Journal of clinical gastroenterology最新文献

{"title":"Letter to the Editor: End-of-life in Hepatocellular Carcinoma How Palliative Care and Social Factors Impact Care and Cost.","authors":"J Brian Cassel","doi":"10.1097/MCG.0000000000002114","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002114","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800907","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 Repeat Per-oral Endoscopic Myotomy After Failed POEM for Achalasia: A Systematic Review and meta-analysis.","authors":"Umar Hayat, Faisal Kamal, Usman Iqbal Rana, Amna Iqbal, Manesh K Gangwani, Hassam Ali, Keerthy Gopalakrishnan, Umer Farooq, Hafiz M Akbar, Kishore Kumar, Doulas G Adler","doi":"10.1097/MCG.0000000000002117","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002117","url":null,"abstract":"<p><strong>Background: </strong>Per-oral endoscopic myotomy (POEM) is an effective option for treating achalasia. Despite its high efficacy, a fraction of patients remain symptomatic after POEM, and the data on the optimal management of these patients is limited. Few studies have evaluated the effectiveness of repeat POEM after a failed POEM.</p><p><strong>Aim: </strong>To evaluate the efficacy and safety of repeat POEM for persistent symptoms after the initial POEM.</p><p><strong>Methods: </strong>We searched major databases from inception to April 2024 to identify studies evaluating the efficacy and safety of repeat POEM after failed POEM in patients with achalasia. Our outcomes of interest were clinical success (a reduction in the Eckardt score to ≤3 after the procedure), adverse events, and differences in pre-procedure and post-procedure Eckardt scores. Using the random effects model, we calculated pooled rates with 95% CI for categorical variables and mean difference (MD) with 95% CI for continuous variables.</p><p><strong>Results: </strong>We included 6 observational studies with 123 patients. The mean time between myotomies ranged from 12.2 to 13.5 months. The pooled rate (95% CI) of clinical success was 82.69% (95% CI; 69.65%-93.06%). The pooled rate (95% CI) of adverse events was 17.97% (95% CI: 5.08%-35.15%). The pooled mean±SD post-procedure Eckardt score was 1.63±1.93. The mean post-procedure Eckardt score was significantly lower than the re-procedure Eckardt score, MD (95% CI): 3.68 (2.58, 4.78).</p><p><strong>Conclusion: </strong>Repeated POEM is an effective option for persistent symptoms of achalasia after initial POEM; however, it is associated with nontrivial adverse events.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800906","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":"Validation of the Laryngeal Cognitive-affective Tool in a Taiwanese Population.","authors":"Amanda J Krause, Rena Yadlapati, Ming-Wun Wong, Tiffany Taft, John E Pandolfino, C Prakash Gyawali, Chien-Lin Chen","doi":"10.1097/MCG.0000000000002116","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002116","url":null,"abstract":"<p><strong>Background and aim: </strong>The laryngeal cognitive-affective tool (LCAT) was recently validated in the US to assess laryngeal-specific hypervigilance and anxiety. The aim of this study was to examine LCAT validity in the Taiwanese population.</p><p><strong>Methods: </strong>This prospective single-center study enrolled adults from Hualien Tzu Chi Hospital with laryngeal symptoms for >6 months.</p><p><strong>Results: </strong>One hundred four patients included: mean age 49.5 years (SD 13.3), 69% female, mean BMI 25.3 kg/m2 (5.8), and mean LCAT 25.9 (15.2). The LCAT had excellent internal consistency (α=0.969) and split-half reliability (Guttman=0.925).</p><p><strong>Conclusions: </strong>The LCAT is newly validated in the Taiwanese population and assesses laryngeal-specific cognitive-affective processes in patients with chronic laryngeal symptoms.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769457","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":"Infliximab Trough Levels Are Associated With Endoscopic Remission in Small Bowel Crohn's Disease.","authors":"Wei Han, Bingqing Bai, Yuqing Wang, Jing Hu, Juan Wu, Qiuyuan Liu, Yongrong Shi, Qiao Mei","doi":"10.1097/MCG.0000000000002111","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002111","url":null,"abstract":"<p><strong>Goals: </strong>To identify the association between infliximab trough levels (ITL) and treatment outcomes in small bowel Crohn's disease (SB-CD).</p><p><strong>Background: </strong>Higher ITL are associated with favorable treatment outcomes in CD. However, the association between ITL and SB-CD treatment outcomes are rarely studied.</p><p><strong>Study: </strong>This was a retrospective cross-sectional study. Patients with SB-CD who received maintenance infliximab therapy were recruited, and treatment efficacy was evaluated through double balloon endoscopy. Serum samples were collected to test ITL. The primary outcome was endoscopic remission (ER), which is defined as a Simple Endoscopic Score of Crohn's disease (SES-CD) of <3. The secondary outcome was mucosal healing (MH) (SES-CD: 0) and endoscopic response (SES-CD decreased by 50% from baseline). The factors associated with ER were also explored through logistic regression analysis.</p><p><strong>Results: </strong>In total, 111 patients with SB-CD were enrolled. Forty-seven patients (42.3%) achieved ER. Median ITL was significantly higher in patients with ER than patients without ER (2.74 vs. 1.12 µg/mL, P<0.01). In a multivariate model, an elevated ITL was the only independent factor associated with an increased probability of ER [odds ratio (OR): 1.24, 95% CI: 1.08-1.43, P=0.003]. The cutoff level of ITL used to predict ER with a specificity of >80% was 3.45 µg/mL, and the area under the curve (AUC) was 0.790. Meanwhile, the AUC cutoff to predict MH and endoscopic responses was 0.767 and 0.759, respectively.</p><p><strong>Conclusions: </strong>There was a significant association between higher ITL and favorable SB-CD treatment outcomes.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769450","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":"Comment on: Effectiveness of Early Thiopurine Use in Korean Patients With Moderate-to-severe Ulcerative Colitis: A Prospective Multicenter Cohort (MOSAIK) Study.","authors":"Fadi H Mourad, Viraj C Kariyawasam, Rupert W Leong","doi":"10.1097/MCG.0000000000002113","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002113","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769491","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":"Medical and Demographic Characteristics of Patients With Eosinophilic Esophagitis and Celiac Disease: A Retrospective Cohort Study.","authors":"Mohamed Aly, Benjamin D Liu, Gengqing Song","doi":"10.1097/MCG.0000000000002105","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002105","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic esophagitis (EoE) and celiac disease are both chronic T helper cell-mediated inflammatory conditions of the digestive tract. Although an association between these two conditions has been suggested, it has not been well characterized in a real-world setting.</p><p><strong>Goals: </strong>Our objective was to better examine the association between celiac disease and EoE using a real-world population database.</p><p><strong>Study: </strong>This was a retrospective cohort study of data using TriNetX, a global population database, to identify patient records using International Classification of Disease 10 (ICD-10) codes. We organized participants into six distinct cohorts predicated on age and diagnoses of celiac disease and EoE between April 28, 2003, and April 28, 2023. Patient demographics, prevalence, incidence, and medical characteristics of each cohort were extracted.</p><p><strong>Results: </strong>Among 46,398 patients with EoE and 84,383 patients with celiac disease, individuals with EoE demonstrated a higher prevalence (2.76%) and incidence (329/100,000 persons/year) of celiac disease compared with those without EoE (0.21% prevalence and 146/100,000 incidence, between 2021 and 2023). A concurrent diagnosis of both conditions increased the risk of asthma (RR: 2.00 pediatric, 1.82 adult), allergic rhinitis (RR: 2.35 pediatric, 1.81 adult), atopic dermatitis (RR: 3.28 pediatric, 2.07 adult), and rheumatoid arthritis (RR: 3.53 pediatric, 1.41 adult). In addition, patients with celiac disease with EoE exhibited a heightened risk for iron deficiency anemia (aHR 1.789; 95% CI: 1.166 to 2.745).</p><p><strong>Conclusions: </strong>Both the incidence and prevalence of EoE are elevated in patients with celiac disease and vice versa. These concurrent diagnoses affect disease characteristics and heighten the risk of complications in celiac disease.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769452","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":"Oral Capsule FMT Combined With Bezlotoxumab Is a Successful Rescue Protocol Following Failure of FMT Alone in the Treatment of Recurrent C. difficile Infection.","authors":"Austin Hoeg, Nataliia Kuchma, Andrew Krane, Carolyn Graiziger, Juana Thomas, Colleen R Kelly, Alexander Khoruts","doi":"10.1097/MCG.0000000000002108","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002108","url":null,"abstract":"<p><strong>Goals: </strong>Evaluate the benefit of adding bezlotoxumab to repeat fecal microbiota transplantation (FMT) in patients with recurrent Clostridioides difficile infections after the failure of FMT alone.</p><p><strong>Background: </strong>The initial failure of FMT in breaking the cycle of recurrent Clostridium difficile(C. difficile) infections is associated with a greater risk of subsequent failure. Our previous analysis showed that FMT failure is associated with delayed repair of fecal microbiota at 1 week after administration. We hypothesized that increasing the symptom-free interval by adding bezlotoxumab would improve the outcomes of a second FMT.</p><p><strong>Study: </strong>A new rescue protocol that combines FMT with bezlotoxumab for patients who previously failed FMT alone was implemented in 2 academic medical centers. The clinical outcomes of a new protocol were captured in a prospective registry. The results were compared in a retrospective analysis of clinical outcomes of prior experience with repeat FMT by itself. All FMT preparations were standardized for dose. Bezlotoxumab administration was synchronized temporally with the second FMT to maximize its duration of action.</p><p><strong>Results: </strong>Our historical cure rate of second FMT in treatment of recurrent C. difficile infection was 48% (15/31 patients). Addition of bezlotoxumab to the second FMT resulted in a cure rate of 89% (24/27 patients).</p><p><strong>Conclusions: </strong>Addition of bezlotoxumab markedly improved the cure rate of the second FMT following initial FMT failure. The rationale for the protocol design highlights the importance of understanding the pharmacokinetics of both bezlotoxumab and FMT. Similar principles may apply to other live biotherapeutic products that are becoming available for prevention of C. difficile infection recurrence.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769454","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 Carvedilol and Propranolol in Reducing the Portal Vein Pressure: A Systematic Review and Meta-analysis.","authors":"Window Hu, Shunyu Yao, Min Qiao","doi":"10.1097/MCG.0000000000002106","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002106","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>The portal vein pressure higher than 10 mm Hg in patients with hepatic cirrhosis is more likely to have serious complications and poor prognosis. Nonselective receptor blockers (NSBBs) can reduce the portal vein pressure; however, the efficacy and safety of different NSBBs in reducing portal vein pressure were unconsistent. A systematic review and meta-analysis was conducted to evaluate the efficacy and safety of carvedilol versus propranolol in reducing portal vein pressure in this study.</p><p><strong>Materials and methods: </strong>We assessed Randomized controlled trials (RCTs) through PubMed, Web of science, Embase, and Cochrane library up to January 2024. Data from eligible studies were pooled in fixed-effect or random-effect meta-analysis models, using RevMan software. Two researchers screened articles, extracted data, and assessed the study quality independently according to the PRISMA guidelines. The primary outcomes were the reduction of hepatic venous pressure gradient (HVPG), the hemodynamic response rate, and the incidence of adverse events. Secondary outcomes were mean artery pressure (MAP) and heart rate (HR).</p><p><strong>Results: </strong>A total of 7 RCTs, including 351 patients, were included in our meta-analysis. The results indicated that the magnitude of reduction in HVPG was greater in carvedilol compared with propranolol (MD: 1.08; 95% CI: 0.61 to 1.54; I2=0%, P<0.00001) in short-term follow-up. Carvedilol's hemodynamic response rate was higher than that of propranolol (OR: 0.44; 95% CI: 0.27 to 0.72; I2=0%, P = 0.001).</p><p><strong>Conclusions: </strong>Our meta-analysis indicated that compared with propranolol, carvedilol was better in lowering portal hypertensive and had higher response rate in patients with hepatic cirrhosis. There was no obvious difference in safety between the 2 medications.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006298","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":"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":"The Effects of Gluten-free Diet on Body Mass Indexes in Adults with Celiac Disease: A Systematic Review and Meta-analysis of Observational Studies.","authors":"Noam Peleg, Yaron Niv, Ram Dickman, Doron Boltin, Alex Krauthammer, Michal Herman-Edelstein, Nidal Issa, Jacob E Ollech, Tom Konikoff, Rachel Gingold-Belfer","doi":"10.1097/MCG.0000000000001998","DOIUrl":"10.1097/MCG.0000000000001998","url":null,"abstract":"<p><strong>Goals and background: </strong>Gluten-free diet (GFD) includes a higher intake of sugars and fats. Previous studies have investigated its effect on body mass index (BMI) in celiac disease (CD) patients but had contradictive conclusions. Thus, we conducted a systematic review and meta-analysis examining the effect of GFD on BMI in CD patients.</p><p><strong>Study: </strong>Systematically, we conducted literature research using Medline, Scopus, and Embase, and we identified 1565 potential studies/abstracts. Only studies of patients with CD under a GFD with recorded BMI before and after dietary intervention were included. Subgroup analyses based on study design and BMI categories were performed. We calculated the pooled odds ratios (ORs) and 95% confidence intervals (Cls) for the number of patients in each BMI group according to the World Health Organization (WHO) definitions after GFD using fixed and random effect meta-analysis.</p><p><strong>Results: </strong>The analysis included 10 studies and 38 sub-studies/data sets, which encompassed 2450 patients from 5 countries. We found nonsignificant odds for changing the BMI group (pooled OR 0.972, 95% CI: 0.858-1.101, P =0.65) after GFD. However, looking specifically at BMI subgroups, we found higher odds for BMI category change after GFD in underweight patients (OR 0.588, 95% CI: 0.479-0.723, P <0.001), and overweight patients,25<BMI<30, (OR 1.332, 95% CI: 1.167-1.521, P <0.001). No publication bias was demonstrated, and the amount of heterogeneity between studies was moderate ( I2 =54.13).</p><p><strong>Conclusion: </strong>Although crucial in patients with CD, GFD is associated with increased BMI in some CD patient populations. Accordingly, special considerations and follow-up should be maintained in overweight patients with CD after GFD.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"989-997"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305777","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}