Latest news with #Gastroenterology
Medscape
15 hours ago
- Health
- Medscape
Cirrhosis Mortality Prediction Boosted by Machine Learning
Among hospitalized patients with cirrhosis, a machine learning (ML) model enhanced mortality prediction compared with traditional methods and was consistent across country income levels in a large global study. 'This highly inclusive, representative, and globally derived model has been externally validated,' Jasmohan Bajaj, MD, professor of medicine at Virginia Commonwealth University in Richmond, Virginia, told Medscape Medical News . 'This gives us a crystal ball. It helps hospital teams, transplant centers, gastroenterology and intensive care unit services triage and prioritize patients more effectively.' The study supporting the model, which Bajaj said 'could be used at this stage,' was published online in Gastroenterology . The model is available for downloading at CLEARED Cohort Analyzed Wide variations across the world regarding available resources, outpatient services, reasons for admission, and etiologies of cirrhosis can influence patient outcomes, according to Bajaj and colleagues. Therefore, they sought to use ML approaches to improve prognostication for all countries. They analyzed admission-day data from the prospective Chronic Liver Disease Evolution And Registry for Events and Decompensation (CLEARED) consortium, which includes inpatients with cirrhosis enrolled from six continents. The analysis compared ML approaches with logistical regression to predict inpatient mortality. The researchers performed internal validation (75/25 split) and subdivision using World-Bank income status: low/low-middle (L-LMIC), upper middle (UMIC), and high (HIC). They determined that the ML model with the best area-under-the-curve (AUC) would be externally validated in a US-Veteran cirrhosis inpatient population. The CLEARED cohort included 7239 cirrhosis inpatients (mean age, 56 years; 64% men; median MELD-Na, 25) from 115 centers globally; 22.5% of centers belonged to LMICs, 41% to UMICs, and 34% to HICs. A total of 808 patients (11.1%) died in the hospital. Random-Forest analysis showed the best AUC (0.815) with high calibration. This was significantly better than parametric logistic regression (AUC, 0.774) and LASSO (AUC, 0.787) models. Random-Forest also was better than logistic regression regardless of country income-level: HIC (AUC,0.806), UMIC (AUC, 0.867), and L-LMICs (AUC, 0.768). Of the top 15 important variables selected from Random-Forest, admission for acute kidney injury, hepatic encephalopathy, high MELD-Na/white blood count, and not being in high income country were variables most predictive of mortality. In contrast, higher albumin, hemoglobin, diuretic use on admission, viral etiology, and being in a high-income country were most protective. The Random-Forest model was validated in 28,670 veterans (mean age, 67 years; 96% men; median MELD-Na,15), with an inpatient mortality of 4% (1158 patients). The final Random-Forest model, using 48 of the 67 original covariates, attained a strong AUC of 0.859. A refit version using only the top 15 variables achieved a comparable AUC of 0.851. Clinical Relevance 'Cirrhosis and resultant organ failures remain a dynamic and multidisciplinary problem,' Bajaj noted. 'Machine learning techniques are one part of multi-faceted management strategy that is required in this population.' If patients fall into the high-risk category, he said, 'careful consultation with patients, families, and clinical teams is needed before providing information, including where this model was derived from. The results of these discussions could be instructive regarding decisions for transfer, more aggressive monitoring/ICU transfer, palliative care or transplant assessments.' Meena B. Bansal, MD, system chief, Division of Liver Diseases, Mount Sinai Health System in New York City, called the tool 'very promising.' However, she told Medscape Medical News , 'it was validated on a VA [Veterans Affairs] cohort, which is a bit different than the cohort of patients seen at Mount Sinai. Therefore, validation in more academic tertiary care medical centers with high volume liver transplant would be helpful.' Furthermore, said Bansal, who was not involved in the study, 'they excluded those that receiving a liver transplant, and while only a small number, this is an important limitation.' Nevertheless, she added, 'Artificial intelligence has great potential in predictive risk models and will likely be a tool that assists for risk stratification, clinical management, and hopefully improved clinical outcomes.' This study was partly supported by a VA Merit review to Bajaj and the National Center for Advancing Translational Sciences, National Institutes of Health. No conflicts of interest were reported by any author.
Yahoo
10-07-2025
- Health
- Yahoo
The Best Diets to Help Prevent Constipation, According to a New Study
Reviewed by Dietitian Emily Lachtrupp, M.S., RDThis study found that Mediterranean and plant-based diets may prevent constipation. Vegetables, nuts and healthy fats had the strongest associations. Start incorporating these foods into your meals and snacks to lower constipation you've ever struggled to poop, you know how annoying, and sometimes painful, it can be. Constipation is clinically defined as having fewer than three bowel movements a week. But that's not all. If your stools are hard, dry or lumpy, or you have to strain to get them out, you might be constipated. And if you're able to go but feel like you can't get it all out? That's also a sign of constipation. If you can relate to any of this, know that you're not alone. About 16% of American adults have symptoms of constipation. This number increases to 33% for those over 60. And constipation can be costly. Some experts estimate that people with constipation and commercial health insurance average $8,700 more annually in health care costs compared to people without constipation. Typically, increasing fiber and fluid intake are two things that are recommended to help get things moving. But a new study done by researchers at Mass General Brigham in Boston has a few more suggestions regarding diet and which foods may help. They published their findings in the journal Gastroenterology. Let's break down what they found. Researchers drew data from three large, previously conducted, long-term U.S. studies: the Nurses' Health Study (NHS), the Nurses' Health Study II (NHSII) and the Health Professionals' Follow-Up Study (HPFS). The NHS started in 1976 and included 121,700 female nurses; the NHSII included over 116,400 female nurses and began in 1989. Starting in 1986, the HPFS enrolled just over 51,500 male health care workers. From these cohorts, researchers pulled data on participants who met their criteria, resulting in almost 28,000 women from the NHS with an average age of 78, about 56,000 women from the NHSII with an average age of 61, and over 12,200 men from the HPFS with an average age of 79. They also took data on demographics, including age, sex, race, smoking status, physical activity, medical history, medications, supplements, BMI and socioeconomic status. Constipation was assessed in biannual questionnaires, asking, 'In the past year, have you been bothered by constipation for at least 12 weeks (not necessarily consecutive)?' Individuals with irritable bowel syndrome with constipation subtype (IBS-C) were identified by answering yes to the constipation question, plus to 'If yes, were your bowel movements associated with abdominal pain?' Researchers defined chronic constipation as having a bowel movement every three or more days. In all three cohorts, food frequency questionnaires were completed every four years. The FFQs included 131 food and beverage items, asking how often and how much participants ate. Responses were converted into average servings per day. Researchers then applied this to five different eating patterns, resulting in scores for each one, including the alternate Mediterranean diet (aMED) score, plant-based diet index (PDI), low-carb diet (LCD) score, Western diet and the empirical dietary inflammatory pattern (EDIP) score. The EDIP attempts to quantify the amount of inflammatory food you eat by tracking 18 food groups that may raise inflammatory markers in the body. Based on their scores, participants were placed into groups called quintiles. The quintiles ranged from low to high scores. During the study follow-up periods, which were 25 to 30 years, there were over 7,500 cases of chronic constipation. After running statistical analyses, including adjusting for confounding factors (e.g., demographics and fiber intake), researchers found: Compared to the lowest groups, the groups that scored highest on Mediterranean diet and plant-based diet experienced a 16% and 20% decreased risk for constipation, respectively. The groups that scored highest on the inflammatory diet scale (EDIP) and Western diet scale were associated with a 24% and 22% increased risk for constipation, respectively. Among the individual dietary components, higher intake of all types of vegetables, nuts and salad dressing were associated with lower risks for constipation. Comparing the highest quintile (Q5) to the lowest (Q1), greater adherence to the Mediterranean diet and a plant-based diet were associated with a 25% and a 27% decreased risk for irritable bowel syndrome with constipation, respectively. These results suggest that greater adherence to the Mediterranean diet or a plant-based diet reduces the risk of chronic constipation. This is independent of fiber intake. In other words, researchers adjusted for total fiber intake and still found that, even by taking away any influence fiber might have on constipation, these eating patterns still helped reduce the risk of constipation. In particular, they found that tomatoes, cruciferous vegetables, leafy green vegetables and dark yellow vegetables appeared to be the primary dietary components driving the protective associations between the aMED and PDI with reduced risk of constipation. Eating patterns that increased the risk of constipation included the Western diet and EDIP. The Western diet, sometimes referred to as the typical American diet, is characterized by high intake of red or processed meats, refined grains, french fries, high-fat dairy products, sweets, desserts and butter. In addition to vegetables, researchers also found strong associations between nuts and healthy fats with reduced risk of constipation. Since researchers adjusted for fiber, they essentially removed fiber's effects on constipation for analysis. This suggests that there is some other component in these foods that is responsible for reducing the risk of constipation. 'Although the study did not specifically address the mechanisms by which these diets were protective, we suspect that bioactive compounds found in vegetables and nuts—such as polyphenols, antioxidants and healthy fats (e.g., monounsaturated fats)—likely contribute to constipation prevention,' says senior study author Kyle Staller, M.D., M.P.H. 'These benefits are most likely driven by the way they impact our gut microbiome, the community of bacteria and other microbes that live in our gut. It's possible that these foods promote the growth of beneficial gut bacteria that produce compounds that we think may be beneficial to the lining (and therefore function) of the gut, like short-chain fatty acids.' Still, Staller says that fiber is still a key nutrient for avoiding constipation and supporting a healthy gut. If you're not ready to go all in with the Mediterranean or plant-based diets, you can start adding the foods that seem to have more influence over constipation, according to this study: tomatoes, cruciferous vegetables, leafy green vegetables, dark yellow vegetables, nuts and healthy fats, like olive oil. Need some inspiration? Try our Roasted Squash & Lentil Kale Salad to get your leafy green/cruciferous and dark yellow veggies, plus olive oil. Or our mouthwatering Tomato Salad with Lemon-Basil Vinaigrette to get your fill of tomatoes and olive oil. If you're ready to go for it, a great place to start is with our 7-Day Mediterranean Diet Meal Plan for Beginners or our 7-Day Mediterranean Diet Meal Plan for a Healthy Gut. The Mediterranean diet is loaded with fruits, vegetables, whole grains, legumes, nuts, seeds, seafood, lean protein, healthy fats and a little dairy. If you're interested in trying a meal plan with no meat, but a little yogurt or kefir, check out our 7-Day Plant-Based Diet Meal Plan for Beginners. If you think plant-based means boring, this will change your mind! Other habits that can influence constipation include physical activity, stress and fluid intake. And while alcohol may help you go, these study authors caution against using it as a constipation cure, since it can have negative consequences on your gut health and other organs, including your brain. Plus, in the long run, regularly imbibing can increase chronic inflammation, which, in turn, increases disease risk—exactly the opposite of what you're trying to accomplish. This study suggests that the Mediterranean and plant-based diets are associated with lower rates of constipation. On the other end of the spectrum fall the Western diet and inflammatory diets, which are associated with higher rates of constipation. According to these researchers, it's not just fiber that contributes to a reduced risk of constipation. The antioxidants in vegetables, nuts and healthy fats also appear to contribute. There are many reasons the Mediterranean diet has been ranked as the healthiest eating pattern for several years. Following the Mediterranean diet also helps reduce disease risk, including heart disease, dementia, osteoporosis and macular degeneration. Now we can add constipation to the list. Read the original article on EATINGWELL
South China Morning Post
10-07-2025
- Health
- South China Morning Post
HKU launches clinical trial in Hong Kong to treat chronic hepatitis B patients
The University of Hong Kong (HKU) has launched a clinical trial for a gene-related therapy aimed at treating chronic hepatitis B infection, giving patients hope for a cure in the future. Professor Yuen Man-fung, chief of the division of gastroenterology and hepatology at HKU's medical faculty, said on Thursday that existing medication for hepatitis B patients could only suppress the virus and had to be taken for decades. He expected that the new treatment could enable patients to discontinue long-term medication. 'If we can suppress the virus and also eradicate the virus if possible, then the patients will not suffer or will have a minimal risk or lower risk of suffering from liver cancer development and cirrhosis or liver failure,' he said. 'And that obviously will bring hope … [to the] patients.' Chronic hepatitis B affects more than 300 million people worldwide and is a primary cause of liver cirrhosis, cancer and liver failure. Around 6.2 per cent of the population of Hong Kong is affected by the condition.
Health Line
04-07-2025
- Health
- Health Line
Biologics for Crohn's Disease: 6 Ways They May Benefit You
If other treatments haven't worked for you, biologics may be worth considering for managing Crohn's disease. In certain instances, they can be an excellent treatment option. As someone living with Crohn's disease, you've likely heard about biologics. These are a type of prescription drug administered via an injection or intravenous (IV) drip. They manage inflammation by blocking certain proteins or chemical pathways. You may have thought about trying them yourself. Here are six reasons this advanced type of treatment may be helpful for you and what you may want to consider. Your Crohn's isn't responding to traditional treatments Perhaps you've been taking different Crohn's disease medications, such as steroids and immunomodulators, for a while now. However, you're still having flare-ups several times a year. American College of Gastroenterology guidelines strongly recommend taking a biologic agent if you have moderate to severe Crohn's disease that's resistant to steroids or immunomodulatory therapy. Your doctor may also consider combining a biologic with an immunomodulator, even if you haven't tried those drugs separately yet. You have a new diagnosis Traditionally, treatment plans for Crohn's disease involved a step-up approach. Less expensive drugs, like steroids, were tried first, while more expensive biologics were a last resort. More recently, guidelines have suggested a top-down approach with a new diagnosis. This is when stronger drugs are tried first, as evidence has pointed to better results when biologic treatments are started right after diagnosis. A 2021 review of 31 trials found that for people with moderate to severe Crohn's disease, the combination of a biologic drug (infliximab) with a non-biologic drug (azathioprine) had the most promising results for managing symptoms. The 2025 ACG guidelines also recommend the combination of both drugs over either individually. You experience a complication known as fistulas Fistulas are abnormal connections between body parts. In Crohn's disease, a fistula can occur when an ulcer extends through your intestinal wall, which connects your intestine and skin, or your intestine and another organ. If a fistula becomes infected, it can be life threatening. If you have a fistula, your doctor may prescribe biologics known as TNF inhibitors because they're so effective. The Food and Drug Administration (FDA) has approved biologics specifically to treat Crohn's disease with fistulas and to maintain fistula closure. You want to maintain remission Corticosteroids are known to bring about remission but aren't able to maintain that remission. If you've been taking steroids for 3 months or longer, your doctor may suggest you try a biologic instead. Clinical studies show that anti-TNF biologics are able to maintain remission in people with moderately severe Crohn's disease. Researchers note that the benefits of these drugs in maintaining remission generally outweigh the risks for most people. Dosing may only be once per month The thought of an injection may be scary, but after the initial few doses, most biologics are administered only once every two months. This may be once every month if your condition does not respond. However, it may be reassuring to know that the needle is very small, and the medication is injected just under your skin. Most biologics are also offered in the form of an auto-injector, which means you can get the injections without ever seeing a needle. You can even give yourself certain biologics at home after you're trained properly on how to do so. Some self-administered biologics may need to be given biweekly, such as Humira and Entyvio. They may have fewer side effects than steroids Corticosteroids, such as prednisone or budesonide, work by suppressing the entire immune system. Biologics, on the other hand, work in a more selective way by targeting specific proteins in your immune system that are proven to be associated with Crohn's inflammation. As they are more precise, they typically have fewer side effects than corticosteroids. However, almost all drugs carry the risk of side effects. For biologics, the most common side effects are related to how they're administered. You might experience minor irritation, redness, pain, or a reaction at the site of injection. There's also a slightly higher risk of infection, but the risk is not as high as with other drugs, such as corticosteroids. »MORE: What to know about switching to biologics Biologics safety The first biologic for Crohn's disease was approved in 1998, so biologics have quite a bit of experience and safety testing to show for themselves. You may be hesitant to try a biologic because you heard they were 'strong' drugs, or you're concerned about the high costs. However, while biologics are considered a more aggressive treatment option, they're also more targeted drugs, and they work very well. Unlike some older treatments for Crohn's disease that weaken the whole immune system, biologic drugs target specific inflammatory proteins known to be involved in Crohn's disease. In contrast, corticosteroid drugs suppress your entire immune system. However, you'll still want to consider all side effects and discuss with your doctor whether biologics are the best option for you. Choosing a biologic Before biologics, there were few treatment options aside from surgery for people with severe Crohn's disease. Now, there are several options: adalimumab (Humira, Exemptia) certolizumab pegol (Cimzia) infliximab (Remicade, Remsima, Inflectra) natalizumab (Tysabri) ustekinumab (Stelara) vedolizumab (Entyvio) risankizumab (Skyrizi) guselkumab (Tremfya) You'll have to work with your insurance company to find out whether a particular biologic is covered under your plan. Takeaway Biologic medications are targeted treatment options for Crohn's disease and other autoimmune conditions. They are typically strong but effective and may have fewer side effects than some other traditional treatments. However, like with all drugs, there are things you'll want to consider to determine if this option is right for you. Certain factors may mean this type of treatment is suitable for you, but it'll depend on your specific circumstances. Speaking with your doctor can help you figure out if biologics are a good option.
Daily Mail
23-06-2025
- Health
- Daily Mail
The REAL reason you feel bloated and gassy - and how you can tackle it for good: Dietitian and scientist DR EMILY LEEMING
Do you often feel painfully bloated by the end of the day? Are you frequently gassy? If the answer is yes then there's a good chance you have been told it's irritable bowel syndrome (IBS) – but there could be another underlying reason for your symptoms that's often missed. Research, such as a study published in the Journal of Gastroenterology in 2020, has found that as many as half of those diagnosed with IBS also have small intestinal bacterial overgrowth (SIBO).
