The American Journal of Gastroenterology最新文献

{"title":"Microbial Dysbiosis in the Urinary Microbiome of Patients with Cirrhosis.","authors":"Johannes Woltsche,Christian Pacher-Deutsch,Stefan Fürst,Lukas Gulden,Jakob Schwarzl,Nicole Feldbacher,Maximilian Nepel,Lavra Celcer,Natalie Hasl,Victoria Rieper,Vanessa Stadlbauer,Angela Horvath","doi":"10.14309/ajg.0000000000003634","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003634","url":null,"abstract":"INTRODUCTIONCirrhosis is associated with microbiome alterations beyond the gut, including skin, saliva, and serum. This study investigated the urinary microbiome (UMB) in patients with cirrhosis, who have an increased risk of urinary tract infections (UTIs).METHODSMidstream urine from 137 patients was analysed via 16S rRNA sequencing; 68 patients with cirrhosis and 32 non-cirrhotic controls met inclusion criteria.RESULTSPatients with cirrhosis showed significantly reduced alpha-diversity. The UMB of controls was enriched in Streptococcus species.DISCUSSIONReduced microbial diversity and lower Streptococcus abundance in patients with cirrhosis might help to explain their heightened susceptibility to UTIs.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568443","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":"A splenic artery aneurysm masquerading as a gastric subepithelial tumor.","authors":"Alan Zakko,Vincent Notar-Francesco,Nicholas G Brown","doi":"10.14309/ajg.0000000000003633","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003633","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"685 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568434","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":"Reflux Hypersensitivity or Functional Heartburn Can Be the Cause of Persistent Symptoms in Patients With Confirmed GERD Refractory to PPI Treatment.","authors":"Daniel Sifrim","doi":"10.14309/ajg.0000000000003612","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003612","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568444","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":"Unexpected Origin: Gastric Mature Cystic Teratoma Presenting as a Hepatic Mass.","authors":"Kai Zhang,Longhao Zhang,Junwei Zhang,Xin Lu,Haitao Zhao,Yiyao Xu","doi":"10.14309/ajg.0000000000003621","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003621","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533514","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":"Asymptomatic Yersinia Colitis Mimicking Neoplasia in Ulcerative Colitis.","authors":"Kentaro Kojima,Jun Takada,Masahito Shimizu","doi":"10.14309/ajg.0000000000003626","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003626","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533469","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":"Adding clip before endoscopic cyanoacrylate injection decreases ectopic embolisms in gastric varices: a randomized controlled trial.","authors":"Guangchuan Wang,Lijun Peng,Ping Li,Haijun Mou,Xiaopei Li,Qun Li,Xingsi Qi,Kemei Lu,Huijing Yao,Wei Wang,Lianhui Zhao,Yifu Xia,Mingyan Zhang,Junyuan Zhu,Jiali Ma,Junshan Li,Congxiang Li,Xiaofeng Liu,Biguang Tuo,Xiubin Sun,Juan Carlos García-Pagán,Chunqing Zhang","doi":"10.14309/ajg.0000000000003629","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003629","url":null,"abstract":"BACKGROUND AND AIMSEctopic embolism caused by cyanoacrylate migration is a severe complication. We aimed to test the hypothesis that prior clipping can reduce ectopic embolism secondary to endoscopic cyanoacrylate injection (ECI) in gastric varices with a gastrorenal shunt.METHODSIn this multicenter, open-label, parallel, randomized controlled trial, patients with fundal gastric varices and gastrorenal shunts from 10 tertiary hospitals were randomly assigned to clip-assisted ECI (Clip-ECI, n=35) and conventional ECI groups (Con-ECI, n=35). The primary outcome was the occurrence of ectopic embolism. Computed tomography (CT) was performed within 48 hours of the initial injection to screen for cyanoacrylate (marked with lipiodol) migration.RESULTSThe technical success rate was 100% in both groups. The Clip-ECI group had a significantly lower incidence of cyanoacrylate embolism than the Con-ECI group (11.4% vs. 42.9%, p = 0.003). Symptomatic pulmonary embolism occurred in four patients in the Con-ECI group, of which one patient died. In contrast, no symptomatic embolism event was observed in the Clip-ECI group (11.4% vs. 0%, p = 0.114). No clip-related bleeding was reported. No significant differences were observed in the total rebleeding rate (14.3% vs. 14.3%) and survival rate (97.1% vs. 93.9%) between the Clip-ECI and Con-ECI groups during a median follow-up of 10.1 (interquartile range [IQR]: 7.7-12.9) and 9.9 (IQR: 6.3-12.6) months, respectively.CONCLUSIONClipping before endoscopic cyanoacrylate injection reduces the risk of ectopic embolism in patients with fundal varices with a portal-systemic shunt, without compromising safety or efficacy.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533513","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":"Geographical Distance from Transplant Center and Impact on Waitlist Outcomes and Healthcare Utilization Pre-Listing.","authors":"Mayur Brahmania,Yashasavi Sachar,Juan Pablo Arab,Mohammad Qasim Khan,Piali Bhati,Kristyne Onizuka,Anouar Teriaky,Karim Qumosani,Andrew McClure,Blayne Welk,Melody Lam,Ephraim Tang,Anton Skaro,Adam Rahman","doi":"10.14309/ajg.0000000000003628","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003628","url":null,"abstract":"BACKGROUND AIMSDecompensated cirrhosis has a median survival of two years without liver transplantation (LT). This study investigates if distance from LT center affects waitlist mortality and receipt of LT.METHODSThe study population was generated from the transplant database in London, Ontario, Canada. Adult patients on the waitlist for LT between January 1, 2012 and December 31, 2021, were included. Data was linked to the Institute for Clinical Evaluative Sciences (ICES) to examine clinically relevant outcomes, using ≤150km vs >150km to stratify descriptive analysis. Multivariate time-to-event analyses were conducted to evaluate the hazards of increasing distance from LT center on waitlist mortality and receipt of LT.RESULTSOf the 552 patients meeting study criteria, 394 (71.4%) received LT in an overall predominantly male cohort (n=390, 70%), with a median age of 59 years (IQR 52-64) and median distance from the LT center of 110 km (IQR 59-191). There were no significant differences between patients living ≤150 km (n=362) vs >150 km (n=190) from the LT center. In terms of liver disease etiology-alcohol-related liver disease remained the most common (32.9% vs 33.2%; p=0.95) across both categories, with no difference in median MELD-Na scores between those that did and did not receive transplant(17 [IQR 9-25] vs 18 [IQR 10-27]; p=0.12). On multivariable analysis, distance to the LT center did not impact receipt of LT, waitlist mortality, or post-listing ED visits and hospitalizations. MELD-Na at listing was a significant predictor of increased waitlist mortality (HR 1.12; CI 1.09-1.16; p<0.01), while hepatocellular carcinoma (HCC) diagnosis was associated with reduced waitlist mortality (HR 0.13; CI 0.04-0.45; p <0.01). Patients further from the LT center had a higher median number of hospitalizations (2 vs 1; p=0.02) and emergency room (ED) visits (3 vs 2; p <0.01) in the year before LT listing, and significantly ED utilization within 90 days post-listing (0 [IQR 0-2] vs 0 [IQR 0-1]; p<0.05), albeit this was not consistent on multivariable analysis.CONCLUSIONGeographical distance does not significantly impact LT waitlist mortality or receipt of LT. However, differences in healthcare utilization suggest disparities may still manifest with a negative impact on patients in the pre-LT setting.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533509","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":"How I Approach It: Stool Testing for Colon Cancer: Growing options.","authors":"Aasma Shaukat,Seth Crockett","doi":"10.14309/ajg.0000000000003631","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003631","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533511","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":"Bloating and distention patients form 6 distinct latent clusters based on symptoms, diet, psychosocial and quality of life parameters.","authors":"Anjali Byale,Olafur S Palsson,Magnus Simrén,Jan Tack,Boris Le Nevé,Rim Hassouna,Shrikant Bangdiwala,Ami Sperber,Douglas Drossman,Madhusudan Grover","doi":"10.14309/ajg.0000000000003622","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003622","url":null,"abstract":"BACKGROUND/AIMSBloating, distention, and gas-related gastrointestinal (GI) symptoms are frequently reported by patients across the spectrum of Disorders of Gut-Brain Interaction (DGBI). We aimed to characterize these using latent class modelling in a large multi-national survey.METHODSA nationwide survey of adults in the US, UK, and Mexico used quota sampling for demographic balance. It included Rome IV diagnostic questions, Intestinal Gas Questionnaire (IGQ), Patient Health Questionnaires for anxiety and depression (PHQ-4) and somatization (PHQ-12), quality of life (PROMIS Global-10), and lifestyle questions. Latent class analysis (LCA) was performed using 'depmix' in RStudio 4.2.3.RESULTS3,471 subjects experiencing bloating and/or distention (mean age 43 years, 57% female) were included. Using 42 demographic and pertinent clinical variables, LCA revealed 6 distinct clusters. The first two clusters demonstrated limited to moderate impairment in health-related quality of life (HRQoL) and with both characterized by some degree of dietary and supplement associations, however, cluster 2 lacked specific triggers observed in other clusters. The subsequent two clusters showed favorable HRQoL and mild gas-related symptoms, with only cluster 4 exhibiting distinct dietary triggers. The final two clusters, associated with bowel dysfunction, showed a higher prevalence of IBS-C and IBS-M in cluster 5, and IBS-D in cluster 6. These bowel dysfunction clusters exhibited severe gas symptoms in the preceding 24 hours and greater HRQoL impairment compared to the other four clusters. Notably, cluster 5 was linked to dietary triggers, whereas cluster 6 was defined by psychosocial comorbidities.CONCLUSIONSBloating and distention patients are likely driven by variable influences of dietary, psychological and bowel dysfunction. Further studies are needed to identify mechanisms and titrate treatment suited to specific mechanistic drivers.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533512","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":"Switching to entecavir >3 months before the end of tenofovir-based therapy in HBeAg-negative patients may reduce early relapse and hepatitis flare.","authors":"Yi-Cheng Chen,Wen-Juei Jeng,Rong-Nan Chien,Yun-Fan Liaw","doi":"10.14309/ajg.0000000000003630","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003630","url":null,"abstract":"OBJECTIVESStudies have shown that off-therapy clinical relapses occur much more frequently within 24 weeks and seems more severe in tenofovir disoproxil fumarate (TDF)-treated than in entecavir (ETV)-treated patients. A small retrospective study reported a significantly lower 24-week clinical relapse rate in 40 non-ETV (including 3 TDF) treated patients after switching to ETV for ≥12 weeks before the end of therapy (EOT). To confirm the effect of the ETV-switching strategy, a retrospective cohort study was conducted.METHODSTDF or tenofovir alafenamide (TAF) treatment in 18 HBeAg-negative patients was switched to ETV for ≥12 weeks before EOT. Two control groups each 1:2 matched in age, sex, genotype, cirrhosis, baseline HBV DNA, and quantitative HBsAg (qHBsAg) were recruited. All patients were followed up every 1-3 months for ≥6 months after EOT.RESULTSCompared to the TDF/TAF-control, the incidence of clinical relapse and hepatitis flare by week 24 was lower (16.7 vs 58.3%; p=0.009; 11.1 vs 50%; p=0.013, respectively). The rate of hepatitis flare with ALT >10 times upper limit of normal was also lower than TDF/TAF-control group (5.6 vs 33.3%; p=0.040). All differences compared to ETV-control group were non-significant.CONCLUSIONSThe results confirm that the timing of clinical relapse is associated with the last antiviral agent used before EOT. Furthermore, the ETV-switching strategy may reduce clinical relapse and hepatitis flare and the severity of hepatitis flare within 24 weeks after EOT. This strategy seems clinically useful and important for a safer cessation of TDF-based treatment.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533508","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}