Journal of clinical gastroenterology最新文献

{"title":"Machine Learning for Predicting Colorectal Cancer and Advanced Colorectal Polyps: A Systematic Review and Meta-Analysis.","authors":"Sheza Malik, Arsalan Naqvi, Bettina G Tenorio, Faiqa Farrukh, Raseen Tariq, Douglas G Adler","doi":"10.1097/MCG.0000000000002172","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002172","url":null,"abstract":"<p><strong>Introduction: </strong>Machine learning (ML) has become increasingly pivotal in health care, particularly in colorectal cancer (CRC) detection and diagnosis with the use of predictive models and artificial intelligence-assisted colonoscopies. This study evaluates the efficacy of ML models in predicting the risk for CRC and advanced colorectal polyps (ACP) before colonoscopy.</p><p><strong>Methods: </strong>A systematic literature review was conducted following PRISMA guidelines, focusing on studies using ML for CRC and ACP prediction. Data extraction regarding study type, ML methodology, quality of data, and bias assessment was in line with the CHARMS checklist. Meta-analysis was also performed to assess the performance of models for the prediction of CRC, adenoma, or both.</p><p><strong>Results: </strong>This systematic review included 14 studies with 3618 median patients (333 to 263,879). Our study demonstrated considerable heterogeneity in methodologies and outcomes, with area under the receiver operating characteristic (AUROC) ranging from 0.6 to 1. The derivation+validation cohorts showed a pooled sensitivity of 0.832 (95% CI: 0.755-0.889) and specificity of 0.802 (95% CI: 0.722-0.863), with an overall AUROC of 0.883.</p><p><strong>Conclusion: </strong>The review underscores the significant role of ML in CRC and ACP diagnosis and its routine use could efficiently direct high-risk patients to timely colonoscopies and spare the low-risk ones from unnecessary procedures. Despite the promise shown, the variability in methodologies and outcomes highlights the need for standardized approaches and further investigation in this field.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159402","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 of MASLD, Met-ALD, and ALD and Associated Fibrosis Among US Adults: Insights From NHANES 2017 to 2023.","authors":"James M Paik, Kathryn Hobbs, Amolika Gupta, Rand Jamal Alkalbani, Manuel Alexander Reyes, Zobair M Younossi","doi":"10.1097/MCG.0000000000002202","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002202","url":null,"abstract":"<p><strong>Background and aim: </strong>Steatotic liver diseases (SLD) encompasses metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD). Our aim was to determine the age-standardized prevalence of fibrosis stages and cirrhosis in US adults with different subtypes of SLD.</p><p><strong>Methods: </strong>We utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2017 to 2023. SLD was defined by a controlled attenuation parameter (CAP) ≥280 dB/m. MASLD, MetALD, and ALD were defined according to the new nomenclature. Fibrosis and cirrhosis were estimated by liver stiffness measurements.</p><p><strong>Results: </strong>The age-standardized prevalence of SLD was 37.08% (MASLD: 32.42%, MetALD: 2.20%, and ALD: 1.29%) with males having higher prevalence rates versus females [SLD (42.40% vs. 31.59%), MASLD (35.84% vs. 28.88%), MetALD (2.82% vs. 1.56%), and ALD (2.17% vs. 0.38%) (all P < 0.03)]. For MASLD, the highest burden was observed in Mexicans (43.96%), followed by Whites (31.75%), Hispanics (32.69%), Asians (32.41%), and Blacks (27.39%). MetALD was most prevalent among Whites (2.56%) and least prevalent among Asians (0.25%). Between 2017 and 2020 and 2021 and 2023, the prevalence of SLD and its subtypes with fibrosis and cirrhosis increased, coinciding with rising alcohol consumption. Among individuals with MASLD, component of metabolic syndrome (type 2 diabetes and Obesity, especially severe obesity with BMI ≥40 kg/m²) were associated with increased risk of fibrosis and cirrhosis.</p><p><strong>Conclusion: </strong>The burden of SLD, its subtypes, and associated fibrosis in the US is substantial. This highlights an urgent need for targeted public health strategies to manage the rising burden of this important liver disease in the US population.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150533","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":"Photodocumentation of Large Colorectal Polyps: An Audit of Image Quality.","authors":"Anthony Kerbage, Natalie Farha, Muhammad T Sarmini, Carole Macaron, Carol Rouphael, Afshin Khan, Carol A Burke","doi":"10.1097/MCG.0000000000002206","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002206","url":null,"abstract":"<p><strong>Background: </strong>Numerous guidelines recommend photodocumentation (PD) of large colorectal polyps ≥10 mm (LP) preresection relative to an open snare or forceps, and suggests postresection PD of the clear resection base. However, no quality metrics have been proposed. We recently reported that preresection and postresection PD occurred in 82% and 52% of 1693 resected LPs, respectively; however, the quality of PD was not ascertained.</p><p><strong>Aims: </strong>To assess the quality of preresection and postresection PD of LPs based on consensus definitions.</p><p><strong>Methods: </strong>Images of LPs resected between 2016 and 2021 were reviewed by 3 gastroenterologists and 1 fellow for assessment of (1) high-quality preresection PD (enough polyp visualized to estimate size), (2) presence of a tool relative to the LP, (3) estimated polyp size, and (4) high-quality postresection PD (clean base without visible polyp tissue). Confidence levels in PD quality assessment and estimated size were provided. Agreement on size was assessed using free-marginal kappa.</p><p><strong>Results: </strong>One hundred ninety-nine LPs with both preresection and postresection images were included. Reviewers' assessment of high-quality preresection PD ranged from 49% to 82% and 51% to 70% for high-quality postresection PD. One percent of preresection images demonstrated an open snare or forceps relative to the LP. Only 74% to 89% of polyps were estimated by reviewers to be ≥10 mm [Kappa=0.66 (95% CI: 0.48-0.64)]. High-level confidence in PD quality and size assessment was lowest in the fellow compared with established gastroenterologists.</p><p><strong>Conclusions: </strong>Although guidelines recommend PD of LPs preresection and postresection, the quality of PD appears suboptimal. Quality standards in LP PD should be considered and the impact of high-quality PD on patient outcomes should be studied.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150485","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":"Diagnostic Yield of Video Capsule Endoscopy (VCE) in Celiac Disease (CD): A Systematic Review and Meta-analysis.","authors":"Maya Shapiro, Yaron Niv","doi":"10.1097/MCG.0000000000002204","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002204","url":null,"abstract":"<p><strong>Background: </strong>Celiac disease is an immune-mediated disorder triggered by the ingestion of gluten in genetically susceptible individuals. CD mainly involves the proximal small intestine and has diverse clinical features ranging from severe gastrointestinal symptoms to no symptoms. Diagnosis is based on CD-specific serology and small bowel biopsy. Video capsule endocopy (VCE) is a relatively safe method that provides high-resolution imaging of the entire small intestine mucosa. Today, VCE assists in CD diagnosis in many circumstances.</p><p><strong>Methods: </strong>We systematically searched the medical literature databases up to December 31, 2023, for English-language studies on CD diagnosis by the VCE. Our inclusion criteria comprised complete articles with extractable data and focused on the VCE yield of known celiac patients. Following data extraction, a Meta-Analysis was performed using Comprehensive Meta-Analysis Software (version 4; Biostat Inc., Englewood, NJ).</p><p><strong>Results: </strong>We found 22 studies and 46 substudies published up to 31.12.2023 of VCE performed in CD and met our inclusion criteria. Together 1585 patients were studied, of whom 1253 (79.05%) were women. The average age of the patients was 51.94±9.98 SD. A complete small bowel investigation was achieved in 1533 (96.72%) of the patients. Any diagnostic pathology's effect size (ES) was 0.601, 95% CI: 0.518-0.678. Specific findings of villous atrophy, scalloping, mosaic pattern, fissuring, ulcers, or erosions were demonstrated with ES of 0.604, 0.571, 0.440, 0.445, and 0.252 of the cases, and as expected higher in refractory celiac disease.</p><p><strong>Conclusions: </strong>Our findings demonstrate pathognomonic features and supported CE diagnosis in about 60% of the patients.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159390","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":"Factors Associated With Delayed Endoscopic Retrograde Cholangiopancreatography Among Patients With Acute Cholangitis.","authors":"Joseph O Atarere, Boniface Mensah, Bryce Kunkle, Chisom Nwaneki, Eugene Annor, Ramya Vasireddy, Vwaire Orhurhu, David Weisman, Christopher Thompson","doi":"10.1097/MCG.0000000000002203","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002203","url":null,"abstract":"<p><strong>Background and goals: </strong>Delayed ERCP is associated with increased morbidity and mortality from acute cholangitis (AC). We aimed to identify the factors associated with delayed receipt of early or urgent ERCP among patients with AC.</p><p><strong>Study: </strong>For this retrospective cohort study, we analyzed data from the 2016 to 2020 iterations of the Nationwide Inpatient Sample. We stratified the study population as severe versus nonsevere AC and timing of ERCP as urgent (within 24 h of admission), early (between 24 and 48 h of admission), and late (after 48 h of admission). Using multivariable logistic regression, we examined for the factors associated with delay in urgent or early ERCP overall and delay in urgent ERCP among patients with severe AC.</p><p><strong>Results: </strong>Of the 12,613 participants included in this study, 3032 (24.0%) had severe AC. Blacks [aOR 1.53; 95% CI (1.27, 1.85)], Asians/Pacific Islanders [aOR 1.22; 95% CI (1.02, 1.46)], those with a history of bariatric surgery [aOR 2.10; 95% CI (1.40, 3.17)] and those with one [aOR 1.33; 95% CI (1.13, 1.58)] or more comorbidities were more likely to have a delay in receiving ERCP within 48 hours of admission when compared with non-Hispanic Whites and those with no comorbidities respectively. Racial disparities were not observed among patients with severe AC.</p><p><strong>Conclusion: </strong>Black/AA and API's presenting with AC are more likely to have a delay in the receipt of ERCP within 48 hours of admission. Assessing the impact of medical comorbidities on procedural risk is important when deciding timing of ERCP.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159395","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":"Treatment of Opioid-Induced Constipation: Inducing Laxation and Understanding the Risk of Gastrointestinal Perforation.","authors":"Neel Mehta, Adam P Laitman, Rowe B Brookfield, Lucinda A Harris","doi":"10.1097/MCG.0000000000002185","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002185","url":null,"abstract":"<p><p>Patients receiving opioid analgesics may experience constipation [ie, opioid-induced constipation (OIC)], require treatment to induce laxation, and may be at risk for gastrointestinal perforation, an uncommon but potentially life-threatening condition. Management of OIC includes treatment with over-the-counter laxatives and peripherally acting μ-opioid receptor antagonists (PAMORAs; methylnaltrexone, naloxegol, naldemedine). In patients receiving treatment for OIC, gastrointestinal perforation may result from the laxation process, causing disruption of the gastrointestinal lining that may already have compromised integrity. A PubMed literature review and a search of the US Food and Drug Administration Adverse Event Reporting System database identified several cases of gastrointestinal perforation (life-threatening or with mortality) across the range of agents administered for the treatment of OIC or other constipation types. Methylnaltrexone in the subcutaneous form was the first PAMORA approved for OIC. Its real-world use in the ∼6 years before the availability of another OIC-indicated PAMORA helped establish the adverse-event profile of the class, and experience has been gained in identifying and treating appropriate patient populations. Class labeling of PAMORAs includes a contraindication in patients with known or suspected gastrointestinal obstruction or increased risk of recurrent obstruction. Appropriate patient selection during laxation therapy for OIC, regardless of treatment plan, involves consideration of the overall risk versus benefit in patients at increased risk of perforation due to comorbid medical conditions, concurrent medications, or recent gastrointestinal procedures. After initiating treatment for OIC, clinicians should assess the effectiveness of laxation therapy and carefully monitor for signs of gastrointestinal perforation.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144158187","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 Benign Liver EUS Optimal Core Study (BLOCs): A Prospective Randomized Multicenter Study Evaluating Wet-suction Versus Slow Pull Technique for EUS-guided Liver Biopsy.","authors":"Neil R Sharma, Harishankar Gopakumar, Harshit Khara, Abhilash Perisetti, Saurabh Gupta, Mariajose Rojas DeLeon, Marzena Muller, Christina Zelt, Mindy Flanagan, Ashley Rumple, Amitpal Johal, Bradley Confer, Jiahong Li, Meir Mizrahi, Ann Chen, Kefu Li, Mohammad Al-Haddad, Mohamed Othman, Isaac Raijman, Abdul H El Chafic, David Diehl","doi":"10.1097/MCG.0000000000002168","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002168","url":null,"abstract":"<p><strong>Background and aims: </strong>The specimen quality of endoscopic ultrasound-guided liver biopsy (EUS-LB) for benign liver disease evaluation depends on the technique and type of needle used. Using a 19-gauge (19 g) fine needle biopsy (FNB) needle with 3 actuations and wet suction (WS) or slow stylet pull is the current preferred practice. We conducted a randomized prospective multicenter trial to compare wet suction (WS) to slow stylet pull (SP) technique to compare histologic yields, length of procedure, and adverse events (AE).</p><p><strong>Methods: </strong>This prospective randomized trial (NCT03245580) included patients undergoing EUS-LB for parenchymal biopsy at 6 centers in the United States in 2020-2021. A 19 g Franseen tip EUS needle was used for all procedures. For WS, the needle was flushed with saline, and a 20 ml suction syringe with 3 to 5 ml of fluid was used. For SP, a slow pullback of stylet was used. Pathologist was blinded for tissue interpretation.</p><p><strong>Results: </strong>One hundred fifty-three patients across 6 tertiary centers were included, with 75 patients in the WS arm and 78 patients in the SP arm. Histologic outcomes were superior in WS compared with SP [aggregate specimen length (46.5 vs. 34.5 mm, P<0.001), length of longest fragment (14 vs. 11 mm, P<0.001), and number of complete portal tracts (16 vs. 11.5, P<0.001)]. The overall ability to make a histological diagnosis was higher in WS (99% vs. 92%). Procedure length and AE did not differ between groups.</p><p><strong>Conclusions: </strong>The use of WS compared with SP for EUS-LB resulted in superior specimen yields. Total procedure time and adverse events were similar for both techniques.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111016","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 Management and Economic Burden of Gallbladder Polyps.","authors":"Mohamad Ali Ibrahim, Zakaria El Kouzi, Fayrouz Hachicho, Lynn Kobeissi, Jana Haidar Ahmad, Ala I Sharara","doi":"10.1097/MCG.0000000000002197","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002197","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder polyps (GBP) are found incidentally on imaging in ∼5% of the general population. Most are asymptomatic and only a very small percentage are malignant. This study examines real-world clinical practice management of GBP and adherence to the updated joint European guidelines.</p><p><strong>Methods: </strong>Patients with GBP between January 2019 and October 2022 were included. Clinical, radiologic, and surgical data were collected retrospectively.</p><p><strong>Results: </strong>One hundred thirty-eight patients were included (mean age 47.0±14.1; female 46.4%). The average follow-up period was 30.6±40.8 months. During the study period, only 26.0% of patients had an increase in GBP size. There were no predictors for GBP growth. Cholecystectomy was performed in 30 patients: 19 (63.3%) had GBP as the indication, and in those, only 9/19 (47.4%) had proper indications according to guidelines. No malignant polyps were found, and no GBP-related deaths were reported. Increased polyp size (P<0.0001) and number (P=0.014) during follow-up were significantly associated with cholecystectomy. Of the 104 patients who did not have surgery, 70 (67.3%) had no indication for follow-up imaging, but 42 (60%) were advised to continue follow-up. The average increased cost of guideline-inconsistent follow-up imaging was >$51,000 and >$67,000 for unindicated cholecystectomies, bringing total waste expenditures to >$118,000.</p><p><strong>Conclusion: </strong>The natural history of GBP does not justify close or prolonged follow-up, especially in young individuals without risk factors. Poor adherence to guidelines by radiologists, gastroenterologists, surgeons, and other health care providers should be addressed, offering a real opportunity for medical education and significant health care savings.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078379","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":"Cyclic Vomiting Syndrome in Adults at the National Level: Impact of Demographics, Burden of Comorbidities, Effect of Hospital Factors, and Determinants of Mortality.","authors":"Faris Shweikeh, Abdur Rahman Jabir, Madison Simons, Samita Garg, Michael Cline, Scott Gabbard, Anthony Lembo, Matthew Hoscheit","doi":"10.1097/MCG.0000000000002180","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002180","url":null,"abstract":"<p><strong>Goals: </strong>The aim of this study was to assess clinical, economic, and epidemiological characteristics of hospitalized patients in the United States with cyclic vomiting syndrome (CVS).</p><p><strong>Background: </strong>CVS is a poorly understood disorder of gut-brain interaction (DGBI) characterized by recurring episodes of intractable nausea and vomiting.</p><p><strong>Study: </strong>The study utilized the Healthcare Cost and Utilization Project's National Inpatient Sample between 2016 and 2019. χ2 test and logistic regression were performed to compare the variables. All analyses included sample weights, strata, and clusters to account for the complex survey design.</p><p><strong>Results: </strong>Admission rates declined from 11,055 in 2016 to 8625 in 2019. Mean age (34.7 y), females (62.5%), and racial distribution (61.8% white) remained stable. Patients were more likely to be 18 to 30 years old (37.2%) and female (62.5%). Comorbidities included anxiety/depression (38.6%) and cannabis use (35.0%). Overall, 90.4% were discharged routinely (ie, to home). Older age (P=0.002) and female gender (P<0.001) had higher length of stay (LOS) and charges. Hispanics incurred higher costs (P<0.001). Depression/anxiety comorbidity (P<0.001) and teaching hospitals (P<0.001) were associated with significantly higher LOS and cost.</p><p><strong>Conclusions: </strong>The number of hospitalizations declined between 2016 and 2019, with the latter having 8625 hospitalizations costing over $300 million. Young females represent a larger group, African Americans were disproportionally affected, and Hispanics had the highest hospitalization costs. Anxiety and depression are primary comorbidities. The disparities identified can help clinicians identify riskier CVS patients who may become a burden on the healthcare system, stratifying them for closer monitoring with the goal of improved outcomes.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078337","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":"Anupam Kumar Singh, Siddharth Shukla, Ritesh Acharya, Chhagan Lal Birda, Pramod Kumar Sah, Shravya Singh, Vaneet Jearth, Jimil Shah, Ashish Agarwal, Arun Kumar Sharma, Yashwant Raj Sakaray, Saroj Kant Sinha, Usha Dutta","doi":"10.1097/MCG.0000000000002196","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002196","url":null,"abstract":"<p><strong>Background: </strong>Clostridioides difficile infection (CDI) and acute severe ulcerative colitis (ASUC) are both independently associated with poor outcome. The impact of CDI on the outcome of severe flare of ulcerative colitis is not studied. In the current study, we assess the impact of CDI on the outcome of ASUC.</p><p><strong>Methods: </strong>Data of ASUC patients were collected from January 2022 to July 2024. Parameters included were demographic profile, disease characteristics, biochemical investigations, and stool C. difficile toxin A/B (CDTA). Patients were categorized into ASUC-CDI and ASUC groups. Primary outcomes were need of rescue therapy, colectomy, and mortality during index admission. Six-month outcomes were flare of disease, colectomy, and mortality.</p><p><strong>Results: </strong>Of the 117 patients included, 91 (77.8%) patients were in the ASUC group and 26 (22.2%) in the ASUC-CDI group. Baseline parameters were similar between the 2 groups. Overall, 86 (73.5%) patients responded to corticosteroid therapy. Need of rescue therapy (24.2% vs. 33.6%, P=0.287), colectomy (3.3% vs. 11.5%, P=0.093), and mortality (1.1% vs. 3.8%, P=0.345) rates were comparable between the ASUC and ASUC-CDI groups. Six-month colectomy (4.4% vs. 15.4%) and mortality (1.1% vs. 7.7%) rates were numerically higher in the ASUC-CDI group, though statistically nonsignificant.</p><p><strong>Conclusion: </strong>The immediate and short-term outcome of patients with acute severe ulcerative colitis in the presence of C. difficile infection is determined by the severity of ulcerative colitis flare.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078341","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}