American Journal of Gastroenterology最新文献

{"title":"Diagnostic Accuracy of Spleen-Dedicated 100 Hz Transient Elastography to Predict High-Risk Esophageal Varices.","authors":"Jain Harsh Prakash, Prajna Anirvan, Shubham Gupta, Mohd Imran Chouhan, Mansi Chaudhary, Biswajit Sahoo, Hemanta Kumar Nayak, Manas Kumar Panigrahi","doi":"10.14309/ajg.0000000000003741","DOIUrl":"10.14309/ajg.0000000000003741","url":null,"abstract":"<p><strong>Introduction: </strong>The Baveno VII consensus suggested different splenic stiffness measurement (SSM) cut-offs to predict High-Risk Esophageal Varices (HREV) and clinically significant portal hypertension (CSPH) in patients with cirrhosis. Few studies have validated these cut-offs using spleen-dedicated 100 Hz transient elastography (TE). We have assessed the diagnostic performance of SSM in predicting HREV and CSPH using a spleen-dedicated 100 Hz TE and compared it with other noninvasive algorithms.</p><p><strong>Methods: </strong>This is a single-centre prospective study including patients with cirrhosis. Endoscopy, spleen-dedicated TE, and laboratory investigations were performed for all participants. A new SSM cut-off to rule out HREV was derived from our cohort. Its performance was compared with existing algorithms by determining endoscopy spare rate and HREV miss rate. The cut-offs suggested by the Baveno VII consensus for predicting HREV and CSPH were compared with the new SSM cut-off value.</p><p><strong>Results: </strong>HREV were present in 33 (28.4%) of 116 patients (97 compensated and 19 recompensated cirrhosis). The Area under Receiver Operating Curve of SSM, liver stiffness measurement (LSM) alone, combination of LSM and platelet count (PC), and combination of LSM, PC, and SSM were 0.849, 0.683, 0.808, and 0.864, respectively. An SSM cut-off value of 35 kPa in compensated cirrhosis had a corresponding sensitivity of 95.6%. On extrapolating this cut-off in the overall cohort, SSM alone spared more endoscopies as compared with the Baveno VI criteria combining LSM and PC (44.8% vs 21.5%) and had a lower HREV miss rate as compared with the Baveno VII criteria for HREV (6.1% vs 15.1%). The combination of LSM, PC, and SSM narrowed the gray zone of CSPH to 12.9% when the single value of SSM cut-off derived from this study (35 kPa) was used.</p><p><strong>Discussion: </strong>SSM alone can accurately predict HREV in cirrhosis, and its combination with LSM and PC precisely predicted CSPH, saving a significant number of endoscopies. The SSM cut-off to rule out HREV may vary with etiology.</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":"144939161","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":"New Eczematous Eruption in Patients With Inflammatory Bowel Disease Who Stop Janus Kinase Inhibitors.","authors":"Russell Yanofsky, Benjamin D McDonald, Newsha Nikzad, David Choi, Christopher R Shea, Angad A Chadha, David T Rubin","doi":"10.14309/ajg.0000000000003742","DOIUrl":"10.14309/ajg.0000000000003742","url":null,"abstract":"<p><strong>Introduction: </strong>Janus kinase inhibitors (JAKi) are small-molecule therapies used in inflammatory bowel disease (IBD). We describe 8 patients with IBD who developed an eczematous eruption, presumed atopic dermatitis (AD), after stopping JAKi therapy.</p><p><strong>Methods: </strong>This case series describes 8 patients with IBD who developed de novo AD after withdrawal of JAKi therapy.</p><p><strong>Results: </strong>Median time to AD onset was 7 days (interquartile range 2-12). Two cases with biopsy-confirmed AD resolved after reinitiation of JAKi therapy and adjunct AD treatments.</p><p><strong>Discussion: </strong>A subset of patients with IBD may have latent susceptibility to AD, unmasked by therapy cessation and potentially triggered by an immune rebound effect.</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":"144938995","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":"Effect of oral proton pump inhibitor administration on reducing the delayed bleeding risk in five upper gastrointestinal endoscopic treatments.","authors":"Hiroko Abe, Waku Hatta, Kunio Tarasawa, Yutaka Hatayama, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Tomoyuki Koike, Akira Imatani, Shin Hamada, Kenji Fujimori, Kiyohide Fushimi, Atsushi Masamune","doi":"10.14309/ajg.0000000000003746","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003746","url":null,"abstract":"<p><strong>Objective: </strong>Although proton pump inhibitor (PPI) is often prescribed for reducing delayed bleeding in upper gastrointestinal endoscopic treatments, no studies with a sufficient sample size evaluated its reduced effect compared with absence of acid-suppressive agents. This study aimed to investigate the effect of oral PPI on reducing delayed bleeding in five upper gastrointestinal endoscopic treatments.</p><p><strong>Methods: </strong>This population-based cohort study collected data from patients who were either prescribed with PPIs or received no acid-suppressive therapy and who underwent esophageal endoscopic mucosal resection (E-EMR), esophageal endoscopic submucosal dissection (E-ESD), gastric endoscopic mucosal resection (G-EMR), gastric endoscopic submucosal dissection (G-ESD), or percutaneous endoscopic gastrostomy (PEG) in Japan between 2012 and 2022 from the Diagnosis Procedure Combination database. The primary outcome was delayed bleeding in each procedure. We conducted propensity score matching (PSM) to balance two comparison groups and performed logistic regression analyses to compare bleeding outcomes.</p><p><strong>Results: </strong>This study included data on 172,635 patients. After PSM, the delayed bleeding risk with PPI use was significantly lower in G-EMR (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.52-0.84) and G-ESD (OR, 0.39; 95% CI, 0.30-0.50). In contrast, a lower delayed bleeding risk of PPI was not observed in E-EMR (OR, 1.05; 95% CI, 0.56-1.99), E-ESD (OR, 1.09; 95% CI, 0.86-1.38), and PEG (OR, 1.03; 95% CI, 0.93-1.13). The subgroup and sensitivity analyses almost consistently confirmed the main results.</p><p><strong>Conclusions: </strong>Oral PPI administration contributed to reducing delayed bleeding risk in G-EMR and G-ESD, but not in E-EMR, E-ESD, and PEG.</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":"144938648","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":"Accurate Nonendoscopic Detection of Early Esophageal Squamous Malignant Lesions Using Sponge-Based Methylated DNA Biomarkers.","authors":"Yan Bian, Yusi Xu, Chu Chu, Ye Gao, Huishan Jiang, Qianqian Meng, Chuting Yu, Jun Zhou, Zhaoshen Li, Wei Wang, Han Lin, Luowei Wang","doi":"10.14309/ajg.0000000000003745","DOIUrl":"10.14309/ajg.0000000000003745","url":null,"abstract":"<p><strong>Introduction: </strong>Early detection of esophageal squamous cell carcinoma (ESCC) significantly improves patient quality of life and outcomes. We aimed to train and validate a predictive algorithm using methylated DNA markers (MDMs) based on encapsulated sponge cell collection device (CCD) samples.</p><p><strong>Methods: </strong>CCD samples in the training set (n = 120) were taken from 2 medical centers, and those in the validation set (n = 70) were prospectively collected from another medical center. The case group contained a diverse range of esophageal high-grade lesions, including high-grade intraepithelial neoplasia (HGIN), early ESCC, and advanced ESCC. The algorithms were trained on the training set and tested to evaluate diagnostic performance in a prospective validation set.</p><p><strong>Results: </strong>The MDM model was constructed using logistic regression with 2 MDMs (OTOP2 and KCNA3). The areas under the receiver operating characteristic curves were 0.933 (95% confidence interval [CI] 0.881-0.986) and 0.911 (95% CI 0.841-0.981) in the training and validation sets, respectively. The overall sensitivity was 90.0% at a specificity of 91.4% in the training set. The sensitivity was 90.0%, 95.0%, and 90.0% for HGIN, early ESCC, and advanced ESCC in the training set, respectively. The sensitivity and specificity were 87.5% and 86.7% in the validation set, respectively. The areas under the receiver operating characteristic curves for the complex model that included the 2 MDMs and age were 0.961 (95% CI, 0.920-1.000) and 0.940 (95% CI, 0.889-0.990) in the training and validation sets, respectively.</p><p><strong>Discussion: </strong>The assay of MDMs in CCD samples offers a highly accurate method of predicting HGIN/ESCC, thereby providing the potential for early diagnosis and screening for HGIN/ESCC.</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":"144939135","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":"Distinct Clinical Phenotypes in Lactase Nonpersistence: Symptomatic, Asymptomatic, and Gassy-Asymptomatic.","authors":"Michal Azimov, Ida Cohen-Michnik, Moshe Rottenstreich, Lior Katz, Haim Zeigerman, Avihu H Yona","doi":"10.14309/ajg.0000000000003740","DOIUrl":"10.14309/ajg.0000000000003740","url":null,"abstract":"<p><strong>Introduction: </strong>Lactase deficiency allows undigested lactose to reach the colon, where fermentation triggers gastrointestinal symptoms. Although lactase persistence (LP) vs non-persistence (LNP) is genetically defined, many LNP individuals are symptoms-free, suggesting additional determinants of the phenotype. We aimed to define clinically relevant LNP subgroups and examine microbiome features that differ among them.</p><p><strong>Methods: </strong>In 146 healthy adults, LP-associated single nucleotide polymorphisms were genotyped and a standardized 25 g lactose load was administered. Breath hydrogen, methane, blood glucose, and symptom scores were collected over 3 hours. Microbiome composition (n = 60) was profiled by 16S-rRNA sequencing of stool samples.</p><p><strong>Results: </strong>Among LNP individuals (116/146, 79%), 3 distinct phenotypes emerged: Symptomatic (35/116, 30%), who produced hydrogen and reported symptoms; Gassy Asymptomatic (67/116, 58%), who produced hydrogen without symptoms; and Asymptomatic (14/116, 12%), who neither produced hydrogen nor had symptoms. All LNP subgroups showed similarly low blood glucose elevations after lactose load compared with LP. A novel metric, peak hydrogen production rate (ppm/hour), improved correlation with symptom severity (R = 0.49) vs the conventional hydrogen peak (R = 0.34). Microbiome analyses revealed higher abundances of certain genera such as Lactobacillus and Megasphaera in asymptomatic LNP subgroups, suggesting possible microbial contributions to the absence of symptoms.</p><p><strong>Discussion: </strong>Seventy percent of genetically LNP adults tolerate lactose without symptoms. Classifying LNP individuals into distinct subgroups and incorporating hydrogen production rate into breath-test interpretation may enhance diagnostic precision, prevent unnecessary dietary restrictions, and generate new hypotheses linking fermentation kinetics and symptoms. Microbiome associations remain correlative and warrant functional validation in larger, controlled studies.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938634","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":"Letter to the Editor.","authors":"Sara J Cromer, Wajd Alkabbani, Elisabetta Patorno","doi":"10.14309/ajg.0000000000003653","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003653","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938890","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 Rare Case of Large Mucosal Poorly Differentiated Colorectal Adenocarcinoma.","authors":"Shota Nishide, Shusei Fukunaga, Risa Kawasaki, Tadashi Ochiai, Yasuhiro Fujiwara","doi":"10.14309/ajg.0000000000003737","DOIUrl":"10.14309/ajg.0000000000003737","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939088","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 Impact of Integrating Pelvic Magnetic Resonance Imaging at Diagnosis on Early Detection of Perianal Crohn's Disease in Pediatrics.","authors":"Mikaela Antaya, Alexandra S Hudson, E Paul Lerner, Khadija Nasser, Matthew W Carroll, Daniela M Isaac, Eytan Wine, Troy Perry, Adrienne Thompson, Hien Q Huynh","doi":"10.14309/ajg.0000000000003733","DOIUrl":"10.14309/ajg.0000000000003733","url":null,"abstract":"<p><strong>Introduction: </strong>Perianal Crohn's disease (CD) can be a severe manifestation of pediatric CD. Earlier detection may alter outcomes. The aim of this study was to determine if performing pelvic magnetic resonance imaging (MRI) on newly diagnosed pediatric patients with CD would identify asymptomatic perianal CD and lead to earlier biologic use and less perianal surgery.</p><p><strong>Methods: </strong>Patients were prospectively enrolled into the Edmonton Pediatric Inflammatory Bowel Disease Clinic registry (baseline pelvic MRI since 2018). A retrospective review (2018-2023) was performed. A blinded radiologist re-read the positive MRIs using St. James and Parks criteria.</p><p><strong>Results: </strong>One hundred thirty-nine patients were included (median age 13 [interquartile range 11-16, range 6-18]). Overall, 19% (n = 27/139) had subclinical perianal disease (MR+/asymptomatic [ASx]). For patients who were both asymptomatic and had a normal perianal examination (n = 86/139, 62%), their subclinical perianal disease rate was similar at 20% (n = 17/86). Compared with MR-/ASx, MR+/ASx patients had a relative risk of 1.40 (95% confidence interval [CI] 1.18-1.68) and 1.32 (95% CI 1.17-1.52) of starting a biologic at 6 and 12 months, respectively. MR+/Sx needed the most and earliest perianal surgery, but MR+/ASx also had higher rates and faster time to perianal surgery than MR-/ASx ( P = 0.02). Perianal side branch fistula was a predictor of surgery (odds ratio 107.6, [95% CI 16.9-2,178] P < 0.0001).</p><p><strong>Discussion: </strong>One in 5 newly diagnosed pediatric patients with CD had subclinical perianal disease, even when having a normal perianal physical examination. These patients needed more and earlier perianal surgery and had higher biologic use despite their perianal disease being subclinical. Adding routine MR imaging at the time of pediatric CD diagnosis may help inform treatment decisions and improve these outcomes.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939036","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":"Avoidant/Restrictive Eating in People With and Without Bowel Symptoms in the General Population: Prevalence, Clinical Profile, and Associated Factors.","authors":"Amanda Blomsten, Inês A Trindade, Sanna Nybacka, Chloé Melchior, Joost P Algera, Cecilia Weznaver, Stine Störsrud, Hans Törnblom, Magnus Simrén","doi":"10.14309/ajg.0000000000003735","DOIUrl":"10.14309/ajg.0000000000003735","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to investigate the prevalence of avoidant/restrictive eating in individuals with versus without bowel symptoms in the general population and identify factors associated with avoidant/restrictive eating.</p><p><strong>Methods: </strong>In this Swedish population-based internet health survey, we included individuals with at least 1 bowel symptom used to diagnose a functional bowel disorder according to the Rome IV criteria, and an age-matched and sex-matched control group without bowel symptoms. Cutoffs for the Nine-Item Avoidant/Restrictive food intake disorder screen were used to determine the prevalence of avoidant/restrictive eating. Demographics and clinical characteristics were assessed using validated questionnaires, and independent factors associated with avoidant/restrictive eating were determined by hierarchical multiple regression analysis.</p><p><strong>Results: </strong>Avoidant/restrictive eating was more common in individuals with bowel symptoms (n = 825) compared with controls (n = 1806) (22.8% vs 18.2%, P < 0.001). Individuals with bowel symptoms with avoidant/restrictive eating were more often female, had lower body mass index, more likely to report overlapping functional dyspepsia, reported more severe bowel, psychological and somatic symptoms, shape/weight concerns, and a lower quality of life. Bowel symptom severity emerged as the strongest factor explaining the variability of avoidant/restrictive eating severity.</p><p><strong>Discussion: </strong>Avoidant/restrictive eating is common in individuals with bowel symptoms and associated with a more severe clinical profile, indicating a need to discuss eating behavior with patients. However, avoidant/restrictive eating is also common in individuals in the general population without bowel symptoms.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939104","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":"Type 4A Choledochal Cyst With Duodenal Compression.","authors":"Rohan Ahuja, Parvir Aujla, Vaibhav Wadhwa","doi":"10.14309/ajg.0000000000003736","DOIUrl":"10.14309/ajg.0000000000003736","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939059","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}