Goals: We identified prognostic factors for mortality after Suspected small bowel bleeding (SSBB) and evaluated the impact of severe anemia and other clinical factors on patient survival. Background: SSBB is characterized by an inability to identify the cause of bleeding despite esophagogastroduodenoscopy and colonoscopy. Study: This retrospective observational study included patients aged ≥20 years with SSBB who underwent capsule endoscopy (CE) at Hokkaido University Hospital in Japan from April 2015 to March 2022. Patient characteristics, blood transfusion history, CE results, blood test results, and post-CE mortality events were collected from electronic medical records. Results: CE was performed in 99 patients to investigate the causes of SSBB, identifying bleeding sources in 40.4%. Over a median follow-up of 35 months (range: 0 to 94), mortality occurred in 34 cases. The overall 3-year survival rate was 71.1%. Multivariate analysis identified hemoglobin levels <8.0 g/dL [hazard ratio ( HR )=9.75; 95% CI: 1.26-75.15; P =0.003] and end-stage cancer ( HR =4.94; 95% CI: 2.02-12.10; P <0.001) as independent prognostic factors for mortality after CE for SSBB. Even after excluding patients with small bowel tumors and end-stage cancer, hemoglobin levels <8.0 g/dL ( HR =5.07; 95% CI: 1.10-23.03; P =0.037) remained an independent predictor of mortality. The overall 5-year survival rates for patients without small bowel tumors and end-stage cancer in the groups with hemoglobin levels of ≥8.0 g/dL and <8.0 g/dL were 89.0% and 56.8%, respectively. Conclusion: Hemoglobin levels <8.0 g/dL significantly predict mortality in patients with SSBB.
GOALS:To compare a vision transformer with 2 convolutional neural network architectures for multiclass lesion classification in capsule endoscopy images. BACKGROUND:Manual review of capsule endoscopy is time-consuming and subject to interobserver variability. Deep learning can automate lesion recognition; however, most prior capsule endoscopy work evaluates a small number of classes, and systematic comparisons between transformer and convolutional architectures across many lesion categories are limited. STUDY:Two publicly available data sets (SEE-AI and Kvasir-Capsule) were merged and preprocessed to create a 21-class image data set (∼58,000 frames). Images were resized to 224 × 224 pixels and split using stratified sampling into training (n=40,587), validation (n=8696), and test (n=8696) sets. A pretrained Vision Transformer, DenseNet121, and ResNet50 were fine-tuned using categorical cross-entropy loss and Adam optimization, with early stopping. Performance was assessed using accuracy, macroaveraged precision, recall, F1 Score, and the area under the receiver operating characteristic curve. RESULTS:On the independent test set, the vision transformer achieved 92.2% accuracy with macroaveraged precision/recall/F1-score of 0.92 and an area under the receiver operating characteristic curve of 0.99. DenseNet121 achieved 74.0% accuracy (F1-score 0.78; area under the receiver operating characteristic curve 0.85). ResNet50 achieved 38.0% accuracy (F1-score 0.40; area under the receiver operating characteristic curve 0.55). CONCLUSIONS:In this merged 21-class capsule endoscopy image data set, the vision transformer achieved higher frame-level classification performance than DenseNet121 and ResNet50 under the present experimental conditions. Importantly, the data set was split at the image level rather than at the patient or procedure level, because frames from the same examination may be correlated; therefore, performance figures likely reflect benchmark results on this frame-level public data set and should not be interpreted as estimates of patient-level generalization or as evidence of definitive architectural superiority. These findings support further evaluation of transformer-based approaches, but grouped reanalysis, external validation, and workflow-oriented studies are required before clinical implementation.
Goals: To compare a vision transformer with 2 convolutional neural network architectures for multiclass lesion classification in capsule endoscopy images. Background: Manual review of capsule endoscopy is time-consuming and subject to interobserver variability. Deep learning can automate lesion recognition; however, most prior capsule endoscopy work evaluates a small number of classes, and systematic comparisons between transformer and convolutional architectures across many lesion categories are limited. Study: Two publicly available data sets (SEE-AI and Kvasir-Capsule) were merged and preprocessed to create a 21-class image data set (∼58,000 frames). Images were resized to 224 × 224 pixels and split using stratified sampling into training (n=40,587), validation (n=8696), and test (n=8696) sets. A pretrained Vision Transformer, DenseNet121, and ResNet50 were fine-tuned using categorical cross-entropy loss and Adam optimization, with early stopping. Performance was assessed using accuracy, macroaveraged precision, recall, F1 Score, and the area under the receiver operating characteristic curve. Results: On the independent test set, the vision transformer achieved 92.2% accuracy with macroaveraged precision/recall/F1-score of 0.92 and an area under the receiver operating characteristic curve of 0.99. DenseNet121 achieved 74.0% accuracy (F1-score 0.78; area under the receiver operating characteristic curve 0.85). ResNet50 achieved 38.0% accuracy (F1-score 0.40; area under the receiver operating characteristic curve 0.55). Conclusions: In this merged 21-class capsule endoscopy image data set, the vision transformer achieved higher frame-level classification performance than DenseNet121 and ResNet50 under the present experimental conditions. Importantly, the data set was split at the image level rather than at the patient or procedure level, because frames from the same examination may be correlated; therefore, performance figures likely reflect benchmark results on this frame-level public data set and should not be interpreted as estimates of patient-level generalization or as evidence of definitive architectural superiority. These findings support further evaluation of transformer-based approaches, but grouped reanalysis, external validation, and workflow-oriented studies are required before clinical implementation.
BACKGROUND AND GOALS:Spontaneous bacterial peritonitis (SBP) is a serious complication in patients with cirrhosis and ascites, with additional risks posed by multidrug-resistant organisms (MDRO). This real-world study evaluated clinical outcomes in patients with SBP and the impact of MDRO. METHODS:This study identified US adults with SBP receiving guideline-recommended treatment with antibiotics and albumin from January 2012 to June 2022. Antibiotic utilization trends, health care resource utilization, and clinical outcomes [in-hospital and ICU mortality and hospital and ICU length of stay (LOS)] were assessed and stratified by MDRO status. RESULTS:A total of 10,956 patients with 12,570 encounters were identified. Median age was 57.0 years (IQR=49.0 to 65.0), and 62.4% were male; suspected MDRO infections occurred in 15% of encounters. Third-generation cephalosporins were used in 71.6%, 49.2% had acute kidney injury, and 20.0% and 7.2% had hepatorenal syndrome and hepatic encephalopathy, respectively. Median hospital LOS was 7.2 days (IQR=4.3 to 12.9), with 17.7% in-hospital mortality. ICU care was required in 14.5% of encounters, with a median ICU LOS of 3.6 days (IQR=1.7 to 6.7) and ICU mortality of 29.7%. MDRO infections were associated with increased in-hospital mortality (OR=2.24, P<0.001) and decreased hazard of hospital discharge (ie, prolonged LOS; HR=0.43, P<0.001). Receiving albumin within 24 hours of admission was associated with a 72% higher hazard of hospital discharge (ie, shorter LOS; HR=1.72, P<0.001). CONCLUSION:This study highlights the clinical and resource burden of SBP, emphasizing the impact of MDRO infections and the importance of timely albumin administration concordant with clinical guidelines.
GOALS:We identified prognostic factors for mortality after Suspected small bowel bleeding (SSBB) and evaluated the impact of severe anemia and other clinical factors on patient survival. BACKGROUND:SSBB is characterized by an inability to identify the cause of bleeding despite esophagogastroduodenoscopy and colonoscopy. STUDY:This retrospective observational study included patients aged ≥20 years with SSBB who underwent capsule endoscopy (CE) at Hokkaido University Hospital in Japan from April 2015 to March 2022. Patient characteristics, blood transfusion history, CE results, blood test results, and post-CE mortality events were collected from electronic medical records. RESULTS:CE was performed in 99 patients to investigate the causes of SSBB, identifying bleeding sources in 40.4%. Over a median follow-up of 35 months (range: 0 to 94), mortality occurred in 34 cases. The overall 3-year survival rate was 71.1%. Multivariate analysis identified hemoglobin levels <8.0 g/dL [hazard ratio ( HR )=9.75; 95% CI: 1.26-75.15; P =0.003] and end-stage cancer ( HR =4.94; 95% CI: 2.02-12.10; P <0.001) as independent prognostic factors for mortality after CE for SSBB. Even after excluding patients with small bowel tumors and end-stage cancer, hemoglobin levels <8.0 g/dL ( HR =5.07; 95% CI: 1.10-23.03; P =0.037) remained an independent predictor of mortality. The overall 5-year survival rates for patients without small bowel tumors and end-stage cancer in the groups with hemoglobin levels of ≥8.0 g/dL and <8.0 g/dL were 89.0% and 56.8%, respectively. CONCLUSION:Hemoglobin levels <8.0 g/dL significantly predict mortality in patients with SSBB.
The primary goal of variceal screening in patients with cirrhosis is to identify high-risk esophageal varices (HREV) and implement preventative measures. Historically, endoscopic screening was recommended for all patients with cirrhosis; however, this approach is increasingly recognized as neither cost-effective nor clinically necessary for all patients. As the prevalence of compensated advanced chronic liver disease (cACLD) continues to rise, there is increasing interest in noninvasive risk stratification methods to effectively tailor patient selection for endoscopic screening. Current clinical guidelines encourage the use of noninvasive predictive scores and algorithms to accurately identify patients at increased risk of having HREV and thereby reduce unnecessary screening endoscopies. In this review, we provide an evaluation of the various available noninvasive methods to predict HREV, including the Baveno criteria, platelet count:spleen diameter ratio, and the EVendo score. We review the performance, strengths, and limitations of these noninvasive methods—especially the machine learning-based EVendo score—and discuss future directions for optimizing risk stratification in patients with cirrhosis.
Objectives: While glucagon-like peptide 1 receptor agonists (GLP1-RAs) increase the risk of gastric food retention (GFR) and inadequate bowel preparation (IBP), the confounding role of diabetes mellitus is still questioned. Here, we compare the outcomes of endoscopic procedures in patients on GLP1-RAs versus matched diabetics off GLP1-RAs, while also assessing the role of a 24-hour preprocedural liquid diet and bowel preparation in mitigating this risk. Methods: A retrospective case-control study of patients 18 years or older on GLP1-RAs versus matched diabetics off GLP1-RAs who underwent outpatient EGD and/or colonoscopy between January 2018 and June 2023. The case group never held their GLP1-RAs. Primary outcomes were the risk of GFR and IBP. Secondary outcomes included the rates of aborted procedures, periprocedural aspiration, and the risk of GFR in GLP1-RAs who underwent EGD alone versus EGD + colonoscopy. Results: Our study included 417 EGDs (212 cases vs. 205 controls) and 637 colonoscopies (303 cases vs. 334 controls). There was no significant difference in age, gender, BMI, and preprocedural A1c% between groups. The GFR was significantly higher in the cases compared with controls (4.7% vs. 1%, P =0.03), whereas there was no difference in IBP (16.5% vs. 16.5%, P =1). There was no significant difference in EGD abortion (1.9% vs. 0.5%, P =0.3) or colonoscopy abortion (7.6% vs. 6%, P =0.4) between cases and controls. None of the patients in both groups had periprocedural aspiration or conversion to general anesthesia. Compared with EGD alone (n=105), cases who underwent a concomitant colonoscopy (n=107) had a significantly lower risk of GFR (9.5% vs. 0%, P <0.01). Discussion: GLP1-RAs increase the risk of GFR independent of concomitant diabetes but not the rate of IBP. The absolute procedural risks associated with GLP1-RAs are minimal. A 24-hour liquid diet combined with bowel preparation appears to offset the risk of GFR associated with GLP1-RAs.
Background: Perianal Crohn’s disease (PCD) is a severe and disabling phenotype of Crohn’s disease that often requires multidisciplinary medical and surgical management. Although ustekinumab (UST) and vedolizumab (VDZ) are widely used after antitumor necrosis factor (anti-TNF) failure, direct comparative data specifically in PCD remain limited. Methods: We conducted a multicenter, retrospective cohort study using the TriNetX US Collaborative Network to compare the effectiveness of UST versus VDZ in adults (18 y or older) with PCD between January 2017 and May 2023. Outcomes were perianal-specific clinical events, including definitive fistula surgery, incision and drainage, diversion procedures, and antibiotic use (metronidazole or ciprofloxacin), assessed at 1 and 2 years after biological initiation. Propensity score matching (PSM) (1:1) was performed to balance baseline variables. Time-to-event analyses were conducted in the matched population using Kaplan–Meier methods, and hazard ratios (HRs) were estimated using Cox proportional hazards models within the matched cohorts. Results: A total of 2936 patients were identified before PSM: 1997 patients in the UST group and 939 patients in the VDZ group. After PSM, 936 patients were included in each cohort. In the matched cohorts, UST was associated with significantly lower risk of definitive perianal fistula surgery (HR: 0.66, 95% CI: 0.50-0.89; P <0.01), and composite surgical events (HR: 0.70, 95% CI: 0.54-0.87; P <0.01) compared with VDZ at 1 year. Rates of antibiotic use, incision and drainage of perianal abscess, and diversion procedures were numerically lower but not statistically significant. At 2 years, these findings persisted, with significantly lower cumulative incidence of definitive perianal fistula surgery (HR: 0.78, 95% CI: 0.61-0.90; P =0.03), composite surgical events (HR: 0.81, 95% CI: 0.69-0.90; P <0.01), and antibiotic use (HR: 0.86, 95% CI: 0.75-0.93; P =0.04) in the UST cohort compared with VDZ. Rates of incision and drainage and diversion procedures remained similar between groups. Conclusion: In this large real-world cohort, UST was associated with lower risks of perianal surgical interventions at one and two years and reduced antibiotic utilization at two years compared with VDZ in patients with PCD. These findings highlight meaningful differences in real-world effectiveness between therapies and support the need for prospective studies to further evaluate comparative effectiveness in this population.
Background: Post-transjugular intrahepatic portosystemic shunt (TIPS) outcome data are derived largely from alcohol- or viral-related cirrhosis; etiology-specific evidence in metabolic dysfunction-associated steatotic liver disease (MASLD) remains limited. Given differences in portal hypertension physiology and cardiometabolic burden, whether post-TIPS outcomes in MASLD mirror other etiologies is uncertain. Methods: Using the TriNetX US Collaborative Network, we identified adults with cirrhosis who underwent initial TIPS placement on or after January 1, 2015, and categorized them as MASLD versus alcohol- or viral-related cirrhosis. Propensity Score Matching was performed to balance the demographics, liver disease severity (MELD-Na components), hematologic indices, and cirrhosis-related complications. Complementary analyses were performed to incorporate cardiometabolic comorbidities. The primary outcomes were 1-year overall survival and transplant-free survival. Secondary outcomes included liver transplantation, TIPS revision, variceal bleeding, paracentesis, hepatic encephalopathy, hepatorenal syndrome, and initiation of dialysis. Results: After matching, 467 patients remained in each cohort (median follow-up, 365 d). One-year overall survival did not differ between MASLD and alcohol- or viral-related cirrhosis ( HR 0.94, 95% CI: 0.70-1.24; P =0.64), nor did transplant-free survival ( HR 1.09, 95% CI: 0.85-1.41; P =0.50). Most post-TIPS complications were comparable. Liver transplantation occurred more frequently in the MASLD cohort ( RR 1.89, 95% CI: 1.08-3.30; P =0.02). The findings were consistent after additional matching for cardiometabolic comorbidities. Conclusion: When baseline disease severity is comparable, MASLD-related cirrhosis is not associated with worse short-term survival or post-TIPS complication rates compared with alcohol- or viral-related cirrhosis, supporting the extrapolation of contemporary short-term TIPS outcome data to MASLD.
Background: Inflammatory bowel disease (IBD) is a chronic systemic inflammatory disorder associated with elevated cardiovascular risk. While prior studies have linked IBD to increased risk of myocardial infarction (MI), post-MI outcomes in this population remain poorly characterized. We aimed to evaluate post-MI outcomes in patients with IBD compared with non-IBD controls. Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Five databases were searched from inception to July 2025. We included observational studies comparing post-MI outcomes in adults with and without IBD. Random-effects meta-analyses were performed using hazard ratios (HRs) and odds ratios (ORs) with 95% CIs. Heterogeneity was assessed using the I 2 statistic. Results: Nine retrospective cohort studies encompassing 9.45 million patients were included. IBD was associated with significantly increased risk of MACE (HR: 1.31, 95% CI: 1.07-1.59), all-cause mortality (HR: 1.25, 95% CI: 1.12-1.39), and recurrent MI (HR: 1.22, 95% CI: 1.08-1.39) following index myocardial infarction compared with non-IBD patients. Pooled ORs showed increased odds of major bleeding (OR: 1.38, 95% CI: 1.13-1.70) and transfusion (OR: 1.41, 95% CI: 1.35-1.47), but lower odds of heart failure (OR: 0.81, 95% CI: 0.74-0.89) and no significantly increased odds of stroke. Conclusions: Patients with IBD have statistically significantly higher risks of MACE, all-cause mortality, recurrent MI, blood transfusions, and major bleeding compared with the non-IBD population. These findings emphasize the potential role for tailored cardiovascular risk stratification, bleeding risk mitigation, and longitudinal management strategies in patients with IBD.
Introduction: Endoscopic retrograde cholangiopancreatography (ERCP) is essential for pancreaticobiliary disease management; however, there are risks associated with the procedure, particularly post-ERCP pancreatitis (PEP). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used in metabolic disease, possess anti-inflammatory and cytoprotective properties that may influence periprocedural outcomes. Their impact on ERCP adverse events remains unclear; therefore, we aimed to investigate whether GLP-1 influences short-term postprocedural outcomes using a large real-world database. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, identifying adults (18 y or older) who underwent ERCP between January 2015 and December 2024. Patients were categorized based on documented preprocedure GLP-1 receptor agonist exposure. Propensity score matching (1:1) was performed using demographic, clinical, procedural, and pharmacologic covariates to minimize confounding, yielding 2 well-balanced cohorts. Thirty-day post-ERCP outcomes—including acute pancreatitis, cholangitis, sepsis, gastrointestinal bleeding, biliary stricture, choledocholithiasis, and repeat ERCP—were assessed using ICD-10 and CPT codes. Risk ratios (RRs) and hazard ratios (HRs) with 95% CIs were calculated. Results: Of 250,502 patients with ERCP screened, 21,818 propensity-matched individuals were included in the final analysis. Compared with matched nonusers, patients receiving GLP-1 receptor agonists had significantly lower 30-day rates of all major ERCP-related adverse events. GLP-1 RA exposure was associated with reduced risks of acute pancreatitis (RR: 0.47, 95% CI: 0.43-0.51), cholangitis (RR: 0.56, 95% CI: 0.50-0.62), sepsis (RR: 0.51, 95% CI: 0.46-0.57), gastrointestinal bleeding (RR: 0.49, 95% CI: 0.40-0.61), biliary stricture (RR: 0.52, 95% CI: 0.48-0.55), repeat ERCP (RR: 0.53, 95% CI: 0.48-0.58), and choledocholithiasis (RR: 0.66, 95% CI: 0.62-0.71). Results were consistent across time-to-event analyses over the 30-day follow-up period. Conclusions: In this large real-world analysis, preprocedure GLP-1 RA therapy was associated with markedly reduced 30-day ERCP-related adverse events, most notably PEP. These findings highlight a potential protective role of GLP-1 signaling in the periprocedural inflammatory response and support prospective studies evaluating GLP-1 RAs as adjunctive prophylactic agents in ERCP. Further prospective studies are needed.
Introduction: Young-onset esophageal adenocarcinoma (EAC) often presents at advanced stages and is associated with poor outcomes. We aimed to examine the epidemiology of young-onset Barrett’s esophagus (BE) using the TriNetX database. Methods: Young-onset BE patients (age 18 to younger than 50 y) with esophagogastroduodenoscopy (EGD) within 1 year before index BE diagnosis between 2014 and 2023 were included. Negative binomial regression was used to evaluate incident-time trends, and logistic regression to assess for independent predictors of young-onset BE. Results: BE diagnosis was present in 76,691 (3.3%) of 2,337,786 patients that underwent EGD, of which 14,120 (18%) had prevalent young-onset BE. BE dysplasia/EAC was present in 6% of young-onset patients at initial diagnosis. Conventional BE risk factors also predicted young-onset BE: GERD (OR=2.4), White race (OR=2.4), male sex (OR=2.2), smoking (OR=1.2), and obesity (OR=1.1). Each additional risk factor increased the probability of BE prevalence by 74% in young patients versus 54% in older patients. The prevalence of young-onset BE was 4.5% with GERD and ≥3 additional risk factors, and 2.3% when ≥3 risk factors were present. Discussion: Young-onset BE accounts for 18% of all BE cases, demonstrates a striking 6% rate of dysplasia/neoplasia at initial diagnosis, and has a prevalence of 4.5% in those with GERD and ≥3 risk factors. These findings suggest that young-onset BE is an important patient population that merits further study. Additional studies are necessary to study the cost-effectiveness of BE screening in younger patients with multiple risk factors.
Background: Esophageal variceal bleeding (EVB) is a life-threatening complication of liver cirrhosis. Carvedilol, a nonselective beta-blocker with alpha 1-blocking properties, and endoscopic variceal ligation (EVL) are both recommended for prophylaxis, but their comparative performance remains uncertain.Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, searching PubMed, Web of Science, and Embase to July 2025. Trials comparing carvedilol with EVL in adults with cirrhosis were included. Outcomes included all-cause and bleeding-related mortality, variceal bleeding, hepatic complications, and adverse events.Results: Nine RCTs enrolling 1385 patients were included. Carvedilol and EVL showed no significant differences in all-cause mortality (RR: 1.00, 95% CI: 0.64-1.54), variceal bleeding (RR: 1.04, 95% CI: 0.75-1.45), or bleeding-related mortality (RR: 1.71, 95% CI: 0.83-3.50). Rates of ascites (new or worsening), hepatocellular carcinoma, spontaneous bacterial peritonitis, hepatorenal syndrome/acute kidney injury, and TIPS requirement were also comparable. Treatment-related adverse event rates did not differ significantly (RR: 1.43, 95% CI: 0.65-3.11).Conclusion: Carvedilol and EVL provide similar prophylactic efficacy and safety profiles for EVB prevention in cirrhosis. Carvedilol represents a viable, noninvasive alternative, particularly in settings where endoscopy is impractical.
Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction with symptoms including abdominal pain associated with a change in stool form or frequency. IBS global prevalence is around 4% and its impact on patient’s quality of life and social functioning is substantial. Multidisciplinary working teams of the Israeli Society of Neurogastroenterology and Motility evaluated all validated approaches to IBS management. The aim was to develop a national, evidence-based position document on IBS management for general practitioners and adult and pediatric gastroenterologists. This position document comprehensively reviewed therapeutic options, including patient education (including specific national communities), dietary modifications (particularly the low FODMAP diet), antispasmodic drugs, probiotics, antibiotics (eg, rifaximin), secretagogues (eg, linaclotide), neuromodulators, psychological therapies (including cognitive behavioral therapy and gut-directed hypnotherapy), and complementary medicine approaches. The importance of establishing a positive physician-patient communication with a therapeutic partnership, including an empathic approach and implementation of the bio-psycho-social model, was also strongly emphasized. A structured treatment algorithm incorporating multiple therapeutic tools that are locally available was developed as well. We hope that this position paper will provide a practical and updated tool for the management of IBS in Israel and in other countries as well.
Initially viewed as a vestigial organ of little physiological significance, there has been an evolution of understanding about the roles the appendix may serve with respect to gastrointestinal immunoregulation and immunotolerance, as well as interactions with diseases related to disordered GI immunotolerance, such as ulcerative colitis. Emerging data related to medical and endoscopic therapies for appendicitis management has challenged the long-maintained belief that surgical intervention is the only appropriate option for management of this condition. Finally, a focused review of appendiceal neoplasia as it pertains to gastroenterology practice allows an opportunity to better hone disease recognition, understand therapeutic options including evolving endoscopic techniques, and examine the association between appendiceal neoplasia and traditional colorectal neoplasia to help provide a framework for future diagnostic and surveillance needs. In total, collective experience suggests that rather than a simple endoscopic afterthought, understanding the role of the appendix and associated diseases is an important component for any gastroenterologist’s practice.
GOALS:A systematic review was conducted to evaluate the efficacy and safety of proton pump inhibitor (PPI) therapy in relieving nocturnal reflux symptoms and sleep disturbances. BACKGROUND:Nocturnal gastroesophageal reflux disease (GERD) is commonly associated with sleep disturbances. The benefits of PPI therapy for GERD-related nocturnal reflux and sleep disturbance remain unclear. STUDY:We searched the MEDLINE, EMBASE, and Cochrane CENTRAL databases from inception to March 1, 2026, for randomized controlled trials (RCTs) in adults with GERD and sleep disturbances that compared any PPI to placebo or an alternative therapy. The primary outcome was the proportion of patients experiencing relief from nighttime heartburn. Secondary outcomes included relief from GERD-related sleep disturbances, changes in subjective sleep quality, work productivity, and treatment-emergent adverse events (TEAEs). RESULTS:Five RCTs involving 1495 patients met the inclusion criteria. Three placebo-controlled trials consistently showed that PPI therapy improved nighttime heartburn relief and GERD-related sleep disturbances compared with placebo. Subjective sleep quality and sleep-related daytime functioning also generally improved with PPI therapy. However, the findings were more heterogeneous across trials because of differences in study populations, comparators, and outcome measures. Across the placebo-controlled studies, TEAEs were generally similar between the PPI and placebo groups. CONCLUSIONS:PPI therapy was associated with improvement in nighttime heartburn and reflux-related sleep disturbances, especially in patients with reflux-driven nocturnal symptoms. The available evidence also suggests potential improvement in subjective sleep quality and sleep-related daytime functioning.
Acute cholecystitis affects ∼200,000 individuals annually in the United States, with laparoscopic cholecystectomy as the gold standard treatment. However, in high-risk surgical candidates, alternative drainage methods are necessary. Percutaneous transhepatic gallbladder drainage (PT-GBD) has traditionally served as the primary alternative intervention, offering rapid decompression, but is limited by a negative impact on the patient's quality of life, the risk of long-term or even permanent tube placement, adverse events, and high recurrence rates. Endoscopic approaches, such as endoscopic transpapillary gallbladder drainage (ET-GBD) and, more recently, endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), have emerged as viable alternatives to PT-GBD. EUS-GBD, first introduced in 2007, offers technical and clinical outcomes comparable to PT-GBD with fewer adverse events, shorter hospital stays, and lower rates of recurrence. The introduction of lumen-apposing metal stents (LAMS) has revolutionized EUS-GBD, simplifying deployment and enabling subsequent internal gallbladder access, which allows additional interventions such as cholecystoscopy and stone removal. EUS-GBD is now supported by international guidelines, and 1 device has achieved FDA approval for the management of acute cholecystitis in nonsurgical candidates. Proper patient selection is essential, guided by multidisciplinary evaluation, with EUS-GBD contraindicated in specific scenarios such as gallbladder perforation, coagulopathy, and large-volume ascites. Technical considerations include choice of access site (transgastric versus transduodenal), stent type, and procedural route [direct (freehand) or wire-guided]. Postprocedural care and stent management remain variable and nonstandardized. Emerging data suggest that interval cholecystectomy can still be performed safely after EUS-GBD. As adoption of EUS-GBD with LAMS expands, structured training and standardization of practice are crucial to optimizing outcomes.
Goals: A systematic review was conducted to evaluate the efficacy and safety of proton pump inhibitor (PPI) therapy in relieving nocturnal reflux symptoms and sleep disturbances. Background: Nocturnal gastroesophageal reflux disease (GERD) is commonly associated with sleep disturbances. The benefits of PPI therapy for GERD-related nocturnal reflux and sleep disturbance remain unclear. Study: We searched the MEDLINE, EMBASE, and Cochrane CENTRAL databases from inception to March 1, 2026, for randomized controlled trials (RCTs) in adults with GERD and sleep disturbances that compared any PPI to placebo or an alternative therapy. The primary outcome was the proportion of patients experiencing relief from nighttime heartburn. Secondary outcomes included relief from GERD-related sleep disturbances, changes in subjective sleep quality, work productivity, and treatment-emergent adverse events (TEAEs). Results: Five RCTs involving 1495 patients met the inclusion criteria. Three placebo-controlled trials consistently showed that PPI therapy improved nighttime heartburn relief and GERD-related sleep disturbances compared with placebo. Subjective sleep quality and sleep-related daytime functioning also generally improved with PPI therapy. However, the findings were more heterogeneous across trials because of differences in study populations, comparators, and outcome measures. Across the placebo-controlled studies, TEAEs were generally similar between the PPI and placebo groups. Conclusions: PPI therapy was associated with improvement in nighttime heartburn and reflux-related sleep disturbances, especially in patients with reflux-driven nocturnal symptoms. The available evidence also suggests potential improvement in subjective sleep quality and sleep-related daytime functioning.
OBJECTIVE:This study aimed to identify if pain catastrophizing is a mediator between pain intensity and functioning (functional disability and sleep), as well as mental health (anxiety and depression) in patients with pain-predominant disorders of gut-brain interaction (DGBI). BACKGROUND:Pediatric pain is a significant problem that can lead to impairment in functioning and mental health. It is well documented in the pediatric literature that greater pain severity, pain catastrophizing, anxiety, depression, and reduced functioning are correlated. In youth with pain-predominant DGBI, the exact nature of how pain catastrophizing impacts functioning and mental health is less studied. METHODS:A retrospective review of de-identified data collected as part of clinical care for pediatric patients attending a neurogastroenterology subspecialty clinic was completed. RESULTS:Mediation analyses demonstrated that pain catastrophizing was a significant mediator in the relationships between pain intensity and functional disability, depression, and anxiety. Pain catastrophizing was not a mediator in the relationship between pain intensity and sleep disturbances. CONCLUSIONS:Pain catastrophizing represents a malleable cognitive factor of the pain experience. Clinical intervention on pain catastrophizing appraisals has the potential to improve functioning and mental health, even if pain intensity remains unchanged.
