The American Journal of Gastroenterology最新文献

{"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}

{"title":"Effect of second sigmoid colon intubation during colonoscopy on adenoma detection rate in overweight and obese patients: A prospective randomized controlled trial.","authors":"Fei Han,Haining Zhou,Huijuan Wang,Lingli Zhang,Weiguo Ren,Nan Wang,Yuhan Hou,Yimeng Deng,Xiangyu Li,Jianning Yao","doi":"10.14309/ajg.0000000000003611","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003611","url":null,"abstract":"OBJECTIVESThe sigmoid colon is the most tortuous part of the large intestine and is often the most easily compressed during intubation, and more easily missed during withdrawal observation. This study aimed to ascertain whether a second sigmoid colon intubation could enhance the adenoma detection rate (ADR).METHODSWe conducted a randomized controlled trial of patients aged 45 and above with a body mass index over 24 who underwent colonoscopy. At the time of the first withdrawal to the rectum, patients were randomized to the standard withdrawal (SW) group, which underwent withdrawal to the anus, or the second intubation (SI) group, which underwent reinsertion into the sigmoid colon. During the second intubation, we pushed the colonoscope forward without straightening it, allowing for slight looping that could be used to flatten the colonic folds as the tip of the instrument was advanced. Observations were made during both the intubation and withdrawal. The ADR in the sigmoid colon was the main result.RESULTSThis trial involved a total of 650 patients, including 325 in the SI group and 325 in the SW group. In the sigmoid colon, the ADR and polyp detection rate (PDR) in the SI group were substantially greater than those in the SW group (ADR 24.3% vs. 14.5%, p = 0.001; PDR 29.2% vs. 17.8%, p = 0.001). Older age, smoking, longer duration of the second inspection, and the identification of lesions during the initial withdrawal from the sigmoid colon were independent predictors of further adenomas discovered during the second intubation.CONCLUSIONSUsing a second intubation of the sigmoid colon can effectively enhance the detection rate of sigmoid colon adenomas and polyps.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488252","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":"Fructose and Lactose Malabsorption or Intolerance or Hypersensitivity: Which Triggers Symptoms and Why?","authors":"Satish S C Rao","doi":"10.14309/ajg.0000000000003577","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003577","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488219","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":"Performing Endoscopy Safely in Pregnant Patients: Best Practices for the Gastroenterology Team.","authors":"Amanda H Lim,Faisal S Ali,Erin J Ciampa,Tyler M Berzin","doi":"10.14309/ajg.0000000000003610","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003610","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"653 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488218","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":"FIB-4 score in young healthy adults and its association with end stage liver disease: a nationwide retrospective study.","authors":"Michal Kasher Meron,Tzipi Hornik-Lurie,Pnina Rotman-Pikielny,Gil Ben Yakov,Gilad Twig,Tomas Karpati","doi":"10.14309/ajg.0000000000003605","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003605","url":null,"abstract":"OBJECTIVESMetabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent and underdiagnosed among young healthy adults, with or without metabolic syndrome. This study assessed whether FIB-4 scores in young healthy adults are associated with incident end stage liver disease (LD).METHODSThis retrospective study was conducted using a nationwide community and hospital database. Included were young adults, ages 18-40, with a FIB-4 score calculated during 2005-2020. People diagnosed with liver metastasis or chronic LD, other than MASLD, before or during the study, were excluded. The primary outcome was the first diagnosis of cirrhosis, cirrhosis-related complications, or hepatocellular carcinoma. Cox proportional models were applied, with FIB-4 score categorized by percentiles.RESULTSThere were 430 incident cases of end stage LD in 11,057,421 person-years (mean age at diagnosis 30.0 ± 5.3 years). FIB-4 score was associated with incident end stage LD. After adjusting for multiple confounders, people with FIB-4 in the 75th-94th, 95th-98th and ≥ 99th percentiles were 35%, 140% and 760% more likely to develop end stage LD, respectively, compared to people with FIB-4 score in the 5th-49th percentiles. Each point of FIB-4 score was associated with a 2.2-fold greater risk of incident end stage LD (adjusted hazard ratio= 2.21 (95% CI 1.91-2.56).CONCLUSIONSFIB-4 score is associated with increased risk for end stage LD in young healthy adults.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478695","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 Do I Manage Marginal Ulcers After Roux-En-Y Gastric Bypass?","authors":"Zehra Naseem,Aun Muhammad,Roberto Simons- Linares","doi":"10.14309/ajg.0000000000003606","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003606","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478830","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 Prospective Comparison of Ustekinumab and Anti-TNF Therapy in the Treatment of Crohn's-like Disease of the Pouch.","authors":"Edward L Barnes,Laura Raffals,Taha Qazi,Parakkal Deepak,Shannon Chang,Poonam Beniwal-Patel,Peter Dr Higgins,Raymond K Cross,Jennifer I Barr,Chelsea Anderson,Millie D Long,Hans H Herfarth,Marla Dubinsky,Michael D Kappelman,Maia Kayal","doi":"10.14309/ajg.0000000000003608","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003608","url":null,"abstract":"BACKGROUNDMany patients with chronic pouchitis and Crohn's-like disease of the pouch (CLDP) are treated with biologics; however, the comparative effectiveness of advanced therapies in this population has not been systematically evaluated. We sought to compare the effectiveness of anti-tumor necrosis factor alpha (anti-TNF) therapies and ustekinumab in patients with chronic inflammatory conditions of the pouch.METHODSWe conducted a prospective, multi-center, cohort study. We included patients with chronic pouchitis and CLDP initiating treatment with anti-TNF therapies or ustekinumab. The primary outcome was clinical remission at 6 months after induction. We also evaluated clinical remission at 6 months among patients with chronic pouchitis and CLDP separately.RESULTSAmong 132 patients, 106 (80%) had a diagnosis of CLDP and 82 (62%) initiated therapy with ustekinumab. A significantly higher proportion of patients with CLDP treated with ustekinumab were in clinical remission at 6 months as compared to patients treated with anti-TNF therapy (62% vs. 40%, P=0.027) however there was no significant difference among patients with chronic pouchitis (P=0.946). There was no independent statistical significance in the odds of remission at 6 months among patients with CLDP among patients receiving ustekinumab compared to anti-TNF therapy (aOR 1.91, 95% CI 0.69-5.30) after adjusting for presence of a fistula, number of preoperative advanced therapies, and number of advanced therapies after IPAA.CONCLUSIONThese data suggest the potential benefit of ustekinumab in patients with CLDP and should prompt future novel effectiveness evaluations in this population.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478874","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":"Vonoprazan High-dose Dual, Vonoprazan Triple and Rabeprazole Reverse Hybrid Therapies for First-line Treatment of H. pylori Infection: A Multicenter Randomized Trial.","authors":"Ping-I Hsu,Chien-Lin Chen,Chih-An Shih,Kuan-Yang Chen,Wei-Chen Tai,Seng-Kee Chuah,Chia-Long Lee,Feng-Woei Tsay,Jyh-Chin Yang,Wei-Yi Lei,Chao-Hung Kuo,Chang-Bih Shie,Hsi-Chang Lee,Yoshio Yamaoka,David Y Graham,Deng-Chyang Wu,","doi":"10.14309/ajg.0000000000003607","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003607","url":null,"abstract":"OBJECTIVESThe study aimed to compare the efficacy of 14-day vonoprazan high-dose dual, vonoprazan triple and rabeprazaole reverse hybrid therapies for the first-line treatment of H. pylori infection.METHODSIn the multi-center, randomized, open-label trial, we consecutively recruited adult H. pylori-infected patients from six centers in Taiwan. Subjects were randomly assigned (1:1:1) to 14-day vonoprazan high-dose dual, vonoprazan triple or rabeprazole reverse hybrid therapy. Eradication status was determined by 13C-urea breath test. The primary outcome was the eradication rate of H. pylori assessed in the intention-to-treat population.RESULTSBetween December 2021 and April 2024, 906 patients were recruited. The eradication rates were 83.8% (253/302) for vonoprazan high-dose dual therapy, 90.1% (272/302) for vonoprazan triple therapy, and 89.1% (271/302) for rabeprazole reverse hybrid therapy in intention-to-treat analysis. Vonoprazan high-dose dual therapy was inferior to both vonoprazan triple (95% confidence interval: -11.5% to -1.1%; p=0.022) and rabeprazole reverse hybrid therapies (95% confidence interval: -10.7% to 0.1%; p=0.031). There were no significant differences in the overall proportions of patients experiencing adverse events among vonoprazan high-dose dual, vonoprazan triple, and rabeprazole reverse hybrid groups (10.3%, 15.2%, and 15.6%, respectively). Body weight ≥60 kg, clarithromycin resistance, and poor drug adherence were independent risk factors predicting eradication failure for the three corresponding therapies, with odds ratios of 3.2 (1.3-7.5), 4.8 (1.2-18.9), and 14.8 (2.8-78.8), respectively.CONCLUSIONVonoprazan triple therapy and rabeprazole reverse hybrid therapy are preferable to vonoprazan dual therapy for first-line treatment of H. pylori infection.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"248 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478875","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":"Intraoperative Enteroscopy-Guided Surgical Ligation: A Novel Approach for Simultaneous Diagnosis and Treatment of Hookworm-Induced Obscure Small Intestinal Bleeding.","authors":"Mei Zeng,Xiankun Ren,Wenguang Yang,Sichao Wen,Yuhong Ren,Bin Yang,Mingwen Guo","doi":"10.14309/ajg.0000000000003604","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003604","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"242 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370317","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":"Fruits, vegetables, legumes and potatoes and risk of Crohn's disease and ulcerative colitis.","authors":"Antoine Meyer,Franck Carbonnel,Christina C Dahm,Jytte Halkjær,Anne Tjønneland,Matthias B Schulze,Carlotta Sacerdote,Rosario Tumino,Bas Oldenburg,José M Huerta,Marcela Guevara,Dagfinn Aune,Marc J Gunter,Alicia K Heath,Paolo Vineis,Tammy Y N Tong,Aurélien Amiot,Simon S M Chan","doi":"10.14309/ajg.0000000000003602","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003602","url":null,"abstract":"OBJECTIVESLow intake of fiber, fruits and vegetables is associated with the risk of developing Crohn's disease (CD) and ulcerative colitis (UC). We therefore aimed to assess the risk of developing CD and UC according to individual fruits, vegetables, legumes, and potatoes and their diversity in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.METHODSValidated food frequency questionnaires collected at baseline were used to assess fruits, vegetables, legumes, and potatoes intakes. The association between these foods and CD and UC risks were estimated using Cox models stratified by center, sex and age; and adjusted for smoking status, BMI, physical activity, energy intake, educational level and alcohol intake.RESULTS341,519 individuals were followed prospectively. Among them, 149 developed CD and 379 developed UC after a median follow-up of 13.4 years. High intake of combined fruits, vegetables, legumes, and potatoes were associated with a lower risk of CD (fourth vs first quartile adjusted HR=0.44, 95%CI: 0.26-0.76; p-trend<0.01) but not UC (aHR=1.07, 95%CI: 0.76-1.50; p-trend=0.73). Pooled consumption of apple/pear, banana, mushrooms, and onion/garlic was associated with a lower risk of CD (fourth vs first quartile aHR 0.58; 95%CI: 0.33-1.02, p-trend 0.03). A higher risk of UC was observed with high intakes of potatoes (fourth vs first quartile aHR 1.51; 95%CI: 1.05-2.17). Fruits/Vegetables/Legumes/Potatoes diversity score was not associated with risk of CD nor of UC.CONCLUSIONSHigh apple/pear, banana, mushrooms, and onion/garlic intake is associated with a lower risk of developing CD whereas high intake of potatoes is associated with UC.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370318","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}