Gastro hep advances最新文献

{"title":"Association of Statin, Metformin, and Aspirin Use With Hepatocellular Carcinoma in the All of Us Research Program","authors":"Erik Almazan , Raymond T. Chung","doi":"10.1016/j.gastha.2024.08.014","DOIUrl":"10.1016/j.gastha.2024.08.014","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 1","pages":"Article 100535"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Order Set on Exocrine Pancreatic Insufficiency in Chronic Pancreatitis, Pancreatic Cancer, and Pancreatic Resection","authors":"Michael Ladna ,&nbsp;Ishaan Madhok ,&nbsp;Adnan Bhat ,&nbsp;Nicole Ruiz ,&nbsp;Jackson Brown ,&nbsp;Jake Wilson ,&nbsp;Peter Jiang ,&nbsp;Robert Taylor ,&nbsp;Mark Radetic ,&nbsp;John George ,&nbsp;Christopher Forsmark","doi":"10.1016/j.gastha.2024.08.019","DOIUrl":"10.1016/j.gastha.2024.08.019","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Enzyme insufficiency (EPI) is common in chronic pancreatitis (CP), pancreatic ductal adenocarcinoma (PDAC), and after pancreatic resection. 40%–50% of CP patients and 70%–80% of PDAC patients develop EPI. 1/3rd of these patients are prescribed Pancreatic enzyme replacement therapy (PERT), often at an inadequate dose, with evidence that this leads to increased morbidity and mortality. This study aimed to develop and implement an EPIC-based best practice alert (BPA) and smart set to improve the management of EPI.</div></div><div><h3>Methods</h3><div>A retrospective analysis of all patients with International Classification of Diseases codes for EPI, CP, and PDAC or CPT code for pancreatic resection from Feb-2018 to Feb-2021. Appropriate use of PERT was defined as ≥ 40,000 units of lipase with each meal. The BPA and smart set were implemented into the electronic medical record in Feb-2020. The BPA fired if the patient was already on PERT or if an order for PERT was placed and directed the clinician to the smart set which provided PERT formulations each prefilled to the minimum therapeutic dose of 40,000 units of lipase.</div></div><div><h3>Results</h3><div>A significant increase in the proportion of patients on minimum therapeutic dose of PERT from 61.9% to 72.9% (<em>P</em> ≤ .001). Ordering of pancreatic elastase, A1c, vitamin D, and dual X-ray absorptiometry increased from 20.4% to 29.9% (<em>P</em> &lt; .001), 54.7%–62.1% (<em>P</em> = .001), 30.9%–48.1% (<em>P</em> &lt; .001) and 10%–18% (<em>P</em> &lt; .001), respectively. The BPA triggered a total of 30,838 times resulting in the smart being opened a total of 624 (2.02%) times over 24 months.</div></div><div><h3>Conclusion</h3><div>The BPA and smart set were associated with an improvement in the diagnosis and management of EPI and related complications in CP, PDAC, and s/p pancreatic resection.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 1","pages":"Article 100541"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11713485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nucleos(t)ide Analog Treatment Discontinuation in Chronic Hepatitis B Virus Infection: A Systematic Literature Review","authors":"Robert Gish ,&nbsp;Kosh Agarwal ,&nbsp;Anadi Mahajan ,&nbsp;Supriya Desai ,&nbsp;Saifuddin Kharawala ,&nbsp;Rob Elston ,&nbsp;Joyeta Das ,&nbsp;Stuart Kendrick ,&nbsp;Vera Gielen","doi":"10.1016/j.gastha.2024.08.015","DOIUrl":"10.1016/j.gastha.2024.08.015","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The aim of this systematic literature review (SLR) was to examine outcomes and associated predictors following nucleos(t)ide analog (NA) treatment cessation in adult patients with chronic hepatitis B virus infection.</div></div><div><h3>Methods</h3><div>The SLR was conducted according to PRISMA methodology. All included studies were quality assessed using appropriate scales or checklists.</div></div><div><h3>Results</h3><div>The SLR identified 145 studies. Cumulative rates of clinical relapse (40 studies), virological relapse (53 studies), biochemical relapse (10 studies) and retreatment events (14 studies) post NA cessation varied widely across studies (clinical relapse: 40%–65%, virological relapse: 75%–94%, biochemical relapse: 63%–73%, retreatment rates: 30%–78% at 24 and 144 weeks, respectively). Significant predictors with adequate evidence of clinical relapse included older age, male gender, and higher hepatitis B surface antigen (HBsAg) and hepatitis B virus DNA at baseline and end of treatment. HBsAg loss was reported in 25 studies, with overall median HBsAg loss rates ranging from 2% at 24 weeks (5 studies) to 11% at 192 weeks (2 studies) post NA cessation. There was adequate evidence for lower HBsAg level at baseline and end of treatment as a significant and consistent predictor of HBsAg loss.</div></div><div><h3>Conclusion</h3><div>There is considerable heterogeneity among studies of NA cessation. Data are currently incomplete to provide strong recommendations for NA cessation or to identify patients who may benefit most from this approach in clinical practice. Further studies are required to provide clearer guidelines, and tools to assess and monitor patients who may benefit from NA treatment cessation.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 1","pages":"Article 100536"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol Relapse After Liver Transplantation: Risk Factors, Outcomes, and a Comparison of Risk Stratification Models","authors":"Karen Young ,&nbsp;Yuval A. Patel ,&nbsp;Benson Hoffman ,&nbsp;Sarah Peskoe ,&nbsp;Shein-Chung Chow ,&nbsp;Karli Erhart ,&nbsp;Jennifer Jackson ,&nbsp;Stephanie Garbarino","doi":"10.1016/j.gastha.2024.09.005","DOIUrl":"10.1016/j.gastha.2024.09.005","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Alcohol-related liver disease is a leading cause of liver transplantation (LT) in the United States; however, alcohol relapse remains a risk, and real-world assessment of relapse prediction scores is lacking. The primary aim of this study was to assess risk factors for alcohol relapse and compare effectiveness of pre-existing risk scores (e.g., Sustained Alcohol Use Post-Liver Transplant (SALT) and Harmful Alcohol Use Post-Liver Transplant (HALT) scores).</div></div><div><h3>Methods</h3><div>This was a retrospective chart review of 69 adults who underwent LT for alcohol-related liver disease at Duke University Hospital from January 1, 2018, to January 1, 2021. Outcome variables included relapse post-LT, severity of relapse, and graft dysfunction.</div></div><div><h3>Results</h3><div>Sixty-seven patients with a median follow-up time of 43 months were included. Eighteen (27%) experienced alcohol relapse. Of those, 16 (89%) had heavy alcohol use and 3 of those patients (17%) experienced graft dysfunction. Factors significantly associated with relapse included younger age, prior relapse, significant psychiatric comorbidities, alcohol use after cirrhosis diagnosis, shorter abstinence before LT listing, and prior alcohol treatment program. When applying SALT and HALT scores, the area under the curve was 0.69 (95% confidence interval 0.53–0.85) and 0.66 (95% confidence interval 0.50–0.81), respectively.</div></div><div><h3>Conclusion</h3><div>In our cohort, heavy alcohol use before transplantation and legal issues did not predict relapse, which are common components of prediction scores. Less than 5% of patients had graft dysfunction due to relapse, suggesting good graft outcomes. While the HALT and SALT scores were validated in our cohort, our finding of additional significant predictors of relapse, in addition to previously reported risk factors providing protective effect, suggests opportunity for further optimization of prediction scores.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 1","pages":"Article 100550"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xanthomatosis Coli Associated With Nontuberculous Mycobacterial Disease","authors":"Naoya Masuda ,&nbsp;Kenji Yamazaki ,&nbsp;Ryoji Kushima","doi":"10.1016/j.gastha.2025.100692","DOIUrl":"10.1016/j.gastha.2025.100692","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 8","pages":"Article 100692"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168871","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":"Adverse Childhood Experiences Are Associated With an Increased Risk of Dyspepsia in Patients Undergoing Upper Endoscopy","authors":"Rachel Zuzul ,&nbsp;Allison O. Taylor ,&nbsp;Caroline Labriola ,&nbsp;Frances Wang ,&nbsp;Grace Sekaya ,&nbsp;Tomi Akinyemiju ,&nbsp;Meira Epplein ,&nbsp;Katherine S. Garman","doi":"10.1016/j.gastha.2025.100680","DOIUrl":"10.1016/j.gastha.2025.100680","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Stress is a risk factor for dyspepsia; however, neither the type nor timing of stress exposures across the lifespan in this syndrome are well understood. We aimed to understand the association between both adverse childhood experiences (ACEs) and experience of current life stress with dyspepsia by collecting and analyzing survey data from a racially diverse cohort of adult research patients presenting for upper endoscopy (esophagogastroduodenoscopy).</div></div><div><h3>Methods</h3><div>The Gastric Immune Response and Cancer Interception study is a cohort study that enrolled adults scheduled for esophagogastroduodenoscopy at an academic center and administered a detailed survey, including questions on ACEs, current adult stress, and dyspepsia symptoms. Endoscopy and pathology results were abstracted from the medical record. Multivariable logistic regression was performed to determine the association between stress exposures and dyspepsia outcomes.</div></div><div><h3>Results</h3><div>Among 187 participants who completed dyspepsia questions, exposure to 2 or more ACEs compared to none was associated with over a two-and-a-half-fold increase in the odds of self-reported dyspepsia (age-adjusted odds ratio = 2.56; 95% confidence interval: 1.24–5.25), with the strongest association with ACE measures of childhood abuse. ACEs were also associated with epigastric pain syndrome (<em>P</em> &lt; .001) and mixed syndrome (<em>P</em> = .0001), but not with postprandial distress syndrome (<em>P</em> = .095). No association was found between current adult stress and dyspepsia.</div></div><div><h3>Conclusion</h3><div>In patients undergoing endoscopy, exposure to multiple ACEs were associated with dyspepsia. These findings suggest that assessing ACEs in patients with dyspepsia could help provide additional insights into factors associated with dyspepsia symptoms beyond <em>Helicobacter pylori</em> infection and acid-related injury.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 7","pages":"Article 100680"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169621","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":"Pearls From the Pros: Management of Refractory Microscopic Colitis","authors":"June Tome,&nbsp;Darrell S. Pardi","doi":"10.1016/j.gastha.2025.100685","DOIUrl":"10.1016/j.gastha.2025.100685","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 8","pages":"Article 100685"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144205415","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-Onset Colorectal Cancer Survival by Race and Ethnicity in a Large Community-Based Insured Population","authors":"James H-E Kang ,&nbsp;Christopher D. Jensen ,&nbsp;Natalia Udaltsova ,&nbsp;Jessica M. Badalov ,&nbsp;Bruce H. Fireman ,&nbsp;Lori Sakoda ,&nbsp;Raymond Liu ,&nbsp;Ruoding Tan ,&nbsp;Norelle R. Reilly ,&nbsp;Jeffrey K. Lee","doi":"10.1016/j.gastha.2025.100693","DOIUrl":"10.1016/j.gastha.2025.100693","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Colorectal cancer (CRC) incidence in those under age 50 is increasing and minority populations are known to have worse CRC survival outcomes. Therefore, we evaluated 5-year CRC-specific survival by race and ethnicity among medically insured patients with early-onset CRC.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included Kaiser Permanente Northern California patients aged 18–49 years diagnosed with CRC between 2006 and 2019. Five-year CRC-specific survival by race and ethnicity was assessed using Kaplan-Meier survival analyses and unadjusted and adjusted Cox proportional hazards models.</div></div><div><h3>Results</h3><div>Among 1620 patients, 50.3% were White, 21.6% Hispanic, 20.1% Asian or Pacific Islander, and 8.0% Black. Stage IV disease was found in 23.4% of White, 28.7% of Black, 30.1% of Asian or Pacific Islander, and 31.1% of Hispanic patients. Five-year CRC-specific survival probability estimates ranged from 74.4% in Hispanic patients to 79.9% in White patients with no statistically significant differences in unadjusted risk estimates. However, after adjusting for age, sex, comorbidities, and socioeconomic status measures, risk of death was higher in Hispanic vs White patients (hazard ratio: 1.46; 95% confidence interval: 1.08–1.97) but was attenuated (hazard ratio: 1.13; 95% confidence interval: 0.83–1.53) after further adjustment for stage at diagnosis.</div></div><div><h3>Conclusion</h3><div>Among medically insured patients in a large integrated healthcare setting, Hispanic patients were more likely to be diagnosed with stage IV CRC and had the lowest 5-year CRC-specific survival probability compared to other race groups. Additional research is needed to identify factors contributing to the higher rate of late-stage disease diagnosis in Hispanic patients.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 8","pages":"Article 100693"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144229585","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 Human Oral Microbial Consortium Associated With Periodontitis Attenuates Weight Loss in Dextran Sulfate Sodium–Induced Colitis","authors":"Eri Ikeda ,&nbsp;Masaya Yamaguchi ,&nbsp;Shigetada Kawabata","doi":"10.1016/j.gastha.2025.100698","DOIUrl":"10.1016/j.gastha.2025.100698","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 8","pages":"Article 100698"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279306","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":"Internal Fistulas Discovered on Cross-Sectional Imaging Predict Future Intra-Abdominal Abscesses","authors":"Vikas J. Patel ,&nbsp;Maher Homsi ,&nbsp;Nicholas A. Orriols ,&nbsp;Naueen A. Chaudhry ,&nbsp;Joseph R. Grajo ,&nbsp;Abdullah Malkawi ,&nbsp;Patricia Moser ,&nbsp;Isaac L. Molina ,&nbsp;Robert Case ,&nbsp;Fares Ayoub ,&nbsp;Nicholas I. Kaufman ,&nbsp;Tiffany Lambrou ,&nbsp;Ellen M. Zimmermann","doi":"10.1016/j.gastha.2025.100684","DOIUrl":"10.1016/j.gastha.2025.100684","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Internal fistulas found on cross-sectional imaging (CSI) performed during routine care of patients with Crohn’s disease (CD) are often considered incidental findings. This study aimed to assess outcomes in patients with internal fistulas on CSI.</div></div><div><h3>Methods</h3><div>This is a single tertiary care center, retrospective case-control study of CD outcomes. Patients who had magnetic resonance enterography or computer tomography enterography performed between 2007 and 2017 were included. Electronic medical record data up to 2017 were included as variables in logistic regression analysis. CSI was scored by 3 abdominal radiologists blinded to the electronic medical record.</div></div><div><h3>Results</h3><div>Subjects included 199 CD patients: 63 patients (cases) had internal fistulas on index scan and 136 had no internal fistula. The cases and controls were well-matched for age, race, smoking status, body mass index, and years of disease. During follow-up, cases had a more complicated disease course with higher incidence of intra-abdominal abscess formation (19.1% vs 3.7%; <em>P</em> &lt; .001) and abdominal surgery (44.4% vs 24.3%; <em>P</em> &lt; .001). Patients with fistula were more likely to require surgery (odds ratio 4.96, <em>P</em> &lt; .001) and to develop intra-abdominal abscess (odds ratio 6.05, <em>P</em> &lt; .001). The index scan of cases was more likely to demonstrate inflammation (95.2% vs 39.7%; <em>P</em> &lt; .001) and stricture (27.0% vs 7.35%; <em>P</em> &lt; .001) than controls though the presence of an internal fistula was the only independent variable predictive of intra-abdominal abscess.</div></div><div><h3>Conclusion</h3><div>CD patients with internal fistulas identified by CSI have worse disease outcomes. Presence of internal fistula is the only independent risk factor for future intra-abdominal abscess regardless of the patient’s symptoms.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 8","pages":"Article 100684"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144306584","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}