Translational gastroenterology and hepatology最新文献

Background and objective: Gaslighting is defined as behaviors inflicted on an individual which invalidate or call into question their ability to judge their own lived experience. Research into gaslighting in other contexts, such as domestic violence, underscore its potentially damaging effects. Medical gaslighting is an increasingly used, but poorly defined issue in a progressively more complex healthcare system in the United States. Limited studies constructively evaluate this breakdown in the provider-patient relationship and no studies exist evaluating gaslighting in the care of patients with digestive diseases. This narrative review aims to add clarity to the definition of medical gaslighting, evaluate the mechanisms that perpetuate gaslighting in gastroenterology practice and offer pragmatic solutions to begin to reduce its prevalence.

Methods: Narrative overview of the literature retrieved from searches of computerized databases.

Key content and findings: The potential root causes of gaslighting in gastroenterology practices are multifaceted and complex, and encompass patient, provider, and systemic factors.

Conclusions: An important distinction for medical gaslighting from other forms of gaslighting is the role of intent. As such, we propose the term "medical invalidation" be added to this construct and conceptualize medical gaslighting as occurring on a continuum. Within each facet of the relationship between system, provider and patient there are opportunities to prevent and recover from the occurrence of medical invalidation/medical gaslighting.

Background and objective: Eosinophilic gastrointestinal disorders (EGID) are a heterogeneous group of conditions, comprising eosinophilic esophagitis (EoE) and non-EoE EGID which have gained considerable research interest. There are likely to be differences in disease characteristics between populations with distinct dietary, environmental and cultural backgrounds. However much of our understanding on EGID have come from studies from Europe and North America. The aim of this review is to summarize the recent developments and updates in EGID focusing on disease phenotype specifically in Asian patients, and identify opportunities for future research pertaining to disease profile in the Asian population.

Methods: Original studies, systematic reviews, meta-analyses and review articles up to March 2024 were systematically searched on PubMed, with specific focus on newer studies published in the past 10 years. Case reports, conference abstracts and articles that were not published in the English language were excluded.

Key content and findings: Prevalence and incidence of EoE and non-EoE EGID have reportedly increased globally over time, but population-based studies are lacking in Asia. Based on heterogeneous data from a limited number of studies from Asia, there are features in epidemiology, clinical phenotype, and treatment response that may be appreciably distinct in Asian patients with EoE and non-EoE EGID, as compared to the Western patient population. Moreover, the efficacy of novel biologic therapies such as dupilumab in the Asian population has not been well-defined.

Conclusions: There is a lack of robust data on many basic aspects of EGID in Asia. There is a pressing need to bridge this gap by building research networks and collaborations across wider regions in Asia, to gather high-quality, multicenter data using standardized and uniform criteria and build a more accurate understanding of EGID in Asian patients.

Background and objective: Liver transplantation is the gold standard treatment for patients with hepatocellular carcinoma (HCC). Current allocation systems face a complex issue due to the imbalance between available organs and recipients. The prioritization of HCC patients remains controversial, leading to potential disparities in access to transplantation. Factors such as tumor size, alpha-fetoprotein (AFP) levels, Model of End-Stage Liver Disease (MELD) score, and response to locoregional therapy (LRT) contribute to determining waitlist dropout risk in HCC patients. Several statistical and machine learning (ML) models have been proposed to predict waitlist dropout, incorporating variables related to tumor and patient factors, underlying liver disease, and waitlist time. This narrative review aims to summarize the evidence regarding different prediction models of HCC waitlist dropout.

Methods: All published articles up to December 25, 2023, were considered. Articles not based on prediction models using conventional statistical methods or ML models were excluded.

Key content and findings: Factors such as tumor size, AFP levels, MELD score, and LRT response have been shown to impact disease progression in these patients, influencing waitlist dropout. Most articles in the literature are based on statistical models. Both ML and statistical models may offer promising results, but their application is currently limited. Several attempts have been made to find the best model to stratify the risk of waitlist dropout in HCC patients. However, to date, none of the explored models have been implemented. The allocation of HCC recipients is still based on supplementary scoring systems or geographical criteria.

Conclusions: Improving methodology and databases in future research is essential to obtain accurate and reliable models for clinicians. This is the only way to achieve real applicability.

Background and objective: Acute pancreatitis (AP) is a complex inflammatory disorder with potential systemic repercussions including sepsis, multiple organ failure and mortality. As such, the development of a prognostic tool to assess the complications and severity of AP is critical as urgent medical intervention is warranted in cases of severe AP to prevent complications and reduce mortality. Despite the plethora of scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) score available for prognostication of AP, they often require manual invasive blood testing and lack the ability to monitor the dynamic progression of the disease. To this end, heart rate variability (HRV), a measure of the autonomic nervous system's modulation on cardiac activity, has emerged as a promising tool. Having been previously posited as a tool to monitor the progression of cardiovascular and neurological conditions, the use of HRV as a risk stratification tool for AP is highly plausible. Therefore, this study aims to synthesize the existing literature regarding the usage of HRV as a tool for the prognostication and monitoring of AP.

Methods: A comprehensive literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus and Embase from inception to December 2023. Articles with mentions of AP and HRV were reviewed, and the complications of AP and its effects on HRV parameters were analyzed.

Key content and findings: Early studies on the use of HRV in AP have revealed the association of decreased HRV parameters with the development of subsequent complications, reflecting the suppression of sympathetic activity as a predominant driving force. In addition, HRV has also been shown to outperform other established scoring systems in predicting outcomes of the complications of AP, but more studies are needed to validate its accuracy.

Conclusions: Preliminary studies have shown that certain parameters of HRV may be used to predict the severity of AP and prognosticate outcomes. Although HRV monitoring demonstrates potential to be superior to existing scoring systems in AP, more research is needed to validate its use as a prognostic tool. Nevertheless, the prospective utility of HRV monitoring in predicting the onset and outcomes of AP and its complications remains optimistic.

Culture is a broadly defined term and patients' cultural identity may show up in the medical setting in visible and invisible ways. In this paper, we aim to discuss cultural considerations in gastrointestinal (GI) care. Our definition of "culture" reflects the commonly ascribed race and ethnicity and will also discuss other minority groups such as sexual and gender minorities (SGMs). We will review what is known about rates of GI conditions across various cultural groups, acknowledging that our data reflect inequity in representation. While the healthcare system has overall shown an increased awareness of the role that systemic and institutional racism plays in affecting patient care, this has not been widely studied in the context of GI though has a profound impact. Multiple factors affect the interaction between patients' cultural identities and engagement in and quality of GI care. Stigma related to cultural factors or cultural intersection has the capacity to shape if, when, and how medical care is approached, received and applied. Conditions and symptoms in GI are often complicated; health literacy (HL) is the ease with which patients can navigate getting from diagnosis to treatment and engage in self-management and also interacts with cultural context. Some aspects of a patient's experience, background and skill are imperceptible and require the healthcare provider to attend to treatment with humility, respect and self-reflection if they wish to effectively engage. We introduce the concept of cultural humility to GI and offer practical suggestions for those providing clinical care. We also call for future investment in a diverse healthcare delivery system and continued legislation to promote social equity.