JGH Open最新文献

{"title":"Peroxisome Proliferator-Activated Receptor (PPAR) Agonists for Patients With Primary Biliary Cholangitis With Inadequate Response to Ursodeoxycholic Acid (UDCA): A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Maadeha H. Zaidi,&nbsp;Zaroon Haider,&nbsp;FNU Sadia,&nbsp;Muhammad Tayyab,&nbsp;Muhammad Naveed Tariq,&nbsp;Hasaan H. Ans,&nbsp;Muhammad Bilal Javaid,&nbsp;Ahmad Khan,&nbsp;Muhammad Hassan Ahmad,&nbsp;Rahman Rasheed,&nbsp;Uzair Jafar,&nbsp;Huzaifa Ahmad Cheema,&nbsp;Asma'a Munasar Ali Alsubari,&nbsp;Muhammad Shahzil,&nbsp;Essam Rashad,&nbsp;Rehmat Ullah Awan,&nbsp;Hassam Ali,&nbsp;Prasun K. Jalal","doi":"10.1002/jgh3.70196","DOIUrl":"https://doi.org/10.1002/jgh3.70196","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Peroxisome proliferator-activated receptor (PPAR) agonists are agents used for patients with primary biliary cholangitis (PBC) who do not respond to conventional agents like ursodeoxycholic acid (UDCA). This meta-analysis aimed to assess the safety and efficacy of PPAR agonists, including fibrates and selective PPAR agonists, on biochemical response and safety outcomes in patients with primary biliary cholangitis who were non-responders to UDCA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched various electronic databases, including MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov, to retrieve randomized controlled trials (RCTs) comparing PPAR agonists to placebo in patients with PBC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our meta-analysis, including 12 RCTs involving 973 patients, showed that PPAR agonists, including fibrates and selective PPAR agonists, significantly reduce mean alkaline phosphatase (ALP) levels from baseline to follow-up as compared to placebo. They also increase the number of patients with the composite biochemical response (RR 5.51; 95% CI: 2.80, 10.86) and normalize ALP levels with a reduction in pruritus NRS Score and the incidence of pruritus. There was no significant change between the two groups when assessing the mean change in total bilirubin, adverse events, serious adverse events, or mean change in PBC-40 score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, our research underscores the potential of novel PPAR agonists in improving biochemical markers in PBC, particularly in patients unresponsive to UDCA. However, further studies with larger sample sizes, longer follow-up durations, and a focus on patient-centered outcomes are necessary. Additionally, exploring combination therapies and mechanistic insights will help us fully realize the therapeutic potential of PPAR agonists in PBC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70196","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144219980","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":"Gastric Myoelectrical Activity Patterns and Water-Load Satiety Test in Patients With Chronic Dyspeptic Symptoms","authors":"Uday C. Ghoshal,&nbsp;Mahesh K. Goenka,&nbsp;Uzma Mustafa,&nbsp;Awanish Tewari,&nbsp;Nikhil Sonthalia,&nbsp;Subhamoy Das,&nbsp;Nabaruna Chakraborty,&nbsp;Akash Roy,&nbsp;Shruti Keyal,&nbsp;Sourish Roy","doi":"10.1002/jgh3.70189","DOIUrl":"https://doi.org/10.1002/jgh3.70189","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background/Aims</h3>\u0000 \u0000 <p>Patients with chronic dyspeptic symptoms may or may not experience nausea and vomiting. Consensus papers suggested that gastroparesis should be defined by symptoms like nausea and vomiting rather than investigations only. Recognizing that gastric dysrhythmias contribute to nausea, vomiting, and maybe a biomarker and therapeutic target, the primary hypothesis of the study was that dyspeptic patients with predominant nausea and vomiting, without mechanical obstruction, would show different gastric myoelectrical activity (GMA) on electrogastrography (EGG) and tolerance to the water-load satiety test (WLST) than those without these symptoms. The secondary aim was to assess the relationship between GMA, WLST, and demographic and clinical profiles.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data of 660 chronic dyspeptic patients undergoing WLST-based EGG were retrospectively analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 660 patients, 287 (females 158[55%]) experienced nausea with or without vomiting, while 373 (females 151[41%]) did not. Nausea with or without vomiting was significantly associated with female gender, younger age, and weight loss (151[40.5%] vs. 158[55.1%], <i>p</i> &lt; 0.001; 47[36,59] vs. 41[29,55], <i>p</i> &lt; 0.001; 62[16.6%] vs. 85[29.6%], <i>p</i> &lt; 0.001). Patients with nausea with/without vomiting could drink lesser volumes of water compared to those without (500[400,500] vs. 500[450,550], <i>p</i> = 0.007). Gastric dysrhythmia was present in both groups. Normogastric power change was significantly lower in patients with nausea with or without vomiting, compared to those with neither nausea nor vomiting (3.7[−5.5, 11.5] vs. 7.3[−1.7,16], <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients experiencing nausea with or without vomiting have significantly more GMA abnormalities as evidenced by reduced power change in the normogastria range after water intake, and could drink lesser water, compared to patients without these symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214082","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":"Association of Estimated Plasma Volume Status With Invasive Hemodynamics and All-Cause Mortality in Patients With Liver Cirrhosis","authors":"Esteban Kosak Lopez,&nbsp;Phuuwadith Wattanachayakul,&nbsp;Jose Manuel Martinez Manzano,&nbsp;Andrew Geller,&nbsp;Simone A. Jarrett,&nbsp;John Malin,&nbsp;Raul Leguizamon,&nbsp;Tara A. John,&nbsp;Rasha Khan,&nbsp;Ian McLaren,&nbsp;Alexander Prendergast,&nbsp;Kevin Bryan Lo,&nbsp;Zurab Azmaiparashvili","doi":"10.1002/jgh3.70195","DOIUrl":"https://doi.org/10.1002/jgh3.70195","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Estimated plasma volume status (ePVS) correlates with intravascular congestion and prognosis in patients with heart failure. The ePVS relationship with invasive hemodynamic profiling and clinical outcomes in patients with liver cirrhosis (LC) remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center retrospective cohort study included LC patients who underwent right heart catheterization (RHC) between 2018 and 2023. Estimated plasma volume status (ePVS) was calculated using the Strauss-derived Duarte formula, with patients classified into high (&gt; 5.5%) and low-ePVS (≤ 5.5%) groups. Cox-multivariable analysis was used to determine if ePVS was associated with all-cause mortality within 1 year post-RHC among transplant-free patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 353 patients with LC (median age 59 years, 59% male, 45% Caucasian, and 29% African American), 79% were classified into the high-ePVS group. Compared to the low-ePVS group, the high-ePVS group had significantly higher right atrial pressure (9 vs. 6 mmHg, <i>p</i> = 0.01), pulmonary arterial wedge pressure (14 vs. 11 mmHg, <i>p</i> = 0.014), cardiac output (9.8 vs. 6.4 L/min, <i>p</i> &lt; 0.0001), and cardiac index (5 vs. 3.1 L/min/m², <i>p</i> &lt; 0.0001). Additionally, the high-ePVS group exhibited a higher prevalence of cirrhosis-related complications, including ascites, splenomegaly, and varices, and a greater likelihood of receiving orthotopic liver transplantation within 1 year (38% vs. 11%, <i>p</i> &lt; 0.0001). Among transplant-free patients, ePVS was independently associated with all-cause mortality at 1 year (HR 1.15, 95% CI: 1.00–1.32, <i>p</i> = 0.048).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study demonstrated that ePVS was associated with intravascular congestion, hyperdynamic circulation, and cirrhosis complications. Furthermore, ePVS was independently associated with all-cause mortality among transplant-free LC patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190958","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 Reviewing Procedure With Visual Gaze Patterns on Improving Endoscopic Submucosal Dissection Skills","authors":"Huy Thanh Dang,&nbsp;Fumiaki Ishibashi,&nbsp;Kosuke Okusa,&nbsp;Kentaro Mochida,&nbsp;Takao Tonishi,&nbsp;Sho Suzuki","doi":"10.1002/jgh3.70193","DOIUrl":"https://doi.org/10.1002/jgh3.70193","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>No previous studies have reported on whether tracking and reviewing physicians' gaze patterns affect the endoscopic submucosal dissection (ESD) training process. This study investigated differences in physicians' gaze patterns during ESD and assessed how reviewing their procedure afterward impacted ESD skills.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>The gazing points of three trainees during mucosal incision, submucosal dissection, and hemostasis were captured and recorded using the eye-tracking device. Fifteen short video clips were created from six recorded videos. Three trainees and two expert endoscopists later reviewed these video clips. Key outcomes included: (1) time spent gazing at the appropriate mucosal incision direction, (2) time spent gazing at the appropriate submucosal dissection line, and (3) time required to identify bleeding points. During video review, the trainees spent significantly more time fixating on the appropriate mucosal incision direction than during live performance (24.9 s vs. 6.4 s, <i>p</i> &lt; 0.01). However, this was still shorter than expert reviewers (28.4 s, <i>p</i> &lt; 0.01). Similarly, the trainees spent more time observing the appropriate submucosal dissection line during review than in real-time (12.9 s vs. 4.8 s, <i>p</i> &lt; 0.05), with no significant difference compared to the experts (14.6 s, <i>p</i> = 0.66). However, there was no significant difference in time to identify the bleeding point between review and real-time performance (9.3 s vs. 11.4 s, <i>p</i> = 1.00).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This pilot study suggests that video-based review with eye-tracking feedback may help trainees adopt expert-like visual strategies during ESD, potentially enhancing procedural performance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70193","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144171846","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":"Compounding Prevalence of Inflammatory Bowel Disease in a 2024 Population-Based Study From Canterbury, New Zealand","authors":"Angela J. Forbes,&nbsp;Andrew S. Day,&nbsp;Chris M. A. Frampton,&nbsp;Richard B. Gearry","doi":"10.1002/jgh3.70192","DOIUrl":"https://doi.org/10.1002/jgh3.70192","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>The epidemiological patterns of inflammatory bowel disease (IBD) can give insights into disease etiology and health system burden. This study aimed to measure the population-based prevalence in Canterbury and consider the region's position within the 4-stage epidemiological model of IBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Gastroenterology clinics in Canterbury were searched for patients with a confirmed diagnosis of IBD. Demographic and disease details (including Montreal phenotype) were extracted from individual medical records. The prevalence of IBD, Crohn's disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU) was established for the total population and for age, sex, and ethnic sub-groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 4042 individuals (1 in 150 people) in Canterbury with IBD were identified. The point prevalence of IBD on 1st January 2024 was 671 (95% CI 651–692) per 100 000 persons. The prevalence of CD 386 (95% CI 370–402) was higher than UC 264 (95% CI 251–277) each per 100 000. Almost three times as many individuals had IBD in 2024, compared to a 2005 study. The majority of the cohort were New Zealand European (92.9%) followed by Māori (4.2%), Asian (2.6%) and Pacific peoples (0.3%). Older adults (65+ years) comprised 21% of the population with a prevalence of 845 (95% CI 789–904) per 100 000 persons.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Canterbury has the highest reported prevalence of IBD in Oceania to date, and there is a growing proportion of older age patients. The rapid rise in cases supports the hypothesis that Canterbury is in the compounding prevalence stage of the epidemiological model of IBD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70192","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179312","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":"Proctitis and Other Gastrointestinal Manifestations in Mpox Disease: A Systematic Review and Meta-Analysis","authors":"Prakasini Satapathy,&nbsp;Abhay M. Gaidhane,&nbsp;Nasir Vadia,&nbsp;Soumya V. Menon,&nbsp;Kattela Chennakesavulu,&nbsp;Rajashree Panigrahi,&nbsp;Sanjit Sah,&nbsp;Suraj Tiwari,&nbsp;S. Govinda Rao,&nbsp;Khang Wen Goh,&nbsp;Rachana Mehta,&nbsp;Muhammed Shabil,&nbsp;Mahendra Singh,&nbsp;Ganesh Bushi","doi":"10.1002/jgh3.70190","DOIUrl":"https://doi.org/10.1002/jgh3.70190","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mpox, caused by the monkeypox virus (MPXV), is primarily recognized for its dermatologic and systemic symptoms. However, emerging evidence suggests a significant prevalence of gastrointestinal (GI) manifestations, particularly proctitis, diarrhea, nausea, vomiting, and abdominal pain. Despite the growing clinical recognition of these symptoms, their epidemiology and impact remain poorly understood. This systematic review and meta-analysis aim to quantify the prevalence of GI manifestations in Mpox patients and assess their clinical significance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review following PRISMA guidelines was conducted across PubMed, Embase, and Web of Science, including quantitative studies published up until October 2024 that reported GI manifestations in Mpox patients. Screening and data extraction were performed using Nested Knowledge software, and study quality was assessed using the Newcastle–Ottawa Scale. Meta-analysis was conducted using R version 4.4, with heterogeneity evaluated via the <i>I</i>² statistic. Sensitivity analyses and publication bias were assessed using Doi plots and the Luis Furuya-Kanamori (LFK) index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 1229 records, 33 studies met the eligibility criteria, yielding a pooled prevalence of proctitis in Mpox patients at 24.75% (95% CI: 18.93%–31.04%) across 5878 participants, with high heterogeneity (<i>I</i>² = 94.8%). The prediction interval for proctitis ranged from 1.46% to 61.76%. The pooled prevalence of other GI manifestations was 30.45% (95% CI: 18.27%–44.14%) across 2237 participants, with significant heterogeneity (<i>I</i>² = 95.2%) and a prediction interval ranging from 0.00% to 85.28%. Sensitivity analyses confirmed the stability of these estimates, while publication bias was indicated by LFK index values exceeding 2.77.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This meta-analysis highlights the substantial burden of GI manifestations in Mpox, particularly proctitis, with considerable variability across studies. The findings underscore the need for standardized diagnostic criteria and increased clinical recognition of GI symptoms in Mpox management. Further research into the underlying pathophysiology and integrating GI symptom assessment into Mpox surveillance and treatment strategies could enhance diagnostic accuracy and patient care outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Successful Case of Endoscopic Detorsion of Gastric Volvulus and Percutaneous Endoscopic Gastrostomy Placement for Gastropexy in an Elderly Patient","authors":"Jerapas Thongpiya,&nbsp;Ahmed Shukri,&nbsp;Pitchaporn Yingchoncharoen,&nbsp;Atul Ratra,&nbsp;Kanak Das","doi":"10.1002/jgh3.70180","DOIUrl":"https://doi.org/10.1002/jgh3.70180","url":null,"abstract":"<p>Gastric volvulus is an uncommon life-threatening condition, caused by abnormal rotation of more than 180° of the stomach along its long axis. Typical presentation includes patients &gt; 50 years old, pre-existing hiatal, diaphragmatic hernias, or previous surgery. This condition carries a high morbidity, which necessitates prompt recognition and management with surgery or endoscopy. Here, we present a successful case of endoscopic detorsion of gastric volvulus and percutaneous endoscopic gastrostomy placement for gastropexy in an elderly patient.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144135743","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":"Frailty Predicts Mortality and Procedural Performance in Patients With Non-Variceal Upper Gastrointestinal Bleeding","authors":"Ali Jaan,&nbsp;Adeena Maryyum,&nbsp;Hassam Ali,&nbsp;Umer Farooq,&nbsp;Dushyant Singh Dahiya,&nbsp;Qurat Ul Ain Muhammad,&nbsp;Fernando J. Castro","doi":"10.1002/jgh3.70188","DOIUrl":"https://doi.org/10.1002/jgh3.70188","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalization in the United States, with approximately 400 000 admissions annually and a 5%–10% mortality rate. This study aimed to evaluate frailty's impact on NVUGIB outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We utilized the 2019 National Readmission Database (NRD) to identify adult patients (≥ 18 years) admitted with a principal diagnosis of NVUGIB using ICD-10-CM codes. NVUGIB hospitalizations were stratified by frailty using the hospital frailty risk score (HFRS) of 5 or more as the cut-off for frailty. Multivariate regression analyses were conducted to analyze the outcomes. STATA 14.2 was used for statistical testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 218 647 NVUGIB admissions, 99 892 (45.69%) were frail. Frail patients were older, more often female, and had higher comorbidity burdens. They showed significantly greater in-hospital mortality (adjusted odds ratio [aOR] 5.64, 95% CI 4.94–6.44; <i>p</i> &lt; 0.001), acute kidney injury (5.85), respiratory failure (6.93), septic shock (40.94), hemorrhagic shock (2.64), vasopressor use (4.36), mechanical ventilation (6.04), and ICU admission (5.41). Although frail patients had higher odds of esophagogastroduodenoscopy (EGD) with intervention (1.04; <i>p</i> &lt; 0.001), they were less likely to receive EGD within 24 h (0.75; <i>p</i> &lt; 0.001). They also had higher odds of rebleeding (1.18; <i>p</i> &lt; 0.001) and radioembolization (2.69; <i>p</i> &lt; 0.001). Length of stay increased by 2.30 days, total charges rose by $28 518, discharge to rehabilitation was more frequent (3.12; <i>p</i> &lt; 0.01), and 30-day readmission was higher (15.24% vs. 11.43%, HR 1.16; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Frailty independently predicts worse clinical outcomes and increased resource use in NVUGIB. Recognizing frailty may improve risk stratification and guide more tailored management strategies for this high-risk population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70188","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144100414","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":"Usefulness of Spleen Index and Alkaline Phosphatase Level for Predicting Post-Liver Biopsy Bleeding","authors":"Hirohito Takeuchi,&nbsp;Katsutoshi Sugimoto,&nbsp;Tatsuya Kakegawa,&nbsp;Hiroshi Takahashi,&nbsp;Takuya Wada,&nbsp;Masakazu Abe,&nbsp;Yu Yoshimasu,&nbsp;Kazuharu Harada,&nbsp;Masataka Taguri,&nbsp;Takao Itoi","doi":"10.1002/jgh3.70183","DOIUrl":"https://doi.org/10.1002/jgh3.70183","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The significance of liver biopsy is increasing with an increase in chronic liver disease and gene panel testing. Although non-invasive methods such as elastography and biomarkers assess liver fibrosis, biopsy remains the definitive diagnostic gold standard. We evaluated the predictors of bleeding complications in liver biopsies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>A total of 697 patients were enrolled in this study between May 2017 and October 2022. We examined bleeding complications and procedures following liver biopsy and the liver biopsy needle size, blood test results, and spleen index to determine factors related to bleeding complications. Bleeding complications occurred in 23 patients (3.3%), including 20 cases at the liver puncture site, two instances of biliary bleeding, and one intercostal artery injury. The treatments varied and included hepatic arterial embolization (2 patients, 0.3%), blood transfusion therapy (3 patients, 0.4%), radiofrequency ablation (2 patients, 0.3%), endoscopic nasobiliary drainage (1 patient, 0.1%), and other treatments. In multivariate and ROC analyzes, a higher spleen index (Odds ratio: 1.13 [1.07–1.20], AUC: 0.74, optimal cut-off value: 16.2, sensitivity: 0.74, specificity: 0.64) and ALP level (Odds ratio: 1.00 [1.00–1.01], AUC: 0.71, optimal cut-off value: 94.5, sensitivity: 0.83, specificity: 0.49) were associated with an increased risk of bleeding. Other significant factors influencing bleeding included age, PT-INR, needle size, and Child–Pugh score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The identified risk factors included spleen index and ALP level, particularly in relation to bleeding complications during liver biopsy. Therefore, these predictors should be considered before performing a liver biopsy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144091782","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":"History of Previous Medication Self-Discontinuation Predicts the Current Adherence to 5-Aminosalicylates in Patients With Ulcerative Colitis","authors":"Shogo Kitahata,&nbsp;Ayaka Nakamura,&nbsp;Yuka Kimura,&nbsp;Mai Fukumoto,&nbsp;Kana Matsuoka,&nbsp;Takuya Matsuda,&nbsp;Kazuya Murakawa,&nbsp;Taisei Murakami,&nbsp;Kei Onishi,&nbsp;Hirofumi Izumoto,&nbsp;Kozue Kanemitsu-Okada,&nbsp;Tomoe Kawamura,&nbsp;Taira Kuroda,&nbsp;Junko Matsuoka,&nbsp;Fujimasa Tada,&nbsp;Hideki Miyata,&nbsp;Atsushi Hiraoka,&nbsp;Kazuhiro Tange,&nbsp;Yasunori Yamamoto,&nbsp;Eiji Takeshita,&nbsp;Yoshiou Ikeda,&nbsp;Shinya Furukawa,&nbsp;Eiji Tsubouchi,&nbsp;Tomoyuki Ninomiya,&nbsp;Yoichi Hiasa","doi":"10.1002/jgh3.70181","DOIUrl":"https://doi.org/10.1002/jgh3.70181","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Medication adherence is critical in 5-aminosalicylate therapy for patients with ulcerative colitis. Patients with a history of previous medication self-discontinuation may continue to have low adherence due to the influence of inappropriate disease awareness. This study aimed to determine the association between the history of previous medication self-discontinuation and current adherence to 5-aminosalicylates in patients with ulcerative colitis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>This cross-sectional study was conducted in Japan from 2021 to 2024. A self-administered questionnaire was used in 228 patients with ulcerative colitis who were taking 5-aminosalicylates. We defined adherence as consumption of ≥ 80% of the prescribed dose. Patients with a history of previous medication self-discontinuation were defined as having discontinued medication at least once in the past by their own judgment. The current adherence rate to 5-aminosalicylates in this study was 92.9% (212/228). The proportion of patients with a history of previous medication self-discontinuation was 7.8% (18/228). History of previous medication self-discontinuation (<i>p</i> &lt; 0.001), younger age (<i>p</i> &lt; 0.001), and once-daily 5-aminosalicylates regimen (<i>p</i> &lt; 0.001) were inversely associated with current adherence to 5-aminosalicylates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>History of previous medication self-discontinuation was inversely associated with current adherence to 5-aminosalicylates among patients with ulcerative colitis. The results of this study suggest that determining the history of previous medication self-discontinuation may be a valuable tool in assessing current adherence to 5-aminosalicylates, which can be cumbersome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70181","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144100767","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}