Clinical Gastroenterology and Hepatology最新文献

Background & aims: Elemental diets (EDs) have desirable safety and efficacy profiles in several clinical settings partly due to modulation of gut microbiome. Palatability of EDs remains the main barrier to compliance/adherence, and their effect has not been prospectively explored in microbiome-driven disorders such as small intestinal bacterial overgrowth (SIBO) and intestinal methanogen overgrowth (IMO). We aimed to assess the effect, tolerance, and safety of a novel palatable ED (PED) in subjects with IMO and/or SIBO.

Methods: Adult subjects with positive lactulose breath tests (LBT) for SIBO and/or IMO completed one week of screening, 2 weeks of exclusive oral PED, and 2 weeks of follow-up during reintroduction of regular diet. Primary endpoint was changes in stool microbiome after PED and reintroduction of regular diet. Secondary endpoints included tolerability, rate of normalization of LBT, change in stool form based on daily diary and artificial intelligence-analyzed images, symptomatic response, and adverse events.

Results: All 30 enrolled subjects tolerated the PED and completed the trial. Several taxonomic differences were detected including decreased relative abundance of Prevotella_9 and Fusobacterium. Abundance of Methanobrevibacter smithii decreased at the end of the trial and correlated with average daily methane levels (p=0.024, r=0.489). Maximum methane levels (41±35 to 12±15 ppm, p<0.001) and hydrogen rise (43±42 to 12±11 ppm, p<0.001) dropped significantly, with 73% normalizing their LBT. Adequate global relief of symptoms was reported in 83% of subjects. No serious or severe adverse events were observed.

Conclusion: PED significantly impacts the gut microbiome. Tolerance to EDs improve with enhanced palatability. Larger studies with longer follow-up are needed to assess response durability. (ClinicalTrials.gov ID: NCT05978973).

Background & aims: Non-malignant liver and pancreatic diseases are common in the United States and lead to significant morbidity, mortality, and health care utilization. We used national survey and claims databases to investigate rates and trends in the liver and pancreatic disease burden over the past decade in the United States.

Methods: The Nationwide Emergency Department Sample, National Inpatient Sample, Vital Statistics of the U.S.: Multiple Cause-of-Death Data, Optum Clinformatics® Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample and Medicaid files were used to estimate claims-based prevalence, medical care use, and mortality with an all-listed liver or pancreatic disease diagnosis.

Results: In the U.S. population, liver disease contributed to 2.7 million emergency department visits, 2.0 million hospital stays, and 134,000 deaths in 2021. Pancreatitis was a less common but still significant cause of health care use contributing to 733,000 emergency department visits, 552,000 hospital stays, and 9,000 deaths in 2021. For both conditions, male and American Indian / Alaska Native persons had a greater mortality and medical care use burden. During the study period, both medical care use and mortality rates with a liver disease diagnosis rose, concerningly reversing previously declining trends. For pancreatitis, medical care use rates stabilized or declined during recent years and the mortality rate declined through 2019 and then rose through 2021.

Conclusions: The burden of non-malignant liver and pancreatic diseases in the United States is substantial. The rise in liver disease mortality rates following the reversal of a previous downward trend is particularly concerning. Hence ongoing surveillance of liver disease and pancreatitis prevalence may better inform research programs.