Gastroenterology Research最新文献

Background: Histologic remission is increasingly recognized as an important endpoint in ulcerative colitis (UC) management. Consensus guidelines on adopting histologic scoring systems in clinical practice are lacking in the United States. This study aimed to assess the knowledge, attitudes, and practices of pathologists, primarily located in North America, regarding histologic evaluation in UC.

Methods: This study surveyed a group of pathologists who have completed postdoctoral medical training with demonstrated interest and involvement in the field of gastrointestinal pathology to evaluate their knowledge, practices, and perspectives on histologic assessment using standardized scoring systems in clinical practice in UC patients. The survey was hosted on an online platform, and responses were recorded anonymously.

Results: A total of 57 responses were included in the analysis. Nearly two-thirds of pathologists acknowledged a lack of familiarity with the criteria for histologic remission as defined by the Nancy Index (NI), Robarts Histopathology Index (RHI), and Geboes score (GS). A majority (37/57; 65%) of pathologists did not support routine inclusion of a histologic score in pathology reports. The remaining 20/57 (35%) pathologists advocated for the incorporation of a standardized index, with the NI favored by 10/20 (50%) followed by the GS (n = 3; 15%) and the IBD-Distribution, Chronicity and Activity score (n = 3; 15%). Nearly a half (27/57; 47%) of the respondents acknowledged a favorable role for artificial intelligence in this setting.

Conclusions: The current survey highlights the need for collaborative efforts among pathologists, gastroenterologists, and professional societies to establish a consensus guideline for routine histologic assessment in UC. Additional guidance from professional societies and research are required to integrate artificial intelligence-driven approaches into routine clinical practice.

Background: Diverticulitis is a common colon pathology that contributes a significant healthcare burden due to hospitalizations, colonoscopies, and operations. Although recent clinical practice guidelines (CPGs) advocate for less frequent and selective use of antibiotics, colonoscopies, admissions, and operations, rates of admissions and elective operations for diverticulitis have paradoxically increased over time. Understanding where patients seek care for diverticulitis can identify areas where CPGs are or are not being followed. This study aimed to describe care settings, treating providers, and characterize treatment patterns for diverticulitis.

Methods: This prospective cohort study included patients with diverticulitis diagnosed via computed tomography (CT) scan at a single institution between 2019 and 2020. The CT scan setting (outpatient, emergency department, or inpatient), main treating provider specialty (medicine, surgery, gastroenterology, or emergency medicine), and clinical characteristics were identified. For each patient, antibiotic prescription, screening colonoscopy within a year of diagnosis, and surgical referrals were characterized.

Results: A total of 310 patients (mean age 62, 60.3% female) were included, with 71.3% being new diagnoses of diverticulitis. Eighteen percent of diagnoses were complicated diverticulitis. Most diagnoses occurred in the outpatient setting (60%), followed by the emergency department (36.5%), then inpatient (3.5%). Complicated diverticulitis cases more frequently presented to the emergency department than outpatient (25% vs. 12.9%, P = 0.002). Antibiotics were prescribed in 91% of cases, with the highest rate in the emergency department (96.5%) compared to outpatient (87.6%) or inpatient (90.9%, P = 0.036). Colonoscopy was up to date in 45.1% of uncomplicated and 54.4% of complicated cases (P = 0.137). Surgical referrals occurred in 38.7% of patients, with higher rates for complicated diverticulitis (84.2% vs. 28.6%, P < 0.001).

Conclusion: Most episodes of diverticulitis are uncomplicated and occur in the outpatient setting. However, care remains fragmented across multiple specialties, making it challenging to measure the appropriate delivery of CPG-concordant care for diverticulitis. The variation in management of diverticulitis highlights the need for a more coordinated, system-level approach to enable high-quality care delivery.

Background: Identifying risk factors for poor outcomes in patients with hepatocellular carcinoma (HCC) treated with transarterial radioembolization (TARE) can aid in developing personalized management strategies, such as the early use of immune checkpoint inhibitors (ICIs).

Methods: In this retrospective review, we included HCC patients who received TARE at The Ohio State University Comprehensive Cancer Center from January 1, 2015, to August 30, 2022. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS). Cox proportional hazard analysis was conducted to find the independent predictors of PFS and OS.

Results: We included 141 patients (median age of 65 years; 80% Caucasian; 80% male). Better PFS was associated with higher albumin (alb) (hazard ratio (HR) = 0.58, P = 0.005) and lower total bilirubin (T bili) levels (HR = 0.70, P = 0.034). Better OS was associated with a history of ablation (HR = 0.35, P < 0.001) and higher pre-TARE alb (HR = 0.63, P = 0.01); OS was worse in those with hepatic encephalopathy (HR = 2.01, P = 0.006). There was a notable trend toward worse OS in patients with ascites (HR = 1.71, P = 0.06) and metabolic-dysfunction-associated fatty liver disease (MAFLD)-associated HCC (HR = 1.86, P = 0.08). The receipt of ICI therapy was associated with a significantly better OS (P = 0.016), with a median OS of 1,102 days (95% confidence interval (CI): 884 - 1,509) compared to 614 days (95% CI: 493 - 829).

Conclusion: We present pretreatment risk factors (low alb, high T bili, MAFLD, hepatic encephalopathy, and ascites) that can predict poor outcomes in HCC patients treated with TARE. Preemptively treating such high-risk patients with ICI could improve their outcomes.

Background: Functional dyspepsia (FD) is a prevalent gastrointestinal disorder characterized by upper abdominal discomfort, often refractory to standard acid suppression therapy. Potassium-competitive acid blockers (PCABs), such as vonoprazan and tegoprazan, provide rapid and sustained gastric acid inhibition and may represent a therapeutic alternative. However, their efficacy in FD remains unclear. This systematic review and meta-analysis aimed to evaluate the effect of PCAB therapy on symptom outcomes in adults with FD.

Methods: A systematic search of PubMed, EMBASE, and Cochrane CENTRAL was conducted from inception to June 13, 2025, to identify studies evaluating PCABs in adult FD patients. Eligible studies included randomized controlled trials and prospective or retrospective cohorts reporting validated symptom scores before and after PCAB therapy. Studies were included in meta-analysis if they reported 4-week outcomes with sufficient data for effect size calculation. Standardized mean differences (SMDs) were pooled using a DerSimonian-Laird random-effects model. Heterogeneity was assessed with the I² statistic, and robustness was evaluated with leave-one-out sensitivity analysis and Baujat plots.

Results: Five studies comprising 366 patients were included. Four treatment arms from three studies (n = 276) were eligible for meta-analysis. The pooled SMD for symptom improvement at 4 weeks was 1.09 (95% confidence interval (CI): 0.67 - 1.52), indicating a moderate-to-large treatment effect in favor of PCABs. Heterogeneity was substantial (I² = 77.8%), but sensitivity analyses showed that no single study unduly influenced results. The remaining two studies, excluded from quantitative pooling due to incompatible timepoints or outcome structures, also demonstrated statistically significant symptom improvement, supporting consistency of effect across the evidence base.

Conclusion: PCABs may offer clinically meaningful symptom relief in FD, with pooled data suggesting a moderate-to-large effect size. While heterogeneity and limited sample size temper generalizability, findings were consistent across studies and robust to sensitivity testing. PCABs show promise as a potential therapeutic option in FD, particularly in patients who do not respond to or cannot tolerate proton pump inhibitors. Further placebo-controlled trials are needed to confirm efficacy and define long-term outcomes.

Background: Drug-induced liver injury (DILI) presents a significant diagnostic challenge, often leading to delayed detection. Unstructured clinical notes contain comprehensive medication data vital for DILI surveillance but are difficult to analyze systematically. Large language models (LLMs) show promise for automated extraction but require real-world clinical data validation to assess feasibility for clinical applications like DILI surveillance.

Methods: We retrospectively validated an LLM system on 100 randomly sampled Medical Information Mart for Intensive Care IV (MIMIC-IV) discharge summaries. Gold standard unique medication lists were derived via manual annotation and manual deduplication based on normalized drug names. LLM outputs underwent identical deduplication. Performance was assessed using precision, recall, and F1-score comparing deduplicated lists. MIMIC-IV data use agreement (DUA) compliance was ensured.

Results: Comparison yielded a precision of 0.85, recall of 1.00, and an F1-score of 0.92 for unique medication identification. The 174 false positives resulted from parsing or normalization errors; no medication hallucinations occurred. A subsequent DILI database lookup failed for approximately 6.2% of correctly identified unique medications, evaluated as a separate feasibility measure.

Conclusions: The LLM demonstrates high accuracy and perfect recall for unique medication extraction and identification from complex clinical notes, establishing technical feasibility. This represents a feasible and possible integration of LLM towards developing automated tools for enhanced DILI surveillance and improved patient safety.

Background: The Hispanic population is the fastest-growing ethnic group in the USA and is projected to comprise 30% of the US population by 2050. Despite socioeconomic disadvantages and often presenting with more severe disease phenotypes, previous studies in chronic diseases have shown that Hispanics experience lower overall inpatient mortality compared with other ethnic groups - a phenomenon known as the "Hispanic Paradox". In alcoholic liver cirrhosis (ALC), this paradox is particularly evident: Hispanics frequently develop more advanced forms of alcoholic liver cirrhosis, yet survival outcomes are often similar or even superior to those of non-Hispanic populations. This study aims to assess the risk and burden of alcoholic liver cirrhosis in the Hispanic population and to compare the clinical phenotype of ALC with that observed in non-Hispanic populations.

Methods: This retrospective analysis used the Nationwide Inpatient Sample (NIS) database (2016 - 2019) to examine adults hospitalized with ALC. Patients with other causes of cirrhosis were excluded. Patients were stratified into Hispanic and non-Hispanic groups. Diagnoses, complications, and comorbidities were captured using the International Classification of Disease, 10th Revision (ICD-10) codes. The primary outcome was inpatient mortality; secondary outcomes included length of stay (LOS) and total hospitalization charges (TOTCHG). Statistical analyses were performed using Chi-square, t-tests, and Mann-Whitney U tests.

Results: Among patients hospitalized with alcoholic cirrhosis (n = 1,002,115), 17% were Hispanic. Hispanic patients were younger (mean age 54 vs. 57 years, P < 0.001), more often male (81% vs. 67%, P < 0.001), and had similar Charlson Comorbidity Index (CCI) scores. Despite slightly lower inpatient mortality (5.9% vs. 6.8%, P < 0.001), Hispanics experienced higher rates of complications, including esophageal varices (28% vs. 23%), variceal bleeding (10% vs. 7%), acute liver failure (27% vs. 25%), and hepatocellular carcinoma (4% vs. 2%) (P < 0.001 for all). Median TOTCHG was significantly higher ($46,494 vs. $38,881, P < 0.001) in Hispanic patients.

Conclusions: Hispanic patients with alcoholic cirrhosis (ALC) experience a higher burden of cirrhosis-related complications and increased healthcare utilization compared to other ethnic groups yet exhibit lower observed inpatient mortality. These disparities highlight the need for earlier detection, culturally tailored public health interventions, and improved access to preventive and specialty liver care to improve outcomes in this vulnerable population.

Background: Acute cholangitis (AC) is a serious condition caused by partial or complete obstruction of the common bile duct (CBD), leading to biliary tract infection. We aimed to evaluate whether teaching hospitals with trainees and non-teaching hospitals impact the outcome of AC in the United States.

Methods: This study utilized the National Inpatient Sample database to analyze adult hospitalizations (> 18 years old) with a primary diagnosis of AC in the USA from 2016 to 2020. A multivariate logistic regression along with Chi-square and t-tests was performed using SAS 9.4 software to analyze inpatient AC-associated mortality, inflation-adjusted total hospitalization costs (THC), and length of stay (LOS) in US teaching and non-teaching hospitals during the study period.

Results: This study included a total of 30,300 patients, out of whom 23,535 (about 78%) were managed in teaching hospitals and 6,765 (about 22%) were managed in non-teaching hospitals. Primary outcomes showed a significant increase in mortality for patients managed in teaching hospitals (2.77% vs. 2.08%, P = 0.01) in comparison to non-teaching hospitals, hospital LOS was slightly higher in teaching hospitals (5 days (interquartile range (IQR): 3 - 6) vs. 4 days (IQR: 3 - 8)) and so did hospital cost ($15,259 vs. $14,506) in comparison to non-teaching hospitals. Secondary outcomes showed that patients in teaching hospitals had higher incidence of septic shock (16.06% vs. 12.53%, P < 0.0001), intensive care unit (ICU) admissions (6.61% vs. 5.07%, P = 0.0002), and intubation (5.30% vs. 3.46%, P < 0.0001) in comparison to non-teaching hospitals.

Conclusion: Our study found higher mortality rates for AC patients in teaching hospitals compared to non-teaching hospitals. Teaching hospitals also had higher rates of septic shock, ICU admission, and intubation, with no difference in endoscopic retrograde cholangiopancreatography (ERCP) use. These differences could be due to several factors, such as greater resident and fellow autonomy in teaching hospitals and a potentially more proactive approach by physicians in non-teaching hospitals. Additionally, teaching hospitals often manage more complex, higher-acuity cases, which could contribute to worse outcomes.

Background: Rebleeding is a major challenge and a serious complication of non-variceal upper gastrointestinal bleeding (NVUGIB). Prophylactic transcatheter arterial embolization (P-TAE) has emerged as a potential management strategy for high-risk cases. This study aimed to evaluate the efficacy and safety of P-TAE compared with no embolization (NE) in the absence of angiographic evidence of bleeding or therapeutic arterial embolization (TAE).

Methods: The study systematically searched Medline and Embase databases from inception until November 15, 2024. The primary outcome was the overall rebleeding rate, while secondary outcomes included mortality, need for additional interventions, transfusion requirements, hospital/intensive care unit (ICU) stay, and procedure-related adverse events.

Results: The meta-analysis included 10 studies with a total population of 1,253 patients. Compared to NE, the pooled data indicated that P-TAE was not associated with significantly reduced rates of rebleeding (odds ratio (OR): 0.69, 95% confidence interval (CI): 0.39 - 1.22, P = 0.20) or all-cause mortality (OR: 0.70, 95% CI: 0.40 - 1.23). Although P-TAE trended towards lower rates of repeat interventions, blood transfusions, and shorter hospital stays, these differences were not statistically significant. Conversely, P-TAE and TAE had similar rates of rebleeding (OR: 1.08, 95% CI: 0.70 - 1.68, P = 0.05) and all-cause mortality (OR: 0.72, 95% CI: 0.34 - 1.51, P = 0.39). The analysis found no significant differences in adverse events or the need for repeat procedures between the two embolization approaches.

Conclusion: This review suggests that P-TAE may not significantly reduce rebleeding or mortality compared with standard therapy for high-risk NVUGIB. However, the current findings remain inconclusive, and further comprehensive research with larger sample sizes is required to conclusively substantiate these observations.

Background: Statins are reported to reduce colorectal cancer (CRC) risk in the general population, but their effect on individuals with inflammatory bowel disease (IBD) remains uncertain. We aimed to evaluate the relationship between statin use and CRC risk in patients with IBD.

Methods: A comprehensive review of the literature was conducted on PubMed, Web of Science, and EMBASE to evaluate the association between statin use and the development of CRC in patients with IBD. After deduplication, there were 324 studies screened, and those reporting odds ratios (ORs) or hazard ratios (HRs) for CRC risk in IBD patients using statins were included. The primary endpoints included the development of CRC (OR) and time to CRC (HR). A meta-analysis utilizing fixed or random-effects models, heterogeneity tests, and a funnel plot was performed in R (version 4.3.0) with alpha of 0.05.

Results: This meta-analysis included seven studies involving 59,596 patients: three for OR (11,116 patients) and four for HR (48,480 patients). The pooled OR was 0.22 (95% confidence interval (CI): 0.01 - 7.81), suggesting 78% lower odds of CRC in statin users, though not statistically significant (P = 0.21), with potential publication bias. The pooled HR was 0.77 (95% CI: 0.63 - 0.94), indicating a significant 23% reduction in CRC hazard for statin users (P < 0.05), with low publication bias.

Conclusion: Our meta-analysis showed that statin use is associated with a reduced risk of CRC in IBD, significant in HR-based but not in OR-based analysis. Large randomized controlled trials are needed to clarify the duration of statin use and their chemopreventive effects, independent of factors such as targeted therapy for chronic mucosal inflammation.