American Journal of Gastroenterology最新文献

{"title":"Is Carbohydrate Intolerance associated with carbohydrate malabsorption in Disorders of Gut-Brain Interaction (DGBI)?","authors":"Hiba Mikhael-Moussa, Charlotte Desprez, André Gillibert, Anne-Marie Leroi, François Mion, Guillaume Gourcerol, Chloé Melchior","doi":"10.14309/ajg.0000000000003483","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003483","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to explore the prevalence of carbohydrate (lactose and fructose) intolerance in patients with disorders of gut-brain interaction (DGBI), and to characterize those patients in terms of gastrointestinal and non-gastrointestinal symptoms.</p><p><strong>Methods: </strong>DGBI patients who were referred to the Physiology Unit of our Hospital between May 2022 and December 2023 for lactose (25g) and fructose (25g) breath tests were prospectively included. Patients were required to have a negative glucose breath test, prior to lactose and fructose breath tests, and to have completed the adult carbohydrate perception questionnaire (aCPQ) during each breath test. Intolerance was defined as an increase of ≥20 mm in the visual analog scale (VAS) score from baseline in at least one of the 5 symptoms (pain, nausea, bloating, flatulence, diarrhea) assessed with the aCPQ.</p><p><strong>Results: </strong>Among the 301 DGBI patients included in our analysis, 178 (59.1%) had carbohydrate intolerance. Carbohydrate-intolerant patients were significantly more likely to be female (p-value < 0.001), to have 2 or more DGBI (p-value= 0.001), to have lactose maldigestion (p-value< 0.001) and fructose malabsorption (p-value= 0.023), higher IBS and somatic symptom severity, and lower quality of life (p-value < 0.001) compared to patients without carbohydrate intolerance. The binary logistic regression showed that lactose maldigestion (p-value= 0.001), as well as somatic symptoms (p-value= 0.025), were independently associated with carbohydrate intolerance (Nagelkerke R Square= 0.206).</p><p><strong>Discussion: </strong>Carbohydrate intolerance affects a substantial group of DGBI patients, impacting their quality of life and symptom severity. Further research is needed to explore the underlying mechanisms in patients who do not have carbohydrate malabsorption/maldigestion.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE SAN DIEGO CONSENSUS FOR LARYNGOPHARYNGEAL SYMPTOMS AND LARYNGOPHARYNGEAL REFLUX DISEASE.","authors":"Rena Yadlapati, Philip Weissbrod, Erin Walsh, Thomas L Carroll, Walter W Chan, Jackie Gartner-Schmidt, Livia Guadagnoli, Marie Jette, Jennifer C Myers, Ashli O'Rourke, Rami Sweis, Justin Wu, Julie M Barkmeier-Kraemer, Daniel Cates, Chien-Lin Chen, Enrique Coss-Adame, Gregory Dion, David Francis, Mami Kaneko, Jerome R Lechien, Stephanie Misono, Anais Rameau, Sabine Roman, Anne Vertigan, Yinglian Xiao, Frank Zerbib, Madeline Greytak, John E Pandolfino, C Prakash Gyawali","doi":"10.14309/ajg.0000000000003482","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003482","url":null,"abstract":"<p><strong>Background: </strong>The term 'laryngopharyngeal reflux' ('LPR') is frequently applied to aerodigestive symptoms despite lack of objective reflux evidence. This initiative aimed to develop a modern care paradigm for LPR supported by otolaryngology and gastroenterology disciplines.</p><p><strong>Methods: </strong>A 28-member international inter-disciplinary working group developed practical statements within the following domains: definition/terminology, initial diagnostic evaluation, reflux monitoring, therapeutic trials, behavioral factors and therapy, and risk stratification. Literature reviews guided statement development and were presented at virtual/in-person meetings. Each statement underwent 2 or more rounds of voting per the RAND Appropriateness Method; statements reaching appropriateness with ≥80% agreement are included as recommendations.</p><p><strong>Results: </strong>The term 'laryngopharyngeal symptoms' (LPS) applies to aerodigestive symptoms with potential to be induced by reflux and include cough, voice change, throat clearing, excess throat phlegm, and throat pain. 'Laryngopharyngeal reflux disease' (LPRD) refers to patients with LPS and objective evidence of reflux. Importantly, the presence of LPS does not equate to LPRD. Laryngoscopy has value in assessing for non-reflux laryngopharyngeal processes, but laryngoscopic findings alone cannot diagnose LPRD. LPS patients should be categorized as with or without concurrent esophageal reflux symptoms. While lifestyle modification and empiric trials of acid suppression ± alginates are appropriate when esophageal reflux symptoms coexist, upper endoscopy and ambulatory reflux monitoring are required for LPRD diagnosis when symptoms persist, when LPS is isolated, or when management needs to be escalated to include invasive anti-reflux management. The two recommended ambulatory reflux monitoring modalities, 24h pH-impedance and 96h wireless pH monitoring, are not mutually exclusive with distinct roles for the evaluation of LPS. Laryngeal hyperresponsiveness and hypervigilance commonly contribute to both LPS and LPRD presentations and are responsive to laryngeal recalibration therapy and neuromodulators.</p><p><strong>Conclusions: </strong>The San Diego Consensus represents the formal modern-day inter-disciplinary care paradigm to evaluate and manage LPS and LPRD.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CENTORING AND ANCHORING APPROACH TO ENDOSCOPICALLY MANAGE NON-HEALING PEG SITE FISTULA.","authors":"Mayank Goyal, Ashwariya Ohri, Preeyati Chopra, Khusbhoo Gala, Navtej S Buttar","doi":"10.14309/ajg.0000000000003481","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003481","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Utility of Multitarget Stool DNA Testing in Community-Based Clinical Practice.","authors":"Abhinav K Rao, Shivam Kalra, Danny Tran, Angeli Patel, Ibrahim Al-Saadi, Levi C Diggins, Don C Rockey, Brett Van Leer-Greenberg","doi":"10.14309/ajg.0000000000003480","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003480","url":null,"abstract":"<p><strong>Background: </strong>Multitarget stool DNA (MT-sDNA) tests (i.e., Cologuard®) serve as screening tests for colorectal cancer (CRC) and are recommended by the USPSTF every 1-3 years. Here, in a primary care setting, our aim was to evaluate the diagnostic performance of MT-sDNA testing and colonoscopy findings following a positive MT-sDNA testing result.</p><p><strong>Methods: </strong>This was retrospective cohort study of electronic health record (EHR) data including all patients who underwent MT-sDNA tests (Cologuard®, Exact Sciences, Madison, WI) at 35 network primary care facilities from Winter of 2019 to Spring of 2023. Patients who were high risk, had a prior colonoscopy or prior negative MT-sDNA test result were excluded. Assessment of pathology was as previously described, including for advanced adenomas and CRC.</p><p><strong>Results: </strong>Among the 5,827 patients for which MT-sDNA testing was ordered, 3,119 patients completed the test; 482 (15%) had a positive MT-sDNA test, the majority of whom were women, had an average age of 65, and were predominantly White (Supplemental Figure 1, Table 1). Among these 482 patients, 277 (57%) had a follow-up screening colonoscopy, with 253 patients having complete colonoscopy data. Ten patients (4%) had CRC, 61 (24%) had advanced adenomas, and 184 (73%) patients had neither. The sigmoid colon was the most common site for CRC, with 8 out of 10 patients having TNM stage ≥ 1 CRC.</p><p><strong>Conclusion: </strong>The rate of colon cancer detection (10/5,827 (0.2%) patients for whom it was ordered and 10/3,119 (0.3%) who completed the test) was lower than expected in a screening cohort. The majority of patients who completed MT-sDNA testing had a false positive result for advanced adenomas or CRC (73%). Together, these findings raise questions about the effectiveness of screening based on MT-sDNA testing in an average risk population.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid Development of Giant Esophageal Pseudo-Diverticulosis.","authors":"Nishali Shah, Matthew Pelton, Anish Vinit Patel","doi":"10.14309/ajg.0000000000003478","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003478","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Cannabis Use in Gastroparesis: A Propensity Matched Analysis 41,374 gastroparesis patients.","authors":"Yassine Kilani, Daniel Alejandro Gonzalez Mosquera, Priscila Castro Puelo, Mohammad Aldiabat, James K Ruffle, Madi Y Mahmoud, Adam D Farmer","doi":"10.14309/ajg.0000000000003479","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003479","url":null,"abstract":"<p><strong>Background: </strong>Cannabinoids are being explored as potential treatments for gastroparesis due to their anti-emetic, gastric motility modulation, appetite stimulation, and analgesic properties coupled with their increasing use due to legalization in many states. While these theoretical benefits are promising, clinical evidence remains limited. This study aimed to evaluate the effects of cannabis use on clinical outcomes and healthcare utilization in gastroparesis patients using large-scale real-world data.</p><p><strong>Methods: </strong>We conducted a cohort study using the TriNetX research network to identify U.S. adults (≥18 years) with gastroparesis. From an initial cohort of 119 million (2004-2024), patients were stratified into cannabis users and non-users (controls). Propensity score matching (1:1) accounted for demographics, body mass index, comorbidities, laboratory parameters, and treatments. Primary outcomes included emergency department (ED) visits, hospitalizations, and esophagogastroduodenoscopy (EGD) rates.</p><p><strong>Results: </strong>Among 41,374 gastroparesis patients, cannabis users (n=20,687) and non-users (n=20,687) were propensity-matched. Cannabis users were younger with higher rates of diabetes, mood/anxiety disorders, elevated hemoglobin A1c, and opioid use (p<0.001). Cannabis use was associated with increased ED visits (adjusted odds ratio (aOR) = 1.73, 95%CI: 1.66-1.80) and hospitalizations (aOR = 1.44, 95%CI: 1.39-1.50) but reduced EGD utilization (aOR = 0.93, 95%CI: 0.88-0.98).</p><p><strong>Conclusions: </strong>Cannabis use in gastroparesis patients appears to increase healthcare utilization. These findings underscore the need to carefully assess the risks and benefits of cannabis in gastroparesis management. Prospective studies are essential to evaluate cannabinoids' efficacy and safety in this context.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Ling et al.","authors":"Kai Gao, Zhaohui Zhang, Mingjuan Jin","doi":"10.14309/ajg.0000000000003396","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003396","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Polypectomy Practices Vary Widely Among US Endoscopists and Commonly Deviate from Guidelines: An Analysis of Colonoscopy Registry Data.","authors":"Seth D Crockett, Jennifer Holub, Audrey H Calderwood, Rajesh N Keswani","doi":"10.14309/ajg.0000000000003461","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003461","url":null,"abstract":"<p><strong>Background: </strong>Best practices for removal of <1 cm colon polyps exist, but adherence to this guidance is uncertain.</p><p><strong>Methods: </strong>Using GI Quality Improvement Consortium (GIQuIC) Registry data, colonoscopies with polyps <1cm were analyzed for polypectomy technique used, and differences in practices according to patient, procedure, and provider characteristics.</p><p><strong>Results: </strong>Among 1,830,067 colonoscopies, cold forceps, cold snare, and hot snare polypectomy were used in 35%, 58%, and 11% of cases respectively. Technique varied by polyp type, geographic region, and provider specialty. Gastroenterologists' practices aligned with guidelines more closely than non-GI endoscopists.</p><p><strong>Conclusion: </strong>Polypectomy technique varies widely among US endoscopists and may not follow best practices.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Risk Stratification Tool for Relapse After Intravenous-to-Subcutaneous Switching of Infliximab in Patients with Inflammatory Bowel Diseases.","authors":"Yannick Hoffert, Zhigang Wang, Mathurin Fumery, Maria Nachury, Maëva Bazoge, Anthony Buisson, Erwin Dreesen","doi":"10.14309/ajg.0000000000003466","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003466","url":null,"abstract":"<p><strong>Objectives: </strong>A subcutaneous formulation of infliximab was recently approved for maintenance therapy of inflammatory bowel disease (IBD). However, limited clinical experience, particularly with patients on escalated intravenous infliximab regimens, poses challenges for the transition to subcutaneous therapy. We investigated the pharmacokinetics and pharmacodynamics of subcutaneous infliximab to identify early predictors of relapse upon switching.</p><p><strong>Methods: </strong>We repurposed data from a prospective, multicenter trial involving patients with IBD switching from intravenous to subcutaneous infliximab. We estimated each patient's infliximab clearance using Bayesian forecasting from a pre-switch sample and a population pharmacokinetics model. We performed pharmacodynamics modeling to evaluate pre-switch predictors of post-switch relapse. Relapse was defined as clinical recurrence (partial Mayo score >2 or Harvey-Bradshaw Index >4 leading to therapeutic escalation) or an increase in fecal calprotectin ≥150 μg/g upon switching.</p><p><strong>Results: </strong>Using data from 98 patients with IBD, we identified infliximab clearance and fecal calprotectin as independent predictors of relapse. A two-item risk score stratified patients into low-risk (<19% probability of relapse; 75/98; 77%) and high-risk (≥19% probability of relapse; 23/98; 23%) groups (sensitivity 0.52 [95%CI 0.31-0.73], specificity 0.95 [95%CI 0.87-0.99], positive predictive value 75% [95%CI 48-93%], negative predictive value 87% [95%CI 77-93%]). Our pharmacokinetics-pharmacodynamics model classified patients with and without relapse (p <0.0001) with an area under the receiver operating characteristic curve of 0.83 (95%CI 0.71-0.93).</p><p><strong>Conclusions: </strong>Pre-switch infliximab clearance and fecal calprotectin are accurate predictors of relapse after switching to subcutaneous infliximab. An interactive risk stratification tool facilitates confirmation of a stratified medicine approach to improve infliximab therapy in IBD.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of Clostridioides difficile: The Times They are a Changing.","authors":"Paul Feuerstadt, Jessica Allegretti, Sahil Khanna","doi":"10.14309/ajg.0000000000003445","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003445","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}