The American Journal of Gastroenterology最新文献

{"title":"VALIDATION OF ESOPHAGEAL GLOBAL SYMPTOM SEVERITY AS A PATIENT REPORTED OUTCOME FOR EVALUATION OF REFLUX SYMPTOMS.","authors":"Walter W Chan,Matthew Schroeder,Allyson Richardson,Neemit Shah,Mayssan Muftah,Samya Muftah,Stefano Siboni,Marco Sozzi,Ming-Wun Wong,Chien-Lin Chen,C Prakash Gyawali,","doi":"10.14309/ajg.0000000000003499","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003499","url":null,"abstract":"BACKGROUNDVisual analog scales (VAS) are simple, easy for patients to comprehend, and require limited translation. We evaluated the value of esophageal global symptom severity (GSS) measured using VAS in assessing initial reflux symptom burden as compared to other validated questionnaires, esophageal symptom burden, and outcome following reflux management.METHODSWe analyzed pooled data from published historical cohorts of patients undergoing pH-impedance testing for reflux symptoms from three continents (North America, Europe, Asia). Univariate (Spearman correlation), multivariable (general linear regression) and receiver operating characteristic (ROC) analyses were performed to compare GSS with validated symptom instruments including gastroesophageal reflux disease questionnaire (GERDQ), GERD health-related quality of life (GERD-HRQL), and reflux symptom index (RSI), and metrics from pH-impedance monitoring per Lyon Consensus 2.0.RESULTS1296 patients (mean age 52.0 years, 61.9% female) were included, 937, 197, and 162 from North America, Europe, and Asia, respectively. GSS significantly correlated with GERDQ (R=0.455), GERD-HRQL (R=0.440), RSI (R=0.491), acid exposure time (AET) (R=0.158), and total reflux episodes (R=0.161) (p<0.0001 for each comparison). Mean GSS was higher with abnormal GERDQ, GERD-HRQL, and RSI, pathologic AET and conclusive GERD per Lyon Consensus (p<0.0001 each comparison). On ROC analyses, GSS was non-inferior to GERDQ, GERD-HRQL, and RSI in predicting pathologic AET and total reflux episodes, and conclusive GERD. Percentage improvement in GSS after antireflux treatment significantly correlated with change in GERDQ (R=0.536, p<0.0001) and treatment satisfaction (R=0.532 p=0.0002). On multivariable linear regression analyses, percentage change in GSS remained an independent predictor of both change in GERDQ (β=0.813, p<0.0001) and satisfaction with anti-reflux therapy (β=1.90, p=0.0006).CONCLUSIONSGSS correlates with other validated reflux questionnaires and discriminates abnormal from normal reflux burden in patients with reflux symptoms. GSS change also reflects reflux treatment outcome and satisfaction. GSS is a useful addition to patient symptom assessment before and after GERD treatment.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872006","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":"Distinguishing Retrieval Augmented Generation From Prompt Engineering: Implications for Reproducibility in Large Language Model Research and Applications.","authors":"Mauro Giuffrè","doi":"10.14309/ajg.0000000000003439","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003439","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857236","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":"Demystifying Carbohydrate Maldigestion: A Clinical Review.","authors":"Brooks D Cash,Daksesh Patel,Kate Scarlata","doi":"10.14309/ajg.0000000000003374","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003374","url":null,"abstract":"Carbohydrate intolerance is a poorly understood and potentially overlooked cause of unexplained gastrointestinal symptoms, particularly among patients with disorders of gut-brain interaction. Symptoms related to carbohydrate intolerance arise from bacterial fermentation of unabsorbed carbohydrates leading to increased gases and osmotic load within the gastrointestinal tract. This mechanism is shared across various carbohydrates, including lactose, sucrose, maltose, fructose, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Primary forms of carbohydrate maldigestion typically affect one specific type of carbohydrate and result from inherited defects in specific brush-border enzymes or transport mechanisms, whereas secondary, or acquired, forms of carbohydrate maldigestion can arise from conditions that affect the structural integrity or function of the pancreas and small intestine. Although confirmation of a disaccharidase deficiency does not imply clinical relevance, obtaining a careful patient history with appropriate use of breath testing, duodenal disaccharidase assay, and response to dietary modification can help identify patients whose symptoms are associated with carbohydrate maldigestion and who may benefit from treatment. Dietary modification remains the cornerstone of therapy for patients with carbohydrate intolerance and should focus on determining the most liberal diet for patients that allows symptom control. Given the complexity and time-consuming nature of this process, clinicians are encouraged to engage the help of dietitians with expertise in the treatment of disorders of gut-brain interaction where available. Enzyme replacement therapy can also be an important adjunct to dietary management, with sacrosidase improving symptoms in sucrase-isomaltase deficiency and helping patients to liberalize their diet.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"24 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849538","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 Odd Thing About Odds Ratios.","authors":"Gabriel V Lupu,Robert S Sandler,Sasha Deutsch-Link","doi":"10.14309/ajg.0000000000003401","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003401","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831800","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":"Quality of Evidence Backing Recommendations for Eosinophilic Esophagitis.","authors":"Anil Minocha","doi":"10.14309/ajg.0000000000003404","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003404","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831799","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":"Effectiveness of a model of care based on Fibrosis-4 and liver stiffness measurement for the screening of patients with type 2 diabetes mellitus at risk of advanced liver disease: results from an Italian prospective multicentre study.","authors":"Gian Paolo Caviglia,Arianna Ferro,Roberta D'Ambrosio,Riccardo Perbellini,Pietro Lampertico,Giulia Periti,Luca Valenti,Carlo Ciccioli,Grazia Pennisi,Salvatore Petta,Lucia Brodosi,Maria Letizia Petroni,Francesca Marchignoli,Loris Pironi,Alessandra Sagripanti,Maria Eva Argenziano,Gianluca Svegliati-Baroni,Chiara Rosso,Federica Barutta,Angelo Armandi,Gabriella Gruden,Elisabetta Bugianesi","doi":"10.14309/ajg.0000000000003493","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003493","url":null,"abstract":"BACKGROUND AIMSPatients with type 2 diabetes mellitus (T2DM) are at increased risk for metabolic dysfunction-associated steatotic liver disease (MASLD), advanced liver fibrosis, and metabolic dysfunction-associated steatohepatitis (MASH). We evaluated the prevalence and severity of MASLD among patients with T2DM at their first referral to diabetes clinics, and assessed the effectiveness of the 2-tier screening approach by Fibrosis-4 (FIB-4) and vibration-controlled transient elastography (VCTE).METHODSConsecutive patients with T2DM from six different diabetes clinics were prospectively enrolled. Liver stiffness measurement (LSM) was assessed by VCTE, while liver steatosis by controlled attenuation parameter (CAP) (Fibroscan, Echosens, France). \"At risk MASH\" was assessed by FibroScan-AST (FAST) score.RESULTS800 patients (median age: 59, 53-65 years; males: 485, 60.6%) met the inclusion criteria. Prevalence of liver steatosis (CAP ≥ 248 db/m) was 73.6%. The proportion of patients at medium/high risk of advanced liver fibrosis (LSM ≥ 8.0 kPa) was 16.9%. Patients with \"at risk MASH\" (FAST > 0.67) were 12.0%.A 2-tier screening for advanced liver fibrosis by FIB-4 and VCTE would have led to 70 (8.8%) patients referred to liver clinics with a false-negative rate of 9.6% (n = 77; patients with FIB-4 < 1.3 and LSM ≥ 8.0 kPa). At multivariate analysis, overweight/obesity (OR = 3.13, 95%CI 1.23-7.97) and elevated ALT (OR = 1.91, 95%CI 1.17-3.10) were independently associated with LSM ≥ 8.0 kPa in patients with FIB-4 < 1.3.CONCLUSIONSIn diabetes clinics, the 2-tier screening using FIB-4 and VCTE is effective for the identification of T2DM patients to be referred to hepatologists. VCTE referral may be considered for patients with overweight/obesity and elevated ALT classified as at low risk of advanced liver fibrosis by FIB-4.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831798","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":"Rural-urban disparities in hepatocellular carcinoma deaths are driven by hepatitis C-related HCC.","authors":"Andrew M Moon,Gabriel V Lupu,Ellen W Green,Sasha Deutsch-Link,Louise M Henderson,Hanna K Sanoff,Ted K Yanagihara,Nima Kokabi,David M Mauro,A Sidney Barritt","doi":"10.14309/ajg.0000000000003487","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003487","url":null,"abstract":"OBJECTIVESRecent data suggest emerging rural-urban disparities in hepatocellular carcinoma (HCC) burden in the US. We aimed to assess (1) trends in rural vs urban HCC-related mortality and (2) differences in underlying chronic liver disease etiologies contributing to HCC-related deaths.METHODSWe utilized the National Vital Statistics System to examine crude and age-adjusted HCC death rates overall and by etiology for rural and urban residents from 2005-2023. Using the NCI Joinpoint Trend Analysis Software, we identified statistically significant changes in average percentage change (APC) in HCC mortality rates.RESULTSExamining mortality rates over time, average APC in HCC deaths were significantly higher in rural residents (crude AAPC 4.64, 95% CI 4.10, 5.34; age-adjusted AAPC 3.53, 95% CI 3.09, 4.07) compared to urban residents (crude AAPC 2.72, 95% CI 2.43, 3.01; age-adjusted AAPC 1.68, 95% CI 1.28, 2.13). Differences in HCC death rate changes were driven by a significantly greater recent decline in HCC cases from hepatitis C virus (HCV) in urban residents (crude APC -6.69, 95% CI -8.85, -5.30 from 2017-2023) compared to rural residents (crude APC -3.31, 95% CI -8.05, 0.73 from 2016-2023).CONCLUSIONSAnnual increases in HCC deaths have been more pronounced in rural compared to urban populations. Deaths from HCV-related HCC have declined with a geographical disparity that favors urban populations, possibly driven by decreased access to HCV screening or availability of highly effective direct-acting antiviral therapies for rural residents. These findings underscore the need for targeted HCV screening and treatment strategies in rural populations in addition to ongoing strategies to combat alcohol use and metabolic diseases.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"218 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822583","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":"Adenoma Detection Rates Calculated Using All Exams Are Associated with Lower Risk for Post Colonoscopy Colorectal Cancer: Data From the New Hampshire Colonoscopy Registry.","authors":"Joseph C Anderson,Douglas K Rex,Todd A Mackenzie,William Hisey,Christina M Robinson,Lynn F Butterly","doi":"10.14309/ajg.0000000000003488","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003488","url":null,"abstract":"INTRODUCTIONWe used New Hampshire Colonoscopy Registry (NHCR) data to examine the association between post-colonoscopy colorectal cancer (PCCRC) risk and an adenoma detection rate (ADR) which was calculated using exams with all indications, as compared to ADR restricted to only screening exams.METHODSOur cohort study included NHCR patients with an index exam and at least one follow-up event, either a colonoscopy or a CRC diagnosis. Our outcome, PCCRC was any CRC diagnosed ≥ 6 months after an index exam. The exposure variable was endoscopist-specific ADR (ADR-A), calculated for all indications, divided into quintiles. We also compared the ADR-A to a screening ADR (ADR-S). Cox regression was used to model the hazard of PCCRC on ADR, controlling for age, sex, and other covariates.RESULTSIn 32,535 patients, a lower hazard for PCCRC (n=178) was observed for ADR-A's > 23%, as compared to ADR-A's <23% (Reference) (23%-<29%: HR=0.56, 95%CI:0.36-0.87;29%-<34%: HR=0.60, 95% CI:0.38-0.94; 34%-<44%: HR=0.43,95% CI: 0.29-0.65; and ≥44%: HR=0.32, 95% CI: 0.16-0.63). The highest quartile of ADR-A (42%+)(HR=0.41 95%CI:0.23-0.75) had a similar protection from PCCRC as the highest quartile of ADR-S (35%+)(HR=0.38 95%CI:0.21-0.70). We observed 95% CIs for ADR's were 28% narrower (median=0.72;IQR:0.10) for endoscopists when using ADR-A versus ADR-S.DISCUSSIONOur data demonstrating lower PCCRC risk in exams performed by endoscopists with higher ADR's calculated with all exams helps to validate ADR-A as a quality measure. ADR-A may also increase precision of the calculated ADR. Endoscopists should strive for a higher ADR-A with 44% as an aspirational target.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822584","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":"Early Stage Crohn's Disease-Associated Small Bowel Adenocarcinoma at Ileal Stenosis Detected by Ballon-Assisted Enteroscopy.","authors":"Masashi Ohno,Atsuhi Nishida,Yoshihiro Yokota,Takayuki Imai,Ryoji Kushima,Osamu Inatomi","doi":"10.14309/ajg.0000000000003484","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003484","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819245","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":"Novel Closure of Large Gastric Defect Using a Dual-Channel Endoscope.","authors":"Shuangzhu Yang,Jingjing Lian,Aiping Xu,Tao Chen,Meidong Xu","doi":"10.14309/ajg.0000000000003485","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003485","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819244","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}