American Journal of Gastroenterology最新文献

{"title":"Global Consensus Statement on the Management of Pregnancy in Inflammatory Bowel Disease.","authors":"Uma Mahadevan, Cynthia H Seow, Edward L Barnes, María Chaparro, Emma Flanagan, Sonia Friedman, Mette Julsgaard, Sunanda Kane, Siew Ng, Joana Torres, Gillian Watermeyer, Jesus Yamamoto-Furusho, Christopher Robinson, Susan Fisher, Phil Anderson, Richard Gearry, Dana Ďuricová, Marla Dubinsky, Millie Long","doi":"10.14309/ajg.0000000000003651","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003651","url":null,"abstract":"<p><strong>Introduction: </strong>Pregnancy can be a complex and risk filled event for women with inflammatory bowel disease (IBD). High-quality studies in this population are lacking, with limited data on medications approved to treat IBD during pregnancy. For patients, limited knowledge surrounding pregnancy impacts pregnancy rates, medication adherence, and outcomes. Limited provider knowledge leads to highly varied practices in care affected by local dogma, available resources, individual interpretation of the literature, and fear of harming the fetus. The variations in guidelines by different societies and countries reflect this and lead to confusion for physicians and patients alike. The Global Consensus Consortium is a group of 39 IBD and content experts and 7 patient advocates from 6 continents who convened to review and assess current data and come to an agreement on best practices based on these data.</p><p><strong>Methods: </strong>The GRADE process was used when sufficient published data were available and the RAND process in those instances where expert opinion was needed to guide consistent practice. Recommendations were informed by the guiding principle that maternal health best supports infant health.</p><p><strong>Results: </strong>The topics were divided into 10 categories with 34 GRADE recommendations and 35 Consensus statements.</p><p><strong>Discussion: </strong>Overall, the goal of the group was to provide data-driven and practical guidance to improve the care of women with IBD around the globe based on the best available research.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938915","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 Lei Sun et al.","authors":"Yizhen Luo, Xiongjian Cui, Jianli Zhou, Yijiang Zhuang, Chenrui Zheng, Qiru Su, Yungen Gan, Zhiyong Li, Hongwu Zeng","doi":"10.14309/ajg.0000000000003592","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003592","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939050","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":"Spray Cryotherapy Esophageal Consortium Consensus Recommendations for Liquid Nitrogen Spray Cryotherapy in Barrett's Esophagus and Esophageal Cancer Using a Modified Delphi Process.","authors":"Tilak Shah, Zaid Ansari, Akram Ahmad, Walter Coyle, Bruce B Greenwald, Toufic Kachaamy, Shivangi Kothari, Neil Sharma, George Smallfield, Shyam Thakkar, Franklin Tsai, Han Zhang, Shai Friedland, Norio Fukami, Shaffer Mok, Alireza Sedarat, Michael Smith, John Vargo, Pankaj Vashi, Field Willingham, Alla Turshudzhyan, Vivek Kaul","doi":"10.14309/ajg.0000000000003752","DOIUrl":"10.14309/ajg.0000000000003752","url":null,"abstract":"<p><strong>Introduction: </strong>The study aimed to develop consensus recommendations for the safe and appropriate use of liquid nitrogen spray cryotherapy in Barrett's esophagus and esophageal cancer.</p><p><strong>Methods: </strong>Statements were initially formulated and grouped into categories of indications, training, preprocedure, intraprocedure, and postprocedure recommendations, frequency/timing of repeat procedures, and contraindications. Two investigators assessed the strength of the evidence for each statement using Grading of Recommendations Assessment, Development, and Evaluation methodology. Nineteen experts were invited to participate in a modified Delphi process. For statements that received >80% agreement, minor iterative edits were performed until there was unanimous consensus. If a threshold of 80% agreement was not reached, the statement was modified based on feedback and included in the next Delphi round. Statements were rejected if no consensus was reached after 3 rounds.</p><p><strong>Results: </strong>After 3 Delphi rounds, 41 of 42 statements were accepted either in their original version (n = 11) or after modification based on expert input (n = 30).</p><p><strong>Discussion: </strong>Through a modified Delphi process, we developed expert and evidence-based consensus recommendations to guide safe and appropriate use of liquid nitrogen spray cryotherapy in Barrett's esophagus and esophageal cancer.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939013","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":"Timing the Scan: Optimizing Screening for Osteoporosis and Risk of Fracture in Celiac Disease.","authors":"Francesco Tovoli, Guido Zavatta, Giovanni Monaco, Dante Pio Pallotta, Kinga Skoracka, Alberto Raiteri, Agnese Pratelli, Maria Boe, Iwona Krela-Kaźmierczak, Uberto Pagotto, Alessandro Granito","doi":"10.14309/ajg.0000000000003750","DOIUrl":"10.14309/ajg.0000000000003750","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with celiac disease (CeD) have an increased risk of osteoporosis and fractures, but the ideal timing for bone mineral density (BMD) assessment remains unclear due to conflicting recommendations. This study evaluated the optimal timing for dual-energy x-ray absorptiometry (DXA) screening considering different clinical targets: early detection of BMD alterations, osteoporosis diagnosis, or fracture risk stratification.</p><p><strong>Methods: </strong>Observational study prospectively enrolling 627 patients with CeD (>25 years) who underwent DXA scans of the lumbar spine and hip as part of standard care. Data on clinical presentation, serology, histology, and fracture risk were analyzed. Logistic regression identified risk factors of low BMD and osteoporosis. The reliability of the National Osteoporosis Guidelines Group (NOGG) guidelines for avoiding unnecessary DXAs was assessed.</p><p><strong>Results: </strong>Low BMD for age was present in 17.2% of patients, with significant prevalence in the 25-34 years age group (13.4%), further increasing in the 45-54 years age group. Osteoporosis was detected in 17.9% of patients, with prevalence increasing significantly in patients aged older than 45 years. Risk factors included weight loss, underweight status, and iron-deficiency anemia. Using the NOGG criteria, 67% of patients could have avoided DXA, with a 0.5% risk of missing clinically significant findings requiring treatment (but also losing 15.7% patients with low BMD for age).</p><p><strong>Discussion: </strong>The ideal timing for DXA screening in patients with CeD depends on the clinical objective. DXA at diagnosis maximizes the early detection of low bone mass, whereas the NOGG criteria effectively identified patients at high risk of fractures, reducing unnecessary scans. However, their use should be weighed against an underdetection of clinically relevant BMD alterations. Tailoring DXA timing to healthcare resources and patient demographics may optimize outcomes and resource allocation.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939001","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":"How We Approach It: Alfapump.","authors":"Hugo E Vargas, Martha Grace Knuttinen, Lisa Rotellini Coltvet, Jill Kocourek","doi":"10.14309/ajg.0000000000003751","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003751","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938926","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":"First-Round Fecal Immunochemical Test Concentration Predicts Colorectal Cancer and Advanced Neoplasia in Second-Round Screening.","authors":"Masau Sekiguchi, Marcus Westerberg, Christian Löwbeer, Johannes Blom, Anna Forsberg","doi":"10.14309/ajg.0000000000003738","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003738","url":null,"abstract":"<p><strong>Introduction: </strong>Enhancing fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening requires identifying additional predictive factors for colorectal neoplasia beyond current-round FIT concentration. We investigated whether first-round FIT concentration could predict colorectal neoplasia detection in the second screening round, using data from the randomized controlled trial Screening of Swedish Colons (SCREESCO).</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis of SCREESCO FIT-arm participants with negative two-stool FIT (<10 μg Hb/g feces) in the first screening round, followed by a positive FIT (≥10 μg Hb/g feces) in the second round two years later with work-up colonoscopy. We used binary regression models to assess risk factors for colorectal neoplasia, including CRC and advanced colorectal neoplasia (ACN), at colonoscopy, according to participants' characteristics and first- and second-round FIT concentrations.</p><p><strong>Results: </strong>In total, 1,991 individuals were included, with median FIT concentrations of 2.2 and 21.8 μg Hb/g feces in the first and second rounds, respectively. Higher first-round FIT concentration was associated with increased risks of CRC and ACN in the second round. Compared to those with first-round FIT concentrations of 0.0-1.9 μg Hb/g feces, the risk ratios for ACN were 1.38 (95% CI: 1.07-1.80) for 2.0-5.9 and 1.85 (95% CI: 1.38-2.48) for 6.0-9.9 μg Hb/g feces. For fixed second-round FIT concentration, the absolute risk of ACN increased in accordance with higher first-round FIT concentration.</p><p><strong>Discussion: </strong>Even an increase in low levels of FIT concentration is associated with future CRC and ACN detection. Combining first- and second-round FIT results could enhance the efficacy of screening.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov number, NCT02078804.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938716","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":"Screening for Barrett Esophagus and Esophageal Adenocarcinoma: Approaches and Outcomes.","authors":"Natalie J Wilson, Nicholas Mordan, Cole Potrock, Nicholas J Shaheen","doi":"10.14309/ajg.0000000000003753","DOIUrl":"10.14309/ajg.0000000000003753","url":null,"abstract":"<p><p>Barrett esophagus (BE) is the only known histological precursor to esophageal adenocarcinoma (EAC). The incidence of EAC has risen significantly over the past 4 decades in the United States and other Western countries, and the prognosis of EAC remains poor, with over half of individuals diagnosed at a late stage. Despite this, fewer than 1 in 5 eligible individuals undergo endoscopic screening for BE. Current screening practices rely on upper endoscopy, limiting widespread adoption and missing a significant portion of at-risk individuals. Recent technological advancements in minimally invasive screening modalities have the potential to expand screening efforts, improve detection rates, and reduce healthcare resource utilization. This review discusses the conceptual underpinnings and hurdles to successful screening for EAC and BE, evaluates newer technologies for screening, including nonendoscopic cell collection devices, blood-based biomarkers, transnasal endoscopy, and exhaled volatile organic compounds, and examines emerging methods for enhancing detection of dysplasia and intestinal metaplasia, including artificial intelligence and wide area transepithelial sampling. The value of screening in light of a recent randomized trial of surveillance from the United Kingdom, as well as a landmark study on nonendoscopic risk stratification for dysplasia in BE, are considered. While direct evidence linking screening to reduced EAC mortality is lacking, trials highlight promising outcomes in early detection of precancerous and cancerous lesions. Future directions, challenges, and recommendations for optimizing BE screening are discussed.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938987","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":"Evolution of Hepatitis A-Related Acute Liver Failure in North America Over 22 years.","authors":"Usamah Chaudhary, Ahmad Anouti, Jody A Rule, William M Lee","doi":"10.14309/ajg.0000000000003743","DOIUrl":"10.14309/ajg.0000000000003743","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatitis A virus (HAV) is a rare cause of acute liver failure (ALF) that carries a relatively good prognosis for recovery. In recent years, overall numbers of HAV cases have declined, likely because of increased hepatitis A vaccination rates.</p><p><strong>Methods and results: </strong>We reviewed the Acute Liver Failure Study Group registry for the number HAV-related ALF cases over 24 years.</p><p><strong>Discussion: </strong>Overall, the number of HAV ALF cases enrolled steeply declined. After 2010, when we began recording acute liver injury (ALI: International normalized ratio ≥ 2 but no encephalopathy), an apparent increase in ALI incidence was noted, despite a near absence of ALF cases.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938643","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":"Fatty Pancreas Disease and the Risk of Future Diseases of the Exocrine Pancreas: A US Matched Cohort Study.","authors":"Arjun Chatterjee, Amandeep Singh, Raj Jessica Thomas, Renan Prado, Ridhima Kaul, Andrew Ford, Rupayan Kundu, Huijun Xiao, Qijun Yang, John McMichael, Dawn Schwartz, Bryan Loebl, Rajat Garg, Charles Martin, Prabhleen Chahal","doi":"10.14309/ajg.0000000000003725","DOIUrl":"10.14309/ajg.0000000000003725","url":null,"abstract":"<p><strong>Introduction: </strong>Fatty pancreas disease (FPD), marked by excess fat within the pancreas, is often incidentally detected on imaging. Despite recognized metabolic links, its clinical significance remains unclear. More granular data from large, well-characterized US cohorts are needed to clarify its relevance. This study quantified intrapancreatic fat deposition and assess its natural history and related outcomes.</p><p><strong>Methods: </strong>Adults 18 years and older with radiologically confirmed FPD between 2004 and 2024 were identified from institutional databases. Controls without FPD were matched 1:2 by age, sex, body mass index, and smoking status. Patients with excessive alcohol intake, previous pancreatitis, pancreatic cancer, surgery, cystic fibrosis, or prolonged steroid/antiviral use were excluded. Fat content in the pancreas and liver, as well as subcutaneous and visceral fat areas, were measured using iNtuition software on noncontrast computed tomography scans.</p><p><strong>Results: </strong>We included 82 FPD patients and 164 matched controls (median age 65 years; 55% women; median body mass index 32). Subcutaneous and hepatic fat were similar between groups, but intrapancreatic fat deposition was markedly higher in FPD patients (26.8% vs 4.9%, P < 0.001). Over a mean 4-year follow-up, FPD patients had significantly higher rates of acute pancreatitis (12% vs 1.2%, P < 0.001), chronic pancreatitis (6.1% vs 0.6%, P = 0.017), pancreatic cysts (34.1% vs 4.9%, P < 0.001), and pancreatic cancer (1.6% vs 0%, P = 0.012). Extrapancreatic cancer incidence did not differ.</p><p><strong>Discussion: </strong>FPD is associated with an increased risk of pancreatic cancer, acute pancreatitis, chronic pancreatitis, and incidental pancreatic cysts, independent of obesity or hepatic steatosis, suggesting a potentially causative role of FPD in the pathogenesis of exocrine pancreatic diseases.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938646","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 Portal Hypertension Decompensation Score: A Validated Predictive Model of Liver Decompensation Related to Portal Hypertension.","authors":"Angus W Jeffrey, Avik Majumdar, Gary Jeffrey, Luis Calzadilla-Bertot, Michael Wallace, Tim Mitchell, Yi Huang, John Joseph, George Garas, Wendy Cheng, Leon A Adams","doi":"10.14309/ajg.0000000000003744","DOIUrl":"10.14309/ajg.0000000000003744","url":null,"abstract":"<p><strong>Introduction: </strong>There is a need for noninvasive risk stratification in people with compensated advanced chronic liver disease (cACLD) to prognosticate and guide management. We aimed to develop a score that predicts decompensation in people with cACLD without the need for a liver stiffness measurement.</p><p><strong>Methods: </strong>A multicenter state-wide cohort of patients with cACLD between 2004 and 2015 were followed until decompensation. A predictive score using serum markers was developed in a training cohort (n = 967) using competing risk analysis and internally validated (n = 417). Further external validation and comparison with other scores was undertaken in 315 patients between 2017 and 2024.</p><p><strong>Results: </strong>Decompensation occurred in 172 (17.8%), 64 (15.3%), and 51 patients (16.2%) in the training and 2 validation cohorts ( P = 0.60) after median follow-up of 3.2, 3.4, and 1.9 years, respectively. Bilirubin, alanine aminotransferase, alkaline phosphatase, albumin, and platelets predicted decompensation and combined into a final model-the Portal Hypertension Decompensation Score (PDS). The PDS was well calibrated with good discrimination for predicting decompensation. In the 2 validation cohorts, accuracy (time-dependent area under the curve) of the PDS for predicting decompensation was high at 2 years (0.75 and 0.82) and 5 years (0.74 and 0.83). A low score (< -3.348) had a sensitivity of 74%-84% in prediction of no decompensation with a negative predictive value of 91%-95%, whereas a high score (> -2.828) was 87%-93% specific for future decompensation with a positive predictive value of 33%-58%.</p><p><strong>Discussion: </strong>The PDS is an accurate predictor of decompensation in cACLD. It discriminates patients who are low risk from those who are high risk and who may benefit from further evaluation or treatment, without requiring the use of liver stiffness measurement.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939053","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}