Clinical Gastroenterology and Hepatology最新文献

{"title":"All FODMAPs Aren’t Created Equal: Results of a Randomized Reintroduction Trial in Patients With Irritable Bowel Syndrome","authors":"Shanti Eswaran ,&nbsp;Kara J. Jencks ,&nbsp;Prashant Singh ,&nbsp;Samara Rifkin ,&nbsp;Theresa Han-Markey ,&nbsp;William D. Chey","doi":"10.1016/j.cgh.2024.03.047","DOIUrl":"10.1016/j.cgh.2024.03.047","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div><span>A diet low in fermentable oligo, di, monosaccharides<span>, and polyols (FODMAPs) is one of the recommended management strategies for </span></span>irritable bowel syndrome (IBS). However, while effective, adherence to restricting dietary FODMAPs can be challenging and burdensome. The question remains whether limiting all FODMAPs during the restrictive phase of the diet is necessary for symptomatic improvement in the dietary treatment of IBS, or if targeting selected groups of FODMAPs for restriction is sufficient for clinical response. Our study aimed to determine which individual FODMAPs are most likely to lead to symptom generation in patients with IBS who have improved with fodmap restriction.</div></div><div><h3>Methods</h3><div>Patients meeting Rome IV criteria for IBS were invited to participate in a 12-week study to identify individual FODMAP sensitivities. Those subjects who demonstrated symptom improvement after a 2- to 4-week open-label FODMAP elimination period were recruited to a 10-week blinded-phased FODMAP reintroduction phase of 7 days for each FODMAP. Throughout the study period, daily symptom severity (0–10 point numerical rating system) was recorded. A mixed effect statistical analysis model was used.</div></div><div><h3>Results</h3><div><span>Between 2018 and 2020, 45 subjects were enrolled. Twenty-five subjects improved with FODMAP elimination, and 21 patients continued into the reintroduction phase of the study. Fructans and galacto-oligosaccharides (GOS) both were associated with worsened abdominal pain (</span><em>P</em> = .007 and <em>P</em> = .04, respectively). GOS were associated with an increase in bloating (<em>P</em> = 03). Both bloating and abdominal pain worsened throughout the study, regardless of the FODMAP reintroduction (<em>P</em> = .006).</div></div><div><h3>Conclusion</h3><div>Our results suggest that the reintroduction of select FODMAPs may be responsible for symptom generation in patients with IBS who have responded to a low FODMAP diet, and provide a strong rationale for performing a future trial comparing the treatment effects of a limited low-FODMAP diet and a standard low-FODMAP diet.</div></div><div><h3>Clinicaltrials.gov</h3><div><span><span>NCT03052439</span><svg><path></path></svg></span></div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 351-358.e5"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904262","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":"Baseline and Dynamic MAF-5 Score to Predict Liver Fibrosis and Liver-Related Events in General Population With MASLD","authors":"Shanghao Liu ,&nbsp;Xuanwei Jiang ,&nbsp;Junliang Fu,&nbsp;Vincent Wai-Sun Wong,&nbsp;Victor W. Zhong,&nbsp;Xiaolong Qi","doi":"10.1016/j.cgh.2024.07.005","DOIUrl":"10.1016/j.cgh.2024.07.005","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 365-368.e3"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874297","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":"MetALD: The Outcome of Living Under the Shadow of Alcohol for 4 Decades","authors":"Nahum Méndez-Sánchez,&nbsp;Mariana M. Ramírez-Mejía","doi":"10.1016/j.cgh.2024.05.009","DOIUrl":"10.1016/j.cgh.2024.05.009","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 377-378"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141080740","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":"FODMAPs in IBS: Revisiting Restriction","authors":"Andrea Shin","doi":"10.1016/j.cgh.2024.06.019","DOIUrl":"10.1016/j.cgh.2024.06.019","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 222-224"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497296","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":"Setting a Value for Novel GERD Treatments","authors":"Fouad Otaki,&nbsp;John O. Clarke","doi":"10.1016/j.cgh.2024.06.039","DOIUrl":"10.1016/j.cgh.2024.06.039","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 220-221"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619475","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":"Endoscopic, Histologic, and Composite Endpoints in Patients With Ulcerative Colitis Treated With Etrasimod","authors":"Fernando Magro ,&nbsp;Laurent Peyrin-Biroulet ,&nbsp;Bruce E. Sands ,&nbsp;Silvio Danese ,&nbsp;Vipul Jairath ,&nbsp;Martina Goetsch ,&nbsp;Abhishek Bhattacharjee ,&nbsp;Joseph Wu ,&nbsp;Diogo Branquinho ,&nbsp;Irene Modesto ,&nbsp;Brian G. Feagan","doi":"10.1016/j.cgh.2024.07.010","DOIUrl":"10.1016/j.cgh.2024.07.010","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Histologic remission, a potentially important treatment target in ulcerative colitis (UC), is associated with favorable long-term outcomes. Etrasimod is an oral, once-daily, selective sphingosine 1-phosphate (S1P)_1,4,5 receptor modulator for the treatment of moderately to severely active UC. This post-hoc analysis of the ELEVATE UC program evaluated the efficacy of etrasimod according to histologic and composite (histologic/endoscopic/symptomatic) endpoints and examined their prognostic value.</div></div><div><h3>Methods</h3><div>Patients with moderately to severely active UC were randomized 2:1 to once-daily oral etrasimod 2 mg or placebo. Histologic and composite endpoints, including disease clearance (endoscopic/histologic/symptomatic remission), were assessed at Weeks 12 (ELEVATE UC 52; ELEVATE UC 12) and 52 (ELEVATE UC 52). Logistic regressions examined associations between baseline and Week 12 histologic/composite endpoints and Week 52 outcomes.</div></div><div><h3>Results</h3><div>At Weeks 12 and 52, significant improvements with etrasimod vs placebo were observed in histologic/composite outcomes, including endoscopic improvement-histologic remission and disease clearance. The proportion of patients treated with etrasimod achieving clinical remission at Week 52 was higher among those with disease clearance at Week 12 vs those without disease clearance (73.9% [17/23] vs 28.3% [71/251]). Histologic improvement and endoscopic improvement at Week 12 were moderately and strongly associated with clinical remission at Week 52 (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.27–4.41; and OR, 6.36; 95% CI, 3.47–11.64, respectively). Histologic remission and endoscopic improvement at Week 12 were strongly associated with endoscopic improvement-histologic remission at Week 52 (OR, 3.21; 95% CI, 1.70–6.06 and OR, 5.47; 95% CI, 2.89–10.36, respectively).</div></div><div><h3>Conclusions</h3><div>Etrasimod was superior to placebo for achievement of stringent histologic and composite endpoints.</div><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, Number: <span><span>NCT03945188</span><svg><path></path></svg></span>; <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, Number: <span><span>NCT03996369</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 341-350.e6"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874343","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":"Endoscopic Ultrasound Guided Portosystemic Pressure Gradient Correlates with Clinical Parameters and Liver Histology.","authors":"Jennifer M Kolb, Marc Monachese, Raymond A Rubin, Thomas J Wang, Alyssa Choi, Ahmad N Bazarbashi, Bhaumik Brahmbhatt, Ali Zakaria, Pedro Cortes, Varun Kesar, William F Abel, Wen-Pin Chen, Christine McLaren, Amirali Tavangar, Amit G Singal, Pushpak Taunk, Michael B Wallace, Prashant Kedia, David Lee, Ali Abbas, Paul Yeaton, Natalie Cosgrove, Vivek Kesar, Kenneth J Chang, Marvin Ryou, Jason Samarasena","doi":"10.1016/j.cgh.2024.12.022","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.022","url":null,"abstract":"<p><strong>Background/aims: </strong>Endoscopic ultrasound guided portosystemic pressure gradient measurement (EUS-PPG) is a novel technique to evaluate for portal hypertension (PH), a diagnosis that can prognosticate and guide therapy for patients. This study evaluated the safety and efficacy of EUS-PPG and correlation with clinical parameters and liver histology.</p><p><strong>Methods: </strong>We conducted a multi-center, retrospective study of patients undergoing EUS-PPG from January 2020 to December 2022 for suspected liver disease or PH. Linear regression was used to examine the relationship between EUS-PPG and clinical parameters of PH and the chi square test, Fisher's exact test, and Wilcoxon Rank Sums test described correlation with liver biopsy histology and non-invasive markers of fibrosis (FIB-4, APRI). Logistic regression was performed to identify the strongest predictor of histologic cirrhosis.</p><p><strong>Results: </strong>Across 8 centers, 385 patients were enrolled and 373 had successful EUS-PPG (technical success 97%). Higher median PPGs were observed in patients with than without esophageal varices (11.6mmHg vs 4.1), portal hypertensive gastropathy (10.5mmHg vs 3.3), and thrombocytopenia (7.6 mmHg vs 4.4) (p<0.001). Individuals with PH and clinically significant PH (PPG>10) were 6.7 and 3.8 times more likely to have cirrhosis on histology. EUS-PPG was the best overall predictor of biopsy proven cirrhosis (AUC 0.84) compared to FIB-4 (0.72), and APRI (0.54). There were 2 minor adverse events related to PPG (post procedural pain).</p><p><strong>Conclusions: </strong>EUS-PPG measurement was technically feasible, safe and demonstrated strong correlation with clinical parameters of PH and liver histology. The strongest predictor of cirrhosis was EUS-PPG >5mm Hg which outperformed non-invasive markers of fibrosis.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074049","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":"Safety and clinical effectiveness of GLP1 receptor agonists in inflammatory bowel disease patients.","authors":"Priya Sehgal, James D Lewis, Octavia Pickett-Blakely, Neilanjan Nandi, Meena Bewtra, Gary R Lichtenstein","doi":"10.1016/j.cgh.2024.12.017","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.017","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074028","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 machine-learning model score predicts advanced fibrosis and cirrhosis in indeterminate FIB-4 patients.","authors":"Sebastian Niezen, Timothy R Morgan, Heather M Patton, Jasmohan S Bajaj, Elliot B Tapper, Shari S Rogal","doi":"10.1016/j.cgh.2024.12.020","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.020","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074041","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":"IL-17A inhibitor-induced pouchitis.","authors":"Hiroki Kiyohara, Yohei Mikami, Takanori Kanai","doi":"10.1016/j.cgh.2024.12.015","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.015","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074051","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}