The American Journal of Gastroenterology最新文献

{"title":"Severe Melanosis Coli Associated With Chronic Aloe Vera Supplement Use.","authors":"Maison Furley,Omar Martinez-Uribe,Robin Zachariah","doi":"10.14309/ajg.0000000000004028","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004028","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731343","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":"Sex does not impact the performance of non-invasive tests for clinically significant portal hypertension in cACLD.","authors":"Paula Höfinger,Helena Schluchter,Georg Semmler,Lorenz Balcar,Benedikt Simbrunner,Lukas Hartl,Benedikt Silvester Hofer,Georg Kramer,Paul Thöne,Christian Sebesta,Marlene Hintersteininger,Philipp Schwabl,Albert Friedrich Stättermayer,Michael Trauner,Thomas Reiberger,Eva Schaden,Mattias Mandorfer,Mathias Jachs","doi":"10.14309/ajg.0000000000004033","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004033","url":null,"abstract":"BACKGROUNDClinically significant portal hypertension (CSPH) denotes the hemodynamic threshold for hepatic decompensation in advanced chronic liver disease (cACLD) and is increasingly diagnosed by noninvasive tests. Although liver stiffness measurement (LSM) by VCTE is affected by body composition, intriguingly, no data on sex differences of its diagnostic or prognostic performance are available. We aimed to address this knowledge gap.METHODSA total of 420 stable outpatients who underwent HVPG measurement from 2007 to 2022 at the Vienna Hepatic Hemodynamic Lab were included. The sex-specific diagnostic performance of prevailing NITs was evaluated. Moreover, the sex-specific cumulative incidences of first hepatic decompensation were analyzed using competing risk models stratified by the Baveno VII criteria and the sequential Baveno VII-VITRO algorithm.RESULTSTwo-hundred eighty-one (66.9%) patients were male, while 139 (33.1%) were female. LSM performed better in male patients (AUROC = 0.845) than in female patients (AUROC = 0.811; p = 0.447), while for VITRO, the AUROC in female patients (0.854) was higher, as compared to male (0.814) subjects (p = 0.370). The ANTICIPATE ± NASH model exhibited the highest AUROC in both sexes (male = 0.885; female = 0.872; p = 0.755). Finally, Baveno VII criteria and the sequential Baveno VII-VITRO algorithms were similarly effective in ruling-in/out CSPH in males and females. Thus, we observed a comparable diagnostic performance of NITs between the sexes, with no statistically significant differences. Interestingly, female patients classified as \"ruled-in\" by Baveno VII as well as by sequential Baveno VII-VITRO algorithm showed a trend towards higher decompensation rates, as compared to males.CONCLUSIONSIndividual noninvasive tests and Baveno VII-based algorithms show a similar accuracy for the diagnosis of CSPH and prognostication in males and females.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731746","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":"Spontaneous Recovery and Mortality in Patients with ALD Referred for Early Liver Transplantation.","authors":"Bima J Hasjim,Allison J Kwong,Amanda Cheung,Katherine M Cooper,Deepika Devuni,Kawthar Mohamed,Giovanni Roldan,Kevin Wang,Sasha Deutsch-Link,Hersh Shroff,Kaleb Tesfai,Veeral Ajmera,Nicholas Lim","doi":"10.14309/ajg.0000000000004032","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004032","url":null,"abstract":"INTRODUCTIONAlcohol-associated liver disease (ALD), including alcohol-associated hepatitis (AH), is the leading cause of liver transplant (LT) in the United States (US), and acceptance of LT without a mandatory period of abstinence is increasing. However, some patients may achieve spontaneous recovery (SR) without LT. We evaluated predictors of mortality and SR among patients with ALD referred for early LT.METHODSRESOLVE-ALD is a retrospective cohort of adults with ALD and <6 months of sobriety referred for early LT between 2018-2021 at six transplant centers across the US. Fine-Gray competing risk regression evaluated predictors of 12-month mortality, with LT considered as a competing risk. Multivariable logistic regression identified predictors of 12-month SR, defined by the expanded Baveno VII criteria.RESULTSOf 607 patients, the median MELD 3.0 was 29 (IQR 22-36); the median time from last drink was 2.6 months (IQR 1.1-4.1). Independent predictors of 12-month mortality included higher INR (sHR 1.49, 95% CI 1.23-1.79) and higher BUN (sHR 1.16 per 10 mg/dL, 95% CI 1.07-1.25). After 12 months, 18.5% achieved SR without LT. Predictors of SR at 12 months were lower INR (OR 0.52, 95%CI 0.31-0.83) and higher platelet count (OR 1.04 per 10x103/µL, 95%CI 1.01-1.08).CONCLUSIONSAmong patients with ALD and short-term abstinence, BUN and platelets are novel predictors of outcomes, along with INR. Utilizing these predictors - or recalibrating existing MELD coefficients - in this unique patient population may help refine medical selection criteria and improve utility and equity in access to early LT.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731342","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 WE APPROACH IT: REPORTING ESOPHAGEAL MANOMETRY FINDINGS.","authors":"Benjamin D Rogers,Walter W Chan,C Prakash Gyawali","doi":"10.14309/ajg.0000000000004030","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004030","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731345","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":"Post-Stroke Oropharyngeal Dysphagia: A Clinical Approach to Diagnosis and Management.","authors":"Edoardo Vincenzo Savarino,Jose Maria Remes-Troche,Adriana Lazarescu","doi":"10.14309/ajg.0000000000004029","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004029","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"143 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731712","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":"Choledochoscope removal of a sharp appendiceal foreign body.","authors":"Yao Chen,Wei Chen,Xiaofang Zhou,Yihan Ma","doi":"10.14309/ajg.0000000000004034","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004034","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731344","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":"Pediatric Versus Adult Colonoscopes Effectiveness in Obese Patients: The PACE Randomized Clinical Trial.","authors":"Akram I Ahmad,Zaid Ansari,Tasneem Jamal Al-Din,Michael A Nicolas,David Restrepo,Ashraf Almomani,Effa Zahid,Adalberto Gonzalez,Daniel Klein,Brenda Jimenez,Fernando Castro,Asad Ur Rahman","doi":"10.14309/ajg.0000000000004027","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004027","url":null,"abstract":"BACKGROUNDObesity is highly prevalent among US adults and is linked to a higher risk of colorectal neoplasia, making it essential to optimize colonoscopy for this population. However, comparative data guiding colonoscope selection in obese individuals remain limited.METHODSA randomized equivalence clinical trial conducted at two Cleveland Clinic Florida locations included patients aged ≥18 years with a body mass index of ≥30 kg/m2, scheduled for screening or surveillance colonoscopy. The primary outcome was a composite of successful cecal intubation within 10 minutes without the need for scope exchange. Participants were randomly assigned in a 1:1 ratio to slim (pediatric) or adult colonoscopes.RESULTSA total of 245 participants entered the study protocol between January and September 2025. The primary endpoint was achieved in 94.3% of the slim colonoscope group and 92.6% of the adult colonoscope group, resulting in an unadjusted absolute risk difference of 1.7% (95% CI: -4.3% to 8.2%). This confirms equivalence within the predefined ±10% margin. After adjusting for gender, BMI, bowel preparation quality, diverticulosis, and surgical history, the adjusted risk difference 2.6% (95% CI: -4.3% to 8.6%). Secondary outcomes, including insertion time, withdrawal time, overall cecal intubation rate, terminal ileum intubation rate, adenoma detection rate, and use of ancillary maneuvers, were similar between the study groups.CONCLUSIONAmong expert endoscopists, slim and adult colonoscopes are equivalent in facilitating non-difficult colonoscopy in obese patients, with a trend toward improved performance using the slim colonoscope.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719484","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":"Challenging the Paradigm a Symptom-Based Classification Is Sufficient for Identifying Disorders of Gut-Brain Interaction.","authors":"Michael Potter,Nicholas J Talley","doi":"10.14309/ajg.0000000000003998","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003998","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147695170","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":"Differentiating IgG4-related Sclerosing Cholangitis from Primary Sclerosing Cholangitis: A Comprehensive Systematic Review and Meta-analysis of Diagnostic Features.","authors":"Mark C Wang,Albert C Chong,Erick Cruz Grave,Andrew Tarakji,Kabir Rahal,Lucas Nastaskin,Abby Kunitsky,Karin J Saric,Helen Lee,Ara Sahakian,James L Buxbaum","doi":"10.14309/ajg.0000000000004024","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004024","url":null,"abstract":"INTRODUCTIONImmunoglobulin G4-related sclerosing cholangitis (IgG4-SC) and primary sclerosing cholangitis (PSC) are cholestatic disorders which may be difficult to differentiate. Importantly, PSC is an untreatable progressive fibroinflammatory disease, whereas IgG4-SC responds to immunosuppression if recognized in a timely manner. This systematic review and meta-analysis aimed to identify and define the performance of clinical, biochemical, radiographic, and histologic features to differentiate between these two diseases.METHODSA systematic search for comparative studies of IgG4-SC and PSC through November 2023 (with repeat evaluation for interval literature in December 2024) was performed and data extraction performed in duplicate. Pooled proportions, odds ratios (OR), means, and standardized mean differences of pertinent diagnostic features were calculated using random-effects inverse-variance models.RESULTSWe identified thirty-eight studies comparing patients with IgG4-SC and PSC. IgG4-SC patients were more likely to have pancreatic disease (p <0.001) but less likely to have inflammatory bowel disease (p<0.001) than those with PSC. Serum IgG4 was significantly higher in IgG4-SC (p<0.001), as anticipated. Radiographically, IgG4-SC demonstrated long distal strictures (p=0.02) and symmetric ductal thickening (p<0.001), whereas PSC showed a beaded appearance (p=0.038). With the exception of IgG4 staining, histologic features including periductal fibrosis were similar between these entities, though sample size was limited for these features.DISCUSSIONOur meta-analysis shows that IgG4-SC and PSC present with similar clinical and radiographic features and possibly comparable histology. A history of unusual pancreatitis and elevated IgG4 (serum or tissue) prompt assessment for more specific radiographic features which if present warrant a therapeutic treatment trial.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"238 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147684806","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":"An Unusual Culprit: Emphysematous Gastritis Due to Mycobacterium Mucogenicum.","authors":"Ethan Shamsian,Alexis Fisher,Yash Shah,Brooke Baker,Kabir Chhabra,Suut Gokturk,Ahmed Al-Khazraji","doi":"10.14309/ajg.0000000000004022","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004022","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"77 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663769","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}