Pub Date : 2025-01-27DOI: 10.14309/ajg.0000000000003284
Shih-Wei Lai, Kuan-Fu Liao
{"title":"Predicting Risk of Colorectal Cancer After Adenoma Removal.","authors":"Shih-Wei Lai, Kuan-Fu Liao","doi":"10.14309/ajg.0000000000003284","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003284","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-16DOI: 10.14309/ajg.0000000000003317
Scott Silvey, Nilang Patel, Jacqueline G O'Leary, Jasmohan S Bajaj
Despite negative outcomes, hepatic encephalopathy (HE) is not included in model-for-end-stage liver disease (MELD) scores, including MELD3.0. In a national Veterans affairs (VA) database, we studied the additive mortality predictive impact of a documented inpatient overt HE diagnosis on MELD3.0 and MELD-Na scores in 75,327 Veterans (26.8% with HE, 22% 90-day and 37% 1-year mortality). The addition of HE to MELD3.0 and MELD-Na significantly improved their mortality prediction with interactions at 90-days and 1-year on multivariable regression. A documented inpatient HE episode is additive to the mortality prediction of MELD3.0 by 4-5 extra points and could enhance future MELD iterations.
{"title":"ENHANCEMENT OF CIRRHOSIS MORTALITY PREDICTION BY INCLUDING HEPATIC ENCEPHALOPATHY TO MELD3.0 IN A NATIONAL VETERAN COHORT.","authors":"Scott Silvey, Nilang Patel, Jacqueline G O'Leary, Jasmohan S Bajaj","doi":"10.14309/ajg.0000000000003317","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003317","url":null,"abstract":"<p><p>Despite negative outcomes, hepatic encephalopathy (HE) is not included in model-for-end-stage liver disease (MELD) scores, including MELD3.0. In a national Veterans affairs (VA) database, we studied the additive mortality predictive impact of a documented inpatient overt HE diagnosis on MELD3.0 and MELD-Na scores in 75,327 Veterans (26.8% with HE, 22% 90-day and 37% 1-year mortality). The addition of HE to MELD3.0 and MELD-Na significantly improved their mortality prediction with interactions at 90-days and 1-year on multivariable regression. A documented inpatient HE episode is additive to the mortality prediction of MELD3.0 by 4-5 extra points and could enhance future MELD iterations.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.14309/ajg.0000000000003182
Jiayi Hong, Zijin Liu, Huihong Zhai
{"title":"Long-Term Natural History of Autoimmune Gastritis: Results From a Prospective, Monocentric Series.","authors":"Jiayi Hong, Zijin Liu, Huihong Zhai","doi":"10.14309/ajg.0000000000003182","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003182","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.14309/ajg.0000000000003260
Sarah L Melton, Jonathan Abdelmalak, Rebecca Burgell, Jessica A Fitzpatrick
{"title":"The Importance of Dietary Measures for Clinical Utility.","authors":"Sarah L Melton, Jonathan Abdelmalak, Rebecca Burgell, Jessica A Fitzpatrick","doi":"10.14309/ajg.0000000000003260","DOIUrl":"10.14309/ajg.0000000000003260","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-15DOI: 10.14309/ajg.0000000000003214
Giulio Francesco Romiti, Gregory Y H Lip
{"title":"Later Is Not Always Better: Timing of Oral Anticoagulant Resumption After Endoscopic Procedures, Between New Data and Residual Uncertainties.","authors":"Giulio Francesco Romiti, Gregory Y H Lip","doi":"10.14309/ajg.0000000000003214","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003214","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.14309/ajg.0000000000003252
Rena Yadlapati, Dayna Early, Prasad G Iyer, Douglas R Morgan, Neil Sengupta, Prateek Sharma, Nicholas J Shaheen
{"title":"Quality Indicators for Upper GI Endoscopy.","authors":"Rena Yadlapati, Dayna Early, Prasad G Iyer, Douglas R Morgan, Neil Sengupta, Prateek Sharma, Nicholas J Shaheen","doi":"10.14309/ajg.0000000000003252","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003252","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.14309/ajg.0000000000003315
Anisa Choudhary, Katha Makwana, Judy Nee, Qasim Aziz
{"title":"Hypermobility syndromes and their impact on GI illnesses: a review for gastroenterologists.","authors":"Anisa Choudhary, Katha Makwana, Judy Nee, Qasim Aziz","doi":"10.14309/ajg.0000000000003315","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003315","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.14309/ajg.0000000000003295
Lluís Mundet, Tennekoon Buddhika Karunaratne, Omar Ortega, Alba Raventós, Pere Clavé
Background: Fecal incontinence (FI) is a prevalent condition that disproportionately impacts women. Although sphincter biomechanics are well studied, the integrity of the cortico-anal motor pathway remains elusive. We evaluated the cortico-spino-anorectal pathway in women with FI against age-matched (AM-HV) and young healthy (Y-HV) volunteers.
Methods: Observational study with 18 women with FI (mean age: 63.4±11.1), 15 AM-HV (60.7±9.01, and 15 Y-HV (24.2±5.39), conducted in a tertiary hospital. Participants underwent clinical evaluation, high-resolution anorectal manometry (HRAM), endoanal ultrasound, and transcranial/translumbosacral magnetic stimulation to assess anorectal motor evoked potentials (MEP). Clinical severity was measured with St. Mark's score, and quality of life with FIQL and EQ5D.
Results: Patients had longer MEP latencies than AM-HV in the cortico-anal (25.93±3.67 ms vs 22.89±1.38 ms) andright lumbo-rectal segments (5.64±1.35 ms vs4.39±1.27 ms; p<0.05) but not in the tibial segment (control)(33.35±2.88 ms vs 32.08±2.05 ms; p>0.05). However, tibial latencies were longer in AM-HV compared to Y-HV (32.08±2.05 ms vs 29.21±2.75 ms; p=0.003). In FI, 41.1% had cortico-anorectal impairments, 50% lumbo-anal, and 44.4% sacral. Overall, 82.4% showed delayed latencies in at least one of the 12 segments. HRAM revealed 83.24% had external anal sphincter (EAS) dysfunction, 40% internal sphincter dysfunction, and 23.57% both. MEP latencies inversely correlated with EAS squeeze strength. FI patients had significantly poorer EQ5D scores compared to both control groups.
Conclusion: Women with FI show significant neuropathy in the cortico-spino-anorectal pathway linked to impaired anorectal function. These findings underscore the brain-gut axis's role in FI pathophysiology, advocating for advanced neurophysiological diagnostics and targeted interventions.
背景：大便失禁（FI）是一种普遍的条件，不成比例地影响妇女。尽管括约肌生物力学已经得到了很好的研究，但皮质-肛门运动通路的完整性仍然难以捉摸。我们评估了FI女性与年龄匹配（AM-HV）和年轻健康（Y-HV）志愿者的皮质-脊髓-肛肠通路。方法：对某三级医院18例女性FI患者（平均年龄：63.4±11.1），15例AM-HV患者（60.7±9.01），15例Y-HV患者（24.2±5.39）进行观察性研究。参与者通过临床评估、高分辨率肛管直肠测压（HRAM）、肛管内超声和经颅/经腰骶磁刺激来评估肛管直肠运动诱发电位（MEP）。临床严重程度采用St. Mark评分，生活质量采用FIQL和EQ5D。结果：患者在皮质-肛门段（25.93±3.67 ms vs 22.89±1.38 ms）和右腰直肠段（5.64±1.35 ms vs4.39±1.27 ms）的MEP潜伏期长于AM-HV；p0.05)。然而，与Y-HV相比，AM-HV患者的胫骨潜伏期更长(32.08±2.05 ms vs 29.21±2.75 ms；p = 0.003)。在FI中，41.1%有皮质肛肠损伤，50%有腰肛门损伤，44.4%有骶骨损伤。总体而言，82.4%的人在12个片段中至少有一个显示延迟。HRAM显示83.24%存在外肛门括约肌功能障碍，40%存在内括约肌功能障碍，23.57%存在外肛门括约肌功能障碍。MEP潜伏期与EAS挤压强度呈负相关。与对照组相比，FI患者的EQ5D评分明显较低。结论：患有FI的女性在与肛肠功能受损相关的皮质-脊髓-肛肠通路中表现出明显的神经病变。这些发现强调了脑肠轴在FI病理生理中的作用，提倡先进的神经生理学诊断和有针对性的干预。
{"title":"Study of the cortico-anorectal neurophysiology in women with fecal incontinence.","authors":"Lluís Mundet, Tennekoon Buddhika Karunaratne, Omar Ortega, Alba Raventós, Pere Clavé","doi":"10.14309/ajg.0000000000003295","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003295","url":null,"abstract":"<p><strong>Background: </strong>Fecal incontinence (FI) is a prevalent condition that disproportionately impacts women. Although sphincter biomechanics are well studied, the integrity of the cortico-anal motor pathway remains elusive. We evaluated the cortico-spino-anorectal pathway in women with FI against age-matched (AM-HV) and young healthy (Y-HV) volunteers.</p><p><strong>Methods: </strong>Observational study with 18 women with FI (mean age: 63.4±11.1), 15 AM-HV (60.7±9.01, and 15 Y-HV (24.2±5.39), conducted in a tertiary hospital. Participants underwent clinical evaluation, high-resolution anorectal manometry (HRAM), endoanal ultrasound, and transcranial/translumbosacral magnetic stimulation to assess anorectal motor evoked potentials (MEP). Clinical severity was measured with St. Mark's score, and quality of life with FIQL and EQ5D.</p><p><strong>Results: </strong>Patients had longer MEP latencies than AM-HV in the cortico-anal (25.93±3.67 ms vs 22.89±1.38 ms) andright lumbo-rectal segments (5.64±1.35 ms vs4.39±1.27 ms; p<0.05) but not in the tibial segment (control)(33.35±2.88 ms vs 32.08±2.05 ms; p>0.05). However, tibial latencies were longer in AM-HV compared to Y-HV (32.08±2.05 ms vs 29.21±2.75 ms; p=0.003). In FI, 41.1% had cortico-anorectal impairments, 50% lumbo-anal, and 44.4% sacral. Overall, 82.4% showed delayed latencies in at least one of the 12 segments. HRAM revealed 83.24% had external anal sphincter (EAS) dysfunction, 40% internal sphincter dysfunction, and 23.57% both. MEP latencies inversely correlated with EAS squeeze strength. FI patients had significantly poorer EQ5D scores compared to both control groups.</p><p><strong>Conclusion: </strong>Women with FI show significant neuropathy in the cortico-spino-anorectal pathway linked to impaired anorectal function. These findings underscore the brain-gut axis's role in FI pathophysiology, advocating for advanced neurophysiological diagnostics and targeted interventions.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.14309/ajg.0000000000003297
A Ezquerra-Durán, L Alcalá-González, I K Araujo, J Alcedo, J Serra, E Barba
Introduction: The causal relationship between chronic opioid use and esophageal motor dysfunction in symptomatic patients has not been established.
Methods: A prospective before-and-after multicenter study, including chronic active opioid patients referred for esophageal motility tests due to non-obstructive dysphagia.
Results: 37 patients were evaluated, 27 (73%) had criteria of opioid-induced esophageal dysfunction (OIED). In 19 patients who discontinued opioids for at least 7 days, esophageal motor disorders resolved in 10 (52.6%), accompanied by a clinical success response (defined as Eckardt ≤3) in 64.3%.
Discussion: Discontinuation of opioids is associated with clinical and esophageal motility improvement in up to half of the patients.
{"title":"Prospective evaluation of opioid cessation in patients with suspected Opioid-induced esophageal dysfunction (OIED).","authors":"A Ezquerra-Durán, L Alcalá-González, I K Araujo, J Alcedo, J Serra, E Barba","doi":"10.14309/ajg.0000000000003297","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003297","url":null,"abstract":"<p><strong>Introduction: </strong>The causal relationship between chronic opioid use and esophageal motor dysfunction in symptomatic patients has not been established.</p><p><strong>Methods: </strong>A prospective before-and-after multicenter study, including chronic active opioid patients referred for esophageal motility tests due to non-obstructive dysphagia.</p><p><strong>Results: </strong>37 patients were evaluated, 27 (73%) had criteria of opioid-induced esophageal dysfunction (OIED). In 19 patients who discontinued opioids for at least 7 days, esophageal motor disorders resolved in 10 (52.6%), accompanied by a clinical success response (defined as Eckardt ≤3) in 64.3%.</p><p><strong>Discussion: </strong>Discontinuation of opioids is associated with clinical and esophageal motility improvement in up to half of the patients.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-09DOI: 10.14309/ajg.0000000000003314
Rahul Karna, David Cartwright, James S Mallery, Guru Trikudanathan
{"title":"Isolated IgG4 Related Cholecystitis: A Rare Presentation Of IgG4 Disease.","authors":"Rahul Karna, David Cartwright, James S Mallery, Guru Trikudanathan","doi":"10.14309/ajg.0000000000003314","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003314","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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