American Journal of Gastroenterology最新文献

{"title":"Cancer Risks in Attenuated and Classical Familial Adenomatous Polyposis: A Nationwide Cohort with Matched, Non-Exposed Individuals: Cancer and surgery in AFAP and FAP patients.","authors":"Søren Hammershøj Beck, John Gásdal Karstensen, Steffen Bülow, Klaus Kaae Andersen, Thomas van Overeem Hansen, Helle Højen, Niels Jespersen, Tine Plato Kuhlmann, Hans Christian Pommergaard, Mads Damgaard Wewer, Laus Wullum, Anne Marie Jelsig, Johan Burisch","doi":"10.14309/ajg.0000000000003167","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003167","url":null,"abstract":"<p><strong>Introduction: </strong>Familial adenomatous polyposis (FAP) is caused by pathogenic variants in the APC gene. FAP is usually categorized according to phenotype: classical FAP (CFAP) and attenuated FAP (AFAP); the latter is considered to have a milder disease course. We aimed to assess the risk of overall and specific cancers in CFAP and AFAP patients compared to matched, non-exposed individuals.</p><p><strong>Methods: </strong>All known Danish FAP patients were classified as either CFAP or AFAP and assigned four matched, non-exposed individuals. The risk of overall and specific cancers, and mortality were analyzed.</p><p><strong>Results: </strong>The analysis included 311 CFAP patients, 134 AFAP patients, and 1,600 non-exposed individuals. The overall cancer risk was significantly higher for both CFAP and AFAP patients than for non-exposed individuals, with hazard ratios (HR) of 4.77 (95% confidence interval (CI), 3.61-6.32; P<0.001) for CFAP and 3.22 (95% CI, 2.16-4.80; P<0.001) for AFAP. No significant difference was observed when comparing CFAP and AFAP (HR=1.48; 95% CI, 0.98-2.25; P=0.0646). The HR of colonic cancer was 2.16 (95% CI, 0.99-7.72; P=0.0522) and 2.72 (95% CI, 1.19-6.22; P=0.0177 for CFAP and AFAP), respectively compared to non-exposed and did not differ between CFAP and AFAP patients (HR=0.80; 95% CI, 0.32-2.00; P=0.6278). Mortality was significantly higher in CFAP (HR=2.96; 95% CI, 2.04-4.28; P<0.001), but not in AFAP (HR=1.40; 95% CI, 0.73-2.69; P=0.311).</p><p><strong>Conclusion: </strong>Nationwide data reveal differing risk profiles for specific cancers and mortality in AFAP and CFAP compared to non-exposed individuals. The cancer burden of AFAP necessitates consistent monitoring of these patients.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543115","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":"Comparing Right-sided Colon Adenoma and Serrated Polyp Miss Rates with Water Exchange and CO2 Insufflation: A Randomized Controlled Trial.","authors":"Chi-Liang Cheng, Jui-Hsiang Tang, Yu-Hsi Hsieh, Yen-Lin Kuo, Kuan-Chieh Fang, Chih-Wei Tseng, I-Chia Su, Chun-Chao Chang, Yi-Ning Tsui, Bai-Ping Lee, Ke-Yun Zou, Yun-Shien Lee, Felix W Leung","doi":"10.14309/ajg.0000000000003168","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003168","url":null,"abstract":"<p><strong>Introduction: </strong>Postcolonoscopy colorectal cancers primarily occur in the right-sided colon because of missed adenomas and serrated polyps (SPs). Water exchange (WE) improves cleanliness and visibility of the right-sided colon. We hypothesized that WE could reduce the right-sided colon adenoma (rAMR) and SP miss rate (rSPMR) compared to standard colonoscopy.</p><p><strong>Methods: </strong>We randomly assigned 386 colonoscopy patients to insertion with either WE or CO2 insufflation. During the first withdrawal, polypectomies were performed up to the hepatic flexure. A second endoscopist, blinded to the insertion technique, reexamined the right-sided colon. The miss rate was determined by dividing the number of additional adenomas or SPs by the total number detected in both examinations. The primary outcome was the combined rAMR and rSPMR.</p><p><strong>Results: </strong>WE significantly decreased the combined rAMR and rSPMR (22.2% vs 32.2%, P < 0.001) and rSPMR alone (22.5% vs 37.1%, P = 0.002) compared to CO2 insufflation, but not rAMR (21.8% vs 29.8%, P = 0.079). Additionally, WE significantly increased the detection of SP per colonoscopy (SPPC) in the right-sided colon (0.95 ± 1.56 vs 0.50 ± 0.79, P < 0.001). Multivariate logistic regression analysis showed that ≥2 SPs in the right-sided colon was an independent predictor of rSPMR (odds ratio [OR], 3.47; 95% confidence interval [CI], 1.89─6.38), along with a higher right-sided colon Boston Bowel Preparation Scale score (OR, 0.55; 95% CI, 0.32─0.94).</p><p><strong>Conclusions: </strong>The significant reduction in rSPMR and increase in right-sided colon SPPC suggest that colonoscopy insertion using WE is a valid alternative to CO2 insufflation (Clinical trial registration number: NCT04124393).</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543116","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":"Social Disadvantage and Disparities in Chronic Liver Disease: A Systematic Review.","authors":"Bima J Hasjim, Alexandra Harris, Salva N Balbale, Joy E Obayemi, Molly Beestrum, Praneet Polineni, Mitchell Paukner, Mohsen Mohammadi, Oriana C Dentici, Kiarri N Kershaw, Marquita W Lewis-Thames, Sanjay Mehrotra, Daniela P Ladner","doi":"10.14309/ajg.0000000000003171","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003171","url":null,"abstract":"<p><strong>Introduction: </strong>Social determinants of health (SDOH) may impact chronic liver disease (CLD) outcomes but are not clearly understood. We conducted a systematic review to describe the associations of SDOH with mortality, hospitalizations, and readmissions among patients with CLD.</p><p><strong>Methods: </strong>This review was registered (PROSPERO ID: CRD42022346654) and identified articles through MEDLINE, Embase, Cochrane Library, and Scopus databases. The review included studies that reported SDOH characteristics within the domains of economic stability, health care access, education, social and community context, and the neighborhood built environment. Associated outcomes of interest were mortality, hospitalizations, or readmissions. The Cochrane Risk of Bias in Non-randomized Studies for Exposure (ROBINS-E) was used to assess study quality and risk of bias.</p><p><strong>Results: </strong>A total of 5,205 abstracts were screened, 60 articles underwent full-text review, and 27 articles were included in the final review. Poor economic stability, healthcare access, social support, and household/environmental conditions were associated with higher mortality and hospital readmissions among patients with CLD. Increasing distance (≥25 miles away) from a liver transplantation (LT) center was associated with higher mortality despite increasing access to the LT waitlist. When assessing the overall risk of bias among included studies, most had \"Some Concern\" (N=13, 48.1%) or \"High Risk\" (N=11, 40.7%) while a minority had \"Very High Risk\" (N=3, 11.1%). No studies were categorized as \"Low Risk.\"</p><p><strong>Conclusions: </strong>Unfavorable SDOH were associated with increased mortality and hospital readmissions among patients with CLD. Rigorous empirical research is needed to identify evidence-based strategies that aim to mitigate disparities among vulnerable populations.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543123","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":"TM6SF2-rs58542926 genotype has opposing effects on incidence of hepatic and cardiac events in a community cohort: TM6SF2 effects on liver and cardiac outcomes.","authors":"Vincent L Chen, Antonino Oliveri, Chinmay Raut, Yanhua Chen, Kelly C Cushing-Damm, Elizabeth K Speliotes","doi":"10.14309/ajg.0000000000003169","DOIUrl":"10.14309/ajg.0000000000003169","url":null,"abstract":"<p><strong>Background and aims: </strong>TM6SF2-rs58542926-T is associated with increased cirrhosis and modestly decreased coronary artery disease prevalence. However, relative effects of TM6SF2 genotype on major adverse cardiovascular events (MACE) vs. liver-related events (LRE) is not known.</p><p><strong>Approach: </strong>We utilized the UK Biobank, a prospective cohort with genetic and inpatient diagnosis data. The primary predictor was TM6SF2-rs58542926 genotype and the primary outcomes were MACE and LRE. Effects were reported as subhazard ratios (sHR) and 10-year cumulative incidence by Fine-Gray competing risk analyses.</p><p><strong>Results: </strong>>430,000 individuals met inclusion criteria. TM6SF2-rs58542926-TT genotype (vs. CC) was associated with higher incidence of LRE (adjusted sHR 3.16, 95% confidence interval [CI] 1.86-5.37) and lower incidence of MACE (adjusted sHR for TT vs. CC genotype 0.76, 95% CI 0.63-0.91 ). In individuals with Fibrosis-4 (FIB4) <1.3, 1.3-2.67, and >2.67, 10-year LRE incidence in TM6SF2-rs58542926-TT vs. CC individuals was 0.08% vs. 0.06% (p>0.05), 0.81% vs. 0.20% (p<0.0001), and 10.5% vs. 3.4% (p=0.00094), respectively. The corresponding values for MACE were 3.8% vs. 5.1% (p=0.032), 6.4% vs. 8.2% (p=0.040), and 17.1% vs. 12.4% (p>0.05). The absolute decrease in MACE with rs58542926-TT (vs. CC) genotype exceeded the absolute increase in LRE in all groups but FIB4>2.67. Associations of TM6SF2 genotype with LRE/MACE were significant in men but not women. TM6SF2-rs58542926-T allele was also associated with increased hepatic steatosis and corrected T1 time by magnetic resonance imaging, with greater effect sizes in men than women.</p><p><strong>Conclusions: </strong>TM6SF2 genotype has opposite effects on LRE vs. MACE incidence, and absolute effects on MACE were greater except in those with highest FIB4 scores. Effects were strongest in men. These findings clarify implications of TM6SF2 genotype based on personalized clinical risk.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543125","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":"Ulcerative Jejunitis in Celiac Disease: A Thirty-Year U.S. Experience.","authors":"Yevgen Chornenkyy, Masa Peric, David Marin Flores, Yuho Ono, Shweta A Shinagare, Katelyn Dannheim, Sarah Shannahan, Shana Rakowsky, Saja Asakrah, Monika Vyas, Jon Arnason, Daniel Leffler, Ciaran Kelly, Rupa Mukherjee, Amelie Therrien","doi":"10.14309/ajg.0000000000003170","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003170","url":null,"abstract":"<p><strong>Introduction: </strong>Ulcerative jejunitis (UJ) or ulcerative enteritis (UE) is a rare complication of celiac disease (CeD). Guidelines regarding diagnosis and management are missing and these cases have seldom been reported in the United States.</p><p><strong>Design: </strong>Single center case-series of CeD in which UE developed at a large academic center in the USA. Clinical presentation, diagnosis, treatment, and evolution of disease were collected.</p><p><strong>Results: </strong>Eight cases were identified (6M/2F, mean age 59.5 (38-77) years). Presentations included intestinal obstruction (n=3), GI hemorrhage (n=3), and malabsorption (n=2). Ulcers were present in the duodenum in 4 patients, and exclusively past the angle of Treitz in only 4 cases, which makes the term ulcerative enteritis (UE) more appropriate than UJ. Six out of eight had T-cell receptor (TCR) clonal gene rearrangements and two had definite aberrant T cells. Corticosteroids were tried in all patients without improvement and 5 underwent surgical resection. Three patients received cladribine. One patient received an autologous stem cell transplant, followed by ruxolitinib. Two were subsequently diagnosed with enteropathy-associated T-cell lymphoma (EATL), including one with cerebral EATL, and 1 died from hemophagocytic syndrome. Two are still alive, including one only on GFD and two were lost to follow-up after surviving at least 30 months post treatment.</p><p><strong>Conclusion: </strong>UE seems a more appropriate term to describe an ulcerative complication of CeD at high risk of obstruction or bleeding. Steroids were not effective. Treatment outcomes were variable, but with a 50% death rate.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543126","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":"Hereditary Cancer Syndromes.","authors":"Robin Wilson, Nicholas Bartell, Danielle Marino","doi":"10.14309/ajg.0000000000003162","DOIUrl":"10.14309/ajg.0000000000003162","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cloverleaf Esophageal Diverticula.","authors":"Anjali Bhatt, Kenneth Ford, Eitan Podgaetz, Vani Ja Konda, Anh D Nguyen","doi":"10.14309/ajg.0000000000003159","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003159","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Ching-Pin et al.","authors":"Saqr Alsakarneh, Jana G Hashash, Francis A Farraye, Hassan Ghoz","doi":"10.14309/ajg.0000000000003102","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003102","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Dahly and Morris.","authors":"Varol Tunali, Beyza Hilal Ermiş, Özkan Ufuk Nalbantoğlu","doi":"10.14309/ajg.0000000000003109","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003109","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492925","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":"Nonmalignant dermatologic disorders in Inflammatory Bowel Disease.","authors":"Kim L Isaacs, Christopher J Sayed","doi":"10.14309/ajg.0000000000003155","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003155","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) is associated with extraintestinal manifestations (EIMs) that can affect multiple body systems. EIMs are seen in up to 50 % of patients with IBD. [1] Skin involvement is particularly common occurring in up to 15-20% of patients. [1] Skin reactivity presents in multiple forms with unique pathology. Therapy for IBD also may affect the skin directly though inflammatory processes or indirectly due to skin infections. This review will concentrate on the most common non-malignant dermatologic conditions associated with IBD with a focus on prevalence, diagnostic approaches, and management strategies.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492923","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}