American Journal of Gastroenterology最新文献

{"title":"Higher Rate of Spontaneous Bacterial Peritonitis Recurrence With Secondary Spontaneous Bacterial Peritonitis Prophylaxis Compared With No Prophylaxis in 2 National Cirrhosis Cohorts.","authors":"Scott Silvey, Nilang R Patel, Stephanie Y Tsai, Mahum Nadeem, Richard K Sterling, John D Markley, Evan French, Jacqueline G O'Leary, Jasmohan S Bajaj","doi":"10.14309/ajg.0000000000003075","DOIUrl":"10.14309/ajg.0000000000003075","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous bacterial peritonitis (SBP) bacteriology has changed over time. Reappraisal of primary SBP prophylaxis showed an increased rate of resistance in patients on primary prophylaxis with resultant discontinuation of this prophylaxis throughout the Veterans Affairs (VA). We aimed to re-evaluate the risk-benefit ratio of secondary SBP prophylaxis (SecSBPPr).</p><p><strong>Methods: </strong>Using validated International Classification of Diseases-9/10 codes, we used the VA Corporate Data Warehouse and the Non-VA National TriNetX database to identify patients in 2 different large US systems who survived their first SBP diagnosis (with chart review from 2 VA centers) between 2009 and 2019. We evaluated the prevalence of SecSBPPr and compared outcomes between those who started on SecSBPPr vs not.</p><p><strong>Results: </strong>We identified 4,673 veterans who survived their index SBP episode; 54.3% of whom were prescribed SecSBPPr. Multivariable analysis showed higher SBP recurrence risk in those on vs off SecSBPPr (hazards ratio 1.63 [1.40-1.91], P < 0.001). This was accompanied by higher fluoroquinolone resistance odds in SecSBPPr patients (odds ratio = 4.32 [1.36-15.83], P = 0.03). In TriNetX, we identified 6,708 patients who survived their index SBP episode; 48.6% were on SecSBPPr. Multivariable analysis similarly showed SecSBPPr increased SBP recurrence risk (hazards ratio 1.68 [1.33-1.80], P < 0.001). Both data sets showed higher SBP recurrence trends over time in SecSBPPr patients. Results remained consistent at 6-month and 2-year timepoints.</p><p><strong>Discussion: </strong>In 2 national data sets of >11,000 patients with SBP, we found that SecSBPPr was prescribed in roughly half of patients. When initiated, SecSBPPr, compared with no prophylaxis after SBP, increased the risk of SBP recurrence in multivariable analysis by 63%-68%, and this trend worsened over time. SecSBPPr should be reconsidered in cirrhosis.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1066-1075"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131616","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":"Continuing Medical Education Questions: May 2025.","authors":"Arslan A Kahloon","doi":"10.14309/ajg.0000000000003443","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003443","url":null,"abstract":"<p><p>Article Title: Quality Indicators for EUS.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"120 5","pages":"949"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952098","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":"Cloverleaf Esophageal Diverticula.","authors":"Anjali Bhatt, Kenneth Ford, Eitan Podgaetz, Vani J A Konda, Anh D Nguyen","doi":"10.14309/ajg.0000000000003159","DOIUrl":"10.14309/ajg.0000000000003159","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"943"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492947","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 Lai and Liao.","authors":"Andrew D Mosholder, Kira Leishear","doi":"10.14309/ajg.0000000000003444","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003444","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963501","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 Caldera and Vattoth.","authors":"Michael Camilleri","doi":"10.14309/ajg.0000000000003441","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003441","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953480","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 Smith.","authors":"Azizullah Beran, John J Guardiola","doi":"10.14309/ajg.0000000000003440","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003440","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960198","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":"Acute Gastroenteritis Is a Risk Factor for the Development of Disorders of Gut-Brain Interaction in Children.","authors":"Aishwarya Palorath, Claire Narang, Lourdes Forster, Oneith Cadiz, Amber Langshaw, Amanda Fifi, Alan Delamater, Amber N Balda, Samantha Arrizabalo, Miguel Saps","doi":"10.14309/ajg.0000000000003477","DOIUrl":"10.14309/ajg.0000000000003477","url":null,"abstract":"<p><strong>Introduction: </strong>Acute gastroenteritis (AGE) is the most common disease predisposing to the development of disorders of gut-brain interactions (DGBIs) in adults (postinfectious DGBI [PI-DGBI]). There is paucity of data on incidence and risk factors for the development of PI-DGBI in children. The aims of this study are to (i) assess whether AGE predisposes children to the development of PI-DGBI and (ii) assess whether the severity of AGE is associated with the development of PI-DGBI.</p><p><strong>Methods: </strong>This was a prospective, controlled, cohort study. Children with recent AGE (cases) and siblings (controls) were followed for 6 months. We assessed DGBIs using a validated questionnaire (QPGS IV) per Rome criteria.</p><p><strong>Results: </strong>Forty-nine cases and 55 controls were enrolled; 4 cases (8.1%) and 1 control (1.8%) had a previous diagnosis of DGBI. At 3 months, 10 cases (20.4%) were diagnosed with DGBI vs 1 (1.8%) control ( P = 0.00). Among children without a history of DGBI before the AGE, 6 (12.2%) cases vs 0 control were diagnosed with DGBI ( P = 0.01) at follow-up. At 6 months, 5 cases (1 lost to follow-up) vs 0 control had persistent DGBI ( P = 0.03). Severity of AGE was correlated with PI-DGBI (ρ = 0.707, P = 0.00).</p><p><strong>Discussion: </strong>Children with AGE are more likely to develop DGBIs compared with controls. AGE symptom severity is associated with PI-DGBI.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963824","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 Jia et al.","authors":"Shane W Goodwin, Piotr Wilk, Yuhong Yuan, Michael Haan, Vipul Jairath","doi":"10.14309/ajg.0000000000003518","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003518","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144148851","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":"Is Carbohydrate Intolerance Associated With Carbohydrate Malabsorption in Disorders of Gut-Brain Interaction?","authors":"Hiba Mikhael-Moussa, Charlotte Desprez, André Gillibert, Anne-Marie Leroi, François Mion, Guillaume Gourcerol, Chloé Melchior","doi":"10.14309/ajg.0000000000003483","DOIUrl":"10.14309/ajg.0000000000003483","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to explore the prevalence of carbohydrate (lactose and fructose) intolerance in patients with disorders of gut-brain interaction (DGBI) and to characterize those patients regarding gastrointestinal and nongastrointestinal symptoms.</p><p><strong>Methods: </strong>Patients with DGBI who were referred to the physiology unit of our hospital between May 2022 and December 2023 for lactose (25 g) and fructose (25 g) breath tests were prospectively included. Patients were required to have a negative glucose breath test, before lactose and fructose breath tests, and to have completed the adult carbohydrate perception questionnaire during each breath test. Intolerance was defined as an increase of ≥20 mm in the Visual Analog Scale score from baseline in at least 1 of the 5 symptoms (pain, nausea, bloating, flatulence, and diarrhea) assessed with the adult Carbohydrate Perception Questionnaire.</p><p><strong>Results: </strong>Among the 301 patients with DGBI included in our analysis, 178 (59.1%) had carbohydrate intolerance. Carbohydrate-intolerant patients were significantly more likely to be female ( P value < 0.001), to have 2 or more DGBI ( P value = 0.001), to have lactose maldigestion ( P value< 0.001) and fructose malabsorption ( P value = 0.023), higher irritable bowel syndrome and somatic symptom severity, and lower quality of life ( P value < 0.001) compared with patients without carbohydrate intolerance. The binary logistic regression showed that lactose maldigestion ( P value = 0.001), as well as somatic symptoms ( P value = 0.025), were independently associated with carbohydrate intolerance (Nagelkerke R Square = 0.206).</p><p><strong>Discussion: </strong>Carbohydrate intolerance affects a substantial group of patients with DGBI, affecting their quality of life and symptom severity. Further research is needed to explore the underlying mechanisms in patients who do not have carbohydrate malabsorption/maldigestion.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802252","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 San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease.","authors":"Rena Yadlapati, Philip Weissbrod, Erin Walsh, Thomas L Carroll, Walter W Chan, Jackie Gartner-Schmidt, Livia Guadagnoli, Marie Jette, Jennifer C Myers, Ashli O'Rourke, Rami Sweis, Justin Wu, Julie M Barkmeier-Kraemer, Daniel Cates, Chien-Lin Chen, Enrique Coss-Adame, Gregory Dion, David Francis, Mami Kaneko, Jerome R Lechien, Stephanie Misono, Anais Rameau, Sabine Roman, Anne Vertigan, Yinglian Xiao, Frank Zerbib, Madeline Greytak, John E Pandolfino, C Prakash Gyawali","doi":"10.14309/ajg.0000000000003482","DOIUrl":"10.14309/ajg.0000000000003482","url":null,"abstract":"<p><strong>Introduction: </strong>The term laryngopharyngeal reflux (LPR) is frequently applied to aerodigestive symptoms despite lack of objective reflux evidence. The aim of this initiative was to develop a modern care paradigm for LPR supported by otolaryngology and gastroenterology disciplines.</p><p><strong>Methods: </strong>A 28-member international interdisciplinary working group developed practical statements within the following domains: definition/terminology, initial diagnostic evaluation, reflux monitoring, therapeutic trials, behavioral factors and therapy, and risk stratification. Literature reviews guided statement development and were presented at virtual/in-person meetings. Each statement underwent 2 or more rounds of voting per the RAND Appropriateness Method; statements reaching appropriateness with ≥80% agreement are included as recommendations.</p><p><strong>Results: </strong>The term laryngopharyngeal symptoms (LPS) applies to aerodigestive symptoms with potential to be induced by reflux and include cough, voice change, throat clearing, excess throat phlegm, and throat pain. Laryngopharyngeal reflux disease (LPRD) refers to patients with LPS and objective evidence of reflux. Importantly, the presence of LPS does not equate to LPRD. Laryngoscopy has value in assessing for nonreflux laryngopharyngeal processes, but laryngoscopic findings alone cannot diagnose LPRD. LPS patients should be categorized as with or without concurrent esophageal reflux symptoms. While lifestyle modification and empiric trials of acid suppression ± alginates are appropriate when esophageal reflux symptoms coexist, upper endoscopy and ambulatory reflux monitoring are required for LPRD diagnosis when symptoms persist, when LPS is isolated, or when management needs to be escalated to include invasive antireflux management. The two recommended ambulatory reflux monitoring modalities, 24-hour pH-impedance and 96-hour wireless pH monitoring, are not mutually exclusive with distinct roles for the evaluation of LPS. Laryngeal hyperresponsiveness and hypervigilance commonly contribute to both LPS and LPRD presentations and are responsive to laryngeal recalibration therapy and neuromodulators.</p><p><strong>Discussion: </strong>The San Diego Consensus represents the formal modern-day interdisciplinary care paradigm to evaluate and manage LPS and LPRD.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802275","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}