American Journal of Gastroenterology最新文献

{"title":"ACG Workforce of the Future Task Force: Advanced Practice Provider Workforce Subgroup Report.","authors":"Tauseef Ali, Sarah Enslin, Irteza Inayat, Monica Nandwani, Kimberly Orleck, Amy L Stewart, Bria Strada, Emeline Suttie","doi":"10.14309/ajg.0000000000004109","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004109","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"121 9S","pages":"S30-S42"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015374","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 Time-Dependent Association Between Irritable Bowel Syndrome and All-Cause and Cause-Specific Mortality in the NIH-AARP Cohort Study.","authors":"Daniela S Gutiérrez-Torres, Fangyu Li, Linda M Liao, Carrie R Daniel, Shreela V Sharma, Ruosha Li, Eric L Brown, Qing Lan, Maki Inoue-Choi, Baharak Moshiree, Paul Albert, Rashmi Sinha, Emily Vogtmann","doi":"10.14309/ajg.0000000000003861","DOIUrl":"10.14309/ajg.0000000000003861","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence on the association between irritable bowel syndrome (IBS) and mortality is conflicting. In this study, we estimated the association between IBS and all-cause and cause-specific mortality in the NIH-AARP Diet and Health Study.</p><p><strong>Methods: </strong>IBS diagnoses between 1994 and 2008 were identified from Medicare claims data, and mortality outcomes through 2019 were obtained through linkage to the National Death Index. Using multivariable Cox proportional hazards regression models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality within partitioned follow-up time categories (>2-5, >5-8, >8-11, >11-14, >14-17, and >17 years) with adjustment for confounders, including habitual diet and proxies for personal health advocacy/healthcare access.</p><p><strong>Results: </strong>Of 132,697 individuals with available data, 5,030 (3.8%) had a prevalent IBS diagnosis. During the earliest follow-up interval (>2-5 years), the risk of all-cause mortality among individuals with IBS was 25% lower compared with those without IBS (HR = 0.75, 95% CI: 0.64-0.88), in the fully adjusted model. The inverse association attenuated over time such that during the >17-year follow-up interval, individuals with IBS had only an 8% lower risk of all-cause mortality (HR = 0.92, 95% CI: 0.87-0.98). Individuals diagnosed with IBS also had a lower risk of cancer and cardiovascular disease mortality, which attenuated over time.</p><p><strong>Discussion: </strong>We found time-dependent inverse associations between IBS and all-cause, cancer and cardiovascular disease mortality. Although this association seemed to be strongly confounded by personal health advocacy/healthcare access during very short follow-up, further research is needed to explore the factors contributing to these associations observed after longer follow-up.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2293-2301"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948432","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":"Psychological Resilience and Mental Wellbeing Mitigate the Risk of Irritable Bowel Syndrome.","authors":"Meng Zhang, Judith Wellens, Jianhui Zhao, Haosen Ji, Jing Sun, Xinxuan Li, Rahul Kalla, Yuan Ding, Evropi Theodoratou, Jack Satsangi, Xue Li","doi":"10.14309/ajg.0000000000003833","DOIUrl":"10.14309/ajg.0000000000003833","url":null,"abstract":"<p><strong>Introduction: </strong>Comorbidities between mental disorders and irritable bowel syndrome (IBS) have been widely reported, yet associations between mental wellbeing and IBS, particularly regarding underlying genetic modification and proteomic signatures, remain underexplored.</p><p><strong>Methods: </strong>This prospective cohort study analyzed 75,842 IBS-free participants aiming to investigate the prospective association between mental wellbeing and the risk of IBS in UK Biobank. Mental wellbeing was assessed through life satisfaction, positive affect, neuroticism, and depressive/anxiety symptoms. Cox models evaluate the hazard ratio (HR) for mental wellbeing and plasma proteome in relation to incident IBS during follow-up. Proteomic profiling identified mental wellbeing-associated proteins, with pathway enrichment analysis revealing biological mechanisms. Mediation and Mendelian randomization analyses further examine intermediate pathways and causality.</p><p><strong>Results: </strong>With a 12.4-year follow-up period, 1,400 cases of incident IBS were documented. Better mental wellbeing mitigated IBS risk dose-dependently (low risk group: HR, 0.37; 95% confidence interval [CI]: 0.31-0.43). Higher life satisfaction (HR, 0.41; 95% CI: 0.30-0.56) and positive affect (HR, 0.50; 95% CI: 0.41-0.62) were inversely associated with IBS risk, whereas neuroticism (HR, 2.35; 95% CI: 1.92-2.88) and depressive/anxiety symptoms (HR, 3.09; 95% CI: 2.17-4.42) increased the risk. Findings remained consistent in across prevalent IBS and IBS subtypes. Mental wellbeing effects were independent of genetic predisposition. Mediation analyses revealed about 27% of protective effect of mental wellbeing were mediated through reduced depression and anxiety. Mendelian randomization supports causal protective effects of positive mental wellbeing on IBS. Proteomic profiling identified mental wellbeing-associated proteins mainly enriched in cytokine-cytokine receptor interactions. Chromogranin A and gastrin emerged as key protein biomarkers, showing significant associations with both mental wellbeing components and IBS risk.</p><p><strong>Discussion: </strong>Our study demonstrates that enhanced mental wellbeing confers substantial protection against IBS development, highlighting psychological interventions as potential primary prevention strategies.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2302-2312"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891984","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 Costs of Inflammatory Bowel Disease and the Financial Impact of Insurance Delays.","authors":"Shubha Bhat, Tolulope Falaiye, Jonathan Moses, Dana J Lukin","doi":"10.14309/ajg.0000000000003975","DOIUrl":"10.14309/ajg.0000000000003975","url":null,"abstract":"<p><strong>Abstract: </strong>Inflammatory bowel diseases (IBDs) are chronic gastrointestinal disorders with systemic manifestations for which highly effective therapies and better understanding of treatment targets have transformed patient care. Owing to the low mortality and frequent early onset, as well as increasing prevalence of IBD, most patients are living with their disease for decades. Presently, proactive use of treat-to-target approaches aimed at endoscopic outcomes and integration of steroid-sparing advanced therapies have become a cornerstone of IBD management, with the intent to optimize patient outcomes and achieve remission. However, the substantial costs tied to research, development, and intricate manufacturing have resulted in advanced therapies being costly, leading to widespread implementation of a complex and nonstandardized prior authorization (PA) process. The heterogeneity in policies, coverage exclusions, and standard procedures across insurers makes the PA navigation process labor-intensive, costly, and time-consuming, and does not always result in consistent favorable outcomes or coverage for patients. In addition, insurer-related treatment delays have been associated with adverse clinical outcomes and increased absenteeism. Furthermore, PA denials often lead to the use of nonpreferred agents lacking evidence of clinical benefit. This review will attempt to summarize the costs related to IBD, assess how delays related to the PA process and administrative processes contribute to both direct and indirect cost burdens, and identify strategies that can potentially reduce overall costs in both pediatric and adult IBD care.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2132-2139"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300801","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.0000000000004162","DOIUrl":"https://doi.org/10.14309/ajg.0000000000004162","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"121 9","pages":"2355"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872683","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":"2026 CME Information.","authors":"","doi":"10.14309/01.ajg.0001208300.09665.2e","DOIUrl":"10.14309/01.ajg.0001208300.09665.2e","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"121 9","pages":"1809-1810"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872726","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":"Resection Depth of Underwater Versus Conventional Endoscopic Mucosal Resection for Intermediate-Sized Colorectal Tumors.","authors":"Yuzuru Tamaru, Akihiro Miyakawa, Haruhisa Shimura, Takuya Yamada, Kosuke Maehara, Yorinobu Sumida, Naohiro Kato, Shuhei Sugata, Takuro Hamada, Takeshi Mizumoto, Ryusaku Kusunoki, Tsuyoshi Hatakeyama, Shigeto Yoshida, Sauid Ishaq, Toshio Kuwai","doi":"10.14309/ajg.0000000000003913","DOIUrl":"10.14309/ajg.0000000000003913","url":null,"abstract":"<p><strong>Introduction: </strong>Underwater endoscopic mucosal resection (UEMR) does not involve submucosal injection. Its ability to achieve sufficient resection depth comparable with that of conventional endoscopic mucosal resection (CEMR) remains unclear. This randomized controlled trial aimed to compare UEMR and CEMR, with a specific focus on resection depth.</p><p><strong>Methods: </strong>In this noninferiority randomized controlled trial at 4 Japanese institutions, patients with colorectal tumors measuring 10-20 mm were randomly assigned to the UEMR or CEMR group. The primary outcome was resection depth analyzed per protocol, with a noninferiority margin of 400 μm.</p><p><strong>Results: </strong>In total, 217 patients were randomly assigned to the UEMR (n = 109) or CEMR (n = 108) group. The mean resection depths were 1,688.9 ± 1,510.0 μm for UEMR and 1,432.3 ± 1,294.2 μm for CEMR, with a mean difference of 256.6 μm (95% confidence interval: -119.9-633.1 μm; P = 0.18). Subgroup analyses revealed that UEMR achieved significantly greater resection depths in the cecum and ascending colon (1,822.4 ± 1,469.7 μm vs 1,096.5 ± 1,007.6 μm; P = 0.01) and in lesions with superficial morphology (1,238.7 ± 862.2 μm vs 731.6 ± 376.1 μm; P < 0.01) than CEMR. Nonexpert operators also achieved deeper resections with UEMR than with CEMR (1,786.6 ± 1,471.6 μm vs 1,192.4 ± 1,074.7 μm; P = 0.07).</p><p><strong>Discussion: </strong>UEMR achieved a resection depth comparable with that of CEMR. Given its consistent negative horizontal margins, UEMR may become the gold standard for resecting intermediate-sized colorectal tumors.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2178-2185"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13523724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145931824","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":"Women and Younger Adults With Inflammatory Bowel Disease are at Greater Risk of Financial Toxicity From Inflammatory Bowel Disease.","authors":"Elizabeth Araka, Olivia Kahn-Boesel, Emily W Lopes, Nneka N Ufere, Ashwin Ananthakrishnan, Bharati Kochar","doi":"10.14309/ajg.0000000000003847","DOIUrl":"10.14309/ajg.0000000000003847","url":null,"abstract":"<p><strong>Introduction: </strong>Financial toxicity, the combined objective burden and subjective distress that affects patients' medical care, is not well described in patients with inflammatory bowel disease (IBD). We aimed to characterize financial toxicity in patients with IBD.</p><p><strong>Methods: </strong>We designed and administered a deidentified survey to patients with IBD. The primary outcome, financial toxicity, was defined as a score <22 on the Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) scale, a validated measure. We constructed multivariable logistic regression models to evaluate associations adjusting for age, sex, race, type of IBD, IBD medications, household income, and education level.</p><p><strong>Results: </strong>Respondents (n = 669) had a median age of 49 years, were 62% female and 92% White. 52% were currently treated with advanced IBD-therapy, and 58% reported IBD in remission/minimal activity. 53% were employed full-time. 61% had an annual household income ≥$100,000. 69% had private insurance, and 31% had Medicare. 21% reported trouble paying medical bills in the past year; 34% of working adults missed work in the past 7 days because of IBD. 39% experienced financial toxicity. Adjusting for confounders, adults aged younger than 65 years were more likely to experience toxicity than older adults (adjusted odds ratio [aOR]: 6.78, 95% CI: 2.60-17.65). Those with education less than a Bachelor Degree (aOR: 2.73, 95% CI: 1.70-4.37), annual household income <$60,000 (aOR: 3.71, 95% CI: 2.14-6.42), and women were more likely to experience financial toxicity (aOR: 1.90; 95% CI: 1.28-2.81).</p><p><strong>Discussion: </strong>Financial toxicity was prevalent among patients with IBD, particularly among younger adults, those with lower income and education, and women. Inquiring about financial toxicity should be incorporated into IBD clinical practice.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2271-2279"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145627777","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":"2026 CME Information.","authors":"","doi":"10.14309/01.ajg.0001208300.09665.2e","DOIUrl":"https://doi.org/10.14309/01.ajg.0001208300.09665.2e","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":"121 9","pages":"2082-2083"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148981891","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":"An Eosinophilic Esophagitis Endoscopic Reference Score Threshold of 2 or Less Is Robust for Assessing Endoscopic Response to Treatment of Eosinophilic Esophagitis.","authors":"Craig C Reed, Stefani Aleman, Alexandra A Weir, Sean S LaFata, Timothy S Gee, Angelica R Lackey, Arjun K Juneja, Hannah L Thel, Brenderia A Cameron, Justin McCallen, Christopher J Lee, Gustaf N Hendrick, Jose C Bermudez, Daniel Song, Walker D Redd, Trevor S Barlowe, Cary C Cotton, Evan S Dellon","doi":"10.14309/ajg.0000000000003876","DOIUrl":"10.14309/ajg.0000000000003876","url":null,"abstract":"<p><strong>Introduction: </strong>Assessment of eosinophilic esophagitis (EoE) endoscopic findings is critical in determining disease activity. However, response thresholds for the EoE Endoscopy Reference Score (EREFS) are not definitively established. We assessed EREFS response thresholds in patients with EoE treated with topical corticosteroids.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of newly diagnosed patients with EoE treated with topical corticosteroid who had a follow-up endoscopy with biopsy and EREFS assessed pretreatment/post-treatment. We explored endoscopic response thresholds. Patients with and without endoscopic response were compared and predictors of response were determined. Histologic and global symptom responses were determined and residual endoscopic findings calculated.</p><p><strong>Results: </strong>Of 333 patients, 219 (68%), 206 (62%), 142 (43%), 70 (21%), 139 (42%), and 142 (43%) met response thresholds for EREFS ≤2, EREFS ≤2 with no components >1 nor worsening of any component, EREFS ≤1, EREFS = 0, inflammatory subscore = 0, and fibrostenotic subscore = 0, respectively. On multivariate analysis, lower body mass index (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.85-0.95), heartburn (aOR: 2.74; 95% CI: 1.37-5.48), and lower total baseline EREFS (aOR: 0.57; 95% CI: 0.29-0.71) independently predicted EREFS ≤2. After treatment, 74% with EREFS≤2 vs 23% with EREFS>2 ( P < 0.001) had histologic response at <15 eos/hpf. Endoscopic responders more frequently endorsed a global symptom response (89% vs 56%; P < 0.001) and had minimal residual endoscopic findings. Outcomes stratified for adults and children were comparable with the entire cohort.</p><p><strong>Discussion: </strong>Post-treatment EREFS ≤2 was consistent with symptom and histologic response for the entire cohort. These data support EREFS ≤2 as a robust threshold to define endoscopic response.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":"2149-2157"},"PeriodicalIF":8.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12860544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145706766","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}