The American Journal of Gastroenterology最新文献

{"title":"Second Trimester Twist: Sigmoid Volvulus as a Rare Cause of Abdominal Pain During Pregnancy.","authors":"Gabrielle Gillow,Tess Petersen,Neena Mohan","doi":"10.14309/ajg.0000000000003343","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003343","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062025","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":"When a Pancreatic Mass Isn't Malignant: A Case of Pancreatic Splenosis.","authors":"Shuji Mitsuhashi,Chinmay Guralwar,David Bartlett,Naoki Takahashi,Shounak Majumder,Santhi Swaroop Vege","doi":"10.14309/ajg.0000000000003345","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003345","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062089","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":"LONG-TERM PROGNOSIS OF NON-CELIAC ENTEROPATHIES AND A SCORE TO IDENTIFY PATIENTS WITH POOR OUTCOMES: A 30-YEAR MULTICENTER LONGITUDINAL STUDY.","authors":"Annalisa Schiepatti,Stiliano Maimaris,Davide Scalvini,Suneil Raju,Katerina E Ingham,Calvin M Johnson,Alberto Rubio-Tapia,Chiara Maruggi,Georgia Malamut,Marco Vincenzo Lenti,Antonio Di Sabatino,Giacomo Caio,Umberto Volta,Fabiana Zingone,Giovanni Marasco,Giovanni Barbara,Govind Makharia,Lalita Mehra,Prasenjit Das,Knut Ea Lundin,Simon S Cross,David S Sanders,Federico Biagi","doi":"10.14309/ajg.0000000000003331","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003331","url":null,"abstract":"INTRODUCTIONLong-term prognosis of non-celiac enteropathies (NCEs) is poorly understood. We aimed to evaluate long-term outcomes and develop a prognostic score for NCEs.METHODSNCEs patients from an international multicenter cohort (4 Italian centers,1 UK, 1 French,1 Norwegian,1 USA,1 Indian) followed-up over 30 years were enrolled. Complications and mortality were analysed with Kaplan-Meier curves, standardized mortality ratios (SMR) and multivariate Cox regression. A clinical score to identify patients at risk of poor outcomes was developed.RESULTS261 patients were enrolled (144F, mean age at diagnosis 49±18 years, median follow-up 70 months, IQR 24-109). The most common etiologies were idiopathic villous atrophy (39%), drug-related (17%), common variable immune-deficiency (15%), infectious (10%) and autoimmune enteropathy (9%). 5-year and 10-year complication-free survival were 89% and 77%, respectively, while 5-year and 10-year overall survival were 88% and 74%, respectively. Causes of death included sepsis/major infections (22%), lymphoproliferative disorders (22%), solid-organ malignancies (12%), cardiovascular/metabolic disease (10%), and was unknown in 33%. Mortality was increased in NCEs compared with the general population (SMR 3.17, 95%CI 2.24-4.34). Older age at diagnosis (p<0.001), anemia (HR 2.53,95%CI 1.33-4.80,p<0.01), lack of clinical (HR 3.21,95%CI 1.68-6.18,p<0.01) and histological response (HR 2.14,95%CI 1.08-4.23,p=0.04) were independent predictors of mortality at Cox regression. A 5-point score was developed to identify high-risk patients: very low risk (0pts), low risk (1-2pts), intermediate risk (3pts) and high risk (4-5pts), with 10-year survival rates of 100%, 87%, 62% and 16%, respectively.CONCLUSIONSMortality in NCEs is increased due to complications and lack of response to current therapies. We developed a clinical score to personalise follow-up. Targeted treatments are needed to improve outcomes.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056838","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":"Family History of Colorectal Cancer is the Risk of Colorectal Neoplasia: Some Issues to Be Addressed.","authors":"Xin Ling,Yi Liao,Jing-Jing Yang,Wei Han,Yong-Wei Hu","doi":"10.14309/ajg.0000000000003307","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003307","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056840","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":"Body Mass Index Did Not Impact Efficacy and Safety of Etrasimod: A Post Hoc Analysis of the ELEVATE UC Clinical Program.","authors":"Andres J Yarur,Millie D Long,Joana Torres,Neilanjan Nandi,Raymond K Cross,Arcangelo M Abbatemarco,David Blanco,Wojciech Niezychowski,Catherine Crosby,Joseph Wu,Gokul Pradeep,Martina Goetsch,Remo Panaccione","doi":"10.14309/ajg.0000000000003330","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003330","url":null,"abstract":"OBJECTIVEHigh body mass index (BMI) may reduce ulcerative colitis (UC) treatment efficacy. Etrasimod is an oral, once-daily (QD), selective sphingosine 1-phosphate (S1P)1,4,5 receptor modulator for the treatment of moderately to severely active UC. This post hoc analysis assessed treatment outcomes according to BMI in ELEVATE UC 52 and ELEVATE UC 12.METHODSPatients receiving etrasimod 2 mg QD or placebo were stratified by BMI: <25, 25-‍30, and >30 kg/m2. Efficacy and safety were assessed at Weeks 12 (pooled data) and 52 (ELEVATE UC 52 only) in addition to biomarkers assessments from Week 0-12.RESULTSFor BMI <25 (N = 443) and 25-30 kg/m2 (N = 217) subgroups, more patients receiving etrasimod vs placebo achieved clinical remission at Weeks 12 (BMI <25 kg/m2: 27.9% vs 13.3%; 25-30 kg/m2: 28.5% vs 10.0%; all P<0.001) and 52 (BMI <25 kg/m2: 30.8% vs 10.0%; 25-30 kg/m2: 33.3% vs 6.3%; all P<0.0001); and also for all other efficacy endpoints (P<0.05). In the BMI >30 kg/m2 subgroup (N = 127), more patients receiving etrasimod vs placebo achieved clinical remission at Week 52 (36.5% vs 3.9%; P<0.0001) and most other efficacy endpoints at Weeks 12 and 52 (all P<0.05). Overall, regardless of baseline BMI, numerically lower fecal calprotectin levels were observed with etrasimod vs placebo in treatment responders. The safety profile of etrasimod was consistent between BMI subgroups.CONCLUSIONA high BMI did not significantly impact efficacy and safety outcomes of etrasimod. (NCT03945188; NCT03996369).","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056892","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":"Comparative Improvement in Health-Related Quality of Life with Advanced Therapies for Moderate-to-Severe Crohn's Disease: A Network Meta-Analysis.","authors":"Pablo A Olivera,María L Parks,Ignacio Zubiaurre,Laurent Peyrin-Biroulet,Juan S Lasa,Laura E Targownik","doi":"10.14309/ajg.0000000000003333","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003333","url":null,"abstract":"BACKGROUND AND AIMSThe comparative efficacy of advanced therapies to improve health-related quality of life (HR-QoL) in Crohn's disease (CD) is unknown. We aimed to compare the impact of approved advanced therapies for moderate-to-severe CD on HR-QoL.METHODSWe searched MEDLINE, Embase, and Cochrane CENTRAL from inception to December 2023. We included randomized controlled trials (RCTs) that assessed approved advanced therapies for the treatment of adults with moderate-to-severe luminal CD. The primary outcome was change from baseline in the Inflammatory Bowel Disease Questionnaire (IBDQ). Pairwise random-effects meta-analyses were conducted, and we reported results as mean differences (MD) for continuous outcomes and risk ratios for binary outcomes, with corresponding 95% confidence intervals (CI). A random-effects frequentist network meta-analysis was conducted, and the competing interventions were ranked using the P-score.RESULTSOur search strategy 34 records that fulfilled our eligibility criteria. In pairwise meta-analysis, advanced therapies were associated with improvements in IBDQ score (MD 16.07, 95% CI 12.59 - 19.54) after induction. In network meta-analysis, upadacitinib 45mg ranked first for change in IBDQ after induction (MD 23.10, 95% CI 14.41 - 31.78, P-score 0.86). For maintenance studies, advanced therapies showed a significant improvement in IBDQ score in pairwise meta-analysis (MD 12.72, 95% CI 10.47 - 14.97). Infliximab 10mg/kg ranked first for change in IBDQ after maintenance (MD 24.91, 95% CI 12.99 - 36.83, P-score 0.90).CONCLUSIONAdvanced therapies were associated with improvements in HR-QoL after induction and maintenance. Upadacitinib 45mg and infliximab 10mg/kg ranked highest after induction and maintenance, respectively.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"129 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056893","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":"Cost-Utility Analysis of Non-Invasive Tests to Initiate Hepatocellular Carcinoma Surveillance in Metabolic Dysfunction-Associated Steatotic Liver Disease.","authors":"Pakanat Decharatanachart,Kittiyod Poovorawan,Pisit Tangkijvanich,Phunchai Charatcharoenwitthaya,Thoetchai Peeraphatdit,Suthira Taychakhoonavudh,Sombat Treeprasertsuk,Roongruedee Chaiteerakij","doi":"10.14309/ajg.0000000000003332","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003332","url":null,"abstract":"BACKGROUND AIMSNon-invasive tests (NITs), e.g. Fibrosis-4 Index (FIB-4) and vibration-controlled elastography (VCTE), have been used to identify metabolic dysfunction-associated steatotic liver disease (MASLD) patients at high risks for hepatocellular carcinoma (HCC). This study investigates the cost-effectiveness of NITs to identify MASLD patients with advanced liver fibrosis and initiate HCC surveillance.METHODSA cost-utility analysis using a Markov model compared no use of NITs with three NIT strategies: 1) FIB-4 and VCTE (FIB-4/VCTE), 2) FIB-4 alone, and 3) VCTE alone to identify advanced liver fibrosis and initiate HCC surveillance with biannual ultrasonography with alpha-fetoprotein in 4 MASLD populations: 1) general MASLD patients, 2) MASLD patients with body mass index (BMI) >30 kg/m2, 3) MASLD patients with diabetes, and 4) MASLD patients with three metabolic traits (diabetes, hypertension and BMI >30).RESULTSFIB-4/VCTE was the most cost-effective approach across all groups, showing the lowest ICER, followed by FIB-4 alone and VCTE alone. In the general MASLD population, both FIB-4/VCTE and FIB-4 alone were cost-effective in the US, while only FIB-4/VCTE was cost-effective in Thailand. For MASLD patients with BMI >30, all strategies were cost-effective in the US, while only FIB-4/VCTE was cost-effective in Thailand. In MASLD patients with diabetes or 3 metabolic traits, all strategies were cost-effective in the US, while FIB-4/VCTE and FIB-4 alone were cost-effective in Thailand.CONCLUSIONSUsing FIB-4/VCTE to initiate HCC surveillance is cost-effective for MASLD patients. If VCTE is unavailable, FIB-4 alone is a cost-effective alternative for MASLD patients with diabetes or 3 metabolic traits.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056894","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":"Electronic Interventions to Improve Quality for Inpatient Cirrhosis Care: a prospective evaluation.","authors":"Dustin Romain,Shengchen Hao,Katie Grzyb,Linda Bashaw,Neehar D Parikh,Elliot B Tapper","doi":"10.14309/ajg.0000000000003334","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003334","url":null,"abstract":"BACKGROUNDEfforts to improve adherence to quality measures in cirrhosis care are encouraged by AASLD to improve clinical outcomes.METHODSWe prospectively evaluated two best practice advisory (BPA) interventions to alert clinicians caring for patients with cirrhosis and acute variceal hemorrhage (AVH) or spontaneous bacterial peritonitis (SBP).RESULTSOur BPAs increased utilization. Ceftriaxone use was associated with adverse outcomes such as more blood product and broad-spectrum antibiotic use. The albumin BPA was associated with reduced mortality.CONCLUSIONSBPAs should be used with care and are best in settings with low baseline utilization of quality indicators.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056896","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":"Peranal Endoscopic Myectomy for Salvage Resection of a Neuroendocrine Tumor in the Lower Rectum.","authors":"Kenta Yao,Kinichi Hotta,Tadakazu Shimoda,Kenichiro Imai,Sayo Ito,Kazunori Takada,Hiroyuki Ono","doi":"10.14309/ajg.0000000000003335","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003335","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056839","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":"Medications for Alcohol Use Disorder Are Increasingly Being Prescribed in American Patients with Advanced Liver Disease.","authors":"Abhishek Shenoy,Venkata Sai Jasty,Sarah Uttal,Sarah Nasser,Gerald Scott Winder,Jessica Mellinger,Robert J Fontana","doi":"10.14309/ajg.0000000000003328","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003328","url":null,"abstract":"The number of alcohol use disorder patients with mild (n=101) and severe alcoholic liver disease (n=112) increased between 2013 and 2023 (p=0.06). Naltrexone was prescribed in 65%, acamprosate 26% and disulfiram 9%. Internal medicine providers were the most frequent prescribers (51%) followed by Psychiatry (30%), and GI/Hepatology (9%) (p=0.001). Duration of use was longest with naltrexone compared to acamprosate and disulfiram (360 vs 251 vs 190 days, p=0.032). The rate of AUD medication discontinuation for adverse events was similar in both groups (14% vs 12%). Naltrexone, acamprosate, and disulfiram are increasingly being prescribed in American patients with mild and severe ALD with similar tolerability and efficacy.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991683","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}