Journal of clinical gastroenterology最新文献

{"title":"Lean Metabolic Dysfunction-Associated Steatotic Liver Disease: A Comparative Analysis of Hepatic and Oncological Outcomes.","authors":"Chaula Desai, Sweta Lohani, Anuj R Sharma, Lucas Schwartz, Saigopal R Gujjula, Adhithya Baskar, Udhaya Baskar, Suriya Baskar, Anush Vasikaran","doi":"10.1097/MCG.0000000000002153","DOIUrl":"10.1097/MCG.0000000000002153","url":null,"abstract":"<p><strong>Goals: </strong>To compare outcomes of MASLD in obese and nonobese populations.</p><p><strong>Background: </strong>MASLD is emerging as one of the leading causes of liver failure and liver-related morbidity and mortality, with an increasing prevalence in the nonobese or lean population. The purpose of this study is to compare hepatic and oncological outcomes between MASLD patients with lean BMI and nonlean BMI.</p><p><strong>Study: </strong>The National Inpatient Sample (NIS) was queried from 2016 to 2020 for adult hospitalizations with MASLD. Exclusion criteria included concurrent diagnoses of viral hepatitis, alcoholic hepatitis, primary biliary cholangitis, hereditary hemochromatosis, autoimmune hepatitis, or Wilson disease. Outcomes of MASLD and its complications were compared between the lean and nonlean subgroups.</p><p><strong>Results: </strong>Patients with lean BMI had higher mortality rates (odds ratio: 2.10, P <0.001). The lean cohort also had higher odds of cirrhosis, portal hypertension, SBP, and ascites. The lean subgroup had higher odds of gastrointestinal malignancies including esophageal cancer, gastric cancer, pancreatic cancer, and colorectal cancer.</p><p><strong>Conclusions: </strong>Hospitalized lean MASLD patients had higher odds of mortality, ​​hepatic morbidities, and gastrointestinal malignancies. These results challenge the use of BMI as a predictor of morbidity and mortality for MASLD patients. Future studies should focus on therapeutic options for MASLD and compare their efficacies between lean and nonlean populations.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"922-926"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500922","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":"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. χ 2 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":"885-892"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","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":"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":"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":"936-945"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","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":"Development and Validation of a Machine Learning-based Model for Prediction of Liver Fibrosis and MASH.","authors":"Maojie Liu, Longfeng Jiang, Juan Yang, Yao Yao, Xuerong Puyang, Xinyuan Ge, Jing Lu, Lu Zhang, Yuqian Yan, Hongbing Shen, Ci Song","doi":"10.1097/MCG.0000000000002166","DOIUrl":"10.1097/MCG.0000000000002166","url":null,"abstract":"<p><strong>Background and aim: </strong>The development of accurate noninvasive tests to identify individuals with metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis is of great clinical importance. In this study, we aimed to develop 2 noninvasive diagnostic models on the basis of routine clinical and laboratory data, using machine learning, to identify patients with MASH and significant fibrosis (fibrosis stages 2 to 4), respectively.</p><p><strong>Methods: </strong>This analysis included the training (n=456) and the validation (n=105) sets of patients who underwent liver biopsy and laboratory testing for liver disease at 2 hospitals in China. Logistic regression, random forest, support vector machine, and the XGBoost algorithm were used to construct models, respectively. The best diagnostic models for MASH and significant fibrosis were compared with 7 existing noninvasive scoring systems including AAR, AST to platelet ratio index (APRI), BARD score, fibrosis-4 (FIB-4), fibrotic non-alcoholic steatohepatitis (NASH) index (FNI), homeostatic model assessment of insulin resistance (HOMA-IR), and non-alcoholic fatty liver disease fibrosis score (NFS). Performance was estimated by the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>The final noninvasive diagnostic model integrated 19 indicators derived from routine clinical and laboratory tests. The XGBoost models exhibited superior performance in MASH and significant fibrosis with an improved AUROC value (MASH, 0.670, 95% CI 0.530-0.811; significant fibrosis, 0.713, 95% CI 0.611-0.815) compared with other noninvasive scoring systems in the validation set.</p><p><strong>Conclusions: </strong>Utilizing machine learning can assist in diagnosing MASH and significant fibrosis based on clinical epidemiological information with good diagnostic performance.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"927-935"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"Increased Prevalence of Pulmonary Diseases in Patients With Inflammatory Bowel Disease: A Retrospective Multicenter Study\".","authors":"Qingxin Dou, Yiheng Yao, Liang Liu","doi":"10.1097/MCG.0000000000002363","DOIUrl":"10.1097/MCG.0000000000002363","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"949-950"},"PeriodicalIF":2.7,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499306","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":"High-Resolution Manometry Assessment of Esophagitis Across Los Angeles Grades Validates Lyon 2.0 Criteria.","authors":"Marco Sozzi, Stefano Siboni, Pierfrancesco Visaggi, Ivan Kristo, Nicola De Bortoli, Benjamin D Rogers, Salvatore Tolone, Elisa Marabotto, Andrea Pasta, Francesco Calabrese, Daniele Bernardi, Carlo G Riva, Roberta De Maron, Francesca Senzani, Sebastian F Schoppmann, Emanuele L G Asti, Edoardo V Savarino, C P Gyawali","doi":"10.1097/MCG.0000000000002448","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002448","url":null,"abstract":"<p><strong>Introduction: </strong>Gastroesophageal reflux disease (GERD) with erosive esophagitis is driven by antireflux barrier (ARB) dysfunction, yet a comprehensive high-resolution manometry (HRM) assessment across Los Angeles (LA) grades is lacking. This study evaluates HRM metrics in patients with erosive esophagitis to validate Lyon 2.0 consensus criteria, hypothesizing that LA grade B esophagitis shares manometric features with severe GERD (LA grades C-D) and that HRM can stratify LA grade A patients for objective GERD risk.</p><p><strong>Methods: </strong>A retrospective multicenter study (July 2022 to July 2025) enrolled 254 patients with GERD symptoms and erosive esophagitis (LA grade A: 145, B: 84, C-D: 25) across 6 centers. Patients underwent off-PPI endoscopy, HRM, and pH monitoring. HRM assessed esophagogastric junction (EGJ) morphology, EGJ-contractile integral (EGJ-CI), ineffective esophageal motility (IEM), straight leg raise (SLR), and Milan Score. Pathologic GERD was defined per Lyon 2.0 criteria.</p><p><strong>Results: </strong>LA grades B and C-D showed a higher rate of hiatal hernia, positive SLR, and lower EGJ-CI compared with LA grade A (P<0.001). Milan Score increased with esophagitis severity (P<0.001). Reflux monitoring confirmed pathologic GERD in 96% (B) and 100% (C-D) versus 50% (A) based on pH and impedance criteria. In LA grade A, patients with ≥2 disrupted ARB mechanisms (67.5%) had higher GERD rates than those with intact ARB (29.2%).</p><p><strong>Discussion: </strong>HRM supports Lyon 2.0 inclusion of LA grade B as definitive GERD, with manometric profiles similar to C-D. In LA grade A, compromised ARB identifies higher GERD risk, guiding therapy escalation.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228034","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":"GI PCR Versus Stool Culture: Can Positive-Result Cohorts Determine the Preferred Initial Test?","authors":"Yuan Xue","doi":"10.1097/MCG.0000000000002453","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002453","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228014","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":"Comparison of the Efficacy of Dexrabeprazole and Rabeprazole in Inhibiting Intragastric and Intraesophageal Acidity in Gastroesophageal Reflux Disease.","authors":"Elvan Isik, Serhat Bor","doi":"10.1097/MCG.0000000000002449","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002449","url":null,"abstract":"<p><strong>Background: </strong>Proton pump inhibitors (PPIs) are the cornerstone of gastroesophageal reflux disease (GERD) treatment, but concerns regarding their efficacy and side effects persist. Dexrabeprazole, the R(+) enantiomer of rabeprazole, may offer similar efficacy with a lower dose, potentially addressing these issues.</p><p><strong>Aim: </strong>This study aimed to compare the efficacy and safety of dexrabeprazole 10 mg and rabeprazole 20 mg in GERD patients with pathologic acid reflux.</p><p><strong>Method: </strong>A total of 48 GERD patients were included: 24 received dexrabeprazole 10 mg and 24 constituted the historical active-control group receiving rabeprazole 20 mg, once daily for 7 days. Gastric and intraesophageal acidity, GERD symptoms (heartburn, regurgitation), and adverse event frequency were assessed pre- and post-treatment.</p><p><strong>Results: </strong>Both groups showed significant improvements in esophageal and gastric acidity, acid reflux frequency, and GERD symptoms. Dexrabeprazole 10 mg significantly reduced regurgitation scores by day 1 (P=0.001), whereas rabeprazole 20 mg did not achieve similar reductions at this time point (P=0.114). In addition, the reduction in 24-hour intraesophageal pH <4 times was greater in the dexrabeprazole group (P=0.035). There were no significant differences in adverse events or laboratory findings between groups.</p><p><strong>Conclusion: </strong>Dexrabeprazole 10 mg demonstrated comparable efficacy to rabeprazole 20 mg and provided faster improvement in regurgitation and a greater reduction in intraesophageal acid exposure. These findings suggest that dexrabeprazole 10 mg may be an effective alternative to higher doses of rabeprazole in GERD management. Further studies are warranted to confirm these results and explore their long-term benefits.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228056","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 Trajectory of Gastrointestinal Symptom Experience Following Fecal Microbiota Transplant for Recurrent Clostridioides Difficile Infection.","authors":"Hijab Zehra, Nataliia Kuchma, Annie W Lin, Glen Morris, Olivia Solano, Sharon Lopez, Amanda J Kabage, Byron P Vaughn, Alexa Weingarden, Monika Fischer, Alexander Khoruts, Levi Teigen","doi":"10.1097/MCG.0000000000002424","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002424","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrent Clostridioides difficile infection (rCDI) increases the risk of persistent gastrointestinal symptoms after treatment. Although fecal microbiota transplantation (FMT) effectively prevents CDI recurrence after antibiotics, the trajectory of gastrointestinal symptom severity remains poorly characterized.</p><p><strong>Methods: </strong>We tracked gastrointestinal symptom severity in a prospective, multicenter cohort study of adults with rCDI after treatment with standardized FMT products. Patients who experienced a CDI recurrence during the follow-up period were excluded. The IBS Symptom Severity Scale (IBS-SSS) was used as a measure of symptom severity, not as a diagnostic tool. Patients completed the IBS-SSS at the time of FMT, 1-week, 1-month, and 3-months post-FMT. The primary outcome was the change in IBS-SSS score after treatment. Subgroup analyses were conducted among patients with baseline IBS-SSS ≥175 (moderate/severe symptom severity) and <175 (none/mild symptom severity). Linear mixed-effects models were used to evaluate longitudinal changes and identify clinical predictors of IBS-SSS scores.</p><p><strong>Results: </strong>Among 107 patients included, median IBS-SSS scores decreased from 170 (range: 0 to 440) at baseline to 76 (range: 0 to 390) at week 1 and 54 (0 to 445) at month 3 (P<0.001). In those with baseline IBS-SSS ≥175 (n=51), 64% had none or mild symptom severity at month 3. In those with baseline IBS-SSS <175 (n=53), symptom severity was observed to remain as none or mild at month 3 in all but one patient.</p><p><strong>Conclusion: </strong>FMT administered for prevention of rCDI was followed by a rapid (1 wk) and sustained (3 mo) reduction in gastrointestinal symptom scores in patients who did not develop CDI recurrence. These data help characterize the expected early post-FMT symptom trajectory, providing foundational evidence to better inform patient expectations and future interventions for persistent symptoms.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193989","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":"Monoclonal Antibody Therapy in Eosinophilic Esophagitis: A Narrative Review of Effects on Dysphagia, Histologic Response, and Endoscopic Outcomes.","authors":"Nwal Hadaki, Bisher Sawaf, Kyrillos M Gerges, Hassam Cheema, Adam Alhaddad, Amr Kais, Akira Saito, Mohammad Al-Haddad","doi":"10.1097/MCG.0000000000002450","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002450","url":null,"abstract":"<p><p>Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disorder characterized by esophageal eosinophilic infiltration and symptoms of esophageal dysfunction, most notably dysphagia and food impaction. The prevalence of EoE has increased substantially over the past 2 decades, and the disease is now recognized as a major cause of esophageal morbidity in both adults and adolescents. Although proton pump inhibitors, swallowed topical corticosteroids, dietary elimination strategies, and endoscopic dilation remain the cornerstone of therapy, a considerable proportion of patients experience persistent symptoms, disease recurrence, or treatment-related limitations. Advances in understanding the immunopathogenesis of EoE have identified type 2 inflammatory pathways as central drivers of disease activity, leading to the development of targeted monoclonal antibody therapies. Several monoclonal antibodies directed against interleukin-4, interleukin-5, interleukin-13, and Siglec-8 have been evaluated in randomized controlled trials, demonstrating variable effects on clinical symptoms, histologic remission, and endoscopic disease severity. This review synthesizes current evidence on monoclonal antibody therapy for EoE in adolescents and adults, with emphasis on their mechanistic rationale, clinical efficacy, and limitations. Particular attention is given to the frequently observed discordance between symptomatic improvement and histologic or endoscopic response. Current guideline recommendations, regulatory considerations, and future research directions are also discussed.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194067","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}