Digestion最新文献

{"title":"Endoscopic treatment strategies for gastric foveolar-type adenoma with a raspberry-like appearance.","authors":"Tomoyo Iwano, Nobuyuki Suzuki, Hiroya Ueyama, Shunsuke Nakamura, Yasuko Uemura, Momoko Yamamoto, Daiki Abe, Shotaro Oki, Yoichi Akazawa, Tsutomu Takeda, Kumiko Ueda, Mariko Hojo, Shuko Nojiri, Takashi Yao, Akihito Nagahara","doi":"10.1159/dig/acmag031","DOIUrl":"https://doi.org/10.1159/dig/acmag031","url":null,"abstract":"<p><strong>Background/objectives: </strong>Endoscopic treatment strategies for gastric foveolar-type adenoma with a raspberry-like appearance (GFA-R) have not yet been established. We aimed to clarify the efficacy and safety of endoscopic procedures for GFA-R.</p><p><strong>Methods: </strong>We extracted GFA-Rs, which were pathologically diagnosed in accordance with WHO classification, at our hospital from January 2009 to December 2023 by endoscopy and retrospectively analyzed their clinicopathological features and endoscopic outcomes.</p><p><strong>Results: </strong>Eighty-eight GFA-Rs were collected from 74 patients. The mean size of GFA-Rs was 4.2 mm (range, 1-10 mm). All lesions demonstrated intramucosal neoplasms without lymphovascular invasion. Endoscopic procedures included only biopsy (n=6), cold forceps polypectomy (CFP; n=42, as outpatient 38/42), cold snare polypectomy (CSP; n=4), endoscopic mucosal resection (EMR; n=36, as inpatient 36/36). The overall en bloc resection rate was 93.9 % (77/82), with rates of 92.9 % (39/42) for CFP, 75.0 % (3/4) for CSP, and 97.2 % (35/36) for EMR, respectively. Lesions smaller than 5 mm were more often treated with CFP while lesions larger than 5 mm were more often treated with EMR. No complications, such as post-operative bleeding or delayed perforation, occurred regardless of the endoscopic procedure. The mean follow-up period was 28.7 months (range, 2-165 months). No local recurrences occurred at 1 year (9-18 months) after an endoscopic procedure for 62 lesions, 2 years (19-30 months) for 40 lesions, and 3 years (31-42 months) for 24 lesions.</p><p><strong>Conclusions: </strong>These results suggest that endoscopic procedures for GFA-R are effective and safe regardless of the procedure used. Moreover, outpatient CFP may be a simple, useful, and cost-effective endoscopic procedure for GFA-R smaller than 5 mm.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidelines for Colonic Diverticular Disease-2026, Second Edition: Management of Diverticular Bleeding and Acute Diverticulitis.","authors":"Chikamasa Ichita, Naoyoshi Nagata, Tomonori Aoki, Fumiaki Ishibashi, Takaaki Kishino, Takaomi Kessoku, Yuki Kojima, Daisuke Saito, Yoshinori Sato, Yasuyuki Tanaka, Naoyuki Tominaga, Tomohiko Machida, Noriaki Manabe, Takashi Murakami, Hiroyuki Imaeda, Motohiro Esaki, Mitsuru Kaise, Akiko Shiotani, Mitsuhiro Fujishiro, Takatsugu Yamamoto, Hiromi Kataoka, Kazuhide Higuchi, Akihito Nagahara","doi":"10.1159/dig/acmag017","DOIUrl":"https://doi.org/10.1159/dig/acmag017","url":null,"abstract":"<p><p>Colonic diverticular disease is becoming increasingly common in Japan, paralleling population aging and changes in lifestyle and medication use. The predominance of right-sided diverticulosis in Asian populations, in contrast to the left-sided predominance in Western populations, influences clinical presentation and management. In Japan, diverticulitis has become a clinically important problem, and diverticular bleeding is currently the most frequent cause of acute lower gastrointestinal bleeding (LGIB). The Japanese Gastroenterological Association updated its clinical guidelines for diverticular bleeding and diverticulitis in 2026. Key domains including epidemiology, diagnostic and therapeutic strategies, and priority clinical and future research questions were addressed. Evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation approach, and recommendations were formulated via a modified Delphi process with external review. These guidelines aim to provide Japanese and Asian evidence-based consensus that complements Western guidelines. Recommendations for acute LGIB and diverticular bleeding are as follows: risk stratification with the Shock Index and Oakland and NOBLADS scores guides triage; pre-colonoscopy contrast-enhanced computed tomography is the widely used diagnostic modality; routine colonoscopy within 24 h is not suggested for all patients; endoscopic band ligation or direct clipping is suggested post-detection of stigmata of recent hemorrhage; and early oral refeeding is suggested. Recommendations for diverticulitis are as follows: post-resolution colonoscopy is suggested to exclude colorectal cancer; outpatient treatment and withholding of antibiotics are suggested in selected uncomplicated cases; and primary anastomosis may be favored over Hartmann's procedure in selected complicated cases.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Structured, Repetitive Simulation Program for Endoscopic Coagulation Hemostasis with Hemostatic Forceps: An Assessor-Blinded Randomized Controlled Trial Using a Bleeding Ulcer Model.","authors":"Suguo Suzuki, Takeshi Kanno, Yutaka Hatayama, Yutaro Arata, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Waku Hatta, Kaname Uno, Akira Imatani, Tomoyuki Koike, Atsushi Masamune","doi":"10.1159/dig/acmag013","DOIUrl":"10.1159/dig/acmag013","url":null,"abstract":"<p><strong>Introduction: </strong>Prompt endoscopic hemostasis is required to control upper gastrointestinal bleeding. Current training relies on on-the-job exposure, with limited evidence supporting the use of dry-lab simulators. This study aimed to develop a structured, repeatable simulation-based training (SBT) program for thermal coagulation hemostasis and evaluate its efficacy.</p><p><strong>Methods: </strong>This single-center, assessor-blinded, randomized controlled trial was conducted at Tohoku University Hospital from December 2023 to June 2025. Nonexpert endoscopists were randomized into either an intervention group (five SBT sessions, including basic and hemostasis tasks, over 2 months) or a control group. Co-primary outcomes were procedure time and blinded video-based rubric scores for hemostasis at both low- and high-difficulty sites. Changes in self-efficacy were assessed using a visual analog scale (VAS). The analysis followed intention-to-treat principles.</p><p><strong>Results: </strong>Twenty participants were enrolled, with nine in the intervention group and 11 in the control group. At the final assessment, the intervention group demonstrated shorter procedure times at both the antrum (43.6 vs. 51.3 s, p = 0.02) and the upper gastric body (32.6 vs. 59.7 s, p < 0.01). Significant within-group reductions were observed only in the intervention group (effect sizes of 0.62 in the antrum and 0.80 in the upper body). Rubric-based scores improved at high-difficulty sites (p = 0.03). All five VAS domains improved significantly in the intervention group, whereas two domains increased in the control group.</p><p><strong>Conclusion: </strong>Structured SBT with a high-fidelity bleeding simulator improved technical performance, efficiency, and self-efficacy in coagulation hemostasis, representing a scalable framework for competency-based education.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrathin endoscope-assisted pancreatobiliary interventions: from direct transpapillary access to created access routes.","authors":"Tadahisa Inoue, Masanao Nakamura, Kiyoaki Ito","doi":"10.1159/dig/acmag030","DOIUrl":"https://doi.org/10.1159/dig/acmag030","url":null,"abstract":"<p><strong>Background: </strong>ERCP is the standard endoscopic approach for pancreatobiliary diseases, but it relies mainly on fluoroscopic assessment and cannot provide direct intraductal visualization. Ultrathin upper gastrointestinal endoscopes, originally developed for transnasal or pediatric endoscopy, have therefore been used as forward-viewing platforms for direct observation and therapy in the bile duct, pancreatic duct, gallbladder, and peripancreatic cavities. This review summarizes ultrathin endoscope-assisted interventions through both natural and created access routes, excluding dedicated mother-baby and digital single-operator cholangiopancreatoscopy systems as the main focus.</p><p><strong>Summary: </strong>Direct transpapillary peroral cholangioscopy is the most established application. It has been used for detection of residual stones, lithotripsy for difficult bile duct stones, evaluation of biliary strictures and intraductal tumors, targeted biopsy, and selective biliary drainage. Various access-assisting techniques and multibending ultrathin endoscopes have improved technical success. However, direct transpapillary insertion remains technically demanding because it requires scope exchange, reinsertion, ductal cannulation with a relatively large endoscope, and maintenance of intraductal stability. EUS-created access routes can provide stable conduits for direct endoscopic intervention.</p><p><strong>Key messages: </strong>With the rapid development of dedicated cholangiopancreatoscopy, direct transpapillary use of ultrathin endoscopes is likely to become more selective and complementary. Created access routes may expand the value of ultrathin endoscopes, but evidence for these approaches remains limited, and their clinical role requires further evaluation.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Color Features on Linked Color Imaging and Histology of Early Gastric Cancer in Previously <i>Helicobacter pylori</i>-Infected Stomachs.","authors":"Masayuki Higashino, Shoko Ono, Noriyuki Otsuka, Hiroki Egami, Erina Ishibe, Masaki Inoue, Masayoshi Ono, Naoya Sakamoto","doi":"10.1159/dig/acmag001","DOIUrl":"10.1159/dig/acmag001","url":null,"abstract":"<p><strong>Introduction: </strong>Linked color imaging (LCI) enhances subtle mucosal color differences and may facilitate the detection of early gastric cancer (EGC), particularly in Helicobacter pylori (H. pylori)-eradicated stomachs. However, the histological basis underlying LCI-derived color changes remains incompletely understood.</p><p><strong>Methods: </strong>We retrospectively analyzed 32 patients with differentiated-type intramucosal EGC in previously H. pylori-infected stomachs who underwent endoscopic submucosal dissection. Color values obtained by white-light imaging (WLI) and LCI were quantified using the CIE 1976 L*a*b* color space. Histological parameters, including superficial vascular density, glandular density, mucosal thickness, and the proportion of intestinal metaplasia (IM), were evaluated in cancerous tissue and adjacent noncancerous mucosa. Associations between endoscopic color values and histological findings were assessed using Spearman's rank correlation.</p><p><strong>Results: </strong>LCI significantly increased the color difference (ΔE) between cancerous lesions and adjacent noncancerous mucosa compared with WLI (p < 0.001). Under LCI, a* values showed a moderate positive correlation with superficial vascular density (ρ = 0.39, p < 0.001), particularly within the 0-100 μm layer (ρ = 0.41, p < 0.001). LCI b* values demonstrated a moderate negative correlation with the proportion of IM in the adjacent noncancerous mucosa (ρ = -0.49, p < 0.001), with significantly lower b* values observed in cases with severe IM.</p><p><strong>Conclusion: </strong>LCI-derived color values are associated with superficial vascularity in EGC and IM in the background mucosa of previously H. pylori-infected stomachs. These findings provide histological insight into the color characteristics observed with LCI.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and burden of functional dyspepsia and \"gastroparesis-like\" symptoms in a primary care diabetes population.","authors":"Heithem Soliman, I-Hsuan Huang, Hamid Ferdosi, Bert Broeders, Cedric Van de Bruaene, Lukas Michaja Balsiger, Karen Van den Houte, Florencia Carbone, Jan Tack","doi":"10.1159/dig/acmag027","DOIUrl":"https://doi.org/10.1159/dig/acmag027","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of gastroparesis (GP) and functional dyspepsia (FD) in diabetes remains unknown. Nausea and/or vomiting are now considered cardinal symptoms for GP, defining the \"gastroparesis-like symptoms\" (GPLS). We aimed to assess the prevalence of GPLS and FD in type 1 (T1D) and type 2 diabetes (T2D) in a primary care population.</p><p><strong>Methods: </strong>An online survey was addressed to primary care patients with diabetes through patient associations. The survey included the type of diabetes and the Rome IV Diagnostic Questionnaire. GPLS patients were defined as having nausea and/or vomiting ≥ 1 day/week and postprandial distress syndrome as per Rome criteria. Symptoms severity (PAGI-SYM), quality of life (QoL) (PAGI-QoL), anxiety (GAD-7), depression (PHQ-9), and somatization (PHQ-15) scores were also assessed.</p><p><strong>Results: </strong>Among 273 respondents, 216 patients were included in the analysis, (146 T1D, 68 T2D. and 2 non-specified diabetes). The prevalence of GPLS was 4.6%, with a higher prevalence in patients with T2D (10.3% vs 2.1%; p=0.01). The global prevalence of FD was 11.6% with no difference between T1D and T2D (13.2% vs 10.3%; p=0.52). GPLS patients had higher symptom burden, higher anxiety, depression, and somatization scores and worse QoL as compared to non-GPLS patients (all p<0.05). They had a higher prevalence of associated disorders of gut-brain interaction. Compared to FD patients without GPLS, the scores were numerically higher although not statistically significant.</p><p><strong>Conclusion: </strong>The prevalence of GPLS is high among diabetic patients, especially those with T2D. The impact on quality of life, anxiety, and depression is comparable to FD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dual Therapy with Tacrolimus and Infliximab for Patients with Refractory Ulcerative Colitis.","authors":"Naokuni Sakiyama, Ryosuke Yamaguchi, Kazuki Kakimoto, Mai Utsumi, Suzune Sugishima, Hideaki Mitooka, Noboru Mizuta, Masatoshi Kaizuka, Hikaru Shimizu, Koji Nishida, Keijiro Numa, Naohiko Kinoshita, Kei Nakazawa, Ryoji Koshiba, Yuki Hirata, Takako Miyazaki, Makoto Okabe, Shiro Nakamura, Hiroki Nishikawa","doi":"10.1159/dig/acmag022","DOIUrl":"https://doi.org/10.1159/dig/acmag022","url":null,"abstract":"<p><strong>Background: </strong>In refractory cases of ulcerative colitis (UC) where tacrolimus treatment is ineffective, colectomy is often required. This study aimed to evaluate the efficacy and safety of dual therapy with tacrolimus and infliximab. We also assessed the effectiveness of infliximab monotherapy in maintaining remission after discontinuation of dual therapy.</p><p><strong>Methods: </strong>We included 21 patients with moderate-to-severe UC treated at our institution between March 2011 and August 2024, in which infliximab was added because clinical remission was not achieved with tacrolimus. In cases where clinical remission was achieved through dual therapy, tacrolimus was discontinued and maintenance therapy with infliximab alone was continued. The primary outcome was clinical remission at 8 weeks after initiation of dual therapy. Secondary outcomes included colectomy-free survival, relapse-free survival during infliximab maintenance, and adverse events.</p><p><strong>Results: </strong>The median duration of dual therapy was 77 days. Clinical remission was achieved in 38.1% (8/21) of patients, and a clinical response was observed in 42.9% (9/21) at week 8. The cumulative colectomy-free survival rate at one year after initiating dual therapy was 61.9% (95% CI: 44.3-86.6%). Among patients who achieved remission and continued infliximab maintenance therapy, the cumulative relapse-free survival rate at one year was 68.6% (95% CI: 44.5-100.0%). Adverse events during dual therapy were infrequent and included acute kidney injury, infections, and skin rash.</p><p><strong>Conclusions: </strong>Dual therapy with tacrolimus and infliximab demonstrated favorable efficacy and an acceptable safety profile. This strategy may represent a new treatment option for patients with refractory UC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Treatment for Pancreatobiliary Diseases in Patients with Surgically Altered Anatomy: A Perspective from Double-Balloon Endoscopy.","authors":"Haruka Toyonaga, Makoto Masaki, Shintaro Yodozawa, Kazusa Tsuru, Ryuto Kashima, Shoji Takayama, Tatsuya Nakagawa, Takuya Takayama, Masahiro Orino, Hironao Matsumoto, Natsuko Saito, Kimi Sumimoto, Masahiro Takeo, Takeshi Yamashina, Katsunori Yoshida, Makoto Takaoka, Toshihito Seki, Masaaki Shimatani","doi":"10.1159/dig/acmag026","DOIUrl":"https://doi.org/10.1159/dig/acmag026","url":null,"abstract":"<p><strong>Background: </strong>The number of patients with surgically altered anatomy (SAA) is increasing worldwide. In these patients, pancreatobiliary disease is difficult to treat, because a conventional duodenoscope cannot reach the papilla or the bilioenteric anastomosis through the long reconstructed limb. For many years the main treatment options were reoperation or percutaneous drainage, both of which are invasive.</p><p><strong>Summary: </strong>Double-balloon endoscopy (DBE), first reported in 2001, made it possible to insert the endoscope stably through the long limb and to reach the target perorally. The short-type DBE, and later a newly designed short-type DBE, then made therapeutic ERCP practical, because standard ERCP devices could be used. In a Japanese multicenter prospective study of 311 patients with SAA, the target site was reached in 97.7% (304/311) and the overall procedural success rate of 92.3% (287/311). Among the 283 patients requiring treatment, therapeutic success was achieved in 97.9% (277/283). Adverse events occurred in 10.6% (33/311), and 32 of the 33 events were managed conservatively. In this review we describe how DBE-assisted ERCP (DBE-ERCP) developed, summarize the current evidence, and discuss how it should be positioned relative to single-balloon endoscopy (SBE), interventional endoscopic ultrasound (EUS), and percutaneous drainage.</p><p><strong>Key messages: </strong>DBE-ERCP and interventional EUS should be regarded as complementary approaches. DBE-ERCP is an important first-line option for many benign biliary disorders in non-Roux-en-Y gastric bypass SAA, particularly when preservation of the native papilla or surgical anastomosis and repeated intervention are important. Alternative approaches should be considered early in selected settings, including interventional EUS after failed balloon-endoscopy access or in malignant biliary obstruction, and EDGE or laparoscopy-assisted ERCP in Roux-en-Y gastric bypass anatomy when appropriate expertise is available. Treatment should be individualized according to the reconstruction anatomy, disease target, need for repeat intervention, and local expertise.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with all-cause mortality in Gastroesophageal Carcinoma in Situ: Nationwide Cohort Study.","authors":"Su Youn Nam, Junwoo Jo, Sung Kook Kim","doi":"10.1159/dig/acmag019","DOIUrl":"https://doi.org/10.1159/dig/acmag019","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of esophageal and gastric carcinoma in situ (CIS) is excellent but population-level incidence pattern and mortality determinants remain limited.</p><p><strong>Methods: </strong>We conducted a nationwide study using Korea Healthcare Bigdata. National Cancer Registry data were linked with Health Insurance Review and Assessment Service claims. Patients diagnosed with esophageal or gastric CIS between 2007 and 2019 were followed until death or December 2022. Incidence was analyzed with linear regression, survival with Kaplan-Meier methods and log-rank tests, and mortality risk with Cox proportional hazards models.</p><p><strong>Results: </strong>We identified 978 esophageal and 15,705 gastric CIS patients. Gastric CIS increased sharply (slope 212/year), while esophageal CIS rose gradually (slope 9/year). Mortality risk increased with age: patients ≥ 80 years had hazard ratios (HRs) of 5.08 (95% confidence interval [CI], 1.98-13.06) for esophageal CIS and 30.18 (95% CI, 14.17-64.26) for gastric CIS. In gastric CIS, male sex (HR 1.57; 95% CI, 1.36-1.82), squamous cell in situ (HR 3.45; 95% CI 1.29-9.26), adenocarcinoma in situ (HR 1.95; 95% CI 1.71-2.23), hypertension (HR 2.12; 95% CI 1.86-2.41), and cerebrovascular disease (HR 1.72; 95% CI 1.45-2.04) were independent mortality predictors. No comorbidities significantly predicted mortality in esophageal CIS. Body mass index and physical activity were inversely associated with gastric CIS mortality. Sex-stratified analyses showed consistent age and vascular risk effects in both sexes, while squamous histology and heart disease increased mortality only in men.</p><p><strong>Conclusions: </strong>Esophageal and gastric CIS exhibit distinct prognostic patterns.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149105622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upadacitinib for Acute Severe Ulcerative Colitis: Real-World Tertiary Care Outcomes.","authors":"Fares Jamal, Alejandro J Gonzalez, Sandra Elmasry, Amani Elshaer, Talha Malik","doi":"10.1159/dig/acmag024","DOIUrl":"https://doi.org/10.1159/dig/acmag024","url":null,"abstract":"<p><p>Background Acute severe ulcerative colitis (ASUC) affects up to 25% of patients with ulcerative colitis. Despite intravenous (IV) corticosteroids as first-line therapy, 30-40% require rescue treatment and up to 40% undergo colectomy within one year. Upadacitinib (UPA) has shown ability to induce rapid response in moderate-severe UC, but real-world data in ASUC remain limited. We aimed to describe outcomes of UPA initiation for ASUC across Mayo Clinic sites. Methods We conducted a descriptive study of 23 adults hospitalized with ASUC between 2022-2025 at Mayo Clinic. Patients with their first ASUC admission who were started on UPA were included. All patients received IV methylprednisolone (40-60 mg/day) within 24-48 hours of admission, followed by UPA initiation (inpatient or shortly after discharge). Clinical, laboratory, and treatment data were extracted from electronic medical records. Outcomes included colectomy during admission and colectomy within one year. Descriptive statistics were done using Microsoft Excel. Results Twenty-three patients received UPA (median age 35 years; 88% pancolitis; 4% PSC). Out of the 23, 18 were started on UPA during the ASUC admission. Before admission, 10 patients (43%) were receiving corticosteroids, three (13%) were on mesalamine, one (4%) on azathioprine, and 12 (52%) were on biologic therapy; four patients (17%) were already on lower dose UPA maintenance. The median number of prior advanced therapies was two (range 1-4). Admission labs showed a mean CRP of 56.3 mg/L (SD 44.9) and fecal calprotectin of 2521.9 µg/g (SD 783.9). Patients received IV corticosteroids for a mean of 3.7 days (SD 1.1), and UPA was initiated at a median of hospital day 3 (IQR 4). 2/18 patients (11.1%), who were started on UPA inpatient, required colectomy during admission. Of the 23 patients who received UPA during hospitalization or shortly after discharge, one year colectomy rate was 4/23 (17%). Conclusions In this cohort, initiation of UPA during hospitalization or shortly after discharge for ASUC was feasible and was associated with lower colectomy rates compared with published outcomes for patients treated with infliximab or cyclosporine, both during hospitalization (11.1% vs. 21% vs. 25%) and at one year (17% vs. 35% vs. 45%). These findings suggest that UPA may serve as an effective rescue option for hospitalized ASUC patients, particularly when rapid control of inflammation is needed. Larger prospective studies are warranted to confirm these observations and to define optimal timing, patient selection, and long-term safety in the ASUC setting.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}