American Journal of Gastroenterology最新文献

{"title":"ASSESSING MUCOSAL RECOVERY DURING THE FIRST 15 MONTHS OF ADOPTING A GLUTEN-FREE DIET IN CHILDREN WITH CELIAC DISEASE.","authors":"Denis Chang, Madison Wong, Cleo R Davidowitz, Imad Absah, Vahe Badalyan, Mohammad K Chaaban, Lisa Fahey, Daniela M Isaac, Maya Khanna, Marihan Lansing, Edwin Liu, Catherine Raber, Arunjot Singh, Marisa G Stahl, Catharine M Walsh, Jocelyn A Silvester, Maureen M Leonard","doi":"10.14309/ajg.0000000000003400","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003400","url":null,"abstract":"<p><strong>Objective: </strong>Determine contemporary rates of early mucosal recovery in children with celiac disease (CeD).</p><p><strong>Methods: </strong>Multicenter retrospective cohort study in Canada and the United States. Children diagnosed with CeD between 2016 and 2021 who underwent a follow-up biopsy within 15 months of diagnosis were included.</p><p><strong>Results: </strong>Overall, 96/130 (74%) had mucosal recovery, including 48% (12/25) children who were assessed within 3 months. Musculoskeletal symptoms at diagnosis were the only clinical characteristic associated with persistent enteropathy.</p><p><strong>Conclusions: </strong>While mucosal recovery can occur within months, more than a quarter of children with CeD had persistent enteropathy within 15 months of treatment.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622953","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":"Disseminated Talaromyces marneffei involving the colon: a unique opportunistic infection.","authors":"Wenfang Xiong, Lingling Lai, Yi Tu","doi":"10.14309/ajg.0000000000003415","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003415","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622967","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":"Acetic Acid-Indigo Carmine Chromocolonoscopy for Proximal Serrated Lesions: A Randomized, Three-Arm Colonoscopy Study.","authors":"Hideaki Kinugasa, Sakiko Hiraoka, Sayo Kobayashi, Minoru Matsubara, Teruya Nagahara, Reiji Higashi, Kensuke Takei, Masayasu Ohmori, Takashi Nakamura, Takao Tsuzuki, Shouichi Tanaka, Ryosuke Hirai, Junki Toyosawa, Yuki Aoyama, Yasushi Yamasaki, Toshihiro Inokuchi, Masahiro Takahara, Takehiro Tanaka, Toshiharu Mitsuhashi, Motoyuki Otsuka","doi":"10.14309/ajg.0000000000003411","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003411","url":null,"abstract":"<p><strong>Objectives: </strong>Aggressive colorectal cancer (CRC) frequently originates from serrated lesions (SLs), particularly in the proximal colon, which are challenging to detect using standard screening colonoscopy. Although duplicate examinations or chromocolonoscopies are recommended for detecting proximal SLs, evidence from randomized trials is limited. We evaluated the effectiveness of tandem colonoscopy with an acetic acid-indigo carmine mixture (AIM) for detecting SLs in the proximal colon compared to white-light imaging (WLI) and indigo carmine (IC).</p><p><strong>Methods: </strong>This three-arm, multicenter, randomized controlled trial involving nine institutions enrolled patients undergoing colonoscopy and assigned them randomly to the WLI, IC, or AIM group. The primary outcomes were the SL-detection rate (SDR) of proximal lesions during the second examination (SDR2nd) and SL additional rate (SAR). Secondary outcomes included the detection and additional rates of other polyps, factors contributing to SAR, and complications.</p><p><strong>Results: </strong>Between 2021 and 2024, 1,319 participants with 1,267 polyps were included in the analysis. With AIM, the SDR2nd and SAR were significantly higher compared to WLI or IC (WLI vs. AIM: 2.7% vs. 14.0%, p<.001; IC vs. AIM: 7.9% vs. 14.0%, p=.002, and WLI vs. AIM: 22.4% vs. 69.3%, p<.001; IC vs. AIM: 45.8% vs. 69.3%, p=.001). AIM conferred a higher adenoma-detection rate (ADR)2nd than with WLI (10.5% vs. 24.7%; p<.001) and was an independent factor for SAR (odds ratio [95% confidence interval]: 7.79 [3.76-17.08]). No major adverse events were observed.</p><p><strong>Conclusions: </strong>AIM significantly improved proximal colon SDRs and outperformed WLI and IC. The relationship between SDR and CRC incidence warrants further investigation.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623185","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":"Preventing Postendoscopic Submucosal Dissection Coagulation Syndrome With Transrectal Drainage Tubes: Are We Targeting the Right Patients and Mechanisms?","authors":"Kun Yang, Song Zhao","doi":"10.14309/ajg.0000000000003365","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003365","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623180","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":"Microscopic Colitis and Risk of Venous Thromboembolism: A Nationwide Matched Cohort Study.","authors":"Anders Forss, Gabriella Bröms, David Bergman, Marcus Thuresson, Jiangwei Sun, Carl Eriksson, Ola Olén, Bengt Zöller, Jonas F Ludvigsson","doi":"10.14309/ajg.0000000000003408","DOIUrl":"10.14309/ajg.0000000000003408","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory diseases have been associated with increased risk of venous thromboembolism (VTE). However, data on VTE are lacking in large population-based cohorts of microscopic colitis (MC).</p><p><strong>Methods: </strong>This study included all Swedish adults with incident MC without prior VTE (1990-2017; n = 12,489; follow-up until 2021). MC and subtypes (collagenous colitis and lymphocytic colitis) were defined from prospectively recorded colorectal histopathology reports from all 28 pathology departments in Sweden. Individuals with MC were matched for birth year, sex, calendar year, and county with up to 5 general population reference individuals (n = 55,809) without prior MC. Sensitivity analyses included full sibling comparisons and stricter definitions of VTE requiring a primary diagnosis of VTE and a prescription of anticoagulant medication. Incidence rates and multivariable-adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for VTE events were calculated using Cox proportional hazards modelling.</p><p><strong>Results: </strong>Over a median of 10.0 years of follow-up, 755 (6.0%; 11.3/1,000 person-years) incident VTE events occurred in individuals with MC and 2,674 (4.8%; 8.6/1,000 person-years) in reference individuals. Individuals with MC had a higher overall relative risk of any VTE event compared with reference individuals (aHR 1.21, 95% CI 1.11-1.32) including higher risk of pulmonary embolism (aHR 1.23, 95% CI 1.08-1.40), deep vein thrombosis of the legs (aHR 1.16, 95% CI 1.03-1.32), and other VTE events (aHR 1.31, 95% CI 1.08-1.58). The results remained robust in sensitivity analyses.</p><p><strong>Discussion: </strong>In this population-based study, individuals with MC had a 21% higher risk of VTE compared with reference individuals, equivalent to 1 extra VTE event for every 37 MC individuals followed for 10 years.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623169","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":"Mirikizumab Improves Quality of Life and Work Productivity in Patients with Moderately to Severely Active Crohn's Disease: Results from the Phase 3 VIVID-1 study.","authors":"Scott D Lee, Severine Vermeire, Ryan Ungaro, Aisha Vadhariya, Frederick Durand, Nathan Morris, Guanglei Yu, Deborah A Fisher, Kristina Traxler, Millie Long","doi":"10.14309/ajg.0000000000003410","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003410","url":null,"abstract":"<p><strong>Objectives: </strong>Mirikizumab demonstrated significant efficacy compared to placebo in patients with Crohn's disease (CD) in the phase 3 VIVID-1 study. Here, we report the impact of mirikizumab versus placebo on health-related quality of life (HRQoL) and work productivity in VIVID-1.</p><p><strong>Methods: </strong>VIVID-1 patients randomized to receive mirikizumab (N=579) or placebo (N=199) were included. The effect of mirikizumab on HRQoL was assessed at Weeks 12 and 52 using the Inflammatory Bowel Disease Questionnaire (IBDQ), Short Form-36 Health Survey (SF-36), EQ-5D-5L visual analogue scale (VAS), and Work Productivity and Activity Impairment:CD (WPAI:CD) measures. Cochran-Mantel-Haenszel test with non-responder imputation (binary endpoints) and analysis of covariance with modified baseline observation carried forward (continuous endpoints) were used for treatment comparisons.</p><p><strong>Results: </strong>Greater improvements in mean change from baseline to Weeks 12 and 52 were observed with mirikizumab versus placebo in IBDQ total and domain scores, SF-36 summary and domain scores, and EQ-5D-5L VAS scores (all p<0.001). Significant improvements with mirikizumab versus placebo were observed in WPAI:CD scores at Week 12: absenteeism (p=0.001), presenteeism (p = 0.005), activity impairment (p<0.001), and overall work impairment (p=0.002); these improvements were maintained at Week 52 (all p<0.001, except absenteeism). At Weeks 12 and 52, a greater proportion of mirikizumab-treated patients versus placebo achieved IBDQ response, IBDQ remission, and clinically important improvement in physical and mental component summaries of SF-36 (all p<0.001).</p><p><strong>Conclusions: </strong>Patients with moderately to severely active CD treated with mirikizumab reported clinically meaningful improvements in HRQoL and work productivity versus placebo at Week 12 which were maintained at Week 52.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623173","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 Only Fluid Therapy Be the Answer in Prevention of Postendoscopic Retrograde Pancreatitis?","authors":"Pulkit Jayeshbhai Patel, Devendra Desai, Vikram Dharap, Digvijay Hodgar","doi":"10.14309/ajg.0000000000003356","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003356","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143622954","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":"Infections in Standard or Tapered Dose of Prednisolone for Alcohol-Associated Hepatitis: A Randomized Trial (STASH Trial).","authors":"Anand V Kulkarni, Karan Kumar, Suprabhat Giri, Juan Pablo Arab, Shantan Venishetty, Madhumita Premkumar, Harshith B Kadnur, Mithun Sharma, Manasa Alla, Sowmya Iyengar, Gauri Nayak, Vivek Anand Saraswat, Rajesh Gupta, Padaki Nagaraja Rao, K Rajender Reddy, Duvvur Nageshwar Reddy","doi":"10.14309/ajg.0000000000003416","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003416","url":null,"abstract":"<p><strong>Objectives: </strong>Current guidance recommends a 40-mg dose of prednisolone (or equivalent) for severe alcohol-associated hepatitis (AAH), while infections are not uncommon in them. The benefits of a rapid prednisolone tapering regimen in mitigating infection in patients with AAH are unknown. The primary objective was to assess the incidence of infection by day 90. The key secondary objectives were the incidence of mortality, acute kidney injury (AKI), readmissions rate and adverse events.</p><p><strong>Methods: </strong>In this multicenter randomized clinical trial, patients with severe AAH were included from 15/03/2023 to 28/08/2024. Participants were randomly assigned to receive a standard fixed prednisolone dose (40 mg/day) for 4 weeks or 40 mg/day tapered by 10 mg/day every week over 4 weeks.</p><p><strong>Results: </strong>Two hundred fifty-four patients were enrolled (age: 41.16±8.2 years,98% men). The incidence of infection on day 90 was 33.1% (42 of 127;95% confidence interval[CI],23.8-44.7) in the fixed-dose group compared with 19.7% (25 of 127;95% CI, 16.1-37) in tapered dose group, with a hazard ratio [HR] of 0.57 (95%CI,0.35-0.94; P=0.03). On competing risk regression analysis after adjustment for relevant covariates, tapered dose of prednisolone was associated with a lower incidence of infection by day 90 (sHR, 0.34 [95% CI,0.15-0.78]; P=0.01). Nineteen percent (24/127;95% CI, 12.5-26.8) in the fixed-dose group and 8.6% (11/127;95%CI,4.4-14.9; P=0.02) in the tapered-dose group had microbiologically proven infections. There were no differences in mortality, AKI incidence, hospitalizations or all-cause adverse events.</p><p><strong>Conclusions: </strong>In patients with severe AAH, a tapered prednisolone regimen may mitigate the frequency of infections. (CTRI/2023/03/050521).</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623141","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":"Minimum platelet count threshold for safe colonoscopic polypectomy: A large-scale propensity scored-matched analysis.","authors":"Hye Kyung Hyun, Nak-Hoon Son, Cheal Wung Huh, Hyun Chul Lim, So Hyeon Gwon, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim","doi":"10.14309/ajg.0000000000003412","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003412","url":null,"abstract":"<p><strong>Introduction: </strong>The association between post-polypectomy bleeding (PPB) and thrombocytopenia remains unclear, and current evidence is insufficient to provide definitive guidelines for managing patients with thrombocytopenia undergoing endoscopic procedures. We assessed the association between thrombocytopenia and PPB to identify the minimum platelet count threshold for safe colonoscopic polypectomy.</p><p><strong>Methods: </strong>This large cohort study included patients who had undergone colonoscopy and polypectomy in Korea between 2005 and 2022. A wide range of covariates, including patient-, polyp-, and procedure-related factors, were collected. We identified the optimal platelet cut-off value of 90,000/μL using Youden's Index method and conducted propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) analyses to determine the effect of thrombocytopenia on PPB risk.</p><p><strong>Results: </strong>Overall, 21,562 patients were screened, including 16,852 individuals and 41,930 polyps. Among these patients, 198 (1.2%) had platelet counts < 90,000/μL, and 16,654 (98.8%) had platelet counts of ≥ 90,000/μL. After PSM, patients with platelet counts < 90,000/μL demonstrated significantly elevated risks for immediate PPB (OR 2.67, 95% CI 1.06-6.71) and delayed PPB (OR 9.66, 95% CI 1.21-77.52) compared with those with platelet counts of ≥ 90,000/μL. In high-risk procedures (EMR and ESD for large polyp > 20 mm), the optimal platelet count threshold was identified as 100,000/μL for safe colonoscopic polypectomy. The results obtained using IPTW were consistent.</p><p><strong>Discussion: </strong>Patients with platelet counts < 90,000/μL exhibited significantly elevated rates of IPPB and DPPB, suggesting that maintaining platelet levels above this threshold may be crucial for ensuring the safety of colonic polypectomy.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623172","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":"International, multicenter analysis of endoscopic full-thickness resection of duodenal neuroendocrine tumors.","authors":"Andreas Wannhoff, Zaheer Nabi, Leon M G Moons, Gregory Haber, Phillip Ge, Tobias Dertmann, Pierre H Deprez, Wojciech Korcz, Christopher Bouvette, Julius Mueller, George Tribonias, Giuseppe Grande, John J Kim, Alexander Weich, Henriette Heinrich, Matthias Mollenkopf, Jeffey George, Mathieu Pioche, Francesco Azzolini, Konstantinos Kouladouros, Phil Boger, Bu'Hussain Hayee, Mohammad Bilal, Barbara A J Bastiaansen, Karel Caca","doi":"10.14309/ajg.0000000000003409","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003409","url":null,"abstract":"<p><strong>Objectives: </strong>Non-exposed endoscopic full-thickness resection (EFTR) using a dedicated full-thickness resection device (FTRD) can be used to perform en bloc resection of subepithelial lesions throughout the gastrointestinal tract. Here we aim to evaluate the safety and efficacy of EFTR for the management of duodenal neuroendocrine tumors (dNET).</p><p><strong>Methods: </strong>International multicenter retrospective study of device assisted EFTR for dNET. Study outcomes included rates of technical success, R0 resection, and adverse events (AE).</p><p><strong>Results: </strong>171 patients were included across 35 centers. Lesions had a median size of 10 mm and were in the duodenal bulb in 143 cases (83.6%). Technical success was achieved in 164 (95.9%) and R0 resection in 123 cases (71.9%). R0 resection rate for lesions located in the proximal third of the bulb was 62.0% compared to 83.9% for more distal locations (P = 0.002). R0 resection rate was not affected by lesion size or depth of invasion. On multivariable analysis, date of resection (2021 onwards) and location distal to the proximal third of the duodenal bulb were independent predictors of R0 resection, but not case volume per participating center. Follow-up information was available for 114 patients (66.7%), and demonstrated two recurrences over a median follow-up of 10 months. Severe AEs occurred in 3 patients (1.8%).</p><p><strong>Conclusions: </strong>EFTR of dNET showed high technical success and R0 resection rates and very low rate of severe AEs. It could become endoscopic treatment of choice for dNET, at least for lesions not within proximity of the pylorus.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623146","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}