Clinical Gastroenterology and Hepatology最新文献

英文中文

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.05.032

Yi Bao, Yanming Xu

引用次数: 0

The Cost of Inflammatory Bowel Disease Care: How to Make it Sustainable IBD 护理的成本--如何使其可持续发展。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.06.049

Johan Burisch , Jennifer Claytor , Inmaculada Hernandez , Jason Ken Hou , Gilaad G. Kaplan

The rising global prevalence of inflammatory bowel diseases (IBDs), such as Crohn’s disease and ulcerative colitis, underscores the need to examine current and future IBD care costs. Direct health care expenses, including ambulatory visits, hospitalizations, and medications, are substantial, averaging $9,000 to $12,000 per person annually in high-income regions. However, these estimates do not fully account for factors such as disease severity, accessibility, and variability in health care infrastructure among regions. Indirect costs, predominantly stemming from loss in productivity due to absenteeism, presenteeism, and other intangible costs, further contribute to the financial burden of IBD. Despite efforts to quantify indirect costs, many aspects remain poorly understood, leading to an underestimation of their actual impact. Challenges to achieving cost sustainability include disparities in access, treatment affordability, and the absence of standardized cost-effective care guidelines. Strategies for making IBD care sustainable include early implementation of biologic therapies, focusing on cost-effectiveness in settings with limited resources, and promoting the uptake of biosimilars to reduce direct costs. Multidisciplinary care teams leveraging technology and patient-reported outcomes also hold promise in reducing both direct and indirect costs associated with IBD. Addressing the increasing financial burden of IBD requires a comprehensive approach that tackles disparities, enhances access to cost-effective therapeutics, and promotes collaborative efforts across health care systems. Embracing innovative strategies can pave the way for personalized, cost-effective care accessible to all individuals with IBD, ensuring better outcomes and sustainability.

克罗恩病（CD）和溃疡性结肠炎（UC）等炎症性肠病（IBD）在全球的发病率不断上升，这凸显了研究当前和未来 IBD 护理成本的必要性。包括门诊就医、住院治疗和药物在内的直接医疗费用十分可观，在高收入地区平均每人每年为 9,000 到 12,000 美元。然而，这些估算并未充分考虑疾病的严重程度、可及性以及不同地区医疗基础设施的差异等因素。间接成本主要来源于缺勤、旷工造成的生产力损失以及其他无形成本，它们进一步加重了 IBD 的经济负担。尽管人们努力量化间接成本，但对许多方面仍然知之甚少，导致对其实际影响的低估。实现成本可持续性所面临的挑战包括就医机会的差异、治疗费用的可负担性以及缺乏标准化的具有成本效益的护理指南。使 IBD 护理可持续发展的策略包括尽早实施生物疗法，在资源有限的情况下注重成本效益，以及促进生物仿制药的使用以降低直接成本。利用技术和患者报告结果的多学科护理团队也有望降低与 IBD 相关的直接和间接成本。要解决 IBD 带来的日益沉重的经济负担，就必须采取综合措施，消除差异，提高成本效益疗法的可及性，并促进医疗保健系统之间的合作。采用创新策略可以为所有 IBD 患者提供个性化、具有成本效益的治疗铺平道路，从而确保更好的治疗效果和可持续性。

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引用次数: 0

Culturally Sensitive and Inclusive IBD Care 具有文化敏感性和包容性的 IBD 护理。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.06.052

Victor Chedid , Laura Targownik , Oriana M. Damas , Sophie Balzora

As the prevalence of inflammatory bowel disease (IBD) increases within historically disadvantaged communities, it is imperative to better understand how intersectionality—defined as the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism)—intersects and social determinants of health influence the patient’s experiences within the medical system when navigating their disease. Culturally sensitive care is characterized by the ability to deliver patient-centered care that recognizes how the intersectionality of an individual’s identities impacts their disease journey. An intentional consideration and sensitivity to this impact play important roles in providing an inclusive and welcoming space for historically disadvantaged individuals living with IBD and will help address health inequity in IBD. Cultural competence implies mastery of care that understands and respects values and beliefs across cultures, while cultural humility involves recognizing the complexity of cultural identity and engaging in an ongoing learning process from individual patient experiences. Heightening our patient care goals from cultural competence to cultural sensitivity allows healthcare professionals and the systems in which they practice to lead with cultural humility as they adopt a more inclusive and humble perspective when caring for patient groups with a diverse array of identities and cultures and to avoid maintaining the status quo of implicit and explicit biases that impede the delivery of quality IBD care. In this article, we review the literature on IBD care in historically disadvantaged communities, address culturally sensitive care, and propose a framework to incorporating cultural humility in IBD practices and research.

随着炎症性肠病（IBD）在历来处于不利地位的社区中发病率的增加，当务之急是更好地理解交叉性，即多种形式的歧视（如种族主义、性别歧视和阶级歧视）的影响如何以复杂、累积的方式与健康的社会决定因素交织在一起，影响患者在医疗系统中治疗疾病的经历。文化敏感性护理的特点是能够提供以患者为中心的护理，认识到个人身份的交叉性如何影响他们的疾病历程。对这种影响的有意考虑和敏感性在为历史上处于不利地位的 IBD 患者提供一个包容和欢迎的空间方面发挥着重要作用，并将有助于解决 IBD 患者的健康不平等问题。文化胜任力意味着在理解和尊重不同文化的价值观和信仰的基础上掌握护理技巧，而文化谦逊则包括认识到文化身份的复杂性，并从患者的个人经历中不断学习。将我们的患者护理目标从文化能力提升到文化敏感性，可使医疗保健专业人员及其所在的系统在护理具有不同身份和文化的患者群体时，采取更具包容性和谦逊的视角，以文化谦逊的态度进行领导，并避免维持阻碍提供优质 IBD 护理的隐性和显性偏见的现状。在本文中，我们将回顾有关历史上弱势社区 IBD 护理的文献，探讨文化敏感性护理，并提出将文化谦逊纳入 IBD 实践和研究的框架。

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引用次数: 0

Role of Early On-Treatment Serum HBV RNA Declines in Predicting Hepatocellular Carcinoma Risk in Patients With Chronic Hepatitis B 治疗早期血清 HBV RNA 下降在预测慢性乙型肝炎患者肝细胞癌风险中的作用。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.07.024

Shi Liu , Grace Lai-Hung Wong , Rong Fan , Junqi Niu , Hong Ma , Wanying Liang , Xingyu Lu , Jianping Xie , Jia Shang , Dongying Xie , Yali Liu , Bin Zhou , Qing Xie , Jie Peng , Hongbo Gao , Huiying Rao , Jinjun Chen , Jifang Sheng , Sheng Shen , Song Yang , Jian Sun

Background and Aims

Hepatocellular carcinoma (HCC) risk prediction models established in patients with chronic hepatitis B receiving nucleos(t)ide analogue (NA) rarely include viral factors because of mediocre predictability of traditional viral markers. Here, we investigate the role of serum hepatitis B virus (HBV) RNA, a novel biomarker, in predicting HCC risk in NA-treated patients.

Methods

A total of 1374 NA-treated patients were enrolled from 2 prospective chronic hepatitis B cohorts. Serum HBV RNA was detected at baseline, year 1, 2 and 3 of treatment. Cox proportional-hazard model was used to investigate the association of HBV RNA kinetics with HCC risk.

Results

After a median follow-up of 5.4 years, 76 patients developed HCC. HBV RNA declines at year 1 (adjusted hazard ratio, 0.70; P = .009) and 2 (adjusted hazard ratio, 0.71; P = .016) were independently associated with HCC risk. Patients with less HBV RNA decline at year 1 (≤0.4 log₁₀ copies/mL) or 2 (≤0.6 log₁₀ copies/mL) had 2.22- and 2.09-folds higher HCC risk, respectively, than those with more declines. When incorporating these early on-treatment HBV RNA declines into existing HCC risk scores, including PAGE-B (age, sex, and platelets), modified PAGE-B (mPAGE-B) (age, sex, platelets, and albumin), and aMAP (age, sex, platelets, and albumin-bilirubin score) score, they could enhance their predictive performance (ie, C-index 0.814 vs 0.78 [model _{(PAGE-B + year-1 HBV RNA decline)} vs PAGE-B score based on baseline parameters]).

Conclusions

Serum HBV RNA declines at year 1 and 2 were significantly associated with on-treatment HCC risk. Incorporating early on-treatment HBV RNA declines into HCC risk prediction models can be useful tools to guide appropriate surveillance strategies in NA-treated patients.

背景和目的：在接受核苷类似物（NA）治疗的慢性乙型肝炎（CHB）患者中建立的肝细胞癌（HCC）风险预测模型很少包含病毒因素，因为传统病毒标志物的预测能力一般。在此，我们研究了血清乙型肝炎病毒（HBV）RNA这一新型生物标志物在预测NA治疗患者HCC风险中的作用：两个前瞻性慢性乙型肝炎队列共招募了1374名接受过NA治疗的患者。在基线、治疗第1年、第2年和第3年检测血清HBV RNA。采用 Cox 比例危险模型研究 HBV RNA 动力学与 HCC 风险的关系：中位随访 5.4 年后，76 例患者发展为 HCC。第 1 年（调整后危险比 (aHR) = 0.70，P = .009）和第 2 年（aHR = 0.71，P = .016）的 HBV RNA 下降与 HCC 风险独立相关。第 1 年（=< 0.4 log10 copies/mL）或第 2 年（=10 copies/mL）HBV RNA 下降较少的患者的 HCC 风险分别比下降较多的患者高 2.22 倍和 2.09 倍。将这些早期治疗时的 HBV RNA 下降纳入现有的 HCC 风险评分（包括 PAGE B、mPAGE B 和 aMAP 评分）时，可提高其预测性能[即 C 指数，0.814 vs. 0.788（模型（PAGE B + 第 1 年 HBV RNA 下降）vs. 基于基线参数的 PAGE B 评分）]：结论：血清 HBV RNA 在第 1 年和第 2 年的下降与治疗期间的 HCC 风险显著相关。将治疗早期的 HBV RNA 下降纳入 HCC 风险预测模型可作为有用的工具，指导对接受 NA 治疗的患者采取适当的监测策略。

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引用次数: 0

Variance Between Clinical Guidance and Real-World Management of Metabolic Dysfunction-associated Steatotic Liver Disease in the United States 美国代谢功能障碍相关性脂肪肝的临床指导与实际管理之间的差异。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.08.018

Mary E. Rinella, Mark L. Hartman, Shraddha Shinde, David Schapiro, Victoria Higgins, Quentin M. Anstee

引用次数: 0

Is a Simplified, Less Restrictive Low FODMAP Diet Possible? Results From a Double-Blind, Pilot Randomized Controlled Trial 简化的、限制较少的低 FODMAP 饮食可行吗？双盲随机对照试验的结果。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.04.021

Prashant Singh, Samuel W. Chey, Judy Nee, Shanti Eswaran, Anthony Lembo, William D. Chey

引用次数: 0

Double Wire Cannulation and Mechanical Lithotripsy in Billroth II With Therapeutic Gastroscope 使用治疗性胃镜对比洛斯 II 型进行双线插管和机械碎石。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.07.014

Grace E. Kim, Uzma D. Siddiqui

引用次数: 0

Prevalence and Costs of Eosinophilic Esophagitis in the United States 美国嗜酸性粒细胞食管炎的发病率和费用。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.09.031

Hannah L. Thel , Chelsea Anderson , Angela Z. Xue , Elisabeth T. Jensen , Evan S. Dellon

Background & Aims

Eosinophilic esophagitis (EoE) has been continually increasing in prevalence, but current estimates are lacking. We aimed to determine updated estimates of the prevalence and medical costs associated with EoE in the United States (U.S.).

Methods

We used two large administrative databases, MarketScan and Medicare, and International Classification of Disease codes to calculate annual prevalence of EoE, as well as age- and sex-stratified estimates, standardized to the U.S. population. Health care utilization, including medications and endoscopic procedures, was quantified, and annual EoE-associated costs were estimated.

Results

We identified 20,435 EoE cases in MarketScan in 2022 and 1913 EoE cases in Medicare in 2017. This translated to prevalences of 163.08 cases/100,000 and 64.83 cases/ 100,000 in MarketScan and Medicare, respectively. There was a 5-fold increase in prevalence in both databases since 2009. In MarketScan, prevalence was higher among males (204.45/100,000 vs 122.06/100,000 among females); for both sexes, peak prevalence was from 40 to 44 years of age. Standardized to the U.S. population, the prevalence of EoE was 142.5/100,000, extrapolating to 472,380 cases. Total EoE-associated health care costs were estimated to be $1.32 billion in 2024 dollars after accounting for inflation.

Conclusions

The prevalence of EoE continues to increase, with a rate of 1 in 617 in 2022 in those <65 years of age, and 1 in 1562 in 2017 those ≥65 years. Standardized to the U.S. population, the overall prevalence was approximately 1 in 700. EoE-associated annual costs were estimated to be $1.3 billion in 2024 dollars, representing a substantial financial burden.

背景和目的：嗜酸性粒细胞食管炎（EoE）的发病率一直在持续上升，但目前缺乏相关的估计数据。我们旨在确定美国嗜酸性粒细胞食管炎患病率和相关医疗费用的最新估计值：我们使用了两个大型行政数据库（MarketScan 和医疗保险）以及国际疾病分类代码，以美国人口为标准，计算出每年的肠易激综合征患病率以及按年龄和性别分层的估计值：对包括药物和内窥镜手术在内的医疗保健使用情况进行了量化，并估算了每年与肠易激综合征相关的费用：2022年，我们在MarketScan中发现了20,435例EoE病例，2017年在Medicare中发现了1,913例EoE病例。这意味着 MarketScan 和 Medicare 的患病率分别为 163.08 例/100,000 人和 64.83 例/100,000 人。自 2009 年以来，这两个数据库中的患病率均增长了 5 倍。在MarketScan中，男性发病率较高（204.45例/100,000人，女性为122.06例/100,000人）；男女发病高峰期均为40-44岁。按照美国人口的标准，肠易激综合征的发病率为 142.5/100,000，推断出 472,380 个病例。在考虑通货膨胀因素后，以 2024 年美元计算，与肠易激综合征相关的医疗总成本估计为 13.2 亿美元：肠易激综合征的发病率持续上升，在 2022 年，每 617 人中就有 1 人患有肠易激综合征。

{"title":"Prevalence and Costs of Eosinophilic Esophagitis in the United States","authors":"Hannah L. Thel , Chelsea Anderson , Angela Z. Xue , Elisabeth T. Jensen , Evan S. Dellon","doi":"10.1016/j.cgh.2024.09.031","DOIUrl":"10.1016/j.cgh.2024.09.031","url":null,"abstract":"<div><h3>Background & Aims</h3><div>Eosinophilic esophagitis (EoE) has been continually increasing in prevalence, but current estimates are lacking. We aimed to determine updated estimates of the prevalence and medical costs associated with EoE in the United States (U.S.).</div></div><div><h3>Methods</h3><div>We used two large administrative databases, MarketScan and Medicare, and International Classification of Disease codes to calculate annual prevalence of EoE, as well as age- and sex-stratified estimates, standardized to the U.S. population. Health care utilization, including medications and endoscopic procedures, was quantified, and annual EoE-associated costs were estimated.</div></div><div><h3>Results</h3><div>We identified 20,435 EoE cases in MarketScan in 2022 and 1913 EoE cases in Medicare in 2017. This translated to prevalences of 163.08 cases/100,000 and 64.83 cases/ 100,000 in MarketScan and Medicare, respectively. There was a 5-fold increase in prevalence in both databases since 2009. In MarketScan, prevalence was higher among males (204.45/100,000 vs 122.06/100,000 among females); for both sexes, peak prevalence was from 40 to 44 years of age. Standardized to the U.S. population, the prevalence of EoE was 142.5/100,000, extrapolating to 472,380 cases. Total EoE-associated health care costs were estimated to be $1.32 billion in 2024 dollars after accounting for inflation.</div></div><div><h3>Conclusions</h3><div>The prevalence of EoE continues to increase, with a rate of 1 in 617 in 2022 in those <65 years of age, and 1 in 1562 in 2017 those ≥65 years. Standardized to the U.S. population, the overall prevalence was approximately 1 in 700. EoE-associated annual costs were estimated to be $1.3 billion in 2024 dollars, representing a substantial financial burden.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 272-280.e8"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564004","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}

引用次数: 0

Developing Leadership Skills and Experience during Gastroenterology Fellowship 在消化内科研究员培训期间培养领导技能和经验。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.08.029

Mohammad Bilal, Amy S. Oxentenko

引用次数: 0

Gut Goo: Physiology, Diet, and Therapy of Intestinal Mucus and Biofilms in Gastrointestinal Health and Disease 肠粘液：肠道粘液和生物膜在胃肠道健康和疾病中的生理、饮食和治疗》（Gut Goo: Physiology, Diet, and Therapy of Intestinal Mucus and Biofilms in Gastrointestinal Health and Disease）。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.09.007

John Damianos , Nada Abdelnaem , Michael Camilleri

The gastrointestinal tract has remarkable capacity to withstand considerable insults from exposure to abrasive food particles, chemicals, allergens, and pathogenic microbes. Maintaining a robust epithelial barrier sequesters these potentially harmful substances in the lumen, preventing absorption into the systemic circulation. Normal functioning of this barrier is central in diverse physiological processes including digestion, immunity, inflammation, and gut-brain signaling. One crucial component of the barrier is the mucus layer covering the epithelium. There is increased appreciation of the importance of mucus in maintenance of the gut barrier, and how dysregulation of the mucus layer contributes to several common gastrointestinal pathologies. This manuscript reviews the physical and chemical properties of mucus, its maintenance and turnover, and its role in maintaining gut barrier integrity. The dynamic interactions of the mucus layer within the gut ecosystem are illustrated by highlighting how a weakened mucus layer or defective mucus production facilitate pathogenic microbial colonization and mucosal biofilm formation. These may potentially contribute to the pathogenesis of gastrointestinal diseases such as inflammatory bowel diseases or result in secretion and mucosal damage and inflammation in bile acid diarrhea. A final goal is to review how certain dietary factors, especially low-fiber diets and emulsifiers common in Western diets, can harm the mucus layer. This report summarizes evidence from preclinical and human studies that document damage to the mucus layer, and reviews approaches, including diets and probiotics, that promote a healthy mucus layer and break down pathogenic biofilms, thereby potentially preventing and/or treating gastrointestinal diseases that impact mucosal integrity.

胃肠道具有非凡的承受能力，能够抵御来自磨蚀性食物颗粒、化学物质、过敏原和病原微生物的巨大伤害。维持稳健的上皮屏障可将这些潜在的有害物质阻隔在管腔内，防止其被吸收进入全身循环。上皮屏障的正常功能是消化、免疫、炎症和肠脑信号传导等多种生理过程的核心。屏障的一个重要组成部分是覆盖上皮的粘液层。人们越来越认识到粘液在维护肠道屏障中的重要性，以及粘液层失调如何导致几种常见的胃肠道病症。本手稿回顾了粘液的物理和化学特性、粘液的维持和周转以及粘液在维持肠道屏障完整性方面的作用。通过强调粘液层减弱或粘液生成缺陷如何促进病原微生物定植和粘膜生物膜形成，说明了粘液层在肠道生态系统中的动态相互作用。这些可能会导致炎症性肠病等胃肠道疾病的发病机制，或导致胆汁酸腹泻的分泌和粘膜损伤及炎症。最后一个目标是回顾某些饮食因素，特别是西方饮食中常见的低纤维饮食和乳化剂如何损害粘液层。本报告总结了临床前研究和人体研究中证明粘液层受损的证据，并回顾了包括饮食和益生菌在内的促进粘液层健康和分解病原生物膜的方法，从而有可能预防和/或治疗影响粘膜完整性的胃肠道疾病。

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