Journal of clinical gastroenterology最新文献

{"title":"Fecal Immunochemical Testing for Colorectal Cancer Screening Outside High-income Countries: A Systematic Review and Meta-Analysis.","authors":"Catherine P Cheney, Luderve Rosier, Sarah Cantrell, Nathan M Thielman, Brian A Sullivan","doi":"10.1097/MCG.0000000000002214","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002214","url":null,"abstract":"<p><strong>Goal: </strong>Investigate fecal immunochemical testing (FIT) for CRC screening outside high-income countries (HIC).</p><p><strong>Background: </strong>Colorectal cancer (CRC) incidence in low- and middle-income countries (LMIC) is rising, but optimal screening strategies in resource-limited settings remain unclear. FIT is an evidence-based, low-cost modality for population-based CRC screening. We performed a systematic review with meta-analysis to better understand the diagnostic performance of FIT for detecting CRC among average-risk individuals living outside HICs.</p><p><strong>Study: </strong>A systematic search of studies conducted in LMICs, defined by the World Bank, was conducted on August 8, 2024. Studies were eligible if they assessed FIT as a diagnostic test for CRC in asymptomatic, average-risk participants. Pooled estimates for FIT sensitivity and specificity were calculated using a bivariate Bayesian statistical analysis (MetaBayesDTA).</p><p><strong>Results: </strong>Our search returned 333 distinct studies. Of these, 263 were excluded after title and abstract screening. We reviewed 61 full texts with 7 meeting inclusion/exclusion criteria. These studies were published between 2015 and 2022 and included 100,619 participants from Argentina, Brazil, China, Iran, and Thailand. Most used a FIT hemoglobin cutoff of 50 ng/mL (n=4). FIT return rate ranged from 78% to 99%, and positivity ranged from 2.1% to 29%. FIT sensitivity ranged from 55% to 92%, specificity from 71% to 94%, PPV from 2% to 16%, and NPV from 98% to 100%. After meta-analysis, pooled estimates for sensitivity and specificity for CRC were 75% (95% CI: 64%-85%) and 89% (95% CI: 77%-95%), respectively.</p><p><strong>Conclusions: </strong>FIT-based CRC screening shows promise, but data was geographically limited to middle-income countries. This highlights the need for research evaluating screening modalities and completion of the screening continuum in LMICs.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reinterpreting Early Liver Stiffness Decline in Chronic Hepatitis B: Strengths, Caveats, and Future Directions.","authors":"Gokhan Koker","doi":"10.1097/MCG.0000000000002208","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002208","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Clostridioides difficile Infection on the Outcome of Severe Flare of Ulcerative Colitis.","authors":"Cong Dai, Yu-Hong Huang","doi":"10.1097/MCG.0000000000002217","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002217","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overuse of Intravenous Proton-Pump Inhibitors in the Treatment of Low-Risk Upper Gastrointestinal Bleeding.","authors":"Michael M Sutton, Mathew J Gregoski, Don C Rockey","doi":"10.1097/MCG.0000000000002211","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002211","url":null,"abstract":"<p><strong>Background: </strong>In patients with acute upper GI bleeding (UGIB), current best practice is to discontinue or transition (to oral) intravenous proton pump inhibitors (PPIs) when esophagogastroduodenoscopy (EGD) reveals low risk or no peptic ulcer disease (PUD).</p><p><strong>Study: </strong>This retrospective study from a large academic medical center evaluated the use of intravenous PPIs in patients admitted with acute UGIB due to low-risk PUD or non-PUD UGIB. Complete clinical data including endoscopic lesions and the duration of intravenous PPI therapy were recorded.</p><p><strong>Results: </strong>Of 335 patients with acute UGIB, 253 had no PUD or an ulcer with only low-risk stigmata; 79 patients [31% (95% CI: 26%-37%)] received the appropriate duration of IV PPI. For patients with low-risk PUD (n=42), patients received on average 5.3 excess doses of intravenous PPI, and patients receiving continuous intravenous PPI received an average of 41 additional hours of IV PPI. Likewise, excess PPI therapy was common for patients found to have no lesions or no PUD. Lesions most often associated with inappropriate IV PPI use included: no identifiable lesion (n=59; 34%), low-risk PUD (n=42; 24%), gastritis (n=31; 18%), esophagitis (n=24, 14%), and AVMs (n=21, 12%). The length of hospital stay was shorter in patients who received appropriate PPI therapy after EGD compared with those who did not (4.3 vs. 7.2 d, P=0.001).</p><p><strong>Conclusions: </strong>IV PPIs are grossly overused in patients with UGIB, suggesting that there is substantial room for improvement in the use of PPIs in patients with acute UGIB.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Urban-rural Disparities in Hepatocellular Carcinoma Mortality in the United States From 1999 to 2020.","authors":"Chun-Wei Pan, Pojaskorn Danpanichkul, Ramsey Cheung, Paulo Pinheiro, Patricia D Jones, Robert J Wong","doi":"10.1097/MCG.0000000000002162","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002162","url":null,"abstract":"<p><strong>Objective: </strong>Hepatocellular carcinoma (HCC) is a growing public health concern in the United States. While socioeconomic factors have been linked to HCC outcomes, the impact of urban-rural residence remains understudied. This analysis examines trends in HCC mortality between urban and rural areas from 1999 to 2020.</p><p><strong>Materials and methods: </strong>Using the \"Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research\" database, we analyzed age-adjusted HCC mortality rates in urban and rural counties. Joinpoint regression was used to calculate annual percentage change and average annual percentage change (AAPC) in mortality rates. We examined trends by demographics and geographic regions.</p><p><strong>Results: </strong>Overall HCC mortality increased from 1999 to 2020 (AAPC: 1.24%). Rural areas experienced a more rapid rise (AAPC: 1.97%) in HCC mortality compared with urban areas (AAPC: 1.11%), and in 2020 HCC mortality in rural areas surpassed that in urban areas. Significant disparities in HCC mortality were also observed by other sociodemographic factors, with the highest HCC mortality among men, older adults, and ethnic minority populations in rural regions.</p><p><strong>Conclusion: </strong>Significant disparities in HCC mortality were observed by urban-rural geography in the United States, which seems to be exacerbated by underlying sociodemographic factors. Better understanding of potential modifiable drivers of these disparities will help guide interventions to improve long-term patient outcomes.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medications for Weight Loss and MASLD: A National Survey of Hepatology and Gastroenterology Provider Practices, Attitudes, and Knowledge Before Resmetirom.","authors":"Gene Y Im, Amon Asgharpour, Elizabeth S Aby, Jonathan G Stine, Jessica L Mellinger, Jay Luther, Manhal Izzy, Lamia Haque, Brian T Lee, Thomas G Cotter, Courtney B Sherman, Loretta L Jophlin, Aparna Goel, John Rice, Shaun Chandna, Blanca Lizaola-Mayo, Po-Hung Chen, Ashwani K Singal, Meena B Bansal","doi":"10.1097/MCG.0000000000002147","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002147","url":null,"abstract":"<p><strong>Goals: </strong>Our aim was to perform a national survey of provider attitudes, practices, and knowledge regarding weight loss and MASLD medications in patients with MASLD.</p><p><strong>Background: </strong>While weight loss is a cornerstone in the management of metabolic dysfunction-associated steatotic liver disease (MASLD), FDA-approved medications for weight loss remain underutilized.</p><p><strong>Results: </strong>We conducted a survey before resmetirom approval of hepatology and gastroenterology providers practicing in 44 states. Surveys were sent to 747 providers with 304 complete responses (41%), of whom 260 (86%) work at a liver transplant center. While nearly all respondents (96%) believed that weight loss medications could benefit patients with MASLD, 77% have never/rarely prescribed them due to low comfort (81%). Among weight loss medication prescribers, glucagon-like peptide-1 (GLP-1) receptor agonists were preferred (66%). In contrast, 63% had prescribed off-label medications for MASLD in the past 12 months, most commonly vitamin E (30%) and GLP-1 receptor agonists (25%). The top reported barriers to prescribing weight loss medications were lack of training/unfamiliarity, cost/insurance coverage, and side-effects, which may be explained by low formal obesity education and lack of knowledge (only 33% of FDA-approved medications for weight loss were correctly identified by >50% of providers). Overall, there was reasonable provider-reported adherence to the 2023 AASLD practice guidance for MASLD.</p><p><strong>Conclusions: </strong>This nationwide survey of hepatology and gastroenterology providers before resmetirom demonstrates that while off-label prescribing for MASLD was common, weight loss medication prescription rates remain very low due to low comfort possibly from insufficient education despite strong beliefs that they can benefit patients with MASLD.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance, Efficacy, and Safety of Lubiprostone in Bowel Preparation Regimens: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Yizhong Wu, Joseph Gung, Kyle S Liu, Alexander D Grieme, Manuel Garza, Daryl Ramai, Aline Ghaleb, Andrew Han","doi":"10.1097/MCG.0000000000002215","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002215","url":null,"abstract":"<p><strong>Introduction: </strong>Bowel preparation is an essential part of the colonoscopy process, with inadequate or poor bowel preparation associated with decreased polyp detection. We performed a systematic review and meta-analysis to investigate the effects of adjunct lubiprostone bowel prep on colonoscopies performance.</p><p><strong>Methods: </strong>We conducted a comprehensive search in PubMed, Embase, Cochrane, and Web of Science from inception until February 2025 for RCTs comparing lubiprostone adjunct therapy, bowel prep and control. Our data was analyzed for polyp detection rates, bowel prep quality, colonoscopy duration, adverse events, and side effects. A random effects model was used, and the data were presented using pooled odds ratios (OR) and mean differences (MD) with 95% CI.</p><p><strong>Results: </strong>Eight RCT manuscripts were included with 1322 patients (657 in the lubiprostone group and 665 in the control group). There was no significant difference in polyp detection rate between groups (OR: 1.27, 95% CI: 0.92-1.76, P=0.15, I2: 0%). The lubiprostone group had significantly higher odds of excellent bowel prep compared with control (OR: 2.25, 95% CI: 1.52-3.33, P<0.0001, I2: 41%) and significantly lower odds of poor bowel prep (P=0.009). Colonoscopy duration in minutes was similar (P=0.17). Adverse event odds were similar between groups (P=0.22).</p><p><strong>Conclusion: </strong>Lubiprostone as an adjunct agent for bowel prep improves the odds of excellent quality prep while mitigating the odds of poor prep. Lubiprostone adjunct bowel prep is similar to control in adverse effects.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Clinical Effectiveness and Safety of Vedolizumab and Ustekinumab in Biologic-Naive Patients With Crohn's Disease By Disease Location: Results from the EVOLVE Expansion Study.","authors":"Michael Scharl, Britt Christensen, Brian Bressler, Neil R Brett, Lauren Gianchetti, Celine Gisler, Pravin Kamble, Shashi Adsul, Zeinab Farhat, Marc Ferrante","doi":"10.1097/MCG.0000000000002186","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002186","url":null,"abstract":"<p><strong>Goals: </strong>This analysis compared the real-world effectiveness and safety of vedolizumab versus ustekinumab in biologic-naive patients by CD location.</p><p><strong>Background: </strong>Crohn's disease (CD) location may affect disease course and treatment decisions.</p><p><strong>Study: </strong>Medical charts of biologic-naive patients with CD aged 18 years or older initiating vedolizumab or ustekinumab were analyzed in the multicenter, observational, retrospective EVOLVE Expansion study. Outcomes with vedolizumab versus ustekinumab over 36 months were compared in patients with baseline isolated ileal, ileocolonic, and isolated colonic CD (Montreal classification).</p><p><strong>Results: </strong>This analysis included 293 patients with ileal (vedolizumab, n=158, ustekinumab, n=135), 185 with ileocolonic (vedolizumab, n=91, ustekinumab, n=94), and 121 with colonic (vedolizumab, n=84, ustekinumab, n=37) CD. Cumulative rates over 36 months were similar between vedolizumab and ustekinumab in ileal, ileocolonic, and colonic CD subgroups for clinical response, remission, mucosal healing, and treatment persistence. There were no differences in risks of serious adverse events, serious infections, CD exacerbations, and CD-related hospitalizations between cohorts across disease location; the risk of CD-related surgeries was similar in patients with ileocolonic and colonic CD, and higher with vedolizumab versus ustekinumab in patients with ileal CD. CD-related surgeries for ileal CD were reported in 12 of 158 (7.6%) vedolizumab-treated patients and 3 of 135 (2.2%) ustekinumab-treated patients.</p><p><strong>Conclusions: </strong>Effectiveness, safety, and health care resource utilization outcomes over 36 months were similar between treatment cohorts regardless of baseline disease location. The number of patients requiring CD-related surgeries was low. Both vedolizumab and ustekinumab can be used as first-line biologics in patients with CD, regardless of disease location.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological Therapies in Inflammatory Bowel Disease: Predictive Factors of Nonresponse.","authors":"Teresa Da Cunha, Rachael Hagen, Haleh Vaziri","doi":"10.1097/MCG.0000000000002179","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002179","url":null,"abstract":"<p><p>The treatment modalities for inflammatory bowel disease (IBD) have been rapidly expanding over the past years. Biological therapies are the leading choice of therapy in moderate and severe IBD, aiming to help patients achieve meaningful clinical, endoscopic, and laboratory responses. However, some patients are primary nonresponders and fail to show any response, while others relapse after an initial response, also known as secondary nonresponders. In this article, we review the mechanism of action of the currently available biological therapies for IBD, assessment of treatment response, the nonresponse rates to each therapy, clinical and laboratory factors affecting the efficacy of therapies, and suggested targeted drug levels.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Safety and Efficacy of Colorectal Endoscopic Submucosal Dissection in the Elderly: A Large Western Analysis of 710 Lesions.","authors":"Fares Ayoub, Mai Khalaf, Samanthika Sahasra Devalaraju, Tara Keihanian, Wasseem Skef, Salmaan Jawaid, Mohamed Othman","doi":"10.1097/MCG.0000000000002213","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002213","url":null,"abstract":"<p><strong>Background and study aims: </strong>Colorectal endoscopic submucosal dissection (ESD) is increasingly used for the management of laterally spreading colorectal lesions in the West. With increasing life expectancy and prevalence of colorectal neoplasia, ESD is frequently performed in the elderly. While ESD has been shown to be safe in elderly Eastern populations, there are key differences in endoscopist, patient, and lesion characteristics in the West. We investigated the safety and outcomes of colorectal ESD in a large Western cohort.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed 710 colorectal lesions undergoing ESD at a tertiary medical center from July 2015 to November 2024. Patients were divided into 3 age groups: under 65 years (n=342), 65 to 75 years (n=272), and older than 75 years (n=96). Outcomes included en-bloc and R0 resection rates, procedural and postprocedural adverse events, and length of stay.</p><p><strong>Results: </strong>En-bloc resection rates (87.4%, 80.9%, and 80.2%) and R0 resection rates (69.6%, 68%, and 61.5%) were comparable across the <65, 65 to 75, and ≥75 groups, respectively. Despite higher comorbidities and use of antithrombotics/anticoagulants in the elderly group, overall postprocedure adverse event rates were low and with no significant difference among groups (6.7%, 8.5%, and 6.3%) (P=0.651). A higher length of stay in the ≥75 group was noted compared with the <65, 65 to 75, respectively (1.1 d, vs. 0.6 and 0.5, P<0.001).</p><p><strong>Conclusions: </strong>Colorectal ESD in Western elderly patients by expert endoscopists is safe and effective, with outcomes comparable to younger cohorts. This study supports ESD as a feasible option for managing colorectal neoplasms in an aging population.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}