Digestion最新文献

{"title":"AI-Generated Guidance for Nonspecialist Physicians Managing Inflammatory Bowel Disease: Expert Evaluation and Case-Based Testing of GPT-4 and DeepSeek.","authors":"Yan Liu, Chaoqun Hu, Xiaomei Song, Lingya Xiang, Wei Tan, Hong Guo, Hao Wang","doi":"10.1159/dig/acmag018","DOIUrl":"10.1159/dig/acmag018","url":null,"abstract":"<p><strong>Introduction: </strong>Shortages of inflammatory bowel disease (IBD) specialists, particularly in China and other resource-constrained settings, mean that many patients are managed by nonspecialist physicians. Artificial intelligence (AI) models may provide clinical guidance, but their practical value for nonspecialists remains uncertain. We evaluated the quality of AI-generated IBD guidance and its utility for nonspecialist physicians using standardized, case-based clinical vignettes.</p><p><strong>Methods: </strong>Twenty real-world IBD clinical questions submitted by nonspecialist physicians and one standardized case vignette were entered into GPT-4 and DeepSeek using identical prompts. Seven IBD specialists independently rated response accuracy and completeness on 5-point Likert scales, and 12 nonspecialist physicians rated clinical usefulness. The 12 nonspecialist physicians completed a two-round crossover, pre-post case-based test using 20 IBD clinical vignettes to evaluate whether reviewing AI outputs improves responses to common management vignettes.</p><p><strong>Results: </strong>Both models produced generally accurate and complete answers (median expert scores ≥4.0 out of 5). Experts rated DeepSeek higher for the accuracy and completeness of diagnosis, treatment, and follow-up. After reviewing AI answers, nonspecialist physicians' case-based test scores improved significantly: median per-round score (0-10) increased from 5.5 to 8.0 for GPT-4 (Δ = 3.0, p < 0.001) and from 6.0 to 8.0 for DeepSeek (Δ = 2.5, p < 0.001). The between-model difference in score change was not significant (p = 0.781). Across both models, common limitations included limited patient-level individualization, inconsistent red-flag/referral triggers, and lack of verifiable, time-stamped references; no harmful recommendations were identified, but safety omissions were present in both models.</p><p><strong>Conclusion: </strong>GPT-4 and DeepSeek generated relatively accurate and comprehensive guidance and improved nonspecialist physicians' performance in IBD case vignette testing, supporting their potential as adjunct educational and reference tools for clinical reasoning. If implemented clinically, AI-based support should incorporate explicit safety prompts (red flags and referral triggers) and be validated prospectively within real-world workflows.</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":"149080209","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":"Efficacy and safety of remimazolam sedation for gastrointestinal endoscopy in elderly versus non-elderly patients.","authors":"Daisuke Yamaguchi, Ryoji Ichijima, Hisatomo Ikehara, Yosuke Minoda, Mitsuru Esaki, Ayako Takamori, Akiyoshi Yoh, Moeko Shirouzu, Kento Sadashima, Yutaro Fujimura, Takuya Shimamura, Hironobu Takedomi, Takashi Akutagawa, Nanae Tsuruoka, Yasuhisa Sakata, Takuya Wada, Chika Kusano, Ryo Shimoda, Motohiro Esaki","doi":"10.1159/dig/acmag023","DOIUrl":"https://doi.org/10.1159/dig/acmag023","url":null,"abstract":"<p><strong>Background/aims: </strong>This study aimed to evaluate the efficacy, recovery profile, and safety of remimazolam sedation during gastrointestinal (GI) endoscopy in elderly and non-elderly patients.</p><p><strong>Methods: </strong>This post hoc secondary analysis used data from a multicenter randomized controlled trial of remimazolam vs. midazolam for sedated GI endoscopy in Japan (jRCTs071240062). Patients receiving remimazolam were divided into elderly (≥65 years, n=19) and non-elderly (n=20) groups. Outcomes included sedation success, sedative dose, time to awakening, time to ambulation, and adverse events.</p><p><strong>Results: </strong>Sedation was successful in 100% of patients in both groups. ASA-PS class I was less common in the elderly group (26.3% vs. 65.0%, p=0.025), whereas the upper/lower GI endoscopy ratio did not differ (12/7 vs. 8/12, p=0.205). Total remimazolam dose was significantly lower in the elderly group (3.7 ± 0.9 vs. 5.7 ± 1.6 mg, p<0.001). More elderly patients were sedated with the initial dose alone (52.6% vs. 5.0%, p=0.001). Time to awakening (1.9 ± 3.5 vs. 0.8 ± 1.8 min, p=0.205) and ambulation (3.9 ± 3.7 vs. 2.0 ± 2.5 min, p=0.077) did not differ significantly. Adverse events were observed only in the elderly group (4/19 [21.1%] vs. 0/20, p=0.047), including hypoxemia (n=2), hypertension (n=1), and hypotension (n=1), all of which were mild and resolved with minimal intervention.</p><p><strong>Conclusion: </strong>Remimazolam provided effective sedation for GI endoscopy, and elderly patients received a lower total dose under the study protocol. Although these adverse events were mild and resolved with minimal intervention, their occurrence in elderly patients warrants careful monitoring. These exploratory findings warrant confirmation in adequately powered prospective studies.</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":"149080151","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":"Epigenetic and Transcriptional Dysregulation of Ribosomal Genes in Esophageal Adenocarcinoma: A Multi-Omics Mendelian Randomization Study.","authors":"Yushan Chen, Cuiyan Zheng, Lingling Huang, Hongwei Huang, Yong Lin, Shaoqiang Chen","doi":"10.1159/dig/acmag020","DOIUrl":"10.1159/dig/acmag020","url":null,"abstract":"<p><strong>Introduction: </strong>The rising incidence and poor prognosis of esophageal adenocarcinoma (EAC) highlight the urgent need to identify novel molecular determinants. Ribosome heterogeneity has emerged as a potential factor in carcinogenesis, yet its causal relevance in EAC remains unclear. We aimed to systematically evaluate the causal effects of ribosome-related genes on EAC risk by integrating multi-omics data.</p><p><strong>Methods: </strong>We applied summary-data-based Mendelian randomization (SMR) to analyze 1,329 ribosome-related genes, integrating mQTL, eQTL, pQTL data, and a large EAC GWAS. Bayesian colocalization and esophageal tissue transcriptome analyses validated causal signals. We compared mRNA/protein levels of candidate genes in normal HET-1A esophageal cells versus EAC cell lines OE33 and OE19 and validated methylation-gene correlations using the TCGA-ESCA cohort. Crucially, functional assays, including CCK-8, Transwell, colony formation, and apoptosis assays, were performed in OE33 cells following gene overexpression to verify their causal roles.</p><p><strong>Results: </strong>SMR analyses identified EIF2B2 and RPS6KL1 as causal protective genes for EAC; genetically elevated expression of both reduced EAC risk. A regulatory cascade was uncovered, whereby specific CpG methylation repressed gene transcription to alter disease susceptibility. Consistently, EIF2B2 and RPS6KL1 mRNA and protein were markedly lower in OE33/OE19 tumor cells than HET-1A. TCGA data confirmed negative correlation between RPS6KL1 promoter cg19899223 methylation and gene expression (ρ = -0.27, p = 0.00015). Functionally, overexpression of EIF2B2 and RPS6KL1 in OE33 cells significantly suppressed cell viability, invasion, and colony formation, while inducing apoptosis, thereby experimentally validating their tumor-suppressive effects.</p><p><strong>Conclusion: </strong>By integrating multi-omics evidence with functional assays, this study identifies EIF2B2 and RPS6KL1 as causal protective factors in EAC etiology. These findings suggest that maintaining ribosomal homeostasis via these genes acts as a barrier against EAC, highlighting their potential for risk stratification and therapeutic targeting.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024187","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":"High infiltration level of a prognostic improvement associated T cells is favorable for the prognosis of patients with gastric adenocarcinoma.","authors":"Tong Wu, Zengning Li, Juan Tian, Minyu Nong, Xuanhua Chen, Yongle Li, Ying Rao, Yixin Liu, Shuhan Wang, Lihe Jiang","doi":"10.1159/dig/acmag021","DOIUrl":"https://doi.org/10.1159/dig/acmag021","url":null,"abstract":"<p><p>Gastric cancer is the fifth most common cancer and the third leading cause of cancer-related deaths worldwide. Currently, research on the tumor microenvironment of gastric cancer remains to be developed. In this study, we obtained scRNA-seq data of gastric cancer from the GEO database, and used the Seurat package for clustering. We used the Bayesian cell Proportion Reconstruction algorithm to calculate the cell subpopulation content in TCGA samples, and combined it with TCGA survival data to perform Kaplan-Meier and univariable Cox analyses. We further performed multivariable Cox regression analysis incorporating age, sex, TNM stage, and histological type to evaluate the independent prognostic value of PIA T-cells. We found that a prognostic improvement associated T cells (PIA T-cells) had a better prognosis in gastric adenocarcinoma tissues with higher levels of PIA T-cells. To further characterize the biological identity of this population, we analyzed canonical T-cell functional markers and found that PIA T-cells exhibited a distinct phenotypic profile (CD4(low/negative), CD8A(moderate), GZMB(moderate), IFNG(low)), distinguishing them from other T-cell subsets. Unlike other T cell subpopulations, PIA T-cells expressed significantly higher levels of eight genes (ASPM, ATAD2, CENPF, DUT, MKI67, NUSAP1, TOP2A, and TYMS). The study of PIA T-cells may provide insights into gastric cancer tumor microenvironment-related treatments and inform future therapeutic strategies.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024291","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":"Semaglutide and Tirzepatide for the Treatment of MASH: What Works, What is Coming, and What is Missing.","authors":"Sakkarin Chirapongsathorn, Frank Tacke","doi":"10.1159/dig/acmag014","DOIUrl":"10.1159/dig/acmag014","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), are increasingly prevalent conditions closely linked to obesity, insulin resistance, and cardiometabolic diseases. Although lifestyle modification remains the cornerstone of management, it frequently fails to achieve sustained histologic improvement, suggesting that patients require effective pharmacologic therapies.</p><p><strong>Summary: </strong>Incretin-based treatments, including glucagon-like peptide-1 (GLP-1) receptor (GLP-1R) agonists (GLP-1RAs) and newer dual agonists additionally targeting glucose-dependent insulinotropic polypeptide, have emerged as promising disease-modifying options. These agents improve hepatic steatosis primarily through weight reduction and enhanced insulin sensitivity, while also exerting pleiotropic effects on inflammation and lipid metabolism. Phase 2 clinical trials consistently demonstrate improvement in steatohepatitis with GLP-1RAs, with encouraging signals of fibrosis improvement observed with dual agonists such as tirzepatide. Interim data from a phase 3 clinical trial with semaglutide show clinically meaningful benefits in both MASH resolution and fibrosis regression. These findings have led to accelerated regulatory approval of semaglutide for the treatment of non-cirrhotic MASH with stage F2-F3 fibrosis. In addition to hepatic effects, incretin-based therapies provide substantial cardiometabolic benefits, reinforcing their relevance in a disease strongly associated with cardiovascular risk.</p><p><strong>Key messages: </strong>Overall, mono- and dual-incretin agonist therapies represent a significant advance in the treatment landscape of MASLD/MASH, although long-term outcome data are required to confirm durability, safety, and impact on major adverse liver-related outcomes.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918054","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":"Follicular dendritic cell staining pattern as a prognostic marker for the watch-and-wait policy in patients with gastrointestinal follicular lymphoma.","authors":"Akira Tari, Hideki Asaoku, Takeshi Okatani, Kazuki Boda, Hideharu Okanobu, Takehiro Tanaka, Tadashi Koga, Tadashi Yoshino","doi":"10.1159/dig/acmag016","DOIUrl":"https://doi.org/10.1159/dig/acmag016","url":null,"abstract":"<p><strong>Background/aims: </strong>Gastrointestinal follicular lymphoma (GI-FL) patients with low tumor burden are often managed with a \"watch and wait\" (W&W) strategy, but regular endoscopic examinations impose a significant burden. We investigated whether the follicular dendritic cell (FDC) staining pattern of GI-FL lesions could help identify a lower-risk subgroup of patients during W&W follow-up.</p><p><strong>Methods: </strong>We studied 76 Japanese patients with GI-FL (September 2003-July 2022), classified by CD21 staining into \"duodenal pattern\" (n=57) and \"nodal pattern\" (n=19) groups. All patients underwent regular clinical, endoscopic, and imaging follow-up. Progression-free survival (PFS), time to treatment required (TTR), and overall survival (OS) were compared between the two groups.</p><p><strong>Results: </strong>Patients with a \"duodenal pattern\" had better outcomes than those with a \"nodal pattern.\" In the \"duodenal pattern\" group, 25 of 57 patients (43.9%) progressed, but only 9 (15.8%) required treatment. In the \"nodal pattern\" group, 14 of 19 patients (73.7%) progressed and all required treatment; 8 (42.1%) developed local compressive symptoms necessitating immediate treatment, versus none in the \"duodenal pattern\" group. OS was excellent in both groups.</p><p><strong>Conclusion: </strong>The FDC staining pattern of the tumor is a useful marker for the management of patients with GI-FL. Patients with an FDC \"duodenal pattern\" have slower disease progression and rarely require treatment. These findings suggest that the \"duodenal\" FDC pattern may help identify candidates for future prospective studies of individualized or de-escalated surveillance, which could ultimately reduce the physical and financial burden of follow-up while maintaining good outcomes.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917976","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":"Lactose Sensitivity and Malabsorption in Functional Dyspepsia and Functional Dyspepsia-Irritable Bowel Syndrome Overlap.","authors":"Anna Vecsei, Heinz F Hammer, Johann Hammer","doi":"10.1159/dig/acmag011","DOIUrl":"10.1159/dig/acmag011","url":null,"abstract":"<p><strong>Introduction: </strong>Lactose intolerance is frequently suspected in disorders of gut-brain interaction, yet symptoms often do not align with objective malabsorption. While lactose-related symptoms have been investigated in irritable bowel syndrome (IBS), data on functional dyspepsia (FD), particularly patients with overlapping IBS, remain limited. This study examined the relative contribution of lactose sensitivity and lactose malabsorption to symptom burden, and evaluated whether FD-IBS overlap is associated with greater symptom severity than FD alone.</p><p><strong>Methods: </strong>In this cross-sectional study, adults underwent standardized lactose hydrogen breath and symptom testing. Diagnoses followed Rome IV criteria. Lactose malabsorption was defined as ≥20 ppm hydrogen increase; lactose sensitivity as ≥20 mm rise on the adult Carbohydrate Perception Questionnaire. Group differences were tested non-parametrically; adjusted effects used a general linear model with age and gender.</p><p><strong>Results: </strong>Among 587 patients, lactose sensitivity was more prevalent than lactose malabsorption (54.9% versus 41.2%; p < 0.001) and occurred more frequently in patients with FD-IBS overlap than in those with FD alone (69.8% versus 52.7%; p < 0.001). Patients with overlap exhibited the highest symptom burden (p < 0.001). In multivariate analysis, lactose sensitivity and younger age were independently associated with FD-IBS overlap, whereas lactose malabsorption and gender were not.</p><p><strong>Conclusion: </strong>Lactose sensitivity, not malabsorption, was closely associated with symptom burden in patients with FD. FD-IBS overlap was linked to amplified burden, underscoring the importance of validated symptom assessment alongside breath testing for diagnostic precision.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905365","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":"The Efficacy and Safety of <i>Helicobacter pylori</i> Eradication Regimens in Patients Receiving Hemodialysis: A Systematic Review and Network Meta-Analysis.","authors":"Satoshi Sato, Jun Watanabe, Takeshi Kanno, Keigo Misawa, Hiromi Sekiguchi, Tomonori Yano, Atsushi Masamune, Tomoari Kamada","doi":"10.1159/dig/acmag012","DOIUrl":"10.1159/dig/acmag012","url":null,"abstract":"<p><strong>Introduction: </strong>Helicobacter pylori eradication is clinically important in patients on hemodialysis (HD), who are at risk for serious gastrointestinal complications. However, altered drug metabolism and antibiotic resistance in patients on HD complicate H. pylori eradication. This study aimed to perform a network meta-analysis to synthesize existing evidence on the efficacy and safety of H. pylori eradication regimens in patients on HD.</p><p><strong>Methods: </strong>We searched MEDLINE, the Cochrane Library, EMBASE, Ichushi-Web, ICTRP, and <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link>. Two reviewers independently selected randomized controlled trials that evaluated H. pylori eradication therapy in patients undergoing HD. We performed a frequentist random effects network meta-analysis. The primary outcome was eradication rate, and the secondary outcomes were treatment completion rates and all adverse events. We used CINeMA to assess the confidence in the evidence. The study protocol was registered at OSF (<ext-link ext-link-type=\"uri\" xlink:href=\"https://osf.io/gn978/\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">https://osf.io/gn978/</ext-link>).</p><p><strong>Results: </strong>Ten trials involving 481 patients were included in the analysis. Seven eradication regimens were compared: six concomitant and one sequential regimen. Relative to standard-dose proton pump inhibitor/clarithromycin/amoxicillin regimens (PAC), the evidence is very uncertain about the effect of the proton pump inhibitor/clarithromycin regimen on the eradication rate (odds ratio, 0.11; 95% confidence interval, 0.01-1.07). For reduced-dose PAC (in which clarithromycin or amoxicillin is dose reduced), alternative regimens (with azithromycin, metronidazole, or levofloxacin), and sequential regimens, the estimates were too imprecise to determine whether a difference from PAC exists (low certainty). Treatment completion rates were generally favorable (83-100%), and adverse events were most frequent with standard-dose PAC (45%).</p><p><strong>Conclusion: </strong>Reduced-dose PAC and alternative and sequential regimens may be considered for H. pylori eradication in patients on HD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896586","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":"Risk of Extraintestinal Solid Organ Malignancy in Patients with Inflammatory Bowel Disease: A Propensity-Matched Cohort Study.","authors":"Aakash Desai, Rishi Chowdhary, Himsikhar Khataniar, Francis A Farraye, Raymond K Cross, Stephen B Hanauer, Parambir S Dulai, Miguel Regueiro, Gursimran S Kochhar","doi":"10.1159/dig/acmag010","DOIUrl":"10.1159/dig/acmag010","url":null,"abstract":"<p><strong>Introduction: </strong>There is limited and conflicting data regarding the risk of thyroid, kidney, and prostate cancers in patients with inflammatory bowel disease (IBD).</p><p><strong>Methods: </strong>This was a retrospective cohort study using the US Collaborative Network comparing the risk of thyroid, kidney, and prostate cancer in IBD compared to non-IBD (control) cohort. One-to-one propensity score matching was performed for demographics and comorbid conditions. Cox proportional hazard model was used to identify risk factors for each cancer.</p><p><strong>Results: </strong>There were 200,280 matched pairs in the IBD and control cohorts (mean age 43.7 ± 19.5 years, 46.1% male, 76% white). Compared with non-IBD controls, patients with IBD had increased odds of thyroid cancer (aOR 1.37, 95% CI: 1.19-1.59), kidney cancer (aOR 1.37, 95% CI: 1.22-1.54), and prostate cancer (aOR 1.39, 95% CI: 1.29-1.51). These associations were generally consistent across IBD subtypes and sex strata. Racial/ethnic disparities were observed for each cancer. Patients with IBD aged 18-39 years had increased odds of thyroid cancer (aOR 1.41, 95% CI: 1.08-1.84), but not kidney or prostate cancer, compared with controls. Long-term systemic steroid use was associated with increased risk of thyroid cancer (HR 1.75, 95% CI: 1.29-2.36) and kidney cancer (HR 1.52, 95% CI: 1.24-1.87), while type 2 diabetes mellitus and obesity were associated with increased risk of all three cancers in the IBD cohort.</p><p><strong>Conclusion: </strong>In this focused analysis of selected extraintestinal solid organ malignancies, IBD was associated with increased risk of thyroid, kidney, and prostate cancer. These findings support further research into cancer-specific mechanisms, surveillance patterns, and risk stratification in patients with IBD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148838924","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":"Therapeutic Outcomes and Risks of Plasmapheresis in Hypertriglyceridemia Acute Pancreatitis: A Systematic Review and Meta-analysis.","authors":"Ningning Cui, Wen Wang, Wei Xu","doi":"10.1159/dig/acmag004","DOIUrl":"https://doi.org/10.1159/dig/acmag004","url":null,"abstract":"<p><strong>Background: </strong>Hypertriglyceridemia acute pancreatitis (HTG-AP) is constantly increasing and has a higher proportion of severe cases. The benefit of plasmapheresis as a therapeutic intervention for HTG-AP remains controversial. Thus we conducted a meta-analysis to search existing evidence to evaluate its efficacy and safety.</p><p><strong>Methods: </strong>A comprehensive literature search was performed in key electronic databases to search eligible studies based on predetermined criteria. Included studies compared plasmapheresis combined with standard medical therapy (Plasmapheresis group, PE group) versus standard medical therapy alone (Control group) in HTG-AP patients. Study outcomes were the 24-hour serum triglyceride (TG) reduction rate, in-hospital mortality, incidence of local/systemic complications, hospital length of stay (LOS), hospitalization costs, and recurrence rate.</p><p><strong>Results: </strong>A total of 986 articles were retrieved and 20 studies involving 1,576 patients (PE group: n=636; Control group: n=940) were included. Analysis revealed that no statistically significant difference was found in mortality (RR 1.43, 95%CI 0.91-2.26, P=0.12), incidence of systemic complications (RR: 0.96; 95%CI: 0.61-1.50; P = 0.86), incidence of local complications (RR 1.01, 95% CI 0.84-1.21; P=0.91) , requirement for invasive procedures (RR 0.86, 95% CI 0.48-1.54, P=0.62) between PE group and Control group. PE group has higher TG reduction at both 24h (SMD 10.13, 95% CI 3.39-16.87, P<0.01) and 48h (SMD 8.14, 95%CI 4.30-11.98, P<0.0001) compared with control group. PE group exhibited a prolonged LOS (WMD 2.40, 95%CI 0.14-4.66, P=0.04) alongside substantially increased costs (WMD 27.56, 95%CI 16.61-38.51, P<0.00001). Subgroup analysis indicated plasmapheresis increased mortality in non-severe cases.</p><p><strong>Conclusion: </strong>While plasmapheresis significantly reduces serum TG levels, it confers no significant benefit on critical clinical outcomes in HTG-AP. Thus existing clinical evidence does not support its use as a routine treatment for HTG-AP. Large-scale RCTs should be carried out to further evaluate its efficacy, optimal indications, and timing.</p><p><strong>Key words: </strong>plasmapheresis; plasma exchange; double filtration plasmapheresis; hypertriglyceridemic acute pancreatitis; meta-analysis.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1"},"PeriodicalIF":3.4,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148826285","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}