Journal of clinical gastroenterology最新文献

{"title":"The Epidemiology of Young-Onset Barrett's Esophagus in the United States: A National Population-Based Study Using the TriNetX Database.","authors":"Anila R Vasireddy, Apoorva K Chandar, Mart A Maravillas, Jaime A Perez, Sandra L Algarin Perneth, Jennifer M Kolb, Cadman L Leggett, David A Katzka, Prasad G Iyer, Srinivas Gaddam, Amrit K Kamboj","doi":"10.1097/MCG.0000000000002394","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002394","url":null,"abstract":"<p><strong>Introduction: </strong>Young-onset esophageal adenocarcinoma (EAC) often presents at advanced stages and is associated with poor outcomes. We aimed to examine the epidemiology of young-onset Barrett's esophagus (BE) using the TriNetX database.</p><p><strong>Methods: </strong>Young-onset BE patients (age 18 to younger than 50 y) with esophagogastroduodenoscopy (EGD) within 1 year before index BE diagnosis between 2014 and 2023 were included. Negative binomial regression was used to evaluate incident-time trends, and logistic regression to assess for independent predictors of young-onset BE.</p><p><strong>Results: </strong>BE diagnosis was present in 76,691 (3.3%) of 2,337,786 patients that underwent EGD, of which 14,120 (18%) had prevalent young-onset BE. BE dysplasia/EAC was present in 6% of young-onset patients at initial diagnosis. Conventional BE risk factors also predicted young-onset BE: GERD (OR=2.4), White race (OR=2.4), male sex (OR=2.2), smoking (OR=1.2), and obesity (OR=1.1). Each additional risk factor increased the probability of BE prevalence by 74% in young patients versus 54% in older patients. The prevalence of young-onset BE was 4.5% with GERD and ≥3 additional risk factors, and 2.3% when ≥3 risk factors were present.</p><p><strong>Discussion: </strong>Young-onset BE accounts for 18% of all BE cases, demonstrates a striking 6% rate of dysplasia/neoplasia at initial diagnosis, and has a prevalence of 4.5% in those with GERD and ≥3 risk factors. These findings suggest that young-onset BE is an important patient population that merits further study. Additional studies are necessary to study the cost-effectiveness of BE screening in younger patients with multiple risk factors.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838515","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":"Carvedilol Versus Endoscopic Variceal Ligation for Prophylaxis of Esophageal Variceal Bleeding in Patients With Liver Cirrhosis: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Luiz G S Almeida, Ocílio R Gonçalves, Thiago H F de Oliveira, João V Andrade Fernandes, Hildel F L Filho, Maria J G Siqueira, Paweł Łajczak, Wagner Rios-Garcia, Jefferson H Marques Fontes, Lucas L Mendes, Marcos de Vasconcelos Carneiro","doi":"10.1097/MCG.0000000000002380","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002380","url":null,"abstract":"<p><strong>Background: </strong>Esophageal variceal bleeding (EVB) is a life-threatening complication of liver cirrhosis. Carvedilol, a nonselective β-blocker with α1-blocking properties, and endoscopic variceal ligation (EVL) are both recommended for prophylaxis, but their comparative performance remains uncertain.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, searching PubMed, Web of Science, and Embase to July 2025. Trials comparing carvedilol with EVL in adults with cirrhosis were included. Outcomes included all-cause and bleeding-related mortality, variceal bleeding, hepatic complications, and adverse events.</p><p><strong>Results: </strong>Nine RCTs enrolling 1385 patients were included. Carvedilol and EVL showed no significant differences in all-cause mortality (RR: 1.00, 95% CI: 0.64-1.54), variceal bleeding (RR: 1.04, 95% CI: 0.75-1.45), or bleeding-related mortality (RR: 1.71, 95% CI: 0.83-3.50). Rates of ascites (new or worsening), hepatocellular carcinoma, spontaneous bacterial peritonitis, hepatorenal syndrome/acute kidney injury, and TIPS requirement were also comparable. Treatment-related adverse event rates did not differ significantly (RR: 1.43, 95% CI: 0.65-3.11).</p><p><strong>Conclusion: </strong>Carvedilol and EVL provide similar prophylactic efficacy and safety profiles for EVB prevention in cirrhosis. Carvedilol represents a viable, noninvasive alternative, particularly in settings where endoscopy is impractical.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838494","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":"Potential Celiac Disease as a Window Into Gluten-Mediated Enteropathy.","authors":"Alexa R Weingarden, Nielsen Q Fernandez-Becker","doi":"10.1097/MCG.0000000000002389","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002389","url":null,"abstract":"<p><p>Potential celiac disease is defined as having positive celiac serology in the absence of intestinal villous atrophy. This phenotype is common, accounting for ∼1 in 5 celiac patients. Many patients never develop the enteropathy characteristic of active celiac disease, and antibodies may even normalize despite continuing to consume gluten. There is no reliable way to predict who will go on to develop active celiac disease, and there is a lack of evidence on how best to manage these patients. By understanding biochemical and immunologic differences between potential and active celiac disease, we may learn how celiac disease develops and elucidate new targetable pathways to prevent or ameliorate villous atrophy.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838537","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":"Multicenter Single-arm Phase II Trial of Lenvatinib in Patients With Advanced Hepatocellular Carcinoma After Progression on First-line Atezolizumab Plus Bevacizumab.","authors":"Zeeshan Ali, Syeda Alizay Safdar Kirmani, Wasiq Subhani, Muhammad Anwar","doi":"10.1097/MCG.0000000000002393","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002393","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838450","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":"Protective Impact of GLP-1 Therapy on Post-ERCP Outcomes: A TriNetX Retrospective Cohort Analysis.","authors":"Muhammad A I Kazi, Junaid Khan, Syed M Mufarrih, Jessica Widmer, Abdulhameed Al-Sabban, Shayan S Irani, Todd H Baron, Andrew Canakis","doi":"10.1097/MCG.0000000000002374","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002374","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is essential for pancreaticobiliary disease management; however, there are risks associated with the procedure, particularly post-ERCP pancreatitis (PEP). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used in metabolic disease, possess anti-inflammatory and cytoprotective properties that may influence periprocedural outcomes. Their impact on ERCP adverse events remains unclear; therefore, we aimed to investigate whether GLP-1 influences short-term postprocedural outcomes using a large real-world database.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX US Collaborative Network, identifying adults (18 y or older) who underwent ERCP between January 2015 and December 2024. Patients were categorized based on documented preprocedure GLP-1 receptor agonist exposure. Propensity score matching (1:1) was performed using demographic, clinical, procedural, and pharmacologic covariates to minimize confounding, yielding 2 well-balanced cohorts. Thirty-day post-ERCP outcomes-including acute pancreatitis, cholangitis, sepsis, gastrointestinal bleeding, biliary stricture, choledocholithiasis, and repeat ERCP-were assessed using ICD-10 and CPT codes. Risk ratios (RRs) and hazard ratios (HRs) with 95% CIs were calculated.</p><p><strong>Results: </strong>Of 250,502 patients with ERCP screened, 21,818 propensity-matched individuals were included in the final analysis. Compared with matched nonusers, patients receiving GLP-1 receptor agonists had significantly lower 30-day rates of all major ERCP-related adverse events. GLP-1 RA exposure was associated with reduced risks of acute pancreatitis (RR: 0.47, 95% CI: 0.43-0.51), cholangitis (RR: 0.56, 95% CI: 0.50-0.62), sepsis (RR: 0.51, 95% CI: 0.46-0.57), gastrointestinal bleeding (RR: 0.49, 95% CI: 0.40-0.61), biliary stricture (RR: 0.52, 95% CI: 0.48-0.55), repeat ERCP (RR: 0.53, 95% CI: 0.48-0.58), and choledocholithiasis (RR: 0.66, 95% CI: 0.62-0.71). Results were consistent across time-to-event analyses over the 30-day follow-up period.</p><p><strong>Conclusions: </strong>In this large real-world analysis, preprocedure GLP-1 RA therapy was associated with markedly reduced 30-day ERCP-related adverse events, most notably PEP. These findings highlight a potential protective role of GLP-1 signaling in the periprocedural inflammatory response and support prospective studies evaluating GLP-1 RAs as adjunctive prophylactic agents in ERCP. Further prospective studies are needed.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147838478","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":"Outcomes of HIV-positive Patients With Variceal Upper Gastrointestinal Bleeding in the United States: An Analysis From the National Inpatient Sample.","authors":"Renuka Verma, Kaitlyn Novotny, Kamleshun Ramphul, Banreet Singh Dhindsa, Douglas G Adler","doi":"10.1097/MCG.0000000000002248","DOIUrl":"10.1097/MCG.0000000000002248","url":null,"abstract":"<p><strong>Background: </strong>Variceal upper gastrointestinal bleeding (VUGIB) is associated with significant morbidity and mortality. Historically, patients with human immunodeficiency virus (HIV) infection have experienced worse clinical outcomes compared with HIV-negative individuals. There is a paucity of data on HIV patients suffering from VUGIB.</p><p><strong>Aim: </strong>Our study aims to investigate the impact of HIV status on VUGIB outcomes.</p><p><strong>Methods: </strong>We queried the National Inpatient Sample between 2016 and 2022 using the International Classification of Diseases, Tenth revision codes to identify patients admitted with VUGIB. The patients with HIV were stratified into one group, and the remaining patients were in the control group. A 1:10 propensity-score matched analysis was performed to compare in-hospital outcomes of patients with and without HIV suffering from VUGIB.</p><p><strong>Results: </strong>Our study included 320 HIV patients and 32,320 non-HIV patients who were hospitalized for VUGIB secondary to cirrhosis. After 1:10 propensity-score matching, we had 2760 VUGIB patients without HIV and 300 patients with HIV. All-cause mortality was significantly higher in the HIV group as compared with non-HIV (10% vs. 6%, P <0.01). The median cost of hospital stay was higher in the HIV group, and they were more likely to require ICU and mechanical or NIV. Both groups had similar lengths of stay and comparable use of interventional and diagnostic endoscopy.</p><p><strong>Conclusions: </strong>HIV increases the risk of poor outcomes and mortality in patients with variceal GI bleed.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"454-458"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080613","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":"World Gastroenterology Organization (WGO) News and Events.","authors":"Lizzie Murphy","doi":"10.1097/MCG.0000000000002357","DOIUrl":"10.1097/MCG.0000000000002357","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"i"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377386","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":"Concurrence of Reflux Disease and Colonic Neoplasia.","authors":"Anna M Buchner, Amnon Sonnenberg","doi":"10.1097/MCG.0000000000002289","DOIUrl":"10.1097/MCG.0000000000002289","url":null,"abstract":"<p><strong>Background and aims: </strong>Prolonged inhibition of gastric acid secretion may constitute a risk factor for colon polyps (CP) and colorectal cancer (CRC). We hypothesized that esophageal diseases treated with antisecretory medications may be associated with an increased frequency of CP and CRC.</p><p><strong>Methods: </strong>In a case-control studies using the University of Pennsylvania Health System (UPenn) electronic database, we examined the occurrence of eosinophilic esophagitis (EoE), nonerosive reflux disease (NERD), erosive esophagitis (EE), or Barrett's esophagus (BE), in patients with CP or CRC. For comparisons of cases (with CP or CRC) and control subjects (without CP or CRC), we calculated odds ratios (OR) with their 95% CI, using multivariate logistic regressions to adjust for the confounding influences of demographic characteristics (age, sex, and race/ethnicity).</p><p><strong>Results: </strong>The UPenn database contained 89,100 individual patients who underwent a colonoscopy and EGD between January 2000 and December 2024. Among these, 35,841 were diagnosed with CP and 3,228 with CRC. A total of 2137 patients were diagnosed with EoE, 18,223 with EE, 57,397 with NERD, and 6614 with BE. CPs were significantly associated with EoE (OR: 1.17, 95% CI: 1.07-1.28), EE (OR: 1.71, 95% CI: 1.65-1.77), NERD (OR: 1.76, 95% CI: 1.71-1.81), and BE (OR: 1.80, 95% CI: 1.71-1.90). CRC was significantly associated with BE (OR: 1.22, 95% CI: 1.08-1.33), but no other types of esophageal disease.</p><p><strong>Conclusions: </strong>The occurrence of any type of reflux disease is associated with an increased risk for colonic neoplasia. Long-term inhibition of gastric acid secretion by antisecretory medication may constitute a risk factor for the occurrence of colon polyps and possibly colorectal cancer.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"403-405"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564234","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":"Noninvasive Screening for High-Risk Esophageal Varices in Cirrhosis: Current and Emerging Methods.","authors":"Eric Markarian, Tien Dong, Arpan Patel, James H Tabibian","doi":"10.1097/MCG.0000000000002378","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002378","url":null,"abstract":"<p><p>The primary goal of variceal screening in patients with cirrhosis is to identify high-risk esophageal varices (HREV) and implement preventative measures. Historically, endoscopic screening was recommended for all patients with cirrhosis; however, this approach is increasingly recognized as neither cost-effective nor clinically necessary for all patients. As the prevalence of compensated advanced chronic liver disease (cACLD) continues to rise, there is increasing interest in noninvasive risk stratification methods to effectively tailor patient selection for endoscopic screening. Current clinical guidelines encourage the use of noninvasive predictive scores and algorithms to accurately identify patients at increased risk of having HREV and thereby reduce unnecessary screening endoscopies. In this review, we provide an evaluation of the various available noninvasive methods to predict HREV, including the Baveno criteria, platelet count:spleen diameter ratio, and the EVendo score. We review the performance, strengths, and limitations of these noninvasive methods-especially the machine learning-based EVendo score-and discuss future directions for optimizing risk stratification in patients with cirrhosis.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815655","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 Efficacy of Single Dose Linaclotide in Polyethylene Glycol-Based Bowel Preparation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Yizhong Wu, Alexander Grieme, Kyle S Liu, Vincent Nguyen, Colby Adamson, Manuel Garza, Eric R Smith, Daryl Ramai, Andrew Han, Bryce Bushe, Douglas G Adler","doi":"10.1097/MCG.0000000000002267","DOIUrl":"10.1097/MCG.0000000000002267","url":null,"abstract":"<p><strong>Introduction: </strong>Adjunct agents in bowel preparation for colonoscopy have the potential to improve procedure outcomes. We performed a systematic review and meta-analysis to investigate the effects of adjunct single-dose linaclotide with bowel prep on colonoscopy outcomes.</p><p><strong>Methods: </strong>We conducted a comprehensive search in PubMed, Embase, Cochrane, and Web of Science from inception until April 2025 for randomized controlled trials comparing single-dose linaclotide adjunct bowel prep and standard bowel prep. Our pooled data was analyzed for adenoma detection rates (ADR), polyp detection rates (PDR), bowel prep quality, adverse reactions, and other secondary outcomes. A random effects model was used, and the data was presented using pooled odds ratios (OR) and mean differences (MD) with 95% CI.</p><p><strong>Results: </strong>Seven manuscripts were included with 2209 patients (1267 in the linaclotide group and 942 in the control group). The linaclotide group had a significantly higher ADR (OR: 1.31, 95% CI: 1.04-1.64, P =0.02, I2 0%) and PDR (OR: 1.43, 95% CI: 1.13-1.80, P =0.003, I2 0%). Adequate prep was higher in the linaclotide group among patients with diagnosed constipation ( P =0.002). The linaclotide group had a lower incidence of abdominal pain ( P =0.0009), bloating ( P =0.0006), and sleep disturbance ( P =0.002).</p><p><strong>Conclusion: </strong>Linaclotide used as a single dose adjunct to bowel prep before colonoscopy increased ADR and PDR. Adequate prep was higher with linaclotide in patients with diagnosed constipation. Linaclotide also decreased the odds of abdominal pain, bloating, and sleep disturbances.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"424-431"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345576","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}