Pub Date : 2026-01-22DOI: 10.14309/ajg.0000000000003893
{"title":"Correction to: Clinical Evolution, Complications, and Need for Advanced Therapy in Patients With Ulcerative Colitis (Abstract S2018); Pioneering Minimally Invasive Management of Pancreatic Neuroendocrine Tumor: First EUS-RFA Case in Colombia (Abstract S3312); and Jejunal Diverticulum With Arteriovenous Malformation (Abstract S4758).","authors":"","doi":"10.14309/ajg.0000000000003893","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003893","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"142 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005445","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}
OBJECTIVESThe recommendation to discontinue low-dose aspirin (LDA) during the periprocedural period of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) remains controversial in patients at low thrombotic risk. If continuation of LDA does not increase bleeding risk, gastric ESD could be safely performed under sustained antiplatelet effects, benefiting patients. This study aimed to evaluate whether continuation of LDA is non-inferior to discontinuation regarding ESD-related bleeding risk in patients with low thrombotic risk.METHODSPatients with gastric mucosal neoplasms and low thrombotic risk who were taking LDA were eligible. Participants were randomly assigned to either the Discontinuation or Continuation group. No prophylaxis was performed except for cauterizing exposed vessels at the ulcer base. The primary endpoint was the incidence of ESD-related major bleeding.RESULTSA total of 551 patients were enrolled. In the modified intent-to-treat analysis, the incidence of ESD-related major bleeding (95% CI) was 7.6% (4.8-11) in the Discontinuation group (n=276) and 10% (6.9-14) in the Continuation group (n=275), yielding a risk difference of 2.5% (-2.3 to 7.4). The upper limit of the two-sided 90% CI (6.6%) exceeded the predefined non-inferiority margin (Δ5%, P = 0.157). The per-protocol analysis supported this negative result, with a risk difference of 4.4% (-0.5 to 9.5). Two patients in the Continuation group developed cerebral infarction.CONCLUSIONSThe non-inferiority of LDA continuation over discontinuation for ESD-related major bleeding in gastric ESD was not demonstrated. Therefore, discontinuation of LDA during the periprocedural period is recommended for patients with low thrombotic risk. (UMIN000013177).
目的：对于低血栓形成风险的早期胃癌（EGC）患者，在内镜下粘膜剥离（ESD）围手术期停止低剂量阿司匹林（LDA）的建议仍存在争议。如果继续使用LDA不会增加出血风险，则胃ESD可以在持续抗血小板作用下安全地进行，使患者受益。本研究旨在评估在低血栓形成风险患者中，继续服用LDA是否优于停止服用。方法采用LDA治疗的低血栓形成风险的胃粘膜肿瘤患者。参与者被随机分配到停药组或继续用药组。除了烧灼溃疡底部暴露的血管外，没有进行任何预防。主要终点是静电放电相关大出血的发生率。结果共纳入551例患者。在修改后的意向治疗分析中，停药组（n=276） esd相关大出血发生率（95% CI）为7.6%(4.8-11)，续药组（n=275）为10%(6.9-14)，风险差异为2.5%（-2.3至7.4）。双侧90% CI的上限（6.6%）超过了预定的非劣效性边界（Δ5%, P = 0.157）。每个方案分析支持这一阴性结果，风险差异为4.4%（-0.5至9.5）。延续组2例患者发生脑梗死。结论继续使用LDA治疗胃ESD相关大出血的非劣效性尚未得到证实。因此，对于血栓形成风险低的患者，建议在围手术期停用LDA。(UMIN000013177)。
{"title":"Low-dose aspirin continuation during gastric ESD in patients with low thrombotic risk: a randomized trial.","authors":"Noriya Uedo,Takuji Gotoda,Kohei Takizawa,Takuji Akamatsu,Hisashi Doyama,Osamu Dohi,Koichi Kawabe,Shoichi Kayaba,Yoshimasa Miura,Satoshi Ono,Ichiro Oda,Kiyotaka Umeki,Tatsuya Mikami,Toshiyuki Yoshio,Kenshi Matsumoto,Mitsuru Matsuda,Yoshinobu Yamamoto,Yasuaki Nagami,Takeshi Yamashina,Hideki Ishikawa, ","doi":"10.14309/ajg.0000000000003928","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003928","url":null,"abstract":"OBJECTIVESThe recommendation to discontinue low-dose aspirin (LDA) during the periprocedural period of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) remains controversial in patients at low thrombotic risk. If continuation of LDA does not increase bleeding risk, gastric ESD could be safely performed under sustained antiplatelet effects, benefiting patients. This study aimed to evaluate whether continuation of LDA is non-inferior to discontinuation regarding ESD-related bleeding risk in patients with low thrombotic risk.METHODSPatients with gastric mucosal neoplasms and low thrombotic risk who were taking LDA were eligible. Participants were randomly assigned to either the Discontinuation or Continuation group. No prophylaxis was performed except for cauterizing exposed vessels at the ulcer base. The primary endpoint was the incidence of ESD-related major bleeding.RESULTSA total of 551 patients were enrolled. In the modified intent-to-treat analysis, the incidence of ESD-related major bleeding (95% CI) was 7.6% (4.8-11) in the Discontinuation group (n=276) and 10% (6.9-14) in the Continuation group (n=275), yielding a risk difference of 2.5% (-2.3 to 7.4). The upper limit of the two-sided 90% CI (6.6%) exceeded the predefined non-inferiority margin (Δ5%, P = 0.157). The per-protocol analysis supported this negative result, with a risk difference of 4.4% (-0.5 to 9.5). Two patients in the Continuation group developed cerebral infarction.CONCLUSIONSThe non-inferiority of LDA continuation over discontinuation for ESD-related major bleeding in gastric ESD was not demonstrated. Therefore, discontinuation of LDA during the periprocedural period is recommended for patients with low thrombotic risk. (UMIN000013177).","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014926","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 : 2026-01-22DOI: 10.14309/ajg.0000000000003927
Alyse Bedell,Alexandra R McDermott,Jordan E Karpin,Tina G Rodriguez,Laura R Glick,Clara B Aeder,David T Rubin
BACKGROUNDAdults with inflammatory bowel disease (IBD) experience disproportionately high rates of comorbid mental health conditions, including depression and anxiety, which are associated with increased disease activity, reduced treatment adherence, higher healthcare utilization, and reduced quality of life. In this narrative review, we discuss ethical and practical considerations for mental health screening in adult patients with IBD and propose actionable strategies for implementation in gastroenterology practices.METHODSThis narrative review applies the Four-Box Model of Clinical Medical Ethics to evaluate challenges and opportunities associated with anxiety and depression screening in IBD care. Practical considerations were developed based on existing literature on mental health screening in medical settings and expert opinion.RESULTSMental health screening in gastroenterology clinics is ethically justified and practically feasible when implemented with appropriate safeguards. Key challenges include limited visit time, clinician discomfort, symptom overlap between IBD and mental health comorbidities, and management of suicidal ideation. Opportunities include leveraging validated brief screening tools, normalizing mental health discussions, and establishing clear workflows for positive screens.CONCLUSIONThe implementation of routine mental health screening for adults with IBD aligns with core ethical principles and supports comprehensive biopsychosocial care. With thoughtful implementation, gastroenterology practices can improve identification of depression and anxiety and facilitate timely access to appropriate mental health services.
{"title":"Ethical and Practical Considerations for Mental Health Screening in Adult Patients with Inflammatory Bowel Disease.","authors":"Alyse Bedell,Alexandra R McDermott,Jordan E Karpin,Tina G Rodriguez,Laura R Glick,Clara B Aeder,David T Rubin","doi":"10.14309/ajg.0000000000003927","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003927","url":null,"abstract":"BACKGROUNDAdults with inflammatory bowel disease (IBD) experience disproportionately high rates of comorbid mental health conditions, including depression and anxiety, which are associated with increased disease activity, reduced treatment adherence, higher healthcare utilization, and reduced quality of life. In this narrative review, we discuss ethical and practical considerations for mental health screening in adult patients with IBD and propose actionable strategies for implementation in gastroenterology practices.METHODSThis narrative review applies the Four-Box Model of Clinical Medical Ethics to evaluate challenges and opportunities associated with anxiety and depression screening in IBD care. Practical considerations were developed based on existing literature on mental health screening in medical settings and expert opinion.RESULTSMental health screening in gastroenterology clinics is ethically justified and practically feasible when implemented with appropriate safeguards. Key challenges include limited visit time, clinician discomfort, symptom overlap between IBD and mental health comorbidities, and management of suicidal ideation. Opportunities include leveraging validated brief screening tools, normalizing mental health discussions, and establishing clear workflows for positive screens.CONCLUSIONThe implementation of routine mental health screening for adults with IBD aligns with core ethical principles and supports comprehensive biopsychosocial care. With thoughtful implementation, gastroenterology practices can improve identification of depression and anxiety and facilitate timely access to appropriate mental health services.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014925","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 : 2026-01-21DOI: 10.14309/ajg.0000000000003924
Ligang Liu,Kang Wang,Marjorie V Neidecker,Haoran Yang,Nahata C Milap
INTRODUCTIONHelicobacter pylori (H. pylori) infection remains a significant global health burden. The 2024 American College of Gastroenterology (ACG) guideline recommended bismuth quadruple therapy (BQT) as the first-line treatment for treatment-naive patients. This study aimed to assess the cost-effectiveness of five regimens from a US healthcare payer perspective.METHODSA Markov model was employed to evaluate five H. pylori eradication regimens: (1) clarithromycin triple therapy, (2) vonoprazan dual therapy, (3) vonoprazan triple therapy, (4) rifabutin triple therapy, and (5) BQT. We simulated a hypothetical cohort of treatment-naïve adults with H. pylori over 1-, 10-, 20-year and lifetime horizons. Model outcomes were measured in incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) at willingness-to-pay (WTP) thresholds of $100,000 and $150,000/QALY. Deterministic and probabilistic sensitivity analysis (PSA) were performed to assess model robustness.RESULTSBQT had the lowest lifetime cost per patient ($ 193,651) and was used as the reference. Rifabutin and vonoprazan triple therapies had ICERs of $45,971 and $290,572 per QALY gained, respectively. Clarithromycin triple and vonoprazan dual therapies were dominated by BQT. Rifabutin triple therapy had the highest NMB, followed by BQT. Scenario analysis confirmed that rifabutin triple therapy maintained the highest NMB over 10- and 20-year horizons. Sensitivity analyses identified eradication rates of BQT were among the most influential parameters. PSA showed rifabutin triple therapy had the highest probability of being cost-effective at both WTP thresholds, followed by BQT.CONCLUSIONBQT was found to be the cost-effective first-line treatment. Rifabutin triple therapy was a cost-effective alternative. Policymakers should prioritize BQT and rifabutin triple therapy versus other therapies.
{"title":"Cost-effectiveness of first-line regimens for Helicobacter pylori infection in the United States.","authors":"Ligang Liu,Kang Wang,Marjorie V Neidecker,Haoran Yang,Nahata C Milap","doi":"10.14309/ajg.0000000000003924","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003924","url":null,"abstract":"INTRODUCTIONHelicobacter pylori (H. pylori) infection remains a significant global health burden. The 2024 American College of Gastroenterology (ACG) guideline recommended bismuth quadruple therapy (BQT) as the first-line treatment for treatment-naive patients. This study aimed to assess the cost-effectiveness of five regimens from a US healthcare payer perspective.METHODSA Markov model was employed to evaluate five H. pylori eradication regimens: (1) clarithromycin triple therapy, (2) vonoprazan dual therapy, (3) vonoprazan triple therapy, (4) rifabutin triple therapy, and (5) BQT. We simulated a hypothetical cohort of treatment-naïve adults with H. pylori over 1-, 10-, 20-year and lifetime horizons. Model outcomes were measured in incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) at willingness-to-pay (WTP) thresholds of $100,000 and $150,000/QALY. Deterministic and probabilistic sensitivity analysis (PSA) were performed to assess model robustness.RESULTSBQT had the lowest lifetime cost per patient ($ 193,651) and was used as the reference. Rifabutin and vonoprazan triple therapies had ICERs of $45,971 and $290,572 per QALY gained, respectively. Clarithromycin triple and vonoprazan dual therapies were dominated by BQT. Rifabutin triple therapy had the highest NMB, followed by BQT. Scenario analysis confirmed that rifabutin triple therapy maintained the highest NMB over 10- and 20-year horizons. Sensitivity analyses identified eradication rates of BQT were among the most influential parameters. PSA showed rifabutin triple therapy had the highest probability of being cost-effective at both WTP thresholds, followed by BQT.CONCLUSIONBQT was found to be the cost-effective first-line treatment. Rifabutin triple therapy was a cost-effective alternative. Policymakers should prioritize BQT and rifabutin triple therapy versus other therapies.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005516","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}
{"title":"Gallstone Ileus: A Rare Complication of EUS-Guided Gallbladder Drainage.","authors":"Arsalan Khan,Dayyan Adoor,Gregory Schaefer,Matthew Krafft","doi":"10.14309/ajg.0000000000003926","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003926","url":null,"abstract":"","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"194 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005010","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 : 2026-01-21DOI: 10.14309/ajg.0000000000003923
Mohammad Jarrah,Nicole E Rich,Gloria Figueroa,Stephanie Marie Garces,Mohammed Al-Hasan,Lisa Quirk,Sruthi Yekkaluri,Julia Terrell,Hannah Pitts,Suaiba Syeda,Patricia D Jones,Adam Yopp,Amit G Singal
BACKGROUND AIMSAlthough treatment delays have been reported for several cancers, fewer studies have described the prevalence, contributing factors, and impact on survival in patients with HCC. We aimed to evaluate these aspects in a multicenter cohort.METHODSWe conducted a retrospective cohort study of patients diagnosed with HCC from 2010 to 2018 across 4 U.S. health systems. Treatment delay was defined as the first treatment >90 days after HCC diagnosis. Univariable and multivariable logistic regression analyses were performed to identify factors associated with treatment delays. The association between treatment delay and overall survival was evaluated using multivariable Cox regression analysis.RESULTSAmong 1,561 eligible patients (median age 61.7 years, 75.0% men, 65.5% BCLC stage 0/A), treatment delays occurred in 357 (22.9%) patients. Treatment delays were most frequent with BCLC stage 0 (31.1%), followed by stage A (24.3%), stage B (22.6%), and stage C (13.6%). Men (OR 0.68, 95%CI 0.51 - 0.91) and patients with BCLC stage C HCC (vs stage A: OR 0.40, 95%CI 0.25 - 0.63) were less likely to experience delays, whereas those with BCLC stage 0 (vs stage A: OR 1.56, 95%CI 1.06 - 2.29) were more likely to experience delays. In a 6-month landmark analysis, survival did not differ between delayed vs. timely treatment (HR 1.09, 95%CI 0.87 - 1.37). Median survival from the 6-month landmark was 12.1 months (IQR: 5.5 - 23.3) and 14.6 months (IQR: 5.1 - 30.0) for the treatment delay and timely treatment groups, respectively.CONCLUSIONTreatment delays exceeding 90 days occurred in over one-fifth of patients but were not associated with significant differences in survival.
{"title":"Treatment Delays and Survival in Patients with Hepatocellular Carcinoma: A Multicenter Cohort Study.","authors":"Mohammad Jarrah,Nicole E Rich,Gloria Figueroa,Stephanie Marie Garces,Mohammed Al-Hasan,Lisa Quirk,Sruthi Yekkaluri,Julia Terrell,Hannah Pitts,Suaiba Syeda,Patricia D Jones,Adam Yopp,Amit G Singal","doi":"10.14309/ajg.0000000000003923","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003923","url":null,"abstract":"BACKGROUND AIMSAlthough treatment delays have been reported for several cancers, fewer studies have described the prevalence, contributing factors, and impact on survival in patients with HCC. We aimed to evaluate these aspects in a multicenter cohort.METHODSWe conducted a retrospective cohort study of patients diagnosed with HCC from 2010 to 2018 across 4 U.S. health systems. Treatment delay was defined as the first treatment >90 days after HCC diagnosis. Univariable and multivariable logistic regression analyses were performed to identify factors associated with treatment delays. The association between treatment delay and overall survival was evaluated using multivariable Cox regression analysis.RESULTSAmong 1,561 eligible patients (median age 61.7 years, 75.0% men, 65.5% BCLC stage 0/A), treatment delays occurred in 357 (22.9%) patients. Treatment delays were most frequent with BCLC stage 0 (31.1%), followed by stage A (24.3%), stage B (22.6%), and stage C (13.6%). Men (OR 0.68, 95%CI 0.51 - 0.91) and patients with BCLC stage C HCC (vs stage A: OR 0.40, 95%CI 0.25 - 0.63) were less likely to experience delays, whereas those with BCLC stage 0 (vs stage A: OR 1.56, 95%CI 1.06 - 2.29) were more likely to experience delays. In a 6-month landmark analysis, survival did not differ between delayed vs. timely treatment (HR 1.09, 95%CI 0.87 - 1.37). Median survival from the 6-month landmark was 12.1 months (IQR: 5.5 - 23.3) and 14.6 months (IQR: 5.1 - 30.0) for the treatment delay and timely treatment groups, respectively.CONCLUSIONTreatment delays exceeding 90 days occurred in over one-fifth of patients but were not associated with significant differences in survival.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005447","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 : 2026-01-21DOI: 10.14309/ajg.0000000000003925
Sasha Deutsch-Link,Isabelle S Byers,Hyundam Gu,Juan Pablo Arab
Addiction intersects with a wide range of gastrointestinal (GI) and liver diseases, impacting the development of disease and long-term outcomes. This review highlights the most clinically relevant substance use disorders in gastroenterology and hepatology, including alcohol use disorder (AUD), opioid use disorder, and cannabis use disorder. AUD can lead to alcohol-associated liver disease, which is one of the primary causes of liver disease in the United States and is currently the leading indication for liver transplantation. AUD is also associated with the development of GI malignancies. Opioid use disorder is associated with impaired foregut motility, opioid-induced constipation, narcotic bowel syndrome, and increased risk of hepatitis C virus in the setting of injection drug use. Cannabis use disorder is associated with cannabis hyperemesis syndrome, and synthetic cannabinoids have demonstrated hepatotoxic effects. Effective management of substance use disorders in GI and liver diseases requires a multidisciplinary approach that incorporates behavioral interventions and pharmacotherapy. Medications for alcohol use disorder and opioid use disorder are underutilized despite strong evidence for safety and efficacy, even in patients with hepatic dysfunction. Gastroenterologists and hepatologists are often well-positioned to identify and address substance use disorders early and should strive to provide coordinated care that improves both addiction and GI/liver-related outcomes.
{"title":"Addiction in Gastrointestinal and Liver Disorders.","authors":"Sasha Deutsch-Link,Isabelle S Byers,Hyundam Gu,Juan Pablo Arab","doi":"10.14309/ajg.0000000000003925","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003925","url":null,"abstract":"Addiction intersects with a wide range of gastrointestinal (GI) and liver diseases, impacting the development of disease and long-term outcomes. This review highlights the most clinically relevant substance use disorders in gastroenterology and hepatology, including alcohol use disorder (AUD), opioid use disorder, and cannabis use disorder. AUD can lead to alcohol-associated liver disease, which is one of the primary causes of liver disease in the United States and is currently the leading indication for liver transplantation. AUD is also associated with the development of GI malignancies. Opioid use disorder is associated with impaired foregut motility, opioid-induced constipation, narcotic bowel syndrome, and increased risk of hepatitis C virus in the setting of injection drug use. Cannabis use disorder is associated with cannabis hyperemesis syndrome, and synthetic cannabinoids have demonstrated hepatotoxic effects. Effective management of substance use disorders in GI and liver diseases requires a multidisciplinary approach that incorporates behavioral interventions and pharmacotherapy. Medications for alcohol use disorder and opioid use disorder are underutilized despite strong evidence for safety and efficacy, even in patients with hepatic dysfunction. Gastroenterologists and hepatologists are often well-positioned to identify and address substance use disorders early and should strive to provide coordinated care that improves both addiction and GI/liver-related outcomes.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005446","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 : 2026-01-21DOI: 10.14309/ajg.0000000000003922
Raseen Tariq,Ankita Sethi,Shivaram Arunachalam,Darrell S Pardi,William A Faubion,Sahil Khanna
INTRODUCTIONClostridioides difficile infection (CDI) present a significant challenge in patients with inflammatory bowel disease (IBD), with high recurrence rates and complications. Predicting recurrent CDI (rCDI) in IBD patients is crucial for implementing targeted interventions to improve patient outcomes. This study aimed to develop and validate a predictive model (RecurCDI-IBD) using supervised machine learning (ML) to identify IBD patients at high risk of developing rCDI.METHODSData were collected from adult IBD patients diagnosed with CDI between 2013 and 2021. Inclusion criteria included adult patients with a confirmed diagnosis of CDI and a history of IBD. The Gradient Boosting Machine learning model (XGBoost) was used to train a binary classification model. Feature engineering included demographic data (age, gender), clinical data (IBD subtype, medication use, comorbidities), and laboratory data. The primary outcome was the occurrence of rCDI within 60 days of the initial CDI episode.RESULTSThe RecurCDI-IBD model achieved an accuracy of 80.05% and an Area Under the Curve of 0.88 for predicting recurrent CDI. Key predictive features included IBD subtype, gender, specific medications (such as steroids and anti-TNF agents), and comorbidities (such as chronic pulmonary and renal disease).CONCLUSIONThe RecurCDI-IBD model demonstrates good discriminatory ability with balanced precision and recall in identifying IBD patients at higher risk for recurrent CDI. These findings highlight the potential of data-driven approaches to support clinical risk assessment. Further studies incorporating larger and more diverse cohorts and prospective external validation are needed to confirm generalizability and optimize clinical applicability.
{"title":"Machine Learning Model Predicts Recurrent Clostridioides difficile Infection in Patients With Inflammatory Bowel Disease (Recur CDI-IBD).","authors":"Raseen Tariq,Ankita Sethi,Shivaram Arunachalam,Darrell S Pardi,William A Faubion,Sahil Khanna","doi":"10.14309/ajg.0000000000003922","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003922","url":null,"abstract":"INTRODUCTIONClostridioides difficile infection (CDI) present a significant challenge in patients with inflammatory bowel disease (IBD), with high recurrence rates and complications. Predicting recurrent CDI (rCDI) in IBD patients is crucial for implementing targeted interventions to improve patient outcomes. This study aimed to develop and validate a predictive model (RecurCDI-IBD) using supervised machine learning (ML) to identify IBD patients at high risk of developing rCDI.METHODSData were collected from adult IBD patients diagnosed with CDI between 2013 and 2021. Inclusion criteria included adult patients with a confirmed diagnosis of CDI and a history of IBD. The Gradient Boosting Machine learning model (XGBoost) was used to train a binary classification model. Feature engineering included demographic data (age, gender), clinical data (IBD subtype, medication use, comorbidities), and laboratory data. The primary outcome was the occurrence of rCDI within 60 days of the initial CDI episode.RESULTSThe RecurCDI-IBD model achieved an accuracy of 80.05% and an Area Under the Curve of 0.88 for predicting recurrent CDI. Key predictive features included IBD subtype, gender, specific medications (such as steroids and anti-TNF agents), and comorbidities (such as chronic pulmonary and renal disease).CONCLUSIONThe RecurCDI-IBD model demonstrates good discriminatory ability with balanced precision and recall in identifying IBD patients at higher risk for recurrent CDI. These findings highlight the potential of data-driven approaches to support clinical risk assessment. Further studies incorporating larger and more diverse cohorts and prospective external validation are needed to confirm generalizability and optimize clinical applicability.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005008","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 : 2026-01-20DOI: 10.14309/ajg.0000000000003921
Antonio Z Gimeno-García,Federica Benítez-Zafra,Ignacio Redondo-Zaera,Noelia Cruz-Perdomo,Michelle Bautista,Dalia Morales-Arráez,Alberto Pardo-Balteiro,Pilar Borque,Marco A Navarro-Dávila,Alejandro Jiménez-Sosa,Rubén Berenguer,Juan Tellechea,Silvia Alayón-Miranda,Jorge Mon,Ana Romero,Laura Álvarez,Rocío Del Castillo,Aroa Perdomo,Domingo Hernández-Negrín,Sharay Gámez,Yaiza Cedrés,Paula Haridian Quintana-Díaz,Fabiola Pérez-González,David Nicolás-Pérez,Manuel Hernández-Guerra
OBJECTIVESProper bowel preparation is crucial for increasing the adenoma detection rate. A novel application based on the use of a convolutional neural network (CNN) can differentiate between adequate and inadequate bowel preparation on the basis of images of rectal effluents taken before the examination. The aim of this study was to evaluate whether a software-driven approach improves colon cleansing quality during colonoscopies compared with standard care.METHODSA multicenter randomized controlled trial was conducted. Consecutive patients were assigned to a standard-care group or an intervention group. The latter group was trained to use a web application linked to a CNN, enabling them to send a picture of their most recent rectal effluent and receive feedback on the adequacy of their bowel preparation. Patients were instructed to follow the recommendations provided by the platform.RESULTSOverall, 774 patients were eligible and randomized. The intention-to-treat analysis revealed statistically significant differences in bowel cleansing quality in favor of the intervention group (91% vs. 84.2%, OR 1.88, 95% CI [1.21-2.93)], P=0.005). The right and left colon exhibited better cleansing in the intervention group (90.4% vs. 84.8%, P=0.016 and 95.3% vs. 91.5%, P=0.03, respectively). In the per-protocol analysis, bowel cleansing quality was also significantly higher in the intervention group, both overall (93.3% vs. 85.6%, OR 2.34 (1.36-4.02), P=0.002) and by segment. When aiming for excellent bowel preparation (BBPS >7), cleansing was significantly better in the intervention group overall and by segment.CONCLUSIONA software application-driven colon cleansing process improves preparation quality in outpatients (NCT05871814).
目的适当的肠道准备是提高腺瘤检出率的关键。一项基于卷积神经网络（CNN）的新应用可以根据检查前拍摄的直肠流出物图像来区分肠道准备充分和不充分。本研究的目的是评估与标准护理相比，软件驱动的方法是否能提高结肠镜检查期间的结肠清洁质量。方法采用多中心随机对照试验。连续的患者被分配到标准治疗组或干预组。后一组被训练使用一个与CNN相连的网络应用程序，使他们能够发送他们最近的直肠流出物的照片，并收到关于他们肠道准备是否充分的反馈。患者被指示遵循平台提供的建议。结果共纳入774例患者。意向治疗分析显示，干预组在肠道清洁质量方面存在统计学差异（91%对84.2%,OR 1.88, 95% CI [1.21-2.93]， P=0.005）。干预组左、右结肠清洁效果较好（90.4%∶84.8%，P=0.016; 95.3%∶91.5%，P=0.03）。在按方案分析中，干预组的肠道清洁质量也显著更高，无论是总体（93.3% vs. 85.6%, OR 2.34 (1.36-4.02)， P=0.002）还是分段。当以良好的肠道准备（BBPS >7）为目标时，干预组的整体和部分清洁明显更好。结论应用软件驱动的结肠清洁流程提高了门诊患者的制剂质量（NCT05871814）。
{"title":"An Artificial Intelligence-Guided Strategy to Reduce Poor Bowel Preparation: A Multicenter Randomized Controlled Study.","authors":"Antonio Z Gimeno-García,Federica Benítez-Zafra,Ignacio Redondo-Zaera,Noelia Cruz-Perdomo,Michelle Bautista,Dalia Morales-Arráez,Alberto Pardo-Balteiro,Pilar Borque,Marco A Navarro-Dávila,Alejandro Jiménez-Sosa,Rubén Berenguer,Juan Tellechea,Silvia Alayón-Miranda,Jorge Mon,Ana Romero,Laura Álvarez,Rocío Del Castillo,Aroa Perdomo,Domingo Hernández-Negrín,Sharay Gámez,Yaiza Cedrés,Paula Haridian Quintana-Díaz,Fabiola Pérez-González,David Nicolás-Pérez,Manuel Hernández-Guerra","doi":"10.14309/ajg.0000000000003921","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003921","url":null,"abstract":"OBJECTIVESProper bowel preparation is crucial for increasing the adenoma detection rate. A novel application based on the use of a convolutional neural network (CNN) can differentiate between adequate and inadequate bowel preparation on the basis of images of rectal effluents taken before the examination. The aim of this study was to evaluate whether a software-driven approach improves colon cleansing quality during colonoscopies compared with standard care.METHODSA multicenter randomized controlled trial was conducted. Consecutive patients were assigned to a standard-care group or an intervention group. The latter group was trained to use a web application linked to a CNN, enabling them to send a picture of their most recent rectal effluent and receive feedback on the adequacy of their bowel preparation. Patients were instructed to follow the recommendations provided by the platform.RESULTSOverall, 774 patients were eligible and randomized. The intention-to-treat analysis revealed statistically significant differences in bowel cleansing quality in favor of the intervention group (91% vs. 84.2%, OR 1.88, 95% CI [1.21-2.93)], P=0.005). The right and left colon exhibited better cleansing in the intervention group (90.4% vs. 84.8%, P=0.016 and 95.3% vs. 91.5%, P=0.03, respectively). In the per-protocol analysis, bowel cleansing quality was also significantly higher in the intervention group, both overall (93.3% vs. 85.6%, OR 2.34 (1.36-4.02), P=0.002) and by segment. When aiming for excellent bowel preparation (BBPS >7), cleansing was significantly better in the intervention group overall and by segment.CONCLUSIONA software application-driven colon cleansing process improves preparation quality in outpatients (NCT05871814).","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005014","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 : 2026-01-13DOI: 10.14309/ajg.0000000000003920
Yin Zhang,Xue Li,Qiwen Fang,Deliang Yang,Krishnan Bhaskaran,Angel Ys Wong,Wai K Leung
BACKGROUNDDisruption of gut microbiota by antibiotic use has been linked to the development of inflammatory bowel disease (IBD). This study aimed to evaluate the association between antibiotic use for non-gastrointestinal (GI) infections and the risk of IBD flare-ups, and to examine whether route of administration, antimicrobial spectrum, and antibiotic class modulate this risk.METHODSWe conducted a self-controlled case series (SCCS) study using territory-wide electronic medical records from Hong Kong. Adults with IBD who experienced at least one flare-up and received at least one course of antibiotics for infections outside the GI tract between 2000 and 2024 were included, to reduce indication bias related to gastrointestinal symptoms. Conditional Poisson regression models were used to estimate incidence rate ratios (IRRs) by comparing across predefined risk periods to the baseline period.RESULTSAmong 810 patients, IBD flare incidence was elevated during the month preceding antibiotics (IRR 2.85), increased further during treatment (IRR 3.44), and peaked within two weeks after treatment (IRR 4.79), and returned to baseline levels within six months, versus baseline. Increased incidences were observed for oral antibiotics during and two weeks after treatment (IRRs 3.91 and 3.70), but not for injectable antibiotics (interaction p-values <0.01). The IRRs for broad-spectrum antibiotics were higher than those for narrow-spectrum agents from one month before to six weeks after antibiotic use, versus baseline.CONCLUSIONSAntibiotic use for non-GI infections was associated with a short-term increase in IBD flare risk. Injectable or narrow-spectrum antibiotics may have a relatively smaller impact on potential IBD flare-ups.
{"title":"Association Between Antibiotic Use for Non-Gastrointestinal Infections and Inflammatory Bowel Diseases Flare-Ups: A Self-Controlled Case Series Study.","authors":"Yin Zhang,Xue Li,Qiwen Fang,Deliang Yang,Krishnan Bhaskaran,Angel Ys Wong,Wai K Leung","doi":"10.14309/ajg.0000000000003920","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003920","url":null,"abstract":"BACKGROUNDDisruption of gut microbiota by antibiotic use has been linked to the development of inflammatory bowel disease (IBD). This study aimed to evaluate the association between antibiotic use for non-gastrointestinal (GI) infections and the risk of IBD flare-ups, and to examine whether route of administration, antimicrobial spectrum, and antibiotic class modulate this risk.METHODSWe conducted a self-controlled case series (SCCS) study using territory-wide electronic medical records from Hong Kong. Adults with IBD who experienced at least one flare-up and received at least one course of antibiotics for infections outside the GI tract between 2000 and 2024 were included, to reduce indication bias related to gastrointestinal symptoms. Conditional Poisson regression models were used to estimate incidence rate ratios (IRRs) by comparing across predefined risk periods to the baseline period.RESULTSAmong 810 patients, IBD flare incidence was elevated during the month preceding antibiotics (IRR 2.85), increased further during treatment (IRR 3.44), and peaked within two weeks after treatment (IRR 4.79), and returned to baseline levels within six months, versus baseline. Increased incidences were observed for oral antibiotics during and two weeks after treatment (IRRs 3.91 and 3.70), but not for injectable antibiotics (interaction p-values <0.01). The IRRs for broad-spectrum antibiotics were higher than those for narrow-spectrum agents from one month before to six weeks after antibiotic use, versus baseline.CONCLUSIONSAntibiotic use for non-GI infections was associated with a short-term increase in IBD flare risk. Injectable or narrow-spectrum antibiotics may have a relatively smaller impact on potential IBD flare-ups.","PeriodicalId":520099,"journal":{"name":"The American Journal of Gastroenterology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961500","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：