Clinical Gastroenterology and Hepatology最新文献

{"title":"Endoscopic Ultrasound-Guided Through-the-Needle Biopsy for the Diagnosis of Cholangiocarcinoma (With Video).","authors":"Zhenyun Gong, Duanmin Hu, Guilian Cheng","doi":"10.1016/j.cgh.2025.02.036","DOIUrl":"10.1016/j.cgh.2025.02.036","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233374","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":"Prevalence and Impact of Social Risk in Patients With Inflammatory Bowel Diseases: National Estimates from the United States.","authors":"Seo Hyun Kim, Yuchen Qi, Matthew P Banegas, Michael D Kappelman, Nghia H Nguyen, Brigid S Boland, Carlos Lago Hernandez, Ronghui Xu, Siddharth Singh","doi":"10.1016/j.cgh.2025.03.031","DOIUrl":"10.1016/j.cgh.2025.03.031","url":null,"abstract":"<p><strong>Background and aims: </strong>Social risks are individual-level factors associated with adverse health outcomes. We determined the prevalence and impact of social risks on healthcare use among patients with inflammatory bowel diseases (IBDs) in the United States.</p><p><strong>Methods: </strong>In the U.S. National Health Interview Survey 2023, we estimated social risks across 6 domains (food insecurity, financial hardship, housing instability, transportation needs, education and employment, discrimination) in adults with IBD. We evaluated the association between burden of social risk (0 of 6 domains [none], 1 of 6 domains [mild], 2 of 6 domains [moderate], and ≥3 of 6 domains [severe]), unplanned healthcare utilization (emergency department and/or hospitalization), and medication nonadherence, accounting for differences in age, sex, race/ethnicity, insurance, income, and comorbidities.</p><p><strong>Results: </strong>Of 572 people included in the survey (mean age 56 years; 57% female; 81% non-Hispanic White [NHW], 12.9% Hispanic), 64% (95% confidence interval [CI], 59%-69%) experienced social risk across 1 or more domains (food insecurity, 22%; financial hardship, 28%; housing instability, 14%; transportation needs, 9%; education and employment, 9%; discrimination, 41%). Prevalence of severe social risk was higher in racial and ethnic minority groups (non-Hispanic Black vs Hispanic vs NHW: 37% vs 28% vs 12%). A higher burden of social risk was associated with higher risk of unplanned healthcare utilization (severe vs none: odds ratio, 3.5; 95% CI, 1.2-10.2) and cost-related medication nonadherence (OR, 11.8; 95% CI, 2.7-52.1), after accounting for income and insurance status.</p><p><strong>Conclusions: </strong>Social risks are prevalent in adults with IBD and negatively impact healthcare utilization and medication nonadherence. Efforts to routinely identify and address social risks in patients with IBD should be part of standard clinical care.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233375","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":"Survival With and Without Liver Transplantation in Critically Ill Patients With Cirrhosis: A 20-Year Experience.","authors":"William Bernal, Therese Bittermann, Roosey Sheth, Francesca Trovato, Mark J McPhail, Pervez Khan, Stacey Calvert, Tasneem Pirani, Sameer Patel, Robert Loveridge, Christopher Willars, Georg Auzinger, Julia A Wendon","doi":"10.1016/j.cgh.2025.04.029","DOIUrl":"10.1016/j.cgh.2025.04.029","url":null,"abstract":"<p><strong>Background & aims: </strong>In 2015, we reported the outcome of patients with cirrhotic chronic liver disease with unplanned admission to a specialist single-center Liver Intensive Therapy Unit (LITU) demonstrating progressive improvement in short-term survival. We investigated if this and long-term survival had continued to improve, and its relation to use and outcome of liver transplantation (LT).</p><p><strong>Methods: </strong>A retrospective cohort study of consecutive adult patients with cirrhosis and unplanned emergent first LITU admission January 2000 to March 2020. Demographic and clinical variables were obtained at admission; acute-on-chronic liver failure (ACLF) grade was categorized as 0 (no ACLF), 1 or 2, or 3. Transplant-free survival (TFS) and LT practices were characterized and survival compared using time-to-event analysis.</p><p><strong>Results: </strong>The cohort comprised 1688 patients (62% male; median age 52 years [interquartile range, 43-60 years]) with Model for End-Stage Liver Disease score 28 (interquartile range, 18-37); 23% had no ACLF, 39% had ACLF 1 or 2, and 37% had ACLF 3; TFS closely related to ACLF grade (P < .001). LITU TFS was 51.9% in 2000 to 2009, increasing to 70.6% in 2010 to 2020 (P < .001); improvement for ACLF 3 was smaller: 31.0% to 45.8%, (P < .001). There was no difference in TFS survival in 2010 to 2014 vs 2015 to 2020. Long-term TFS was poor with <20% of patients alive without LT 1 year after LITU admission. During follow-up, 280 underwent LT: the proportion transplanted increased from 12.6% in 2000 to 2009 to 20.2% in 2010 to 2020, with 1- and 5-year post-transplant survival of 91% and 81.9%.</p><p><strong>Conclusions: </strong>TFS has now plateaued with need for novel interventions to improve survival in ACLF. LT is infrequently utilized but has excellent outcomes. ACLF survivors should be closely followed up with strong consideration given for transplant assessment.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233376","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":"Diagnostic Accuracy of Noninvasive Biomarkers and Imaging for Evaluating Postoperative Recurrence in Crohn's Disease.","authors":"Sunil Samnani, Christina M Ray, Priyanka Gill, Levi Stein, Katherine A Buhler, Rupert W Leong, Rebecca L Smith, Peter De Cruz, Gilaad G Kaplan, Cynthia H Seow, Cathy Lu, Leonardo Guizzetti, Frank Hoentjen, John K Marshall, Siddharth Singh, Remo Panaccione, Kerri L Novak, Christopher Ma","doi":"10.1016/j.cgh.2025.03.030","DOIUrl":"10.1016/j.cgh.2025.03.030","url":null,"abstract":"<p><strong>Background & aims: </strong>Colonoscopy is recommended to monitor for Crohn's disease (CD) recurrence after surgical resection. However, repeated colonoscopy is invasive and resource-intensive. We conducted a systematic review and meta-analysis to evaluate the pooled diagnostic accuracy of noninvasive biomarkers and imaging measures for detecting endoscopic CD recurrence, as compared with colonoscopy.</p><p><strong>Methods: </strong>A systematic review was conducted to January 31, 2024, to identify studies evaluating the diagnostic accuracy of C-reactive protein (CRP), fecal calprotectin, computed tomography and magnetic resonance enterography, or intestinal ultrasound (IUS) compared with colonoscopy for detecting CD recurrence. Estimates of sensitivity, specificity, and positive and negative likelihood ratios were pooled using a random-effects hierarchical summary receiver operating characteristic model.</p><p><strong>Results: </strong>A total of 17 studies (N = 1080) evaluated inflammatory biomarkers and 20 studies (N = 1053) assessed imaging measures. The pooled sensitivity and specificity of CRP (threshold, 5.0 mg/L) were 0.45 (95% confidence interval [CI], 0.33-0.58) and 0.83 (95% CI, 0.68-0.92), respectively. Fecal calprotectin (threshold, 50 μg/g) was moderately sensitive 0.76 (95% CI, 0.70-0.82) but less specific 0.66 (95% CI, 0.56-0.75). Sensitivity for computed tomography enterography/magnetic resonance enterography and IUS was 0.89 (95% CI, 0.73-0.96) and 0.92 (95% CI, 0.75-0.96); specificity was 0.65 (95% CI, 0.43-0.82) and 0.76 (95% CI, 0.52-0.90), respectively. Using optimized radiographic parameters for IUS, specificity was improved to 0.85 (95% CI, 0.71-0.93).</p><p><strong>Conclusion: </strong>The high sensitivity of fecal calprotectin (<50 μg/g) and cross-sectional imaging can help reduce the need for invasive and costly colonoscopy monitoring for CD recurrence after surgery. Applying optimal definitions of sonographic recurrence by IUS parameters may further improve specificity for making therapeutic decisions without endoscopy.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224554","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":"The Vasopressin Biomarker Copeptin is Linked to Systemic Inflammation and Refines Prognostication in Decompensated Cirrhosis.","authors":"Lukas Hartl, Marlene Hintersteininger, Benedikt Simbrunner, Mathias Jachs, Benedikt Silvester Hofer, David Josef Maria Bauer, Nina Dominik, Michael Schwarz, Lorenz Balcar, Georg Kramer, Annarein J C Kerbert, Minneke J Coenraad, Thierry Thevenot, Richard Moreau, Jonel Trebicka, Joan Clària, Rodrig Marculescu, Michael Trauner, Mattias Mandorfer, Thomas Reiberger","doi":"10.1016/j.cgh.2025.04.030","DOIUrl":"10.1016/j.cgh.2025.04.030","url":null,"abstract":"<p><strong>Background & aims: </strong>Copeptin, an arginine-vasopressin biomarker, may confer prognostic information in patients with advanced chronic liver disease (ACLD).</p><p><strong>Methods: </strong>Patients with ACLD included in the Vienna Cirrhosis Study (NCT03267615) between January 2017 and April 2023 and available copeptin levels were prospectively recruited and classified into 6 predefined clinical ACLD stages from S0 (subclinical portal hypertension) to S5 (further decompensation). A prognostic score (MELD-copeptin score) in patients with decompensated ACLD (dACLD) was developed in a derivation cohort (n = 150) and validated in an internal (n = 148) and an external validation cohort (n = 771).</p><p><strong>Results: </strong>Among 475 patients with ACLD, 177 were compensated, whereas 298 were decompensated. Median levels of copeptin increased with progressive ACLD severity (S0, 7.5 pmol/L vs S5, 14.3 pmol/L; P < .001). Copeptin (adjusted Beta, 0.10; P < .001) was independently associated with interleukin-6 levels in dACLD. In dACLD, copeptin was linked to higher risk of further decompensation (adjusted subdistribution hazard ratio, 1.01; 95% confidence interval, 1.00-1.01; P = .039), acute-on-chronic liver failure (adjusted subdistribution hazard ratio, 1.01; 95% confidence interval, 1.01-1.02; P < .001), and liver-related death (adjusted subdistribution hazard ratio, 1.01; 95% confidence interval, 1.01-1.02; P < .001) independently of relevant cofactors. The MELD-copeptin score yielded higher area under the receiver operating characteristics (AUROCs) for liver-related events than the MELD-Na score in the internal validation cohort, accurately predicting liver-related death at 6 months (AUROC, 0.777 vs MELD-Na, 0.673), 1 year (AUROC, 0.784 vs MELD-Na, 0.661), and 2 years of follow-up (AUROC, 0.741 vs MELD-Na, 0.636). Similarly, the MELD-copeptin score consistently yielded higher AUROCS for the development of liver-related death and acute-on-chronic liver failure at 3, 6, and 12 months of follow-up in the external validation cohort.</p><p><strong>Conclusions: </strong>In patients with dACLD, copeptin is independently linked to systemic inflammation. The MELD-copeptin score identifies patients with dACLD at risk for impaired clinical outcomes.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224555","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":"Single-session Combined Endoscopic and Surgical Treatment of Gallstone Ileus.","authors":"Zehra Naseem, Aun Muhammad, Hassan Siddiki","doi":"10.1016/j.cgh.2025.01.045","DOIUrl":"10.1016/j.cgh.2025.01.045","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990794","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":"Concomitant Medications and Advanced Therapies in Ulcerative Colitis: Patient-centric Approach for Optimal Disease Control.","authors":"Ferdinando D'Amico, Laurent Peyrin-Biroulet, Silvio Danese","doi":"10.1016/j.cgh.2025.01.040","DOIUrl":"10.1016/j.cgh.2025.01.040","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955119","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":"The Impact of Age on Disorders of Gut-brain Interaction.","authors":"Tia D Andrade, Vikram Rangan, Sarah Ballou","doi":"10.1016/j.cgh.2025.05.001","DOIUrl":"10.1016/j.cgh.2025.05.001","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955231","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":"Rare Endoscopic Findings of Inverted Esophageal Squamous Cell Carcinoma.","authors":"Xingyu Ding, Lu Xie, Hangbin Jin","doi":"10.1016/j.cgh.2025.04.009","DOIUrl":"10.1016/j.cgh.2025.04.009","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982122","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":"Recurrent Erythropoietic Protoporphyria Post Liver Transplant.","authors":"Antoine Robert, Shula Schechter, Anna S F Lok","doi":"10.1016/j.cgh.2025.02.019","DOIUrl":"10.1016/j.cgh.2025.02.019","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978746","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}