Journal of clinical gastroenterology最新文献

Background: Inflammatory bowel disease (IBD) is a multisystem illness with intestinal and extraintestinal manifestations. We aimed to analyze the association of developing pulmonary diseases (PDs) in patients with IBD.

Methods: In this retrospective cohort study, TriNetX was used to identify patients with IBD who were prescribed at least one IBD-specific medication or advanced therapy. Patients with an inpatient visit and no IBD comprised the control group. Propensity score matching (PSM) was used to balance cohorts. The odds ratio (OR) of developing PDs all-cause mortality were determined.

Results: After PSM, there were 155,668 patients (46.6±17.5 y, 50.9% female) in each group. Patients with IBD had an increased prevalence of developing all assessed PDs except for pyothorax (P=0.087), lung abscesses (P=0.411), pleural disease (OR: 0.89 [0.80-0.98], P=0.013), and pneumothorax (OR: 0.67 [0.62-0.73], P<0.001) compared with the control group. There were at least 2-fold increased prevalence of developing asthma (OR: 2.17 [2.09-2.26]), bronchiectasis (OR: 2.35 [2.12-2.61]), chronic bronchitis (OR: 2.40 [2.11-2.72]), and vasculitis (OR: 2.33 [1.99-2.72]) compared with the control group (all P<0.001).

Conclusion: Given the increased association of developing PDs, clinicians should engage in proactive monitoring and risk reduction strategies to mitigate the development of various PDs in the IBD patient population.

Helicobacter pylori infections are the major cause of gastrointestinal disease, mainly chronic gastritis, peptic ulcer, and gastric carcinomas, affecting half of the population globally. Due to the emergence of antibiotic resistance, the efficacy of current standard therapies, particularly clarithromycin and metronidazole, has been reduced. Nitazoxanide (NTZ), a broad-spectrum antimicrobial drug, has shown promising efficacy against H. pylori infections. This study aims to assess the comparative efficacy and safety of NTZ-based regimens versus standard triple therapy in H. pylori infections. A comprehensive literature search was conducted across 4 databases. Eight randomized controlled trials, comprising 1286 participants, comparing NTZ-based regimens with standard triple therapy, were included. A random-effects model was used to estimate pooled risk ratios (RRs) with 95% confidence intervals (CIs). NTZ-based therapy showed significant improvement in primary outcome, which includes H. pylori eradication rate compared to standard triple therapy. In per-protocol (PP) and intention-to-treat patients, durational analysis showed significant improvement in H. pylori eradication rates (RR=1.40; 95% CI: 1.19-1.56; P<0.0001) and (RR=1.36; 95% CI: 1.19-1.56; P<0.0001), respectively. In addition, post follow-up assessment also shows significant effects in both patients per-protocol (RR= 1.40; 95% CI: 1.21-1.62; P<0.0001) and intention-to-treat (RR=1.36; 95% CI: 1.19-1.56; P<0.0001). In secondary outcomes, NTZ-based therapy showed non-significant reduction in abdominal pain (RR=0.50) and nausea (RR=0.78). Risk of bias was reported as low to high, although certainty of evidence was consistently high. Egger's test shows non-significant publication bias (P=0.161). Future research should focus on NTZ's optimal duration, resistance pattern, safety, and symptom relief.

Objective: This study aimed to evaluate the impact of MetS on inpatient outcomes, health care utilization, and discharge patterns in hospitalized IBD patients.

Background: Inflammatory bowel disease (IBD) is a chronic, immune-mediated condition associated with rising prevalence, high hospitalization rates, and substantial health care costs. In parallel, the growing burden of metabolic syndrome (MetS) may further worsen clinical outcomes and resource utilization in this population.

Materials and methods: We conducted a retrospective analysis of the 2016-2020 National Inpatient Sample, identifying 241,772 hospitalized IBD patients. Patients were stratified by the presence of MetS, and the 2 cohorts were compared regarding inpatient outcomes including mortality, intensive care interventions, length of stay (LOS), and discharge disposition. Multivariable logistic regression models were used to assess associations between MetS, its individual components (hypertension, diabetes, obesity, and dyslipidemia), and key inpatient outcomes.

Results: Of the cohort, 6382 (2.6%) had MetS. Compared with patients without MetS, those with MetS were older, had higher comorbidity burden, longer LOS (5.77 vs 5.30 d), and increased likelihood of central line placement, intubation, and vasopressor use. Discharge to home was less frequent (57.4% vs 73.7%), with higher rates of skilled nursing or home health needs. Multivariable analysis demonstrated that MetS and individual components independently increased odds of mortality, intensive care interventions, and resource utilization.

Conclusions: MetS significantly worsens inpatient outcomes and increases health care utilization in hospitalized IBD patients. Early identification and targeted management of metabolic comorbidities may reduce complications, optimize resource use, and improve discharge outcomes, underscoring the importance of integrated metabolic care in this population.

Background: The incidence of duodenal neuroendocrine tumors (D-NETs) has been steadily rising. Endoscopic resection has become the preferred treatment option for smaller, localized lesions. We aimed to corroborate the efficacy and safety of endoscopic resection of D-NETs in a Western population and to evaluate treatment durability and disease course by examining long-term outcomes after resection.

Methods: This was a retrospective cohort study of patients who underwent endoscopic resection of a nonampullary D-NET from 2012 through 2020 at a single institution in the United States. Demographic, clinical, and procedural data were abstracted in duplicate and independent fashion. Outcomes were assessed through medical records review and follow-up phone calls.

Results: Over the study period, 58 patients underwent endoscopic resection of 59 D-NETs. Follow-up data were available in 85% of patients with a median follow-up duration of 23 months. Almost all D-NETs were located in the duodenal bulb, and all were biologically indolent. The mean size 6.6 mm (range: 1 to 27 mm). The most common resection technique was cap- or band-assisted endoscopic mucosal resection (73%). Negative resection margins were achieved in 78% of the sample. Delayed hemorrhage and perforation occurred in 5 and 6 patients, respectively; all but one were managed endoscopically. The presence of residual or recurrent neoplasm was identified at follow-up endoscopy in 10 patients and did not appear to be associated with resection margin status or endoscopic removal technique. No patients required surgical resection of a NET, were diagnosed with metastatic NET, or died as the result of their neuroendocrine tumor during follow-up.

Conclusion: Endoscopic resection appears to be reasonably safe and durably effective in treating localized duodenal neuroendocrine tumors, but attention to endoscopic rescue of adverse events and to follow-up is necessary.

Background: Metabolic dysfunction associated steatotic liver disease (MASLD) has been associated with adverse pregnancy outcomes. Data are limited with regard to whether this association is solely related to MASLD versus comorbid metabolic conditions. This study aims to evaluate the independent contribution of MASLD to maternal and fetal outcomes.

Methods: This single center retrospective study included adult pregnant patients who received care between 2000 and 2021. Patients with MASLD before pregnancy were age-matched with controls without chronic liver disease. Baseline FIB-4 score, within 2 years before conception, was considered a surrogate of prepregnancy MASLD severity, as an elevated FIB-4 score suggests a high risk of advanced fibrosis. Outcomes of interest included gestational age, birthweight, pre-eclampsia, 5-minute APGAR scores, gestational diabetes, and gestational hypertension. Multivariable regression was used to study the impact of MASLD and fibrosis severity on pregnancy outcomes.

Results: We identified 117 pregnant women with pre-existing MASLD and 168 controls. Patients with MASLD (cases) had more underlying comorbidities than controls, including type 2 diabetes mellitus (27.4% vs. 10.1%, P<0.001), hypertension (23.9% vs. 10.7%, P=0.005), obesity (55.6% vs. 30.4% P<0.001), and metabolic syndrome (17.1% vs 4.8%, P=0.001). No differences were observed in adverse maternal or fetal outcomes between cases and controls. Among cases, no association was observed between FIB4 and adverse maternal and fetal outcomes in multivariate regression analysis.

Conclusions: Neither MASLD nor fibrosis severity, by FIB-4 score, independently influences maternal and fetal outcomes. The adverse outcomes likely reflect extrahepatic components of metabolic syndrome.

Background: We aimed to examine the relationship between disease symptoms and disease phenotype in a large Canadian cohort of persons with Crohn's disease (CD).

Methods: Adults (n=1515) with CD from 14 Canadian centers participated in the Mind And Gut Interactions Cohort (MAGIC) between 2018 and 2023. Disease activity was measured using the 24-item IBD Symptom Inventory-Short-Form (IBDSI-SF). We compared the symptoms commonly associated with active versus inactive disease, and explored symptoms patterns in relation to disease phenotype, based on the Montreal Classification. To assess psychological status the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9 were used.

Results: The mean disease duration was 15.6±11.8 years. The 5 most common symptoms were similar for those with active disease, although at higher prevalence (89% to 98%) versus those with inactive disease (47% to 79%), and included fatigue, diarrhea, gas, bloating, and urgency. The intensity of symptoms was higher in those with active than inactive IBDSI-SF scores. The rank order and relative distribution of the symptoms and intensity of the symptoms reported were similar between those with different disease phenotypes B1, B2, and B3 and L1, L2, and L3. Persons with active IBDSI-SF had a higher prevalence of anxiety (24.6%) and depression (38.2%) versus persons with inactive IBDSI-SF (6.3% and 8%, respectively).

Conclusions: Individuals with CD with active and inactive disease by IBDSI, experience similar symptoms, but the prevalence of symptoms and their intensity is greater in persons with active IBDSI. Persons with inactive IBDSI report many symptoms. There was no difference in symptom reporting by disease behavior or location.

Background: Peroral endoscopic myotomy (POEM) is a standard achalasia treatment, matching surgery in efficacy. However, myotomy length varies. Shorter myotomies are gaining attention for potential benefits. This study compares short versus long myotomies to identify the optimal approach.

Methods: We conducted a systematic review and meta-analysis of Randomized Controlled Trials (RCTs) retrieved from PubMed (MEDLINE), Scopus, Web of Science (WoS), and Cochrane Central Register of Controlled Trials (CENTRAL) until November 28, 2024. Pooled results were calculated using risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes, with 95% CI (PROSPERO ID: CRD42024621638).

Results: Four RCTs with 419 patients were included. Clinical success (Eckardt score ≤3) showed no significant difference between short and long myotomy (97.4% vs. 95.9%, RR: 1.02 with 95% CI: 0.98-1.06, P =0.33), Reflux symptoms (RR: 0.93, 95% CI: 0.60-1.47, P =0.77), and reflux esophagitis (RR: 0.83, 95% CI: 0.55-1.27, P =0.39). However, short myotomy significantly reduced pathologic acid exposure (RR: 0.57, 95% CI: 0.36-0.91, P =0.02), procedural time (MD: -16.61 min, 95% CI: -26.40 to -6.81, P <0.001), and hospital stay (MD: -2.37 d, 95% CI: -4.67 to -0.06, P =0.04). Intraprocedural complications were similar ( P =0.73), as was integrated relaxation pressure ( P =0.95), indicating similar postoperative esophageal function.

Conclusion: Short myotomy reduced acid exposure, procedure time, and hospital stay in POEM for achalasia without compromising clinical success or symptom improvement. It shows potential as an effective treatment, but large-scale RCTs are needed for definitive clinical endorsement.

Aims: ERCP training should adapt to the rapid development of ERCP technology and indications. China has a large population and vast land area, but ERCP training resources are insufficient. To make effective use of scarce ERCP training resources, the Standardized Training for ERCP Procedure (STEP) program was launched as a pilot trial. We aimed to report the graduation and competence situations and analyze the predictive factors.

Methods: This was a prospective multicenter study from January 2015 to May 2021 containing 2 stages: the training program stage and the graduate questionnaire survey stage. The graduation and competence rates were investigated and analyzed.

Results: In the training stage, 146 trainees completed the training, 113 (77.4%) graduated. The gender ratio (men vs. women) was 6.7:1. The mean age was 40.14±4.13 years. In total, 11 trainees failed the institutional mentored training phase (IMTP), 18 failed the practice strengthen training phase (PSTP), and 4 failed the comprehensive theoretical test. In the questionnaire survey stage, the response rate was 92%, of which 76.9% (80/104) achieved competence. ERCP cases performed independently in IMTP (OR=1.129, P =0.025) and ERCP volume in training years (OR=1.018, P =0.026) were predictive factors for graduation. Job title (senior physician) (OR=78.811, P =0.018) and main practice form of PSTP (independently) (OR=17.062, P =0.031) were predictive factors for competence in available graduates.

Conclusions: The STEP achieved an acceptable graduation and competence rate. We gained valuable experience in framework organization and multiple assessment checkpoints. Therefore, this standardized training model is suitable for developing countries with rapid progress in ERCP.

Objective: Constipation is commonly seen among patients with cardiovascular diseases and is linked to adverse outcomes. However, the association between constipation and the risk of stroke remains conflicting. Therefore, we aim to conduct a systematic review and meta-analysis to summarize the available data on this topic.

Methods: We identified potentially eligible studies from the MEDLINE and EMBASE databases, searching from inception to May 2024, to investigate the association between constipation and stroke. To be included, studies needed to compare the incidence of stroke between groups with and without constipation. Effect size and 95% CIs were combined using the generic inverse variance method.

Results: Our meta-analysis included 8 studies that met the eligibility criteria. There were 5,360,573 participants, with a mean age of 53.9 years and 69% are males. We found that patients with constipation have a 41% increased risk of stroke with a pooled risk ratio of 1.41 (95% CI: 1.13-1.75; P < 0.01, I2 = 99%) compared with those without constipation. Subgroup analysis revealed that patients with constipation have a 50% increased risk of ischemic stroke with a pooled risk ratio of 1.50 (95% CI: 1.15-1.96; P < 0.01, I2 = 99%), but no statistical significance was found for mixed-type stroke outcome.

Conclusions: Our study revealed that constipation is associated with a higher risk of stroke. These findings could influence future strategies for cardiovascular disease prevention and management in patients with chronic constipation.

Introduction: Eosinophilic Esophagitis (EoE) is a chronic immune-mediated disorder characterized by eosinophil infiltration into the esophageal mucosa. These changes lead to symptoms such as dysphagia, food impaction, and abdominal pain. Although less common, eosinophilic gastritis (EoG) shares similar inflammatory mechanisms but has fewer randomized controlled trials (RCTs) supporting treatment efficacy. Conventional treatments often fail to achieve histologic remission, whereas biological therapies targeting type 2 (T2) inflammation show promising results. This systematic review and meta-analysis evaluate the efficacy and safety of monoclonal antibodies in EoE, with a systematic review of EoG studies.

Methods: A systematic review and meta-analysis were conducted using PRISMA guidelines to assess the efficacy and safety of monoclonal antibodies in EoE and EoG. Thorough searches were conducted across PubMed, Cochrane, and Embase up to June 2025. Primary outcomes were changed in Peak Eosinophilic Count, and secondary outcomes were endoscopic reference score (EREFS), overall adverse events, and serious adverse events.

Results: Eight RCTs having 865 participants with EoE, treated with 6 monoclonal antibodies, were included in the meta-analysis, and 3 additional RCTs (155 participants) with EoG were included in the systematic review but not the meta-analysis. Quality assessment using the Cochrane RoB 2 tool showed overall low risk of bias. Monoclonal antibodies significantly reduced peak eosinophil count, MD was -59.17 [95% CI: (-88.88, -29.45)], and improved EREFS. Dupilimab showed the strongest efficacy among the 6 antibodies evaluated, and the adverse events were comparable to placebo.

Conclusions: Monoclonal antibodies, particularly dupilumab, demonstrate efficacy in reducing peak eosinophil count and improving EREFS in EoE, with a favorable safety profile. Although the systematic review of EoG studies suggests similar trends, the limited number of RCTs precludes conducting a meta-analysis. Small sample sizes, lack of patient-reported outcomes, and high heterogeneity highlight the need for larger, standardized trials to confirm these findings and to assess long-term effects.