American Journal of Gastroenterology最新文献

{"title":"A Risk Stratification Tool for Relapse After Intravenous-To-Subcutaneous Switching of Infliximab in Patients With Inflammatory Bowel Diseases.","authors":"Yannick Hoffert, Zhigang Wang, Mathurin Fumery, Maria Nachury, Maëva Bazoge, Anthony Buisson, Erwin Dreesen","doi":"10.14309/ajg.0000000000003466","DOIUrl":"10.14309/ajg.0000000000003466","url":null,"abstract":"<p><strong>Introduction: </strong>A subcutaneous formulation of infliximab was recently approved for maintenance therapy of inflammatory bowel disease (IBD). However, limited clinical experience, particularly with patients on escalated intravenous infliximab regimens, poses challenges for the transition to subcutaneous therapy. We investigated the pharmacokinetics and pharmacodynamics of subcutaneous infliximab to identify early predictors of relapse on switching.</p><p><strong>Methods: </strong>We repurposed data from a prospective, multicenter trial involving patients with IBD switching from intravenous to subcutaneous infliximab. We estimated each patient's infliximab clearance using Bayesian forecasting from a preswitch sample and a population pharmacokinetics model. We performed pharmacodynamics modeling to evaluate preswitch predictors of postswitch relapse. Relapse was defined as clinical recurrence (partial Mayo score >2 or Harvey-Bradshaw Index >4 leading to therapeutic escalation) or an increase in fecal calprotectin ≥150 μg/g on switching.</p><p><strong>Results: </strong>Using data from 98 patients with IBD, we identified infliximab clearance and fecal calprotectin as independent predictors of relapse. A 2-item risk score stratified patients into the low-risk (<19% probability of relapse; 75/98; 77%) and high-risk (≥19% probability of relapse; 23/98; 23%) groups (sensitivity 0.75 [95% CI 0.48-0.93], specificity 0.87 [95% CI 0.77-0.93] positive predictive value 52% [95% CI 31-73%], negative predictive value 95% [95% CI 87-99%]). Our pharmacokinetics-pharmacodynamics model classified patients with and without relapse ( P < 0.0001) with an area under the receiver operating characteristic curve of 0.83 (95% CI 0.71-0.93).</p><p><strong>Discussion: </strong>Preswitch infliximab clearance and fecal calprotectin are accurate predictors of relapse after switching to subcutaneous infliximab. An interactive risk stratification tool facilitates confirmation of a stratified medicine approach to improve infliximab therapy in IBD.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794553","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":"Accurately Predicting Recurrent Primary Sclerosing Cholangitis After Liver Transplantation.","authors":"Ming Gao, Xuefeng Ma","doi":"10.14309/ajg.0000000000003423","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003423","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794555","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":"Treatment of Clostridioides difficile : The Times They Are Changing.","authors":"Paul Feuerstadt, Jessica Allegretti, Sahil Khanna","doi":"10.14309/ajg.0000000000003445","DOIUrl":"10.14309/ajg.0000000000003445","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794343","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":"Suggestions to Strengthen a Systematic Review.","authors":"Nosaibah Razaqi, Rachana Mehta, Shubham Kumar, Ranjana Sah","doi":"10.14309/ajg.0000000000003387","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003387","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794191","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 of Polysaccharide Hemostatic Powder on Blood Oozing Among Patients With Postendoscopic Sphincterotomy Bleeding: A Randomized Controlled Trial.","authors":"Hengcun Li, Jiaxuan Zuo, Wenhai Wang, Shanshan Wu, Yu Zhao, Yongqiu Wei, Jiugang Song, Zheng Zhang, Weilong Yao, Junxiong Wang, Chuntao Liu, Hongtao Wei, Zheng Liang, Xiaohan Yang, Kaiqi Yang, Fujing Lv, Yongjun Wang, Peng Li, Shutian Zhang","doi":"10.14309/ajg.0000000000003468","DOIUrl":"10.14309/ajg.0000000000003468","url":null,"abstract":"<p><strong>Introduction: </strong>Postendoscopic sphincterotomy (EST) bleeding presents challenges for endoscopists using side-viewing duodenoscopes. Recently, polysaccharide hemostatic powder (PHP) has shown promising results in managing gastrointestinal hemorrhage. Given the established efficacy of endoscopic clips in addressing post-EST bleeding, we aim to evaluate the efficacy of PHP and its noninferiority to endoscopic clips in patients with nonpulsatile post-EST bleeding.</p><p><strong>Methods: </strong>Patients with nonpulsatile post-EST bleeding were randomized to receive either PHP or endoscopic clips. The primary end point was the immediate hemostasis rate, with secondary end points including delayed bleeding rate, overall treatment success rate, mean hemostasis time, and other major complications.</p><p><strong>Results: </strong>A total of 104 patients with nonpulsatile post-EST bleeding were included. Immediate hemostasis was achieved in 100% of the PHP group and 92.3% in the endoscopic clip group (risk difference, 7.7%, 95% confidence interval (CI) = 0.5%-15.0%, P = 0.022). Four patients in the endoscopic clip group experienced immediate hemostasis failure. Hemostasis time was shorter in the PHP group (50.77 vs 62.81 seconds, P = 0.011). One delayed bleeding case (2.1%) occurred in the clip group, whereas none were observed in the PHP group. The overall treatment success rate was higher in the PHP group compared with the endoscopic clip group (100% vs 90.4%; P = 0.022). No differences were observed in adverse events.</p><p><strong>Discussion: </strong>PHP is not inferior to endoscopic clip and could be of use in immediate hemostasis for nonpulsatile post-EST bleeding, with the added advantage of ease of use. Further research is needed to assess its efficacy in preventing delayed bleeding ( chictr.org.cn , ChiCTR2400092280).</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794559","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":"A Case of Multiple Gastrointestinal Ulcers Caused by Dental Floss Used for Endoscopic Submucosal Dissection Defect Closure.","authors":"Jiayao Zheng, Shijie Yang, Wanyin Deng","doi":"10.14309/ajg.0000000000003472","DOIUrl":"10.14309/ajg.0000000000003472","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794540","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":"Long-Term Sustained Improvement in Unplanned Healthcare Utilization in Patients With Inflammatory Bowel Disease.","authors":"Gil Y Melmed, Brant Oliver, Alice Kennedy, Jason K Hou, Donald Lum, Siddharth Singh, Welmoed K van Deen, Ridhima Oberai, S Alandra Weaver, James Testaverde, Corey A Siegel","doi":"10.14309/ajg.0000000000003454","DOIUrl":"10.14309/ajg.0000000000003454","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel diseases are associated with unpredictable disease exacerbation and need for urgent care. We aimed to assess long-term sustained improvement in emergency department utilization after completion of a multicenter quality improvement (QI) initiative.</p><p><strong>Methods: </strong>After the QI initiative, we developed an \"urgent care toolkit\" for sites to implement. We measured patient-reported and provider-reported outcomes at clinical visits.</p><p><strong>Results: </strong>Improvements in emergency department utilization and hospitalization were sustained for over 3 years after completion of the initiative.</p><p><strong>Discussion: </strong>Efforts to sustain improvements after a QI initiative can result in long-term improvement in patient outcomes.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794567","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":"Barrett's Esophagus in Time and Space: A Methylation Panel for Tracking Esophageal Cancer.","authors":"Daniel H Jacobson, Rebecca C Fitzgerald","doi":"10.14309/ajg.0000000000003378","DOIUrl":"10.14309/ajg.0000000000003378","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1265-1266"},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794557","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":"Patient-Reported Outcome Measures in Benign Esophageal Disorders.","authors":"John E Pandolfino, Ronnie Fass, Walter W Chan, C Prakash Gyawali","doi":"10.14309/ajg.0000000000003467","DOIUrl":"10.14309/ajg.0000000000003467","url":null,"abstract":"<p><p>Patient-reported outcome (PRO) measures are essential tools for assessing a patient's subjective experience related to disease and health. PROs measure symptom severity and evaluate treatment efficacy across a range of conditions at a particular point in time. Although PROs focusing on esophageal symptoms and esophageal hypervigilance exist, disease-specific PROs for commonly encountered benign esophageal disorders such as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), and achalasia are limited. Most GERD-specific PROs fail to address the complete spectrum of GERD presentations and those that provide daily assessment are more suited for research. Similarly, many EoE-specific PROs were designed for clinical trials. Comprehensive instruments incorporating EoE symptoms, as well as endoscopic and histologic features of active inflammation and fibrostenotic changes are needed. The psychometric properties of the Eckardt Score used for achalasia have significant limitations, stemming primarily from the dominance of dysphagia in scoring. Newer achalasia-specific PROs attempt to overcome this by capturing nuanced patient experiences. Broader symptom PROs are often used to assess esophageal symptoms across the spectrum of benign esophageal disorders, including a PRO that assesses esophageal hypervigilance and symptom-specific anxiety. Future efforts should focus on creating user-friendly PROs that comprehensively evaluate not just clinical presentation but also the disease state, which will enhance clinical symptom follow-up, quality of life assessment, and research applications. Assessments of hypervigilance and visceral anxiety will complement these applications as these measures are both a PRO and an important moderator of symptom severity and quality of life.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794568","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.","authors":"Nora Vladimirova, Jakob M Møller, Johan Burisch, Mikkel Østergaard","doi":"10.14309/ajg.0000000000003380","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003380","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794161","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}