Clinical Gastroenterology and Hepatology最新文献

{"title":"The Comparative Trials of Fecal Immunochemical Testing vs Colonoscopy: What COLONPREV Tells Us and What to Anticipate From the Others.","authors":"Thomas F Imperiale","doi":"10.1016/j.cgh.2025.08.026","DOIUrl":"10.1016/j.cgh.2025.08.026","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005920","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":"Rethinking Endoscopic Ultrasound-guided Choledochoduodenostomy With Lumen-apposing Metal Stent: The Indication Matters as Much as the Stent.","authors":"Giuseppe Dell'Anna, Antonio Facciorusso, Gianfranco Donatelli","doi":"10.1016/j.cgh.2025.08.028","DOIUrl":"10.1016/j.cgh.2025.08.028","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006005","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":"Reliability and Responsiveness of Endoscopic Indices for Assessing Crohn's Disease Postoperative Recurrence in the PREVENT trial.","authors":"Jurij Hanzel, Sudheer K Vuyyuru, Brian Bressler, Mark A Samaan, Malcolm Hogan, Guangyong Zou, Lisa M Shackelton, Julie Remillard, Peter De Cruz, Miguel Regueiro, Siddharth Singh, Ryan W Stidham, Marjolijn Duijvestein, Geert R D'Haens, Laurent Peyrin-Biroulet, Silvio Danese, Bruce E Sands, Remo Panaccione, Brian G Feagan, Vipul Jairath, Christopher Ma","doi":"10.1016/j.cgh.2025.08.021","DOIUrl":"10.1016/j.cgh.2025.08.021","url":null,"abstract":"<p><strong>Background & aims: </strong>Assessing endoscopic activity is integral in the management of postoperative Crohn's disease (CD). We aimed to comprehensively characterize the reliability and responsiveness of different endoscopic instruments when used to assess postoperative CD activity.</p><p><strong>Methods: </strong>Ileocolonoscopy videos (n = 70) from the PREVENT (Prospective, Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial Comparing REMICADE ® [infliximab] and Placebo in the Prevention of Recurrence in Crohn's Disease Patients Undergoing Surgical Resection Who Are at an Increased Risk of Recurrence) trial were reviewed by 3 blinded central readers. Disease activity was assessed using the Rutgeerts and modified Rutgeerts scores, POCER (postoperative Crohn's endoscopic recurrence) index, REMIND (groupe de REcherche sur les Maladies INflammatoires Digestives) score, Simple Endoscopic Score for Crohn's Disease (SES-CD), and the Crohn's Disease Endoscopic Index of Severity (CDEIS). Reliability was quantified by the intraclass correlation coefficient (ICC). Responsiveness was quantified using the win probability (WinP) defined as the probability that a patient in the treatment (infliximab) group had a better score than a patient in the placebo group. The neoterminal ileum, anastomosis, and distal colon were scored separately.</p><p><strong>Results: </strong>Interrater reliability was substantial for the Rutgeerts and modified Rutgeerts scores, ileal REMIND score, SES-CD, and CDEIS (ICC 0.74-0.80), moderate for the POCER index (ICC 0.49), and fair for the anastomotic REMIND score (ICC 0.30). A large degree of responsiveness was observed for the Rutgeerts and modified Rutgeerts scores, ileal REMIND score, SES-CD, and CDEIS (WinP 0.75-0.83). The degree of responsiveness for the POCER index and the anastomotic REMIND score was small (WinP 0.54 and 0.53, respectively). Estimates of index reliability and responsiveness were consistently lower when assessed at the anastomosis or distal colonic segment compared with the neoterminal ileum.</p><p><strong>Conclusions: </strong>Existing endoscopic indices are reliable and responsive for assessing postoperative CD activity in the neoterminal ileum, although are suboptimal for evaluation in the anastomosis or distal colonic segment.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999853","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":"Defining Noninvasive Criteria for Indicating Drug Therapy in Metabolic dysfunction-associated Steatotic Liver Disease in Clinical Practice.","authors":"Antonio Olveira, Javier Crespo, Luis Ibañez-Samaniego, Rocío Gallego-Durán, Jose Luis Calleja, Rocío Aller, Anna Soria, Judith Gómez-Camarero, Rosa Martín-Mateos, Salvador Benlloch, Juan M Pericàs, Rosa María Morillas, Vanesa Bernal-Monterde, Moisés Diago, Juan Turnes, Maria Poca, Oreste Lo Iacono, Douglas Maya-Miles, Desamparados Escudero, Raúl J Andrade, José Miguel Rosales, Francisco Jorquera, Conrado Fernández-Rodríguez, Manuel Hernández-Guerra, Manuel Romero-Gómez, Javier Ampuero","doi":"10.1016/j.cgh.2025.08.023","DOIUrl":"10.1016/j.cgh.2025.08.023","url":null,"abstract":"<p><strong>Background & aims: </strong>Resmetirom is the first Food and Drug Administration-approved drug for metabolic dysfunction-associated liver disease (MASLD) in F2 and F3 patients with steatohepatitis. Noninvasive criteria have been proposed for initiating treatment; however, these have not been validated in clinical practice. We validated the proposed criteria and established new guidelines for initiating resmetirom treatment in clinical practice.</p><p><strong>Methods: </strong>This was a cross-sectional study of 1281 MASLD patients from the HEPAmet registry with biopsy, comorbidity assessment, analytical profile, and elastography. Identification of MASLD with F2 and F3 was the main endpoint. A comprehensive review of international guidelines and expert consensus up to November 2024, focusing on therapeutic indications, was conducted.</p><p><strong>Results: </strong>A total of 38% (n = 486 of 1281) of patients were diagnosed with MASLD F2 and F3 based on biopsy. However, only 39% and 56% of them met treatment eligibility criteria according to the Expert Panel Criteria and the American Association for the Study of Liver Diseases Practice Guidance, respectively. They included 45% of patients with early-stage fibrosis. False positive and false negative rates ranged from 23% to 41% and 44% to 60%, respectively, with area under the receiver-operating characteristic curve values below 0.60.These findings were validated in an external cohort. A two-step strategy, first selecting patients with Fibrosis-4 (FIB-4) ≥1.30, or with diabetes and overweight if FIB-4 <1.30, followed by a liver stiffness between 8 and 25 kPa, demonstrated higher positive (55%) and negative predictive values (77%) and higher area under the receiver-operating characteristic curve (0.67).This approach successfully identified 74% of the target population.</p><p><strong>Conclusions: </strong>The diagnostic performance and reliability of the proposed noninvasive criteria for initiating resmetirom treatment were suboptimal. About the half of patients with indication would not receive treatment under these criteria. A new strategy, using FIB-4, the presence of diabetes and overweight, and liver stiffness improved the identification of MASLD patients with F2 and F3.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999858","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":"Insufficiency of Wearables for Sleep Stage Assessment.","authors":"Alex Barnes, Réme Mountifield","doi":"10.1016/j.cgh.2025.08.022","DOIUrl":"10.1016/j.cgh.2025.08.022","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999882","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 Consensus Statement on the Management of Pregnancy in Inflammatory Bowel Disease","authors":"Uma Mahadevan ,&nbsp;Cynthia H. Seow ,&nbsp;Edward L. Barnes ,&nbsp;María Chaparro ,&nbsp;Emma Flanagan ,&nbsp;Sonia Friedman ,&nbsp;Mette Julsgaard ,&nbsp;Sunanda Kane ,&nbsp;Siew Ng ,&nbsp;Joana Torres ,&nbsp;Gillian Watermeyer ,&nbsp;Jesus Yamamoto-Furusho ,&nbsp;Christopher Robinson ,&nbsp;Susan Fisher ,&nbsp;Phil Anderson ,&nbsp;Richard Gearry ,&nbsp;Dana Duricova ,&nbsp;Marla Dubinsky ,&nbsp;Millie Long ,&nbsp;Lindsay Rous","doi":"10.1016/j.cgh.2025.04.005","DOIUrl":"10.1016/j.cgh.2025.04.005","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Pregnancy can be a complex and risk-filled event for women with inflammatory bowel disease (IBD). High-quality studies in this population are lacking, with limited data on medications approved to treat IBD during pregnancy. For patients, limited knowledge surrounding pregnancy impacts pregnancy rates, medication adherence, and outcomes. Limited provider knowledge leads to highly varied practices in care affected by local dogma, available resources, individual interpretation of the literature, and fear of harming the fetus. The variations in guidelines by different societies and countries reflect this and lead to confusion for physicians and patients alike. The Global Consensus Consortium is a group of 39 IBD and content experts and 7 patient advocates from 6 continents who convened to review and assess current data and come to an agreement on best practices based on these data.</div></div><div><h3>Methods</h3><div>The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) process was used when sufficient published data were available and the RAND (Research and Development) process in those instances where expert opinion was needed to guide consistent practice. Recommendations were informed by the guiding principle that maternal health best supports infant health.</div></div><div><h3>Results</h3><div>The topics were divided into ten categories with 34 GRADE recommendations and 35 consensus statements.</div></div><div><h3>Conclusions</h3><div>Overall, the goal of the group was to provide data-driven and practical guidance to improve the care of women with IBD around the globe based on the best available research.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 11","pages":"Pages S1-S60"},"PeriodicalIF":12.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945262","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":"High-resolution Manometry in Treated Achalasia: Scoping Review and Novel Nomenclature.","authors":"Alberto Barchi, C Prakash Gyawali, John Pandolfino, Gwen M C Masclee, Niek Warringa, Edoardo Vespa, Edoardo V Savarino, Renato Salvador, Sabine Roman, Dustin A Carlson, Rena Yadlapati, Albert J Bredenoord","doi":"10.1016/j.cgh.2025.08.020","DOIUrl":"10.1016/j.cgh.2025.08.020","url":null,"abstract":"<p><strong>Background & aims: </strong>Chicago Classification (CC) for high-resolution manometry (HRM) is the standard for diagnostic criteria of primary motility disorders, achalasia being the most relevant. CC does not include recommendations on HRM in treated achalasia, either after surgery or endoscopic interventions.</p><p><strong>Methods: </strong>After systematic review of literature on 3 major databases (Pubmed/MEDLINE, Embase, Web of Science) from inception to December 2024, a group of 12 esophageal motility experts provided recommendations for HRM interpretation in treated achalasia and proposed novel nomenclature and management flowchart to address gaps in diagnostic CC hierarchy.</p><p><strong>Results: </strong>The search yielded 40 articles on HRM in treated achalasia. Unsuccessful achalasia treatment results in high-integrated relaxation pressure (IRP) and obstructive features especially on provocative maneuvers. We propose the term treated achalasia with outflow obstruction (TAOO) instead of achalasia. Conversely, the term adequately treated achalasia (ATA) is suggested in the absence of obstructive features, instead of absent contractility or ineffective motility, which could be misleading. We propose an IRP cutoff of the upper limit of normal according HRM system utilized, similar to that recommended for the naïve sphincter by CC to describe incomplete sphincter relaxation despite treatment. Intrabolus pressurization and abnormal IRP on rapid drink challenge (RDC) are additional obstructive features. Assessment of body contractility, either ineffective (<450 mmHg.cm.s) or spastic (<4.5 sec), is relevant to disease profiling. HRM combined with impedance represents a valuable tool to assess esophageal emptying.</p><p><strong>Conclusions: </strong>This scoping review with expert recommendations provides guidance for HRM interpretation in treated achalasia and introduces novel descriptive terms to describe pathophysiology following achalasia treatment. Conventional CC should not be used in treated achalasia description.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945281","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":"Virtual Reality Application in Hospitalized Patients with Decompensated Cirrhosis: A Feasibility Pilot Study.","authors":"Kathryn A Schmidt, Alberto Calleri, Kamalpreet S Hara, Xiao Jing Iris Wang, Douglas A Simonetto","doi":"10.1016/j.cgh.2025.08.018","DOIUrl":"10.1016/j.cgh.2025.08.018","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945362","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 Belzutifan on Pancreatic Cystic Lesions and Neuroendocrine Tumors in Patients With Von Hippel-Lindau Disease.","authors":"Hamza Ahmed Chaudhry, Shantanu Solanki, Sireesha Yedururi, Suresh T Chari","doi":"10.1016/j.cgh.2025.08.016","DOIUrl":"10.1016/j.cgh.2025.08.016","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945248","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":"International Magnetic Resonance Imaging Consensus for use in Luminal Crohn's Disease Trials and Clinical Practice.","authors":"Bénédicte Caron, Vipul Jairath, Bruce E Sands, David T Rubin, Mariangela Allocca, Valérie Laurent, Kerri Novak, Remo Panaccione, Peter Bossuyt, David H Bruining, Axel Dignass, Iris Dotan, Joel Fletcher, Mathurin Fumery, Federica Furfaro, Jonas Halfvarson, Ailsa Hart, Taku Kobayashi, Noa Krugliak Cleveland, Torsten Kucharzik, Andrea Laghi, Peter L Lakatos, Rupert W Leong, Edward V Loftus, Edouard Louis, Fernando Magro, Pablo A Olivera, Sebastien Shaji, Britta Siegmund, Stephan R Vavricka, Silvio Danese, Jaap Stoker, Laurent Peyrin-Biroulet","doi":"10.1016/j.cgh.2025.08.019","DOIUrl":"10.1016/j.cgh.2025.08.019","url":null,"abstract":"<p><strong>Background & aims: </strong>Cross-sectional imaging is an integral part of evaluating disease activity and complications in Crohn's disease. There remains a need to develop guidance that may be for both clinical trials and clinical practice. This initiative aimed to develop consensus statements for definitions of response and remission, transmural healing, optimal timing for assessing, and evaluation of treatment efficacy in patients with Crohn's disease using magnetic resonance enterography in clinical trials and clinical practice.</p><p><strong>Methods: </strong>Thirty-three international experts (gastroenterologists [n = 29] and radiologists [n = 4] participated in a consensus process. A systematic literature review was conducted to inform initial consensus, and statements were discussed and voted on using a modified Delphi method. Consensus was defined as at least 75% agreement among voters.</p><p><strong>Results: </strong>The Magnetic Resonance Index of Activity (MaRIA) score and the simplified MaRIA score should be used to determine response and remission in moderate-to-severe Crohn's disease. Response was defined as a MaRIA score <11 or an improvement of at least 25%, and a decrease of at least 1 point in the simplified MaRIA score. Remission was defined as a MaRIA score <7 or a simplified MaRIA score <1. Five different definitions were proposed for transmural healing. For the time point of assessment, the group proposed week 24 for response; weeks 24, 52, or 54 for remission; and weeks 52 or 104 for transmural healing.</p><p><strong>Conclusions: </strong>A consensus expert panel has developed standardized definitions of magnetic resonance enterography response, remission, and the optimal timing for response assessment in patients with luminal Crohn's disease. Further research is needed to clarify the method for measuring transmural healing.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":12.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945203","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}