Journal of clinical gastroenterology最新文献

Background: The Inflammation, Microbiome, and Alimentation: Gastro-Intestinal and Neuropsychiatric Effects Strategy for Patient Oriented Research Network (IMAGINE) has conducted a 5-year multicenter prospective observational cohort study, Mind And Gut Interactions Cohort (MAGIC) in 14 centers across Canada from 2018 to 2022. Herein, we investigated the relationship between ulcerative colitis (UC) phenotypes, demographics and other relevant outcomes, and symptom reporting.

Methods: At baseline, participants answered surveys assessing disease activity, medications and complementary therapies, lifestyle factors, psychological status, and comorbidities. UC phenotypes were classified by the Montreal Classification. Herein, we describe the association between phenotypes and demographics, medications used, comorbidities, and symptoms experienced in adults with UC. The Inflammatory Bowel Disease Symptom Inventory (IBDSI) was used to assess symptoms.

Results: The maximal extent phenotypic distribution based on chart review was E1 (proctitis) n=261 (14.5%), E2 (left-sided colitis) n=671 (37.2%), and E3 (subtotal or pancolitis) n=794 (44.0%). More males had E3. Different phenotypes did not lead to differences in the use of complementary therapies. There was greater likelihood of primary sclerosing cholangitis but a lower likelihood of hypertension in E3. Among the 25 different symptoms queried in the IBDSI, there was no difference across phenotypes, except among persons with overall active IBDSI, there was more waking for urges for bowel movements in persons with E3.

Conclusions: Overall, there was no difference in symptom reporting based on extent of UC except for cohort with overall active IBDSI there were some differences in nocturnal waking based on disease extent.

Objective: In low-risk populations, the faecal immunochemical FIT test is excellent at excluding colonic malignancy, with a negative predictive value (NPV) of 99.8%. However, effectiveness in a high-risk iron deficiency anaemia (IDA) population is unclear. This has significant resource implications for health care services worldwide. This study aims to establish the NPV of FIT for colorectal cancer in patients with IDA.

Design/method: Single-centre retrospective study. Over 12 months, paired cases of FIT <10 µg Hb/g faeces and IDA were identified. Those not completing colonoscopy or CT pneumocolon were excluded. The prevalence of cancer, low-risk and high-risk polyps, defined by British Society of Gastroenterology (BSG) guidelines, was established, and the NPV was calculated.

Results: One thousand twenty-three cases were identified, of which 451 had undergone complete colonic investigation. Mean age was 68 (SD: 11.8). 286/451 (63%) were female. 381/451 had undergone colonoscopy, 78/451 CT pneumocolon with 404/451 also having gastroscopy (OGD). 8/451 (1.8%) had a colonic malignancy. 11/404 (2.7%) had an upper GI malignancy and 14/451 (3.1%) a cancer outside the GI tract. The NPV for colorectal cancer was 98.2% (95% CI: 96.9-99.5). In 24/451 (5.3%) advanced polyps were found, NPV 94.7% (95% CI: 92.6%-96.8%). In 118/451 (26%) low-risk polyps were found, NPV 73.8% (95% CI: 69.8%-77.9%).

Conclusion: The NPV of FIT in IDA appears lower than reported in low-risk symptomatic populations, and it is unclear if this is adequate to negate the need for colonoscopy. Prospective multicentre studies are needed to evaluate this fully.

Backgrounds and aims: Celiac disease (CeD) presents with various gastrointestinal and systemic comorbidities, causing significant social and health burdens. Given the substantial symptom burden and lack of therapeutic options beyond the gluten-free diet, patients with CeD may have limited or unsatisfying interactions with healthcare providers.

Methods: Using the All of Us Research Program, we analyzed five categories of surveys: basic, lifestyle, overall health, social factors of health, and healthcare access and utilization, for participants with self-reported or electronic health records-documented CeD. To increase diagnostic accuracy, we excluded CeD patients without compatible HLA haplotypes or with a polygenic risk score associated with a low probability of CeD. Each patient with CeD was matched to cohort participants without CeD using the following matching parameters: age, genetically inferred ancestry, and sex.

Results: Individuals with CeD (n=1816) were more likely to report severe fatigue (12.0% vs. 8.4%), frequent specialist visits (≥13 per year: 6.6% vs. 4.3%), and negative interactions with healthcare. On multivariate logistic regression, the following symptoms and healthcare interactions were independently associated with CeD: fatigue severity (OR=1.19, 95% CI [1.11-1.27]), more frequent medical specialist visits OR=1.69, 95% CI: 1.51-1.90, and negative provider interactions were all positively associated with increased likelihood of CeD.

Conclusions: Participants with CeD reported significantly greater functional limitations, higher difficulty assessing care, and a higher degree of fatigue, compared to participants without CeD, underscoring the need to integrate social determinants of health and patient-reported experiences into clinical management.

Hepatorenal syndrome (HRS) is a phenotype of kidney injury specific to patients with liver cirrhosis and ascites, characterized by impaired kidney function due to reduced blood flow and reduced glomerular filtration rate. HRS can occur quickly with acute kidney injury (HRS-AKI). In those not meeting HRS-AKI criteria, this can develop as HRS-acute kidney disease (HRS-AKD) or HRS-chronic kidney disease (HRS-CKD). This pathophysiology occurs along a continuum, dependent on timing of the disease course, and the presence of functional and structural abnormalities. Traditionally, pharmacologic treatment for HRS has relied on midodrine, octreotide, and albumin. Norepinephrine and albumin use have been limited by the need for continuous monitoring and intensive care unit (ICU). The development and expanded availability of the synthetic vasopressin analog terlipressin offers promise for effective therapy to reverse HRS and decrease the need for renal replacement therapy (RRT). While norepinephrine and terlipressin have similar efficacy, terlipressin has more supportive data, is not restricted to the ICU, and is considered the preferred therapy in combination with albumin. The objective of this literature review is to summarize and critically appraise published models of current medical therapies used to treat HRS, along with their history and mechanisms of action, and to provide a review of HRS, including emerging concepts in diagnosis and treatment.

Objective: The advancement of gastric cancer screening methodology based on endoscopic gastrointestinal tract examination is a pertinent global issue. This approach is designed to identify precancerous lesions and early-stage cancers. The aim was to integrate chromoscopy into endoscopic screening for early gastric cancer diagnostics.

Methods: The study involved 3062 residents of the Republic of Kazakhstan with a history of complaints or various diseases of the digestive organs. This cohort underwent endoscopic examinations using the chromoscopy method with further morphologic studies of the biopsy specimen obtained during endoscopic examination, according to the results of which the gastric cancer risk groups were formed.

Results: As a result of gastric endoscopy of 2976 patients without a previously established diagnosis of gastric cancer using the chromoscopy method, the following were found: inflammatory diseases of the stomach-72.9%, gastric ulcerative lesions-9.5%, gastric submucosal masses-1.1%, polypous gastric mass on a thin peduncle-0.83%, polypous gastric mass on a broad peduncle-4%, pathomorphologically verified gastric mesenchymal neoplasms under 3 cm in size-1.4%, over 3 cm-7.4% (including 0.8% with oesophageal cancer with spread to the stomach), cancer of the lower third of the oesophagus-1.53% of cases. The stomach was without pathology only in 0.4% of cases. The analysis of chromoendoscopy results of 86 people with previously diagnosed gastric cancer ("dynamic" group) showed that 94.19% of patients showed positive dynamics after treatment, in 3.49% of cases no dynamics was observed, in 2.32% of cases-negative dynamics.

Conclusions: Considering the findings of this study, it is recommended that chromoscopy be included in the algorithm for the screening of early gastric cancer and for the dynamic follow-up of patients undergoing treatment.

Introduction: Gastroesophageal reflux disease (GERD) plays an important role in lung transplant (LT) outcomes. This study aims to evaluate the impact of a novel sleep positioning device (SPD) on lung function in LT recipients with GERD.

Methods: In this single-center cohort study, LT recipients (2014 to 2019) with GERD who were prescribed an SPD within 2 years of LT were included. A historical control group of LT recipients with GERD on PPI only (2011 to 2013) was selected to compare forced expiratory volume in 1 second (FEV1) as a marker of lung function.

Results: Twenty LT recipients using SPD (cases) and 54 patients in the historical control group with proven GERD were included. Mean (SD) interval between LT and SPD prescription was 8.6 (5.7) months. Mean % predicted FEV1 was higher in SPD users than controls post-LT at 6 months (80% vs. 69%) and 1 year (80% vs. 71%), respectively. Among SPD users, post-SPD FEV1 was higher than pre-SPD FEV1 (82% vs. 70%).

Conclusion: Use of a novel SPD can stabilize or improve pulmonary function in patients with GERD after LT. SPD may be a safe and cost-effective adjunctive therapy for the management of GERD after LT.

Background: The presence of extraintestinal manifestations with cutaneous diseases in patients with inflammatory bowel disease (IBD) can pose significant complications. Though the prevalence of IBD has been increasing in racial and ethnic minority groups, most literature has characterized several cutaneous manifestations (CM) of IBD in patients of white skin, with a lack of studies describing these complications in patients with other skin tones.

Methods: Our study aimed to determine the rates of various CM of IBD in skin of color using a health care database to identify white and non-white patients with a diagnosis of IBD who were prescribed at least one IBD-specific medication or advanced therapy.

Results: Of the total IBD patients, after propensity score matching there were 35,624 patients identified in both the white and non-white cohorts. Among non-white patients, there was a >2-fold odds of developing hidradenitis suppurativa and increased odds of vitiligo. Psoriasis, herpes zoster, and leukocytoclastic vasculitis exhibited a decreased association in non-white patients. There was no difference in erythema nodosum, pyoderma gangrenosum, oral aphthae, Sweet syndrome, and acquired epidermolysis bullosa.

Conclusion: With the rise of IBD in non-white populations, the representation of CM of IBD in this population is significantly limited, underrecognized, and thus undertreated. Our results reveal increased prevalence of several CM in the non-white IBD patient population. Recognition of CM in non-white patients with IBD can enhance quality of life and reduce morbidity among this population.

Background and aims: Sarcopenia (SP) is increasingly recognized as a poor prognostic factor for patients with Crohn's disease (CD). We aimed to use radiographically-measured SP to determine a disease-specific definition and measure its association with CD-related outcomes.

Methods: This retrospective study included adults with CD seen at our outpatient tertiary center between 2019 and 2021 who underwent a CT scan within 3 months of visit. Using axial cross-sectional measurements at the L3 vertebral level, skeletal muscle area was indexed to height to derive skeletal muscle index (SMI). Demographics, comorbidities, CD phenotype, and outcomes, including hospitalization at 1 year, were analyzed in univariate and multivariate models.

Results: One hundred twenty-four patients with CD were included, with a mean age of 52.2±16.6 years and 53.2% (66/124) women. Overall, 33.1% (41/124) had SP based on sex-specific cutoffs with men representing 75.6% (31/41) of the sarcopenic population. In bivariate analysis, patients with SP had a higher likelihood of hospitalization (43.9% vs. 22.9% for non-SP, P=0.02) and penetrating CD phenotype (20.0% vs. 2.3% for non-SP, P<0.05). On multivariate regression, higher SMI was associated with decreased hospitalization, with each 10-unit increase in SMI conferring 0.54 lower odds (OR: 0.54 [95% CI: 0.32-0.92], P=0.02). Patients with higher SMI trended towards lower use of biologics (OR: 0.70 [95% CI: 0.45-1.09], P=0.12). Our novel SP definition derived from an IBD population performed similarly to definitions from the literature.

Conclusion: Our study demonstrates the application of an automated algorithm for the quantification of body composition based on CT scan in patients with CD. SP and low SMI were associated with increased hospitalization at 1 year.

Background and aims: Most colorectal cancer (CRC) screening tests, including fecal immunochemical (FIT) and multitarget stool DNA tests, require patients to scrape a stool sample at home before mailing it to a central lab. This requirement not only deters screening adherence but can also introduce risks of human error, environmental exposure, and transit-related issues. The multitarget stool RNA test (mt-sRNA), which comprises a FIT component and an RNA molecular component, is the only FDA-approved stool-based test for the detection of both CRC and advanced adenomas (AA) that does not require patients to perform an at-home FIT. Instead, trained technicians complete the FIT in the laboratory after the sample is received. This study evaluates the comparability of at-home and in-laboratory FIT in relation to mt-sRNA test performance.

Methods: To assess comparability between the 2 FIT methods, banked residual stool samples from the mt-sRNA test pivotal clinical trial (CRC-PREVENT) were used. As part of clinical trial requirements, subjects were required to collect a stool sample using the mt-sRNA collection kit and complete an at-home FIT swab before shipping the sample back to the laboratory. Patients were subsequently required to complete a screening colonoscopy. Residual stool was sampled using the in-laboratory FIT. Both FIT collection methods (at-home and in-laboratory) were analyzed identically. FIT results were compared with each other and with colonoscopy, to assess concordance, sensitivity, and specificity.

Results: A total of 1079 stool samples were tested using both at-home and in-laboratory FIT methods. Overall concordance was 93%. Among 20 CRC cases, the sensitivity for both methods was 75% (n=15). For 231 AA cases, sensitivity for the at-home and in-laboratory FIT was 33% and 38%, respectively. Positive percent agreement (PPA) for colorectal neoplasia was 87%. Among 791 subjects with negative findings, specificity for the at-home and in-laboratory FIT was 94% and 95%, respectively. For subjects with negative findings, the negative percent agreement (NPA) was 98%. When incorporating the in-laboratory FIT into the mt-sRNA test, method-calibrated CRC and AA sensitivities were 94% and 48%, respectively. Method-calibrated specificity for no lesions on colonoscopy was 90%.

Conclusions: Our findings suggest that in-laboratory FIT performance may enhance the diagnostic accuracy of the mt-sRNA test. The in-laboratory method may also reduce inadequate sampling and improve patient ease of use.