American Journal of Gastroenterology最新文献

{"title":"Proton-Pump Inhibitor Use and Cardiovascular Adverse Event Risk.","authors":"Shih-Wei Lai, Kuan-Fu Liao","doi":"10.14309/ajg.0000000000003381","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003381","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750728","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":"Overall and Cause-Specific Mortality in Patients with Barrett's Esophagus: A Systematic Review and Meta-Analysis of Population-Based Studies.","authors":"Tarek Sawas, Alex R Jones, Rand Alsawas, Rachna Talluri, Hayley Rogers, Olgert Bardhi, David Spezia-Lindner, Danielle Gerberi, Siddharth Singh, M Hassan Murad, Nicholas J Shaheen, David A Katzka, Sachin Wani","doi":"10.14309/ajg.0000000000003456","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003456","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend endoscopic surveillance of Barrett's esophagus (BE), but do not account for competing mortality unrelated to esophageal cancer (EC). We conducted a systematic review and meta-analysis to estimate EC and non-EC mortality risk in BE patients.</p><p><strong>Method: </strong>We searched multiple databases for studies reporting mortality in BE. We included population-based studies providing standardized mortality ratio (SMR). The primary outcome was SMR from all causes, EC and non-EC etiologies. SMR was calculated by dividing the observed mortality over the expected mortality. Logarithmic form of SMRs were pooled using random effects model.</p><p><strong>Results: </strong>Our search yielded 2826 articles, of which 7 studies (n=34,454) were included. All-cause mortality was elevated in BE patients compared to population controls [pooled SMR 1.24 (95% CI:1.01 - 1.53)] driven in part by increased EC mortality risk [SMR 8.98 (95 CI:5.12-15.77)]. The mortality risk was still increased but attenuated after excluding EC mortality [SMR:1.21 (95% CI:1-1.46)]. There was no increased mortality risk for non-EC malignancies [SMR:1.22 (95% CI:0.82-1.82)] or mortality due to non-cancer etiologies [SMR:1.13 (95% CI:0.90 - 1.43)]. Death due to cardiovascular diseases was higher in BE [SMR:1.16 (95% CI:1.02-1.33)]. BE patients were 10 times more likely to die from non-cancer etiologies than EC [RR: 10.71 (95% CI: 5.98 - 19.16)]. Subgroup analysis of studies that excluded prevalent EC at baseline (3 studies) also showed increased all-cause [SMR: 1.12 (95% CI: 1.07 - 1.18) and EC mortality [SMR 4.7 (95% CI: 3.58 - 6.17)] among BE patients.</p><p><strong>Conclusion: </strong>BE patients exhibit a higher all-cause mortality, driven in part by risk of EC mortality. A personalized approach to surveillance, mitigating risk of EC while recognizing the broader mortality risks, is warranted.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750726","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":"Liver Cleansing Imposters: An Analysis Of Popular Online Liver Supplements.","authors":"Ahmed Telbany, Abhishek Vasantkumar Patel, Pooja Viswanath, Evelyn Inga, Swathi Paleti","doi":"10.14309/ajg.0000000000003451","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003451","url":null,"abstract":"<p><strong>Background: </strong>The liver supplement market is rapidly expanding, yet the efficacy and safety of these products remain largely unsubstantiated. This study aimed to analyze the best-selling liver \"cleansing\" supplements on Amazon®, the leading online retailer in the United States.</p><p><strong>Methods: </strong>We identified the top 20 liver cleanse supplements on Amazon® using specific search criteria. Product composition, marketing claims, customer reviews, sales data, and revenue were analyzed. AMZScout® was used for sales analytics, and FakeSpot® for review authenticity assessment. The most common ingredients were identified, and their scientific evidence evaluated through structured PubMed searches with predefined criteria for evidence quality assessment.</p><p><strong>Results: </strong>The 20 top-selling supplements generated total annual sales of 1,420,584 units with a revenue of $38,783,937. All products claimed to \"eliminate toxins\" or provide \"liver detox/cleanse,\" while 85% claimed to \"enhance liver function.\" The average product rating was 4.4/5 stars, with review reliability averaging 73% ± 20%. Milk thistle was the most common ingredient (19/20 products), followed by dandelion and turmeric root (13/20 each). Scientific evidence supporting these ingredients' efficacy in liver health was limited and inconclusive.</p><p><strong>Conclusions: </strong>This study reveals a thriving market for liver supplements despite limited scientific evidence supporting their efficacy. The prevalence of bold health claims, high consumer satisfaction, and significant sales highlight the need for more rigorous evaluation and regulation of these products. Healthcare providers should be aware of these trends to better counsel patients on evidence-based approaches to liver health.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750705","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":"Risk of Colorectal Endoscopic Submucosal Dissection in Older Adults: A Nationwide Study in Japan.","authors":"Chikamasa Ichita, Tadahiro Goto, Akiko Sasaki, Kiyohide Fushimi, Sayuri Shimizu","doi":"10.14309/ajg.0000000000003447","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003447","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the risks of colorectal endoscopic submucosal dissection (ESD) in older adult patients, given the increasing number of ESD in an aging population.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the Japanese nationwide database from 2012 to 2023. Patients aged ≥60 who underwent colorectal ESD were included. The primary outcome was overall adverse events (AEs), including in-hospital mortality, procedure-related perforation, abdominal surgery, aspiration pneumonia, and significant post-operative bleeding and thromboembolic events. We first examined the association between age and AEs using multivariable regression adjusting for patient characteristics. Next, to explore the factors associated with overall AEs in those aged ≥85, we fit a multivariable logistic regression.</p><p><strong>Results: </strong>The study included 143,925 cases. Age distribution was as follows: 60-64 (13.5%), 65-74 (44.9%), 75-84 (35.8%), and ≥85 (5.8%). The prevalence of overall AEs increased with age: 5.3% for ages 60-64 years, 7.9% for ages 85-89 and 9.2% for ages ≥90. Patients aged ≥85 had a higher prevalence of overall AEs compared to patients aged 60-64, with an adjusted odds ratio (aOR) of 1.19 (95% confidence interval [CI]: 1.07-1.33, p < 0.01) for those aged 85-89 and an aOR of 1.45 (95% CI: 1.16-1.80, p < 0.01) for those aged ≥90. The majority of AEs in patients aged ≥85 were due to significant post-operative bleeding, with anticoagulant use and body mass index ≥30 identified as key risk factors.</p><p><strong>Conclusions: </strong>The risks of AEs during colorectal ESD increase with age, particularly in patients aged ≥85 years.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750731","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":"Gastric (Foveolar) Dysplasia in Barrett's Esophagus: A Clinical, Molecular and Long-Term Outcome Study.","authors":"Helen H Wang, Yuho Ono, Thomas G Paulson, William M Grady, Robert D Odze","doi":"10.14309/ajg.0000000000003450","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003450","url":null,"abstract":"<p><strong>Background and aims: </strong>The aim of this long-term progression study was to evaluate the clinical and pathologic features of gastric type dysplasia in Barrett's esophagus (BE).</p><p><strong>Methods: </strong>Baseline biopsies from 208 BE patients from the Seattle prospective cohort were evaluated for the type and grade of dysplasia (gastric or intestinal). Twenty-seven patients progressed to cancer and 181 did not over the long term follow up period. Patients with gastric or intestinal dysplasia were compared to each other with regard to their flow cytometric DNA content abnormalities and progression rates to cancer.</p><p><strong>Results: </strong>Of the 59 patients with dysplasia at baseline, 12 (20%) had gastric dysplasia only, 24 (41%) had mixed gastric and intestinal dysplasia, and 23 (39%) had intestinal dysplasia only. Patients with any gastric dysplasia component (alone or mixed with intestinal dysplasia) showed a significantly higher rate of high-grade dysplasia (72% vs 23%, P < 0.001) at baseline and cancer development (47% versus 22%, P = 0.05), and a significantly shorter time frame to cancer development (32 versus 64 months, P = 0.008), as well as a longer BE segment length (P = 0.05), and higher rate of aneuploidy (P = 0.04), compared to patients with pure intestinal dysplasia. By multivariable analysis, gastric dysplasia showed a higher hazard ratio of progression to cancer compared to intestinal dysplasia patients.</p><p><strong>Conclusion: </strong>Gastric type dysplasia is common in BE. Our study suggests that this type of dysplasia may represent a more aggressive form of neoplastic precursor than conventional intestinal type dysplasia.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750698","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 Case of Systemic Sarcoidosis of The Stomach Treated with ESD.","authors":"Muyun Liu, Jie Gao, Chang Sun, Ying Chen, Xingang Shi, Wei An","doi":"10.14309/ajg.0000000000003448","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003448","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750673","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":"Association of Components of Metabolic Syndrome and the Progression of Nonalcoholic Fatty Liver Disease.","authors":"Phuc Le, Moosa Tatar, Michael B Rothberg, Laura A Wilson, Daniela Allende, Anna Mae Diehl, Rohit Loomba, Naga Chalasani, Brent A Neuschwander-Tetri, Kris Kowdley, Arun J Sanyal, James Tonascia, Srinivasan Dasarathy","doi":"10.14309/ajg.0000000000003455","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003455","url":null,"abstract":"<p><strong>Introduction: </strong>The effects of metabolic syndrome (MetS), its individual components, and baseline liver histology, on the rates of progression and regression of nonalcoholic fatty liver disease (NAFLD) were evaluated.</p><p><strong>Methods: </strong>We conducted a post-hoc analysis of a multi-center prospective cohort study using the non-interventional registry of the nonalcoholic steatohepatitis (NASH) Clinical Research Network (2002-2022). We included patients ≥18 years with biopsy-proven NAFLD. Outcomes included progression/regression of histology defined by changes in NAFLD activity score, NASH or fibrosis. Crude incidence rates (IR) were compared among patients with MetS versus those without using Kaplan-Meier curves and log-rank test. Cox proportional hazard models were used to estimate effects of MetS and its components on the fibrosis progression/regression.</p><p><strong>Results: </strong>We included 452 patients; mean age was 51 years, one-third was male, and 85% was White. Median follow-up was 4.3 (range: 1-15.6) years. At baseline, patients with MetS, large waist circumference, and impaired glucose tolerance/diabetes had worse ballooning and fibrosis scores and a higher prevalence of definite NASH than those without. MetS was not associated with fibrosis progression or regression. Impaired glucose tolerance/diabetes was associated with a higher risk for fibrosis progression (aHR=1.61; 95% CI: 1.11-2.34) while hypertension was associated with a lower risk (aHR=0.64; 95% CI: 0.43-0.96).</p><p><strong>Discussion: </strong>In the cohort of NAFLD patients, MetS was associated with greater histological severity at baseline but was not a risk factor for disease progression or regression. Impaired glucose/diabetes was associated with a higher rate and hypertension with a lower rate of fibrosis progression.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750678","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 Practical Guide to the Use of Guselkumab for Moderate-Severe Ulcerative Colitis.","authors":"Maia Kayal","doi":"10.14309/ajg.0000000000003446","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003446","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750676","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":"Loss of response to off-label swallowed topical corticosteroids in eosinophilic esophagitis can be overcome by a switch to an esophageal-targeted budesonide formulation.","authors":"Fritz R Murray, Jean-Benoit Rossel, Ekaterina Safroneeva, Catherine Saner, Bernhard Morell, Andrea Kreienbuehl, Thomas Greuter, Alex Straumann, Luc Biedermann, Alain Schoepfer, Philipp Schreiner","doi":"10.14309/ajg.0000000000003449","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003449","url":null,"abstract":"<p><strong>Objective: </strong>Swallowed topical corticosteroids (STC) are effective in treating patients with eosinophilic esophagitis (EoE). However, real-world data about loss of response to STC are limited and whether patients with off-label STC (olSTC) failure may achieve histologic remission after a switch to budesonide orodispersible tablets (BOT), is unknown.</p><p><strong>Methods: </strong>We analyzed prospectively collected data between 2015 to 2023 from the Swiss Eosinophilic Esophagitis Cohort Study and compared patients with prior histologic olSTC-failure (≥15 eos/hpf), histologic remission after olSTC (<15 eos/hpf) and STC-naïve patients before BOT treatment. Furthermore, we evaluated the course of olSTC-failure patients after a switch to BOT and used logistic regression to explore potential associations between patients with olSTC-failure and clinical factors.</p><p><strong>Results: </strong>A total of 340 patients (76% male, median age = 43 years) with BOT were analyzed. Twenty-six percent had prior olSTC non-response, 16% were in remission with prior olSTC and 58% were STC-naïve. In the multivariable logistic regression, olSTC treatment duration in years (OR 1.37 (95% CI 1.12-1.67, p=0.002), off-label STC adherence <80% in the last two years before BOT (6.30; 1.19-33.29, p =0.03) and age <30 years (6.57; 1.85-23.37, p=0.004) were independently associated with histologic non-response to olSTC. Histologic or combined remission to BOT was not different in patients with prior olSTC response (n=44) compared to patients non-responded to olSTC (n=66) (77.3% vs. 62.1%, p=0.095 and 61.4% vs. 42.4%, p = 0.052).</p><p><strong>Conclusion: </strong>Most patients non-responding to olSTC are not true corticosteroid-refractory but respond to an esophageal-targeted budesonide formulation. Age below 30 years, longer treatment duration and low adherence are associated with olSTC-failure.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750707","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 Vittori et al.","authors":"C Prakash Gyawali, Walter W Chan, Benjamin D Rogers, John E Pandolfino","doi":"10.14309/ajg.0000000000003366","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003366","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727500","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}