JGH Open最新文献

{"title":"The Visualization of the Importance of Covariance Importance in a Machine Learning Model for Advanced Liver Fibrosis in a Nationally Representative Sample","authors":"Alexander A. Huang,&nbsp;Samuel Y. Huang","doi":"10.1002/jgh3.70200","DOIUrl":"https://doi.org/10.1002/jgh3.70200","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Accurate prediction of liver disease is vital for early intervention, given its potential severity. This study aims to improve the prediction of advanced liver fibrosis and investigate its associations with factors, ultimately contributing to healthier lifestyle choices and timely management of liver disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study included adults from the US National Health and Nutrition Examination Survey (2017–2020). Questionnaires captured demographic, dietary, exercise, and mental health information. Advanced fibrosis was defined using liver stiffness measurement (LSM) with a 9.5 kPa threshold. XGBoost, a machine learning model, predicted fibrosis, assessed using AUROC. SHAP provided visual explanations of the model's predictions and feature contributions. Model gain, cover, and frequency measured feature importance, enabling transparent, and interpretable analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 6979 adults (age &gt; 18) that were included in the study with an average age of 49.02 and 3523 (50%) female. The machine learning model had an area under the receiver operator curve of 0.885. The top eight covariates include waist circumference (gain = 0.185), GGT (gain = 0.101), platelet count (gain = 0.059), AST (gain = 0.057), weight (gain = 0.049), HDL-cholesterol (gain = 0.032), and ferritin (gain = 0.034).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, the utilization of machine learning models proves to be highly effective in accurately predicting the risk of liver fibrosis. By considering various factors such as demographic information, laboratory results, physical examination findings, and lifestyle factors, these models successfully identify crucial risk factors associated with liver fibrosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624574","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":"Impact of COVID-19 on Venous Thromboembolism in Inflammatory Bowel Disease Hospitalizations: A Propensity-Matched Analysis","authors":"Mihir Prakash Shah,&nbsp;Dushyant Singh Dahiya,&nbsp;Pius Ojemolon,&nbsp;Charmy Parikh,&nbsp;Yash Shah,&nbsp;Bhanu Siva Mohan Pinnam,&nbsp;Manesh Kumar Gangwani,&nbsp;Hassam Ali,&nbsp;Chun-Wei Pan,&nbsp;Ruchir Paladiya,&nbsp;Abdul Mohammed,&nbsp;Saurabh Chandan,&nbsp;Benjamin Mba,&nbsp;Babu P. Mohan","doi":"10.1002/jgh3.70220","DOIUrl":"https://doi.org/10.1002/jgh3.70220","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Patients diagnosed with Inflammatory bowel disease (IBD) face a notably higher risk of venous thromboembolism (VTE), leading to significant health challenges. Similarly, coronavirus disease 2019 (COVID-19) is associated with an increased susceptibility to thrombosis. We aimed to assess the impact of COVID-19 on the risk of developing VTE in patients with an underlying diagnosis of IBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed the National Inpatient Sample (NIS) 2020–21 to identify adult patients with IBD admitted with or without a principal diagnosis of COVID-19. We divided these patients into three groups (without COVID-19, with uncomplicated COVID-19, and with complicated COVID-19). Hospitalization characteristics, in-hospital mortality, odds of VTE, healthcare burden, and complications were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>IBD patients with complicated COVID-19 infection had significantly higher odds of VTE (OR 5.60, 95% C.I. 3.63–8.65, <i>p</i> 0.001), an increase in odds of mortality (OR 29.13, 95% C.I. 22.59–37.57, <i>p</i> 0.001), higher healthcare resource utilization (including length of stay and total hospitalization charges), and worse secondary outcomes (like acute kidney injury and pancytopenia), compared to IBD patients without COVID-19. IBD patients with uncomplicated COVID-19 also had higher odds of VTE (OR 1.81, 95% C.I. 1.39–2.36, <i>p</i> 0.001) than those without COVID-19; however, there was no difference in mortality or length of stay between these two groups, and those with uncomplicated COVID-19 had lower average total hospitalization charges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with both complicated and uncomplicated COVID-19 were associated with higher odds of VTE compared to those without COVID-19. Patients with complicated COVID-19, in addition, also had higher odds of mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598531","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":"Clinical Characteristics of Gastrointestinal Malignancy and Validation of the IDIOM Model Among Patients With Iron Deficiency Anemia in Thailand","authors":"Kanjira Titsisaeng,&nbsp;Noraworn Jirattikanwong,&nbsp;Phichayut Phinyo,&nbsp;Pojsakorn Danpanichkul,&nbsp;Kanokwan Pinyopornpanish,&nbsp;Nithi Thinrungroj,&nbsp;Phuripong Kijdamrongthum,&nbsp;Apinya Leerapun,&nbsp;Taned Chitapanarux,&nbsp;Wasuwit Wanchaitanawong","doi":"10.1002/jgh3.70221","DOIUrl":"https://doi.org/10.1002/jgh3.70221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gastrointestinal malignancy is a concerning etiology of iron deficiency anemia (IDA). The IDIOM model predicts gastrointestinal malignancy risk in IDA patients using age, sex, hemoglobin, and mean corpuscular volume (MCV) as parameters. This study aimed to evaluate the clinical characteristics of gastrointestinal malignancy and externally validate the IDIOM model in Thai IDA patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cross-sectional study was conducted on adult IDA patients who underwent gastrointestinal endoscopy at Chiang Mai University Hospital between 2019 and 2023. Clinical characteristics were compared between patients with and without gastrointestinal malignancy. The IDIOM model's performance was assessed with discrimination, calibration, and clinical usefulness. To improve its performance, the model was updated using recalibration and refitting methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 474 IDA patients, 101 (21.3%) had gastrointestinal malignancy, predominantly colorectal cancer (<i>n</i> = 80, 16.9%). Patients with gastrointestinal malignancy were more likely to be male (54.5% vs. 41.3%, <i>p</i> = 0.018), older (65.0 vs. 59.1 years, <i>p</i> &lt; 0.001), symptomatic (78.2% vs. 44.0%, <i>p</i> &lt; 0.001), and had higher rates of positive fecal immunochemical tests (80.9% vs. 29.5%, <i>p</i> &lt; 0.001) and lower MCV (68.0 vs. 71.8 fl, <i>p</i> = 0.002). External validation of the IDIOM model yielded an AuROC of 62.9% (95% CI, 56.8%–68.9%). The calibration assessment revealed both underestimation and extreme risk predictions. After updating, the AuROC improved to 67.2% (95% CI, 61.1%–73.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Distinct clinical features should alert physicians to the possibility of underlying gastrointestinal malignancy in IDA patients. Given the limited performance of the IDIOM model in the Thai population, a region-specific prediction model tailored to local clinical characteristics is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606423","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":"Gastroparesis and Systemic Lupus Erythematosus: A Propensity Score-Matched Study of US National Database Analysis","authors":"Noppachai Siranart,&nbsp;Pannathorn Nakaphan,&nbsp;Thanathip Suenghataiphorn,&nbsp;Panisara Fangsaard,&nbsp;Tanattida Phanthong,&nbsp;Patavee Pajareya,&nbsp;Somkiat Phutinart,&nbsp;Pawaris Tirakunwichcha,&nbsp;Suwit Paksin,&nbsp;Pornnicha Sowalertrat,&nbsp;Sakkarin Chirapongsathorn,&nbsp;Kittithat Tantitanawat","doi":"10.1002/jgh3.70227","DOIUrl":"https://doi.org/10.1002/jgh3.70227","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While gastrointestinal involvement is a common manifestation of systemic lupus erythematosus (SLE), the association between gastroparesis and SLE remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the National Inpatient Sample (NIS) database from 2016 to 2021. Patients with gastroparesis were categorized into SLE and non-SLE groups. Similarly, patients with SLE were categorized into gastroparesis and nongastroparesis groups. Clinical characteristics, comorbidities, hospitalization data, and outcomes were compared. The primary outcome was the association between SLE and primary gastroparesis. Secondary outcomes were clinical impacts of gastroparesis in patients with or without SLE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 12 538 228 patients were included from the NIS database. Of these, 1 165 925 patients (9.3%) were diagnosed with gastroparesis during hospitalization, while 11 372 303 patients (90.7%) did not have gastroparesis. SLE was significantly more common in patients with gastroparesis compared to those without (1.6% vs. 0.7%, <i>p</i> &lt; 0.001; aOR 1.87 [95% CI: 1.80–1.95]). Among patients hospitalized with gastroparesis, those with SLE had a longer length of stay, with a β-coefficient of 0.31 (95% CI: 0.07–0.55, <i>p</i> = 0.009), lower hospitalization charges, with mean differences of $4761 (95% CI: 442–9080, <i>p</i> = 0.031), and a higher rate of intervention needs, with odds ratios of 1.31 (95% CI: 1.09–1.56, <i>p</i> = 0.003). After propensity-score matching (1:1), SLE patients aged ≥ 65 had higher hospital charges, with mean differences of $7287 (95% CI: 2928–11 646, <i>p</i> = 0.01), compared to non-SLE patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gastroparesis is associated with SLE, contributing to longer hospitalizations, higher costs, and increased need for invasive interventions. These findings underscore the importance of evaluating gastroparesis in SLE patients to enable early management and reduce potential complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70227","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606443","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":"Where Do Patients With Cirrhosis Die? A CDC WONDER Analysis From 1999 to 2020","authors":"Areej Iftikhar,&nbsp;Fatima Noor Alam,&nbsp;Danish Ali Ashraf,&nbsp;Saad Hassan Qureshi,&nbsp;Muzamil Akhtar,&nbsp;Ayesha Islam Khan,&nbsp;Muhammad Raza,&nbsp;Raheel Qureshi,&nbsp;Raheel Ahmed","doi":"10.1002/jgh3.70205","DOIUrl":"https://doi.org/10.1002/jgh3.70205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liver Cirrhosis is a growing cause of morbidity and mortality worldwide, but significant knowledge gaps remain regarding disparities in the place of patient death. This study aims to analyze the place of death trends for cirrhosis patients in the United States from 1999 to 2020, to direct preventive and palliative care measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this descriptive study, death certificates were examined using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, using ICD codes K70.3, K71.7, and K74. The variables studied were the year, sex, age, race, rural–urban, census regions, and state. Percentages of deaths in each location were trended over time for interpretation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 1999 and 2020, a total of 1 090 420 deaths were attributed to cirrhosis. The majority of these fatalities occurred in inpatient medical facilities (48.75%), followed by the decedent's home (25.71%). Men consistently exhibited higher deaths in all settings, especially in medical facility—inpatient settings (31.39%), and the highest deaths were for the 55–64 age group. NH White population reported the highest mortality in all places of death, whereas the South led mortality records among census regions. The least deaths occurred in non-core (non-metro) areas, and state-wise analysis revealed California to have the highest number of deaths (75 723), seconded by Texas (55 447).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mortality due to cirrhosis increased gradually from 1999 to 2019, with a steep rise observed in 2019–2020. Men, the White race, 55–65 years age bracket, and residents of rural and Southern census regions reported the highest number of deaths from cirrhosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582250","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":"Frequent Dietetic Involvement Enhances Adherence and Clinical Outcomes of Exclusive Enteral Nutrition in Adults With Crohn's Disease","authors":"Matthew K. W. Chu,&nbsp;Alice S. Day,&nbsp;Damjana Bogatic,&nbsp;Martine Hatzi,&nbsp;Samuel K. S. Chu,&nbsp;Samuel P. Costello,&nbsp;Robert V. Bryant","doi":"10.1002/jgh3.70207","DOIUrl":"https://doi.org/10.1002/jgh3.70207","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Use of Exclusive Enteral Nutrition (EEN) in adults has been limited by lack of defined protocols, poor adherence and perceived lack of efficacy. This study evaluated EEN therapy in adults with Crohn's disease (CD) to identify determinants of clinical efficacy, adherence, and therapy completion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, multicenter study included consecutive adults (≥ 18 years old) prescribed EEN for CD between February 1, 2019, and February 28, 2022, at two tertiary teaching hospitals. The primary outcome was clinical remission (Harvey Bradshaw Index (HBI) ≤ 4) or response (HBI reduction ≥ 3). Therapy completion and adherence were measured. Intention-to-treat and per-protocol analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One-hundred-and-eight patients were included; 54 (50.0%) were female. Mean age was 41.8 ± 16.1 years. Ileocolonic disease was present in 47.2% (51/108), and 40.7% (44/108) had stricturing phenotype. Baseline HBI was 8 (IQR 6–11); 60.2% (65/108) received advanced therapies. Among 80 patients treated for remission induction, remission and response rates were 50.0% (40/80) and 48.8% (39/80), respectively. Completion rate was 69.4% (75/108). Complete diet adherence was observed in 67.6% (73/108). On multivariable analysis, frequency of dietetic review was associated with therapy completion (odds ratio (OR) 2.26, 95% confidence interval (CI) 1.51–3.39, <i>p</i> &lt; 0.001). Active smoking (OR 0.11, 95% CI 0.02–0.83, <i>p</i> = 0.032) reduced odds of remission, whereas early remission (OR 17.56, 95% CI 3.18–96.84, <i>p</i> = 0.001) and early response (OR 4.94, 95% CI 1.09–22.43, <i>p</i> = 0.039) were predictors of clinical remission at end-of-therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early assessment and frequent dietetic follow-up improve EEN adherence, completion, and outcomes in adults with CD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551211","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":"Navigating the Second Victim Experience in Gastrointestinal Endoscopy and Colonoscopy","authors":"Hareesha Rishab Bharadwaj,&nbsp;Syed Hasham Ali,&nbsp;Aditya Gaur,&nbsp;Muhtasim Fuad,&nbsp;Matan Bone,&nbsp;Khabab Abbasher Hussien Mohamed Ahmed,&nbsp;Dushyant Singh Dahiya","doi":"10.1002/jgh3.70215","DOIUrl":"https://doi.org/10.1002/jgh3.70215","url":null,"abstract":"&lt;p&gt;Gastrointestinal endoscopy is a cornerstone of modern gastroenterological practice, offering both diagnostic and therapeutic benefits with a commendably high safety profile. Nevertheless, despite its minimally invasive nature, endoscopic procedures are not without risk. Significant complications and adverse events (AEs) can occur. Certain studies reveal that up to 85% of colonoscopists experience AEs [&lt;span&gt;1&lt;/span&gt;]. In the UK, for instance, AE rates range from 2.8 per 1000 colonoscopies in screening populations to 5 per 1000 in symptomatic patients—figures that align closely with international data [&lt;span&gt;2&lt;/span&gt;]. Within the NHS Bowel Cancer Screening Programme, which evaluated 263 129 colonoscopies between 2006 and 2014, the perforation rate was reported at a low 0.06% [&lt;span&gt;3&lt;/span&gt;]. Importantly, complication risks are notably higher in older adults; a JAMA study demonstrated significantly elevated 30-day post-colonoscopy complication rates in individuals aged ≥ 75 compared to those aged 50–74. Diagnostic colonoscopies also carry a higher risk (0.1%) relative to screening procedures (0.04%) [&lt;span&gt;2-4&lt;/span&gt;]. Colonoscopy-related 30-day mortality remains low, estimated between 1 in 100 000 and 1 in 10 000 procedures [&lt;span&gt;5, 6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;While the medical management of complications such as perforation, bleeding, pancreatitis, and cholangitis is well established—supported by evidence-based protocols—far less attention has been given to the broader implications for endoscopists themselves. The emotional, professional, and medico-legal consequences of AEs can be substantial, directly impacting clinicians' well-being, confidence, and quality of care provided [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Injuries resulting from medical management, rather than the underlying disease, can arise from a spectrum of circumstances ranging from preventable errors to unavoidable complications [&lt;span&gt;1&lt;/span&gt;]. Although attention is often directed towards patient outcomes, issues such as miscommunication, insufficient informed consent, and lack of systemic support frequently intensify the endoscopist's burden [&lt;span&gt;1, 8&lt;/span&gt;]. This underscores the pressing need for comprehensive strategies that not only focus on preventing complications but also provide meaningful support for clinicians managing their aftermath. Notably, some studies suggest that over half of AEs may be preventable with improved systems and training. Still, even when unavoidable, such events can significantly undermine an endoscopist's confidence and professional standing [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The emotional toll is particularly profound for trainees, who may lack the experience, mentorship, and structured guidance to manage complications effectively. Current training programs often inadequately address non-technical aspects of AE management—including disclosure, apology, and patient communication—leaving clinicians to confront these challenges without sufficient preparation or support. The abs","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144519759","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":"Machine-Learning Prediction of Bleeding After Endoscopic Submucosal Dissection for Early Gastric Cancer: A Multicenter Study","authors":"Hiroki Maruyama,&nbsp;Kazuya Takahashi,&nbsp;Kosuke Kojima,&nbsp;Nao Nakajima,&nbsp;Hiroki Sato,&nbsp;Ken-ichi Mizuno,&nbsp;Soichi Sugitani,&nbsp;Shuji Terai","doi":"10.1002/jgh3.70203","DOIUrl":"https://doi.org/10.1002/jgh3.70203","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for early gastric cancer (GC); however, post-ESD bleeding remains a serious and unpredictable complication. This study aimed to develop machine-learning (ML) models to predict post-ESD bleeding and identify associated risk factors, ensuring accurate and interpretable predictions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective, multicenter clinical database was constructed for patients who underwent ESD for early GC. An ML model was developed using patient characteristics and perioperative findings to predict bleeding within 28 days post-ESD. Its performance was compared with that of a logistic regression–based non-ML model. Feature importance analysis was performed to aid interpretation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1084 patients (median age: 75 years), post-ESD bleeding occurred in 63 (5.8%). The area under the curve of the ML model was better than that of the non-ML model (0.80 vs. 0.71, <i>p</i> = 0.03). Furthermore, the ML model demonstrated a trend toward higher sensitivity compared with the non-ML model (0.74 vs. 0.58, <i>p</i> = 0.58). When stratified by ML-estimated bleeding probability, observed bleeding rates were 2.3%, 8.8%, and 28.6% in the low- (&lt; 50%), intermediate- (50%–80%), and high-probability (≥ 80%) groups, respectively. The odds of bleeding were significantly higher in the intermediate- (OR 4.03, <i>p</i> = 0.03) and high-probability (OR 16.7, <i>p</i> &lt; 0.01) groups compared to the low-probability group. Anticoagulant use with atrial fibrillation emerged as a key predictor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The ML model effectively rules out post-ESD bleeding and identifies clinically meaningful risk factors, supporting its use in personalized prophylactic strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70203","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514645","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":"Anti-Inflammatory Peptides as Promising Therapeutics Agent Against Inflammatory Bowel Diseases: A Systematic Review","authors":"Kiarash Ghazvini,&nbsp;Zahra Taghiabadi,&nbsp;Mohammad Ali Karimi,&nbsp;Mahdi Hosseini Bafghi,&nbsp;Mahdiesadat Paryan,&nbsp;Razieh Amirfakhrian","doi":"10.1002/jgh3.70212","DOIUrl":"https://doi.org/10.1002/jgh3.70212","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Inflammatory bowel disease (IBD) is linked to dysregulated mucosal immunity, microbiota imbalances, and environmental factors, though its exact cause remains unknown. Current treatments often have limitations, necessitating innovative therapies. This review evaluates anti-inflammatory peptides (AIPs) as emerging therapeutic agents, focusing on their efficacy in Ulcerative Colitis and Crohn's disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>A systematic review was conducted in February 2023, adhering to PRISMA 2020 guidelines. Studies published from 2010 to 2023 on AIPs for IBD treatment were retrieved from Medline, Web of Science, and Cochrane databases using keywords such as IBDs, AIPs, Crohn's disease, Ulcerative Colitis, and therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen studies met the inclusion criteria, comprising 12 animal studies, four clinical trials, and one case–control study. H-SN1 (snake venom peptide) and GLP-2② (glucagon-like peptide-2 dimer) effectively inhibited TNF cytotoxicity. Oral AVX-470 (bovine-derived anti-TNF antibody) reduced enterocyte TNF, MPO, and apoptosis levels. Ac2-26 (annexin A1 mimic) and αs2-casein peptide combined with synbiotics were shown to restore gut homeostasis and dysbiosis. AMP-18 (gastrokine-1) and MBCP (buffalo milk peptide) stabilized tight junctions, preserving intestinal barrier integrity and potentially preventing IBD progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AIPs effectively reduce inflammation, regulate gut microbiota, and stabilize the intestinal barrier, showing promise for managing IBD. However, their therapeutic potential is limited by protease degradation, poor bioavailability, and possible cytotoxicity. Future research should enhance their stability, delivery systems, and pharmacokinetic properties to optimize their clinical applicability and safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514643","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":"Examination of the Diameter of the Rectum and the Thickness of the Anterior Wall of the Rectum by Ultrasound in Children With Chronic Constipation and Abdominal Pain in the Age Range of 2–18 Years","authors":"Mitra Azra Aldaghi,&nbsp;Nafiseh Shourideh Yazdi,&nbsp;Mohammad Esmail Ahmad Abadi,&nbsp;Rahil Mahmoudi,&nbsp;Hadi Lotfi","doi":"10.1002/jgh3.70202","DOIUrl":"https://doi.org/10.1002/jgh3.70202","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <p>Abdominal pain is one of the most common complaints to the pediatric clinic and can be challenging for the physician. Among children who present with abdominal pain, constipation is one of the main causes of abdominal pain, and its incidence in childhood is estimated at 1%–30%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Hundrerd children with chronic constipation, defined according to the Rome IV constipation criteria, who were referred to Sabzevar Children's Clinic, were included in the study. Hundred people in the control group were selected from children without constipation who underwent abdominal ultrasound due to abdominal pain. Consent was obtained from the children's parents, and the child's consent was also obtained for ultrasound. Rectal diameter and rectal anterior wall thickness were measured by an experienced radiologist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results determined that the diameter of the rectum measured by ultrasound in children with constipation is greater than in the control group. Also, the thickness of the rectum was lower in children with constipation compared to the control group. It was found that there was no significant relationship between gender and constipation in children. There was a significant relationship between constipation in children and their body mass index (BMI) and age. The results of the study showed that there was no significant relationship between history of urinary tract infection and constipation and socioeconomic status in children. There was a significant relationship between the diameter of the rectum and the duration of constipation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Ultrasound can be useful in diagnosing children with constipation in whom it is difficult to take a history and physical examination.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144514587","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}