Journal of clinical gastroenterology最新文献

{"title":"Clinical Impact of High-dose Esomeprazole-amoxicillin Dual Therapy as Rescue Treatment for Helicobacter pylori Infection: A Prospective, Multicenter, Randomized Trial.","authors":"Chao Wang, He-Jie Wang, Keng Li, Yin Wang, Yuan-Yuan Lin, Cheng-Zhao Weng, Jie Chen, Shao-Hua Xie, Wei Jiang, Yu-Cheng Zhu","doi":"10.1097/MCG.0000000000002100","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002100","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the effectiveness and safety of high-dose dual therapy (HDDT) using esomeprazole and amoxicillin to furazolidone-based quadruple therapy (FBQT) in treating nonresponsive patients with Helicobacter pylori (H. pylori) infection.</p><p><strong>Materials and methods: </strong>A total of 209 patients with H. pylori infection, who had previously received ineffective treatment and visited an outpatient clinic, were randomly assigned to either the HDDT or FBQT groups. All patients underwent a 14-day treatment regimen, and the success rates of H. pylori eradication and safety of the treatment regimens were assessed 4 weeks posttreatment.</p><p><strong>Results: </strong>Following the 14-day treatment period, the intention-to-treat (ITT) analysis revealed eradication rates of 93.6% for HDDT and 86.9% for FBQT. In the per-protocol (PP) analysis, eradication rates were 94.5% for HDDT and 88.7% for FBQT. No significant difference in eradication rates was observed between the two groups. HDDT exhibited significantly lower rates of adverse reactions (9.1% in ITT and 9.2% in PP) compared with FBQT (58.6% in ITT and 59.8% in PP). Multivariate analysis identified interval time, alkaline phosphatase, and serum creatinine level as factors influencing the eradication rate. The area under the receiver operating curve of the interval time between the FBQT group and the HDDT group and the success of H. pylori eradication were 0.622 and 0.578, respectively. The optimal salvage treatment intervals were determined as 6 months for FBQT and 1 year for HDDT.</p><p><strong>Conclusion: </strong>HDDT using high-dose esomeprazole and amoxicillin demonstrated efficacy in treating H. pylori infection, with the added benefits of reduced side effects and improved medication compliance compared with FBQT. HDDT can be considered a rescue treatment option when other methods fail, with treatment intervals optimized accordingly.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576210","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":"Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Liver Cirrhosis.","authors":"Tien-Shin Chou, Yuan Lin, Ming-Lung Tsai, Chin-Ju Tseng, Jhih-Wei Dai, Ning-I Yang, Chih-Lang Lin, Li-Wei Chen, Ming-Jui Hung, Tien-Hsing Chen","doi":"10.1097/MCG.0000000000002089","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002089","url":null,"abstract":"<p><strong>Objective: </strong>Comparing direct oral anticoagulants (DOACs) and warfarin's efficacy and safety in patients with nonvalvular atrial fibrillation (AF) and liver cirrhosis (LC).</p><p><strong>Background: </strong>Evidence of the pharmacodynamics of DOACs is limited in patients with AF and LC.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in the largest hospital system in Taiwan, involving patients with AF and LC for the years 2012 to 2021. Hazards of thromboembolic events (ischemic stroke, transient ischemic attack, and systemic embolism), intracranial hemorrhage, gastrointestinal, major bleeding, and all-cause mortality were investigated with a new-user, active comparator design. Inverse probability of treatment weighting was applied to balance potential confounders between treatment groups.</p><p><strong>Results: </strong>In total, 478 DOAC users and 247 warfarin users were included. DOACs and warfarin demonstrated similar trends in preventing thromboembolic events, namely ischemic stroke [adjusted hazard ratio (aHR), 1.05 (95% CI: 0.42-2.61)], transient ischemic attack [aHR, 1.36 (95% CI: 0.18-10.31)], and systemic embolism [aHR, 0.49 (95% CI: 0.14-1.70)]. DOAC use was associated with a similar risk of intracranial hemorrhage [aHR, 0.65 (95% CI: 0.26-1.59)] and gastrointestinal bleeding [aHR, 0.64 (95% CI: 0.39-1.03)], a decreased risk of major bleeding [aHR, 0.64 (95% CI: 0.42-0.99)], and a reduction in mortality [aHR, 0.73 (95% CI: 0.54-0.99)]. DOAC users exhibited a significant reduction in major bleeding risk in patients with Child-Pugh class A (aHR, 0.48; 95% CI: 0.33-0.70).</p><p><strong>Conclusions: </strong>DOACs showed potential safety advantages over warfarin for patients with nonvalvular AF and LC, particularly in reducing major bleeding risk in those with Child-Pugh class A.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576212","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":"Prevalence and Pathophysiology of Loose Stools and Their Impact on Clinical Severity and Quality of Life in Women With Fecal Incontinence.","authors":"Alba Raventós, Silvia Carrión, Daniel Españó, Cristina Bascompte, Tennekoon Buddhika Karunaratne, Pere Clavé, Lluís Mundet","doi":"10.1097/MCG.0000000000002095","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002095","url":null,"abstract":"<p><strong>Objective: </strong>To compare the impact of fecal consistency with anorectal sphincter dysfunctions on clinical severity and quality of life (QoL) in women with fecal incontinence (FI).</p><p><strong>Background: </strong>FI affects up to 24% of middle-aged women, significantly impacting their QoL. Pathophysiological studies have focused more on sphincter and anorectal dysfunctions than on the role of fecal consistency.</p><p><strong>Patients and methods: </strong>A cross-sectional observational study evaluating anorectal physiology, neurophysiology, and fecal consistency with regard to clinical severity and QoL. Patients with a Bristol Stool Chart (BSC) score of 5 or more (BSC ≥5) underwent a breath test to detect bacterial overgrowth (small intestinal bacterial overgrowth), lactose or fructose/sorbitol malabsorption, and/or a cholestyramine test to detect bile acid malabsorption. We compared anorectal physiology, clinical severity, and QoL of those with BSC ≥5 with BSC <5.</p><p><strong>Results: </strong>The study included 150 women with an average age of 64.81 ± 11.96. FI types varied: 64.38% had urge FI, 15.06% had passive FI, and 19.18% had both. Among them, 56.2% had BSC ≥5, linked to bile acid malabsorption (20.5%), lactose malabsorption (17.9%), small intestinal bacterial overgrowth (14.3%), and fructose/sorbitol malabsorption (14.3%). Anorectal dysfunctions were highly prevalent, with 49.1% showing external anal sphincter insufficiency, 9.8% internal, and 34.7% both. Those with BSC ≥5 experienced significantly worse clinical severity and QoL (St. Mark 17.3 ± 2.69 vs 12.9 ± 3.27), and more pronounced issues in Fecal Incontinence Quality of Life Scale dimensions of lifestyle, coping, depression, and EuroQol 5-dimension of anxiety/depression and pain/discomfort.</p><p><strong>Conclusions: </strong>Fecal consistency of BSC ≥5 significantly worsens clinical severity and QoL in women with FI. Specific diagnostic and therapeutic approaches addressing loose stools are needed before any rehabilitation treatment.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576214","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":"Brain Fog in Gastrointestinal Disorders: Small Intestinal Bacterial Overgrowth, Gastroparesis, Irritable Bowel Syndrome.","authors":"Maan El Halabi, Remy Arwani, Satish C Rao, Henry P Parkman","doi":"10.1097/MCG.0000000000002094","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002094","url":null,"abstract":"<p><strong>Introduction: </strong>Brain fog (BF) is a term used to describe difficulties with concentration, memory, and overall mental clarity. Links of BF to chronic fatigue syndrome and COVID-19 have been described, as well as recently to small intestinal bacterial overgrowth (SIBO) and probiotics.</p><p><strong>Aim: </strong>To investigate the association between BF, SIBO, intestinal methanogen overgrowth (IMO), gastrointestinal (GI) medications, and specific GI disorders [irritable bowel syndrome (IBS) and gastroparesis] by utilizing a questionnaire to help diagnose BF.</p><p><strong>Methods: </strong>Patients undergoing lactulose breath testing (LBT) for clinical assessment of SIBO filled out a demographic questionnaire, including an inquiry about the presence of BF, a symptom questionnaire (PAGI-SYM), and a BF Questionnaire (BFQ; 20 BF symptoms rated never=0 to always=4, total score 0 to 80).</p><p><strong>Results: </strong>A total of 102 patients underwent LBT, with the most common indication being bloating (67%), of whom 55 (54%) reported BF. The BFQ score was significantly higher in patients reporting BF than those not [38.2±15.6 vs. 10.9±9.4 (SEM) (P=0.001)]. Patients with BF were more likely to be on probiotics and proton pump inhibitors compared with those without BF (P=0.04). There was no major difference in the use of narcotics, prokinetics, or prebiotics. Gastroparesis and IBS were more common in patients who reported BF (P=0.01 and 0.05, respectively), but not SIBO or IMO by breath testing.</p><p><strong>Conclusions: </strong>BF was observed in over one-half of patients with common GI disorders. The prevalence of BF was higher in patients on probiotics and those with gastroparesis and IBS. The BFQ may be useful to diagnose and quantify BF severity.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576207","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 Impact of Visual Distraction Interventions on Patients' Pain and Anxiety During Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Omar Saab, Hasan Al-Obaidi, Nooraldin Merza, Umesh Bhagat, Alhareth Al-Sagban, Marwah Algodi, Mohamed Abuelazm, Hashem El-Serag","doi":"10.1097/MCG.0000000000002086","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002086","url":null,"abstract":"<p><strong>Background and objective: </strong>Patients undergoing colonoscopy may experience psychological distress related to the procedure, which may deter adherence and acceptance of future colonoscopies. Visual/audiovisual distraction interventions to alleviate colonoscopy-related pain and anxiety have been developed. This study aims to investigate the impact of these interventions on colonoscopy-related outcomes.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) testing the efficacy of visual/audiovisual distraction. Eligible studies were systematically retrieved by searching PubMed, EMBASE, WOS, SCOPUS, and Cochrane through June 2024 and extracted by 2 investigators. Continuous and dichotomous outcome variables were pooled using Cohen's d and risk ratio (RR) with confidence interval (CI) using Stata MP version 17. We assessed heterogeneity using the χ2 test and I2 statistic (PROSPERO ID: CRD42024555902).</p><p><strong>Results: </strong>We included 13 RCTs with 1439 patients randomized to an active intervention (n=804) or usual care (n=635). Only 3 RCTs were endoscopists-blinded studies, whereas the rest were open-label. The interventions included playing nature scene videos, real-time videos of the colonoscopy, or movies preferred by the patients. The active intervention arm was associated with a significant reduction in the pain experienced during colonoscopy (Cohen's d: -0.57, 95% CI [-0.79, -0.35], P<0.0001), reduced anxiety related to colonoscopy (Cohen's d: -0.66, 95% CI [-1.15, -0.18], P=0.01), and increased patients' satisfaction (Cohen's d: 0.65, 95% CI [0.49, 0.80], P<0.0001) compared with patients who received the usual care during colonoscopy. There were no significant differences between both groups in the willingness to re-undergo the procedure (RR: 1.11, 95% CI [0.98, 1.25], P=0.09), analgesia use (Cohen's d: -0.21, 95% CI [-0.42, 0.0], P=0.05), or total procedure duration (Cohen's d: -0.12, 95% CI [-0.24, 0.0], P=0.06).</p><p><strong>Conclusions: </strong>Visual/audiovisual distraction interventions decrease colonoscopy-associated pain and anxiety and increase patients' satisfaction. These are promising interventions to improve patient compliance and quality of care during colonoscopy.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576218","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":"Strategies, Technologies, and Tips for Successful Cecal Intubation.","authors":"Alexander Miller, Joseph C Anderson","doi":"10.1097/MCG.0000000000002096","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002096","url":null,"abstract":"<p><p>Successful cecal intubation is crucial in ensuring a complete evaluation of the colonic mucosa. Although completion of colonoscopies should be successful in close to 100% of all examinations in the hands of experienced gastroenterologists, there are some patients with colons which can be difficult to navigate. Factors such as older age, presence of diverticular disease, as well as high or low body mass index can present challenges for endoscopists. Challenges can be divided into those that are left sided and are associated with severe angulations of the colon versus those that are right sided and present as redundant colons. Both require different strategies to achieve completion. This review will cover methods, technologies as well the evolution of colonoscope insertion tubes which can help in navigating colons, especially those that are challenging. There will also be a discussion about basic principles and techniques that should be employed in all colonoscopies.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576216","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":"Association Between Irritable Bowel Syndrome and Lower Urinary Tract Symptomatology: A Cross-sectional Study in Mexican Population.","authors":"Francisco A Felix-Tellez, María F Del Rio O Brien, María E Ibarra Tapia, Miriam A Escobar Montes, Guadalupe J Peña Barajas, Salvador A Mercado Basoco, Firenze G González Gómez, José M Remes-Troche, José A Velarde-Ruiz-Velasco","doi":"10.1097/MCG.0000000000002093","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002093","url":null,"abstract":"<p><strong>Goals: </strong>This study aimed to investigate the clinical phenotype of urinary symptoms in patients diagnosed with irritable bowel syndrome, the factors associated with this overlap, and the impact of urinary symptoms on their quality of life.</p><p><strong>Background: </strong>Irritable bowel syndrome is a common disorder, affecting up to 3.8% of the population. The overlap with other disorders of the gut-brain interaction, psychiatric disorders, and other somatic disorders is common. Moreover, the association between irritable bowel syndrome and urinary symptoms has been recognized, but the clinical phenotype remains unclear.</p><p><strong>Study: </strong>This cross-sectional study involved patients with irritable bowel syndrome according to Rome IV. Lower urinary tract symptoms were classified using the International Continence Society's classification. Data on demographics, medical history, medication use, anxiety, depression, and quality of life were collected and analyzed using logistic regression analysis.</p><p><strong>Results: </strong>The study included 428 subjects, 86 diagnosed with irritable bowel syndrome. Patients exhibited a higher prevalence of lower urinary tract symptoms (60.5%, 95% CI: 50.5-71.9). Multivariate analysis revealed associations between irritable bowel syndrome and lower urinary tract symptoms (OR: 2.49, 95% CI: 1.48-4.18, P=0.001), particularly storage urinary symptoms (OR: 1.94, 95% CI: 1.10-3.40, P=0.021). Patients with urinary symptoms reported significantly lower quality of life compared with those without these symptoms (50.8±17.2 vs. 76.7±21.8, P<0.001).</p><p><strong>Conclusions: </strong>Irritable bowel syndrome is associated with lower urinary tract symptoms, contributing to a significant reduction in quality of life. Clinicians should consider referring patients with irritable bowel syndrome and lower urinary tract symptoms to experts in urodynamics to provide targeted management.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501236","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":"Effectiveness of Early Thiopurine Use in Korean Patients With Moderate-to-Severe Ulcerative Colitis: A Prospective Multicenter Cohort (MOSAIK) Study.","authors":"Hye Kyung Hyun, Ji Won Kim, Jun Lee, Yoon Tae Jeen, Tae-Oh Kim, Joo Sung Kim, Jae Jun Park, SungNoh Hong, Dong Il Park, Hyun-Soo Kim, YooJin Lee, Eun Suk Jung, Youngdoe Kim, Su Young Jung, Jae Hee Cheon","doi":"10.1097/MCG.0000000000002087","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002087","url":null,"abstract":"<p><strong>Background: </strong>Thiopurines play an important role in the management of steroid-refractory and steroid-dependent ulcerative colitis. However, the effectiveness of the early use of thiopurines in ulcerative colitis remains controversial.</p><p><strong>Materials and methods: </strong>In this multicenter prospective cohort (MOSAIK) study, we divided patients with ulcerative colitis into those who underwent early (within 6 mo of diagnosis) and late (6 mo after diagnosis) thiopurine therapy to determine the effectiveness of early thiopurine treatment. The primary outcome was the cumulative rate of clinical relapse (Mayo score >2 points). Multivariate Cox proportional hazards regression was used to identify independent clinical factors associated with the outcomes.</p><p><strong>Results: </strong>Overall, 333 patients with moderate-to-severe ulcerative colitis were included. Of the 118 patients treated with thiopurines, 65 (55.1%) and 53 (44.9%) received thiopurine therapy within and after 6 months of diagnosis. The cumulative use rate of thiopurines was 38.9% at 3 years after diagnosis. The median initial dose of thiopurines was 0.7 mg/kg (0.3 to 2.0); the median maintenance dose was 1.1 mg/kg (0.3 to 2.4). The cumulative rate of clinical relapse was not significantly different between patients who started thiopurine therapy within 6 months of diagnosis and those who started therapy 6 months after diagnosis (P=0.712). The presence of extraintestinal manifestations (hazard ratio: 4.674, 95% CI: 1.210-18.061, P=0.025) independently predicted an increased risk of clinical relapse.</p><p><strong>Conclusions: </strong>Patients with ulcerative colitis who received early thiopurine therapy did not differ significantly in terms of clinical relapse compared with those who received late therapy.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501238","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":"End-of-life in Hepatocellular Carcinoma: How Palliative Care and Social Factors Impact Care and Cost.","authors":"Spencer R Goble, Amir Sultan, Jose D Debes","doi":"10.1097/MCG.0000000000002091","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002091","url":null,"abstract":"<p><strong>Objective: </strong>Investigate the impacts of palliative care consults, race, and socioeconomic status on the prevalence of invasive procedures in patients with hepatocellular carcinoma (HCC).</p><p><strong>Background: </strong>Palliative care, race, and socioeconomic status can all influence end-of-life care preferences, but their roles in HCC have not been adequately explored.</p><p><strong>Materials and methods: </strong>This is a cross-sectional study of patients with HCC from 2016 to 2019 using the National Inpatient Sample. Terminal and nonterminal hospitalizations were assessed with logistical regression evaluating associations between palliative care, race, income, and procedures along with do-not-resuscitate orders and cost. Procedures included mechanical ventilation, tracheostomy, and cardiopulmonary resuscitation (CPR) among others.</p><p><strong>Results: </strong>A total of 217,060 hospitalizations in patients with HCC were included, 18.1% of which included a palliative care encounter. The mean age was 65.0 years (SD = 11.3 y), 73.9% were males and 55.5% were white. Procedures were increased in terminal hospitalizations in black [CPR adjusted odds ratio (aOR) = 2.57, P < 0.001] and Hispanic patients (tracheostomy aOR = 3.64, P = 0.018) compared with white patients. Palliative care encounters were associated with reduced procedures during terminal hospitalizations (mechanical ventilation aOR = 0.47, P < 0.001, CPR aOR = 0.24, P < 0.001), but not in nonterminal hospitalizations. No association between income and end-of-life procedures was found. Palliative care was associated with decreased mean cost in terminal ($23,608 vs $31,756, P < 0.001) and nonterminal hospitalizations ($15,786 vs $19,914, P < 0.001).</p><p><strong>Conclusions: </strong>Palliative care is associated with less aggressive end-of-life care and decreased costs in patients with HCC. Black and Hispanic race were both associated with more aggressive end-of-life care.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501239","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":"Safety and Efficacy of Endoscopic Submucosal Dissection for Rectal Neoplasms Extending to the Dentate Line: A Systematic Review and Meta-analysis.","authors":"Harishankar Gopakumar, Dushyant Singh Dahiya, Peter V Draganov, Mohamed O Othman, Neil R Sharma","doi":"10.1097/MCG.0000000000002090","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002090","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic submucosal dissection (ESD) is a superior, minimally invasive technique compared with other snare-based endoscopic resection techniques for rectal neoplasms extending to the dentate line (RNDLs). However, performing a successful ESD in the anal canal can be challenging due to vascularity and limited scope stability. In this meta-analysis, we aim to evaluate the safety and efficacy of ESD for RNDLs.</p><p><strong>Methods: </strong>We performed a comprehensive electronic database search from January 2005 through January 2024 for studies evaluating outcomes of ESD performed for managing RNDLs. Pooled proportions were calculated using random-effect models. Heterogeneity was evaluated using I2 and Q statistics.</p><p><strong>Results: </strong>Data were extracted from 11 studies comprising 496 patients. The pooled en bloc resection rates were 93.60% (95% CI = 90.70-95.70). The pooled R0 resection rate was 80.60% (95% CI = 70.50-87.80). The pooled recurrence rate was 4.00% (95% CI = 2.40-6.50). There was no evidence of significant heterogeneity calculated using the Q test and I2 statistic. The main adverse events were anal pain, postprocedural bleeding, and anal stricture with pooled rates of 20.20% (95% CI = 14.80-26.90), 8.20% (95% CI = 4.70-14.0), and 3.50% (95% CI = 2.10-5.70), respectively.</p><p><strong>Conclusions: </strong>ESD is a safe and effective option for managing RNDLs with a low recurrence rate. Adverse events such as postprocedural perianal pain, postprocedural bleeding, and anal stenosis seem to be more common compared with colorectal ESD done for more proximal lesions. However, these can typically be managed conservatively or with minimally invasive endoscopic techniques.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501240","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}