American Journal of Gastroenterology最新文献

Introduction: Current guidelines recommend endoscopic surveillance of Barrett's esophagus (BE) but do not account for competing mortality unrelated to esophageal cancer (EC). We conducted a systematic review and meta-analysis to estimate EC and non-EC mortality risk in BE patients.

Methods: We searched multiple databases for studies reporting mortality in BE. We included population-based studies providing standardized mortality ratio (SMR). The primary outcome was SMR from all causes and EC and non-EC etiologies. SMR was calculated by dividing the observed mortality over the expected mortality. Logarithmic form of SMRs was pooled using random-effects model.

Results: Our search yielded 2,826 articles, of which 7 studies (n = 34,454) were included. All-cause mortality was elevated in BE patients compared with population controls (pooled SMR 1.24, 95% confident interval [CI] 1.01-1.53) driven in part by increased EC mortality risk (SMR 8.98, 95 CI 5.12-15.77). The mortality risk was still increased but attenuated after excluding EC mortality (SMR 1.21, 95% CI 1-1.46). There was no increased mortality risk of non-EC malignancies (SMR 1.22, 95% CI 0.82-1.82) or mortality due to noncancer etiologies (SMR 1.13, 95% CI 0.90-1.43). Death due to cardiovascular diseases was higher in BE (SMR 1.16, 95% CI 1.02-1.33). BE patients were 10 times more likely to die from noncancer etiologies than EC (risk ratio 10.71, 95% CI 5.98-19.16). Subgroup analysis of studies that excluded prevalent EC at baseline (3 studies) also showed increased all-cause (SMR 1.12, 95% CI 1.07-1.18) and EC mortality (SMR 4.7, 95% CI 3.58-6.17) among BE patients.

Discussion: BE patients exhibit a higher all-cause mortality, driven in part by risk of EC mortality. A personalized approach to surveillance, mitigating risk of EC while recognizing the broader mortality risks, is warranted.

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).