JGH Open最新文献

{"title":"Diet Stacking – An Expanding Challenge for Gastroenterologists and Dietitians in Managing Chronic Gastrointestinal Disorders","authors":"Sarah L. Melton,&nbsp;Simon R. Knowles,&nbsp;Kok-Ann Gwee,&nbsp;Peter R. Gibson,&nbsp;Caroline J. Tuck,&nbsp;Alice S. Day","doi":"10.1002/jgh3.70314","DOIUrl":"10.1002/jgh3.70314","url":null,"abstract":"<p>Dietary therapy has an established role in managing gastrointestinal disorders, as a short-term induction therapy (e.g., exclusive enteral nutrition for Crohn's disease), a long-term monotherapy (e.g., gluten-free diet for coeliac disease and a personalized FODMAP diet) or adjunct therapy (e.g., Mediterranean diet). As use of dietary therapies rises, it is becoming increasingly common for gastroenterologists and dietitians to encounter patients who are simultaneously following two or more dietary therapies to achieve optimal symptom control, to manage multiple concurrent medical issues, or for social or religious reasons. This practice is termed ‘diet stacking’. The aim of this review is to clarify the principles behind the safe and effective combination of dietary interventions with specific attention to potential risks, mitigation of risk and practical application. For gastroenterologists, awareness of current dietary practices of their patients prior to advising dietary therapy is warranted and, in those who are diet stacking, risk assessment is essential. Validated screening tools to evaluate risks, particularly of disordered eating, are limited. The management of those who currently or are at risk of diet stacking is best directed toward gastrointestinal dietitians who offer time, appropriate skills for assessment, and the delivery of pragmatic patient education to safely implement appropriate dietary interventions, and assess for the need for engaging psychological primary management or co-management. In conclusion, diet stacking is common, and requires awareness and often multi-disciplinary management to ensure it is implemented safely.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12689454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should We Screen Sooner? Elevated CRC Incidence in Solid Organ Transplant Recipients in the United States Before and After the COVID-19 Pandemic","authors":"Alexander Malik,&nbsp;Thai Hau Koo,&nbsp;Rishi Chowdhary,&nbsp;Mohammed Zaahid Sheriff,&nbsp;Adrian Lindsey","doi":"10.1002/jgh3.70317","DOIUrl":"10.1002/jgh3.70317","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Solid organ transplant (SOT) recipients have an elevated malignancy risk due to long-term immunosuppression; however, the risk of colorectal cancer (CRC) is not well characterized, and current screening guidelines are not tailored to this population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the TriNetX U.S. Collaborative Network to identify adults with SOT (kidney, liver, heart, or lung transplantation) between 2005 and 2025. SOT patients were propensity-score matched 1:1 to non-transplant controls, and CRC incidence at the 10-year and 20-year follow-up was compared. Sensitivity analyses evaluated CRC incidence before (2015–2019) and after (2020–2024) the COVID-19 pandemic onset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 90 510 SOT recipients (matched to 90 510 controls from 9.8 million general patients). After matching, the baseline characteristics were balanced. SOT recipients had a higher cumulative incidence of CRC than controls at both 10 years (0.17% of kidney transplant patients vs. 0.02% of controls; <i>p</i> &lt; 0.001) and 20 years posttransplantation. This elevated risk was observed across the kidney, liver, lung, and heart transplant cohorts (odds ratios: 1.3 for CRC in SOT vs. non-SOT at 10–20 years). Additionally, CRC incidence was higher in the post-COVID era compared to the pre-2019 era in all SOT groups (e.g., kidney 0.25% vs. 0.14%). This increase was most pronounced in older recipients (≥ 70 years) and Hispanic patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SOT recipients in the United States exhibit a significantly higher long-term CRC risk, a disparity that appears to have widened after the pandemic. These findings underscore the need to revisit CRC screening strategies in SOT recipients, particularly older and long-term transplant survivors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12689456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for Osteoporosis in Inflammatory Bowel Disease Patients at a Tertiary IBD Clinic","authors":"Tamerik Urbisinov,&nbsp;Daniel Lightowler,&nbsp;Fiona Yeaman","doi":"10.1002/jgh3.70313","DOIUrl":"10.1002/jgh3.70313","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with Inflammatory bowel disease (IBD) are at an increased risk of osteoporosis. There are limited studies internationally showing low screening rates for osteoporosis in IBD patients. There are no studies of osteoporosis screening in an Australian IBD cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine the screening rate of osteoporosis in patients with IBD in an Australian tertiary IBD clinic using an extensive risk factor assessment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective clinical audit; 252 individual patient records were reviewed from IBD clinic lists. A hybridized screening criterion was created from the European Crohn's and Colitis Organisation, British Society of Gastroenterology and Royal Australian College of General Practitioners guidelines. If patients were not up to date with screening, they were assessed as to whether they had met screening criteria during 2020/2021 and if they were recommended for a dual energy x-ray absorptiometry (DEXA) scan. If patients met criteria, DEXA scan results were collated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>173 patients with IBD were included, 23 patients were up to date with screening and 150 required risk assessment. 101 patients met screening criteria, 12 had a DEXA completed during the study period. In the 35 DEXAs completed before or during the study, 37% showed osteoporosis, 40% showed osteopenia and 23% were normal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A minority of patients who were identified as at risk of osteoporosis had a DEXA scan completed. Rates of reduced bone mineral density were high in the DEXA scans completed. Future directions should focus on validating expanded Medicare criteria to ensure at-risk patients may be screened.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12683940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns and Predictors of Steroid Use in a Real-World Inflammatory Bowel Disease Cohort","authors":"Rodger Wu,&nbsp;Consuelo Rivas,&nbsp;Wai Kin Su,&nbsp;Renée Deschenes,&nbsp;William Wilson,&nbsp;Joseph L. Pipicella,&nbsp;Susan J. Connor,&nbsp;Jane M. Andrews,&nbsp;the Crohn's Colitis Cure (CCCure) Data Insights Program","doi":"10.1002/jgh3.70308","DOIUrl":"10.1002/jgh3.70308","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patterns of steroid use in inflammatory bowel disease remain poorly characterized in real-world settings. Steroid exposure is associated with adverse effects and often indicates suboptimally controlled disease. Therefore, patterns and predictors of steroid use in a large inflammatory bowel disease cohort were examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Steroid exposure over a 3-year window was explored. Use was classified by duration—short (1–28 days), moderate (29–56 days), prolonged (&gt; 56 days), and recency (within last year, prior years or no exposure). Associations with demographic and disease-related factors were assessed using multivariable logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5436 people (median age 42 years, IQR 32–56), 18.3% (<i>n</i> = 994) were steroid exposed. 57.6% had Crohn's disease and 50.2% were female. Crohn's disease was associated with lower odds of both <i>prolonged</i> and <i>recent</i> exposure compared to ulcerative colitis (AOR 0.72, <i>p</i> = 0.001 and AOR 0.78, <i>p</i> = 0.037, respectively). Females had a greater likelihood of both <i>prolonged</i> and <i>recent</i> exposure (AOR 1.22, <i>p</i> = 0.048 and AOR 1.23, <i>p</i> = 0.041, respectively). Young adults (20–29 years) had higher odds of <i>prolonged</i> and <i>recent</i> use than those &gt; 70 years (AOR 6.59 and 9.12, respectively, <i>p</i> &lt; 0.001). Combination immunomodulator and advanced therapy use was associated with a higher likelihood of both prolonged and recent use compared to 5-aminosalicylic acid therapy alone (AOR 4.01, <i>p</i> = 0.002 and AOR 4.54, <i>p</i> &lt; 0.001). Age at diagnosis had a modest effect size (AOR 1.03, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Steroid use was modest, with over 80% unexposed over 3 years. Proactive optimization of therapy, particularly in younger individuals and those with ulcerative colitis, may further reduce steroid exposure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12685766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145726662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Gastric Epithelial Neoplasm of Fundic-Gland Mucosa Lineage: Histopathological Features of Background Gastric Mucosa","authors":"Ryo Watanabe,&nbsp;Tomoyuki Yada,&nbsp;Takashi Oide,&nbsp;Miki Yoshinobu,&nbsp;Yugo Kawasaki,&nbsp;Masaaki Mino,&nbsp;Keita Odaka,&nbsp;Katsunori Sekine,&nbsp;Naomi Uemura","doi":"10.1002/jgh3.70324","DOIUrl":"10.1002/jgh3.70324","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Gastric epithelial neoplasm of fundic-gland mucosa lineage (GEN-FGML) has been increasingly recognized in recent years; however, few studies have investigated the histopathology of the background gastric mucosa surrounding the lesion. This study clarifies the histopathological features of the background gastric mucosa in GEN-FGML.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A retrospective analysis was conducted of 30 GEN-FGML lesions (28 patients) diagnosed at our institution between December 2012 and 2023, excluding cases of gastric adenocarcinoma of fundic-gland mucosa type. Patients were classified according to <i>Helicobacter pylori</i> infection status, and clinicopathological features were compared. The background gastric mucosa was evaluated using the Updated Sydney System (USS). In total, 15 lesions (13 patients) were in the uninfected group, and 15 lesions (15 patients) were in the past <i>H. pylori</i> infection group (i.e., the infected group); no lesions from patients with current infection were included. In the uninfected group, none of the lesions showed histopathological atrophy or intestinal metaplasia. Conversely, histopathological atrophy was observed in 12 lesions in the infected group. Although 86.7% (13/15 lesions) of the infected cases were endoscopically located in nonatrophic areas, 10 displayed mild histopathological atrophy (USS 1+).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Oxyntic gland adenoma and gastric adenocarcinoma of fundic-gland type arise predominantly from mildly atrophic mucosa with preserved fundic glands in previously infected stomachs, and, albeit less frequently, from severely atrophic mucosa. During routine endoscopic examinations, careful observation of the fundic gland is warranted regardless of the presence of background mucosal atrophy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12682231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional and Fasting Strategies for the Management of MASLD/MASH: An Integrative Review","authors":"Diya Tawk,&nbsp;Ghalia Ghader,&nbsp;Yasmina Khatib,&nbsp;Philippe Attieh,&nbsp;Tya Youssef,&nbsp;Mahmoud Othman,&nbsp;Frederic Harb,&nbsp;Sami Azar,&nbsp;Hilda E. Ghadieh","doi":"10.1002/jgh3.70315","DOIUrl":"https://doi.org/10.1002/jgh3.70315","url":null,"abstract":"<p>Non-alcoholic fatty liver disease (NAFLD), recently redefined as metabolic dysfunction-associated steatotic liver disease (MASLD), has emerged as the most common chronic liver disease worldwide, affecting nearly one in three adults. Despite its growing prevalence, there is still no approved pharmacological treatment, making lifestyle modification the cornerstone of management. Among the most promising strategies are nutritional interventions and structured fasting regimens, which target the underlying metabolic dysfunction driving disease progression. This review explores the impact of various dietary patterns—including the Mediterranean diet, low-glycemic index and low-carbohydrate diets, plant-based approaches, and the DASH diet—on hepatic steatosis, liver enzymes, and metabolic health. Evidence from randomized trials and meta-analyses highlights the Mediterranean diet as particularly effective in reducing liver fat and improving cardiometabolic outcomes, especially when combined with physical activity. Plant-based and DASH diets also demonstrate significant benefits, although accessibility, adherence, and cultural factors remain as challenges. Fasting interventions, such as intermittent fasting, time-restricted eating, alternate-day fasting, periodic fasting, and the fasting-mimicking diet, have gained increasing attention. These regimens improve insulin sensitivity, promote fat oxidation, and reduce intrahepatic fat, with growing evidence supporting their safety and effectiveness in MASLD management. While results are encouraging, long-term adherence, standardization of fasting protocols, and individualized patient considerations remain key areas for future research. In summary, nutritional and fasting strategies represent practical, non-pharmacological options to prevent and manage MASLD. By addressing both hepatic and systemic metabolic dysfunction, they hold promise not only for improving liver health but also for reducing the broader burden of obesity, diabetes, and cardiovascular disease.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70315","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Multiple Pharmacological Interventions and Magnetic Control on Capsule Endoscopy Gastrointestinal Transit Time and Diagnostic Yield: A Systematic Review and Meta-Analysis","authors":"Sunny Kumar,&nbsp;Ashok Kumar,&nbsp;Rabia Safdar,&nbsp;Tooba Idrees,&nbsp;Sharan Ram,&nbsp;Saifullah Syed,&nbsp;Anjlee Parkash,&nbsp;Beesham Kumar,&nbsp;Sarmad Ali,&nbsp;Hamzah M. Alghzawi,&nbsp;Asharib Sohaib,&nbsp;Muhammad Abdul Rehman Khan,&nbsp;Hira Riaz","doi":"10.1002/jgh3.70321","DOIUrl":"https://doi.org/10.1002/jgh3.70321","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Capsule endoscopy (CE) is widely used for non-invasive evaluation of the small bowel; however, its effectiveness may be hindered by slow gastrointestinal transit and limited battery duration. A range of approaches—including pharmacologic agents, bowel-cleansing preparations, and magnetically guided control—has been introduced to improve the efficiency of the examination. This systematic review and meta-analysis compares the impact of these interventions on transit dynamics and examination completion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Comprehensive searches of PubMed, Scopus, and Web of Science identified randomized controlled trials and observational studies assessing magnetic guidance, prokinetics, or purgatives in adults undergoing small-bowel capsule endoscopy. Outcomes of interest included gastric transit time (GTT), small bowel transit time (SBTT), and completion rate (CR). All pooled analyses were performed using a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-three studies comprising 9095 participants met inclusion criteria. Erythromycin and magnetic guidance were consistently associated with faster gastric passage, while lubiprostone and polyethylene glycol (PEG) shortened SBTT compared with control groups. Metoclopramide and castor oil demonstrated the strongest associations with higher completion rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Interventions vary in their effects on CE performance, and no single strategy enhances all parameters simultaneously. Erythromycin and magnetic steering are most useful for expediting gastric transit, whereas lubiprostone and PEG are more effective within the small bowel. For improving overall completion, metoclopramide remains a dependable option. These findings support individualized preparation strategies tailored to the specific diagnostic goals of CE.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 12","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145652529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Practical Approach in Differentiating IBD From Other Causes of Enterocolitis","authors":"Ida Hilmi,&nbsp;Nik Arsyad Nik Muhammad Affendi,&nbsp;Xin-Hui Khoo,&nbsp;Nik Raihan Nik Mustapha,&nbsp;Deborah Chia Hsin Chew","doi":"10.1002/jgh3.70268","DOIUrl":"https://doi.org/10.1002/jgh3.70268","url":null,"abstract":"<p>Inflammatory bowel disease (IBD) is emerging in Asia, but there are many challenges in making the diagnosis. There is no gold standard for the diagnosis of IBD, which is often made based on a combination of clinical, endoscopic, radiological, and histological features, none of which are specific for the condition. Although there are many non-infectious mimics, such as Behcet's, drug-induced enterocolitis, and lymphoma, the main dilemma is differentiating IBD from infection; namely, Crohn's disease (CD) from intestinal tuberculosis (ITB). However, a careful history/examination, targeted investigations, along with histopathology should make it possible to make a definitive diagnosis of IBD in the majority of cases. In cases where the diagnosis is still unclear, empirical treatment based on the most likely diagnosis can be started, but careful reassessment is essential.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 11","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70268","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145626470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Utility of Liver Biopsy in Persistent Unexplained Liver Enzyme Elevation: A Retrospective Cohort Study","authors":"S. Jaawan,&nbsp;A. Krämer,&nbsp;R. Masri,&nbsp;A. Neesse,&nbsp;V. Ellenrieder,&nbsp;A. Amanzada,&nbsp;P. Ströbel,&nbsp;F. Bremmer,&nbsp;G. Petzold","doi":"10.1002/jgh3.70310","DOIUrl":"10.1002/jgh3.70310","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>Chronically elevated liver enzymes without a clear etiology remain a frequent diagnostic challenge. This study evaluated the diagnostic yield of liver biopsy in such cases and assessed if laboratory parameters predict histological clarification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 71 patients with unexplained elevated liver enzymes who underwent percutaneous liver biopsy between 2015 and 2021 at a tertiary referral center in Germany. Clinical characteristics and lab values were compared between patients with clarified and unclarified diagnoses. ROC analysis was performed for ALT and AST. Histopathological characteristics and biopsy-related complications were recorded.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A definitive diagnosis was reached in 47.9% of cases. The most frequent findings were autoimmune hepatitis (35.3%), drug-induced liver injury (23.5%), and NAFLD (23.5%). ALT and AST levels were significantly higher in patients with clarified diagnoses (ALT: <i>p</i> = 0.0079; AST: <i>p</i> = 0.0096). ROC analysis showed moderate performance (ALT AUC = 0.684; AST AUC = 0.679). Fibrosis stages ≥ F2 were found in 28.2% of patients. Biopsy complications occurred in 2.8%, all minor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Liver biopsy clarified the etiology in nearly half of patients and revealed diagnoses not apparent through non-invasive work-up. While ALT and AST levels were associated with diagnostic yield, they lacked sufficient predictive value. Biopsy remains a valuable tool in selected patients with unexplained liver enzyme elevations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 11","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12640264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of In-Hospital and At-Home Administration of Bowel Preparation Agents Before Outpatient Colonoscopy in Elderly Patients","authors":"Daisuke Yamaguchi,&nbsp;Kasumi Gondo,&nbsp;Tadahiro Nomura,&nbsp;Yumi Mizuta,&nbsp;Shota Fukami,&nbsp;Satoshi Ishida,&nbsp;Shunichiro Kimura,&nbsp;Shun Fujimoto,&nbsp;Yuichiro Tanaka,&nbsp;Naoyuki Hino,&nbsp;Keisuke Ario,&nbsp;Seiji Tsunada,&nbsp;Yasuhisa Sakata,&nbsp;Motohiro Esaki","doi":"10.1002/jgh3.70303","DOIUrl":"https://doi.org/10.1002/jgh3.70303","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Most patients take bowel preparation agents at home before undergoing outpatient colonoscopy. However, some elderly patients undergo bowel preparation at the hospital. This study compared the outcomes of in-hospital (Group A) versus at-home (Group B) bowel preparation in elderly patients to clarify the usefulness of in-hospital bowel preparation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Patients and Methods</h3>\u0000 \u0000 <p>From September 2022 to September 2023, 151 patients aged 70 years or older undergoing outpatient colonoscopy at Ureshino Medical Center were prospectively enrolled (51 in Group A and 100 in Group B). The primary endpoint was bowel preparation time. Secondary endpoints were the number of defecations, colonoscopy start time, and adverse events. Propensity score matching (PSM) was applied to account for baseline differences, and multivariate analysis was conducted to identify factors associated with bowel preparation time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After PSM, 26 matched pairs were analyzed. Group A had a significantly shorter bowel preparation time (192.1 ± 80.5 vs. 271.1 ± 57.9 min, <i>p</i> &lt; 0.001), shorter time from preparation to colonoscopy (259.3 ± 70.2 vs. 341.4 ± 67.1 min, <i>p</i> &lt; 0.001), and fewer defecations (8.5 ± 4.6 vs. 11.2 ± 4.1, <i>p</i> &lt; 0.001) than Group B. There were no significant intergroup differences in adverse events or patient satisfaction. Multivariate analysis revealed that in-hospital preparation was strongly associated with shorter bowel preparation time (odds ratio 8.87, 95% CI 3.16–24.92, <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>For elderly patients, in-hospital bowel preparation is beneficial because it significantly shortens preparation and colonoscopy start times and reduces defecations, while maintaining safety and satisfaction rates compared with at-home preparation.</p>\u0000 \u0000 <p><b>Trial Registration:</b> University Hospital Medical Information Network Clinical Trials Registry: UMIN000057045</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 11","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70303","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}