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Continuing Medical Education Questions: February 2026. 继续医学教育问题:2026年2月。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-02-01 DOI: 10.14309/ajg.0000000000003895
Ernesto S Robalino Gonzaga

Article Title: The San Diego Consensus for Laryngopharyngeal Symptoms and Laryngopharyngeal Reflux Disease.

文章标题:关于咽喉症状和咽喉反流病的圣地亚哥共识。
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引用次数: 0
Gastric-Shaped Esophagus in Achalasia. 贲门失弛缓症的胃状食管。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-02-01 Epub Date: 2025-06-05 DOI: 10.14309/ajg.0000000000003567
Fu Guan, Shengbing Wang
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引用次数: 0
Efficacy of Rebamipide in the Prevention of Nonsteroidal Anti-Inflammatory Drug-Induced Gastrointestinal Mucosal Breaks: A Systematic Review and Meta-Analysis. 利巴米胺预防非甾体抗炎药诱导的胃肠道粘膜破裂的疗效:一项系统综述和荟萃分析。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-02-01 Epub Date: 2025-05-14 DOI: 10.14309/ajg.0000000000003535
Rochelle Ivy A Cion, Ian Gabriel A Juyad, Eric B Yasay

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most used medications worldwide. A major limitation of these drugs is gastrointestinal (GI) mucosal injury. Several gastroprotective agents have been recommended but are limited by their long-term effects. Rebamipide is a promising mucoprotective agent, but its efficacy is not established. We performed a meta-analysis assessing the efficacy of rebamipide in preventing NSAID-induced GI mucosal breaks as compared with placebo and the standard proton-pump inhibitors (PPIs).

Methods: Four electronic databases were searched from inception to October 2023 for randomized controlled trials that compared rebamipide with placebo or PPIs. Data were pooled to obtain the risk ratio (RR) with 95% confidence interval (CI). Heterogeneity and publication bias were assessed with I2 statistic and funnel plot, respectively.

Results: A total of 472 studies were screened, with 13 studies included. Pooled analyses showed that rebamipide significantly reduced the incidence of NSAID-induced GI mucosal breaks as compared with placebo (RR 0.55, 95% CI 0.31-0.99, P ≤ 0.00001). Rebamipide is also comparable with the standard PPIs in preventing NSAID-induced mucosal breaks (RR 1.00, 95% CI 0.51-1.95, P = 1.00). Regarding addition of rebamipide to PPIs, there are still insufficient data to support its effect on further improving prevention of GI mucosal breaks as compared with PPIs alone (RR 0.72, 95% CI 0.43-1.21; P = 0.11).

Discussion: Rebamipide is effective in preventing NSAID-induced GI mucosal breaks. Rebamipide may also be as good as the standard PPIs in preventing NSAID-induced GI mucosal breaks and, hence, may be an alternative, especially in those with contraindications to long-term PPI use.

简介:非甾体抗炎药(NSAIDs)是世界范围内使用最多的药物之一。这些药物的一个主要限制是胃肠道粘膜损伤。已经推荐了几种胃保护剂,但由于其长期影响而受到限制。利巴米胺是一种很有前途的粘膜保护剂,但其疗效尚未确定。我们进行了一项荟萃分析,评估了与安慰剂和标准质子泵抑制剂(PPIs)相比,利巴米胺在预防非甾体抗炎药诱导的胃肠道(GI)粘膜破裂方面的疗效。方法:检索4个电子数据库,从建立到2023年10月,将利巴米胺与安慰剂或PPIs进行比较的随机对照试验。合并数据获得95%置信区间的风险比(RR)。异质性和发表偏倚分别采用I2统计量和漏斗图进行评估。结果:共筛选472项研究,纳入13项研究。合并分析显示,与安慰剂相比,利巴米胺显著降低了非甾体抗炎药引起的胃肠道粘膜破裂的发生率[RR: 0.55, 95%CI 0.31-0.99, p≤0.00001]。瑞巴米胺在预防非甾体抗炎药引起的粘膜破裂方面也与标准ppi相当[RR: 1.00, 95%CI 0.51-1.95, p=1.00]。关于在PPIs中添加利巴米胺,与单独使用PPIs相比,仍没有足够的数据支持其对进一步改善胃肠道粘膜破裂的预防作用[RR: 0.72, 95% CI 0.43-1.21;p = 0.11)。结论:利巴米胺可有效预防非甾体抗炎药引起的胃肠道粘膜破裂。在预防非甾体抗炎药引起的胃肠道粘膜破裂方面,利巴米胺可能与标准PPI一样好,因此可能是一种替代方案,特别是对于那些长期使用PPI的禁忌症患者。
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引用次数: 0
Response to Zhao et al. 回复赵等人。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-02-01 Epub Date: 2025-12-18 DOI: 10.14309/ajg.0000000000003831
Ping-I Hsu, Deng-Chyang Wu, Chih-An Shih, Yu-Hwa Liu
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引用次数: 0
Letter to the Editor. 给编辑的信。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-02-01 Epub Date: 2025-11-26 DOI: 10.14309/ajg.0000000000003815
Feng Chen, Yanggang Hong, Zhendi Shu
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引用次数: 0
A Case of Gallbladder Cancer With a Rare H-Like Morphology Pancreaticobiliary Maljunction. 胆囊癌合并罕见h型胰胆管畸形1例。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-02-01 Epub Date: 2025-06-05 DOI: 10.14309/ajg.0000000000003569
Takafumi Tokunaga, Shinya Kohashi, Arata Sakai
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引用次数: 0
Letter to the Editor. 给编辑的信。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-02-01 Epub Date: 2026-01-12 DOI: 10.14309/ajg.0000000000003851
Shyam Menon
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引用次数: 0
Letter to the Editor. 给编辑的信。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-02-01 Epub Date: 2025-10-27 DOI: 10.14309/ajg.0000000000003775
Ozdal Ersoy
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引用次数: 0
MELD-Lactate and lactate clearance in critically ill cirrhosis patients with sepsis. meld -乳酸和乳酸清除率在重症肝硬化脓毒症患者中的应用。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-01-27 DOI: 10.14309/ajg.0000000000003934
Rehma Shabbir, Luis Garrido-Trevino, Jacqueline G O'Leary, Ashok Chaudhary, Rakhi Maiwall, Vinod Arora, Harshvardhan V Tevethia, Shiv K Sarin, Lauren Hall, Gerald O Ogola, Patrick S Kamath, Sumeet K Asrani

Objectives: MELD-lactate (MELD-LA) score is an independent predictor of inpatient mortality and organ failure validated in over 8,600 patients across diverse settings. However, its utility in sepsis, particularly when combined with lactate clearance (LA clearance), has not been fully evaluated. In this study, we examined the dynamic role of MELD-LA with 24-hour LA clearance as a predictor of 30-day mortality in critically ill patients with cirrhosis and sepsis.

Methods: We analyzed cirrhosis patients with sepsis admitted to the ICU in a large U.S. healthcare system (20 hospitals) from 2014-2022, examining MELD-LA and LA clearance within 24 hours as predictors of 30-day mortality. We externally validated our findings in the APASL-ACLF Research Consortium, a multinational Asian cohort (31 centers) from 2009-2019.

Results: A total of 3,879 cirrhosis patients with sepsis were admitted to the ICU (43.2% female, 20.5% Hispanic, 12.4% on dialysis; mean initial LA 4.5 mmol/L, MELD 20.8, MELD-LA 17.6). Survivors showed a median lactate change of -1.04 (35% clearance) compared to -0.4 (12%) for non-survivors. LA clearance within 24 hours was influenced by the presenting MELD-LA. In the North American cohort, ≥35% LA clearance was associated with improved 30-day survival (OR 0.41, 95% CI 0.31-0.53; p<0.001). Similarly, in the APASL cohort (n=1,259), ≥35% clearance was linked to a 60% reduction in mortality (OR 0.42, 95% CI 0.28-0.62; p<0.001). When stratified by LA clearance, patients with LA clearance of ≥35% had a higher percentage of early administration of resuscitative measures than those with LA clearance of < 10% especially with regards to early antibiotic administration (82.5% vs 67.6%; p-value <0.001).

Conclusion: Early reduction in initial LA by one-third predicts 30-day mortality and may indicate treatment response in cirrhosis patients with sepsis in the ICU. Combining MELD-LA and LA clearance early enables better risk stratification and informs management.

目的:meld -乳酸(MELD-LA)评分是住院患者死亡率和器官衰竭的独立预测指标,在不同环境下的8600多例患者中得到验证。然而,它在脓毒症中的应用,特别是与乳酸清除(LA清除)联合使用时,尚未得到充分评估。在这项研究中,我们研究了MELD-LA与24小时LA清除率的动态作用,作为肝硬化和脓毒症危重患者30天死亡率的预测因子。方法:我们分析了2014-2022年美国大型医疗保健系统(20家医院)ICU收治的肝硬化脓毒症患者,检查MELD-LA和24小时内LA清除率作为30天死亡率的预测因子。我们在APASL-ACLF研究联盟中外部验证了我们的发现,这是一个2009-2019年的跨国亚洲队列(31个中心)。结果:共有3879例肝硬化脓毒症患者入住ICU(43.2%为女性,20.5%为西班牙裔,12.4%为透析患者;平均初始LA 4.5 mmol/L, MELD 20.8, MELD-LA 17.6)。幸存者的中位乳酸变化为-1.04(35%清除率),而非幸存者的中位乳酸变化为-0.4(12%)。24小时内LA清除率受到MELD-LA的影响。在北美队列中,≥35%的LA清除率与30天生存率的提高相关(OR 0.41, 95% CI 0.31-0.53)。结论:早期初始LA减少三分之一可预测30天死亡率,并可能表明ICU肝硬化脓毒症患者的治疗反应。早期结合MELD-LA和LA清除可以更好地进行风险分层,并为管理层提供信息。
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引用次数: 0
Optimal Single or Combined Parameters for Dyssynergic Defecation on Anorectal Manometry: A Proof-of-Concept Machine Learning Study. 肛门直肠测压中失调排便的最佳单一或组合参数:一项概念验证机器学习研究。
IF 7.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2026-01-27 DOI: 10.14309/ajg.0000000000003932
John A Damianos, Saam Dilmaghani, Ayah Matar, Houssam Halawi, Nicholas Oblizajek, Michael Camilleri

Objective: To perform a proof-of-concept study to evaluate the performance of individual and combined anorectal manometry (ARM) and balloon expulsion testing (BET) parameters for diagnosing dyssynergic defecation (DD) using machine learning (ML).

Methods: A single gastrointestinal motility specialist assessed (2008-2018) 307 patients. A machine learning model was constructed on ARM/BET data. BET was weight-based in 235 patients and time-based in 72 patients. Missing data were imputed. Data were split 75% train/25% test with preprocessing performed. Five common ML models were trained, and performance was compared using receiver-operating characteristic (ROC) area under the curve (AUC) and accuracy based on 100 bootstrapped samples. The most accurate models were fine-tuned and evaluated on the test set.

Results: The median age was 40 years, BMI 22.2 kg/m2, and 81% were female. Two-hundred and twenty-two (72.3%) patients had a clinical diagnosis of DD. Compared to patients without clinical diagnosis of DD, patients with DD had significantly lower rectoanal pressure gradient (RAG) (median -34.7 [IQR -57.1, -13.0] vs. -24.6 [IQR -44.5, -2.4] mmHg, p=0.009) and more abnormal BET (59.5% vs 11.8%, p<0.001). Four features were retained in the optimized model as predictors of DD: abnormal BET, greater resting anal pressure (RAP), and more negative RAG. The optimal parameter was abnormal BET (p=0.003), but combinations of two manometry results (RAP and RAG) yielded positive predictive values (PPV) >80%. The optimized logistic regression (LR) model had an AUC of 0.878, with a sensitivity of 75.0% and specificity of 81.8% at a probability threshold of 0.704.

Conclusion: Abnormal BET, or combination of two manometric parameters (RAP and RAG), provide >80% PPV for diagnosing DD in patients with chronic constipation.

目的:进行一项概念验证研究,评估使用机器学习(ML)诊断协同排便障碍(DD)的单独和联合肛门直肠测压(ARM)和气囊排出试验(BET)参数的性能。方法:一名胃肠运动专家评估了(2008-2018)307例患者。基于ARM/BET数据构建了机器学习模型。235例患者以体重为基础,72例患者以时间为基础。缺失的数据被输入。数据分成75%训练/25%测试,并进行预处理。训练了5种常见的ML模型,并使用基于100个bootstrap样本的接收者工作特征(receiver-operating characteristic, ROC)曲线下面积(area under curve, AUC)和准确率对其性能进行了比较。在测试集上对最精确的模型进行微调和评估。结果:中位年龄40岁,BMI 22.2 kg/m2, 81%为女性。临床诊断为DD的患者222例(72.3%),与未临床诊断为DD的患者相比,DD患者直肠肛管压力梯度(RAG)显著降低(中位数为-34.7 [IQR -57.1, -13.0]比-24.6 [IQR -44.5, -2.4] mmHg, p=0.009), BET异常较多(59.5%比11.8%,p80%)。优化后的logistic回归(LR)模型AUC为0.878,灵敏度为75.0%,特异性为81.8%,概率阈值为0.704。结论:BET异常或RAP、RAG两项测压参数联合可为慢性便秘患者诊断DD提供bbb80 % PPV。
{"title":"Optimal Single or Combined Parameters for Dyssynergic Defecation on Anorectal Manometry: A Proof-of-Concept Machine Learning Study.","authors":"John A Damianos, Saam Dilmaghani, Ayah Matar, Houssam Halawi, Nicholas Oblizajek, Michael Camilleri","doi":"10.14309/ajg.0000000000003932","DOIUrl":"https://doi.org/10.14309/ajg.0000000000003932","url":null,"abstract":"<p><strong>Objective: </strong>To perform a proof-of-concept study to evaluate the performance of individual and combined anorectal manometry (ARM) and balloon expulsion testing (BET) parameters for diagnosing dyssynergic defecation (DD) using machine learning (ML).</p><p><strong>Methods: </strong>A single gastrointestinal motility specialist assessed (2008-2018) 307 patients. A machine learning model was constructed on ARM/BET data. BET was weight-based in 235 patients and time-based in 72 patients. Missing data were imputed. Data were split 75% train/25% test with preprocessing performed. Five common ML models were trained, and performance was compared using receiver-operating characteristic (ROC) area under the curve (AUC) and accuracy based on 100 bootstrapped samples. The most accurate models were fine-tuned and evaluated on the test set.</p><p><strong>Results: </strong>The median age was 40 years, BMI 22.2 kg/m2, and 81% were female. Two-hundred and twenty-two (72.3%) patients had a clinical diagnosis of DD. Compared to patients without clinical diagnosis of DD, patients with DD had significantly lower rectoanal pressure gradient (RAG) (median -34.7 [IQR -57.1, -13.0] vs. -24.6 [IQR -44.5, -2.4] mmHg, p=0.009) and more abnormal BET (59.5% vs 11.8%, p<0.001). Four features were retained in the optimized model as predictors of DD: abnormal BET, greater resting anal pressure (RAP), and more negative RAG. The optimal parameter was abnormal BET (p=0.003), but combinations of two manometry results (RAP and RAG) yielded positive predictive values (PPV) >80%. The optimized logistic regression (LR) model had an AUC of 0.878, with a sensitivity of 75.0% and specificity of 81.8% at a probability threshold of 0.704.</p><p><strong>Conclusion: </strong>Abnormal BET, or combination of two manometric parameters (RAP and RAG), provide >80% PPV for diagnosing DD in patients with chronic constipation.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":" ","pages":""},"PeriodicalIF":7.6,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146049833","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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American Journal of Gastroenterology
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