American Journal of Gastroenterology最新文献

{"title":"Curcumin Suppresses Growth of Recurrent Colorectal Adenoma After Endoscopic Resection: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.","authors":"Tetsuji Takayama, Koichi Okamoto, Hideki Ishikawa, Kaizo Kagemoto, Tatsuhisa Yasaka, Takashi Hisabe, Koichi Kawabe, Toyotaka Kasai, Masaya Kubota, Masahito Shimizu, Tomoyuki Abe, Jiro Nakamoto, Masahiko Nakasono, Sho Takahashi, Keita Harada, Shinji Kitamura, Hisashi Nakamura, Shinya Minami, Manabu Sawaya, Koshi Fujikawa, Toshihito Tanahashi, Shin-Ichiro Hori, Tsutomu Nagata, Yasushi Sato, Michihiro Mutoh","doi":"10.14309/ajg.0000000000004193","DOIUrl":"10.14309/ajg.0000000000004193","url":null,"abstract":"<p><strong>Introduction: </strong>Experimental and limited clinical studies suggest that curcumin has chemopreventive activity in the colorectum. This large-scale clinical trial evaluated the efficacy and safety of curcumin in patients with previously endoscopically resected colorectal neoplasia.</p><p><strong>Methods: </strong>This randomized, double-blind, placebo-controlled multicenter trial enrolled patients with previously resected colorectal neoplasia. Eligible patients were randomly assigned (1:1), using a stratified, computer-generated scheme to receive oral submicron-powdered curcumin (Theracurmin; 180 mg twice daily) or identical placebo capsules for 2 years. All analyses were performed according to a modified intention-to-treat principle including all randomly assigned patients who underwent the 2-year colonoscopy.</p><p><strong>Results: </strong>Between April 1, 2016, and March 31, 2020, 577 patients were randomly assigned to curcumin (n = 287) or placebo groups (n = 290). The detection rate of recurrent colorectal adenomas at 2 years, the primary end point, did not differ significantly between groups (risk ratio 0.98; 95% confident interval 0.82-1.16). However, the detection rate of adenomas ≥6 mm, a prespecified lesion category recommended for endoscopic resection in Japanese guidelines, was significantly lower with curcumin (risk ratio, 0.56; 95% confident interval, 0.33-0.95; P = 0.04). The per-patient number of adenomas ≥6 mm was also significantly lower ( P = 0.03), and the median size of all detected adenomas was significantly smaller in the curcumin group ( P = 0.003). The inhibitory effect seemed more pronounced in patients with higher baseline adenoma burden and in men in exploratory analyses. Treatment-related adverse events were infrequent and mild.</p><p><strong>Discussion: </strong>Curcumin inhibited the growth of recurrent colorectal adenomas, despite no significant reduction in the overall incidence of recurrence. This is the first large-scale randomized clinical trial demonstrating the suppressive efficacy of curcumin against colorectal neoplasia, and also highlighting the importance of incorporating growth-related endpoints, in addition to incidence-based or detection-based end points, in chemoprevention studies (jRCTs061180079).</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860389","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":"Greater Esophageal Cancer Burdens in Rural United States: A Surveillance, Epidemiology, and End Results Program Analysis.","authors":"Annabel Gerber, Ji Yoon Yoon, Chin Hur, Joel H Rubenstein","doi":"10.14309/ajg.0000000000004189","DOIUrl":"10.14309/ajg.0000000000004189","url":null,"abstract":"<p><strong>Aim: </strong>To compare rural and urban trends in esophageal cancer (EC) incidence and mortality, including adenocarcinoma (EAC), squamous cell carcinoma (ESCC), and esophagogastric junction adenocarcinoma (EGJAC).</p><p><strong>Methods: </strong>Joinpoint analysis of Surveillance, Epidemiology, and End Results (SEER) registries from 1992 through 2022.</p><p><strong>Results: </strong>EAC incidence and mortality were greater in rural areas, with trends diverging around 1999. EGJAC incidence and mortality and ESCC incidence decreased in urban areas and had no significant trend in rural areas.</p><p><strong>Conclusion: </strong>There are substantial disparities in EC incidence and mortality trends by rurality. Understanding the cause of these trends could support cancer control efforts.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860347","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":"Early Use of Anti-Tumor Necrosis Factor Therapy for Penetrating Complications in Children With Crohn's Disease: Multicenter Insight to a Challenging Clinical Problem.","authors":"Eduardo Contijoch, Jonathan Moses","doi":"10.14309/ajg.0000000000004154","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004154","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823982","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":"Can Early Control of Inflammation Change the Trajectory of Pediatric Eosinophilic Esophagitis?","authors":"Ruggiero Francavilla, Fernanda Cristofori","doi":"10.14309/ajg.0000000000004134","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004134","url":null,"abstract":"<p><p>In pediatric eosinophilic esophagitis (EoE), the therapeutic horizon may extend beyond symptom control to the prevention of irreversible esophageal remodeling. This editorial examines the post hoc EoE KIDS analysis, showing that dupilumab markedly improves inflammatory endoscopic features in young children, while fibrostenotic lesions remain largely absent or unchanged over short-term follow-up. Interpreted alongside natural history data linking diagnostic delay and persistent inflammation to stricture formation, these findings sharpen a compelling hypothesis: timely, sustained suppression of type 2 inflammation may redefine the long-term trajectory of pediatric EoE.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148823989","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":"Diffuse Cavernous Hemangioma of the Colon and Rectum.","authors":"Xing Huang, Zhigang Xiao","doi":"10.14309/ajg.0000000000004185","DOIUrl":"10.14309/ajg.0000000000004185","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148807905","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":"AI-Assisted Second Forward-View Examination of the Right Colon Significantly Improves the Adenoma Detection Rate: A Multicenter Randomized Controlled Trial.","authors":"Yusuke Nishikawa, Ai Fujimoto, Yorihito Hayashi, Junji Tanaka, Nobuyuki Sato, Keita Suzuki, Kenzo Hara, Hikari Kobayashi, Tomomi Hiraoka, Ryo Shimizu, Kazunori Hijikata, Mitsuko Inuyama, Masashi Ono, Takahito Toba, Takahisa Matsuda","doi":"10.14309/ajg.0000000000004184","DOIUrl":"10.14309/ajg.0000000000004184","url":null,"abstract":"<p><strong>Introduction: </strong>Adenomas in the right colon are likely to be missed during colonoscopy because of anatomical complexity and lesion characteristics. Although reinspection strategies and artificial intelligence (AI)-assisted colonoscopy improve adenoma detection, prospective randomized studies of their combined effectiveness in the right colon are limited. This multicenter randomized controlled trial aimed to compare standard colonoscopy with an AI-assisted second forward-view examination of the right colon to determine whether this strategy improves the adenoma detection rate (ADR).</p><p><strong>Methods: </strong>Patients undergoing colonoscopy were randomly assigned in a 1:1 ratio to either the AI-assisted colonoscopy group (AI group) or the standard colonoscopy group (non-AI group). In the AI group, a second forward-view examination of the right colon was performed using real-time AI assistance. The primary outcome was the right colon ADR.</p><p><strong>Results: </strong>A total of 606 patients were included in the analysis (AI group, n = 305; non-AI group, n = 301). The right colon ADR in the AI group was significantly higher than that in the non-AI group (36.4% vs 27.9%; P = 0.03; absolute increase, 8.5%). The improvement was driven by increased detection of small, flat lesions and those in anatomically challenging regions, such as the ascending colon. Subgroup analyses showed consistent improvement in the right colon ADR with AI assistance regardless of endoscopist experience.</p><p><strong>Discussion: </strong>The AI-assisted second forward-view examination significantly improved the right colon ADR. This combined strategy may improve adenoma detection in the right colon regardless of endoscopist experience. However, the independent contribution of AI assistance warrants further investigation.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148807870","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":"Zachary L Smith","doi":"10.14309/ajg.0000000000004137","DOIUrl":"10.14309/ajg.0000000000004137","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757847","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":"Xinxin Bai, Jianing Wu, Bensheng Wu","doi":"10.14309/ajg.0000000000004130","DOIUrl":"10.14309/ajg.0000000000004130","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758019","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":"Maxime Pichon, Christophe Burucoa, Driffa Moussata","doi":"10.14309/ajg.0000000000004112","DOIUrl":"10.14309/ajg.0000000000004112","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724677","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":"Advanced cannulation techniques vs early EUS-BD in case of difficult biliary cannulation in patients with DMBO: an international propensity score-matched analysis.","authors":"Marco Spadaccini, Jérémie Albouys, Cecilia Binda, Aurelio Mauro, Arnaldo Amato, Michele Amata, Filippo Antonini, José Ramón Aparicio Tormo, Paolo Giorgio Arcidiacono, Giovanni Aragona, Alexander Arlt, Debora Berretti, Torsten Beyna, Ivo Boskoski, Lucio Carrozza, Natalia Causada Calo, Anna Cominardi, Giuseppe Dell'Anna, Giovanna Del Vecchio Blanco, Roberto Di Mitri, Gianfranco Donatelli, Francesco Ferrara, Alessandro Fugazza, Pietro Fusaroli, Joan B Gornals, Mateusz Jagielski, Kareem Khalaf, Romain Legreos, Andrea Lisotti, Giovanni Lombardi, Ludovic Lukenga Safu, Alberto Martino, Belen Martínez-Moreno, Tajana Pavic, Enrique Perez-Cuadrado Robles, Ulrich Rosien, Valeria Poletti, Abdulrahman Qatomah, Daryl Ramai, Gianenrico Rizzatti, Giacomo Emanuele Maria Rizzo, Andrada Seicean, Cristiano Spada, Albert Sumalla-Garcia, Ilaria Tarantino, Maria Terrin, Viveksandeep Thoguluva Chandrasekar, Edoardo Troncone, Giuseppe Vanella, Thomas Veiser, Katina Zheng, Cesare Hassan, Carlo Fabbri, Andrea Anderloni, Jeremie Jacques, Alessandro Repici","doi":"10.14309/ajg.0000000000004182","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004182","url":null,"abstract":"<p><strong>Background and objectives: </strong>Biliary drainage(BD)in distal malignant biliary obstruction(DMBO)is often hampered by difficult biliary cannulation(DBC)during endoscopic retrograde cholangiopancreatography(ERCP). Advanced cannulation techniques(aERCP)may overcome DBC but still fail in up to 15% of cases, increasing the risk of adverse events(AEs). Early endoscopic ultrasound-guided BD(eEUS-BD)is a potential alternative. The aim of this study is to directly compare safety and efficacy of EUS-BD and aERCP.</p><p><strong>Methods: </strong>This is a retrospective, multicentric study(29 centres in United States, Canada, Europe), including patients with DMBO and common bile duct(CBD)diameter >12 mm, treated up to 2024. DBC cases managed with either eEUS-BD or aERCP were analysed. A 1:2 propensity score-matched cohort was generated to ensure comparability, with regression modeling and inverse probability of treatment weighting(IPTW)performed as sensitivity analyses. AEs rate was the primary outcome; secondary outcomes included BD failure and clinical success.</p><p><strong>Results: </strong>Standard cannulation failed in 2066/10,738(19.2%)ERCPs. aERCP and eEUS-BD were attempted in 1733 and 333 cases, respectively. After matching, 313 patients per EUS-BD group and 626 patients per aERCP group were analyzed. AEs occurred in 18.2% of aERCPs and 9.3% of eEUS-BD(p<0.01), with post-procedural pancreatitis the most frequent AE after aERCP(55 cases, 12.0%). Both regression and IPTW confirmed the robustness of these findings on the entire cohort. Technical success was significantly lower with aERCP(82.0% vs. 95.9%, p<0.01), clinical success was comparable(94.5% vs. 96.4%, p=0.89).</p><p><strong>Conclusions: </strong>In patients with DMBO and dilated CBD, eEUS-BD is associated with fewer AEs and higher technical success than aERCP, supporting its role as a safer, more effective option in DBC.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700595","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}