Journal of clinical gastroenterology最新文献

{"title":"Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation and Liver Cirrhosis.","authors":"Tien-Shin Chou, Yuan Lin, Ming-Lung Tsai, Chin-Ju Tseng, Jhih-Wei Dai, Ning-I Yang, Chih-Lang Lin, Li-Wei Chen, Ming-Jui Hung, Tien-Hsing Chen","doi":"10.1097/MCG.0000000000002089","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002089","url":null,"abstract":"<p><strong>Objective: </strong>Comparing direct oral anticoagulants (DOACs) and warfarin's efficacy and safety in patients with nonvalvular atrial fibrillation (AF) and liver cirrhosis (LC).</p><p><strong>Background: </strong>Evidence of the pharmacodynamics of DOACs is limited in patients with AF and LC.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in the largest hospital system in Taiwan, involving patients with AF and LC for the years 2012 to 2021. Hazards of thromboembolic events (ischemic stroke, transient ischemic attack, and systemic embolism), intracranial hemorrhage, gastrointestinal, major bleeding, and all-cause mortality were investigated with a new-user, active comparator design. Inverse probability of treatment weighting was applied to balance potential confounders between treatment groups.</p><p><strong>Results: </strong>In total, 478 DOAC users and 247 warfarin users were included. DOACs and warfarin demonstrated similar trends in preventing thromboembolic events, namely ischemic stroke [adjusted hazard ratio (aHR), 1.05 (95% CI: 0.42-2.61)], transient ischemic attack [aHR, 1.36 (95% CI: 0.18-10.31)], and systemic embolism [aHR, 0.49 (95% CI: 0.14-1.70)]. DOAC use was associated with a similar risk of intracranial hemorrhage [aHR, 0.65 (95% CI: 0.26-1.59)] and gastrointestinal bleeding [aHR, 0.64 (95% CI: 0.39-1.03)], a decreased risk of major bleeding [aHR, 0.64 (95% CI: 0.42-0.99)], and a reduction in mortality [aHR, 0.73 (95% CI: 0.54-0.99)]. DOAC users exhibited a significant reduction in major bleeding risk in patients with Child-Pugh class A (aHR, 0.48; 95% CI: 0.33-0.70).</p><p><strong>Conclusions: </strong>DOACs showed potential safety advantages over warfarin for patients with nonvalvular AF and LC, particularly in reducing major bleeding risk in those with Child-Pugh class A.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576212","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":"Evaluating the GALAD Score for Detection of Hepatocellular Carcinoma in Patients With Cirrhosis.","authors":"Thong Duy Vo, Sang Hoai Mai, Huong Tu Lam","doi":"10.1097/MCG.0000000000002097","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002097","url":null,"abstract":"<p><strong>Introduction: </strong>Early diagnosis of hepatocellular carcinoma (HCC) is crucial but challenging, and late detection limits its treatment and prognosis. We aimed to evaluate the GALAD score as a novel yet highly accurate and promising diagnostic tool for HCC.</p><p><strong>Methods: </strong>A prospective and retrospective cohort study was conducted in 196 adult patients with cirrhosis, including 102 with HCC and 94 without. The diagnostic performance of the GALAD score for HCC detection was compared with that of single biomarkers.</p><p><strong>Results: </strong>In patients with cirrhosis with HCC, the GALAD score was 2.5 (95% CI: -2.43 to 11.09), which was significantly higher than the GALAD score of -2.46 (95% CI: -6.15 to 2.04) in patients with cirrhosis without HCC (P<0.001). Patients with multiple tumors had a significantly higher GALAD score than those with a single tumor (P=0.0081). There was a moderate correlation between the GALAD score and tumor size in patients with cirrhosis (r=0.44; P<0.001). The GALAD score had an area under the receiver operating characteristic curve of 0.91, higher than that of all single biomarkers used to diagnose HCC (all P<0.001). The optimal cutoff for diagnosing HCC using the GALAD score was -0.518, achieving a sensitivity of 87.25%, specificity of 82.98%, positive predictive value of 84.62%, and negative predictive value of 84.78%. At this cutoff, the GALAD score demonstrated superior sensitivity compared with single or combined biomarkers.</p><p><strong>Conclusions: </strong>The GALAD score shows promise in detecting HCC in patients with cirrhosis. The GALAD score could be applied in clinical practice to diagnose HCC in patients with cirrhosis, and calculating the GALAD score in clinical settings may help predict tumor size and quantity before imaging results become available.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Yield of Small Bowel Videocapsule Endoscopy in Patients with Iron Deficiency Anemia. A Systematic Review and meta-analysis.","authors":"Roberta Elisa Rossi, Angelo Zullo, Silvia Ferretti, Giulia Migliorisi, Luigi Gatta, Vincenzo De Francesco, Alessandro Del Forno, Giacomo Marcozzi, Benedetta Masoni, Gianluca Franchellucci, Cesare Hassan, Alessandro Repici","doi":"10.1097/MCG.0000000000001968","DOIUrl":"10.1097/MCG.0000000000001968","url":null,"abstract":"<p><strong>Background and aim: </strong>Gastrointestinal (GI) bleeding or malabsorption represents the most frequent aetiologies of iron deficiency anemia (IDA). The cause of IDA remains undetermined in ~10% to 20% of patients undergoing upper and lower GI endoscopies. In this scenario, a small bowel examination with videocapsule endoscopy (VCE) is recommended. We performed a systematic review with meta-analysis to evaluate the diagnostic yield of VCE in patients with IDA without overt bleeding, assessing the prevalence of either any lesion or lesions at high potential of bleeding.</p><p><strong>Materials and methods: </strong>A computerized literature search was performed using relevant keywords to identify all the pertinent articles published until March 2023.</p><p><strong>Results: </strong>Twelve studies with a total of 1703 IDA patients (Males: 47%; age range: 19-92 y) were included in this systematic review. The diagnostic yield of VCE for overall lesions in the small bowel was 61% (95% CI=44-77; 95 CI=97.2-98.1; I2 =97.7%). When analyzing only small bowel lesions likely responsible of IDA, the diagnostic yield was 40% (95% CI=27-53; 95% CI=95.3-97; I2 =96.3%).</p><p><strong>Conclusion: </strong>VCE plays a relevant role in the diagnostic work-up of patients with IDA without overt bleeding with a satisfactory diagnostic yield.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"998-1002"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477561","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, Feasibility, and Safety of the X-Tack Endoscopic HeliX Tacking System: A Multicenter Experience.","authors":"Andrew Canakis, Sanad Maher Dawod, Enad Dawod, Malorie Simons, Bianca Di Cocco, Donevan Richard Westerveld, Roberto Paolo Trasolini, Tyler M Berzin, Christopher A Marshall, Ahmed Maher Abdelfattah, Neil B Marya, George B Smallfield, Matthew Kaspar, Guilherme M Campos, Wasseem Skef, Prashant Kedia, Terrence A Smith, Hiroyuki Aihara, Matthew T Moyer, Kartik Sampath, Srihari Mahadev, David L Carr-Locke, Reem Z Sharaiha","doi":"10.1097/MCG.0000000000001977","DOIUrl":"10.1097/MCG.0000000000001977","url":null,"abstract":"<p><strong>Background and aims: </strong>The application of endoscopic suturing has revolutionized defect closures. Conventional over-the-scope suturing necessitates removal of the scope, placement of the device, and reinsertion. A single channel, single sequence, through-the-scope suturing device has been developed to improve this process. This study aims to describe the efficacy, feasibility, and safety of a through-the-scope suturing device for gastrointestinal defect closure.</p><p><strong>Methods: </strong>This was a retrospective multicenter study involving 9 centers of consecutive adult patients who underwent suturing using the X-Tack Endoscopic HeliX Tacking System (Apollo Endosurgery). The primary outcomes were technical success and long-term clinical success. Secondary outcomes included adverse events, recurrence, and reintervention rates.</p><p><strong>Results: </strong>In all, 56 patients (mean age 53.8, 33 women) were included. Suturing indications included fistula repair (n=22), leak repair (n=7), polypectomy defect closure (n=12), peroral endoscopic myotomy (POEM) site closure (n=7), perforation repair (n=6), and ulcers (n=2). Patients were followed at a mean duration of 74 days. Overall technical and long-term clinical success rates were 92.9% and 75%, respectively. Both technical and clinical success rates were 100% for polypectomies, POEM-site closures, and ulcers. Success rates were lower for the repair of fistulas (95.5% technical, 54.5% clinical), leaks (57.1%, 28.6%), and perforations (100%, 66.7%). No immediate adverse events were noted.</p><p><strong>Conclusion: </strong>This novel, through-the-scope endoscopic suturing system, is a safe and feasible method to repair defects that are ≤3 cm. The efficacy of this device may be better suited for superficial defects as opposed to full-thickness defects. Larger defects will need more sutures and probably a double closure technique to provide a reinforcement layer.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"1052-1057"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567036","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":"Utility of Intraprocedural Luminal Diameter and Distensibility Measurements During the Esophageal Peroral Endoscopic Myotomy Procedure.","authors":"Chiemeziem Eke, Ian Greenberg, Bryce Bushe, Andrew Joelson, Priyanka Acharya, David Lee, Amrita Sethi, Prashant Kedia","doi":"10.1097/MCG.0000000000001960","DOIUrl":"10.1097/MCG.0000000000001960","url":null,"abstract":"<p><strong>Goals: </strong>Through evaluation of the lower esophageal sphincter immediately before and after myotomy using an endoluminal functional lumen imaging probe (EFLIP), our study aimed to determine the clinical response to peroral endoscopic myotomy (POEM) and the incidence of postprocedure reflux.</p><p><strong>Background: </strong>Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and diminished peristalsis. POEM is a therapeutic option for durable management of achalasia. However, symptomatic acid reflux and esophagitis are well-known adverse effects of the procedure.</p><p><strong>Study: </strong>Electronic medical records of 168 patients who underwent POEM for achalasia at 2 tertiary care referral centers from May 2014 to May 2021 were reviewed. EFLIP was used at a range of catheter fill volumes to assess LES dynamics. Preprocedure and postprocedure Eckardt Symptom Scores were recorded.</p><p><strong>Results: </strong>Significant clinical improvement from POEM was sustained in over 94% of patients after 1 year. EFLIP changed intraprocedural management 5% of the time by means of myotomy extension. In patients with reflux>1 year following POEM, there was no significant difference in post-POEM LES diameter or change in LES diameter compared with those without reflux. However, post-POEM LES distensibility index (DI) was significantly higher in patients with reflux after 1 year compared with those without reflux.</p><p><strong>Conclusions: </strong>POEM is a safe and increasingly effective therapy for patients with symptomatic achalasia. Intraprocedural EFLIP measurements suggest that post-POEM reflux may be correlated more with DI than LES diameter. Yet, more data is needed to substantiate these outcomes.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"970-974"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139477735","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":"Colorectal Cancer Prevention: Is Chat Generative Pretrained Transformer (Chat GPT) ready to Assist Physicians in Determining Appropriate Screening and Surveillance Recommendations?","authors":"Lisandro Pereyra, Francisco Schlottmann, Leandro Steinberg, Juan Lasa","doi":"10.1097/MCG.0000000000001979","DOIUrl":"10.1097/MCG.0000000000001979","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether a publicly available advanced language model could help determine appropriate colorectal cancer (CRC) screening and surveillance recommendations.</p><p><strong>Background: </strong>Poor physician knowledge or inability to accurately recall recommendations might affect adherence to CRC screening guidelines. Adoption of newer technologies can help improve the delivery of such preventive care services.</p><p><strong>Methods: </strong>An assessment with 10 multiple choice questions, including 5 CRC screening and 5 CRC surveillance clinical vignettes, was inputted into chat generative pretrained transformer (ChatGPT) 3.5 in 4 separate sessions. Responses were recorded and screened for accuracy to determine the reliability of this tool. The mean number of correct answers was then compared against a control group of gastroenterologists and colorectal surgeons answering the same questions with and without the help of a previously validated CRC screening mobile app.</p><p><strong>Results: </strong>The average overall performance of ChatGPT was 45%. The mean number of correct answers was 2.75 (95% CI: 2.26-3.24), 1.75 (95% CI: 1.26-2.24), and 4.5 (95% CI: 3.93-5.07) for screening, surveillance, and total questions, respectively. ChatGPT showed inconsistency and gave a different answer in 4 questions among the different sessions. A total of 238 physicians also responded to the assessment; 123 (51.7%) without and 115 (48.3%) with the mobile app. The mean number of total correct answers of ChatGPT was significantly lower than those of physicians without [5.62 (95% CI: 5.32-5.92)] and with the mobile app [7.71 (95% CI: 7.39-8.03); P < 0.001].</p><p><strong>Conclusions: </strong>Large language models developed with artificial intelligence require further refinements to serve as reliable assistants in clinical practice.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"1022-1027"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139691905","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 Review of IgG4-related Sclerosing Cholangitis (IgG4-SC).","authors":"Neil C Khoury, John W Birk","doi":"10.1097/MCG.0000000000001984","DOIUrl":"10.1097/MCG.0000000000001984","url":null,"abstract":"<p><p>IgG4-related sclerosing cholangitis (IgG4-SC) is a unique, steroid-responsive, fibroinflammatory condition that is more commonly found in older men and is strongly associated with autoimmune pancreatitis (AIP). It may pose a diagnostic challenge at times due to closely mimicking hepatobiliary diseases such as primary sclerosing cholangitis (PSC), secondary sclerosing cholangitis (SSC), and cholangiocarcinoma. IgG4-SC has an excellent prognosis when promptly diagnosed and treated with steroids. Literature search strategy: The authors searched PubMed and Google Scholar, for articles with the search terms \"autoimmune cholangiopathy\" and \"IgG4 cholangiopathy.\"</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"963-969"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139931402","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":"Colorectal Neoplasia in Asian Americans Undergoing First Time Asymptomatic Average-risk Screening Colonoscopies.","authors":"Brendan Chen, Katie Hsia, Kirsten Loscalzo, Caitlin Fai, Samir Gupta, Sushrut Jangi","doi":"10.1097/MCG.0000000000001969","DOIUrl":"10.1097/MCG.0000000000001969","url":null,"abstract":"<p><strong>Goals: </strong>We identified the prevalence and subtype of colorectal neoplasia removed during index screening colonoscopies in a large Asian American population.</p><p><strong>Background: </strong>Asian Americans are the fastest growing demographic group in the United States yet there is a paucity of data on the characteristics of colorectal neoplasia found in this cohort.</p><p><strong>Study: </strong>Cross-sectional study of 2208 index colonoscopies performed on average-risk Asian and White patients at a large, tertiary academic center. Patients were identified via diagnostic or procedure codes between 2015 and 2020, with retrospective classification of polyp histopathology. Univariate and multivariate analysis were performed to identify risk factors associated with colorectal neoplasia.</p><p><strong>Results: </strong>A total of 2208 patients were identified, of which 1085 were Asian. When adjusted for age and sex, Asians were as likely as Whites to have any type of colorectal neoplasia [44.2% vs. 43.5%, odds ratio (OR)=0.93, (CI: 0.78-1.11)]. On multivariate analysis, Asians were less likely to have sessile serrated polyps (5.5% vs. 9.9%, OR=0.53, 95% CI: 0.38-0.73) and more likely to have tubular adenomas in the left colon (22.6% vs. 18.0%, OR=1.33, 95% CI: 1.08-1.64) compared with Whites.</p><p><strong>Conclusions: </strong>Quality measures, such as sessile serrated polyp detection rates, may need to take into account demographic factors such as race. The prevalence of colorectal neoplasia among Asian Americans is substantial and warrants efforts to promote optimal uptake of colorectal cancer screening tests.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"1011-1015"},"PeriodicalIF":2.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139566985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Pathophysiology of Loose Stools and Their Impact on Clinical Severity and Quality of Life in Women With Fecal Incontinence.","authors":"Alba Raventós, Silvia Carrión, Daniel Españó, Cristina Bascompte, Tennekoon Buddhika Karunaratne, Pere Clavé, Lluís Mundet","doi":"10.1097/MCG.0000000000002095","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002095","url":null,"abstract":"<p><strong>Objective: </strong>To compare the impact of fecal consistency with anorectal sphincter dysfunctions on clinical severity and quality of life (QoL) in women with fecal incontinence (FI).</p><p><strong>Background: </strong>FI affects up to 24% of middle-aged women, significantly impacting their QoL. Pathophysiological studies have focused more on sphincter and anorectal dysfunctions than on the role of fecal consistency.</p><p><strong>Patients and methods: </strong>A cross-sectional observational study evaluating anorectal physiology, neurophysiology, and fecal consistency with regard to clinical severity and QoL. Patients with a Bristol Stool Chart (BSC) score of 5 or more (BSC ≥5) underwent a breath test to detect bacterial overgrowth (small intestinal bacterial overgrowth), lactose or fructose/sorbitol malabsorption, and/or a cholestyramine test to detect bile acid malabsorption. We compared anorectal physiology, clinical severity, and QoL of those with BSC ≥5 with BSC <5.</p><p><strong>Results: </strong>The study included 150 women with an average age of 64.81 ± 11.96. FI types varied: 64.38% had urge FI, 15.06% had passive FI, and 19.18% had both. Among them, 56.2% had BSC ≥5, linked to bile acid malabsorption (20.5%), lactose malabsorption (17.9%), small intestinal bacterial overgrowth (14.3%), and fructose/sorbitol malabsorption (14.3%). Anorectal dysfunctions were highly prevalent, with 49.1% showing external anal sphincter insufficiency, 9.8% internal, and 34.7% both. Those with BSC ≥5 experienced significantly worse clinical severity and QoL (St. Mark 17.3 ± 2.69 vs 12.9 ± 3.27), and more pronounced issues in Fecal Incontinence Quality of Life Scale dimensions of lifestyle, coping, depression, and EuroQol 5-dimension of anxiety/depression and pain/discomfort.</p><p><strong>Conclusions: </strong>Fecal consistency of BSC ≥5 significantly worsens clinical severity and QoL in women with FI. Specific diagnostic and therapeutic approaches addressing loose stools are needed before any rehabilitation treatment.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576214","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":"Brain Fog in Gastrointestinal Disorders: Small Intestinal Bacterial Overgrowth, Gastroparesis, Irritable Bowel Syndrome.","authors":"Maan El Halabi, Remy Arwani, Satish C Rao, Henry P Parkman","doi":"10.1097/MCG.0000000000002094","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002094","url":null,"abstract":"<p><strong>Introduction: </strong>Brain fog (BF) is a term used to describe difficulties with concentration, memory, and overall mental clarity. Links of BF to chronic fatigue syndrome and COVID-19 have been described, as well as recently to small intestinal bacterial overgrowth (SIBO) and probiotics.</p><p><strong>Aim: </strong>To investigate the association between BF, SIBO, intestinal methanogen overgrowth (IMO), gastrointestinal (GI) medications, and specific GI disorders [irritable bowel syndrome (IBS) and gastroparesis] by utilizing a questionnaire to help diagnose BF.</p><p><strong>Methods: </strong>Patients undergoing lactulose breath testing (LBT) for clinical assessment of SIBO filled out a demographic questionnaire, including an inquiry about the presence of BF, a symptom questionnaire (PAGI-SYM), and a BF Questionnaire (BFQ; 20 BF symptoms rated never=0 to always=4, total score 0 to 80).</p><p><strong>Results: </strong>A total of 102 patients underwent LBT, with the most common indication being bloating (67%), of whom 55 (54%) reported BF. The BFQ score was significantly higher in patients reporting BF than those not [38.2±15.6 vs. 10.9±9.4 (SEM) (P=0.001)]. Patients with BF were more likely to be on probiotics and proton pump inhibitors compared with those without BF (P=0.04). There was no major difference in the use of narcotics, prokinetics, or prebiotics. Gastroparesis and IBS were more common in patients who reported BF (P=0.01 and 0.05, respectively), but not SIBO or IMO by breath testing.</p><p><strong>Conclusions: </strong>BF was observed in over one-half of patients with common GI disorders. The prevalence of BF was higher in patients on probiotics and those with gastroparesis and IBS. The BFQ may be useful to diagnose and quantify BF severity.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142576207","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}