Clinical Gastroenterology and Hepatology最新文献

{"title":"Dysphagia Megalatriensis.","authors":"Zehra Naseem, Arjun Chatterjee, Yi Qin","doi":"10.1016/j.cgh.2024.08.050","DOIUrl":"10.1016/j.cgh.2024.08.050","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496259","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":"Calibration, Clinical Utility, and Specificity of Clinical Decision Support Tools in Inflammatory Bowel Disease.","authors":"Dahham Alsoud, João Sabino, Marc Ferrante, Bram Verstockt, Séverine Vermeire","doi":"10.1016/j.cgh.2024.09.020","DOIUrl":"10.1016/j.cgh.2024.09.020","url":null,"abstract":"<p><strong>Background & aims: </strong>Clinical decision support tools (CDSTs) have been developed to predict response to vedolizumab (VDZ) and ustekinumab (UST) in Crohn's disease (CD) and ulcerative colitis (UC). In addition to assessing their discrimination performance, our study aimed to evaluate their calibration, clinical utility, and specificity.</p><p><strong>Methods: </strong>We included 280 patients with CD and 218 patients with UC initiating VDZ, and 194 patients with CD initiating UST. We assessed discrimination by comparing rates of effectiveness outcomes between response probability groups forecasted by CDSTs. Calibration curves and decision curve analysis evaluated the calibration and clinical utility of VDZ-CDSTs. Additionally, we examined the agreement between UST-CDST and VDZ-CDST in assigning response probability groups among patients with CD starting UST.</p><p><strong>Results: </strong>In the overall cohort, CDSTs allocated 7.2%, 50.0%, and 42.8% of the patients to the low-, intermediate-, and high-response probability groups, respectively. VDZ-CDSTs groups demonstrated significant differences in the rates of clinical and endoscopic response and remission, whereas UST-CDST groups showed significant discrimination only for clinical remission. Although VDZ-CDSTs overestimated clinical remission rates, they more accurately predicted rates of VDZ persistence without need for surgery or dose escalation. Compared with empirically treating all patients with VDZ, VDZ-CDSTs yielded higher net benefits in selecting patients who would continue VDZ without need for surgery or dose escalation. Finally, the agreement between UST-CDST and VDZ-CDST in predicting response was 73.7%.</p><p><strong>Conclusion: </strong>VDZ-CDSTs significantly discriminated response to VDZ and were more beneficial in identifying patients who would continue therapy without requiring surgery or dose escalation, compared with treating all patients empirically.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496258","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":"Hepatitis Delta Virus Testing and Prevalence Among Chronic Hepatitis B Patients Across Three U.S. Safety-net Health Systems.","authors":"Robert J Wong, Mamta K Jain, Bolin Niu, Yi Zhang, George Therapondos, Mae Thamer","doi":"10.1016/j.cgh.2024.09.025","DOIUrl":"10.1016/j.cgh.2024.09.025","url":null,"abstract":"<p><strong>Background & aims: </strong>Despite a high prevalence of risk factors associated with hepatitis delta virus (HDV) infection among safety-net populations, data evaluating HDV testing and prevalence are limited. We aim to evaluate HDV testing practices and HDV prevalence among an ethnically diverse, multi-center cohort of safety-net patients with chronic hepatitis B (CHB).</p><p><strong>Methods: </strong>We retrospectively evaluated 13,218 patients with CHB (54.2% male, 57.9% non-White minorities, 12.5% human immunodeficiency virus, and 23.0% hepatitis C virus) across 3 United States safety-net health systems from 2010 to 2022 to evaluate proportion tested for HDV and proportion positive among those tested. Adjusted multivariate logistic regression models evaluated for predictors of HDV testing and predictors of anti-HDV positive.</p><p><strong>Results: </strong>Anti-HDV testing was performed in 6.1% overall and in 4.9% that met American Association for the Study of Liver Diseases criteria for HDV testing. Greater odds of testing were observed in men vs women (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.27-1.75), Asian individuals vs White individuals (OR, 2.18; 95% CI, 1.74-2.72), Black/African American individuals vs White individuals (OR, 1.29; 95% CI, 1.07-1.56), and patients with Medicare or Medicaid. Among patients with CHB tested for HDV, 15.7% were positive (22.9% among those meeting American Association for the Study of Liver Diseases HDV testing criteria). Only 2 patients (1.6%) had follow-up HDV RNA testing. Greater proportion of anti-HDV positive was observed in patients with baseline cirrhosis (47.4% vs 13.3%; P < .001), and patients with Medicare or Medicaid vs those with commercial insurance.</p><p><strong>Conclusions: </strong>Among an ethnically diverse, multi-center safety-net cohort of patients with CHB, low rates of HDV testing were observed, even among those with high-risk HDV risk factors. Among those tested, 15.7% were positive, only 2 had follow up RNA testing. This highlights the need for greater awareness, education, and advocacy to improve HDV testing rates.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496264","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":"Trauma-Informed Care in Gastroenterology: A Survey of Provider Attitudes, Knowledge, and Skills.","authors":"Christina Tsai, Sara Abdelhalim, Serre-Yu Wong, Xianhong Xie, Manasi Agrawal, Laurie A Keefer","doi":"10.1016/j.cgh.2024.09.015","DOIUrl":"10.1016/j.cgh.2024.09.015","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496277","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":"Patients with Inflammatory Bowel Disease are at Increased Risk for Complications of Herpes Zoster.","authors":"Freddy Caldera, Siddharth Singh, Emily E Zona, Oscar Ramirez Ramirez, Jonathan Inselman, Herbert Heien, Andrew P Keaveny, Mary S Hayney, Francis A Farraye","doi":"10.1016/j.cgh.2024.09.022","DOIUrl":"10.1016/j.cgh.2024.09.022","url":null,"abstract":"<p><strong>Background & aims: </strong>Patients with inflammatory bowel disease (IBD) are at an increased risk for vaccine-preventable diseases, such as herpes zoster (HZ). The aim of this study was to determine whether complications of HZ are more frequent in patients with IBD than in non-IBD controls.</p><p><strong>Methods: </strong>This was a retrospective, cohort study using the Optum Research Database. Patients with IBD were matched 1:1 to non-IBD controls based on age, sex, and index year, which was defined as the diagnosis of HZ. We then identified the complications of HZ that occurred up to 90 days after the index date. We compared patients with IBD with non-IBD controls and evaluated the 90-day risk of HZ complications. We used a composite primary outcome for any HZ complication. Secondary outcomes were risk factors for complications.</p><p><strong>Results: </strong>A total of 4756 patients with IBD met the inclusion criteria and were matched to the controls. Patients with IBD were more likely to have complications of HZ than controls (738 [15.52%] vs 595 [12.51%]; P < .0001). Patients with IBD with higher comorbidity scores were more likely to develop complications (1.86 vs 1.18; P < .0001). In the logistic regression analysis of patients with IBD having a higher comorbidity score, above 50 years of age, on anti-tumor necrosis factor (TNF) or corticosteroids were all at increased risk of a complication of HZ.</p><p><strong>Conclusion: </strong>Patients with IBD are more likely to have complications of HZ than controls. Efforts are needed to increase HZ vaccine uptake to reduce the morbidity of HZ.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496272","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":"Authors' Reply to the Letter to the Editor.","authors":"Sung Won Chung, Won-Mook Choi","doi":"10.1016/j.cgh.2024.09.024","DOIUrl":"10.1016/j.cgh.2024.09.024","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496257","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":"Hepatitis D Virus Infection Markedly Increases the Risk of Hepatocellular Carcinoma in Patients with Viral B Cirrhosis.","authors":"Dominique Roulot, Richard Layese, Ségolène Brichler, Nathalie Ganne, Tarik Asselah, Fabien Zoulim, Emmanuel Gordien, Pierre Nahon, Françoise Roudot-Thoraval","doi":"10.1016/j.cgh.2024.08.046","DOIUrl":"10.1016/j.cgh.2024.08.046","url":null,"abstract":"<p><strong>Background & aims: </strong>The specific causative role of hepatitis delta virus (HDV) infection in the development of hepatocellular carcinoma (HCC) remains debated and was not specifically demonstrated in patients with cirrhosis. Here we compared HCC incidence in hepatitis B virus (HBV)-HDV coinfected and HBV monoinfected patients with cirrhosis.</p><p><strong>Methods: </strong>A total of 142 HBV-HDV and 271 HBV-infected patients with cirrhosis from the French ANRSCO12 CirVir and DeltaVir cohorts, with histologically proven cirrhosis and no history of decompensation, were included in the study.</p><p><strong>Results: </strong>HBV-HDV patients were younger than HBV patients (37.2 vs 53.8 years), they were more often immigrants from sub-Saharan Africa, and displayed less comorbidities and more altered liver tests. After adjustment for age, cumulative incidences of HCC in coinfected and monoinfected patients at 1, 3, and 5 years were 5.2%, 11.8%, and 20.2% versus 1.1%, 2.5%, and 4.4%, respectively (P < .001). In multivariate analysis, HDV infection was an independent factor associated with the development of HCC (hazard ratio [HR], 2.94; 95% confidence interval [CI], 1.19-7.25; P = .019). Other independent factors were age (HR, 1.08; 95% CI, 1.05-1.11; P < .001), overweight (HR, 0.45; 95% CI, 0.22-0.93; P = .031), smoking (HR, 2.26; 95% CI, 1.23-4.16; P = .009), increased γ-glutamyltransferase (HR, 2.73; 95% CI, 1.24-6.00; P = .013), total bilirubin >17 μmol/L (HR, 2.68; 95% CI, 1.33-5.42; P = .006), and platelet count <150.000/mm³ (HR, 3.11; 95% CI, 1.51-6.41; P = .002). HDV coinfection was not an independent factor of liver decompensation, transplantation, or death.</p><p><strong>Conclusions: </strong>The incidence of HCC seems significantly higher in HBV-HDV than in HBV-infected patients with cirrhosis. HDV infection emerges as an independent risk factor for HCC, indicating that in patients with cirrhosis, HDV plays a causative role for HCC independently of HBV.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496263","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":"Outpatient Intensive Nutrition Therapy Improves Survival and Frailty in Males With Alcohol-related ACLF - Randomized Controlled Trial.","authors":"Patal Giri, Sunil Taneja, Nancy Sahni, Harish Bhujade, B K Padhi, Tanka Karki, Pratibha Garg, Sahaj Rathi, Arka De, Nipun Verma, Madhumita Premkumar, Ajay Duseja","doi":"10.1016/j.cgh.2024.09.021","DOIUrl":"10.1016/j.cgh.2024.09.021","url":null,"abstract":"<p><strong>Background & aims: </strong>Improvement in the nutritional status of patients with acute-on-chronic liver failure (ACLF) may lead to reduction in morbidity and mortality. This study assessed the impact of dietician-supported outpatient intensive nutrition therapy (OINT) on survival and frailty in patients with alcohol-related ACLF METHODS: Seventy patients with alcohol-related ACLF (Asia Pacific Association for the Study of the Liver [APASL] criteria) and frailty were randomized 1:1 to receive standard medical therapy (SMT) plus OINT (intervention) vs SMT (control) alone. The primary outcome was an improvement in survival at 3 months. Secondary outcome measures included improvement in frailty, prognostic scores, and hospitalization.</p><p><strong>Results: </strong>There was a significant improvement in overall survival in the OINT group as compared with the SMT group after 3 months of follow up (91.4% [standard error (SE), 4.7%] vs 57.1% [SE, 8.4%]; P < .00). On Cox regression model, inclusion in the intervention arm, baseline skeletal muscle index (SMI), and APASL ACLF Research Consortium (AARC score) were independent predictors of survival (P < .05). The liver frailty index (LFI) score also significantly improved in the OINT as compared with SMT (Δ-0.93; 95% confidence interval, -0.71 to 1.13 vs Δ -0.33; 95% confidence interval, -0.44 to 0.72; P < .00). The disease severity including MELD, MELD-Na, and AARC score showed a significant improvement in the OINT group as compared with the SMT group (P < .05). The patients in OINT group had lesser number of hospitalizations 6 (17%) vs 16 (45.7%) (P = .01) as compared with the SMT group.</p><p><strong>Conclusion: </strong>Outpatient intensive nutrition therapy significantly improves survival, frailty, and disease severity with a reduction in number of hospitalizations and supports the key role of nutrition in treatment of patients with alcohol-related ACLF.</p><p><strong>Clinical trial registry number: </strong>ctri.nic.in/ CTRI/2022/01/039735.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496270","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 of Chronic Liver Disease in Cholangiocarcinoma: A Meta-Analysis.","authors":"Ethan Kai Jun Tham, Ryan Yanzhe Lim, Benjamin Koh, Darren Jun Hao Tan, Cheng Han Ng, Michelle Law, Elina Cho, Nicole Shu Ying Tang, Claire Shiying Tan, Benedix Kuan Loo Sim, En Ying Tan, Wen Hui Lim, Mei Chin Lim, Toru Nakamura, Pojsakorn Danpanichkul, Sakkarin Chirapongsathorn, Karn Wijarnpreecha, Hirokazu Takahashi, Asahiro Morishita, Ming-Hua Zheng, Alfred Kow, Mark Muthiah, Jia Hao Law, Daniel Q Huang","doi":"10.1016/j.cgh.2024.09.028","DOIUrl":"10.1016/j.cgh.2024.09.028","url":null,"abstract":"<p><strong>Background and aims: </strong>Chronic liver disease is a known risk factor for cholangiocarcinoma (CCA), but the proportion of people with CCA who have concurrent chronic liver disease is unclear. We aimed to evaluate the prevalence of chronic liver diseases in people with CCA.</p><p><strong>Methods: </strong>In this single-arm meta-analysis, we searched MEDLINE and EMBASE from inception to August 10, 2024, for articles in English containing data for CCA with and without chronic liver diseases. Data were pooled to obtain the prevalence of different chronic liver diseases, with further stratification by geographical location and tumor location.</p><p><strong>Results: </strong>In total, 118,068 individuals diagnosed with CCA were included, of whom 16,771 had chronic liver diseases. A pooled analysis of 109 studies determined that the prevalence of chronic liver disease was 25.23% (95% confidence interval [CI], 20.82%-30.23%; I² = 99.0%), and 10.21% (7.75%-13.35%; I² = 98.6%) of CCA patients had cirrhosis. Chronic liver diseases were associated more with intrahepatic CCAs, compared with extrahepatic CCAs (relative risk, 2.46; 95% CI, 2.37-2.55; P < .0001). This was observed across all etiologies of liver disease, except for primary sclerosing cholangitis, which was associated with extrahepatic CCAs (relative risk, 0.49; 95% CI, 0.43-0.57; P < .0001).</p><p><strong>Conclusions: </strong>Around 1 in 4 people with CCA have chronic liver diseases, and 1 in 10 have cirrhosis.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496273","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":"Acute-onset Type 1 Diabetes Mellitus and Pancreatic Atrophy Caused by an Immune Checkpoint Inhibitor.","authors":"Yasuhiro Watanabe, Satoru Iwamoto, Shin'ichi Miyamoto","doi":"10.1016/j.cgh.2024.08.048","DOIUrl":"10.1016/j.cgh.2024.08.048","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":" ","pages":""},"PeriodicalIF":11.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496255","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}