American Journal of Gastroenterology最新文献

{"title":"Glucagon-Like Peptide-1 Receptor Agonists Use Does Not Increase the Risk for Acute Pancreatitis and Is Associated with Lower Complications in Patients with Type 2 Diabetes Who Develop Acute Pancreatitis: A Multi-Center Analysis.","authors":"Luis M Nieto, John Martinez, Sharon I Narvaez, Donghyun Ko, Do Han Kim, Kenneth J Vega, Saurabh Chawla","doi":"10.14309/ajg.0000000000003525","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003525","url":null,"abstract":"<p><strong>Background: </strong>Type 2 Diabetes Mellitus (T2DM) can lead to structural pancreatic changes potentially predisposing to Acute Pancreatitis (AP), increasing morbidity and mortality. Scarce data exists on the outcomes of AP in T2DM patients who are taking Glucagon-like peptide-1 receptor agonists (GLP-1 RAs). The study aim was to evaluate AP outcome and all-cause mortality in T2DM patients using GLP-1 RAs.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using population-based data from the TriNetX platform. T2DM patients receiving GLP-1 RAs drugs (semaglutide, liraglutide, dulaglutide and tirzepatide) between January 1, 2015, and October 31, 2023 were included. This patient cohort was matched with T2DM patients who did not receive GLP-1 RAs according to age, demographics, comorbidities, and medication by using 1:1 propensity matching. To avoid confounding, etiologies of AP including alcohol-induced, trauma, biliary, class Ia drug-induced, hypertriglyceridemia, and post-ERCP were excluded from both cohorts. Primary outcomes were risk of developing AP, need for parenteral nutrition, systemic complications (sepsis, systemic inflammatory response syndrome, shock, mechanical ventilation, acute kidney injury (AKI)) and local pancreatic complications. The secondary outcome was all-cause mortality. Cox proportional hazards models were used to estimate hazard ratios (HRs).</p><p><strong>Results: </strong>A total of 740,370 patients with T2DM were identified with 29,423 on GLP -1 RAs; 20,459 out of those 29,423 (mean [SD] age, 58.1 [11.9] years; 10,190 [49.85%] female) were matched with 20,459 individuals (mean [SD] age, 57.5 [13.9] years; 10,301 [50.35%] female) who did not take GLP-1 RAs. The GLP-1 RAs group had lower risk of complicated pancreatitis (HR, 0.32; 95% CI, 0.14-0.74), parenteral nutrition needs (HR, 0.28; 95% CI, 0.09-0.83), sepsis (HR, 0.71; 95% CI, 0.59-0.84), AKI (HR, 0.54; 95% CI, 0.49-0.60), shock (HR, 0.52; 95% CI, 0.36-0.75) and mechanical ventilation support during admission (HR, 0.23; 95% CI, 0.16-0.33) compared with the non- GLP-1 RAs group. Also, all-cause mortality was decreased in the GLP-1 agonist group compared to the non-GLP-1 agonist group (HR, 0.45; 95% CI, 0.41-0.49). Important to note that the GLP-1 RAs group had a tendency of lower risk of uncomplicated pancreatitis (HR, 0.71; 95% CI, 0.49-1.01) but without statistically significant result. No difference was found between the groups in risk of developing SIRS if it occurs.</p><p><strong>Conclusion: </strong>GLP-1 RAs use does not increase AP risk, is associated with lower complications in those who developed AP and linked with lower all-cause mortality in T2DM patients. Prospective studies are needed to determine the mechanisms behind these findings.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962065","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 Wei et al.","authors":"Guy Boeckxstaens, Runze Quan, Hind Hussein","doi":"10.14309/ajg.0000000000003496","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003496","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952629","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 Gao and Ma.","authors":"Bishoi Aziz, Andrew Mason","doi":"10.14309/ajg.0000000000003473","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003473","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957276","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":"Validation of an Epigenetic Prognostic Assay to Accurately Risk Stratify Patients With Barrett's Esophagus.","authors":"Yichen Zhou, Lei Sun, Yue Lv","doi":"10.14309/ajg.0000000000003469","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003469","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958498","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 No-Biopsy Approach for Pediatric Celiac Disease: Ready for Prime Time in North America?","authors":"Erica J Brenner","doi":"10.14309/ajg.0000000000003471","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003471","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964263","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":"Enrollment in Metabolic Dysfunction-Associated Steatohepatitis Clinical Trials: A Pooled Analysis of Screen Failure Rates.","authors":"Matheus Souza, Lubna Al-Sharif, Ivanna Diaz, Samira Mohamad Khalil","doi":"10.14309/ajg.0000000000003520","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003520","url":null,"abstract":"<p><strong>Introduction: </strong>Screen failure is a major challenge in the enrollment of metabolic dysfunction-associated steatohepatitis (MASH) randomized controlled trials (RCTs) but its impact has not been systematically assessed.</p><p><strong>Methods: </strong>We searched PubMed and the Cochrane Library databases for phase ≥2 RCTs of MASH pharmacotherapies in adults using histological inclusion criteria. Screen failure rates (SFRs) were pooled using a generalized linear mixed model.</p><p><strong>Results: </strong>Of 67 included RCTs, 58 reported enrollment data. The pooled SFR was 56.28% (95% CI 50.14 to 62.23) in 44949 individuals. The most common reason for screen failure was ineligibility. SFR was higher in more recent trials, globally conducted trials, and trials funded by pharmaceutical companies. Meta-regressions showed an increase in SFR over time and with more trial sites.</p><p><strong>Discussion: </strong>Evidence-based strategies to reduce the high SFR in MASH clinical trials are urgently needed.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958435","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":"Measuring Food-Specific-IgG4s With Milk.","authors":"Eva M Macías, Antonio Velasco Guardado, Ignacio Dávila","doi":"10.14309/ajg.0000000000003474","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003474","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956038","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 Minocha.","authors":"Evan S Dellon, Shailja C Shah, Bryan G Sauer, Nirmala Gonsalves","doi":"10.14309/ajg.0000000000003476","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003476","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957813","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":"Seasonal Patterns in Eosinophilic Esophagitis-Related Emergency Department Visits: A National Database Analysis.","authors":"Chun-Wei Pan, Alejandro Nieto Dominguez, Daniel Guifarro, Pojsakorn Danpanichkul, Maoyin Pang","doi":"10.14309/ajg.0000000000003226","DOIUrl":"10.14309/ajg.0000000000003226","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigates seasonal variations in eosinophilic esophagitis (EoE)-related emergency department visits among adults.</p><p><strong>Methods: </strong>We analyzed the National Emergency Department Sample (2016-2021), identifying adult patients with EoE using ICD-10 codes. Generalized additive models assessed seasonal patterns.</p><p><strong>Results: </strong>Among 18,791 EoE-related emergency department visits, a significant seasonal variation was observed, peaking in summer and nadiring in winter. This pattern was consistent across all US regions.</p><p><strong>Conclusion: </strong>Seasonal dietary habits and social behaviors likely contribute to EoE exacerbations. Healthcare providers should emphasize management strategies during high-risk periods, particularly summer months and weekends.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1135-1139"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Lyon Score: A Novel Reflux Scoring System Based on the Lyon Consensus 2.0 That Associates With Treatment Outcome From Antireflux Therapy.","authors":"C Prakash Gyawali, Lorenzo Marchetti, Benjamin D Rogers, Walter W Chan, Ming-Wun Wong, Pierfrancesco Visaggi, Arvind Rengarajan, Dustin A Carlson, Edoardo Savarino, Nicola de Bortoli, Chien-Lin Chen, John Pandolfino","doi":"10.14309/ajg.0000000000003083","DOIUrl":"10.14309/ajg.0000000000003083","url":null,"abstract":"<p><strong>Introduction: </strong>We explored if a score derived from parameters from esophageal testing could increase confidence in diagnosing conclusive gastroesophageal reflux disease and in predicting outcome.</p><p><strong>Methods: </strong>A prediction score was developed using metrics based on Lyon Consensus 2.0 thresholds extracted from endoscopy and pH-impedance monitoring. The Lyon score was the sum of weighted scores derived from a logistic regression model. The outcome was response to antireflux therapy, defined as 50% reduction in global symptoms on validated questionnaires. An existing database of endoscopy-negative patients with typical reflux symptoms undergoing esophageal testing from 2 centers (Europe and the United States) constituted the developmental cohort, while 2 separate cohorts (Europe and Asia) served as validation cohorts. Receiver operating characteristics analysis determined performance of the Lyon score in predicting treatment response.</p><p><strong>Results: </strong>In 281 developmental cohort patients (median age 53 years, 57.7% female), the Lyon score demonstrated an area under the curve (AUC) of 0.819 in predicting 50% symptom improvement ( P < 0.001) on receiver operating characteristics, with an optimal threshold of 6.25 (sensitivity 81.2%, specificity 73.4%). Of the individual components, only acid exposure time (AUC 0.799, P < 0.001), mean nocturnal baseline impedance (AUC 0.785, P < 0.001), and reflux episodes (AUC 0.764, P < 0.001) approached the Lyon score performance. The Lyon score segregated treatment response in both the European (AUC 0.908, P < 0.001) and Asian validation cohorts (AUC 0.637, P < 0.001) and outperformed the DeMeester score in sensitivity for predicting outcome in the developmental and Asian validation cohorts.</p><p><strong>Discussion: </strong>The novel Lyon score segregates reflux phenotypes and identifies likelihood of symptom response from antireflux therapy.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1009-1018"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}