The American Journal of Gastroenterology最新文献

{"title":"Defining risk in Alcohol associated Liver Disease using the Model for End Stage Liver Disease.","authors":"Richard Parker,Guru Aithal,Michael Allison,Mayur Brahmania,Ewan Forrest,Hannes Hagström,Brian T Lee,Soyoun J Park,Anne McCune,Timothy Morgan,Keval Naik,Steven Masson,Neil Rajoriya,Devanshi Seth,Ken Liu,John Chetwood,Esperance Schaefer,J Luther,R Goodman,Ian Rowe, ","doi":"10.14309/ajg.0000000000003649","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003649","url":null,"abstract":"BACKGROUNDAlcohol associated liver disease (ALD) is a common cause of morbidity and premature mortality. Most prognostic scores have been defined in the short term. We used a large retrospective cohort of patients with ALD to describe the natural history of ALD and to define risk prediction in the longer term, taking non-liver mortality into account.METHODSThe WALDO cohort includes 734 patients with biopsy-proven ALD. Prognostic scores were assessed with dynamic area under the curve (AUCt) and C-index. Risk estimates for morbidity and mortality were derived for the model for end stage liver disease (MELD) and validated in an external cohort.RESULTSDuring a median follow up of 4.9 years, 240 patients died from liver disease or underwent LT, and 114 patients died from non-liver causes. Outcomes varied across the spectrum of ALD: the cumulative incidence of liver-related death or LT in people with decompensated cirrhosis or alcohol associated hepatitis was 47% and 40% respectively, compared to 7.4% in patients without cirrhosis and 13% in compensated cirrhosis. MELD was the best predictor of outcomes: (AUCt for mortality/LT at one year was 0.853), although MELD3.0 and Child-Turcotte-Pugh score performed similarly. Risk of liver-related outcomes were tabulated for integer values of the MELD score. Risk estimates based on the MELD were well calibrated in an external cohort.CONCLUSIONSThese data illustrate the natural history of ALD and define the risks of outcomes based on the MELD score across the spectrum of disease.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appendix Arising in the Left Thoracic Cavity: Giant Congenital Diaphragmatic Hernia.","authors":"Li Junting,Yang Shiwei,Wu Bing,Shahid Ali,Wang Yong","doi":"10.14309/ajg.0000000000003645","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003645","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PBC-HOPE: A randomized controlled trial of hypnosis and psychoeducation in women with primary biliary cholangitis and fatigue.","authors":"Aurélie Untas,Cécile Goffette,Cécile Flahault,Christel Vioulac,Olivier Chazouillères,Sara Lemoine,Pierre-Antoine Soret,Karima Ben Belkacem,Farid Gaouar,Nathalie Bernard,Alexandra Rousseau,Christophe Corpechot","doi":"10.14309/ajg.0000000000003639","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003639","url":null,"abstract":"OBJECTIVESFatigue is the main symptom of primary biliary cholangitis (PBC), but has not yet been improved by any therapeutic intervention. This study evaluated the efficacy and safety of hypnosis and psychoeducation in improving fatigue associated with PBC (PBC-HOPE ClinicalTrial.gov number, NCT03630718).METHODSFifty-five women with PBC and significant fatigue, defined by a PBC-40 fatigue score ≥ 33, were randomly assigned to standard care (SC) alone (n=18), SC plus hypnosis (n=18) and SC plus psychoeducation (n=19), with four weekly sessions for the intervention groups. Self-report questionnaires, including the PBC-40, were completed at inclusion (D0) and Week 12 (W12). The first eight patients in each group were interviewed at both times. The primary outcome was the difference in PBC-40 fatigue score between D0 and W12. The secondary and exploratory outcomes were the psychometric scores and interview findings.RESULTSThe primary outcome was not achieved, with a median (interquartile range) difference in PBC-40 fatigue score of -3.0 (-10.0; 1.0), -6.0 (-8.0; -4.0), and -6.0 (-11.5; -4.8) for SC, SC-hypnosis, and SC-psychoeducation, respectively. The quantitative secondary outcomes were consistent with this result. The qualitative exploratory outcomes indicated that both interventions positively modified patients' perceptions of fatigue, underlining the appropriation of the intervention. No serious adverse events occurred.DISCUSSIONSAt 12 weeks, hypnosis and psychoeducation interventions were not associated with a significant reduction in quantitative measures of fatigue associated with PBC. However, the qualitative changes in perceived fatigue associated with these interventions suggest that maintenance sessions could be beneficial in the longer term.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"195 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ileal Perforation Caused by Ingested Toothpicks.","authors":"Ting-Yu Shi,Liang Guo","doi":"10.14309/ajg.0000000000003643","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003643","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local post-procedural cryoprevention significantly reduces the incidence of post-ERCP pancreatitis: a multicenter randomized controlled trial.","authors":"Shunjiro Azuma,Yosuke Kobayashi,Ryo Harada,Kei Yane,Kenji Sawada,Akiko Tsujimoto,Osamu Inatomi,Tomoaki Matsumori,Kenichi Yoshimura,Shujiro Yazumi,Akira Kurita","doi":"10.14309/ajg.0000000000003644","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003644","url":null,"abstract":"OBJECTIVESPost-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a common, potentially serious adverse event of ERCP. While rectal NSAIDs are recommended for prevention, their use in Japan is limited due to dosage concerns. This multicenter randomized controlled trial evaluated the efficacy and safety of ice water irrigation to the papilla in reducing PEP.METHODSThis single-blind trial enrolled 880 adults with a native papilla undergoing ERCP at eight hospitals in Japan (March 2022-February 2024). After three withdrawals, 877 were analyzed (cryoprevention: 434; control: 443). The primary outcome was PEP incidence, defined as abdominal pain within 24 hours and serum amylase or lipase ≥3 times the upper normal limit. Secondary outcomes included cholangitis, bleeding, perforation, and mortality.RESULTSPEP incidence was significantly lower in the cryoprevention group (3.2%; 95% CI, 1.7%-5.4%) than the control group (6.8%; 95% CI, 4.6%-9.6%) (P = 0.02), with absolute and relative risk reductions of 3.6% and 52.4%. No significant differences were observed in secondary outcomes, including cholangitis (0.9% vs 1.1%; P = 1.00), bleeding (1.4% vs 2.5%; P = 0.33), or perforation (0.9% vs 0.2%; P = 0.21). One control patient died from severe PEP. No adverse events related to cryoprevention were reported.CONCLUSIONSCryoprevention using ice water significantly reduced PEP incidence, demonstrating a safe, effective, and low-cost strategy. This approach offers a practical alternative, where NSAID use is limited.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of early oral refeeding in patients with chronic pancreatitis after extracorporeal shock wave lithotripsy of pancreatic stone (SHEEL): A multicenter randomized controlled trial.","authors":"Fan Wang,Jin-Hui Yi,Chun-Hua Zhou,Jing Yang,Ping Yue,Li-Ping Ling,Zhen-Yu Jiang,Kıvanç Görgülü,Tao-Jing Ran,Xia-Yin He,Jia-Jia Li,Yuan Sun,Xiang Ao,Hong-Suo Chen,Hui Chen,Teng Wang,Ying-Yi Qin,Rui-Xi Guo,Chao Wu,Hana Algül,Tong Dang,Xiao-Feng Zhang,Duo-Wu Zou,Xun Li,Zhuan Liao,Zhao-Shen Li,Liang-Hao Hu","doi":"10.14309/ajg.0000000000003642","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003642","url":null,"abstract":"BACKGROUNDFasting after extracorporeal shock wave lithotripsy (ESWL) is often used to avoid pancreas injury and reduce risk of pancreatitis. However, the optimal timing of oral refeeding after ESWL remains unclear. This study evaluates the impact of early oral refeeding on post-ESWL pancreatitis.METHODSThis multicenter randomized controlled trial was conducted at six centers in China. Patients without complications at 6 hours after ESWL were randomly assigned (1:1) to the 6-hour fasting or 24-hour fasting group. Patients in the 6-hour fasting group started oral intake at 6 hours after ESWL, whereas those in the 24-hour fasting group fasted for 24 hours after ESWL. The primary outcome was post-ESWL pancreatitis, analysed on the intention-to-treat principle.RESULTSBetween May 2023, and April 2024, 216 patients were enrolled, with 107 patients randomly assigned to the 6-hour fasting group and 109 patients to the 24-hour fasting group. Post-ESWL pancreatitis occurred in 2 (1.9%) of 107 patients assigned to the 6-hour fasting group and in 3 (2.8%) of 109 patients assigned to the 24-hour fasting group (risk difference -0.9%, 95% confidence interval -6.1 to 4.2). There were no differences between the two groups in post-ESWL pancreatitis, severity of post-ESWL pancreatitis, other complications and transient adverse events. Additionally, the incidences of abdominal discomfort and hunger were significantly lower in 6-hour fasting than 24-hour fasting group. Among all post-ESWL pancreatitis, 80.8% of post-ESWL pancreatitis occurred within 6 hours after ESWL.DISCUSSIONEarly oral refeeding in patients after ESWL was safe and did not increase the incidence of post-ESWL pancreatitis. This was also associated with reduced abdominal discomfort and hunger.TRIAL REGISTRATIONClinicalTrials.gov Identifier: NCT05669573.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potassium Chloride-induced Acute hemorrhagic Erosive Gastropathy.","authors":"Zhuo Cheng,Zhijie Xu","doi":"10.14309/ajg.0000000000003636","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003636","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Zhong et al and Xu et al.","authors":"Qiuyue Tu,Jiyu Zhang,Saif Ullah,Bingrong Liu","doi":"10.14309/ajg.0000000000003575","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003575","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fecal Immunochemical Test (FIT) Completion by Instruction Type: A Randomized Clinical Trial Comparing QR-Code linked Video to Pictorial Instructions.","authors":"Neha Naidoo,Ari Bell-Brown,Amanda Kimura,Nkem Akinsoto,Victoria Fang,Amy Peck,Jerry Wood,Rachel B Issaka","doi":"10.14309/ajg.0000000000003637","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003637","url":null,"abstract":"BACKGROUND AND AIMSLow-literacy, pictorial instructions improve fecal immunochemical test (FIT) completion and might enhance colorectal cancer (CRC) screening. The aim of this study was to compare FIT completion among English- and Spanish-speaking patients in an organized CRC screening program based on the type of instructions received (quick response (QR)-code linked to a video vs. pictorial instructions).METHODSIn this randomized controlled quality improvement study, English- and Spanish-speaking patients eligible for mailed outreach through an organized CRC screening program were randomized 1:1 to receive a FIT kit with either a QR-code linked video or pictorial instructions in their preferred language. Patient demographics (gender, age, race, ethnicity, and insurance type) and clinical outcomes (FIT completion and time to completion) were abstracted from electronic health records.RESULTS13,471 English-speaking patients and 508 Spanish-speaking patients were included. Overall, 31.9% of patients who received mailed outreach completed CRC screening by FIT. However, FIT completion was higher among patients who received QR-code instructions vs. pictorial instructions (33.5% vs 30.4%, absolute difference 3.1%, 95% CI 1.5% - 4.6%). These findings were similar among English- and Spanish-speaking patients. The median time to FIT completion was two days longer (24 days, 95% CI 23-25) for patients who received QR-code instructions versus pictorial instructions, however there was no difference in time to FIT completion by language group.CONCLUSIONProviding QR-code based education offers a promising format for delivering low literacy instructions, which might be a practical strategy to improve FIT completion for CRC screening.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Colonoscopy Colorectal Cancer in Fecal Immunochemical Test-Positive Individuals: Prevalence, Predictors, and Root-Cause Analysis in a Nationwide Cohort.","authors":"Natalie Wilson,Mohammad Bilal,Anders Westanmo,Rahul Karna,Amy Gravely,Aasma Shaukat","doi":"10.14309/ajg.0000000000003635","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003635","url":null,"abstract":"OBJECTIVESPost-colonoscopy colorectal cancer (PCCRC) represents an important real-world colonoscopy quality indicator. Using a national database, we evaluated predictors of PCCRC in fecal immunochemical test (FIT)-positive individuals, determined the PCCRC 3-year rate (PCCRC-3y), and performed a root cause analysis (RCA).METHODSThis retrospective cohort study evaluated FIT-positive patients who underwent colonoscopy from January 2015 to July 2022. Data was collected from the Veterans Affairs (VA) national database. PCCRC was defined as CRC detected ≥6 months after colonoscopy. CRC was identified using SNOMED codes and the VA Cancer Registry. The World Endoscopy Organization methodology was used to perform the RCA and calculate the PCCRC-3y rate.RESULTSWe identified 132 PCCRCs among 52,167 FIT-positive individuals. The PCCRC-3y rate was 6.4% (95% CI, 5.0-7.7%). PCCRC locations were proximal colon (43.2%), distal colon (34.8%), and rectum (22%). Root causes were likely new CRC (17.4%), missed lesions with adequate (31.2%) or inadequate (9.8%) examination, incomplete polyp resection (22%), and detected but unresected lesions (19.7%). 16.7% of patients with PCCRC had poor bowel preparation on index colonoscopy. The cecal intubation rate was 88.6% and rectal retroflexion rate was 84.5%. In 14.4% of cases, recommended surveillance intervals did not adhere to established guidelines. Independent predictors of PCCRC were ages 70-79 (HR 7.86; 95% CI, 1.08-57.39), age ≥80 (HR 10.18; 95% CI, 1.06-97.98), tubulovillous adenoma (HR 3.98; 95% CI, 2.52-6.29), and adenoma with high-grade dysplasia (HR 10.15; 95% CI, 5.91-17.42).CONCLUSIONSAmong FIT-positive individuals, the PCCRC-3y rate was 6.4%, with missed lesions and incomplete resection as key contributors. These findings provide useful information on quality metrics in FIT-based CRC screening programs.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}