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American Journal of Gastroenterology, The
Journal Prestige (SJR): 4.197
Citation Impact (citeScore): 5
Number of Followers: 188  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9270 - ISSN (Online) 1572-0241
Published by LWW Wolters Kluwer Homepage  [301 journals]
  • ACG Clinical Guidelines: Management of Benign Anorectal Disorders

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      Authors: Wald; Arnold; Bharucha, Adil E.; Limketkai, Berkeley; Malcolm, Allison; Remes-Troche, Jose M.; Whitehead, William E.; Zutshi, Massarat
      Abstract: imageBenign anorectal disorders of structure and function are common in clinical practice. These guidelines summarize the preferred approach to the evaluation and management of defecation disorders, proctalgia syndromes, hemorrhoids, anal fissures, and fecal incontinence in adults and represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was assessed using the Grading of Recommendations Assessment, Development and Evaluation process. When the evidence was not appropriate for Grading of Recommendations Assessment, Development and Evaluation, we used expert consensus to develop key concept statements. These guidelines should be considered as preferred but are not the only approaches to these conditions.
      PubDate: Thu, 07 Oct 2021 17:19:02 GMT-
       
  • Pain Experience in Pancreatitis: Strong Association of Genetic Risk Loci
           for Anxiety and PTSD in Patients With Severe, Constant, and
           Constant-Severe Pain

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      Authors: Dunbar; Ellyn K.; Greer, Phil J.; Amann, Stephen T.; Alkaade, Samer; Banks, Peter; Brand, Randall; Conwell, Darwin L.; Forsmark, Christopher E.; Gardner, Timothy B.; Guda, Nalini M.; Lewis, Michele D.; Machicado, Jorge D.; Muniraj, Thiruvengadam; Papachristou, Georgios I.; Romagnuolo, Joseph; Sandhu, Bimaljit S.; Sherman, Stuart; Slivka, Adam; Wilcox, C. Mel; Yadav, Dhiraj; Whitcomb, David C.; for the NAPS2 Consortium
      Abstract: imageINTRODUCTION: Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are progressive inflammatory syndromes with variable features. Pain is the primary feature that contributes to low physical and mental quality of life with a third of patients reporting severe pain. Pain experience is worsened by depression. Here, we tested the hypothesis that genetic risk of the psychiatric conditions of anxiety and post-traumatic stress disorder (PTSD) is associated with pain in CP and RAP + CP subjects.METHODS: The study cohort included phenotyped and genotyped RAP and CP patients from the North American Pancreatitis Study II of European Ancestry. Candidate genetic association studies were based on the absence of pain vs pain that is constant, constant-severe, or severe. Twenty-eight candidate genetic loci for anxiety and PTSD risk were identified in the literature and were the focus of this study.RESULTS: We identified 24 significant pain-associated single nucleotide polymorphisms within 13 loci across the 3 pain patterns in CP and RAP + CP (P < 0.002). Thirteen anxiety or PTSD genes were within these pain loci indicating nonrandom associations (P < 4.885 × 10−23). CTNND2 was associated with all pain categories and all pancreatitis etiologies. Implicated systems include neuronal signaling (HTR2A, DRD3, NPY, and BDNF), hypothalamic-pituitary-adrenal axis (NR3C1 and FKBP5), and cell-cell interaction (CTNND2 and THBS2).DISCUSSION: A component of constant and severe pain in patients with RAP and CP is associated with genetic predisposition to anxiety and PTSD. Identification of patients at risk eligible for trials of targeted treatment as a component of a multidisciplinary pain management strategy should be formally evaluated.
      PubDate: Wed, 06 Oct 2021 12:43:02 GMT-
       
  • Outcomes After TIPS for Ascites and Variceal Bleeding in a Contemporary
           Era—An ALTA Group Study

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      Authors: Boike; Justin Richard; Mazumder, Nikhilesh Ray; Kolli, Kanti Pallav; Ge, Jin; German, Margarita; Jest, Nathaniel; Morelli, Giuseppe; Spengler, Erin; Said, Adnan; Lai, Jennifer C.; Desai, Archita P.; Couri, Thomas; Paul, Sonali; Frenette, Catherine; Verna, Elizabeth C.; Rahim, Usman; Goel, Aparna; Gregory, Dyanna; Thornburg, Bartley; VanWagner, Lisa B.; on behalf of the Advancing Liver Therapeutic Approaches (ALTA Study Group
      Abstract: imageINTRODUCTION: Advances in transjugular intrahepatic portosystemic shunt (TIPS) technology have led to expanded use. We sought to characterize contemporary outcomes of TIPS by common indications.METHODS: This was a multicenter, retrospective cohort study using data from the Advancing Liver Therapeutic Approaches study group among adults with cirrhosis who underwent TIPS for ascites/hepatic hydrothorax (ascites/HH) or variceal bleeding (2010–2015). Adjusted competing risk analysis was used to assess post-TIPS mortality or liver transplantation (LT).RESULTS: Among 1,129 TIPS recipients, 58% received TIPS for ascites/HH and 42% for variceal bleeding. In patients who underwent TIPS for ascites/HH, the subdistribution hazard ratio (sHR) for death was similar across all Model for End-Stage Liver Disease Sodium (MELD-Na) categories with an increasing sHR with rising MELD-Na. In patients with TIPS for variceal bleeding, MELD-Na ≥20 was associated with increased hazard for death, whereas MELD-Na ≥22 was associated with LT. In a multivariate analysis, serum creatinine was most significantly associated with death (sHR 1.2 per mg/dL, 95% confidence interval [CI] 1.04–1.4 and 1.37, 95% CI 1.08–1.73 in ascites/HH and variceal bleeding, respectively). Bilirubin and international normalized ratio were most associated with LT in ascites/HH (sHR 1.23, 95% CI 1.15–1.3; sHR 2.99, 95% CI 1.76–5.1, respectively) compared with only bilirubin in variceal bleeding (sHR 1.06, 95% CI 1.00–1.13).DISCUSSION: MELD-Na has differing relationships with patient outcomes dependent on TIPS indication. These data provide new insights into contemporary predictors of outcomes after TIPS.
      PubDate: Tue, 05 Oct 2021 12:05:57 GMT-
       
  • A Comprehensive Literature Review and Expert Consensus Statement on
           Therapeutic Drug Monitoring of Biologics in Inflammatory Bowel Disease

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      Authors: Cheifetz; Adam S.; Abreu, Maria T.; Afif, Waqqas; Cross, Raymond K.; Dubinsky, Marla C.; Loftus, Edward V. Jr; Osterman, Mark T.; Saroufim, Ariana; Siegel, Corey A.; Yarur, Andres J.; Melmed, Gil Y.; Papamichael, Konstantinos
      Abstract: imageTherapeutic drug monitoring (TDM) of biologics is a rapidly evolving field. We aimed to provide a consensus statement regarding the clinical utility of TDM for biologics in inflammatory bowel disease (IBD). A modified Delphi method was applied to develop consensus statements. A comprehensive literature review was performed regarding TDM of biologic therapies in IBD, and 45 statements were subsequently formulated on the potential application of TDM in IBD. The statements, along with literature, were then presented to a panel of 10 gastroenterologists with expertise in IBD and TDM who anonymously rated them on a scale of 1–10 (1 = strongly disagree and 10 = strongly agree). An expert consensus development meeting was held virtually to review, discuss, refine, and reformulate statements that did not meet criteria for agreement or that were ambiguous. During the meeting, additional statements were proposed. Panelists then confidentially revoted, and statements rated ≥7 by 80% or more of the participants were accepted. During the virtual meeting, 8 statements were reworded, 7 new statements were proposed, and 19 statements were rerated. Consensus was finally reached in 48/49 statements. The panel agreed that reactive TDM should be used for all biologics for both primary nonresponse and secondary loss of response. It was recommended that treatment discontinuation should not be considered for infliximab or adalimumab until a drug concentration of at least 10–15 μg/mL was achieved. Consensus was also achieved regarding the utility of proactive TDM for anti–tumor necrosis factor therapy. It was recommended to perform proactive TDM after induction and at least once during maintenance. Consensus was achieved in most cases regarding the utility of TDM of biologics in IBD, specifically for reactive and proactive TDM of anti–tumor necrosis factors.
      PubDate: Tue, 05 Oct 2021 11:49:49 GMT-
       
  • The “Changing Landscapes” Special Edition

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      Authors: Lacy; Brian E.; Spiegel, Brennan
      Abstract: No abstract available
      PubDate: Tue, 05 Oct 2021 10:26:16 GMT-
       
  • “Sickeningly Sweet”…. High-Fructose Corn Syrup-Caveat
           Emptor!

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      Authors: Johnson; David A.
      Abstract: imageNo abstract available
      PubDate: Tue, 05 Oct 2021 10:22:04 GMT-
       
 
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