Clinical Gastroenterology and Hepatology最新文献

{"title":"Double Wire Cannulation and Mechanical Lithotripsy in Billroth II With Therapeutic Gastroscope.","authors":"Grace E Kim, Uzma D Siddiqui","doi":"10.1016/j.cgh.2024.07.014","DOIUrl":"10.1016/j.cgh.2024.07.014","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"A25-A26"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874342","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":"Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results From a Double-Blind, Pilot Randomized Controlled Trial.","authors":"Prashant Singh, Samuel W Chey, Judy Nee, Shanti Eswaran, Anthony Lembo, William D Chey","doi":"10.1016/j.cgh.2024.04.021","DOIUrl":"10.1016/j.cgh.2024.04.021","url":null,"abstract":"<p><p>A low fermentable oligo-, mono-, di-saccharides, and polyols (FODMAPs) diet (LFD) is the most evidence-based dietary therapy for patients with irritable bowel syndrome (IBS).¹ However, the current step-down approach to the LFD has significant limitations including being costly, complex, time-consuming, and associated with reduced dietary intake of some micronutrients.^2-4 Recently, a step-up approach has been proposed that restricts only a limited number of FODMAPs initially, evaluating symptom response and restricting additional FODMAPs only if necessary.^2,5,6 In a double-blind trial, fructans and galacto-oligosaccharides were found to be the most likely FODMAP subgroups to trigger IBS symptoms.⁷ To date, no study has compared the efficacy of a traditional LFD restriction phase with a more targeted or simplified restriction phase. In a double-blind, pilot-feasibility randomized controlled trial, we compared the efficacy of a 4-week FODMAP-simple restriction phase (eliminating solely fructans and galactooligosaccharides) and a traditional LFD restriction phase in patients with IBS with diarrhea (IBS-D) (ClinicalTrials.gov registration number NCT05831306).</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"362-364.e2"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904286","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, Grace Lai-Hung Wong, Rong Fan, Junqi Niu, Hong Ma, Wanying Liang, Xingyu Lu, Jianping Xie, Jia Shang, Dongying Xie, Yali Liu, Bin Zhou, Qing Xie, Jie Peng, Hongbo Gao, Huiying Rao, Jinjun Chen, Jifang Sheng, Sheng Shen, Song Yang, Xiaoguang Dou, Zhengang Zhang, Vincent Wai-Sun Wong, Jinlin Hou, Jian Sun","doi":"10.1016/j.cgh.2024.07.024","DOIUrl":"10.1016/j.cgh.2024.07.024","url":null,"abstract":"<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>After a median follow-up of 5.4 years, 76 patients developed HCC. HBV RNA declines at year 1 (adjusted hazard ratio, 0.70; P = .009) and 2 (adjusted hazard ratio, 0.71; P = .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]).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","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}

{"title":"Variance Between Clinical Guidance and Real-World Management of Metabolic Dysfunction-associated Steatotic Liver Disease in the United States.","authors":"Mary E Rinella, Mark L Hartman, Shraddha Shinde, David Schapiro, Victoria Higgins, Quentin M Anstee","doi":"10.1016/j.cgh.2024.08.018","DOIUrl":"10.1016/j.cgh.2024.08.018","url":null,"abstract":"<p><p>Clinical practice guidelines can facilitate diagnosis and management of patients with metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction associated steatohepatitis (MASH), although their implementation to date has been suboptimal.^1,2 Using recently published 2023 American Association for the Study of Liver Diseases (AASLD) practice guidance-based recommendations as a reference,³ we assessed current real-world management of patients with MASH to identify gaps in clinical practice. We extracted data from the Adelphi Real World MASH Disease Specific Programme, a cross-sectional survey with retrospective data capture (from 85 hepatologists, gastroenterologists, and endocrinologists [Supplementary Table 1] and 633 patients [Supplementary Table 2] in the United States between January and June 2022). Two key goals of the AASLD guidance algorithm served as reference points: exclude fibrosis in low-prevalence populations (Goal A) and identify/manage people with 'at-risk' MASH or cirrhosis (Goal B).³ Patients were split into 2 groups: Goal A comprised 100 patients initially diagnosed by primary care physicians (PCPs)/endocrinologists, and Goal B included 533 patients managed by gastroenterologists/hepatologists.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"374-376.e3"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104981","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, Chelsea Anderson, Angela Z Xue, Elisabeth T Jensen, Evan S Dellon","doi":"10.1016/j.cgh.2024.09.031","DOIUrl":"10.1016/j.cgh.2024.09.031","url":null,"abstract":"<p><strong>Background & aims: </strong>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.).</p><p><strong>Methods: </strong>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.</p><p><strong>Population: </strong>Health care utilization, including medications and endoscopic procedures, was quantified, and annual EoE-associated costs were estimated.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>The prevalence of EoE continues to increase, with a rate of 1 in 617 in 2022 in those <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.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"272-280.e8"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761390/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut Goo: Physiology, Diet, and Therapy of Intestinal Mucus and Biofilms in Gastrointestinal Health and Disease.","authors":"John Damianos, Nada Abdelnaem, Michael Camilleri","doi":"10.1016/j.cgh.2024.09.007","DOIUrl":"10.1016/j.cgh.2024.09.007","url":null,"abstract":"<p><p>The gastrointestinal tract has remarkable capacity to withstand considerable insults from exposure to abrasive food particles, chemicals, allergens, and pathogenic microbes. Maintaining a robust epithelial barrier sequesters these potentially harmful substances in the lumen, preventing absorption into the systemic circulation. Normal functioning of this barrier is central in diverse physiological processes including digestion, immunity, inflammation, and gut-brain signaling. One crucial component of the barrier is the mucus layer covering the epithelium. There is increased appreciation of the importance of mucus in maintenance of the gut barrier, and how dysregulation of the mucus layer contributes to several common gastrointestinal pathologies. This manuscript reviews the physical and chemical properties of mucus, its maintenance and turnover, and its role in maintaining gut barrier integrity. The dynamic interactions of the mucus layer within the gut ecosystem are illustrated by highlighting how a weakened mucus layer or defective mucus production facilitate pathogenic microbial colonization and mucosal biofilm formation. These may potentially contribute to the pathogenesis of gastrointestinal diseases such as inflammatory bowel diseases or result in secretion and mucosal damage and inflammation in bile acid diarrhea. A final goal is to review how certain dietary factors, especially low-fiber diets and emulsifiers common in Western diets, can harm the mucus layer. This report summarizes evidence from preclinical and human studies that document damage to the mucus layer, and reviews approaches, including diets and probiotics, that promote a healthy mucus layer and break down pathogenic biofilms, thereby potentially preventing and/or treating gastrointestinal diseases that impact mucosal integrity.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"205-215"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459521","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":"Patients With Inflammatory Bowel Disease Are at Increased Risk for Complications of Herpes Zoster.","authors":"Freddy Caldera, Siddharth Singh, Emily E Zona, Oscar Ramirez Ramirez, Jonathan Inselman, Herbert Heien, Andrew P Keaveny, Mary S Hayney, Francis A Farraye","doi":"10.1016/j.cgh.2024.09.022","DOIUrl":"10.1016/j.cgh.2024.09.022","url":null,"abstract":"<p><strong>Background & aims: </strong>Patients with inflammatory bowel disease (IBD) are at an increased risk for vaccine-preventable diseases, such as herpes zoster (HZ). The aim of this study was to determine whether complications of HZ are more frequent in patients with IBD than in non-IBD controls.</p><p><strong>Methods: </strong>This was a retrospective, cohort study using the Optum Research Database. Patients with IBD were matched 1:1 to non-IBD controls based on age, sex, and index year, which was defined as the diagnosis of HZ. We then identified the complications of HZ that occurred up to 90 days after the index date. We compared patients with IBD with non-IBD controls and evaluated the 90-day risk of HZ complications. We used a composite primary outcome for any HZ complication. Secondary outcomes were risk factors for complications.</p><p><strong>Results: </strong>A total of 4756 patients with IBD met the inclusion criteria and were matched to the controls. Patients with IBD were more likely to have complications of HZ than controls (738 [15.52%] vs 595 [12.51%]; P < .0001). Patients with IBD with higher comorbidity scores were more likely to develop complications (1.86 vs 1.18; P < .0001). In the logistic regression analysis of patients with IBD having a higher comorbidity score, above 50 years of age, on anti-tumor necrosis factor (TNF) or corticosteroids were all at increased risk of a complication of HZ.</p><p><strong>Conclusion: </strong>Patients with IBD are more likely to have complications of HZ than controls. Efforts are needed to increase HZ vaccine uptake to reduce the morbidity of HZ.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"331-340.e2"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496272","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":"Developing Leadership Skills and Experience during Gastroenterology Fellowship.","authors":"Mohammad Bilal, Amy S Oxentenko","doi":"10.1016/j.cgh.2024.08.029","DOIUrl":"10.1016/j.cgh.2024.08.029","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"200-204"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459518","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":"Human Endoscopic Ultrasonography Using Linear Array Scope for Pancreatic Diseases.","authors":"Matthew J DiMagno, Eugene P DiMagno","doi":"10.1016/j.cgh.2024.05.016","DOIUrl":"10.1016/j.cgh.2024.05.016","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"378-379"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080738","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":"Esophageal Large-Cell Neuroendocrine Carcinoma Mimicking Benign Submucosal Tumor Treated With Endoscopic Submucosal Dissection.","authors":"Jiao Li, Zhengkui Zhou, Xiaobin Sun","doi":"10.1016/j.cgh.2024.06.043","DOIUrl":"10.1016/j.cgh.2024.06.043","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"A21-A22"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757501","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}