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December 2021

Volume 161Issue 6p1731-2070, e1-e20

In Memoriam

  • In Memoriam: Michael N. Marsh, BTh, DPhil, DM, DSc, FRCP

    • Arzu Ensari,
    • Kamran Rostami,
    • Michael N. Marsh
    Published online: October 01, 2021
    p1731-1733
    With personal regret, we note the death of Professor Michael N. Marsh. For more than 50 years, the name Marsh has dominated not only the world of celiac disease but additionally the fields of intestinal morphology and immunopathology, promoting the accurate measurement and interpretation of normal vs pathologic mucosae.

Covering the Cover

  • Covering the Cover

    Published in issue: December 2021
    p1734-1735
    Early liver transplantation within 6 months of abstinence for alcohol-related liver disease is associated with low rate of relapse in a Canadian pilot program.

Commentaries

  • Acute Pancreatitis in Elderly Patients

    • Armando A. Baeza-Zapata,
    • Diego García-Compeán,
    • Joel O. Jaquez-Quintana,
    • Collaborators
    Published online: August 09, 2021
    p1736-1740
    Acute pancreatitis (AP) is 1 of the most common gastrointestinal causes of hospital admissions worldwide and represents more than 275,000 cases per year. It is an inflammatory disease with an unpredictable clinical outcome. Because the incidence of AP has been increasing globally, it has been seen more frequently in elderly individuals because of an aging population. Some reports indicate that AP in these individuals is clinically more severe and systemic complications more frequent, leading to higher mortality compared with younger individuals.
  • Diversity and Inclusion in Pancreatic Cancer Clinical Trials

    • Kelly M. Herremans,
    • Andrea N. Riner,
    • Robert A. Winn,
    • Jose G. Trevino
    Published online: August 17, 2021
    p1741-1746.e3
    Pancreatic cancer is defined by the lethality of the disease. With an estimated 5-year survival rate of 9% and increasing incidence, it is projected to soon become the second leading cause of cancer deaths in the United States.1 Pancreatic cancer does not affect all populations equally, as significant health disparities exist between race, ethnicity, and gender. Over the last 2 decades black individuals have persistently had a 19% higher incidence of pancreatic cancer when compared with other racial groups.
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  • The Learning Health System: The Tools Are Here—Why Aren’t We Moving Forward?

    • Douglas A. Corley,
    • Amy Kilbourne
    Published online: August 08, 2021
    p1747-1750
    The exhortations seem simple enough for patients with hepatitis C who have been successfully treated: “Surveillance for [hepatocellular carcinoma (HCC)] is not recommended for patients with stages 0−2 fibrosis post-sustained virologic response” (p. 1579)1 and that “surveillance for HCC with liver imaging ± serum AFP [α-fetoprotein] should be pursued twice annually for an indefinite duration in all patients with stage 3 fibrosis or liver cirrhosis” (p. 1579).1 These are best practice statements for optimizing care/value from the American Gastroenterological Association and are consistent with guidance from other specialty groups.
  • Recommendations for a More Organized and Effective Approach to the Early Detection of Pancreatic Cancer From the PRECEDE (Pancreatic Cancer Early Detection) Consortium

    • Tamas A. Gonda,
    • Jessica N. Everett,
    • Michael Wallace,
    • Diane M. Simeone,
    • On behalf of the PRECEDE Consortium
    Published online: August 26, 2021
    p1751-1757
    Pancreatic cancer is an aggressive, difficult-to-treat disease that is on track to become the second most deadly malignancy in adults by 2030.1 Although significant advances in treatment are being made, screening and early detection hold the greatest promise in affecting mortality. Effective screening for pancreatic cancer, per National Cancer Institute recommendations, should: (1) demonstrate ability to detect early cancer; (2) show that screening reduces cancer mortality, and (3) prove that benefits of screening outweigh harms.
  • Impact of COVID-19 on Pancreatic Cancer Research and the Path Forward

    • Raffaella Casolino,
    • Andrew V. Biankin,
    • The PanCaCovid-19 Study Group
    Published online: August 10, 2021
    p1758-1763
    The severe acute respiratory syndrome coronavirus-2 and related coronavirus disease 2019 (COVID-19) pandemic have deleteriously affected cancer research worldwide, including basic, translational, and clinical fields, because of prolonged shut-down of research laboratories consequent to lockdown restrictions, curtailment of researchers’ laboratory access, decreased availability of patient samples, and clinical trial disruptions.1–5 In addition, cuts in funding are significantly contributing to the impact and are threatening the viability of cancer research as a whole.
  • Defining Primary Sclerosing Cholangitis: Results From an International Primary Sclerosing Cholangitis Study Group Consensus Process

    • Cyriel Y. Ponsioen,
    • David N. Assis,
    • Kirsten M. Boberg,
    • Christopher L. Bowlus,
    • Mark Deneau,
    • Douglas Thorburn,
    • Lars Aabakken,
    • Martti Färkkilä,
    • Bret Petersen,
    • Christian Rupp,
    • Stefan G. Hübscher,
    • On behalf of the International PSC Study Group
    Published online: August 09, 2021
    p1764-1775.e5
    Open Access
    Primary sclerosing cholangitis (PSC) is a chronic progressive inflammatory disease of the bile ducts that is surrounded by much uncertainty. First of all, it is a rare disease, with reported prevalence between 0 and 31.7 per 100,000 individuals,1,2 and establishing a diagnosis can be difficult. The primary pathology is hidden deep in the liver, and there is no specific and easy noninvasive diagnostic test for PSC. Histologic features of fibrosing cholangiopathy are present in <20% of liver biopsy specimens obtained from patients with PSC and can also be seen in cases of secondary sclerosing cholangitis.
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  • Montreal, Rome, and Lyon Consensus: Will They Resolve the Conundrum of Gastroesophageal Reflux Disease

    • Ravinder K. Mittal
    Published online: August 27, 2021
    p1776-1779
    Several review articles on phenotypes of gastroesophageal reflux disease (GERD)1–4 prompted me to reflect on my views about the status of GERD in 2021. I have been caring for patients with esophageal disorders and GERD and engaged in research on the physiology and pathophysiology of GERD and the genesis of heartburn and esophageal pain since 1983. The 1980s was an exciting time for the esophagus because that was when the revolutionary proton pump inhibitors (PPIs) emerged as an effective treatment for erosive esophagitis.

Mentoring, Education, and Training Corner

  • How to Approach Long-term Enteral and Parenteral Nutrition

    • Alia Hadefi,
    • Marianna Arvanitakis
    Published online: September 20, 2021
    p1780-1786
    Long-term enteral or parenteral nutrition is defined as a medical nutritional therapy that is provided through either the enteral or intravenous route for >6 months. Depending on the patient’s nutritional needs and underlying disease, the administration of enteral and/or parenteral nutrition may be total (exclusive) or supplemental (partial or complementary). Of note, home parenteral nutrition (HPN) is a primary life-saving therapy for patients suffering from chronic intestinal failure owing to benign or malignant disease.

Editorials

  • Bringing Primary and Secondary Prevention Into Play in Community Prevention of Gastrointestinal Cancers

    • Han-Mo Chiu
    Published online: September 05, 2021
    p1787-1789
    The epidemiological pattern of malignancies has changed markedly in recent decades, and many countries have experienced “cancer transition,” which is represented by the decline or stabilization of smoking, a traditionally well-established carcinogen, and infection-related cancers. Obesity-related cancers, such as cancer of the colorectum, corpus uteri, gallbladder, kidney, multiple myeloma, and pancreas, have increased substantially in many countries as a result of economic development. Globally, in 2012, it was estimated that 3.6% (n = 481,000) of all new cancer cases in adults older than 30 years were attributable to a high body mass index (BMI).
  • Proton Pump Inhibitor Use: A Risk Factor for Inflammatory Bowel Disease or an Innocent Bystander?

    • Kristine Højgaard Allin,
    • Paul Moayyedi
    Published online: September 05, 2021
    p1789-1791
    Proton pump inhibitors (PPIs) dramatically reduce gastric acid secretion and are widely used in the prevention and treatment of acid-related gastrointestinal diseases.1 Gastric acid secretion rapidly returns once PPIs are discontinued so these drugs are often used long-term. US data show that in 2011–2012 approximately 8% of adults had used prescription PPIs during the past 30 days. In line with these data, a Danish nationwide study reported a prevalence of PPI use of 7% in 2014, and, from 2002–2014, PPI use increased 4-fold.
  • Integrin Inhibitors in Inflammatory Bowel Disease: From Therapeutic Antibodies to Small-Molecule Drugs

    • Julian Panés
    Published online: September 13, 2021
    p1791-1793
    Accumulation of leukocytes is the hallmark of inflammation; in inflammatory bowel disease (IBD) this is the result of 3 components: increased recruitment of circulating leukocytes, proliferation of lymphocytes, and resistance of these cells to apoptosis.1 It was hypothesized that by blocking the initial recruitment process, intestinal inflammation can be controlled, and the GEMINI pivotal trials of the anti-α4β7 integrin antibody vedolizumab provided the proof of clinical concept of this principle in ulcerative colitis2 (UC) and Crohn’s disease (CD).
  • Chemoradiotherapy or Surgery for Very Early Esophageal Squamous Cancer: Can a Nonrandomized Trial Give Us the Answer?

    • Daniel L.P. Holyoake,
    • Elizabeth C. Smyth
    Published online: September 14, 2021
    p1793-1795
    Esophageal squamous cell cancer (SCC) is an important disease globally with a high mortality.1 Although early-stage esophageal SCC can be cured by surgical resection, esophagectomy is associated with long-term morbidity, nutritional challenges, and reduced quality of life.2 Esophageal SCC that is locally advanced can be cured using chemotherapy and radiotherapy without surgery, so it seems sensible for chemoradiotherapy (CRT) to be an option for patients with early-stage cancers.3,4 The question of whether chemoradiotherapy is noninferior to surgery in T1b esophageal SCC has recently been addressed in the JCOG0502 (Japan Clinical Oncology Group) trial, reported by Kato et al in this edition of Gastroenterology.
  • Out With the Old, in With the New: Replacing the “6-Month Abstinence Rule” With Integrated Care for Alcohol-Associated Liver Disease

    • Margarita N. German,
    • Randall Brown,
    • Michael R. Lucey
    Published online: September 23, 2021
    p1795-1797
    Between 2011 and 2015, excessive drinking was responsible for an average of 93,296 deaths (255 per day) and 2.7 million years of potential life lost (29 years lost per death, on average) each year in the United States.1 Within this estimate, which comprised deaths directly caused by alcohol, deaths partially attributable to alcohol, and deaths due to someone else’s drinking, alcohol-associated liver disease (ALD) was the leading chronic cause of directly alcohol-attributable deaths overall (n = 18,164) and among males (n = 12,887) and females (n = 5,277).
  • ZOning in on Novel Roles for Zonula Occludens Proteins in Epithelial Repair

    • Declan F. Mccole
    Published online: September 25, 2021
    p1797-1800
    Zonula occludens-1 (ZO-1) was the first identified tight junction (TJ) protein and is a member of a large family of membrane-associated scaffolding and signaling molecules known as membrane-associated guanylate kinase homologues.1 ZO-1 is conventionally regarded as forming a multidomain scaffold that coordinates the assembly of transmembrane and cytosolic proteins into the TJ and regulates the activity of these proteins once assembled.2–4 Indeed, ZO-1 binds all 3 classes of TJ transmembrane proteins, including claudins, occludin, and the immunoglobulin superfamily of cell adhesion receptors, which includes junctional adhesion molecules.
  • Interplay of Tumor Microenvironment Factors and Cancer Stem Cell Enrichment in Pancreatic Ductal Adenocarcinoma

    • Yuqing Zhang,
    • Jingxuan Yang,
    • Michael S. Bronze,
    • Courtney W. Houchen,
    • Min Li
    Published online: September 14, 2021
    p1800-1802
    Pancreatic ductal adenocarcinoma (PDAC) is the most common histologic type of pancreatic cancer and carries a poor prognosis. Incidence rates have increased leading to the potential for many pancreatic cancer–related deaths in the future.1 PDAC is characterized by a desmoplastic stroma, which is the core feature of the tumor microenvironment (TME).2 The TME is a complex ecosystem containing several cell types, such as immune cells, stellate cells, and stromal fibroblasts as well as extracellular matrix and blood vessels, all of which contribute to the growth and aggressiveness of a tumor (Figure 1).
  • Novel Insights Into Macrophage Diversity During the Course of Pancreatitis

    • Prince Allawadhi,
    • Georg Beyer,
    • Ujjwal M. Mahajan,
    • Julia Mayerle
    Published online: September 25, 2021
    p1802-1805
    Acute pancreatitis (AP) accounts for the highest number of hospital admissions for a benign gastrointestinal disease. Although most of the cases are mild and patients recover without specific treatment, 20% of cases follow a moderate to severe course with risk for multiple organ dysfunction syndrome and death and no medical treatment is available.1,2 Pancreatitis-related mortality depends to a large extent on the presence and duration of systemic inflammatory response syndrome,3 which, if persistent, will result in multiple organ dysfunction syndrome.

Gastroenterology in Motion

  • The Osculating Circles Gastroplasty: A Novel Endoscopic Submucosal Resection Enhanced Endoluminal Suturing for Obesity

    • Tala Mahmoud,
    • Eric J. Vargas,
    • Rabih Ghazi,
    • Rami Abusaleh,
    • Andrew C. Storm,
    • Barham K. Abu Dayyeh
    Published online: September 25, 2021
    p1806-1808.e1
    Endoscopic bariatric therapies have emerged as minimally invasive alternatives to bariatric surgery that augment the therapeutic spectrum as primary and revisional interventions.1 Endoscopic sleeve gastroplasty (ESG) is a primary endoscopic bariatric therapy and involves transoral endoscopic reduction of the gastric reservoir.2 Transoral outlet reduction (TORe) is a minimally invasive option for management of weight regain after Roux-en-Y gastric bypass secondary to dilation of the gastrojejunal anastomosis.
    Online ExtraVideo AbstractAdditional Online Content Available

Clinical Challenges and Images in GI

  • Volvulus of the Appendix

    • Deepika Bhojwani,
    • Stavros Gourgiotis,
    • Constantinos Simillis
    Published online: August 26, 2021
    p1809-1810
    A 57-year-old woman presented with a 4-day history of migratory right iliac fossa pain and abdominal distension. Her past medical history consisted of a deep vein thrombosis, uterine fibroids, and cholecystectomy for gallstone disease. Family history was positive for colon cancer. She was not peritonitic, and there were no palpable abdominal masses on examination. The patient was afebrile on admission, with a neutrophilia of 8.2 × 10^9/L and an elevated C-reactive protein of 85 nmol/L. A computed tomography scan found a distended appendix measuring 28 mm in caliber with a 13 mm appendicolith at the base.

Electronic Clinical Challenges and Images in GI

  • A Rare Cause of Small Bowel Thickening

    • Meike Hirdes,
    • Steffie de Gier,
    • Lodewijk A.A. Brosens
    Published online: April 26, 2021
    e1-e3
    Question: A 48-year-old man, otherwise healthy and not taking any medication, suffered from recurrent episodes of crampy abdominal pain, nausea, and vomiting for >15 years, leading to numerous hospitalizations. During these episodes, laboratory tests showed a normal differential leukocyte count but an elevated C-reactive protein level. In between these episodes, he was free of symptoms. Because of these symptoms, he underwent an appendectomy, without any abnormalities (appendix sana). Twice, an infectious agent (Yersinia enterolitica and Campylobacter jejuni spp.) was found.
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  • Deciphering the “Sausage” Pancreas

    • Natalia E. Castillo Almeida,
    • Prasuna Muppa,
    • Omar Abu Saleh
    Published online: April 26, 2021
    e4-e5
    Question: A 42-year-old man with a history of advanced HIV/AIDS presented with epigastric pain, nausea, and fever. He has no history of alcohol intake. Physical examination showed exquisite tenderness in the epigastric area. Laboratory examination revealed normal white blood cell count (5.7 × 109/L) and platelet count (156 × 109/L); elevated amylase (163 U/L; reference range, 26–102 U/L) and lipase (84 U/L, reference range, 12–61 U/L); HIV-1 RNA of 16,200 copies/mL; and CD4 T lymphocyte cell counts of 6 cells/μL.
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  • Ampullary Tumor With a Rare Etiology: A New Lesion in the Residual Ampulla After Curative Resection of Perihilar Cholangiocarcinoma

    • Haruka Toyonaga,
    • Yusuke Mizukami,
    • Akio Katanuma
    Published online: April 26, 2021
    e6-e9
    Question: A 59-year-old woman was referred to our hospital for jaundice and a liver tumor. A contrast-enhanced computed tomography scan revealed an enhanced 25-mm diameter tumor located in segment 5 near the liver hilum, and the right hepatic artery was involved (Figure A). Hilar biliary obstruction bismuth type IIIa was detected by magnetic resonance cholangiopancreatography (Figure B). After endoscopic retrograde cholangiopancreatography, intraductal ultrasound examination revealed a hilar biliary obstruction from the proximal common bile duct to the left hepatic duct.
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  • Fever and Abdominal Pain in Acute Pancreatitis

    • Rocío Forneiro Pérez,
    • Juan Alfredo Ubiña Martínez,
    • Inmaculada Lendínez Romero
    Published online: April 26, 2021
    e10-e11
    Question: A 44-year-old man with diabetes and a history of severe acute pancreatitis with encapsulated pancreatic necrosis in the context of hyperlipemia requiring admission to the intensive care unit. He was admitted for a second episode of acute pancreatitis. He initially presented renal failure and metabolic acidosis requiring admission to the intensive care unit with the need for vasopressors and the initiation of broad-spectrum antibiotic coverage. Despite antibiotic treatment, on day 7 of admission a high fever occurred, requiring antibiotic escalation with no microbiological findings.
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  • Nausea and Vomiting 8 Months After Liver Transplantation

    • Jordan S. Sack,
    • Rahul S. Patel,
    • Jawad Ahmad
    Published online: April 26, 2021
    e12-e14
    Question: A 32-year-old Caucasian man presented with several weeks of intermittent nausea and vomiting. He had undergone orthotopic liver transplantation 8 months prior for alcoholic cirrhosis complicated by variceal hemorrhage. There was no fever, diarrhea, or gastrointestinal bleeding. Medications were tacrolimus, metoprolol, and insulin. On examination, his abdomen was nontender with normal bowel sounds. Laboratory tests were stable with white blood cell count of 2.3 × 103/μL, hemoglobin of 10.9 g/dL, alanine aminotransferase of 14 U/L, aspartate aminotransferase of 28 U/L, alkaline phosphatase of 75 U/L, total bilirubin of 3.3 mg/dL, and direct bilirubin of 0.5 mg/dL.
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  • A Rare Presentation of Lower Abdominal Pain

    • Wei-Lin Wang,
    • Po-Li Wei,
    • I-Wei Chang
    Published online: April 26, 2021
    e15-e17
    Question: A 69-year-old woman presented to our hospital with lower abdominal pain, especially left lower quadrant of abdomen for 1 month. She did not have bowel habit change, blood-tingled stool, or body weight loss during this episode. In the clinic, 1 firm and nonmobile tumor at the left lower abdomen was palpated. A computed tomography scan revealed a huge (9 × 7 × 6 cm) and ill-defined tumor over left ovary and sigmoid colon area (Figure A). The initial tumor marker survey found carcinoma antigen 125 was 17.4 U/mL (reference value, <35.0 U/mL) and carcinoembryonic antigen was 307 ng/mL (reference value, <4.70 ng/mL).
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Practical Teaching Case

  • Gastrointestinal Bleeding and Acute Liver Failure

    • Arthur Gavotto,
    • Benjamin Rivière,
    • Lauriane Degravi
    Published online: April 08, 2021
    p1811-1812
    Question: A 73-year-old man was referred to emergency after falling at home in a context of fever (38.5°C), abdominal pain, and several episodes of melena. He had undergone emergency surgery 10 days earlier for an acute bowel occlusion requiring resection and anastomosis of a necrotic portion of the small intestine. The patient’s notable history included nonmetastatic basal tongue cancer treated with radiotherapy/chemotherapy (cisplatin then currently cetuximab).

Reviews in Basic and Clinical Gastroenterology and Hepatology

  • Cyclooxygenases and Prostaglandins in Tumor Immunology and Microenvironment of Gastrointestinal Cancer

    • Dingzhi Wang,
    • Carlos S. Cabalag,
    • Nicholas J. Clemons,
    • Raymond N. DuBois
    Published online: October 01, 2021
    p1813-1829
    Chronic inflammation is a known risk factor for gastrointestinal cancer. The evidence that nonsteroidal anti-inflammatory drugs suppress the incidence, growth, and metastasis of gastrointestinal cancer supports the concept that a nonsteroidal anti-inflammatory drug target, cyclooxygenase, and its downstream bioactive lipid products may provide one of the links between inflammation and cancer. Preclinical studies have demonstrated that the cyclooxygenase-2–prostaglandin E2 pathway can promote gastrointestinal cancer development.

Original Research

Continuing Medical Education (CME)/MOC Activities

Clinical Practice Update

  • AGA Clinical Practice Update on Surveillance After Pathologically Curative Endoscopic Submucosal Dissection of Early Gastrointestinal Neoplasia in the United States: Commentary

    • Andrew Y. Wang,
    • Joo Ha Hwang,
    • Amit Bhatt,
    • Peter V. Draganov
    Published online: October 21, 2021
    p2030-2040.e1
    The purpose of this American Gastroenterological Association (AGA) Institute Clinical Practice Update was to review the available evidence and provide expert advice regarding surveillance using endoscopy and other relevant modalities after removal of dysplastic lesions and early gastrointestinal cancers with endoscopic submucosal dissection deemed to be pathologically curative. This Clinical Practice Update was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology.
    Online ExtraAdditional Online Content Available

Research Letters

  • Decreased Antibody Responses to Ad26.COV2.S Relative to SARS-CoV-2 mRNA Vaccines in Patients With Inflammatory Bowel Disease

    • VALERIYA Pozdnyakova,
    • GREGORY J. Botwin,
    • KIMIA Sobhani,
    • JOHN Prostko,
    • JONATHAN Braun,
    • DERMOT P.B. Mcgovern,
    • GIL Y. Melmed,
    • Keren Appel,
    • Andrea Banty,
    • Edward Feldman,,
    • ...
    • Philip Debbas,
    • Melissa Hampton,
    • Emebet Mengesha,
    • James L. Stewart,
    • Edwin C. Frias,
    • Susan Cheng,
    • Joseph Ebinger,
    • Jane C. Figueiredo,
    • Brigid Boland,
    • Aline Charabaty,
    • Michael Chiorean,
    • Erica Cohen,
    • Ann Flynn,
    • John Valentine,
    • David Fudman,
    • Arash Horizon,
    • Jason Hou,
    • Caroline Hwang,
    • Mark Lazarev,
    • Donald Lum,
    • Rebecca Fausel,
    • Swapna Reddy,
    • Mark Mattar,
    • Mark Metwally,
    • Arthur Ostrov,
    • Nimisha Parekh,
    • Laura Raffals,
    • Sarah Sheibani,
    • Corey Siegel,
    • Douglas Wolf,
    • Ziad Younes
    Published online: August 12, 2021
    p2041-2043.e1
    Currently, 3 vaccines have been granted Emergency Use Authorization for coronavirus disease 2019 (COVID-19) prevention in the United States. These include the messenger RNA (mRNA) platform vaccines (mRNA-1273; Moderna/National Institutes of Health) and BNT162b2 (Pfizer-BioNTech) and an adenovirus vector vaccine (Ad26.CoV2.S; Johnson & Johnson), which were 94%, 95%, and 67% effective against COVID-19 infection in their phase III registry trials against the endemic variants at the time, respectively.
    Online ExtraAdditional Online Content Available
  • Sleeve Gastrectomy Confers Higher Risk of Gastroesophageal Reflux Disease Than Gastric Bypass: A Randomized Controlled Trial From the Oseberg Reflux Working Group

    • Jolanta Lorentzen,
    • Asle W. Medhus,
    • Dag Hofsø,
    • Marius Svanevik,
    • Birgitte Seip,
    • Jøran Hjelmesæth
    Published online: August 19, 2021
    p2044-2046.e4
    Obesity is associated with increased intra-abdominal pressure, impaired gastric emptying, and decreased lower esophageal sphincter (LES) pressure, all factors predisposing for gastroesophageal reflux disease (GERD).1 Furthermore, autonomic neuropathy in diabetes may increase the risk of GERD because of abnormal peristalsis and reduced LES pressure. Accordingly, patients with obesity and/or type 2 diabetes have a high prevalence of GERD and esophageal motility disorders. Weight loss reduces acid reflux.
    Online ExtraAdditional Online Content Available
  • Pediatric COVID-19 and Gastrointestinal Symptoms in Africa

    • Anas Brim,
    • Yusuf Ashktorab,
    • Tiziano Russo,
    • Antonio Pizuorno,
    • Gholamreza Oskrochi,
    • Hassan Brim
    Published online: August 18, 2021
    p2047-2050.e3
    One year into the coronavirus disease 2019 (COVID-19) pandemic, the African continent still seems to be spared from the devastating effects the disease had in other continents. Africa’s COVID-19 seems to be of a milder nature both in adults and children. However, lack of data from Africa is significant, and more studies are needed to validate the disease status, clinical manifestations, and future implications for Africa. In this study, we report pediatric COVID-19 features in Africa represented by 8 countries.
    Online ExtraAdditional Online Content Available
  • Testing and Treating Helicobacter pylori Infection in Individuals With Family History of Gastric Cancer is Cost-effective

    • Sheila D. Rustgi,
    • Aaron Oh,
    • Chin Hur
    Published online: August 26, 2021
    p2051-2052.e4
    Gastric cancer (GC) is a major source of cancer-related morbidity and mortality worldwide.1 Up to 10% of cases demonstrate familial aggregation, although whether this is due to genetic factors, shared environment with exposures to toxins, such as Helicobacter pylori infection or tobacco smoke, or a combination of the two is unclear.2 Family history of a first-degree relative with GC increases lifetime risk by 2.5-fold, as does H pylori infection.3,4 A recent randomized controlled trial demonstrated a significant reduction in GC incidence in patients undergoing regular endoscopic surveillance, who had a first-degree relative with GC, were treated for H pylori infection.
    Online ExtraAdditional Online Content Available
  • A Multilocus Blood-Based Assay Targeting Circulating Tumor DNA Methylation Enables Early Detection and Early Relapse Prediction of Colorectal Cancer

    • Guoxiang Cai,
    • Mingyan Cai,
    • Zhiqiang Feng,
    • Rui Liu,
    • Li Liang,
    • Pinghong Zhou,
    • ColonAiQ Group,
    • Boqun Zhu,
    • Shaobo Mo,
    • Hui Wang,
    • ...
    • Yuqiang Nie,
    • Chengcheng Ma,
    • Zhixi Su
    Published online: September 03, 2021
    p2053-2056.e2
    Colorectal cancer (CRC) is one of the most common and deadliest cancers worldwide. Patient survival can be greatly improved if cancerous lesions are detected early.1 Despite a strong recommendation of colonoscopy for CRC screening, patients prefer noninvasive tests, and 83% favor blood-based tests.2 Blood tests that rely on a single DNA methylation biomarker have been approved3; however, they are not recommended due to the low sensitivity for detecting early-stage CRC.4
    Online ExtraAdditional Online Content Available
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