The American Journal of Gastroenterology最新文献

{"title":"A Randomized Trial Testing a Body-Focused Exposure Treatment for Functional Abdominal Pain in Children.","authors":"Nancy L Zucker,Jane Pendergast,Alannah Rivera-Cancel,Lindsay Ives,Brian Small,Martha E Gagliano,Gregory Lewis,Maria Davila,Barbara Keith Walter,Nandini Datta,Savannah Erwin,Madeline Farber,Adrienne L Romer,Chantal Gil,Ilana Pilato,Kate Stein,Michelle Craske,Miranda A L van Tilburg,Gary Maslow,Helen Egger","doi":"10.14309/ajg.0000000000004010","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004010","url":null,"abstract":"BACKGROUNDFunctional abdominal pain (FAP) in young children is common, persistent, and associated with significant impairment and risk for later anxiety disorders. Current treatments often emphasize distraction from pain, which may preclude long-term fear reduction. We tested a novel exposure-based intervention that encourages children to focus on potentially uncomfortable bodily sensations with playful curiosity (Feeling and Body Investigators; FBI) compared to developmentally modified components of current best practices emphasizing distraction (Caregivers in Action; CIA).METHODIn a randomized clinical trial, 107 parent-child dyads (children ages 5-9 with FAP) were assigned to either the FBI or CIA condition, each consisting of ten weekly sessions. Primary outcomes were child- and parent-reported pain intensity, frequency, duration, and interference. Secondary outcomes were negative affect and pain-related distress. Mixed-model and non-parametric analyses evaluated within- and between-group changes.RESULTSBoth interventions resulted in significant reductions in pain intensity, frequency, duration, and interference, as well as improvements in negative affect and distress (all p < .01). However, neither approach was shown to be superior. Both treatments were rated highly acceptable by parents and children, with over 90% of parents reporting the treatment helped them manage their child's symptoms.CONCLUSIONBoth the FBI and CIA interventions reduced pain and improved emotional functioning in young children with FAP. Although the two approaches differed in their focus on attention to pain and use of exposure strategies, they were not significantly different. These findings provide pediatricians and mental health providers with evidence-based options for treating young children with FAP.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578050","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":"Extraluminal esophageal stent misdeployment: a complication of managing an esophageal perforation.","authors":"Vlad Pavel,Patricia Mester,Stephan Schmid,Martina Müller,Arne Kandulski","doi":"10.14309/ajg.0000000000004013","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004013","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578053","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":"Comparative safety of Potassium-competitive acid blockers on the risk of clostridium difficile infection: a multicenter cohort study.","authors":"Gyeongmin Lim,Ju-Young Shin,Da Eun Hyeon,Jie-Hyun Kim,Yuna Kim,Hyun-Soo Kim,Woo Hyeon Yoo,Byeong Jun Song,Chang Won Jeong,Hang A Park,Jae Myung Cha,Ji Hyun Kim,Jongtak Jung,Kyoung Min Moon,Sang Youl Rhee,Seung-Jin Kwag,Shi Nae Yu,Soyoung Lee,Sunghee Park,Rae Woong Park,Ju Hwan Kim","doi":"10.14309/ajg.0000000000004011","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004011","url":null,"abstract":"INTRODUCTIONProton pump inhibitors (PPIs) have been associated with an increased risk of Clostridium difficile infection (CDI) in previous observational studies. However, real-world evidence on the CDI risk of potassium-competitive acid blockers (P-CABs), a newer class of acid suppressive agents, remains limited.METHODSWe conducted a retrospective cohort study using electronic health record data from 15 hospitals standardized to the Observational Medical Outcomes Partnership Common Data Model and integrated through Federated E-Health Big Data for Evidence Renovation Network. Patients newly prescribed P-CABs, PPIs, or Histamine 2 Receptor Antagonists (H2RAs) were included and the primary outcome was the occurrence of CDI. After 1:4 propensity score matching, pairwise comparisons were conducted using Cox proportional hazards models. Hazard ratios (HRs) and 95% confidence intervals (CIs) were then pooled across databases via meta-analysis.RESULTSIn the 1:4 matched cohorts, we identified 61,596 P-CAB users (mean follow-up, 72.6 ± 29.9 days) and 132,683 PPI users (74.9 ± 28.6 days), 42,794 P-CAB users (69.5 ± 32.4 days) and 89,415 H2RA users (69.9 ± 33.1 days), and 85,686 PPI users (71.1 ± 31.2 days) and 159,178 H2RA users (68.0 ± 33.8 days) across the three pairwise comparisons. The pooled HRs were 0.87 (95% CI, 0.69-1.10) for P-CABs vs PPIs, 0.85 (0.64-1.12) for P-CABs vs H2RAs, and 1.13 (0.98-1.29) for PPIs vs H2RAs. Results were generally consistent across subgroup and sensitivity analyses.DISCUSSIONIn this cohort study, P-CAB use was not associated with a higher risk of CDI compared to PPIs or H2RAs.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"102 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578052","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":"Temporal Trends in Hepatitis C Virus (HCV) Screening and Management in Pregnant Women and Infants between 2014 - 2024 in San Francisco, California.","authors":"Megan Betancourt,Randeep Kaur,Jasmine Gamez,Jennifer Price,Annie Luetkemeyer,Dominika Seidman,Monika Sarkar","doi":"10.14309/ajg.0000000000004014","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004014","url":null,"abstract":"OBJECTIVESUniversal hepatitis C virus (HCV) screening is now recommended during pregnancy, although rates of screening, confirmatory viral load testing, and HCV treatment during pregnancy and postpartum remain poorly described.METHODSRetrospective chart review study of birthing parents and infants who delivered at the University of California, San Francisco (UCSF) and Zuckerburg San Francisco General Hospital (ZSFG) between January 1, 2014 and December 31, 2024 using the Epic electronic health record system. Maternal outcomes included HCV antibody screening, confirmatory HCV viral load testing, referral to HCV specialty care, and receipt of antiviral therapy. Infant screening and additional obstetric and neonatal outcomes were also reported.RESULTSDuring the study period, 41,951 pregnant women delivered at our two sites, of whom 13,950 received HCV screening (33.3%) by antibody or RNA testing. Screening rates increased over time from 15.2% in 2014 to 69.1% in 2024 (p < 0.001). Among 328 (2.4%) with a positive screening test, 203 (62.0%) completed HCV RNA testing and 110 (54.2%) had confirmed viremia. Of these, 52 (47.3%) received subspecialty referral and 43/52 (82.7%) received antiviral therapy (2 during pregnancy, 41 postpartum). Overall, 67/110 (60.9%) viremic patients were lost to follow-up. Among 115 infants born to viremic mothers, 30 (26.1%) received HCV screening at a median age of 19.2 months (IQR 13.4 - 22.0). Three infants (10.0%) screened HCV antibody positive; two had undetectable RNA, and one experienced spontaneous viral clearance at 19 months.CONCLUSIONSDespite increasing screening over time, substantial gaps persist in HCV screening, follow-up testing, and linkage to care for pregnant patients and their infants. High loss to follow-up and low infant screening rates highlight the urgent need to strengthen peripartum HCV care pathways to support maternal and pediatric cure and advance HCV elimination goals.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147578020","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":"Endoscopic Management for Non-variceal Upper Gastrointestinal Bleeding: A Network Meta-analysis of Randomized Controlled Trials and Cost-Effectiveness Analyses of Two Healthcare Systems.","authors":"Noppachai Siranart,Yanisa Chumpangern,Patavee Pajareya,Pannathorn Nakaphan,Tanattida Kassels,Watsapon Chuanchai,Sireenada Sattawatthamrong,Panisara Fangsaard,Peenaprapa Tangpradubkiat,Steven N Steinway,Kittithat Tantitanawat,Sakkarin Chirapongsathorn","doi":"10.14309/ajg.0000000000004000","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004000","url":null,"abstract":"BACKGROUNDNon-variceal upper gastrointestinal bleeding (NVGIB) represents an urgent medical condition with high mortality. Standard endoscopic therapies (ST) still carry a high rebleeding rate. Novel modalities such as the over-the-scope clip (OTSC) and hemostatic powder (HP) could be promising alternatives, but their efficacy and cost-effectiveness remain to be explored.METHODSA network meta-analysis and cost-effectiveness analyses were conducted to compare OTSC vs. HP vs. ST. Primary endpoints include 30-day rebleeding and 30-day further bleeding. Markov models with a 12-month time horizon were created across 3 different healthcare settings: the United States (US), Thailand with Boston Scientific products (TH-BOS), and Thailand with China-manufactured alternatives (TH-CHN). Incremental cost-effectiveness ratio (ICER) was evaluated at a willingness-to-pay (WTP) of $100,000 per quality-adjusted life year (QALY) for the US model and THB150,000 per QALY for the TH-BOS and TH-CHN models.RESULTSTen RCTs with 1,120 NVGIB patients were included in the NMA. Lowest 30-day rebleeding was seen in OTSC (P-score:0.996), followed by ST (0.296) and HP (0.208). Similarly, OTSC also achieved lowest 30-day further bleeding (0.906), followed by HP (0.570) and ST (0.024). In CEA, the US model reported OTSC as a dominant approach compared to HP (ICER: -$314) and ST (-$3,112). In the TH model, OTSC still dominated ST (ICER:-THB28,423 for TH-BOS and -22,858 for TH-CHN) and was more cost-effective than HP (THB1,833 for TH-BOS and THB2,026 for TH-CHN).CONCLUSIONOTSC was superior to HP and ST in terms of efficacy and cost-effectiveness, favoring its use as a first-line endoscopic hemostasis intervention for NVGIB.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147502499","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":"Antibiotic use during gastrointestinal infections increases the risk of developing irritable bowel syndrome: a Systematic Review and Meta-Analysis.","authors":"Luigi Colecchia,Giovanni Marasco,Cecilia Capelli,Antonio Facciorusso,Marcello Fabio Maida,Alessandro Vitello,Elton Dajti,Maria Raffaella Barbaro,Arianna Gobbato,Cesare Cremon,Giovanni Barbara","doi":"10.14309/ajg.0000000000004001","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004001","url":null,"abstract":"INTRODUCTIONIrritable bowel syndrome (IBS) is a disorder of gut-brain interaction which negatively affects patients' quality of life. It has been hypothesized that changes in gut microbiota composition and function evoked by antibiotic use represent a trigger for IBS development. This systematic review and meta-analysis aims to assess the incidence of IBS following antibiotic use.METHODSMedline, Embase, and Scopus, along with relevant conference abstracts and citation tracking were searched up to June 15th, 2025. Studies that reported new diagnoses of IBS in patients with documented antibiotic exposure versus controls without antibiotic exposure were included. Data extraction and quality assessment were performed independently by two reviewers. Pooled incidence rates per 1000 person-years, along with incidence rate ratios (IRRs) with 95% confidence intervals (CI) were pooled; heterogeneity was expressed as I2. Meta-regression analysis was performed to assess the impact of confounding covariates.RESULTSThirty-one studies comprising a total of 422,350 patients (244,632 antibiotic users and 177,718 non-users) were included. The overall pooled incidence of IBS was 26% in antibiotic users compared to 20% in non-users, resulting in an IRR of 1.3 (95% CI: 1.07-1.58; p = 0.008). In sensitivity analyses including only studies in which antibiotics were used for gastrointestinal infections, the risk of developing IBS was higher for antibiotic users (IRR: 1.71; 95% CI: 1.16-2.51; p = 0.007), with high heterogeneity (I2 > 90%) among studies. Geographical area, criteria for IBS diagnosis and study quality were associated with estimated effects, explaining the observed heterogeneity.CONCLUSIONAntibiotic use is associated with increased risk of developing IBS, especially following gastrointestinal infections. However, the significant study heterogeneity reduces the power of our results, suggesting that further high-quality research is needed to clarify this relationship.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"240 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483643","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":"Identifying key predictors of metastatic cutaneous Crohn's disease: a case-control study.","authors":"Natalie M Baker,Karla Santiago-Soltero,Ellen Anshelevich,Joseph Ebriani,Kelly Li,David Stein,John S Barbieri,Rahul S Dalal,Alexandra P Charrow","doi":"10.14309/ajg.0000000000004003","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004003","url":null,"abstract":"BACKGROUNDMetastatic cutaneous Crohn's Disease (MCD) is a rare cutaneous manifestation of Crohn's Disease with significant morbidity, yet understanding is limited to case reports and small series. We aimed to identify risk factors associated with MCD development.METHODSThis retrospective case-control study (1/2016-1/2024) included MCD patients confirmed using Delphi Panel criteria and controls with gastrointestinal Crohn's Disease, matched 1:2 by age and sex. Demographic factors, Crohn's Disease characteristics, medication history, surgical history, and extraintestinal manifestations were assessed via chart review. Odds ratios were calculated using conditional logistic regression.RESULTSAmong 474 patients screened, 61 cases were matched with 122 controls. 77.0% were female with no significant differences in smoking history or BMI between groups. Factors significantly associated with increased MCD odds included perianal Crohn's disease (OR 6.79, 95% CI 1.47-31.36, p=0.014) and ostomy history (OR 72.65, 95% CI 3.50-1505.92, p=0.006).CONCLUSIONSThese findings represent an important step toward understanding MCD's pathogenesis and may inform future translational studies.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483600","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":"Virtual Multidisciplinary GI Care Clinic Improves Patient Engagement, Satisfaction, and Outcomes at Reduced Costs and Healthcare Utilization: A Prospective Cohort Study.","authors":"Sameer K Berry,Sanskriti Varma,Chamara Basnayake,Joseph C Ahn,Jeffrey Berinstein,David Cook,Walter Chan,John Allen,William Chey","doi":"10.14309/ajg.0000000000004002","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004002","url":null,"abstract":"INTRODUCTIONChronic gastrointestinal (GI) conditions, including irritable bowel syndrome and other disorders of gut-brain interaction (DGBIs), are prevalent and costly, and fragmented care contributes to suboptimal outcomes. Virtual and multidisciplinary care models may improve outcomes.OBJECTIVESWe aimed to 1) characterize patients receiving virtual GI care, 2) report patient engagement with and patient-reported outcomes after virtual multidisciplinary care, 3) report healthcare utilization and costs from a payer perspective among patients versus propensity score-matched controls identified from claims data.METHODSWe collected descriptive data on patient demographics, clinic provider visits, symptoms, and patient-reported outcomes from 3/2021-9/2022. To evaluate healthcare utilization and costs, we conducted difference-in-difference (DID) analyses using claims data compared with a propensity score-matched control group.RESULTSAmong 234 patients (71% female, mean age 45.4±13.2 years), 51% received a new GI diagnosis, predominately DGBI (63%). Engagement criteria were met by 80% (n=187), who completed a mean of 10 visits and median time-to-first appointment of 6 days. Dietitians (93%), psychologists (76%), and health coaches (64%) were frequently utilized. Engaged patients exhibited significant improvements from pre- to post-clinic in IBS severity (226.7 to 145.6), symptom control (20.2% to 86.6%), quality-of-life dysphoria (27.5 to 32.8), missed workdays (1.0 to 0.7), and satisfaction (37.4% to 96.3%) (all p<0.05). Compared with matched controls, a significantly smaller percent of patients had imaging (15% vs. 44%; p < 0.0001) and GI-related emergency department visits (4% vs. 10%; p =.0028), which contributed to reductions in GI-related costs ($443 PMPM; p=0.047) and all-cause costs ($676 PMPM; p=0.043), equating to annualized savings of $5,316 and $8,112, respectively.CONCLUSIONSVirtual multidisciplinary GI care was associated with high engagement, improved clinical outcomes, and reduced healthcare utilization and costs.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"419 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483786","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 Cautionary Note in the Era of Computer Aided Detection of Polyps at Colonoscopy and Need for Human Centered Design.","authors":"Aasma Shaukat","doi":"10.14309/ajg.0000000000003961","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003961","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373894","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":"Ciliated Hepatic Foregut Cyst with Clustered Echogenic Foci: An Incidental Finding on Health Screening.","authors":"Yuka Miyoshi,Akira Nishio,Nobuyuki Tatsumi,Yasuyuki Yoshida,Hiroshi Wada,Akira Kaneko","doi":"10.14309/ajg.0000000000003993","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003993","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147359236","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}