The American Journal of Gastroenterology最新文献

{"title":"HLA DQA1*05 and risk of anti-TNF treatment failure and anti-drug antibody development in children with Crohn's Disease: HLA DQA1*05 and Pediatric Crohn's Disease.","authors":"Jeremy Adler,Joseph A Galanko,Rana Ammoury,Keith J Benkov,Athos Bousvaros,Brendan Boyle,José M Cabrera,Kelly Y Chun,Jill Dorsey,Dawn R Ebach,Ann M Firestine,Ajay S Gulati,Hans H Herfarth,Traci W Jester,Jess L Kaplan,Ian Leibowitz,Tiffany M Linville,Peter A Margolis,Phillip Minar,Zarela Molle-Rios,Jonathan Moses,Kelly Olano,Dinesh S Pashankar,Lisa Pitch,Shehzad A Saeed,Charles M Samson,Kelly Sandberg,Steven J Steiner,Jennifer A Strople,Jillian S Sullivan,Prateek D Wali,Michael D Kappelman","doi":"10.14309/ajg.0000000000003135","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003135","url":null,"abstract":"OBJECTIVESHLA DQA1*05 has been associated with the development of anti-drug antibodies (ADA) to tumor necrosis factor antagonists (anti-TNF) and treatment failure among adults with Crohn's disease (CD). However, findings from other studies have been inconsistent with limited pediatric data.METHODSWe analyzed banked serum from patients with CD < 21 years of age enrolled in COMBINE, a multi-center, prospective randomized trial of anti-TNF monotherapy vs. combination with methotrexate. The primary outcome was a composite of factors indicative of treatment failure. The secondary outcome was ADA development.RESULTSA trend towards increased treatment failure among HLA DQA1*05 positive participants was not significant (HR 1.58, 95% CI 0.95-2.62; p=0.08). After stratification by HLA DQA1*05 and by methotrexate vs. placebo, patients who were HLA DQA1*05 negative and assigned to methotrexate experienced less treatment failures than HLA DQA1*05 positive patients on placebo (HR 0.31, 95% CI 0.13-0.70; p=0.005).A trend toward increased ADA development among HLA DQA1*05 positive participants was not significant (odds ratio [OR] 1.96, 95% CI 0.90-4.31, p=0.09). After further stratification, HLA DQA1*05 negative participants assigned to methotrexate were less likely to develop ADA relative to HLA DQA1*05 positive patients on placebo (OR 0.12, 95% CI 0.03-0.55; p=0.008).CONCLUSIONSIn a randomized trial of children with CD initiating anti-TNF, 40% were HLA DQ-A1*05 positive, which was associated with a trend toward increased risk of both treatment failure and ADA. These risks were mitigated, but not eliminated, by adding oral methotrexate. HLA DQ-A1*05 is an important biomarker for prognosis and risk stratification.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449297","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":"FOUR-DIMENSIONAL IMPEDANCE MANOMETRY IN ESOPHAGEAL MOTILITY DISORDERS.","authors":"Eric Goudie,Wenjun Kou,John E Pandolfino,Isis K Araujo,Panyavee Pitisuttithum,Sourav Halder,Peter J Kahrilas,Dustin Carlson","doi":"10.14309/ajg.0000000000003151","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003151","url":null,"abstract":"OBJECTIVESFour-dimensional high-resolution impedance manometry (4D HRM) uses impedance to estimate esophageal luminal cross-sectional area and track nadir impedance to measure intrabolus pressure (IBP). We aimed to determine whether 4D HRM metrics could define abnormal esophagogastric junction (EGJ) opening between Chicago Classification v4.0 (CCv4.0) motility disorders and compare 4D HRM with functional lumen imaging probe (FLIP) metrics.METHODSSymptomatic adult patients who completed high-resolution impedance manometry and FLIP were included and compared to an asymptomatic control group. 4D HRM analysis used custom-built software to measure IBP, maximum EGJ diameter and distensibility index (DI) on supine test swallows. 4D HRM metrics were compared to FLIP EGJ metrics.RESULTSNinety patients (31 normal motility; 16 ineffective esophageal manometry; 9 absent contractility; 8 conclusive EGJ outflow obstruction (EGJOO); 12 type I achalasia; 14 type II achalasia; 12 type III achalasia and 34 asymptomatic controls) were included. Phase 2 and 3 IBP was higher in type II and III achalasia compared to controls and normal motility groups (p<0.03). Maximum EGJ diameter and EGJ-DI in the conclusive EGJOO and achalasia groups were significantly lower than in controls and normal motility groups (p<0.03). 4D HRM identified 37 out of 44 (84%) subjects with normal EGJ opening and 29 out of 39 (74%) subjects with reduced EGJ opening on FLIP.CONCLUSION4D HRM metrics correlated with expected clinical observations across a spectrum of esophageal motility disorders and defined EGJ obstruction. 4D HRM metrics may have value in defining EGJ obstruction in equivocal cases related to EGJOO or absent peristalsis.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"232 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449298","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":"Refinement of Hy's Law using the Drug-Induced Liver Injury Network Database.","authors":"A Sidney Barritt,Paul H Hayashi,Andrew A Stolz,Huiman Barnhart,Jay H Hoofnagle,","doi":"10.14309/ajg.0000000000003145","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003145","url":null,"abstract":"BACKGROUNDHyman Zimmerman observed that hepatocellular (HC) drug-induced liver injury (DILI) with jaundice had a mortality rate of ≥10% (Hy's Law). Hy's Law does not specify the timing of liver tests nor the definition of HC DILI versus cholestatic or mixed (C/M) DILI. We aimed to assess the validity of Hy's Law in the prospective Drug-Induced Liver Injury Network (DILIN) cohort.METHODSDrugs with ≥10 confirmed DILI cases with jaundice were analyzed. Four permutations of Hy's Law were applied: R≥ 5 using initial (1) or peak (2) ALT, AST and Alk P levels, and the FDA associated criteria of ALT or AST ≥ 3x ULN with Alk P ≤ 2x ULN using initial (3) or peak values (4). Mortality was death or liver transplant adjudicated to be due to DILI.RESULTSUsing initial R values, mortality was 11.1% for HC vs 2.0% for C/M (p<0.001); using peak R values, mortality was 10.3% vs 1.6% (p<0.001). Using FDA associated definition, mortality was 7.9% vs 3.9% (p=0.04) using initial values and 7.9% vs 3.0% (p=0.01) using peak values. Using initial R values, drugs that frequently caused HC injury generally had mortality rates ≥ 10%; while drugs that typically caused C/M injury all had rates <10%. Occasional agents that caused HC injury with jaundice were associated with low mortality.CONCLUSIONSInitial R values were the most reliable means of identifying Hy's Law cases. There were some drugs that caused HC injury with jaundice but with mortality rates <10%. Refinement of Hy's Law is warranted.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449304","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":"Improving the Diagnostic Accuracy of RECAM in North American Patients with Suspected Idiosyncratic Drug-Induced Liver Injury: Improving RECAM accuracy.","authors":"Jacob Ciricillo,Adam Myer,Amoah Yeboah-Korang,Askanda Osman,Farrah Rahim,David G Goldfarb,Yeshika Sharma,Jeremy Louissaint,Kenneth E Sherman,Robert J Fontana","doi":"10.14309/ajg.0000000000003147","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003147","url":null,"abstract":"BACKGROUNDThe RECAM is an updated, electronic version of the RUCAM to diagnose DILI. The primary aim of this study was to compare RECAM versus RUCAM in patients with suspected DILI.METHODSPatient encounters from 10/1/2015 to 9/30/2019 were searched for suspected DILI using ICD-10 K71 codes for toxic liver disease. DILIN expert opinion scores were assigned to each case (1/2/3= probable DILI, 4/5= non-DILI). RECAM and RUCAM scores were compared with DILIN expert opinion scores.RESULTSAmong 766,930 encounters searched, 120 unique patients met inclusion criteria with 72 (60%) adjudicated as probable-DILI. The most frequent suspect drugs were antimicrobials (38.3%), antineoplastics (8.3%), and antirheumatic drugs (8.3%). Mean age was 49.2 + 15.6 years and 50% were female with 45.8% having hepatocellular injury. RUCAM had better agreement with DILIN expert opinion for probable-DILI versus RECAM (66.7% vs. 44.4%, p=0.018). Both had 100% agreement with DILIN expert opinion for non-DILI. Frequently missing laboratory data included HCV RNA (64.3%) and anti-HEV IgM testing (70%), leading to loss of up to 6 points in RECAM scoring but not impacting RUCAM scores. A modified RECAM that made HCV RNA and anti-HEV IgM optional had better agreement with DILIN expert opinion compared to RUCAM (79.2% vs. 66.7%, p=0.09).CONCLUSIONAmong 120 suspected DILI cases, RUCAM had better agreement with DILIN expert opinion scores versus RECAM. Making HCV RNA and anti-HEV IgM testing optional significantly improved agreement between RECAM and DILIN expert opinion. Future modifications to RECAM are needed to improve causality assessment in North American patients with suspected DILI.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142449303","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":"Bile entangled: an unexpected cause of biliary stricture.","authors":"Sofia Bizarro Ponte,Andreia Rei,Sandra Correia,Paulo Salgueiro","doi":"10.14309/ajg.0000000000003137","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003137","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142443739","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":"Spleen Stiffness to Predict Varices Needing Treatments: Appropriate Patient Selection is the Key to Success.","authors":"Harsh Prakash Jain,Shivam Sethi","doi":"10.14309/ajg.0000000000003103","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003103","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436109","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":"Development and Validation of a Pediatric Celiac Disease-Specific Quality of Life Measure.","authors":"Shayna Coburn,Paige J Trojanowski,Jack Vagadori,Pamela Hinds,Monique Germone,Edwin Liu,Randi Streisand,James Bost","doi":"10.14309/ajg.0000000000003132","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003132","url":null,"abstract":"INTRODUCTIONQuality of life (QOL) is critical in screening and management of chronic medical conditions, including celiac disease (CD). This project aimed to develop a CD-specific pediatric QOL measure (\"CDLIFE\") with parallel self- and parent-report forms by generating items through concept elicitation interviews, iterative refinement using cognitive debriefing interviews, and evaluating its psychometric properties and validity.METHODSConcept elicitation interviews were conducted to develop items (nine youth ages 8-19 with CD; 10 parents of youth with CD), followed by cognitive interviews with additional stakeholders (three youth with CD, three parents, and eight clinicians), and item administration (parent/youth reports: n=103/102). Analyses included response frequencies, internal consistency reliability, exploratory factor analyses, and correlations with related measures (PROMIS, PEDSQL, and GFD-VAS).RESULTSFrom concept elicitation interviews, 42 youth and 45 parent items were developed. Cognitive debriefing interviews yielded 36 refined items. Psychometric analyses identified 15 items to remove due to ceiling/floor effects, poor item-to-test correlations; youth-parent mismatch or conceptual mismatch. Total score internal consistency was high (alphas=0.89-0.90). A four-factor model solution had the best fit (Social Impact, External Support, Adaptive Vigilance, Eating Behaviors/Adjustment) with a fifth single-item domain (Financial Resources). The final CDLIFE (21 items) total scores correlated with most related measures in expected directions for parent and youth forms.CONCLUSIONThe CDLIFE may facilitate insight into CD-specific QOL for youth ages 2-18 years, capturing important dimensions of physical and socioemotional health. Administering the CDLIFE will help identify and track families needing support.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436107","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":"Predicting and preventing bleeding in patients with cirrhosis undergoing procedures.","authors":"Erno Jm,Villa E,Intagliata Nm","doi":"10.14309/ajg.0000000000003129","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003129","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436018","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":"The Critical Role of Social Work in Addressing the Global Burden of Gastric Cancer in Adolescents and Young Adults.","authors":"Senlin Ye,Jinli Liu,Ruyi Zhou","doi":"10.14309/ajg.0000000000003082","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003082","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142385229","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":"Participation and Yield in Multiple Rounds of Colorectal Cancer Screening based on Fecal Immunochemical Test: A Systematic Review and Meta-Analysis.","authors":"Yueyang Zhou,Na Li,Jiahui Luo,Yuqing Chen,Yuelun Zhang,Min Dai,Hongda Chen","doi":"10.14309/ajg.0000000000003107","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003107","url":null,"abstract":"BACKGROUND AND AIMSThe evidence on the cumulative participation and yield in multiple rounds of colorectal cancer (CRC) screening based on fecal immunochemical test is sparse. We aimed to assess the trends in participation and detection for advanced colorectal neoplasm under different screening intervals in multi-round FIT-based CRC screening by synthesizing the current available evidence.METHODSPubMed, Embase, and Cochrane were retrieved from January 1, 2002 to April 16, 2024 for potential eligible studies and then we synthesized participation and advanced colorectal neoplasm detection rates for each screening round, along with their respective 95% confidence intervals.RESULTS19 studies involving a total of 2,296,071 individuals were included. As screening rounds increased, participation exhibited a gradual consistent increase, reaching 78.45% and 74.97% for annual and biennial screening strategies. For annual screening, the cumulative detection rates for 3 rounds were 1.38% (95% CI: 1.18-1.63%), 1.95% (95% CI: 1.72-2.21%), and 2.50% (95% CI: 2.29-2.72%), respectively. For biennial screening, the cumulative detection rates for 4 rounds were 2.22% (95% CI: 1.22-3.22%), 3.44% (95% CI: 2.06-4.82%), 4.26% (95% CI: 2.70-5.83%), and 5.10% (95% CI: 3.28-7.29%), respectively. Notably, the per-round detection rate of advanced colorectal neoplasms declined yet as the screening progressed.CONCLUSIONIn population-based CRC screening programs, the participation exhibited a slow upward trend for both screening strategies, but the incremental benefits in CRC detection gradually diminished. Tailored strategies, such as extending intervals for individuals with multiple negative FIT results, might optimize effectiveness and cost-efficiency in population-based CRC screening.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"218 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328831","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}