Pub Date : 2024-10-05DOI: 10.1016/j.cgh.2024.06.053
Pauline A Zellenrath, Laurelle van Tilburg, Roos E Pouw, Rena Yadlapati, Yonne Peters, Michael B Ujiki, Prashanthi N Thota, Norihisa Ishimura, Stephen J Meltzer, Noam Peleg, Won-Tak Choi, John V Reynolds, Alexandros D Polydorides, Arjun D Koch, Judith Honing, Manon C W Spaander
Background and aims: Females with Barrett's esophagus (BE) have a lower risk of neoplastic progression than males, but sufficiently powered risk analyses are lacking. This systematic review and meta-analysis of individual patient data (IPD) aimed to provide more robust evidence on neoplastic progression risk in females.
Methods: We conducted a systematic literature search of 3 electronic databases (Medline, Embase, Google Scholar) from inception until August 2023. Eligible studies (1) reported original data on progression from nondysplastic BE, indefinite for dysplasia, or low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma; and (2) included female and male patients. IPD were quality controlled by 2 independent reviewers. The primary outcome was the association between sex and neoplastic progression risk, adjusted for risk factors using multivariable Cox regression analysis. Secondary outcomes were sex differences in time to progression and annual progression rate.
Results: IPD were obtained from 11 of 66 eligible studies, including 2196 (31%) females. Neoplastic progression risk was lower in females (hazard ratio for males vs females, 1.44; 95% confidence interval, 1.13-1.82) after adjusting for age, smoking, medication use, hiatal hernia, BE length, and baseline pathology. The annual progression rate was 0.88% in females vs 1.29% in males. Time to progression was similar in both sexes: 3.7 years (interquartile range, 2.1-7.7 years) in females and 4.2 years (interquartile range, 2.0-8.1 years) in males.
Conclusion: Although females had a lower neoplastic progression risk, sex differences were smaller than previously reported, and time to progression was similar for both sexes. Future research should focus on other factors than sex to identify low- and high-risk BE patients.
{"title":"Neoplastic Progression Risk in Females With Barrett's Esophagus: A Systematic Review and Meta-Analysis of Individual Patient Data.","authors":"Pauline A Zellenrath, Laurelle van Tilburg, Roos E Pouw, Rena Yadlapati, Yonne Peters, Michael B Ujiki, Prashanthi N Thota, Norihisa Ishimura, Stephen J Meltzer, Noam Peleg, Won-Tak Choi, John V Reynolds, Alexandros D Polydorides, Arjun D Koch, Judith Honing, Manon C W Spaander","doi":"10.1016/j.cgh.2024.06.053","DOIUrl":"10.1016/j.cgh.2024.06.053","url":null,"abstract":"<p><strong>Background and aims: </strong>Females with Barrett's esophagus (BE) have a lower risk of neoplastic progression than males, but sufficiently powered risk analyses are lacking. This systematic review and meta-analysis of individual patient data (IPD) aimed to provide more robust evidence on neoplastic progression risk in females.</p><p><strong>Methods: </strong>We conducted a systematic literature search of 3 electronic databases (Medline, Embase, Google Scholar) from inception until August 2023. Eligible studies (1) reported original data on progression from nondysplastic BE, indefinite for dysplasia, or low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma; and (2) included female and male patients. IPD were quality controlled by 2 independent reviewers. The primary outcome was the association between sex and neoplastic progression risk, adjusted for risk factors using multivariable Cox regression analysis. Secondary outcomes were sex differences in time to progression and annual progression rate.</p><p><strong>Results: </strong>IPD were obtained from 11 of 66 eligible studies, including 2196 (31%) females. Neoplastic progression risk was lower in females (hazard ratio for males vs females, 1.44; 95% confidence interval, 1.13-1.82) after adjusting for age, smoking, medication use, hiatal hernia, BE length, and baseline pathology. The annual progression rate was 0.88% in females vs 1.29% in males. Time to progression was similar in both sexes: 3.7 years (interquartile range, 2.1-7.7 years) in females and 4.2 years (interquartile range, 2.0-8.1 years) in males.</p><p><strong>Conclusion: </strong>Although females had a lower neoplastic progression risk, sex differences were smaller than previously reported, and time to progression was similar for both sexes. Future research should focus on other factors than sex to identify low- and high-risk BE patients.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380166","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}
Pub Date : 2024-10-05DOI: 10.1016/j.cgh.2024.07.046
Daniele Piovani, Georgios K Nikolopoulos, Alessio Aghemo, Ana Lleo, Saleh A Alqahtani, Cesare Hassan, Alessandro Repici, Stefanos Bonovas
Background & aims: Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC.
Methods: We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and nonrandomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval (CI), P value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding.
Results: We identified 215 eligible primary studies and performed 350 meta-analyses across 7 domains: lifestyle, reproductive, metabolic, dietary, infections, interventions, and contaminants and occupational exposures. Based on longitudinal evidence, body mass index (relative risk [RR] per 5-unit increase, 1.27; 95% CI, 1.21‒1.33), hip circumference (RR per 5-cm increase, 1.16; 95% CI, 1.11‒1.22), infection of bile ducts (RR, 31.7; 95% CI, 24.8-40.6), high parity (RR, 1.48; 95% CI, 1.30‒1.68), obesity (RR, 1.70; 95% CI, 1.44‒2.01), overweight (RR, 1.28; 95% CI, 1.14‒1.43), waist circumference (RR per 5-cm increase, 1.14; 95% CI, 1.10‒1.18), and waist-to-height ratio (RR per 0.1 increase, 1.49; 95% CI, 1.36‒1.64) were robustly associated with increased GBC risk, whereas high education (RR, 0.63; 95% CI, 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption, and insufficient physical activity.
Conclusions: This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas. (Systematic review registration: CRD42023434673.).
{"title":"Environmental Risk Factors for Gallbladder Cancer: Field-Wide Systematic Review and Meta-Analysis.","authors":"Daniele Piovani, Georgios K Nikolopoulos, Alessio Aghemo, Ana Lleo, Saleh A Alqahtani, Cesare Hassan, Alessandro Repici, Stefanos Bonovas","doi":"10.1016/j.cgh.2024.07.046","DOIUrl":"10.1016/j.cgh.2024.07.046","url":null,"abstract":"<p><strong>Background & aims: </strong>Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC.</p><p><strong>Methods: </strong>We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and nonrandomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval (CI), P value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding.</p><p><strong>Results: </strong>We identified 215 eligible primary studies and performed 350 meta-analyses across 7 domains: lifestyle, reproductive, metabolic, dietary, infections, interventions, and contaminants and occupational exposures. Based on longitudinal evidence, body mass index (relative risk [RR] <sub>per 5-unit increase</sub>, 1.27; 95% CI, 1.21‒1.33), hip circumference (RR <sub>per 5-cm increase</sub>, 1.16; 95% CI, 1.11‒1.22), infection of bile ducts (RR, 31.7; 95% CI, 24.8-40.6), high parity (RR, 1.48; 95% CI, 1.30‒1.68), obesity (RR, 1.70; 95% CI, 1.44‒2.01), overweight (RR, 1.28; 95% CI, 1.14‒1.43), waist circumference (RR <sub>per 5-cm increase</sub>, 1.14; 95% CI, 1.10‒1.18), and waist-to-height ratio (RR <sub>per 0.1 increase</sub>, 1.49; 95% CI, 1.36‒1.64) were robustly associated with increased GBC risk, whereas high education (RR, 0.63; 95% CI, 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption, and insufficient physical activity.</p><p><strong>Conclusions: </strong>This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas. (Systematic review registration: CRD42023434673.).</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380165","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}
Pub Date : 2024-10-04DOI: 10.1016/j.cgh.2024.07.043
Amisha Ahuja, Nitin K Ahuja
{"title":"Preparing the Next Generation of Gastroenterologists to Tackle Climate Change.","authors":"Amisha Ahuja, Nitin K Ahuja","doi":"10.1016/j.cgh.2024.07.043","DOIUrl":"10.1016/j.cgh.2024.07.043","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380167","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}
Pub Date : 2024-10-04DOI: 10.1016/j.cgh.2024.08.038
Meredith E Pittman, Avleen Kaur, Thin Phyu Phyu Aung, Linda A Lee, Yasutoshi Shiratori
{"title":"The Impact of Immigration Status on Gastric Cancer Risk in a Community Hospital in New York City.","authors":"Meredith E Pittman, Avleen Kaur, Thin Phyu Phyu Aung, Linda A Lee, Yasutoshi Shiratori","doi":"10.1016/j.cgh.2024.08.038","DOIUrl":"10.1016/j.cgh.2024.08.038","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380168","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}
Pub Date : 2024-10-03DOI: 10.1016/j.cgh.2024.09.002
Kevin J Kane, Christopher D Jensen, Jingrong Yang, Huyun Dong, Sophie A Merchant, Pradeep Koripella, Xiaoran Li, Jeffrey M Hendel, Douglas A Corley, Jeffrey K Lee
Background and aims: Prior antibiotic use may be a factor in the rising incidence of colorectal cancer seen in those under 50 years of age (early-onset colorectal cancer [EOCRC]); however, the few studies to examine this link have reported conflicting results. Therefore, we evaluated the association between oral antibiotic use in adulthood and EOCRC in a large integrated healthcare system in the United States.
Methods: A population-based nested case-control study was conducted among Kaiser Permanente Northern California patients 18-49 years of age diagnosed with EOCRC (adenocarcinoma of the colon or rectum) in 1998-2020 who had ≥2 years of continuous pharmacy benefit prior to diagnosis. Cases were matched 4:1 to healthy controls on birth year, sex, race and ethnicity, medical facility, and duration of pharmacy benefit. Antibiotic exposure >1 year before the diagnosis/index date was assessed using prescribing records. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. A sensitivity analysis was performed among those with ≥10 years of continuous prescribing records.
Results: A total of 1359 EOCRC cases were matched to 4711 healthy controls. Antibiotic use in adulthood was not significantly associated with EOCRC in unadjusted or adjusted analyses (adjusted odds ratio, 1.04; 95% confidence interval, 0.94-1.26). No associations were seen for cumulative number of oral antibiotic dispensations or for any prior period of antibiotic exposure.
Conclusions: In a large U.S. healthcare setting, there was no conclusive evidence of an association between oral antibiotic use in adulthood and risk of EOCRC.
{"title":"Oral Antibiotic Use in Adulthood and Risk of Early-Onset Colorectal Cancer: A Case-Control Study.","authors":"Kevin J Kane, Christopher D Jensen, Jingrong Yang, Huyun Dong, Sophie A Merchant, Pradeep Koripella, Xiaoran Li, Jeffrey M Hendel, Douglas A Corley, Jeffrey K Lee","doi":"10.1016/j.cgh.2024.09.002","DOIUrl":"10.1016/j.cgh.2024.09.002","url":null,"abstract":"<p><strong>Background and aims: </strong>Prior antibiotic use may be a factor in the rising incidence of colorectal cancer seen in those under 50 years of age (early-onset colorectal cancer [EOCRC]); however, the few studies to examine this link have reported conflicting results. Therefore, we evaluated the association between oral antibiotic use in adulthood and EOCRC in a large integrated healthcare system in the United States.</p><p><strong>Methods: </strong>A population-based nested case-control study was conducted among Kaiser Permanente Northern California patients 18-49 years of age diagnosed with EOCRC (adenocarcinoma of the colon or rectum) in 1998-2020 who had ≥2 years of continuous pharmacy benefit prior to diagnosis. Cases were matched 4:1 to healthy controls on birth year, sex, race and ethnicity, medical facility, and duration of pharmacy benefit. Antibiotic exposure >1 year before the diagnosis/index date was assessed using prescribing records. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. A sensitivity analysis was performed among those with ≥10 years of continuous prescribing records.</p><p><strong>Results: </strong>A total of 1359 EOCRC cases were matched to 4711 healthy controls. Antibiotic use in adulthood was not significantly associated with EOCRC in unadjusted or adjusted analyses (adjusted odds ratio, 1.04; 95% confidence interval, 0.94-1.26). No associations were seen for cumulative number of oral antibiotic dispensations or for any prior period of antibiotic exposure.</p><p><strong>Conclusions: </strong>In a large U.S. healthcare setting, there was no conclusive evidence of an association between oral antibiotic use in adulthood and risk of EOCRC.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142379169","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}
Pub Date : 2024-10-02DOI: 10.1016/j.cgh.2024.08.037
Ka Shing Cheung, Wai K Leung
{"title":"Response to A Lin, A Jiang, P Luo.","authors":"Ka Shing Cheung, Wai K Leung","doi":"10.1016/j.cgh.2024.08.037","DOIUrl":"10.1016/j.cgh.2024.08.037","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142375227","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}
Pub Date : 2024-10-02DOI: 10.1016/j.cgh.2024.08.035
Jennifer Christie
{"title":"Editorial: Getting to the Real Skinny on GLP-1RAs and the Risk of Aspiration During Endoscopy.","authors":"Jennifer Christie","doi":"10.1016/j.cgh.2024.08.035","DOIUrl":"10.1016/j.cgh.2024.08.035","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371142","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}
Pub Date : 2024-10-02DOI: 10.1016/j.cgh.2024.07.045
Gong Feng, Ferenc E Mózes, Dong Ji, Sombat Treeprasertsuk, Takeshi Okanoue, Toshihide Shima, Huiqing Liang, Emmanuel Tsochatzis, Jinjun Chen, Jörn M Schattenberg, Christian Labenz, Sanjiv Mahadeva, Wah Kheong Chan, Xiaoling Chi, Adèle Delamarre, Victor de Lédinghen, Salvatore Petta, Elisabetta Bugianesi, Hannes Hagström, Jérôme Boursier, José Luis Calleja, George Boon-Bee Goh, Rocio Gallego-Durán, Arun J Sanyal, Jian-Gao Fan, Laurent Castéra, Michelle Lai, Stephen A Harrison, Manuel Romero-Gomez, Seung Up Kim, Yongfen Zhu, Geraldine Ooi, Junping Shi, Masato Yoneda, Atsushi Nakajima, Jing Zhang, Monica Lupsor-Platon, Bihui Zhong, Jeremy F L Cobbold, Chun-Yan Ye, Peter J Eddowes, Philip Newsome, Jie Li, Jacob George, Fangping He, Myeong Jun Song, Hong Tang, Yuchen Fan, Jidong Jia, Liang Xu, Su Lin, Yiling Li, Zhonghua Lu, Yuemin Nan, Junqi Niu, Xuebing Yan, Yongjian Zhou, Chenghai Liu, Hong Deng, Qing Ye, Qing-Lei Zeng, Lei Li, Jing Wang, Song Yang, Huapeng Lin, Hye Won Lee, Terry Cheuk-Fung Yip, Céline Fournier-Poizat, Grace Lai-Hung Wong, Grazia Pennisi, Angelo Armandi, Wen-Yue Liu, Ying Shang, Marc de Saint-Loup, Elba Llop, Kevin Kim Jun Teh, Carmen Lara-Romero, Amon Asgharpour, Sara Mahgoub, Mandy Sau-Wai Chan, Clemence M Canivet, Fanpu Ji, Yongning Xin, Jin Chai, Zhiyong Dong, Giovanni Targher, Christopher D Byrne, Na He, Man Mi, Feng Ye, Vincent Wai-Sun Wong, Michael Pavlides, Ming-Hua Zheng
Background & aims: Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs).
Methods: We analyzed data from 3004 individuals with biopsy-proven metabolic dysfunction-associated fatty liver disease (MAFLD) across 29 Chinese and 9 international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9034 patients with MAFLD to examine associations between the acFibroMASH index and the risk of LREs.
Results: In the pooled global cohort, the acMASH index identified MASH with an area under the receiver operating characteristic curve (AUROC) of 0.802 (95% confidence interval [CI], 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI, 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI, 0.693-0.800; P < .01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted hazard ratio, 11.23; 95% CI, 3.98-31.66).
Conclusions: This multi-ethnic study validates the acMASH index as a reliable, noninvasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.
背景与目的:代谢功能障碍相关性脂肪性肝炎(MASH)和纤维化MASH是重大的健康挑战。这项跨国研究旨在验证用于MASH诊断的acMASH指数(包括血清肌酐和天冬氨酸氨基转移酶浓度),并开发一种新的指数(acFibroMASH),用于无创识别纤维化MASH,并探索其对肝脏相关事件(LREs)的预测价值:我们分析了29个中国队列和9个国际队列中3004名经活检证实患有代谢功能障碍相关性脂肪肝(MAFLD)的患者的数据,以验证acMASH指数并开发acFibroMASH指数。此外,我们还利用来自9034名MAFLD患者的多国队列的独立外部数据,研究了acFibroMASH指数与LREs风险之间的关联:在汇总的全球队列中,acMASH 指数识别 MASH 的 AUROC 为 0.802(95%CI 0.786-0.818)。acFibroMASH指数(包括acMASH指数和肝脏硬度测量)能准确识别纤维化MASH,在衍生队列中的AUROC为0.808,在验证队列中的AUROC为0.800。值得注意的是,acFibroMASH 指数的 AUROC 为 0.835(95% CI 0.786-0.882),优于 FAST 评分的 0.750(95% CI 0.693-0.800,P0.39):这项多种族研究验证了 acMASH 指数是识别 MASH 的可靠、无创检测方法。新提出的 acFibroMASH 指数是识别纤维化 MASH 和预测 LRE 风险的可靠检测方法。
{"title":"acFibroMASH Index for the Diagnosis of Fibrotic MASH and Prediction of Liver-related Events: An International Multicenter Study.","authors":"Gong Feng, Ferenc E Mózes, Dong Ji, Sombat Treeprasertsuk, Takeshi Okanoue, Toshihide Shima, Huiqing Liang, Emmanuel Tsochatzis, Jinjun Chen, Jörn M Schattenberg, Christian Labenz, Sanjiv Mahadeva, Wah Kheong Chan, Xiaoling Chi, Adèle Delamarre, Victor de Lédinghen, Salvatore Petta, Elisabetta Bugianesi, Hannes Hagström, Jérôme Boursier, José Luis Calleja, George Boon-Bee Goh, Rocio Gallego-Durán, Arun J Sanyal, Jian-Gao Fan, Laurent Castéra, Michelle Lai, Stephen A Harrison, Manuel Romero-Gomez, Seung Up Kim, Yongfen Zhu, Geraldine Ooi, Junping Shi, Masato Yoneda, Atsushi Nakajima, Jing Zhang, Monica Lupsor-Platon, Bihui Zhong, Jeremy F L Cobbold, Chun-Yan Ye, Peter J Eddowes, Philip Newsome, Jie Li, Jacob George, Fangping He, Myeong Jun Song, Hong Tang, Yuchen Fan, Jidong Jia, Liang Xu, Su Lin, Yiling Li, Zhonghua Lu, Yuemin Nan, Junqi Niu, Xuebing Yan, Yongjian Zhou, Chenghai Liu, Hong Deng, Qing Ye, Qing-Lei Zeng, Lei Li, Jing Wang, Song Yang, Huapeng Lin, Hye Won Lee, Terry Cheuk-Fung Yip, Céline Fournier-Poizat, Grace Lai-Hung Wong, Grazia Pennisi, Angelo Armandi, Wen-Yue Liu, Ying Shang, Marc de Saint-Loup, Elba Llop, Kevin Kim Jun Teh, Carmen Lara-Romero, Amon Asgharpour, Sara Mahgoub, Mandy Sau-Wai Chan, Clemence M Canivet, Fanpu Ji, Yongning Xin, Jin Chai, Zhiyong Dong, Giovanni Targher, Christopher D Byrne, Na He, Man Mi, Feng Ye, Vincent Wai-Sun Wong, Michael Pavlides, Ming-Hua Zheng","doi":"10.1016/j.cgh.2024.07.045","DOIUrl":"10.1016/j.cgh.2024.07.045","url":null,"abstract":"<p><strong>Background & aims: </strong>Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs).</p><p><strong>Methods: </strong>We analyzed data from 3004 individuals with biopsy-proven metabolic dysfunction-associated fatty liver disease (MAFLD) across 29 Chinese and 9 international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9034 patients with MAFLD to examine associations between the acFibroMASH index and the risk of LREs.</p><p><strong>Results: </strong>In the pooled global cohort, the acMASH index identified MASH with an area under the receiver operating characteristic curve (AUROC) of 0.802 (95% confidence interval [CI], 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI, 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI, 0.693-0.800; P < .01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted hazard ratio, 11.23; 95% CI, 3.98-31.66).</p><p><strong>Conclusions: </strong>This multi-ethnic study validates the acMASH index as a reliable, noninvasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371141","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}
Pub Date : 2024-10-01DOI: 10.1016/j.cgh.2024.09.003
Anne I Hahn, Duco T Mülder, Robert J Huang, Margaret J Zhou, Benjamin Blake, Omonefe Omofuma, John D Murphy, Daniela S Gutiérrez-Torres, Ann G Zauber, James F O'Mahony, M Constanza Camargo, Uri Ladabaum, Jennifer M Yeh, Chin Hur, Iris Lansdorp-Vogelaar, Reinier Meester, Monika Laszkowska
Background & aims: Whether gastric cancer (GC) precursor lesions progress to invasive cancer at similar rates globally remains unknown. We conducted a systematic review and meta-analysis to determine the progression of precursor lesions to GC in countries with low versus medium/high incidence.
Methods: We searched relevant databases for studies reporting the progression of endoscopically confirmed precursor lesions to GC. Studies were stratified by low (<6 per 100,000) or medium/high (≥6 per 100,000) GC incidence countries. Random-effects models were used to estimate the progression rates of atrophic gastritis (AG), intestinal metaplasia (IM), and dysplasia to GC per 1000 person-years.
Results: Among the 5829 studies identified, 44 met our inclusion criteria. The global pooled estimates of the progression rate per 1000 person-years were 2.09 (95% confidence interval, 1.46-2.99), 2.89 (2.03-4.11), and 10.09 (5.23-19.49) for AG, IM, and dysplasia, respectively. The estimated progression rates per 1000 person-years for low versus medium/high GC incidence countries, respectively, were 0.97 (0.86-1.10) versus 2.47 (1.70-2.99) for AG (P < .01), 2.37 (1.43-3.92) versus 3.47 (2.13-5.65) for IM (P = .29), and 5.51 (2.92-10.39) versus 14.80 (5.87-37.28) for dysplasia (P = .08). There were no differences for progression of AG between groups when high-quality studies were compared.
Conclusions: Similar progression rates of IM and dysplasia were observed among low and medium/high GC incidence countries. This suggests that the potential benefits of surveillance for these lesions in low-risk regions may be comparable with those of population-wide interventions in high-risk regions. Further prospective studies are needed to confirm these findings and inform global screening and surveillance guidelines.
背景和目的:全球胃癌(GC)前驱病变进展为浸润性癌症的比例是否相似仍是未知数。我们进行了一项系统性回顾和荟萃分析,以确定低发病率国家与中/高发病率国家的胃癌前病变进展情况:我们在相关数据库中检索了报告内镜确诊前驱病变发展为 GC 的研究。研究按照低发病率和中/高发病率进行了分层:在确定的 5829 项研究中,有 44 项符合我们的纳入标准。每千人年AG、IM和发育不良的进展率全球汇总估计值分别为2.09(95% CI 1.46-2.99)、2.89(2.03-4.11)和10.09(5.23-19.49)。低 GC 发病率国家与中/高 GC 发病率国家的每千人年估计进展率分别为 0.97(0.86-1.10) vs. AG 2.47(1.70-2.99)(p 结论:低GC发病率国家和中/高GC发病率国家的IM和发育不良进展率相似。这表明,在低风险地区监测这些病变的潜在益处可能与在高风险地区采取全民干预措施的益处相当。需要进一步的前瞻性研究来证实这些发现,并为全球筛查和监测指南提供信息。
{"title":"Global Progression Rates of Precursor Lesions for Gastric Cancer: A Systematic Review and Meta-Analysis.","authors":"Anne I Hahn, Duco T Mülder, Robert J Huang, Margaret J Zhou, Benjamin Blake, Omonefe Omofuma, John D Murphy, Daniela S Gutiérrez-Torres, Ann G Zauber, James F O'Mahony, M Constanza Camargo, Uri Ladabaum, Jennifer M Yeh, Chin Hur, Iris Lansdorp-Vogelaar, Reinier Meester, Monika Laszkowska","doi":"10.1016/j.cgh.2024.09.003","DOIUrl":"10.1016/j.cgh.2024.09.003","url":null,"abstract":"<p><strong>Background & aims: </strong>Whether gastric cancer (GC) precursor lesions progress to invasive cancer at similar rates globally remains unknown. We conducted a systematic review and meta-analysis to determine the progression of precursor lesions to GC in countries with low versus medium/high incidence.</p><p><strong>Methods: </strong>We searched relevant databases for studies reporting the progression of endoscopically confirmed precursor lesions to GC. Studies were stratified by low (<6 per 100,000) or medium/high (≥6 per 100,000) GC incidence countries. Random-effects models were used to estimate the progression rates of atrophic gastritis (AG), intestinal metaplasia (IM), and dysplasia to GC per 1000 person-years.</p><p><strong>Results: </strong>Among the 5829 studies identified, 44 met our inclusion criteria. The global pooled estimates of the progression rate per 1000 person-years were 2.09 (95% confidence interval, 1.46-2.99), 2.89 (2.03-4.11), and 10.09 (5.23-19.49) for AG, IM, and dysplasia, respectively. The estimated progression rates per 1000 person-years for low versus medium/high GC incidence countries, respectively, were 0.97 (0.86-1.10) versus 2.47 (1.70-2.99) for AG (P < .01), 2.37 (1.43-3.92) versus 3.47 (2.13-5.65) for IM (P = .29), and 5.51 (2.92-10.39) versus 14.80 (5.87-37.28) for dysplasia (P = .08). There were no differences for progression of AG between groups when high-quality studies were compared.</p><p><strong>Conclusions: </strong>Similar progression rates of IM and dysplasia were observed among low and medium/high GC incidence countries. This suggests that the potential benefits of surveillance for these lesions in low-risk regions may be comparable with those of population-wide interventions in high-risk regions. Further prospective studies are needed to confirm these findings and inform global screening and surveillance guidelines.</p>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371143","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}
Pub Date : 2024-09-27DOI: 10.1016/j.cgh.2024.08.034
Mark Tawfik, Chloe Lahoud, Sherif Andrawes
{"title":"Endoscopic Submucosal Dissection Provides Hemostasis by Curative Resection for a Large Bleeding and Obstructive Duodenal Lipoma.","authors":"Mark Tawfik, Chloe Lahoud, Sherif Andrawes","doi":"10.1016/j.cgh.2024.08.034","DOIUrl":"10.1016/j.cgh.2024.08.034","url":null,"abstract":"","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":null,"pages":null},"PeriodicalIF":11.6,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142342790","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}