Clinical Gastroenterology and Hepatology最新文献

{"title":"Embolization of patent paraumbilical vein for the treatment of recurrent hepatic encephalopathy and hepatic myelopathy.","authors":"Zhengyu Wang, Yong Lv, Guohong Han","doi":"10.1016/j.cgh.2025.01.023","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.01.023","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662637","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":"Testosterone replacement reduces morbidity and mortality for most patients with cirrhosis.","authors":"Elliot B Tapper, Xi Chen, Neehar D Parikh","doi":"10.1016/j.cgh.2025.02.004","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.02.004","url":null,"abstract":"<p><strong>Background: </strong>Many men with cirrhosis have low testosterone levels. This is associated with sarcopenia, anemia, and poor quality of life. Data are lacking, however, regarding the clinical impact of testosterone replacement METHOD: We conducted an emulated clinical trial evaluating the impact of testosterone replacement among men who were diagnosed with hypogonadism at the same time as their diagnosis of cirrhosis (new user design). We used nationally representative Medicare data (2008-2020) to examine the risk of death, decompensation events, and fractures in patients who did or did not receive testosterone. We balanced treated and untreated with inverse probability of treatment weighting and evaluated outcomes using an intention-to-treat design.</p><p><strong>Results: </strong>282 (7.4%) of patients with testicular hypofunction and cirrhosis received testosterone replacement after diagnosis. Patients started on testosterone spent 28.6% of patient-days on therapy and patients not started would spend 0.5% of patient-days on therapy (p<0.0001). Testosterone use was associated with lower mortality (sHR 0.92, 0.85-0.99). Testosterone also led to a lower risk of new decompensation events (sHR 0.92, 0.86-0.99) and especially for ascites requiring paracentesis (sHR 0.82, 0.76-0.89) and variceal hemorrhage (sHR 0.67, 0.54-0.85) with less effect on HE requiring hospitalization (sHR 0.92, 0.84-1.01) and fractures (sHR 0.99, 0.91-1.08) and without increased risk of hepatocellular carcinoma (sHR 1.09, 0.91-1.3). There was substantial heterogeneity of treatment effect across baseline subgroups.</p><p><strong>Conclusion: </strong>In our target trial emulation of a nationally representative cohort of older patients with cirrhosis and hypogonadism, testosterone use improved clinical outcomes.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647304","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":"Early occurrence of hepatic encephalopathy following TIPS-insertion is linked to impaired survival: a multicenter cohort study.","authors":"Martin A Kabelitz, Lisa Sandmann, Michael Praktiknjo, Jim B Mauz, Timo Alexander Auer, Tony Bruns, Johannes Chang, Uli Fehrenbach, Jan Hinrichs, Christian Jansen, Roman Klöckner, Johannes Kluwe, Michael Köhler, Carsten Meyer, Felix Piecha, Maike Rebecca Pollmanns, Cristina Ripoll, Michael Schultheiss, Leon Louis Seifert, Fabian Stöhr, Lukas Sturm, Jonel Trebicka, Alexander Zipprich, Christian Labenz, Dominik Bettinger, Benjamin Maasoumy","doi":"10.1016/j.cgh.2025.01.024","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.01.024","url":null,"abstract":"<p><strong>Background and aims: </strong>Hepatic encephalopathy (HE) is a common complication following transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, the prognostic significance of overt HE post-TIPS remains controversial.</p><p><strong>Methods: </strong>We screened 2137 patients who underwent TIPS insertion at eight German tertiary care centers between 2004 and 2021. Patients with pre-emptive TIPS placement, hepatocellular carcinoma, missing data, and non-PTFE covered stents were excluded. Competing risk analysis was performed, considering liver transplantation as a competing event. To correct for immortal time bias, landmark analyses were conducted, with the landmark being set at 30 and 90-days post-TIPS. Outcome data were assessed for up to 30 months post-TIPS insertion.</p><p><strong>Results: </strong>A total of 1356 patients (median MELD: 13 (IQR 10-17), age: 60 (IQR 54-67), 64% male, 12% HE before TIPS), were included. Overall, HE post-TIPS was linked to impaired survival (p<0.001, sHR: 1.41 [1.15-1.73]). However, this was only confirmed if HE occurred within the first 30 days post-TIPS (early HE; p<0.001, sHR: 2.02 [1.59-2.57]). Additionally, patients with a history of HE (p<0.001, sHR: 1.59 [1.21-2.07]) and history of HE and early HE post-TIPS (p<0.001, sHR: 3.44 [2.34-5.04]) showed impaired survival. These findings were confirmed in the landmark and multivariable analyses.</p><p><strong>Conclusion: </strong>Early HE post-TIPS is associated with significantly reduced survival. Therefore, patients who experience early HE or have a history of HE should be closely monitored by physicians, as they constitute a particularly vulnerable group with impaired survival.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647303","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":"Practical and Impactful Tips for Private Industry Collaborations with GI Practices.","authors":"John A Martin, Vasu Appalaneni, Ekta Gupta, Inessa Khaykis","doi":"10.1016/j.cgh.2025.01.021","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.01.021","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639419","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":"Epidemiology, Natural History and Treatment of IBD in Africa: A Scoping Review.","authors":"Mmeyeneabasi Omede, Asa Itam-Eyo, Albert Park, Joanah Ikobah, Maryam K Ibrahim, Evaristus Chukwudike, Awab Ali-Ibrahim, Melis Lydston, Akwi W Asombang, Ashwin N Ananthakrishnan","doi":"10.1016/j.cgh.2024.12.036","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.036","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel diseases (IBD); Crohn's disease (CD), ulcerative colitis (UC)) are global diseases. There is a paucity of knowledge about the burden and epidemiology of IBD in Africa. We performed a scoping review of the published literature on IBD in Africa to identify burden, risk factors, and outcomes as well as knowledge gaps.</p><p><strong>Methods: </strong>A comprehensive search was conducted in MEDLINE, Embase, Web of Science, AIM, Africa Wide, Cochrane and ClinicalTrials.gov in November 2024. Studies were screened and selected based on predefined inclusion criteria. Data extraction was conducted using Covidence. Literature was summarized focusing on the incidence and prevalence, environmental factors, diagnosis, outcomes, and management of IBD.</p><p><strong>Results: </strong>Out of 6,896 references identified, a total of 268 studies met inclusion criteria. This included data from 21,089 patients with IBD (10,426 CD, 7,956 UC, 329 Unspecified IBD, 2,378 uncategorized IBD). There were few studies examining temporal incidence of IBD; in the sparse available data, a similar increase was notable as seen in the West. Studies of genetics and environment revealed many shared findings from known associations from western cohorts (such as environmental hygiene) but highlight some differences as well. Use of biologic or advanced therapy was sparse.</p><p><strong>Conclusion: </strong>We identified a paucity of publications regarding the risk factors, burden, and outcomes of IBD in Africa. There were few prospective studies and regional variations in representation. There is a need for more prospective data to inform our knowledge and management strategies accurately.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639631","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":"Proton Pump Inhibitors for Inducing and Maintaining Remission in Eosinophilic Esophagitis: An Updated Systematic Review and Meta-Analysis.","authors":"Alfredo J Lucendo, Lucía Gutiérrez-Ramírez, Antonio Tejera-Muñoz, Javier Molina-Infante, Ángel Arias","doi":"10.1016/j.cgh.2025.01.016","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.01.016","url":null,"abstract":"<p><strong>Background & aims: </strong>Proton pump inhibitor (PPI) therapy results in clinical and histological remission in approximately 50% of eosinophilic esophagitis (EoE) patients. We aimed to systematically update this topic due to cumulative data from pediatric/adult populations in wider geographical settings.</p><p><strong>Methods: </strong>A search in MEDLINE, EMBASE, and SCOPUS databases was performed. Primary outcomes were clinical response and histological remission (< 15 eos/HPF). Subgroup analyses included age group, PPI drug and dosage, study design, data origin, and risk of bias. Data were pooled using random-effects models.</p><p><strong>Results: </strong>Seventy-three studies comprising 7304 patients were included. PPI therapy led to clinical response in 65% (95%CI, 57.2-72.4; I² 0), and histological remission in 45.4% (95%CI, 41.6- 49.3) of patients, without differences between children and adults (41.2% vs. 48%, p 0.17). Overall, 34.1% (95%CI, 27.9-40.5) achieved <5 eos/HPF. Pooled effectiveness was significantly superior (p<0.001) in Western Pacific areas, principally Japan (67.9%), compared to American and European (40.6% and 44.4%, respectively). Histological remission was significantly higher with double PPI doses compared to standard (51.7% vs. 28.3%, p 0.005). Response was significantly higher in studies with lower risk of bias. Maintenance half doses led to sustained histological remission in 68.2% (95%CI, 63.7%-72.6%; I²=0) of patients.</p><p><strong>Conclusions: </strong>PPI therapy induces clinic-histological remission in almost half of pediatric and adult EoE patients. Response to PPIs is significantly higher in Japan. Sustained remission is common on tapering PPI doses.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633577","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 on \"Recent Advancements and Future Perspectives of Per Oral Endoscopic Myotomy\" - Authors Response.","authors":"Mohan Ramchandani, Zaheer Nabi, Pradev Inavolu","doi":"10.1016/j.cgh.2024.12.033","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.033","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633564","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 age-related and disease-related complications and mortality in elderly-onset IBD - a population-based study.","authors":"Dana Ben Hur, Guy Issaschar, Ran Moshe, Boris Lebedenko, Rona Lujan, Ziona Haklai, Yiska Loewenberg Weisband, Amir Ben-Tov, Natan Lederman, Eran Matz, Iris Dotan, Dan Turner, Gabriel D Pinto, Matti Waterman","doi":"10.1016/j.cgh.2025.01.020","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.01.020","url":null,"abstract":"<p><strong>Background & aims: </strong>In this nationwide cohort from Israel (Epi-IIRN), we aimed to characterize risks for age-related complications, mortality and IBD-related surgeries in patients with elderly-onset inflammatory bowel diseases (EO-IBD).</p><p><strong>Methods: </strong>Data of patients with EO-IBD (≥65 years) diagnosed during 2005-2020 were retrieved from the epi-IIRN database. EO-IBD Patients were compared to 3 age-, sex- and district-matched non-IBD individuals, for age-related outcomes. Incident EO-IBD patients were matched to 4 adult-onset (AO) IBD (≥18<65 years) by IBD-subtype-, sex- and district. Cumulative incidence functions were calculated to estimate event probabilities over time accounting for death as a competing risk. Proportional subdistribution hazards models were used to assess predictors of medication use, surgery and complications.</p><p><strong>Results: </strong>Of 2,826 EO-IBD cases, 2,162 had 3 matched non-IBD controls. Mortality rates/1000 PY were similar in EO-IBD and non-IBD controls (292.32 (273.53-311.85) vs.291.24 (280.31-302.42), respectively) as were mortality causes and risk (aHR, 95% CI) for pneumonia 1.04 (0.84-1.29), fractures 1.03 (0.82-1.29), bacteremia 2.16 (0.87-5.40) and thromboembolism 0.58 (0.27-1.23). When matching 2,826 EO-IBD to 11,304 AO-IBD, EO-IBD had lower exposure to thiopurines (aHR= 0.44 [0.39-0.49], and anti-TNF (aHR=0.37 [0.32-0.42] and higher risk for abdominal surgery (aHR=1.23 [1.04-1.46] in CD, aHR=1.51 [2.04-3.08] in UC, respectively) but lower perianal surgery risk (HR=0.27 [0.16-0.47]) in CD. The calculated frequencies of repeat perianal and abdominal surgery in EO-CD and AO-CD at 3 years were 7.1% vs. 36%, respectively and 29% and 21%, respectively.</p><p><strong>Conclusions: </strong>Compared with non-IBD elderly, EO-IBD have similar risk for death and complications. Compared to AO-IBD, EO-IBD are at higher risk for abdominal surgery, but not for perianal surgery.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633600","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":"Needle Track Seeding after Trans-gastric EUS-guided Tissue Sampling: Maybe not as Rare as You Think.","authors":"Mehdi Mohamadnejad, Mohammad Al-Haddad","doi":"10.1016/j.cgh.2024.12.035","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.035","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633568","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":"Perspectives on the International Consensus for ASUC Clinical Trial Design: Enhancing Clarity and Applicability.","authors":"Arshdeep Singh, Vandana Midha, Ajit Sood","doi":"10.1016/j.cgh.2024.12.034","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.034","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633569","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}