The Revista de Gastroenterología de México (RGM) is the official publication of the Asociación Mexicana de Gastroenterología, founded in 1935 by Dr. Abraham Ayala González, under the former name Revista de Gastro-Enterología. It is one of the most prestigious journals of scientific dissemination in Mexico and Latin America, with more than 2,700 articles published since its founding and an average of 77 articles annually.1,2

From the beginning of its publication, the RGM has been a space belonging to the entire medical community, both in Mexico and abroad, for the publication of works regarding the clinical and surgical practice related to the digestive tract, as well as for providing relevant and up-to-date information on the specialty of gastroenterology. The journal is published every three months and consists of peer-reviewed works that include original articles, scientific letters, clinical images, brief communications, and letters to the editors. It also publishes review articles, clinical guidelines, and consensuses that are requested by the editorial committee.3 According to the final metrics of 2018, the RGM was characterized as an open access journal with a Source Normalized Impact per Paper (SNIP) of 0.505 and a Hirsch index (H) of 18, putting it in 94th place, from a total of 131 international gastroenterology journals,4 and in 3rd place in Latin America.5

In recent years, works have been published that have examined the most-cited articles in the diverse medical and surgical specialties of oncology,6 cardiology,7 anesthesiology,8 general surgery,9 and urology,10 utilizing bibliometric principles. Bibliometrics is a field of scientific and technologic study for constructing research indicators. The analysis of citations is one of its main methodologies, which arose from the need to objectively measure scientific activity.11,12 Even though there is no perfect method, citation analysis enables the impact of a research study to be evaluated, within the advances of a given scientific discipline, through the number of times an article is cited.13,14 To that end, the Web of Science (Thomson Reuters), Google Scholar (Google Inc.), Scopus (Elsevier), and PubMed (National Library of Medicine) databases are the most widely used in bibliometric studies, each one with certain characteristics, such as multidisciplinary coverage, number of indexed journals, updating frequency, type of access, and time period of the articles.15

The aim of the present study was to identify and characterize the most frequently cited original articles, review articles, and consensuses published in the RGM, to have an accurate overview of the impact the journal has had on the area of gastroenterology.

The most frequently cited original articles, review articles, and consensuses published in the RGM were determined, utilizing Elsevier’s Scopus database, and the data obtained from the PubMed and Google Scholar databases were then compared. The search for the works and their hierarchical classification were based on the results obtained from Scopus, given that it is the database that includes the highest number of indexed journals and the lowest number of duplicate citations. When articles had the same number of citations in the Scopus database, the number of citations in the PubMed and Google Scholar databases was utilized for their hierarchical classification.

The search was carried out in May 2020 and encompassed the original articles published from 1949 to 1974 and from 1974 to 2020, to include the years covered by the Scopus database. The articles were categorized in descending order, according to the number of citations, registering the titles and abstracts of the 50 most cited original articles, for their thorough review.

In addition to the number of citations, the following data for each article were obtained: year of publication, authors, participating institutions, country of origin, study design (prospective, retrospective, cross-sectional, meta-analysis, and case series), level of evidence (Oxford Centre for Evidence-Based Medicine), area of study (gastroenterology, endoscopy, surgery, hepatology, and pediatrics), and topic of study.

Finally, an analysis of the most widely read articles on the RGM website was carried out, using alternative metrics to have an overview of reader interaction with the different digital contents, including the number of times an article has been viewed (on PDF, HTML, and EPUB formats), usage (a way to signal if anyone is reading the article or otherwise using the research), captures (indicates that someone wants to come back to the work), and social media (indicates the activity on social media related to the research).

The initial search on the Scopus database produced 2,814 works published in the RGM within the study time frame, with a total of 3,863 citations. The 50 most-cited articles (Table 1) accounted for 826 (21%) of the total number of citations. Each article had a minimum of 10 citations and a mean of 16.5 citations per article. Three articles had more than 30 citations, 10 articles had more than 20 citations, and the remaining articles had 10 or more citations.

The most relevant consensuses and review articles are described in Table 2, identifying the 10 most relevant works, with a total of 208 citations.

The original article with the most citations was the 2004 study by Franklin et al.16 on the utility of laparoscopic right hemicolectomy in the colon cancer scenario, with 39 citations, followed by Zablah et al.17 (prevalence of functional gastrointestinal disorders, 34 citations), Hernández-Aranda et al.18 (refeeding syndrome, 33 citations), Rodríguez-Garcia et al.19 (treatment of Giardia lamblia, 29 citations), and Lizardi-Cervera et al.20 (prevalence of nonalcoholic fatty liver disease and metabolic syndrome, 26 citations).

Fig. 1 shows the classification by topic of the original articles with the highest number of citations. The most frequent topic was functional gastrointestinal disorders (n = 9), followed by viral hepatitis (n = 6), and gastric cancer (n = 4). Less frequently viewed topics were colon cancer, gastroesophageal reflux disease, nonalcoholic steatohepatitis, obesity, and ulcerative colitis (UC). The majority of the works were on general topics of gastroenterology (58%) and surgery (20%). Other areas covered were endoscopy, hepatology, and pediatrics (Table 3).

Figure 1.

Clasificación de artículos originales más citados por tema.

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A total of 291 authors belonged to 120 institutions and the authors of the most-cited original works were from 7 countries. The healthcare institutions with the highest number of published works were the Instituto Mexicano del Seguro Social (IMSS) and the Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” (INCMNSZ), as shown in Table 4.

Thirty-six percent of the most-cited original articles were studies with a nonrandomized prospective design, followed by cross-sectional studies (26%) and randomized prospective studies (18%). Sixty-five percent of the studies had levels of evidence III and IV and 22% had levels of evidence I and II.

Table 5 describes the most widely read articles of the RGM, which includes articles with more than 2 million views.

In the present study, we identified the most-cited original articles, review articles, and consensuses of greater impact published in the official journal of the Asociación Mexicana de Gastroenterología, the RGM. The shared characteristics of the articles were identified and analyzed, together with their relation to the number of citations. Said analysis is an acknowledgement of the researchers and institutions that have contributed to the Mexican medical literature through original works and up-to-date information in the field of gastroenterology and its related areas.

The role of bibliometrics in evaluating the quality of scientific literature has been debated in recent years. A directly proportional relation between the perception of the success of an article and the number of citations87 has been reported in reviews, whether due to the originality of the information at the time of its publication or to the conversion into a “dogmatic” status of works within a certain area of study. Nevertheless, it is important to keep in mind that the number of citations of an article is a surrogate measure of the relevance and relative impact of said article in the scientific literature.88,89 Therefore, the number of citations, alone, cannot substitute other measures of quality in research, such as peer review.90

The most-cited article was the case series of laparoscopic right hemicolectomies by Franklin et al.,16 at the Texas Endosurgery Institute. It is a prospective study spanning 11 years (1991-2002) on the oncologic and nononcologic utility of laparoscopy, suggesting noninferiority, when compared with the open technique. The first laparoscopic resection of the colon was simultaneously reported in 1991 by Jacobs et al.91 in Miami and Fowler and White92 in Kansas. In the 1990s, the oncologic utility of laparoscopic colectomies was a subject of discussion, and the team of Franklin et al.16 were pioneers in the field.93 The mediatic impact of their article and its success can be understood in that context, which is highlighted by the presence of a world class study in a Mexican journal.

The RGM dates back to 1935, but the most-cited original articles correspond to the period between 1996 and 2018, which is most likely associated with greater access to scientific literature, thanks to the Internet and the increase in the number of scientific journals worldwide. The years in which there was a larger number of highly cited articles were 1999, 2004, 2005, 2007, 2009, and 2010, with four articles per year, respectively. Over time, a change in the focus of the topics studied can be observed, beginning with a search for risk factors and then moving to the study of biochemical or molecular markers or clinical outcomes.

The IMSS was the institution with the highest number of publications. That result could involve bias associated with the multicenter nature and structure of the Mexican healthcare system. Nevertheless, the IMSS, together with the INCMNSZ and the Hospital Universitario “Dr. Eleuterio González” of the Universidad Autónoma de Nuevo León (UANL), are the institutions with a relevant number of members associated with the National System of Researchers.94

With respect to the study designs, the majority of the works were quasi-experimental studies, i.e., nonrandomized prospective studies, followed by cross-sectional and randomized prospective studies. Interestingly, 65% of the works had evidence levels III and IV, reflecting the fact that a study does not require level I or level II evidence to significantly impact the scientific literature.

In addition, the interaction of the medical community with digital media, as well as their increased use in recent years, can be observed through different alternative metrics. Scientific studies have had greater reach, resulting from the use of the Internet and social media.

The present review provides an overview of the most highly cited original works published in the RGM. The 50 most-cited articles account for a total of 826 citations and the 10 most-cited consensuses and review articles account for 208 citations. Those works present diversity in disciplines related to gastroenterology and reflect the work of different active research groups in Mexico and other countries. The original articles described herein are the recipients of 20% of all the citations from the RGM, demonstrating the importance and impact they have had on the scientific community.

No patients participated in the present study, nor were patient data utilized, and so obtaining informed consent was not necessary. Likewise, given that there were no interventions, maneuvers, or information management involved, the study was considered a low-risk analysis and required no review or approval by the local ethics committee. Even so, the study meets the current research regulations and the confidentiality of personal and identification data, as well as the anonymity of the participants (all healthcare workers that participated voluntarily) are guaranteed. The present article contains no personal information that could identify the participants.

No financial support was received in relation to this article.

The authors declare that there is no conflict of interest.