Journal of clinical gastroenterology最新文献

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The Electronic Frailty Index is Associated With In-hospital Mortality and Unfavorable Prognosis in Hospitalized Elderly Chinese Patients With Gastrointestinal Bleeding. 中国老年消化道出血住院患者的电子衰弱指数与住院死亡率和不良预后相关
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-07-04 DOI: 10.1097/MCG.0000000000002222
Fan Zhang, Yu-Jun Xiong, Xiang-Da Meng, Qing-Feng Luo
{"title":"The Electronic Frailty Index is Associated With In-hospital Mortality and Unfavorable Prognosis in Hospitalized Elderly Chinese Patients With Gastrointestinal Bleeding.","authors":"Fan Zhang, Yu-Jun Xiong, Xiang-Da Meng, Qing-Feng Luo","doi":"10.1097/MCG.0000000000002222","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002222","url":null,"abstract":"<p><strong>Background: </strong>Frailty is prevalent in older adults with gastrointestinal bleeding (GIB) and is associated with unfavorable prognosis. The electronic Frailty Index (eFI) quantifies cumulative health deficits and may predict mortality and adverse events in this population.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted on 1424 hospitalized patients aged 65 years or older with GIB in Beijing Hospital (2013-2019). The eFI was derived from 45 variables encompassing chronic diseases, nursing assessments, and laboratory data. Restricted cubic spline modeling and Logistic regression analyses assessed the relationships between eFI, unfavorable prognosis, and mortality.</p><p><strong>Results: </strong>Of the 1424 hospitalized patients included, 46.0% experienced unfavorable prognosis and 30.3% died during hospitalization. A nonlinear association was observed between the eFI and both outcomes. Using a threshold of 0.27, patients were classified as frail (eFI ≥0.27) or nonfrail (eFI <0.27). Compared with nonfrail patients, those in the frail group had significantly higher adjusted risks of in-hospital mortality (OR: 3.69, 95% CI: 2.45-5.55) and unfavorable prognosis (OR: 3.51, 95% CI: 2.41-5.11). The area under the curve (AUC) for the eFI was 0.76 for predicting in-hospital mortality and 0.72 for unfavorable prognosis, indicating good discriminative ability.</p><p><strong>Conclusion: </strong>The eFI demonstrated prognostic utility for predicting in-hospital mortality and unfavorable prognosis in older adults with GIB. The threshold of 0.27 offers a practical basis for frailty assessment and risk stratification, underscoring the importance of multidisciplinary approaches to improve outcomes in this high-risk group. Further validation in multicenter and non-Chinese cohorts is warranted.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575529","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}
引用次数: 0
Prevention of Liver Fibrosis and Hepatocellular Carcinoma Using Antiplatelet Drugs: A Systematic Review and Meta-analysis. 使用抗血小板药物预防肝纤维化和肝细胞癌:系统回顾和荟萃分析。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-07-03 DOI: 10.1097/MCG.0000000000002219
Rui-Jing Wang, Jie Wang, Xiu-Ying Zhang, Yang Yue, Bo Shen, Yu-Ting Zhang
{"title":"Prevention of Liver Fibrosis and Hepatocellular Carcinoma Using Antiplatelet Drugs: A Systematic Review and Meta-analysis.","authors":"Rui-Jing Wang, Jie Wang, Xiu-Ying Zhang, Yang Yue, Bo Shen, Yu-Ting Zhang","doi":"10.1097/MCG.0000000000002219","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002219","url":null,"abstract":"<p><strong>Goal: </strong>The aim of our research was to compile and analyze all existing observational data through a meta-analysis, evaluating the relationship between antiplatelet drugs, such as aspirin and clopidogrel, and the risks of liver fibrosis, portal vein thrombosis (PVT), and hepatocellular carcinoma (HCC).</p><p><strong>Background: </strong>The association between antiplatelet drug use, especially the use of agents other than aspirin, and liver fibrosis, PVT, and HCC in patients with liver disease remains unclear.</p><p><strong>Study: </strong>Cochrane Library, Web of Science, EMBASE, and PubMed were searched for all records from their inception through Jul. 20, 2024. Per the defined inclusion and exclusion criteria, we carried out literature screening and data extraction. Following that, the quality of these studies was appraised with the Newcastle-Ottawa Scale. The primary outcomes were liver fibrosis, HCC, and PVT. Statistical analysis was conducted using Stata 17.</p><p><strong>Results: </strong>The final analysis included 29 studies with 13,000 patients. Pooled results showed the HCC incidence after antiplatelet drug treatment was 3.6% (95% CI: 2.4%, 5.2%). The incidence of PVT after antiplatelet drug treatment was 48.6% (95% CI: 29.8%, 67.8%). Compared with the group not using antiplatelet drugs, the risk of liver fibrosis [hazard ratio (HR): 0.65, 95% CI: 0.56, 0.77; P<0.001] and the risk of HCC (HR: 0.63, 95% CI: 0.54, 0.73; P<0.001) were notably reduced in the group using antiplatelet drugs.</p><p><strong>Conclusions: </strong>The use of antiplatelet drugs may help prevent liver fibrosis, PVT, and HCC. Owing to the constraints of existing evidence, high-quality randomized controlled studies are essential to further corroborate these findings.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575528","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}
引用次数: 0
Trends in Substance Use Disorder Among Hospitalized Patients With Inflammatory Bowel Disease: An 11-Year Nationwide Study. 炎症性肠病住院患者物质使用障碍的趋势:一项为期11年的全国性研究
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-07-02 DOI: 10.1097/MCG.0000000000002205
Melanie Zheng, Lauren DeDecker, Po-Hung Chen, Berkeley N Limketkai
{"title":"Trends in Substance Use Disorder Among Hospitalized Patients With Inflammatory Bowel Disease: An 11-Year Nationwide Study.","authors":"Melanie Zheng, Lauren DeDecker, Po-Hung Chen, Berkeley N Limketkai","doi":"10.1097/MCG.0000000000002205","DOIUrl":"10.1097/MCG.0000000000002205","url":null,"abstract":"<p><strong>Goals: </strong>We described the temporal trend of substance use disorder (SUD) and SUD subtypes among patients hospitalized with inflammatory bowel disease (IBD), accounting for readmissions within the calendar year.</p><p><strong>Background: </strong>One in six patients with IBD is estimated to have a concomitant SUD. SUD has had mounting morbidity and mortality rates since 2010 and has been shown to adversely affect IBD activity.</p><p><strong>Study: </strong>We performed a retrospective analysis of patients hospitalized at least once with IBD from 2010 through 2020 using the Nationwide Readmissions Database. Multivariable logistic regression analysis evaluated associations between SUD and age, sex, insurance type, income for the ZIP Code, and geographic region.</p><p><strong>Results: </strong>Of 2,532,450 patients hospitalized with IBD, 26.5% and 17.0% involved SUD in Crohn's disease (CD) and ulcerative colitis (UC), respectively. Between 2010 and 2020, the prevalence of patients with SUD increased from 23.8% to 27.9% in CD (Ptrend<0.001) and 14.2% to 19.4% in UC (Ptrend<0.001). Rates of alcohol, opioid, and cannabis use disorders increased (Ptrend<0.001 for all). Patients with SUD were more likely to be male [CD: OR: 1.26; 95% CI: 1.24-1.27; UC: 1.34, (1.31-1.36)], have Medicaid insurance compared with Medicare [CD: 1.59, (1.55-1.63); UC: 1.84, (1.78-1.90)], and be in a lower income quartile [lowest to highest quartile, CD: 1.54, (1.51-1.58); UC: 1.56, (1.52-1.61)].</p><p><strong>Conclusions: </strong>SUD among IBD patients continued to increase over time, with the predominant substances used shifting from alcohol to opioids and cannabis. Rates of SUD among patients hospitalized with CD were consistently higher than those with UC or with non-IBD-related hospitalizations.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575530","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}
引用次数: 0
The Tissue Systems Pathology Test Objectively Risk-Stratifies Patients With Barrett's Esophagus: Results From a Multicenter US Clinical Experience Study. 组织系统病理学检验能客观地对巴雷特食管患者进行风险分级:美国多中心临床经验研究结果。
IF 2.7 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-07-01 DOI: 10.1097/MCG.0000000000002040
Nicolas A Villa, Miguel Ordonez-Castellanos, Michael Yodice, Kirsten Newhams, Shahin Ayazi, Christian Smolko, Meenakshi Arora, Rebecca J Critchley-Thorne, Harshit S Khara, David L Diehl
{"title":"The Tissue Systems Pathology Test Objectively Risk-Stratifies Patients With Barrett's Esophagus: Results From a Multicenter US Clinical Experience Study.","authors":"Nicolas A Villa, Miguel Ordonez-Castellanos, Michael Yodice, Kirsten Newhams, Shahin Ayazi, Christian Smolko, Meenakshi Arora, Rebecca J Critchley-Thorne, Harshit S Khara, David L Diehl","doi":"10.1097/MCG.0000000000002040","DOIUrl":"10.1097/MCG.0000000000002040","url":null,"abstract":"<p><strong>Background: </strong>Barrett's esophagus (BE) is a diagnosis of esophageal intestinal metaplasia, which can progress to esophageal adenocarcinoma (EAC), and guidelines recommend endoscopic surveillance for early detection and treatment of EAC. However, current practices have limited effectiveness in risk-stratifying patients with BE.</p><p><strong>Aim: </strong>This study aimed to evaluate use of the TSP-9 test in risk-stratifying clinically relevant subsets of patients with BE in clinical practice.</p><p><strong>Methods: </strong>TSP-9 results for tests ordered by 891 physicians for 8080 patients with BE with clinicopathologic data were evaluated. Orders were from nonacademic (94.3%) and academic (5.7%) settings for nondysplastic BE (NDBE; n=7586; 93.9%), indefinite for dysplasia (IND, n=312, 3.9%), and low-grade dysplasia (LGD, n=182, 2.3%).</p><p><strong>Results: </strong>The TSP-9 test scored 83.2% of patients with low risk, 10.6% intermediate risk, and 6.2% high risk, respectively, for progression to HGD/EAC within 5 years. TSP-9 provided significant risk-stratification independently of clinicopathologic features, within NDBE, IND, and LGD subsets, male and female, and short- and long-segment subsets of patients. TSP-9 identified 15.3% of patients with NDBE as intermediate/high-risk for progression, which was 6.4 times more than patients with a pathology diagnosis of LGD. Patients with NDBE who scored intermediate or high risk had a predicted 5-year progression risk of 8.1% and 15.3%, respectively, which are similar to and higher than published progression rates in patients with BE with confirmed LGD.</p><p><strong>Conclusions: </strong>The TSP-9 test identified a high-risk subset of patients with NDBE who were predicted to progress at a higher rate than confirmed LGD, enabling early detection of patients requiring management escalation to reduce the incidence of EAC. TSP-9 scored the majority of patients with NDBE as low risk, providing support to adhere to 3- to 5-year surveillance per guidelines.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"531-536"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141492182","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}
引用次数: 0
The Utility of Patency Capsule in Patients With Crohn's Disease. 通畅胶囊在克罗恩病患者中的应用。
IF 2.7 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-07-01 DOI: 10.1097/MCG.0000000000002048
Tarek Odah, Christian Karime, Jana G Hashash, Jami A Kinnucan, Michael F Picco, Francis A Farraye
{"title":"The Utility of Patency Capsule in Patients With Crohn's Disease.","authors":"Tarek Odah, Christian Karime, Jana G Hashash, Jami A Kinnucan, Michael F Picco, Francis A Farraye","doi":"10.1097/MCG.0000000000002048","DOIUrl":"10.1097/MCG.0000000000002048","url":null,"abstract":"<p><strong>Background: </strong>Video capsule retention is a complication that can have serious consequences in patients with Crohn's disease (CD). The patency capsule was developed to detect small bowel strictures. The usefulness of patency capsules in patients who do not have evidence of small bowel disease on imaging is uncertain.</p><p><strong>Study: </strong>This is a multicenter retrospective study of patients with suspected or confirmed CD who underwent a patency capsule study between January 2017 and February 2023. We excluded patients who were lost to follow-up or did not have computerized tomography or magnetic resonance imaging of the abdomen within 180 days before or after the patency capsule study.</p><p><strong>Results: </strong>A total of 105 patients met the inclusion criteria with 69% having a confirmed CD diagnosis. The majority of patients (95/105; 90.5%) passed their patency capsule. A total of 91 patients had their subsequent video capsule endoscopy (VCE), with 96.7% (88/91) successfully passing the capsule. Out of those who passed the VCE, 2 patients had patency capsule retention. Both had normal small bowel imaging. Meanwhile, the 3 patients who had VCE retention had evidence of small bowel disease in their imaging scans. The presence of abnormal small bowel wall thickening or stricture on imaging had a statistically significant association with VCE retention ( P =0.02).</p><p><strong>Conclusion: </strong>Our study demonstrated a statistically significant association between small bowel disease on imaging and retention of both patency capsules and VCE. Small bowel imaging in patients with suspected or documented CD had a negative predictive value of 100% for VCE retention.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"562-568"},"PeriodicalIF":2.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894596","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}
引用次数: 0
Fecal Immunochemical Testing for Colorectal Cancer Screening Outside High-income Countries: A Systematic Review and Meta-Analysis. 粪便免疫化学检测用于高收入国家以外的结直肠癌筛查:系统回顾和荟萃分析。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-06-25 DOI: 10.1097/MCG.0000000000002214
Catherine P Cheney, Luderve Rosier, Sarah Cantrell, Nathan M Thielman, Brian A Sullivan
{"title":"Fecal Immunochemical Testing for Colorectal Cancer Screening Outside High-income Countries: A Systematic Review and Meta-Analysis.","authors":"Catherine P Cheney, Luderve Rosier, Sarah Cantrell, Nathan M Thielman, Brian A Sullivan","doi":"10.1097/MCG.0000000000002214","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002214","url":null,"abstract":"<p><strong>Goal: </strong>Investigate fecal immunochemical testing (FIT) for CRC screening outside high-income countries (HIC).</p><p><strong>Background: </strong>Colorectal cancer (CRC) incidence in low- and middle-income countries (LMIC) is rising, but optimal screening strategies in resource-limited settings remain unclear. FIT is an evidence-based, low-cost modality for population-based CRC screening. We performed a systematic review with meta-analysis to better understand the diagnostic performance of FIT for detecting CRC among average-risk individuals living outside HICs.</p><p><strong>Study: </strong>A systematic search of studies conducted in LMICs, defined by the World Bank, was conducted on August 8, 2024. Studies were eligible if they assessed FIT as a diagnostic test for CRC in asymptomatic, average-risk participants. Pooled estimates for FIT sensitivity and specificity were calculated using a bivariate Bayesian statistical analysis (MetaBayesDTA).</p><p><strong>Results: </strong>Our search returned 333 distinct studies. Of these, 263 were excluded after title and abstract screening. We reviewed 61 full texts with 7 meeting inclusion/exclusion criteria. These studies were published between 2015 and 2022 and included 100,619 participants from Argentina, Brazil, China, Iran, and Thailand. Most used a FIT hemoglobin cutoff of 50 ng/mL (n=4). FIT return rate ranged from 78% to 99%, and positivity ranged from 2.1% to 29%. FIT sensitivity ranged from 55% to 92%, specificity from 71% to 94%, PPV from 2% to 16%, and NPV from 98% to 100%. After meta-analysis, pooled estimates for sensitivity and specificity for CRC were 75% (95% CI: 64%-85%) and 89% (95% CI: 77%-95%), respectively.</p><p><strong>Conclusions: </strong>FIT-based CRC screening shows promise, but data was geographically limited to middle-income countries. This highlights the need for research evaluating screening modalities and completion of the screening continuum in LMICs.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475442","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}
引用次数: 0
Overuse of Intravenous Proton-Pump Inhibitors in the Treatment of Low-Risk Upper Gastrointestinal Bleeding. 静脉过量使用质子泵抑制剂治疗低危上消化道出血。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-06-23 DOI: 10.1097/MCG.0000000000002211
Michael M Sutton, Mathew J Gregoski, Don C Rockey
{"title":"Overuse of Intravenous Proton-Pump Inhibitors in the Treatment of Low-Risk Upper Gastrointestinal Bleeding.","authors":"Michael M Sutton, Mathew J Gregoski, Don C Rockey","doi":"10.1097/MCG.0000000000002211","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002211","url":null,"abstract":"<p><strong>Background: </strong>In patients with acute upper GI bleeding (UGIB), current best practice is to discontinue or transition (to oral) intravenous proton pump inhibitors (PPIs) when esophagogastroduodenoscopy (EGD) reveals low risk or no peptic ulcer disease (PUD).</p><p><strong>Study: </strong>This retrospective study from a large academic medical center evaluated the use of intravenous PPIs in patients admitted with acute UGIB due to low-risk PUD or non-PUD UGIB. Complete clinical data including endoscopic lesions and the duration of intravenous PPI therapy were recorded.</p><p><strong>Results: </strong>Of 335 patients with acute UGIB, 253 had no PUD or an ulcer with only low-risk stigmata; 79 patients [31% (95% CI: 26%-37%)] received the appropriate duration of IV PPI. For patients with low-risk PUD (n=42), patients received on average 5.3 excess doses of intravenous PPI, and patients receiving continuous intravenous PPI received an average of 41 additional hours of IV PPI. Likewise, excess PPI therapy was common for patients found to have no lesions or no PUD. Lesions most often associated with inappropriate IV PPI use included: no identifiable lesion (n=59; 34%), low-risk PUD (n=42; 24%), gastritis (n=31; 18%), esophagitis (n=24, 14%), and AVMs (n=21, 12%). The length of hospital stay was shorter in patients who received appropriate PPI therapy after EGD compared with those who did not (4.3 vs. 7.2 d, P=0.001).</p><p><strong>Conclusions: </strong>IV PPIs are grossly overused in patients with UGIB, suggesting that there is substantial room for improvement in the use of PPIs in patients with acute UGIB.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475446","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}
引用次数: 0
Trends in Urban-rural Disparities in Hepatocellular Carcinoma Mortality in the United States From 1999 to 2020. 1999年至2020年美国肝细胞癌死亡率城乡差异趋势
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-06-23 DOI: 10.1097/MCG.0000000000002162
Chun-Wei Pan, Pojaskorn Danpanichkul, Ramsey Cheung, Paulo Pinheiro, Patricia D Jones, Robert J Wong
{"title":"Trends in Urban-rural Disparities in Hepatocellular Carcinoma Mortality in the United States From 1999 to 2020.","authors":"Chun-Wei Pan, Pojaskorn Danpanichkul, Ramsey Cheung, Paulo Pinheiro, Patricia D Jones, Robert J Wong","doi":"10.1097/MCG.0000000000002162","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002162","url":null,"abstract":"<p><strong>Objective: </strong>Hepatocellular carcinoma (HCC) is a growing public health concern in the United States. While socioeconomic factors have been linked to HCC outcomes, the impact of urban-rural residence remains understudied. This analysis examines trends in HCC mortality between urban and rural areas from 1999 to 2020.</p><p><strong>Materials and methods: </strong>Using the \"Centers for Disease Control and Prevention Wide Ranging Online Data for Epidemiologic Research\" database, we analyzed age-adjusted HCC mortality rates in urban and rural counties. Joinpoint regression was used to calculate annual percentage change and average annual percentage change (AAPC) in mortality rates. We examined trends by demographics and geographic regions.</p><p><strong>Results: </strong>Overall HCC mortality increased from 1999 to 2020 (AAPC: 1.24%). Rural areas experienced a more rapid rise (AAPC: 1.97%) in HCC mortality compared with urban areas (AAPC: 1.11%), and in 2020 HCC mortality in rural areas surpassed that in urban areas. Significant disparities in HCC mortality were also observed by other sociodemographic factors, with the highest HCC mortality among men, older adults, and ethnic minority populations in rural regions.</p><p><strong>Conclusion: </strong>Significant disparities in HCC mortality were observed by urban-rural geography in the United States, which seems to be exacerbated by underlying sociodemographic factors. Better understanding of potential modifiable drivers of these disparities will help guide interventions to improve long-term patient outcomes.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475450","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}
引用次数: 0
Medications for Weight Loss and MASLD: A National Survey of Hepatology and Gastroenterology Provider Practices, Attitudes, and Knowledge Before Resmetirom. 减肥药和MASLD:一项全国肝病和胃肠病学提供者的实践、态度和知识调查。
IF 2.7 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-06-23 DOI: 10.1097/MCG.0000000000002147
Gene Y Im, Amon Asgharpour, Elizabeth S Aby, Jonathan G Stine, Jessica L Mellinger, Jay Luther, Manhal Izzy, Lamia Haque, Brian T Lee, Thomas G Cotter, Courtney B Sherman, Loretta L Jophlin, Aparna Goel, John Rice, Shaun Chandna, Blanca Lizaola-Mayo, Po-Hung Chen, Ashwani K Singal, Meena B Bansal
{"title":"Medications for Weight Loss and MASLD: A National Survey of Hepatology and Gastroenterology Provider Practices, Attitudes, and Knowledge Before Resmetirom.","authors":"Gene Y Im, Amon Asgharpour, Elizabeth S Aby, Jonathan G Stine, Jessica L Mellinger, Jay Luther, Manhal Izzy, Lamia Haque, Brian T Lee, Thomas G Cotter, Courtney B Sherman, Loretta L Jophlin, Aparna Goel, John Rice, Shaun Chandna, Blanca Lizaola-Mayo, Po-Hung Chen, Ashwani K Singal, Meena B Bansal","doi":"10.1097/MCG.0000000000002147","DOIUrl":"10.1097/MCG.0000000000002147","url":null,"abstract":"<p><strong>Goals: </strong>Our aim was to perform a national survey of provider attitudes, practices, and knowledge regarding weight loss and MASLD medications in patients with MASLD.</p><p><strong>Background: </strong>While weight loss is a cornerstone in the management of metabolic dysfunction-associated steatotic liver disease (MASLD), FDA-approved medications for weight loss remain underutilized.</p><p><strong>Results: </strong>We conducted a survey before resmetirom approval of hepatology and gastroenterology providers practicing in 44 states. Surveys were sent to 747 providers with 304 complete responses (41%), of whom 260 (86%) work at a liver transplant center. While nearly all respondents (96%) believed that weight loss medications could benefit patients with MASLD, 77% have never/rarely prescribed them due to low comfort (81%). Among weight loss medication prescribers, glucagon-like peptide-1 (GLP-1) receptor agonists were preferred (66%). In contrast, 63% had prescribed off-label medications for MASLD in the past 12 months, most commonly vitamin E (30%) and GLP-1 receptor agonists (25%). The top reported barriers to prescribing weight loss medications were lack of training/unfamiliarity, cost/insurance coverage, and side-effects, which may be explained by low formal obesity education and lack of knowledge (only 33% of FDA-approved medications for weight loss were correctly identified by >50% of providers). Overall, there was reasonable provider-reported adherence to the 2023 AASLD practice guidance for MASLD.</p><p><strong>Conclusions: </strong>This nationwide survey of hepatology and gastroenterology providers before resmetirom demonstrates that while off-label prescribing for MASLD was common, weight loss medication prescription rates remain very low due to low comfort possibly from insufficient education despite strong beliefs that they can benefit patients with MASLD.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12312645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475444","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}
引用次数: 0
Performance, Efficacy, and Safety of Lubiprostone in Bowel Preparation Regimens: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Lubiprostone在肠道准备方案中的性能、疗效和安全性:随机对照试验的系统回顾和荟萃分析。
IF 2.8 4区 医学
Journal of clinical gastroenterology Pub Date : 2025-06-20 DOI: 10.1097/MCG.0000000000002215
Yizhong Wu, Joseph Gung, Kyle S Liu, Alexander D Grieme, Manuel Garza, Daryl Ramai, Aline Ghaleb, Andrew Han
{"title":"Performance, Efficacy, and Safety of Lubiprostone in Bowel Preparation Regimens: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Yizhong Wu, Joseph Gung, Kyle S Liu, Alexander D Grieme, Manuel Garza, Daryl Ramai, Aline Ghaleb, Andrew Han","doi":"10.1097/MCG.0000000000002215","DOIUrl":"10.1097/MCG.0000000000002215","url":null,"abstract":"<p><strong>Introduction: </strong>Bowel preparation is an essential part of the colonoscopy process, with inadequate or poor bowel preparation associated with decreased polyp detection. We performed a systematic review and meta-analysis to investigate the effects of adjunct lubiprostone bowel prep on colonoscopies performance.</p><p><strong>Methods: </strong>We conducted a comprehensive search in PubMed, Embase, Cochrane, and Web of Science from inception until February 2025 for RCTs comparing lubiprostone adjunct therapy, bowel prep and control. Our data was analyzed for polyp detection rates, bowel prep quality, colonoscopy duration, adverse events, and side effects. A random effects model was used, and the data were presented using pooled odds ratios (OR) and mean differences (MD) with 95% CI.</p><p><strong>Results: </strong>Eight RCT manuscripts were included with 1322 patients (657 in the lubiprostone group and 665 in the control group). There was no significant difference in polyp detection rate between groups (OR: 1.27, 95% CI: 0.92-1.76, P =0.15, I2 : 0%). The lubiprostone group had significantly higher odds of excellent bowel prep compared with control (OR: 2.25, 95% CI: 1.52-3.33, P <0.0001, I2 : 41%) and significantly lower odds of poor bowel prep ( P =0.009). Colonoscopy duration in minutes was similar ( P =0.17). Adverse event odds were similar between groups ( P =0.22).</p><p><strong>Conclusion: </strong>Lubiprostone as an adjunct agent for bowel prep improves the odds of excellent quality prep while mitigating the odds of poor prep. Lubiprostone adjunct bowel prep is similar to control in adverse effects.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475447","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}
引用次数: 0
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