American Journal of Gastroenterology最新文献

{"title":"More Is Not Always Better: Challenging the Dogma of Secondary Prophylaxis for Spontaneous Bacterial Peritonitis.","authors":"Sasha Deutsch-Link, Elizabeth C Arant, Marina Serper","doi":"10.14309/ajg.0000000000003250","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003250","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852006","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":"Efficacy and safety of transcutaneous auricular vagus nerve stimulation in patients with constipation-predominant irritable bowel syndrome: a single-center, single-blind, randomized controlled trial.","authors":"Jie Liu, Chaolan Lv, Mengqing Yin, Mengtao Zhu, Bo Wang, Jiashuang Tian, Kenji Hashimoto, Yue Yu","doi":"10.14309/ajg.0000000000003257","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003257","url":null,"abstract":"<p><strong>Introduction: </strong>Transcutaneous auricular vagus nerve stimulation (taVNS) is a promising therapy for irritable bowel syndrome (IBS). This clinical trial aims to evaluate the influence of taVNS on autonomic functions, rectal sensation, and acetylcholine (Ach) levels and to explore potential mechanisms involving gut microbiota and metabolic profiles.</p><p><strong>Methods: </strong>This study was a single-center, single-blind, randomized controlled trial executed at the First Affiliated Hospital of USTC, Anhui, China. Individual patients' IBS-C-related symptoms and mental health were assessed and scored using questionnaires at baseline and at week 4. Levels of Serum Ach and nitric oxide (NO), anorectal manometry, and heart rate variability (HRV) were assessed both prior to and following the therapy. Fecal samples from each group were assessed to compare the gut microbiota, short-chain fatty acids, and gut microbiota-derived tryptophan metabolites.</p><p><strong>Results: </strong>Between September 2023 and May 2024, 40 participants (n=20 in both taVNS and sham-taVNS group) completed the four-week study by performing an intention-to-treat (ITT) analysis. No differences in all parameters between taVNS and sham-taVNS groups at the baseline was found. The taVNS significantly improved the VAS score (P < 0.001), IBS Severity Scoring System (IBS-SSS) (P < 0.001), weekly frequency of spontaneous bowel movements (SBMs) (P < 0.001), weekly frequency of complete SBMs (CSBMs) (P = 0.004), Bristol Stool Form Scale (BSFS) (P < 0.001), Hamilton Anxiety Scale (HAMA) (P < 0.001), Hamilton Depression Scale (HAMD) (P < 0.001), and IBS-QOL scores (P < 0.001). Furthermore, taVNS improved rectal sensation in IBS-C patients, including improvements in the threshold volume for initial sensation (P = 0.033), the urge to defecate (P = 0.022), and rectoanal inhibitory reflex (P = 0.002). Moreover, taVNS elevated serum levels of Ach (P = 0.005) and reduced NO (P = 0.016) while also enhancing vagal activity (P < 0.001) as determined by spectral analysis of HRV. Three individuals in the taVNS group and two in the control group had adverse consequences, which were manageable. Additionally, taVNS led to a significant rise in the level of the genus Bifidobacterium (P = 0.038), increased levels of acetic (P = 0.003), butyric (P = 0.011), and propionic acids (P = 0.005). It also decreased tryptophan metabolism content, including 3-hydroxyanthranilic acid (P = 0.007), anthranilic acid (P = 0.026) and L-tryptophan (P = 0.002).</p><p><strong>Discussion: </strong>The study manifested that non-invasive taVNS effectively improved constipation and abdominal pain symptoms in IBS-C patients. The alleviation of IBS-C symptoms may be attributed to the integrative effects of taVNS on rectal functions, mediated through vagal, cholinergic, and multi-omics mechanisms.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845611","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":"Proximal polyps are associated with higher incidence of colorectal cancer: Analysis of the Minnesota Colon Cancer Control Study.","authors":"Paolo Goffredo, Alexander Troester, Jack M Wolf, Kyle Rudser, Timothy R Church, Aasma Shaukat","doi":"10.14309/ajg.0000000000003256","DOIUrl":"10.14309/ajg.0000000000003256","url":null,"abstract":"<p><strong>Background: </strong>Despite reports indicating that polyps proximal to the splenic flexure have higher rates of metachronous colorectal adenocarcinoma (CRC), the role of adenoma location on surveillance recommendations remains unclear. This study aimed to analyze the association between index polyp location and post-colonoscopy CRC among participants of the Minnesota Colon Cancer Control Study (MCCCS).</p><p><strong>Methods: </strong>The MCCCS randomized 46,551 patients 50-80 years to usual care, annual, or biennial screening with fecal occult-blood testing (FOBT). Screening was performed between 1976-1992. Positive FOBT was followed by colonoscopy. We analyzed participants whose colonoscopy revealed at least one adenoma. Patients were divided into those with at least one lesion proximal to the splenic flexure and those without.</p><p><strong>Results: </strong>Of 2,295 patients, 815 had proximal adenomas. The majority were men; mean age =62 years at randomization, and 69 years at index polyp. There was a high rate of advanced adenomas: 44% ≥1 polyp ≥1 cm, 35% with villous histology, and 5% high grade dysplasia. At 20 years, 87 patients had a CRC diagnosis, and the estimated cumulative incidence of CRC was 4.3%. Proximal adenomas had a higher risk of developing a post-colonoscopy CRC (SHR=1.63, 95% CI=1.05-2.53, P=0.03), which was attenuated after adjusting for polyp multiplicity in sensitivity analyses (SHR=1.56, 95% CI=0.96-2.53, P=0.07).</p><p><strong>Conclusion: </strong>Although patients with proximal adenomas were found to have higher hazards of post-colonoscopy CRC, adjusting for polyp multiplicity attenuated the strength of association. Further research is warranted to determine whether polyp location should be factored in the determination of appropriate surveillance intervals.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845617","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":"Evaluating Artificial Intelligence-Driven Responses to Acute Liver Failure Queries: A Comparative Analysis Across Accuracy, Clarity, and Relevance.","authors":"Sheza Malik, Lewis J Frey, Jason Gutman, Asim Mushtaq, Fatima Warraich, Kamran Qureshi","doi":"10.14309/ajg.0000000000003255","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003255","url":null,"abstract":"<p><strong>Introduction: </strong>Recent advancements in Artificial Intelligence (AI), particularly through the deployment of Large Language Models (LLMs), have profoundly impacted healthcare. This study assesses five LLMs-ChatGPT 3.5, ChatGPT 4, BARD, CLAUDE, and COPILOT-on their response accuracy, clarity, and relevance to queries concerning acute liver failure (ALF). We subsequently compare these results with Chat GPT4 enhanced with Retrieval Augmented Generation (RAG) technology.</p><p><strong>Methods: </strong>Based on real-world clinical use and the American College of Gastroenterology guidelines, we formulated 16 ALF questions or clinical scenarios to explore LLMs' ability to handle different clinical questions. Using the \"New Chat\" functionality, each query was processed individually across the models to reduce any bias. Additionally, we employed the RAG functionality of GPT-4, which integrates external sources as references to ground the results. All responses were evaluated on a Likert scale from 1 to 5 for accuracy, clarity, and relevance by four independent investigators to ensure impartiality.</p><p><strong>Result: </strong>ChatGPT 4, augmented with RAG, demonstrated superior performance compared to others, consistently scoring the highest (4.70, 4.89, 4.78) across all three domains. ChatGPT 4 exhibited notable proficiency, with scores of 3.67 in accuracy, 4.04 in clarity, and 4.01 in relevance. In contrast, CLAUDE achieved 3.04 in clarity, 3.6 in relevance, and 3.65 in accuracy. Meanwhile, BARD and COPILOT exhibited lower performance levels; BARD recorded scores of 2.01 in accuracy and 3.03 in relevance, while COPILOT obtained 2.26 in accuracy and 3.12 in relevance.</p><p><strong>Conclusion: </strong>The study highlights Chat GPT 4 +RAG's superior performance compared to other LLMs. By integrating RAG with LLMs, the system combines generative language skills with accurate, up-to-date information. This improves response clarity, relevance, and accuracy, making them more effective in healthcare. However, AI models must continually evolve and align with medical practices for successful healthcare integration.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845613","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":"Comments on Treatment Decision for Locally Resected T1 Colorectal Carcinoma Verification of the Japanese Guideline Criteria for Additional Surgery Based on Long-Term Clinical Outcomes.","authors":"Yinfang Wu, Qi Zhao","doi":"10.14309/ajg.0000000000003230","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003230","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142826832","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":"Comments on Limited Sustained Remission After Nucleos(t)ide Analog Withdrawal: Results From a Large, Global, Multiethnic Cohort of Patients With Chronic Hepatitis B (RETRACTB Study).","authors":"Yinfang Wu, Zhongwei Zhang","doi":"10.14309/ajg.0000000000003206","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003206","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142826732","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":"Antivirals in Preventing Perinatal Transmission of Hepatitis B: Start and Stop Times are Shifting.","authors":"Norah A Terrault, Hugo E Vargas","doi":"10.14309/ajg.0000000000003177","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003177","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798676","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":"Metoclopramide May Not Decrease the Need for Second-Look Esophagogastroduodenoscopy in Patients With Overall Active Upper Gastrointestinal Bleeding.","authors":"Wenjing Sun, Kangqi Wu","doi":"10.14309/ajg.0000000000003189","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003189","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798694","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 Borup et al.","authors":"Anne-Marie Ellegaard, Martin L Kårhus, Matilde Winther-Jensen, Filip K Knop, Line L Kårhus","doi":"10.14309/ajg.0000000000003200","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003200","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798938","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":"Supplementary Considerations on the Timing of Direct Oral Anticoagulants Resumption.","authors":"Xin Zhou, Xiaofeng Zhang, Yaling Li, Jun Li","doi":"10.14309/ajg.0000000000003188","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003188","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798945","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}