Department of Gastroenterology and Hepatology

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The efficacy of antireflux mucosectomy (ARMS) and antireflux mucosal ablation (ARMA) for gastroesophageal reflux disease (GERD) by 24-h pH monitoring: systematic review and meta-analysis.
Al-Obaidi, H.; Saab, O.; Merza, N.; Wakil, A.; Rabeeah, S.; Al-Obaidi, M.; Alsagban, A.; Algodi, M.; Baig, M.U.; Kobeissy, A.; Sharaiha, R. (Springer, 2025-07-09)
BACKGROUND: Gastroesophageal reflux disease (GERD) is a prevalent and chronic disorder impacting a significant proportion of the global population, approximately 15%. Most GERD patients show improvement with medical treatment, including proton pump inhibitors (PPIs); however, around 40% continue to experience symptoms despite ongoing PPI use. Antireflux mucosal ablation (ARMA) and antireflux mucosectomy (ARMS) are minimally invasive endoscopic procedures for treating GERD. OBJECTIVE: This meta-analysis aimed to evaluate the efficacy of ARMA and ARMS through the DeMeester score, acid exposure time (AET), and clinical success rate. METHODS: Studies reporting pre- and postprocedure esophageal 24 h pH monitoring following ARMA and ARMS were included. Pooled data analysis assessed changes in the DeMeester score and AET using the standardized mean difference (SMD). Clinical success rate, defined as significant symptom improvement or reduced reliance on PPIs, was also analyzed. RESULTS: Pooled data from three ARMA studies showed a significant postprocedure decrease in median AET (SMD: - 20.74, 95% CI [- 25.51, - 15.97], p < 0.0001). Similarly, six ARMS studies demonstrated a significant reduction in DeMeester score (SMD: - 2.79, 95% CI [- 4.33, - 1.26], p < 0.0001). The overall clinical success rate for ARMS was 78%, while ARMA achieved 87%. CONCLUSIONS: Both ARMA and ARMS displayed promising efficacy in improving GERD-related outcomes based on reductions in AET and DeMeester scores and achieving high clinical success rates. However, the high heterogeneity observed suggests further research is needed to identify patient-specific factors influencing treatment response.
Comparing Weight Loss and Metabolic Outcomes of Virtual Versus In-Person Follow-Up Care in Bariatrics: A Propensity-Matched Analysis at 12 and 36 Months Post-ESG
Lahooti, A.; Johnson, K.E.; Aneke-Nash, C.; Al Zureikat, Q.; Baig, M.U.; Hanscom, M.; Buckholz, A.; Schwartz, R.E.; Newberry, C.; Sampath, K.; Carr-Locke, D.; Mahadev, S.H.; Kumar, S.; Sharaiha, R.Z. (Springer, 2025-06-10)
INTRODUCTION: The rising prevalence of obesity and demand for minimally invasive treatments has led to increased adoption of endoscopic sleeve gastroplasty (ESG). As telemedicine expands in bariatrics, understanding the role of virtual follow-up care is crucial. This study aims to use propensity-matching to compare weight loss and metabolic outcomes between virtual and in-person follow-up modalities post-ESG. METHODS: Data from patients with obesity who underwent ESG at a single tertiary care center between August 2013 and November 2024 were prospectively collected and retrospectively analyzed. Eligible patients were those with a body mass index (BMI) of 30 kg/m² or greater (or > 27 kg/m² with comorbidities). All procedures were performed by a single therapeutic endoscopist using a full-thickness technique. Patients were categorized into virtual or in-person follow-up groups based on whether over 70% of their post-procedure visits were conducted virtually or in-person, respectively. To account for potential baseline differences, propensity score matching was employed. The primary outcomes assessed were the impact of follow-up method on percent total body weight loss (%TBWL) and changes in metabolic parameters at 12 and 36 months post-ESG. RESULTS: Data from 113 patients (mean age, 43.9 years; 80.5% female, BMI 36.0 kg/m²), were analyzed, and stratified by follow-up modality (in-person: n = 54, virtual: n = 59). After propensity matching, baseline differences were eliminated and both groups demonstrated improvements in ALT, HbA1c, LDL, TG, SBP, and mean %TBWL exceeding ten at all time points, with no statistically significant differences between groups at 12 or 36 months. DISCUSSION: Telemedicine is expected to remain in the management of obesity due to its convenience. This study found no significant differences in weight loss or metabolic changes between propensity-matched groups, demonstrating comparable effectiveness of virtual and in-person follow-up. Future research should refine telemedicine strategies and assess their long-term impact on weight maintenance.
Association of Primary Language With Treatment and Outcomes in Inflammatory Bowel Disease.
Sahyoun, L.C.; Chavez, V.; Vasudevan, J.; Kogan, L.; Mukkamala, B.; Ochi, M.G.; Anand, T.; Ahmed, Z.; Tang, Z.; Feagins, L.A.; Gaidos, J.K.J. (Lippincott, Williams & Wilkins, 2025-06-06)
BACKGROUND: As rates of inflammatory bowel disease (IBD) rise among non-English speaking populations, it is imperative to better understand the impact of language barriers and cultural differences on disease management. METHODS: Multi-center, retrospective, cohort study of adult patients with IBD who spoke a language other than English, matched 1:2 to English-speaking controls. Patients were enrolled at their first clinic visit and then followed up to 12 months. Advanced therapy (AT) was defined as a biologic or small molecule. Primary outcome was the rate of AT use between cohorts. Secondary outcomes included rates of AT initiation and corticosteroid-free clinical remission at 6 and 12 months. RESULTS: 144 patients with IBD (48 non-English speakers, 96 English speakers) were included in this study. Both cohorts had similar baseline disease activity based on physician global assessment, however non-English-speaking patients had significantly higher rates of baseline elevated fecal calprotectin (91.7% vs 50%, P=0.014). After multivariate analysis to adjust for baseline differences, we found no difference in prior or current advanced therapy use. Rates of initiation of advanced therapy were similar between the two groups at 6- and 12-month follow up. Adjusted rates of corticosteroid-free clinical remission were not different at 6 and 12 months. CONCLUSIONS: Primary language spoken did not significantly impact the rates of advanced therapy use or overall IBD disease activity in two academic practices. Future studies are warranted to understand the effect of language on medication adherence, patient satisfaction and understanding, and disease outcomes.
DHA suppresses hormone-sensitive and castration-resistant prostate cancer growth by decreasing de novo lipogenesis.
Tamarindo, G.H.; Ribeiro, C.F.; Rodrigues, S.; Góes, R.M.; Loda, M. (Elsevier, 2025-05-16)
OBJECTIVE: De novo lipogenesis (DNL) is associated with prostate cancer (PCa) progression, while fatty acid synthase (FASN) overexpression is a hallmark of DNL. Palmitate, its main product, is a saturated fatty acid that supports PCa growth. Polyunsaturated fatty acids (PUFAs), which can be acquired from the microenvironment, undergo peroxidation more readily and affect membrane fluidity. Docosahexaenoic acid (DHA) is a prototype PUFA omega-3 produced inefficiently in human cells. Its levels are low in PCa cells compared to normal cells. We hypothesize that excess DHA may reprogram lipid metabolism and induce cell growth suppression. METHODS: Androgen-responsive LNCaP, castration-resistant cells C4-2 and 22Rv1, human PCa castration-resistant organoids, and prostate cancer xenografts were exposed to DHA. RESULTS: DHA accumulated into lipid droplets as triacylglycerols and cholesterol esters, led to increased phospholipid acyl chain unsaturation and altered phospholipid ratio, a known trigger of endoplasmic reticulum (ER) stress. DHA caused a decrease in sterol regulatory element-binding protein (SREBP) transcriptional program, which, in turn, led to decreased expression of FASN. The subsequent reduction in DNL caused downregulation of the androgen receptor (AR) and its splice variant AR-V7. In addition, Œ≤-oxidation was enhanced, and DHA was preferentially oxidized over palmitate. Glucose oxidation also increased in the presence of DHA. Finally, DHA led to ROS overproduction, oxidative damage, and ER stress. CONCLUSIONS: DHA reduces the growth of hormone-sensitive and castration-resistant PCa both in vitro and in vivo via deregulation of lipid metabolism.
The sensory neuroimmune frontier.
Kim, B.S.; Artis, D. (Elsevier, 5/4/25)
Sensing and recognition are key properties of both the immune and nervous systems. In the immune system, pattern recognition or antigen-specific receptors represent classic motifs in innate and adaptive immunity, respectively. In the nervous system, there is a major anatomic division between how we sense stimuli from within the body (vagal sensory nervous system) and the outside world (somatosensory nervous system). However, in the last 5 years, there has been an explosion of discoveries revealing interactions between the immune and the sensory nervous systems that govern an array of physiologic and pathologic processes including allergy, infection, autoimmunity, regeneration, cancer, and beyond. Herein, we highlight recent advances that demonstrate how peripheral sensory neuroimmunology has emerged as a powerful field that provides new insights into classic immunologic processes including immune hypersensitivity, inflammation, and tissue homeostasis.
Outcomes of EUS-guided liver biopsy using 22-gauge versus 19-gauge needles with a novel hydrostatic sampling technique.
Magahis, P.T.; Hissong, E.; Hanscom, M.; Carr-Locke, D.L.; Sampath, K.; Sharaiha, R.Z.; Mahadev, S.H. (Elsevier, 5/8/25)
BACKGROUND AND AIMS: Prior data have shown specimen quality suffers when 22-gauge needles are used in place of 19G needles during endoscopic ultrasound-guided liver biopsy (EUS-LB). Emerging data suggest a novel hydrostatic sampling technique (HST) may offer improved performance over wet suction (WS). We hypothesized EUS-LB using a 22G fine-needle biopsy needle with the HST would attain similar tissue adequacy to 19G needles. METHODS: We retrospectively examined a prospectively collected database of EUS-LBs between 1/2021-9/2024. All biopsies were performed with a 22G or 19G needle using one pass with three actuations. All specimens were re-reviewed by an expert pathologist blinded to needle gauge and technique. RESULTS: 126 EUS-LBs (30 via 22G HST, 44 via 19G HST, and 52 via 19G WS) were performed in 120 patients. Compared to 22G HST, tissue adequacy (length ≥2cm and ≥11 complete portal tracts [CPTs]) was identical in 19G HST (93% vs. 93%, p=0.98) and lower in 19G WS (93% vs. 85%, p=0.25). Median aggregate specimen length was 5.10 cm, 5.63 cm, and 5.30 cm and CPT count was 24, 26, and 21 in 22G HST, 19G HST, and 19G WS, respectively. 22G HST had significantly less blood contamination compared to both 19G HST and 19G WS with no significant differences in specimen fragmentation. CONCLUSIONS: When using the HST, EUS-LB with 22G needles meets adequacy standards at high rates similar to 19G needles. The HST may allow for the use of 22G needles in patients at high risk for adverse events or with challenging anatomies.
GI Genius increases small and right-sided adenoma and sessile serrated lesion detection rate when used with EndoCuff in a real-world setting: a retrospective United States study.
Kim, J.H.; Wang, J.; Pence, C.; Magahis, P.; Dawod, E.; Schnoll-Sussman, F.; Sharaiha, R.Z.; Wan, D. (Korean Society of Gastrointestinal Endoscopy, 4/22/25)
BACKGROUND/AIMS: The real-world efficacy of computer-aided detection (CADe) systems, such as GI Genius (Medtronic), is unclear. We examined the colonoscopy metrics using CADe alone and with a mucosal exposure device (EndoCuff; Olympus) in a real-world setting. METHODS: We retrospectively reviewed screening and surveillance colonoscopies before, during, and after CADe use in a large tertiary care center. Outcomes included the adenomas per colonoscopy (APC), sessile serrated lesions per colonoscopy, adenoma detection rate (ADR), sessile serrated lesion detection rate (SSLDR), advanced ADR, total polyp detection rate, and true histology rate. The ADR and SSLDR were further examined according to size, colon location, and EndoCuff use. RESULTS: A total of 798 colonoscopies were performed, including 386 pre-CADe, 178 CADe, and 234 post-CADe. In cases where CADe was used with the EndoCuff, the 1 to 5 mm ADR increased from 36.3% (pre-CADe) to 52.1% (CADe) (p=0.01). The 1 to 5 mm SSLDR increased from 9.6% (pre-CADe) to 17.1% (CADe) (p=0.02). The right-sided ADR increased from 30.8% (pre-CADe) to 42.7% (CADe) (p=0.03). The right-sided SSLDR increased from 12.3% (pre-CADe) to 24.8% (CADe) (p<0.001). No significant changes were observed when only CADe was used. No differences were found in other outcome measures. Post-CADe metrics returned to pre-CADe levels. CONCLUSIONS: GI Genius is useful for identifying small and right-sided polyps only when used with the EndoCuff.
Gene-based therapies for steatotic liver disease.
Iakovleva, V.; de Jong, Y.P. (Cell Press, 4/19/25)
Advances in nucleic acid delivery have positioned the liver as a key target for gene therapy, with adeno-associated virus vectors showing long-term effectiveness in treating hemophilia. Steatotic liver disease (SLD), the most common liver condition globally, primarily results from metabolic dysfunction-associated and alcohol-associated liver diseases. In some individuals, SLD progresses from simple steatosis to steatohepatitis, cirrhosis, and eventually hepatocellular carcinoma, driven by a complex interplay of genetic, metabolic, and environmental factors. Genetic variations in various lipid metabolism-related genes, such as patatin-like phospholipase domain-containing protein 3 (PNPLA3), 17Œ≤-hydroxysteroid dehydrogenase type 13 (HSD17B13), and mitochondrial amidoxime reducing component 1 (MTARC1), impact the progression of SLD and offer promising therapeutic targets. This review largely focuses on genes identified through clinical association studies, as they are more likely to be effective and safe for therapeutic intervention. While preclinical research continues to deepen our understanding of genetic factors, early-stage clinical trials involving gene-based SLD therapies, including transient antisense and small molecule approaches, are helping prioritize therapeutic targets. Meanwhile, hepatocyte gene editing technologies are advancing rapidly, offering alternatives to transient methods. As such, gene-based therapies show significant potential for preventing the progression of SLD and enhancing long-term liver health.
Assessment of Access Barriers to Rifaximin Among Patients with Hepatic Encephalopathy Using Adjudicated Claims Data
Jesudian, A.; Gagnon-Sanschagrin, P.; Maitland, J.; Yokoji, K.; Gurin, A.; Heimanson, Z.; Samson, A.; Olujohungbe, O.; Bumpass, B. (Springer, 4/7/25)
INTRODUCTION: Continuous treatment with rifaximin 550 mg (hereafter rifaximin) is associated with lower hospitalization rates in patients with hepatic encephalopathy (HE); however, access barriers may exist. This study assessed gaps in rifaximin access and the impact of treatment gaps, particularly those resulting from claim rejections, on hospitalizations and healthcare costs among patients with HE in the United States. METHODS: The IQVIA PharMetrics Plus database linked with Longitudinal Access and Adjudicated Data (2015-2022) were used to identify adults with HE who had ≥1 paid rifaximin prescription fill. Rifaximin treatment gaps were assessed during the 12-month period from the first observed attempt at receiving rifaximin (index date). Adjusted number of overt HE (OHE) hospitalizations and healthcare costs were compared over the 6 months following the index date between Cohort 1, who had no gap due to claim rejection and had < 7 days of treatment gap due to other reasons, and Cohort 2, who had ≥ 1 rejection gap or had ≥ 7 days of non-rejection gap. RESULTS: During the year following the index date, 94.7% of the 1711 patients experienced a treatment gap, including 34.8% with initiation gaps from first attempt at receiving rifaximin to first paid claim (77.7% of initiation gaps due to rejected claims) and 72.0% with gaps in access during active treatment (14.8% of active treatment gaps due to rejected claims). Compared with Cohort 1 (n = 432; mean age 56.3 years), Cohort 2 (n = 679; mean age 54.8 years) had 1.55 times the incidence rate of OHE hospitalizations [adjusted incidence rate ratio: 1.55 (95% confidence interval: 1.10-2.20)] and incurred US$1579 more in healthcare-associated costs per-patient-per-month (all p < 0.05). CONCLUSION: Prescription claim rejections frequently led to delays in rifaximin initiation and gaps in access during active treatment. Access barriers to rifaximin were associated with increased hospitalizations and healthcare costs in patients with HE.
The Impact of Endoscopic Healing on Disease-Related Outcomes in Patients With Ulcerative Proctitis
Liu, E.Y.; An, A.; Khan, S.; Battat, R.; Longman, R.; Scherl, E.; Sahyoun, L.; Lukin, D.J. (Oxford University Press, 3/31/25)
BACKGROUND AND AIMS: Ulcerative proctitis (UP) is a limited form of ulcerative colitis. While achieving endoscopic healing (EH) in ulcerative colitis improves long-term outcomes, the benefit of EH in UP is uncertain. This study aimed to assess the impact of EH on outcomes in UP. METHODS: This single-center retrospective study included adults with UP and ≥2 endoscopies, with active inflammation (Mayo endoscopic score [MES] 1-3) at index. EH was defined as MES 0-1 at follow-up procedure. The relationship of EH to inflammatory bowel disease (IBD)-related outcomes was assessed using univariate analysis and multivariable logistic regression assessed the effect of EH on IBD-related outcomes. RESULTS: Among 200 UP patients, 109 (54.5%) had EH at follow-up endoscopy at median 19 months (interquartile range: 7, 32). EH was associated with fewer IBD-related emergency department (ED) visits (EH: 8.3%, no EH: 21%, P = .01), hospitalizations (5.5% vs 18%), and GI visits (mean: 1.47/year [SD: 1.40], vs 2.96/year [2.52], P < .001). Patients with EH were less likely to have iron deficiency anemia (23% vs 41%, P = .007), Clostridioides difficile (0.9% vs 6.6%, P = .048), or initiate new biologic therapy after relapse (15% vs 33%, P = .034). Patients with EH had a greater time to clinical relapse (21 [24] vs 9 months [14]; P = .006) and lower odds of an IBD-related ED visit (OR: 0.32, 95% CI: 0.13, 0.73) or hospitalization (0.26 [0.09, 0.67]). Baseline presence of a cecal patch did not impact outcomes. CONCLUSIONS: UP patients with EH had less IBD-related healthcare utilization, fewer IBD-related complications, and were less likely to escalate therapy after relapse than patients without EH. Using a treatment target of EH may therefore be desirable in UP.

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