JGH Open最新文献

{"title":"Editorial: The Role of Esophageal Manometry in Diagnosing Achalasia and Esophageal Motility Disorders: Challenges and Advances","authors":"Kee Huat Chuah","doi":"10.1002/jgh3.70093","DOIUrl":"10.1002/jgh3.70093","url":null,"abstract":"<p>Achalasia is a condition associated with significant morbidity and mortality. Among patients with achalasia, esophageal cancer, and pneumonia have been identified as carrying high mortality risks, with hazard ratios of 8.82 and 2.28, respectively [<span>1</span>]. Despite these risks, the diagnosis of achalasia is often overlooked. Although a German study demonstrated that the delay from symptom onset to diagnosis has shortened from 35 months to 20 months over 15 years, a diagnostic delay of nearly 2 years remains a cause for concern [<span>2</span>].</p><p>In this context, two large retrospective studies on consecutive patients undergoing esophageal manometry, conducted by Ghoshal et al. in India [<span>3</span>] and Abbass et al. in Pakistan [<span>4</span>], are particularly timely. The spectrum of manometric diagnoses varied across countries, but the frequency of achalasia was high: 56% in India and 55.9% in Pakistan. In Malaysia, 50.1% of patients with non-obstructive dysphagia were diagnosed with achalasia (Table 1) [<span>5</span>]. Taken together, these findings suggest that achalasia is not uncommon in selected populations, particularly among patients presenting with dysphagia.</p><p>Interestingly, most patients with achalasia in India and Malaysia were classified as Type II, while those in Pakistan were predominantly Type I. Symptom duration before diagnosis averaged 18 months for patients under 60 years and 36 months for those over 60 years in India, whereas in Pakistan, it could extend as long as 8 years [<span>3-5</span>]. This prolonged duration in Pakistan may explain the higher prevalence of Type I achalasia, as Type I represents disease progression from Type II over time.</p><p>These findings highlight significant gaps in the timely diagnosis of achalasia. Greater education for clinicians to improve early detection and referral to tertiary centers is essential. Equally important is encouraging patients to seek medical consultation early. In line with these goals, the Malaysian Society of Gastroenterology and Hepatology and the Malaysian Upper Gastrointestinal Surgical Society have collaborated to highlight, recommend, and standardize the approach to managing patients with achalasia and esophagogastric junction outflow obstruction [<span>6</span>].</p><p>Treatment options resulting in good symptom improvement for achalasia are available. With the advent of newer treatment options, including peroral endoscopic myotomy (POEM), treatment outcomes have improved further. POEM has been found to be superior to pneumatic dilation for all types of achalasia and even better than Heller's myotomy for Type III achalasia [<span>7</span>].</p><p>Studies from India [<span>3</span>] and Malaysia also reported that ineffective esophageal motility (IEM) was the second most common diagnosis after achalasia (Table 1). IEM is commonly associated with GERD and was reported in up to 38% of patients with abnormal esophageal acid exposure [<span>8</spa","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11711043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956523","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":"Relationship Between Adenoma Detection Rate and Respective Withdrawal Time in Different Colon Segments: A Retrospective, Single-Center Study","authors":"Xujin Chen, Bingxin Xu, Bingni Wei, Lin Ji, Cheng Yang, Qiang Zhan","doi":"10.1002/jgh3.70095","DOIUrl":"10.1002/jgh3.70095","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aims</h3>\u0000 \u0000 <p>The 6-min withdrawal time for colonoscopy is widely considered the standard of care. However, there may not be appropriate if the 6-min is equally divided into various colon segments. Since the adenoma detection in each colon segment is not the same, there may be differences with the withdrawal time in different colon segments. Our objective was to evaluate the relationships between adenoma detection rate (ADR) and respective withdrawal time in different colon segments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Outpatients, age range 18–75 years, undertaking complete colonoscopy were enrolled in this study from November 2019 to November 2020 in the digestive endoscopy center. The entire colon was divided into four different segments: ascending colon, transverse colon, descending colon and rectosigmoid colon. The respective withdrawal time and ADR in each colon segment were recorded respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 586 outpatients (279 males, 307 females) enrolled in this study and the general ADR was 38.2%. The positive withdrawal time (adenomas detected) was longer than negative withdrawal time (non-adenomas detected) (334.04 ± 24.21 s vs. 303.65 ± 5.20 s, t = 1.26, <i>p</i> < 0.001). ADR in ascending colon, transverse colon, descending colon and rectosigmoid colon were respectively 30.5%, 2.9%, 3.1% and 7.5%. While all of their positive withdrawal time were longer than negative withdrawal time (94.34 ± 33.76 s vs. 70.40 ± 41.84 s, <i>t</i> = 3.31, <i>p</i> = 0.001; 85.40 ± 49.76 s vs. 71.66 ± 36.87 s, <i>t</i> = 1.95, <i>p</i> = 0.025; 80.29 ± 39.85 s vs. 69.73 ± 35.96 s, <i>t</i> = 1.40, <i>p</i> = 0.016;100.95 ± 55.92 s vs. 80.96 ± 42.87 s, <i>t</i> = 3.61; <i>p</i> < 0.001, respectively). The withdrawal time threshold in the ascending colon, transverse colon, descending colon, rectosigmoid colon determined by receiver operating characteristic (ROC) curve were 77, 61, 56 and 109 s, respectively. In the ascending colon, ADR was significantly higher (47.0% vs. 33.1%, <i>p</i> < 0.001) when the colonoscopy withdrawal time was ≥ 77 s. When the withdrawal time was ≥ 61 s in the transverse colon (42.7% vs. 32.7%, <i>p</i> = 0.013), ≥ 59 s in the descending colon (42.3% vs. 29.9%, <i>p</i> = 0.004) and ≥ 109 s in rectosigmoid colon (52.2% vs. 33.9%, <i>p</i> < 0.001), ADR was also significantly higher. After adjusting for age, sex and BMI, Logistic regression analysis showed that withdrawal time ≥ 77 s in the ascending colon (OR, 1.796; 95% CI, 1.273–2.532; <i>p</i> < 0.001), ≥ 61 s in the transverse colon (OR, 1.535; 95% CI, 1.094–2.155; <i>p</i>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956528","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":"Intensified and Accelerated Rescue Infliximab Therapy for Acute Severe Ulcerative Colitis in Pregnancy: A Case Report","authors":"Saiumaeswar Yogakanthi,&nbsp;Timothy Phan,&nbsp;Emma Flanagan,&nbsp;Linda Yang,&nbsp;Chamara Basnayake,&nbsp;Iniyaval Thevathasan,&nbsp;Julien Schulberg","doi":"10.1002/jgh3.70091","DOIUrl":"10.1002/jgh3.70091","url":null,"abstract":"<p>Acute severe ulcerative colitis (ASUC) in pregnancy poses a clinical challenge with significant risk to both mother and fetus. Anti-TNF alpha therapy is known to be safe in pregnancy, however, data surrounding outcomes in ASUC is limited. In this report, we present the case of a pregnant patient of 10 weeks' gestation with ASUC successfully managed with intensified and accelerated infliximab therapy for a total dose of 35 mg/kg during a single admission. This case highlights the use of this therapeutic strategy, as a part of a multidisciplinary approach, to avoid the need for a high-risk colectomy.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956527","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":"Upper GI Endoscopy in Resource-Constrained Settings: Bridging the Gap","authors":"Muhammad Uwais Ashraf,&nbsp;Madhumita Premkumar","doi":"10.1002/jgh3.70089","DOIUrl":"https://doi.org/10.1002/jgh3.70089","url":null,"abstract":"&lt;p&gt;Upper gastrointestinal (GI) endoscopy is an essential adjunct to gastroenterology and hepatology practice, providing invaluable diagnostic and therapeutic capabilities for patients with GI diseases [&lt;span&gt;1&lt;/span&gt;]. Therapeutic gastrointestinal endoscopy (GIE) is required for the management of acute GI bleeding, including portal hypertension or ulcer-related bleeding. It is also needed in patients who require post-pyloric feeding, GI malignancy, and for management of benign and malignant strictures. Colonoscopy is needed for screening of large bowel cancers, inflammatory bowel disease, and GI tuberculosis. However, in resource-limited settings, this essential procedure remains out of reach for millions of patients [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;As global health inequities persist, we must address the challenges and explore innovative solutions to bring basic GIE service-gastroduodenoscopy and colonoscopy to those who need it the most. Although advanced endoscopic procedures like endoscopic retrograde cholangiopancreatography and endoscopic ultrasound remain in the specialist domain, basic endoscopy should be accessible at sites where surgical training is provided, with opportunities for training fellows in medicine and surgical units in workshops to provide GIE services in West Africa [&lt;span&gt;3-5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this issue of JGH Open, Nziku et al. describe their experience of providing endoscopy services in Tanzania [&lt;span&gt;6&lt;/span&gt;]. In Tanzania, 4.3 gastroenterologists are practicing per 10 000 000 people [&lt;span&gt;7&lt;/span&gt;]. The delivery of GIE procedures, both diagnostic and therapeutic, and patient outcomes are not well described in the literature. Rebleeding in this study occurred in 40.1% of patients as rebleeding was higher in patients who received conservative treatment (72.0%) compared with endoscopic treatment.&lt;/p&gt;&lt;p&gt;In another large study from Zanzibar on 3146 patients, gastro-duodenitis, peptic ulcer disease are the most common endoscopic diagnoses in Zanzibar [&lt;span&gt;8&lt;/span&gt;]. The presence of &lt;i&gt;H. pylori&lt;/i&gt; was significantly associated with duodenal ulcer and gastric cancer. In another study conducted by Pan-African Academy of Christian Surgeons sites in rural Africa, 20 surgical trainees performed a total of 2181 GIE procedures [&lt;span&gt;3&lt;/span&gt;]. Of all procedures, 546 (26.7%) involved cancer or mass, 267 (12.2%) involved a report of blood loss, and 452 (20.7%) reported pain as a component of the diagnosis. Interventions beyond biopsy were reported in 555 (25%) procedures. This reflects the need for better delivery of GIE services in a rural setting, with the establishment of better training facilities.&lt;/p&gt;&lt;p&gt;In a study from Nigeria, rebleeding rates were low following endoscopic therapy (5.5%) and were expectedly higher in patients who had conservative treatment (75.0%) [&lt;span&gt;9&lt;/span&gt;]. As such the present study attempts to bridge the gap in the requirement of specialist GI care in a resource-constrained setting and provides useful in","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111360","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":"Evaluation of the Efficacy of Lusutrombopag for Chronic Liver Disease Based on Pre-Treatment Platelet Counts: A Retrospective Multicenter Study","authors":"Takayoshi Suga,&nbsp;Satoru Kakizaki,&nbsp;Atsushi Naganuma,&nbsp;Takeshi Hatanaka,&nbsp;Satoshi Takakusagi,&nbsp;Daichi Takizawa,&nbsp;Hirotaka Arai,&nbsp;Takashi Ueno,&nbsp;Keisuke Iizuka,&nbsp;Toru Fukuchi,&nbsp;Shuichi Saito,&nbsp;Hiroki Tojima,&nbsp;Yuichi Yamazaki,&nbsp;Toshio Uraoka","doi":"10.1002/jgh3.70081","DOIUrl":"10.1002/jgh3.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oral thrombopoietin receptor agonists are used to treat thrombocytopenia in patients with chronic liver disease who are scheduled for invasive procedures. The efficacy of lusutrombopag based on the pretreatment platelet count was investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients treated at nine hospitals from December 2015 to December 2023 were included. Efficacy was assessed by comparing the proportion of patients achieving a platelet count ≥ 50 000/μL and the change in platelet count.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy patients were eligible for evaluation. Patients with a pretreatment platelet count &lt; 40 000/μL had a significantly lower rate of achieving a platelet count of ≥ 50 000/μL than those with a pretreatment count of 40 000–50 000/μL (62.5% vs. 84.2%, <i>p</i> = 0.038); however, there was no significant difference in the change in platelet count (25 700 vs. 24 400/μL, <i>p</i> = 0.972). Patients with viral-related cirrhosis showed a significantly greater change in platelet count than the others (29 100 vs. 19 200/μL, <i>p</i> = 0.012). For patients receiving multiple lusutrombopag treatments, the change in platelet count was significantly lower in the second treatment than in the first treatment (26 900 vs. 20 800/μL, <i>p</i> = 0.041). The main adverse event observed was thrombosis (2.9%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Lusutrombopag increases platelet count regardless of pretreatment levels, but efficacy, defined as achieving a platelet count of ≥ 50 000/μL, may be insufficient in patients with a pretreatment platelet count &lt; 40 000/μL. Additionally, patients with non-viral liver disease responded less well to treatment compared to those with viral liver disease. Therefore, treatment strategies should be tailored based on pretreatment platelet counts and the etiology of liver disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11686089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915917","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":"Safety of Colonoscopies in Patients on Advanced Heart Failure Therapies Who Received a Heart Transplant","authors":"Zaid Ansari,&nbsp;Akram Ahmad,&nbsp;Osama Sharjeel Khan,&nbsp;Vuha Reddi,&nbsp;Fernando Castro","doi":"10.1002/jgh3.70090","DOIUrl":"10.1002/jgh3.70090","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients undergoing evaluation for a heart transplant are frequently on inotropic medications or mechanical circulatory support (MCS) devices, which places them at a higher risk for anesthesia-related complications. These patients often require colonoscopies for bleeding or screening purposes, but there are limited data on the safety and outcomes of colonoscopy in this setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective, two-center study between the years 2015 and 2021 of patients with heart failure who subsequently underwent a heart transplant. To be included in the study, patients were required to be on advanced heart failure therapies at the time of colonoscopy. Advanced heart failure therapies were defined as requiring inotropes (milrinone or dobutamine), vasopressors (norepinephrine or vasopressin), or MCS such as an impella, left ventricular assist device (LVAD), intra-aortic balloon pump (IABP), or extra-corporeal membrane oxygenation (ECMO). Indications for colonoscopy, adequacy of bowel preparation, and complications were reported.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 92 patients were included in the study. The most common indication was colon cancer screening (67%), and the remainder were performed due to gastrointestinal bleeding. An inadequate bowel preparation was reported on 20% of patients, but the cecum was reached in all of them. There was no association between the inadequacy of bowel preparation and the presence of MCS (20% vs. 17%, <i>p</i> value 0.67). In colonoscopies performed for screening, 8% (5/62) of patients were found to have an advanced adenoma. In colonoscopies performed for bleeding, 17% (5/30) had a source that required therapeutic intervention and use of hemostatic clips was the preferred modality. Only four patients had a complication of bleeding requiring clips after polypectomy during the index procedure, with no anesthesia-related adverse events (such as hypotension, arrhythmias, or cardiac arrest) or addition of inotropes, vasopressors, or MCS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Colonoscopy in patients on advanced heart failure therapies is acceptable with not only a low rate of complications but also a high rate of inadequate bowel preparation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915921","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":"Management Outcomes of Variceal Bleeding in Northern Tanzania: Insights From a Single-Center Retrospective Analysis","authors":"Eliada B. Nziku,&nbsp;Elifuraha W. Mkwizu,&nbsp;Abid M. Sadiq,&nbsp;Fuad H. Said,&nbsp;Doreen T. Eliah,&nbsp;Ibrahim Ali Ibrahim Muhina,&nbsp;Tumaini E. Mirai,&nbsp;Furaha S. Lyamuya,&nbsp;Nyasatu G. Chamba,&nbsp;Elichilia R. Shao,&nbsp;Kajiru G. Kilonzo,&nbsp;Sarah J. Urasa","doi":"10.1002/jgh3.70088","DOIUrl":"10.1002/jgh3.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Due to the expensiveness and unavailability of endoscopy management in Tanzania, the management outcomes of variceal bleeding are unknown. The objective of this study was to assess the management outcomes of patients with variceal bleeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study conducted between April 2012 and April 2022. The study enrolled all patients diagnosed with variceal bleeding aged 18 years and older. Socio-demographic and clinic characteristics, treatment modalities, and outcomes were collected. Statistical analysis was done using a chi-square test. Multivariable logistic regression was used to determine factors associated with rebleeding and mortality. A <i>p</i>-value of ≤ 0.05 was considered statistically significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 534 patients were enrolled based on diagnostic endoscopy findings. Esophageal varices were identified in 88.9% of patients, gastric varices in 0.9%, and 10.1% had both. Conservative treatment was given to 77.5% of patients, and endoscopic treatment was performed in 22.5%: endoscopic variceal ligation (17.6%), endoscopic injection sclerotherapy (4.3%), and both (0.6%). Rebleeding occurred in 40.1%, and factors associated with rebleeding were patients without insurance (<i>p</i> = 0.037), without comorbidities (<i>p</i> = 0.042), with non-communicable diseases (<i>p</i> = 0.039), and with chronic infections (<i>p</i> = 0.035). In-hospital mortality was 8.1%, and factors associated with mortality were a shorter length of stay (<i>p</i> = 0.045), patients without comorbidities (<i>p</i> = 0.041), and grade II esophageal varices (<i>p</i> = 0.043).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study shows a high rate of variceal bleeding among patients treated conservatively. Mortality and rebleeding rates in our setting remain high, which appears to be due to the expensiveness and unavailability of endoscopic treatment. Available endoscopic interventions will be vital in improving the outcomes of patients with variceal bleeding.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915919","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":"Ensuring the Future Pool of Gastroenterologists in the United Kingdom Is Imperative","authors":"Hareesha Rishab Bharadwaj,&nbsp;Medha Sridhar Rao,&nbsp;Aditya Gaur,&nbsp;Khabab Abbasher Hussien Mohamed Ahmed,&nbsp;Arkadeep Dhali","doi":"10.1002/jgh3.70084","DOIUrl":"10.1002/jgh3.70084","url":null,"abstract":"<p>This perspective article explores the importance of fostering interest in gastroenterology among medical students and addressing the barriers that deter them from pursuing careers in this specialty. The paper highlights the critical role of early exposure to research, specialized electives, and mentorship in encouraging students to consider gastroenterology as a career choice. Current challenges include limited access to specialized electives and research opportunities within UK medical schools, inadequate hands-on experience, and a perceived lack of stability and control over future training pathways. Additionally, suboptimal working conditions in the National Health Service (NHS) and uncertainty in the allocation of foundation jobs further discourage students from specializing in gastroenterology. To address these issues, the paper proposes several strategies: expanding gastroenterology electives, increasing research opportunities through grassroots initiatives and developing targeted mentorship programs to guide and inspire students. Furthermore, enhancing diversity and representation within the specialty by removing barriers for female medical students is crucial for creating a more inclusive environment. This article combines insights from existing literature, personal experiences, and innovative educational initiatives to provide a comprehensive overview of the current state of gastroenterology training for medical students. The recommendations aim to inspire new approaches to medical education and training that will cultivate a well-prepared, diverse, and motivated workforce ready to advance the field of gastroenterology.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883260","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":"Linkage to Care of People With Chronic Hepatitis B Virus and Hepatitis C Virus Infection Among Blood Donors: Experience From an Apex Treatment Centre Under National Viral Hepatitis Control Program, India","authors":"Sk Mahiuddin Ahammed,&nbsp;Boby Maibam Singh,&nbsp;Swapan Saren,&nbsp;Pratik Dey,&nbsp;Raja Roy,&nbsp;Abhijit Chowdhury","doi":"10.1002/jgh3.70085","DOIUrl":"10.1002/jgh3.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Chronic viral hepatitis is a major public health challenge. The World Health Organization (WHO) and many national programs have set goals for elimination of viral hepatitis by 2030. Screening, Linkage to care (LTC), and access to treatment are very important steps to eliminate viral hepatitis. The study aimed to assess the cascade of chronic viral hepatitis care and the barrier of LTC in the National Viral Hepatitis Control Program (NVHCP).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this observational cross-sectional study, healthy voluntary blood donors from two leading blood banks, who were HBsAg or anti-HCV reactive, were advised to attend the clinic of NVHCP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 116 569 healthy blood donors, prevalence of chronic HBV and HCV were 0.5% and 0.2% respectively. LTC was very poor. Only 27.7% HBsAg positive and 8.9% anti HCV positive patients attended NVHCP clinic. However, those who attended the clinic, 87.8% HBV and 100% HCV-infected patients were retained. All HCV patients (<i>n</i> = 16) achieved SVR-12. Among HBV-infected patients, treatment eligibility was 21%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this study, LTC was very poor. Only 27.7% of chronic HBV and 9% of HCV patients attended the NVHCP clinic. Immediate interventions are required to enhance LTC for asymptomatic patients with chronic viral hepatitis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11664039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883263","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":"Efficacy of Vonoprazan 10 mg and 20 mg for Patients With Proton Pump Inhibitor-Refractory Functional Dyspepsia: A Double-Blinded, Randomized Study","authors":"Chalermrat Bunchorntavakul,&nbsp;Pantaree Jaigla","doi":"10.1002/jgh3.70082","DOIUrl":"https://doi.org/10.1002/jgh3.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A proportion of patients with functional dyspepsia (FD) have inadequate symptom control with proton pump inhibitors (PPIs) treatment. Vonoprazan demonstrates higher efficacy in acid reduction than PPI; however, the existing efficacy data for vonoprazan in treating PPI-refractory FD is limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This double-blinded, randomized controlled trial study was conducted at Rajavithi Hospital, Bangkok between December 2022 and 2023. Patients with FD who were unresponsive to the standard dose PPI were randomly assigned (1:1) to receive either 10 mg or 20 mg of vonoprazan for a 4-week duration, with a subsequent 4-week follow-up after treatment. The primary outcome was changes in the Global Overall Symptoms Scale (GOSS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty patients were randomized without significant differences in baseline characteristics between both groups. The mean GOSS between the 10-mg vonoprazan and the 20-mg vonoprazan arm were 25.73 and 26.17 at week 0, 14.33 and 15.50 at week 2, 9.37 and 10.04 at week 4, and 9.79 and 9.33 at week 8, respectively (all <i>p</i> &lt; 0.001 vs. baseline and <i>p</i> &gt; 0.05 between groups). The quality of life was improved, with the Nepean dyspepsia index changing −4.13 and −4.25 at week 4, respectively (all <i>p</i> &lt; 0.001 vs. baseline; <i>p</i> = 0.853 between groups). Symptom response rates (&gt; 50% improvement in GOSS) were 72.4% and 75.9% at week 8, respectively (<i>p</i> = 0.24 between groups). No serious adverse events were observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Vonoprazan demonstrated significant effects in the alleviation of symptoms in PPI-refractory FD patients. There was no statistically significant difference in symptom alleviation between the 10 mg and 20 mg doses of vonoprazan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"8 12","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142868974","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}