Citations

331 Background: The relationship between plant-based dietary patterns and upper gastrointestinal (GI) cancers remains unclear. The Healthful Plant-Based Diet Index (hPDI) is a tool that measures adherence to plant-based diet and generates “scores” for clinical comparison. We conducted a systematic review and meta-analysis to examine the association between hPDI and the risk of esophageal and gastric cancers. Methods: A PubMed search identified relevant studies reporting on the association between hPDI and upper GI cancers. Reference lists were manually searched for additional studies. Study selection followed PRISMA guidelines, and quality was assessed using the Newcastle–Ottawa Scale (NOS). Pooled risk estimates were calculated using inverse-variance fixed-effects models, with subgroup analyses by cancer type. Sensitivity analyses were conducted using leave-one-out approach and by switching between fixed- and random-effects models. Forest plots and funnel plots were generated with RevMan 5.4, while Begg’s and Egger’s tests for publication bias were performed using Stata 15. Results: A total of four studies were included, all with high NOS scores. Overall, higher hPDI scores were associated with a significantly lower risk of upper GI cancers (RR = 0.64, 95% CI: 0.56–0.75). In subgroup analyses, the inverse association was consistent for both esophageal cancer (RR = 0.66, 95% CI: 0.54–0.79) and gastric cancer (RR = 0.63, 95% CI: 0.50–0.79). Between-study heterogeneity was low (I² = 35%, P = 0.16). Publication bias assessment indicated no evidence of small-study effects, as Begg’s test was non-significant (P = 0.88) and Egger’s test showed no significant bias (P = 0.76). Sensitivity analyses confirmed the robustness of the findings, with consistent results after sequential exclusion of individual studies and when using random-effects models. Conclusions: Higher hPDI scores were associated with a significantly reduced risk of esophageal and gastric cancers, indicating that adherence to a healthy plant-based diet may reduce upper GI cancer risk. These findings highlight the potential role of dietary modification in upper GI cancer prevention.

ABSTRACT Objective To comprehensively evaluate the validity of ICD-10-CM codes for both prevalent diagnoses and less common diseases, and to assess the performance of a large language model (LLM)-based system in validating these codes. Materials and Methods This retrospective study analyzed hospital admissions from the Medical Information Mart for Intensive Care (MIMIC-IV) database. We developed a validated LLM-based system using GPT-4o, refined through iterative prompt engineering, to assess ICD-10-CM code validity. We measured the PPV of ICD-10-CM codes, PPV of principal and secondary diagnoses, and the performance of an LLM-based system in code validation. Results Among 865,079 assigned codes, the PPV was 84.6% (95% CI, 84.5%-84.6%). Principal diagnoses had a PPV of 93.9% (95% CI, 93.7%-94.1%), while secondary diagnoses had a PPV of 83.8% (95% CI, 83.7%-83.9%). The LLM system demonstrated high performance in validating ICD codes, achieving 93.6% accuracy, 95.4% sensitivity and 85.2% specificity. Among correctly assigned secondary diagnoses, the majority (67.9%) represented historical or baseline conditions, while 32.1% reflected active conditions that deviated from baseline status; 22.3% of these emerged after hospital admission. PPV decreases with later diagnosis positions, with the largest decline occurring between principal and secondary diagnoses. Discussion and Conclusion In this large-scale evaluation, ICD-10-CM codes exhibited generally high accuracy, though variability existed by position and condition type. A validated LLM system performed comparably to physician review and offers a scalable means to improve coding accuracy. These findings support the potential for integrating LLM-based auditing into routine workflows to strengthen the quality of administrative and research data.

Purpose of review The rising prevalence of obesity, now affecting over 40% of U.S. adults, poses critical implications for colorectal cancer screening, as obesity increases the risk of both colorectal adenomas and cancer. Despite these elevated risks, patients with obesity have lower colonoscopy screening participation and face unique barriers that compromise procedural quality. This review aims to highlight the challenges encountered during colonoscopy in obese patients and examine emerging solutions that may enhance screening effectiveness and patient outcomes. Recent findings Obesity is associated with suboptimal bowel preparation, prolonged cecal intubation times, lower adenoma detection rates, and increased sedation-related complications. These challenges stem from altered gastrointestinal physiology, body habitus, and comorbid conditions. Recent innovations in bowel preparation strategies, sedation protocols, and endoscopic technologies—such as robotic-assisted colonoscopy and artificial intelligence-enhanced visualization—have demonstrated promise in addressing these limitations. Institutional initiatives, including tailored protocols and endoscopy team training, are also contributing to improved outcomes. Summary As obesity rates climb, adapting colonoscopy practices to meet the needs of this population is essential. Incorporating evidence-based strategies and emerging technologies can help overcome procedural barriers, improve detection rates, and reduce disparities in colorectal cancer screening. Continued research and guideline refinement are needed to optimize care delivery for patients with obesity.

Abstract Background Patients with inflammatory bowel disease (IBD) are at increased risk of herpes zoster (HZ) infection due to innate immune abnormalities and use of immunosuppressive therapy. The recombinant zoster vaccine (RZV) is recommended, but its efficacy in preventing recurrent HZ among patients with IBD is not well established. Methods Using data from the TriNetX Linked Network, we conducted a retrospective cohort study of adults (≥18 years) with IBD and a prior uncomplicated HZ episode. Patients with IBD who received RZV were propensity score-matched 1:1 with those who did not. The primary outcome was subsequent HZ complications. Secondary outcomes included subtypes of HZ complications and recurrent uncomplicated HZ. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated via Cox proportional hazards models. Results After matching, 1260 vaccinated and 1260 unvaccinated patients with IBD were included. Compared to the unvaccinated cohort, patients receiving RZV had a significantly reduced incidence of HZ complications (7.4% vs. 14.5%; HR, 0.75; 95% CI, 0.58–0.97; P = .028). Postherpetic neuralgia was notably decreased (5.8% vs. 12.5%; HR, 0.66; P = .010), and no central nervous system involvement occurred among vaccinated patients. Protective effects were more pronounced in patients with ulcerative colitis, females, and those not receiving immunosuppressive therapy. Conclusions RZV substantially lowers the risk of HZ complications in patients with IBD, offering significant clinical benefits to those at high risk due to immunosuppression. These findings underscore the importance of RZV as part of preventive care strategies in patients with IBD.

AbstractCholecystectomy is the standard treatment for acute cholecystitis, but it may not be suitable for all patients. For those who cannot undergo surgery, a percutaneous cholecystostomy tube (PCT) and ERCP-guided transpapillary gallbladder drainage are viable options. We aimed to perform a nationwide study to assess 30-day readmission rates, adverse events (AEs), and mortality rates in these two cohorts.We conducted a nationwide cohort study using data from the Nationwide Readmissions Database (NRD) from 2016 to 2019. We identified patients with acute cholecystitis during the index admission who underwent either PCT or ERCP-guided gallbladder drainage. Propensity score matching along with multivariable regression was used to compare cohorts.During the study period, 3,592 patients (average age 63.0 years) underwent endoscopic drainage, whereas 80,372 patients (average 70.8 years) underwent Interventional Radiology drainage. Utilizing multivariate Cox regression analysis, compared with ERCP, PCT had a higher risk for 30-day readmission (adjusted hazard ratio [aHR] 1.47; 95% confidence interval [CI] 1.27 to 1.71; P < 0.001). The PCT group had a significantly higher rate of readmission for acute cholecystitis compared with the ERCP group (2.72% vs 0.86%; P < 0.005). Cox proportional hazard ratio showed a 3.41-fold increased risk (95% CI 1.99 to 5.84) for readmission in the PCT group. ERCP was consistently associated with lower rates of post-procedural AEs compared with PCT including acute hypoxemic respiratory failure (P < 0.001), acute renal failure (P < 0.001), shock (P < 0.001), and need for blood transfusions (P < 0.001).Our nationwide analysis revealed that ERCP-guided gallbladder drainage should be the preferred approach for managing acute cholecystitis when unfit for surgery.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) has surged as a major cause of liver transplants in the United States. Existing studies have presented conflicting findings regarding the association between liver characteristics (specifically steatosis and fibrosis) and mortality. This study investigates the relationship between the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) via vibration-controlled transient elastography (VCTE) and all-cause mortality in MASLD patients. Methods: Using the NHANES 2017-2018 database, 3821 individuals representing the United States population with MASLD underwent VCTE for liver stiffness measurement. Exclusion criteria were applied, eliminating ineligible cases, incomplete examinations, underage individuals, and those with hepatitis B or C, along with significant alcohol consumption history. Cox proportional hazard models assessed the hazard ratio (HR) for all-cause mortality in CAP and LSM. Cox regression analysis with interaction terms was employed for deeper exploration. Results: The study unveiled a strong, independent correlation between LSM and all-cause mortality. However, the CAP failed to demonstrate a significant association with mortality in both univariate and adjusted analyses, contrary to recent findings. The analysis underscores the importance of accurately measuring liver stiffness via VCTE in predicting adverse outcomes in MASLD patients, emphasizing the pivotal role of fibrosis in assessing mortality risk. Conclusion: This study reaffirms the robust link between liver fibrosis (measured through VCTE) and mortality among MASLD individuals. The absence of a significant association between steatosis (indicated by CAP) and mortality challenges recent research, urging further comprehensive investigations with larger cohorts to delineate steatosis’ precise impact on MASLD-related mortality.