Journal of clinical gastroenterology最新文献

{"title":"Factors Associated With Delayed Endoscopic Retrograde Cholangiopancreatography Among Patients With Acute Cholangitis.","authors":"Joseph O Atarere, Boniface Mensah, Bryce Kunkle, Chisom Nwaneki, Eugene Annor, Ramya Vasireddy, Vwaire Orhurhu, David Weisman, Christopher Thompson","doi":"10.1097/MCG.0000000000002203","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002203","url":null,"abstract":"<p><strong>Background and goals: </strong>Delayed ERCP is associated with increased morbidity and mortality from acute cholangitis (AC). We aimed to identify the factors associated with delayed receipt of early or urgent ERCP among patients with AC.</p><p><strong>Study: </strong>For this retrospective cohort study, we analyzed data from the 2016 to 2020 iterations of the Nationwide Inpatient Sample. We stratified the study population as severe versus nonsevere AC and timing of ERCP as urgent (within 24 h of admission), early (between 24 and 48 h of admission), and late (after 48 h of admission). Using multivariable logistic regression, we examined for the factors associated with delay in urgent or early ERCP overall and delay in urgent ERCP among patients with severe AC.</p><p><strong>Results: </strong>Of the 12,613 participants included in this study, 3032 (24.0%) had severe AC. Blacks [aOR 1.53; 95% CI (1.27, 1.85)], Asians/Pacific Islanders [aOR 1.22; 95% CI (1.02, 1.46)], those with a history of bariatric surgery [aOR 2.10; 95% CI (1.40, 3.17)] and those with one [aOR 1.33; 95% CI (1.13, 1.58)] or more comorbidities were more likely to have a delay in receiving ERCP within 48 hours of admission when compared with non-Hispanic Whites and those with no comorbidities respectively. Racial disparities were not observed among patients with severe AC.</p><p><strong>Conclusion: </strong>Black/AA and API's presenting with AC are more likely to have a delay in the receipt of ERCP within 48 hours of admission. Assessing the impact of medical comorbidities on procedural risk is important when deciding timing of ERCP.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159395","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 Benign Liver EUS Optimal Core Study (BLOCs): A Prospective Randomized Multicenter Study Evaluating Wet-suction Versus Slow Pull Technique for EUS-guided Liver Biopsy.","authors":"Neil R Sharma, Harishankar Gopakumar, Harshit Khara, Abhilash Perisetti, Saurabh Gupta, Mariajose Rojas DeLeon, Marzena Muller, Christina Zelt, Mindy Flanagan, Ashley Rumple, Amitpal Johal, Bradley Confer, Jiahong Li, Meir Mizrahi, Ann Chen, Kefu Li, Mohammad Al-Haddad, Mohamed Othman, Isaac Raijman, Abdul H El Chafic, David Diehl","doi":"10.1097/MCG.0000000000002168","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002168","url":null,"abstract":"<p><strong>Background and aims: </strong>The specimen quality of endoscopic ultrasound-guided liver biopsy (EUS-LB) for benign liver disease evaluation depends on the technique and type of needle used. Using a 19-gauge (19 g) fine needle biopsy (FNB) needle with 3 actuations and wet suction (WS) or slow stylet pull is the current preferred practice. We conducted a randomized prospective multicenter trial to compare wet suction (WS) to slow stylet pull (SP) technique to compare histologic yields, length of procedure, and adverse events (AE).</p><p><strong>Methods: </strong>This prospective randomized trial (NCT03245580) included patients undergoing EUS-LB for parenchymal biopsy at 6 centers in the United States in 2020-2021. A 19 g Franseen tip EUS needle was used for all procedures. For WS, the needle was flushed with saline, and a 20 ml suction syringe with 3 to 5 ml of fluid was used. For SP, a slow pullback of stylet was used. Pathologist was blinded for tissue interpretation.</p><p><strong>Results: </strong>One hundred fifty-three patients across 6 tertiary centers were included, with 75 patients in the WS arm and 78 patients in the SP arm. Histologic outcomes were superior in WS compared with SP [aggregate specimen length (46.5 vs. 34.5 mm, P<0.001), length of longest fragment (14 vs. 11 mm, P<0.001), and number of complete portal tracts (16 vs. 11.5, P<0.001)]. The overall ability to make a histological diagnosis was higher in WS (99% vs. 92%). Procedure length and AE did not differ between groups.</p><p><strong>Conclusions: </strong>The use of WS compared with SP for EUS-LB resulted in superior specimen yields. Total procedure time and adverse events were similar for both techniques.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111016","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":"Real-World Management and Economic Burden of Gallbladder Polyps.","authors":"Mohamad Ali Ibrahim, Zakaria El Kouzi, Fayrouz Hachicho, Lynn Kobeissi, Jana Haidar Ahmad, Ala I Sharara","doi":"10.1097/MCG.0000000000002197","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002197","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder polyps (GBP) are found incidentally on imaging in ∼5% of the general population. Most are asymptomatic and only a very small percentage are malignant. This study examines real-world clinical practice management of GBP and adherence to the updated joint European guidelines.</p><p><strong>Methods: </strong>Patients with GBP between January 2019 and October 2022 were included. Clinical, radiologic, and surgical data were collected retrospectively.</p><p><strong>Results: </strong>One hundred thirty-eight patients were included (mean age 47.0±14.1; female 46.4%). The average follow-up period was 30.6±40.8 months. During the study period, only 26.0% of patients had an increase in GBP size. There were no predictors for GBP growth. Cholecystectomy was performed in 30 patients: 19 (63.3%) had GBP as the indication, and in those, only 9/19 (47.4%) had proper indications according to guidelines. No malignant polyps were found, and no GBP-related deaths were reported. Increased polyp size (P<0.0001) and number (P=0.014) during follow-up were significantly associated with cholecystectomy. Of the 104 patients who did not have surgery, 70 (67.3%) had no indication for follow-up imaging, but 42 (60%) were advised to continue follow-up. The average increased cost of guideline-inconsistent follow-up imaging was >$51,000 and >$67,000 for unindicated cholecystectomies, bringing total waste expenditures to >$118,000.</p><p><strong>Conclusion: </strong>The natural history of GBP does not justify close or prolonged follow-up, especially in young individuals without risk factors. Poor adherence to guidelines by radiologists, gastroenterologists, surgeons, and other health care providers should be addressed, offering a real opportunity for medical education and significant health care savings.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078379","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":"Cyclic Vomiting Syndrome in Adults at the National Level: Impact of Demographics, Burden of Comorbidities, Effect of Hospital Factors, and Determinants of Mortality.","authors":"Faris Shweikeh, Abdur Rahman Jabir, Madison Simons, Samita Garg, Michael Cline, Scott Gabbard, Anthony Lembo, Matthew Hoscheit","doi":"10.1097/MCG.0000000000002180","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002180","url":null,"abstract":"<p><strong>Goals: </strong>The aim of this study was to assess clinical, economic, and epidemiological characteristics of hospitalized patients in the United States with cyclic vomiting syndrome (CVS).</p><p><strong>Background: </strong>CVS is a poorly understood disorder of gut-brain interaction (DGBI) characterized by recurring episodes of intractable nausea and vomiting.</p><p><strong>Study: </strong>The study utilized the Healthcare Cost and Utilization Project's National Inpatient Sample between 2016 and 2019. χ2 test and logistic regression were performed to compare the variables. All analyses included sample weights, strata, and clusters to account for the complex survey design.</p><p><strong>Results: </strong>Admission rates declined from 11,055 in 2016 to 8625 in 2019. Mean age (34.7 y), females (62.5%), and racial distribution (61.8% white) remained stable. Patients were more likely to be 18 to 30 years old (37.2%) and female (62.5%). Comorbidities included anxiety/depression (38.6%) and cannabis use (35.0%). Overall, 90.4% were discharged routinely (ie, to home). Older age (P=0.002) and female gender (P<0.001) had higher length of stay (LOS) and charges. Hispanics incurred higher costs (P<0.001). Depression/anxiety comorbidity (P<0.001) and teaching hospitals (P<0.001) were associated with significantly higher LOS and cost.</p><p><strong>Conclusions: </strong>The number of hospitalizations declined between 2016 and 2019, with the latter having 8625 hospitalizations costing over $300 million. Young females represent a larger group, African Americans were disproportionally affected, and Hispanics had the highest hospitalization costs. Anxiety and depression are primary comorbidities. The disparities identified can help clinicians identify riskier CVS patients who may become a burden on the healthcare system, stratifying them for closer monitoring with the goal of improved outcomes.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078337","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 Clostridioides difficile Infection on the Outcome of Severe Flare of Ulcerative Colitis.","authors":"Anupam Kumar Singh, Siddharth Shukla, Ritesh Acharya, Chhagan Lal Birda, Pramod Kumar Sah, Shravya Singh, Vaneet Jearth, Jimil Shah, Ashish Agarwal, Arun Kumar Sharma, Yashwant Raj Sakaray, Saroj Kant Sinha, Usha Dutta","doi":"10.1097/MCG.0000000000002196","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002196","url":null,"abstract":"<p><strong>Background: </strong>Clostridioides difficile infection (CDI) and acute severe ulcerative colitis (ASUC) are both independently associated with poor outcome. The impact of CDI on the outcome of severe flare of ulcerative colitis is not studied. In the current study, we assess the impact of CDI on the outcome of ASUC.</p><p><strong>Methods: </strong>Data of ASUC patients were collected from January 2022 to July 2024. Parameters included were demographic profile, disease characteristics, biochemical investigations, and stool C. difficile toxin A/B (CDTA). Patients were categorized into ASUC-CDI and ASUC groups. Primary outcomes were need of rescue therapy, colectomy, and mortality during index admission. Six-month outcomes were flare of disease, colectomy, and mortality.</p><p><strong>Results: </strong>Of the 117 patients included, 91 (77.8%) patients were in the ASUC group and 26 (22.2%) in the ASUC-CDI group. Baseline parameters were similar between the 2 groups. Overall, 86 (73.5%) patients responded to corticosteroid therapy. Need of rescue therapy (24.2% vs. 33.6%, P=0.287), colectomy (3.3% vs. 11.5%, P=0.093), and mortality (1.1% vs. 3.8%, P=0.345) rates were comparable between the ASUC and ASUC-CDI groups. Six-month colectomy (4.4% vs. 15.4%) and mortality (1.1% vs. 7.7%) rates were numerically higher in the ASUC-CDI group, though statistically nonsignificant.</p><p><strong>Conclusion: </strong>The immediate and short-term outcome of patients with acute severe ulcerative colitis in the presence of C. difficile infection is determined by the severity of ulcerative colitis flare.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078341","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 Impact of Housing Insecurity on Hospitalized Patients With Diagnosis of Cirrhosis: A Comparative Analysis Using Data from the National Inpatient Sample.","authors":"Joseph A Akambase, Yasmin Ali, Spencer R Goble","doi":"10.1097/MCG.0000000000002193","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002193","url":null,"abstract":"<p><strong>Background: </strong>The impact of homelessness on clinical outcomes and health care utilization among hospitalized cirrhosis patients has not been well-characterized.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using the National Inpatient Sample (2016 to 2021) to analyze hospitalizations of adults with cirrhosis, comparing outcomes between those with and without homelessness. Demographic, clinical, and hospital-level characteristics were assessed, along with outcomes such as mortality and AMA discharges. Health care utilization metrics, including length of stay (LOS) and cost, were also evaluated, with multivariable regression used to adjust for confounders.</p><p><strong>Results: </strong>Among 4,579,858 hospitalizations for cirrhosis, 109,640 (2.4%) involved homeless patients, who were younger (mean 53.5 vs. 60.6 y, P<0.001) and predominantly male (80.4% vs. 58.9%, P<0.001). Homeless patients had higher rates of alcohol use (73.5% vs. 30.9%, P<0.001), opioid use disorder (11.8% vs. 3.6%, P<0.001), and psychiatric comorbidities (62% vs. 37.4%, P<0.001). Hispanic and Native American patients were over-represented, while white patients were under-represented. Mortality was lower in homeless patients (aOR=0.49, 95% CI: 0.45-0.54, P<0.001). However, AMA discharges were significantly higher (9.6% vs. 2.7%, P<0.001). Homeless patients had longer hospital stays (mean 7.3 vs. 6.2 d, P<0.001) but lower per-day hospitalization costs ($2278 vs. $2859, P<0.001).</p><p><strong>Conclusion: </strong>Despite lower mortality rates and cost per hospitalization day, high AMA discharge rates and prolonged hospital stays underscore the challenges to safe discharge among patients with cirrhosis experiencing homelessness.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078401","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":"Comparison of Efficacy on First-Line Helicobacter Pylori Eradication Between Potassium-Competitive Acid Blocker (P-CAB)-Based Therapies Versus Proton-Pump Inhibitor (PPI)-Based Therapies: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.","authors":"Xiaoyu Wan, Heng Jiang, Kangning Peng","doi":"10.1097/MCG.0000000000002190","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002190","url":null,"abstract":"<p><strong>Background: </strong>Helicobacter pylori (H. pylori) is a gram-negative bacterium that infects over half of the world population, accountable for 89% of all gastric cancer cases. The efficacy of the proton-pump inhibitor (PPI) based-triple therapy is declining, while the novel potassium-competitive acid blocker (P-CAB) based therapy gets new attention. However, it remains unclear regarding the optimal duration and number of comedication(s) for P-CAB-based regimens, which P-CAB is the best-in-class, and whether P-CABs perform better than all PPIs.</p><p><strong>Objective: </strong>To compare the efficacy on first-line H. pylori eradication between P-CAB-based therapies versus PPI-based therapies.</p><p><strong>Methods: </strong>A systematic review on randomized controlled trials, with network meta-analysis conducted under the Frequentist approach. The P-score method was used to rank the probability of being the best intervention.</p><p><strong>Results: </strong>For the first-line treatment eradicating H. pylori infection, the 7-day vonoprazan-based triple therapy (VAC7) has the highest P-score for the probability of being the best intervention (0.96). VAC7 has a significantly higher eradication rate of H. pylori than most PPI-based therapies, including esomeprazole-based, lansoprazole-based, pantoprazole-based, and omeprazole-based regimens, as well as the other P-CAB based regimens, such as tegroprazan-based triple regimen (OR: 2.41, 95% CI: 1.13-5.15).</p><p><strong>Conclusion: </strong>Vonoprazan-based triple therapy has a higher eradication rate than PPI-based triple therapies, as well as other P-CABs based regimens. It remains unclear whether VAC7 is superior over vonoprazan-based dual therapy (VA7). Overall, VAC7 should be recommended for clinical and public health interventions, with VA7 as a possible alternative considering the local antimicrobial resistance profiles.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968010","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":"Associations Between Antiparietal Cell Antibody Values and Atrophy in a South and Southeast Asian General Population.","authors":"Mitsushige Sugimoto, Takeshi Matsuhisa, Hafeza Aftab, Sirikan Limpakan, Sunil K Sharma Dhakal, Kim Sang, Kyaw Htet, Than Than Yee, Yoshio Yamaoka","doi":"10.1097/MCG.0000000000002195","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002195","url":null,"abstract":"<p><strong>Goals: </strong>To investigate the association between atrophy severity and antiparietal cell antibody (APCA) levels in South and Southeast Asia.</p><p><strong>Background: </strong>APCA is an autoantibody that damages gastric parietal cells; autoimmune gastritis (AIG) is a chronic gastric inflammatory disease related to APCA and severe predominant corpus atrophy. Although a positive APCA result is a key clinical diagnostic tool for AIG, its rates vary widely among ethnic groups, and its exact relationship with AIG and predominant corpus atrophy remains unclear.</p><p><strong>Study: </strong>Associations between histopathology-assessed and endoscopy-assessed atrophy, APCA positivity rates, Helicobacter pylori status, and pepsinogen levels were investigated in 1982 symptomatic patients from Vietnam, Thailand, Myanmar, Bangladesh, and Nepal.</p><p><strong>Results: </strong>Overall, 38.5% of participants were negative for Helicobacter pylori infection, while 57.6% had a current infection. A positive APCA result, defined as a titer >10, was present in 44.0% of participants (95% confidence interval: 41.8%-46.3%, 873/1982). Pathologic atrophy, corpus atrophy, and predominant corpus atrophy were found in 8.7% (169/1982), 5.1% (101/1982), and 4.1% (81/1982) of participants, respectively. Positive APCA rates significantly differed among countries (10.6% to 63.8%, P<0.001). No significant correlation was found between APCA results and the presence or severity of atrophy.</p><p><strong>Conclusions: </strong>Although APCA positivity was high among symptomatic patients from South and Southeast Asian countries, few had severe predominant corpus atrophy or positive pepsinogen tests, which suggests a low rate of AIG in this population. Long-term surveillance of APCA-positive individuals is necessary to determine the clinical significance of a positive APCA result without AIG.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982576","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":"Reproducibility of the AGREE II Tool for Assessing the Methodological Quality of Clinical Practice Guidelines for the Management of Antithrombotic Agents in Patients Undergoing GI Endoscopy.","authors":"Denisse Camille Dayto, Wojciech Blonski, Tea Reljic, Farina Klocksieben, Jeffrey Gill, Rene D Gomez-Esquivel, Brijesh Patel, Pushpak Taunk, Andrew Sephien, Camille Thelin, Ambuj Kumar","doi":"10.1097/MCG.0000000000002069","DOIUrl":"10.1097/MCG.0000000000002069","url":null,"abstract":"<p><strong>Background: </strong>Clinical practice guidelines (CPGs) exist for the management of antithrombotic agents in the periendoscopic period; however, their methodological qualities vary. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool has been validated for the assessment of the methodological quality of CPGs; however, its reproducibility has not been assessed. The goal of this study was to assess the reproducibility of the AGREE II tool for CPGs published within the last 6 years for the management of antithrombotic agents in the periendoscopic period.</p><p><strong>Study: </strong>A systematic search of PubMed and Embase databases was performed to identify eligible CPGs published between January 1, 2016 and April 14, 2022. The quality of the CPG was independently assessed by 6 reviewers using the AGREE II instrument. The reproducibility was summarized as weighted κ statistic and intraclass correlation coefficient using the SPSS statistical analysis package.</p><p><strong>Results: </strong>The search yielded 343 citations with 7 CPGs from Europe, Asia, and the United States included in the critical appraisal. The overall mean weighted κ score across all guidelines was 0.300 (range, 0.093 to 0.384) indicating a fair agreement. The overall intraclass correlation coefficient was 0.462 (range, 0.175 to 0.570) for single measures and 0.837 (range, 0.560 to 0.888) for average measures indicating moderate reliability.</p><p><strong>Conclusions: </strong>Our study shows only a fair overall interobserver agreement in the methodological quality of the included CPGs. The results suggest the need for education and training of CPG raters to enhance the application of the AGREE II tool to improve its reproducibility.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"443-447"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107834","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 Lactulose Breath Test Can Predict Refractory Gastroesophageal Reflux Disease by Measuring Bacterial Overgrowth in the Small Intestine.","authors":"Jing Xu, Qiu Qu, Yu Yang, Jie Yang, Ting Fang, Jiajia Yin, Qiquan Mo, Zihan Wu, Linran Zeng, Huiping He, Jinxiao Fu, Hongjian Zhou, Wei Huang, Hong Ju Yang","doi":"10.1097/MCG.0000000000002031","DOIUrl":"10.1097/MCG.0000000000002031","url":null,"abstract":"<p><strong>Objective: </strong>The diagnosis of RGERD in patients typically involves 24-hour esophageal pH monitoring, but due to its invasiveness and low patient compliance, new screening methods are needed. In this study, a lactulose breath test (LBT) was conducted to detect the growth of small intestine bacteria (SIBO) and explore the potential relationship between LBT and RGERD to identify a new treatment method for RGERD.</p><p><strong>Methods: </strong>A total of 178 patients with gastroesophageal reflux were enrolled from June 2020 to December 2022 in the Gastroenterology Department, Building 3, the First Affiliated Hospital of Kunming Medical University; these patients included 96 patients with nonrefractory GERD (NRGERD) and 82 patients with RGERD. The Gerd Q score, reflux symptom index (RSI) score, gastroscopy results, clinical symptoms, and other related indicators were collected. Statistical methods were used to analyze the gathered data.</p><p><strong>Results: </strong>The incidence of acid reflux and heartburn in patients with RGERD was significantly greater than that in patients with NRGERD (67.10% vs. 42.70%, P <0.01 and 65.00% vs. 34.40%, P <0.01). The CH 4 values of patients with RGERD were significantly greater than those of patients with NRGERD at each time point, and there was a correlation between the CH 4 values at 60 min and RGERD ( P <0.05). For patients with RGERD, the incidence of abdominal pain, acid regurgitation, and heartburn was greater in the CH 4 -positive group than in the CH 4 -negative group (61.90% vs. 57.50%, 69.05% vs. 65.00%, 69.05% vs. 57.50%, P >0.05). The incidence of nausea was also greater in the CH 4 -positive group than in the CH 4 -negative group (61.90% vs. 35.00%, P <0.05).</p><p><strong>Conclusion: </strong>Increased CH 4 levels are correlated with RGERD. In addition, patients with RGERD may develop SIBO after long-term use of PPIs, and interventions involving SIBO could provide new ideas for the treatment of RGERD.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":"448-455"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11974629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419342","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}