JGH Open最新文献

{"title":"Intravenous Versus Oral Iron After Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Mohamed Abuelazm,&nbsp;Ahmed Fares,&nbsp;Mohammad Adam,&nbsp;Yazan Sallam,&nbsp;Ahmed Mazen Amin,&nbsp;Hosam I. Taha,&nbsp;Mustafa Turkmani,&nbsp;Fouad Jaber","doi":"10.1002/jgh3.70225","DOIUrl":"https://doi.org/10.1002/jgh3.70225","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background &amp; Objective</h3>\u0000 \u0000 <p>Few trials have compared the efficacy of intravenous (IV) iron repletion to oral repletion for patients with gastrointestinal bleeding (GIB). We aim to guide clinical decision-making and optimize treatment strategies through the findings from these studies to provide a step closer to a consensus on the most effective approach to iron supplementation for patients with GIB.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Embase, CENTRAL, Scopus, and Web of Science from inception to April 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI). PROSPERO ID: CRD42024542759.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Three RCTs that included 254 patients were included. IV iron was significantly associated with increased complete response (RR: 1.60 with 95% CI [1.24, 2.07], <i>p</i> &lt; 0.01) compared to oral iron, with no significant difference between IV iron and oral iron in partial response (RR: 2.13 with 95% CI [0.60, 7.50], <i>p</i> = 0.24). IV iron was significantly associated with increased Hb concentration (MD: 1.45 g/dL with 95% CI [0.50, 2.40], <i>p</i> &lt; 0.01) and ferritin change (MD: 220.02 μg/L with 95% CI [22.31, 417.73], <i>p</i> = 0.03) compared to oral iron. However, there was no significant difference between IV and oral iron in transferrin saturation (MD: 4.71% with 95% CI [−5.96, 15.38], <i>p</i> = 0.39).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With uncertain evidence, IV iron demonstrated increased hemoglobin and ferritin concentrations and achieved complete response rates in patients with GIB.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70225","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144647657","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 Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer Patients With Concurrent Advanced Malignancies With Expected Poor Prognosis","authors":"Hiroki Takemoto,&nbsp;Hidehiko Takigawa,&nbsp;Takahiro Kotachi,&nbsp;Hajime Teshima,&nbsp;Akiyoshi Tsuboi,&nbsp;Hidenori Tanaka,&nbsp;Ken Yamashita,&nbsp;Yuji Urabe,&nbsp;Toshio Kuwai,&nbsp;Shiro Oka","doi":"10.1002/jgh3.70226","DOIUrl":"https://doi.org/10.1002/jgh3.70226","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Despite improved outcomes for malignant tumors, evidence regarding the management of patients with multiple malignancies remains limited. We aimed to evaluate the clinical outcomes and prognosis of patients undergoing endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) complicated by advanced malignancies in other organs with a poor prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We retrospectively reviewed 3703 gastric cancer patients who underwent ESD at our hospital (2005–2022), focusing on those with advanced extra-gastric malignancies with a 5-year survival rate of &lt; 50%. ESD was performed for local tumor control based on patient preference when feasible, including lesions meeting standard, expanded, or relative indications where curative resection was unachievable. Clinicopathological characteristics and outcomes were analyzed. Twenty-six patients met the inclusion criteria. En bloc resection was achieved in all cases (100%), with curative and non-curative resection in 16 (62%) and 10 (38%) cases, respectively. None of the 10 patients with non-curative resection exhibited lymphovascular invasion or GC recurrence. Complications included delayed bleeding, perforation, and pneumonia, each in one patient (4%), all leading to disseminated intravascular coagulation (DIC) and death within 30 days post-ESD. Notably, no complications were reported after 2010. Eleven patients died from advanced malignant tumors, with no GC recurrences observed during follow-up in surviving patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Recently, no severe complications have been observed with ESD. Although ESD for local control in EGC with concurrent advanced extra-gastric malignancies may be acceptable, the risk of severe complications, including DIC, remains. Therefore, careful patient selection and thorough informed consent are essential.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70226","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624770","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 Size–Growth Rate Relationship in Hepatocellular Carcinoma","authors":"Dhanushan Gnanendran,&nbsp;Adina Olaru,&nbsp;Meetal Shah,&nbsp;Jonathan Jackson,&nbsp;Suresh V. Venkatachalapathy,&nbsp;Aloysious D. Aravinthan","doi":"10.1002/jgh3.70224","DOIUrl":"https://doi.org/10.1002/jgh3.70224","url":null,"abstract":"&lt;p&gt;Hepatocellular carcinoma (HCC), a leading cause of cancer-related deaths worldwide, remains a significant clinical challenge, contributing to ~800 000 deaths each year [&lt;span&gt;1&lt;/span&gt;]. Surveillance is an effective strategy in managing HCC, with studies showing improved early-stage detection, curative treatment, and better survival rates with surveillance [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The HCC surveillance strategy includes an ultrasound scan (US) every 6 months, based on the shortest mean doubling time observed in growth kinetics studies conducted in the 1980s [&lt;span&gt;3, 4&lt;/span&gt;], a finding that has been corroborated by more recent research [&lt;span&gt;5, 6&lt;/span&gt;]. Based on this evidence, international organizations such as the European Association for the Study of the Liver (EASL), along with national bodies, recommend a six-monthly US for HCC surveillance [&lt;span&gt;2-7&lt;/span&gt;]. However, one issue with this recommendation is the assumption that HCC grows at a relatively predictable and constant rate. Studies show a significant variation in tumor volume doubling time, ranging from 2.2 to 11.3 months [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;One factor likely to influence HCC growth rate is tumor size. Understanding the relationship between tumor size and growth rate can aid in treatment planning and prioritizing patients at risk of faster tumor progression. To explore this potential association, a prospective study was designed at a single tertiary-care centre, with approval from the Nottingham University Hospital Clinical Effectiveness Board (19-223C). All newly diagnosed HCC patients were eligible for inclusion if they had undergone at least two cross-sectional imaging studies of the same modality (CT or MRI) at different time points prior to any treatment. Patients with a prior history of HCC presenting with recurrent disease were excluded. HCC was defined as any lesion classified as Liver Imaging Reporting and Data System (LI-RADS) LR-5 on initial or subsequent cross-sectional imaging, or confirmed histologically. All cross-sectional images were independently reviewed by two hepatobiliary radiologists (M.S. and J.J.), showing excellent interobserver agreement (&lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.8339). The HCC growth rate was calculated by measuring the maximum diameter on initial and follow-up cross-sectional imaging, expressing the change in size over the time interval between the scans.&lt;/p&gt;&lt;p&gt;A total of 144 HCC lesions from 65 patients were included in the analysis. Analysis revealed a significant correlation between initial tumor size and monthly growth rate (Spearman's rank correlation coefficient (ρ) = 0.526, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). When stratified by initial size, tumors with a diameter ≥ 110 mm exhibited a significantly lower median growth rate compared to tumors with a diameter &lt; 110 mm (median 1.4 [IQR 1.1–2.3] vs. 1.6 [IQR 0.8–3.0] mm/month; &lt;i&gt;p&lt;/i&gt; = 0.03).&lt;/p&gt;&lt;p&gt;Tumors measuring 10–20 mm exhibited a median growth rate of 0.24 mm per month (IQR 0.12–0.58). At this ra","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70224","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615447","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":"Post Hoc Analysis of Anxiety and Behavioral Changes in Japanese Patients With Inflammatory Bowel Disease due to the COVID-19 Pandemic: Relationship Between Municipal Population at the Place of Residence and Anxiety","authors":"Kohei Wagatsuma,&nbsp;Masanori Nojima,&nbsp;Takayuki Matsumoto,&nbsp;Minoru Matsuura,&nbsp;Hideki Iijima,&nbsp;Katsuyoshi Matsuoka,&nbsp;Naoki Ohmiya,&nbsp;Shunji Ishihara,&nbsp;Fumihito Hirai,&nbsp;Ken Takeuchi,&nbsp;Satoshi Tamura,&nbsp;Fukunori Kinjo,&nbsp;Nobuhiro Ueno,&nbsp;Makoto Naganuma,&nbsp;Kenji Watanabe,&nbsp;Rintaro Moroi,&nbsp;Nobuaki Nishimata,&nbsp;Satoshi Motoya,&nbsp;Koichi Kurahara,&nbsp;Sakuma Takahashi,&nbsp;Atsuo Maemoto,&nbsp;Hiroto Hiraga,&nbsp;Masayuki Saruta,&nbsp;Keiichi Tominaga,&nbsp;Takashi Hisabe,&nbsp;Hiroki Tanaka,&nbsp;Shuji Terai,&nbsp;Toshihiro Inokuchi,&nbsp;Hironobu Takedomi,&nbsp;Kazuyuki Narimatsu,&nbsp;Katsuya Endo,&nbsp;Masanao Nakamura,&nbsp;Tadakazu Hisamatsu,&nbsp;Hiroshi Nakase,&nbsp;J-DESIRE Group","doi":"10.1002/jgh3.70209","DOIUrl":"https://doi.org/10.1002/jgh3.70209","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The Japan COVID-19 Survey and the Questionnaire for Inflammatory Bowel Disease (J-DESIRE) identified multiple factors associated with anxiety regarding the novel coronavirus disease 2019 (COVID-19). However, no regional differences in anxiety were observed. In this post hoc analysis of J-DESIRE, we investigated the relationship between the municipal population size at the place of residence (MPSPR) and anxiety among patients with IBD in Japan during the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We analyzed 2958 questionnaires collected from patients with IBD aged ≥ 16 years between March 2020 and June 2021. The primary endpoint was the association between the visual analogue scale (VAS) scores of anxiety and MPSPR during the COVID-19 pandemic. The mean VAS score for anxiety was higher than the overall mean VAS score in municipalities with large and small populations, while it was lower in municipalities with medium populations. Therefore, we categorized the population into three groups based on MPSPR: ≤ 150 000, 150 001–1 000 000, and ≥ 1 000 001. The three groups had different background factors, contents of anxiety, and sources of information regarding therapeutic drugs. These differences may have led to differences in the degree and content of anxiety.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We investigated the association between anxiety in Japanese patients with IBD and MPSPR nationwide during the COVID-19 pandemic in Japan. The results obtained in this analysis are useful not only in special situations such as the COVID-19 pandemic but also for considering regional differences in medical care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624573","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 Visualization of the Importance of Covariance Importance in a Machine Learning Model for Advanced Liver Fibrosis in a Nationally Representative Sample","authors":"Alexander A. Huang,&nbsp;Samuel Y. Huang","doi":"10.1002/jgh3.70200","DOIUrl":"https://doi.org/10.1002/jgh3.70200","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Accurate prediction of liver disease is vital for early intervention, given its potential severity. This study aims to improve the prediction of advanced liver fibrosis and investigate its associations with factors, ultimately contributing to healthier lifestyle choices and timely management of liver disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study included adults from the US National Health and Nutrition Examination Survey (2017–2020). Questionnaires captured demographic, dietary, exercise, and mental health information. Advanced fibrosis was defined using liver stiffness measurement (LSM) with a 9.5 kPa threshold. XGBoost, a machine learning model, predicted fibrosis, assessed using AUROC. SHAP provided visual explanations of the model's predictions and feature contributions. Model gain, cover, and frequency measured feature importance, enabling transparent, and interpretable analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 6979 adults (age &gt; 18) that were included in the study with an average age of 49.02 and 3523 (50%) female. The machine learning model had an area under the receiver operator curve of 0.885. The top eight covariates include waist circumference (gain = 0.185), GGT (gain = 0.101), platelet count (gain = 0.059), AST (gain = 0.057), weight (gain = 0.049), HDL-cholesterol (gain = 0.032), and ferritin (gain = 0.034).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In conclusion, the utilization of machine learning models proves to be highly effective in accurately predicting the risk of liver fibrosis. By considering various factors such as demographic information, laboratory results, physical examination findings, and lifestyle factors, these models successfully identify crucial risk factors associated with liver fibrosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70200","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 on Venous Thromboembolism in Inflammatory Bowel Disease Hospitalizations: A Propensity-Matched Analysis","authors":"Mihir Prakash Shah,&nbsp;Dushyant Singh Dahiya,&nbsp;Pius Ojemolon,&nbsp;Charmy Parikh,&nbsp;Yash Shah,&nbsp;Bhanu Siva Mohan Pinnam,&nbsp;Manesh Kumar Gangwani,&nbsp;Hassam Ali,&nbsp;Chun-Wei Pan,&nbsp;Ruchir Paladiya,&nbsp;Abdul Mohammed,&nbsp;Saurabh Chandan,&nbsp;Benjamin Mba,&nbsp;Babu P. Mohan","doi":"10.1002/jgh3.70220","DOIUrl":"https://doi.org/10.1002/jgh3.70220","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Patients diagnosed with Inflammatory bowel disease (IBD) face a notably higher risk of venous thromboembolism (VTE), leading to significant health challenges. Similarly, coronavirus disease 2019 (COVID-19) is associated with an increased susceptibility to thrombosis. We aimed to assess the impact of COVID-19 on the risk of developing VTE in patients with an underlying diagnosis of IBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed the National Inpatient Sample (NIS) 2020–21 to identify adult patients with IBD admitted with or without a principal diagnosis of COVID-19. We divided these patients into three groups (without COVID-19, with uncomplicated COVID-19, and with complicated COVID-19). Hospitalization characteristics, in-hospital mortality, odds of VTE, healthcare burden, and complications were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>IBD patients with complicated COVID-19 infection had significantly higher odds of VTE (OR 5.60, 95% C.I. 3.63–8.65, <i>p</i> 0.001), an increase in odds of mortality (OR 29.13, 95% C.I. 22.59–37.57, <i>p</i> 0.001), higher healthcare resource utilization (including length of stay and total hospitalization charges), and worse secondary outcomes (like acute kidney injury and pancytopenia), compared to IBD patients without COVID-19. IBD patients with uncomplicated COVID-19 also had higher odds of VTE (OR 1.81, 95% C.I. 1.39–2.36, <i>p</i> 0.001) than those without COVID-19; however, there was no difference in mortality or length of stay between these two groups, and those with uncomplicated COVID-19 had lower average total hospitalization charges.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with both complicated and uncomplicated COVID-19 were associated with higher odds of VTE compared to those without COVID-19. Patients with complicated COVID-19, in addition, also had higher odds of mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics of Gastrointestinal Malignancy and Validation of the IDIOM Model Among Patients With Iron Deficiency Anemia in Thailand","authors":"Kanjira Titsisaeng,&nbsp;Noraworn Jirattikanwong,&nbsp;Phichayut Phinyo,&nbsp;Pojsakorn Danpanichkul,&nbsp;Kanokwan Pinyopornpanish,&nbsp;Nithi Thinrungroj,&nbsp;Phuripong Kijdamrongthum,&nbsp;Apinya Leerapun,&nbsp;Taned Chitapanarux,&nbsp;Wasuwit Wanchaitanawong","doi":"10.1002/jgh3.70221","DOIUrl":"https://doi.org/10.1002/jgh3.70221","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Gastrointestinal malignancy is a concerning etiology of iron deficiency anemia (IDA). The IDIOM model predicts gastrointestinal malignancy risk in IDA patients using age, sex, hemoglobin, and mean corpuscular volume (MCV) as parameters. This study aimed to evaluate the clinical characteristics of gastrointestinal malignancy and externally validate the IDIOM model in Thai IDA patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cross-sectional study was conducted on adult IDA patients who underwent gastrointestinal endoscopy at Chiang Mai University Hospital between 2019 and 2023. Clinical characteristics were compared between patients with and without gastrointestinal malignancy. The IDIOM model's performance was assessed with discrimination, calibration, and clinical usefulness. To improve its performance, the model was updated using recalibration and refitting methods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 474 IDA patients, 101 (21.3%) had gastrointestinal malignancy, predominantly colorectal cancer (<i>n</i> = 80, 16.9%). Patients with gastrointestinal malignancy were more likely to be male (54.5% vs. 41.3%, <i>p</i> = 0.018), older (65.0 vs. 59.1 years, <i>p</i> &lt; 0.001), symptomatic (78.2% vs. 44.0%, <i>p</i> &lt; 0.001), and had higher rates of positive fecal immunochemical tests (80.9% vs. 29.5%, <i>p</i> &lt; 0.001) and lower MCV (68.0 vs. 71.8 fl, <i>p</i> = 0.002). External validation of the IDIOM model yielded an AuROC of 62.9% (95% CI, 56.8%–68.9%). The calibration assessment revealed both underestimation and extreme risk predictions. After updating, the AuROC improved to 67.2% (95% CI, 61.1%–73.3%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Distinct clinical features should alert physicians to the possibility of underlying gastrointestinal malignancy in IDA patients. Given the limited performance of the IDIOM model in the Thai population, a region-specific prediction model tailored to local clinical characteristics is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastroparesis and Systemic Lupus Erythematosus: A Propensity Score-Matched Study of US National Database Analysis","authors":"Noppachai Siranart,&nbsp;Pannathorn Nakaphan,&nbsp;Thanathip Suenghataiphorn,&nbsp;Panisara Fangsaard,&nbsp;Tanattida Phanthong,&nbsp;Patavee Pajareya,&nbsp;Somkiat Phutinart,&nbsp;Pawaris Tirakunwichcha,&nbsp;Suwit Paksin,&nbsp;Pornnicha Sowalertrat,&nbsp;Sakkarin Chirapongsathorn,&nbsp;Kittithat Tantitanawat","doi":"10.1002/jgh3.70227","DOIUrl":"https://doi.org/10.1002/jgh3.70227","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While gastrointestinal involvement is a common manifestation of systemic lupus erythematosus (SLE), the association between gastroparesis and SLE remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed data from the National Inpatient Sample (NIS) database from 2016 to 2021. Patients with gastroparesis were categorized into SLE and non-SLE groups. Similarly, patients with SLE were categorized into gastroparesis and nongastroparesis groups. Clinical characteristics, comorbidities, hospitalization data, and outcomes were compared. The primary outcome was the association between SLE and primary gastroparesis. Secondary outcomes were clinical impacts of gastroparesis in patients with or without SLE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 12 538 228 patients were included from the NIS database. Of these, 1 165 925 patients (9.3%) were diagnosed with gastroparesis during hospitalization, while 11 372 303 patients (90.7%) did not have gastroparesis. SLE was significantly more common in patients with gastroparesis compared to those without (1.6% vs. 0.7%, <i>p</i> &lt; 0.001; aOR 1.87 [95% CI: 1.80–1.95]). Among patients hospitalized with gastroparesis, those with SLE had a longer length of stay, with a β-coefficient of 0.31 (95% CI: 0.07–0.55, <i>p</i> = 0.009), lower hospitalization charges, with mean differences of $4761 (95% CI: 442–9080, <i>p</i> = 0.031), and a higher rate of intervention needs, with odds ratios of 1.31 (95% CI: 1.09–1.56, <i>p</i> = 0.003). After propensity-score matching (1:1), SLE patients aged ≥ 65 had higher hospital charges, with mean differences of $7287 (95% CI: 2928–11 646, <i>p</i> = 0.01), compared to non-SLE patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gastroparesis is associated with SLE, contributing to longer hospitalizations, higher costs, and increased need for invasive interventions. These findings underscore the importance of evaluating gastroparesis in SLE patients to enable early management and reduce potential complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70227","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144606443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where Do Patients With Cirrhosis Die? A CDC WONDER Analysis From 1999 to 2020","authors":"Areej Iftikhar,&nbsp;Fatima Noor Alam,&nbsp;Danish Ali Ashraf,&nbsp;Saad Hassan Qureshi,&nbsp;Muzamil Akhtar,&nbsp;Ayesha Islam Khan,&nbsp;Muhammad Raza,&nbsp;Raheel Qureshi,&nbsp;Raheel Ahmed","doi":"10.1002/jgh3.70205","DOIUrl":"https://doi.org/10.1002/jgh3.70205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Liver Cirrhosis is a growing cause of morbidity and mortality worldwide, but significant knowledge gaps remain regarding disparities in the place of patient death. This study aims to analyze the place of death trends for cirrhosis patients in the United States from 1999 to 2020, to direct preventive and palliative care measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this descriptive study, death certificates were examined using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database, using ICD codes K70.3, K71.7, and K74. The variables studied were the year, sex, age, race, rural–urban, census regions, and state. Percentages of deaths in each location were trended over time for interpretation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 1999 and 2020, a total of 1 090 420 deaths were attributed to cirrhosis. The majority of these fatalities occurred in inpatient medical facilities (48.75%), followed by the decedent's home (25.71%). Men consistently exhibited higher deaths in all settings, especially in medical facility—inpatient settings (31.39%), and the highest deaths were for the 55–64 age group. NH White population reported the highest mortality in all places of death, whereas the South led mortality records among census regions. The least deaths occurred in non-core (non-metro) areas, and state-wise analysis revealed California to have the highest number of deaths (75 723), seconded by Texas (55 447).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Mortality due to cirrhosis increased gradually from 1999 to 2019, with a steep rise observed in 2019–2020. Men, the White race, 55–65 years age bracket, and residents of rural and Southern census regions reported the highest number of deaths from cirrhosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70205","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequent Dietetic Involvement Enhances Adherence and Clinical Outcomes of Exclusive Enteral Nutrition in Adults With Crohn's Disease","authors":"Matthew K. W. Chu,&nbsp;Alice S. Day,&nbsp;Damjana Bogatic,&nbsp;Martine Hatzi,&nbsp;Samuel K. S. Chu,&nbsp;Samuel P. Costello,&nbsp;Robert V. Bryant","doi":"10.1002/jgh3.70207","DOIUrl":"https://doi.org/10.1002/jgh3.70207","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Aim</h3>\u0000 \u0000 <p>Use of Exclusive Enteral Nutrition (EEN) in adults has been limited by lack of defined protocols, poor adherence and perceived lack of efficacy. This study evaluated EEN therapy in adults with Crohn's disease (CD) to identify determinants of clinical efficacy, adherence, and therapy completion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, multicenter study included consecutive adults (≥ 18 years old) prescribed EEN for CD between February 1, 2019, and February 28, 2022, at two tertiary teaching hospitals. The primary outcome was clinical remission (Harvey Bradshaw Index (HBI) ≤ 4) or response (HBI reduction ≥ 3). Therapy completion and adherence were measured. Intention-to-treat and per-protocol analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One-hundred-and-eight patients were included; 54 (50.0%) were female. Mean age was 41.8 ± 16.1 years. Ileocolonic disease was present in 47.2% (51/108), and 40.7% (44/108) had stricturing phenotype. Baseline HBI was 8 (IQR 6–11); 60.2% (65/108) received advanced therapies. Among 80 patients treated for remission induction, remission and response rates were 50.0% (40/80) and 48.8% (39/80), respectively. Completion rate was 69.4% (75/108). Complete diet adherence was observed in 67.6% (73/108). On multivariable analysis, frequency of dietetic review was associated with therapy completion (odds ratio (OR) 2.26, 95% confidence interval (CI) 1.51–3.39, <i>p</i> &lt; 0.001). Active smoking (OR 0.11, 95% CI 0.02–0.83, <i>p</i> = 0.032) reduced odds of remission, whereas early remission (OR 17.56, 95% CI 3.18–96.84, <i>p</i> = 0.001) and early response (OR 4.94, 95% CI 1.09–22.43, <i>p</i> = 0.039) were predictors of clinical remission at end-of-therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Early assessment and frequent dietetic follow-up improve EEN adherence, completion, and outcomes in adults with CD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"9 7","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70207","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}