The American Journal of Gastroenterology最新文献

{"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}

{"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}

{"title":"A Cancerous Crossroad: Invasive Adenocarcinoma with Multiple Enteric Fistulae.","authors":"Sedra Tibi,Rachel Sergah,Samuel Phen,Anas Kawayeh","doi":"10.14309/ajg.0000000000003533","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003533","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982447","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 Phase 2 Randomized, Double-Blind, Placebo-Controlled Study of the Safety and Efficacy of Metopimazine Mesylate (NG101) in Participants with Gastroparesis.","authors":"Jack Loesch,Eyad Hamza,Pankaj J Pasricha,Judy Nee,Michael Cline,James MacDougall,Madison Simons,John T Brown,Samita Garg,Matthew Hoscheit,Scott Gabbard,Cyril De Colle,Anthony Lembo","doi":"10.14309/ajg.0000000000003534","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003534","url":null,"abstract":"BACKGROUNDThere is an urgent need for effective and safe treatment of gastroparesis. Metopimazine, a selective, peripherally restricted dopamine D2 receptor antagonist, is used in France for the symptomatic treatment of nausea and vomiting and chemotherapy-induced nausea and vomiting.AIMTo assess the safety and efficacy of oral NG101, the mesylate salt of metopimazine, for the treatment of gastroparesis.METHODSWe conducted a 12-week phase 2 multicenter trial with NG101 5, 10, and 20 mg 4 times a day versus placebo. The primary endpoint was the change in mean nausea severity from the Diabetic and Idiopathic Gastroparesis Symptoms Daily Diary (DIGS-DD) during weeks 7-12 of the Treatment Period from baseline. The DIGS-DD measured nausea, abdominal pain, early satiety, postprandial fullness, and vomiting at their worst in the past 24 hours using a 0 to 10-point numeric rating scale. Patient Global Impression of Change (PGI-C) questionnaires, including nausea, were assessed weekly using a 7-point balanced ordinal score.RESULTSOf 161 randomized participants (45.3% diabetic and 54.7% idiopathic), mean DIGS-DD nausea severity scores decreased from baseline during Weeks 7-12 in all treatment groups, but these improvements were not statistically significant compared to placebo. However, there were statistically significant improvements in nausea PGI-C during Weeks 1-12 for all treatment groups compared with placebo. Trends in safety and efficacy favored patients with idiopathic gastroparesis compared to those with diabetic gastroparesis.CONCLUSIONWhile NG101 did not meet statistical significance in its primary endpoint for reducing nausea severity, it demonstrated a favorable safety profile and significant improvement in some secondary endpoints. Further study is needed to determine if NG101 is an effective treatment for patients with idiopathic gastroparesis.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982534","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 Effectiveness of Forceps-Assisted Cannulation for Difficult Cannulation During ERCP: Results of the SOCCER Randomized Controlled Trial.","authors":"Steven M Hadley,Jessica I Chevalier,Grace E Tomasetti,Julia C Hill,Madison C Duclos,David A Klibansky,Heiko Pohl,Corey A Siegel,Arifa Toor,Steven P Bensen,Jeffrey M Adler,Stuart R Gordon,Timothy B Gardner","doi":"10.14309/ajg.0000000000003531","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003531","url":null,"abstract":"OBJECTIVESForceps-assisted cannulation has been reported to facilitate difficult papillary cannulation during ERCP, especially in the context of abnormal papillary anatomy or associated papillary diverticula. We performed a randomized, controlled trial to evaluate if forceps-assisted cannulation improves cannulation success rates, reduces the incidence of difficult cannulations, and decreases the risk of post-ERCP pancreatitis.METHODS152 patients with difficult papillary cannulation during ERCP were randomized to cannulation with or without forceps. Difficult cannulation was defined as: papilla in/on the rim of a diverticulum, difficult cannulation (defined as 5 or more attempts, 5 or more minutes, or 2 or more unintended PD wire passages), redundant tissue overlaying the papilla, or a type 2, 3, or 4 papilla. The primary clinical outcome was rate of successful cannulation.RESULTS70 patients underwent forceps-assisted cannulation and 81 did not use forceps. Forceps patients were younger (62 vs. 68 years p=0.009), but otherwise baseline demographics, ERCP indication, trainee involvement and papilla classification were similar with failed initial cannulation the most common reason for enrollment. 100% of patients in the forceps-assisted group vs. 83.9% in the no forceps group (p<0.001) underwent successful cannulation. All patients in the no forceps group who crossed over to the forceps group had successful cannulation. While not statistically significant, the difficult cannulation rate (57.1 vs. 69.1, p=0.132) was higher in the no forceps group and the PEP rate was low in both groups (5.7 vs 3.7, p=0.705).CONCLUSIONSUsing forceps-assisted technique to overcome difficult cannulation improves ERCP cannulation success rates.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982434","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":"Yersinia enterocolitis: an unusual mimic of colon cancer.","authors":"Gavisha Waidyaratne,Naima Hashi,Marissa Bruce,Jordan Burlen","doi":"10.14309/ajg.0000000000003530","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003530","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"232 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982446","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":"Assessing Gastrointestinal Awareness on TikTok: A Content Analysis of Colorectal Cancer, IBS, and IBD Narratives.","authors":"Shivangini Duggal,Swati Mahapatra,Keith Garrison,Alejandro Robles","doi":"10.14309/ajg.0000000000003539","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003539","url":null,"abstract":"BACKGROUNDSocial media platforms like TikTok are major sources of health information but raise concerns about misinformation.METHODSWe conducted a content analysis of the top 200 TikTok videos on colorectal cancer (CRC), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). Videos were categorized by content focus and narrator type.RESULTSCRC videos were largely healthcare-provider generated (66.5%), while IBS and IBD content was mostly patient-driven (79.14% and 80.32%), with frequent misinformation. Dietary changes were commonly discussed; evidence-based treatments were underrepresented.CONCLUSIONGreater healthcare engagement and content regulation are needed to improve the quality of online gastrointestinal health information.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982460","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 Twist of Fate: Internal Hernia Leading to Volvulus in Pregnancy Post-Roux-en-Y.","authors":"Sofi Damjanovska,Daniel Karb,Jeffry Katz","doi":"10.14309/ajg.0000000000003529","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003529","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982476","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":"Comparing precutting endoscopic mucosal resection using snare-tip and ESD knife for large nonpedunculated colorectal polyps: a randomized controlled trial.","authors":"Chang Kyo Oh,Young Wook Cho,Young-Seok Cho","doi":"10.14309/ajg.0000000000003540","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003540","url":null,"abstract":"BACKGROUNDPrecutting endoscopic mucosal resection (EMR-P) is a modified EMR method for the resection of large non-pedunculated colorectal polyps. In EMR-P, a mucosal incision is made using a snare-tip or endoscopic submucosal dissection (ESD) knife. However, there are concerns that the snare-tip may have a lower procedural success rate than the ESD knife. We aimed to assess the efficacy and safety of EMR-P using a snare-tip compared with that using an ESD knife for large non-pedunculated colorectal polyps.METHODSLarge non-pedunculated colorectal polyps (15-25 mm) were randomly allocated to either the snare-tip or ESD knife EMR-P group. The primary outcome was the en bloc resection rate.RESULTSResection was performed using a snare-tip or ESD knife in 53 patients each. In the intention-to-treat population, the en bloc resection rates for the snare-tip and ESD knife EMR-P groups were not significantly different (98.1% vs. 98.1%, P=1.000). The R0 resection rate in the snare-tip group was not significantly different from that in the ESD knife group (88.7% vs. 92.5%, P=0.663). The total procedure time was 8.9 min (interquartile range [IQR], 7.5-10.3) and 9.3 min (IQR, 7.2-10.9) in the snare-tip and ESD knife groups, respectively (P =0.550). The local recurrence rate was 0% in both groups. No perforations were observed in either group.CONCLUSIONSEMR-P using a snare-tip was non-inferior to EMR-P using a ESD knife for large non-pedunculated colorectal polyps. EMR-P using a snare-tip is considered as effective and safe as an ESD knife.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982432","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":"Yoga for Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Omar Saab,Hasan Al-Obaidi,Marwah Algodi,Asma Algodi,Yasir Rashid,Alhareth Al-Sagban,Mohanad Albayyaa,Nooraldin Merza,Layth Alzubaidy,Brooks Cash","doi":"10.14309/ajg.0000000000003524","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003524","url":null,"abstract":"BACKGROUNDIrritable bowel syndrome (IBS) affects between 10% and 20% of the global population. The therapeutic effect of Yoga on IBS symptoms has been investigated by several randomized controlled trials (RCTs) with inconsistent findings. We conducted this review to synthesize the current evidence on yoga's effect on IBS symptoms.METHODSA systematic review and meta-analysis through systematically searching PubMed, EMBASE, WOS, SCOPUS, and Cochrane through October 2024. Continuous variables were pooled using the standardized mean difference (SMD), with confidence intervals (CI) using Stata MP v. 17. We assessed heterogeneity using the chi-square test and I2 statistic. PROSPERO ID: CRD42024611633.RESULTSEleven RCTs with 535 patients were included. Seven RCTs included adults, three included pediatric or adolescent patients, and another included adolescents and young adults. The yoga intervention type varied among the included trials, with program duration from six weeks to eight months and session duration from 40 to 90 minutes. There was no difference between Yoga and control groups in alleviating the severity of GI symptoms (SMD: -0.66, with 95% CI [-1.51, 0.18], p= 0.12), anxiety (SMD: -0.39, with 95% CI [-0.85, 0.06], p= 0.09), depression (SMD: -0.46, with 95% CI [-1.15, 0.22], p= 0.19), or improving quality of life (QoL) (SMD: 0.53, with 95% CI [-0.38, 1.44], p= 0.25).CONCLUSIONWith uncertain evidence, yoga did not reduce the GI severity of symptoms, anxiety, depression, or improve QoL in IBS patients. In light of the considerable methodological heterogeneity and the high risk of bias within the included RCTs, Yoga cannot be recommended as a treatment for IBS before conducting further large-scale RCTs to fill the current evidence gaps.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945148","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}