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Building a Successful and Sustainable Academic Career in Gastroenterology
Sprung, Brandon; Marino, Danielle; Yoon, Sonia; Kaul, Vivek
doi : 10.14309/ajg.0000000000000964
December 2020 - Volume 115 - Issue 12 - p 1927-1930
Starting a new job as an academic gastroenterologist can be very exciting and anxiety provoking at the same time. This is particularly true when the junior faculty member is faced with the unique challenges of practicing medicine in today's world while still attempting to maintain work-life balance and avoid professional burnout. In discussions with several junior colleagues in the specialty over the years, it became clear that there is a relative lack of structured guidance in the literature regarding helping them navigate these turbulent waters in their early careers and setting them up for professional success in the long term.
Environmental Impact of Endoscopy: “Scope” of the Problem
Gayam, Swapna
doi : 10.14309/ajg.0000000000001005
December 2020 - Volume 115 - Issue 12 - p 1931-1932
Pancreaticoportal Fistula Causing Hepatic Necrosis Treated With Pancreatic Duct Stenting
Perry, Lauren M.; Pan, Dana; Loehfelm, Thomas W.; Tejaswi, Sooraj; Gholami, Sepideh
doi : 10.14309/ajg.0000000000000554
December 2020 - Volume 115 - Issue 12 - p 1933
Diffuse Colonic Polyposis: Extraordinary Spectrum of Disease
Bierle, Lindsey; Mouchli, Mohamad; Grider, Douglas J.
doi : 10.14309/ajg.0000000000000566
December 2020 - Volume 115 - Issue 12 - p 1934
Transjugular Intrahepatic Portosystemic Shunt for a Challenging Pregnancy
Kapila, Nikhil; Dorsey, Ying Claire; Shah, Jigesh; King, Lindsay; Ravindra, Kadiyala; Knechtle, Stuart; Patel, Yuval
doi : 10.14309/ajg.0000000000000602
December 2020 - Volume 115 - Issue 12 - p 1935
Novel Negative Pressure Box for Aerosol Protection During Upper Endoscopy: A Brief Report on Safety and Barrier Performance
Benmassaoud, Amine; Barkun, Alan; Gonzalez, Anne V.; Beaudoin, Stephane; Bessissow, Ali; Bitton, Alain; Martel, Myriam; White, Sheryl; Chen, Yen-I
doi : 10.14309/ajg.0000000000000840
December 2020 - Volume 115 - Issue 12 - p 1936
Continuing Medical Education Questions: December 2020
Henderson, Phillip K.
doi : 10.14309/ajg.0000000000001074
December 2020 - Volume 115 - Issue 12 - p 1937-1938
Article Title: Integrating genomics into clinical practice in HCC: The challenges ahead
Continuing Medical Education Questions: December 2020
Moawad, Fouad J.
doi : 10.14309/ajg.0000000000001073
December 2020 - Volume 115 - Issue 12 - p 1939
Article Title: The Role of Symptom Association Analysis in Gastroesophageal Reflux Testing
Smoking and Colorectal Cancer Risk, Overall and by Molecular Subtypes: A Meta-Analysis
Botteri, Edoardo; Borroni, Elisa; Sloan, Erica K.; Bagnardi, Vincenzo; Bosetti, Cristina; Peveri, Giulia; Santucci, Claudia; Specchia, Claudia; van den Brandt, Piet; Gallus, Silvano; Lugo, Alessandra
doi : 10.14309/ajg.0000000000000803
December 2020 - Volume 115 - Issue 12 - p 1940-1949
The aim of this study was to provide the most comprehensive and up-to-date evidence on the association between cigarette smoking and colorectal cancer (CRC) risk.
The Role of Symptom Association Analysis in Gastroesophageal Reflux Testing
Kamal, Afrin N.; Clarke, John O.; Oors, Jac M.; Smout, André J.; Bredenoord, Albert J.
doi : 10.14309/ajg.0000000000000754
December 2020 - Volume 115 - Issue 12 - p 1950-1959
Gastroesophageal reflux disease is characterized by the reflux of gastric contents into the esophagus with an estimated worldwide prevalence of 8%–33%. The current paradigm in gastroesophageal reflux disease diagnosis relies on recognition of symptoms and/or the presence of mucosal disease at the time of esophagogastroduodenoscopy.
Integrating Genomics Into Clinical Practice in Hepatocellular Carcinoma: The Challenges Ahead
Pillai, Anjana; Ahn, Joseph; Kulik, Laura
doi : 10.14309/ajg.0000000000000843
December 2020 - Volume 115 - Issue 12 - p 1960-1969
The incidence and mortality related to hepatocellular carcinoma (HCC) continue to increase in the United States, with most patients presenting at advanced stages where curative therapy and long-term survival is unlikely. Fortunately, significant progress has been made in identifying the landscape of HCC mutations due to advances in whole genome expression profiling. Drug development has also evolved in recent years with multiple first- and second-line systemic chemotherapy agents approved for HCC for the first time in over a decade. However, despite advances in molecular profiling, mutations that were identified at the highest frequency were not amenable to drug development, and curative therapy for advanced HCC remains elusive. This review focuses on the current understanding of HCC genomics and the limitations of translating the current HCC molecular profiling into clinical practice and examines the effectiveness and benefits of approved systemic therapies for advanced HCC.
Compensated Cirrhosis and 20 mm Hg: A Point of No Return?
Reverter, Enric; Ott, Peter
doi : 10.14309/ajg.0000000000000770
December 2020 - Volume 115 - Issue 12 - p 1970-1971
This editorial comments on the findings from the study by Jindal et al. recently published in The American Journal of Gastroenterology. Weaknesses and strengths of the study are presented, and potential therapeutic strategies for compensated cirrhotic patients with an HVPG ?20 mm Hg are proposed.
A Real-World Promising Result of Endoscopic Full-Thickness Resection: It's Time for Endoscopic Full-Thickness Resection to Be Widely Used
Chu, Yuan; Xu, Meidong
doi : 10.14309/ajg.0000000000001028
December 2020 - Volume 115 - Issue 12 - p 1972-1973
During the past 2 decades, we have witnessed the rise and prevalence of endoscopic resection. Endoscopic full-thickness resection (EFTR) is a key technique in dealing with some difficult gastrointestinal lesions that are not eligible for conventional endoscopic mucosal resection or endoscopic submucosal dissection. However, EFTR is demanding with respect to endoscopic resection experience and defects closure skills, which limits its widespread use in clinical practice. Full-thickness resection device simplifies the operation and makes EFTR easier to master, even in low-level medical institutions. As the high-level evidence accumulates and technique improves, it's time for EFTR to be accepted and used by more and more endoscopists.
Making the Diagnosis of Bile Acid Diarrhea
Walters, Julian R.F.
doi : 10.14309/ajg.0000000000000962
December 2020 - Volume 115 - Issue 12 - p 1974-1975
Bile acid diarrhea is a frequent, treatable cause of functional diarrhea but is difficult to diagnose when the nuclear medicine 75seleno-taurohomocholic acid test is unavailable. An alternative approach is testing blood for the bile acid precursor, 7?-OH-4-cholesten-3-one, which is raised with increased bile acid synthesis. A recent article has defined measurements that have high negative and positive predictive values, further exploring how they can be improved by incorporating measures such as age, stool number, fibroblast growth factor 19, or plasma sulfated bile acids. Other articles have looked at the percentage of fecal primary bile acids. Together, they promise better use of diagnostic biomarkers for this condition.
Positive Effect of Bimodal Release Ondansetron in Irritable Bowel Syndrome With Diarrhea: Relevance of Low-Grade Inflammation?
Melchior, Chloé; Simrén, Magnus
doi : 10.14309/ajg.0000000000001022
December 2020 - Volume 115 - Issue 12 - p 1976-1978
There is a clear unmet need for new treatments in irritable bowel syndrome with diarrhea (IBS-D). Ondansetron, an old 5-hydroxy-tryptamine3 antagonist, used for chemotherapy-induced nausea and vomiting and with favorable side effect profile, has shown promising results in previous trials. In this issue, efficacy with a novel bimodal release ondansetron formulation was presented in IBS-D. The bimodal release ondansetron improved stool consistency, presumably by slowing transit time, and tended to improve other IBS symptoms as well. The authors proposed C-reactive protein levels as a tool to select responders because a better response was seen in patients with slightly elevated C-reactive protein levels. Future large-scale studies will determine the role of bimodal release ondansetron in IBS-D with and without low-grade inflammation.
An Evolutionary Medicine Perspective on Treatment of Pediatric Functional Abdominal Pain
Leontiadis, Grigorios I.; Longstreth, George F.
doi : 10.14309/ajg.0000000000001024
December 2020 - Volume 115 - Issue 12 - p 1979-1980
In a recent issue, Kovacic et al. analyze data from a randomized sham-controlled trial and show that pretreatment vagal efficiency, an index related to respiratory sinus arrhythmia, is a predictor of pain improvement in adolescents with functional abdominal pain when treated with auricular percutaneous electrical nerve field stimulation. The underlying premise is the polyvagal hypothesis, an explanatory framework for the evolution of the mammalian autonomic nervous system, which proposes that functional gastrointestinal disorders can result from a chronic maladaptive state of autonomic neural control mechanisms after traumatic stress. This is an opportunity for us to stimulate physicians’ interest in evolutionary medicine.
Contraction Reserve With Ineffective Esophageal Motility on Esophageal High-Resolution Manometry is Associated With Lower Acid Exposure Times Compared With Absent Contraction Reserve
Quader, Farhan; Rogers, Benjamin; Sievers, Tyson; Mumtaz, Shaham; Lee, Mindy; Lu, Thomas; Gyawali, C. Prakash
doi : 10.14309/ajg.0000000000000811
December 2020 - Volume 115 - Issue 12 - p 1981-1988
Ineffective esophageal motility (IEM) is a minor motor disorder with potential reflux implications. Contraction reserve, manifested as augmentation of esophageal body contraction after multiple rapid swallows (MRS), may affect esophageal acid exposure time (AET) in IEM.
Gastric Cancer Among American Indian and Alaska Native Populations in the United States, 2005–2016
Melkonian, Stephanie C.; Pete, Dornell; Jim, Melissa A.; Haverkamp, Donald; Wiggins, Charles L.; Bruce, Michael G.; White, Mary C.
doi : 10.14309/ajg.0000000000000748
December 2020 - Volume 115 - Issue 12 - p 1989-1997
American Indian and Alaska Native (AI/AN) populations have higher gastric cancer rates than the general US population. This study provides a comprehensive overview of incidence rates among AI/AN persons during 2005–2016 compared with non-Hispanic whites (whites).
Efficacy and Safety of Endoscopic Full-Thickness Resection in the Colorectum: Results From the German Colonic FTRD Registry
Meier, Benjamin; Stritzke, Bettina; Kuellmer, Armin; Zervoulakos, Philipp; Huebner, Georg Hermann; Repp, Michael; Walter, Benjamin; Meining, Alexander; Gutberlet, Klaus; Wiedbrauck, Thomas; Glitsch, Anne; Lorenz, Albrecht; Caca, Karel; Schmidt, Arthur
doi : 10.14309/ajg.0000000000000795
December 2020 - Volume 115 - Issue 12 - p 1998-2006
Endoscopic full-thickness resection (EFTR) is a powerful option for resection of colorectal lesions not amenable to conventional endoscopic resection. The full-thickness resection device (FTRD) allows clip-assisted EFTR with a single-step technique. We report on results of a large nationwide FTRD registry.
Colonoscopy and Reduction of Colorectal Cancer Risk by Molecular Tumor Subtypes: A Population-Based Case-Control Study
Hoffmeister, Michael; Bl?ker, Hendrik; Jansen, Lina; Alwers, Elizabeth; Amitay, Efrat L.; Carr, Prudence R.; Kloor, Matthias; Herpel, Esther; Roth, Wilfried; Chang-Claude, Jenny; Brenner, Hermann
doi : 10.14309/ajg.0000000000000819
December 2020 - Volume 115 - Issue 12 - p 2007-2016
In previous studies, the protective effect of colonoscopy was generally stronger for distal colorectal cancer than for proximal colorectal cancer (CRC). This study aimed to investigate whether reduction of CRC risk through colonoscopy varies according to major tumor markers and pathways of CRC.
Incidence and Bedside Predictors of the First Episode of Overt Hepatic Encephalopathy in Patients With Cirrhosis
Tapper, Elliot B.; Zhao, Lilli; Nikirk, Samantha; Baki, Jad; Parikh, Neehar D.; Lok, Anna S.; Waljee, Akbar K.
doi : 10.14309/ajg.0000000000000762
December 2020 - Volume 115 - Issue 12 - p 2017-2025
Hepatic encephalopathy (HE) is associated with marked increases in morbidity and mortality for patients with cirrhosis. We aimed to determine the risk of and predictors for HE in contemporary patients.
The Use of NACSELD and EASL-CLIF Classification Systems of ACLF in the Prediction of Prognosis in Hospitalized Patients With Cirrhosis
Cao, Zhujun; Liu, Yuhan; Cai, Minghao; Xu, Yumin; Xiang, Xiaogang; Zhao, Gangde; Cai, Wei; Wang, Hui; Wang, Weijing; Xie, Qing
doi : 10.14309/ajg.0000000000000771
December 2020 - Volume 115 - Issue 12 - p 2026-2035
Acute-on-chronic liver failure (ACLF) is defined by the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) consortium and the North American Consortium for the Study of End-Stage Liver Disease (NACSELD) as an acute deterioration of cirrhosis with multiple organ failures and high short-term mortality. However, their diagnostic criteria differ. We aimed to compare these 2 criteria in the prediction of prognosis in hospitalized cirrhosis.
Social Determinants of Outcomes in Inflammatory Bowel Disease
Bernstein, Charles N.; Walld, Randy; Marrie, Ruth Ann
doi : 10.14309/ajg.0000000000000794
December 2020 - Volume 115 - Issue 12 - p 2036-2046
In a population-based inflammatory bowel disease (IBD) cohort, we aimed to determine whether having lower socioeconomic status (LSS) impacted on outcomes.
Peripheral Corticotropin-Releasing Factor Triggers Jejunal Mast Cell Activation and Abdominal Pain in Patients With Diarrhea-Predominant Irritable Bowel Syndrome
Guilarte, Mar; Vicario, Mar?a; Mart?nez, Cristina; de Torres, Inés; Lobo, Beatriz; Pigrau, Marc; Gonz?lez-Castro, Ana; Rodi?o-Janeiro, Bruno K.; Salvo-Romero, Elo?sa; Fortea, Marina; Pardo-Camacho, Cristina; Antol?n, Mar?a; Saperas, Esteban; Azpiroz, Fernando; Santos, Javier; Alonso-Cotoner, Carmen
doi : 10.14309/ajg.0000000000000789
December 2020 - Volume 115 - Issue 12 - p 2047-2059
To determine the effect of peripheral CRF on intestinal barrier function in diarrhea-predominant IBS (IBS-D). Irritable bowel syndrome (IBS) pathophysiology has been linked to life stress, epithelial barrier dysfunction, and mast cell activation. Corticotropin-releasing factor (CRF) is a major mediator of stress responses in the gastrointestinal tract, yet its role on IBS mucosal function remains largely unknown.
Intrarectal Electromotive Botulinum Toxin Type A Administration in Children With Intractable Constipation: A Randomized Clinical Trial
Kajbafzadeh, Abdol-Mohammad; Sharifi-Rad, Lida; Nabavizadeh, Behnam; Ladi-Seyedian, Seyedeh-Sanam; Alijani, Maryam; Farahmand, Fatemeh; Motamed, Farzaneh; Alimadadi, Hosein; Fallahi, Arash; Fallahi, Gholam-Hossein
doi : 10.14309/ajg.0000000000000940
December 2020 - Volume 115 - Issue 12 - p 2060-2067
Children with refractory constipation might not respond to conventional medical treatments. In this study, we assessed the effectiveness of intrarectal botulinum toxin type A/electromotive drug administration (BoNTA/EMDA) on constipation in these children and compared its efficacy with routine intrasphincteric BoNTA injection.
The Bowel CLEANsing National Initiative: A Low-Volume Same-Day Polyethylene Glycol (PEG) Preparation vs Low-Volume Split-Dose PEG With Bisacodyl or High-Volume Split-Dose PEG Preparations—A Randomized Controlled Trial
Barkun, Alan N.; Martel, Myriam; Epstein, Ian L.; Hallé, Pierre; Hilsden, Robert J.; James, Paul D.; Rostom, Alaa; Sey, Michael; Singh, Harminder; Sultanian, Richard; Telford, Jennifer J.; von Renteln, Daniel
doi : 10.14309/ajg.0000000000000760
December 2020 - Volume 115 - Issue 12 - p 2068-2076
Bowel cleanliness has been shown to be superior with split-dose vs nonsplit preparations; we aimed to directly assess the poorly characterized comparative efficacies of split-dose vs same-day polyethylene glycol (PEG) regimens.
Biochemical Diagnosis of Bile Acid Diarrhea: Prospective Comparison With the 75Seleno-Taurohomocholic Acid Test
Borup, Christian; Wildt, Signe; Rumessen, Jüri; Graff, Jesper; Bouchelouche, Pierre Nordine; Andersen, Trine Borup; Vinter-Jensen, Lars; Zaremba, Anna; German J?rgensen, S?ren Peter; Gregersen, Tine; N?jgaard, Camilla; Timm, Hans Bording; Rainteau, Dominique; Gauliard, Emilie; Munck, Lars Kristian
doi : 10.14309/ajg.0000000000000772
December 2020 - Volume 115 - Issue 12 - p 2086-2094
The diagnosis of bile acid diarrhea is often missed because the availability of the 75seleno-taurohomocholic acid (SeHCAT) test is limited. We aimed to compare the biomarkers 7?-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor 19 (FGF19) with the SeHCAT test.
Psychiatric Comorbidity in Patients With Chronic Pancreatitis Associates With Pain and Reduced Quality of Life
Phillips, Anna Evans; Faghih, Mahya; Drewes, Asbj?rn Mohr; Singh, Vikesh K.; Yadav, Dhiraj; Olesen, S?ren Schou
doi : 10.14309/ajg.0000000000000782
December 2020 - Volume 115 - Issue 12 - p 2077-2085
Abdominal pain, frequent in patients with chronic pancreatitis (CP), has a negative impact on quality of life (QOL). Psychiatric comorbidities including anxiety and depression are associated with pain, but their prevalence and effects on QOL in CP have not been quantified. We studied the prevalence of anxiety and depression in patients with CP and their associated patient and disease characteristics and impact on QOL.
Upper Gastrointestinal Cancer Risk and Surveillance Outcomes in Li-Fraumeni Syndrome
Katona, Bryson W.; Powers, Jacquelyn; McKenna, Danielle B.; Long, Jessica M.; Le, Anh N.; Hausler, Ryan; Zelley, Kristin; Jennings, Sarah; Domchek, Susan M.; Nathanson, Katherine L.; MacFarland, Suzanne P.; Maxwell, Kara N.
doi : 10.14309/ajg.0000000000000935
December 2020 - Volume 115 - Issue 12 - p 2095-2097
To assess the upper gastrointestinal (UGI) cancer risk and surveillance outcomes in Li-Fraumeni syndrome (LFS).
Dilation Modifies Association Between Symptoms and Esophageal Eosinophilia in Adult Patients With Eosinophilic Esophagitis
Safroneeva, Ekaterina; Cotton, Cary C.; Schoepfer, Alain M.; Zwahlen, Marcel; Woosley, John T.; Dellon, Evan S.
doi : 10.14309/ajg.0000000000000957
December 2020 - Volume 115 - Issue 12 - p 2098-2102
We investigated whether dilation modifies the association between symptoms and esophageal eosinophilia (peak esophageal eosinophils/high-power field [eos/hpf]) in patients with eosinophilic esophagitis enrolled into a randomized trial comparing the efficacy of budesonide and fluticasone.
Optimization of Pancreatic Juice Collection: A First Step Toward Biomarker Discovery and Early Detection of Pancreatic Cancer
Levink, Iris J. M.; Nesteruk, Kateryna; Visser, Dido I.; Sieuwerts, Anieta M.; Fernandes, Celio J.C.; Jansen, Maurice P.H.M.; van Driel, Lydi M.J.W.; Poley, Jan-Werner; Peppelenbosch, Maikel P.; Cahen, Djuna L.; Fuhler, Gwenny M.; Bruno, Marco J.
doi : 10.14309/ajg.0000000000000939
December 2020 - Volume 115 - Issue 12 - p 2103-2108
Imaging-based surveillance programs fail to detect pancreatic ductal adenocarcinoma at a curable stage, creating an urgent need for diagnostic biomarkers.
Full Potential of 6-Mercaptopurine in IBD May Remain Untapped
Korelitz, Burton I.; Sachar, David B.; Schneider, Judy
doi : 10.14309/ajg.0000000000000769
December 2020 - Volume 115 - Issue 12 - p 2109-2110
Management of Small Bowel Villous Atrophy in Patients Seronegative for Celiac Disease: High Diagnostic Accuracy of Celiac Lymphogram
Fern?ndez-Ba?ares, Fernando; N??ez, Concepci?n; Montoro, Miguel; Roy, Garbi?e; Esteve, Maria
doi : 10.14309/ajg.0000000000000768
December 2020 - Volume 115 - Issue 12 - p 2110
Exceptional Cause of Upper Gastrointestinal Bleeding: Ischemic Gastropathy
Fern?ndez Alvarez, Paula; Maldonado Pérez, Belén; Caunedo Alvarez, Angel
doi : 10.14309/ajg.0000000000000784
December 2020 - Volume 115 - Issue 12 - p 2111-2112
Simultaneous Provocation Mesenteric Angiography With Coil Embolisation and Therapeutic Gastroscopy to Treat Occult Gastrointestinal Bleeding
Meade, Susanna; van Liere, Elsa L.S.A.; Diamantopoulos, Athanasios; Ray, Shuvra
doi : 10.14309/ajg.0000000000000791
December 2020 - Volume 115 - Issue 12 - p 2112-2113
Practical Tips on TIPS: When and When Not to Request It
Singal, Ashwani K.
doi : 10.14309/ajg.0000000000000797
December 2020 - Volume 115 - Issue 12 - p 2113-2114
Durable Complete Response of Brain Metastasis From Hepatocellular Carcinoma On Treatment With Nivolumab and Radiation Treatment
Ye, Liangtao; Zhang, Changhua; Seidensticker, Max; Mayerle, Julia; Reiter, Florian P.; De Toni, Enrico N.
doi : 10.14309/ajg.0000000000000800
December 2020 - Volume 115 - Issue 12 - p 2114-2116
Tofacitinib in the Treatment of Crohn's-Like Disease of the Pouch
Bauer, Christina M.; Barnes, Edward L.; Herfarth, Hans H.
doi : 10.14309/ajg.0000000000000801
December 2020 - Volume 115 - Issue 12 - p 2116-2117
Acute Pancreatitis and Biliary Obstruction Induced by Ectopic Pancreas
Du, Zu-Chao; Li, Xin-Jian; Zhang, Zhan-Tian; Zhou, Yan-Mei; Bai, Kai-Song; Dong, Xiang-Hui; Sun, Bei; Bai, Xue-Wei
doi : 10.14309/ajg.0000000000000812
December 2020 - Volume 115 - Issue 12 - p 2118-2119
Calendar of Courses, Symposiums and Conferences
doi : 10.14309/ajg.0000000000001080
December 2020 - Volume 115 - Issue 12 - p 2120
