RNA, a novel biomarker, in predicting HCC risk in NA-treated patients.</div></div><div><h3>Methods</h3><div>A total of 1374 NA-treated patients were enrolled from 2 prospective chronic hepatitis B cohorts. Serum HBV RNA was detected at baseline, year 1, 2 and 3 of treatment. Cox proportional-hazard model was used to investigate the association of HBV RNA kinetics with HCC risk.</div></div><div><h3>Results</h3><div>After a median follow-up of 5.4 years, 76 patients developed HCC. HBV RNA declines at year 1 (adjusted hazard ratio, 0.70; <em>P</em> = .009) and 2 (adjusted hazard ratio, 0.71; <em>P</em> = .016) were independently associated with HCC risk. Patients with less HBV RNA decline at year 1 (≤0.4 log₁₀ copies/mL) or 2 (≤0.6 log₁₀ copies/mL) had 2.22- and 2.09-folds higher HCC risk, respectively, than those with more declines. When incorporating these early on-treatment HBV RNA declines into existing HCC risk scores, including PAGE-B (age, sex, and platelets), modified PAGE-B (mPAGE-B) (age, sex, platelets, and albumin), and aMAP (age, sex, platelets, and albumin-bilirubin score) score, they could enhance their predictive performance (ie, C-index 0.814 vs 0.78 [model _{(PAGE-B + year-1 HBV RNA decline)} vs PAGE-B score based on baseline parameters]).</div></div><div><h3>Conclusions</h3><div>Serum HBV RNA declines at year 1 and 2 were significantly associated with on-treatment HCC risk. Incorporating early on-treatment HBV RNA declines into HCC risk prediction models can be useful tools to guide appropriate surveillance strategies in NA-treated patients.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 291-299.e15"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055147","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}