Clinical Gastroenterology and Hepatology最新文献

{"title":"Bias in the Bowels: Disparities Exist in Constipation Testing in a Diverse Patient Cohort.","authors":"Ahmun Zafar, Yuqing Liu, Joseph Menand, Christopher Vélez, Xiaotao Zhang, Yuying Luo","doi":"10.1016/j.cgh.2025.05.006","DOIUrl":"10.1016/j.cgh.2025.05.006","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141075","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":"Blue Notes","authors":"Charles J. Kahi MD, MS, AGAF","doi":"10.1016/j.cgh.2025.04.001","DOIUrl":"10.1016/j.cgh.2025.04.001","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 7","pages":"Pages 1075-1076"},"PeriodicalIF":11.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115717","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":"Elsewhere in the AGA Journals","authors":"","doi":"10.1016/S1542-3565(25)00300-3","DOIUrl":"10.1016/S1542-3565(25)00300-3","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 7","pages":"Pages A15-A17"},"PeriodicalIF":11.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144115721","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 letter to Matheus Souza et al.","authors":"Marilia De Brito Gomes, Bianca Barros","doi":"10.1016/j.cgh.2025.03.029","DOIUrl":"10.1016/j.cgh.2025.03.029","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132069","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":"Effect of Cecal Intubation Rate on Post Colonoscopy Colorectal Cancer Deaths and Detection of Colorectal Cancer Precursors.","authors":"Jasmin Zessner-Spitzenberg, Elisabeth Waldmann, Lisa-Maria Rockenbauer, Alexandra Demschik, Andreas Klinger, Daniela Penz, Michael Trauner, Monika Ferlitsch","doi":"10.1016/j.cgh.2025.01.035","DOIUrl":"10.1016/j.cgh.2025.01.035","url":null,"abstract":"<p><strong>Background & aims: </strong>The visualization of the whole colonic mucosa with complete colonoscopy including cecal intubation has been accepted as a quality parameter for screening colonoscopy. However, there is little evidence regarding the cecal intubation rate (CIR) and its association with long-term patient outcome.</p><p><strong>Methods: </strong>We did a linkage of individuals that participated in an Austrian Colonoscopy Quality Assurance Program to the Austrian death registry to obtain information on deaths of post-colonoscopy colorectal cancer (PCCRC). We performed logistic regression and time-to-event analyses to estimate the association the CIR with the probability to detect adenomas or proximal serrated polyps and the hazards for PCCRC death.</p><p><strong>Results: </strong>A total of 349,782 screening participants between January 2012 and December 2022 were included. With every 1 percentage point increase in the CIR, the probability to detect an adenoma increased by 1 percentage point (odds ratio, 1.01; 95% confidence interval [CI], 1.0-1.01; P < .001) and increased by 3 percentage points to detect a proximal serrated polyp (odds ratio, 1.03; 95% CI, 1.01-1.04; P < .001). There was a significantly lower risk for PCCRC death when endoscopists had a CIR of 95% to 100% (hazard ratio, 0.44; 95% CI, 0.33-0.59; P < .001), compared with endoscopists with a CIR <90% or 90% to 95%.</p><p><strong>Conclusions: </strong>The endoscopist's CIR is strongly associated with their ability to detect adenomas and proximal serrated polyps. A CIR of 95% to 100% was associated with the lowest hazards for PCCRC death. Based on this data, a CIR above 95% is the desirable target.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132068","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":"Symptoms of Constipation: Relationship Between Questionnaires and Diaries and Impact on Quality of Life.","authors":"Gad Mehanna Al Snih, Kent R Bailey, Nicholas R Oblizajek, Adil E Bharucha","doi":"10.1016/j.cgh.2025.05.005","DOIUrl":"10.1016/j.cgh.2025.05.005","url":null,"abstract":"<p><strong>Background & aims: </strong>Widely used to identify constipation in clinical trials and epidemiologic studies, bowel questionnaires have not been adequately validated vs the gold standard approach, diaries. Constipation is associated with poor quality-of-life (QoL). However, the contribution of individual symptoms to QoL is unknown.</p><p><strong>Methods: </strong>Bowel symptoms (questionnaires and 2-week bowel diaries), somatic symptom scores (range, 0-4), and bowel symptom-related QoL were evaluated in healthy women and women with constipation in the community and clinic.</p><p><strong>Results: </strong>The bowel variables were significantly correlated and not significantly different between the first and second weeks of the diary. Agreement between bowel symptoms assessed with questionnaires and diaries was significant (P < .001) but varied among symptoms. Of 73 participants who reported 0 to 2 stools/week on questionnaires, 63 (86%) recorded more frequent stools in a diary. Among participants with frequent (≥25% of the time) hard stools, straining, and incomplete evacuation on a questionnaire, respectivelym 32%, 49%, and 23% recorded these symptoms less frequently in a diary. Only 116 of 222 participants (52%) satisfied constipation criteria by questionnaires and diaries; the remainder satisfied either questionnaire or diary criteria. Stool form, excessive straining, incomplete evacuation, and somatic symptoms were independently associated with poor QoL. Each unit increase in the somatic symptom score was associated with an increased odds of poor QoL (odds ratio, 5.31; 95% confidence interval, 4.54-6.08).</p><p><strong>Conclusions: </strong>Disparities exist between bowel symptoms recorded with questionnaires and diaries. Bowel diaries characterize constipation symptoms in a refined manner; only 52% of participants satisfied constipation symptom criteria on both instruments. Somatic symptoms overshadow the contribution of bowel symptoms to QoL.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126914","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":"Performance of a Smartphone-based Stool Test For Use in Colorectal Cancer Screening: Population-based Study.","authors":"Michael Hoffmeister, Teresa Seum, Leopold Ludwig, Hermann Brenner","doi":"10.1016/j.cgh.2025.04.027","DOIUrl":"10.1016/j.cgh.2025.04.027","url":null,"abstract":"<p><strong>Background & aims: </strong>Noninvasive colorectal cancer (CRC) screening bears high potential for increasing participation if implemented in a straightforward way. We have evaluated the feasibility and diagnostic performance of a smartphone-based fecal immunochemical test (FIT) for CRC screening and compared its performance with a laboratory-based FIT.</p><p><strong>Methods: </strong>Individuals scheduled for a screening colonoscopy in gastroenterology practices in Southern Germany enrolled into the BLITZ study between 2021 and 2023 were offered a smartphone-based FIT and a laboratory FIT. The smartphone-based FIT consists of a rapid test and a smartphone app. The app quantitatively evaluates the result of the rapid test using the smartphone camera. The feasibility of the smartphone-based FIT was evaluated in a self-administered questionnaire. The comparative performance of the 2 FITs was evaluated by sensitivity, specificity, and receiver-operator curve (ROC) measures.</p><p><strong>Results: </strong>Of 654 study participants who were offered both a smartphone-based FIT in addition to the laboratory FIT, 361 (55%) made use of the smartphone-based FIT, 274 (76%) of those had a valid smartphone-based FIT, and 643 (98%) used the laboratory FIT. Overall, 89% considered the smartphone-based FIT as a useful alternative offer to the laboratory FIT. The reasons why the smartphone-based FIT was not used were mostly technical (app- or smartphone-related, 47%) or reflecting more general concerns or attitudes towards such a test (44%). The smartphone-based FIT showed a sensitivity for advanced neoplasms (28%; 95% confidence interval [CI], 13%-47%) similar to the laboratory FIT (34%; 95% CI, 18%-54%) at an identical specificity (92%; 95% CI, 87%-95%).</p><p><strong>Conclusion: </strong>The smartphone-based FIT could serve as an alternative in addition to currently offered laboratory FITs.</p><p><strong>Study registration: </strong>German Clinical Trials Register (drks.de), Number: DRKS00008737.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126913","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":"PErsistence and Safety of Subcutaneous Infliximab 1 Year After Switch From Intravenous Route in IBD Patients in REMission.","authors":"Nicolas Mathieu, Marianne Hupé, Frédéric Heluwaert, Pauline Rivière, Xavier Hébuterne, Antoine Chupin, Vered Abitbol, Guillaume Bouguen, Lucine Vuitton, Jean-Marc Gornet, Céline Montuclard, Stéphane Nancey, Guillaume Cadiot, Pauline Wils, Cyrielle Gilletta, Astrid de Maissin, Romain Altwegg, Elise Chanteloup, Laurianne Plastaras, Philippe Ah Soune, Arnaud Bourreille, Carmen Stefanescu, Philippe Seksik, Marion Simon, Mathieu Uzzan, Pierre Andrau, Cléa Rouillon, Yves Arondel, Anthony Buisson, Laurent Peyrin-Biroulet, Bassirou Mboup, Eric Vicaut, David Laharie","doi":"10.1016/j.cgh.2025.04.028","DOIUrl":"10.1016/j.cgh.2025.04.028","url":null,"abstract":"<p><strong>Background and aims: </strong>Real-life data regarding inflammatory bowel disease (IBD) evolution after switch from intravenous infliximab (IV-IFX) to subcutaneous infliximab (SC-IFX) is necessary. The aim of this prospective multicenter cohort study was to describe the persistence, effectiveness and tolerance of SC-IFX after switch from IV-IFX.</p><p><strong>Methods: </strong>IBD patients in steroid-free clinical remission for at least 6 months on IV-IFX were enrolled in a prospective national French cohort when they switched to SC-IFX. Patients were assessed at inclusion and at weeks 12, 24, and 48. The primary endpoint was the persistence of SC-IFX at week 48. Secondary endpoints comprised steroid-free clinical remission at week 48, IV-IFX switch-back rate, and evolution of infliximab levels during the study period.</p><p><strong>Results: </strong>Among the 426 patients included (72.4% with Crohn's disease , 27.5% with ulcerative colitis; 45.1% female; median age 37 [interquartile range, 29-50] years; median disease duration of 12 years in Crohn's disease, 13 years in ulcerative colitis), 56% were on IV-IFX standard dosing (5 mg/kg 8-weekly) and 16% received combination therapy with an immunomodulator drug at baseline. At week 48, SC-IFX persistence was 95.4% (95% confidence interval, 93.3%-97.5%) and 86.9% of patients were on steroid-free clinical remission. Mean infliximab levels were 8.0 μg/mL at inclusion and 18.0 μg/mL at week 48 (P < .0001). Among the 19 (4.5%) patients who stopped SC-IFX, 6 (1.4%) switched back to IV-IFX. There were 222 adverse events reported in 42.4% of patients, and 12 led to treatment discontinuation, including 6 (1.4%) severe adverse events.</p><p><strong>Conclusions: </strong>In this large multicenter prospective cohort, persistence at 1 year of SC-IFX was more than 95% of IBD patients switched in remission from IV-IFX, confirming excellent effectiveness and tolerance of SC-IFX.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119020","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":"Global Epidemiology of Primary Biliary Cholangitis: An Updated Systematic Review and Meta-analysis.","authors":"Jarell Jie-Rae Tan, Ambrose Hon Lam Chung, Jing Hong Loo, Joo Wei Ethan Quek, Sagar Sharma, Corrine Lee Singh, Roe Xin Jacqueline Yap, Wei Xuan Tay, Matthew K Smith, Ellina Lytvyak, Andrew Mason, Aldo J Montano-Loza, Yu Jun Wong","doi":"10.1016/j.cgh.2025.03.025","DOIUrl":"10.1016/j.cgh.2025.03.025","url":null,"abstract":"<p><strong>Background & aims: </strong>Primary biliary cholangitis (PBC) demonstrates significant geographical variability in its epidemiology. We aim to provide an updated estimate on the global and temporal trends of the prevalence and incidence of PBC from 1976 to 2024.</p><p><strong>Methods: </strong>We systematically searched three electronic databases from inception to August 20, 2024, to include all studies reporting the incidence or prevalence of PBC. The outcomes of interest were the prevalence and incidence of PBC. Subgroup analysis was performed by study type, study period, geographical region, sex, Human Development Index, method of diagnosis, and latitude. The temporal trend of PBC prevalence and incidence was analyzed using meta-regression. The study protocol was registered with PROSPERO (CRD42024595102).</p><p><strong>Results: </strong>A total of 59 studies, encompassing 381 million participants and 129,455 patients with PBC across 25 countries were included. The pooled global prevalence of PBC was 18.1 cases per 100,000 people (95% confidence interval, 14.6-22.0; I² = 99.9%; 55 studies) among population-based studies with low risk of bias. The incidence rate of PBC was 1.8 per 100,000 person-years (95% confidence interval, 1.5-2.3; I² = 99.6%; 46 studies). PBC prevalence was higher in countries with higher latitude, higher Human Development Index, in America and among the female sex. Global prevalence of PBC has increased over time, with the Western Pacific region experiencing the greatest rise in PBC prevalence over time.</p><p><strong>Conclusion: </strong>The rising prevalence of PBC represents a growing healthcare burden in Western Pacific region. The association between latitude and PBC prevalence requires further studies.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119019","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":"Transferrin Saturation and Serum Ferritin Are Main Predictors of Liver Iron Content in Subjects With Hyperferritinemia.","authors":"Giulia Risca, Sara Pelucchi, Raffaella Mariani, Mara Botti, Giulia Capitoli, Filiberto Di Gennaro, Stefania Galimberti, Alberto Piperno","doi":"10.1016/j.cgh.2025.02.033","DOIUrl":"10.1016/j.cgh.2025.02.033","url":null,"abstract":"<p><strong>Background and aims: </strong>Hyperferritinemia is widespread and is caused by or associated with a variety of diseases requiring complex diagnostic workup. Magnetic resonance imaging-based liver iron quantification (LIC^MRI) can differentiate subjects with iron overload requiring treatment but is still limited to specialized centers and costly. We aimed to determine whether parameters belonging to the diagnostic setting of hyperferritinemia could lead to a more selective use of LIC^MRI.</p><p><strong>Methods: </strong>We enrolled a cohort of 570 subjects with hyperferritinemia from a tertiary hospital center. They underwent full clinical and laboratory evaluation, and LIC^MRI. We applied a partitioning tree to explore which features were relevant in classifying LIC^MRIseverity from grade 1 to 3.</p><p><strong>Results: </strong>A total of 66.1% had LIC^MRI≤3 mg/g (grade 1), while 11.2% had LIC^MRI above 7 mg/g (grade 3). The partitioning tree model showed a global accuracy of 78% (95% confidence interval, 74%-81%) in predicting the severity of LIC^MRI in the entire series. Sensitivity and specificity were high to distinguish patients with grade 1 from those with grade 3 but not from patients with grade 2. Focusing on the LIC^MRI threshold of 7 mg/g, we found that transferrin saturation (TSAT) ≥60% and TSAT <60% with serum ferritin ≥963 μg/L correctly classified 61 (95.3%) subjects with grade 3 LIC^MRI to class 3. Based on these cutoffs, 193 subjects with LIC^MRI grade 1 and 2 were also selected for LIC^MRI assessment, while 316 patients (55.4%) would be addressed to follow-up.</p><p><strong>Conclusions: </strong>TSAT and serum ferritin allow us to identify more than 95% of patients with a LIC^MRI grade 3 and reduce MRI requirements by more than 50%.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119096","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}