American Journal of Gastroenterology最新文献

{"title":"Severe Polypharmacy Increases Risk of Hospitalization Among Older Adults With Inflammatory Bowel Disease.","authors":"Darren Drittel, William Schreiber-Stainthorp, Olivia Delau, Sakteesh V Gurunathan, Joshua Chodosh, Dorry L Segev, Mara McAdams-DeMarco, Seymour Katz, John Dodson, Aasma Shaukat, Adam S Faye","doi":"10.14309/ajg.0000000000003036","DOIUrl":"10.14309/ajg.0000000000003036","url":null,"abstract":"<p><strong>Introduction: </strong>As the inflammatory bowel disease (IBD) patient population is aging, the prevalence of polypharmacy is rising. However, data exploring the prevalence, risk factors, and clinical outcomes associated with polypharmacy among older adults with IBD are limited. The aim of the study is to determine (i) prevalence of polypharmacy (≥5 medications) and potentially inappropriate medication (PIM) utilization in older adults with IBD, (ii) changes in medications over time, (iii) predictors of polypharmacy, and (iv) the impact of polypharmacy/PIMs on 1-year hospitalization rates.</p><p><strong>Methods: </strong>We conducted a retrospective single-center study of older adults with IBD from September 1, 2011, to December 31, 2022. Wilcoxon-signed rank and McNemar tests were used to assess changes in polypharmacy between visits, with ordinal logistic regression and Cox proportional hazards models used to determine risk factors for polypharmacy and time to hospitalization, respectively.</p><p><strong>Results: </strong>Among 512 older adults with IBD, 74.0% experienced polypharmacy at the initial visit, with 42.6% receiving at least one PIM. In addition, severe polypharmacy (≥10 medications) was present among 28.6% individuals at the index visit and increased to 38.6% by the last visit ( P < 0.01). Multivariable analysis revealed that age ≥70 years, body mass index ≥30.0 kg/m 2 , previous IBD-related surgery, and the presence of comorbidities were associated with polypharmacy. Moreover, severe polypharmacy ( adj hazard ratio 1.95, 95% confidence interval 1.29-2.92), as well as PIM use ( adj hazard ratio 2.16, 95% confidence interval 1.37-3.43) among those with polypharmacy, was significantly associated with all-cause hospitalization within a year of the index visit.</p><p><strong>Discussion: </strong>Severe polypharmacy was initially present in more than 25% of older adults with IBD and increased to 34% within 4 years of the index visit. Severe polypharmacy, as well as PIM utilization among those with polypharmacy, were also associated with an increased risk of hospitalization at 1 year, highlighting the need for deprescribing efforts in this population.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"844-855"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003406","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}

{"title":"Calendar of Courses, Symposiums and Conferences.","authors":"","doi":"10.14309/ajg.0000000000003394","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003394","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"120 4","pages":"931"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770887","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":"Migration of a Surgical Ligation Device to the Appendix Tube After Appendectomy.","authors":"Xinrui Zhu, Jianming Xiong, Kai Deng","doi":"10.14309/ajg.0000000000003081","DOIUrl":"10.14309/ajg.0000000000003081","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"698"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399126","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":"Duodenal Obstruction Caused by an Isolated Spontaneous Celiac Artery Dissection.","authors":"Avi Toiv, Zachary Saleh, Andrew M Watson, Cyrus R Piraka","doi":"10.14309/ajg.0000000000003134","DOIUrl":"10.14309/ajg.0000000000003134","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"700-701"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567404","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":"Oral Breathing Facilitates Endoscopic Operability Compared With Nasal Breathing in Peroral Endoscopy: A Randomized Controlled Trial.","authors":"Keitaro Takahashi, Takuya Iwama, Momotaro Muto, Kazuyuki Tanaka, Yu Kobayashi, Katsuyoshi Ando, Shin Kashima, Nobuhiro Ueno, Kentaro Moriichi, Hiroki Tanabe, Kazumichi Harada, Takashi Teramoto, Mikihiro Fujiya","doi":"10.14309/ajg.0000000000003040","DOIUrl":"10.14309/ajg.0000000000003040","url":null,"abstract":"<p><strong>Introduction: </strong>Unsedated peroral endoscopy, including ultrathin endoscopy (UE) and conventional endoscopy (CE), is feasible in clinical practice but requires improved endoscopic operability and patient tolerance. Currently, the impact of the breathing method on these factors remains unclear. We conducted the first randomized controlled trial comparing oral breathing (OB) and nasal breathing (NB) during both UE and CE to assess their influence.</p><p><strong>Methods: </strong>About 252 eligible patients undergoing CE or UE were randomly assigned to OB or NB groups. Endoscopists and patients rated endoscopic operability and patient tolerance using a 100-mm visual analog scale. Visibility from the oral cavity to the middle pharynx was recorded.</p><p><strong>Results: </strong>OB led to a higher rate of improved visibility from the oral cavity to the middle pharynx compared with NB, ranging from 79.3% to 81.0%. Multivariate correlation analyses showed significantly lower visual analog scale scores for endoscopic operability with OB compared with NB in both UE and CE groups ( P < 0.05). No significant differences were found in the overall evaluation of patient tolerance between OB and NB groups in UE and CE, whereas the smaller diameter of UE exhibited better patient tolerance compared with CE. Discriminant analysis comparing endoscope types and breathing methods revealed that UE with OB outperformed other combinations in the overall evaluation of endoscopic operability and patient tolerance ( P < 0.05).</p><p><strong>Discussion: </strong>OB facilitates endoscopic operability compared with NB in peroral endoscopy. UE with OB is recommended as the preferred choice for unsedated peroral endoscopy in daily practice.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"799-810"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003404","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":"Is ChatGPT-4 a Reliable Tool in Autoimmune Hepatitis?","authors":"Francesca Colapietro, Daniele Piovani, Nicola Pugliese, Alessio Aghemo, Vincenzo Ronca, Ana Lleo","doi":"10.14309/ajg.0000000000003179","DOIUrl":"10.14309/ajg.0000000000003179","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence-based chatbots offer a potential avenue for delivering personalized counseling to patients with autoimmune hepatitis. We assessed accuracy, completeness, comprehensiveness, and safety of Chat Generative Pretrained Transformer-4 responses to 12 inquiries out of a pool of 40 questions posed by 4 patients with autoimmune hepatitis.</p><p><strong>Methods: </strong>Questions were categorized into 3 areas: diagnosis (1-3), quality of life (4-8), and medical treatment (9-12). 11 key opinion leaders evaluated responses using a Likert scale with 6 points for accuracy, 5 points for safety, and 3 points for completeness and comprehensiveness.</p><p><strong>Results: </strong>Median scores for accuracy, completeness, comprehensiveness, and safety were 5 (4-6), 2 (2-2), and 3 (2-3), respectively; no domain exhibited superior evaluation. Postdiagnosis follow-up question was the trickiest with low accuracy and completeness, but safe and comprehensive features. Agreement among key opinion leaders (Fleiss Kappa statistics) was slight for the accuracy (0.05) but poor for the remaining features (-0.05, -0.06, and -0.02, respectively).</p><p><strong>Discussion: </strong>Chatbots show good comprehensibility, but lack reliability. Further studies are needed to integrate Chat Generative Pretrained Transformer within clinical practice.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"914-919"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543120","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 Cancer Screening in the United States: A Review of Current Evidence, Challenges, and Future Perspectives.","authors":"Dan Li, Douglas R Morgan, Juan E Corral, Elizabeth A Montgomery, Arnoldo Riquelme, Shailja C Shah","doi":"10.14309/ajg.0000000000003301","DOIUrl":"10.14309/ajg.0000000000003301","url":null,"abstract":"<p><p>Gastric cancer remains a leading cause of cancer-related mortality worldwide. In the United States, gastric cancer incidence and mortality are substantially higher among non-White racial and ethnic groups and new immigrants from high-incidence countries. This is in large part related to the higher prevalence of Helicobacter pylori -associated gastric premalignant changes in these populations. Apart from primary prevention, early detection of gastric cancer is the principal strategy to reduce gastric cancer mortality and improve survival. Extensive evidence in Asian countries has demonstrated the benefits of endoscopic screening in detecting early-stage gastric cancer and reducing gastric cancer-related mortality. By contrast, direct, high-quality US-based data, such as from large clinical trials or observational studies, on important outcomes of gastric cancer screening are still lacking. In this review, we evaluate and summarize the latest global evidence on the epidemiology and predisposing factors of gastric cancer as well as the efficacy, benefits vs. risks, and cost-effectiveness of gastric cancer screening. We further discuss the critical knowledge gaps and challenges in promoting gastric cancer screening in the United States. Dedicated research is urgently needed to enrich the US-based data on gastric cancer primary and secondary prevention to inform clinical practice and reduce gastric cancer-related morbidity and mortality in a cost and resource efficient manner.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"765-777"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613029","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":"Impact of Diabetes, Drug-Induced Liver Injury, and Sepsis on Outcomes in Metabolic Dysfunction Associated Fatty Liver Disease-Related Acute-on-Chronic Liver Failure.","authors":"Ashish Kumar, Anil Arora, Ashok Choudhury, Vinod Arora, Mohamed Rela, Dinesh Kumar Jothimani, Mamun A Mahtab, Harshad Devarbhavi, Chundamanni E Eapen, Ashish Goel, Cesar Yaghi, Qin Ning, Tao Chen, Jidong Jia, Duan Zhongping, Saeed S Hamid, Amna S Butt, Wasim Jafri, Akash Shukla, Seok S Tan, Dong J Kim, Anoop Saraya, Jinhua Hu, Ajit Sood, Omesh Goyal, Vandana Midha, Girish K Pati, Ayaskant Singh, Guan H Lee, Sombat Treeprasertsuk, Kessarin Thanapirom, Ameet Mandot, Ravikiran Maghade, Rinaldi C Lesmana, Hasmik Ghazinyan, Virukalpatti G Mohan Prasad, Abdul K Dokmeci, Jose D Sollano, Zaigham Abbas, Ananta Shrestha, George K Lau, Diana A Payawal, Gamal E Shiha, Ajay Duseja, Sunil Taneja, Nipun Verma, Padaki N Rao, Anand V Kulkarni, Fazal Karim, Vivek A Saraswat, Shahinul Alam, Debashis Chowdhury, Chandan K Kedarisetty, Sanjiv Saigal, Praveen Sharma, Ghulam N Yattoo, Abraham Koshy, Ajay K Patwa, Mohamed Elbasiony, Pravin M Rathi, Sudhir Maharshi, Vishwa M Dayal, Ashish K Jha, Kemal F Kalista, Rino A Gani, Man F Yuen, Virendra Singh, Violeta A Sargsyan, Chien H Huang, Saurabh S Mukewar, Shaojie Xin, Ruveena B Rajaram, Charles Panackel, Sunil Dadhich, Sanjeev Sachdeva, Ajay Kumar, Sanatan Behera, Lubna Kamani, Hemamala V Saithanyamurthi, Babita Prasad, Shiv K Sarin","doi":"10.14309/ajg.0000000000002951","DOIUrl":"10.14309/ajg.0000000000002951","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and its complication, MAFLD-related acute-on-chronic liver failure (MAFLD-ACLF), is rising. Yet, factors determining patient outcomes in MAFLD-ACLF remain understudied.</p><p><strong>Methods: </strong>Patients with MAFLD-ACLF were recruited from the Asian Pacific Association for the Study of the Liver-ACLF Research Consortium (AARC registry). The diagnosis of MAFLD-ACLF was made when the treating unit had identified the etiology of chronic liver disease as MAFLD (or previous nomenclature such as non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, or non-alcoholic steatohepatitis-cirrhosis). Patients with coexisting other etiologies of chronic liver disease (such as alcohol, hepatitis B virus, hepatitis C virus, etc.) were excluded. Data were randomly split into derivation (n = 258) and validation (n = 111) cohorts at a 70:30 ratio. The primary outcome was 90-day mortality. Only the baseline clinical, laboratory features and severity scores were considered.</p><p><strong>Results: </strong>The derivation group had 258 patients; 60% were male, with a mean age of 53. Diabetes was noted in 27% and hypertension in 29%. The dominant precipitants included viral hepatitis (hepatitis A virus and hepatitis E virus, 32%), drug-induced injury (drug-induced liver injury, 29%), and sepsis (23%). Model for End-Stage Liver Disease-Sodium (MELD-Na) and AARC scores on admission averaged 32 ± 6 and 10.4 ± 1.9. At 90 days, 51% survived. Nonviral precipitant, diabetes, bilirubin, international normalized ratio, and encephalopathy were independent factors influencing mortality. Adding diabetes and precipitant to MELD-Na and AARC scores, the novel MAFLD-MELD-Na score (+12 for diabetes, +12 for nonviral precipitant), and MAFLD-AARC score (+5 for each) were formed. These outperformed the standard scores in both cohorts.</p><p><strong>Discussion: </strong>Almost half of patients with MAFLD-ACLF die within 90 days. Diabetes and nonviral precipitants such as drug-induced liver injury and sepsis lead to adverse outcomes. The new MAFLD-MELD-Na and MAFLD-AARC scores provide reliable 90-day mortality predictions for patients with MAFLD-ACLF.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"816-826"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141625689","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: April 2025.","authors":"Bhavana Bhagya Rao","doi":"10.14309/ajg.0000000000003393","DOIUrl":"10.14309/ajg.0000000000003393","url":null,"abstract":"<p><p>Article Title: Optimizing Bowel Preparation Quality for Colonoscopy: Consensus Recommendations by the US Multi-Society Task Force on Colorectal Cancer.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"120 4","pages":"708"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770898","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 Yu Yang et al.","authors":"Yuzuru Tamaru, Toshio Kuwai, Yoshiki Kajiwara, Shiro Oka, Shoichi Saito, Yosuke Fukunaga, Hiroshi Kawachi, Manabu Takamatsu, Kinichi Hotta, Hiroaki Ikematsu, Motohiro Kojima, Yutaka Saito, Yukihide Kanemitsu, Masayoshi Yamada, Shigeki Sekine, Shinji Tanaka, Shinji Nagata, Takahiro Nakamura, Kazutaka Yamada, Maki Konno, Soichiro Ishihara, Yusuke Saitoh, Kenji Matsuda, Kazutomo Togashi, Koji Komori, Megumi Ishiguro, Takashi Okuyama, Akihiro Ohuchi, Shinobu Ohnuma, Kazuhiro Sakamoto, Tamotsu Sugai, Kenji Katsumata, Hiro-O Matsushita, Hiro-O Yamano, Keisuke Nakai, Toshio Uraoka, Naohiko Akimoto, Hirotoshi Kobayashi, Yoichi Ajioka, Kenichi Sugihara, Hideki Ueno","doi":"10.14309/ajg.0000000000003336","DOIUrl":"10.14309/ajg.0000000000003336","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"925-926"},"PeriodicalIF":8.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539778","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}