The American Journal of Gastroenterology最新文献

{"title":"Long-term Efficacy and Safety of Selective PPARδ Agonist Seladelpar in Primary Biliary Cholangitis: ASSURE Interim Study Results.","authors":"Cynthia Levy,Palak J Trivedi,Kris V Kowdley,Stuart C Gordon,Christopher L Bowlus,Maria Carlota Londoño,Gideon M Hirschfield,Aliya Gulamhusein,Eric J Lawitz,John M Vierling,Marlyn J Mayo,Ira M Jacobson,Andreas E Kremer,Christophe Corpechot,David Jones,Peter Buggisch,Shuqiong Zhuo,Sarah Proehl,Carrie Heusner,Charles A McWherter,Daria B Crittenden,","doi":"10.14309/ajg.0000000000003603","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003603","url":null,"abstract":"OBJECTIVESEvaluate interim data from the ongoing, open-label, long-term efficacy and safety ASSURE study of seladelpar, a selective peroxisome proliferator-activated receptor δ agonist, in primary biliary cholangitis (PBC).METHODSPatients rolling over from the phase 3, randomized, placebo-controlled, 12-month RESPONSE study or with previous participation in earlier legacy seladelpar studies were enrolled. Interim evaluations included composite biochemical response (alkaline phosphatase [ALP] <1.67×upper limit of normal [ULN], total bilirubin ≤ULN, and ALP decrease ≥15%), pruritus numerical rating scale (NRS) change among patients with a baseline score ≥4, and safety.RESULTSAt interim cutoff, 337 patients were enrolled and received ≥1 seladelpar 10-mg dose; 54 placebo-treated and 104 seladelpar-treated from RESPONSE and 179 from legacy studies. The composite response rate at RESPONSE completion was 62% (79/128) with seladelpar and 20% (13/65) with placebo. After 12 months in ASSURE, response rates were 72% (21/29) in patients continuing seladelpar and 94% (15/16) in crossover seladelpar patients. In legacy trial patients, response rates were 73% (120/164) and 70% (69/99) after 12 and 24 months of treatment in ASSURE, respectively. The NRS decrease at RESPONSE completion in seladelpar-treated patients with baseline NRS ≥4 (-3.4) was maintained after 6 additional months of treatment (-3.8); changes were similar in crossover seladelpar (-3.8) and legacy patients (-3.5) after 6 months of treatment in ASSURE. No seladelpar-related serious adverse events were reported.CONCLUSIONSSeladelpar demonstrated durable improvements in cholestatic biomarkers and pruritus in patients with PBC with up to 2 years of treatment and remained overall safe with long-term use.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370315","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":"All Aboard the All-Exam Adenoma Detection Rate.","authors":"Uri Ladabaum","doi":"10.14309/ajg.0000000000003536","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003536","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319756","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 Efficacy in Children With Eosinophilic Esophagitis With Prior Swallowed Topical Corticosteroid Use: A Subgroup Analysis.","authors":"Mirna Chehade,Salvatore Oliva,Dhandapani Ashok,Ruiqi Liu,Jennifer Maloney,Raolat M Abdulai,Margee Louisias,Allen Radin","doi":"10.14309/ajg.0000000000003599","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003599","url":null,"abstract":"INTRODUCTIONSwallowed topical corticosteroids (STCs) are commonly used to treat eosinophilic esophagitis (EoE); however, not all patients respond, and others may be intolerant or have contraindications. We assessed dupilumab efficacy in children with EoE with prior STC use, and with prior inadequate response/intolerance/contraindication (IRIC) to STCs in the phase 3 EoE KIDS study.METHODSEligible patients were aged 1-11 years with EoE unresponsive to proton-pump inhibitors. In Part A, patients were randomized to weight-tiered higher- or lower-exposure dupilumab, or placebo up to Week (W)16. In Part B, dupilumab groups continued treatment, while patients receiving placebo switched to higher- or lower-exposure dupilumab through W52. Efficacy by prior STC status was assessed at W16 and W52.RESULTSOf 102 patients, 82 (80%) received prior STCs and 59 (58%) had prior IRIC to STCs. At W16, higher-exposure dupilumab improved rates of histologic remission vs placebo in patients with prior STC use (60.7% vs 0.0%, nominal P < 0.0001) and prior IRIC to STCs (60.9% vs 0.0%, nominal P < 0.0001). Secondary endoscopic and histologic outcomes were similar. Responses were maintained at W52 with higher-exposure dupilumab, with improvements observed in patients who switched from placebo to higher-exposure dupilumab. Results were similar or numerically lower with lower-exposure dupilumab. Findings appeared comparable in those without prior STC use or prior IRIC, although patient numbers were small. Dupilumab safety was consistent with the known safety profile.DISCUSSIONDupilumab may be an effective treatment in children with EoE with prior STC use, or prior IRIC to STCs.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144320084","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":"Unresolved Challenges in MAFLD-ACLF Risk Stratification: A Critical Appraisal.","authors":"Renu Sah,Ankita Mathur,Venkata Dileep Kumar Veldi","doi":"10.14309/ajg.0000000000003548","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003548","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295805","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":"Trends in Underrepresented Fellows in Gastroenterology.","authors":"Judy Daboul,Gavisha Waidyaratne,Sean G Kelly,Jacob Skeans,Jianing Ma,Jing Peng,Lindsay A Sobotka","doi":"10.14309/ajg.0000000000003596","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003596","url":null,"abstract":"BACKGROUNDMost Gastroenterology (GI) societies support interventions to improve diversity in medicine. It remains unclear whether these efforts have been effective.OBJECTIVEExamine nationwide trends of underrepresented minorities in medicine (UIM) in GI compared to other Internal Medicine (IM) fellowships.METHODSRetrospective cohort study used Accreditation Council for Graduate Medical Education (ACGME) race and gender data from 2011 to 2021. Fellows identifying as Hispanic, African American, or Native American/Alaskan were subclassified as UIM.RESULTSThe average percentage of fellows identifying as UIM or female in GI were lower than most IM specialties. The proportion of UIM fellows in GI did not increase during the studied time (p=0.98) unlike the proportion of female fellows (p=0.06) in GI.CONCLUSIONEfforts to promote a more inclusive workforce in GI have had limited success over the past decade. Successful interventions that institutions can implement include supporting minority applicants, structured mentorship, and bias mitigation training.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295803","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":"Dissatisfaction and Barriers in Electronic Health Record Use for Inflammatory Bowel Disease Patients: A Nationwide Survey of Major IBD Centers.","authors":"Hasan Saleh,Sara Horst,Jami Kinnucan","doi":"10.14309/ajg.0000000000003598","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003598","url":null,"abstract":"BACKGROUNDElectronic health records (EHR) are a growing source of burden for clinicians treating inflammatory bowel disease (IBD).METHODSWe conducted an EHR survey study targeting IBD clinicians at leading IBD programs throughout the United States.RESULTSSurveys were sent to 65 IBD participants, with 46 (70.8%) responses collected, 41 (89%) were physicians. All clinicians (100%) believe there are opportunities for EHR improvement. Nineteen (41.3%) clinicians felt that their EHR does not enhance IBD patient care.CONCLUSIONThis is the first IBD program survey in the United States showing significant dissatisfaction and opportunity for EHR enhancements to improve patient care.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295804","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 3-day linaclotide administration to reduce the PEG volume for colonoscopy bowel preparation: A multicenter, noninferiority, randomized controlled trial.","authors":"Peng Pan,Huixin Chen,Tongchang Wang,Kaijun Liu,Biguang Tuo,Rong Wang,Hongyu Fu,Chunmeng Jiang,Lisha Chen,Qiu Zhao,Wen Wang,Weigang Chen,Qiang Guo,Weichang Chen,Yanqing Li,Zibin Tian,Zhijie Feng,Shaoqi Yang,Yi Fan,Fujuan Luan,Youxiang Chen,Zhaoshen Li,Yu Bai","doi":"10.14309/ajg.0000000000003557","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003557","url":null,"abstract":"OBJECTIVESSeveral studies have investigated the role of linaclotide in bowel preparation; however, dosage and timing still warrant further exploration.METHODSThis non-inferiority randomized controlled study was performed in sixteen medical centers. The eligible subjects were randomly assigned to three groups: the Lct + 3 L PEG group (Group A), the 3 L PEG group (Group B), or the Lct + 2 L PEG group (Group C). The primary outcome was the adequate bowel preparation rate based on the Boston Bowel Preparation Scale. Safety was assessed based on the incidence of adverse reactions.RESULTSA total of 1607 eligible subjects were enrolled, and 1545 colonoscopy videos were uploaded. In the intention-to-treat analysis, the results of the non-inferiority test indicated that the adequate bowel preparation rate in Group C (87.58%, 95% CI: 85.08 to 90.62%) was neither inferior to that of Group A (88.79%, 95% CI: 86.11 to 91.46%) nor Group B (83.99%, 95% CI: 80.88 to 87.09%). The overall incidence of adverse reactions in Group A was higher than that in Group C (13.64% vs 8.19%, P = 0.012). There were no significant differences in polyp detection rate (P = 0.089), adenoma detection rate (P = 0.776), and bowel preparation completion rate (P = 0.052).CONCLUSIONSThe adequate bowel preparation rate of the combination of 3-day linaclotide and 2 L PEG was neither inferior to the combination of 3-day linaclotide and 3 L PEG nor 3 L PEG alone in the average-risk population.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146165","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":"Listening Beyond the Symptoms: Existential Needs and Identity in Older Adults With Inflammatory Bowel Disease.","authors":"Partha Pal","doi":"10.14309/ajg.0000000000003514","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003514","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146162","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":"Overlap of esophageal disorders of gut-brain interactions (E-DGBIs) and GERD is highly prevalent in patients with refractory reflux symptoms.","authors":"Federico Caldart,Charlotte Gabriel,Blandine Vauquelin,Pauline Rivière,Arthur Berger,Frank Zerbib","doi":"10.14309/ajg.0000000000003542","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003542","url":null,"abstract":"BACKGROUNDEsophageal disorders of gut-brain interaction (E-DGBIs) are highly prevalent in patients with unproven gastro-esophageal reflux disease (GERD) who do not respond to proton pump inhibitors (PPIs). The aim of this study was to determine the prevalence and characteristics of confirmed refractory GERD and E-DGBIs in consecutive patients with refractory reflux symptoms.PATIENTS AND METHODSPatients with typical refractory reflux symptoms were prospectively enrolled. Data on age, gender, primary symptoms, pH and pH-impedance monitoring data, presence of esophageal motor disorders and endoscopy results were collected. Patients were classified as unproven and proven GERD, e-DGBI alone, refractory GERD and overlap between GERD and E-DGBI. Questionnaires were obtained for reflux symptoms, presence of other DGBIs, levels of anxiety and depression and on visceral sensitivity.RESULTSA total of 119 patients were included. Among 46 proven GERD patients, 13 (28%) had isolated refractory GERD and 33 (72%) had an overlap of GERD and E-DGBIs. Among unproven GERD group, 23 (31.5%) had GERD and 50 (68.5%) had an E-DGBI. Functional dyspepsia (70.6%) and irritable bowel syndrome (33.6%) were highly prevalent.No difference was found in symptom presentation, anxiety, depression and visceral sensitivity scores. A higher acid exposure time and number of reflux episodes were found in patients with confirmed refractory GERD compared to overlap E-DGBI-GERD group.CONCLUSIONE-DGBIs are highly prevalent in patients with proven GERD and refractory reflux symptoms. Studies with outcome data are needed to determine whether patients with overlapping E-DGBIs and GERD should be identified with pH-impedance monitoring on PPI therapy before an interventional treatment option is considered.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114218","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":"Artificial Intelligence in Gastroenterology Education: DeepSeek Passes the Gastroenterology Board Examination and Outperforms Legacy ChatGPT Models.","authors":"Andrew F Ibrahim,Pojsakorn Danpanichkul,Alexander Hayek,Edwin Paul,Annmarie Farag,Masab Mansoor,Charat Thongprayoon,Wisit Cheungpasitporn,Mohamed O Othman","doi":"10.14309/ajg.0000000000003552","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003552","url":null,"abstract":"INTRODUCTIONDeepSeek was evaluated in gastroenterology board examination performance against legacy ChatGPT offline models, which previously showed failing performance.METHODSThe performances of the DeepSeek base R1 model and search-augmented R1 model were assessed using American College of Gastroenterology self-assessments (455 questions).RESULTSDeepSeek exceeded passing threshold. Search-augmented DeepSeek scored 81.5% across all questions, and the R1 base model scored 77.1%. Both search-augmented and offline DeepSeek models surpassed offline ChatGPT-3 (65.1%) and ChatGPT-4 (62.4%) (p < 0.001).DISCUSSIONDeepSeek exhibited passing performance on the gastroenterology board examination, but gaps in niche topics and image exclusion limit utility. It may supplement education if validated by specialists.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103775","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}