Journal of clinical gastroenterology最新文献

{"title":"Early Endoscopic Retrograde Cholangiopancreatography is Associated With Improved Health Care Resource Utilization in Acute Biliary Pancreatitis Without Cholangitis.","authors":"Brandon K Chu, Ahmed Abdelbaki, Melica Nikahd, Peter Lee, Hamza Shah, Raj Shah, Jordan Burlen, Erica Park, Mitchell L Ramsey, Eric T Swei, Georgios I Papachristou, Phil A Hart, Somashekar G Krishna","doi":"10.1097/MCG.0000000000002341","DOIUrl":"10.1097/MCG.0000000000002341","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in managing uncomplicated acute biliary pancreatitis (ABP) remains unclear. This population-based study assessed the impact of ERCP timing on outcomes in hospitalized ABP patients without cholangitis or sepsis.</p><p><strong>Methods: </strong>Using the Nationwide Readmission Database (2016 to 2020), patients with ABP who underwent ERCP were identified, excluding those with cholangitis/sepsis. ERCP timing was categorized as early (0 to 1 d) or delayed (2 to 7 d). Outcomes, including mortality, 30-day readmissions, and health care resource utilization were analyzed using multivariable logistic regression.</p><p><strong>Results: </strong>Among 54,250 noninfectious ABP patients, 42.13% underwent ERCP. There was no significant difference in in-hospital mortality between early and delayed ERCP groups (0.26% vs. 0.24%, P =0.73). However, 30-day readmission rates rose with each day of delay in the delayed ERCP group ( P <0.001) and were higher overall (8.26% vs. 7.51%, P =0.03). Delayed ERCP was associated with increased 30-day readmissions (OR: 1.11, 95% CI: 1.00-1.22); using alternate categorical thresholds, ERCP on day 4 or later was also linked to higher odds of readmission (OR: 1.35, 95% CI: 1.18-1.54). Early ERCP was associated with reduced mean length of stay by 1.51 days (95% CI: -1.51 to -1.50; P <0.001) and hospital costs by $1536.45 (95% CI: -$1545.37 to -$1527.52; P <0.001) after multivariable adjustment. Compared with day 4 or later, ERCP on days 2 to 3 further reduced stay by 2.42 days and costs by $3756.95 (both P <0.001).</p><p><strong>Conclusion: </strong>Delayed ERCP was associated with increased 30-day readmission rates and greater health care resource utilization and ERCP performed within 4 days may improve hospital quality metrics in patients with noninfectious acute biliary pancreatitis.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"654-660"},"PeriodicalIF":2.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165693","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":"Trends, Burden, and Impact of Infections on Outcomes Among Patients With Alcohol-Associated Hepatitis: A Nationwide Analysis.","authors":"Carol Singh, Abdelrahman Khater, Bipneet Singh, Aalam Sohal, Marina Roytman","doi":"10.1097/MCG.0000000000002434","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002434","url":null,"abstract":"<p><strong>Background: </strong>Alcohol-associated hepatitis (AH), characterized by severe inflammation of the liver among patients with heavy alcohol use, has been associated with increased susceptibility to developing infections. This study evaluates the trends, burden, and impact of infections on the clinical course of AH.</p><p><strong>Methods: </strong>Data from the 2016 to 2022 National Inpatient Sample database were used to identify adult patients with AH. Patients were stratified into 2 groups: those with and without infections. We collected data on patient demographics, liver-related decompensations, comorbidities, and outcomes [in-hospital mortality, sepsis, shock, acute kidney injury (AKI), intensive care unit (ICU) admission, and thrombotic events]. Multivariate logistic/linear regression analysis was used to assess the impact of infections on these outcomes.</p><p><strong>Results: </strong>Among the 917,345 patients with AH, 186,655 (20.3%) developed infections. The most frequent infections observed included urinary tract infection (9%), pneumonia (6.0%), and skin/soft tissue infections (2.7%). After adjusting for confounding factors, patients with infections had higher odds of in-hospital mortality (aOR: 1.84, 95% CI: 1.75-1.95), sepsis (aOR: 1.87, 95% CI: 1.77-1.97), AKI (aOR: 1.78, 95% CI: 1.73-1.84), shock (aOR: 2.54, 95% CI: 2.43-2.65), ICU admissions (aOR: 2.52, 95% CI: 2.42-2.63), pulmonary embolism (aOR: 2.02, 95% CI: 1.74-2.35), and deep vein thrombosis (aOR: 2.39, 95% CI: 2.13-2.70), (all P<0.001).</p><p><strong>Conclusions: </strong>The development of systemic infections in patients with AH leads to worse clinical outcomes. Early identification, management, and prevention are necessary to prevent adverse outcomes and improve the overall prognosis among these patients.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148630533","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 Mediating Role of Pain Catastrophizing in Functioning and Mental Health for Youth With Pain-predominant Disorders of Gut-Brain Interaction.","authors":"Megan M Miller, Jillian E Austin, Kahleb D Graham, Jen Hardy, Neha R Santucci","doi":"10.1097/MCG.0000000000002427","DOIUrl":"10.1097/MCG.0000000000002427","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify if pain catastrophizing is a mediator between pain intensity and functioning (functional disability and sleep), as well as mental health (anxiety and depression) in patients with pain-predominant disorders of gut-brain interaction (DGBI).</p><p><strong>Background: </strong>Pediatric pain is a significant problem that can lead to impairment in functioning and mental health. It is well documented in the pediatric literature that greater pain severity, pain catastrophizing, anxiety, depression, and reduced functioning are correlated. In youth with pain-predominant DGBI, the exact nature of how pain catastrophizing impacts functioning and mental health is less studied.</p><p><strong>Methods: </strong>A retrospective review of de-identified data collected as part of clinical care for pediatric patients attending a neurogastroenterology subspecialty clinic was completed.</p><p><strong>Results: </strong>Mediation analyses demonstrated that pain catastrophizing was a significant mediator in the relationships between pain intensity and functional disability, depression, and anxiety. Pain catastrophizing was not a mediator in the relationship between pain intensity and sleep disturbances.</p><p><strong>Conclusions: </strong>Pain catastrophizing represents a malleable cognitive factor of the pain experience. Clinical intervention on pain catastrophizing appraisals has the potential to improve functioning and mental health, even if pain intensity remains unchanged.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470860","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":"Clarifying Statistical Methods in a TriNetX Study of GLP-1 Therapy on Post-ERCP Outcomes.","authors":"Joshua Wang","doi":"10.1097/MCG.0000000000002425","DOIUrl":"10.1097/MCG.0000000000002425","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446976","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 Potential Role of THR-β Agonizts in Reversing Liver Fibrosis and Cirrhosis Across Etiologies: Toward a Pan-Antifibrotic Therapy?","authors":"Kamran B Lankarani","doi":"10.1097/MCG.0000000000002361","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002361","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446955","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":"Is Perfect Adherence Over Multiple Rounds of Fecal Occult Blood Testing Really Unnecessary in Colorectal Cancer Screening?","authors":"Jie Chen, Han Zhang","doi":"10.1097/MCG.0000000000002429","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002429","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436847","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":"Optimizing Approach to Nonobstructive Dysphagia: A Cost-Minimization Analysis.","authors":"Ashwin Gupta, Rishi Naik, Michael Vaezi, James C Slaughter, Dhyanesh Patel","doi":"10.1097/MCG.0000000000002411","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002411","url":null,"abstract":"<p><strong>Objectives: </strong>Dysphagia affects over 15 million US adults. The initial workup often involves performing an esophagogastroduodenoscopy (EGD), and in 32% of cases, the EGD is normal, prompting further evaluation. This study aimed to identify the most cost-effective approach for diagnosing and managing nonobstructive dysphagia (NOD).</p><p><strong>Methods: </strong>We compared the cost of multiple scenarios in the initial workup of NOD: (1) esophageal high-resolution manometry (HRM); (2) esophageal impedance planimetry (EndoFLIP); or (3) empiric dilation followed by HRM or EndoFLIP if dilation fails. Distributions of HRM and EndoFLIP diagnoses in NOD were determined from prior published large cohorts, which were then cross-referenced to determine the costs of different clinical scenarios.</p><p><strong>Key results: </strong>Approaches using EndoFLIP compared with HRM with or without empiric dilation had notably higher average per-patient costs of ∼$300 to $430. HRM-first strategies remained more cost-effective in all scenarios unless the HRM failure rates exceeded 48.8%.</p><p><strong>Conclusions and inferences: </strong>Our study found potential savings of $1 to $2 billion when performing HRM instead of EndoFLIP in the initial workup of NOD. The difference is attributed to the relatively higher cost of EndoFLIP and the more frequent need for follow-up testing, which often includes HRM. However, the cost of EndoFLIP, particularly when normal during the initial EGD, may be justified as patient comfort and tolerability are critical unmeasured components of patient care.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411603","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":"Impact of GI PCR Versus Stool Culture on Clinical Outcomes in Hospitalized Patients: A Retrospective Cohort Study.","authors":"Bolaji Ayinde, Mena Louis, Adeel Akhtar, Nate Grabill, Ana Tucker, Jake Slaton, Phillip J Gross","doi":"10.1097/MCG.0000000000002419","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002419","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal (GI) infections are a common cause of hospitalization, often requiring prompt diagnosis to guide treatment. While traditional stool culture remains widely used, it is limited by long turnaround times and narrow organism detection. Multiplex gastrointestinal PCR (GI PCR) offers broader, faster pathogen identification. This study compares the clinical impact of GI PCR and stool culture in patients admitted with suspected infectious gastroenteritis.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a large regional health system, including adult inpatients who had positive stool culture results, GI PCR, or both between January 2019 and September 2024. The primary outcome was hospital length of stay (LOS). Secondary outcomes included targeted antibiotic therapy prescription, antibiotic duration, and inpatient colonoscopy rates. LOS and antibiotic duration were modeled using generalized additive models for location, scale, and shape (GAMLSS); logistic regression was used for targeted antibiotic therapy prescription.</p><p><strong>Results: </strong>Out of the 408 patients with positive findings, 154 were positive only on stool culture, 153 only on GI PCR, and 101 tested positive on both. GI PCR was associated with a 33.6% reduction in mean LOS compared with stool culture (IRR 0.664, 95% CI: 0.526-0.840, P<0.001). Targeted antibiotic prescription occurred in 59.5% of PCR patients versus 21.4% of those with stool culture alone (OR 5.38, 95% CI: 3.26-8.89, P<0.001). Median antibiotic duration was similar across groups. Colonoscopy was rare (2.0%) and did not differ by test type.</p><p><strong>Conclusion: </strong>GI PCR significantly improves hospital efficiency and antibiotic targeting in patients with suspected GI infections and should be considered as the primary diagnostic strategy in inpatient settings.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411562","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 Body Roundness Index, A Body Shape Index, and Cardiometabolic Indices With Gastric Intestinal Metaplasia Severity Assessed by OLGA Staging.","authors":"Mete Ucdal, Faruk Yazıcı, Evren Ekingen","doi":"10.1097/MCG.0000000000002416","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002416","url":null,"abstract":"<p><strong>Background and aim: </strong>Gastric intestinal metaplasia (IM) is a recognized precancerous lesion whose progression may be influenced by metabolic dysfunction. Novel anthropometric indices, including the Body Roundness Index (BRI) and A Body Shape Index (ABSI), have emerged as superior predictors of visceral adiposity in comparison to the conventional body mass index (BMI). However, the association of these indices with gastric precancerous lesions remains largely unexplored. This study aims to investigate the relationship between BRI, ABSI, BMI, and cardiometabolic indices (TyG, TyG-BMI) with the severity of IM, as measured by the Operative Link on Gastritis Assessment (OLGA) staging system.</p><p><strong>Methods: </strong>This prospective cross-sectional study included 250 patients who underwent upper gastrointestinal endoscopy with gastric biopsy. IM was assessed histopathologically and graded using the OLGA staging system (stages 0 to IV). Anthropometric indices (BMI, BRI, and ABSI) and cardiometabolic indices (TyG, TyG-BMI) were computed from standardized measurements. Receiver operating characteristic (ROC) analysis, Spearman correlation, and multivariate logistic regression were performed.</p><p><strong>Results: </strong>Of 250 patients (average age: 53.6±18.9 y; 51.6% female), 154 (61.6%) were identified as IM-positive. All anthropometric and cardiometabolic indices were significantly elevated in IM-positive individuals (P<0.001). The Body Roundness Index (BRI) exhibited the strongest correlation with OLGA stage (ρ=0.448, P<0.001) and IM grade (ρ=0.493, P<0.001). In the prediction of advanced OLGA stages (≥stage III), the triglyceride-glucose (TyG) index demonstrated the highest discriminative capacity (AUC=0.848), followed by BRI (AUC=0.815) and waist circumference (AUC=0.809). In multivariate analysis, adjusting for age, sex, and Helicobacter pylori status, BRI (odds ratio=1.665, 95% CI: 1.281-2.164, P<0.001), TyG (odds ratio=3.823, 95% CI: 1.925-7.591, P<0.001), and their combination (BRI: odds ratio=1.469; TyG: odds ratio=2.654) persisted as independent predictors of intestinal metaplasia (IM) positivity. Tertile analysis demonstrated a dose-response relationship: the prevalence of IM increased from 39.8% (T1) to 82.1% (T3) for BRI and from 42.9% (T1) to 83.1% (T3) for TyG, with P-trend values <0.001 for both.</p><p><strong>Conclusions: </strong>BRI and TyG index are independently associated with gastric IM severity and demonstrate superior predictive performance compared with conventional BMI. These noninvasive, easily calculable indices may serve as practical tools for identifying individuals at increased risk of gastric precancerous lesions in clinical practice.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411637","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":"Midterm Evaluation of EUS-guided Gastroenterostomy for Gastric Outlet Obstruction: An International Collaborative Study.","authors":"Andrew Canakis, Monica Gaidhane, Haroon M Shahid, Amy Tyberg, Dillon C Miller, Romy Bareket, Conan Chen, Petko Karagyozov, Avik Sarkar, Jessica L Widmer, Everson L Artifon, Prashant Kedia, Salil Chowdhury, Divya M Chalikonda, Vincent Dioguardi, David E Loren, Thomas E Kowalski, Alexander Schlachterman, Anand Kumar, Austin Chiang, Domenica Cunto, Carolos Robles-Medranda, Michel Kahaleh","doi":"10.1097/MCG.0000000000002174","DOIUrl":"10.1097/MCG.0000000000002174","url":null,"abstract":"<p><strong>Background: </strong>EUS-guided gastroenterostomy (EUS-GE) is a minimally invasive therapy for the management of gastric outlet obstruction (GOO). EUS-GE has demonstrated excellent short-term efficacy without the risks of surgical bypass. However, there is limited data on follow-up outcomes. In this study, we collected 6-month follow-up data on patients who underwent EUS-GE for benign and malignant etiologies, to aim to show the shift in paradigm in their management algorithm.</p><p><strong>Methods: </strong>This was a retrospective multicenter study across 7 international centers of consecutive patients undergoing EUS-GE over a 4-year period who were entered in a dedicated registry. Demographic characteristics, procedure-related information, and follow-up data were collected. Primary outcome was the 6-month data on clinical resolution of GOO.</p><p><strong>Results: </strong>Ninety-one patients were included (71 malignant and 20 benign cases). Technical success was 99% due to high expertise and volume. Clinical success at 48 hours was 97% (88/90) with an average procedure time of 47 minutes and length of stay of 5.86 days. At 3 months, 87 (95.6%) patients had achieved clinical resolution. At 6 months, 48 (53%) subjects were alive, 40 (44%) were deceased, 3 were lost to follow-up (3.3%) and 1 (1%) had a recurrence of GOO. Clinical success at 6 months follow-up was 98% (47/48).</p><p><strong>Conclusions: </strong>The majority of patients with GOO who undergo EUS-GE showed clinical resolution at 6-month follow-up. Patients with malignant etiology are appropriately palliated during their life span. Further prospective studies are necessary to obtain long-term data regarding EUS-GE for benign etiologies.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"523-527"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605152","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}