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American Journal of Gastroenterology, The
Journal Prestige (SJR): 4.197
Citation Impact (citeScore): 5
Number of Followers: 165  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9270 - ISSN (Online) 1572-0241
Published by LWW Wolters Kluwer Homepage  [299 journals]
  • How I Approach Colonoscopy in Anatomically Difficult Colons
    • Authors: Rex; Douglas K.
      Abstract: imageNo abstract available
      PubDate: Wed, 06 Nov 2019 14:27:18 GMT-
  • Efficacy of Tenapanor in Treating Patients With Irritable Bowel Syndrome
           With Constipation: A 12-Week, Placebo-Controlled Phase 3 Trial (T3MPO-1)
    • Authors: Chey; William D.; Lembo, Anthony J.; Rosenbaum, David P.
      Abstract: imageOBJECTIVES: Tenapanor is a first-in-class, minimally absorbed, small-molecule inhibitor of the gastrointestinal sodium/hydrogen exchanger isoform 3. This phase 3 trial assessed the efficacy and safety of tenapanor 50 mg b.i.d. for the treatment of patients with constipation-predominant irritable bowel syndrome (IBS-C).METHODS: In this phase 3, double-blind study ( identifier NCT02621892), patients with IBS-C were randomized to tenapanor 50 mg b.i.d. or placebo b.i.d. for 12 weeks followed by a 4-week randomized withdrawal period. The primary efficacy variable was the proportion of patients who reported a reduction in average weekly worst abdominal pain of ≥30.0% and an increase of ≥1 complete spontaneous bowel movement from baseline, both in the same week, for ≥6 weeks of the 12-week treatment period.RESULTS: Of the 629 randomized patients with IBS-C, 606 (96.3%) were included in the intention-to-treat analysis set (tenapanor: n = 307; placebo: n = 299) and 533 (84.7%) completed the 12-week treatment period. In the intention-to-treat analysis set (mean age 45 years, 81.4% women), a significantly greater proportion of patients treated with tenapanor met the primary endpoint than patients treated with placebo (27.0% vs 18.7%, P = 0.020). Abdominal symptoms and global symptoms of IBS also improved with tenapanor (P < 0.05 vs placebo). Diarrhea was the most commonly reported adverse event, resulting in study drug discontinuation in 6.5% and 0.7% of patients receiving tenapanor and placebo, respectively, during the 12-week treatment period.DISCUSSION: Tenapanor 50 mg b.i.d. improved IBS-C symptoms and was generally well tolerated, offering a potential new treatment option for patients with IBS-C.
      PubDate: Mon, 08 Jul 2019 08:26:02 GMT-
  • Ursodeoxycholic Acid Treatment Preferentially Improves Overall Survival
           Among African Americans With Primary Biliary Cholangitis
    • Authors: Gordon; Stuart C.; Wu, Kuan-Han Hank; Lindor, Keith; Bowlus, Christopher L.; Rodriguez, Carla V.; Anderson, Heather; Boscarino, Joseph A.; Trudeau, Sheri; Rupp, Loralee B.; Haller, Irina V.; Romanelli, Robert J.; VanWormer, Jeffrey J.; Schmidt, Mark A.; Daida, Yihe G.; Sahota, Amandeep; Vincent, Jennifer; Zhang, Talan; Li, Jia; Lu, Mei; for the FOLD Investigators
      Abstract: imageBACKGROUND: We used data from the Fibrotic Liver Disease Consortium to evaluate the impact of ursodeoxycholic acid (UDCA) treatment across race/ethnicity, gender, and clinical status among patients with primary biliary cholangitis.METHODS: Data were collected from “index date” (baseline) through December 31, 2016. Inverse Probability of Treatment Weighting was used to adjust for UDCA treatment selection bias. Cox regression, focusing on UDCA-by-risk factor interactions, was used to assess the association between treatment and mortality and liver transplant/death.RESULTS: Among 4,238 patients with primary biliary cholangitis (13% men; 8% African American, 7% Asian American/American Indian/Pacific Island [ASINPI]; 21% Hispanic), 78% had ever received UDCA. The final multivariable model for mortality retained age, household income, comorbidity score, total bilirubin, albumin, alkaline phosphatase, and interactions of UDCA with race, gender, and aspartate aminotransferase/alanine aminotransferase ≥1.1. Among untreated patients, African Americans and ASINPIs had higher mortality than whites (adjusted hazard ratio [aHR] = 1.34, 95% confidence interval [CI] 1.08–1.67 and aHR = 1.40, 95% CI 1.11–1.76, respectively). Among treated patients, this relationship was reversed (aHR = 0.67, 95% CI 0.51–0.86 and aHR = 0.88, 95% CI 0.67–1.16). Patterns were similar for liver transplant/death. UDCA reduced the risk of liver transplant/death in all patient groups and mortality across all groups except white women with aspartate aminotransferase/alanine aminotransferase ≥1.1. As compared to patients with low-normal bilirubin at baseline (≤0.4 mg/dL), those with high-normal (1.0> 0.7) and mid-normal bilirubin (0.7> 0.4) had significantly higher liver transplant/death and all-cause mortality.DISCUSSION: African American and ASINPI patients who did not receive UDCA had significantly higher mortality than white patients. Among African Americans, treatment was associated with significantly lower mortality. Regardless of UDCA treatment, higher baseline bilirubin, even within the normal range, was associated with increased mortality and liver transplant/death compared with low-normal levels.
      PubDate: Fri, 17 May 2019 11:20:00 GMT-
  • Checkpoint Inhibitor–Induced Colitis
    • Authors: Bellaguarda; Emanuelle; Hanauer, Stephen
      Abstract: imageImmune checkpoint inhibitors have revolutionized treatment and overall survival for several different types of cancer. Antibodies to cytotoxic T-lymphocyte-associated protein 4 and to programmed cell death protein 1 and its ligand enhance cytotoxic T-cell survival, thus augmenting antitumor action and consequently inducing immune-related adverse events, of which the most relevant is diarrhea and colitis. This review compiles recent data on pathophysiology, clinical manifestations, and treatment of immune-mediated colitis (IMC). The pathogenesis of IMC is not completely understood, but recent studies have focused on the role of regulatory T cells and interactions with the gut microbiome. While sharing similarities with inflammatory bowel disease, IMC is considered a distinct form of colitis with acute onset and rapid progression leading to potential complications including bowel perforation and death. Prompt recognition and management of IMC is imperative for optimal outcomes. Although prospective clinical trials are lacking to guide therapy, recent guidelines recommend early endoscopic evaluation to establish the diagnosis and prompt initiation of corticosteroids. Response to first-line therapy should be assessed early to determine the need of escalation to biologic agents. With treatment, most patients will experience full resolution of symptoms, and subsequent rechallenge with anti–programmed cell death protein 1 or anti–programmed death-ligand 1 inhibitors can be considered.
      PubDate: Thu, 16 May 2019 23:31:49 GMT-
  • Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: A
           Systematic Review and Meta-Analysis of Case-Control Studies
    • Authors: Shah; Ayesha; Talley, Nicholas J.; Jones, Mike; Kendall, Bradley J.; Koloski, Natasha; Walker, Marjorie M.; Morrison, Mark; Holtmann, Gerald J.
      Abstract: imageINTRODUCTION: We conducted a systematic review and meta-analysis to compare the prevalence of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS) and controls.METHODS: Electronic databases were searched up to December 2018 for studies reporting SIBO prevalence in patients with IBS. Prevalence rates, odds ratios (ORs), and 95% confidence intervals (CIs) of SIBO in patients with IBS and controls were calculated.RESULTS: We included 25 studies with 3,192 patients with IBS and 3,320 controls. SIBO prevalence in patients with IBS was significantly increased compared with controls (OR = 3.7, 95% CI 2.3–6.0). In studies using only healthy controls, the OR for SIBO in patients with IBS was 4.9 (95% CI 2.8–8.6). With breath testing, SIBO prevalence in patients with IBS was 35.5% (95% CI 33.6–37.4) vs 29.7% (95% CI 27.6–31.8) in controls. Culture-based studies yielded a SIBO prevalence of 13.9% (95% CI 11.5–16.4) in patients with IBS and 5.0% (95% CI 3.9–6.2) in controls with a cutoff value of 105 colony-forming units per milliliter vs 33.5% (95% CI 30.1–36.9) in patients with IBS and 8.2% (95% CI 6.8–9.6) in controls with a cutoff value of 103 colony-forming unit per milliliter, respectively. SIBO prevalence diagnosed by lactulose breath test is much greater in both patients with IBS (3.6-fold) and controls (7.6-fold) compared with glucose breath test. Similar difference is seen when lactulose breath test is compared with culture methods. OR for SIBO in patients with IBS-diarrhea compared with IBS-constipation was 1.86 (95% CI 1.83–2.8). Methane-positive breath tests were significantly more prevalent in IBS-constipation compared with IBS-diarrhea (OR = 2.3, 95% CI 1.2–4.2). In patients with IBS, proton pump inhibitor was not associated with SIBO (OR = 0.8, 95% CI 0.5–1.5, P = 0.55).DISCUSSION: This systematic review and meta-analysis suggests a link between IBS and SIBO. However, the overall quality of the evidence is low. This is mainly due to substantial “clinical heterogeneity” due to lack of uniform selection criteria for cases and controls and limited sensitivity and specificity of the available diagnostic tests.
      PubDate: Thu, 16 May 2019 23:29:56 GMT-
  • Histological Remission in Ulcerative Colitis: Under the Microscope Is the
    • Authors: Chateau; Thomas; Feakins, Roger; Marchal-Bressenot, Aude; Magro, Fernando; Danese, Silvio; Peyrin-Biroulet, Laurent
      Abstract: imageIn recent years, the therapeutic goals in ulcerative colitis (UC) have become increasingly stringent. Histological features seem to be a reliable predictor of disease outcomes after therapy, and histological remission (HR) is the new frontier in the treatment of UC. Here, we first provide a historical perspective before reviewing indexes in the era of biologics; histology as a treatment goal in UC trials; the poor correlation between symptoms, endoscopy, and histology; and the impact of histology on disease outcomes. HR seems to be a promising end point for the treatment of UC because it is typically associated with better outcomes. Two new validated indexes are available to assess histology more accurately in trials, and they may also be applicable to clinical practice. Additional interventional trials are now necessary to establish definitions of HR and its potential for disease modification.
      PubDate: Thu, 16 May 2019 23:29:16 GMT-
  • ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth
    • Authors: Pimentel; Mark; Saad, Richard J.; Long, Millie D.; Rao, Satish S. C.
      Abstract: imageSmall intestinal bacterial overgrowth is defined as the presence of excessive numbers of bacteria in the small bowel, causing gastrointestinal symptoms. This guideline statement evaluates criteria for diagnosis, defines the optimal methods for diagnostic testing, and summarizes treatment options for small intestinal bacterial overgrowth. This guideline provides an evidence-based evaluation of the literature through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. In instances where the available evidence was not appropriate for a formal GRADE recommendation, key concepts were developed using expert consensus.
      PubDate: Thu, 16 May 2019 23:28:18 GMT-
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