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Clinical Outcomes of Terlipressin Using Continuous Infusion Versus Bolus in Patients With Acute Variceal Hemorrhage-A Randomized Controlled Trial. 急性静脉曲张出血患者连续输注特利加压素与大剂量特利加压素的临床疗效——一项随机对照试验。
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-11-14 DOI: 10.1097/MCG.0000000000002287
Shahab Abid, Nazish Butt, Chaudary Qasim, Abhishek Lal, Om Parkash, Amna Subhan, Faisal Wasim, Adeel Abid, Syed Ali, Rustam Khan, Anum Shaikh, Shazana Zulfiqar, Natasha Khalid, Adeel Khoja, Zohair Karim, Safia Awan, Saeed Hamid

Goals: To compare clinical outcomes of terlipressin as continuous versus bolus infusion for the management of acute variceal hemorrhage.

Background: Terlipressin is commonly used in the management of acute variceal bleeding, but evidence on the optimal method of administration-continuous infusion versus intermittent bolus-is limited.

Study: Patients presented with acute variceal bleeding were randomized into 2 arms: the intervention arm and the control arm received continuous and bolus infusion of terlipressin, respectively. Clinical endpoints included in-hospital mortality, 6-week mortality, the length of hospital stay, rebleeding and transfusion rates, and adverse events. Hemodynamic outcomes included were stability of heart rate, systolic, diastolic, and mean arterial blood pressures.

Results: A total of 128 patients were analysed. In-hospital mortality was none in both arms (P=0.490). Mean length of stay for the intervention arm was 60.56±30.87 hours and the control arm was 57.80±33.35 hours (P=0.569). Rebleeding was reported in 2 patients in each arm (P=0.569). Packed cell transfusion rates were, 2.47±1.59 versus 2.17±0.98 units in intervention and control arm, respectively (P=0.256). The 6-week mortality was 7 in the intervention and 12 in the control arms (P=0.220). Bolus administration led to a greater reduction in heart rate at 4, 8, and post-20 hours (P<0.05). Systolic blood pressure improved at 16 and 24 hours in the intervention arm (P=0.02).

Conclusions: There was no difference in length of hospital stay, packed cell volume, rebleeding, and mortality between both modes of terlipressin administration. Somewhat better improvement in systolic blood pressure was observed in patients who received a continuous infusion of terlipressin without any impact on clinical outcomes.

目的:比较特利加压素连续输注与大剂量输注治疗急性静脉曲张出血的临床效果。背景:特立加压素常用于急性静脉曲张出血的治疗,但关于最佳给药方法——连续输注还是间歇给药——的证据有限。研究:急性静脉曲张出血患者随机分为2组,干预组和对照组分别给予特利加压素持续输注和大剂量输注。临床终点包括住院死亡率、6周死亡率、住院时间、再出血和输血率以及不良事件。血流动力学结果包括心率、收缩压、舒张压和平均动脉血压的稳定性。结果:共分析了128例患者。两组住院死亡率均为零(P=0.490)。干预组平均住院时间为60.56±30.87小时,对照组平均住院时间为57.80±33.35小时(P=0.569)。两组各有2例再出血(P=0.569)。干预组和对照组的填充细胞输液率分别为2.47±1.59和2.17±0.98单位(P=0.256)。干预组6周死亡率为7例,对照组为12例(P=0.220)。在4小时、8小时和20小时后,大剂量给药可显著降低心率(结论:两种特利加压素给药模式在住院时间、堆积细胞体积、再出血和死亡率方面均无差异。在持续输注特利加压素的患者中,收缩压的改善程度有所改善,但对临床结果没有任何影响。
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引用次数: 0
Comments on "Association Between Irritable Bowel Syndrome and Lower Urinary Tract Symptomatology: A Cross-Sectional Study in Mexican Population". 对“肠易激综合征与下尿路症状之间的关系:墨西哥人群的横断面研究”的评论。
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-11-14 DOI: 10.1097/MCG.0000000000002283
Jing Zhang, Jinfeng Chi, Yiheng Yao
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引用次数: 0
The AFS Endoscopic Classification of Esophago-Gastric Junction Integrity is Superior to the Hill Classification in Terms of Interobserver Variability. 食管胃连接完整性的AFS内镜分类在观察者间变异性方面优于Hill分类。
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-11-13 DOI: 10.1097/MCG.0000000000002288
Stefano Siboni, Marco Sozzi, Andrea Lovece, Pamela Milito, Pierfrancesco Visaggi, Matteo Ghisa, Michele Puricelli, Vito Annese, Giuseppe Dell'Anna, Guglielmo Albertini Petroni, Ivan Kristo, Martin Riegler, Lorenzo Cusmai, Veronica Lazzari, Tommaso Panici Tonucci, Edoardo Vespa, Reza Asari, Davide Ferrari, Erica Centorrino, Andrea Scardino, Roberta De Maron, Salvatore Tolone, Edoardo Vincenzo Savarino, Nicola De Bortoli, Sebastian Schoppman, Emanuele Asti

Goals: To compare the interobserver variability of the American Foregut Society (AFS) endoscopic classification of esophago-gastric junction (EGJ) integrity with the Hill classification among endoscopists with varying expertise, assessing reproducibility in real-world clinical settings.

Background: Gastroesophageal reflux disease (GERD) is a common indication for esophagogastroduodenoscopy (EGD), yet endoscopic EGJ assessment often lacks standardization. The Hill classification, traditionally used, has limitations, including vague grade distinctions and poor interobserver reliability. The AFS classification, incorporating axial hiatal hernia length (L), hiatal aperture diameter (D), and gastroesophageal flap valve presence (F), offers a standardized protocol to improve consistency and stratification of EGJ disruption.

Study: This multicenter, prospective, blinded study involved 21 endoscopists (10 gastroenterologists, 11 surgeons) evaluating 48 deidentified EGJ video clips using both Hill and AFS classifications. Participants, with varied experience levels, graded EGJ integrity independently. Interobserver agreement was assessed using the Intraclass Correlation Coefficient (ICC) and Fleiss' Kappa (κ) for overall and individual components.

Results: The AFS classification demonstrated superior interobserver agreement (ICC=0.749) compared with the Hill classification (ICC=0.651) (P=0.002). AFS grade 4 showed the highest concordance (κ=0.730), while Hill grade 2 had the lowest (κ=0.239). Agreement was excellent among experienced AFS users (ICC=0.813) and good for first-time users (ICC=0.709) (P=0.003). Interobserver variability of the AFS classification among first-time users was significantly lower than the Hill classification variability (P=0.025). L and D components showed good agreement (ICC=0.729, 0.686), while F had moderate agreement (ICC=0.441). No significant specialty-based differences were observed (P=0.516).

Conclusions: The AFS classification offers lower interobserver variability and greater reproducibility than the Hill classification, enhancing diagnostic consistency in GERD evaluation across expertise levels and specialties.

目的:比较美国前肠学会(AFS)内镜下食管胃结(EGJ)完整性分类与Hill分类在不同专业内镜医师之间的观察者间可变性,评估现实世界临床环境中的可重复性。背景:胃食管反流病(GERD)是食管胃十二指肠镜检查(EGD)的常见适应症,但内镜下EGJ的评估往往缺乏标准化。传统上使用的希尔分类有局限性,包括模糊的等级区分和较差的观察者之间的可靠性。AFS分类,包括轴裂孔疝长度(L)、裂孔孔径直径(D)和胃食管瓣瓣存在(F),提供了一个标准化的方案,以提高EGJ破坏的一致性和分层。研究:这项多中心、前瞻性、盲法研究涉及21名内窥镜医师(10名胃肠病学家,11名外科医生),使用Hill和AFS分类对48个确定的EGJ视频片段进行评估。不同经验水平的参与者独立对EGJ完整性进行评分。使用整体和单个成分的类内相关系数(ICC)和Fleiss Kappa (κ)来评估观察者间的一致性。结果:AFS分类的观察者间一致性(ICC=0.749)优于Hill分类(ICC=0.651) (P=0.002)。AFS 4级的一致性最高(κ=0.730), Hill 2级的一致性最低(κ=0.239)。经验丰富的AFS用户的一致性非常好(ICC=0.813),首次用户的一致性很好(ICC=0.709) (P=0.003)。首次使用者AFS分类的观察者间变异性显著低于Hill分类变异性(P=0.025)。L和D成分一致性较好(ICC=0.729, 0.686), F成分一致性中等(ICC=0.441)。不同专业间无显著差异(P=0.516)。结论:与Hill分类相比,AFS分类提供了更低的观察者间变异性和更高的可重复性,增强了不同专业水平和专业对GERD评估的诊断一致性。
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引用次数: 0
Long-Term Reflux Outcomes-A Pragmatic Study of Mucosal Integrity Testing. 长期反流结果-粘膜完整性测试的实用研究
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-11-13 DOI: 10.1097/MCG.0000000000002285
Dhweeja Dasarathy, Ahmed Samy, Sara Treat, Rishi Naik, James C Slaughter, Michael Vaezi, Dhyanesh Patel

Background and aims: Mucosal integrity testing (MI) is a diagnostic modality for gastroesophageal reflux disease (GERD). The aim of this study was to evaluate whether MI predicted long-term improvement in reflux symptoms and the ability to discontinue proton pump inhibitors (PPIs).

Methods: Patients with suspected GERD who underwent MI with (N=86) or without (N=25) wireless pH capsule placement were studied. The GERD-questionnaire (GERD-Q) and GERD health-related quality of life (GERD-HRQL) were administered at follow-up. Logistic regression models were used to estimate the predicted probability of reflux resolution and PPI discontinuation.

Key results: Complete resolution (CR) occurred in 73% (81/111), while reflux remained partially resolved (PR) in 27% (30/111) at a median follow-up of 2.5 years. In the CR group, 33% (27/81) no longer required PPI therapy compared with 13% (4/30) in the PR group. Median (IQR) MI patterns of change over distance from the squamocolumnar junction differed in the 2 groups with the CR group having a higher intercept (4130 Ω vs. 3045 Ω, P<0.01) and flatter slope (71 Ω/cm vs. 224 Ω/cm, P<0.01). MI (C-index 0.71) was better than pH (C-index 0.49) at predicting long-term resolution of reflux in this cohort.

Conclusions and inferences: This is the first outcome-based study to show that changes in MI can predict long-term outcomes. One in 3 patients with higher mucosal impedance (suggesting normal mucosal integrity) can discontinue PPIs long-term.

背景和目的:粘膜完整性测试(MI)是胃食管反流病(GERD)的一种诊断方式。本研究的目的是评估心肌梗死是否预示反流症状的长期改善以及停止质子泵抑制剂(PPIs)的能力。方法:对疑似胃食管反流并行心肌梗死(N=86)或未行无线pH胶囊置入(N=25)的患者进行研究。随访时进行GERD问卷(GERD- q)和GERD健康相关生活质量(GERD- hrql)。使用Logistic回归模型估计反流消退和停用PPI的预测概率。主要结果:在中位随访2.5年期间,73%(81/111)患者完全缓解(CR), 27%(30/111)患者部分缓解(PR)。在CR组中,33%(27/81)不再需要PPI治疗,而PR组为13%(4/30)。中位(IQR)心肌梗死模式随着距离鳞状柱连接处的距离的变化在两组中有所不同,CR组具有更高的截距(4130 Ω vs. 3045 Ω)。结论和推论:这是第一个基于结果的研究,表明心肌梗死的变化可以预测长期预后。1 / 3粘膜阻抗较高的患者(表明粘膜完整性正常)可以长期停用PPIs。
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引用次数: 0
Short-term and Long-term Efficacy of Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis: A Meta-analysis. 经口胃镜下肌切开术治疗难治性胃轻瘫的短期和长期疗效:一项荟萃分析。
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-11-11 DOI: 10.1097/MCG.0000000000002279
Shahryar Khan, Muhammad Shafiq, Mashal Alam Khan, Aamer Ahmad, Nimra Ehsan, Nouman Ahmad, Alok Tripathi, Tuba Esfandyari

Background: Gastric peroral endoscopic myotomy (G-POEM) is an emerging endoscopic approach to treat refractory gastroparesis (GP). Previous studies have shown short-term benefits, but the long-term outcomes are unclear. This analysis evaluated the short- and long-term efficacy of G-POEM compared with standard medical treatment for adults with refractory GP.

Methods: We performed a systematic review and meta-analysis of studies that evaluated G-POEM for refractory GP. Clinical success was defined variably across studies, most commonly as a ≥50% reduction in Gastroparesis Cardinal Symptom Index (GCSI) scores or combined symptoms and gastric emptying improvement. Pooled estimates for clinical success, GCSI scores, and gastric emptying scintigraphy (GES) were calculated using a random effects model. Adverse events and predictors of long-term outcomes were assessed.

Results: This meta-analysis included 23 studies involving 871 patients who underwent G-POEM. The clinical response rates remained consistently above 70% during the first year, peaked at 79% at 24 months, and reached 81% at 60 months. G-POEM was associated with significant and durable reductions in GCSI scores at 1 month (SMD -2.68, 95% CI: -3.58 to -1.78), 12 months (SMD -2.12, 95% CI: -2.73 to -1.50), and 60 months (SMD -2.55, 95% CI: -4.88 to -0.23), as well as sustained improvements in gastric emptying at 12 months (SMD -33.60%, P <0.05) and 24 months (SMD -36.17%, P <0.05). Adverse events occurred in 7% of the cases. Predictors of long-term clinical success included idiopathic etiology (P=0.04), shorter disease duration (P=0.04), prior botulinum toxin injection (P=0.02), and higher baseline symptom severity (P <0.05).

Conclusions: G-POEM may offer sustained symptoms and gastric emptying improvement in refractory GP, but findings should be interpreted cautiously given reliance on observational data, variable success definitions, lack of sham-controlled evidence, and the absence of a standard effective medical comparator. Careful patient selection remains essential, and randomized trials are needed to confirm its long-term efficacy.

背景:胃经口内镜下肌切开术(G-POEM)是一种新兴的内镜下治疗难治性胃轻瘫(GP)的方法。之前的研究显示了短期的好处,但长期的结果还不清楚。该分析评估了G-POEM与标准药物治疗对成人难治性GP的短期和长期疗效。方法:我们对评价G-POEM治疗难治性GP的研究进行了系统回顾和荟萃分析。临床成功的定义在不同的研究中是可变的,最常见的是胃轻瘫主要症状指数(GCSI)评分降低≥50%或综合症状和胃排空改善。使用随机效应模型计算临床成功率、GCSI评分和胃排空显像(GES)的汇总估计。评估不良事件和长期预后的预测因素。结果:这项荟萃分析包括23项研究,涉及871例接受G-POEM治疗的患者。临床缓解率在第一年一直保持在70%以上,在24个月时达到79%的峰值,在60个月时达到81%。G-POEM与GCSI评分在1个月(SMD -2.68, 95% CI: -3.58至-1.78)、12个月(SMD -2.12, 95% CI: -2.73至-1.50)和60个月(SMD -2.55, 95% CI: -4.88至-0.23)的显著和持久降低相关,以及胃排空在12个月(SMD -33.60%, P)的持续改善相关。G-POEM可能在难治性GP中提供持续的症状和胃排空改善,但由于依赖于观察数据、不同的成功定义、缺乏假对照证据和缺乏标准有效的医学比较物,研究结果应谨慎解释。谨慎的患者选择仍然是必要的,需要随机试验来证实其长期疗效。
{"title":"Short-term and Long-term Efficacy of Gastric Peroral Endoscopic Myotomy for Refractory Gastroparesis: A Meta-analysis.","authors":"Shahryar Khan, Muhammad Shafiq, Mashal Alam Khan, Aamer Ahmad, Nimra Ehsan, Nouman Ahmad, Alok Tripathi, Tuba Esfandyari","doi":"10.1097/MCG.0000000000002279","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002279","url":null,"abstract":"<p><strong>Background: </strong>Gastric peroral endoscopic myotomy (G-POEM) is an emerging endoscopic approach to treat refractory gastroparesis (GP). Previous studies have shown short-term benefits, but the long-term outcomes are unclear. This analysis evaluated the short- and long-term efficacy of G-POEM compared with standard medical treatment for adults with refractory GP.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of studies that evaluated G-POEM for refractory GP. Clinical success was defined variably across studies, most commonly as a ≥50% reduction in Gastroparesis Cardinal Symptom Index (GCSI) scores or combined symptoms and gastric emptying improvement. Pooled estimates for clinical success, GCSI scores, and gastric emptying scintigraphy (GES) were calculated using a random effects model. Adverse events and predictors of long-term outcomes were assessed.</p><p><strong>Results: </strong>This meta-analysis included 23 studies involving 871 patients who underwent G-POEM. The clinical response rates remained consistently above 70% during the first year, peaked at 79% at 24 months, and reached 81% at 60 months. G-POEM was associated with significant and durable reductions in GCSI scores at 1 month (SMD -2.68, 95% CI: -3.58 to -1.78), 12 months (SMD -2.12, 95% CI: -2.73 to -1.50), and 60 months (SMD -2.55, 95% CI: -4.88 to -0.23), as well as sustained improvements in gastric emptying at 12 months (SMD -33.60%, P <0.05) and 24 months (SMD -36.17%, P <0.05). Adverse events occurred in 7% of the cases. Predictors of long-term clinical success included idiopathic etiology (P=0.04), shorter disease duration (P=0.04), prior botulinum toxin injection (P=0.02), and higher baseline symptom severity (P <0.05).</p><p><strong>Conclusions: </strong>G-POEM may offer sustained symptoms and gastric emptying improvement in refractory GP, but findings should be interpreted cautiously given reliance on observational data, variable success definitions, lack of sham-controlled evidence, and the absence of a standard effective medical comparator. Careful patient selection remains essential, and randomized trials are needed to confirm its long-term efficacy.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145488918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Feasibility of Multimodal Physical Therapy Intervention on Pelvic Floor Symptoms and Function in Adults With Constipation: A Pilot Randomized Controlled Trial. 多模式物理治疗干预成人便秘盆底症状和功能的可行性:一项随机对照试验
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-11-07 DOI: 10.1097/MCG.0000000000002278
Yi-Fang Tsai, Po-Chuan Chen, Kuan-Yin Lin

Goals: To investigate the feasibility and effectiveness of an 8-week multimodal physical therapy program for adults with constipation.

Background: Constipation is a common multifactorial digestive disease in adults. A multimodal intervention program may better improve pelvic floor muscle (PFM) function and alleviate symptoms.

Study: This pilot randomized controlled trial was conducted at a Tertiary Medical Center in Taiwan. Adults with functional constipation were recruited and randomly assigned to either the intervention group (IG) or the control group (CG). The IG received a multimodal physical therapy intervention, including therapist-guided lifestyle modification education, twice-weekly physical exercise, and pelvic floor muscle training for 8 weeks. The CG received only 1 session of lifestyle modification education after baseline assessment. Assessments were conducted at baseline and after the 8-week program. Primary outcomes included feasibility measures. Secondary outcomes comprised symptom severity, PFM function, health-related quality of life (HRQOL), and physical activity levels.

Results: A total of 27 participants were recruited (IG: n=14, CG: n=13). The consent rate was 65.2%, with an overall withdrawal rate of 14.8%. No adverse events were reported, and treatment satisfaction was moderate to high. After the 8-week intervention, significant improvements were observed in symptom severity (P=0.003), PFM coordination (P=0.011), PFM strength (P=0.007), HRQOL (P=0.013), and physical activity levels (P=0.037) in the IG, whereas no significant changes were observed in the CG.

Conclusions: An 8-week multimodal physical therapy intervention program appears feasible and potentially effective in improving constipation symptoms, PFM function, HRQOL, and physical activity levels in adults with constipation.

目的:探讨成人便秘患者8周多模式物理治疗方案的可行性和有效性。背景:便秘是成人常见的多因素消化系统疾病。多模式干预方案可以更好地改善盆底肌(PFM)功能并减轻症状。研究:本研究在台湾某三级医疗中心进行随机对照试验。招募功能性便秘的成年人并随机分配到干预组(IG)或对照组(CG)。IG接受多模式物理治疗干预,包括治疗师指导的生活方式改变教育,每周两次体育锻炼和盆底肌肉训练,为期8周。在基线评估后,CG只接受了1次生活方式改变教育。评估分别在基线和8周后进行。主要结局包括可行性测量。次要结局包括症状严重程度、PFM功能、健康相关生活质量(HRQOL)和身体活动水平。结果:共招募27名参与者(IG: n=14, CG: n=13)。同意率为65.2%,总退出率为14.8%。无不良事件报告,治疗满意度中至高。干预8周后,IG症状严重程度(P=0.003)、PFM协调性(P=0.011)、PFM强度(P=0.007)、HRQOL (P=0.013)和体力活动水平(P=0.037)均有显著改善,而CG无显著变化。结论:一项为期8周的多模式物理治疗干预方案在改善便秘患者便秘症状、PFM功能、HRQOL和身体活动水平方面似乎是可行的,并且可能有效。
{"title":"Feasibility of Multimodal Physical Therapy Intervention on Pelvic Floor Symptoms and Function in Adults With Constipation: A Pilot Randomized Controlled Trial.","authors":"Yi-Fang Tsai, Po-Chuan Chen, Kuan-Yin Lin","doi":"10.1097/MCG.0000000000002278","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002278","url":null,"abstract":"<p><strong>Goals: </strong>To investigate the feasibility and effectiveness of an 8-week multimodal physical therapy program for adults with constipation.</p><p><strong>Background: </strong>Constipation is a common multifactorial digestive disease in adults. A multimodal intervention program may better improve pelvic floor muscle (PFM) function and alleviate symptoms.</p><p><strong>Study: </strong>This pilot randomized controlled trial was conducted at a Tertiary Medical Center in Taiwan. Adults with functional constipation were recruited and randomly assigned to either the intervention group (IG) or the control group (CG). The IG received a multimodal physical therapy intervention, including therapist-guided lifestyle modification education, twice-weekly physical exercise, and pelvic floor muscle training for 8 weeks. The CG received only 1 session of lifestyle modification education after baseline assessment. Assessments were conducted at baseline and after the 8-week program. Primary outcomes included feasibility measures. Secondary outcomes comprised symptom severity, PFM function, health-related quality of life (HRQOL), and physical activity levels.</p><p><strong>Results: </strong>A total of 27 participants were recruited (IG: n=14, CG: n=13). The consent rate was 65.2%, with an overall withdrawal rate of 14.8%. No adverse events were reported, and treatment satisfaction was moderate to high. After the 8-week intervention, significant improvements were observed in symptom severity (P=0.003), PFM coordination (P=0.011), PFM strength (P=0.007), HRQOL (P=0.013), and physical activity levels (P=0.037) in the IG, whereas no significant changes were observed in the CG.</p><p><strong>Conclusions: </strong>An 8-week multimodal physical therapy intervention program appears feasible and potentially effective in improving constipation symptoms, PFM function, HRQOL, and physical activity levels in adults with constipation.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Opioid Provision After Inpatient Care is Associated With Poor Outcomes in Inflammatory Bowel Disease. 住院治疗后提供阿片类药物与炎症性肠病预后不良相关
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-11-05 DOI: 10.1097/MCG.0000000000002277
J Westley Heinle, Sarah Kazzaz, Eric W Schaefer, Guodong Liu, Shannon Dalessio, Matthew D Coates

Goals: In this study, we investigate clinical outcomes of inflammatory bowel disease (IBD) patients prescribed opioids after discharge from the hospital or emergency department (ED).

Background: IBD is commonly associated with abdominal pain. Opioids are frequently prescribed to address pain in IBD patients. Importantly, however, there is limited evidence of analgesic benefit. In addition, there are significant safety concerns about opioid use in this setting.

Study: This retrospective study utilized Merative MarketScan claims databases to identify IBD patients who had a hospital or ED visit between 2017 and 2021. Two patient groups were formed based on whether they received an opioid prescription within 7 days of discharge or not. Demographics and baseline clinical features were evaluated. Using χ2 tests and logistic regression, clinical outcomes were compared between groups at 3 time points (1, 3, and 6 mo) starting 7 days after discharge.

Results: Thirty-five thousand eight hundred ninety IBD patients were included in the analysis, with 7892 (22.0%) patients in the opioid prescription group. Using logistic regression analysis, IBD opioid users were found to be significantly more likely to experience repeat ED visits, hospitalizations and opioid prescriptions at multiple time points. IBD opioid users were also more likely to receive corticosteroids and undergo medication escalation during follow-up. Ulcerative colitis opioid users also trended toward being more likely to undergo IBD-associated surgery 6 months after discharge.

Conclusions: Patients who are prescribed opioids after acute hospital care are more likely to have poor clinical outcomes. Physicians should avoid prescribing opioids to IBD patients at discharge from the ED or hospital.

目的:在本研究中,我们调查炎症性肠病(IBD)患者在出院或急诊科(ED)后服用阿片类药物的临床结果。背景:IBD通常伴有腹痛。阿片类药物经常用于治疗IBD患者的疼痛。然而,重要的是,有有限的证据表明它有镇痛作用。此外,在这种情况下使用阿片类药物也存在重大的安全问题。研究:这项回顾性研究利用Merative MarketScan索赔数据库来确定2017年至2021年间住院或急诊科就诊的IBD患者。根据出院后7天内是否接受阿片类药物处方分为两组。评估人口统计学和基线临床特征。采用χ2检验和logistic回归,比较两组患者出院后第7天开始的3个时间点(1、3、6个月)的临床结果。结果:纳入分析的IBD患者为35000 890例,其中阿片类药物处方组7892例(22.0%)。通过logistic回归分析,发现IBD阿片类药物使用者更有可能在多个时间点重复就诊、住院和服用阿片类药物。IBD阿片类药物使用者也更有可能接受皮质类固醇治疗,并在随访期间进行药物升级。溃疡性结肠炎阿片类药物使用者也倾向于在出院后6个月接受ibd相关手术。结论:急性住院治疗后处方阿片类药物的患者更有可能出现不良临床结果。医生应避免给IBD患者在出院时开阿片类药物。
{"title":"Opioid Provision After Inpatient Care is Associated With Poor Outcomes in Inflammatory Bowel Disease.","authors":"J Westley Heinle, Sarah Kazzaz, Eric W Schaefer, Guodong Liu, Shannon Dalessio, Matthew D Coates","doi":"10.1097/MCG.0000000000002277","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002277","url":null,"abstract":"<p><strong>Goals: </strong>In this study, we investigate clinical outcomes of inflammatory bowel disease (IBD) patients prescribed opioids after discharge from the hospital or emergency department (ED).</p><p><strong>Background: </strong>IBD is commonly associated with abdominal pain. Opioids are frequently prescribed to address pain in IBD patients. Importantly, however, there is limited evidence of analgesic benefit. In addition, there are significant safety concerns about opioid use in this setting.</p><p><strong>Study: </strong>This retrospective study utilized Merative MarketScan claims databases to identify IBD patients who had a hospital or ED visit between 2017 and 2021. Two patient groups were formed based on whether they received an opioid prescription within 7 days of discharge or not. Demographics and baseline clinical features were evaluated. Using χ2 tests and logistic regression, clinical outcomes were compared between groups at 3 time points (1, 3, and 6 mo) starting 7 days after discharge.</p><p><strong>Results: </strong>Thirty-five thousand eight hundred ninety IBD patients were included in the analysis, with 7892 (22.0%) patients in the opioid prescription group. Using logistic regression analysis, IBD opioid users were found to be significantly more likely to experience repeat ED visits, hospitalizations and opioid prescriptions at multiple time points. IBD opioid users were also more likely to receive corticosteroids and undergo medication escalation during follow-up. Ulcerative colitis opioid users also trended toward being more likely to undergo IBD-associated surgery 6 months after discharge.</p><p><strong>Conclusions: </strong>Patients who are prescribed opioids after acute hospital care are more likely to have poor clinical outcomes. Physicians should avoid prescribing opioids to IBD patients at discharge from the ED or hospital.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Invisible Burdens: The Influence of Stigma and Social Determinants on Quality of Life in Perianal Fistulizing Crohn's Disease. 看不见的负担:耻辱感和社会决定因素对肛周瘘管性克罗恩病生活质量的影响。
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-11-03 DOI: 10.1097/MCG.0000000000002275
Shabari Shenoy, Jake Debroff, Joshua Lacoste, Elisabeth Giselbrecht, Nicole O Gbenebitse, Rachita Llona, Hunter R Moran, Felix Rozenberg, Laurie Keefer, Serre-Yu Wong

Introduction: Perianal fistulizing Crohn's disease (PFCD) is known to impact patients' quality of life (QoL). However, the interactions between PFCD activity itself with patients' psychosocial well-being and social determinants of health (SDOH) are not fully understood.

Methods: We conducted a survey study of adult patients with clinically active and inactive PFCD defined by the presence or absence of perianal pain and/or drainage between July 2023 and April 2024. The survey included the Crohn's anal fistula quality of life (CAF-QoL) scale, PROMIS scale, IBD Internalized Stigma Scale (modified), Everyday discrimination scale, Health Leads screening tool for SDOH, and Cantril ladder for life satisfaction.

Results: The study included 97 patients with active and 31 with inactive PFCD. Patients with active PFCD reported lower QoL (P<0.001), higher rates of anxiety and depression (P<0.001), decreased life satisfaction (P<0.001), and higher internalized stigma (P<0.001) than patients with inactive PFCD. Lower QoL was associated with lower annual household income (P<0.004) and elevated internalized stigma (P=0.001). Nonwhite patients with active PFCD reported higher internalized stigma related to discrimination experiences (P=0.006). Patients with active PFCD were more likely to report social isolation compared with inactive patients (23.7% vs. 0.0%, P=0.001).

Conclusion: Internalized stigma, nonwhite race, financial resource strain, and social isolation negatively impact patients with PFCD, with those having symptomatic PFCD more affected than those with inactive perianal disease. Providers should screen for these factors to identify vulnerable patients who would benefit from psychosocial care and patient navigation.

简介:众所周知,肛周瘘性克罗恩病(PFCD)会影响患者的生活质量(QoL)。然而,PFCD活动本身与患者心理社会健康和健康的社会决定因素(SDOH)之间的相互作用尚未完全了解。方法:我们对2023年7月至2024年4月期间临床活动性和非活动性PFCD的成年患者进行了一项调查研究,其定义为存在或不存在肛周疼痛和/或引流。调查内容包括克罗恩肛瘘生活质量量表(cafqol)、PROMIS量表、IBD内化污名量表(改良版)、日常歧视量表、Health Leads SDOH筛查工具、Cantril生活满意度量表。结果:纳入活动性PFCD 97例,非活动性PFCD 31例。结论:内化污名、非白人种族、经济资源紧张和社会隔离对PFCD患者有负面影响,有症状的PFCD患者比无症状的PFCD患者受影响更大。提供者应筛选这些因素,以确定易受伤害的患者,这些患者将受益于心理社会护理和患者导航。
{"title":"Invisible Burdens: The Influence of Stigma and Social Determinants on Quality of Life in Perianal Fistulizing Crohn's Disease.","authors":"Shabari Shenoy, Jake Debroff, Joshua Lacoste, Elisabeth Giselbrecht, Nicole O Gbenebitse, Rachita Llona, Hunter R Moran, Felix Rozenberg, Laurie Keefer, Serre-Yu Wong","doi":"10.1097/MCG.0000000000002275","DOIUrl":"https://doi.org/10.1097/MCG.0000000000002275","url":null,"abstract":"<p><strong>Introduction: </strong>Perianal fistulizing Crohn's disease (PFCD) is known to impact patients' quality of life (QoL). However, the interactions between PFCD activity itself with patients' psychosocial well-being and social determinants of health (SDOH) are not fully understood.</p><p><strong>Methods: </strong>We conducted a survey study of adult patients with clinically active and inactive PFCD defined by the presence or absence of perianal pain and/or drainage between July 2023 and April 2024. The survey included the Crohn's anal fistula quality of life (CAF-QoL) scale, PROMIS scale, IBD Internalized Stigma Scale (modified), Everyday discrimination scale, Health Leads screening tool for SDOH, and Cantril ladder for life satisfaction.</p><p><strong>Results: </strong>The study included 97 patients with active and 31 with inactive PFCD. Patients with active PFCD reported lower QoL (P<0.001), higher rates of anxiety and depression (P<0.001), decreased life satisfaction (P<0.001), and higher internalized stigma (P<0.001) than patients with inactive PFCD. Lower QoL was associated with lower annual household income (P<0.004) and elevated internalized stigma (P=0.001). Nonwhite patients with active PFCD reported higher internalized stigma related to discrimination experiences (P=0.006). Patients with active PFCD were more likely to report social isolation compared with inactive patients (23.7% vs. 0.0%, P=0.001).</p><p><strong>Conclusion: </strong>Internalized stigma, nonwhite race, financial resource strain, and social isolation negatively impact patients with PFCD, with those having symptomatic PFCD more affected than those with inactive perianal disease. Providers should screen for these factors to identify vulnerable patients who would benefit from psychosocial care and patient navigation.</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145438160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Large North American Multicenter Experience on Endoscopic Submucosal Dissection of Rectal Neoplasms Extending to the Dentate Line. 北美多中心直肠肿瘤延伸至齿状线的内镜粘膜下解剖的大型经验。
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-10-29 DOI: 10.1097/MCG.0000000000002265
Neil R Sharma, Harishankar Gopakumar, Talia F Malik, Aqsa Khan, Dushyant S Dahiya, Ishaan Vohra, Christina M Zelt, Ashley Rumple, Mindy Flanagan, Antonio Mendoza-Ladd, Abdul A Adam, Ahmed B Saeed, Mohamed Othman, Saowanee Ngamruengphong, Suchapa Arayakarnkul, Amit Bhatt, Dennis Yang, Mohammad Bilal, Mariajose Rojas De Leon, Alexander Schlachterman, Pranita Madaka, Faisal Kamal, Anand Kumar, Blake Thompson, Prashant Kedia, David Diehl, Sagar Shah, Alireza Sedarat, Andrew Y Wang, Amaninder Dhaliwal, Davinderbir S Pannu, Meir Mizrahi, Michel Kahaleh, Sherif Andrawes, Peter V Draganov

Introduction: The ideal resection strategy for rectal neoplasms extending to the dentate line (RNDLs) remains unclear. Transanal surgical approaches and endoscopic mucosal resection (EMR) have their limitations related to inadequate visualization, device maneuverability, and securing an adequate margin on the anal side. Endoscopic submucosal dissection (ESD) appears to overcome some of the limitations of transanal surgical and snare-based endoscopic techniques. Therefore, we evaluated the safety and efficacy of ESD for resection of distal rectal lesions within 2 cm of the dentate line.

Methods: This is a large-scale multicenter retrospective study of patients who underwent ESD for RNDLs between 2015 and 2023. The primary outcomes were the rates of R0 and en bloc resection. Secondary outcomes were immediate and delayed adverse events.

Results: A total of 255 patients across 20 institutions were included (mean age 63.60, women 52.20%). The median lesion size was 40 mm (IQR: 30 to 55), and the median resection time was 110 minutes (IQR: 81 to 169). The en bloc resection rate was 93.70% (n=236), and the rate of R0 resection was 85.40% (n=216). The rate of overall adverse events was 8.70% (n=22, 95% CI: 5.22% to 12.17%), with 13 cases of bleeding (5.10%), 4 cases of full-thickness perforation, and 1 case of postprocedural pain requiring intervention. All AEs were managed conservatively without the need for subsequent surgical or endoscopic interventions.

Conclusions: ESD is safe and effective for resecting RNDLs with high en bloc and R0 resection rates, offering the potential for complete resection with minimal morbidity. It offers advantages over TEN, TAMIS, and other forms of transanal surgery due to the anatomy being less conducive to the equipment required for these techniques, lower cost, and lower rates of complications. However, careful patient selection, meticulous procedural planning, and close follow-up are essential to ensure optimal outcomes and minimize the risk of complications. Long-term follow-up studies and additional prospective controlled trials are warranted.

直肠肿瘤延伸至齿状线(RNDLs)的理想切除策略尚不清楚。经肛门手术入路和内镜粘膜切除术(EMR)有其局限性,包括不充分的可视化、设备可操作性和确保肛门侧足够的切缘。内镜下粘膜剥离术(ESD)似乎克服了一些经肛门手术和基于陷阱的内镜技术的局限性。因此,我们评估了ESD在齿状线2 cm范围内切除直肠远端病变的安全性和有效性。方法:这是一项大规模的多中心回顾性研究,研究对象是2015年至2023年间接受ESD治疗的rndl患者。主要结果是R0和整体切除率。次要结局是即时和延迟的不良事件。结果:20家机构共纳入255例患者(平均年龄63.60岁,女性52.20%)。中位病灶大小为40 mm (IQR: 30 ~ 55),中位切除时间为110分钟(IQR: 81 ~ 169)。整体切除率为93.70% (n=236), R0切除率为85.40% (n=216)。总不良事件发生率为8.70% (n=22, 95% CI: 5.22% ~ 12.17%),其中出血13例(5.10%),全层穿孔4例,术后疼痛1例需要干预。所有ae均保守处理,无需后续手术或内镜干预。结论:ESD对于rndl的切除是安全有效的,具有很高的整体和R0切除率,提供了以最小的发病率完全切除的潜力。与TEN、TAMIS和其他形式的经肛门手术相比,它具有优势,因为解剖结构对这些技术所需的设备不太有利,成本更低,并发症发生率更低。然而,仔细的患者选择、细致的手术计划和密切的随访是确保最佳结果和最小化并发症风险的必要条件。长期随访研究和额外的前瞻性对照试验是必要的。
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引用次数: 0
Efficacy and Safety of Low Volume Bowel Preparation for Colonoscopy in Hospitalized Patients: A Randomized Noninferiority Trial. 住院患者结肠镜检查小容量肠准备的有效性和安全性:一项随机非效性试验。
IF 2.7 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-10-24 DOI: 10.1097/MCG.0000000000002269
Karen Xiao, Fatima Khan, Richard Link, Armando Dominguez-Diaz, Prince Ameyaw, Jamil Alexis, Cheng-Hung Tai, Valerie Assalone, Mimoza Nasufi, Michelle L Hughes, Caroline Loeser, Kenneth Hung, Darrick K Li

Goals: To evaluate whether low-volume bowel preparation achieved similar rates of bowel cleansing as standard volume bowel preparations among hospitalized patients and assess the tolerability and safety of their use in this population.

Background: The use of low-volume bowel preparations for colonoscopy preparation is understudied in the inpatient setting, where standard volume preparations remain the standard of care.

Methods: We conducted a multicenter, randomized, single-blind, noninferiority trial. Hospitalized adult patients were randomized to receive low volume (2 L polyethylene glycol and ascorbic acid, 2L PEG+ASC) or standard volume bowel preparation (4 L polyethylene glycol and electrolyte lavage solution, 4L PEG-ELS) before colonoscopy. The primary outcome was noninferiority with respect to the achievement of adequate bowel preparation. Secondary outcomes included rates of electrolyte derangements, acute kidney injury, and patient tolerability.

Results: Five hundred twenty patients were randomized to 2L PEG+ASC (n=257) and 4L PEG-ELS (n=263). In per-protocol analysis, 2L PEG+ASC was noninferior to 4L PEG-ELS for achievement of adequate bowel preparation (55.0% vs. 52.9%, P =0.007). No significant difference was detected with regard to hyponatremia (1.6% vs. 3.3%, P =0.50), hypokalemia (5.3% vs. 8.7%, P =0.27), hyperkalemia (1.1% vs. 0.0% P =0.24), or acute kidney injury (4.3% vs. 3.3%, P =0.73). More 2L PEG+ASC patients found the preparation to be "easy" to tolerate compared with 4L PEG-ELS patients (29.0% vs. 13.1%, P <0.001).

Conclusions: Among hospitalized patients, 2L PEG+ASC was noninferior to 4L PEG-ELS for achieving bowel cleanliness with similar rates of electrolyte disturbance and acute kidney injury and with higher tolerability (ClinicalTrials.gov number, NCT05054036).

目的:评估在住院患者中,小容量肠道准备是否达到了与标准容量肠道准备相似的肠道清洁率,并评估其在该人群中的耐受性和安全性。背景:低容量肠制剂用于结肠镜检查准备的研究在住院环境中尚不充分,其中标准体积制剂仍然是标准的护理。方法:我们进行了一项多中心、随机、单盲、非劣效性试验。住院成年患者在结肠镜检查前随机接受低容量(2L聚乙二醇和抗坏血酸,2L PEG+ASC)或标准容量肠道准备(4L聚乙二醇和电解质灌洗液,4L PEG- els)。主要结局是非劣效性的关于实现充分的肠道准备。次要结局包括电解质紊乱率、急性肾损伤和患者耐受性。结果:520例患者随机分为2L PEG+ASC组(257例)和4L PEG- els组(263例)。在每个方案分析中,2L PEG+ASC在实现充分的肠道准备方面不逊于4L PEG- els(55.0%比52.9%,P=0.007)。在低钠血症(1.6% vs. 3.3%, P=0.50)、低钾血症(5.3% vs. 8.7%, P=0.27)、高钾血症(1.1% vs. 0.0% P=0.24)或急性肾损伤(4.3% vs. 3.3%, P=0.73)方面无显著差异。与4L PEG- els患者相比,更多2L PEG+ASC患者发现该制剂“容易”耐受(29.0% vs. 13.1%)。结论:在住院患者中,2L PEG+ASC在实现肠道清洁方面不低于4L PEG- els,电解质紊乱和急性肾损伤的发生率相似,耐受性更高(ClinicalTrials.gov号,NCT05054036)。
{"title":"Efficacy and Safety of Low Volume Bowel Preparation for Colonoscopy in Hospitalized Patients: A Randomized Noninferiority Trial.","authors":"Karen Xiao, Fatima Khan, Richard Link, Armando Dominguez-Diaz, Prince Ameyaw, Jamil Alexis, Cheng-Hung Tai, Valerie Assalone, Mimoza Nasufi, Michelle L Hughes, Caroline Loeser, Kenneth Hung, Darrick K Li","doi":"10.1097/MCG.0000000000002269","DOIUrl":"10.1097/MCG.0000000000002269","url":null,"abstract":"<p><strong>Goals: </strong>To evaluate whether low-volume bowel preparation achieved similar rates of bowel cleansing as standard volume bowel preparations among hospitalized patients and assess the tolerability and safety of their use in this population.</p><p><strong>Background: </strong>The use of low-volume bowel preparations for colonoscopy preparation is understudied in the inpatient setting, where standard volume preparations remain the standard of care.</p><p><strong>Methods: </strong>We conducted a multicenter, randomized, single-blind, noninferiority trial. Hospitalized adult patients were randomized to receive low volume (2 L polyethylene glycol and ascorbic acid, 2L PEG+ASC) or standard volume bowel preparation (4 L polyethylene glycol and electrolyte lavage solution, 4L PEG-ELS) before colonoscopy. The primary outcome was noninferiority with respect to the achievement of adequate bowel preparation. Secondary outcomes included rates of electrolyte derangements, acute kidney injury, and patient tolerability.</p><p><strong>Results: </strong>Five hundred twenty patients were randomized to 2L PEG+ASC (n=257) and 4L PEG-ELS (n=263). In per-protocol analysis, 2L PEG+ASC was noninferior to 4L PEG-ELS for achievement of adequate bowel preparation (55.0% vs. 52.9%, P =0.007). No significant difference was detected with regard to hyponatremia (1.6% vs. 3.3%, P =0.50), hypokalemia (5.3% vs. 8.7%, P =0.27), hyperkalemia (1.1% vs. 0.0% P =0.24), or acute kidney injury (4.3% vs. 3.3%, P =0.73). More 2L PEG+ASC patients found the preparation to be \"easy\" to tolerate compared with 4L PEG-ELS patients (29.0% vs. 13.1%, P <0.001).</p><p><strong>Conclusions: </strong>Among hospitalized patients, 2L PEG+ASC was noninferior to 4L PEG-ELS for achieving bowel cleanliness with similar rates of electrolyte disturbance and acute kidney injury and with higher tolerability (ClinicalTrials.gov number, NCT05054036).</p>","PeriodicalId":15457,"journal":{"name":"Journal of clinical gastroenterology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145345619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of clinical gastroenterology
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