American Journal of Gastroenterology最新文献

Introduction: Endoscopic retrograde appendicitis therapy (ERAT) is a new and noninvasive endoscopic technique originally developed by Liu in China for the management of acute appendicitis. Although its safety and efficacy have been extensively validated in adult populations, evidence regarding its use in pediatric patients remains scarce. The aim of this study was to evaluate the clinical outcomes of ERAT in pediatric appendicitis.

Methods: This retrospective study analyzed pediatric patients who underwent ERAT in our hospital between January 2019 and August 2022. Data collected included patient demographics, the success rate of ERAT, and the duration of hospital stay. In addition, recurrence rates were assessed during the follow-up to evaluate the safety and long-term efficacy of the procedure.

Results: A total of 73 patients were included in this study. Appendiceal intubation was successfully performed in 72 of 73 patients (98.63%). Among these patients, 72.22% of patients had appendiceal fecal stones or food residue, and the success rate of stone removal was 94.23%. Overall, the clinical success rate of the procedure was 91.78%. The median procedure time was 22 minutes (interquartile range 15-36.5), and the median postoperative hospital stay was 2 days (interquartile range 1-4). During the 1-year follow-up, 14.92% of the patients had recurrent appendicitis.

Discussion: ERAT seems to be a safe and effective alternative approach to treat appendicitis in pediatric patients, especially for obstructive appendicitis with appendicolith.

Introduction: Aggressive colorectal cancer (CRC) frequently originates from serrated lesions (SLs), particularly in the proximal colon, which are challenging to detect using standard screening colonoscopy. Although duplicate examinations or chromocolonoscopies are recommended for detecting proximal SLs, evidence from randomized trials is limited. We evaluated the effectiveness of tandem colonoscopy with an acetic acid-indigo carmine mixture (AIM) for detecting SLs in the proximal colon compared with white-light imaging (WLI) and indigo carmine (IC).

Methods: This 3-arm, multicenter, randomized controlled trial involving 9 institutions enrolled patients undergoing colonoscopy and assigned them randomly to the WLI, IC, or AIM group. The primary outcomes were the SL-detection rate (SDR) of proximal lesions during the second examination (SDR 2nd ) and SL additional rate (SAR). Secondary outcomes included the detection and additional rates of other polyps, factors contributing to SAR, and complications.

Results: Between 2021 and 2024, 1,319 participants with 1,267 polyps were included in the analysis. With AIM, the SDR 2nd and SAR were significantly higher compared with WLI or IC (WLI vs AIM: 2.7% vs 14.0%, P < 0.001; IC vs AIM: 7.9% vs 14.0%, P = 0.002, and WLI vs AIM: 22.4% vs 69.3%, P < 0.001; IC vs AIM: 45.8% vs 69.3%, P = 0.001). AIM conferred a higher adenoma detection rate 2nd than with WLI (10.5% vs 24.7%; P < 0.001) and was an independent factor for SAR (odds ratio [95% confidence interval]: 7.79 [3.76-17.08]). No major adverse events were observed.

Discussion: AIM significantly improved proximal colon SDRs and outperformed WLI and IC. The relationship between SDR and CRC incidence warrants further investigation.

Introduction: To understand trends in the risk of all-cause hospitalization for individuals with inflammatory bowel disease, we explored age, period, and cohort effects in Canada.

Methods: Repeated cross-sectional survey data from the 2005-2014 Canadian Community Health Survey linked to the Discharge Abstract Database to capture the all-cause hospitalization within 3 years of entry into the study for eligible individuals. Random-effects 2-level models estimated fixed effects for age and random effects for time periods and birth cohorts on the risk of all-cause hospitalization within 3 years entry into the study.

Results: An estimated 197,000 individuals were eligible for study inclusion. From this, an estimated 70,140 all-cause hospitalizations occurred within 3 years postentry into the study. The risk of hospitalization within 3 years increased with age and across birth cohorts, with older cohorts experiencing greater risks of hospitalization. A small temporal effect was identified for both inflammatory bowel disease groups. Within birth cohorts, the risk of hospitalization increased across ages for Crohn's disease, but in individuals with ulcerative colitis, the risk decreased across ages, except for the 2 oldest birth cohorts.

Discussion: These data support the hypothesis that age effects are primarily responsible for increased risk of hospitalizations. As the prevalence of IBD continues to rise and age distribution of Canadians shifts toward an older-aged population, increasing the allocation of healthcare resources to prevent age-related risks of hospitalizations would be beneficial to reduce hospital burdens.

Introduction: Small bowel adenocarcinoma (SBA) and T-cell lymphoma (TCL) are rare but aggressive malignancies associated with celiac disease (CD).

Methods: We retrospectively compared 43 CD-associated SBA and 43 CD-associated TCL across international referral centers.

Results: CD-associated SBA showed a significantly ( P < 0.01) better survival than CD-associated TCL. TCL more frequently presented with multifocal involvement and advanced stage, whereas SBA predominantly involved the jejunum. Refractoriness to a gluten-free diet was identified in 70% of TCL but only in one SBA.

Discussion: Our findings demonstrated a worse prognosis of CD-associated TCL in comparison with CD-associated SBA.

Introduction: Irritable bowel syndrome (IBS) and celiac disease (CeD) are common disorders that share overlapping symptoms. In this systematic review and meta-analysis, we aimed to provide up-to-date and comprehensive estimates of the prevalence of CeD in patients with IBS.

Methods: We searched several databases through January 2025 for studies reporting the prevalence of CeD in patients with IBS. Eligible studies used Rome III or Rome IV criteria for IBS diagnosis and used serological screening with tissue transglutaminase, endomysial antibodies, or deamidated gliadin peptide, and/or confirmatory duodenal biopsies for CeD diagnosis. We used random-effects meta-analysis to estimate the pooled prevalence of seropositive and biopsy-proven CeD with 95% confidence intervals (CI). We calculated pooled odds ratios to compare the likelihood of CeD between patients with IBS and controls.

Results: A total of 29 studies comprising 7,209 patients with IBS were included. The pooled seroprevalence of CeD in patients with IBS was 6% (95% CI, 5%-8%), and the pooled prevalence of biopsy-proven CeD was 2% (95% CI, 2%-3%). A significant proportion of seropositive patients (15%; 95% CI, 6%-24%) did not undergo endoscopy and biopsy. Patients with IBS had significantly higher odds of a positive serology than controls (odds ratio 4.42; 95% CI, 2.82-6.92). The odds of CeD were similar across genders and IBS subtypes. There was a limited number of studies from Europe and no studies from the United States.

Discussion: CeD is highly prevalent in patients with IBS, according to the Rome III and Rome IV criteria. A positive diagnosis of IBS should not be made without excluding CeD.

Chronic liver disease and liver cancer such as hepatocellular carcinoma (HCC) have a growing global health burden. In many areas, liver disease and cancer have a rising incidence, later diagnosis, and higher mortality. Although guidelines recommend regular surveillance, the timely detection of liver disease and HCC remains inconsistent. This is largely due to low awareness, restricted access to care, and fragmented healthcare systems. It is well known that patient empowerment through knowledge, engagement, and shared decision-making could therefore help to improve outcomes. However, this is frequently complicated by stigma, low health literacy, and comorbidities. These challenges could be improved by Artificial Intelligence (AI). AI methods can analyze healthcare data and could directly impact screening and risk stratification. In addition, the emergence of large language models (LLMs) such as ChatGPT provides new tools that can support the patient journey.Here, we provide a systematic overview of the capabilities of Artificial Intelligence (AI) methods to potentially improve liver cancer care. We highlight that AI tools in liver cancer care could be used in two ways: they can help healthcare professionals (HCPs) and patients alike. HCP-focused AI tools can constitute clinical decision-support systems and improve care continuity via telemedicine and remote monitoring. Patient-focused AI applications can have the potential to empower patients, by providing personalized education, counseling, and improved patient engagement. However, we also point out the need for caution in the implementation of this technology. Key concerns are related to ethical considerations, regulation, data privacy, transparency, algorithmic bias, rigorous clinical validation and patient preferences and needs. When these concerns are resolved, AI could help to deliver more personalized, participatory, and equitable liver disease care.