American Journal of Gastroenterology最新文献

{"title":"Reply to Jiang et al.","authors":"Laurens A van Kleef, Willem Pieter Brouwer","doi":"10.14309/ajg.0000000000004177","DOIUrl":"10.14309/ajg.0000000000004177","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"e101-e102"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879022","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":"2026 CME Information.","authors":"","doi":"10.14309/01.ajg.0001208300.09665.2e","DOIUrl":"https://doi.org/10.14309/01.ajg.0001208300.09665.2e","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"121 10","pages":"2371-2372"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102881","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":"How I Approach Refractory Constipation Symptoms.","authors":"Yuying Luo, Laurie Keefer, Kyle Staller","doi":"10.14309/ajg.0000000000004061","DOIUrl":"10.14309/ajg.0000000000004061","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2357-2360"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148025652","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":"Peritoneal Metastasis Mimicking Liver Metastasis in Rectal Cancer.","authors":"Xing Huang","doi":"10.14309/ajg.0000000000003994","DOIUrl":"10.14309/ajg.0000000000003994","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2368"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147632357","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":"High Detection Rates and Associated Factors of Colorectal Serrated Lesions: A Multicenter Prospective Study in the Asia-Pacific.","authors":"Masau Sekiguchi, Yasuhiko Mizuguchi, Jun Konishi, Kenichiro Imai, Hyun-Soo Kim, Daizen Hirata, Rashid N Lui, Jae Myung Cha, Li-Chun Chang, Tiing Leong Ang, Wei Jie Jonathan Lee, Keiko Nakamura, Yasuo Kakugawa, Nozomu Kobayashi, Yutaka Saito, Maki Konno, Kazunori Takada, Yoshihiro Kishida, Kinichi Hotta, Mineo Iwatate, Yasushi Sano, Louis Ho-Shing Lau, Mee-Yon Cho, Han-Mo Chiu, Tan Chin Kimg, Shigeki Sekine, Yoshitaka Murakami, Takahisa Matsuda","doi":"10.14309/ajg.0000000000003979","DOIUrl":"10.14309/ajg.0000000000003979","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal serrated lesions (SLs) are recognized as precursors of colorectal cancer (CRC); however, their detection rates and prevalence remain inadequately defined. We aimed to assess their detection rates and estimate their prevalence in the Asia-Pacific, as well as to examine their associated factors.</p><p><strong>Methods: </strong>This was a multicenter prospective study in the Asia-Pacific. Asymptomatic individuals aged 40-74 years undergoing first-time colonoscopy for CRC screening were prospectively enrolled. To ensure precise prevalence estimates, colonoscopy procedures involved repeated proximal colon inspection using panchromoendoscopy with indigo carmine dye. Detection rates of proximal SLs and sessile serrated lesions (SSLs) were calculated. Mixed-effects logistic regression analyses, accounting for institution-level variability, were performed to identify factors associated with proximal SL and SSL detection. Associations between SLs and synchronous advanced colorectal neoplasia were evaluated.</p><p><strong>Results: </strong>Among 965 participants, detection rates of proximal SLs and SSLs were 16.1% (95% confidence interval [CI], 13.8-18.5) and 8.6% (6.9-10.6), respectively. Institutional differences affected detection of proximal SLs (adjusted median odds ratio [OR], 1.44; 95% CI, 1.25-1.79) and SSLs (1.34; 1.18-1.62). A family history of CRC was associated with higher SSL detection (adjusted OR, 2.36; 95% CI, 1.29-4.33). Detection of proximal SLs was associated with synchronous advanced colorectal neoplasia (OR, 1.94; 95% CI, 1.24-3.02 and 1.90; 1.18-3.07, respectively).</p><p><strong>Discussion: </strong>This multicenter study demonstrates that detection rates and estimated prevalence of SLs are higher than previously reported in the Asia-Pacific and highlights the impact of institutional differences, challenging the notion of their low regional prevalence.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2545-2554"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147289062","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 Bidirectional Relationship Between Cognitive Function and Active Inflammatory Bowel Disease.","authors":"Bharati Kochar, Adam S Faye, Elizabeth Araka, Rachel Glasser, Aarushi Gupta, Alison Rusher, Poonam Beniwal-Patel, Sara Horst, Hans Herfarth, Christine S Ritchie, Ashwin N Ananthakrishnan","doi":"10.14309/ajg.0000000000003965","DOIUrl":"10.14309/ajg.0000000000003965","url":null,"abstract":"<p><strong>Introduction: </strong>Cognitive impairment, a precursor to dementia, is an important geriatric syndrome. We aimed to describe cognitive function in adults 60 years or older with inflammatory bowel disease (IBD) and determine the relationship between cognitive function and IBD activity.</p><p><strong>Methods: </strong>We recruited patients with IBD 60 years or older from 6 American centers. We collected demographics, IBD history, administered IBD activity indices, and the Montreal Cognitive Assessment (MoCA). Follow-up assessments were nested in routine clinical care within 1 year. The primary outcome was change in cognitive function testing at follow-up; secondary outcome was IBD activity at follow-up. We constructed multivariate logistic regression models to assess for the outcomes.</p><p><strong>Results: </strong>We recruited 356 patients with a median age of 70 years (range: 60-89 years), 51% female, 66% had at least a bachelor's degree; median IBD duration was 18 years, and 60% had Crohn's disease. At baseline, 42% screened positive for cognitive impairment. Deficits in delayed recall and visuospatial functioning were the most prevalent. At follow-up within a year, 31% demonstrated an improved MoCA score, while 19% had a worse MoCA score. Adjusting for age, race, education, depression, number of comorbidities, IBD type, IBD duration, and cognitive function score at baseline, symptomatically active IBD at baseline was significantly associated with worsening cognitive testing at follow-up (aOR: 3.01, 95% CI: 1.20-7.50). We also found that deficits in delayed recall, a MoCA subdomain, were significantly associated with symptomatically active IBD at follow-up (aOR: 2.22, 95% CI: 1.10-4.47).</p><p><strong>Discussion: </strong>These data provide further impetus to effectively treat IBD in older adults and suggest that delayed recall could be a useful screening tool for older adults with IBD.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2513-2521"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177398","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":"Adjunctive Use of p53 Immunohistochemistry for Risk Stratification in Barrett's Esophagus: A Systematic Review and Meta-Analysis.","authors":"Tarek Sawas, Perica Davitkov, Margaret Zhou, Swathi Eluri, David A Leiman, Aaron P Thrift, Siddharth Singh, John Inadomi, David Katzka, Joel H Rubenstein, Matthew Stachler, Sachin Wani","doi":"10.14309/ajg.0000000000003977","DOIUrl":"10.14309/ajg.0000000000003977","url":null,"abstract":"<p><strong>Introduction: </strong>The adjunctive use of p53 immunohistochemistry has been proposed as a potential tool to improve risk stratification in Barrett's esophagus (BE) with conflicting results. We performed a systematic review and meta-analysis to evaluate the performance of p53 in predicting progression to advanced neoplasia (high-grade dysplasia [HGD] and esophageal adenocarcinoma [EAC]) among patients with BE.</p><p><strong>Methods: </strong>We searched multiple databases for studies that evaluated the use of aberrant p53 in esophageal biopsies among patients with BE and reported progression rates to HGD/EAC. The outcomes were p53 test characteristics and incidence and risk ratio (RR) for progression to HGD/EAC in patients with and without aberrant p53 using random effects models.</p><p><strong>Results: </strong>Among the 27 included studies, the proportion of patients with aberrant p53 expression at baseline was 20% (95% CI: 14%, 27%). The rate of progression with and without aberrant p53 was 8 per 100 person-years (95% CI: 6, 11) and 0.3 per 100 person-years (95% CI: 0.1, 0.6), respectively. Compared with patients without aberrant p53 expression, those with aberrant p53 had a higher risk for progression to HGD/EAC in cohort studies (RR = 10.2 [95% CI: 6.9, 15.0]) and case control studies (RR = 3.3 [95% CI: 2.5, 4.4]). The sensitivity for progression for non-dysplastic Barrett's esophagus and low-grade dysplasia/indefinite for dysplasia was 42% and 77% and specificity was 96% and 76%, respectively.</p><p><strong>Discussion: </strong>While aberrant p53 expression has been associated with an increased risk of progression to advanced neoplasia in patients with BE undergoing surveillance, the diagnostic characteristics are suboptimal precluding uniform clinical adoption. Prospective studies with standardized grading protocols are needed to determine whether p53-guided surveillance strategies can meaningfully improve patient outcomes.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2411-2422"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281673","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":"Merel M Verweij, Michiel T J Bak, Annemarie C de Vries, Ilse Molendijk, Oddeke van Ruler","doi":"10.14309/ajg.0000000000004178","DOIUrl":"10.14309/ajg.0000000000004178","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"e100"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918120","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":"Model for End-Stage Liver Disease-Lactate and Lactate Clearance in Critically Ill Cirrhosis Patients With Sepsis.","authors":"Rehma Shabbir, Luis Garrido-Trevino, Jacqueline G O'Leary, Ashok Chaudhary, Rakhi Maiwall, Vinod Arora, Harshvardhan V Tevethia, Shiv K Sarin, Lauren Hall, Gerald O Ogola, Patrick S Kamath, Sumeet K Asrani","doi":"10.14309/ajg.0000000000003934","DOIUrl":"10.14309/ajg.0000000000003934","url":null,"abstract":"<p><strong>Introduction: </strong>A Model for End-Stage Liver Disease-lactate (MELD-LA) score is an independent predictor of inpatient mortality and organ failure validated in more than 8,600 patients across diverse settings. However, its utility in sepsis, particularly when combined with lactate clearance (LA clearance), has not been fully evaluated. In this study, we examined the dynamic role of MELD-LA with 24-hour LA clearance as a predictor of 30-day mortality in critically ill patients with cirrhosis and sepsis.</p><p><strong>Methods: </strong>We analyzed cirrhosis patients with sepsis admitted to the intensive care unit (ICU) in a large US healthcare system (20 hospitals) from 2014 to 2022, examining MELD-LA and LA clearance within 24 hours as predictors of 30-day mortality. We externally validated our findings in the Asian Pacific Association for the Study of the Liver-acute-on-chronic liver failure Research Consortium, a multinational Asian cohort (31 centers) from 2009 to 2019.</p><p><strong>Results: </strong>A total of 3,879 cirrhosis patients with sepsis were admitted to the ICU (43.2% female, 20.5% Hispanic, 12.4% on dialysis; mean initial LA 4.5 mmol/L, MELD 20.8, MELD-LA 17.6). Survivors showed a median lactate change of -1.04 (35% clearance) compared with -0.4 (12%) for nonsurvivors. LA clearance within 24 hours was influenced by the presenting MELD-LA. In the North American cohort, ≥35% LA clearance was associated with improved 30-day survival (odds ratio 0.41, 95% CI 0.31-0.53; P < 0.001). Similarly, in the Asian Pacific Association for the Study of the Liver cohort (n = 1,259), ≥35% clearance was linked to a 60% reduction in mortality (odds ratio 0.42, 95% CI 0.28-0.62; P < 0.001). When stratified by LA clearance, patients with LA clearance of ≥35% had a higher percentage of early administration of resuscitative measures than those with LA clearance of < 10% especially regarding early antibiotic administration (82.5% vs 67.6%; P value <0.001).</p><p><strong>Discussion: </strong>Early reduction in initial LA by one-third predicts 30-day mortality and may indicate treatment response in cirrhosis patients with sepsis in the ICU. Combining MELD-LA and LA clearance early enables better risk stratification and informs management.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2483-2491"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146049706","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 Impact of Body Weight Change on Liver Histology in Metabolic Dysfunction-Associated Steatotic Liver Disease Across Various Histological Endpoints: A Systematic Review and Meta-Analysis.","authors":"Dujinthan Jayabalan, Sugam Dhakal, Jeffrey Chandra, Daniel A Fasser, Gary P Jeffrey, George Garas, Eduardo Vilar-Gomez, Luis Calzadilla-Bertot, Leon A Adams","doi":"10.14309/ajg.0000000000003918","DOIUrl":"10.14309/ajg.0000000000003918","url":null,"abstract":"<p><strong>Introduction: </strong>Weight loss is the cornerstone of treatment for metabolic dysfunction-associated liver disease (MASLD); however, its impact on liver histology across patient subgroups remains incompletely characterized. This systematic review and meta-analysis aimed to quantify the effects of body weight change across multiple histological endpoints in patients with biopsy-proven MASLD.</p><p><strong>Methods: </strong>PubMed, EMBASE, MEDLINE (Ovid), and Google Scholar were searched from inception for trials reporting percentage change in body weight in MASLD or metabolic dysfunction-associated steatohepatitis (MASH) patients with paired liver biopsies. Proportions of patients achieving the primary outcomes: Complete resolution of MASH without worsening of fibrosis and ≥1-stage fibrosis improvement without worsening of MASH were analyzed using random-effects proportional meta-analysis. Revised Cochrane risk of bias tool for randomized trials 2 and Risk of Bias in Nonrandomized Studies of Interventions I were used for assessing risk of bias.</p><p><strong>Results: </strong>Twenty-six studies with 1,963 participants were included. Proportion attaining complete resolution of MASH without worsening of fibrosis was 0.12 (95% confidence interval [CI]: 0.08-016, I 2 = 76%) which significantly improved with observed weight loss >3% (0.25, 95% CI: 0.20-0.30, P < 0.001). Mean age significantly contributed to heterogeneity ( P = 0.021, R 2 = 43%). Proportion attaining ≥1-stage fibrosis improvement without worsening of MASH was 0.17 (95% CI: 0.13-0.22, I 2 = 62%). No significant differences were found based on baseline body mass index, type 2 diabetes mellitus prevalence, or Hispanic/Latino ethnicity.</p><p><strong>Discussion: </strong>Even modest observed weight loss is associated with MASH resolution. MASH resolution and ≥1-stage fibrosis improvement are not affected by body mass index, type 2 diabetes mellitus, or Hispanic/Latino ethnicity, reinforcing the importance of lifestyle interventions across populations. The proportions observed serve as benchmark estimates of histological response for future clinical trial design.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2449-2464"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931759","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}