Journal of clinical gastroenterology最新文献

{"title":"Real-world Study of Three-gas Breath Testing Nationwide and the Association With Symptoms.","authors":"Mark Pimentel, Gabriela Leite, LiJin Joo, Ali Rezaie, Ruchi Mathur, Darren Brenner, Linda Nguyen, Mohamad Rashid, Ava Hosseini, Daniel Brimberry, Matthew Mitcho, David Richardson, Fabrice Wilfong","doi":"10.1097/MCG.0000000000002326","DOIUrl":"10.1097/MCG.0000000000002326","url":null,"abstract":"<p><strong>Goals and background: </strong>Hydrogen (H 2 ) breath testing (BT) is used to diagnose small intestinal bacterial overgrowth (SIBO), and methane (CH 4 ) to diagnose constipation. Recently, a third microbially derived gas, hydrogen sulfide (H 2 S), was added to BT and associated with diarrhea. Here, we assess a 3-gas BT nationwide, comparing the results to gastrointestinal (GI) symptoms.</p><p><strong>Study: </strong>Consecutive subjects (N=6000) undergoing 3-gas at-home BT were asked to complete a symptom questionnaire. Substrate choice (glucose or lactulose) was at physician's discretion. H 2 , CH 4, and H 2 S levels, and presence/absence of SIBO (≥20 ppm rise in H 2 within 90 min), intestinal methanogen overgrowth (IMO) (≥10 ppm CH 4 ), and intestinal sulfide overproduction (ISO, defined here as ≥2 ppm H 2 S) were compared with symptom severity. Gas interactions and symptoms' correlations were determined using machine learning (Uniform Manifold Approximation and Projection [UMAP]).</p><p><strong>Results: </strong>A total of 3004 subjects who completed breath tests and primary questions were included. Bloating was the most common reason for BT. More subjects reported severe or very severe symptoms for bloating (52.9%) than diarrhea (17.8%), constipation (17.1%), or abdominal pain (17.1%). SIBO positivity was more common using lactulose (27%) versus glucose (7.3%). Higher H 2 levels correlated with more severe diarrhea ( P =0.031), and CH 4 levels correlated with constipation ( P =0.002). Higher H 2 S levels correlated with more severe diarrhea ( P <0.0001), urgency ( P =0.003), and abdominal pain ( P =0.01). UMAP revealed that H 2 S levels increased symptom severity, and ISO (alone or with SIBO/IMO) drove greater diarrhea, urgency, bloating, and overall severity, with highest pain and severity in ISO alone.</p><p><strong>Conclusions: </strong>H 2 , CH 4 , and H 2 S are associated with unique symptoms: CH 4 with constipation and H 2 S with diarrhea and a greater overall symptom severity. Glucose appears less sensitive than lactulose, suggesting it could potentially miss some symptomatic patients.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"406-417"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165689","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":"The Management of Irritable Bowel Syndrome: A Position Paper of the Neurogastroenterology and Motility Section of the Israeli Gastroenterology Association.","authors":"Fahmi Shibli, Roy Dekel, Ron Yishai, Joseph Lysy, Ami Sperber, Nir Bar, Ronnie Baruch, Sigal Frishman, Anat Nevo Shor, Tiberiu Hershkovici, Tamar Thurm, Amir Mari, Dan Carter, Rita Brun, Yuval Ishay, Ram Dickman","doi":"10.1097/MCG.0000000000002388","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002388","url":null,"abstract":"<p><p>Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction with symptoms including abdominal pain associated with a change in stool form or frequency. IBS global prevalence is around 4% and its impact on patient's quality of life and social functioning is substantial. Multidisciplinary working teams of the Israeli Society of Neurogastroenterology and Motility evaluated all validated approaches to IBS management. The aim was to develop a national, evidence-based position document on IBS management for general practitioners and adult and pediatric gastroenterologists. This position document comprehensively reviewed therapeutic options, including patient education (including specific national communities), dietary modifications (particularly the low FODMAP diet), antispasmodic drugs, probiotics, antibiotics (eg, rifaximin), secretagogues (eg, linaclotide), neuromodulators, psychological therapies (including cognitive behavioral therapy and gut-directed hypnotherapy), and complementary medicine approaches. The importance of establishing a positive physician-patient communication with a therapeutic partnership, including an empathic approach and implementation of the bio-psycho-social model, was also strongly emphasized. A structured treatment algorithm incorporating multiple therapeutic tools that are locally available was developed as well. We hope that this position paper will provide a practical and updated tool for the management of IBS in Israel and in other countries as well.</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":"147815787","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":"Does >200 mg of Propofol Sedation Allow Healthy Individuals to Undergo a Colonoscopy and Drive Themselves Home?","authors":"Ichitaro Horiuchi, Kaori Horiuchi, Hiroe Kitahara, Akira Horiuchi","doi":"10.1097/MCG.0000000000002252","DOIUrl":"10.1097/MCG.0000000000002252","url":null,"abstract":"<p><strong>Goals: </strong>Colonoscopy is a common gastrointestinal endoscopic procedure for which sedation is frequently used. We investigated whether sedation with >200 mg propofol allows healthy individuals to undergo colonoscopy and drive themselves home.</p><p><strong>Methods: </strong>This was a prospective study in which healthy subjects (20 to 96 y) who underwent screening, surveillance, or diagnostic colonoscopy with propofol sedation between January 2024 and December 2024, and were allowed to drive themselves home, were enrolled. A nurse using an age-adjusted standard protocol administered the propofol as a bolus injection. Among the enrolled subjects, 300 subjects with >200 mg of propofol sedation received questionnaires asking about the primary outcome measure (the occurrence of adverse events within 24 hr postcolonoscopy) and secondary outcome measures (their overall satisfaction and clinical outcomes).</p><p><strong>Results: </strong>All 3152 subjects successfully completed their colonoscopy. The mean propofol dose used for colonoscopy was 203 mg (range: 80 to 480 mg), and 1261 (40%) of the subjects received >200 mg propofol. The colorectal polyp removal was successful in 1293 (41%) of subjects. The only adverse event was a transient need for supplemental oxygen, required in 21 subjects (0.7%) during the colonoscopy. The questionnaires revealed that 219 (73%) of the 300 questionnaire respondents were able to drive home or to their office safely 2 hours postcolonoscopy. All 300 subjects had no accidents within 24 hours of their colonoscopy. Most (99%) were willing to have the same procedure again.</p><p><strong>Conclusions: </strong>Propofol sedation at doses >200 mg allowed healthy individuals to undergo a colonoscopy and drive themselves home safely 2 hours later.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"449-453"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274879","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":"A Population-Based Assessment of Physical Activity and Exercise in Persons With IBD.","authors":"Sydney Chochinov, Casandra Dolovich, Gia Ly, Adebanke Oketola, Samuel Narvey, Maitreyi Raman, Sandra Webber, Charles N Bernstein","doi":"10.1097/MCG.0000000000002220","DOIUrl":"10.1097/MCG.0000000000002220","url":null,"abstract":"<p><strong>Goals/background: </strong>We aimed to assess the physical activity (PA) and exercise profiles of persons with IBD, their limitations in undertaking PA/exercise, and how PA correlates with active disease and fatigue in a Canadian population-based sample.</p><p><strong>Study: </strong>A cross-sectional survey study was undertaken by participants in the University of Manitoba IBD Research Registry. The survey included sociodemographic factors, PA/exercise, the International Physical Activity Questionnaire (IPAQ), Inflammatory Bowel Disease Symptom Inventory (IBDSI), and Modified Fatigue Impact Scale (MFIS). Bivariate and logistic regression analyses assessed the association between PA and disease activity and fatigue.</p><p><strong>Results: </strong>The survey was completed by 1257 of 2740 invitees (45.8%). Because of 163 missing age or PA responses, 1094 were included in the data analysis. The mean age of participants was 60.8+/-13.0 years. Activity status was inactive in 42.5%, moderately active in 32.0%, and highly active in 25.5%. Activity levels were similar for those >55 versus those <55 years. Thirty-eight percent reported that IBD never impacted their PA/exercise. Persons with Crohn's disease were more likely to be inactive than persons with ulcerative colitis. Logistic regression analysis showed that the odds of engaging in lower levels of PA were greater for persons with active IBDSI versus persons with non-active IBDSI (aOR: 1.51, 95% CI: 1.11-2.04), with an increase in MFIS score (aOR: 1.02, 95% CI: 1.01-1.03), in females with ulcerative colitis, and in those who smoke.</p><p><strong>Conclusion: </strong>These findings underscore the need for tailored PA/exercise guidelines for individuals with IBD. Future research should explore objective measures of PA to better understand PA/exercise in both younger and older adult populations.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"432-441"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575525","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":"Comparative Efficacy and Safety of Nitazoxanide-based Triple Therapy Versus Standard Triple Therapy in Treating Helicobacter Pylori Infections: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Syed Hassan Ali, Umais Ahmed Shaikh, Alishba Shahzad, Keertan Khemani, Vania Zeeshan, Rabeya Musharaf, Raam Kumar, Fizza Raza, Abeer Iftikhar Hussain, Umaimah Naeem","doi":"10.1097/MCG.0000000000002328","DOIUrl":"10.1097/MCG.0000000000002328","url":null,"abstract":"<p><p>Helicobacter pylori infections are the major cause of gastrointestinal disease, mainly chronic gastritis, peptic ulcer, and gastric carcinomas, affecting half of the population globally. Due to the emergence of antibiotic resistance, the efficacy of current standard therapies, particularly clarithromycin and metronidazole, has been reduced. Nitazoxanide (NTZ), a broad-spectrum antimicrobial drug, has shown promising efficacy against H. pylori infections. This study aims to assess the comparative efficacy and safety of NTZ-based regimens versus standard triple therapy in H. pylori infections. A comprehensive literature search was conducted across 4 databases. Eight randomized controlled trials, comprising 1286 participants, comparing NTZ-based regimens with standard triple therapy, were included. A random-effects model was used to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs). NTZ-based therapy showed significant improvement in primary outcome, which includes H. pylori eradication rate compared to standard triple therapy. In per-protocol (PP) and intention-to-treat patients, durational analysis showed significant improvement in H. pylori eradication rates (RR=1.40; 95% CI: 1.19-1.56; P <0.0001) and (RR=1.36; 95% CI: 1.19-1.56; P <0.0001), respectively. In addition, post follow-up assessment also shows significant effects in both patients per-protocol (RR= 1.40; 95% CI: 1.21-1.62; P <0.0001) and intention-to-treat (RR=1.36; 95% CI: 1.19-1.56; P <0.0001). In secondary outcomes, NTZ-based therapy showed non-significant reduction in abdominal pain (RR=0.50) and nausea (RR=0.78). Risk of bias was reported as low to high, although certainty of evidence was consistently high. Egger's test shows non-significant publication bias ( P =0.161). Future research should focus on NTZ's optimal duration, resistance pattern, safety, and symptom relief.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"373-384"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985071","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":"Hepatorenal Syndrome in Focus: Emerging Diagnostic Criteria and Current Therapeutic Approaches.","authors":"Shaun Chandna, Mark R Baniqued, Rhett Harmon, Patrick Chan, Jeffrey Wang, Jignesh H Patel","doi":"10.1097/MCG.0000000000002332","DOIUrl":"10.1097/MCG.0000000000002332","url":null,"abstract":"<p><p>Hepatorenal syndrome (HRS) is a phenotype of kidney injury specific to patients with liver cirrhosis and ascites, characterized by impaired kidney function due to reduced blood flow and reduced glomerular filtration rate. HRS can occur quickly with acute kidney injury (HRS-AKI). In those not meeting HRS-AKI criteria, this can develop as HRS-acute kidney disease (HRS-AKD) or HRS-chronic kidney disease (HRS-CKD). This pathophysiology occurs along a continuum, dependent on timing of the disease course, and the presence of functional and structural abnormalities. Traditionally, pharmacologic treatment for HRS has relied on midodrine, octreotide, and albumin. Norepinephrine and albumin use have been limited by the need for continuous monitoring and intensive care unit (ICU). The development and expanded availability of the synthetic vasopressin analog terlipressin offers promise for effective therapy to reverse HRS and decrease the need for renal replacement therapy (RRT). While norepinephrine and terlipressin have similar efficacy, terlipressin has more supportive data, is not restricted to the ICU, and is considered the preferred therapy in combination with albumin. The objective of this literature review is to summarize and critically appraise published models of current medical therapies used to treat HRS, along with their history and mechanisms of action, and to provide a review of HRS, including emerging concepts in diagnosis and treatment.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"385-393"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018750","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":"Comments on \"Prevalence of Eating Disorders Among Adults With Irritable Bowel Syndrome: A Cross-Sectional Study\".","authors":"Liang Liu, Yiheng Yao, Shengnan Li","doi":"10.1097/MCG.0000000000002290","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002290","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":"60 5","pages":"469-470"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645547","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":"When Normal Imaging Says Enough: Rethinking the Role of Patency Capsule in Crohn's Disease.","authors":"Mengjia Chen, Yuanhan Lin, Bujiang Wang","doi":"10.1097/MCG.0000000000002246","DOIUrl":"10.1097/MCG.0000000000002246","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"469"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955823","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 Role of Endoscopic Bariatric Treatments in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Lillian Dawit, Cameron Quon, Vismaya Bachu, Hellen Jumo, Lavender Micalo, Danny Issa","doi":"10.1097/MCG.0000000000002291","DOIUrl":"10.1097/MCG.0000000000002291","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global health concern, closely linked to obesity and metabolic syndrome, and characterized by hepatic steatosis, inflammation, and fibrosis. While lifestyle modifications and bariatric surgery for weight loss have been the cornerstones of treatment, endoscopic bariatric therapies (EBTs) have emerged as minimally invasive alternatives that offer meaningful weight loss and metabolic improvements, potentially benefiting patients with MASLD. Current evidence indicates that EBTs can significantly reduce liver steatosis, improve liver biochemistry markers, and enhance overall metabolic health. This review aims to evaluate the current evidence on the efficacy, safety, and potential role of EBTs in the management of MASLD, highlighting their impact on liver-related outcomes and metabolic parameters. A comprehensive literature review was conducted using PubMed, identifying observational studies, systematic reviews, meta-analyses, and retrospective and prospective trials that examine the effects of EBTs on metabolic markers and liver disease. This review underscores the potential of EBTs as therapeutic options for MASLD, particularly for patients who are unable to achieve sufficient weight loss through lifestyle interventions alone. While current evidence supports their potential role, further large-scale, long-term studies are needed to establish their efficacy in altering long-term disease progression and to define their place in clinical management algorithms.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"394-402"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768216","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":"Patient-reported Symptoms Are Independent of Extent of Disease in Longstanding Ulcerative Colitis: Magic in Imagine.","authors":"Charles N Bernstein, Zoann Nugent, Remo Panaccione, Deborah A Marshall, Gilaad G Kaplan, Stephen Vanner, Levinus A Dieleman, Lesley A Graff, Anthony Otley, Jennifer Jones, Michelle Buresi, Sanjay Murthy, Mark Borgaonkar, Brian Bressler, Alain Bitton, Kenneth Croitoru, Sacha Sidani, Aida Fernandes, Paul Moayyedi","doi":"10.1097/MCG.0000000000002329","DOIUrl":"10.1097/MCG.0000000000002329","url":null,"abstract":"<p><strong>Background: </strong>The Inflammation, Microbiome, and Alimentation: Gastro-Intestinal and Neuropsychiatric Effects Strategy for Patient Oriented Research Network (IMAGINE) has conducted a 5-year multicenter prospective observational cohort study, Mind And Gut Interactions Cohort (MAGIC) in 14 centers across Canada from 2018 to 2022. Herein, we investigated the relationship between ulcerative colitis (UC) phenotypes, demographics and other relevant outcomes, and symptom reporting.</p><p><strong>Methods: </strong>At baseline, participants answered surveys assessing disease activity, medications and complementary therapies, lifestyle factors, psychological status, and comorbidities. UC phenotypes were classified by the Montreal Classification. Herein, we describe the association between phenotypes and demographics, medications used, comorbidities, and symptoms experienced in adults with UC. The Inflammatory Bowel Disease Symptom Inventory (IBDSI) was used to assess symptoms.</p><p><strong>Results: </strong>The maximal extent phenotypic distribution based on chart review was E1 (proctitis) n=261 (14.5%), E2 (left-sided colitis) n=671 (37.2%), and E3 (subtotal or pancolitis) n=794 (44.0%). More males had E3. Different phenotypes did not lead to differences in the use of complementary therapies. There was greater likelihood of primary sclerosing cholangitis but a lower likelihood of hypertension in E3. Among the 25 different symptoms queried in the IBDSI, there was no difference across phenotypes, except among persons with overall active IBDSI, there was more waking for urges for bowel movements in persons with E3.</p><p><strong>Conclusions: </strong>Overall, there was no difference in symptom reporting based on extent of UC except for cohort with overall active IBDSI there were some differences in nocturnal waking based on disease extent.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"442-448"},"PeriodicalIF":2.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040820","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}