American Journal of Gastroenterology最新文献

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).

Introduction: Janus kinase inhibitors (JAKi) are small-molecule therapies used in inflammatory bowel disease (IBD). We describe 8 patients with IBD who developed an eczematous eruption, presumed atopic dermatitis (AD), after stopping JAKi therapy.

Methods: This case series describes 8 patients with IBD who developed de novo AD after withdrawal of JAKi therapy.

Results: Median time to AD onset was 7 days (interquartile range 2-12). Two cases with biopsy-confirmed AD resolved after reinitiation of JAKi therapy and adjunct AD treatments.

Discussion: A subset of patients with IBD may have latent susceptibility to AD, unmasked by therapy cessation and potentially triggered by an immune rebound effect.