The American Journal of Gastroenterology最新文献_第5页

The Role of Patient-Reported Outcomes in Cirrhosis. 肝硬化患者报告结果的作用。

The American Journal of Gastroenterology Pub Date : 2025-05-20 DOI: 10.14309/ajg.0000000000003551

Archita P Desai,Alexander N Scherer,Marina Serper

引用次数: 0

Think out of the box - A rare case of intestinal polyarterites nodosa. 跳出常规思维——一例罕见的肠多动脉结节。

The American Journal of Gastroenterology Pub Date : 2025-05-20 DOI: 10.14309/ajg.0000000000003555

A Toppeta,D Gridavilla,A Dell'Era,G Maconi

引用次数: 0

13C-Spirulina Gastric Emptying Breath Test Normative Values in Healthy Children- A Multicenter Study with Comparison to Symptomatic Children. 13c -螺旋藻胃排空呼吸试验在健康儿童中的正常值——一项与有症状儿童比较的多中心研究

The American Journal of Gastroenterology Pub Date : 2025-05-16 DOI: 10.14309/ajg.0000000000003545

Katja Karrento,Bruno P Chumpitazi,Liyun Zhang,Pippa Simpson,Robert J Shulman

{"title":"13C-Spirulina Gastric Emptying Breath Test Normative Values in Healthy Children- A Multicenter Study with Comparison to Symptomatic Children.","authors":"Katja Karrento,Bruno P Chumpitazi,Liyun Zhang,Pippa Simpson,Robert J Shulman","doi":"10.14309/ajg.0000000000003545","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003545","url":null,"abstract":"BACKGROUNDDiagnosing pediatric gastroparesis presents a significant challenge due to lack of normative data in children. We aimed to determine normative values for gastric emptying using the non-radioactive 13C-Spirulina gastric emptying breath test (13C-GEBT) in a large cohort of healthy children (HC) and examine differences compared to children with gastroparesis-like symptoms (GLS).METHODS301 HC ages 7-18 years completed the 13C-GEBT with 10 different breath samples x 4 hours. 13CO2 excretion rate (kPCD) was determined by change in 13CO2/12CO2. Outcome variables included: kPCD at 10 time points, peak (maximum) kPCD, time to peak (Tmax) kPCD, and area under curve (AUC) of 13CO2 excretion, along with breath test half emptying time (BT t ½). Results were compared to 13C-GEBT data from peri- and post-pubertal patients 11-18 years of age with GLS.RESULTS216 HC, 51·4% female, completed the test meal within the allotted time. Females vs. males had lower peak kPCD (p=0·003), longer Tmax (p=0·04), lower AUC (p<0·001), and longer BT_t½ (p<0·0001). Peak kPCD (p=0·01, p<0·001) and AUC (p=0·012, p<0·001) were higher in pre- vs peri- and post-pubertal children. BT_t½ and Tmax were shorter in HC vs. GLS (p<0·001, p<0·0001, respectively), consistent with faster gastric emptying in HC. Normative reference values based on 5th percentile kPCD and Tmax were established for peri- and post-pubertal females. An algorithm incorporating key variables demonstrated 80.8% sensitivity for diagnosis of gastroparesis.CONCLUSIONSThis study demonstrates sex and pubertal differences in gastric emptying in children and provides the first reference values for female children.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065576","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}

引用次数: 0

The American Journal of Gastroenterology Pub Date : 2025-05-16 DOI: 10.14309/ajg.0000000000003546

Soo Young Hwang,Mohammad Saeid Rezaee-Zavareh,Abdelrahman M Attia,Emily A Kaymen,Nguyen Tran,Ghassan K Abou-Alfa,Neehar D Parikh,Amit G Singal,Ju Dong Yang

{"title":"Immune-related Adverse Events are Associated with Improved Outcomes after Immune Checkpoint Inhibitor Treatment in Hepatocellular Carcinoma: A Systematic Review and Meta-analysis.","authors":"Soo Young Hwang,Mohammad Saeid Rezaee-Zavareh,Abdelrahman M Attia,Emily A Kaymen,Nguyen Tran,Ghassan K Abou-Alfa,Neehar D Parikh,Amit G Singal,Ju Dong Yang","doi":"10.14309/ajg.0000000000003546","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003546","url":null,"abstract":"INTRODUCTIONImmune checkpoint inhibitors (ICIs) have become the first-line treatment for unresectable hepatocellular carcinoma (HCC). Prognostic value of immune-related adverse events (irAEs) in these patients remains controversial. We aimed to investigate the association between irAEs and clinical outcomes in HCC patients treated with ICIs.METHODSWe searched the PubMed, Scopus, Web of Science, and CENTRAL databases for articles published from inception to June 2024, using keywords including ICI, HCC, and irAEs. Statistical analysis was done with a random effects model.RESULTSOf 3,028 studies, 24 (4,127 patients) met the criteria for inclusion. Atezolizumab plus bevacizumab was the most common treatment regimen (n=10 studies). IrAEs were associated with an increased objective response rate (ORR) (pooled relative ratio [RR]: 1.73; 95% confidence interval [CI]: 1.36-2.21, I2=41%), a higher disease control rate (DCR) (pooled RR: 1.45; 95% CI: 1.21-1.74, I2=74%), and longer progression-free survival (PFS) (pooled hazard ratio [HR]: 0.66; 95% CI: 0.52-0.84, I2=71%). There was a trend toward longer overall survival (OS) for patients with irAEs compared to those without (pooled HR: 0.84; 95% CI: 0.63-1.12, I2=73%). Subgroup analysis indicated a survival benefit for patients with grade 1-2 irAEs (pooled HR: 0.50; 95% CI: 0.36-0.67, I2=0%) and for those with endocrine irAEs (pooled HR: 0.63; 95% CI: 0.48-0.83, I2=12%).DISCUSSIONThe development of irAEs is associated with favorable clinical outcomes in HCC, including improved PFS and higher ORR. OS benefit was noted in patients with mild irAEs but not those with severe irAEs.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"232 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065574","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}

引用次数: 0

Sarcopenia is an Independent Risk Factor for the Decline in Anal Sphincter Function and Increased Levator Laxity in Women. 肌少症是女性肛门括约肌功能下降和提肛肌松弛增加的独立危险因素。

The American Journal of Gastroenterology Pub Date : 2025-05-16 DOI: 10.14309/ajg.0000000000003544

Leila Neshatian,Alicia Liu,Brooke Gurland,Sa Shen,Gabriella Grant,Laren Becker,George Triadafilopoulos,Vipul Sheth

{"title":"Sarcopenia is an Independent Risk Factor for the Decline in Anal Sphincter Function and Increased Levator Laxity in Women.","authors":"Leila Neshatian,Alicia Liu,Brooke Gurland,Sa Shen,Gabriella Grant,Laren Becker,George Triadafilopoulos,Vipul Sheth","doi":"10.14309/ajg.0000000000003544","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003544","url":null,"abstract":"BACKGROUND AND AIMSPelvic floor disorders are prevalent in women. Sarcopenia, or age-related muscle mass loss, may be a contributing factor. We aimed to investigate the association between sarcopenia, as measured by the Psoas Muscle Index (PMI), and pelvic floor and anal sphincter function in women with evacuation disorders.METHODSWe conducted a retrospective analysis of data from women who underwent MR defecography and high-resolution anorectal manometry. As an indicator of overall muscle mass measurement, PMI was computed at the L4 level.RESULTSWomen with evacuation disorders who had MRI diagnosis of sarcopenia (98/264; 37.1%), were older and had lower BMI (p<0.001), with comparable rates of parity and pelvic surgery. There was a significant association between diminished PMI and decreased anal resting (p<0.001) and squeeze (p<0.001) pressures, as well as increased levator hiatus length (p:0.004), descent (p:0.01), and anorectal angle (p:0.002). Patients with sarcopenia were more likely to have anal hypotension and hypocontractility (p:<0.001), and increased levator hiatus laxity measurements (p<0.05), associated with lower obstructive defecation scores (9 vs 11, p:0.003), and higher Wexner fecal incontinence scores (8 vs 4, p:0.03). Sarcopenia was an independent risk factor for anal hypotension and hypocontractility, levator enlargement, and exaggerated levator hiatus descent.CONCLUSIONSSarcopenia significantly impacts anal sphincter function and pelvic floor dynamics in women with evacuation disorders, serving as a risk factor for anal hypotension/hypocontractility and levator laxity. These findings highlight the need for integrated approaches in managing pelvic floor disorders, taking into account the role of muscle mass and strength in treatment strategies.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065575","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}

引用次数: 0

Gender-Affirming Hormone Therapy and Risk of IBD Flare in Transgender and Gender Diverse Adults. 性别确认激素治疗和跨性别和性别不同的成人IBD爆发的风险。

The American Journal of Gastroenterology Pub Date : 2025-05-16 DOI: 10.14309/ajg.0000000000003543

Audrey Bennett,Justin Field,Kira L Newman,Benjamin Click,Shravya Pothula,Sara Horst,Jenna Davison,Austin Lin,Victor Chedid

{"title":"Gender-Affirming Hormone Therapy and Risk of IBD Flare in Transgender and Gender Diverse Adults.","authors":"Audrey Bennett,Justin Field,Kira L Newman,Benjamin Click,Shravya Pothula,Sara Horst,Jenna Davison,Austin Lin,Victor Chedid","doi":"10.14309/ajg.0000000000003543","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003543","url":null,"abstract":"OBJECTIVESLittle is known about the impact of gender-affirming hormone therapy (GAHT) on transgender and gender diverse adults with inflammatory bowel disease (IBD). The primary aim was to evaluate the incidence of IBD flare in the year before and after GAHT initiation.METHODSA retrospective study across five IBD centers. Flare was defined as need for steroids, IBD-associated emergency department visit, or need for IBD medication change. Factors associated with IBD flare were assessed with univariate analysis and multivariable logistic regression controlling for age and IBD type.RESULTS85 transgender and gender diverse adults with IBD who initiated GAHT were included in this study. 46 (54.1%) received estrogen and 39 (45.9%) received testosterone. In the year prior to GAHT, 42 (49%) flared compared to 32 (38%) in the year after, p=0.06. There was no statistically significant difference in incidence of flare by age, IBD type, or IBD therapy type. Individuals with active IBD at GAHT initiation were more likely to flare in univariate (58% vs 24%, p=0.003) and multivariable analysis (aOR 5.1 [95% CI 1.7 - 15.2]). In both univariate and multivariable analysis, individuals who received testosterone were more likely to flare in the year after starting GAHT, testosterone: 51% vs estrogen: 26%, p=0.02 with an aOR 3.1 [95% CI 1.2 - 8.1].CONCLUSIONSWhile there was no overall increased risk of flare in the year after GAHT start, those with active IBD prior to hormone start and those who received testosterone were more likely to experience an IBD flare.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065573","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}

引用次数: 0

Recycling in Ambulatory Gastrointestinal Endoscopy, A Single Center Experience. 循环在流动胃肠道内窥镜，一个单一的中心经验。

The American Journal of Gastroenterology Pub Date : 2025-05-15 DOI: 10.14309/ajg.0000000000003538

Immanuel K Ho,Daniel V Carr,Mary S Coniglio,Karen Rodriguez,Carolyn Simeonides,Frederick A Nunes

{"title":"Recycling in Ambulatory Gastrointestinal Endoscopy, A Single Center Experience.","authors":"Immanuel K Ho,Daniel V Carr,Mary S Coniglio,Karen Rodriguez,Carolyn Simeonides,Frederick A Nunes","doi":"10.14309/ajg.0000000000003538","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003538","url":null,"abstract":"INTRODUCTIONGastrointestinal endoscopy depends on high utilization of resources and is associated with significant production of waste. Recycling is one strategy that could decrease the carbon footprint from endoscopic activities and reduce landfill waste.OBJECTIVETo assess the impact of recycling of endoscopic materials in a high-volume university outpatient ambulatory endoscopy center.METHODS3063 patients (1253 M, 1810 F) underwent gastrointestinal procedures over a 6-month period from 1/15/2024 to 6/15/2024. Endoscopy equipment consisting of cinch pad, gauze, lubricant gel packaging, sponge, suction valves, biopsy valve, air water cleaning adapter, water jet connector, suction tubing, plastic bowl, dual end brush, air/water bottle cap, and irrigation tubing were recycled after use. Data was collected through analysis of company invoices. Greenhouse gas avoidance was determined utilizing United States Environmental Protection Agency Waste Reduction Model (WARM). The daily procedure volume and room turnover time were compared to a control group of 3060 patients in the preceding six months.RESULTSTotal waste recycled equaled 1708.4 kg, or 0.56 kg per procedure. In contrast to landfilling, recycling was resulted in a net reduction of 4.42 metric tons of CO2 equivalent. Compared to controls, volume per day increased (28.9 vs. 24.3; p<0.05), turnover time per patient decreased (18.2 min vs. 19.9 min; p<0.05), and total regulated medical waste collected remained steady (3007.9 kg vs. 2976.1 kg) (p=0.11).CONCLUSIONRecycling used endoscopy equipment is feasible, reduces the carbon footprint, and does not impede endoscopy unit efficiency.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992003","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}

引用次数: 0

CLINICAL CHARACTERISTICS AND PATHOPHYSIOLOGY OF FECAL INCONTINENCE MIXED WITH CONSTIPATION (FI-MC): AN UNDERRECOGNIZED PROBLEM. 大便失禁合并便秘（fi-mc）的临床特征和病理生理：一个未被充分认识的问题。

The American Journal of Gastroenterology Pub Date : 2025-05-15 DOI: 10.14309/ajg.0000000000003532

Busra Inal,Yun Yan,Abeer Aziz,Satish Rao

{"title":"CLINICAL CHARACTERISTICS AND PATHOPHYSIOLOGY OF FECAL INCONTINENCE MIXED WITH CONSTIPATION (FI-MC): AN UNDERRECOGNIZED PROBLEM.","authors":"Busra Inal,Yun Yan,Abeer Aziz,Satish Rao","doi":"10.14309/ajg.0000000000003532","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003532","url":null,"abstract":"BACKGROUND AND AIMSFecal incontinence (FI) and Chronic constipation (CC) are diagnosed as distinct problems, although, many suffer with both problems. The phenotypical features and underlying mechanisms of FI mixed with CC (FI-MC) is unclear. We investigated the clinical and pathophysiological characteristics of FI-MC and compared with FI alone and healthy controls.METHODSIn a retrospective study, FI patients were categorized as having FI-MC or FI alone. For comparison we recruited healthy controls. All subjects completed bowel symptom questionnaire, anorectal manometry, balloon expulsion, neurophysiology and anal ultrasound tests. Data were compared between the three groups.RESULTSWe evaluated 165 patients with FI-MC, 184 with FI, and 31 controls. The prevalence of excessive straining, incomplete evacuation, pain, bloating, use of digital maneuvers and enemas were higher (p<0.001) in the FI-MC than FI group. Anal resting pressure was lower (p<0.001) in FI than FI-MC group and controls. Anal squeeze and sustained squeeze pressures were lower (p<0.001) and lumbar and sacral plexus nerve conduction were prolonged (p<0.001) in the FI-MC and FI groups compared to controls, but similar between patient groups. Dyssynergic defecation was more (p<0.01) prevalent in FI-MC than FI or controls. Rectal sensory thresholds were lower in the FI-MC group than controls (p<0.05), but not between patient groups. FI group had higher (p<0.01) prevalence of anal sphincter defects than FI-MC.CONCLUSIONSFI patients can be categorized into two phenotypes as FI alone and FI-MC. Each group demonstrates distinct clinical characteristics and pathophysiology. Recognizing each phenotype may improve management of FI patients.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992019","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}

引用次数: 0

Hereditary Alpha-Tryptasemia is Associated with Ongoing Symptoms in Individuals with Celiac Disease Despite Following a Gluten-Free Diet. 遗传性α -胰蛋白酶血症与乳糜泻患者持续症状相关，尽管遵循无麸质饮食

The American Journal of Gastroenterology Pub Date : 2025-05-14 DOI: 10.14309/ajg.0000000000003537

Amelie Therrien,Srihitha Akula,Michelle Galeas-Pena,Emma Frank,Lily Gillette,Jocelyn A Silvester,Daniel A Leffler,Javier Villafuerte Galvez,Ciaran P Kelly,Olga Pozdnyakova,Sarah Glover,Jonathan J Lyons

{"title":"Hereditary Alpha-Tryptasemia is Associated with Ongoing Symptoms in Individuals with Celiac Disease Despite Following a Gluten-Free Diet.","authors":"Amelie Therrien,Srihitha Akula,Michelle Galeas-Pena,Emma Frank,Lily Gillette,Jocelyn A Silvester,Daniel A Leffler,Javier Villafuerte Galvez,Ciaran P Kelly,Olga Pozdnyakova,Sarah Glover,Jonathan J Lyons","doi":"10.14309/ajg.0000000000003537","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003537","url":null,"abstract":"BACKGROUNDHereditary alpha-tryptasemia (HαT) is caused by increased copy number of TPSAB1 when encoding for alpha-tryptase, resulting in elevated basal serum tryptase (BST). Many affected individuals report irritable bowel syndrome-like and reflux symptoms. We aimed to assess the prevalence of HαT in celiac disease (CeD) and whether this genetic trait modifies disease course. Methods: Prospective cohort of subjects with CeD or non-celiac gluten sensitivity (NCGS) either at diagnosis (Dx), with persisting symptoms on a gluten-free diet (GFD), or in clinical remission. BST levels were determined by immunoassay and tryptase genotyping was performed on gDNA using ddPCR. Duodenal and gastric biopsies were stained for c-KIT, and mast cell (MC) counts were averaged over 5 hpf.RESULTSThere were 153 eligible subjects; 13 NCGS and 140 CeD (8 newly Dx patients, 66 with persisting symptoms, 66 in remission). HαT was found in 9 subjects, all symptomatic with CeD (6.4%). One was newly Dx, and the others had persisting symptoms (12.3% of subgroup). Excluding HαT, BST levels were higher among CeD vs NCGS (median 5.4 vs 3.9 mcg/L p<0.05). Duodenal MC counts were higher in CeD vs controls (p<0.05), and 24% higher in those with HαT (median HαT CeD 27.3/hpf, non-HαT CeD 22.0 /hpf, controls 18.4/hpf). MC counts did not differ based on villous atrophy or clinical presentation.CONCLUSIONThe prevalence of HαT in CeD is similar to the general population, however, all participants with CeD and HαT had ongoing GI symptoms. Evaluation for HαT should be considered in the management of CeD patients with persisting symptoms.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982444","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}

引用次数: 0

A Cancerous Crossroad: Invasive Adenocarcinoma with Multiple Enteric Fistulae. 癌症的十字路口：浸润性腺癌合并多发性肠瘘。

The American Journal of Gastroenterology Pub Date : 2025-05-14 DOI: 10.14309/ajg.0000000000003533

Sedra Tibi,Rachel Sergah,Samuel Phen,Anas Kawayeh

引用次数: 0