American Journal of Gastroenterology最新文献

{"title":"Integrating Non-Invasive Liver Assessment into Screening Colonoscopy: A Prospective Cross-Sectional Study.","authors":"Marwan Qasem, Ondřej Bednář, Vojtěch Procházka, Dominik Hegyi, Karel Dvořák","doi":"10.14309/ajg.0000000000004236","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004236","url":null,"abstract":"<p><strong>Introduction: </strong>Steatotic liver disease is underdiagnosed despite guideline recommendations for risk-based case-finding. Colorectal cancer (CRC) screening colonoscopy engages a prevention-oriented, healthcare-seeking population in whom liver disease may go undetected. We assessed the feasibility, acceptance, and yield of non-invasive liver assessment integrated into screening colonoscopy visits.</p><p><strong>Methods: </strong>This prospective cross-sectional study enrolled adults aged ≥50 years attending screening colonoscopy. Individuals with known chronic liver disease were excluded. Participants underwent hepatic ultrasound and point shear wave elastography. Liver stiffness measurements (LSM) were interpreted using prespecified thresholds of 1.30, 1.50, and 1.70 m/s (∼5, 7, and 9 kPa, respectively). We assessed whether risk-factor-based criteria would have identified participants with elevated stiffness, and evaluated the Fibrosis-4 index (FIB-4) against LSM thresholds.</p><p><strong>Results: </strong>Of 692 adults offered participation, 610 enrolled (88.2% acceptance); one was excluded for decompensated heart failure. Reliable LSM was obtained in 578 of 609 (94.9%). Ultrasound-defined steatosis was identified in 55.5%. LSM exceeded 1.30 m/s in 25.3%; 9.0% and 5.0% met thresholds consistent with significant fibrosis (≥1.50 m/s) and compensated advanced chronic liver disease (≥1.70 m/s), respectively. Among participants with LSM ≥1.50 m/s, exposure profiles were metabolic in 63.5%, mixed metabolic-alcohol in 21.2%, and alcohol-related in 15.4%. Risk-factor criteria were met by 76.6% and captured 46/52 participants with LSM ≥1.50 m/s. At this threshold, FIB-4 showed modest discrimination (AUROC 0.682); sensitivity decreased from 0.706 using a single threshold to 0.529 using age-adjusted thresholds.</p><p><strong>Discussion: </strong>Opportunistic liver assessment integrated into screening colonoscopy was feasible, well accepted, and identified previously undetected steatosis and elevated LSM.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149222994","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":"Implementation of Programmatic Mailed Fecal Immunochemical Testing for Colorectal Cancer Screening in the Veterans Health Administration.","authors":"Jason A Dominitz, Douglas J Robertson, Anita Patil, Yiwen Yao, Roycelyn Mitchell, Sara L Bonkowski, Andrew J Gawron, Jacquelyn Granquist, Lori Hoffman-Hogg, Tonya Kaltenbach, Jane Kim, Grace McKee, Linda Ritchison, Chris Moore","doi":"10.14309/ajg.0000000000004235","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004235","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic prompted the Veterans Health Administration (VA) to implement programmatic mailed fecal immunochemical test (FIT) screening for colorectal cancer. This paper describes VA's programmatic mailed FIT development, implementation and initial outcomes.</p><p><strong>Methods: </strong>VA adapted mailed FIT processes from a Centers for Disease Control and Prevention-sponsored Mailed FIT Implementation Guide, performed regional pilots, created a national Mailed FIT Implementation Team (MFIT), and issued formal policy. The MFIT then provided training and disseminated tools to support VA mailed FIT programs.</p><p><strong>Results: </strong>Programmatic mailed FIT has been implemented in 89.5% of eligible facilities. Between December 1, 2022 and September 30, 2025, 643,933 FIT were ordered and 40.2% were returned. Of those, 89.1% were testable and 10.9% were cancelled, primarily due to missing sample collection date (63.2%) or receipt >15 days after collection (31.5%). Of the 230,427 FIT results, 7.4% were abnormal and colonoscopy was completed in 54.4%. Among 5846 VA colonoscopies, adenomas were detected in 68.0%, and adenocarcinoma was found in 2.3%. Linear regression analysis demonstrated a direct correlation between increasing mailed FIT adoption and the proportion of Veterans who are up to date with screening (r=0.65, p=0.003).</p><p><strong>Conclusions: </strong>VA has successfully developed and disseminated strong practices for population-level CRC screening outreach with programmatic mailed FIT. This practice is associated with moderate levels of adherence and significant improvements in the overall proportion of Veterans who are up to date with screening. Further dissemination of mailed FIT programs, process improvement, and sharing of best practices is ongoing.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223021","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":"Pharmacobezoar: An Unexpected Cause of Dysphagia in a Patient With Treated Achalasia.","authors":"Roma N Ahuja, Anh D Nguyen","doi":"10.14309/ajg.0000000000004234","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004234","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190608","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 Pichon et al.","authors":"William D Chey, Steven Moss, Douglas Morgan, Shailja Shah","doi":"10.14309/ajg.0000000000004195","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004195","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179153","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 Bai et al.","authors":"Catherine Y Wang, Logan McLennan, Ritam H Patel, Swati Yarlagadda, Maxwell E Shramuk, Joy J Liu, Darren M Brenner","doi":"10.14309/ajg.0000000000004198","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004198","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179175","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":"Modern Approach to Reflux Testing: When, Which, and How?","authors":"Walter W Chan, Matthew K Schroeder, Muhammad Hashim Hayat, C Prakash Gyawali","doi":"10.14309/ajg.0000000000004232","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004232","url":null,"abstract":"<p><p>Modern reflux monitoring technology provides for both prolonged wireless and 24-hour catheter-based testing options. Wireless pH monitoring offers the advantages of patient comfort and prolonged assessment for up to 96 hours to account for day-to-day variation of GERD, but only distal acid reflux is measured. pH-impedance monitoring detects all reflux episodes regardless of acidity, characterizes refluxate content, identifies proximal extent, and measures baseline mucosal impedance which reflects mucosal integrity as well as longitudinal reflux-related injury, but the indwelling catheter causes patient discomfort and limits monitoring to 24 hours. Metrics from reflux monitoring and findings from endoscopy, together with adjunctive tests such as high-resolution manometry, can provide conclusive and/or supportive evidence for or against pathologic reflux, utilizing the Lyon Consensus 2.0 framework. Selection of optimal testing strategy should depend on presenting symptom phenotypes, clinical indications and scenarios, local testing options, and patient tolerance. Testing should be performed off acid suppressive therapy for patients with unproven GERD, while those with proven GERD and persistent symptoms despite optimized anti-reflux therapy should undergo pH-impedance monitoring on acid suppression. If endoscopy is indicated, wireless monitoring can be performed at the same setting, especially for typical perceptive (heartburn, chest pain) symptoms. pH-impedance monitoring is preferred for primary regurgitation and belching, while both modalities are options for atypical symptoms. Reflux monitoring may be indicated for assessing symptoms after foregut interventions, although no consensus on post-operative thresholds or optimal testing methodology has been established. Reflux monitoring is a valuable tool for evaluating and directing management of esophageal symptoms.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179215","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":"Duodenal involvement in MUTYH-associated polyposis: findings from an international study and implications for endoscopic surveillance.","authors":"Becky Truscott, Imogen Bennett, Arron S Lacey, Arthur S Aelvoet, Angel Alonso Sanchez, M Rosario Aznárez, Ann-Sofie Backman, Jan Bjork, Gabriel Capella, Susan K Clark, Chrystelle Colas, Antoine Dardenne, Evelien Dekker, Sunil Dolwani, Christine Drogan, Núria Dueñas, Zeinab Ghorbanoghli, Sara Gonzalez Romero, Karl Heinimann, Robert Hüneburg, Caroline Ledertoug Kahn, Bryson W Katona, Kalaikshiga Kengadaran, Erika Koeppe, Sonia S Kupfer, Lars Joachim Lindberg, Derek Mann, Claudia Monaco, Maureen E Mork, Matilde Navarro Garcia, Maartje Nielsen, Yann Parc, Maria T Ricci, Jean-Christophe Saurin, Anthony J Scott, Elena Stoffel, Karin Van de Tuin, Monique E van Leerdam, Hans Vasen, Maribel Verdesoto Rodriguez, Eduardo Vilar, Olivier Vinet, Marco Vitellaro, Hannah D West, Joanna J Hurley, Andrew R Latchford, Julian R Sampson, Laura E Thomas","doi":"10.14309/ajg.0000000000004220","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004220","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to better document incidence and progression of duodenal disease in MUTYH-associated polyposis (MAP).</p><p><strong>Methods: </strong>Incidences of duodenal cancer, and duodenal polyposis by age and genotype were assessed in individuals with genetically confirmed MAP.</p><p><strong>Results: </strong>At first endoscopy, 91/679 participants (13.4%) had duodenal adenoma(s) at a median age of 53 years (range 22 to 81 years). 439/679 participants had 1370 further endoscopies, over a median period of 6.3 years (range 1 month to 30 years). This included 365 without adenomas at first endoscopy, of whom 83 (22.7%) developed non-ampullary adenomas during follow-up at a median age of 53 years (range 29-76). Thirty-eight adenomas (5.5%) contained high-grade dysplasia (HGD), of which thirty-five had a known size and 20 (57.1%) of these were 10mm or smaller. Ampullary lesions were uncommon (31/679, 4.6%). Duodenal cancer was diagnosed in 5/679 participants (0.74%) at a median age of 65 years (range 47-83 years) and at a median of 12 months (range 9-24 months) following a surveillance endoscopy. At least four were located distally (in the third or fourth part). The cumulative incidences of duodenal adenomas and cancer at 70 years were 16.5-63.5%, depending on genotype, and 0.58%, respectively. Adenoma incidence was significantly higher in Y179C (hazard ratio 5.33 (2.94-9.67, <0.001) and E480X (4.07 (2.16-7.67), <0.001) than G396D homozygotes.</p><p><strong>Conclusions: </strong>Future clinical guidelines for MAP should consider genotype-specific recommendations for duodenal surveillance, the importance of assessing the distal duodenum (i.e. D3, D4) and polypectomy of all detectable adenomas.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179166","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":"Letter to the Editor.","authors":"Cynthia W Buness, Steve Wadsworth, Kevin M Johnson, Martine Brown, Mark Chatterley, Fionna Kopp, Christine Browner, Jane Weyer, Lorrie Williams","doi":"10.14309/ajg.0000000000004202","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004202","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163632","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":"Letter to the Editor.","authors":"Palak J Trivedi, Victoria Homer, Johannes R Hov, Michael Trauner, M Nabil Quraishi, Benjamin H Mullish, Gideon M Hirschfield, Laura Cristoferi, Marco Carbone","doi":"10.14309/ajg.0000000000004201","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004201","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163422","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":"Oral Vancomycin Therapy for Primary Sclerosing Cholangitis: Beacon of Hope or a Dead End?","authors":"Mark Deneau","doi":"10.14309/ajg.0000000000004194","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004194","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163884","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}