The American Journal of Gastroenterology最新文献

{"title":"Colorectal cancer incidence and mortality by age group, colon location, and histology in Canada.","authors":"Kathleen M Decker,Pascal Lambert,Jen Bravo,Alain Demers,Harminder Singh","doi":"10.14309/ajg.0000000000004141","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004141","url":null,"abstract":"BACKGROUNDColorectal cancer (CRC) incidence is increasing among younger individuals in many countries. We examined CRC incidence and mortality by age group, site, and histology in Canada.METHODSData from the Canadian Cancer Registry and the Canadian Vital Statistics Death Database were used to determine CRC incidence from 1992 to 2019 and mortality from 1974 to 2022. We calculated incidence by age group, site, and histology and mortality by age group and site. Annual percent change was calculated using Joinpoint Regression. Age-period-cohort models with splines were run to indicate influence on CRC incidence.RESULTSCRC incidence was stable for individuals 20-29 years, increased for those 30-49, remained stable for 50-54, and decreased for 55 years and older. Proximal, distal, and rectal cancer incidence was stable or increased for individuals less than 55 and decreased for those over 55. Adenocarcinoma CRCs increased for those less than 55. Mucinous and signet ring cell CRCs decreased or remained stable for all ages. Neuroendocrine CRCs increased for most ages. Age, cohort, and period effects are evident. CRC mortality stopped decreasing in the late 1990s for individuals 20-49 but decreased for those over 50. Proximal and distal CRC mortality decreased for all ages. Rectal cancer mortality increased.CONCLUSIONS AND RELEVANCECRC incidence and mortality in Canada vary by age, site, and histology. In addition to a reduction in the screening start age, CRC screening programs must focus on individuals 50-54 years of age as they have not experienced a decrease in CRC incidence.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539166","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-Marketing Safety Signals of Microbiota-Based Live Biotherapeutic Products for Recurrent Clostridioides difficile Infection: A FAERS Pharmacovigilance Study.","authors":"Eun Jeong Gong,Chang Seok Bang,Jae Jun Lee,Gwang Ho Baik","doi":"10.14309/ajg.0000000000004133","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004133","url":null,"abstract":"BACKGROUNDREBYOTA and VOWST are the first FDA-approved live biotherapeutic products (LBPs) for recurrent Clostridioides difficile infection (rCDI). Prior FDA safety alerts (2019-2020) regarding invasive infections from investigational fecal microbiota transplantation underscore the need for post-marketing surveillance of these novel products.AIMSTo characterize the real-world safety profiles of REBYOTA and VOWST using the FDA Adverse Event Reporting System (FAERS) and compare them against established CDI therapeutics.METHODSWe performed disproportionality analysis of FAERS data (Q1;2020-Q4;2025). REBYOTA and VOWST were identified as primary suspect drugs using BLA numbers and drug name matching. Comparators included fidaxomicin, bezlotoxumab, and vancomycin (CDI-filtered). Four methods were applied: reporting odds ratio (ROR), proportional reporting ratio, information component, and empirical Bayes geometric mean. Signals required ≥2 methods agreement.RESULTSWe identified 231 REBYOTA and 813 VOWST primary suspect reports, yielding 18 and 54 disproportionality signals, respectively. Both products' signals were consistent with known gastrointestinal adverse events. No signals were detected for bacteremia, septic shock, or anaphylaxis. Death was reported at lower-than-expected frequency for VOWST (ROR 0.29; 95% CI 0.15-0.53). A VOWST-specific UTI cluster (Klebsiella UTI ROR 405.73; Pseudomonal UTI ROR 168.54) was identified; head-to-head comparison showed no significant UTI difference versus REBYOTA (ROR 1.39, NS), suggesting stimulated reporting bias rather than a biological signal. Route-dependent adverse event profiles differed between oral VOWST and rectal REBYOTA.CONCLUSIONSFDA-approved LBPs demonstrate reassuring post-marketing safety profiles without transmitted infection signals. The extreme VOWST UTI signal is likely attributable to FDA-mandated expedited reporting obligations rather than a causal drug effect.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539262","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":"Case-based Diagnostic Algorithms and Multidimensional Clinical Profiles for common Disorders of Gut-Brain Interaction using Rome V criteria.","authors":"Brian E Lacy,Adam D Farmer,Hans Tornblom","doi":"10.14309/ajg.0000000000004131","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004131","url":null,"abstract":"The accurate diagnosis of disorders of gut-brain interaction (DGBI), such as functional dyspepsia and irritable bowel syndrome, is crucial for improving patient symptoms, outcomes and ultimately, quality of life. However, busy clinicians often face challenges in diagnosing and managing these conditions, particularly when patients present with non-specific gastrointestinal symptoms together with psychosocial distress and/or social issues. DGBI are among the most common reasons for gastroenterology referral, with a global prevalence of approximately 40% in adults based on large-scale epidemiologic studies. While diagnostic algorithms aid in positively identifying DGBI, they often overlook key factors influencing treatment decisions. The Rome V Multidimensional Clinical Profile (MDCP) offers a comprehensive, patient-centered framework that extends beyond diagnosis alone. It integrates five core domains: (1) the primary diagnosis, (2) clinical modifiers, (3) impact on daily activities and quality of life, (4) psychosocial modifiers, and (5) physiological features and biomarkers. By considering comorbidities, illness severity, psychosocial contributors, and potential biomarkers, the MDCP enables clinicians to develop a holistic understanding of the patient's condition. This multidimensional approach facilitates tailored, evidence-based treatment plans that address the biopsychosocial aspects of DGBI, ultimately enhancing symptom management and patient well-being. Furthermore, it highlights gaps in knowledge and stimulates targeted research into these highly prevalent disorders. This case-oriented educational review will evaluate three DGBIs - functional dyspepsia, irritable bowel syndrome, and chronic abdominal pain - using the MDCP approach.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539194","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":"10 Pearls for Clinical Practice in Disorders of Gut-Brain Interaction.","authors":"Lin Chang,Heidi M Staudacher,Sarah Ballou,Giovanni Barbara","doi":"10.14309/ajg.0000000000004136","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004136","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"241 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539193","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":"Sigmoid Volvulus With Concurrent Large Right Inguinal Hernia.","authors":"Matthew Posen,Marcel Ghanim,Mukarram Amine","doi":"10.14309/ajg.0000000000004132","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004132","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"173 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539266","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":"Absolute risk of malignancy by treatment in patients with Crohn's disease compared to the general population: a nationwide population-based cohort study.","authors":"Åsa H Everhov,Julia Eriksson,Jonas Söderling,Johan Askling,Jonas Halfvarson,Karin E Smedby,Jonas F Ludvigsson,Henrik Toft Sørensen,Ola Olén, ","doi":"10.14309/ajg.0000000000004119","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004119","url":null,"abstract":"BACKGROUNDReal-world data quantifying absolute cancer risk in Crohn's disease (CD) by treatment status are lacking but are essential for patient counselling.METHODWe linked nationwide Swedish register data and assessed incident cancers overall and by type in patients with CD 2007-2023. We estimated age-stratified incidence rate (IR) differences compared to the general population in a \"once-exposed-always-exposed\" design. Treatment cohorts comprised new users of thiopurine, tumor necrosis factor inhibitors (TNFi), thiopurine+TNFi, vedolizumab, ustekinumab, and patients naïve to immunomodulatory drugs.RESULTSWe followed 38,733 patients and 360,616 comparator subjects for a median 7.3 years. The IR differences for any cancer (number of excess cancers in each treatment cohort per 1,000 person-years versus the matched population) were 2.43 (95%CI:1.92;2.94) for the naive cohort; 3.14 (95%CI:2.50;3.78) for thiopurine-treated, 2.42 (95%CI:1.63;3.22) for TNFi-treated, 2.59 (95%CI:1.53;3.64) for thiopurine +TNFi, 2.61 (95%CI:-0.08;5.30) for vedolizumab, and 1.54 (95%CI:-1.34;4.41) for ustekinumab. The excess cancer incidence was primarily due to non-melanoma skin cancer (squamous cell and basal cell carcinoma). After exclusion of non-melanoma skin cancers, the excess overall cancer incidence was 1.27 to 0.96 cases/1,000 person-years in the naïve, thiopurine, and TNFi-treated groups, but not significantly increased in the other. IR differences for overall cancer increased and HRs decreased with increasing patient age.CONCLUSIONElevated overall cancer incidence was observed across all treatment cohorts, also in treatment-naïve patients. After exclusion of non-melanoma skin cancer, the excess cancer incidence in CD was around 1 extra case per 1,000 person-years due to lung-, small bowel -, hepatobiliary, and hematologic cancer.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"235 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462591","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 Efficacy of Tenapanor in Treating Patients With Irritable Bowel Syndrome With Constipation: A 26-Week, Placebo-Controlled Phase 3 Trial (T3MPO-2).","authors":"William D Chey,Anthony J Lembo,Yang Yang,David P Rosenbaum","doi":"10.14309/ajg.0000000000004082","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004082","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148441126","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":"Characteristics and outcomes of patients with imaging-defined MASLD and histological steatosis grade S0.","authors":"Wen-Yue Liu,Li-You Lian,Seung Up Kim,Terry Cheuk-Fung Yip,Salvatore Petta,Atsushi Nakajima,Emmanuel Tsochatzis,Junping Shi,Wah-Kheong Chan,Jérôme Boursier,Elisabetta Bugianesi,Yusuf Yilmaz,Hannes Hagström,Manuel Romero-Gomez,Khalid Alswat,José Luis Calleja,Hirokazu Takahashi,Victor de Lédinghen, Shalimar,Laurent Castéra,Arun J Sanyal,George Boon-Bee Goh,Philip N Newsome,Jian-Gao Fan,Michelle Lai,Sandeep Aggarwal,Stergios Kechagias,Yoichi Hiasa,Bheesham Dayal,Zhongtao Zhang,Jacob George,Mohamed El-Kassas,Jinjun Chen,Hong You,Barham K Abu Dayyeh,Huiping Sheng,Leon A Adams,Jing Wang,Fangping He,Huiqing Liang,Yong-Feng Yang,Xiaoling Chi,Bihui Zhong,Yan Bi,Yuqiang Mi,Yongfen Zhu,Rixing Bai,Jing Zhang,Bingyuan Wang,Jinghai Song,Hong Deng,Qing Xie,Lang Bai,Yongning Xin,Wen Xie,Jie Li,Céline Fournier,Bing Liao,Hong-Hai Xu,Yang-Yang Li,Huai Zhang,Qin Feng,Mirko Zoncapè,Chutian Wu,Hye Won Lee,Grace Lai-Hung Wong,Angelo Armandi,Ying Shang,Grazia Pennisi,Elba Llop,Masato Yoneda,Marc de Saint-Loup,Rocio Gallego-Durán,Paloma Carrillo Fernández,Amon Asgharpour,Kevin Kim-Jun Teh,Mandy Sau-Wai Chan,Huapeng Lin,Sherlot Juan Song,Waleed K Al-Hamoudi,Hiroshi Isoda,Teruki Miyake,Sanjaya K Satapathy,Mengyi Li,Keshni Sharma,Mohammed Emadeldeen,Ling Zhou,Xiaofei Tong,Fateh Bazerbachi,Xiaotang Fan,Huanming Xiao,Junzhao Ye,Liang Xu,Xiaolin Wang,Tamadr Abdulrhman Aldoheyan,Giovanni Targher,Christopher D Byrne,Vincent Wai-Sun Wong,Ming-Hua Zheng","doi":"10.14309/ajg.0000000000004116","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004116","url":null,"abstract":"BACKGROUND AND AIMSMetabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver disease, and liver biopsy remains the gold standard for diagnosis. However, a subset of patients diagnosed with MASLD by imaging paradoxically exhibit steatosis grade S0 upon liver biopsy, posing a diagnostic challenge. This study investigates the outcomes and causes of \"steatosis 0\".METHODS\"Steatosis 0\" was defined as imaging-detected MASLD with a biopsy-defined steatosis grade S0. We used global cohorts to evaluate outcomes, histologic progression via paired biopsies, and possible causes. The cause analysis included MRI-PDFF for fat distribution, pathologist consistency testing, and comparison of serial biopsy sections.RESULTSIn a follow-up cohort of 3,273 biopsy individuals from 16 centers, 123 (3.8%) exhibited \"steatosis 0\". Of these, 29.3% of them had advanced fibrosis (\"burnt-out\" MASLD) and demonstrated a risk of liver-related events, while those without advanced fibrosis had no such events. In the paired-biopsy cohort of 1,865 patients, 74 (4.0%) individuals initially showed steatosis grade S0; among them, 93.2% retained no or mild steatosis on follow-up biopsy. MRI-PDFF assessments in 42 MASLD patients revealed heterogeneous hepatic fat distribution, with some segments showing steatosis grade S0 despite elevated average liver fat. Inter-pathologist variability and discrepancies across consecutive biopsy sections contributed to misclassification of steatosis grade.CONCLUSION\"Steatosis 0\" represents a potential diagnostic gray zone in MASLD. It may be caused by \"burnt-out\" MASLD, uneven liver fat distribution, or variability in pathological assessment. Understanding the causes and implications of \"steatosis 0\" is critical for diagnosis and management.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462588","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":"Dose May Matter: CYP2C19 Genotype and PPI Response in Pediatric Eosinophilic Esophagitis.","authors":"Paroma Bose,Chizoba N Umeweni,Anthony Perkins,Elizabeth T Jensen,Evan S Dellon,Amanda B Muir,Sandeep K Gupta","doi":"10.14309/ajg.0000000000004117","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004117","url":null,"abstract":"INTRODUCTIONLittle is known about the effect of proton pump inhibitor (PPI) metabolism, based on CYP2C19 genotype, on treatment response in pediatric eosinophilic esophagitis (EoE).METHODSWe conducted a cohort study of pediatric subjects with active histologic EoE treated with PPI therapy. Whole blood samples were tested for CYP2C19 genotype.RESULTSAmong subjects prescribed high PPI dose > 1mg/kg/day, intermediate/slow PPI metabolizers were significantly more likely to have histologic response to PPI therapy compared to normal and rapid PPI metabolizers. No ultra-rapid metabolizers responded to PPI therapy.DISCUSSIONKnowing CYP2C19 genotype may optimize PPI dose for the treatment of EoE in individual patients.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429043","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 manage cirrhosis in a busy outpatient clinic? The P.O.R.T.A.L.V.E.I.N. mnemonic.","authors":"Jasmohan S Bajaj,Douglas M Heuman","doi":"10.14309/ajg.0000000000004118","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004118","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148429045","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}