Clinical Gastroenterology and Hepatology最新文献

{"title":"Intestinal Ultrasound Findings and Their Prognostic Value in Early Crohn's Disease - a Copenhagen IBD Cohort Study.","authors":"Gorm Roager Madsen, Mohamed Attauabi, Johan F K F Ilvemark, Klaus Theede, Jacob Tveiten Bjerrum, Flemming Bendtsen, Jakob Benedict Seidelin, Rune Wilkens, Trine Boysen, Johan Burisch","doi":"10.1016/j.cgh.2024.12.030","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.030","url":null,"abstract":"<p><strong>Background and aims: </strong>We characterize the sonographic features of Crohn's disease at diagnosis and evaluate the prognostic value of intestinal ultrasound during the early stage of disease.</p><p><strong>Methods: </strong>A prospective, population-based cohort of patients with newly diagnosed Crohn's disease were followed with intestinal ultrasound in conjunction with symptomatic, biochemical, and endoscopic evaluations.</p><p><strong>Results: </strong>Between May 2021 and April 2023, 201 patients with adult-onset Crohn's disease were recruited. No associations were found between sonographic inflammation at diagnosis and diagnostic delay. After three months, transmural remission was achieved in 38% of patients, with colonic disease patients achieving transmural remission more often. Transmural remission at three months was significantly associated with steroid-free clinical remission at three months and all subsequent follow-ups within the first year. Transmural remission was also associated with a lower risk of treatment escalation during follow-up until 12 months (26% vs. 53%, p=0.003). At 12 months, 41% had achieved transmural remission. Higher baseline body mass index negatively impacted the likelihood of 12-month transmural remission significantly (overweight: [OR 0.34 (0.12; 0.94)], obese: [OR 0.16 (0.04; 0.73)]). The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) in the terminal ileum at diagnosis was the best predictor of ileocecal resection during the first year, with an optimal threshold of 63 (AUC 0.92, sensitivity 100%, specificity 73%).</p><p><strong>Conclusions: </strong>Transmural remission is an achievable outcome target for many newly diagnosed Crohn's disease patients and is associated with a favorable clinical outcome, including sustained steroid-free clinical remission. Further, intestinal ultrasound findings at diagnosis predict future ileocecal resection.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623757","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":"Worsening disease severity as measured by I-SEE associates with decreased treatment response to topical steroids in eosinophilic esophagitis patients.","authors":"Craig C Reed, Sean S LaFata, Timothy S Gee, Hannah L Thel, Brenderia A Cameron, Angela Z Xue, Akshatha Kiran, Adolfo A Ocampo, Justin McCallen, Christopher J Lee, Stephanie A Borinsky, Walker D Redd, Trevor S Barlowe, Rayan N Kaakati, Cary C Cotton, Swathi Eluri, Evan S Dellon","doi":"10.1016/j.cgh.2025.01.015","DOIUrl":"10.1016/j.cgh.2025.01.015","url":null,"abstract":"<p><strong>Background and aims: </strong>The index of severity for eosinophilic esophagitis (I-SEE) grades eosinophilic esophagitis (EoE) severity across several domains. We assessed associations between EoE features and severity by I-SEE at diagnosis, and baseline I-SEE and outcomes following topical corticosteroids (tCS).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of newly diagnosed EoE patients. Data were extracted to complete I-SEE at diagnosis. Disease activity was categorized as mild (I-SEE 1-6), moderate (7-14), or severe (≥15). We compared baseline characteristics by I-SEE category. We assessed if baseline I-SEE associated with treatment response in patients treated with tCS.</p><p><strong>Results: </strong>Of 1312 patients, there were 657 (50%), 461 (35%), and 194 (15%) with mild, moderate, and severe disease by I-SEE. Baseline scores were similar for children (8.5±6.6) and adults (8.8±6.5) (p=0.37). Compared with mild or moderate disease, patients with severe disease were younger (23.8±19.8 years severe vs. 28.0±19.7 mild vs. 30.3±17.0 moderate; p<0.001), had lower BMI (21.6±7.1 vs. 24.4±7.0 vs. 25.7±6.8; p<0.001), and longer symptom length preceding diagnosis (9.3±10.5 years vs. 5.9±7.5 vs. 7.2±7.9; p<0.001). Baseline category associated with tCS response with severe patients less likely to have histologic response (49% vs. 55% vs. 64%; p=0.03 for <15 eos/hpf) and symptomatic responses, while also having the highest post-treatment EREFS scores.</p><p><strong>Conclusions: </strong>I-SEE correlated with baseline features in a large EoE cohort, performed similarly in children and adults, and associated with post-treatment responses to tCS. These data support that I-SEE provides prognostic data and suggest that severe disease may benefit from intensive upfront management.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613764","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":"Resolving metabolic dysfunction-associated steatotic liver disease reduces subclinical cardiovascular damage in Chinese youths.","authors":"Lili Yang, Yanan Qiao, Min Zhao, Bo Xi","doi":"10.1016/j.cgh.2025.01.014","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.01.014","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585053","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":"To treat of not to treat - prospection and prognosis in IBD.","authors":"Fernando Gomollón","doi":"10.1016/j.cgh.2025.01.013","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.01.013","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585056","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":"Real-World Effectiveness and Safety of Upadacitinib in Crohn's disease: A Multi-Centre Study.","authors":"Jalpa Devi, Anthony Xu, Molly Stone, Anish Patel, Abdul Khan, Nikhil Reddy, Jeremy Klein, Navreet Chowla, Caroline Benson, Bryan Christopher Luu, Katherine Huang, Fnu Jaiprada, Marc Fenster, Ryan Ungaro, Joel Pekow, Amanda M Johnson, Andres J Yarur, Richa Shukla, Julia Huecker, Shrinivas Bishu, Parakkal Deepak","doi":"10.1016/j.cgh.2025.01.012","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.01.012","url":null,"abstract":"<p><strong>Background: </strong>We aimed to describe the real-world effectiveness and safety of upadacitinib (UPA), an oral Janus kinase 1 inhibitor (JAKi) in patients with Crohn's disease (CD).</p><p><strong>Methods: </strong>A retrospective analysis was conducted across nine centers in the United States, focusing on adults with CD treated with UPA 45 mg as induction therapy for active luminal disease. The co-primary endpoints were clinical remission at 12 weeks (Harvey Bradshaw Index ≤ 4 or absence of symptoms on physician's global assessment) and endoscopic remission at 6 months (SEMA-CD score of 0-1 or absence of ulcers). Secondary outcomes included clinical, radiographic and histologic outcomes, and adverse events (AEs).</p><p><strong>Results: </strong>The study included 334 CD patients (median age 34 years and disease duration 12 years, and 44.6% female). Clinical remission was achieved in 52.1% at 12 weeks and 55.9% at 6 months. Endoscopic remission at 6 months was observed in 42.7% of patients. Advanced therapy (AT)-naive patients achieved a higher proportion of clinical remission at 12 weeks (58.6%) and 6 months (97.7%) compared to patients with one prior AT (53.3% and 66.7%) and two or more prior AT exposures (50.2% and 40.5%), respectively. BMI and longer disease duration was associated with lower odds of clinical remission at 12 weeks. AEs were reported in 13.5% and UPA discontinued in 19.1%.</p><p><strong>Conclusion: </strong>UPA was effective at inducing clinical and endoscopic remission in a real-world group of patients with CD, even with prior exposure to multiple prior advanced therapies. No new safety concerns were identified.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585051","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":"Economic Benefit of Implementation of Pediatric Transnasal Endoscopy in Eosinophilic Esophagitis.","authors":"Michael Joseph, Joseph Steinberg, Jacob A Mark, Thomas Wallach, Nathalie Nguyen","doi":"10.1016/j.cgh.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.01.011","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585104","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 En Bloc Vs Piecemeal Resection of Large Colonic Adenomas: Carbon Footprint Post Hoc Analysis of a Randomized Trial.","authors":"Raphaëlle Grau, Pierre-Jean Cottinet, Minh-Quyen Le, Marion Schaefer, Timothée Wallenhorst, Thomas Rösch, Vincent Lépilliez, Stanislas Chaussade, Jérôme Rivory, Romain Legros, Jean-Baptiste Chevaux, Sarah Leblanc, Pierre Lafeuille, Florian Rostain, Enrique Rodriguez de Santiago, Heiko Pohl, Robin Baddeley, Daniel Grinberg, Charles Buiron, João A Cunha Neves, Maximilien Barret, Jérémie Albouys, Arthur Belle, Hugo Lepetit, Martin Dahan, Franck Jacquette, Louis-Jean Masgnaux, Loic Marais, Thierry Ponchon, Jérémie Jacques, Mathieu Pioche","doi":"10.1016/j.cgh.2025.01.009","DOIUrl":"10.1016/j.cgh.2025.01.009","url":null,"abstract":"<p><strong>Background and aims: </strong>Endoscopy makes a significant contribution to the carbon footprint of healthcare. A randomized trial (RESECT-COLON) demonstrated that endoscopic submucosal dissection (ESD) decreases the recurrence rate of large adenomas (>25 mm) vs piecemeal endoscopic mucosal resection (P-EMR), reducing the need for follow-up colonoscopy. We aimed to compare the carbon footprint of those 2 strategies.</p><p><strong>Methods: </strong>Devices used for both procedures were collected prospectively for each of the 359 patients. P-EMR and ESD were assessed using the life cycle assessment, evaluating 4 parameters: endoscopes and disposable medical products, electricity consumption, anesthetic products, and patient transport. The carbon footprint of the follow-up was simulated in both arms with different scenarios. We performed a post hoc analysis of the carbon footprint of these 2 strategies over 18 months.</p><p><strong>Results: </strong>Carbon footprint of a single P-EMR procedure was 63.5 kg carbon dioxide equivalent (CO2e) vs 73.2 kg CO2e for ESD (half for patient transport). Including follow-up in local centers, P-EMR generates 93.5 kg CO2e and ESD 76.3 kg CO2e, corresponding to an absolute reduction of 17 kg CO2e (18%) per procedure for ESD. Simulating a strategy of P-EMR resection and follow-up both performed in local centers, the global impact with 18 months follow-up would be 67.3 kg CO2e, favoring P-EMR over ESD.</p><p><strong>Conclusions: </strong>ESD strategy for lesions over 25 mm could reduce the environmental impact by reducing the associated follow-up colonoscopies and transports of patients. If P-EMR could be performed in local centers with similar quality, results would be in favor of local P-EMR.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572421","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 Real-World Study of Cumulative Steroid Burden Among Patients with Eosinophilic Esophagitis in the United States.","authors":"Mirna Chehade, David A Katzka, Sarah Naeger, Ryan B Thomas, Sarette T Tilton","doi":"10.1016/j.cgh.2025.01.010","DOIUrl":"10.1016/j.cgh.2025.01.010","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572418","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":"Real-world Effectiveness of Fecal Microbiota Transplantation for First or Second Clostridioides difficile Infection","authors":"Sara Ellegaard Paaske ,&nbsp;Simon Mark Dahl Baumwall ,&nbsp;Tone Rubak ,&nbsp;Frederik Hyllested Birn ,&nbsp;Nina Rågård ,&nbsp;Jens Kelsen ,&nbsp;Mette Mejlby Hansen ,&nbsp;Lise Svenningsen ,&nbsp;Anne Lund Krarup ,&nbsp;Christa Marie Culmbach Fernis ,&nbsp;Anders Neumann ,&nbsp;Anders Bergh Lødrup ,&nbsp;Henning Glerup ,&nbsp;Lars Vinter-Jensen ,&nbsp;Morten Helms ,&nbsp;Lise Tornvig Erikstrup ,&nbsp;Anne Karmisholt Grosen ,&nbsp;Susan Mikkelsen ,&nbsp;Christian Erikstrup ,&nbsp;Jens Frederik Dahlerup ,&nbsp;Christian Lodberg Hvas","doi":"10.1016/j.cgh.2024.05.038","DOIUrl":"10.1016/j.cgh.2024.05.038","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div><em>Clostridioides difficile</em> infection (CDI) is associated with high mortality. Fecal microbiota transplantation (FMT) is an established treatment for recurrent CDI, but its use for first or second CDI remains experimental. We aimed to investigate the effectiveness of FMT for first or second CDI in a real-world clinical setting.</div></div><div><h3>Methods</h3><div>This multi-site Danish cohort study included patients with first or second CDI treated with FMT from June 2019 to February 2023. The primary outcome was cure of <em>C. difficile-</em>associated diarrhea (CDAD) 8 weeks after the last FMT treatment. Secondary outcomes included CDAD cure 1 and 8 weeks after the first FMT treatment and 90-day mortality following positive <em>C. difficile</em> test.</div></div><div><h3>Results</h3><div>We included 467 patients, with 187 (40%) having their first CDI. The median patient age was 73 years (interquartile range [IQR], 58–82 years). Notably, 167 (36%) had antibiotic-refractory CDI, 262 (56%) had severe CDI, and 89 (19%) suffered from fulminant CDI. Following the first FMT treatment, cure of CDAD was achieved in 353 patients (76%; 95% confidence interval [CI], 71%–79%) at week 1. At week 8, 255 patients (55%; 95% CI, 50%–59%) maintained sustained effect. In patients without initial effect, repeated FMT treatments led to an overall cure of CDAD in 367 patients (79%; 95% CI, 75%–82%). The 90-day mortality was 10% (95% CI, 8%–14%).</div></div><div><h3>Conclusion</h3><div>Repeated FMT treatments demonstrate high effectiveness in managing patients with first or second CDI. Forwarding FMT in CDI treatment guidelines could improve patient survival. <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, Number: <span><span>NCT03712722</span><svg><path></path></svg></span></div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 602-611.e8"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316862","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":"Performance of AI-Enabled Electrocardiogram in the Prediction of Metabolic Dysfunction–Associated Steatotic Liver Disease","authors":"Prowpanga Udompap ,&nbsp;Kan Liu ,&nbsp;Itzhak Zachi Attia ,&nbsp;Rachel E. Canning ,&nbsp;Joanne T. Benson ,&nbsp;Terry M. Therneau ,&nbsp;Peter A. Noseworthy ,&nbsp;Paul A. Friedman ,&nbsp;Puru Rattan ,&nbsp;Joseph C. Ahn ,&nbsp;Douglas A. Simonetto ,&nbsp;Vijay H. Shah ,&nbsp;Patrick S. Kamath ,&nbsp;Alina M. Allen","doi":"10.1016/j.cgh.2024.08.009","DOIUrl":"10.1016/j.cgh.2024.08.009","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Accessible noninvasive screening tools for metabolic dysfunction–associated steatotic liver disease (MASLD) are needed. We aim to explore the performance of a deep learning–based artificial intelligence (AI) model in distinguishing the presence of MASLD using 12-lead electrocardiogram (ECG).</div></div><div><h3>Methods</h3><div>This is a retrospective study of adults diagnosed with MASLD in Olmsted County, Minnesota, between 1996 and 2019. Both cases and controls had ECGs performed within 6 years before and 1 year after study entry. An AI-based ECG model using a convolutional neural network was trained, validated, and tested in 70%, 10%, and 20% of the cohort, respectively. External validation was performed in an independent cohort from Mayo Clinic Enterprise. The primary outcome was the performance of ECG to identify MASLD, alone or when added to clinical parameters.</div></div><div><h3>Results</h3><div>A total of 3468 MASLD cases and 25,407 controls were identified. The AI-ECG model predicted the presence of MASLD with an area under the curve (AUC) of 0.69 (original cohort) and 0.62 (validation cohort). The performance was similar or superior to age- and sex-adjusted models using body mass index (AUC, 0.71), presence of diabetes, hypertension or hyperlipidemia (AUC, 0.68), or diabetes alone (AUC, 0.66). The model combining ECG, age, sex, body mass index, diabetes, and alanine aminotransferase had the highest AUC: 0.76 (original) and 0.72 (validation).</div></div><div><h3>Conclusions</h3><div>This is a proof-of-concept study that an AI-based ECG model can detect MASLD with a comparable or superior performance as compared with the models using a single clinical parameter but not superior to the combination of clinical parameters. ECG can serve as another screening tool for MASLD in the nonhepatology space.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 4","pages":"Pages 574-582.e3"},"PeriodicalIF":11.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104962","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}