Clinical Gastroenterology and Hepatology最新文献

{"title":"Long-Term Glycemic Control and the Risk of Liver Stiffness Progression and Liver-Related Events in MASLD.","authors":"Xiao-Dong Zhou, Qin-Fen Chen, Seung Up Kim, Terry Cheuk-Fung Yip, Salvatore Petta, Atsushi Nakajima, Emmanuel Tsochatzis, Jérôme Boursier, Elisabetta Bugianesi, Hannes Hagström, Wah-Kheong Chan, Manuel Romero-Gomez, José Luis Calleja, Victor de Lédinghen, Laurent Castéra, Arun J Sanyal, Boon-Bee George Goh, Philip Noel Newsome, Jian-Gao Fan, Michelle Lai, Céline Fournier-Poizat, Hye Won Lee, Grace Lai-Hung Wong, Angelo Armandi, Ying Shang, Grazia Pennisi, Elba Llop, Masato Yoneda, Mirko Zoncapè, Marc de Saint-Loup, Clemence M Canivet, Carmen Lara-Romero, Rocio Gallego-Durán, Paloma Carrillo-Fernández, Amon Asgharpour, Kevin Kim-Jun Teh, Mandy Sau-Wai Chan, Huapeng Lin, Wen-Yue Liu, Giovanni Targher, Christopher D Byrne, Vincent Wai-Sun Wong, Ming-Hua Zheng","doi":"10.1016/j.cgh.2025.10.003","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.10.003","url":null,"abstract":"<p><strong>Background: </strong>The long-term impact of type 2 diabetes (T2D) status and long-term glycemic control on disease progression and clinical outcomes in metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear.</p><p><strong>Aims: </strong>To assess the association of diabetes status and long-term glycemic control with liver stiffness progression or regression, and liver-related events (LRE) in MASLD.</p><p><strong>Methods: </strong>We analyzed patients with MASLD from the VCTE-Prognosis cohort who underwent serial vibration-controlled transient elastography (VCTE) assessments and HbA1c measurements. Long-term glycemic control was evaluated using the time-weighted average (TWA) HbA1c, which reflects both the magnitude and duration of glycemia. Patients were categorized as non-T2D, well-controlled T2D (TWA HbA1c<7%), or poorly controlled T2D (TWA HbA1c≥7%). Liver stiffness progression, regression, and LRE were examined using Kaplan-Meier analyses and Cox proportional hazards models.</p><p><strong>Results: </strong>Of 7,543 patients with MASLD, 4,090 had T2D (2,045 well-controlled, 2,045 poorly controlled), and 3,453 did not have T2D. Over a median follow-up of 4.1 years, patients with T2D had a higher risk of liver stiffness progression (HR=1.501, 95%CI 1.148-1.962, P=0.003) and LRE (HR=2.030, 95%CI 1.241-3.320, P=0.005), but not liver stiffness regression, compared to non-T2D patients. Among patients with T2D, poor glycemic control was associated with a higher risk of liver stiffness progression compared with good glycemic control (HR=1.524, 95%CI 1.182-1.965, P=0.001). No differences were observed for liver stiffness regression (P=0.957) or LRE (P=0.625) with glycemic control. Findings were consistent across sensitivity analyses.</p><p><strong>Conclusions: </strong>T2D was independently associated with a higher risk of liver stiffness progression and LRE in MASLD. Good glycemic control was associated with slower liver stiffness progression, but not regression or LRE.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274001","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":"Experienced Discrimination and Medical Mistrust Among Patients with Cirrhosis: Survey Results from a Multicenter Cohort.","authors":"Nicole E Rich, Jennifer Kramer, Yan Liu, Juana Campos, Lisa Quirk, Donna Smith, Jahna Anyanwu, Amanda Gibbons, Aaron Loewy, Dalal Youssef, Akash Pagadala, Riya Malhorta, Hadley McGhee, Donna White, Meena Tadros, Fasiha Kanwal, Amit G Singal","doi":"10.1016/j.cgh.2025.09.038","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.09.038","url":null,"abstract":"<p><strong>Introduction: </strong>Medical mistrust and experiences of discrimination contribute to racial and ethnic disparities in clinical outcomes for several health conditions; however, the prevalence of these constructs remain understudied in patients with cirrhosis.</p><p><strong>Methods: </strong>We prospectively enrolled patients with cirrhosis to complete surveys at four large U.S. health systems. We administered validated surveys including the Experiences of Discrimination measure and the Group-Based Medical Mistrust Scale (GBMMS). Univariable and multivariable regression models were used to examine associations of race and ethnicity with patient-reported discrimination and medical mistrust.</p><p><strong>Results: </strong>Among 3357 patients, 1037 (30.9%) completed the survey (43.4% White, 22.4% Black, 30.2% Hispanic; median age 61.3 years, 63.0% men). Overall, 27.1% of patients reported experiencing discrimination and 9.8% reported high medical mistrust (GBMMS ≥3). More Black patients reported frequent discrimination (40.5%) compared to Hispanic (22.2%) and White patients (18.7%) (p<0.001). In multivariable analysis, compared to White race, Black race (OR 4.37, 95%CI 2.49 - 7.67) and Hispanic ethnicity (OR 1.85, 95%CI 1.06 - 3.25) were associated with the top quartile of discrimination scores. Similarly, 22.3% of Black patients reported high mistrust compared to 6.8% and 4.2% of White and Hispanic patients, respectively (p<0.001). Black patients continued to be more likely than White patients to report high mistrust in multivariable models (OR 3.59, 95%CI 2.05 - 6.29). There were no statistically significant associations between higher levels of discrimination or mistrust and the composite outcome of hospitalization, decompensation or death.</p><p><strong>Conclusion: </strong>Experienced discrimination and medical mistrust are common among Black patients with cirrhosis. Addressing these factors may mitigate racial and ethnic inequities in care, reduce barriers to care and improve outcomes for patients with cirrhosis.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274085","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":"Non-Invasive Prediction Models of First Decompensation in Compensated Advanced Chronic Liver Disease - A Meta-Analysis.","authors":"Angus W Jeffrey, James Chen, Andrew Chin, Emmanuel A Tsochatzis, Avik Majumdar, Luis Calzadilla-Bertot, Michael C Wallace, Gary P Jeffrey, Leon A Adams","doi":"10.1016/j.cgh.2025.10.002","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.10.002","url":null,"abstract":"<p><strong>Background and aims: </strong>This review aimed to critically appraise available data to determine the accuracy of non-invasive prediction models (NITs) in identifying patients with cACLD who are at increased risk of a first episode of hepatic decompensation.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was conducted from all published articles until February 2025. Studies were included if they evaluated performance of a NIT, defined as two or more individual non-invasive markers that had been combined into a prognostic model. Studies were excluded if analysis was done on a population that included those without cACLD, and studies examining only singular prognostic markers (including baseline liver stiffness in isolation). Summary data was extracted from published reports consisting of the c-statistic and/or AUROC and model calibration. This review was registered with PROSPERO (CRD42024608001).</p><p><strong>Results: </strong>Of 6,540 screened articles, 30 were included consisting of 47,647 participants with cACLD. The articles described 39 prognostic models; of which 19 were suitable for meta-analysis. Random effects meta-analysis found models specifically developed and validated in cACLD provide the best prediction, including the SAVE score (summary c-statistic 0.87, 95% CI 0.82-0.93) and ABC score (0.85, 0.80-0.89). There was limited validation and calibration of all models. Sensitivity analysis of cohorts using an invasive diagnosis for cACLD provided the least heterogeneous outcomes, with all assessed models having an I² < 50%.</p><p><strong>Conclusions: </strong>CACLD specific NITs offer the best option in predicting decompensation, and future studies should focus on robust validation, calibration and external validation with standardised endpoints to ensure that models are reliable for guiding clinical practice in applicable populations.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274091","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":"Diaphragmatic ectopic variceal bleeding secondary to chronic primary idiopathic Budd-Chiari syndrome.","authors":"Ting-Han Wang, Ying-An Chou, Shih-Chieh Chien","doi":"10.1016/j.cgh.2025.10.001","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.10.001","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274070","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":"From Pixels to Peristalsis: Comparing Achalasia Diagnosis with Artificial Intelligence to Expert Endoscopists.","authors":"Evandros Kaklamanos, Kristjana Kristinsdottir, Matthew Wittbrodt, Meng Li, Panyavee Pitisuttithum, Wenjun Kou, Rajesh N Keswani, Dustin Carlson, Mozziyar Etemadi, John E Pandolfino","doi":"10.1016/j.cgh.2025.09.034","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.09.034","url":null,"abstract":"<p><strong>Background & aims: </strong>Esophageal motility disorders, such as achalasia, require the use of multiple tests to establish a diagnosis. Patients are first assessed with upper endoscopy, but subtle disease indicators are often overlooked during the procedure leading to delayed diagnosis. Artificial intelligence (AI) has the potential to prevent these misdiagnoses and serve as an early screening tool to enhance the physician's decision-making.</p><p><strong>Methods: </strong>We developed a video-based transformer model capable of detecting achalasia from upper endoscopy videos. Videos were collected from 1,203 patients who presented with dysphagia between August 2018 and January 2024. The model performance was compared to a baseline of two expert physicians independently reviewing each video and consulting one another for a final consensus decision. A test set of 95 patients was used to evaluate the physician consensus and model performance based on ground truth labels obtained via high-resolution manometry (HRM) the Chicago Classification v4.0 (CCv4.0) scheme.</p><p><strong>Results: </strong>The model attained similar performance to the physician consensus on the test set, achieving an accuracy and F1 of 0.926 and 0.821, respectively, compared to the physicians (0.905, 0.710). The model also obtained fewer false negatives, achieving a sensitivity and negative predictive value (NPV) of 0.800 and 0.947 respectively compared to the physicians (0.550, 0.893). Furthermore, the model's attention mechanism emphasized clinically relevant features such as presence of fluid or food in the esophagus, and a tight lower esophageal sphincter (LES).</p><p><strong>Conclusion: </strong>These results indicate that AI can leverage upper endoscopy videos to detect achalasia with an accuracy comparable to that of expert endoscopists.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257691","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":"Significance of Neoplasia Detection Rate in Barrett's Esophagus: A \"PEEC\" into the Data and Optimal Definitions.","authors":"D Chamil Codipilly, Prasad G Iyer","doi":"10.1016/j.cgh.2025.09.033","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.09.033","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249925","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":"EUS-GUIDED LIVER BIOPSY AND PORTAL PRESSURE MEASUREMENT COMPARED TO TRANSJUGULAR APPROACH: A RANDOMIZED CONTROLLED TRIAL.","authors":"Amine Benmassaoud, Ali Bessissow, Gordan Samoukovic, Philip Wong, Xun Zhao, Marc Deschenes, Giada Sebastiani, Tatiana Cabrera, David Valenti, Louis-Martin Boucher, Jean-Pierre Pelage, Karl Muchantef, Andres Cardenas, Mary Anne Givis, Sheryl White, Guillaume Bousquet-Dion, Catherine Waked, Jeremie Jacques, Elham Rahme, Olivia Geraci, Myriam Martel, Alan Barkun, Chelsea Maedler-Kron, Yen-I Chen","doi":"10.1016/j.cgh.2025.09.025","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.09.025","url":null,"abstract":"<p><strong>Background and aims: </strong>The transjugular (TJ) technique is recommended for the simultaneous evaluation of portal hypertension and hepatic fibrosis, with the hepatic venous pressure gradient (HVPG) and liver biopsy (LB), respectively. Unfortunately, technical challenges have restricted access to HVPG, and TJ-LB are often of suboptimal quality. Endoscopic ultrasound (EUS) is a novel approach capable of obtaining portal pressure gradient (PPG) and LB. Our aim was to compare EUS-PPG-LB to TJ-HVPG-LB.</p><p><strong>Methods: </strong>Patients with chronic liver disease simultaneously evaluated for portal hypertension and liver fibrosis at the McGill University Health Centre were randomly assigned to EUS-PPG-LB or TJ-HVPG-LB. The primary endpoint was the combination of adequate LB (Guideline recommendation: ≥25mm total length and ≥11 complete portal tracts) and reliable HVPG/PPG (expert consensus: two measures within ≤1mmHg). Secondary endpoints assessed technical success, LB quality, HVPG/PPG reliability, patient satisfaction, and adverse events. Intention-to-treat analyses were conducted.</p><p><strong>Results: </strong>Fifty-eight patients were randomized; 29 EUS and 29 TJ. Technical success was 90.0% for EUS and 96.6% for TJ (relative risk [RR], 0.93; 95% confidence interval [CI] 0.81-1.07). Combined adequate LB and reliable HVPG/PPG was 82.8% for EUS and 41.4% for TJ (RR 2.00; 95%CI 1.26-3.18). Proportion of adequate LB was 93.1% for EUS and 41.4% for TJ (RR 2.25; 95%CI 1.44-3.51). Proportion of reliable HVPG/PPG was 89.7% for EUS and 58.6% for TJ (RR 1.53; 95%CI 1.10-2.13).We found no between-group difference in adverse events.</p><p><strong>Conclusion: </strong>EUS is superior to TJ for simultaneous acquisition of adequate LB and reliable PPG, suggesting it has an important role in evaluating chronic liver diseases.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231614","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":"Letter to the Editor re: The Assessment of Gastrointestinal Transit by the Atmo Capsule: A Comparison With the SmartPill Capsule.","authors":"Michael Camilleri","doi":"10.1016/j.cgh.2025.07.048","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.07.048","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228490","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":"OCCASIONAL CONSTIPATION: PREVALENCE AND IMPACT IN THE ROME IV GLOBAL EPIDEMIOLOGY STUDY.","authors":"Annelies Verheyden, Jóhann P Hreinsson, Shrikant I Bangdiwala, Douglas Drossman, Magnus Simrén, Ami D Sperber, Olafur S Palsson, Jan Tack","doi":"10.1016/j.cgh.2025.09.027","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.09.027","url":null,"abstract":"<p><strong>Background & aims: </strong>Recently, a Rome working group defined individuals with occasional constipation (OC). We used the Rome Foundation Global Epidemiology Study database to study the global prevalence of OC, its co-morbidities, quality of life (QoL) impact, and healthcare utilization, compared to subjects without constipation symptoms (No Constipation), or with functional constipation (FC).</p><p><strong>Methods: </strong>54127 adults (26578 females; mean age 43.7) from 26 countries completed an internet survey including Rome IV diagnoses, demographics, psychosocial data, QoL, and medical history. OC was defined as ≥1/5 constipation symptoms without meeting FC criteria, associated with concerns about bowel function. Respondents with other Rome IV bowel disorders or relevant organic disease were excluded.</p><p><strong>Results: </strong>The global prevalence of Rome-defined OC was 7.4%, ranging from 4.3% in the Middle East to 15.8% in Eastern Europe. OC was predominant in females (46.1%) compared to No Constipation (40.2%), but not compared to FC (63.9%). Compared to No Constipation, OC subjects had higher odds of fulfilling Rome IV criteria for upper gastrointestinal disorders, but lower odds in comparison to those with FC. OC was associated with significantly lower QoL (physical 14.5 vs. 16.1 and mental 13.5 vs. 15.3), and a higher prevalence of anxiety (12.3% vs. 5.6%) and depression (12.0% vs. 5.6%) compared to No Constipation. Compared to subjects with FC, OC subjects were more concerned about their bowel function. Healthcare consumption (doctor visits and medication usage) was higher in OC versus No Constipation.</p><p><strong>Conclusion: </strong>Rome-defined OC is common on a global scale, associated with psychological distress, reduced QoL, other Rome IV diagnoses, and high healthcare utilization.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211693","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":"High Prevalence of Difficult Readability of Gluten-Free Diet Recommendations for Celiac Disease Patients.","authors":"Christine D H Lee, Peter H R Green, Anne Lee, Randi Wolf, Benjamin Lebwohl","doi":"10.1016/j.cgh.2025.09.028","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.09.028","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211766","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}