American Journal of Gastroenterology最新文献

Introduction: The COVID-19 pandemic reduced colorectal cancer (CRC) screening, but the rebound in testing and outcomes after the pandemic has not been widely reported. We evaluated CRC test utilization and colorectal neoplasia detection among screening eligible patients in a large health system in 2020 and 2021, compared with 2019 (prepandemic).

Methods: Using a retrospective cohort study design, fecal immunochemical test (FIT) and colonoscopy utilization, FIT positivity, and neoplasia detection were evaluated annually in 2019-2021 among Kaiser Permanente Northern California patients aged 50-75 years overall and by sex, age, race and ethnicity, and spoken language preference.

Results: Compared with 2019, reductions in FIT, colonoscopy, FIT positivity, and neoplasia detection in 2020 were followed by a strong rebound in 2021 and no subgroups by age and sex or minority subgroups by race and ethnicity or spoken language preference demonstrably lagged in their recovery in 2021. Among White persons and those with an English language preference, there was a small lag in recovery to baseline levels. The overall decline in CRC testing by colonoscopy in 2020 was offset by a lesser decrease in FIT utilization in 2020, and a strong rebound in FIT utilization in 2021 helped to offset the small lag in the rebound in colonoscopies completed in 2021.

Discussion: Findings may help guide organizations looking to improve CRC screening and minimize health care disparities related to national emergencies such as pandemics. Long-term studies are needed to evaluate how pandemic-related changes in CRC screening practices will affect future CRC outcomes.

Background: This study aimed to quantitatively examine gastric mucosal nerve density (GMND) in patients with functional dyspepsia (FD) and analyzed its clinical correlation.

Methods: We prospectively enrolled 35 patients with FD and 16 age-and gender-matched healthy controls for comparison of GMND on endoscopic biopsy, scores of Gastroparesis Cardinal Symptom Index (GCSI), and gastric emptying scintigraphy (GES).

Results: Patients with FD had lower GMND than the control subjects in gastric antrum, body, and fundus. GMND was inversely correlated with the GCSI scores, but not correlated with GES parameters.

Conclusion: GMND was reduced in FD and inversely correlated with the symptom severity.

Aim: To assess the safety and efficacy of alfapump on ascites control and quality of life in these patients.

Methods: Patients with cirrhosis and RA requiring ≥2 TPs 30 days prior were enrolled and followed for 24 months (M) post-implant. Primary efficacy endpoint assessed at 6M was reduction in paracentesis requirement; safety end point was device related adverse events resulting in intervention, explant, or death.

Results: 40 patients with RA, (mean MELD-Na: 15±4) received an alfapump. TP requirement decreased from 3.2±1.5 sessions/M pre-implant to 0.2±0.6 sessions/M at 6M post-implant (p<0.001), with 77% of patients having ≥50% reduction. Six (15%) pumps were explanted within 6M due to device related adverse events, 3 (7.5%) due to pump site skin erosion and 3 (7.5%) due to bladder discomfort. Twenty-four renal events occurred in the 0-6M post-implant period; 16 cases were readily reversible stage 1 acute kidney injury. Ascites related symptoms assessed with an Ascites Q score improved from 51.0±19.3 pre- to 32.2±21.9 at 6M post-implant (p<0.001). Physical but not mental components of Short Form 36 improved (p<0.001). The 5 deaths within 6M post-implant were not directly related to device or alfapump therapy.

Conclusions: The alfapump system effectively controlled ascites, which improved quality of life. It may be considered as an alternative to repeat TP in select patients with RA. Complication rates were similar to those expected in patients with RA.

Background/aim: Spondyloarthritis (SpA), the most common extra-intestinal manifestation of inflammatory bowel disease (IBD), is reported in up to 39% of patients with IBD. Despite this high prevalence, risk factors for developing SpA in patients with IBD are not well described. In this study, we aimed to determine the factors associated with SpA symptoms and their prevalence in an IBD cohort.

Methods: Two validated screening questionnaires for the detection of SpA in IBD (DETAIL = DETection of Arthritis in Inflammatory boweL diseases, IBIS-Q = IBD Identification of Spondyloarthritis Questionnaire) were administered to IBD patients without a prior diagnosis of SpA in six US academic medical centers. Demographic data, IBD characteristics, and medication history were recorded.

Results: Screening questionnaires were completed by 588 patients (220 ulcerative colitis, 349 Crohn's disease, 19 IBD-unclassified) with a median age 40 years (IQR 30 - 53) and median disease duration of 12 years (IQR 6 - 22). The number of positive screens was 130 (22%) for DETAIL, 196 (33%) for IBIS-Q and 204 (35%) for either DETAIL or IBIS-Q. Age, female sex, history of smoking, prior bowel surgery, and history of any biologic or targeted small molecule exposure were associated with a positive screen on univariate analysis (Table 1). After multivariate analysis, female sex (OR 2.03; 95% CI 1.41-2.93), older age (OR 1.02; 95% CI 1.01-1.04), history of smoking (OR 1.67; 95% CI 1.04-2.69), and history of any biologic or targeted small molecule exposure (OR 2.27; 95% CI 1.34-3.84) were independently associated with positive screens. Higher number of biologic exposures was associated with higher risk of positive screens, with the highest risk seen with three or more exposures (OR 3.25; 95% CI 1.75-6.03).

Conclusion: A substantial number of IBD patients screen positive for SpA symptoms, indicating a potentially high burden of undiagnosed illness. Factors associated with SpA symptoms include older age, female sex, and more severe disease (based on increased number advanced therapies or prior surgery), whereas IBD phenotype does not independently increase the risk of a positive SpA screen. Further studies are needed to confirm these findings and better characterize SpA in IBD.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is an important public health threat, potentially leading to chronic liver disease and liver cancer. Current guidelines recommend using the FIB-4 score for initial identification of subjects at risk of future complications. We formulate a novel population screening strategy based on the Steatosis-Associated Fibrosis Estimator (SAFE) score, recently developed for MASLD risk stratification in primary care.

Methods: We interrogated the National Health and Nutrition Examination Survey data, 2017-20, in which a sample of subjects representative of US civilian population underwent vibration controlled transient elastography (VCTE). The current guideline and a new, SAFE-based proposal were applied to these data to project the number of subjects to be diagnosed with liver fibrosis gauged by liver stiffness measurement (LSM), including significant (LSM ≥8kPa) and advanced (LSM ≥12kPa) fibrosis, as well as the number of VCTEs to be performed.

Results: In the survey data, 2,691 subjects, projecting to 75.8 million US adults, were found to have MASLD, of whom 11% had LSM 8-12kPa and 6% LSM ≥12kPa. When the current guideline was applied, 18.1 million VCTEs would be needed to diagnose 3.5 million subjects with LSM ≥8kPa and 1.7 million subjects with LSM ≥12kPa. In comparison, a new approach based on the SAFE score would detect 4.9 million with LSM ≥8kPa and 2.5 million subjects with LSM ≥12kPa (37% and 45% improvement over the current guideline, respectively), while requiring 5.0 million fewer VCTEs (28% reduction).

Conclusion: The proposed population risk stratification approach using the SAFE score is simpler and substantially more effective, yielding more subjects with liver fibrosis while requiring less resources compared to the currently recommended algorithm.

Background: The global burden of metabolic diseases is increasing, but estimates of their impact on primary liver cancer are uncertain. We aimed to assess the global burden of primary liver cancer attributable to metabolic risk factors, including high body mass index (BMI) and high fasting plasma glucose (FPG) levels, between 1990 and 2021.

Methods: The total number and age-standardized rates of deaths and disability-adjusted life years (DALYs) from primary liver cancer attributable to each metabolic risk factor were extracted from the Global Burden of Disease Study 1990-2021. The metabolic burden trends of liver cancer across regions and countries by sociodemographic index (SDI) and sex were estimated. The annual percentage changes in age-standardized DALYs rate were also calculated.

Results: Globally, in 2021, primary liver cancer attributable to high BMI and/or high FPG was estimated to have caused 59,970 deaths (95% uncertainty interval [UI]: 20,567 to 104,103) and 1,540,437 DALYs (95% UI: 540,922 to 2,677,135). The age-standardized rates of death and DALYs were 0.70 (95% UI: 0.24 to 1.21) and 17.64 (95% UI: 6.19 to 30.65) per 100,000 person-years. A consistent global rise in liver cancer attributable to metabolic risks was observed from 1990 to 2021, with high BMI identified as the major contributing risk factor. The highest burden of deaths and DALYs of liver cancer consistently occurred in high SDI countries, while the fastest growth trends were observed in low-middle SDI countries. The burdens of high levels of BMI and FPG were higher in men than in women.

Conclusions: Primary liver cancer attributable to high BMI and/or high FPG imposes an increasingly substantial clinical burden on global public health, particularly in high SDI countries. Rapid growth trends are also found in middle-SDI countries.