Gastroenterology Research最新文献

{"title":"Hepatocellular Carcinoma-Related Mortality Trends Associated With Infective Versus Non-Infective Etiologies in ≥ 35 Years Age Group.","authors":"Jay Kakadiya, Yash Nasit, Manthan Vaghani, Smit Bhalala, Areeba Fatima, Jayasree Rajapandian, Kush Varsadiya, Zunirah Ahmed","doi":"10.14740/gr2129","DOIUrl":"10.14740/gr2129","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, with evolving etiologic patterns. While viral hepatitis has historically been the predominant cause, non-infective etiologies such as alcohol-associated liver disease and metabolic dysfunction-associated fatty liver disease (MAFLD) are increasingly driving the disease burden. We evaluated long-term trends in HCC-related mortality in the United States by etiology and demographic subgroups.</p><p><strong>Methods: </strong>Mortality data from 1999 to 2020 were obtained from the Centers for Disease Control and Prevention's Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database. HCC-related deaths were classified as infective (viral hepatitis-associated) or non-infective (liver disease and metabolic disorder) using International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. Age-adjusted mortality rates (AAMRs) were extracted using CDC WONDER. Joinpoint regression was used to assess temporal trends and estimate annual percent change (APC) and average annual percent change (AAPC). Analyses were stratified by sex, age, race/ethnicity, geographic region, and urbanization.</p><p><strong>Results: </strong>Overall HCC-related mortality increased substantially from 1999 to 2020, driven predominantly by non-infective etiologies. Infective AAMRs rose from 1999 to 2013 followed by a significant decline, whereas non-infective AAMRs increased persistently from 1999 to 2020. Mortality rates were consistently higher in males than females. Infective mortality was highest among Asians, while non-infective mortality disproportionately affected Hispanic and American Indian populations. Western US states exhibited the highest mortality rates, and non-infective etiologies accounted for most deaths among individuals aged ≥ 65 years.</p><p><strong>Conclusions: </strong>HCC-related mortality in the United States has increased over the past two decades, largely driven by non-infective etiologies. Targeted public health strategies addressing metabolic risk factors, alcohol use, and demographic disparities are urgently needed to curb this growing burden.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 3","pages":"127-135"},"PeriodicalIF":2.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Observational Clinical Study Assessing the Effectiveness and Safety of Vonoprazan-Based Dual Therapy Versus Proton Pump Inhibitor-Based Triple Therapy for <i>Helicobacter pylori</i> Eradication.","authors":"Sanjay Bandyopadhyay, Gajanan Panchal, Maneesha Khalse, Kamlesh Patel","doi":"10.14740/gr2148","DOIUrl":"10.14740/gr2148","url":null,"abstract":"<p><strong>Background: </strong><i>Helicobacter pylori</i> (<i>H. pylori</i>) is a gram-negative bacterium linked to various gastrointestinal disorders. Our study evaluates the comparative effectiveness, safety, and cost-efficiency of vonoprazan-amoxicillin (VA) dual therapy as an alternative to traditional proton pump inhibitor (PPI)-based triple therapy for eradicating <i>H. pylori</i>.</p><p><strong>Methods: </strong>This real-world, observational, single-center clinical study used medical records of 94 adult patients diagnosed with <i>H. pylori</i> infection in India between July 2024 to March 2025. The patients received 14 days of VA dual therapy or PPI-amoxicillin-clarithromycin (PAC) triple therapy. The primary outcome included <i>H. pylori</i> eradication using a repeat rapid urease test, and the secondary outcomes included the need for rescue therapy, time for symptom resolution, incidence of adverse drug reactions, and cost-comparison of the treatment regimens.</p><p><strong>Results: </strong>Eradication rates were numerically higher with VA than PAC (93.33% vs. 85.71%), although the difference was not statistically significant. As second-line therapy, eradication was achieved in 100% of PAC-to-VA switchers and 33.3% of VA-to-PAC switchers. Symptom resolution was significantly earlier with VA compared to PAC (median, 3 vs. 5 days; P < 0.001). Adverse events were fewer with VA (13.33%) than PAC (28.57%), with taste disturbances more frequent in the PAC group. VA also showed a significantly lower median treatment cost (Indian rupee (INR) 1,020 (US dollar (USD) 12.29) vs. INR 3,380 (USD 40.72); P <0.001) and a better cost-comparison ratio (10.67 vs. 39.43).</p><p><strong>Conclusions: </strong>VA showed numerically higher eradication rates, faster symptom relief, lower costs, and better tolerability than PAC in the Indian setting, supporting its potential as a practical alternative first-line regimen, particularly in settings where clarithromycin resistance is prevalent or suspected.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 3","pages":"155-164"},"PeriodicalIF":2.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Underwater Versus Conventional Cold Snare Polypectomy for Small Colorectal Polyps: A Meta-Analysis of Randomized Controlled Trials.","authors":"Hamza Altal, Mohammad Darweesh, Saba Daher, Usama Abu Heija, Chakradhar Reddy","doi":"10.14740/gr2146","DOIUrl":"10.14740/gr2146","url":null,"abstract":"<p><strong>Background: </strong>Conventional cold snare polypectomy (CCSP) is the standard technique for removal of small non-pedunculated colorectal polyps. However, incomplete resection remains a concern. Recent data suggested that underwater cold snare polypectomy (UCSP) with no submucosal injection may enhance resection depth and histologic clearance. We aimed to compare the two polypectomy techniques with emphasis on efficacy and safety.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Cochrane Central, and ClinicalTrials.gov from inception through March 2026, for randomized controlled trials (RCTs) comparing UCSP and CCSP for 4-10 mm non-pedunculated colorectal polyps. The primary outcome was <i>en bloc</i> resection. Secondary outcomes included non-R0 resection, intraprocedural bleeding, histologic complete resection (R0), and perforation. Random-effects models using DerSimonian-Laird were used to calculate risk ratios (RRs) with 95% confidence intervals (95% CIs).</p><p><strong>Results: </strong>Three RCTs met criteria (n = 822 polyps, total; UCSP 418, CCSP 404). <i>En bloc</i> resection was higher in UCSP compared to CCSP (RR 1.03, 95% CI 1.00-1.06, I² = 0%). UCSP increased histologic complete resection (RR 1.15, 95% CI 1.01-1.31, I² = 81.8%). Adverse events were uncommon; intraprocedural bleeding was similar between groups (RR 0.57, 95% CI 0.16-2.07, I² = 29.5%). No perforations were reported in any arm.</p><p><strong>Conclusions: </strong>UCSP improves <i>en bloc</i> resection of small polyps without increasing adverse events. Further multicenter trials with longitudinal follow-up are needed to assess long-term residual disease.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 3","pages":"119-126"},"PeriodicalIF":2.5,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148294116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic Deprivation Does Not Influence Disease Severity or Access to Dupilumab in Eosinophilic Esophagitis.","authors":"Fatema Ali, Dong Xi","doi":"10.14740/gr2130","DOIUrl":"10.14740/gr2130","url":null,"abstract":"<p><strong>Background: </strong>Studies have explored the relationship between eosinophilic esophagitis (EoE) and various factors such as race, gender, and geographic elements, including urbanization, population density, and climate zones. However, the relationship between socioeconomic advantage or disadvantage and key pathology findings-particularly the esophageal peak eosinophil count at diagnosis, as well as access to biologic therapy-has not been extensively studied in pediatric EoE. This study aimed to examine these relationships to uncover potential influences.</p><p><strong>Methods: </strong>This retrospective cohort study involved children aged 0 to 18 years evaluated in EoE clinic, including 16 patients who were refractory to other conventional therapies and ultimately treated with dupilumab. Details regarding eosinophil count per high power field (HPF) in the proximal and distal esophagus at the time of diagnosis were obtained from electronic medical records. Patients' socioeconomic status was stratified using the Area Deprivation Index (ADI), which ranks neighborhoods based on socioeconomic disadvantage, calculated from the patients' residential addresses. Data were analyzed using two-tailed <i>t</i>-test and multivariate regression analysis.</p><p><strong>Results: </strong>A total of 145 pediatric patients were included in the study. The patient population was spread relatively evenly across the different levels of the ADI. Our analysis showed no significant correlation between ADI and eosinophil count in the distal and proximal esophagus. One hundred twenty-nine patients demonstrated significant histological response to conventional non-dupilumab therapies. In a subset of 16 patients receiving dupilumab, the analysis revealed no significant difference of ADI, and baseline eosinophil count at the diagnosis in the proximal and distal eosinophil count compared with the overall cohort. However, dupilumab treatment was associated with a significant reduction in eosinophil counts, suggesting improved histologic outcomes compared with non-dupilumab therapies.</p><p><strong>Conclusions: </strong>This study examined the potential impact of socioeconomic disparities on pediatric patients with EoE, including those who were refractory to other previous therapies and ultimately treated with dupilumab. Our results suggest that socioeconomic deprivation, as measured by the ADI, is not associated with baseline histologic severity in pediatric EoE. Dupilumab demonstrated significant therapeutic benefit in patients who were refractory to other therapies, and access to dupilumab was not influenced by ADI.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 2","pages":"110-117"},"PeriodicalIF":2.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Natural-Rubber Anal Dilator (ParaSelf) After Pediatric Anorectal Surgery: A Historical-Controlled Intervention Study.","authors":"Kwanhathai Sakulsansern, Suppachai Lawanaskol","doi":"10.14740/gr2124","DOIUrl":"10.14740/gr2124","url":null,"abstract":"<p><strong>Background: </strong>Anal stenosis is a frequent complication after anorectal reconstruction for anorectal malformation (ARM) or Hirschsprung disease (HD). Conventional rigid dilators are uncomfortable, expensive, and poorly adapted to pediatric anatomy. Natural rubber dilators may offer better conformity and outcomes but have not been evaluated. The aim of the study was to compare the efficacy and safety of ParaSelf, a natural rubber-based anal dilator, with conventional rigid dilators in children after anorectal surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 98 children with ARMs or HD. Children who used conventional dilators during 2017-2022 served as the preimplementation control cohort, and children who used ParaSelf during 2022-2025 comprised the post-implementation cohort. The primary endpoint was time to achieve the age-specific target anal diameter, analyzed using multivariable Weibull parametric proportional hazards regression. Secondary endpoints included anal stenosis (including surgery-requiring stenosis), pain, caregiver satisfaction, and major postoperative complications.</p><p><strong>Results: </strong>Of 98 patients, 33 (33.7%) received ParaSelf. The ParaSelf group reached the target diameter faster than controls (median 5.6 vs. 9.4 months). Weibull regression showed a nearly 10-fold higher hazard of reaching the target diameter with ParaSelf (hazard ratio (HR) = 9.9; 95% confidence interval (CI), 5.2 to 18.7; P < 0.001). Pain scores during home dilation were lower (median difference = -2.58; 95% CI, -3.40 to -1.76; P < 0.001), and caregiver satisfaction was higher (median difference = 2.00; 95% CI, 1.52 to 2.48; P < 0.001) with ParaSelf versus conventional dilators. No irritation, bleeding, leakage, or surgery-requiring stenosis occurred in the ParaSelf group.</p><p><strong>Conclusions: </strong>ParaSelf was associated with faster dilation, less pain, fewer complications, and higher caregiver satisfaction than conventional dilators and may be a more acceptable alternative for pediatric anorectal reconstruction.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 2","pages":"100-109"},"PeriodicalIF":2.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Supervised, Online, Home-Based Eccentric Resistance Exercise Program for Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Kedar S Deshpande, Kazunori Nosaka, Aus Molan, Isaac S Raj, John K Olynyk, Oyekoya T Ayonrinde","doi":"10.14740/gr2131","DOIUrl":"10.14740/gr2131","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common non-communicable chronic liver disease worldwide, increasing long-term risk of cirrhosis, type 2 diabetes mellitus, and cardiovascular diseases. Although reducing liver steatosis by increasing physical activity can lower these risks, patients with MASLD often struggle to exercise regularly. We examined the effects of a supervised, home-based, online bodyweight eccentric exercise program on liver and metabolic markers, and physical fitness in patients with MASLD.</p><p><strong>Methods: </strong>Sixteen adults with MASLD (24-91 years) were assigned to an exercise group (n = 9) or a control group receiving lifestyle counselling (n = 7). The exercise group participants performed an online progressive bodyweight eccentric exercise program targeting trunk, leg, and arm muscles for 5 to 25 min per session, 5 days a week, for 8 weeks. Outcome measures included severity of hepatic steatosis (controlled attenuation parameter (CAP)), anthropometric measures (waist and hip circumferences), liver enzymes, and physical function tests, which were assessed at baseline and after the 8-week period.</p><p><strong>Results: </strong>All participants in the exercise group completed 40 exercise sessions, and showed reductions in CAP (-13.2±13.8%, P = 0.03), waist circumference (-4.4±13.5%, P = 0.007), hip circumference (-2.6±11.1%, P = 0.03), and serum gamma-glutamyl transferase (-23.9±30.0%, P = 0.03), which were not evident in the control group. Physical fitness of the exercise group participants improved, including the sit-to-stand (24.3±33.2%, P = 0.03), 3-m timed up and go (-15.6±16.4%, P = 0.01), 2-min step test (37.5±20.5%, P = 0.008), and single-leg balance (25.1±37.6%, P = 0.04).</p><p><strong>Conclusion: </strong>The exercise program was effective in reducing hepatic steatosis and increase physical fitness in patients with MASLD, highlighting the efficacy of the home-based eccentric exercise program in enhancing liver and metabolic health.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 2","pages":"74-84"},"PeriodicalIF":2.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Triple-Biomarker Score Predicts Mortality in Acute Pancreatitis.","authors":"Rauf Agayev, Aliniyaz Mammadov, Emil Iskandarov, Farajullah Idrisov","doi":"10.14740/gr2120","DOIUrl":"10.14740/gr2120","url":null,"abstract":"<p><strong>Background: </strong>Predicting severe outcomes in acute pancreatitis (AP) remains a challenge. The interplay between endothelial dysfunction and systemic inflammation is pivotal in disease progression, but the combined prognostic value of their biomarkers is not well defined. The aims of this study were: 1) to define the interactions between endothelial dysfunction biomarkers and cytokines in patients with AP; 2) to evaluate the prognostic value of triple-marker model regarding prediction of survival in AP.</p><p><strong>Methods: </strong>In a prospective cohort of 100 AP patients, we serially measured biomarkers of endothelial dysfunction (vascular endothelial growth factor (VEGF), von Willebrand factor (vWF), endothelin, E-selectin) and inflammation (tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin) on admission (day 0), day 1, and day 7. We employed correlation analyses, logistic regression, and receiver operating characteristic (ROC) analysis to assess their individual and combined ability to predict mortality.</p><p><strong>Results: </strong>A strong correlational network was observed, particularly among TNF-α, endothelin, E-selectin, CRP, and procalcitonin (all r > 0.75, P < 0.01). While VEGF correlated with TNF-α (P < 0.001), vWF did not show a significant bilateral correlation with it. Crucially, logistic regression revealed that the three-way interaction between vWF, TNF-α, and CRP was a significant predictor of mortality (P = 0.050). This triple-marker model demonstrated excellent predictive power for survival, with an area under the curve (AUC) of 0.861 in ROC analysis (P < 0.001). Kaplan-Meier analysis confirmed that patients with a high vWF-TNF-α-CRP interaction score had significantly lower survival rates (69.2% vs. 98.4%, P < 0.001).</p><p><strong>Conclusions: </strong>The combination of endothelial and inflammatory markers is a more powerful prognostic tool than any marker in isolation. The vWF-TNF-α-CRP interaction model effectively identifies AP patients at high risk of mortality, potentially enabling earlier targeted interventions. This underscores the critical role of the endothelial-inflammatory axis in determining AP outcomes.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 2","pages":"85-99"},"PeriodicalIF":2.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden and Impact of Pneumococcal Pneumonia on Outcomes in Patients With Cirrhosis: A Nationwide Analysis.","authors":"Mariam Alamgir, Nishma Dhand, Isha Kohli, Carol Singh, Aalam Sohal, Nilofar Najafian","doi":"10.14740/gr2139","DOIUrl":"10.14740/gr2139","url":null,"abstract":"<p><strong>Background: </strong>Patients with cirrhosis have impaired immunity, predisposing them to severe infections. <i>Streptococcus pneumoniae</i>, a leading cause of community-acquired pneumonia, may worsen outcomes in this vulnerable patient population. This study aims to evaluate the burden and impact of pneumococcal pneumonia among patients with cirrhosis.</p><p><strong>Methods: </strong>The National Inpatient Sample database (2016-2022) was used to identify adult hospitalizations with cirrhosis. Patients were stratified by the presence or absence of pneumococcal pneumonia. Data were obtained on demographics, liver disease etiology and decompensations, comorbidities, and clinical outcomes. A multivariate logistic/linear regression analysis was used to assess the impact of pneumococcal pneumonia on clinical outcomes.</p><p><strong>Results: </strong>Among 4,716,863 patients with cirrhosis, 90,680 (1.92%) developed pneumococcal pneumonia. Patients with pneumococcal pneumonia had higher odds of in-hospital mortality (adjusted odds ratio (aOR): 2.95, 95% confidence interval (CI): 2.84-3.09), acute kidney injury (aOR: 1.85, 95% CI: 1.79-1.91), shock (aOR: 4.75, 95% CI: 4.58-4.93), intensive care unit admissions (aOR: 7.55, 95% CI: 7.28-7.83), non-home discharges (aOR: 2.29, 95% CI: 2.21-2.38), longer length of stay (adjusted coefficient: 6.61 days, 95% CI: 6.38-6.83), and higher hospitalization charges (adjusted coefficient: $112,230.5, 95% CI: $106,802.3-$117,658.7) (all P < 0.001).</p><p><strong>Conclusion: </strong>We noted an increased in-hospital mortality and higher resource utilization among patients with pneumococcal pneumonia. These findings underscore the importance of targeted preventive strategies, including pneumococcal vaccination and early infection recognition, to reduce morbidity and healthcare burden in this vulnerable population.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 2","pages":"55-63"},"PeriodicalIF":2.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Glucagon-Like Peptide-1 Receptor Agonist Safety Before Upper Endoscopy: A Systematic Review and Meta-Analysis.","authors":"Zohaib Ahmed, Amna Iqbal, Sami Ghazaleh, Abdallah Kobeissy, Ali Nawras, Yaseen Alastal, Hani Saad, Sarmed Mansur, Idrees Mohiuddin, Umair Iqbal, Dushyant Singh Dahiya, Syeda Faiza Arif, Connor Campbell, Wade Lee-Smith, Mohammad W Asif, Faisal Kamal, Aamir Saeed, Omar Horani","doi":"10.14740/gr2108","DOIUrl":"10.14740/gr2108","url":null,"abstract":"<p><strong>Background: </strong>The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has remarkably increased in the past few years as they have demonstrated significant reduction in A1c and major cardiovascular outcomes and have led to weight loss with low risk of hypoglycemia. GLP-1 RA use has raised concerns about potential associations with increased gastric retention and adverse outcomes in upper endoscopy procedures.</p><p><strong>Methods: </strong>We conducted a comprehensive search across multiple databases to identify comparative studies evaluating the impact of GLP-1 RA exposure versus non-exposure on upper endoscopy outcomes. Studies comparing GLP-1 RAs to other medications were excluded. The primary outcome was the presence of retained gastric contents, with secondary outcomes including aspiration risk and the need for repeated esophagogastroduodenoscopy (EGD).</p><p><strong>Results: </strong>Our systematic review included 28 studies, comprising data from 212,082 individuals collected between 2015 and 2023. The meta-analysis revealed that GLP-1 RA use was associated with approximately four times higher odds of retained gastric contents compared to non-exposure (odds ratio (OR): 3.95, confidence interval (CI): 2.691-5.815, P < 0.0001, I²: 82.71%). There were no increased odds of aspiration (OR: 1.09, CI: 0.459-2.600, P = 0.145, I²: 91.44%) or repeated upper endoscopies (OR: 1.82, CI: 0.813-4.085, P = 0.145, I²: 85.32%). However, GLP-1 RA use was significantly associated with increased odds of procedure cancellation (OR: 3.96, CI: 2.870-5.563, P < 0.0001, I²: 4.19%).</p><p><strong>Conclusion: </strong>While GLP-1 RAs do not increase the risk of aspiration or necessitate repeated procedures, they are linked to a higher incidence of retained gastric contents and procedure cancellations. Further randomized controlled trials are necessary to better understand the effects of GLP-1 RAs on upper endoscopy outcomes.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 2","pages":"64-73"},"PeriodicalIF":2.5,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13171266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Mortality in Patients With Strangulating Intestinal Obstruction Who Present With Septic Disseminated Intravascular Coagulation Prior to the Initiation of Treatment.","authors":"En Amada, Yoshihiro Watanabe","doi":"10.14740/gr2119","DOIUrl":"10.14740/gr2119","url":null,"abstract":"<p><strong>Background: </strong>Strangulating ileus is a life-threatening surgical emergency characterized by intestinal ischemia and necrosis due to impaired blood flow and is frequently complicated by septic disseminated intravascular coagulation (DIC). Despite surgical and intensive care management, prognosis remains extremely poor. Early identification of prognostic factors associated with mortality is therefore crucial. This study aimed to identify early predictors of poor prognosis in patients with strangulating ileus complicated by septic DIC.</p><p><strong>Methods: </strong>We retrospectively analyzed 67 patients diagnosed with strangulating ileus at a single institution between 2020 and 2024, who subsequently developed septic DIC according to the Japanese Society for Emergency Medicine criteria and were treated with recombinant thrombomodulin (rTM). Patients with preoperative intestinal perforation, malignant tumors, or those receiving maintenance dialysis were excluded. Systemic inflammatory response syndrome (SIRS) score, Quick Sequential Organ Failure Assessment (qSOFA) score, Sequential Organ Failure Assessment (SOFA) score, DIC score, and white blood cell (WBC) count were evaluated preoperatively (Pre) and on the day after rTM administration (Day 1). Patients were divided into a survival group (S group) and a mortality group (M group), and variables were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors.</p><p><strong>Results: </strong>Among the 67 patients, 38 survived and 29 died. On Day 1, SIRS scores, qSOFA scores, SOFA scores, and DIC scores were all significantly higher in the mortality group than in the survival group (P < 0.05). Mortality was also significantly higher in patients with a Day 1 WBC count < 8,000/µL and those with a Day 1 DIC score > 4. Multivariate logistic regression analysis identified a Day 1 WBC count < 8,000/µL (odds ratio (OR), 19.8; 95% confidence interval (CI), 3.64-72.6; P = 0.012) and a Day 1 DIC score > 4 (OR, 1.75; 95% CI, 1.27-9.34; P = 0.04) as independent predictors of mortality.</p><p><strong>Conclusions: </strong>In patients with strangulating ileus complicated by septic DIC, early leukopenia and persistently high DIC scores after rTM administration are independent poor prognostic factors. Early recognition of these indicators may allow prompt escalation of intensive care and contribute to improved outcomes in this highly lethal condition.</p>","PeriodicalId":12461,"journal":{"name":"Gastroenterology Research","volume":"19 1","pages":"28-34"},"PeriodicalIF":2.5,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}