Clinical Gastroenterology and Hepatology最新文献

{"title":"Reply.","authors":"Patrick W Chang, James L Buxbaum, Ara B Sahakian","doi":"10.1016/j.cgh.2024.06.034","DOIUrl":"10.1016/j.cgh.2024.06.034","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"190-191"},"PeriodicalIF":11.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141598779","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":"Ustekinumab and Vedolizumab Safety and Clearance in Pregnancy With Inflammatory Bowel Disease: Stop the Disease, Not the Drug!","authors":"Joana Torres, Uma Mahadevan","doi":"10.1016/j.cgh.2024.06.005","DOIUrl":"10.1016/j.cgh.2024.06.005","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"28-30"},"PeriodicalIF":11.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141327276","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":"Trainee Participation and Outcomes in High-risk Endoscopic Retrograde Cholangiopancreatography: A Secondary Analysis of the Stent Versus Indomethacin Trial.","authors":"Sachin Wani, Jingwen Zhang, Lydia D Foster, Valerie Durkalski-Mauldin, B Joseph Elmunzer","doi":"10.1016/j.cgh.2024.06.046","DOIUrl":"10.1016/j.cgh.2024.06.046","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"175-178.e2"},"PeriodicalIF":11.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874348","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":"Racial, Ethnic, and Geographic Disparities in Digestive Diseases Mortality in the United States, 2000-2019.","authors":"Wafa A Aldhaleei, Michael B Wallace, Yan Bi, Ann M Rusk, Akshaya Srikanth Bhagavathula","doi":"10.1016/j.cgh.2024.07.035","DOIUrl":"10.1016/j.cgh.2024.07.035","url":null,"abstract":"<p><strong>Background and aims: </strong>The global burden of digestive diseases mortality has been increasing over the last 3 decades. However, little is known about disparities in digestive diseases-specific mortality in the United States. This study aimed to examine racial, ethnic, and state- and county-level disparities in digestive diseases mortality rate in the United States between 2000 and 2019.</p><p><strong>Methods: </strong>We used the Institute of Health Metrics and Evaluation Global Health Data Exchange to gather digestive diseases age-standardized mortality rates for 5 racial and ethnic groups (White, Black, Latino, American Indian/Alaska Native [AI/AN], and Asian/Pacific Islander [API]) by sex, state, and county between 2000 and 2019. We used joinpoint regression analysis to evaluate the overall temporal trends by demography.</p><p><strong>Results: </strong>The overall cause-specific mortality rate decreased from 36.0 to 34.5 deaths per 100,000 population across all groups (2000-2019). In 2019, AI/AN individuals had the highest mortality rate (86.2), followed by White (35.5), Latino and Black (both at 33.6), and API (15.6) individuals. Significant increases occurred across some of the racial and ethnic groups, with an increased average annual percentage change for 2000-2019 among AI/AN (0.87%; 95% confidence interval, 0.77%-0.97%) and White individuals (0.12%; 95% confidence interval, 0.02%-0.22%) particularly among females, while Latino, Black, and API individuals showed reduced average annual percentage change for 2000-2019. AI/AN constitutes the main race affected in the top 10 counties. Substantial state-level variation emerged, with the highest mortality rates in 2019 seen in West Virginia.</p><p><strong>Conclusions: </strong>Despite an overall decrease in digestive diseases mortality, significant disparities persist across racial and ethnic groups. AI/AN and White individuals experienced increased mortality rates, particularly among females. Targeted interventions and further research are needed to address these disparities and improve digestive health equity.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":"59-68.e16"},"PeriodicalIF":11.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104964","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":"Bouveret Syndrome Treated With Endoscopic Lithotripsy and Gallbladder Access via Cholecysto-duodenal Fistula.","authors":"Dexin Chen, Yaqi Zhai, Mingyang Li","doi":"10.1016/j.cgh.2024.10.038","DOIUrl":"10.1016/j.cgh.2024.10.038","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913880","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":"Modified Crohn's Disease Exclusion Diet Maintains Remission in Pediatric Crohn's Disease; Randomized Controlled Trial.","authors":"Rotem Sigall Boneh, Víctor Manuel Navas-López, Séamus Hussey, Gemma Pujol-Muncunill, Sally Lawrence, Helena Rolandsdotter, Anthony Otley, Javier Martín-de-Carpi, Lee Abramas, Marta Herrador-López, Natalia Egea Castillo, Min Chen, Michelle Hurley, Kirsten Wingate, Ola Olen, Tintin Eurenius Rääf, Michal Yaakov, Nicolette Wierdsma, Johan Van Limbergen, Eytan Wine","doi":"10.1016/j.cgh.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.cgh.2024.12.006","url":null,"abstract":"<p><strong>Background & aims: </strong>The Crohn's Disease (CD) Exclusion Diet (CDED)+Partial Enteral Nutrition (PEN) is effective for inducing remission in mild-moderate CD. We assessed whether a 2-week course of Exclusive Enteral Nutrition (EEN), followed by CDED+PEN is superior to 8 weeks of EEN in sustaining clinical remission at week 14 in mild-to-severe CD and if CDED+PEN can maintain remission to week 24.</p><p><strong>Methods: </strong>This international, multicenter, randomized-controlled trial compared 2-weeks of EEN (Modulen®IBD) followed by 3 phases of the CDED+PEN (henceforth CDED) to 8 weeks of EEN, followed by PEN with free diet up to week 24 (henceforth EEN).</p><p><strong>Results: </strong>Out of 64 eligible patients, 56 were randomized (target recruitment failed due to the COVID-19 pandemic, leading to an underpowered study); 30 patients to CDED and 26 to EEN. The primary endpoint at week 14 showed no significant difference between the groups, with sustained corticosteroid-free remission in 21/30(70%) for CDED compared to 16/26(61.5%) for EEN, (p=0.5). At week 8, clinical remission was achieved in 23/30(77%) of CDED versus 14/26(54%) of EEN patients (p=0.07), and 18/30(60%) of CDED versus 11/26(42%) of EEN patients maintained clinical remission to week 24 (p=0.18). BMI Z-score significantly improved in the CDED group but not in EEN group.</p><p><strong>Conclusions: </strong>The study was underpowered to show whether CDED was superior to EEN in sustaining remission. However, two weeks of EEN followed by CDED was effective in inducing remission in CD, with most CDED patients maintaining remission up to 24 weeks. Despite dietary restrictions for 24 weeks, the BMI Z-score improved significantly in the CDED group but not in the EEN group (NCT02843100).</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892324","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":"Differential Efficacy of Advanced Therapies in Inducing Remission in Ulcerative Colitis Based on Prior Exposure to TNF Antagonists.","authors":"Han Hee Lee, Virginia Solitano, Sujay Singh, Ashwin N Ananthakrishnan, Vipul Jairath, Gaurav Syal, Brigid S Boland, Pradipta Ghosh, John T Chang, Siddharth Singh","doi":"10.1016/j.cgh.2024.12.007","DOIUrl":"10.1016/j.cgh.2024.12.007","url":null,"abstract":"<p><strong>Background and aims: </strong>We sought to ascertain how prior exposure to tumor necrosis factor (TNF) antagonists impacts treatment response with various classes of advanced therapies in patients with ulcerative colitis (UC), through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>Through a systematic review of multiple databases through June 30, 2024, we identified 17 randomized controlled trials in 8871 adults with moderate-severe UC who were treated with different advanced therapies vs placebo, and reported efficacy in induction of clinical remission, stratified by prior exposure to TNF antagonists. We calculated the ratio of odds ratio of achieving remission with active drug vs placebo, in TNF antagonist-naïve vs TNF antagonist-exposed patients. We grouped advanced therapies based on primary mechanism of action: lymphocyte trafficking inhibitors (anti-integrins and sphingosine-1 phosphate [S1P] receptor modulators), anti-interleukins (interleukin-12/23 antagonist and selective interleukin-23 antagonists) and Janus kinase inhibitors.</p><p><strong>Results: </strong>Lymphocyte trafficking inhibitors were more efficacious in TNF antagonist-naïve vs exposed patients (5 trials; odds ratio [OR], 1.88; 95% confidence interval [CI], 1.02-3.49), whereas JAK inhibitors were less efficacious in TNF antagonist-naïve vs exposed patients (6 trials; ratio of OR, 0.47; 95% CI, 0.22-1.01). No significant difference was observed in efficacy of selective interleukin-23 antagonists vs placebo in TNF antagonist-naïve vs exposed patients (6 trials; ratio of OR, 1.07; 95% CI, 0.64-1.80). There was minimal heterogeneity across analyses.</p><p><strong>Conclusion: </strong>There is significant heterogeneity of treatment efficacy with different advanced therapies in inducing remission in patients with UC based on prior exposure to TNF antagonists, with plausible potentiation of JAK inhibitors and attenuation of lymphocyte trafficking inhibitors. Future studies on the mechanistic basis for these observations are warranted.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892322","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":"Incidence of Hepatobiliary Malignancies in Primary Sclerosing Cholangitis: Systematic Review and Meta-analysis.","authors":"Matheus Souza, Luan C V Lima, Lubna Al-Sharif, Daniel Q Huang","doi":"10.1016/j.cgh.2024.09.037","DOIUrl":"10.1016/j.cgh.2024.09.037","url":null,"abstract":"<p><strong>Background & aims: </strong>Primary sclerosing cholangitis (PSC) is a known risk factor for hepatobiliary malignancies. We conducted a systematic review and meta-analysis of published studies to determine the incidence and risk factors for hepatobiliary malignancies in people with PSC.</p><p><strong>Methods: </strong>Pubmed and Embase databases were searched from inception to April 10, 2024, for cohort studies reporting data on the incidence of cholangiocarcinoma (CCA), hepatocellular carcinoma (HCC), or gallbladder cancer (GBC) in PSC. Pooled incidence rates with 95% confidence intervals (CIs) were estimated using a random effects model.</p><p><strong>Results: </strong>We identified 51 eligible studies involving 26,482 patients. The total follow-up was 221,258.1 person-years (PYs). The pooled incidence rates for overall PSC were 9.31 (95% CI, 6.84-12.67; I² = 74%), 1.73 (95% CI, 1.20-2.51; I² = 55%), and 1.06 (95% CI, 0.85-1.31; I² = 0%) per 1000 PYs for CCA, HCC, and GBC, respectively. In patients with PSC with inflammatory bowel disease (IBD), rates were 7.16 (95% CI, 4.48-11.44; I² = 96%), 2.19 (95% CI, 1.48-3.25; I² = 58%), and 1.52 (95% CI, 1.21-1.90; I² = 0%) per 1000 PYs, respectively. Subgroup analysis showed that the incidence of CCA was higher in smaller studies (<200 patients), and the incidence of HCC varied significantly by region (P = .03), with Oceania having the highest incidence and Europe having the lowest. Meta-regression determined that PSC-IBD was associated with HCC incidence.</p><p><strong>Conclusion: </strong>The incidence of CCA in PSC is substantial, whereas HCC and GBC are rare. Patients with PSC-IBD may be at higher risk for HCC. These data should be validated in large, prospective studies, and may guide the development of evidence-based surveillance strategies for hepatobiliary malignancies in PSC.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871509","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":"Resolution of Metabolic Dysfunction-associated Steatohepatitis With No Worsening of Fibrosis After Bariatric Surgery Improves 15-year Survival: A Prospective Cohort Study.","authors":"Guillaume Lassailly, Robert Caiazzo, Armelle Goemans, Mikael Chetboun, Viviane Gnemmi, Julien Labreuche, Gregory Baud, Helene Verkindt, Camille Marciniak, Naima Oukhouya-Daoud, Line-Carolle Ntandja-Wandji, Massih Ningarhari, Emmanuelle Leteurtre, Violeta Raverdy, Sébastien Dharancy, Alexandre Louvet, François Pattou, Philippe Mathurin","doi":"10.1016/j.cgh.2024.10.025","DOIUrl":"10.1016/j.cgh.2024.10.025","url":null,"abstract":"<p><strong>Background & aims: </strong>The aim of this study was to investigate the consequences of the histological progression of metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis on long-term survival after bariatric surgery.</p><p><strong>Methods: </strong>From 1994 to 2021, 3028 patients at the University Hospital of Lille were prospectively included. Baseline liver biopsies were systematically performed with proposed follow-up biopsies 1 year after surgery, mainly in patients with MASH. We evaluated the association of the baseline and 1-year histologic progression of MASH and fibrosis status and long-term survival using Cox regression models.</p><p><strong>Results: </strong>At baseline, 2641 patients (89%) had a biopsy, including 232 with MASH (8.7%) and 266 (10.8%) with significant fibrosis (grade F2-F4). The median follow-up was 10.1 years. At 1 year, 594 patients had qualitative paired biopsies. Survival was shorter at the 15-year follow-up in patients with baseline MASH, than in those without (hazard ratio [HR], 2.21; 95% confidence interval [CI], 1.38-3.53) and in F2 to F4 than in F0 to F1 (HR, 3.38; 95% CI, 2.24-5.10). At the 1-year landmark analysis, compared with patients without baseline MASH, mortality increased in those with persistent MASH and/or if fibrosis worsened (adjusted HR, 2.54; 95% CI, 1.06-6.10), but not if MASH resolved without the worsening of fibrosis (adjusted HR, 0.73; 95% CI, 0.28-1.87). Similarly, compared with patients without significant fibrosis at baseline, patients with persistent significant fibrosis had increased mortality (adjusted HR, 4.03; 95% CI, 1.86-8.72) but not if fibrosis improved from F2 to F4 to F0 to F1 (adjusted HR; 1.49; 95% CI, 0.52-4.24).</p><p><strong>Conclusion: </strong>Histologic remission of MASH or significant fibrosis improves survival after bariatric surgery.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871510","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":"Inadequate Efficacy of Biologics for Treating Proximal Ileal Lesions in Crohn's Disease; A Prospective Multicenter Study.","authors":"Kento Takenaka, Tadakazu Hisamatsu, Taku Kobayashi, Hironori Yamamoto, Naoki Ohmiya, Ryohei Hayashi, Katsuyoshi Matsuoka, Masayuki Saruta, Akira Andoh, Norimasa Fukata, Kenji Watanabe, Hiroyuki Imaeda, Fumihito Hirai, Takayuki Matsumoto, Akihiro Hirakawa, Tomonori Yano, Minoru Matsuura, Ryuichi Okamoto, Kazuo Ohtsuka, Mamoru Watanabe","doi":"10.1016/j.cgh.2024.10.030","DOIUrl":"10.1016/j.cgh.2024.10.030","url":null,"abstract":"<p><strong>Background & aims: </strong>Although biologic therapy has revolutionized the treatment of Crohn's disease (CD), surgery remains unavoidable in cases involving ileal complications. We aimed to evaluate the efficacy of biologics on proximal ileal lesions using balloon-assisted enteroscopy (BAE).</p><p><strong>Methods: </strong>This open-label multicenter prospective study was conducted at tertiary referral centers in Japan. We enrolled 253 patients with active ileal CD who were treated with biologics (infliximab/adalimumab/ustekinumab/vedolizumab). BAE was performed at week 0 and week 26, and endoscopic findings were centrally assessed. We evaluated the rate of endoscopic remission (defined as having a maximum modified Simple Endoscopic Score for Crohn's disease <4) at week 26 and patient prognosis (CD-related hospitalization and surgery).</p><p><strong>Results: </strong>At baseline, 74 patients (29.2%) had proximal ileal ulcerations without terminal ileal ulcerations. The second BAE showed that endoscopic remission was achieved in 91 patients (36.0%). Of the patients with complete ulcer healing of the terminal ileum, 28.6% (22/77) had residual ulcers in the proximal ileum. The rate of endoscopic remission in the proximal ileum (50.9%) was relatively lower compared with the colon (63.4%) and terminal ileum (56.7%), a trend consistently observed across all treatment agents. After a median follow-up of 134 weeks, residual ulcerations in the proximal ileum were associated with a poorer prognosis (P = .0126 for hospitalization and P = .0014 for surgery).</p><p><strong>Conclusions: </strong>A substantial proportion of patients with CD exhibited ulcerations in the proximal ileum, which correlated with a poorer prognosis. These lesions proved challenging to heal, regardless of the type of biologic used.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853263","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}