The American Journal of Gastroenterology最新文献

{"title":"How I Approach It: Ustekinumab for Pediatric Crohn’s Disease","authors":"Ajay S. Gulati","doi":"10.14309/ajg.0000000000004223","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004223","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088877","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":"Early Colectomy and Long-Term Risk of Cardiometabolic Disease in Ulcerative Colitis: A Nationwide Cohort Study","authors":"Adam S. Faye,Bharati Kochar,Jordan Axelrad,Jiangwei Sun,Caroline Nordenvall,Jonas Halfvarson,Jonas Söderling,Ola Olén,Jonas F. Ludvigsson","doi":"10.14309/ajg.0000000000004222","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004222","url":null,"abstract":"Background: Ulcerative colitis (UC) is characterized by chronic gastrointestinal inflammation often requiring corticosteroids, both of which may increase long-term cardiometabolic risk. Early colectomy, by eliminating these exposures, may mitigate this risk, though data are limited. Methods: We performed a matched cohort study using the Swedish National Patient Register and ESPRESSO histopathology cohort, identifying individuals aged ≥18 with incident UC (2006–2021, follow-up through 2023). Patients who underwent total colectomy within two years of diagnosis (early colectomy) were matched 1:1 to those without early colectomy using propensity score matching. The primary outcome was incident cardiovascular disease (CVD), with type 2 diabetes mellitus (DM2) assessed as a secondary outcome. Kaplan–Meier and Cox proportional hazards models were used for analyses. Results: Among 1,832 individuals (median age 45 years, 64.6% male, median post-matching follow-up of 9 years), early colectomy was associated with a significantly lower cumulative incidence of CVD on unadjusted Kaplan-Meier analysis (p=0.02). The CVD incidence rate was 9.1 per 1,000 person-years in the early colectomy group versus 13.0 in controls; after adjustment for baseline covariates, early colectomy was associated with a 32% lower risk of CVD, though this did not reach statistical significance (aHR 0.68, 95% CI 0.44–1.06). A numerically lower risk of DM2 was also observed (incidence rate: 5.5 vs 5.8 per 1,000 person-years; aHR 0.76, 95% CI 0.39–1.48); findings were consistent across sensitivity analyses. Conclusions: Early colectomy was associated with numerically lower risks of CVD and DM2 in UC, raising the possibility that earlier surgical intervention may mitigate long-term cardiometabolic risk beyond established IBD-related benefits, though confirmation in larger studies is needed.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088878","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":"Evolving Treatment Patterns and Clinical Outcomes in Children with Newly Diagnosed Crohn's Disease and Ulcerative Colitis in the United States, 2007–2023","authors":"Michelle M. Gonzalez,Dhruv Ahuja,Yuchen Qi,Ronghui Xu,Vipul Jairath,Shane W. Goodwin,Ola Olen,William A. Faubion,Michael D. Kappelman,Siddharth Singh","doi":"10.14309/ajg.0000000000004219","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004219","url":null,"abstract":"Background & Aims: We examined treatment patterns and clinical outcomes in a contemporary cohort of children with newly diagnosed inflammatory bowel disease (IBD) in a large, commercially insured U.S. population. Methods: Using the OptumLabs® Data Warehouse, we created an inception cohort of physician-diagnosed IBD in children aged 6–17 years between 2007–23. We examined cumulative incidence of hospitalization, surgery, safety events, and medication use in patients with Crohn's disease (CD) and ulcerative colitis (UC), overall and stratified by diagnostic era, race and ethnicity, sex, and age at diagnosis. Results: Among 787 children with newly diagnosed CD (age at diagnosis, 13.4±2.9y; 57% male; 82% White, 5% Black, 7% Hispanic) followed over mean 4.6±3.0y, 5-year risk of IBD-related hospitalization and major surgery was 30% and 10%, respectively. In children diagnosed in 2019–23, 1-year cumulative use of corticosteroids and advanced therapy was 46% and 75%, respectively; advanced therapy use increased significantly over time (aHR, 3.43 [95% CI, 2.71–4.32] for 2019–23 vs. 2007–12), while corticosteroid use declined (0.67 [0.53–0.84]). Risk of IBD-related hospitalization was lower in children diagnosed between 2019–23 (0.65 [0.43–0.97]) compared with those diagnosed between 2007-12; surgical risk did not decline significantly, with confidence intervals compatible with a clinically meaningful reduction. Among 399 children with newly diagnosed UC (age at diagnosis, 14.0±3.0y; 53% male; 78% White, 5% Black, 7% Hispanic) followed over 4.5±3.0y, 5-year risk of IBD-related hospitalization and colectomy was 36% and 8%, respectively. Advanced therapy use increased significantly over time (4.46 [2.85–6.98] for 2019–23 vs. 2007–12), with no significant change in hospitalization or surgical risk across eras. No consistent racial and ethnic, age, or sex differences in advanced therapy use or clinical outcomes were identified in either CD or UC. Conclusions: In a contemporary cohort of commercially insured children with newly diagnosed IBD, early advanced therapy use has increased markedly over time. Surgical risk did not decline significantly in either disease; however, the study was not powered to exclude a clinically meaningful reduction, and these findings are hypothesis-generating rather than conclusive.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088897","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":"ACG Clinical Guideline: Preventive Care for Patients With Cirrhosis","authors":"Elliot B. Tapper,Ani Kardashian,Jose Debes,Janet Gripshover,Andrew M. Moon,John J. Kim,Jennifer C. Lai","doi":"10.14309/ajg.0000000000004186","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004186","url":null,"abstract":"Cirrhosis affects more than 2 million Americans and drives substantial healthcare utilization, impaired quality of life, and mortality. Because early-stage disease carries a favorable prognosis and decompensated patients can recompensate, systematic delivery of preventive care is essential. Under the auspices of the American College of Gastroenterology Practice Parameters Committee, a writing group of hepatology experts and 2 Grading of Recommendations, Assessment, Development, and Evaluation methodologists developed PICO questions, conducted librarian-assisted searches of PubMed, Embase, and the Cochrane Library, and prioritized systematic reviews, meta-analyses, and randomized trials. The resulting guidance comprises 18 Grading of Recommendations, Assessment, Development, and Evaluation-assessed recommendations and 6 key concept statements spanning 4 domains: prevention of cirrhosis-specific complications, infection prevention, lifestyle factors, and non-liver-specific conditions. Strong recommendations include carvedilol or variceal ligation of high-risk esophageal varices, semiannual hepatocellular carcinoma surveillance, hepatitis A testing and vaccination, influenza, severe acute respiratory syndrome coronavirus 2, respiratory syncytial virus immunization, and smoking-cessation counseling. Conditional recommendations address lactulose for minimal hepatic encephalopathy, adjunctive rifaximin after hospitalization, short-course antibiotic prophylaxis for upper gastrointestinal bleeding, postdischarge behavioral therapy for alcohol use disorder, dietitian-guided nutrition, structured exercise, and bisphosphonates for osteoporosis. Most evidence was of low certainty. We provide an implementation framework of education, stakeholder engagement, and practice integration to translate these recommendations into routine care.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088896","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":"Continuing Medical Education Questions: October 2026","authors":"Aldanah Althwanay","doi":"10.14309/ajg.0000000000004187","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004187","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"10 1","pages":"2373-2373"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088911","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":"Continuing Medical Education Questions: October 2026","authors":"Daphne Moutsoglou","doi":"10.14309/ajg.0000000000004188","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004188","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"24 1","pages":"2374-2374"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088912","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":"Serrated Polyposis Syndrome: A Review and Consensus Statement by the US Multi-Society Task Force on Colorectal Cancer","authors":"Douglas K. Rex,Joseph C. Anderson,Carol A. Burke,Brian C. Jacobson,Folasade P. May,Swati G. Patel,N. Jewel Samadder,Elena M. Stoffel,Douglas J. Robertson","doi":"10.14309/ajg.0000000000004081","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004081","url":null,"abstract":"Serrated polyposis syndrome (SPS) is the most common polyposis syndrome, yet SPS often goes unrecognized. SPS diagnosis is based on clinical criteria established by the World Health Organization and includes the size, cumulative lifetime number, and location of serrated polyps throughout the colon. Individuals with SPS have an increased risk of prevalent and incident colorectal cancer (CRC). Meticulous inspection, clearing of the colon and frequent surveillance colonoscopy is recommended to decrease incident CRC. Colorectal surgery is indicated for individuals diagnosed with cancer or whose polyp burden cannot be managed endoscopically by expert endoscopists. There is no common germline pathogenic variant associated with SPS. Germline genetic testing is indicated only in individuals who meet criteria for a known hereditary syndrome in the appropriate clinical setting. First-degree relatives of patients with SPS are at heightened risk of CRC and should undergo colonoscopic screening.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149092604","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":"Correction to: Spatiotemporal Study of a Risk-Stratification Epigenetic-Based Biomarker Assay in Patients With Barrett Esophagus","authors":"Sarah E. Laun,Lisa Kann,Jerome Braun,Francia Pierre,Suji Kim,Stacey Gilbert,Daniel Lunz,Andrew Kalra,Ke Ma,Yulan Cheng,Cadman L. Leggett,Ali H. Zaidi,Ashten N. Omstead,Louis Korman,Blair Jobe,Lorrie Perpetua,Bruce D. Greenwald,Tara Maddala,Stephen J. Meltzer","doi":"10.14309/ajg.0000000000004183","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004183","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149049102","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":"Oral vancomycin is not associated with meaningful changes in liver-related endpoints among adults with primary sclerosing cholangitis: A randomized, placebo-controlled trial.","authors":"John E Eaton,Mitchell W Clayton,Denise M Harnois,Duke J Butterfield,Nan Zhang,Sudhakar K Venkatesh,Nicholas V Nguyen,Andrea A Gossard,Keith D Lindor,Nicholas F LaRusso,Elizabeth J Carey","doi":"10.14309/ajg.0000000000004135","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004135","url":null,"abstract":"INTRODUCTIONPrimary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease without approved medical therapies. We examined the efficacy and safety of oral vancomycin (OV) in those with PSC.METHODSIn this phase 3, 18-month, double-blind, placebo-controlled trial, we randomly assigned adults with PSC and a serum alkaline phosphatase (SAP) greater than 1.5 times the upper limit of normal to placebo or oral vancomycin (OV) with dosages ranging from 125-375 mg four times daily pending biochemical response. The primary endpoint was normalization of SAP.RESULTSOf the 82 patients who underwent randomization, 73 individuals had at least one outcome assessment. Individuals who withdrew early were less likely to rate their baseline health as excellent or very good (23.4% vs 54.5%, p<0.01) despite having similar PSC prognostic features to those who completed the study. SAP normalization rates were similar (5% placebo, 6.7% OV, p=1.00) after 18 months. Those who received OV had greater reduction in SAP (+1.2% placebo, -21.9% OV, p=0.03). There were no differences in the changes in either the Mayo PSC risk score (-0.1 placebo, -0.1 OV, p=0.88) or liver stiffness values (+0.1 kPa placebo, -4.0 kPa OV, p=0.15). Discoloration of the teeth and tongue was the most common side effect of OV (17.5%).CONCLUSIONSOV was not associated with clinically significant reductions in markers of PSC disease severity. Impairments in quality of life may influence patient retention in clinical trials.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552572","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":"Disorders of Gut-Brain Interaction like symptoms in Children with Inflammatory Bowel Disease: A Multicenter Prospective Study from the Pediatric IBD Porto Group of the ESPGHAN.","authors":"Massimo Martinelli,Simona Salomone,Caterina Strisciuglio,Aglaia Zellos,Claudio Romano,Valeria Dipasquale,Matteo Bramuzzo,Sara Lega,Marina Aloi,Giulia D'Arcangelo,Marta Velasco Rodríguez-Belvís,Antonio Colucci,Erasmo Miele,Annamaria Staiano,Roma Eleftheria","doi":"10.14309/ajg.0000000000004140","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004140","url":null,"abstract":"BACKGROUND AIMSDisorders of gut-brain interaction (DGBI) are frequently reported in patients with inflammatory bowel disease (IBD), but pediatric data are scarce. We aimed to determine the prevalence of DGBI-like symptoms in children with quiescent IBD compared with healthy controls (HC), and to evaluate their impact on health-related quality of life (HR-QoL), anxiety and symptoms burden.METHODSThis multicenter, prospective, observational study enrolled children aged 10-18 years with biochemically quiescent IBD, with or without endoscopic confirmation of remission from seven European ESPGHAN centers (January 2021-August 2023). Age and sex-matched HC were recruited through primary care pediatricians and screened for subclinical inflammation using fecal calprotectin. DGBI were assessed using Rome IV criteria. HR-QoL and psychological burden were evaluated using IMPACT III, PROMIS Anxiety, Visceral Sensitivity Index-Child, and Behavioral Response Questionnaire-Child.RESULTSA total of 253 children were enrolled (IBD: n=131; HC: n=122). The prevalence of DGBI-like symptoms did not differ between IBD and HC [34.4% vs 41.8%, p=0.30]. Functional abdominal pain disorders were present in 24.4% of children with IBD. Children with IBD and DGBI-like symptoms showed significantly lower IMPACT III scores compared with those without DGBI [median 74 (IQR 62.5-81) vs 84 (70-90); p=0.001], with the greatest impairment in IBD symptoms, energy, and social domains. PROMIS Anxiety scores were higher in the DGBI group [31 (20-44) vs 21.5 (16-28); p<0.001], with a greater proportion exceeding the clinical threshold (>50) (17.8% vs 3.5%; p=0.008). Female sex was the only independent predictor of DGBI (OR 5.2, 95% CI 1.6-16.1; p=0.005).CONCLUSIONSDGBI-like symptoms are common in children with quiescent IBD and are associated with a substantial psychological and quality-of-life burden.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"157 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539185","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}