Clinical Gastroenterology and Hepatology最新文献

{"title":"Predictors of Post-ERCP Pancreatitis: A Comprehensive Systematic Review and Meta-Analysis.","authors":"Azizullah Beran, Tarek Aboursheid, Adel Hajj Ali, Tarek Nayfeh, Hashem Albunni, Alejandra Vargas, Mouhand F Mohamed, Khaled Elfert, Mohammad Shaear, Ite Obaitan, Nasir Saleem, Awais Ahmed, Mark A Gromski, John M DeWitt, Mohammad Al-Haddad, James L Watkins, Evan Fogel, Jeffrey J Easler","doi":"10.1016/j.cgh.2024.11.014","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.11.014","url":null,"abstract":"<p><strong>Background and aims: </strong>Pancreatitis is the most common serious adverse event associated with endoscopic retrograde cholangiopancreatography (ERCP). This meta-analysis aimed to precisely assess the risk factors for post-ERCP pancreatitis (PEP).</p><p><strong>Methods: </strong>We searched electronic databases for studies that assessed risk factors for PEP after adjusting for ≥3 risk factors, including at least one pre-specified patient-related and one procedure-related risk factor, and reported the data as adjusted odds ratios (OR) with 95% confidence intervals. Meta-analyses were conducted using a random-effects model, and pooled adjusted ORs for risk factors reported in ≥3 studies were constructed.</p><p><strong>Results: </strong>A total of 159 studies with 315,580 ERCPs were included, assessing 31 unique risk factors (20 patient-related and 11 procedure-related). Key patient-related predictors of PEP were age ≤60 years (OR: 1.81, high credibility), prior acute pancreatitis (2.59, moderate), age ≤40 (2.33, moderate), asymptomatic choledocholithiasis (4.76, low), prior PEP (4.40, low), sphincter of Oddi dysfunction (3.11, low), and female gender (1.70, low). Key procedure-related predictors of PEP were any guidewire passage into the PD (2.18, high), first ERCP with a native papilla (1.91, high), endoscopic papillary balloon dilation of an intact papilla (2.91, moderate), pancreatic acinarization (4.23, low), any PD cannulation (2.73, low), pancreatic sphincterotomy (2.64, low), difficult cannulation (2.60, low), any pancreatogram (2.40, low), and precut sphincterotomy (1.98, low).</p><p><strong>Conclusions: </strong>Our meta-analysis focused on adjusted risk factors to provide precise estimates of the most important risk factors for PEP. Incorporating our results into a prediction model may reliably help identify high-risk patients, optimize informed consent, and guide prevention and management strategies for PEP.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853268","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":"Functional Lumen Imaging Probe Provides an Accurate Assessment of Esophageal Diameter in Patients with Eosinophilic Esophagitis.","authors":"Ronak V Patel, Dustin A Carlson, Angelika Zalewski, Nirmala Gonsalves, John Pandolfino, Ikuo Hirano","doi":"10.1016/j.cgh.2024.10.032","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.10.032","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853127","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":"A randomized phase 2 study of efmarodocokin alfa, an IL-22 agonist, versus vedolizumab in patients with ulcerative colitis.","authors":"Silvio Danese, Michael E Rothenberg, Jeremy J Lim, Han Ting Ding, Jacqueline M McBride, Yiling Chen, Ajit Dash, Jordan S Mar, Mary Keir, Laurent Peyrin-Biroulet, Julian Panes, Jean-Frederic Colombel, Brian Feagan, John F Valentine, Stefan Schreiber","doi":"10.1016/j.cgh.2024.11.013","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.11.013","url":null,"abstract":"<p><strong>Background and aims: </strong>Efmarodocokin alfa is an interleukin (IL)-22 agonist, with favorable pharmacokinetic (PK) properties and an acceptable safety profile. This study further explored the therapeutic potential of efmarodocokin alfa compared to vedolizumab in patients with ulcerative colitis (UC).</p><p><strong>Methods: </strong>This randomized phase 2 trial evaluated the efficacy, safety, PK, and pharmacodynamics of 3 doses of efmarodocokin alfa administered intravenously every 4 weeks (30 μg/kg [n=43], 60 μg/kg [n=44], and 90 μg/kg [n=43]) compared with placebo (n=22) and with vedolizumab (n=43) in the treatment of moderate to severe UC. Key clinical outcomes were assessed through the modified Mayo Clinic Score, and endoscopic evaluations by a central reader.</p><p><strong>Results: </strong>Efmarodocokin alfa was adequately tolerated with an acceptable safety profile. Although efmarodocokin alfa did not show statistically significant improvement in clinical remission, clinical response, endoscopic healing, or endoscopic remission at week 8 compared to placebo, vedolizumab demonstrated some efficacy. Clinical remission was achieved by 12%, 9%, and 12% of patients in the 30, 60, and 90 μg/kg dose arms, respectively, compared with 9% and 26% of patients in the placebo and vedolizumab arms at week 8. Similarly, endoscopic healing at week 8 was achieved by 14%, 14%, and 12% of patients in the 30, 60, and 90 μg/kg dose arms, respectively, compared with 14% and 33% of patients in the placebo and vedolizumab arms. A dose-dependent increase in pharmacodynamic biomarkers was observed (REG3A and CRP levels).</p><p><strong>Conclusion: </strong>Efmarodocokin alfa did not demonstrate efficacy compared to placebo and this phase 2 study was ended early for futility; however, there was evidence of target engagement (skin AEs, REG3A levels); NCT03558152.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853093","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":"Temporal changes in risk factors of hepatocellular carcinoma in a prospective cirrhosis cohort.","authors":"George Cholankeril, Aaron P Thrift, Saira Khaderi, Fasiha Kanwal, Hashem B El-Serag","doi":"10.1016/j.cgh.2024.11.012","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.11.012","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853277","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":"ASSESSING THE QUALITY OF ARTIFICIAL INTELLIGENCE RESPONSES AND RESISTANCE TO SYCOPHANCY IN PROVIDING PATIENT-CENTERED MEDICAL ADVICE ON GASTROESOPHAGEAL REFLUX DISEASE.","authors":"Benjamin Douglas Liu, Steve D'Souza, Melina Roy, MetroHealth Dietitians, Sherif Saleh, Ronnie Fass, Gengqing Song","doi":"10.1016/j.cgh.2024.10.033","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.10.033","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845808","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":"Reply to \"Kidney Failure, Inflammatory Bowel Disease and Colectomy \".","authors":"Yuanhang Yang, Juan J Carrero","doi":"10.1016/j.cgh.2024.12.001","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.001","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845852","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 unusual case of multiple gastric masses: granulocytic sarcoma.","authors":"Ming Zhou, Fu Guan","doi":"10.1016/j.cgh.2024.11.018","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.11.018","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845803","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":"Validation and epidemiologic definition of the novel steatotic liver disease nomenclature in a national United States cohort with cirrhosis.","authors":"Catherine Mezzacappa, Pedro Ochoa-Allemant, Marina Serper, Tamar H Taddei, Binu V John, David E Kaplan, Nadim Mahmud","doi":"10.1016/j.cgh.2024.10.035","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.10.035","url":null,"abstract":"<p><strong>Background and aims: </strong>Novel steatotic liver disease (SLD) definitions were introduced in 2023. Accurate and meaningful classifications using clinical data are needed to study interventions and outcomes.</p><p><strong>Methods: </strong>In a national cohort of Veterans with cirrhosis and imaging-confirmed steatosis, seven algorithms differentially emphasizing cardiometabolic risk factors (CMRFs) and alcohol exposure were developed to define alcohol-associated liver disease (ALD), metabolic dysfunction associated SLD (MASLD), and MASLD with increased alcohol intake (MetALD). The primary outcome was classification of SLD, which was validated using hospitalizations for major acute cardiac events (MACE) and alcohol use disorder (AUD). Secondary outcomes included longitudinal CTP class, incident hepatocellular carcinoma, and all-cause mortality.</p><p><strong>Results: </strong>In all, 31,514 patients with cirrhosis (median age 64 years) were included. CMRFs (98.8% ≥1) and hazardous alcohol use (65.3%) were highly prevalent. The distributions of MASLD, MetALD, and ALD varied substantially across classification methods with varying CMRF and alcohol criteria. For example, MetALD ranged from 4.7% to 47.2%. Using method 4, incidence rates of MACE hospitalizations in MASLD, MetALD, and ALD were 16.7, 14.5, and 8.4 per 100 person-years, respectively and incidence rates of AUD hospitalizations were 2.0, 26.1, and 47.6 per 100 person-years, respectively. Hypertriglyceridemia and low HDL were common across SLD subtypes, including ALD (67.3% hypertriglyceridemia, 48.2% low HDL). Patients with ALD (HR 1.41, 95% CI 1.34-1.48) had significantly higher hazards of mortality relative to MASLD.</p><p><strong>Conclusion: </strong>Classification of SLD is highly sensitive to relative weighting of CMRFs and alcohol use. Clinically relevant definitions should consider data availability on alcohol and the limitations of lipid measurements in distinguishing SLD subtypes.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845860","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 Elusive Pancreatic Mass.","authors":"Kosaku Morimoto, Kazuyuki Matsumoto, Ryuta Takenaka","doi":"10.1016/j.cgh.2024.11.016","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.11.016","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845790","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":"Authors' Reply to the Letter to the Editor.","authors":"Won-Mook Choi, Young-Suk Lim","doi":"10.1016/j.cgh.2024.10.039","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.10.039","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845814","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}