American Journal of Gastroenterology最新文献

{"title":"The Role of P-CABs in GERD.","authors":"Colin W Howden","doi":"10.14309/ajg.0000000000003140","DOIUrl":"10.14309/ajg.0000000000003140","url":null,"abstract":"<p><p>Potassium-competitive acid blockers (P-CABs) constitute a relatively new class of gastric acid-suppressing drugs. Among this class, vonoprazan is the first to have been approved in the United States. However, some P-CABs including vonoprazan, tegoprazan, and fexuprazan have been available in other countries since at least 2014. The first aim of this article is to review pharmacological differences between P-CABs that are currently approved or in development with proton pump inhibitors. The specific focus thereafter is on the likely role of P-CABs in the treatment of different manifestations of gastroesophageal reflux disease. Multiple clinical trials have compared P-CABs with proton pump inhibitors in erosive esophagitis. Additional trials have compared P-CABs with placebo in nonerosive reflux disease. Relevant results are reviewed, and inferences are drawn for their use in the United States. Finally, consideration is given to additional, potential uses of P-CABs in the broader spectrum of gastroesophageal reflux disease, and some suggestions are made for future research initiatives.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"993-998"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492929","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":"Expected 8-Week Prenatal vs 12-Week Perinatal Tenofovir Alafenamide Prophylaxis to Prevent Mother-to-Child Transmission of Hepatitis B Virus: A Multicenter, Prospective, Open-Label, Randomized Controlled Trial.","authors":"Qing-Lei Zeng, Yi-Hua Zhou, Xiao-Ping Dong, Ji-Yuan Zhang, Guang-Ming Li, Jiang-Hai Xu, Zhi-Min Chen, Ning Song, Hong-Xu Zhang, Ru-Yue Chen, Xue-Yan Lv, Shuo Huang, Wei-Zhe Li, Ya-Jie Pan, Ying-Hua Feng, Zhi-Qin Li, Guo-Fan Zhang, Wan-Bao Lin, Guo-Qiang Zhang, Guo-Tao Li, Wei Li, Yan-Li Zeng, Da-Wei Zhang, Guang-Lin Cui, Jun Lv, Yan-Min Liu, Hong-Xia Liang, Chang-Yu Sun, Fu-Sheng Wang, Zu-Jiang Yu","doi":"10.14309/ajg.0000000000003122","DOIUrl":"10.14309/ajg.0000000000003122","url":null,"abstract":"<p><strong>Introduction: </strong>The course of maternal antiviral prophylaxis to prevent mother-to-child transmission of hepatitis B virus (HBV-MTCT) varies greatly, and it has not been demonstrated in a randomized controlled study.</p><p><strong>Methods: </strong>In this multicenter, open-label, randomized controlled trial, eligible pregnant women with HBV DNA of 5.3-9.0 log 10 IU/mL who received tenofovir alafenamide fumarate (TAF) from the first day of 33 gestational weeks to delivery (expected 8 week) or to 4 weeks postpartum (expected 12 week) were randomly enrolled at a 1:1 ratio and followed until 6 months postpartum. All infants received standard immunoprophylaxis (hepatitis B immunoglobulin and vaccine). The primary end point was the safety of mothers and infants. The secondary end point was the HBV-MTCT rate of infants at the age of 7 months.</p><p><strong>Results: </strong>Among 119 and 120 intention-to-treat pregnant women, 115 and 116 women were followed until delivery, and 110 and 112 per-protocol mother-infant dyads in 2 groups completed the study. Overall, TAF was well tolerated, no one discontinued the therapy due to adverse events (0/239, 0%, 95% confidence interval [CI] 0%-1.6%), and no infant had congenital defects or malformations at delivery (0/231, 0%, 95% CI 0%-1.6%). The infants' physical development at birth (n = 231) and at 7 months (n = 222) was normal. Furthermore, 97.0% (224/231, 95% CI 93.9%-98.5%) of women achieved HBV DNA <5.3 log 10 IU/mL at delivery. The intention-to-treat and per-protocol infants' HBV-MTCT rates were 7.1% (17/239, 95% CI 4.5%-11.1%) and 0% (0/222, 95% CI 0%-1.7%) at the age of 7 months. Comparatively, 15.1% (18/119, 95% CI 9.8%-22.7%) vs 18.3% (22/120, 95% CI 12.4%-26.2%) of women in the 2 groups had mildly elevated alanine aminotransferase levels at 3 months and 6 months postpartum, respectively ( P = 0.507); notably, no one experienced alanine aminotransferase flare (0% [0/119, 95% CI 0%-3.1%] vs 0% [0/120, 0%-3.1%]).</p><p><strong>Discussion: </strong>Maternal TAF prophylaxis to prevent HBV-MTCT is generally safe and effective, and expected 8-week prenatal duration is feasible. ClinicalTrials.gov , NCT04850950.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1045-1056"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387269","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 Zhou et al.","authors":"Gro Askgaard, Peter Jepsen, Morten Daniel Jensen, Anna Emilie Kann, Joanne Morling, Frederik Kraglund, Tim Card, Colin Crooks, Joe West","doi":"10.14309/ajg.0000000000003305","DOIUrl":"10.14309/ajg.0000000000003305","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1157-1158"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447998","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":"Visual Endoscopic Retrograde Appendicitis Therapy Vs Antibiotic Therapy for Treatment of Uncomplicated Acute Appendicitis.","authors":"Ke Zhan, Yang Bai, Tianyu Liu, Xing Su, Qingqing Yang, Yang Liu, Xiangrong Zhou, Yichuan Zhang, Jianhua Tang, Zheng Jiang, Xin Yang, Weihui Liu","doi":"10.14309/ajg.0000000000003118","DOIUrl":"10.14309/ajg.0000000000003118","url":null,"abstract":"<p><strong>Introduction: </strong>Visual endoscopic retrograde appendicitis therapy (V-ERAT) involves a single-use video scope, allowing for real-time visualization of the appendiceal lumen during the procedure to treat uncomplicated acute appendicitis (AA). This study aims to compare V-ERAT to antibiotic therapy in treating uncomplicated AA.</p><p><strong>Methods: </strong>This multicenter, retrospective cohort study was conducted at 9 hospitals in China from August 2021 to July 2023. Propensity score matching was performed to minimize selection bias. A total of 692 uncomplicated AA patients were included, with 188 undergoing V-ERAT and 504 receiving antibiotic therapy. The primary outcome was treatment success rate. The secondary outcomes included recurrent appendicitis rate, the appendectomy rate during the initial hospitalization, length of initial hospitalization, time to disease recurrence, and overall adverse events.</p><p><strong>Results: </strong>The treatment success rate did not differ between the V-ERAT and antibiotic groups (93.6%; 95% confidence interval [CI] 89.1%-96.7% vs 90.5%; 95% CI, 87.6%-92.9%) ( P = 0.225). However, V-ERAT demonstrated a significantly lower risk of appendicitis recurrence compared with antibiotic therapy during the follow-up (log-rank P < 0.001), with a hazard ratio of 0.14 (95% CI, 0.07-0.29, P < 0.001). V-ERAT was associated with a lower appendectomy rate during the initial hospitalization (4.3%; 95% CI, 1.9%-8.2% vs 9.5%; 95% CI, 7.1%-12.4%) ( P = 0.027), a shorter length of initial hospitalization (3 [interquartile range (IQR), 3-4] vs 4 [IQR, 4-6] days, P < 0.001), and a longer time to recurrence (269 [IQR, 210-318] vs 70 [IQR, 21-103] days, P < 0.001). The overall adverse event rates did not differ between the 2 groups (log-rank P = 0.064).</p><p><strong>Discussion: </strong>V-ERAT seems to be a safe and effective alternative to antibiotic therapy in treating uncomplicated AA, significantly reducing the risk of appendicitis recurrence.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1036-1044"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387274","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":"Safety and Effectiveness of Glucagon-like Peptide-1 Receptor Agonists in Inflammatory Bowel Disease.","authors":"Scott R Anderson, Malek Ayoub, Sarah Coats, Scott McHenry, Tingyi Tan, Parakkal Deepak","doi":"10.14309/ajg.0000000000003208","DOIUrl":"10.14309/ajg.0000000000003208","url":null,"abstract":"<p><strong>Introduction: </strong>The safety and effectiveness of glucagon-like peptide receptor agonists (GLP1-RA) in patients with inflammatory bowel disease (IBD) are poorly understood.</p><p><strong>Methods: </strong>Patients with IBD treated with GLP1-RA were retrospectively identified for outcomes of adverse events, weight change, and clinical, endoscopic, and biomarker response.</p><p><strong>Results: </strong>Among a total of 120 patients with IBD, gastrointestinal side effects being the most common (11.5%). Semaglutide showed the most significant weight reduction. C-reactive protein levels decreased after one year ( P = 0.005). No differences were observed in IBD-related hospitalizations or endoscopic scores.</p><p><strong>Discussion: </strong>GLP1-RA therapy appears safe and effective, with an associated C-reactive protein reduction, in patients with IBD.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1152-1155"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881096","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":"HLA DQA1*05 and Risk of Antitumor Necrosis Factor Treatment Failure and Anti-Drug Antibody Development in Children With Crohn's Disease.","authors":"Jeremy Adler, Joseph A Galanko, Rana Ammoury, Keith J Benkov, Athos Bousvaros, Brendan Boyle, José M Cabrera, Kelly Y Chun, Jill Dorsey, Dawn R Ebach, Ann M Firestine, Ajay S Gulati, Hans H Herfarth, Traci W Jester, Jess L Kaplan, Ian Leibowitz, Tiffany M Linville, Peter A Margolis, Phillip Minar, Zarela Molle-Rios, Jonathan Moses, Kelly Olano, Dinesh S Pashankar, Lisa Pitch, Shehzad A Saeed, Charles M Samson, Kelly Sandberg, Steven J Steiner, Jennifer A Strople, Jillian S Sullivan, Prateek D Wali, Michael D Kappelman","doi":"10.14309/ajg.0000000000003135","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003135","url":null,"abstract":"<p><strong>Introduction: </strong>Human leukocyte antigen (HLA) DQA1*05 has been associated with the development of anti-drug antibodies (ADA) to tumor necrosis factor antagonists (anti-TNFα) and treatment failure among adults with Crohn's disease (CD). However, findings from other studies have been inconsistent with limited pediatric data.</p><p><strong>Methods: </strong>We analyzed banked serum from patients with CD aged <21 years enrolled in clinical outcomes of Methotrexate Binary Therapy in practice, a multicenter, prospective randomized trial of anti-TNFα monotherapy vs combination with methotrexate. The primary outcome was a composite of factors indicative of treatment failure. The secondary outcome was ADA development.</p><p><strong>Results: </strong>A trend toward increased treatment failure among HLA DQA1*05-positive participants was not significant (hazard ratio 1.58, 95% confidence interval [CI] 0.95-2.62; P = 0.08). After stratification by HLA DQA1*05 and by methotrexate vs placebo, patients who were HLA DQA1*05 negative and assigned to methotrexate experienced less treatment failures than HLA DQA1*05-positive patients on placebo (hazard ratio 0.31, 95% CI 0.13-0.70; P = 0.005). A trend toward increased ADA development among HLA DQA1*05-positive participants was not significant (odds ratio 1.96, 95% CI 0.90-4.31, P = 0.09). After further stratification, HLA DQA1*05-negative participants assigned to methotrexate were less likely to develop ADA relative to HLA DQA1*05-positive patients on placebo (odds ratio 0.12, 95% CI 0.03-0.55; P = 0.008).</p><p><strong>Discussion: </strong>In a randomized trial of children with CD initiating anti-TNFα, 40% were HLA DQ-A1*05 positive, which was associated with a trend toward increased risk of both treatment failure and ADA. These risks were mitigated, but not eliminated, by adding oral methotrexate. HLA DQ-A1*05 is an important biomarker for prognosis and risk stratification.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"120 5","pages":"1076-1086"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972843","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.0000000000003395","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003395","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"120 5","pages":"1161"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956242","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 Underlying Causes of Secondary Bile Acid Diarrhea May Confound Cancer Risk.","authors":"Christian Borup, Nynne Nyboe Andersen, Signe Wildt, Aske Thorn Iversen, Gry Juul Poulsen, Tine Jess, Lars Kristian Munck","doi":"10.14309/ajg.0000000000003146","DOIUrl":"10.14309/ajg.0000000000003146","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1158-1159"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612371","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":"2025 CME Information.","authors":"","doi":"10.14309/ajg.0000000000003228","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003228","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"120 5","pages":"946-947"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962068","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":"Resurgent Inflation and Its Impact on Medicare Reimbursements for Outpatient Gastroenterology Procedures.","authors":"Dipen D Patel, Stephen T Amann, Benjamin Hart","doi":"10.14309/ajg.0000000000003131","DOIUrl":"10.14309/ajg.0000000000003131","url":null,"abstract":"<p><strong>Introduction: </strong>Rising healthcare costs have led to decreasing reimbursements for various procedures and providers. We chose to analyze Medicare reimbursement trends for 26 esophagogastroduodenoscopy (EGD) and 31 colonoscopy current procedural terminology (CPT) codes from 2018 to 2023 for hospital outpatient centers, ambulatory surgical centers (ASC), and gastroenterologists. We also wanted to look at the effects of inflation on these Medicare reimbursements.</p><p><strong>Methods: </strong>We calculated the nominal percentage change from 2018 to 2023 for each CPT code. We then took inflation data provided by the US Bureau of Labor Statistics and calculated the real change in reimbursements from 2018 to 2023 for each of the 31 colonoscopy and 26 EGD CPT codes.</p><p><strong>Results: </strong>Our results show that although nominal reimbursements to physicians have been steadily declining for performing gastrointestinal procedures, nominal reimbursements to hospital outpatient and ASC have been increasing from 2018 to 2023. After taking into account inflation, physicians saw significant decreases in real purchasing power for performing EGD and colonoscopies. ASC and hospital outpatient centers saw reimbursements keep up with inflation.</p><p><strong>Discussion: </strong>Physician reimbursements for gastroenterology procedures make up a small portion of reimbursements by Medicare compared to Medicare reimbursements to facilities such as ASC and hospital outpatient centers. However, physicians have seen significant reimbursement cuts, whereas facilities have not. Moreover, higher inflation leads to increased expenses for gastroenterology practices. It remains to be seen how these reimbursement changes will affect patients access to care and physicians practice sustainability.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"1127-1134"},"PeriodicalIF":8.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492927","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}