Journal of clinical gastroenterology最新文献

Goals: To compare outcomes of MASLD in obese and nonobese populations.

Background: MASLD is emerging as one of the leading causes of liver failure and liver-related morbidity and mortality, with an increasing prevalence in the nonobese or lean population. The purpose of this study is to compare hepatic and oncological outcomes between MASLD patients with lean BMI and nonlean BMI.

Study: The National Inpatient Sample (NIS) was queried from 2016 to 2020 for adult hospitalizations with MASLD. Exclusion criteria included concurrent diagnoses of viral hepatitis, alcoholic hepatitis, primary biliary cholangitis, hereditary hemochromatosis, autoimmune hepatitis, or Wilson disease. Outcomes of MASLD and its complications were compared between the lean and nonlean subgroups.

Results: Patients with lean BMI had higher mortality rates (odds ratio: 2.10, P<0.001). The lean cohort also had higher odds of cirrhosis, portal hypertension, SBP, and ascites. The lean subgroup had higher odds of gastrointestinal malignancies including esophageal cancer, gastric cancer, pancreatic cancer, and colorectal cancer.

Conclusions: Hospitalized lean MASLD patients had higher odds of mortality, ​​hepatic morbidities, and gastrointestinal malignancies. These results challenge the use of BMI as a predictor of morbidity and mortality for MASLD patients. Future studies should focus on therapeutic options for MASLD and compare their efficacies between lean and nonlean populations.

Aim: This study aims to evaluate anorectal function through high-resolution anorectal manometry (HRAM) in patients with constipation and fecal impaction, considering the limited information available on this subject.

Materials and methods: HRAM conducted between January 2021 and November 2023 (785 procedures) were reviewed. Patients were identified as individuals who experienced at least one episode of hard stools in the last year that were unable to evacuate. They were compared with constipated patients without fecal impaction episodes (control group). HRAM was performed using solid-state equipment (Medtronic). Logistic regression analysis was done to identify demographic-clinical factors and manometric variables associated with fecal impaction.

Results: Fecal incontinence was independently associated with fecal impaction [adjusted odds ratio (aOR): 20.4, 95% CI: 2.5-167.8] after adjusting for demographic and clinical variables. Severe rectal hyposensitivity (no perception of urgency from a volume of 200 mL) was present in 38.2% of patients with fecal impaction and 5.9% of controls (P=0.001). Defecatory dyssynergia was diagnosed in 29.4% of patients with fecal impaction. Lower squeeze pressure and severe rectal hyposensitivity were independently associated with fecal impaction with an aOR of 0.98 (95% CI: 0.98-0.99) and aOR of 10.4 (2-54.1), respectively, and after adjusting for all manometric parameters. Hypotonia and hypo-contractility of the anal canal were found in 53.8% and 46.2% of patients with fecal impaction and incontinence, respectively.

Conclusion: Patients with fecal impaction often show rectal hyposensitivity and anal hypo-contractility, which are independent risk factors for impaction. Fecal incontinence is linked to fecal impaction, and their coexistence is associated with reduced anal canal pressures.

Goals: The purpose of this study was to determine risk factors associated with the development of Fundic Gland Polyps (FGP) and its association with gastric cancer.

Background: Gastric cancer incidence is increasing and may be linked to PPIs. FGP are  common and a possible intermediary between PPI use and the risk of gastric cancer.

Study: This single-center retrospective case-control study compared multiple risk factors between cases with FGP and controls between January 1, 2021 and December 31, 2021. Severe FGP was defined by innumerable, diffuse, or >50 polyps by endoscopic reporting and dysplasia by histopathology. Patient outcomes with severe polyposis and dysplasia were reviewed. Gastrectomy specimens and endoscopic reports were reviewed for FGP in an independent cohort of patients with known gastric cancer. Univariate and multivariate models using logistic regression were constructed.

Results: The main logistic regression model included 591 participants (330 cases and 261 controls). Increasing age [OR: 1.02 (1.01 to 1.03)] and >2 years of PPI use [OR: 2.76 (1.72 to 4.47)] were associated with increased risk of FGP whereas smoking was protective [OR: 5.41 (2.58 to 12.24)]. Most patients with severe FGP (87.5%), low-grade (77%), and high-grade dysplasia (80%) were females. No patients developed gastric cancer on follow-up (mean: 13.9 mo). None of the patients within an independent cohort of gastric cancers diagnosed between January 1, 2021 and December 31, 2021 had FGP.

Conclusions: Although FGP are equally common among sexes, severe and dysplastic FGP are more common among females, but none progressed to cancer. These data could be useful to counsel patients with FGP.

Background: Current endoscopic retrograde cholangiopancreatography (ERCP) and cholangioscopic-based diagnostic sampling for indeterminant biliary strictures remain suboptimal. Artificial intelligence (AI)-based algorithms by means of computer vision in machine learning have been applied to cholangioscopy in an effort to improve diagnostic yield. The aim of this study was to perform a systematic review and meta-analysis to evaluate the diagnostic performance of AI-based diagnostic performance of AI-associated cholangioscopic diagnosis of indeterminant or malignant biliary strictures.

Methods: Individualized searches were developed in accordance with PRISMA and MOOSE guidelines, and meta-analysis according to Cochrane Diagnostic Test Accuracy working group methodology. A bivariate model was used to compute pooled sensitivity and specificity, likelihood ratio, diagnostic odds ratio, and summary receiver operating characteristics curve (SROC).

Results: Five studies (n=675 lesions; a total of 2,685,674 cholangioscopic images) were included. All but one study analyzed a deep learning AI-based system using a convoluted neural network (CNN) with an average image processing speed of 30 to 60 frames per second. The pooled sensitivity and specificity were 95% (95% CI: 85-98) and 88% (95% CI: 76-94), with a diagnostic accuracy (SROC) of 97% (95% CI: 95-98). Sensitivity analysis of CNN studies (4 studies, 538 patients) demonstrated a pooled sensitivity, specificity, and accuracy (SROC) of 95% (95% CI: 82-99), 88% (95% CI: 72-95), and 97% (95% CI: 95-98), respectively.

Conclusions: Artificial intelligence-based machine learning of cholangioscopy images appears to be a promising modality for the diagnosis of indeterminant and malignant biliary strictures.

Background: Dupilumab is the only FDA-approved medication for eosinophilic esophagitis (EoE). Clinical trials have shown its effectiveness in alleviating symptoms and decreasing inflammation associated with EoE. However, real-world data on its efficacy is still limited.

Methods: We searched multiple databases for articles reporting the outcomes of dupilumab for the treatment of EoE and conducted a meta-analysis.

Results: Five retrospective studies including 209 subjects (mean age: 22.12±12.01 y and 61.24% males) were analyzed. The pooled outcome for symptom improvement with dupilumab was 89.2% [95% Cl: 68.0%-97.0%; I2=58%]. Peak eosinophil count improved markedly postdupilumab [pre: 47.13 (95% Cl: 45.5-48.67; I2=98%) vs. post: 6.44 (95% Cl: 0.72-13.60; I2=98%) eos/hpf, P<0.001]. There was a significant reduction in Endoscopic Reference Score (EREFS) [pre: 4.10 (95% Cl: 1.74-6.43; I2=95%) vs. post: 0.77 (95% Cl: 0.14-1.7; I2=95%), P<0.001]. The mean duration of treatment and follow-up was 5.66±1.14 months. The most common adverse event reported was a pain due to injection, which was controlled with local anesthetics.

Conclusion: Our study shows that in a real-world scenario, administration of dupilumab for EoE induces histologic and endoscopic remission and symptomatic improvement. Hence, dupilumab can be considered a treatment option for EoE, especially in resistant cases. Future studies should evaluate its long-term effectiveness for preventing esophageal fibrosis/stricture and long-term side effect profile. Furthermore, cost-effectiveness analysis is warranted to help establish its role as a potential first-line treatment strategy.

Irritable bowel syndrome (IBS) is prevalent and can be disabling. Many patients remain symptomatic despite behavioral and medical therapies. Psychedelic-assisted therapy (PAT), in which serotonergic agents like psilocybin are administered in a psychotherapeutic context, has shown promise for refractory psychiatric disorders, including major depressive disorder and post-traumatic stress disorder. Emerging evidence suggests PAT may also be beneficial for chronic pain conditions, including fibromyalgia, low back pain, and migraines. IBS is highly comorbid with depression, anxiety, and other chronic pain disorders, suggesting shared cognitive and neurological roots and potentially shared therapeutic targets. In this editorial, we discuss 3 lines of evidence for PAT as a treatment for IBS, under the overarching themes of (1) psychological mechanisms (the findings from historic studies of psychedelics for chronic pain and the elements of psychobiological dysfunction targeted by PAT), (2) central nervous system mechanisms (default mode network modulation and induction of neuroplasticity), and (3) the neurointestinal pathophysiology of IBS that may be modified by PAT. We argue that this evidence suggests PAT is worthy of study as a new therapy for IBS, and potentially for other disorders of gut-brain interaction (DGBI). Successful application of PAT to gastrointestinal disease would represent a major step beyond mind-body dualism, with potential implications for other functional somatic disorders.

Background: We aimed to identify predictors of rebleeding in patients with overt gastrointestinal bleeding (GIB) and to develop a rebleeding index.

Methods: This was a prospective study of patients admitted with GIB from 2013 to 2023 at a tertiary care center. Rebleeding was defined as the recurrence of visible bleeding after initial stabilization, endoscopic evaluation, and/or hemostatic therapy, accompanied by a change in vital signs or a hemoglobin (Hgb) decrease of ≥2 g/dL. Independent predictors were determined after adjusting for confounders.

Results: Seven hundred ninety-seven patients with GIB were recruited between 2013 and 2023 and were followed up until death or January 2023. In-hospital, 1-month, 1-year, and end of follow-up rebleeding rates were: 5.3%, 8.9%, 16.2%, and 21.8%, respectively. Sources of rebleeding were different from the original sources in 36% of patients. Predictors of 1-month rebleeding included need for ≥3 packed red blood cell (PRBC) units (HR=1.86; p=0.041), endoscopic stigmata of recent hemorrhage (SRH) (HR=1.99; p=0.007), and Hgb level (HR=0.82; p=0.018; lower Hgb predicts higher rebleeding risk). A rebleeding index based on SRH, Hgb level, and ≥3 PRBC units showed modest performance (AUC=0.68), with higher scores indicating increased rebleeding risk. At the end of follow-up, SRH remained a predictor (HR=1.61; p=0.003), whereas antiplatelets on admission or discharge appeared protective against rebleeding (HR=0.66; p=0.021; HR=0.63; p=0.026).

Conclusion: Predictors of rebleeding after GIB were SRH, PRBC transfusion, and lowest Hgb. The novel index based on these predictors performed favorably compared with the GBS, Rockall systems for UGUB and ABC scores. These data will help guide management and risk stratification of patients with GIB.

Introduction: Several factors affect the difficulty, clinical success, and side effects related to endoscopic retrograde cholangiopancreatography (ERCP), of which the endoscopic appearance of the major papilla is one of the most important. This study aimed to investigate the outcomes related to ERCP in relation to major papilla morphology.

Methods: This study was performed prospectively on 581 patients undergoing ERCP. During ERCP, the endoscopist determined the morphology of the major papilla before the cannulation. Primary outcomes included overall operative success rate and post-ERCP pancreatitis (PEP) at 30 days. Secondary outcomes included clinically significant bleeding, perforation, cholangitis or sepsis, difficult cannulation, number of cannulation attempts, and duration of cannulation.

Results: Papilla type 2 (OR=2.36, 95% CI: 1.07-5.20) and type 3b (OR=3.19, 95% CI: 1.16-8.73) were associated with decreased odds of procedure success. PEP was directly associated with type 4 papilla (OR=3.30, 95% CI: 1.21-8.98). There were direct correlation between difficult cannulation and types 3a (OR=1.89, 95% CI: 1.20-2.98) and 3b (OR=5.05, 95% CI: 1.98-12.86), cannulation duration more than 10 minutes and types 2 (OR=2.66, 95% CI: 1.31-5.39), 3a (OR=2.18, 95% CI:1.30-3.64), and 3b (OR=4.97, 95% CI: 1.94-12.71), and attempted cannulation more than 5 times and types 3a (OR=1.64, 95% CI: 1.01-2.69), and 3b (OR=4.40, 95% CI: 1.75-11.09).

Conclusion: The findings of this study showed that ERCP failure is associated with types 2 and 3b papilla, and papilla type 4 is an independent risk factor for PEP.

Introduction: Screening tests like colonoscopy can prevent colorectal cancer (CRC), yet their effectiveness is often questioned. The Nordic-European Initiative on Colorectal Cancer (NordICC) trial demonstrated that colonoscopy significantly reduces CRC incidence and mortality in per-protocol analysis. However, media coverage of the trial often focused on intention-to-screen findings that showed no change in mortality, possibly contributing to public confusion about colonoscopy benefits. This study aimed to assess whether such media articles undermined public perception and intent to undergo colonoscopic screening.

Methods: We recruited a US nationally representative sample of unscreened adults aged 45 to 75 years at average CRC risk. Respondents were randomized 1:1 to read either a low-quality or high-quality article on NordICC, as rated by a panel of gastroenterologists. Before and after reading their article, participants reported whether they plan to be screened for CRC with a colonoscopy. Our primary outcome was a negative change in intent to undergo colonoscopic screening.

Results: Among the 2013 participants who completed the survey, 1531 (76.1%) stated they planned to undergo colonoscopy or were undecided before reading the article. After reading the media report, 90 (12.0%) people in the low-quality article arm no longer planned to undergo colonoscopy versus 73 (9.3%) in the high-quality article arm; the difference was not statistically significant (P=0.08).

Discussion: A widely promulgated article about NordICC rated as low-quality did not differentially impact attitudes towards colonoscopic CRC screening compared with another mainstream article rated as high-quality. Our study provides reassurance that most people will not summarily change health behaviors after reading a single article, regardless of perceived accuracy.

Objective: Dyspepsia, a common gastrointestinal issue characterized by upper abdominal discomfort, can be influenced by diet, medication, and lifestyle changes. Ramadan fasting involves refraining from food and drink from dawn to sunset, affecting various physiological processes, including digestion. The fasting period can range from 12 to 18 hours depending on the year, potentially impacting the prevalence of dyspeptic symptoms. This study aimed to assess the effect of fasting on dyspeptic symptoms, taking into account demographic and clinical factors.

Materials and methods: A cohort study examined 1258 clinic patients, with 150 meeting specific inclusion criteria. Dyspepsia was diagnosed using Rome IV criteria, with fasting hours taken into consideration. The relationship between dyspepsia, fasting, Non-Steroidal Anti-Inflammatory Drug use, and demographics was analyzed.

Results: Dyspepsia was more prevalent in females (32%) compared with males (23%), with a higher proportion of non-fasting women among dyspeptic patients. Older patients (>65 y) had a higher prevalence of dyspepsia (P = 0.026). Fasting individuals had a 2.1 times greater likelihood of experiencing dyspeptic symptoms. Although Non-Steroidal Anti-Inflammatory Drug use was lower in fasting patients, no significant association with dyspepsia was observed (P = 0.139).

Conclusion: Ramadan fasting increases the risk of dyspeptic symptoms, particularly in women and older adults. Factors such as medication timing and dietary changes during fasting may contribute to this risk. Highlighting the importance of the pre-dawn meal (Suhoor) in managing dyspeptic symptoms is essential. Tailored guidance should be provided to individuals at higher risk during Ramadan.