Journal of clinical gastroenterology最新文献

{"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":"https://doi.org/10.1097/MCG.0000000000002246","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","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":"Refining Risk Estimates Between Pancreatitis and Pancreatic Cancer in Meta-Analytic Models.","authors":"Jinyu Wu, Shiquan Yu","doi":"10.1097/MCG.0000000000002245","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002245","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955860","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 of Nonpharmacological Interventions and Combination With Pharmacological Interventions for Gastroesophageal Reflux Disease: A Systematic Review and Network Meta-Analysis.","authors":"Mei Huang, Zelin Yu, Linlin Wu, Hanyu Liu, Peiqi Li, Jia Yu, Hantong Hu, Jianqiao Fang, Xiaomei Shao","doi":"10.1097/MCG.0000000000002239","DOIUrl":"10.1097/MCG.0000000000002239","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of nonpharmacological therapies for patients with gastroesophageal reflux disease (GERD) has been progressively proved. However, the specific differences in effectiveness among various nonpharmacological interventions and their combinations with pharmacological interventions remain unclear, and the optimal intervention strategy has yet to be conclusively determined.</p><p><strong>Methods: </strong>Systematic searches were conducted in PubMed, Web of Science, Embase, Cochrane, and CNKI from inception to November 6, 2024. A network meta-analysis was conducted using a random effects consistency model within a Bayesian framework with lower esophageal sphincter (LES) pressure as the primary outcome indicator.</p><p><strong>Result: </strong>Thirty-three studies involving 10 nonpharmacological interventions were included. Acupoint stimulation with traditional Chinese medicine (TCM) (SMD=5.83, 95% CI: 1.23 to 10.16), and breathing training with conventional Western medicine (CWM) (SMD=3.88, 95% CI: 0.45 to 7.52) significantly improved LES pressure and reduced esophageal acid exposure time (AET) (SMD=-5.01 to -3.32). In terms of safety, acupoint stimulation with TCM (logOR=-2.51, 95% CI: -5.91 to -0.19) exhibited a significant advantage over CWM. However, acupoint stimulation combined with TCM and breathing training with CWM did not demonstrate a significant improvement in GERD health-related quality of life questionnaire (HRQL) scores.</p><p><strong>Conclusion: </strong>Acupoint stimulation combined with TCM and breathing training with CWM, when compared with CWM and other nonpharmacological interventions, is considered a potential adjunctive therapeutic approach for GERD, demonstrating both efficacy and safety. However, methodological limitations necessitate cautious interpretation of results.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12509446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955808","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":"Evaluating the Impact of Early Palliative Care Consultation on 30-Day and 90-Day Readmissions Among Patients With Decompensated Cirrhosis: A National Perspective.","authors":"Aya Akhras, Saadia Nabi, Kristen Santana, Luis Santiago Zayas, Waseem Wahood, Deannys Batista, Sinay Ceballos, Bernardo Reyes, Franklin Kasmin","doi":"10.1097/MCG.0000000000002235","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002235","url":null,"abstract":"<p><strong>Introduction: </strong>Decompensated cirrhosis leads to recurrent hospitalizations among patients with chronic liver disease. Addressing goals of care early can help alleviate stress, reduce health care utilization and potentially improve quality of life in these patients. Research has shown that palliative care (PC) is used infrequently and often too late in decompensated cirrhosis. Moreover, patients with cirrhosis who are denied a liver transplant are rarely referred to PC. We investigated the impact of PC consultations on unplanned readmissions among patients with decompensated cirrhosis in a nationally representative cohort.</p><p><strong>Methods: </strong>The National Readmission Database was queried from 2010 to 2019 for patients with decompensated cirrhosis using corresponding International Classification of Diseases, 10th edition codes. Patients were categorized by whether they received PC consultation during their index admission. Multivariable, hierarchical logistic regression was conducted to assess factors of receiving PC and unplanned 30-day and 90-day readmissions.</p><p><strong>Results: </strong>Among 1,630,819 patients with decompensated cirrhosis, 121,400 (7.4%) received PC consultation at index admission. Patients had higher odds of receiving PC consultations with increasing age (OR: 1.026), comorbidities such as congestive heart failure (OR: 1.172), renal failure (OR: 1.31), metastatic cancer (OR: 2.82), solid tumors without metastasis (OR: 2.37), and alcohol use disorder (OR: 1.34) (P<0.001). Moreover, patients who received PC consultations had significantly lower odds of unplanned 30-day (OR: 0.337) and 90-day (OR: 0.268) readmissions compared with patients without (P<0.001).</p><p><strong>Conclusion: </strong>PC consultation was associated with lower odds of unplanned 30-day and 90-day readmission among patients with decompensated cirrhosis. Because patients with multiple comorbidities were most likely to receive PC, earlier and broader engagement of PC may further alleviate stress and improve outcomes in this high-risk population.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955857","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":"Fecal Short and Branched Chain Acids as Possible Biomarkers for Inflammatory Bowel Disease and UC and CD Subgroups? A Case-Control Study.","authors":"Justin K Gray, Baochuan Guo, Abdelraheem Baniahmad, Buthina Odat, Nadia Abdelkader, Rebecca L Bearden","doi":"10.1097/MCG.0000000000002237","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002237","url":null,"abstract":"<p><strong>Goals: </strong>Investigate feasibility of short (SCFA) and branched chain fatty acids (BCFA) in human stool as biomarkers for inflammatory bowel disease (IBD).</p><p><strong>Background: </strong>Interest in fecal SCFAs and BCFAs has increased. Evidence shows strong connections between these metabolites and IBD pathogenesis and pathophysiology.</p><p><strong>Study: </strong>A case-control study of 74 stool samples (21 healthy; 24 ulcerative colitis, UC; 29 Crohn's disease, CD) was quantified using a validated, gas chromatography-mass spectrometry (GC-MS) method for acetic, propionic, isobutyric, butyric, isovaleric, valeric, and caproic acid (μg/g stool). Bristol Stool Form Scale (BSFS) and pH were recorded.</p><p><strong>Results: </strong>Receiver operator curve (ROC) analysis resulted in area under the curve (AUC) value of 0.96 (95% CI: 0.89-0.98, P <0.001), with 92% sensitivity and 81% specificity using the acetic/(propionic+butyric+isovaleric+valeric acid) transformation between healthy and IBD groups. ROC analysis resulted in AUC of 0.83 (95% CI: 0.66-0.92, P <0.001), with 75% sensitivity and 86% specificity using the acetic/(isobutyric/propionic acid) transformation between UC and CD subgroups. Acetic acid was the most abundant SCFA (72/74 samples) and nonsignificantly different between groups (healthy vs. IBD; P ≥0.05, 0.161 and UC vs. CD; P ≥0.025, 0.623).</p><p><strong>Conclusions: </strong>Fecal SCFAs and BCFAs demonstrated feasibility as biomarkers for IBD. Increased sensitivity and specificity were achieved over fecal calprotectin (FCP) tests between healthy and IBD patients. No useable data was found in the literature to use a validation cohort.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144955793","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":"Effectiveness of Switching From Intravenous to Subcutaneous Infliximab in Patients With Inflammatory Bowel Disease: An individual participant data meta-analysis.","authors":"Fraser Cummings, Philip J Smith, Mathurin Fumery, Sohail Rahmany, Sreedhar Subramanian, Buki Kwon, Soyeon Park, Young Nam Lee, Anthony Buisson","doi":"10.1097/MCG.0000000000002228","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002228","url":null,"abstract":"<p><strong>Goals: </strong>We assessed clinical outcomes over 6 months in an integrated analysis of inflammatory bowel disease (IBD) patients switching from intravenous (IV) to subcutaneous (SC) infliximab (IFX).</p><p><strong>Background: </strong>Real-world data from large multinational IBD patient populations treated with SC IFX are lacking.</p><p><strong>Study: </strong>This individual participant data meta-analysis combined anonymized data from 3 real-world cohorts and evaluated clinical remission [Crohn's disease (CD): Harvey-Bradshaw Index (HBI)/modified HBI (mHBI) <5; ulcerative colitis (UC): Simple Clinical Colitis Activity Index (SCCAI)/partial Mayo score (PMS) <3], disease activity (HBI/mHBI/SCCAI/PMS), treatment persistence, pharmacokinetics, immunogenicity, biomarkers [fecal calprotectin (FCP); C-reactive protein (CRP)], and reasons for discontinuation. Subgroup analyses determined the effect of clinical parameters on outcomes.</p><p><strong>Results: </strong>Of 428 patients (CD, n=302; UC, n=126), 85.4% were in clinical remission at baseline, which was maintained at 6 months (84.7%), and was higher in patients with CD versus UC (89.8% vs. 71.9%; P<0.001); disease activity scores remained low. High treatment persistence was observed (94.5%) at 6 months. Median serum IFX levels increased from 5.6 μg/mL at baseline to 16.0 μg/mL at 6 months. Most patients (96.1%) maintained negative antidrug antibody status and low levels of FCP and CRP up to 6 months. Drug discontinuation rate was low (5.8%). Intensified preswitch IV IFX was the only factor negatively associated with CD remission at 6 months [intensified vs. standard estimated marginal mean probability difference -0.107 (95% CI: -0.191, -0.024); P=0.012].</p><p><strong>Conclusions: </strong>Switching from IV to SC IFX maintains clinical effectiveness in patients with IBD regardless of various patient factors.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873433","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":"Association of NAFLD and Cardiovascular Events: A Systematic Review and Meta-analysis.","authors":"Mannat K Bhatia, Archit Garg, Junaid Ali, Allan Santos, Mehar K Bhatia, Birgurman Singh, Mehak Bassi, Arkady Broder, Douglas G Adler","doi":"10.1097/MCG.0000000000002232","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002232","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated fatty liver disease (MAFLD) is increasingly recognized as a risk factor for cardiovascular disease (CVD) but the association remains unclear. This systematic review and meta-analysis aimed to quantify these associations.</p><p><strong>Methodology: </strong>We searched multiple databases for articles reporting CVD outcomes in MAFLD and conducted meta-analysis.</p><p><strong>Results: </strong>A total of 49 studies encompassing 1,553,770 individuals with MAFLD were included. MAFLD without advanced fibrosis was significantly associated with increased risks of fatal (HR 1.46, 95% CI 1.23-1.73; P<0.01), nonfatal (HR 1.54, CI 1.29-1.84; P<0.01), and combined CVD events (HR 1.60; CI 1.30-1.97; P<0.01). MAFLD with advanced fibrosis was significantly associated with combined CVD events (HR 1.79, CI 1.09-2.92; P<0.01) but not with fatal CVD events (HR 1.23, CI 1.00-1.52; P=0.06) or nonfatal CVD events (HR 1.08, CI 0.82-1.42; P=0.582).</p><p><strong>Conclusion: </strong>MAFLD, even without advanced fibrosis, is an independent risk factor for CVD. The risk is amplified with advanced fibrosis, particularly for combined CVD events.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784374","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 Perfect MASH Comparing Resmetirom and GLP-1 Agonists for Metabolic-Associated Steatohepatitis: What Does the Current Evidence Suggest?","authors":"Joanne Lin, Victoria Green, Aalam Sohal, Marina Roytman","doi":"10.1097/MCG.0000000000002234","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002234","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the most common causes of chronic liver disease recently due to the rise of metabolic disorders such as diabetes and obesity. It will continue to have a major impact on health care systems globally given its association with cardiovascular disease and liver-related complications such as cirrhosis and hepatocellular carcinoma. In recent years, promising pharmacotherapies have emerged to address MASLD and fibrosis, such as resmetirom and glucagon-like-1 receptor agonists. There are ongoing studies to better understand resmetirom, glucagon-like-1 receptor agonists, and other possible pharmacotherapies. We discuss the current available literature on resmetirom, glucagon-like-1 receptor agonists, their safety and efficacy among patients with MASLD. Furthermore, we propose an algorithm to guide clinicians on which currently available pharmacological therapy to select for effective management of MASLD.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784372","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":"Analysis of Incidence Trends and Predictions of Acute Hepatitis C in China Based on the Age-Period-Cohort Model.","authors":"Qingping Hu, Jing Sun, Chunying Wu, Wei Pan","doi":"10.1097/MCG.0000000000002231","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002231","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the incidence trends of acute hepatitis C (AHC) in China from 1990 to 2021, predict future trends, and explore the drivers of AHC incidence.</p><p><strong>Methods: </strong>Data on AHC incidence in China were collected from the Global Burden of Disease (GBD) 2021 database. Age-period-cohort (APC) model was used to examine the effects of age, period, and birth cohort. The Bayesian Age-period-cohort (BAPC) model was used to predict future incidence trends, and the decomposition algorithm was used to attribute the incidence trends to population aging, population growth, and age-specific changes from 1990 to 2021.</p><p><strong>Results: </strong>Between 1990 and 2021, the incidence of AHC in China continued to decline. The net drift was -1.76% (95% CI -2.11% to -1.41%). A W-shaped local drift and L-shaped longitudinal age curve were observed. The overall local drift was below zero for most age groups, except for the 80-and-older age groups. The highest risks of AHC incidence were observed in the age groups of 0 to 4, 5 to 9, and 80 and older. Downward trends were observed for both period and cohort effects. A higher risk was observed for the birth cohorts of 1922 to 1936 than for the adjacent cohorts. The BAPC model projected that AHC incidence will indicate a relatively stable yet slowly increasing trend from 2022 to 2030, and that AHC incidence in 2030 will be 1.10 times higher than that in 2021. Epidemiological changes are the leading cause of the reduction in the AHC disease burden from 1990 to 2021.</p><p><strong>Conclusion: </strong>Despite existing multitiered prevention strategies for AHC, epidemiological projections indicate a slow upward trajectory in disease burden in the future. Our study demonstrates the urgency of implementing optimized public health strategies, including population-wide active case detection and priority prevention policies, for high-risk populations.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784373","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":"Octreotide and Somatostatin as Prophylactic Agents Against Postendoscopic Retrograde Cholangiopancreatography Pancreatitis: An Updated Comprehensive Systematic Review and Meta-Analysis.","authors":"Ahmad Hormati, Asma Mousavi, Shayan Shojaei, Sanaz Bordbar, Atie Moghtadaei, Hediyeh Alemi, Sadaf G Sepanlou, Amir Kasaeian","doi":"10.1097/MCG.0000000000002224","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002224","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic retrograde cholangiopancreatography (ERCP) is a widely used procedure. Post-ERCP pancreatitis (PEP) remains a significant complication. This meta-analysis aimed to evaluate the efficacy of octreotide in reducing the incidence of PEP.</p><p><strong>Methods: </strong>A comprehensive review of randomized controlled trials (RCTs) was conducted across multiple databases to assess the impact of octreotide administration on post-ERCP outcomes, including acute pancreatitis (overall, mild, moderate, and severe), abdominal pain, and mortality. Pooled risk ratios (RR) were calculated using random-effects meta-analysis. Sensitivity analyses, Galbraith plots, Egger test, Begg funnel plots, and trim-and-fill correction were performed to assess the robustness of the findings, identify outliers, evaluate publication bias, and adjust for potentially missing studies.</p><p><strong>Results: </strong>The analysis included 21 RCTs for overall post-ERCP pancreatitis comprising 7229 patients, 15 RCTs for mild, moderate, and severe pancreatitis, 8 RCTs for abdominal pain, and 5 RCTs for mortality. Octreotide was associated with a significant reduction in the incidence of overall (RR: 0.63; 95% CI: 0.48-0.82) and moderate PEP (RR: 0.39; 95% CI: 0.22-0.67). However, no significant reduction was observed for mild and severe PEP, abdominal pain, or mortality. Evidence of publication bias was noted for overall and mild PEP, but trim-and-fill correction did not alter the significance of the overall pancreatitis result.</p><p><strong>Conclusion: </strong>Octreotide appears to be effective in reducing the risk of overall and moderate PEP. However, its impact on mild and severe PEP remains inconclusive. Further large-scale, high-quality RCTs are needed to refine clinical recommendations regarding its routine prophylactic use in ERCP.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784376","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}