JGH Open最新文献

{"title":"Five-Year CT-Based Skeletal Muscle Decline Curves in Cirrhosis According to Liver Functional Reserve and Routinely Available Clinical Factors","authors":"Suguru Miida,&nbsp;Hiroteru Kamimura,&nbsp;Hitoshi Yoshiji,&nbsp;Masahito Shimizu,&nbsp;Takumi Kawaguchi,&nbsp;Tetsuya Tsuji,&nbsp;Saori Endo,&nbsp;Hiroki Natsui,&nbsp;Hiroki Maruyama,&nbsp;Hiroyuki Abe,&nbsp;Tadashi Namisaki,&nbsp;Takao Miwa,&nbsp;Dan Nakano,&nbsp;Michiyuki Kawakami,&nbsp;Shuji Terai","doi":"10.1002/jgh3.70472","DOIUrl":"10.1002/jgh3.70472","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sarcopenia is common in cirrhosis and is associated with poor outcomes. We aimed to identify factors associated with longitudinal skeletal muscle loss and to explore estimation of future L3 skeletal muscle index (L3-SMI) using routinely available clinical variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective longitudinal study included 175 patients with cirrhosis who underwent serial abdominal CT over five annual time points between 2010 and 2022. The primary analysis used a linear mixed-effects model including annual time point, baseline Child–Pugh class, and their interaction. An exploratory linear regression model estimated Year 5 L3-SMI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the primary model, L3-SMI declined by −1.144 cm²/m²/year in baseline Child–Pugh class A. The time-by-class B interaction was not significant (<i>β</i> = 0.024; 95% CI, −0.250 to 0.298; <i>p</i> = 0.865), whereas class C was associated with an additional annual decline of −1.812 cm²/m²/year compared with class A (95% CI, −2.735 to −0.890; <i>p</i> = 0.0001). This association remained after adjustment for age, sex, baseline HCC status, and the time-by-HCC interaction. In the exploratory Year 5 model, baseline L3-SMI was the dominant predictor; estimates for class C were interpreted cautiously because only five patients were baseline class C.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Baseline hepatic functional reserve, particularly Child–Pugh class C, was associated with faster annual CT-based L3-SMI decline. The Year 5 prediction model is exploratory and requires external validation. Early sarcopenia assessment may facilitate risk stratification in patients with impaired hepatic reserve.</p>\u0000 \u0000 <p><b>Trial Registration:</b> UMIN Clinical Trials Registry: UMIN000051577.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116314","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":"Current Status of Pancreatic Exocrine Insufficiency Diagnosis and Pancreatic Enzyme Replacement Therapy Implementation in Patients With Chronic Pancreatitis","authors":"Noriharu Itoh,&nbsp;Yuko Hasebe,&nbsp;Toru Yada,&nbsp;Kazutaka Nozawa","doi":"10.1002/jgh3.70473","DOIUrl":"10.1002/jgh3.70473","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The prevalence of chronic pancreatitis (CP) is increasing in Japan. This study aimed to elucidate the current status of pancreatic exocrine insufficiency (PEI) diagnosis and the prescription of pancreatic enzyme replacement therapy (PERT) in Japanese patients with CP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective observational study using a large-scale claims database in Japan with a data collection period between April 2008 and August 2022. Patients with CP were categorized into PERT and no-PERT cohorts based on the presence or absence of PERT prescriptions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found an increase in the number of CP diagnoses, PERT prescriptions, and PEI diagnoses over the past decade. The median PERT persistence time was 254.0 days (95% confidence interval: 219.0–288.0), and the 5-year persistence rate was 20.4%. Patients in the PERT cohort (<i>n</i> = 3056) were younger (61.9 vs. 65.4 years), had a higher mean Charlson Comorbidity Index (1.7 vs. 1.3), and were more likely to be underweight (body mass index &lt; 18.5 kg/m², 13.7% vs. 6.0%) than those in the no-PERT cohort (<i>n</i> = 32 861). Patients in the PERT cohort had higher rates of in-hospital deaths (6.3% vs. 4.7%), weight loss (13.3% vs. 9.2%), pancreatic diabetes (1.7% vs. 0.7%), and pancreatic cancer (1.7% vs. 0.7%) than those in the no-PERT cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The number of PEI diagnoses and PERT prescriptions for patients with CP has increased in Japan over the past decade. The low PERT persistence rate suggests the need for further research to understand the factors that affect treatment persistence in CP management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116219","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":"The Fibrosis-4 Index Predicts Ceftriaxone-Associated Gallstone Formation: Risk Stratification Using the Fibrosis-4 Index in a Clinical Cohort","authors":"Hideo Kato,&nbsp;Mao Hagihara,&nbsp;Hiroshige Mikamo,&nbsp;Takuya Iwamoto","doi":"10.1002/jgh3.70468","DOIUrl":"https://doi.org/10.1002/jgh3.70468","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ceftriaxone is widely used because of its broad antimicrobial spectrum and convenient dosing; however, high biliary excretion can lead to calcium–ceftriaxone precipitation and gallstone-like formations. Although exposure-related risk factors have been described, the effect of hepatic fibrosis on ceftriaxone-associated gallstone formations remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To clarify the role of hepatic fibrosis in ceftriaxone-related gallstone formation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective study on adult patients who received intravenous ceftriaxone and underwent abdominal computed tomography at a tertiary hospital between October 2021 and July 2025. The primary outcome was newly detected gallstone formations during or after ceftriaxone therapy. Clinical variables, including treatment duration, cumulative dose, and fibrosis-4 index, were analyzed. Decision tree, Kaplan–Meier, Cox proportional hazards, and receiver operating characteristic analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 320 eligible patients, 98 (30.6%) developed newly detected gallstones. Patients with gallstones had longer treatment duration (10 vs. 6 days, <i>p</i> &lt; 0.001), higher cumulative dose (22 vs. 10 g, <i>p</i> &lt; 0.001), and higher fibrosis-4 scores (2.86 vs. 1.68, <i>p</i> &lt; 0.001). Decision tree analysis identified fibrosis-4 (cutoff: 2.56) as the primary stratifying variable modifying exposure-related thresholds. Kaplan–Meier analysis showed earlier gallstone development in patients with fibrosis-4 ≥ 2.56. In multivariable Cox analysis, fibrosis-4 ≥ 2.56 was independently associated with gallstone formation. The incorporation of fibrosis-4 improved model discrimination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Elevated FIB-4 levels were independently associated with CRO-related gallstone formation. The FIB-4 index may facilitate risk stratification during CRO therapy, although the observed association should not be interpreted as direct evidence of hepatic fibrosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70468","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048442","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":"Comment on “Effect of Multiple Pharmacological Interventions and Magnetic Control on Capsule Endoscopy Gastrointestinal Transit Time and Diagnostic Yield: A Systematic Review and Meta-Analysis”","authors":"Nirupma Gupta,&nbsp;Sushma Narsing Katkuri,&nbsp;Varshini Vadhithala,&nbsp;Sachin Kumar,&nbsp;Sushma Verma,&nbsp;Jeffrin Reneus Paul","doi":"10.1002/jgh3.70361","DOIUrl":"10.1002/jgh3.70361","url":null,"abstract":"&lt;p&gt;We carefully reviewed the systematic review and meta-analysis by Kumar et al., which examined the influence of pharmacological agents and magnetic guidance on gastric transit time (GTT), small bowel transit time (SBTT), and completion rate (CR) in capsule endoscopy (CE). By synthesizing evidence from 53 studies involving over 9000 participants, the authors present one of the most comprehensive evaluations to date addressing strategies aimed at optimizing CE performance. This work addresses a clinically relevant and technically demanding aspect of small bowel assessment and therefore represents a valuable contribution to the field [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Notably, the analysis underscores the variable effects of agents such as metoclopramide, prucalopride, polyethylene glycol, castor oil, and magnetic steering systems, reinforcing the need for individualized rather than standardized preparation protocols. The observation that no single intervention uniformly improves all transit parameters is particularly relevant for clinical practice, where patient characteristics frequently influence procedural outcomes.&lt;/p&gt;&lt;p&gt;Nevertheless, several methodological issues merit further consideration. First, although multiple intervention categories with differing mechanisms of action were included, the analysis did not apply comparative synthesis approaches across these strategies. Adoption of a network meta-analytic framework could have facilitated indirect comparisons and enabled clearer differentiation of the relative effectiveness among interventions [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Second, substantial statistical heterogeneity was observed across several pooled outcomes, particularly for GTT and SBTT, with &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; values exceeding 90%. While the application of random-effects models was appropriate, additional investigation using meta-regression or stratified analyses based on clinical variables—such as diabetic status, prior abdominal surgery, hospitalization, or advanced age—might have provided further insight into the sources of variability across studies [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Third, assessment of publication bias relied primarily on visual inspection of funnel plots. Given that many outcomes were expressed as proportions, incorporation of alternative quantitative approaches, including Doi plots and the Luis Furuya–Kanamori (LFK) index, may have offered a more robust evaluation of potential small-study effects [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Finally, although methodological quality was appraised using RoB 2.0 and the Newcastle–Ottawa Scale, the absence of a structured GRADE-based assessment limits confidence in translating statistically significant findings into strong clinical recommendations, particularly in the context of marked heterogeneity across included studies [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Despite these considerations, the review provides important insights into CE optimization and supports the growing emphasis on patient-tailored preparation strategies","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 9","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041330","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 Performance of the Uric Acid-To-Albumin Ratio in Predicting Severity of Acute Pancreatitis","authors":"Hüsnü Serdar Kızıltunç,&nbsp;Şirin Çetin,&nbsp;Mehmet Batuhan Duman","doi":"10.1002/jgh3.70471","DOIUrl":"10.1002/jgh3.70471","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The uric acid-to-albumin ratio (UAR) has shown prognostic value in several inflammatory conditions, but its role in acute pancreatitis (AP) remains unclear. This study evaluated the prognostic value of UAR for disease severity in patients with AP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this single-center, retrospective study, 147 patients hospitalized with acute pancreatitis between February 2025 and June 2026 were included. UAR, systemic immune-inflammation index (SII), and platelet-to-lymphocyte ratio (PLR) were calculated. Disease severity was classified using the revised Atlanta classification and the BISAP score. Diagnostic performance was assessed by receiver operating characteristic (ROC) analysis with pairwise area under the curve (AUC) comparisons (DeLong method).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-eight patients (25.9%) had moderate-to-severe AP. UAR was higher in the moderate-to-severe group than in the mild group (1.65 ± 0.47 vs. 1.27 ± 0.34; <i>p</i> &lt; 0.001) and increased across BISAP score categories (<i>p</i> &lt; 0.001). UAR had an AUC of 0.741 (95% CI: 0.662–0.810), compared with 0.706 for SII and 0.646 for PLR; however, pairwise differences were not statistically significant. At a cut-off of &gt; 1.54 (Youden index), UAR had a specificity of 82.57% and a negative predictive value of 84.90%. Combining UAR with age increased the AUC to 0.801 and the negative predictive value to 88.57%. Bootstrap validation yielded an optimism-corrected AUC of 0.794. UAR was associated with moderate-to-severe AP in univariable analysis (OR: 10.517; 95% CI: 3.770–29.336; <i>p</i> &lt; 0.001), but not after multivariable adjustment (adjusted OR: 3.462; 95% CI: 0.870–13.773; <i>p</i> = 0.078).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>UAR is a simple, inexpensive biomarker with potential utility in acute pancreatitis severity assessment. Although not independently predictive, it may provide complementary information alongside clinical and laboratory findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 9","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026308","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":"Acute Kidney Injury in Patients With Cirrhosis Exposed to Iodinated Contrast: A Systematic Review and Meta-Analysis","authors":"Tulio L. Correa,&nbsp;Vanio Antunes,&nbsp;Otavio C. Martins,&nbsp;Matheus V. Fernandes,&nbsp;Elisio Bulhoes,&nbsp;Alonzo A. Prata,&nbsp;Ana Carolina Covre Coan,&nbsp;André Milani Reis,&nbsp;Natalia J. Milioli,&nbsp;Ximena Parraga,&nbsp;Beatriz Sordi Chara,&nbsp;Cristiane Valle Tovo","doi":"10.1002/jgh3.70474","DOIUrl":"https://doi.org/10.1002/jgh3.70474","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Iodinated radiocontrast agents are widely used in diagnostic radiography and therapeutic procedures. However, concerns remain regarding their association with contrast-induced acute kidney injury (CI-AKI) and contrast-associated acute kidney injury (CA-AKI). While these risks are frequently discussed in the general population, data on CI and CA-AKI in patients with cirrhosis remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Evaluate the incidence and risk factors associated with CI-AKI or CA-AKI in patients with cirrhosis exposed to iodinated contrast (IC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic search was conducted in PubMed, Embase, and Cochrane Central for studies including patients with cirrhosis exposed to IC. Binary endpoints were assessed using pooled odds ratios (OR), and continuous endpoints using mean differences (MDs) or standardized mean differences (SMDs). The primary outcome was the pooled incidence of AKI in patients with cirrhosis exposed to IC, with secondary outcomes including the risk of CI-AKI compared to unexposed patients and risk factors associated with CA-AKI development. Analyses were performed in R (version 4.3.2).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine observational studies were included, two of which used propensity score matching, encompassing a total of 2389 patients with cirrhosis, of whom 1672 were exposed to IC. The pooled incidence of acute kidney injury was 11.1% (95% CI 5.3%–18.8%). On the leave-one-out analysis, patients with cirrhosis receiving IC had a higher risk of AKI compared to those not receiving IC (OR 2.5; 95% CI 1.4–4.4). The presence of ascites was significantly associated with the development of CA-AKI (OR 3.2; 95% CI 1.8–5.5). Those who developed CA-AKI had significantly higher baseline MELD scores, associated with higher serum bilirubin and INR levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with cirrhosis exposed to IC agents had a higher risk of developing acute kidney injury compared to those not exposed. The development of CA-AKI was significantly associated with the presence of ascites and elevated baseline MELD scores, along with higher serum bilirubin and INR levels.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 9","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70474","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148994454","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":"Real-Time AI-Assisted Detection of Colonic Lesions Using the iIDEAS Intelligent-C Module: A Prospective Single-Center Validation Study","authors":"Hardik Rughwani,&nbsp;Rajat Garg,&nbsp;Sana Fathima Memon,&nbsp;Chung Kwong Yeung,&nbsp;Biji Sreedhar,&nbsp;Kwun Ping Lai,&nbsp;Rajendra Patel,&nbsp;Nitin Jagtap,&nbsp;Syed Jameel Hussain,&nbsp;Mohammed Sanny,&nbsp;Rakesh Kalapala,&nbsp;D. Nageshwar Reddy","doi":"10.1002/jgh3.70470","DOIUrl":"https://doi.org/10.1002/jgh3.70470","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Colorectal cancer (CRC) remains a major cause of cancer mortality, with up to 26% of adenomas missed on conventional colonoscopy. Artificial intelligence (AI)–based computer-aided detection (CADe) systems may reduce these miss rates. We aimed to validate the iIDEAS-C CADe module in a prospective cohort, with co-primary endpoints of adenomas per colonoscopy (APC) and lesion-level miss rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>In this prospective, nonrandomized, single-center study (NCT05784935), consecutive adults (18–75 years) undergoing screening, surveillance, or diagnostic colonoscopy were enrolled between February and May 2023. Each colon segment was inspected twice: an initial blinded withdrawal without CADe, followed by a second inspection with iIDEAS-C. Missed lesions were those identified by CADe during the second inspection and confirmed endoscopically. Secondary outcomes included PDR, ADR, PPC, lesion characteristics, and procedural times.</p>\u0000 \u0000 <p>Two hundred patients (mean age 44.1 ± 12.7 years; 64% male) were included. Eighty-two polyps were detected across 42 patients (PDR = 21%). Endoscopists detected 61/82 polyps (74.4%), yielding a per-polyp miss rate of 25.6%. The iIDEAS-C module detected all 82 lesions, achieving 0% per-polyp and per-adenoma miss rate. Missed lesions were mostly diminutive and proximal. PPC increased from 0.305 to 0.410 (<i>p</i> &lt; 0.0001), PDR from 17.5% to 21.0% (<i>p</i> = 0.016), and APC from 0.115 to 0.140 (<i>p</i> = 0.029). No adverse events occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The iIDEAS-C module demonstrated a 0% lesion-level miss rate and significantly improved key detection metrics, especially for small proximal lesions. Larger multicenter studies are warranted to confirm these findings and assess long-term outcomes. ClinicalTrials.gov: NCT05784935.</p>\u0000 \u0000 <p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT05784935.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 9","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148994544","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":"Current Helicobacter pylori Diagnostics: Established Methods, Resistance Testing, and Emerging Approaches","authors":"Tianhua Tang,&nbsp;Erwin A. Paz,&nbsp;Kan Yu,&nbsp;Khui Hung Lee,&nbsp;Chin Yen Tay,&nbsp;Jingjing Wang,&nbsp;Barry James Marshall,&nbsp;Linli Hu,&nbsp;Wanting Fu,&nbsp;Ziyao Yang","doi":"10.1002/jgh3.70461","DOIUrl":"https://doi.org/10.1002/jgh3.70461","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Accurate diagnosis of <i>Helicobacter pylori</i> infection is required to detect active infection, confirm eradication, assess gastric pathology when indicated, and obtain antimicrobial resistance information that may guide treatment. This review evaluates the clinical roles, limitations, and implementation maturity of established, molecular, and emerging diagnostic approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A narrative review was conducted using PubMed/MEDLINE, Embase, Web of Science, the Cochrane Library, and Google Scholar, prioritizing clinical guidelines, systematic reviews, diagnostic accuracy studies, multicenter validation studies, and directly relevant method-development research. Histology, rapid urease testing, and culture remain established biopsy-based methods, whereas urea breath testing and validated monoclonal stool antigen testing are the leading non-invasive options for detecting active infection and confirming eradication. Serology is useful only in selected settings because it cannot reliably distinguish current from previous infection. Culture provides phenotypic susceptibility results but is technically demanding. qPCR and targeted PCR provide faster, target-specific genotypic information, while next-generation sequencing may broaden resistance-variant detection in specialist or surveillance settings. Genotypic findings require antibiotic-specific interpretation because genotype–phenotype concordance varies. AI-assisted endoscopic interpretation, biosensors, LAMP, CRISPR-based assays, and string test-based sampling may address specific workflow gaps, but most remain adjunctive, selectively implemented, early translational, or investigational.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Diagnostic selection should begin with the clinical question and integrate patient risk, treatment history, medication exposure, local resistance patterns, specimen access, laboratory capacity, turnaround time, and available resources. Wider adoption of newer technologies requires external validation, standardization, quality assurance, regulatory readiness, economic assessment, and evidence that results improve clinical management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 9","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70461","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148943227","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":"Disordered Eating Behaviors Many Years After Education in a Low FODMAP Diet in Patients With Irritable Bowel Syndrome","authors":"Hannah Silva,&nbsp;Simon R. Knowles,&nbsp;Judi Porter,&nbsp;Jaqueline Barrett,&nbsp;Peter R. Gibson,&nbsp;Mayur Garg","doi":"10.1002/jgh3.70467","DOIUrl":"10.1002/jgh3.70467","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The impact of teaching patients with irritable bowel syndrome (IBS) a FODMAP diet on eating behaviors is unknown. We aimed to ascertain disordered eating behaviors and their relationships to current dietary intake and clinical status many years after FODMAP education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>Patients with IBS educated on a FODMAP diet by a gastrointestinal dietitian mean 7.1 (range 2.5–13.4) years prior were cross-sectionally evaluated for current eating behaviors utilizing multiple risk tools, mental health (Depression Anxiety Stress Scales), gastrointestinal symptoms (IBS-SSS), overall, food-related quality of life and dietary intake (Complete Nutritional Assessment Questionnaire), and retrospective analysis of documented mental health conditions. Of 74 participants (84% women, median age 59 (IQR 47–67) years), disordered eating behaviors were identified in 38% by the risk tools comprising Eating Attitudes Test (EAT)-26 in 7%, Nine Item ARFID screen (NIAS) in 24%, ORTO-7 for orthorexia in 21%. While these behaviors were associated with reduced overall and food-related quality of life, multivariable regression analyses identified only psychological distress and symptom severity as independent predictors of ARFID and orthorexia risk. Self-perceived eating pattern (strict low-FODMAP, personalized-FODMAP or habitual diets), level of measured FODMAP intake, or time since dietary education were not related to disordered eating behaviors. No new diagnoses or exacerbation of eating disorders were observed since dietary education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Disordered eating behaviors are commonly present in long-term follow-up of patients with IBS after FODMAP dietary education, but these are related to psychological distress and symptom burden, not to specific dietary effects associated with such education.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 9","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913799","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 and Novel Manometric Features of Pseudoachalasia: Identification of Loss of Respiratory Variation in Lower Esophageal Sphincter Pressure","authors":"Eri Nishikawa,&nbsp;Shinwa Tanaka,&nbsp;Hirofumi Abe,&nbsp;Hiroshi Tanabe,&nbsp;Shinya Hoki,&nbsp;Hitomi Hori,&nbsp;Tatsuya Nakai,&nbsp;Chise Ueda,&nbsp;Satoshi Urakami,&nbsp;Tetsuya Yoshizaki,&nbsp;Takashi Toyonaga,&nbsp;Yuzo Kodama","doi":"10.1002/jgh3.70460","DOIUrl":"10.1002/jgh3.70460","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pseudoachalasia closely mimics idiopathic achalasia in both symptoms and high-resolution manometry (HRM) findings, making accurate diagnosis difficult. This study aimed to clarify the clinical characteristics of pseudoachalasia encountered at our institution and identify novel manometric findings specific to this condition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective study compared the clinical characteristics and HRM findings of patients diagnosed with pseudoachalasia (pseudoachalasia group) with those diagnosed with idiopathic achalasia or esophagogastric junction outflow obstruction (EGJOO), collectively defined as the idiopathic achalasia group, between April 2015 and March 2024. Pseudoachalasia was defined as cases with no mucosal abnormalities on the initial endoscopic examination, and with clinical symptoms, esophagographic findings, and HRM results consistent with achalasia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five patients were diagnosed with pseudoachalasia. Two cases were classified as Type 2 achalasia and three as EGJOO according to the Chicago Classification. Compared with the idiopathic achalasia group, the pseudoachalasia group was older, had a shorter symptom-to-diagnosis interval, and exhibited higher Eckardt scores. HRM demonstrated significantly higher integrated relaxation pressure (IRP) in the pseudoachalasia group. Loss of Respiratory Variation in LES Pressure (LRV-LES) was observed in all patients in the pseudoachalasia group, whereas it was present in 8.3% of patients in the idiopathic achalasia group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Pseudoachalasia was characterized by an older age at onset, a shorter interval from symptom onset to diagnosis, and higher Eckardt scores. HRM demonstrated elevated IRP, and LRV-LES was observed in all cases. LRV-LES may represent a novel manometric finding that can aid in the diagnosis of pseudoachalasia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 9","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898011","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}