American Journal of Gastroenterology最新文献

{"title":"Letter to the Editor.","authors":"Bodhisatwa Choudhuri","doi":"10.14309/ajg.0000000000004035","DOIUrl":"10.14309/ajg.0000000000004035","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"e98"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148025628","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":"Calendar of Courses, Symposiums and Conferences.","authors":"","doi":"10.14309/ajg.0000000000004163","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004163","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"121 10","pages":"2585"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149102838","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":"Evolving Concepts of Treatment Targets for Primary Biliary Cholangitis: A Global Perspective.","authors":"Christopher L Bowlus, Paulo L Bittencourt, Billal Bobat, Aliya Gulamhusein, Kris Kowdley, Cynthia Levy, Ana Lleo, Xiong Ma, Atushi Tanaka","doi":"10.14309/ajg.0000000000004054","DOIUrl":"10.14309/ajg.0000000000004054","url":null,"abstract":"<p><p>Primary biliary cholangitis (PBC) is a chronic cholestatic disease that if left untreated can progress to cirrhosis, end-stage liver disease, liver transplantation and, ultimately, death. PBC occurs worldwide, with rising prevalence in the North American, European, and Asia-Pacific regions. Ursodeoxycholic acid (UDCA) is the globally recommended first-line treatment, but up to half of UDCA-treated patients do not respond adequately. Fortunately, the PBC treatment landscape has evolved, and new treatments with novel mechanisms of action are available for patients with inadequate response to UDCA, but questions remain. Different treatment strategies have emerged in recent years from major societies across the globe regarding treatment targets, timing of treatment response assessment, management of hepatic and extrahepatic manifestations, and choice of second-line therapies. Drug availability also has global variation. Nine international PBC experts, representing the United States, Canada, Europe, Asia, Africa, and Central/South America, collaborated to formulate opinions about the unanswered questions related to treatment targets in PBC. The result of this expert review is a global perspective on terminology related to the definition of responses to treatment, risk stratification, and treatment targets that can guide clinicians to optimize PBC treatment worldwide.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2385-2392"},"PeriodicalIF":8.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147961952","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":"Endoscopic Resection of a Rare Colonic Plasmacytoma.","authors":"Ankoor Patel, Keerthana Kesavarapu, Sarag Boukhar, Arvind J Trindade","doi":"10.14309/ajg.0000000000004214","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004214","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029856","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":"Global Paid and Unpaid Productivity Losses Due to Gastrointestinal Cancer Mortality.","authors":"Pojsakorn Danpanichkul, Yanfang Pang, Krittameth Rakwong, Nut Chotkijnanthakul, Donghee Kim, Matheus Souza, Ahmad Anouti, Andrea Ortiz Maldonado, Nikki Duong, Rashid N Lui, Tarek Sawas, Suthat Liangpunsakul, Michael B Wallace, Ju Dong Yang, Amit G Singal","doi":"10.14309/ajg.0000000000004210","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004210","url":null,"abstract":"<p><strong>Objectives: </strong>Gastrointestinal (GI) cancers contribute substantially to premature mortality, yet their full economic burden, including unpaid work, remains underquantified. We aimed to estimate global productivity losses attributable to GI cancer mortality, considering paid and unpaid work.</p><p><strong>Methods: </strong>Years of productive life lost (YPLL) were calculated using data from GLOBOCAN for GI cancer among working-age individuals (15-64 years) across 185 countries. Paid productivity losses were estimated using the human capital approach, while unpaid work was valued via the opportunity cost method. Country-specific wages, labor force participation, and time allocated to unpaid tasks informed these estimates.</p><p><strong>Results: </strong>In 2022, GI cancers caused 1.16 million deaths among adults. The estimated global productivity loss totaled $177.81 billion (United States Dollars; 31.4% of all cancer-related productivity losses). Paid labor accounted for $102.79 billion (57.81%), and unpaid work contributed $75.02 billion (42.19%). By cancer site, losses were highest for liver ($50.45 billion; 28.4%) and colorectal cancer ($49.53 billion; 27.9%). Eastern Asia experienced the largest losses ($67.62 billion). Very-high Human Development Index (HDI) countries accounted for the largest absolute productivity loss ($92.13 billion) and had the highest proportion of losses attributable to unpaid work (45%). Sex-specific analyses indicated that paid work dominated male losses (65%), while unpaid work dominated female losses (59%).</p><p><strong>Conclusions: </strong>GI cancer mortality causes major global productivity losses; over 40% stems from unpaid work that is often missed by standard estimates and disproportionately borne by females. Better measurement of unpaid work is crucial to developing equitable, gender-responsive cancer policies and healthcare investments worldwide.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015298","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":"Comparison of demographic, clinical, and psychological characteristics among patients with irritable bowel syndrome meeting the Rome clinical, Rome V, and Rome IV criteria.","authors":"Jie Wu, Sukunya Thongchuenjit, Xingyang Luo, Hui Yuan, Qian Li, Xiaomei Zhang, Xiaowei Liu","doi":"10.14309/ajg.0000000000004207","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004207","url":null,"abstract":"<p><strong>Background: </strong>The Rome clinical criteria for irritable bowel syndrome (IBS) were introduced to improve clinical applicability and represent an important advancement within the Rome V process. However, their clinical profiles relative to the standard Rome criteria remain unclear.</p><p><strong>Methods: </strong>Consecutive adults with suspected IBS were prospectively recruited at a tertiary outpatient clinic in China. Participants completed symptom questionnaires and underwent clinical investigations to exclude organic disease. Patients were classified into three mutually exclusive groups: meeting Rome clinical criteria only, meeting Rome V only, and meeting Rome IV. We examined diagnostic discordance and compared demographic, clinical, and psychological characteristics across the three groups.</p><p><strong>Results: </strong>Among 685 participants with suspected IBS, 533 (77.8%) met the Rome clinical criteria, 443 (64.7%) met Rome V, and 238 (34.7%) met Rome IV. The Rome IV criteria missed nearly half (46.3%) of Rome V-defined patients. Of those identified by the Rome clinical criteria, 90 (20.3%) were not captured by the Rome V criteria, primarily due to insufficient symptom duration (51.1%) and inadequate symptom frequency (48.9%). These missed patients showed gastrointestinal symptom severity, psychological burden (gastrointestinal-specific anxiety, somatic symptoms, and perceived stress), quality of life impairment, and healthcare utilization comparable to those meeting Rome V only, while both groups were less severe than Rome IV-defined patients (P < 0.001).</p><p><strong>Discussion: </strong>The Rome clinical criteria identify a clinically meaningful IBS population, with approximately one in five individuals missed by the Rome V criteria. These patients have a disease burden comparable to those meeting the Rome V criteria only.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987703","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":"Alcohol-Use Trajectories and Major Adverse Liver Outcomes in MetALD: A Nationwide Longitudinal Cohort Study.","authors":"Jun-Hyuk Lee, Jimin Park, Sung Ho Ahn, So Young Jeon, Hye Sun Lee, Jonghyun Lee, Jonghyun Kim, Hyo Young Lee, Eileen L Yoon, Dae Won Jun","doi":"10.14309/ajg.0000000000004212","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004212","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol contributes to the progression of steatotic liver disease. However, in individuals with MetALD, the impact of changes in drinking behavior on disease progression remains unclear. We investigated whether longitudinal changes in alcohol consumption were associated with the risk of major adverse liver outcomes (MALO) in people with MetALD.</p><p><strong>Methods: </strong>Data were obtained from the Korean National Health Screening Program. Adults with MetALD who completed three screening examinations (2009-2010, 2011-2012, and 2013-2014) were included (n = 85,554). Participants were categorized by alcohol consumption trajectories: Group 1 (sustained consumption), Group 2 (fluctuating consumption), and Group 3 (consistent reduction). The primary outcome was MALO, with cardiovascular death treated as a competing risk. Changes in cardiometabolic risk factors from baseline to the last examination were also evaluated.</p><p><strong>Results: </strong>Over a median follow-up of 10.1 years, 32.9%, 34.6%, and 32.4% of participants were classified into Groups 1, 2, and 3, respectively. Groups 2 and 3 had lower MALO risks than Group 1 (adjusted subdistribution hazard ratios (95% confidence intervals), 0.80 (0.71-0.91) and 0.70 (0.61-0.79), respectively; both P <0.001). Compared with Group 1, Group 3 had higher rates of resolution of impaired fasting glucose, hypertriglyceridemia, and hypertension.</p><p><strong>Discussion: </strong>Alcohol use in MetALD was highly dynamic, and hepatic risk was better captured using longitudinal drinking trajectories. Both intermittent and consistent alcohol reduction were associated with lower MALO risk, with a stronger association for consistent reduction. Consistent reduction was also accompanied by favorable changes in selected cardiometabolic risk factors.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987757","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":"ISOLATED LARYNGOPHARYNGEAL SYMPTOMS DO NOT PREDICT OBJECTIVE REFLUX EVIDENCE: AN INTERNATIONAL MULTICENTER VALIDATION STUDY OF THE SAN DIEGO CONSENSUS PATHWAY FOR SELECTIVE UPFRONT TESTING.","authors":"Walter W Chan, Daniel Carmona-Guerrero, Francesca Forattini, Andrew Jenkins, Rahul Peravali, Ming-Wun Wong, Chien-Lin Chen, Enrique Coss-Adame, Rena Yadlapati, C Prakash Gyawali","doi":"10.14309/ajg.0000000000004208","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004208","url":null,"abstract":"<p><strong>Background: </strong>Laryngopharyngeal symptoms (LPS) refer to upper aerodigestive tract symptoms with etiologic potential for reflux pathophysiology. We aimed to characterize the clinical presentation/evaluation of LPS and identify predictors of laryngopharyngeal reflux disease (LPRD) in an international cohort of patients with LPS.</p><p><strong>Methods: </strong>We included adult patients with LPS presenting for esophageal testing at 5 international tertiary centers in 3 world regions. Demographics, clinical symptoms, validated patient-reported outcome instruments and esophageal testing data were obtained. The diagnostic yield of objective gastroesophageal reflux disease (GERD) evidence was compared across LPS presentations. Univariate and multivariable analyses were performed, reported as odds ratios (OR) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Of 408 patients (age 53.3±0.7 years, 70% female), 135 (33.1%) had isolated LPS and 273 (66.9%) had LPS with typical reflux symptoms. Symptom burden was higher in LPS with typical symptoms (p≤0.004), as was objective GERD evidence (29.7% vs 17.0%, p=0.006), with similar diagnostic yields between wireless and pH-impedance monitoring in both isolated LPS and LPS with typical symptoms (p=0.36). On multivariable logistic regression evaluating predictors for conclusive GERD, typical symptoms (OR 2.71, CI 1.33-5.55, p=0.006), hiatus hernia (OR 1.80, CI 1.24-2.62, p=0.002) and body mass index (OR 1.08, CI 1.03-1.14, p=0.002) and were independent predictors for conclusive GERD, but LPS type and severity did not predict LPRD. Across world regions, symptom burden was higher despite lower GERD evidence in Asian patients.</p><p><strong>Conclusions: </strong>Clinical presentation of isolated LPS is not predictive of LPRD, unlike LPS with typical symptoms. Our findings support the San Diego Consensus recommendations for selective up-front testing in isolated LPS.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987725","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":"Life expectancy and changing causes of mortality in familial adenomatous polyposis (FAP).","authors":"Benjamin Zare, Susan K Clark, Andrew Latchford","doi":"10.14309/ajg.0000000000004205","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004205","url":null,"abstract":"<p><strong>Background: </strong>The impact of modern management on life expectancy in familial adenomatous polyposis (FAP) remains sparsely reported, and recent treatment effects on disease-related causes of death are unclear. This study provides an updated assessment of life expectancy and mortality causes.</p><p><strong>Methods: </strong>Patients born after January 1935 were identified from a prospectively maintained registry with supplementary clinical record review. Retrospective life table analysis compared mortality with a matched UK Office for National Statistics population. Causes of death were analysed by era and stratified by presentation type - newly presenting patients versus screen-detected relatives identified through family screening.</p><p><strong>Results: </strong>Among 1917 patients with FAP, 364 deaths occurred versus 28 expected in the general population. Screen-detected relatives had consistently lower mortality, comparable to the general population (median SMR 0.66; SMR <1 throughout), whereas overall mortality was markedly higher in the unselected cohort (median SMR 11.09; p < 0.01). Newly presenting patients showed persistently elevated mortality across most birth cohorts.Colorectal disease remained the leading cause of death but declined significantly over time (64% pre-2001 to 31% post-2013; p < 0.01). Conversely, deaths from duodenal (3% to 12%; p < 0.01) and gastric disease (1% to 8%; p < 0.01), as well as non-FAP-related causes, increased. Screen-detected relatives had fewer colorectal deaths, particularly in earlier eras, but proportionally more duodenal and non-FAP-related deaths.</p><p><strong>Conclusion: </strong>Recent FAP cohorts now have mortality comparable to the general population. Although colorectal mortality has declined, gastroduodenal and non-FAP-related causes have increased, underscoring the need for continued surveillance and broader long-term management strategies.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987736","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":"COMPARATIVE REAL-WORLD EFFECTIVENESS OF BIOLOGIC THERAPIES FOR PREVENTING POSTOPERATIVE ENDOSCOPIC RECURRENCE OF CROHN'S DISEASE.","authors":"Newaz Shubidito Ahmed, Rakhbeer Boparai, Mashal Fida, Christine Wang, Ashley N Clarke, Nima Hamidi, Anthony R Maclean, William Donald Buie, Mark S Silverberg, Paulo G Kotze, Cathy Lu, Kerri L Novak, Cynthia H Seow, Joelle St-Pierre, Gilaad G Kaplan, Remo Panaccione, Christopher Ma","doi":"10.14309/ajg.0000000000004213","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004213","url":null,"abstract":"<p><strong>Background: </strong>Postoperative recurrence is common after ileocolonic resection for Crohn's disease (CD). Comparative effectiveness data for advanced treatments for preventing recurrence is limited.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study of adults with CD undergoing ileocolonic resection with primary anastomosis in the Calgary Health Zone, Canada (2016-2020). The primary outcome was endoscopic recurrence within 18 months, assessed using the modified Rutgeerts score as an ordinal endpoint. High-risk recurrence (modified Rutgeerts score ≥i2b) was evaluated as a secondary outcome. Propensity scores were estimated using established clinical risk factors and inverse probability of treatment weighting (IPTW) targeting the average treatment effect among treated patients was applied to ordinal and logistic regression models. Treatment effects were expressed as adjusted odds ratios (aOR) with 95% CI.</p><p><strong>Results: </strong>Among 231 patients, 126 (54.5%) received biologic prophylaxis and 92 (39.8%) received no treatment; endoscopy was performed in 217 patients. High-risk endoscopic recurrence occurred in 42.3% (36/85) of untreated patients compared with 9.4% (6/64) receiving TNF antagonists, 27.8% (10/36) receiving ustekinumab, and 10.0% (2/20) receiving vedolizumab. After weighting for established risk factors for recurrence, all biologic strategies were associated with reduced odds of endoscopic recurrence compared to no treatment (aOR 0.15-0.31, all p<0.05). Vedolizumab was associated with lower odds of recurrence compared with ustekinumab (aOR 0.24 [0.06-0.92], p=0.04) but not TNF antagonists (aOR 0.43 [0.10-1.87], p=0.26).</p><p><strong>Conclusions: </strong>In this real-world cohort, biologic prophylaxis is associated with reduced endoscopic recurrence in CD. Both ustekinumab and vedolizumab are effective options, including after prior TNF exposure.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987738","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}