American Journal of Gastroenterology最新文献

Background: Intravenous albumin reduces mortality in SBP. We sought to characterize albumin use for SBP over time and investigate patient and hospital-level factors associated with use.

Methods: A retrospective cohort study in the Veterans Health Administration between 2008 and 2021 evaluated trends and patient, practice-, and facility-level factors associated with use among patients with cirrhosis hospitalized for SBP confirmed with ascitic fluid criteria.

Results: Among 3,871 Veterans with SBP, 803 (20.7%) did not receive albumin, 1,119 (28.9%) received albumin but not per guidelines and 1,949 (50.3%) received albumin per guidelines; use increased from 66% in 2008 to 88% in 2022. Veterans who identified as Black compared to white were less likely to receive guideline-recommended albumin (OR 0.76, 95%CI 0.59-0.98) in all analyses. Guideline-recommended albumin was more likely to be administered to Veterans with CTP class B (OR 1.39, 95% CI 1.17-1.64) and C (OR 2.21, 95% CI 1.61-3.04) compared to CTP A; and AKI Stage 1 (OR 1.48, 95%CI 1.22 -1.79), Stage 2 (OR 2.17, 95%CI 1.62-2.91), and Stage 3 (OR 1.68, 95%CI 1.18 - 2.40) compared to no AKI. GI/Hepatology consultation (OR 1.60, 95% CI 1.29--1.99), nephrology consultation (OR 1.60, 95%CI 1.23-2.07) and having both GI/hep and nephrology consultations (OR 2.17, 95%CI 1.60-2.96) were associated with higher albumin administration. In exploratory analyses accounting for interactions between model for end stage liver disease sodium (MELD-Na) and albumin, guideline-recommended albumin was associated with lower in-hospital mortality (HR 0.90, 95% CI 0.85 - 0.96).

Conclusion: Future studies should investigate optimizing albumin use for SBP to reduce variability and mitigate healthcare disparities.

Background: and Importance: Growing gastrointestinal cancers in the U.S. necessitate further research due to substantial healthcare and economic impacts. This study aims to analyze trends and future projections for five major gastrointestinal cancers (colorectal, pancreatic, liver, stomach, and esophageal).

Methods: Data were sourced from the Surveillance, Epidemiology, and End Results database, National Center for Health Statistics, and Global Burden of Diseases databases. An age-period-cohort model utilizing the Bayesian Information Criterion method was applied to project incidence and mortality rates to 2040.

Results: Males consistently exhibited higher incidence and mortality rates across all gastrointestinal cancers, with significant variation across the 51 U.S. states. From 2000 to 2020, colorectal cancer incidence and mortality rates declined across all racial groups, except for the incidence rates of American Indian and Alaska Native (AIAN) men, Hispanic men, and Hispanic women, which remained stable. Pancreatic cancer incidence increased across all groups except for AIAN men, while mortality rates rose only for White men and Hispanic women. Liver cancer incidence rose among AIAN men and White, AIAN, and Hispanic women, while mortality rates declined for most groups. Stomach cancer incidence and mortality either declined or stabilized, and esophageal cancer rates showed a general decline. By 2040, increases in incidence and mortality are projected for most gastrointestinal cancers, particularly in men.

Conclusions: Despite varied trends over the past two decades, an overall increase in gastrointestinal cancer incidence and mortality rates is anticipated in the next 20 years in the U.S., underscoring the need for effective prevention and intervention strategies.

Introduction: Fecal microbial transplantation (FMT) has shown promise at inducing remission in ulcerative colitis. This study is the first of its kind to evaluate the efficacy and safety of FMT at inducing remission in Crohn's disease (CD).

Methods: This double-blind, placebo-controlled trial was conducted in three Canadian academic centers; randomized patients with mild to moderate CD received FMT or placebo. The first treatment was administered by colonoscopy followed by weekly fecal capsules for 7 weeks. Primary endpoint was clinical and endoscopic remission at week 8. Secondary outcomes included clinical and endoscopic response, adverse events, and health-related quality of life using generic and disease-specific instruments.

Results: From July 2017 to June 2021, 21 and 13 patients were randomized to FMT and placebo groups, respectively. The trial terminated early due to futility. At week 8, 0% (0/15) of patients in the FMT group versus 8.3% (1/11) in the placebo group reached the primary endpoint of combined clinical and endoscopic remission as per protocol analysis. There were no differences between the groups in clinical or endoscopic responses. One participant in each group had worsening of CD. Although both groups experienced statistically significant improvements in health-related quality of life, only the FMT group had a significant decrease in activity impairment. Although there were no significant changes in microbial diversity or composition, participants who achieved clinical response became more similar to their donors in stool microbial composition.

Discussion: FMT was not effective at inducing clinical and endoscopic remission in CD using the FMT regimen in this study. Future studies may use other strategies to enhance treatment response, including longer intervention, antibiotic pretreatment, optimized donor-recipient pairing, and concomitant anti-inflammatory diet, biologic or small molecule therapies.

The development of new image enhancement modalities and improved endoscopic imaging quality have not led to increased adoption of resect-and-discard in routine practice. Studies have shown that endoscopists have the capacity to achieve quality thresholds to perform optical diagnosis, however, this has not led to acceptance of optical diagnosis as a replacement for pathology for diminutive (1-5mm) polyps. In recent years, Artificial Intelligence (AI)-based Computer Assisted Characterisation (CADx) of diminutive polyps has recently emerged as a strategy that could potentially represent a breakthrough technology to enable widespread adoption of resect-and-discard. Recent evidence suggests that pathology-based diagnosis is suboptimal, as polyp non-retrieval, fragmentation, sectioning errors, incorrect diagnosis as 'normal mucosa', and inter-pathologist variability limit the efficacy of pathology for the diagnosis of 1-5mm polyps. New paradigms in performing polyp diagnosis with or without AI have emerged to compete with pathology in terms of efficacy. Strategies, such as Autonomous AI, AI-assisted human diagnosis, AI-unassisted human diagnosis, and combined strategies have been proposed as potential paradigms for resect-and-discard, although further research is still required to determine the optimal strategy. Implementation studies with high patient acceptance, where polyps are truly being discarded without histologic diagnosis are paving the way towards normalizing resect-and-discard in routine clinical practice. Ultimately the largest challenges for CADx remain liability perceptions from endoscopists. The potential benefits of AI-based resect-and-discard are many, with very little potential harm. Real world implementation studies are therefore required to pave the way for the acceptability of such strategies in routine practice.

Background: Endoscopy, standard-of-care for monitoring Eosinophilic Esophagitis (EoE), assesses mucosal inflammation. The Esophageal String Test (EST®), a minimally invasive swallowed capsule and immunoassays, quantifies EoE inflammation. We determined whether the EST/EoEScore can monitor disease in patients undergoing treatment.

Methods: Thirty-three samples from 14 EoE patients (7 children, 7 adults) who underwent repeat endoscopies and ESTs were studied. Biopsies were analyzed for peak eosinophil counts; ESTs analyzed for EoEScores.

Results: Eosinophil counts and EoEScores significantly correlated during treatment, distinguishing patients with active EoE from treatment-associated remissions for 93.9% of ESTs performed.

Conclusion: The EST can be used to longitudinally monitor responses to treatment in EoE.