American Journal of Gastroenterology最新文献

Introduction: Chronic neurogastroduodenal disorders are heterogeneous and thought to lie on a spectrum of disease encompassing both sensory and neuromuscular pathologies. Abnormalities of interstitial cells of Cajal (ICC), a subset of which generate pacemaker signals and subsequently motility, have been implicated in their pathophysiology. We systematically reviewed the literature to pool ICC deficits observed in chronic neurogastroduodenal disorders.

Methods: Studies quantifying gastric ICC from the corpus or antrum, in adult patients with gastroparesis, functional dyspepsia (FD), or chronic nausea and vomiting syndromes (CNVS) were analyzed (PROSPERO: CRD42024613226). MEDLINE, Embase and CENTRAL databases were searched systematically. Random effects meta-analyses were used to compare ICC counts by disorder group with subgroup analysis by quantification methodology.

Results: Overall, 2,158 studies were screened and 22 included. Comparative studies (n = 12) showed patients with chronic neurogastroduodenal disorders (n = 167 with gastroparesis, n = 19 with FD ± CNVS) had lower ICC counts than nondiabetic controls (n = 130); standardized mean difference -1.58, 95% confidence interval -2.09 to -1.07, P < 0.0001, with more severe deficits in gastroparesis compared to FD ± CNVS (standardized mean difference [SMD] -0.44, P = 0.048). A spectrum of ICC deficits was evident in a subgroup of studies using gold-standard methods with c-KIT antibody and 4',6-diamidino-2-phenylindole-stained nuclei confirmation (7 studies, 246 patients: mean ICC counts 2.29 in gastroparesis vs 3.49 in FD ± CNVS, and 5.27 in controls; P < 0.001 all comparisons). Most studies were at high risk of bias (n = 21).

Discussion: Marked depletion of ICC is a consistent finding in neurogastroduodenal disorders. A spectrum of disease is revealed, with greater depletion associated with delayed emptying. Techniques for clinically defining ICC-driven gastric neuromuscular dysfunction should be prioritized.

Cystic fibrosis (CF) is a multifaceted genetic disorder impacting the respiratory, gastrointestinal, and hepatobiliary systems, necessitating a multidisciplinary approach for management. Its effects are observed throughout all stages of life, from infancy to adulthood, with gastrointestinal manifestations varying at each stage, including conditions such as meconium ileus and gastroparesis. Given its wide range of differential diagnoses and implications, a thorough understanding of its associated conditions is crucial for healthcare professionals. Monitoring CF involves tracking growth and development, as nutritional decline can impede patient progress. Quality of life can differ significantly based on treatment approaches, underscoring the importance of effective therapeutic strategies. The introduction of highly effective modulators has notably improved the clinical course of CF. However, CF providers have begun to identify previously unrecognized nutritional issues such as obesity and eating disorders with the advent of highly effective modulators. With variations in gastrointestinal clinical manifestations and treatment offerings between pediatric and adult providers, it is important to review CF gastrointestinal (GI) diseases in depth encompassing the entire spectrum of the gut health in CF for the larger benefit of pediatric and adult GI providers who may not be primarily focused on CF care. With this article, we aim to empower both pediatric and adult GI providers in dealing with CF GI symptoms effectively in their clinical practice as we see more patients with CF living longer and hope to contribute to their betterment and achieving fulfilling lives.

Introduction: Colonoscopy is one of the most commonly performed endoscopic procedures and is generally considered low-risk. However, when adverse events (AEs) occur, they can present significant challenges in clinical practice. The aim of this study was to estimate the global incidence of colonoscopy-related AEs.

Methods: We searched multiple databases for population-based studies reporting the incidence of colonoscopy-related AEs up to December 22, 2024. Meta-analyses were conducted for both gastrointestinal and nongastrointestinal AEs. Subgroup analyses were performed based on factors including World Health Organization region, publication year, sample size, data collection method, and study design.

Results: Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias.

Discussion: This comprehensive meta-analysis provides valuable insights into the global incidence of colonoscopy-related AEs and underscores the imperative need for continuous efforts to enhance the safety of this procedure.