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American Journal of Gastroenterology, The
Journal Prestige (SJR): 4.197
Citation Impact (citeScore): 5
Number of Followers: 161  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9270 - ISSN (Online) 1572-0241
Published by LWW Wolters Kluwer Homepage  [310 journals]
  • Intake of Dietary Fiber, Fruits, and Vegetables and Risk of Diverticulitis
    • Authors: Ma; Wenjie; Nguyen, Long H.; Song, Mingyang; Jovani, Manol; Liu, Po-Hong; Cao, Yin; Tam, Idy; Wu, Kana; Giovannucci, Edward L.; Strate, Lisa L.; Chan, Andrew T.
      Abstract: imageOBJECTIVES: Although low fiber intake has been considered a risk factor for diverticulitis, prospective evidence is limited in women despite having a disproportionate burden of disease, with little known about variation in the protective effects according to food sources. We assessed the associations of intakes of fiber and major food sources of fiber including fruits and vegetables with risk of diverticulitis in a large cohort of women.METHODS: We followed 50,019 women in the Nurses' Health Study (1990–2014) who were aged 43–70 years and free of diverticulitis, cancer, and inflammatory bowel disease at baseline. Incident diverticulitis was identified through self-report with validity confirmed by review of medical records.RESULTS: We documented 4,343 incident cases of diverticulitis, encompassing 1,106,402 person-years of follow-up. Compared with participants in the lowest quintile, the multivariable hazard ratio of diverticulitis in the highest quintile of total fiber intake was 0.86 (95% confidence interval: 0.78–0.95; P-trend = 0.002). Fiber from fruits and cereals, but not vegetables, was associated with a decreased risk of diverticulitis. Furthermore, intake of total whole fruit intake and specific fruits such as apples/pears and prunes were associated with reduced risk of diverticulitis with a multivariable hazard ratio for diverticulitis of 0.95 (0.92–0.98; P-trend < 0.001) for every serving increase of total whole fruit intake per day.DISCUSSION: Higher intake of dietary fiber and fiber from different food sources, except for vegetable fiber, are associated with a lower risk of diverticulitis in women. A greater intake of whole fruit is also associated with reduced risk.
      PubDate: Mon, 08 Jul 2019 08:26:02 GMT-
  • Loss of Life Expectancy by 10 Years or More From Elevated Aspartate
           Aminotransferase: Finding Aspartate Aminotransferase a Better Mortality
           Predictor for All-Cause and Liver-Related than Alanine Aminotransferase
    • Authors: Xie; Kunlin; Chen, Chien-Hua; Tsai, Shan-Pou; Lu, Po-Jung; Wu, Hong; Zeng, Yong; Ye, Yuanqing; Tu, Huakang; Wen, Christopher; Huang, Maosheng; Zhang, Yajie; Lee, Jun-Han; Tsai, Min-Kuang; Wen, Chi-Pang; Wu, Xifeng
      Abstract: imageOBJECTIVES: Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) are 2 commonly ordered liver function tests, and ALT has long been considered more liver-specific than AST. Between the 2, the one which is better in predicting liver or non–liver-related mortality remains unsettled.METHODS: The cohort, 416,122 adults, came from a self-paying comprehensive health surveillance program during 1994–2008 and was followed up till 2008. Mortality came from National Death Index, with 10,412 deaths identified. Hazard ratios (HRs), computed by Cox model, and life expectancy, by life table method, were presented for 5 levels of AST and ALT with elevated AST or ALT defined as ≥40 IU/L. Liver disease included liver cancer and other liver conditions.RESULTS: There were 3 times more elevated ALT (15.4%) than AST (5.7%). However, those with elevated AST had higher mortality for all-cause (HR = 2.44), for liver disease (HR = 27.2), and for liver cancer (HR = 47.6) than its ALT counterparts (HR = 1.69, 10.8, and 20.2, respectively). Elevated AST also lost more years of life expectancy (10.2) than those lost by ALT (5.2) and larger than most common risks. Elevated AST had increased mortality from all cancers (HR = 3.57), stroke (HR = 1.36), respiratory diseases (HR = 1.34), and injuries (HR = 1.82), other than just liver disease. All-cause mortality remained significantly increased, when high risk groups were excluded, such as frequent drinkers, hepatitis carriers, those died from nonmedical conditions, those died in the first 3 years, or advanced fibrosis index based on 4 factors or aspartate transaminase-to-platelet ratio index. Results were consistent between those returned for second visits and those analyzed in initial visits.DISCUSSION: Those with elevated AST (≥40 IU/L) had life expectancy cut short by 10.2 years, doubled the number of years lost with elevated ALT. For all-cause and for liver-related mortality, AST was an important predictor, better than ALT.
      PubDate: Fri, 17 May 2019 11:20:00 GMT-
  • Efficacy and Safety of Eluxadoline in Patients With Irritable Bowel
           Syndrome With Diarrhea Who Report Inadequate Symptom Control With
           Loperamide: RELIEF Phase 4 Study
    • Authors: Brenner; Darren M.; Sayuk, Gregory S.; Gutman, Catherine R.; Jo, Esther; Elmes, Steven J. R.; Liu, Louis W. C.; Cash, Brooks D.
      Abstract: imageOBJECTIVES: Irritable bowel syndrome with diarrhea (IBS-D) is a functional gastrointestinal disorder with limited effective treatment options. We evaluated the efficacy and safety of eluxadoline in patients with IBS-D who reported inadequate symptom control with prior loperamide.METHODS: Three hundred forty-six adults with IBS-D (Rome III criteria) were randomly assigned to placebo or eluxadoline 100 mg twice daily for 12 weeks. Patients recorded daily IBS-D symptoms, including worst abdominal pain (WAP) and stool consistency (through Bristol Stool Scale). The primary endpoint was proportion of composite responders, defined as patients who met daily composite response criteria (≥40% WAP improvement and
      PubDate: Thu, 16 May 2019 23:34:01 GMT-
  • Opioid-Induced Esophageal Dysfunction: Differential Effects of Type and
    • Authors: Snyder; Diana L.; Crowell, Michael D.; Horsley-Silva, Jennifer; Ravi, Karthik; Lacy, Brian E.; Vela, Marcelo F.
      Abstract: imageOBJECTIVE: Data regarding opioid effects on esophageal function are limited. We previously demonstrated an association between chronic opioid use and esophageal motor dysfunction characterized by esophagogastric junction outflow obstruction, distal esophageal spasm, achalasia type III, and possibly Jackhammer esophagus. Our aim was to characterize the influence of different opioids and doses on esophageal dysfunction.METHODS: Retrospective review of 225 patients prescribed oxycodone, hydrocodone, or tramadol for>3 months, who completed high-resolution manometry from 2012 to 2017. Demographic and manometric data were extracted from a prospectively maintained motility database. Frequency of opioid-induced esophageal dysfunction (OIED, defined as distal esophageal spasm, esophagogastric junction outflow obstruction, achalasia type III, or Jackhammer esophagus on high-resolution manometry, was compared among different opioids. The total 24-hour opioid doses for oxycodone, hydrocodone, and tramadol were converted to a morphine equivalent for dose effect analysis.RESULTS: OIED was present in 24% (55 of 225) of opioid users. OIED was significantly more prevalent with oxycodone or hydrocodone use compared with tramadol (31% vs 28% vs 12%, P = 0.0162), and for oxycodone alone vs oxycodone with acetaminophen (43% vs 21%, P = 0.0482). There was no difference in OIED for patients taking hydrocodone alone vs hydrocodone with acetaminophen. Patients with OIED were taking a higher median 24-hour opioid dose than those without OIED (45 vs 30 mg, P = 0.058).DISCUSSION: OIED is more prevalent in patients taking oxycodone or hydrocodone compared with tramadol. There is greater likelihood of OIED developing with higher doses. Reducing the opioid dose or changing to tramadol may reduce OIED in opioid users.
      PubDate: Thu, 16 May 2019 23:31:49 GMT-
  • Esophagogastric Junction Distensibility on Functional Lumen Imaging Probe
           Topography Predicts Treatment Response in Achalasia—Anatomy Matters!
    • Authors: Jain; Anand S.; Carlson, Dustin A.; Triggs, Joseph; Tye, Michael; Kou, Wenjun; Campagna, Ryan; Hungness, Eric; Kim, Donald; Kahrilas, Peter J.; Pandolfino, John E.
      Abstract: imageINTRODUCTION: To compare the utility of the distensibility index (DI) on functional lumen imaging probe (FLIP) topography to other esophagogastric junction (EGJ) metrics in assessing treatment response in achalasia in the context of esophageal anatomy.METHODS: We prospectively evaluated 79 patients (at ages 17–81 years; 47% female patients) with achalasia during follow-up after pneumatic dilation, Heller myotomy, or per-oral endoscopic myotomy with timed barium esophagram, high-resolution impedance manometry, and FLIP. Anatomic deformities were identified based on consensus expert opinion. Patients were classified based on anatomy and EGJ opening to determine the association with radiographic outcome and Eckardt score (ES).RESULTS: Twenty-seven patients (34.1%) had an anatomic deformity—10 pseudodiverticula at myotomy, 7 epiphrenic diverticula, 5 sigmoid, and 5 sinktrap. A 5-minute column area of>5 cm2 was best associated with an ES of>3, with a sensitivity of 84% (P = 0.0013). Area under the curve for EGJ metrics in association with retention was as follows: DI, 0.90; maximal EGJ diameter, 0.76; integrated relaxation pressure, 0.64; and basal esophagogastric junction pressure, 0.53. Only FLIP metrics were associated with retention given normal anatomy (DI 2.4 vs 5.2 mm2/mm Hg and maximal EGJ diameter 13.1 vs 16.6 mm in patients with and without retention, respectively; P values < 0.0001 and 0.002). Using a DI cutoff of 3 (P = 0.02) had a low DI and/or anatomic deformity. With normal anatomy, 21 of 22 patients with retention had a low or borderline low DI.DISCUSSION: The FLIP DI is most useful metric for assessing the effect of achalasia treatment on EGJ opening. However, abnormal anatomy is an important mediator of outcome and treatment success will be modulated by anatomic defects that impede bolus emptying.
      PubDate: Thu, 16 May 2019 23:29:56 GMT-
  • Gastrointestinal Manifestations of Rheumatological Diseases
    • Authors: Kröner; Paul T.; Tolaymat, Omar A.; Bowman, Andrew W.; Abril, Andy; Lacy, Brian E.
      Abstract: imageRheumatological diseases (RDs) represent a diverse group of diseases that are inherited or related to environmental factors. RDs frequently affect the gastrointestinal (GI) tract, and gastroenterologists are often asked to evaluate patients with symptoms thought to represent an underlying or coexisting RD. GI manifestations of RDs vary based on the organ involved as well as the extent and duration of involvement. Although most manifestations of RD are nonspecific and not life-threatening, the chronicity and severity of symptoms can be debilitating and may lead to serious injury. This narrative review discusses the most common RD encountered by gastroenterologists: systemic lupus erythematosus, systemic sclerosis (scleroderma), dermatomyositis/polymyositis, rheumatoid arthritis, Sjögren syndrome, overlap syndromes, mixed connective tissue disease, Ehlers-Danlos syndromes, and other vasculitides. Each section begins with a brief overview of the condition, followed by a discussion of the etiopathophysiology, physical examination findings, GI manifestations, diagnostic tools (i.e., serologic, imaging, endoscopic, and functional), and treatment options.
      PubDate: Thu, 16 May 2019 23:29:16 GMT-
  • Endoscopic Bariatric Therapy: A Guide to the Intragastric Balloon
    • Authors: Bazerbachi; Fateh; Vargas, Eric J.; Abu Dayyeh, Barham K.
      Abstract: imageIntragastric balloons (IGBs) are the most widely available endoscopic bariatric therapy for class I and II obesity in the United States. Although simple in application and reversible by nature, these devices may help patients initiate the important first steps in weight loss maintenance, provided that parallel efforts are in motion to prevent weight recidivism. Too often, therapeutic nihilism stems from unrealistic expectations of a given therapy. In the case of IGBs, this sentiment may occur when these interventions are applied in a vacuum and not within the purview of a multidisciplinary program that actively involves dieticians, endocrinologists, gastroenterologists, and surgeons. There is a clear and present need to apply different tactics in the remissive strategy to control the obesity pandemic, more so in a struggling landscape of an ever-widening gap in bridging interventions. With such demand, the IGB is an available tool that could be helpful when correctly implemented. In this exposition, we summarize the current state of IGBs available worldwide, discuss their mechanism of action, relay evidence for their short- and long-term efficacy, address safety profile concerns, and suggest procedural considerations in the real-world quotidian application.
      PubDate: Thu, 16 May 2019 23:28:44 GMT-
  • Renal Dysfunction in Cirrhotic Patients
    • Authors: Carrion; Andres F.; Martin, Paul
      Abstract: imageNo abstract available
      PubDate: Thu, 16 May 2019 23:28:18 GMT-
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