Journal of clinical gastroenterology最新文献

{"title":"FIT Testing in Iron Deficiency Anemia: A Retrospective Analysis.","authors":"Gaius Longcroft-Wheaton","doi":"10.1097/MCG.0000000000002338","DOIUrl":"10.1097/MCG.0000000000002338","url":null,"abstract":"<p><strong>Objective: </strong>In low-risk populations, the faecal immunochemical FIT test is excellent at excluding colonic malignancy, with a negative predictive value (NPV) of 99.8%. However, effectiveness in a high-risk iron deficiency anaemia (IDA) population is unclear. This has significant resource implications for health care services worldwide. This study aims to establish the NPV of FIT for colorectal cancer in patients with IDA.</p><p><strong>Design/method: </strong>Single-centre retrospective study. Over 12 months, paired cases of FIT <10 µg Hb/g faeces and IDA were identified. Those not completing colonoscopy or CT pneumocolon were excluded. The prevalence of cancer, low-risk and high-risk polyps, defined by British Society of Gastroenterology (BSG) guidelines, was established, and the NPV was calculated.</p><p><strong>Results: </strong>One thousand twenty-three cases were identified, of which 451 had undergone complete colonic investigation. Mean age was 68 (SD: 11.8). 286/451 (63%) were female. 381/451 had undergone colonoscopy, 78/451 CT pneumocolon with 404/451 also having gastroscopy (OGD). 8/451 (1.8%) had a colonic malignancy. 11/404 (2.7%) had an upper GI malignancy and 14/451 (3.1%) a cancer outside the GI tract. The NPV for colorectal cancer was 98.2% (95% CI: 96.9-99.5). In 24/451 (5.3%) advanced polyps were found, NPV 94.7% (95% CI: 92.6%-96.8%). In 118/451 (26%) low-risk polyps were found, NPV 73.8% (95% CI: 69.8%-77.9%).</p><p><strong>Conclusion: </strong>The NPV of FIT in IDA appears lower than reported in low-risk symptomatic populations, and it is unclear if this is adequate to negate the need for colonoscopy. Prospective multicentre studies are needed to evaluate this fully.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"528-531"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018752","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":"Diabetic Gastroparesis in Evolution.","authors":"Audrey Eubanks, Deborah A Jehu, Chuma Obineme, Amol Sharma","doi":"10.1097/MCG.0000000000002381","DOIUrl":"10.1097/MCG.0000000000002381","url":null,"abstract":"<p><p>Diabetic gastroparesis (DGp) is a chronic and often debilitating complication of diabetes mellitus, characterized by delayed gastric emptying in the absence of mechanical obstruction. Over the past 6 decades, our understanding of DGp has evolved considerably. Clinically, DGp presents with symptoms such as nausea, vomiting, early satiety, bloating, and abdominal pain, which are not always proportional to the degree of gastric emptying delay, underscoring the nature of the disorder. To prepare this review, we conducted a targeted narrative synthesis of the literature, performing structured searches of PubMed, Embase, and Scopus for English-language articles published between 2013 and 2025. Articles were screened for relevance and thematically organized into domains including diagnostics, therapeutics, and emerging interventions. This review provides a comprehensive, chronological account of the evolving landscape of DGp, beginning with early clinical recognition, creation of validated characterization, development of diagnostic modalities with standardized protocols, such as gastric emptying scintigraphy, wireless motility capsule, and emerging modalities such as gas-sensing capsule, body surface gastric mapping, and dynamic gastric magnetic resonance imaging. Treatments for DGp are similarly evolving from traditional promotility dopamine receptor antagonists to nonpharmacologic strategies targeting the gut-brain axis and pylorus-directed procedures. By integrating historical perspectives with contemporary advances, this review provides context for future research directions aimed at improving patient outcomes in this challenging disorder.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"471-479"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147673852","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":"GLP-1 Receptor Agonists and Hepatic Encephalopathy in Cirrhosis: A Protective Signal Requiring Cancer and Nutritional Phenotyping.","authors":"Huimin Wang","doi":"10.1097/MCG.0000000000002421","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002421","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360858","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":"Gastro-Entero-Colic Fistula After Successful EUS Guided Gastroenterostomy: Initial Lessons Learned From an International Cohort.","authors":"Antonio Mendoza Ladd, Michel Ladna, Luke Pecha, Enrique Perez Cuadrado, Kaveh Sharzehi, Meera Bhardwaj, Samuel Han, Jorge Vargas, Sumant Inamdar, Khanh Do-Cong Pham, Olaya Brewer, Christoph Schlag, Pieter Hindryckx, Tomas Hucl, Amrita Sethi, Viliam Masaryk, Harshit Khara","doi":"10.1097/MCG.0000000000002178","DOIUrl":"10.1097/MCG.0000000000002178","url":null,"abstract":"<p><strong>Background: </strong>EUS-guided gastroenterostomy (EUS-GE) is an effective option for the management of gastric outlet obstruction (GOO). Due to the poor prognosis of patients undergoing it, data on its long-term adverse events (AE) is scarce. Herein, we describe a cohort of patients with gastro-entero-colic fistula (GECF) as a late AE of previously successful EUS-GE.</p><p><strong>Methods: </strong>Patients who developed a GECF after EUS-GE from 10 high-volume centers were analyzed. Information collected included demographic characteristics, indications, clinical and technical success rates, stent type and size, fistula characteristics, management, and outcomes.</p><p><strong>Results: </strong>Sixteen cases were identified. The mean interval from index EUS-GE to the diagnosis of GECF was 4 to 8 weeks. The most common cause of GOO was pancreatic adenocarcinoma (PDAC). The transverse colon was the most common site for the GECF (14 patients). A 20×10 mm lumen apposing metal stent (LAMS) was utilized in 10 patients. Endoscopic management with a variety of modalities was successful in 13 cases. Follow-up interval after endoscopic management of the fistula averaged 2 to 4 weeks. At the time of the manuscript elaboration, 10 patients had died, 5 were alive, and 1 was lost to follow-up.</p><p><strong>Conclusions: </strong>This is the first description of a cohort of patients with GECF after EUS-GE. The exact mechanisms leading to GECF in these cases are unknown. Possible explanations include inadvertent colon puncture during the index procedure and/or entrapment of mesocolon. More data is needed to further characterize this AE.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"543-548"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144674867","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":"Underwater Versus Conventional EMR for Superficial Nonampullary Duodenal Tumors ≤20 mm: A GRADE-Assessed Meta-Analysis.","authors":"Abdallfatah Abdallfatah, Samaa Daoud, Ahmed W Hageen, Donia T Mahdy, Hazem Abosheaisha, Douglas G Adler","doi":"10.1097/MCG.0000000000002377","DOIUrl":"10.1097/MCG.0000000000002377","url":null,"abstract":"<p><p>Superficial nonampullary duodenal epithelial tumors (SNADETs) present significant challenges in endoscopic management due to their unique anatomic and histologic features, including thin muscularis propria, abundant vasculature, and Brunner glands. In this study, we aim to evaluate the efficacy and safety of underwater endoscopic mucosal resection (U-EMR) compared with conventional endoscopic mucosal resection (C-EMR) in treating SNADETs ≤20 mm. A systematic search was performed in PubMed, Web of Science, Scopus, and Embase from inception to June 1, 2025. Risk of bias assessment was performed by using the Newcastle-Ottawa scale for cohort studies. Data analysis was conducted using R version 4.2.2 (2022-10-31) and RStudio version 2022.07.2 (2009 to 2022, RStudio, Inc.). Outcomes included clinical success defined as no local recurrence detected on endoscopy after 3 to 6 months of follow-up. Findings from 11 studies involving 1465 patients indicate that U-EMR demonstrates a significantly higher clinical success rate (OR: 2.68, 95% CI: 1.58-4.55; P =0.0003, I2 =0%) and reduced procedure time (MD: -2.74, 95% CI: -5.05 to -0.44; P =0.0198, I2 =96.1%) compared with C-EMR, while showing no statistically significant differences in en bloc resection (OR: 1.42, 95% CI: 0.80-2.53; P =0.2297, I2 =60.2%), R0 resection rates (OR: 1.12, 95% CI: 0.69-1.83; P =0.6477, I2 =61.7%), delayed bleeding, intraoperative perforation, or recurrence rates between the 2 techniques. Despite the comparable safety profiles, the study suggests that U-EMR may offer practical advantages in clinical settings, particularly in terms of efficiency and procedural success; U-EMR is positioned as a potential approach for managing SNADETs.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"490-498"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716965","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":"Evaluation of the Length of Anal High-Pressure Zone as a Barrier for Fecal Incontinence.","authors":"Busra Inal, Yun Yan, R Wang, Abeer Aziz, Amanda Tyra, Satish S C Rao","doi":"10.1097/MCG.0000000000002292","DOIUrl":"10.1097/MCG.0000000000002292","url":null,"abstract":"<p><strong>Purpose: </strong>Fecal incontinence (FI) is a multifactorial problem. The length of the anal high-pressure zone (HPZ) may serve as an independent barrier for anal continence, but its role in the pathogenesis of FI has not been examined. We evaluated the association between the length of anal HPZ and anal sphincter pressures in FI patients with or without anal sphincter defects and compared this with healthy controls.</p><p><strong>Methods: </strong>Patients with FI (≥2 episodes per month) underwent high-resolution anorectal manometry and anal ultrasound tests to assess the anal HPZ, anal sphincter pressures and anal morphology. Data were compared between FI patients with and without sphincter defects and healthy controls.</p><p><strong>Results: </strong>We evaluated 224 FI patients and 34 controls. About 33.0% (74/224) of FI patients had anal sphincter defects. The length of anal HPZ was not different between patients with or without sphincter defects (P=0.571). The HPZ was shorter in FI patients than in controls (P<0.001). It was weakly associated with age, number of leakage episodes, and anal resting pressure in FI patients without (r<0.301, P<0.011) but not with sphincter defects (r<0.142, P>0.092). The lengths of HPZ during voluntary squeeze and reflex anal squeeze pressures were not correlated in both groups (r<0.156, P>0.184), except for a weak association in patients with defects (r=0.163, P=0.048).</p><p><strong>Conclusions: </strong>The length of anal HPZ is shorter in FI patients but is not associated with the strength or intactness of anal sphincter muscles, and FI episodes. The length of anal HPZ may not affect anal barrier function.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":"60 6","pages":"538-542"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251674","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":"World Gastroenterology Organisation (WGO) News and Events.","authors":"Lizzie Murphy","doi":"10.1097/MCG.0000000000002402","DOIUrl":"10.1097/MCG.0000000000002402","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":"60 6","pages":"i"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251753","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":"From Gut to Metabolism: Exploring the Intersection of Inflammatory Bowel Disease and Systemic Metabolic Dysfunction.","authors":"Raseen Tariq, Richard K Sterling, Anita Afzali, Arun J Sanyal","doi":"10.1097/MCG.0000000000002359","DOIUrl":"10.1097/MCG.0000000000002359","url":null,"abstract":"<p><p>Inflammatory bowel diseases (IBD), comprising Crohn's disease and ulcerative colitis, are chronic, relapsing inflammatory disorders increasingly recognized as systemic conditions with significant extraintestinal manifestations. Over the past 3 decades, the prevalence of IBD has risen in parallel with obesity and related metabolic disorders, including type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), chronic kidney disease (CKD), metabolic dysfunction-associated steatotic liver disease (MASLD), and dyslipidemia. This parallel rise raises the possibility of shared or interacting biological pathways linking metabolic dysfunction and intestinal inflammation. Epidemiologic studies suggest increased risks of metabolic comorbidities in IBD independent of traditional factors, while mechanistic insights implicate systemic meta-inflammation, mesenteric adipose tissue remodeling (creeping fat), gut barrier dysfunction, and altered lipid and glucose metabolism. These pathways perpetuate a cycle of immune dysregulation and metabolic injury, amplifying disease severity and complications. Obesity and insulin resistance further impact IBD outcomes by altering pharmacokinetics and therapeutic response to biologics, with a higher body mass index associated with increased treatment failure, earlier loss of response, and heightened infection risk. Emerging data also suggest potential dual benefits of metabolic-directed therapies, such as glucagon-like peptide-1 receptor agonists, which may improve weight, glycemic control, and inflammatory indices. However, most evidence remains observational, with limited longitudinal or mechanistic studies. This narrative review synthesizes current knowledge at the interface of IBD and metabolic dysfunction, highlighting clinical implications, translational insights, and research gaps. Integrating metabolic screening and multidisciplinary management into IBD care may improve outcomes, while future mechanistic and interventional studies are needed to define therapeutic strategies that address both gut inflammation and systemic metabolic disease.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"480-489"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"Suicide Attempts, Schizophrenia, and Depression Among Inflammatory Bowel Disease Patients\": Data From a Large Database.","authors":"Liang Liu, Yiheng Yao, Shengnan Li","doi":"10.1097/MCG.0000000000002345","DOIUrl":"10.1097/MCG.0000000000002345","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"566-567"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165752","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":"Beyond \"Normal IgA\": Total IgA and the Reliability of Serology-based Celiac Diagnosis in Adults.","authors":"Alberto Raiteri, Francesco Tovoli, Alessandro Granito","doi":"10.1097/MCG.0000000000002371","DOIUrl":"10.1097/MCG.0000000000002371","url":null,"abstract":"","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"563-564"},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609059","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}