Pub Date : 2024-04-18DOI: 10.14309/ajg.0000000000002822
Yoo Min Han, J. Yoon, S. Yoo, Su Jin Chung, Jeong-Min Lee, Ji Min Choi, Eun Hyo Jin, Ji Yeon Seo
BACKGROUND AND AIMS Visceral obesity is a risk factor for reflux esophagitis (RE). We investigated the risk of RE according to visceral adipose tissue (VAT) measured by deep neural network architecture using computed tomography and evaluated the longitudinal association between abdominal adipose tissue changes and the disease course of RE. METHODS Individuals receiving health checkups who underwent esophagogastroduodenoscopy (EGD) and abdominal computed tomography (CT) at Seoul National University Healthcare System Gangnam Center between 2015 and 2016 were included. Visceral and subcutaneous adipose tissue areas and volumes were measured using a deep neural network architecture and CT. The association between the abdominal adipose tissue area and volume and the risk of RE was evaluated. Participants who underwent follow-up EGD and abdominal CT were selected; the effects of changes in abdominal adipose tissue area and volume on RE endoscopic grade were investigated using Cox proportional hazards regression. RESULTS We enrolled 6570 patients who underwent EGD and abdomen CT on the same day. RE was associated with male sex, hypertension, diabetes, excessive alcohol intake, current smoking status, and levels of physical activity. The VAT area and volume increased the risk of RE dose-dependently. A decreasing VAT volume was significantly associated with improvement in RE endoscopic grade (HR:3.22, 95%CI:1.82-5.71). Changes in subcutaneous adipose tissue volume and the disease course of RE were not significantly correlated. CONCLUSIONS Visceral obesity is strongly associated with RE. VAT volume reduction was prospectively associated with improvement in RE endoscopic grade dose-dependently. Visceral obesity is a potential target for RE treatment.
背景和目的内脏肥胖是反流性食管炎（RE）的一个风险因素。方法纳入2015年至2016年期间在首尔国立大学医疗保健系统江南中心接受食管胃十二指肠镜检查（EGD）和腹部计算机断层扫描（CT）的健康体检者。使用深度神经网络架构和 CT 测量了内脏和皮下脂肪组织的面积和体积。评估了腹部脂肪组织面积和体积与RE风险之间的关联。我们选取了接受后续胃肠道造影和腹部 CT 检查的参与者，使用 Cox 比例危险度回归法研究了腹部脂肪组织面积和体积的变化对 RE 内镜分级的影响。RE与男性、高血压、糖尿病、过量饮酒、当前吸烟状况和体育锻炼水平有关。VAT面积和体积与RE的风险呈剂量依赖关系。VAT体积的减小与RE内窥镜分级的改善有显著相关性（HR：3.22，95%CI：1.82-5.71）。结论内脏肥胖与RE密切相关。结论内脏肥胖与RE密切相关，VAT体积的减少与RE内镜分级的改善呈剂量依赖性。内脏肥胖是治疗 RE 的潜在目标。
{"title":"Visceral adipose tissue reduction measured by deep neural network architecture improved reflux esophagitis endoscopic grade.","authors":"Yoo Min Han, J. Yoon, S. Yoo, Su Jin Chung, Jeong-Min Lee, Ji Min Choi, Eun Hyo Jin, Ji Yeon Seo","doi":"10.14309/ajg.0000000000002822","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002822","url":null,"abstract":"BACKGROUND AND AIMS\u0000Visceral obesity is a risk factor for reflux esophagitis (RE). We investigated the risk of RE according to visceral adipose tissue (VAT) measured by deep neural network architecture using computed tomography and evaluated the longitudinal association between abdominal adipose tissue changes and the disease course of RE.\u0000\u0000\u0000METHODS\u0000Individuals receiving health checkups who underwent esophagogastroduodenoscopy (EGD) and abdominal computed tomography (CT) at Seoul National University Healthcare System Gangnam Center between 2015 and 2016 were included. Visceral and subcutaneous adipose tissue areas and volumes were measured using a deep neural network architecture and CT. The association between the abdominal adipose tissue area and volume and the risk of RE was evaluated. Participants who underwent follow-up EGD and abdominal CT were selected; the effects of changes in abdominal adipose tissue area and volume on RE endoscopic grade were investigated using Cox proportional hazards regression.\u0000\u0000\u0000RESULTS\u0000We enrolled 6570 patients who underwent EGD and abdomen CT on the same day. RE was associated with male sex, hypertension, diabetes, excessive alcohol intake, current smoking status, and levels of physical activity. The VAT area and volume increased the risk of RE dose-dependently. A decreasing VAT volume was significantly associated with improvement in RE endoscopic grade (HR:3.22, 95%CI:1.82-5.71). Changes in subcutaneous adipose tissue volume and the disease course of RE were not significantly correlated.\u0000\u0000\u0000CONCLUSIONS\u0000Visceral obesity is strongly associated with RE. VAT volume reduction was prospectively associated with improvement in RE endoscopic grade dose-dependently. Visceral obesity is a potential target for RE treatment.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140686154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.14309/ajg.0000000000002817
L. Butterly, William M Hisey, C. Robinson, Bonny L Kneedler, Joseph C. Anderson
BACKGROUND Negative colonoscopies following positive stool tests could result from stool test characteristics or from the quality of endoscopist performance. We used New Hampshire Colonoscopy Registry data to examine the association between endoscopist detection rates and polyp yield in colonoscopies performed for positive FIT or mt-sDNA tests to evaluate the degree to which positive stool tests followed by negative colonoscopy ('false positives') vary with endoscopist quality. Additionally, we investigated the frequency of significant polyps in the sub-group of highest quality colonoscopies following positive stool tests. METHODS We compared the frequencies of negative colonoscopies, and of specific polyps following positive stool tests across quartiles of endoscopist adenoma detection rate (ADR) and clinically significant serrated polyp detection rate (CSSDR). RESULTS Our sample included 864 mt-sDNA+ and 497 FIT+ patients. We found a significantly lower frequency of negative colonoscopies following positive stool tests among endoscopists with higher ADR and CSSDR, particularly in the two highest quartiles. Additionally, detection of any adenoma after a positive stool test for endoscopists in the 4th ADR quartile was 63.3% (FIT+) and 62.8% (mt-sDNA+). Among endoscopists in the 4th CSSDR quartile, SSLs were found in 29.2% of exams following a positive mt-sDNA, and in 13.5% following FIT+ exams. CONCLUSIONS The frequency of negative colonoscopies after positive stool tests was significantly higher in exams performed by endoscopists with low ADR and CSSDR. Our results also suggest a benchmark target of at least 40% for ADR in patients with mt-sDNA+ or FIT+ tests, and 20% for SSLs in mt-sDNA+ patients.
{"title":"Association of endoscopist colonoscopy quality measures with follow-up colonoscopy outcomes after positive stool tests (mt-sDNA or FIT): Retrospective cross-sectional analysis of data from the New Hampshire Colonoscopy Registry.","authors":"L. Butterly, William M Hisey, C. Robinson, Bonny L Kneedler, Joseph C. Anderson","doi":"10.14309/ajg.0000000000002817","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002817","url":null,"abstract":"BACKGROUND\u0000Negative colonoscopies following positive stool tests could result from stool test characteristics or from the quality of endoscopist performance. We used New Hampshire Colonoscopy Registry data to examine the association between endoscopist detection rates and polyp yield in colonoscopies performed for positive FIT or mt-sDNA tests to evaluate the degree to which positive stool tests followed by negative colonoscopy ('false positives') vary with endoscopist quality. Additionally, we investigated the frequency of significant polyps in the sub-group of highest quality colonoscopies following positive stool tests.\u0000\u0000\u0000METHODS\u0000We compared the frequencies of negative colonoscopies, and of specific polyps following positive stool tests across quartiles of endoscopist adenoma detection rate (ADR) and clinically significant serrated polyp detection rate (CSSDR).\u0000\u0000\u0000RESULTS\u0000Our sample included 864 mt-sDNA+ and 497 FIT+ patients. We found a significantly lower frequency of negative colonoscopies following positive stool tests among endoscopists with higher ADR and CSSDR, particularly in the two highest quartiles. Additionally, detection of any adenoma after a positive stool test for endoscopists in the 4th ADR quartile was 63.3% (FIT+) and 62.8% (mt-sDNA+). Among endoscopists in the 4th CSSDR quartile, SSLs were found in 29.2% of exams following a positive mt-sDNA, and in 13.5% following FIT+ exams.\u0000\u0000\u0000CONCLUSIONS\u0000The frequency of negative colonoscopies after positive stool tests was significantly higher in exams performed by endoscopists with low ADR and CSSDR. Our results also suggest a benchmark target of at least 40% for ADR in patients with mt-sDNA+ or FIT+ tests, and 20% for SSLs in mt-sDNA+ patients.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.14309/ajg.0000000000002813
Xu Wang, Xin Shi, Hui Luo, Gui Ren, Xiangping Wang, Jianghai Zhao, Hui Li, Bo Ning, Hang Yi, L. Zhong, Rongchun Zhang, Zhi Ni, Shuhui Liang, Mingxing Xia, Bing Hu, Yanglin Pan, Daiming Fan
OBJECTIVES Fully covered self-expandable metal stents (FCSEMS) are commonly placed in patients with biliary stricture during endoscopic retrograde cholangiopancreatography (ERCP). However, up to 40% of migration has been reported, resulting in treatment failure or the requirement for further intervention. Here we aimed to investigate the effects of metal clip anchoring on preventing the migration of FCSEMS. METHODS Consecutive patients requiring placement of FCSEMS were included in this multicenter randomized trial. The enrolled patients were randomly assigned in a 1:1 ratio to receive clip anchoring (clip group) or not (control group). The primary outcome was the migration rate at 6 months after stent insertion. The secondary outcomes were the rates of proximal and distal migration and stent-related adverse events. The analysis followed the intention-to-treat principle. RESULTS From February 2020 to November 2022, 180 patients with biliary stricture were enrolled, with 90 in each group. The baseline characteristics were comparable between the two groups. The overall rate of stent migration at 6 months was significantly lower in the clip group compared to the control group (16.7% vs. 30.0%, p = 0.030). The proximal and distal migration rates were similar in the two groups (2.2% vs. 5.6%, p=0.205; 14.4% vs. 22.2%, p=0.070). Notably, none of the patients (0/8) who received two or more clips experienced stent migration. There were no significant differences in stent-related adverse events between the two groups. CONCLUSIONS Our data suggest that clip-assisted anchoring is an effective and safe method for preventing migration of FCSEMS without increasing the adverse events.
{"title":"Effects of clip anchoring on preventing migration of fully covered self-expandable metal stent in patients undergoing ERCP: a multicenter, randomized controlled study.","authors":"Xu Wang, Xin Shi, Hui Luo, Gui Ren, Xiangping Wang, Jianghai Zhao, Hui Li, Bo Ning, Hang Yi, L. Zhong, Rongchun Zhang, Zhi Ni, Shuhui Liang, Mingxing Xia, Bing Hu, Yanglin Pan, Daiming Fan","doi":"10.14309/ajg.0000000000002813","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002813","url":null,"abstract":"OBJECTIVES\u0000Fully covered self-expandable metal stents (FCSEMS) are commonly placed in patients with biliary stricture during endoscopic retrograde cholangiopancreatography (ERCP). However, up to 40% of migration has been reported, resulting in treatment failure or the requirement for further intervention. Here we aimed to investigate the effects of metal clip anchoring on preventing the migration of FCSEMS.\u0000\u0000\u0000METHODS\u0000Consecutive patients requiring placement of FCSEMS were included in this multicenter randomized trial. The enrolled patients were randomly assigned in a 1:1 ratio to receive clip anchoring (clip group) or not (control group). The primary outcome was the migration rate at 6 months after stent insertion. The secondary outcomes were the rates of proximal and distal migration and stent-related adverse events. The analysis followed the intention-to-treat principle.\u0000\u0000\u0000RESULTS\u0000From February 2020 to November 2022, 180 patients with biliary stricture were enrolled, with 90 in each group. The baseline characteristics were comparable between the two groups. The overall rate of stent migration at 6 months was significantly lower in the clip group compared to the control group (16.7% vs. 30.0%, p = 0.030). The proximal and distal migration rates were similar in the two groups (2.2% vs. 5.6%, p=0.205; 14.4% vs. 22.2%, p=0.070). Notably, none of the patients (0/8) who received two or more clips experienced stent migration. There were no significant differences in stent-related adverse events between the two groups.\u0000\u0000\u0000CONCLUSIONS\u0000Our data suggest that clip-assisted anchoring is an effective and safe method for preventing migration of FCSEMS without increasing the adverse events.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140702723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.14309/ajg.0000000000002816
Thijs Kuipers, F. A. Ponds, Paul Fockens, B. Bastiaansen, J. Pandolfino, A. Bredenoord
METHODS A dataset of the locally treated patients in a randomized controlled trial comparing POEM with pneumatic dilation (PD) was analyzed. A BOM is defined as a >50% increase in esophageal diameter at its widest point in the distal esophagus between the lower esophageal sphincter and 5 cm above. RESULTS 74 patients were treated in our center, 5-year follow-up data was available in 55 patients (32 (58%) patients randomized to POEM, 23 (42%) PD). In the group initially treated with POEM the incidence of BOM increased from 11.5% (4/38) at three months, 21.1% (8/38) at 1 year, 27.8% (10/36) at 2 years and 31.3% (10/32) at 5 years. None of the patients treated with PD alone developed a BOM. Patients that developed a BOM had higher total Eckardt score and Eckardt regurgitation component compared to patients that underwent POEM without BOM development (3 (2.75-3.25) vs 2 (1.75-3) p=0.032) and (1 (0.75-1 vs 0 (0-1) p=0.041). POEM patients with a BOM more often report reflux symptoms (85% (11/13) vs 46% (2/16), p=0.023) and had a higher acid exposure time ((24.5% (8-47)) vs 6% (1.2-18.7), p=0.027). CONCLUSION 30% of the patients treated with POEM develop a BOM, which is associated with a higher acid exposure, more reflux symptoms and symptoms of regurgitation.
方法分析了一项随机对照试验中局部治疗患者的数据集，该试验比较了 POEM 和气压扩张术 (PD)。BOM 的定义是食管下括约肌和食管上括约肌 5 厘米之间的食管远端最宽处食管直径增大 >50%。在最初接受 POEM 治疗的一组患者中，BOM 的发生率从三个月时的 11.5%（4/38）上升到一年时的 21.1%（8/38）、两年时的 27.8%（10/36）和五年时的 31.3%（10/32）。在单独接受腹膜透析治疗的患者中，没有人出现 BOM。与未发生BOM的POEM患者相比，发生BOM的患者的Eckardt总分和Eckardt反流部分更高（3 (2.75-3.25) vs 2 (1.75-3) p=0.032）和（1 (0.75-1 vs 0 (0-1) p=0.041）。有BOM的POEM患者更常出现反流症状（85%（11/13） vs 46% (2/16)，p=0.023），且酸暴露时间更长（（24.5% (8-47)) vs 6% (1.2-18.7)，p=0.027）。
{"title":"Focal distal esophageal dilation (blown-out myotomy) after achalasia treatment: prevalence and associated symptoms.","authors":"Thijs Kuipers, F. A. Ponds, Paul Fockens, B. Bastiaansen, J. Pandolfino, A. Bredenoord","doi":"10.14309/ajg.0000000000002816","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002816","url":null,"abstract":"METHODS\u0000A dataset of the locally treated patients in a randomized controlled trial comparing POEM with pneumatic dilation (PD) was analyzed. A BOM is defined as a >50% increase in esophageal diameter at its widest point in the distal esophagus between the lower esophageal sphincter and 5 cm above.\u0000\u0000\u0000RESULTS\u000074 patients were treated in our center, 5-year follow-up data was available in 55 patients (32 (58%) patients randomized to POEM, 23 (42%) PD). In the group initially treated with POEM the incidence of BOM increased from 11.5% (4/38) at three months, 21.1% (8/38) at 1 year, 27.8% (10/36) at 2 years and 31.3% (10/32) at 5 years. None of the patients treated with PD alone developed a BOM. Patients that developed a BOM had higher total Eckardt score and Eckardt regurgitation component compared to patients that underwent POEM without BOM development (3 (2.75-3.25) vs 2 (1.75-3) p=0.032) and (1 (0.75-1 vs 0 (0-1) p=0.041). POEM patients with a BOM more often report reflux symptoms (85% (11/13) vs 46% (2/16), p=0.023) and had a higher acid exposure time ((24.5% (8-47)) vs 6% (1.2-18.7), p=0.027).\u0000\u0000\u0000CONCLUSION\u000030% of the patients treated with POEM develop a BOM, which is associated with a higher acid exposure, more reflux symptoms and symptoms of regurgitation.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140703054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.14309/ajg.0000000000002766
S. Hume, J. Holmes, AJ Thompson
{"title":"Individualizing the Approach to Stopping Nucleos(t)ide Analogs: Can We Use a Low HBsAg Threshold to Predict a High Chance of Functional Cure and Minimal Risk of Hepatic Decompensation?","authors":"S. Hume, J. Holmes, AJ Thompson","doi":"10.14309/ajg.0000000000002766","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002766","url":null,"abstract":"","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140701877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-15DOI: 10.14309/ajg.0000000000002812
J. Sijben, L. Rainey, Fleur Maas, Mireille Jm Broeders, P. D. Siersema, Y. Peters
INTRODUCTION Screening for early esophageal adenocarcinoma (EAC) may potentially reduce EAC-related mortality and morbidity. This study aimed to examine the Dutch population's intended uptake of three hypothetical EAC screening test scenarios and preferences for potential future organization. METHODS A total of 8350 Dutch individuals aged 45-75 years were invited, of whom 2258 completed a web-based survey. Participants were randomly assigned to one of three hypothetical screening test scenarios (i.e., transnasal endoscopy, ingestible cell-collection device, or breath analysis). The primary outcome was intended uptake. Secondary outcomes included acceptance of screening eligibility criteria and preferences regarding invitation, counseling, and diagnostic follow-up. We performed exploratory univariable and multivariable regression analyses to assess which determinants were associated with EAC screening intent. RESULTS Intended uptake of screening was highest in the breath analysis scenario (95%), followed by conventional upper endoscopy (78%), an ingestible cell-collection device (75%), and transnasal endoscopy (68%) (p<0.001). Anticipating discomfort was most strongly associated with decreased intention to undergo transnasal endoscopy (OR 0.18, 95% CI 0.11-0.29) or swallow a cell-collection device (OR 0.20, 95% CI 0.13-0.32). Cancer worry and high acceptance of test sensitivity/specificity were consistently associated with a positive intention to participate in screening. Inviting persons for screening based on gastro-esophageal reflux disease (GERD) symptoms, age, or the output of a risk prediction model was acceptable to 74%, 69%, and 66%, respectively. Inviting only men was acceptable for only 41% of women. The majority (58%) preferred to be invited by a public health organization and 32% of the participants preferred to discuss their decision to participate with a health care professional. CONCLUSION Participants in this study self-selected through a web-based survey, potentially introducing selection bias. Participants generally intended to participate in EAC screening, although the level of intent depends on the discomfort and performance associated with the offered screening test. Determining eligibility based on GERD symptoms, age, or a risk calculator, but not sex, would be acceptable to most individuals.
{"title":"The public's intended uptake of hypothetical esophageal adenocarcinoma screening scenarios: a nationwide survey.","authors":"J. Sijben, L. Rainey, Fleur Maas, Mireille Jm Broeders, P. D. Siersema, Y. Peters","doi":"10.14309/ajg.0000000000002812","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002812","url":null,"abstract":"INTRODUCTION\u0000Screening for early esophageal adenocarcinoma (EAC) may potentially reduce EAC-related mortality and morbidity. This study aimed to examine the Dutch population's intended uptake of three hypothetical EAC screening test scenarios and preferences for potential future organization.\u0000\u0000\u0000METHODS\u0000A total of 8350 Dutch individuals aged 45-75 years were invited, of whom 2258 completed a web-based survey. Participants were randomly assigned to one of three hypothetical screening test scenarios (i.e., transnasal endoscopy, ingestible cell-collection device, or breath analysis). The primary outcome was intended uptake. Secondary outcomes included acceptance of screening eligibility criteria and preferences regarding invitation, counseling, and diagnostic follow-up. We performed exploratory univariable and multivariable regression analyses to assess which determinants were associated with EAC screening intent.\u0000\u0000\u0000RESULTS\u0000Intended uptake of screening was highest in the breath analysis scenario (95%), followed by conventional upper endoscopy (78%), an ingestible cell-collection device (75%), and transnasal endoscopy (68%) (p<0.001). Anticipating discomfort was most strongly associated with decreased intention to undergo transnasal endoscopy (OR 0.18, 95% CI 0.11-0.29) or swallow a cell-collection device (OR 0.20, 95% CI 0.13-0.32). Cancer worry and high acceptance of test sensitivity/specificity were consistently associated with a positive intention to participate in screening. Inviting persons for screening based on gastro-esophageal reflux disease (GERD) symptoms, age, or the output of a risk prediction model was acceptable to 74%, 69%, and 66%, respectively. Inviting only men was acceptable for only 41% of women. The majority (58%) preferred to be invited by a public health organization and 32% of the participants preferred to discuss their decision to participate with a health care professional.\u0000\u0000\u0000CONCLUSION\u0000Participants in this study self-selected through a web-based survey, potentially introducing selection bias. Participants generally intended to participate in EAC screening, although the level of intent depends on the discomfort and performance associated with the offered screening test. Determining eligibility based on GERD symptoms, age, or a risk calculator, but not sex, would be acceptable to most individuals.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140699523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.14309/ajg.0000000000002765
Shyam Menon
{"title":"Antibiotic Prophylaxis for ERCP.","authors":"Shyam Menon","doi":"10.14309/ajg.0000000000002765","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002765","url":null,"abstract":"","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140710696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.14309/ajg.0000000000002801
H. Herfarth, M. Long, Jonathan J Hansen, Chelsea Anderson, Emily English, John B. Buse, Edward L Barnes
Introduction After colectomy with ileo-anal pouch anastomosis (IPAA), many patients develop high bowel frequency (BF) refractory to antimotility agents despite normal IPAA morphology. Low circulating levels of glucagon-like protein-1 (GLP-1), a modulator of gastroduodenal motility, have been reported after colectomy. Methods Double-blind crossover study of 8 IPAA patients with refractory high BF treated with daily administration of the GLP-1 receptor agonist (GLP-1-RA) liraglutide or placebo. Results Liraglutide, but not placebo, reduced daily BF by more than 35% (P<0.03). Discussion Larger randomized controlled studies are warranted to delineate the treatment potential of GLP-1RA's in IPAA patients suffering from non-inflammatory high BF.
{"title":"Efficacy and safety of liraglutide in patients with patients with an ileal pouch-anal anastomosis and chronic high bowel frequency: A placebo-controlled, crossover, proof of concept study.","authors":"H. Herfarth, M. Long, Jonathan J Hansen, Chelsea Anderson, Emily English, John B. Buse, Edward L Barnes","doi":"10.14309/ajg.0000000000002801","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002801","url":null,"abstract":"Introduction\u0000After colectomy with ileo-anal pouch anastomosis (IPAA), many patients develop high bowel frequency (BF) refractory to antimotility agents despite normal IPAA morphology. Low circulating levels of glucagon-like protein-1 (GLP-1), a modulator of gastroduodenal motility, have been reported after colectomy.\u0000\u0000\u0000Methods\u0000Double-blind crossover study of 8 IPAA patients with refractory high BF treated with daily administration of the GLP-1 receptor agonist (GLP-1-RA) liraglutide or placebo.\u0000\u0000\u0000Results\u0000Liraglutide, but not placebo, reduced daily BF by more than 35% (P<0.03).\u0000\u0000\u0000Discussion\u0000Larger randomized controlled studies are warranted to delineate the treatment potential of GLP-1RA's in IPAA patients suffering from non-inflammatory high BF.","PeriodicalId":507623,"journal":{"name":"The American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140709857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-09DOI: 10.14309/ajg.0000000000002800
Ignacio Hanna-Jairala, D. Drossman
Irritable bowel syndrome are responsive to treatments using central neuromodulators. Central neuromodulators work by enhancing the synaptic transmission of 5-hydroxytryptamine, noradrenalin and dopamine, achieving a slower regulation or desensitization of their postsynaptic receptors. Central neuromodulators act on receptors along the brain-gut axis, so they are useful in treating psychiatric comorbidities, modifying gut motility, improving central downregulation of visceral signals and enhancing neurogenesis in patients with IBS. Choosing a central neuromodulator for treating IBS should be according to the pharmacological properties and the predominant symptoms. The first-line treatment for pain management in IBS is using tricyclic antidepressants. An alternative for pain management is the serotonin and noradrenaline reuptake inhibitors. Selective serotonin reuptake inhibitors are useful when symptoms of anxiety and hypervigilance are dominant but are not helpful for treating abdominal pain. The predominant bowel habit is helpful when choosing a neuromodulator to treat IBS; SSRIs help constipation, not pain, but may cause diarrhea; TCAs help diarrhea but may cause constipation. A clinical response may occur in 6-8 weeks, but long-term treatment (usually 6-12 months) is required after the initial response to prevent relapse. Augmentation therapy may be beneficial when the therapeutic effect of the first agent is incomplete or associated with side effects. It is recommended to reduce the dose of the first agent and add a second complementary treatment. This may include an atypical antipsychotic or brain-gut behavioral treatment. When tapering central neuromodulators, the dose should be reduced slowly over 4 weeks but may take longer when discontinuation effects occur.
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