American Journal of Gastroenterology最新文献

{"title":"Traditional Serrated Adenomas Associated With Risk of Subsequent High-Risk Polyps and Colorectal Cancer.","authors":"Yufeng Chen, Georgios Polychronidis, Yueyang Zhang, Jiaxian Shen, Yujia Lu, Mengxi Du, Mingyang Song","doi":"10.14309/ajg.0000000000003588","DOIUrl":"10.14309/ajg.0000000000003588","url":null,"abstract":"<p><strong>Introduction: </strong>Traditional serrated adenoma (TSA) is a rare yet established precursor to colorectal cancer (CRC). The risk of colorectal neoplasia after TSA removal remains unclear.</p><p><strong>Methods: </strong>We identified participants without polyps or with TSAs during index colonoscopy from the Mass General Brigham Colonoscopy Cohort (2007-2023). Participants were prospectively followed for recurrence of high-risk polyps and incidence of CRC. We used the time-varying multivariable-adjusted Cox proportional hazards model to estimate the risk of CRC and high-risk polyps associated with baseline diagnosis of TSAs.</p><p><strong>Results: </strong>We identified 109,218 participants without polyps and 252 with TSAs, of whom 35,124 (32%) and 139 (55%) had undergone a follow-up colonoscopy, respectively. TSAs were predominantly located in the distal colon (35%) and rectum (38%), with approximately half sized <10 mm. TSAs tended to demonstrate as a single lesion (84%) but coexist with other types of polyps (70%). Compared with participants without polyps, those with TSAs had higher risk of developing high-risk polyps, high-risk adenomas, high-risk serrated polyps, and CRC, with the hazard ratio (95% confidence interval) of 3.31 (2.35-4.66), 3.07 (2.12-4.44), 6.66 (3.79-11.71), and 7.23 (2.23-23.44), respectively. The risk elevation of high-risk polyps peaked at 3 years post-TSA removal (hazard ratio = 10.85, 95% confidence interval, 6.36-18.52). Among recurrent polyps after TSA removal, 54% (52/96) occurred in the proximal colon and 69% (66/96) was serrated polyps.</p><p><strong>Discussion: </strong>Patients with TSA removal had an elevated risk of colorectal neoplasia, particularly within 3 years after TSA removal, supporting the current US recommendations for a surveillance colonoscopy at 3 years.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257127","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":"Psychomotor Speed From Minimal Hepatic Encephalopathy Testing Is Associated With Physical Frailty in Patients With Advanced Chronic Liver Disease.","authors":"Miguel Sogbe, Randi Wong, Pamela M Bloomer, Alexandra Steinberg, Robert S Rahimi, Jennifer C Lai, Andres Duarte-Rojo","doi":"10.14309/ajg.0000000000003583","DOIUrl":"10.14309/ajg.0000000000003583","url":null,"abstract":"<p><strong>Introduction: </strong>Physical frailty and minimal hepatic encephalopathy (MHE) are common in advanced chronic liver disease (AdvCLD). Although the Psychometric Hepatic Encephalopathy Score is used for MHE diagnosis, its complexity limits routine use. The Stroop EncephalApp (StE) offers a simpler method for MHE diagnosis. We aimed to investigate the association between MHE using the StE and physical frailty by the Liver Frailty Index (LFI), in patients with AdvCLD.</p><p><strong>Methods: </strong>This multicenter study analyzed data from patients with AdvCLD awaiting liver transplantation. Patients were categorized into 2 groups based on the presence or absence of MHE and compared using the LFI and its components. To identify factors influencing the various StE modalities and MHE diagnosis, we used the Spearman rank correlation coefficient and logistic regression models.</p><p><strong>Results: </strong>Of the 267 patients, 73% were diagnosed with MHE, and 18% of the total cohort were classified as frail. Patients with MHE demonstrated poorer LFI scores and were more likely to be categorized as prefrail or frail. Notably, there was a significant correlation between StE time modalities, especially off-time, and the LFI score (rho = 0.438, P < 0.001). Furthermore, multivariable analyses indicated that the LFI was independently associated with MHE (OR 2.41, 95% CI 1.52-3.82).</p><p><strong>Discussion: </strong>The findings suggest that the LFI score in this population reflects its ability to capture the crucial role of psychomotor speed, particularly evident in off-time performance, thus connecting neurocognitive and physical function. Further research is warranted to investigate the effectiveness of interventions targeting cognitive and physical impairments to enhance clinical outcomes in patients with AdvCLD.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245783","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":"Monitoring Inflammatory Bowel Disease Activity: When, How, and Why.","authors":"Jill K J Gaidos, Jana G Hashash","doi":"10.14309/ajg.0000000000003582","DOIUrl":"10.14309/ajg.0000000000003582","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, are disorders caused by inflammation in the gastrointestinal tract leading to a wide variety of symptoms. The presence of symptoms may not always correlate with active intestinal inflammation, and the lack of symptoms does not always indicate control of inflammation. Owing to the variable correlation between clinical symptoms and active intestinal inflammation, the targets for IBD management have been updated to include objective measures of inflammation to complement clinical end points. In addition to clinical remission, these targets include improvements in biochemical markers and endoscopic measures to objectively measure and monitor disease remission. In this review, we will discuss the different strategies for assessing disease activity and the timing of evaluation for each treatment target for outpatient IBD care. We will also highlight the role of radiographic assessment with a focus on intestinal ultrasound for monitoring these treatment end points.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1732-1741"},"PeriodicalIF":7.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245782","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":"Short-Term and Long-Term Outcomes Among a National Cohort of US Veterans Hospitalized for Alcohol-Associated Hepatitis.","authors":"Zeyuan Yang, Judah Kupferman, Wei Zhang, Ashwani K Singal, Michael Ostacher, Ramsey Cheung, Robert J Wong","doi":"10.14309/ajg.0000000000003581","DOIUrl":"10.14309/ajg.0000000000003581","url":null,"abstract":"<p><strong>Introduction: </strong>Excessive alcohol use is highly prevalent among US Veterans, contributing to alcohol-associated hepatitis (AH), a severe form of alcohol-associated liver disease. We evaluate longitudinal outcomes among a national cohort of US Veterans hospitalized with AH.</p><p><strong>Methods: </strong>US Veterans hospitalized with AH from 2010 to 2023 were evaluated to determine the rate of death during index hospitalization and at 28 days and 90 days after hospitalization. Adjusted Cox proportional hazards models evaluated for predictors of aforementioned outcomes. Additional analyses were performed among patients with severe AH with model for end-stage liver disease (MELD) >20.</p><p><strong>Results: </strong>Among 1,560 unique adults hospitalized for AH (58.8% with MELD >20), 6.8% died during index hospitalization, 12.5% within 28 days, and 24.2% within 90 days. Among patients with severe AH with MELD>20, 10.3% died during index hospitalization, 19.2% within 28 days, and 34.9% within 90 days. Older age and increasing number of organ failures were associated with worse outcomes. Black/African Americans had lower risk of death compared with non-Hispanic whites. Treatment with steroids was not associated with significant difference in outcomes among patients with severe AH.</p><p><strong>Discussion: </strong>Among a national cohort of hospitalized Veterans with AH, ∼25% of patients overall and over one-third with severe AH died within 90 days, respectively. These findings emphasize the importance of effective screening for unhealthy alcohol use and prompt linkage to alcohol treatment resources in Veterans to curb this rising epidemic of alcohol-associated liver disease in this vulnerable population.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245784","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":"Little Patients Big Discoveries: Potential Pediatric to Adult Neurogastroenterology Translation.","authors":"Katja Karrento, Peter L Lu, Bruno P Chumpitazi","doi":"10.14309/ajg.0000000000003579","DOIUrl":"10.14309/ajg.0000000000003579","url":null,"abstract":"<p><p>Pediatric neurogastroenterology conditions, including disorders of gut-brain interaction and motility disorders, affect millions of children worldwide. Owing to limited pediatric data, reference ranges and management are often extrapolated from adult studies. We review 4 pediatric neurogastroenterology areas where clinical science may translate and inform adult gastroenterology. Sucrase-isomaltase deficiency can be diagnosed through disaccharidase enzyme testing from duodenal mucosal biopsies. Dietary restriction and sacrosidase supplementation are effective, based on randomized controlled trials, in children with genetic sucrase-isomaltase deficiency; however, they remain to be rigorously studied in adults. Gastric emptying breath testing in large cohorts of children reinforces the importance of biological sex, puberty, and size while deriving normative reference values. Further study of gastric emptying breath testing in adults may help determine the influence of sex and hormones on gastric emptying rates, offering an opportunity to develop tailored reference ranges. Antegrade continence enema therapy is the most common reversible surgical treatment for children with chronic constipation, with high rates of efficacy. Few studies have investigated the efficacy of antegrade continence enema in adult populations. Auricular neurostimulation through percutaneous electrical nerve field stimulation is US Food and Drug Administration approved for use in adolescents with irritable bowel syndrome and functional dyspepsia based on sham-controlled, randomized trials with emerging efficacy data in other pediatric disorders of gut-brain interaction. To date, efficacy studies using auricular neurostimulation in adults with gastrointestinal disorders have not been performed. These areas highlight how pediatric neurogastroenterology generates discoveries with the potential to guide approaches in adult populations, underscoring the bidirectional value of translational clinical science.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1742-1749"},"PeriodicalIF":7.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232966","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":"Racial, Ethnic, and Socioeconomic Disparities in Celiac Disease Trials: A Systematic Review of Participant Diversity and Trial Site Distribution.","authors":"Anthony Kerbage, Jack Loesch, Claire L Jansson-Knodell, Nero Neil, Alberto Rubio-Tapia","doi":"10.14309/ajg.0000000000003580","DOIUrl":"10.14309/ajg.0000000000003580","url":null,"abstract":"<p><strong>Introduction: </strong>Celiac disease (CeD) has traditionally been regarded as a condition affecting non-Hispanic Whites although 10% of cases occur in under-represented minorities. There is growing demand for randomized clinical trials (RCTs) investigating CeD treatments; however, minority participation in CeD trials has not been examined. The aim of this study was to investigate demographic and socioeconomic diversity in RCTs for treatments of CeD.</p><p><strong>Methods: </strong>We conducted a systematic review of RCTs investigating treatments for CeD in the United States. We included studies on serology or biopsy-confirmed CeD conducted domestically. First, participant demographics were analyzed. Second, trial sites were mapped, and county-level demographic and socioeconomic characteristics were compared.</p><p><strong>Results: </strong>We identified 10 RCTs (2011-2023) with 319 participants (mean age: 40.9 years); 70.2% were women. Race was reported in 9 of 10 trials, with 99.6% White and no Black, Asian, or Native American participants. Ethnicity was reported in 4 of 10 trials, with 8.6% Hispanic. Counties without trial sites were more rural, had smaller populations, higher poverty rates, lower incomes, lower educational attainment, and higher Area Deprivation Index scores, indicating greater socioeconomic deprivation.</p><p><strong>Discussion: </strong>Despite efforts to improve minority inclusion in RCTs, significant disparities persist in CeD trials, with minimal racial and ethnic diversity. As demand for pharmacologic treatments grows, future trials must address these gaps through diverse recruitment, equitable site distribution, and targeted outreach to ensure emerging therapies are generalizable and accessible to all patients.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232968","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":"Effectiveness and Safety of Advanced Combination Treatment in Patients With Refractory Inflammatory Bowel Disease or Concomitant Immune-Mediated Disease or Extraintestinal Manifestations: A Multicenter Canadian Study.","authors":"Virginia Solitano, Ropo Ebenezer Ogunsakin, Yuhong Yuan, Charles N Bernstein, Talat Bessissow, Brian Bressler, Frank Hoentjen, Lisa van Lierop, Yvette Leung, Christopher Ma, John Kenneth Marshall, Neeraj Narula, Mohammed Alahmari, Jeffrey D Mccurdy, Sanjay Murthy, Remo Panaccione, Greg Rosenfeld, Raquel Milgrom, Mark Silverberg, Vipul Jairath","doi":"10.14309/ajg.0000000000003573","DOIUrl":"10.14309/ajg.0000000000003573","url":null,"abstract":"<p><strong>Introduction: </strong>Owing to the therapeutic ceiling associated with inflammatory bowel disease (IBD) therapies, some patients may require 2 advanced therapeutic agents, known as advanced combination treatment (ACT) to control disease or treat associated extraintestinal manifestations (EIMs).</p><p><strong>Methods: </strong>We included adult patients with IBD from 9 Canadian centers treated with either 2 biological therapies, a biological plus an oral small molecule, or 2 small molecules. Indications for ACT were the following: (i) refractory IBD, (ii) uncontrolled immune mediated diseases, and (iii) uncontrolled EIMs. Primary outcomes were cumulative rates of clinical and endoscopic response and remission at 6 and 12 months. Secondary outcomes included serious adverse events and infections. Cox-proportional hazard analyses identified independent predictors of treatment effectiveness.</p><p><strong>Results: </strong>We included 105 IBD patients (76 Crohn's disease, 29 ulcerative colitis) with median age 35 years (Interquartile Range 35.4-40.8). At baseline, 39% had perianal involvement, 58% had failed at least 3 advanced therapies, and 40% had previous surgery. The primary reason for ACT was refractory IBD (63.8%), with the add-on approach used in 97.1% cases. The most frequent combination was antitumor necrosis factor + anti-integrin. At 12 months, cumulative rates of clinical and endoscopic response were 60.0% and 32.4%, respectively, and remission rates were 29.5% and 28.6%. Perianal disease was associated with reduced clinical remission (hazard ratio [HR] = 0.33, 95% confidence interval [CI]: 0.17-0.65, P = 0.001) and endoscopic response (HR = 0.42, 95% CI: 0.12-0.50, P = 0.001). Longer disease duration (HR = 0.96, 95% CI: 0.92-0.99, P = 0.035) and baseline steroid use (HR = 0.39, P = 0.006) was associated with reduced clinical remission. Serious adverse events and infections occurred in 12.4% and 7.6% of patients, respectively.</p><p><strong>Discussion: </strong>ACT was effective in achieving clinical and endoscopic outcomes in patients with refractory IBD or concomitant immune-mediated diseases/EIMs, with favorable safety profile.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232953","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":"Different Survival Outcomes of Small Bowel Adenocarcinomas and T-Cell Lymphomas Associated With Celiac Disease.","authors":"Giovanni Santacroce, Alessandro Vanoli, Nicola Aronico, Paola Ilaria Bianchi, Marco Vincenzo Lenti, Carolina Ciacci, Fabiana Zingone, Umberto Volta, Antonio Calabrò, Luca Elli, Rachele Ciccocioppo, Gino Roberto Corazza, Marco Lucioni, Marco Paulli, Antonio Di Sabatino","doi":"10.14309/ajg.0000000000003574","DOIUrl":"10.14309/ajg.0000000000003574","url":null,"abstract":"<p><strong>Introduction: </strong>Small bowel adenocarcinoma (SBA) and T-cell lymphoma (TCL) are rare but aggressive malignancies associated with celiac disease (CD).</p><p><strong>Methods: </strong>We retrospectively compared 43 CD-associated SBA and 43 CD-associated TCL across international referral centers.</p><p><strong>Results: </strong>CD-associated SBA showed a significantly ( P < 0.01) better survival than CD-associated TCL. TCL more frequently presented with multifocal involvement and advanced stage, whereas SBA predominantly involved the jejunum. Refractoriness to a gluten-free diet was identified in 70% of TCL but only in one SBA.</p><p><strong>Discussion: </strong>Our findings demonstrated a worse prognosis of CD-associated TCL in comparison with CD-associated SBA.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232952","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 Comprehensive Review of Gastrointestinal Manifestations in Cystic Fibrosis in the Era of Highly Effective Modulator Therapy.","authors":"Pavithra Saikumar, Sophia Izhar, Brett Rossow, Zachary Sellers, Dhiren Patel","doi":"10.14309/ajg.0000000000003571","DOIUrl":"10.14309/ajg.0000000000003571","url":null,"abstract":"<p><p>Cystic fibrosis (CF) is a multifaceted genetic disorder impacting the respiratory, gastrointestinal, and hepatobiliary systems, necessitating a multidisciplinary approach for management. Its effects are observed throughout all stages of life, from infancy to adulthood, with gastrointestinal manifestations varying at each stage, including conditions such as meconium ileus and gastroparesis. Given its wide range of differential diagnoses and implications, a thorough understanding of its associated conditions is crucial for healthcare professionals. Monitoring CF involves tracking growth and development, as nutritional decline can impede patient progress. Quality of life can differ significantly based on treatment approaches, underscoring the importance of effective therapeutic strategies. The introduction of highly effective modulators has notably improved the clinical course of CF. However, CF providers have begun to identify previously unrecognized nutritional issues such as obesity and eating disorders with the advent of highly effective modulators. With variations in gastrointestinal clinical manifestations and treatment offerings between pediatric and adult providers, it is important to review CF gastrointestinal (GI) diseases in depth encompassing the entire spectrum of the gut health in CF for the larger benefit of pediatric and adult GI providers who may not be primarily focused on CF care. With this article, we aim to empower both pediatric and adult GI providers in dealing with CF GI symptoms effectively in their clinical practice as we see more patients with CF living longer and hope to contribute to their betterment and achieving fulfilling lives.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232951","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 Safety of Pharmacotherapy for Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis.","authors":"Jonathan A Busam, Nisha Batta, Eric D Shah, LiJin Joo, Caroline Marshall, Ali Rezaie, Mark Pimentel","doi":"10.14309/ajg.0000000000003572","DOIUrl":"10.14309/ajg.0000000000003572","url":null,"abstract":"<p><strong>Introduction: </strong>Understanding the safety of pharmacotherapy for irritable bowel syndrome (IBS) enables individuals to make informed treatment decisions. While many studies include the number needed to treat to highlight therapeutic benefits, adding the number needed to harm (NNH), a measure we evaluate herein, could enable more comprehensive risk-benefit assessments.</p><p><strong>Methods: </strong>PubMed, Web of Science, and Cochrane databases were searched through October 2024. Clinical trials investigating IBS pharmacotherapies including discontinuation rates because of adverse events (AEs) were included. Data were pooled using a random-effects model. The primary outcome was NNH for each pharmacotherapy, defined as the reciprocal of the absolute difference in risk of AEs leading to treatment discontinuation between the experimental and placebo groups. Secondary outcomes included the relative risk of withdrawing because of an AE and the most common AEs for each drug.</p><p><strong>Results: </strong>Fifty-four trials met inclusion criteria. For constipation-predominant IBS pharmacotherapies, the NNH for linaclotide, lubiprostone, plecanatide, tegaserod, and tenapanor was 35 ( P < 0.01), 53 ( P = 0.59), 59 ( P < 0.01), 58 ( P = 0.03), and 16 ( P < 0.01), respectively. For diarrhea-predominant IBS pharmacotherapies, the NNH for alosetron and eluxadoline was 14 ( P < 0.01) and 32 ( P < 0.01) whereas the NNH for both rifaximin and ramosetron was a negative, although statistically insignificant, value. For IBS global symptom pharmacotherapies, the tricyclics, the NNH was 24 ( P < 0.01). Many AEs were transient without long-term sequela.</p><p><strong>Discussion: </strong>Among pharmacotherapies for IBS, tricyclics (especially at elevated doses), tenapanor, and alosetron have the highest absolute risk of discontinuation because of an AE when compared with rifaximin, the safest pharmacotherapy studied.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232969","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}