Gastro hep advances最新文献

{"title":"Insurance Denial of Biologic Therapy is Associated With Reduced Remission Rates in Inflammatory Bowel Disease Patients","authors":"Erin Zisman ,&nbsp;Madeline Alizadeh ,&nbsp;Leah Rossmann ,&nbsp;Jennifer Grossman ,&nbsp;Cydney Nguyen ,&nbsp;Pinkle Paul ,&nbsp;Uni Wong","doi":"10.1016/j.gastha.2025.100647","DOIUrl":"10.1016/j.gastha.2025.100647","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Biologic therapy is indicated for patients with moderate to severe inflammatory bowel disease (IBD) and delays in access to these medications have been associated with higher health-care utilization. We examined whether patients who experienced insurance denials of biologics had worse outcomes, as indicated by disease activity and the number of emergency department (ED) visits and hospitalizations had following medication denial.</div></div><div><h3>Methods</h3><div>Our single-center retrospective cohort study included 169 patients with IBD who were seen at a tertiary care center (University of Maryland Medical Center) and had an insurance denial for biologic therapy between March 2021 and October 2021. Data were collected through chart review.</div></div><div><h3>Results</h3><div>At 6 months following denial, 58.0% of patients were in remission, 37.9% had active disease, and 4.1% had unknown status. Those who did not receive medication approval were significantly more likely to have active disease (Odds ratio = 0.16, 95% confidence interval = [0.04‒0.69] <em>P</em> = .042). Compared to patients in remission after delay in therapy initiation, those with active disease were likelier to receive steroids in the year following denial (38.5%, <em>P</em> &lt; .001), trended toward higher likelihood of ED visits (<em>P</em> = .062), and had higher likelihood of hospitalization in that time (27.7% vs 8.2%, <em>P</em> = .002), with a higher number of average ED visits (<em>P</em> = .019) and hospitalizations (<em>P</em> = .003). Patients with active disease post denial had a nearly 80% increase in days between denial and final approval (<em>P</em> = .031).</div></div><div><h3>Conclusion</h3><div>Our study demonstrates an association between insurance denial of biologic therapy and lack of clinical remission with associated increased health-care utilization in IBD patients.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 6","pages":"Article 100647"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923040","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":"Economic Burden of Patients With Chronic Idiopathic Constipation in the USA Before and After Prucalopride Initiation","authors":"Paul Feuerstadt ,&nbsp;Mei Lu ,&nbsp;Emi Terasawa ,&nbsp;Brian Terreri ,&nbsp;Shawn Du ,&nbsp;Selina Pi ,&nbsp;Ben Westermeyer ,&nbsp;Rajeev Ayyagari ,&nbsp;Anthony Lembo ,&nbsp;Baharak Moshiree ,&nbsp;Mena Boules ,&nbsp;Brooks D. Cash","doi":"10.1016/j.gastha.2025.100664","DOIUrl":"10.1016/j.gastha.2025.100664","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Chronic idiopathic constipation (CIC) is associated with substantial health care resource utilization (HCRU) and economic burden; however, real-world evidence on the impact of treatment initiation on HCRU and health care costs are limited. We evaluated HCRU and direct health care costs associated with prucalopride initiation in patients with CIC in the United States.</div></div><div><h3>Methods</h3><div>Data were collected between January 1, 2015, and June 30, 2020, from the IBM MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases for 690 adults with ≥ 1 prescription fill for prucalopride and ≥ 1 constipation-related diagnosis code. All-cause and constipation-related HCRU (outpatient, emergency room, and inpatient visits) for all patients, and pharmacy and medical health care costs for those aged 18–64 years were assessed 6 months before (baseline) and after (study period) prucalopride initiation. Subpopulations examined were patients with prior CIC medication use and males with CIC.</div></div><div><h3>Results</h3><div>Compared with baseline, the mean number of any constipation-related outpatient visits (2.26 vs 1.52; <em>P</em> &lt; .001) and the proportions of patients with these visits (82.6% vs 58.8%; <em>P</em> &lt; .001) significantly decreased after prucalopride initiation. In 564 patients, total constipation-related health care costs significantly increased from baseline during the study period (mean: $1497 vs $2332; <em>P</em> &lt; .001), primarily driven by increased pharmacy costs after prucalopride initiation ($621 vs $1751; <em>P</em> &lt; .001). Constipation-related medical costs significantly decreased during the study period ($876 vs $580; <em>P</em> &lt; .001). Some constipation-related HCRU and health care costs decreased after prucalopride initiation in patients with prior CIC medication use and males.</div></div><div><h3>Conclusion</h3><div>In adults with CIC, constipation-related HCRU and medical costs decreased, while constipation-related health care costs and pharmacy costs increased 6 months after prucalopride initiation.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 7","pages":"Article 100664"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083936","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 Case of Type 2 Autoimmune Pancreatitis Suggesting Two Potential Disease Activity Markers","authors":"Kazuki Natsui ,&nbsp;Seiichi Yoshikawa ,&nbsp;Ayano Kagata ,&nbsp;Yusuke Horibata ,&nbsp;Hiroyuki Usuda ,&nbsp;Manabu Takeuchi ,&nbsp;Shuji Terai","doi":"10.1016/j.gastha.2025.100635","DOIUrl":"10.1016/j.gastha.2025.100635","url":null,"abstract":"<div><div>Autoimmune pancreatitis (AIP) is divided into 2 main subtypes: type 1 AIP (AIP-1) and type 2 AIP (AIP-2). This report describes a young woman diagnosed with AIP-2 using endoscopic ultrasound–guided tissue acquisition. AIP-2 has been reported less frequently than AIP-1 as serologic abnormalities and other organ involvement except for inflammatory bowel disease are absent. Additional laboratory analyses suggest that serum interleukin-8 and leucine-rich alpha-2 glycoprotein are more efficient disease activity biomarkers than conventional C-reactive proteins. We hope that this case report will contribute to the discovery of diagnostic biomarkers for AIP-2.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 6","pages":"Article 100635"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143917642","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":"Prediction of Advanced Fibrosis in Metabolic Dysfunction-Associated Steatotic Liver Disease by Type IV Collagen 7S","authors":"Hiroshi Ishiba ,&nbsp;Yoshio Sumida ,&nbsp;Yoshihiro Kamada ,&nbsp;Hideki Fujii ,&nbsp;Michihiro Iwaki ,&nbsp;Hideki Hayashi ,&nbsp;Hidenori Toyoda ,&nbsp;Satoshi Oeda ,&nbsp;Hideyuki Hyogo ,&nbsp;Miwa Kawanaka ,&nbsp;Asahiro Morishita ,&nbsp;Kensuke Munekage ,&nbsp;Kazuhito Kawata ,&nbsp;Tsubasa Tsutsumi ,&nbsp;Koji Sawada ,&nbsp;Tatsuji Maeshiro ,&nbsp;Hiroshi Tobita ,&nbsp;Yuichi Yoshida ,&nbsp;Masafumi Naito ,&nbsp;Asuka Araki ,&nbsp;Takeshi Okanoue","doi":"10.1016/j.gastha.2025.100668","DOIUrl":"10.1016/j.gastha.2025.100668","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Type IV collagen 7S (COL4-7S) is a simple, noninvasive biomarker for liver fibrosis. However, whether COL4-7S can detect advanced fibrosis (AF) and predict the prognosis of metabolic dysfunction–associated steatotic liver disease (MASLD) is unclear. We examined the clinical efficacy of COL4-7S in diagnosing AF and determining MASLD prognosis.</div></div><div><h3>Methods</h3><div>Overall, 881 Japanese patients with biopsy-proven nonalcoholic fatty liver disease between 1994 and 2020 were enrolled. Serum COL4-7S levels were measured by radioimmunoassay, and 2 cutoff points were set as 5.1 ng/mL and 7.2 ng/mL. The patients were assigned to 3 groups based on the COL4-7S level. Cox regression analysis was used to estimate the predictive performance of COL4-7S for liver-related events (LREs).</div></div><div><h3>Results</h3><div>Overall, 866 MASLD patients were enrolled. The median follow-up period was 4.3 years. Thirty-one patients developed LREs. The area under the curve for COL4-7S in patients with AF was 0.847. The adjusted hazard ratios for LREs in 4.8 ≤ COL4-7S &lt; 6.8 and COL4-7S ≥6.8 patients were 6.0 (<em>P</em> = .009) and 27.9 (<em>P</em> &lt; .001) compared with COL4-7S &lt;4.8, and the adjusted hazard ratio of AF on liver biopsy was 1.6 (<em>P</em> = .286). The incidence rate of LREs was low when the Fibrosis-4 Index (FIB-4) &lt;1.30. When the FIB-4 &gt;1.30, effective stratification of the LRE risk group was possible by stratification of COL4-7S. A combination of FIB-4 and COL4-7S stratified risk groups for future LRE development more effectively than when used singly.</div></div><div><h3>Conclusion</h3><div>COL4-7S accurately diagnosed AF and predicted LREs. COL4-7S and a combination of FIB-4 and COL4-7S might help physicians estimate the prognosis of future LRE risk.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 7","pages":"Article 100668"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144098487","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":"Longitudinal Changes in the Gut Microbiome of Patients With Irritable Bowel Syndrome After Campylobacter Infection are Associated With Proteolytic Activity","authors":"Amanda Blankenberger ,&nbsp;Elvira Lesmana ,&nbsp;Lu Yang ,&nbsp;Isin Y. Comba ,&nbsp;Adam Edwinson ,&nbsp;Margaret Breen-Lyles ,&nbsp;Ashley Keehn ,&nbsp;Robin Patel ,&nbsp;Jun Chen ,&nbsp;Ruben A. Mars ,&nbsp;Purna Kashyap ,&nbsp;Gianrico Farrugia ,&nbsp;Madhusudan Grover","doi":"10.1016/j.gastha.2025.100683","DOIUrl":"10.1016/j.gastha.2025.100683","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 8","pages":"Article 100683"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168867","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":"Risk Prediction in Patients With Metabolic Dysfunction–Associated Steatohepatitis Using Natural Language Processing","authors":"Jordan Guillot ,&nbsp;Christopher Y.K. Williams ,&nbsp;Shadera Azzam ,&nbsp;Balu Bhasuran ,&nbsp;Gail Fernandes ,&nbsp;Boshu Ru ,&nbsp;Joe Yang ,&nbsp;Xiao Zhang ,&nbsp;R. Ravi Shankar ,&nbsp;Jin Ge ,&nbsp;Vivek A. Rudrapatna","doi":"10.1016/j.gastha.2025.100701","DOIUrl":"10.1016/j.gastha.2025.100701","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Metabolic dysfunction–associated steatohepatitis (MASH) is a highly heterogenous condition and a leading cause of end-stage liver disease. Understanding disease progression in real-world settings remains a major unmet need. We sought to define a real-world MASH cohort using natural language processing (NLP) and identify significant associations with all-cause mortality and progression to cirrhosis and liver transplantation.</div></div><div><h3>Methods</h3><div>We developed, validated, and applied a novel NLP algorithm, “NASHDetection,” to identify patients at the University of California San Francisco who were diagnosed with MASH between 2012 and 2022. We used Cox regression with bidirectional stepwise variable selection to identify significant associations with outcomes.</div></div><div><h3>Results</h3><div>NASHDetection was 86% accurate at identifying 2695 MASH patients. At the time of their diagnosis, the median age was 57 years; 55.4% had cirrhosis at baseline, with 34.0% having evidence of decompensation and 10.8% with hepatocellular carcinoma. The most common comorbidities were hypertension (61.9%), hyperlipidemia (47.4%), and type 2 diabetes mellitus (41.5%). Multiple comorbidities were associated with all-cause mortality, including type 2 diabetes mellitus (hazard ratio (HR): 1.36; confidence interval (CI): 1.07–1.73), heart failure (HR: 1.45; CI: 1.01–2.08), and peripheral artery disease (HR: 1.72; CI: 1.04–2.85). Significant laboratory-based predictors of mortality included high–low-density lipoprotein cholesterol (HR: 1.49; CI: 1.20–1.84) and high alkaline phosphatase (HR: 1.94; CI: 1.58–2.38).</div></div><div><h3>Conclusion</h3><div>We described a cohort of real-world MASH patients using a new NLP algorithm and found several potential predictors of progression to all-cause mortality, cirrhosis, and liver transplantation. The use of NLP to characterize these patients can help support the development of future interventional trials in MASH.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 9","pages":"Article 100701"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144535629","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":"Pancreatic Leiomyosarcoma","authors":"Maria R. Karam ,&nbsp;Viviane Smayra ,&nbsp;Rita Slim","doi":"10.1016/j.gastha.2025.100700","DOIUrl":"10.1016/j.gastha.2025.100700","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 8","pages":"Article 100700"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144288767","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":"Listen to Patient’s Gut: A Case Report of a Woman With Fatigue and Bruising","authors":"Maria Mironova ,&nbsp;Nadera Altork ,&nbsp;Harish Gopalakrishna ,&nbsp;David E. Kleiner ,&nbsp;Theo Heller","doi":"10.1016/j.gastha.2025.100714","DOIUrl":"10.1016/j.gastha.2025.100714","url":null,"abstract":"<div><div>A 65-year-old female patient with dermatomyositis and lipodystrophy presented with fatigue and severe anemia. Abdominal auscultation revealed a loud hum in the epigastrium, consistent with a Cruveilhier-Baumgarten murmur, typically associated with portal hypertension. Magnetic resonance imaging showed signs of portal hypertension, including recanalization of paraumbilical vein. Liver biopsy demonstrated sinusoidal dilation without cirrhosis, leading to a diagnosis of portosinusoidal vascular disease. Upper endoscopy confirmed portal hypertensive gastropathy as the cause of anemia. This case highlights the importance of a thorough physical examination in guiding subsequent imaging and diagnostic workup.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 9","pages":"Article 100714"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722139","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":"Ruminococcus gnavus and Biofilm Markers in Feces From Primary Bile Acid Diarrhea Patients Indicate New Disease Mechanisms and Potential for Diagnostic Testing","authors":"Evette B.M. Hillman ,&nbsp;Danielle Carson ,&nbsp;Julian R.F. Walters ,&nbsp;Martin Fritzsche ,&nbsp;Ryan Mate ,&nbsp;Katie E. Chappell ,&nbsp;Elena Chekmeneva ,&nbsp;Maria Gomez Romero ,&nbsp;Stephen J. Lewis ,&nbsp;Sjoerd Rijpkema ,&nbsp;Elizabeth M.H. Wellington ,&nbsp;Ramesh Arasaradnam ,&nbsp;Gregory C.A. Amos","doi":"10.1016/j.gastha.2025.100712","DOIUrl":"10.1016/j.gastha.2025.100712","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Bile acid diarrhea (BAD) is a common cause of frequent loose stools, urgency, and incontinence, which is under-recognized due to limited diagnostic test availability and unclear pathogenesis. This study aimed to investigate fecal changes in well-defined subjects.</div></div><div><h3>Methods</h3><div>Fecal samples were compared in BAD patients (n = 26), diagnosed by SeHCAT testing, and healthy controls (n = 21). Shotgun metagenomic sequencing was used to identify microbiome species and functional genes. An extended set of 38 bile acids was quantified by liquid chromatography mass spectrometry, including various epimers and intermediates, such as iso- (3-beta-OH), oxo (keto), allo (5-alpha), and 3-sulfated forms.</div></div><div><h3>Results</h3><div>Alpha diversity, reflecting microbial richness, was reduced in BAD patients with severe forms of the disease, while beta diversity demonstrated distinct microbial profiles between groups. <em>Ruminococcus gnavus</em> (<em>R. gnavus</em>) was prevalent in BAD patients but rare in controls (odds ratio = 73), while <em>Firmicutes bacterium</em> CAG110, <em>Eubacterium siraeum</em> and 2 <em>Oscillibacter</em> species were less common in BAD (odds ratios = 25–30). Overall, 99 taxa differed significantly between groups. Bile acidtransforming genes (<em>baiA</em>, <em>baiB</em>, <em>hdhA</em>) were more abundant in BAD samples (<em>P</em> ≤ .0012). Most fecal bile acids, including iso-bile acids and intermediates, were higher in BAD. Elevated ursodeoxycholic acid-3-sulfate and relatively lower lithocholic acid and allo-bile acids, including isoallolithocholic acid, reflect changes in bacterial metabolism. Biofilm-associated genes (<em>bssS</em>, <em>pgaA</em>, <em>pgaB</em>) were markedly elevated in BAD patients (<em>P</em> ≤ .00008). SeHCAT values negatively correlated with <em>R. gnavus</em> (rho −0.53, <em>P</em> = .008) and positively with <em>E</em><em>ubacterium siraeum</em> (rho 0.41, <em>P</em> = .041).</div></div><div><h3>Conclusion</h3><div>BAD may result from an overgrowth of <em>R. gnavus</em>, associated with intestinal biofilms and an altered bile acid metabolism.</div></div>","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 9","pages":"Article 100712"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144890032","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 Potential Impact of the Kennedy v. Braidwood Supreme Court Decision on Hepatitis C Diagnosis and Treatment in the United States","authors":"Jordan Anders-Rumsey ,&nbsp;Elliot Tapper ,&nbsp;Anna Lok ,&nbsp;A. Mark Fendrick","doi":"10.1016/j.gastha.2025.100722","DOIUrl":"10.1016/j.gastha.2025.100722","url":null,"abstract":"","PeriodicalId":73130,"journal":{"name":"Gastro hep advances","volume":"4 9","pages":"Article 100722"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144907425","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}