The American Journal of Gastroenterology最新文献

{"title":"PROXIMAL LOCATION AS A PREDICTOR OF METACHRONOUS COLORECTAL CANCER AFTER EXCISION OF ADENOMAS.","authors":"Sandra Baile-Maxía,Carolina Mangas-Sanjuán,Uri Ladabaum,Carmen Sánchez Ardila,Pedro Zapater,Rodrigo Jover","doi":"10.14309/ajg.0000000000003505","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003505","url":null,"abstract":"OBJECTIVESTo compare metachronous colorectal cancer (CRC) and advanced adenoma (AA) risk in patients with proximal vs. distal adenomas.METHODSWe searched Pubmed, EMBASE, and Cochrane for cohort studies and clinical trials. Proximal adenomas were those located proximal to the descending colon. Pooled incidence rate ratios (IRR) for CRC and AA were calculated using a random-effects model.RESULTSCompared with patients with only distal adenomas, patients with any proximal adenoma had a higher risk of metachronous CRC (1.70, 95%CI 1.17-2.45), proximal CRC (3.65,95%CI 1.57-8.46), and AA (1.82,95%CI 1.41-2.34).CONCLUSIONSBaseline adenoma proximal location is associated with future detection of CRC and AA.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889315","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":"Association of Social Isolation from Living Alone and Psychological Distress Among Adults with Chronic Liver Disease in the United States.","authors":"Tiana Walker,Alysa Alejandro-Soto,Lauren Nephew,Patricia Jones,Aneesh Kuruvilla,Reid Sasaki,Nneka N Ufere,Carlos Lago-Hernandez","doi":"10.14309/ajg.0000000000003504","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003504","url":null,"abstract":"OBJECTIVESLittle is known about the effect of social isolation on psychological outcomes of adults with chronic liver disease (CLD).METHODSUsing the US National Health Interview Survey (2014-2018), we explored the associations between social isolation from living alone and serious psychological distress and the moderating effect of neighborhood social cohesion (NSC) among adults with CLD.RESULTSAdults with CLD who lived alone had 1.8 times higher adjusted odds of reporting serious psychological distress. High NSC moderated these findings.CONCLUSIONSSocial isolation is a social risk factor among US adults with CLD that may be moderated by NSC.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889319","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":"Role of Endoscopy in Inflammatory Bowel Disease: What Every Gastroenterologist Should Know.","authors":"Gursimran S Kochhar,Claudia Dziegielewski,Jason N Schairer,Raymond K Cross","doi":"10.14309/ajg.0000000000003507","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003507","url":null,"abstract":"Endoscopy plays a pivotal role in managing inflammatory bowel disease (IBD). The role of endoscopy has evolved over the years, from diagnostic to surveillance to now doing therapeutic procedures to manage patients with IBD. From the initial diagnostic endoscopy, describing the extent and severity of the disease is an essential step in differentiating between Crohn`s disease and ulcerative colitis. Patients with IBD frequently undergo surgeries, and understanding various post-operative configurations and performing endoscopy in post-operative patients can pose a challenge. A thorough understanding of the same can help us to assess disease activity and manage our patients. The purpose of this review is to provide an overview of the role of endoscopy in the management of IBD and to examine various anatomical variations in patients post-operatively.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889317","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":"PARKINSON'S DISEASE AND THE GUT: A PRIMER FOR GASTROENTEROLOGISTS.","authors":"Amol Sharma,Robin M Voigt,Christopher G Goetz,Ali Keshavarzian","doi":"10.14309/ajg.0000000000003508","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003508","url":null,"abstract":"Parkinson's disease (PD) is a chronic, progressive movement disorder and the fastest-growing neurological condition worldwide, affecting over 6 million individuals. In 2017, the economic burden of PD in the United States alone reached $52 billion. Gastrointestinal (GI) symptoms and dysfunction such as constipation, gastroparesis, and dysphagia are common in PD, are difficult to manage, and negatively impact quality of life. Additionally, constipation often precedes motor symptoms by decades, perhaps suggesting that a disrupted bidirectional microbiota-gut-brain axis (MGBA) is present early in PD. Data from mechanistic studies in rodent models and observational human studies demonstrate that gut-microbiota dysbiosis, intestinal hyperpermeability, and gut inflammation may promote neuroinflammation and α-synuclein aggregation, inciting loss of dopaminergic neurons. Studies also indicate that the intestinal milieu may influence symptom severity as well as response to PD treatments. These findings underscore the potential role of the gut as: (1) a site of early diagnosis and risk stratification for populations at high-risk for PD and (2) a potentially disease-modifying treatment approach. This review summarizes the current knowledge on the role of the gut-brain axis in PD pathogenesis, clinical disease course, prodromal GI symptoms and their underlying mechanisms, and stresses current knowledge gaps and future directions.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889318","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":"Gastrointestinal and Extraintestinal Symptoms among Celiac Disease Patients Undergoing a Dose Specified Gluten Challenge: a Systematic Review and Meta-Analysis.","authors":"Marcela Banegas,David Flores Marin,Namrata Naskar,Tulio L Correa,Chloe Rotman,Stephanie Regis,Amelia Simpson,Denis Chang,Jocelyn Silvester,Amelie Therrien","doi":"10.14309/ajg.0000000000003506","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003506","url":null,"abstract":"OBJECTIVESCeliac disease (CeD) is an immune-mediated enteropathy driven by gluten ingestion. Gluten challenges (GC) are commonly used to evaluate novel therapeutics and CeD mechanisms, but their associated symptom burden has not been well characterized. We aim to evaluate the proportion of subjects with gastrointestinal and extraintestinal symptoms during an experimental GC.METHODSPubmed, Embase, CINAHL, and Cochrane Central were searched through December 2024 for studies reporting symptoms in adult CeD patients in remission on a gluten-free diet undergoing a GC. Studies of GC for clinical diagnosis were excluded. Eligible studies included randomized (RCT) and non-randomized trials (non-RCT) that reported symptoms. Data was pooled using random-effects meta-analysis, and heterogeneity was assessed.RESULTSWe identified 48 eligible studies with a total of 1409 participants of which 35 were included in the meta-analysis (6 RCTs, 29 non-RCTs). The most common symptoms were abdominal pain (RCT 0.56, 95% CI 0.45-0.65; non RCT 0.40, 95% CI 0.32-0.49), bloating (RCT 0.55, 95% CI 0.38 to 0.71; non RCT 0.37, 95% CI 0.28-0.47) and nausea (0.41, 95% CI 0.24 to 0.59; non RCT 0.34, 95% CI 0.24-0.46). There was significant heterogeneity across studies, with variable GC doses and durations, no systematic reporting of all symptom categories and missing individual data for some studies. Bloating, fatigue, flatulence and nausea were significantly more reported in studies administering ≥6g gluten/day.CONCLUSIONSGC commonly induces gastrointestinal symptoms in CeD patients, with abdominal pain, bloating and nausea being most frequent. Standardized challenge protocols are needed to advance therapeutic research while minimizing symptom burden.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889314","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":"No Effect of Computer Aided Diagnosis on Colonoscopic Adenoma Detection in a Large Pragmatic Multicenter Randomized Study.","authors":"Katharina Zimmermann-Fraedrich,Susanne Sehner,Thomas Rösch,Jens Aschenbeck,Stefan Schubert,Thomas Liceni,Gero Moog,Helmut Neumann,Rüdiger Berndt,Jochen Weigt,Dominik J Kaczmarek,Andrea May,Albrecht Hoffmeister,Oliver Möschler,Christian Wiessner,Guido Schachschal","doi":"10.14309/ajg.0000000000003500","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003500","url":null,"abstract":"INTRODUCTIONMultiple randomized studies have demonstrated that computer-assisted detection (CADe) improves the colonoscopic adenoma detection rate (ADR); however, these improvements have not been consistently reproduced in some more recent studies.METHODSPatients aged ≥50 years undergoing outpatient colonoscopy in 12 German institutions were randomized to either the CADe group or the control group. The primary outcome parameter was the adenoma detection rate (ADR), while secondary outcomes included the adenomas per colonoscopy (APC) rate, detection rates of different histologic subgroups, and adverse events. The median examiner-specific observed rates and examiner-adjusted rates were compared between treatment groups.RESULTS1627 patients were included (mean age 63.1 years, 39.8% female; 71.% screening indications). The observed median examiner ADR was 40.0% (inter-quartile range IQR 20.0-57.1%) in the study vs. 37.5% (IQR 20.0-50.0%) in the control group. Similarly, adjusted overall ADR was 40.6 % (95%CI: 35.8%, 45.5%) in the study and 38.3% (95%CI: 33.5%, 43.1%) in the control group. No differences were observed in APC or any of the adenoma subgroups with regards to size, morphology, location, and histology as well as colonoscopy indication. The examiner had a large influence on ADR (adjusted median odds ratio/OR 1.32), similar to patient age (OR per 10-years increase 1.40, 95%CI: 1.23, 1.59) and sex (OR 1.62, 95%CI: 1.30, 2.04). On the other hand, more hyperplastic polyps were found by CADe (OR for adjusted HDR = 1.29; 95% CI: 1.02, 1.63; p=0.033).CONCLUSIONSIn patients over the age of 50 with mixed colonoscopy indications, CADe did not increase the adenoma detection rate. Further studies should define the requirements for selective CADe use in routine clinical practice, particularly in relation to the examiner's baseline ADR.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889225","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":"Tapered Corticosteroids in Severe Alcohol-Associated Hepatitis: A Strategy to Maximize Benefit and Minimize Harm.","authors":"Ashwani K Singal,Salvatore Piano","doi":"10.14309/ajg.0000000000003464","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003464","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889305","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":"Addressing Mechanistic and Subtype-specific Limitations in the Study on Fecal Proteolytic Bacteria and Staphylococcal Superantigens in Irritable Bowel Syndrome.","authors":"Jiaqi Wei,Yaohui Zhong,Yaling Li,Jun Li","doi":"10.14309/ajg.0000000000003453","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003453","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889238","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":"Unveiling the Potential: Suggestions for Refining the Bowel Preparation Study on 1 L PEG-Asc Combinations.","authors":"Meng-Wei Ge,Hong-Lin Chen","doi":"10.14309/ajg.0000000000003452","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003452","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872111","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":"Patient-perceived risk of HCC and net benefit of surveillance: A multi-center survey study.","authors":"Amit G Singal,Ju Dong Yang,Prasun K Jalal,Reena Salgia,Neil Mehta,Maarouf A Hoteit,Karissa Kao,Darine Daher,Karim Seif El Dahan,Perla Hernandez,Anish Nayak,Naomy Kim,Sarah Pham,Jamine Gamez,Jonathan P Troost,Neehar D Parikh","doi":"10.14309/ajg.0000000000003494","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003494","url":null,"abstract":"BACKGROUNDHepatocellular carcinoma (HCC) surveillance is underused in clinical practice, and few contemporary data have assessed patients' perceptions of surveillance effectiveness and net benefit.METHODSWe conducted a survey study among adult patients with cirrhosis at 7 health systems in the United States. The survey was based on validated measures, when available, and assessed patient knowledge about HCC surveillance, attitudes regarding surveillance benefits and harms, perceived HCC risk, and trust in their doctors.RESULTSRespondents (n=665; median age 60; 46.5% female) were knowledgeable about HCC surveillance, with no significant differences across sociodemographic groups; however, approximately 1 in 5 patients had knowledge gaps about the need and benefit of surveillance. Over three-fourths of patients believed surveillance improves early HCC detection (80.3%) and survival (77.9%). Whereas 74.0% of patients reported doctors had discussed surveillance benefits, only 54.2% recalled a discussion about potential harms. Patients placed greater importance on surveillance benefits but expressed harms should be measured when assessing the net benefit of surveillance programs. Based on a pictogram depicting current estimates for surveillance benefits and harms, 93.2% of patients chose to undergo surveillance, with no significant differences by race, perceived surveillance benefits, or fear of dying from HCC. Study limitations include response and non-response biases, which may result in an over-estimation for reported surveillance benefits and patient acceptance.CONCLUSIONMost patients with cirrhosis followed at academic health systems have high knowledge about HCC surveillance, believe it is beneficial, and express interest in undergoing surveillance after being counseled about the benefits and harms.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872008","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}