The American Journal of Gastroenterology最新文献

{"title":"Dietary Guidelines 2025-2030 For Americans Are Concerning For Liver Health.","authors":"Nicholas Dunn,Sheel Patel,Luis Antonio Díaz,Robert J Wong,Juan Pablo Arab,Shira Zelber-Sagi,Aleksander Krag,Zobair M Younossi,Ashwani K Singal","doi":"10.14309/ajg.0000000000004114","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004114","url":null,"abstract":"BACKGROUND AIMSThe 2025-2030 Dietary Guidelines for Americans (DGA-2025) introduced substantial changes in nutrition recommendations, including greater emphasis on total protein intake and omission of prior alcohol guidance. We evaluated how individual dietary components-derived from both Healthy Eating Index-2020 (HEI-2020) and z-score models-relate to steatotic liver disease (SLD), fibrosis, and cirrhosis in U.S. adults.METHODSWe analyzed data from 10,944 adults (NHANES 2017-2023) with 24-hour dietary recall and vibration-controlled transient elastography (VCTE). Dietary exposures included HEI-2020 component scores and energy-adjusted z-scores for DGA-2025-aligned food groups. An alcohol adherence score was derived based on prior DGA-2020 thresholds. Logistic regression and stepwise models were adjusted for sociodemographics, diabetes, obesity, caffeine, and survey design.RESULTSSeveral HEI-2020 and z-score components were consistently associated with liver outcomes. High intake of total fruit, whole fruit, vegetables, greens and beans, whole grains, and seafood/plant protein was associated with lower odds of SLD and fibrosis. In contrast, higher intake of red/processed meats, sodium, total protein, saturated fat, and added sugars was associated with a greater prevalence. Alcohol adherence scores were strongly protective across all outcomes. In stepwise models, greens and beans, seafood and plant protein, saturated fat, and alcohol use were retained as independent predictors. Notably, components emphasized in DGA-2025-such as total protein and red meat-were associated with greater fibrosis risk, while several protective components (e.g., greens and beans, seafood/plant protein) were omitted from the updated guidelines.CONCLUSIONSHEI-2020 and z-score models identify multiple protective and adverse dietary components associated with SLD and fibrosis. The findings underscore the importance of component-level nuance-particularly regarding protein sources and alcohol intake-when formulating dietary guidance for liver health.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415818","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":"Designing and Interpreting Large Database Studies in GI and Hepatology.","authors":"Michelle Russin,Andrew Moon","doi":"10.14309/ajg.0000000000004110","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004110","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"220 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415820","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":"Association of Intrapancreatic Fat Deposition with Mortality: A Prospective Cohort Study with Genetic Risk Profiling.","authors":"Xiaowu Dong,Qingtian Zhu,Zhiyin Huang,Xiaolei Shi,Liuhui Wang,Xiaolin Yang,Xin Gao,Weiwei Chen,Shengfeng Wang,Yongfeng Song,Guotao Lu,Tuo Li,Zhongjun Zhou","doi":"10.14309/ajg.0000000000004113","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004113","url":null,"abstract":"BACKGROUND AND AIMSPancreatitis and pancreatic cancer lead to excess mortality in the general population. Excessive intrapancreatic fat deposition (IPFD) is a common driver of diseases of the exocrine pancreas according to the PANDORA hypothesis. However, the relationship of IPFD with mortality has never been investigated. We aimed to explore the association of IPFD with mortality.METHODSParticipants from the UK Biobank were divided into two cohorts based on the availability of IPFD quantified using MRI. The Kaplan-Meier survival analysis and multivariable Cox-proportional hazard model were used. Genome-wide association study (GWAS) on IPFD and Mendelian randomization analysis were performed. An IPFD-linked polygenic risk score (PRS) was applied in the MRI-naïve cohort.RESULTSA total of 55,058 participants were analyzed, 695(1.26%) of whom died during a median follow-up of 4.9 years. Excessive baseline IPFD was significantly associated with an increased risk of all-cause mortality (HR=1.081, p<0.05) and mortality from vascular diseases (HR=1.247, p<0.001). GWAS identified 38 significant IPFD-associated SNPs. The PRS derived from these SNPs showed significant associations with all-cause mortality and mortality from vascular diseases. In the MRI-naïve cohort of 354,761 participants, consistent results were obtained using the PRS as a genetic proxy for IPFD.CONCLUSIONExcessive IPFD is associated with elevated risk of future mortality especially from vascular diseases in the general population.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415831","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":"Dupilumab Improves Endoscopic Features in Children Aged 1-11 Years With Eosinophilic Esophagitis: EoE KIDS Study Results.","authors":"Shauna Schroeder,Mirna Chehade,Calies Menard-Katcher,Navneet Virk Hundal,Ruiqi Liu,Changming Xia,Lacey B Robinson,Jennifer Maloney,Margee Louisias,Allen Radin","doi":"10.14309/ajg.0000000000004115","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004115","url":null,"abstract":"OBJECTIVESThis post hoc analysis assessed the impact of dupilumab on endoscopic features of eosinophilic esophagitis (EoE) using the Endoscopic Reference Score (EREFS) in children 1-11 years of age in the phase 3 EoE KIDS trial.METHODSPatients who received weight-tiered higher-exposure (HE) dupilumab (N=37) or placebo (N=34) for 16 weeks (Part A) and weight-tiered HE dupilumab for 36 additional weeks (N=55) (Part B) in EoE KIDS were included. Change from baseline in EREFS total score, EREFS inflammation and fibrostenotic subscores, component scores, and proportion of patients achieving endoscopic normalization (EREFS total score of 0), were assessed at Week 16 and Week 52.RESULTSAt Week 16, EREFS total score and inflammation subscore were reduced with dupilumab vs placebo (LS mean difference -66.9% [95% CI -89.8, -44.0] and -2.2% [-2.7, -1.8], respectively); improvements in features of fibrostenosis were limited (-0.2% [-0.5, 0.1]), partly due to low baseline scores in these features. At Week 52, outcomes were maintained or further improved in patients continuing dupilumab and improved in placebo patients who switched to dupilumab at Week 16. Continuous dupilumab treatment for 52 weeks led to a greater proportion of patients in endoscopic normalization vs switching to dupilumab at Week 16 (30.3% vs 12.5%).CONCLUSIONSDupilumab improved endoscopic features of EoE at Week 16 vs placebo, and improvements were sustained up to 52 weeks. A greater proportion of patients treated with continuous dupilumab achieved endoscopic normalization at Week 52 compared with those who switched to dupilumab at Week 16.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415833","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":"BEHÇET'S SYNDROME PRESENTING AS SEVERE ULCERATIVE ESOPHAGITIS: A DIAGNOSTIC CHALLENGE.","authors":"Priyanka Panwar,Lavender Otom,Irene Mwandoto,Naomi Mumo,Saleem Abdulkarim","doi":"10.14309/ajg.0000000000004111","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004111","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148415832","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":"Cecal intubation rates, techniques, and neoplasia yields associated with repeat colonoscopy performed with standard endoscopes in 1334 patients referred after prior incomplete colonoscopy.","authors":"John J Guardiola,Easton M Stark,Ujwala Pamidimukkala,Jeremiah D Shultz,Rachel E Lahr,Douglas K Rex","doi":"10.14309/ajg.0000000000004096","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004096","url":null,"abstract":"BACKGROUNDCecal intubation rate (CIR) of ≥ 95% is a key quality metric for colonoscopy. After incomplete colonoscopy, patients are often referred for radiographic studies or centers performing balloon enteroscopy.OBJECTIVETo determine the success of repeat colonoscopy with standard non-balloon endoscopes after a failed colonoscopy.DESIGNWe reviewed 1,334 consecutive patients referred to our center after colonoscopy with failed cecal intubation. Based on the outside procedure report, we classified causes of previous failure as difficult sigmoid, redundant colon, or hernia. We reviewed success rates of cecal intubation at our center, tools and techniques used in successful cases, and the sensitivity of outside radiographic studies performed prior to referral.RESULTSWe achieved CIR in 96.1% of cases - 97.0% in 626 difficult sigmoid colons, 96.9% in 677 redundant colons, and 67.7% in 31 hernia cases (100% in left inguinal, 29% in ventral hernia). Most difficult sigmoid cases were completed with pediatric or ultrathin colonoscopes. Most redundant colon cases were completed with adult colonoscopes. Twenty of 32 lesions ≥ 20 mm in size found on colonoscopy were not identified by prior radiographic studies.CONCLUSIONIn the largest reported series of colonoscopies performed for prior incomplete examinations, we found nearly all cases, except a ventral hernia containing transverse colon, could be completed using standard endoscopic equipment and techniques. In this setting, radiographic studies have low sensitivity for large polyps. We recommend repeat colonoscopy at a referral center or using techniques described herein should be the first approach to a prior incomplete colonoscopy.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148322666","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":"Radiation scatter at fluoroscopy-guided endoscopic procedures: Building towards further optimization.","authors":"Ji Young Bang,Robert Hawes,Shyam Varadarajulu","doi":"10.14309/ajg.0000000000004097","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004097","url":null,"abstract":"INTRODUCTIONExposure to ionizing radiation by endoscopy personnel during fluoroscopy-guided procedures remains a health hazard. We aimed to evaluate a novel lead flap-enhanced artificial intelligence-enabled fluoroscopy (LE-AIF) system to minimize radiation scatter.METHODSWe conducted prospective study of 218 patients who underwent fluoroscopy-guided endoscopic procedures using conventional AIF (C-AIF) or LE-AIF systems. The primary outcome measure was comparison of radiation scatter to endoscopists.RESULTSRadiation scatter to endoscopists and anesthesia personnel were significantly lower using LE- AIF. On linear regression analysis, C-AIF and fluoroscopy duration were associated with radiation scatter.DISCUSSIONLE-AIF significantly reduced radiation scatter at endoscopic procedures.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"271 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148322665","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":"Esophageal Stenosis Secondary to Sengstaken-Blakemore Tube Malposition.","authors":"Yandan Zhong,Tingqiu Ge,Yongfeng Yang","doi":"10.14309/ajg.0000000000004090","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004090","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148299028","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 Rare Case of Gastric Mucosal Change in a Pernicious Anemia Patient.","authors":"Xueying Lai,Shengbo Wang,Yu Wan,Hui Deng","doi":"10.14309/ajg.0000000000004086","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004086","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148299029","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":"Water cooling to prevent electrocoagulation syndrome after endoscopic resection of colorectal neoplasm.","authors":"Qi Zhipeng,Li Bing,He Dongli,Shi Qiang,Ren Zhong,Cai Shilun,Cai Mingyan,Fu Peiyao,Zhu Yangbei,Zhu Liang,Xu Enpan,Zhong Yunshi","doi":"10.14309/ajg.0000000000004089","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004089","url":null,"abstract":"BACKGROUNDWith the increasing frequency of electrocoagulation hemostasis used in endoscopic submucosal dissection (ESD), the incidence of postoperative bleeding is gradually decreasing, while the incidence of post-ESD electrocoagulation syndrome (PECS) is gradually increasing. Water cooling can reduce thermal injury to the intestinal wall after electrocoagulation. Therefore, this study intends to conduct a prospective, multi-center randomized controlled trial to explore the effectiveness of water cooling after electrocoagulation in reducing the occurrence of PECS.METHODSFrom November 2022 to October 2023, 420 patients were prospectively included. The patients were 1:1 randomly divided into two groups, named the standard ESD (S-ESD) group and the water-cooled ESD (W-ESD) group. The main outcome measure was the incidence of PECS. Secondary outcomes were ESD operative time, complete resection rates, and adverse effects.RESULTSThe incidence of PECS in the W-ESD group was significantly lower than that in the S-ESD group (7.6% vs. 17.1%, P = 0.003). The median operation time was also shorter in the W-ESD group than in the S-ESD group (37.0 minutes, IQR: 30.0-47.0 minutes vs 42.5 minutes, IQR: 33.0-60.0 minutes, P < 0.001). There was no significant difference in specimen size between the two groups (3.8cm2, IQR: 3.1-6.3cm2 vs 4.6cm2, IQR: 3.1-7.1cm2, P = 0.286), and the complete resection rate was 100%. No perforation occurred in any patient.CONCLUSIONWater-cooled ESD technology can significantly reduce the occurrence of PECS.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148299277","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}