Journal of Gastroenterology and Hepatology最新文献

{"title":"Mortality outcomes in individuals with MASLD versus MASLD and increased alcohol intake.","authors":"Majd B Aboona, Pojsakorn Danpanichkul, Vincent L Chen, Pooja Rangan, Donghee Kim, Naim Alkhouri, Michael B Fallon, Mazen Noureddin, Juan Pablo Arab, Karn Wijarnpreecha","doi":"10.1111/jgh.16726","DOIUrl":"10.1111/jgh.16726","url":null,"abstract":"<p><strong>Background and aim: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a leading cause of chronic liver disease worldwide. A new entity termed MetALD has also been described and is defined as individuals with MASLD and increased alcohol intake. However, the natural history of MetALD compared with MASLD is unknown. We aimed to compare longitudinal outcomes in patients with MASLD versus MetALD.</p><p><strong>Methods: </strong>This study was performed using data from the National Health and Nutrition Examination Survey from 2011 to 2018. MASLD patients (defined by the United States Fatty Liver Index > 30) who met cardiometabolic criteria including body mass index (BMI) > 25 (BMI > 23 in Asians), hypertension, diabetes mellitus, dyslipidemia, and hypertriglyceridemia were included. MetALD was defined as MASLD with increased alcohol intake (3-6 standard drinks per day in males; 2-5 standard drinks per day in females). A comparison of overall, cardiovascular, cancer-related, and other causes of mortality in patients with MASLD versus MetALD was performed.</p><p><strong>Results: </strong>A total of 2838 individuals with MASLD and 2557 individuals with MetALD were included with a median follow-up time of 56 months. MetALD patients were at increased risk of cancer-related mortality compared with patients with MASLD (hazard ratio 1.32; 95% confidence interval 1.14-1.53; P < 0.01). However, there was no significant difference in overall, cardiovascular, and other causes of mortality.</p><p><strong>Conclusions: </strong>Patients with MetALD were at higher risk for cancer-related mortality than MASLD. Close attention to regular cancer surveillance and accurate classification of alcohol consumption in individuals with diagnosed MASLD is warranted to help improve patient care and outcome.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing inpatient bowel preparation: a scoping review.","authors":"Marianne Marchildon, Jennifer Jackson, Janet Rankin","doi":"10.1111/jgh.16721","DOIUrl":"https://doi.org/10.1111/jgh.16721","url":null,"abstract":"<p><strong>Background and aim: </strong>Inpatients undergoing colonoscopy experience a higher-than-average rate of inadequate bowel preparation (compared to outpatients) leading to canceled procedures, increased stress on the patient, increased time in hospital, and increased cost to the healthcare system. The aim of this scoping review was to identify research surrounding inpatient bowel preparation and to identify modifiable and non-modifiable factors that influence the adequacy of bowel preparation in hospitalized patients undergoing colonoscopy and establish areas where nursing interventions may help improve overall bowel preparation rates.</p><p><strong>Methods: </strong>An initial search of MEDLINE, CINAHL, Scopus, and Embase was undertaken to identify seed articles, followed by a structured search using keywords and subject headings. Studies conducted between 2000 and 2022 and published in English were included. A total of 37 full-text studies were screened for inclusion, with 22 meeting inclusion criteria.</p><p><strong>Results: </strong>Advanced age, decreased mobility, constipation, extended length of stay, and multiple comorbidities were identified as non-modifiable factors associated with inadequate bowel preparation. Narcotic use, failure to follow preparation instruction, and delayed time to colonoscopy were identified as modifiable factors associated with poor bowel preparation.</p><p><strong>Conclusions: </strong>Educational interventions and interprofessional programs, using a multifaceted approach, increase the odds of adequate bowel preparation, including nursing tip sheets, troubleshooting flowsheets, and bowel movement assessment scoring.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer-associated fibroblasts promote the proliferation and metastasis of colon cancer by mediating the RLIM/PML axis through paracrine COMP.","authors":"Zhenfeng Chen, Weirong Chen, Kaihuang Lin, Xigui Chen, Guangrong Lin, Yanchong Li, Chunhui Cui","doi":"10.1111/jgh.16713","DOIUrl":"https://doi.org/10.1111/jgh.16713","url":null,"abstract":"<p><strong>Background and aim: </strong>Cancer-associated fibroblasts (CAFs) are abundant in colon cancer (CC) patients with a poor prognosis. Here, the molecular regulatory mechanism of CAFs on CC growth and metastasis was explored.</p><p><strong>Methods: </strong>The genes' expression was monitored using RT-qPCR, immunoblotting, and immunohistochemistry. Cell viability and proliferation were found using CCK-8 and clone formation assays. The cell migration and invasion were probed using wound healing and Transwell. Co-IP was utilized for ascertaining the interaction between AKT and the ring finger protein, LIM domain interacting (RLIM). The in vivo murine subcutaneous tumor model and the metastasis model were built to further ascertain the axis.</p><p><strong>Results: </strong>The result showed that CAFs motivate the growth and activate the PI3K/AKT pathway of CC cells via paracrine cartilage oligomeric matrix protein (COMP). Moreover, RLIM promoted the growth of CC cells, and its protein stability was regulated by AKT through its phosphorylation. Further, RLIM facilitated the ubiquitination and degradation of promyelocytic leukemia protein (PML). The in vitro and in vivo tests found that PML overexpression could inhibit CC's growth and metastasis, which were enhanced by CAFs.</p><p><strong>Conclusion: </strong>The COMP excreted from CAFs enhances the CC's growth and metastasis through regulating the RLIM/PML axis, supplying a new potential target for the cure of CC.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Washed microbiota transplantation improved the level of serum vitamin D in ulcerative colitis.","authors":"Hui Zhang, Yuyan Xiao, Quan Wen, Sheng Zhang, Pan Li, Cicilia Marcella, Bo Hu, Hui Liu, Faming Zhang, Bota Cui","doi":"10.1111/jgh.16717","DOIUrl":"https://doi.org/10.1111/jgh.16717","url":null,"abstract":"<p><strong>Background and aim: </strong>Vitamin D (VD) deficiency was reported to correlate with ulcerative colitis (UC) activity, which might be closely related to gut microbiota dysbiosis. This study aims to investigate the effects of washed microbiota transplantation (WMT) on VD metabolism in UC.</p><p><strong>Methods: </strong>The serum levels of 25-hdroxyvitamin D [25(OH)D] in 121 patients with UC and 53 healthy controls (HC) were detected. Subsequently, a non-randomized control trial (non-RCT) was conducted. Patients with UC were non-randomly assigned to undergo WMT (n = 28) vs. conventional treatment (5-aminosalicylic acid, 5-ASA, n = 10). Serum levels of 25(OH)D, fecal microbiota, and the expression of vitamin D receptor (VDR) in patients with UC were evaluated with a 3-month follow-up.</p><p><strong>Results: </strong>Serum VD levels collected in the clinic practice indicated that patients with UC had significantly lower VD levels than HC (P < 0.001). In the non-RCT, serum 25(OH)D level and VDR expression significantly increased (P = 0.011, 0.026, respectively) in the WMT group, while no noticeable changes were observed in the non-WMT group. Microbiome profiling revealed that the increase in VD levels after WMT was positively associated with the abundances of Adlercreutzia_equolifaciens, Ruminococcus_obeum, and Dorea but negatively correlated with Escherichia.</p><p><strong>Conclusions: </strong>The study suggested that WMT increases the levels of VD with characteristic changes of specific microbiota, which indicated the association between the VD and the activity of UC might be regulated by gut microbiota.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of metabolic dysfunction-associated steatotic liver disease on BNT162b2 immunogenicity against the severe acute respiratory syndrome coronavirus 2 omicron variant.","authors":"Lok Ka Lam, Jing Tong Tan, Poh Hwa Ooi, Ruiqi Zhang, Kwok Hung Chan, Xianhua Mao, Ivan F N Hung, Wai Kay Seto, Man Fung Yuen, Ka Shing Cheung","doi":"10.1111/jgh.16716","DOIUrl":"https://doi.org/10.1111/jgh.16716","url":null,"abstract":"<p><strong>Background and aim: </strong>We aimed to investigate the effect of metabolic dysfunction-associated steatotic liver disease (MASLD) on three-dose BNT162b2 immunogenicity to the omicron variant.</p><p><strong>Methods: </strong>Adult recipients of three doses of BNT162b2 were prospectively recruited between May and December 2021. The serology of the neutralizing antibody by live virus microneutralization (vMN) to the omicron variant was measured at baseline, day 180, and day 360 after the first dose. The primary outcome was seroconversion (vMN titer ≥ 10) at day 360. Exposure of interest was MASLD, defined as hepatic steatosis (controlled attenuation parameter ≥ 248 dB/m on transient elastography) plus at least one of five cardiometabolic risk factors. Subjects with prior COVID-19 were excluded. A multivariable logistic regression model was used to derive the adjusted odds ratio of seroconversion with MASLD by adjusting for age, sex, antibiotic use, and proton pump inhibitor use.</p><p><strong>Results: </strong>One hundred forty-eight BNT162b2 recipients (male: 48 [32.4%]; median age: 51.0 years [interquartile range, IQR: 44.5-57.3]) were recruited. The median time from the first dose to the third dose was 8.5 months (IQR: 7.9-8.9). MASLD subjects had a lower seroconversion rate than non-MASLD ones (89.6% vs 99.0%; P = 0.007). MASLD was the only independent risk factor for seroconversion (adjusted odds ratio: 0.051, 95% confidence interval: 0.002-0.440). Subgroup analysis of immunogenicity at 4 months after the third dose shows significantly lower vMN titer (13.06 [IQR: 7.69-22.20] vs 33.49 [IQR: 24.05-46.53]; P = 0.004) and seroconversion rate (76.9% vs 97.4%; P = 0.016) in MASLD than non-MASLD subjects, but not within 4 months from the third dose (vMN titer: 46.87 [IQR: 33.12-66.02] vs 41.86 [IQR: 34.47-50.91], P = 0.240; seroconversion rate: 94.3% vs 100%, P = 0.131).</p><p><strong>Conclusion: </strong>Metabolic dysfunction-associated steatotic liver disease was a risk factor for poorer immunogenicity to the omicron variant, with a more pronounced waning effect compared among three-dose BNT162b2 recipients.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic submucosal dissection for lesions developing in the irradiated area of head and neck cancer.","authors":"Yasuhiro Tani, Takashi Kanesaka, Kosuke Urabe, Mizuki Korematsu, Koji Kitamura, Junji Miyabe, Shinji Otozai, Tadashi Yoshii, Minoru Kato, Shunsuke Yoshii, Tomoki Michida, Ryu Ishihara, Koji Konishi, Keiichiro Honma, Takashi Fujii","doi":"10.1111/jgh.16724","DOIUrl":"https://doi.org/10.1111/jgh.16724","url":null,"abstract":"<p><strong>Background and aim: </strong>Effective treatment of lesions that develop in the irradiated area of head and neck squamous cell carcinoma is a major concern. This study aimed to clarify the efficacy and safety of endoscopic resection for such lesions.</p><p><strong>Methods: </strong>Among consecutive patients who underwent endoscopic resection for histologically proven head and neck squamous cell carcinoma between January 2014 and December 2021, those who received definitive radiotherapy/chemoradiotherapy before endoscopic resection were included in this single-center, retrospective study. Short- and long-term outcomes were evaluated.</p><p><strong>Results: </strong>Among 422 patients who underwent endoscopic resection for 615 lesions, 43 patients with 57 lesions were eligible. All 57 lesions were treated with endoscopic submucosal dissection and en bloc resection was achieved in all lesions. Grade 3 of Common Toxicity Criteria for Adverse Events v5.0 occurred in eight (19%) patients (dysphagia, seven; stricture, three; aspiration pneumonia, two; and pharyngeal necrosis, one [some cases overlapped]), but no grade ≥ 4 events occurred. Enteral nutrition by gastrostomy was temporarily required in two patients owing to dysphagia and laryngeal necrosis. During the median follow-up of 40 (interquartile range, 29.5-61) months after endoscopic submucosal dissection for the lesions developed in the irradiated area, local recurrence and metachronous lesions developed in two (5%) and nine (21%) patients, respectively. However, total laryngectomies and tracheostomies were avoided in all patients. The 3-year overall and disease-specific survivals were 81% (95% confidence interval, 64%-91%) and 94% (95% confidence interval, 79%-99%), respectively.</p><p><strong>Conclusions: </strong>Favorable local control and safety of endoscopic submucosal dissection were demonstrated.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin E improves serum markers and histology in adults with metabolic dysfunction-associated steatotic liver disease: Systematic review and meta-analysis.","authors":"Nicholas Ming-Zher Chee, Ram Prasad Sinnanaidu, Wah-Kheong Chan","doi":"10.1111/jgh.16723","DOIUrl":"https://doi.org/10.1111/jgh.16723","url":null,"abstract":"<p><strong>Background and aim: </strong>Multiple clinical trials have been conducted to study the potential benefits of vitamin E for the treatment of metabolic dysfunction-associated steatotic liver disease (MASLD). Despite available evidence, vitamin E is not widely used. This study aimed to assess the effect of vitamin E on serum markers of liver inflammation, specifically serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, and histology, including resolution of metabolic dysfunction-associated steatohepatitis (MASH), in adult patients with MASLD.</p><p><strong>Methods: </strong>A systematic literature search on randomized controlled trials published in English was conducted using electronic databases. Standardized mean difference (SMD) and mean difference (MD) were used for continuous outcomes, while risk ratio (RR) was used for dichotomous outcomes, with corresponding 95% confidence interval (CI).</p><p><strong>Results: </strong>A total of eight studies were included in the qualitative synthesis while seven studies were included in the meta-analysis. Vitamin E significantly reduced serum ALT and AST levels with SMD of -0.82 (95% CI, -1.13 to -0.51) and -0.68 (95% CI, -0.94 to -0.41), respectively. Vitamin E significantly reduced steatosis, lobular inflammation, and hepatocyte ballooning with a MD of -0.60 (95% CI, -0.83 to -0.37), -0.34 (95% CI, -0.53 to -0.16), -0.32 (95% CI, -0.53 to -0.12), and increased MASH resolution with a RR of 1.9 (95%CI, 1.20 to 3.02). However, vitamin E did not reduce fibrosis, with a MD of -0.23 (95% CI, -0.51 to 0.05).</p><p><strong>Conclusion: </strong>Vitamin E resulted in significant improvement in serum markers of liver inflammation and histology in patients with MASLD.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic use and risk of Clostridioides difficile infection in patients with inflammatory bowel disease.","authors":"Alexis Bejcek, Anupama Ancha, Megan Lewis, Ryan Beaver, Kristen Tecson, Jaccallene Bomar, Christopher Johnson","doi":"10.1111/jgh.16720","DOIUrl":"https://doi.org/10.1111/jgh.16720","url":null,"abstract":"<p><strong>Background and aim: </strong>Patients with inflammatory bowel disease (IBD) have an increased risk of Clostridioides difficile infection (CDI) compared with those without IBD, which is worsened with antibiotic usage. While prior studies have shown a correlation between CDI development and certain classes of antibiotics, the IBD population has not been well represented. This study evaluates the rates of CDI with outpatient antibiotic use in patients with IBD.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study composed of patients with IBD and compared the incidence of CDI in patients who received an outpatient prescription for antibiotics (6694 patients) against those without prescriptions (6025 patients) from 2014 to 2020 at our institution. We compared CDI rates based on nine antibiotic classes: penicillins, cephalosporins, sulfonamides, tetracyclines, macrolides, quinolones, clindamycin, metronidazole, and nitrofurantoin.</p><p><strong>Results: </strong>The risk of CDI was low (0.7%) but significantly higher for those with antibiotic exposure (0.9% vs 0.5%, P = 0.005) and had a positive correlation with a smoking history. The increased risk of CDI in the IBD population was attributable to the clindamycin and metronidazole classes (odds ratio = 4.7, 95% confidence interval: 1.9-11.9, P = 0.001; odds ratio = 3.6, 95% confidence interval: 2.1-6.2, P < 0.0001, respectively).</p><p><strong>Conclusions: </strong>The use of clindamycin or metronidazole prescribed in an outpatient setting was associated with a statistically significant increased risk of CDI in patients with IBD. Although the association between clindamycin and CDI is a well-established and common finding, the association between metronidazole and CDI is unique in this study.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141988022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of postoperative adjuvant chemotherapy on elderly patients with colorectal adenocarcinoma: A propensity score matching study.","authors":"Heng Huang, Xijiong Chen, Jinyi Xu, Maopu Tu, Bin Lai, Xi Ouyang","doi":"10.1111/jgh.16685","DOIUrl":"https://doi.org/10.1111/jgh.16685","url":null,"abstract":"<p><strong>Background and aim: </strong>Currently, the primary treatment modality for patients with colorectal adenocarcinoma (CRA) is radical surgery combined with postoperative adjuvant chemotherapy (PAC). However, many elderly patients decline PAC due to concerns about their underlying physiological condition, and the impact of PAC on the prognosis of elderly patients remains uncertain.</p><p><strong>Methods: </strong>We extracted data from the SEER database for CRA patients aged 75 and above between 2010 and 2019. Utilizing propensity score matching (PSM), we stratified the patients into a PAC group and a non-PAC group, enabling us to compare the differences in Kaplan-Meier survival curves between these two groups. Furthermore, through univariate and multivariate Cox regression analyses, we identified the clinical factors that influence the survival of elderly CRA patients and compared the prognostic disparities between the two patient groups within specific subgroups of these clinical factors.</p><p><strong>Results: </strong>Following PSM, a total of 3668 patients were included and divided into the PAC group and the non-PAC group, with no statistically significant differences observed in crucial clinical characteristics between the two groups. Kaplan-Meier analysis revealed a significantly better prognosis for patients in the PAC group compared with those in the non-PAC group. In addition, age, chemotherapy, TNM staging, gender, and preoperative CEA levels were all identified as important factors affecting patient prognosis. Moreover, PAC provided survival benefits across the majority of levels within the aforementioned subgroups. However, in specific subgroups (age > 90, Grade IV stage, median household income < $40 000), PAC did not confer any survival benefits.</p><p><strong>Conclusion: </strong>PAC can significantly improve the prognosis of elderly CRA patients. Nonetheless, in certain population subsets characterized by specific clinical features, PAC does not provide any survival benefits.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effective endoscopic screening for gastric cancer in a cohort with low Helicobacter pylori prevalence.","authors":"Fumiaki Ishibashi, Sho Suzuki, Konomi Kobayashi, Ryu Tanaka, Tomohiro Kawakami, Kentaro Mochida, Mizuki Nagai, Yuichi Ishibashi, Tetsuo Morishita","doi":"10.1111/jgh.16715","DOIUrl":"https://doi.org/10.1111/jgh.16715","url":null,"abstract":"<p><strong>Background and aim: </strong>Periodic endoscopic screening for gastric cancer (GC) is widely performed in East Asia; however, the optimal screening strategy remains unclear. This study aimed to determine the most cost-effective endoscopic screening strategy for the detection and treatment of GC in a cohort with a low Helicobacter pylori prevalence.</p><p><strong>Methods: </strong>The following data were retrospectively extracted from participants who received screening endoscopy between April 2019 and March 2023: age, H. pylori infection status, presence of intestinal metaplasia, pathological diagnosis of GC, and the interval between the most recent endoscopies. A Markov state transition model was constructed based on the cohort data. The cost-effectiveness of 15 strategies with different starting ages (40/50/60 years) and screening intervals (1/2/3/4/5 years) was compared. The net monetary benefit (NMB) and incremental cost-effectiveness ratio (ICER) of quality-adjusted life-years gained by treatment were used as outcomes.</p><p><strong>Results: </strong>A simulation model was constructed based on the cohort data of 94 137 participants (mean age 54.5 years, males 57.9%; 74.4% H. pylori-naïve, 94.2% intestinal metaplasia-negative). The results of the base-case analysis showed that the screening strategy of 4-year intervals starting at the age of 40 years had the highest NMB (97 401 578 yen). In both the Monte Carlo simulation and one-way sensitivity analysis with a varying probability of H. pylori infection status transition, the ICER was superior in the screening strategy every 4 years, starting at age 40 years.</p><p><strong>Conclusions: </strong>Our simulation showed that endoscopic screening at 4-year intervals starting at the age of 40 years was the most cost-effective method.</p>","PeriodicalId":15877,"journal":{"name":"Journal of Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":3.7,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}