Clinical Gastroenterology and Hepatology最新文献

{"title":"Waist-to-Height Ratio Enhances Predictive Accuracy for Severe Hepatic Steatosis and Advanced Fibrosis: A National Cohort Study.","authors":"Sebastian Niezen, Thiago Bosco Mendes, Elliot B Tapper","doi":"10.1016/j.cgh.2025.05.003","DOIUrl":"10.1016/j.cgh.2025.05.003","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086067","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":"Immunogenicity and Efficacy of Subcutaneous Infliximab Monotherapy vs Combination Therapy in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.","authors":"Suzanne I Anjie, Krisztina B Gecse, Chiara M Meloni, Andrés Vidal-Itriago, Mark Löwenberg, Geert R D'Haens","doi":"10.1016/j.cgh.2025.03.021","DOIUrl":"10.1016/j.cgh.2025.03.021","url":null,"abstract":"<p><strong>Background & aims: </strong>Intravenous (IV) infliximab (IFX) combined with an immunomodulator (combination therapy) outperforms IV IFX monotherapy in terms of clinical, endoscopic, and immunogenicity outcomes in patients with inflammatory bowel disease (IBD). With the advent of subcutaneous (SC) IFX, which is associated with higher serum drug concentrations, it is essential to assess whether SC IFX monotherapy provides similar pharmacokinetic and clinical benefits as combination therapy.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis (until August 2024), of studies on patients with IBD treated with SC IFX. The primary outcome was anti-drug antibodies (ADAs) formation within 12 months (M) after starting SC IFX or after switching from IV to SC IFX. Secondary outcomes included treatment persistence, clinical efficacy, and biochemical parameters.</p><p><strong>Results: </strong>Twenty-four studies (n = 3172) were included. Among patients transitioning from IV IFX induction to SC IFX, immunogenicity was more prevalent with monotherapy than combination treatment (median, 68% vs 48%; odds ratio [OR], 3.29; 95% confidence interval [CI], 1.71-6.31; P < .001). Clinical response rates at 12M were comparable, with a trend favoring combination therapy (OR, 0.73; 95% CI, 0.50-1.06; P = .10). In patients switching from IV maintenance to SC IFX, relapse rates were low (median, 12% at 6M, 11% at week 50), with stable biochemical markers. Treatment persistence was high (93% at 6M, 92% at 12M). Among patients with quiescent disease at the time of switching, 1-year relapse rates were 9% to 11%, with baseline immunogenicity predicting treatment failure.</p><p><strong>Conclusion: </strong>SC IFX monotherapy is associated with higher immunogenicity rates compared with combination therapy, particularly in new IFX starters. Although clinical response was comparable, a trend favoring combination therapy warrants further investigation.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085940","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 New International Scheme for the Classification and Management of Clinical Outcomes Post-gastric Peroral Endoscopic Myotomy.","authors":"Yervant Ichkhanian, Marita Salame, John M Wo, Thomas V Nowak, Sarah Stainko, Akira Saito, Robert M Siwiec, Amr Kais, Joo Ha Hwang, Andrew A Li, Juliana Yang, Joseph R Broucek, Tuba Esfandyari, Stephanie Joseph, Michael B Ujiki, Ashley E Williams, Jacob Moremen, Zane Gouda, Alexander Schlachterman, Kristina Hugova, Jan Martinek, Calvin X Geng, Alexander Podboy, Andrew Y Wang, Michael Lajin, Lennon Gregor, Payton M Miller, Hashem Al Bunni, John M DeWitt, Mohammad Al-Haddad","doi":"10.1016/j.cgh.2025.03.022","DOIUrl":"10.1016/j.cgh.2025.03.022","url":null,"abstract":"<p><strong>Background & aims: </strong>Gastric peroral endoscopic myotomy (G-POEM) is an emerging treatment for gastroparesis, but clinical outcomes can be inconsistent; hence, it is vital to enhance our management strategies for patients with clinical failure.</p><p><strong>Methods: </strong>This was a multicenter retrospective review of patients who underwent G-POEM for refractory gastroparesis from September 2015 to November 2023. Clinical outcomes and management post-G-POEM were assessed and categorized into 4 types based on symptom improvement and gastric emptying metrics.</p><p><strong>Results: </strong>Of the 482 patients, 221 (46%) underwent evaluations with pre- and post-G-POEM gastric emptying tests and were included in the study. Type 1 clinical response (clinical success with improved gastric emptying scintigraphy [GES]) was the most common outcome, occurring in 56%. This was followed by type 4 (clinical failure with no GES improvement) at 23%, type 2 (clinical failure with improved GES) at 15%, and type 3 (clinical success with no GES improvement) at 6.7%. Patients with primary clinical failure (types 2 and 4) showed significantly higher daily opioid use at 23%, compared with 7% in types 1 and 3 (P = .032). Clinical failure overall was observed in 60% during a median follow-up of 48 months, with 31% managed by pylorus-directed retreatment and 7% with gastric neurostimulator placement. In the type 1 response group, clinical success was re-established in 71% following pylorus-directed therapies, with repeat G-POEM being an independent predictor of clinical success post-re-treatment (odds ratio, 2.2; P = .02).</p><p><strong>Conclusion: </strong>Our study highlights the importance of post-G-POEM GES assessments for characterizing clinical responses. Type 1 responders are more likely to benefit from subsequent pylorus-directed re-treatments, particularly repeat G-POEM interventions.</p><p><strong>Clinicaltrials: </strong>gov, Number: NCT04434781.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085987","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":"Outcomes of Allogeneic Hematopoietic Stem Cell Transplant in Monogenic Inflammatory Bowel Disease.","authors":"Alyssa Baccarella, Trusha Patel, Maire A Conrad, Marina Macchi, Brooke Boyer, Oliver Pickering, Yelizaveta Borodyanskaya, Shreya Gaddipati, Maya Cohen, Andrea Cubero, Noor Dawany, Jennifer Heimall, Nancy Bunin, Kathleen E Sullivan, Judith R Kelsen","doi":"10.1016/j.cgh.2025.03.018","DOIUrl":"10.1016/j.cgh.2025.03.018","url":null,"abstract":"<p><strong>Background & aims: </strong>Monogenic inflammatory bowel disease (IBD) can result in inborn errors of immunity and intestinal epithelial cell dysfunction, more commonly seen in patients with very early onset IBD (VEO-IBD). Hematopoietic stem cell transplant (HSCT) has emerged as an effective treatment for a subset of patients with monogenic IBD. We sought to evaluate the efficacy and safety of HSCT in these patients. We hypothesized that HSCT will lead to IBD medication-free remission or significant improvement of disease.</p><p><strong>Methods: </strong>This was a single-center, retrospective study of children with monogenic IBD who underwent HSCT at The Children's Hospital of Philadelphia from 2012 to 2022. The primary outcome was IBD medication-free sustained remission, measured by disease activity index. Secondary outcomes included all-cause mortality, growth, hospitalizations, infections, and HSCT-associated complications.</p><p><strong>Results: </strong>Thirty-eight patients with monogenic IBD were identified as eligible for HSCT, with 25 undergoing HSCT as therapy for IBD during the study period. There was 100% survival at a median follow-up of 3 years. Prior to transplant, 76% of patients received immunosuppression, and 20% underwent IBD-related surgery. At most recent follow-up, 92% of patients achieved sustained medication-free remission of IBD and 60% with prior ostomy underwent re-anastomosis. There was significant improvement in growth, hospital days, and severe infections.</p><p><strong>Conclusion: </strong>HSCT resulted in IBD medication-free remission and reduction in disease-associated complications. This highlights the strength of genetic evaluation in patients with VEO-IBD or refractory IBD and consideration of HSCT, which can be curative and lifesaving in patients with monogenic defects involving immune dysfunction.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086041","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":"Long-term Benefits of Resilience-based Integrated Care: Reduced Unplanned Care, Opioid, and Steroid Use in the GRITT-IBD Study.","authors":"Yenamala Reddy, Michelle Mendiolaza, Tina Siganporia, Anthony Biello, Ksenia Gorbenko, Laurie Keefer","doi":"10.1016/j.cgh.2025.03.019","DOIUrl":"10.1016/j.cgh.2025.03.019","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086038","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 pilot randomized control trial to assess the adjunctive effect of diet on response to advanced therapies in patients with UC.","authors":"O M Damas, M Leo, N Colina, M Mijares, I Fernandez, J McALeavy, I Hernandez, C Assumpcao, L Garces, M A Quintero, M Ortega, N Solis, C Batista, B De La Torre, M T Abreu, A R Deshpande, D Kerman, Proksell S, Y Ban","doi":"10.1016/j.cgh.2025.03.020","DOIUrl":"https://doi.org/10.1016/j.cgh.2025.03.020","url":null,"abstract":"<p><p>Diet may influence ulcerative colitis (UC), but its impact on medication response remains unclear. We examined whether two 5-day cycles of a low-calorie, plant-based fasting-mimicking diet (LC-PB) could improve UC response to medications in a controlled trial.</p><p><strong>Methods: </strong>Adults with active UC starting advanced therapies were randomized to LC-PB + therapy or control diet + therapy. The LC-PB diet provided 1,090 kcal on day one and 725 kcal on days 2-5. SCCAI was assessed at baseline and week 8. The study, planned for 60 patients, ended early due to COVID-19. The primary endpoint was clinical response (week 8, SCCAI decrease ≥ 3). Secondary outcomes were clinical improvement (change in SCCAI from baseline), steroid tapering, C-reactive protein (CRP), serum amyloid A (SAA), and FC (FC).</p><p><strong>Results: </strong>Of 32 enrolled patients, 23 completed the study. In ITT, 57% in the LC-PB arm (8/14) achieved clinical response by week 8 vs. 35% in controls (6/17, p = 0.11). Secondary analyses indicated greater clinical improvement, measured as continuous SCCAI, in the LC-PB compared to control group (p = .039). The LC-PB group had better SCCAI sub-scores (i.e. urgency, well-being), reductions in SAA and were tapered off steroids compared to controls. Mean CRP and FC decreased more on the LC-PB, but results were not significant. There were no serious adverse events relating to the diet and no weight loss.</p><p><strong>Conclusion: </strong>The LC-PB diet did not improve clinical response to medications. However, it led to clinical improvement, steroid tapering, and reduced SAA. As results were limited by sample size, larger studies are needed.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085992","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":"Insulin-like Growth Factor-1 Reflects Liver Disease Stage and Improves Prediction of Liver-related Mortality.","authors":"Carolin V Schneider, Stefan Gross, Sriram Balasubramani, Petra Tomanová, Christina Schrader, Malin Fromme, Mattias Mandorfer, Nurdan Guldiken, Kai Markus Schneider, Georg Lurje, Anastasia Raptis, Helen Ye Rim Huang, Sebastian Mueller, Thomas Reiberger, Pierre Nahon, Quentin M Anstee, Ann K Daly, Olivier Govaere, Pavel Strnad","doi":"10.1016/j.cgh.2025.02.030","DOIUrl":"10.1016/j.cgh.2025.02.030","url":null,"abstract":"<p><strong>Background & aims: </strong>Liver-related mortality represents a growing public health concern, disproportionately affecting younger subjects. Because there are no established tools for early detection of individuals at risk for liver-related death (LRD), we analyzed LRD predictors in the UK Biobank (UKB) data and validated the usefulness of serum insulin-like growth factor-1 (IGF-1).</p><p><strong>Methods: </strong>The UKB dataset encompassing 325,981 participants, a median follow-up of 13.5 years, and 846 LRDs was used as a training cohort. IGF-1 was validated in several independent cohorts of different liver disease etiologies and fibrosis stages. A Cox proportional hazard model was used to develop the gamma-glutamyl transferase (GGT)-IGF-1 score that was validated in an independent UKB cohort with 83,528 subjects and 237 LRDs.</p><p><strong>Results: </strong>Among 59 variables in the UKB training cohort, GGT and IGF-1 were identified as the LRD predictors with time-dependent area under the curve (AUROC) >80%. Phenome-wide association study demonstrated the higher liver specificity of IGF-1 compared with GGT. In validation cohorts, IGF-1 levels: (1) increased in subjects with alcohol misuse after alcohol detoxification; (2) were reduced in individuals with alcohol-related/steatotic liver disease or severe alpha-1 antitrypsin deficiency and higher fibrosis stages; and (3) were diminished in participants with more advanced liver cirrhosis and lower levels associated with higher mortality. In the UKB training and validation cohorts, the novel GGT-IGF-1 score achieved an AUROC of 0.87 for LRD and was significantly better than established risk scores (AUROC = 0.77-0.81).</p><p><strong>Conclusions: </strong>The study highlights the usefulness of IGF-1 as a reliable predictor of LRD and identifies a novel, population-based screening tool outperforming the currently used scores.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086033","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":"Diagnosis and Management of Upper Gastrointestinal Involvement in Adult Patients With Crohn's Disease: A Systematic Review.","authors":"Nathaniel A Cohen, Neta Sror, Maliha Naseer, Dominik Bettenworth, Cathy Lu, Raneem Khedraki, Maria Abreu, Raja Atreya, Badr Al-Bawardy, Susan J Connor, Geert d'Haens, Iris Dotan, Axel Dignass, Sara El Ouali, Brian Feagan, Roger Feakins, Richard Gearry, Ilyssa O Gordon, Charlotte Hedin, Taku Kobayashi, Haim Leibovitzh, Nitsan Maharshak, Jacob Ollech, Shaji Sebastian, Britta Siegmund, David T Rubin, Mark S Silverberg, Flavio Steinwurz, Joana Torres, Gill Watermeyer, Cristian Hernandez-Rocha, Paige Gurizzian, Alexa Silfen, Roie Tzadok, Katherine Falloon, Florian Rieder","doi":"10.1016/j.cgh.2025.03.024","DOIUrl":"10.1016/j.cgh.2025.03.024","url":null,"abstract":"<p><strong>Background & aims: </strong>The diagnosis and management of ileocolonic Crohn's disease are well-established. In contrast, standardized guidance pertaining to the diagnosis and management of upper gastrointestinal Crohn's disease (UGICD) is lacking, despite its potentially severe consequences. This comprehensive systematic review describes the prevalence, clinical presentation, and medical and surgical management of involvement of the upper GI tract in adult patients with Crohn's disease.</p><p><strong>Methods: </strong>A systematic review of available literature was conducted using the search engines Medline, Cochrane, and Embase, with pre-defined search algorithms. Studies published from 1947 to July 2024 were considered. The review included papers describing both clinical characteristics and the effectiveness of medical and interventional procedures in patients with UGICD. All included papers underwent quality appraisal using the Joanna Briggs Institute checklist.</p><p><strong>Results: </strong>Following screening and full-text review, 47 articles were eligible. The median prevalence of UGICD was found to be 8.7% (interquartile range, 4.74%-24.36%). Over one-third of patients with UGICD are asymptomatic, and abdominal pain was the most frequently reported symptom in symptomatic patients (41%; range, 5%-93%). Endoscopy is the most used diagnostic tool (96%), with the duodenum being the most common disease location (69%). Accepted definitions of UGICD within each diagnostic modality have not been devised. Anti-tumor necrosis factor therapy appears to be efficacious for UGICD (overall clinical response, 81%). The current data are limited by the significant heterogeneity in study design and definitions between studies, particularly inconsistency in diagnosis and outcome measures used.</p><p><strong>Conclusion: </strong>We highlight the need for the development of standardized guidance in both diagnosing and managing UGICD. This work serves as preparation for an international consensus on the management of UGICD.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085935","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":"ChatGPT Develops a Natural Language Processing Algorithm for Automated Calculation of Colonoscopy Quality Metrics.","authors":"Thomas Y Li, Nabil M Mansour","doi":"10.1016/j.cgh.2025.02.029","DOIUrl":"10.1016/j.cgh.2025.02.029","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085995","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":"Impact of Artificial Intelligence on the Gastroenterology Workforce and Practice.","authors":"Ali Soroush, Shibani P Sabnis, Shivan J Mehta, Shazia Mehmood Siddique","doi":"10.1016/j.cgh.2025.04.023","DOIUrl":"10.1016/j.cgh.2025.04.023","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076422","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}