American Journal of Gastroenterology最新文献

Introduction: A subcutaneous formulation of infliximab was recently approved for maintenance therapy of inflammatory bowel disease (IBD). However, limited clinical experience, particularly with patients on escalated intravenous infliximab regimens, poses challenges for the transition to subcutaneous therapy. We investigated the pharmacokinetics and pharmacodynamics of subcutaneous infliximab to identify early predictors of relapse on switching.

Methods: We repurposed data from a prospective, multicenter trial involving patients with IBD switching from intravenous to subcutaneous infliximab. We estimated each patient's infliximab clearance using Bayesian forecasting from a preswitch sample and a population pharmacokinetics model. We performed pharmacodynamics modeling to evaluate preswitch predictors of postswitch relapse. Relapse was defined as clinical recurrence (partial Mayo score >2 or Harvey-Bradshaw Index >4 leading to therapeutic escalation) or an increase in fecal calprotectin ≥150 μg/g on switching.

Results: Using data from 98 patients with IBD, we identified infliximab clearance and fecal calprotectin as independent predictors of relapse. A 2-item risk score stratified patients into the low-risk (<19% probability of relapse; 75/98; 77%) and high-risk (≥19% probability of relapse; 23/98; 23%) groups (sensitivity 0.75 [95% CI 0.48-0.93], specificity 0.87 [95% CI 0.77-0.93] positive predictive value 52% [95% CI 31-73%], negative predictive value 95% [95% CI 87-99%]). Our pharmacokinetics-pharmacodynamics model classified patients with and without relapse ( P < 0.0001) with an area under the receiver operating characteristic curve of 0.83 (95% CI 0.71-0.93).

Discussion: Preswitch infliximab clearance and fecal calprotectin are accurate predictors of relapse after switching to subcutaneous infliximab. An interactive risk stratification tool facilitates confirmation of a stratified medicine approach to improve infliximab therapy in IBD.

Introduction: Postcolonoscopy colorectal cancers (PCCRCs) are an adverse outcome associated with missed lesions and incomplete polypectomy. However, their molecular features have not been systematically reviewed.

Methods: We searched PubMed, Embase, and Cochrane Library databases from inception to April 2024. Studies examining the molecular characteristics of PCCRCs, including microsatellite instability (MSI), CpG island methylation phenotype (CIMP), genetic mutations, and chromosomal alterations were regarded as eligible.

Results: In total, 15 studies encompassing 11 cohorts, with 2,143 PCCRC and 19,036 sporadic colorectal cancer (SCRC) cases, were analyzed. Compared with SCRC, PCCRC was associated with older age (standardized mean difference 0.29, 95% confidence interval [CI] 0.20-0.38) and more proximal lesions (odds ratio [OR] 2.08, 95% CI 1.91-3.63). Molecularly, PCCRCs were more likely to exhibit MSI (OR 2.28, 95% CI 1.69-3.08), CIMP (OR 2.10, 95% CI 1.39-3.18), and BRAF mutations (OR 1.74, 95% CI 1.22-2.49) but were less likely to exhibit KRAS mutations (OR 0.63, 95% CI 0.45-0.87). Furthermore, MSI was strongly correlated with BRAF mutation (OR 9.36, 95% CI 5.11-17.16) and proximal lesions (OR 6.16, 95% CI 3.74-10.16) in a pooled analysis. Although the pooled 5-year overall survival rate was similar between PCCRC and SCRC cases (hazard ratio 1.03, 95% CI 0.64-1.66), PCCRCs exhibited worse survival compared with screening-detected ones (hazard ratio 1.65, 95% CI 1.46-1.86).

Discussion: Clinical and molecular features indicate that PCCRCs are more likely to be associated with the serrated pathway than with SCRC. Enhancing the detection of clinically significant serrated lesions may improve the efficacy of CRC screening.

Introduction: Upper endoscopy (EGD) is generally recommended in those with chronic gastroesophageal reflux disease (GERD). To evaluate nonendoscopic screening in those without GERD symptoms.

Methods: EsoCheck/Esoguard (LucidDx) was performed in recruited patients without chronic GERD who had ≥3 other BE risk factors.

Results: The EsoGuard assay was positive in 34 of 120 patients. BE was identified in 9 of 27 who had follow-up EGD, positive predictive value = 33% (17%-54%). EGD performed in 22 of 86 subjects with negative assays found no BE, negative predictive value = 100% (85%-100%).

Discussion: Nonendoscopic BE detection is effective in patients without chronic GERD.

Introduction: The liver supplement market is rapidly expanding, yet the efficacy and safety of these products remain largely unsubstantiated. The aim of this study was to analyze the best-selling liver "cleansing" supplements on Amazon, the leading online retailer in the United States.

Methods: We identified the top 20 liver cleanse supplements on Amazon using specific search criteria. Product composition, marketing claims, customer reviews, sales data, and revenue were analyzed. AMZScout was used for sales analytics and FakeSpot for review authenticity assessment. The most common ingredients were identified, and their scientific evidence evaluated through structured PubMed searches with predefined criteria for evidence quality assessment.

Results: The 20 top-selling supplements generated total annual sales of 1,420,584 units with a revenue of $38,783,937. All products claimed to "eliminate toxins" or provide "liver detox/cleanse," whereas 85% claimed to "enhance liver function." The average product rating was 4.4 of 5 stars, with review reliability averaging 73% ± 20%. Milk thistle was the most common ingredient (19/20 products), followed by dandelion and turmeric root (13/20 each). Scientific evidence supporting these ingredients' efficacy in liver health was limited and inconclusive.

Discussion: This study reveals a thriving market for liver supplements, despite limited scientific evidence supporting their efficacy. The prevalence of bold health claims, high consumer satisfaction, and significant sales highlight the need for more rigorous evaluation and regulation of these products. Healthcare providers should be aware of these trends to better counsel patients on evidence-based approaches to liver health.

Introduction: To evaluate the risks of colorectal endoscopic submucosal dissection (ESD) in older adult patients, given the increasing number of ESD in an aging population.

Methods: We conducted a retrospective cohort study using the Japanese nationwide database from 2012 to 2023. Patients aged 60 years or older who underwent colorectal ESD were included. The primary outcome was overall adverse events (AEs), including in-hospital mortality, procedure-related perforation, abdominal surgery, aspiration pneumonia, and significant postoperative bleeding and thromboembolic events. We first examined the association between age and AEs using multivariable regression adjusting for patient characteristics. Next, to explore the factors associated with overall AEs in those aged 85 years or older, we fit a multivariable logistic regression.

Results: The study included 143,925 cases. Age distribution was as follows: 60-64 (13.5%), 65-74 (44.9%), 75-84 (35.8%), and ≥85 (5.8%) years. The prevalence of overall AEs increased with age: 5.3% for ages 60-64 years, 7.9% for ages 85-89 years, and 9.2% for ages 90 years or older. Patients aged 85 years or older had a higher prevalence of overall AEs compared with patients aged 60-64 years, with an adjusted odds ratio of 1.19 (95% confidence interval: 1.07-1.33, P < 0.01) for those aged 85-89 years and an adjusted odds ratio of 1.45 (95% confidence interval: 1.16-1.80, P < 0.01) for those aged 90 years or older. Most AEs in patients aged 85 years or older were due to significant postoperative bleeding, with anticoagulant use and body mass index ≥30 identified as key risk factors.

Discussion: The risks of AEs during colorectal ESD increase with age, particularly in patients aged 85 years or older.

Introduction: Postendoscopic sphincterotomy (EST) bleeding presents challenges for endoscopists using side-viewing duodenoscopes. Recently, polysaccharide hemostatic powder (PHP) has shown promising results in managing gastrointestinal hemorrhage. Given the established efficacy of endoscopic clips in addressing post-EST bleeding, we aim to evaluate the efficacy of PHP and its noninferiority to endoscopic clips in patients with nonpulsatile post-EST bleeding.

Methods: Patients with nonpulsatile post-EST bleeding were randomized to receive either PHP or endoscopic clips. The primary end point was the immediate hemostasis rate, with secondary end points including delayed bleeding rate, overall treatment success rate, mean hemostasis time, and other major complications.

Results: A total of 104 patients with nonpulsatile post-EST bleeding were included. Immediate hemostasis was achieved in 100% of the PHP group and 92.3% in the endoscopic clip group (risk difference, 7.7%, 95% confidence interval (CI) = 0.5%-15.0%, P = 0.022). Four patients in the endoscopic clip group experienced immediate hemostasis failure. Hemostasis time was shorter in the PHP group (50.77 vs 62.81 seconds, P = 0.011). One delayed bleeding case (2.1%) occurred in the clip group, whereas none were observed in the PHP group. The overall treatment success rate was higher in the PHP group compared with the endoscopic clip group (100% vs 90.4%; P = 0.022). No differences were observed in adverse events.

Discussion: PHP is not inferior to endoscopic clip and could be of use in immediate hemostasis for nonpulsatile post-EST bleeding, with the added advantage of ease of use. Further research is needed to assess its efficacy in preventing delayed bleeding ( chictr.org.cn , ChiCTR2400092280).