Florence Wong, Hugo E Vagas, K Rajender Reddy, Mangesh R Pagadala, Christine Pocha, Vinay Sundaram, Jasmohan S Bajaj, Eran Shlomovitz, Emily Bendel, Jeroen Capel, Patrick S Kamath
{"title":"The Effects of Alfapump on Ascites Control and Quality of Life in Patients With Cirrhosis and Recurrent or Refractory Ascites.","authors":"Florence Wong, Hugo E Vagas, K Rajender Reddy, Mangesh R Pagadala, Christine Pocha, Vinay Sundaram, Jasmohan S Bajaj, Eran Shlomovitz, Emily Bendel, Jeroen Capel, Patrick S Kamath","doi":"10.14309/ajg.0000000000003300","DOIUrl":"10.14309/ajg.0000000000003300","url":null,"abstract":"<p><strong>Introduction: </strong>The alfapump system has been shown to be a possible alternative to repeat therapeutic paracentesis (TP) in selected patients with refractory ascites (RA). The objective of this study was to assess the safety and efficacy of alfapump on ascites control and quality of life in these patients.</p><p><strong>Methods: </strong>Patients with cirrhosis and RA requiring ≥2 TPs 30 days prior were enrolled and followed for 24 months postimplant. Primary efficacy end point assessed at 6 months was reduction in paracentesis requirement; safety end point was device-related adverse events resulting in intervention, explant, or death.</p><p><strong>Results: </strong>Forty patients with RA (mean Model of End-stage Liver Disease-Sodium: 15 ± 4) received an alfapump. TP requirement was decreased from 3.2 ± 1.5 sessions per month preimplant to 0.2 ± 0.6 sessions per month at 6 months postimplant ( P < 0.001), with 77% of patients having ≥50% reduction. Six pumps (15%) were explanted within 6 months due to device-related adverse events, 3 (7.5%) due to pump site skin erosion, and 3 (7.5%) due to bladder discomfort. Twenty-four renal events occurred in the 0-6 month postimplant period; 16 cases were readily reversible stage 1 acute kidney injury. Ascites-related symptoms assessed with an Ascites Q score improved from 51.0 ± 19.3 preimplant to 32.2 ± 21.9 at 6 months postimplant ( P < 0.001). Physical but not mental components of Short Form 36 improved ( P < 0.001). The 5 deaths within 6 months postimplant were not directly related to the device or alfapump therapy.</p><p><strong>Discussion: </strong>The alfapump system effectively controlled ascites, which improved quality of life. It may be considered as an alternative to repeat TP in select patients with RA. Complication rates were similar to those expected in patients with RA.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2291-2301"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930592","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}
Linda Jiang, Keming Yang, Melissa Saul, Ravy K Vajravelu, Robert E Schoen
{"title":"Multitarget Stool DNA Testing for Colorectal Cancer Screening in Clinical Practice.","authors":"Linda Jiang, Keming Yang, Melissa Saul, Ravy K Vajravelu, Robert E Schoen","doi":"10.14309/ajg.0000000000003276","DOIUrl":"10.14309/ajg.0000000000003276","url":null,"abstract":"<p><strong>Introduction: </strong>Few studies have evaluated multitarget stool DNA (mt-sDNA) in clinical practice. We analyzed mt-sDNA utilization at the University of Pittsburgh Medical Center.</p><p><strong>Methods: </strong>We assessed mt-sDNA orders between January 1, 2017, and December 31, 2021. Data collection included electronic capture of mt-sDNA orders, completed stool submissions, and test results. Multivariable models were used to assess associations between mt-sDNA completion and results and age, sex, and race.</p><p><strong>Results: </strong>There were 91,664 mt-sDNA orders in 73,704 patients. A total of 54.7% (40,337/73,704) completed an mt-sDNA test, and 7,424 (18.6%) tested positive. Completion rates increased by age <50-59 years (N = 12,818; 48.2%), 60-69 years (14,982; 56.3%), and ≥70 years (N = 9,850; 55.6%) ( P < 0.0001). The completion rate for males (52.7%; 15,297/29,025) did not differ significantly from females (53.3%; 22,353/41,901) ( P = 0.09). By race, the completion rates of White patients (54.1%; 34,874/64,512) and Asian patients (56.9%; 493/867) were higher than those of Black patients (38.8%; 1,699/4,376) ( P < 0.0001). Test completion declined with repeat mt-sDNA orders, with ≤32% completion rate after ≥3 orders. In a multivariable model, older age was associated with greater likelihood of a positive test (odds ratio 1.22, 95% confidence interval 1.20-1.24, P < 0.0001), and Black patients had lower odds of a positive test (odds ratio 0.65, 95% confidence interval 0.56-0.76, P < 0.0001).</p><p><strong>Discussion: </strong>Only 54.7% of patients completed their mt-sDNA test order. Older individuals were more likely to complete testing and test positive. Black patients were less likely to complete testing and, unexpectedly, less likely to test positive. Further exploration of mt-sDNA utilization including better understanding of the determinants of uptake, appropriateness, and evaluation of outcomes at colonoscopy is needed.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2415-2421"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942709","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}
Chutian Wu, Giovanni Targher, Christopher D Byrne, Yilei Mao, Tan To Cheung, Yusuf Yilmaz, Luca Valenti, Nahum Méndez-Sánchez, Silvia Sookoian, Wah-Kheong Chan, Sombat Treeprasertsuk, Hon Ho Yu, Seung Up Kim, Jacob George, Dandan Hu, Giada Sebastiani, John D Ryan, Rodolfo J Oviedo, Jian-Hong Zhong, Jörn M Schattenberg, Amedeo Lonardo, Elena Ruiz-Úcar, Wai-Kay Seto, Mohammadjavad Sotoudeheian, Ponsiano Ocama, Monica Lupşor-Platon, Tian Yang, Hasmik Ghazinyan, Qiuwei Pan, Saeed Hamid, Leon Adams, Jin Chai, Arun Prasad, Nilanka Perera, Khalid Alswat, Vasily Isakov, Shiv Kumar Sarin, Ala I Sharara, Faisal M Sanai, Said A Al-Busafi, Christopher Kenneth Opio, Carlos Jesus Toro-Huamanchumo, Wah Yang, Yu Jun Wong, Guido Torzilli, Yasser Fouad, Ming-Hua Zheng
{"title":"Global, Regional, and National Burden of Primary Liver Cancer Attributable to Metabolic Risks: An Analysis of the Global Burden of Disease Study 1990-2021.","authors":"Chutian Wu, Giovanni Targher, Christopher D Byrne, Yilei Mao, Tan To Cheung, Yusuf Yilmaz, Luca Valenti, Nahum Méndez-Sánchez, Silvia Sookoian, Wah-Kheong Chan, Sombat Treeprasertsuk, Hon Ho Yu, Seung Up Kim, Jacob George, Dandan Hu, Giada Sebastiani, John D Ryan, Rodolfo J Oviedo, Jian-Hong Zhong, Jörn M Schattenberg, Amedeo Lonardo, Elena Ruiz-Úcar, Wai-Kay Seto, Mohammadjavad Sotoudeheian, Ponsiano Ocama, Monica Lupşor-Platon, Tian Yang, Hasmik Ghazinyan, Qiuwei Pan, Saeed Hamid, Leon Adams, Jin Chai, Arun Prasad, Nilanka Perera, Khalid Alswat, Vasily Isakov, Shiv Kumar Sarin, Ala I Sharara, Faisal M Sanai, Said A Al-Busafi, Christopher Kenneth Opio, Carlos Jesus Toro-Huamanchumo, Wah Yang, Yu Jun Wong, Guido Torzilli, Yasser Fouad, Ming-Hua Zheng","doi":"10.14309/ajg.0000000000003288","DOIUrl":"10.14309/ajg.0000000000003288","url":null,"abstract":"<p><strong>Introduction: </strong>The global burden of metabolic diseases is increasing, but estimates of their impact on primary liver cancer are uncertain. We aimed to assess the global burden of primary liver cancer attributable to metabolic risk factors, including high body mass index (BMI) and high fasting plasma glucose (FPG) levels, between 1990 and 2021.</p><p><strong>Methods: </strong>The total number and age-standardized rates of deaths and disability-adjusted life years (DALYs) from primary liver cancer attributable to each metabolic risk factor were extracted from the Global Burden of Disease Study 1990-2021. The metabolic burden trends of liver cancer across regions and countries by sociodemographic index (SDI) and sex were estimated. The annual percentage changes in age-standardized DALYs rate were also calculated.</p><p><strong>Results: </strong>Globally, in 2021, primary liver cancer attributable to high BMI and/or high FPG was estimated to have caused 59,970 deaths (95% uncertainty interval [UI] 20,567-104,103) and 1,540,437 DALYs (95% UI 540,922-2,677,135). The age-standardized rates of death and DALYs were 0.70 (95% UI 0.24-1.21) and 17.64 (95% UI 6.19-30.65) per 100,000 person-years. A consistent global rise in liver cancer attributable to metabolic risks was observed from 1990 to 2021, with high BMI identified as the major contributing risk factor. The highest burden of deaths and DALYs of liver cancer consistently occurred in high SDI countries, while the fastest growth trends were observed in low-middle SDI countries. The burdens of high levels of BMI and FPG were higher in men than in women.</p><p><strong>Discussion: </strong>Primary liver cancer attributable to high BMI and/or high FPG imposes an increasingly substantial clinical burden on global public health, particularly in high SDI countries. Rapid growth trends are also found in middle SDI countries.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2280-2290"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920416","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}
Simon J Hong, Rahul S Dalal, Kristine A Kuhn, Andrew Stahly, Frank I Scott, Benjamin H Click, Anna Way, Fardina Malik, John M Davis, Manar Shmais, Laura E Raffals, Alexa Silfen, David T Rubin, Ishaan Dharia, Abhik Bhattacharya, Bahar Moghaddam, Trayton Mains, Jayde Kurland, Sheena Patel, Michael H Weisman, Joerg Ermann, Reem Jan
{"title":"Prevalence and Risk Factors of Spondyloarthritis Symptoms in a US-Based Multicenter Cohort of Patients With Inflammatory Bowel Disease.","authors":"Simon J Hong, Rahul S Dalal, Kristine A Kuhn, Andrew Stahly, Frank I Scott, Benjamin H Click, Anna Way, Fardina Malik, John M Davis, Manar Shmais, Laura E Raffals, Alexa Silfen, David T Rubin, Ishaan Dharia, Abhik Bhattacharya, Bahar Moghaddam, Trayton Mains, Jayde Kurland, Sheena Patel, Michael H Weisman, Joerg Ermann, Reem Jan","doi":"10.14309/ajg.0000000000003292","DOIUrl":"10.14309/ajg.0000000000003292","url":null,"abstract":"<p><strong>Introduction: </strong>Spondyloarthritis (SpA), the most common extraintestinal manifestation of inflammatory bowel disease (IBD), is reported in up to 39% of patients with IBD. Despite this high prevalence, risk factors of developing SpA in patients with IBD are not well described. In this study, we aimed to determine the factors associated with SpA symptoms and their prevalence in an IBD cohort.</p><p><strong>Methods: </strong>Two validated screening questionnaires for the detection of SpA in IBD (DETAIL = DETection of Arthritis in Inflammatory boweL diseases, IBIS-Q = IBD Identification of Spondyloarthritis Questionnaire) were administered to patients with IBD without a prior diagnosis of SpA in 6 US academic medical centers. Demographic data, IBD characteristics, and medication history were recorded.</p><p><strong>Results: </strong>Screening questionnaires were completed by 588 patients (220 ulcerative colitis, 349 Crohn's disease, and 19 IBD-unclassified), with a median age of 40 years (interquartile range 30-53) and median disease duration of 12 years (interquartile range 6-22). The number of positive screens was 130 (22%) for DETAIL, 196 (33%) for IBIS-Q, and 204 (35%) for either DETAIL or IBIS-Q. Age, female sex, history of smoking, prior bowel surgery, and history of any biologic or targeted small molecule exposure were associated with a positive screen on univariate analysis. After multivariate analysis, female sex (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.41-2.93), older age (OR 1.02, 95% CI 1.01-1.04), history of smoking (OR 1.67, 95% CI 1.04-2.69), and history of any biologic or targeted small molecule exposure (OR 2.27, 95% CI 1.34-3.84) were independently associated with positive screens. Higher number of biologic exposures was associated with higher risk of positive screens, with the highest risk seen with 3 or more exposures (OR 3.25, 95% CI 1.75-6.03).</p><p><strong>Discussion: </strong>A substantial number of patients with IBD screen positive for SpA symptoms, indicating a potentially high burden of undiagnosed illness. Factors associated with SpA symptoms include older age, female sex, and more severe disease (based on increased number of advanced therapies or prior surgery), whereas IBD phenotype does not independently increase the risk of a positive SpA screen. Further studies are needed to confirm these findings and better characterize SpA in IBD.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2330-2338"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930513","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}
Ekaterina Plys, Jean-Luc Bulliard, Aziz Chaouch, Marie-Anne Durand, Luuk A van Duuren, Karen Braendle, Reto Auer, Florian Froehlich, Iris Lansdorp-Vogelaar, Douglas A Corley, Kevin Selby
{"title":"Colorectal Cancer Screening Based on Predicted Risk: A Randomized Controlled Trial.","authors":"Ekaterina Plys, Jean-Luc Bulliard, Aziz Chaouch, Marie-Anne Durand, Luuk A van Duuren, Karen Braendle, Reto Auer, Florian Froehlich, Iris Lansdorp-Vogelaar, Douglas A Corley, Kevin Selby","doi":"10.14309/ajg.0000000000003311","DOIUrl":"10.14309/ajg.0000000000003311","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer (CRC) screening relies primarily on colonoscopy and fecal immunochemical testing (FIT). Aligning utilization of these options with individual CRC risk may optimize benefit with lower risks, individual burden, and societal costs. We studied the effect of communicating personalized CRC risk and corresponding screening recommendations on risk-appropriate screening uptake in an organized screening setting.</p><p><strong>Methods: </strong>Randomized controlled trial among residents aged 50-69 years not yet invited for screening in Vaud, Switzerland. The intervention was a mailed brochure communicating individual 15-year CRC risk and screening recommendation. The control group received a usual brochure comparing FIT and colonoscopy. The primary outcome was self-reported risk-appropriate screening (FIT if <3% risk, FIT or colonoscopy if ≥3% and <6%, and colonoscopy if ≥6%) at 6 months. A secondary outcome was overall screening uptake.</p><p><strong>Results: </strong>Of 5,396 invitations, 1,059 people responded (19%) of whom 258 were randomized to intervention and 257 to control materials (average 15-year risk 1.4% [SD = 0.5], age 52.2 years [SD = 2.2], 51% women). Risk-appropriate screening completion was 37% in the intervention group and 23% in the control group (absolute difference 14%, 95% confidence interval 6%-22%). Overall screening uptake was 50% in the intervention group and 49% in the control group (absolute difference 1%, 95% confidence interval -7% to 10%).</p><p><strong>Discussion: </strong>In a population not known to be at elevated CRC risk, brochures providing personalized CRC risk and screening recommendations improved risk-appropriate screening without impacting overall screening uptake. This approach could be helpful for aligning screening methods, risks, and benefits with cancer risk and resource allocation.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2432-2439"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942715","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}
Luis Garrido-Trevino, Soongjin Ahn, Elliot B Tapper, Olivia C Walker, Gerald Ogola, Sumeet K Asrani
{"title":"Diagnosis of Acute-on-Chronic Liver Failure in Critically Ill Patients With Cirrhosis Using Administrative Data.","authors":"Luis Garrido-Trevino, Soongjin Ahn, Elliot B Tapper, Olivia C Walker, Gerald Ogola, Sumeet K Asrani","doi":"10.14309/ajg.0000000000003422","DOIUrl":"10.14309/ajg.0000000000003422","url":null,"abstract":"<p><strong>Introduction: </strong>We evaluated the positive predictive value (PPV) of International Classification of Diseases, Tenth Revision ( ICD-10 ) codes used to identify organ failures in critically ill patients with cirrhosis.</p><p><strong>Methods: </strong>A cohort of 315 hospitalized cirrhosis patients was analyzed. PPVs were calculated using chart review as the reference standard.</p><p><strong>Results: </strong>Three hundred four patients had an ICD-10 code for cirrhosis. The PPV for liver failure was 33.0%, kidney failure 71.4%, respiratory failure 79.9%, circulatory failure 84.0%, and brain failure 33.3%. Adding laboratory thresholds increased PPVs.</p><p><strong>Discussion: </strong>ICD-10 codes accurately identify organ failures in critically ill patients with cirrhosis and may be helpful for identifying cases of acute-on-chronic liver failure within administrative data.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2443-2447"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646958","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}
Puru Rattan, Joseph C Ahn, Beatriz Sordi Chara, Aidan F Mullan, Kan Liu, Zachi I Attia, Paul A Friedman, Alina Allen, Vijay H Shah, Patrick S Kamath, Peter A Noseworthy, Douglas A Simonetto
{"title":"Training and Performance of an Electrocardiogram-Enabled Machine Learning Model for Detection of Advanced Chronic Liver Disease.","authors":"Puru Rattan, Joseph C Ahn, Beatriz Sordi Chara, Aidan F Mullan, Kan Liu, Zachi I Attia, Paul A Friedman, Alina Allen, Vijay H Shah, Patrick S Kamath, Peter A Noseworthy, Douglas A Simonetto","doi":"10.14309/ajg.0000000000003433","DOIUrl":"10.14309/ajg.0000000000003433","url":null,"abstract":"<p><strong>Introduction: </strong>Building on prior results, we hypothesized that an electrocardiogram (ECG)-enabled machine learning (ML) model could be used to detect advanced chronic liver disease (CLD).</p><p><strong>Methods: </strong>A cohort with CLD and 12-lead ECGs was matched with controls from electronic health records. A ML model was trained as a binary classifier.</p><p><strong>Results: </strong>There are 12,930 patients with CLD and 64,577 controls in the cohort. The model's discriminative ability to classify CLD showed an area under the receiver-operating characteristic curve 0.858 (95% confidence interval: 0.850-0.866), and at the chosen threshold, CLD ECGs had 12 times higher odds of being classified as CLD (diagnostic odds ratio 12.33, 95% confidence interval: 11.16-13.63).</p><p><strong>Discussion: </strong>An ECG-enabled ML model affords great promise in identifying advanced CLD in low resource areas.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2452-2456"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717758","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":"Continuing Medical Education Questions: October 2025.","authors":"Zubair Khan","doi":"10.14309/ajg.0000000000003748","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003748","url":null,"abstract":"<p><p>Article Title: Cardiovascular Risk from Metabolic Dysfunction-Associated Steatotic Liver Disease, Cardiometabolic Risk Factor Count, and Their Longitudinal Changes: A Nationwide Cohort Study.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"120 10","pages":"2236"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224632","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}
Nayna A Lodhia, Brent Hiramoto, Laura Horton, Alison H Goldin, Walter W Chan
{"title":"Obesity Is Independently Associated With Increased Risk of Fecal Incontinence and Altered Rectal Sensitivity.","authors":"Nayna A Lodhia, Brent Hiramoto, Laura Horton, Alison H Goldin, Walter W Chan","doi":"10.14309/ajg.0000000000003308","DOIUrl":"10.14309/ajg.0000000000003308","url":null,"abstract":"<p><strong>Introduction: </strong>Hindgut symptoms are poorly understood complications of obesity. The impact of obesity on fecal incontinence (FI) and anorectal physiology remains unclear, with inconsistent results in prior studies. We aimed to evaluate the relationship between obesity and FI, and the physiological changes in anorectal function.</p><p><strong>Methods: </strong>This was a retrospective cohort study of consecutive adults who underwent high-resolution anorectal manometry (HRAM) at a tertiary center for anorectal symptoms. Demographics, clinical history, surgical/obstetric history, medications, and HRAM findings were reviewed. Patients were classified as nonobese (body mass index [BMI] <25 kg/m 2 ), overweight (BMI 25-29.9 kg/m 2 ), class I obesity (30-34.9 kg/m 2 ), and class II + III obesity (>35 kg/m 2 ). The Fisher exact/Student t test for univariate analyses and logistic/general linear regression for multivariable analyses were performed.</p><p><strong>Results: </strong>A total of 552 adults were included. The mean BMI was higher among patients with FI (27.5 vs 25.9 kg/m 2 , P = 0.013). Compared with the nonobese group, FI was more prevalent in class II + III obesity (31.7% vs 13.2%, P = 0.0024), but not class I obesity or overweight groups. On multivariable analysis controlling for potential confounders, class II + III obesity (adjusted odds ratio 2.89, 95% confidence interval 1.28-6.50, P = 0.02) remained an independent risk factor of FI. Among patients with FI, both BMI (β-coefficient 1.09, P = 0.016) and class II + III obesity (β-coefficient 18.9, P = 0.027) independently predicted increased first rectal sensation volume on HRAM on multivariable regression.</p><p><strong>Discussion: </strong>Classes II + III obesity was an independent risk factor of FI. Among patients with FI, increasing BMI and class II + III obesity were associated with altered rectal sensitivity. Anorectal function testing should be considered to help guide management of FI among patients with obesity.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2373-2381"},"PeriodicalIF":7.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12234804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942721","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}
Virendra Singh, Arun K Sharma, Lakshmi R Narasimhan, Ashish Bhalla, Navneet Sharma, Ratiram Sharma
{"title":"Correction to: Granulocyte Colony-Stimulating Factor in Severe Alcoholic Hepatitis: A Randomized Pilot Study.","authors":"Virendra Singh, Arun K Sharma, Lakshmi R Narasimhan, Ashish Bhalla, Navneet Sharma, Ratiram Sharma","doi":"10.14309/ajg.0000000000003739","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003739","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136374","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}