Clinical and Translational Gastroenterology最新文献

Introduction: Uncertainty persists regarding viral replication activity in untreated low-level viremia (LLV) patients and the need for antiviral therapy. This study compared serum HBV RNA levels in untreated LLV patients, those developing LLV post-nucleos(t)ide analogues (NAs), and patients achieving maintained virological response (MVR).

Methods: A cross-sectional study enrolled untreated LLV, treated LLV, and MVR patients. Propensity score matching (PSM) minimized confounding variables.

Results: Among 364 patients (61 untreated LLV, 60 treated LLV, 243 MVR), PSM analysis of 38 untreated-treated LLV pairs demonstrated significantly lower HBV RNA in untreated LLV (p < 0.001). Similarly, 1:2 PSM of untreated LLV vs. MVR (58 vs. 93 cases) revealed reduced HBV RNA in untreated LLV (p = 0.03).

Conclusions: Untreated LLV patients exhibited lower HBV RNA levels than both treated LLV and MVR patients, reflecting reduced viral transcription and replication. This suggests that antiviral treatment may not be immediately necessary for this subpopulation.

Introduction: In a national United States (US)-based group, we sought to describe barriers identified by sexual and gender minority (SGM) patients and primary care providers (PCPs) that challenge the provision of SGM-affirming digestive healthcare via qualitative methodology.

Methods: Forty patient participants and 24 PCPs were recruited from a random sample of 18 states within the 9 principal US Census Divisions and 2 states near the home institution. Patient participants selected completed a virtual semi-structured qualitative interview regarding their experiences with digestive healthcare and their views on barriers to engaging in digestive health care. PCPs were interviewed on treating SGM patients with GI disorders and interactions with GI consultants. Interviews were conducted until thematic saturation was achieved. The study was conducted from November 2023 to August 2024.

Results: Thematic saturation was achieved at 36 patient participants and 21 PCPs. Major themes included SGM discrimination in digestive healthcare, SGM issues in engaging in digestive healthcare, GI symptoms and other aspects of health-specific conditions, and ways to improve digestive healthcare for the SGM community. Participants noted a link between psychological distress in the SGM population and GI symptoms and offered actionable suggestions to improve SGM-focused digestive healthcare.

Conclusion: Systematic deficiencies were identified in the provision of SGM-affirming digestive care, related to bias within healthcare systems and a lack of understanding of unique SGM-related needs throughout the US. Further research studying improved shared clinician and SGM GI patient engagement is needed to address these sources of health inequity.

Introduction: Disparities in hepatocellular carcinoma (HCC) outcomes are shaped by intersecting social determinants of health (SDOH). We hypothesized that patients experience distinct combinations of socioeconomic barriers that cluster into social risk phenotypes associated with differences in diagnosis, treatment, and survival.

Methods: We analyzed data from 4,877 adults diagnosed with HCC in the Indiana State Cancer Registry (2009-2020). Latent class analysis (LCA) was performed using sex, race, insurance, marital status, occupation, neighborhood Social Deprivation Index (SDI), and distances to screening and Indiana University Hospital. Outcomes included early-stage diagnosis, receipt of curative therapy, and two-year mortality.

Results: Among 4,877 patients, 15.8% were non-White and 24.7% were female. LCA identified six distinct risk classes: (1) Minimal Barriers; (2) Publicly Insured - Married Females; (3) Publicly Insured - Unpartnered Males; (4) Rural and Geographically Distant; (5) Structurally Marginalized; and (6) Unseen and Uninsured. Class 1 had the most favorable characteristics (83.7% private insurance, 16.8% professional occupation) and best outcomes: 55.4% early-stage diagnosis, 24.4% curative therapy, and 55.4% two-year mortality. All other classes had significantly worse outcomes. Compared to Class 1, patients in Class 6 had the lowest early-stage diagnosis (39.7%) and curative therapy (10.5%) and highest mortality (83.6%; OR 4.12, 95% CI 3.06-5.54, P <0.001). Classes 4 and 5, reflecting rural and racially marginalized groups, also had significantly lower odds of early diagnosis and treatment.

Conclusion: Social risk phenotypes based on intersecting SDOH were strongly associated with HCC outcomes and may inform future risk-based intervention strategies.

Introduction: Liver transplantation (LT) recipients are at high risk of developing de novo metabolic syndrome (MetS), which contributes to cardiovascular and cerebrovascular morbidity. This study investigated serum and urinary metabolic changes after LT to identify microbial and metabolic markers associated with MetS development.

Methods: We conducted a prospective, 2-center longitudinal study with biospecimen collection pre-LT and at 6 months, 1 year, and 2-9 years post-LT. Nuclear magnetic resonance spectroscopy was used to characterize serum and urine metabolomic profiles from 73 to 44 patients, respectively. MetS was defined as body mass index >30 kg/m 2 plus at least 1 additional metabolic abnormality.

Results: MetS prevalence increased from 11% pre-LT to 36% post-LT. Post-LT, serum metabolite profiles showed increased phosphocholines and lipid-CH 3 (low density lipoprotein), whereas urine profiles demonstrated higher levels of trimethylamine- N -oxide (TMAO) and phenylacetylglutamine. Patients who developed or had persistent MetS exhibited smaller increases in serum phosphocholines and lipid-CH 3 but greater elevations in urinary TMAO levels compared with patients who remained MetS-free.

Discussion: LT is followed by distinct metabolic shifts reflecting changes in both hepatic lipid metabolism and gut-liver microbial cometabolism. Elevated urinary TMAO, together with reduced serum phosphocholine and lipid-CH 3 responses, characterize patients who develop post-LT MetS and may serve as early biomarkers of cardiometabolic risk in LT recipients.

Introduction: Irritable bowel syndrome (IBS) is a chronic gastrointestinal pain condition that has not been thoroughly studied in relation to environmental exposures and other health issues. Veterans are more susceptible to IBS and may experience specific service-related risks for developing the condition. Evaluating the prevalence of IBS and its links to military service, environmental factors, and health conditions in both men and women Veterans could improve our understanding of etiological factors contributing to IBS.

Methods: This observational cohort study, using a large-scale epidemiological sample from the Million Veteran Program, included self-report data from 546,246 Veterans and examined the prevalence of IBS and its association with military service history, environmental exposures, and health comorbidities.

Results: Of the 546,246 Veterans included, 497,287 (91.0%) were men, and 48,959 (9.0%) were women. The prevalence of IBS was higher in women (13.8%) than in men (4.2%) and varied by race and ethnicity, with the highest in White women (14.7%). Veterans with IBS had worse general health, more pain, and greater pain interference. We found associations between IBS and aspects of military service, including service post-September 2001, and environmental exposures, including a history of exposure to chemical and biological warfare and antinerve agent pills. Individuals with IBS were at a greater likelihood of digestive, neurological, and psychiatric conditions and greater opioid use.

Discussion: IBS prevalence varied across sex, race, and environmental exposures. IBS was associated with several domains of health conditions, including gastrointestinal, psychiatric, and neurological. Our results highlight the link between IBS and environmental factors, including toxicants, and encourage future research into the mechanisms underlying this association.

Introduction: Over one-third of people are not up-to-date with colorectal cancer (CRC) screening, and blood-based tests offer a promising alternative to existing options. We used conjoint analysis to quantify the proportion of people who would prefer a hypothetical blood test over current methods (e.g., fecal immunochemical test, multitarget stool DNA test, colonoscopy).

Methods: We conducted a conjoint analysis survey in a US nationally representative sample of average risk individuals aged 40-75 years who were not up-to-date with CRC screening. We performed latent class analysis to identify groups with similar decision-making profiles and estimated the proportion who would prefer a blood test every 3 years over existing methods.

Results: Overall, 1,009 participants completed the survey. Using latent class analysis, we identified 2 distinct groups: (i) prioritized how the test is performed-39.4%, and (ii) prioritized the accuracy of detecting CRC and advanced adenomas-60.6%. Through simulations using the conjoint data, most individuals in the first group preferred a blood test every 3 years (65.1%), whereas 53.0% of the second group also favored the blood test. In additional simulations that incorporated test accuracy for CRC and advanced adenoma detection, these performance characteristics emerged as important drivers of screening preferences across the different testing options.

Discussion: Among individuals not up-to-date with CRC screening, our findings suggest that many would generally prefer a blood-based screening test over other options, but preference may depend on test accuracy. Offering a blood test option may improve CRC screening uptake, particularly among individuals who are unscreened or overdue for screening.

Introduction: The Donor Risk Index (DRI) is a widely used liver transplant allograft risk model but does not account for the increasing adoption of machine perfusion (MP).

Methods: Using Bayesian updating, we incorporated MP into the DRI framework (DRI-MP). A Bayesian proportional hazards model with informative priors derived from the original DRI was applied to Organ Procurement and Transplantation Network data from January 2022 to June 2024. Model performance was assessed using Harrell Concordance-statistic, calibration plots, and Brier scores.

Results: DRI-MP, defined as DRI × 0.7 for MP cases, improved 90-day graft survival discrimination (Harrell Concordance-statistic: = 0.546 vs 0.535, P = 0.040), while maintaining robust calibration.

Discussion: The Bayesian-updated DRI-MP modestly improves donor risk discrimination, reflecting contemporary transplant practice and providing an implementable tool with continuity from the original DRI.

Introduction: The aim of treat-to-target (T2T) algorithms in inflammatory bowel disease was to maximize the benefit of medical therapies by establishing a framework for disease activity assessment to guide therapeutic decisions. There are limited data on adoption rates of T2T monitoring in real-world practice. We aimed to describe rates of T2T monitoring, predictors of completion, and associations with clinical outcomes.

Methods: A retrospective cohort study was conducted from 2015 to 2021 of individuals with inflammatory bowel disease starting new biologic or small molecule therapy within a multistate healthcare system. The completion of biochemical monitoring including fecal calprotectin or C-reactive protein and structural monitoring including endoscopy or enterography, or both, was assessed between 3 and 6 months and 6 and 12 months, respectively. Healthcare utilization (HCU), defined as emergency department visits, hospitalizations, prednisone prescriptions, or abdominal surgery within 2 years, was also assessed.

Results: A total of 823 patients were included in the cohort, and 127 (15.4%) completed some form of T2T monitoring. Twenty-two patients (2.7%) completed both biochemical and structural monitoring. The completion of T2T was not associated with lower HCU. The completion of only biochemical T2T, but not structural or both biochemical and structural T2T, was associated with decreased 12-month medication persistence (hazard ratio 0.36, 95% confidence interval 0.17-0.75). The completion of just structural T2T (hazard ratio 1.59, 95% confidence interval 1.05-2.39) was associated with higher HCU.

Discussion: In this retrospective cohort of individuals initiating new therapy, the rates of T2T monitoring were low. The completion of all T2T was not associated with lower HCU. The completion of only biochemical T2T monitoring was associated with lower 12-month medication persistence and only structural T2T with higher HCU.

Introduction: Sound speed correction endoscopic ultrasound (SSC-EUS) is a novel imaging technique with limited previous validation. The aim of this study was to evaluate the diagnostic efficacy of SSC-EUS for solid pancreatic lesions (SPL) and compare it with B-mode endoscopic ultrasound (B-EUS), elastography endoscopic ultrasound (EG-EUS), and contrast-enhanced endoscopic ultrasound (CE-EUS).

Methods: A prospective, single-blind, randomized trial included 240 patients with computed tomography/magnetic resonance imaging-confirmed SPL (solid portion >80% of lesion volume). Participants were equally divided into 4 groups (B-EUS, EG-EUS, CE-EUS, and SSC-EUS). Diagnostic thresholds were determined through receiver operating characteristic curves. Subgroup analyses assessed the impact of lesion location (head/body/tail), tumor size (≤3 vs >3 cm), and cancer stage (I/II vs III/IV). Statistical analysis used SPSS 23.0 and GraphPad Prism 8.

Results: Among 240 patients, 138 (57.5%) had malignant lesions. SSC-EUS achieved optimal diagnostic performance at a cutoff sound speed of 1,563 m/s (area under the receiver operating characteristic curve = 0.822, sensitivity = 82.8%, specificity = 78.9%, accuracy = 81.7%). CE-EUS demonstrated the highest overall efficacy (sensitivity = 90.3%, specificity = 82.8%, accuracy = 86.7%), followed by SSC-EUS and EG-EUS, both outperforming B-EUS (accuracy = 70.0%). Subgroup analysis revealed superior sensitivity for pancreatic body lesions (SSC-EUS: 87.5%; CE-EUS: 90.0%), tumors >3 cm (SSC-EUS: 84.2%; CE-EUS: 90.0%), and stage III/IV cancers (SSC-EUS: 81.8%; CE-EUS: 90.9%). EG-EUS strain ratio (cutoff = 4.44) showed limited accuracy (61.7%), whereas elastic strain value A (cutoff = 0.065%) exhibited moderate utility (accuracy = 75.0%).

Discussion: CE-EUS remains the most effective imaging modality for SPL diagnosis. SSC-EUS demonstrates comparable accuracy with EG-EUS and is particularly advantageous for larger tumors (>3 cm) and advanced-stage malignancies. EG-EUS strain ratio lacks clinical robustness, whereas elastic strain value A warrants further validation. Tailoring imaging method selection to lesion characteristics (location, size, and stage) may optimize diagnostic outcomes.