Digestion最新文献

{"title":"Identification of LGR5 and TFF2 as Biomarkers in High-Risk Chronic Atrophic Gastritis: From Multi-Omics Mining to Clinical Validation.","authors":"Qingqing Zhang, Di Wu, Fengyun Guo, Shengnan Yang, Lijing Bao, Ruiying Zhang, Ping Wang","doi":"10.1159/000549887","DOIUrl":"10.1159/000549887","url":null,"abstract":"<p><strong>Introduction: </strong>High-risk chronic atrophic gastritis (CAG; OLGA/OLGIM Ⅲ-Ⅳ) carries significant gastric cancer (GC) risk yet lacks reliable gastric stem cell (GSC)-based biomarkers. We evaluated GSC markers LGR5 (proliferative) and TFF2 (protective) for risk stratification.</p><p><strong>Methods: </strong>TCGA/GEO bioinformatics analysis preceded immunohistochemical validation in 60 clinical samples. Protein co-expression (Wnt/β-catenin, Ki67, Bax) was assessed. Diagnostic/prognostic power was tested via ROC and Kaplan-Meier analyses. Functional networks were deciphered through GO/KEGG enrichment.</p><p><strong>Results: </strong>High-risk CAG and GC tissues showed LGR5 upregulation and TFF2 downregulation (p < 0.001). IHC confirmed these patterns, with concurrent Wnt activation (β-catenin↑, cyclin D1↑) and proliferation-apoptosis imbalance (Ki67↑, Bax↓). TFF2 outperformed LGR5 in diagnosing high-risk CAG (AUC: 0.842 vs. 0.681). Poor GC prognosis correlated with high LGR5/low TFF2 (p < 0.05). Co-expression networks linked LGR5 to metabolic genes (CPS1, ADH6) and TFF2 to mucosal defense (GKN1, PGC).</p><p><strong>Conclusion: </strong>The coordinated assessment of LGR5 and TFF2 offers a promising approach to identifying high-risk CAG. This biomarker pair captures a homeostatic imbalance in GSCs linked to Wnt/β-catenin signaling, establishing a novel molecular framework for early detection and future targeted strategies.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-19"},"PeriodicalIF":3.4,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146043995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<italic>Helicobacter pylori</italic>-Naïve Gastric Neoplasms: Clinicopathological and Molecular Features and Diagnostic Challenges.","authors":"Kotaro Shibagaki, Satoshi Kotani, Yusuke Takahashi, Shinsuke Suemitsu, Mamiko Nagase, Asuka Araki, Shigeru Kawabata, Daisuke Niino, Norihisa Ishimura, Shunji Ishihara","doi":"10.1159/000550663","DOIUrl":"10.1159/000550663","url":null,"abstract":"<p><strong>Background: </strong>With the increasing proportion of the Helicobacter pylori (Hp)-naïve population in Japan, conventional Hp-infected gastric neoplasms (HpIGNs) have decreased, whereas Hp-naïve gastric neoplasms (HpNGNs) are being detected more frequently.</p><p><strong>Summary: </strong>Hp infection remodels the gastric mucosa and promotes tumorigenesis through a high mutational burden and epigenetic dysregulation, contributing to the histologically diverse and aggressive nature of HpIGNs. In contrast, HpNGNs arise with few genetic and epigenetic alterations, resulting in limited morphological diversity determined by the type of their background mucosa. Most HpNGNs arise in the fundic gland mucosa and exhibit a gastric phenotype, whereas those arising from the pyloric gland mucosa or gastric cardia show a variable phenotype. Regardless of histologic subtype, HpNGNs are generally biologically indolent, except for a subset arising in the gastric cardia. The histological classification of HpNGNs does not always fit conventional diagnostic frameworks for gastric neoplasms. In particular, foveolar-type adenomas (FGAs) need to be subclassified into flat and raspberry types, which represent distinct molecular entities. Furthermore, HpNGNs with a MUC6-dominant gastric phenotype, including gastric adenocarcinomas of fundic gland or fundic gland mucosa type and some flat-type FGAs with partial MUC6-dominant components, and pyloric gland adenomas form a morphological and molecular continuum, occasionally making histological distinction difficult. A comprehensive disease concept integrating these lesions may help resolve this diagnostic issue.</p><p><strong>Key messages: </strong>As the prevalence of Hp infection continues to decline worldwide, HpNGNs are expected to emerge as a distinct disease entity, highlighting the need for refined diagnostic frameworks and risk-based surveillance strategies in the post-Hp era.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-17"},"PeriodicalIF":3.4,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13012773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Correlation between Fecal Immunochemical Test and Fecal Calprotectin in the Evaluation of Activity in Patients with Inflammatory Bowel Disease.","authors":"Juan Adrián Torres-Díaz, Obduaris Díaz-Espaillat, Jesus K Yamamoto-Furusho","doi":"10.1159/000550129","DOIUrl":"10.1159/000550129","url":null,"abstract":"<p><strong>Introduction: </strong>The fecal immunochemical test (FIT) is a wide available fecal biomarker that could evaluate the disease activity in inflammatory bowel disease (IBD). The aim was to assess the correlation between the FIT and fecal calprotectin (FC) for evaluating IBD activity.</p><p><strong>Methods: </strong>This was a unicentric, transversal cohort study. Consecutive patients with IBD were included and FIT and FC were determined. The clinical activity was assessed with Truelove-Witts and Yamamoto-Furusho index for UC patients while Harvey-Bradshaw and CDAI for CD patients. Spearman's rank correlation test was used to assess the correlation between FIT and FC. Sensitivity, specificity, and positive (PPV) and negative predictive values (NPVs) for FIT and FC were calculated. Receiver operator curves were constructed.</p><p><strong>Results: </strong>A total of 206 patients were included. One hundred forty-eight (72%) patients had diagnosis of UC and 58 (28%) with CD. The median of FIT was 2.8 μg/g (range, 2.6-2,394 μg/g) and the median for FC level was 265.5 μg/g (range, 22-6,285 μg/g). There was a very good correlation between FIT with and FC in UC patients (r_s = 0.745, p < 0.01) and moderate in CD patients (r_s = 0.574, p < 0.01). A FIT cutoff of 2.6 μg/g identified endoscopic activity in UC patients with a sensitivity of 78%, specificity of 86%, PPV of 91% and NPV of 67% with an area under the curve (AUC) of 0.852 (95% CI: 0.758-0.946).</p><p><strong>Conclusion: </strong>FIT can be an alternative fecal biomarker to assess the disease activity in UC patients.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040618","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":"Quality of Care and Burden in Patients with Celiac Disease: Results from the German Celiac Registry.","authors":"Sibylle Koletzko, Christina Sobotzki, Margit Blömacher, Sandra Plachta-Danielzik, Michael Schumann, Stephanie Baas, Bernd Bokemeyer, Detlef Schuppan","doi":"10.1159/000550496","DOIUrl":"10.1159/000550496","url":null,"abstract":"<p><strong>Introduction: </strong>European and National Celiac Disease (CeD) guidelines offer an easy pathway to diagnose CeD. The German CeD Registry aimed to assess symptoms and clinical findings before diagnosis, diagnostic delay, care during the diagnostic process, and factors associated with persistence of symptoms.</p><p><strong>Methods: </strong>Individuals with CeD provided demographic, clinical, and healthcare-related information. Participants were divided into four subgroups according to age at diagnosis (>18 or <18 years) and year of diagnosis (before and since 2012). Factors associated with symptoms after at least 1 year on a gluten-free diet (GFD) were assessed using multivariate logistic regression.</p><p><strong>Results: </strong>From 11/2019 to 10/2021, 2,333 participants were enrolled. After exclusion of 169 (7.2%), 2,164 remained for analysis, thereof 796 (36.8%) were diagnosed <18 years, and 1,283 (59.3%) since 2012. Most common symptoms before diagnosis included abdominal pain (83%), bloating (82%), fatigue (78%), and diarrhoea (71%). Diagnostic delay after 2012 was longer in adults than children (median 4.4 years [interquartile range; IQR: 1.2-13.0] versus 1.1 [IQR: 0.5-2.2], respectively) (p < 0.001). Guideline-conform diagnoses increased over time. After diagnosis, only 60% received professional dietary counselling. Factors associated with symptoms despite GFD included female gender (odds ratio [OR]: 1.79 [95% confidence interval: 1.34; 2.40], p < 0.001), same symptom before diagnosis (OR: 3.45 [2.45; 4.96], p < 0.001), insufficient information provided at diagnosis (OR: 1.25 [1.00; 1.57], p = 0.046), and age at diagnosis (per decade) (OR: 1.11 [1.04; 1.18], p < 0.001) but not time since diagnosis.</p><p><strong>Conclusions: </strong>Our findings revealed deficits in awareness, the diagnostic process, and post-diagnostic care that are linked to decreased clinical improvement over time.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146040678","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":"Explainable Artificial Intelligence for the Mayo Endoscopic Score in Ulcerative Colitis.","authors":"Jinzhou Zhu, Shiqi Zhu, Xianglin Ding, Lihe Liu, Congying Xu, Haoxiang Ni, Jiaxi Lin, Xiaolin Liu, Yu Wang, Yu Li, Hang Zhao, James Weiquan Li, Rui Li","doi":"10.1159/000550610","DOIUrl":"10.1159/000550610","url":null,"abstract":"<p><strong>Introduction: </strong>The Mayo endoscopic score (MES) is used widely in ulcerative colitis (UC) for severity assessment and therapeutic decision-making. Deep learning (DL) models developed to determine MES currently lack explainability. We aimed to develop explainable models for the MES in patients with UC and examine the human-artificial intelligence interactions with the models.</p><p><strong>Methods: </strong>This was a retrospective multicenter study conducted across four large tertiary institutions in China. A total of 2,600 white light images were used for training. Two approaches were adopted: traditional blackbox or explainable AI (XAI). The trained models were evaluated with three external test datasets (#1 Changshu and Jintan hospitals, n = 100; #2 HyperKvasir, n = 100; #3 Yongding hospital, n = 260), and the performance was compared with endoscopists. The primary outcome was the performance of 4-way classification. For explainability, moreover, Grad-CAM was for computer vision, while local interpretation, variable importance, and partial dependence plots were for the classifier within XAI.</p><p><strong>Results: </strong>In the test #1 dataset, a Xception-backboned XAI showed accuracy of 0.910, Matthew's correlation coefficient 0.880, and Cohen's kappa 0.960 (95% CI, 0.940-0.990). The metrics were better than other models, as well as the two endoscopists. With the AI assistance, the performance of endoscopists were improved (senior's accuracy from 0.890 to 0.930 and junior's accuracy from 0.810 to 0.880). Similar trend was observed in the test #2 and #3 datasets.</p><p><strong>Conclusion: </strong>The use of an explainable framework empowers AI models to achieve improved performance with transparency. XAI can also improve endoscopist performance in interpretation of MES in UC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028661","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":"Characteristics and Prognosis of Esophageal Squamous Cell Carcinoma that Progressed to pT1a-MM or Deeper despite Surveillance Esophagogastroduodenoscopy.","authors":"Yoshiki Hatsushika, Yuji Urabe, Satoshi Masuda, Takahiro Uda, Yukiko Sako, Tomoyuki Gurita, Takeo Nakamura, Kazuki Ishibashi, Hirona Konishi, Akiyoshi Tsuboi, Hidenori Tanaka, Ken Yamashita, Yuichi Hiyama, Yoshihiro Kishida, Hidehiko Takigawa, Akira Ishikawa, Shinji Mii, Toshio Kuwai, Shiro Oka","doi":"10.1159/000550514","DOIUrl":"10.1159/000550514","url":null,"abstract":"<p><strong>Introduction: </strong>In the surveillance of esophageal squamous cell carcinoma (ESCC), advanced lesions may still be detected despite regular screening with esophagogastroduodenoscopy (EGD). In this study, we investigated the endoscopic characteristics and prognosis of ESCC cases that progressed to pT1a-MM or deeper despite undergoing surveillance EGD.</p><p><strong>Methods: </strong>We retrospectively analyzed 225 consecutive superficial ESCC lesions invading beyond the muscularis mucosa that were resected by endoscopic submucosal dissection (ESD) from 215 patients at Hiroshima University Hospital between April 2010 and March 2023. Among them, 28 patients (29 lesions) were classified as the post-EGD ESCC (PEESCC) group, defined as cases where surveillance EGD performed 24 months before diagnosis did not detect neoplasia or carcinoma. The remaining 188 patients (196 lesions) were the screening group. Subsequently, endoscopic findings and prognosis were compared.</p><p><strong>Results: </strong>From the multivariate analysis, the presence of Lugol-voiding lesions (69.0% vs. 39.3%), cervical esophageal location (17.2% vs. 3.1%), small tumor diameter (21.6 ± 12.3 mm vs. 34.0 ± 18.3 mm), and submucosal tumor (SMT)-like elevation (20.7% vs. 7.7%) were significantly identified as characteristic endoscopic findings of PEESCC. The PEESCC group exhibited lower 5-year disease-specific survival (93.1% vs. 98.5%, p = 0.039) and recurrence-free survival (69.0% vs. 83.7%, p = 0.025).</p><p><strong>Conclusion: </strong>PEESCC lesions are associated with distinct endoscopic features and a poorer prognosis than are non-PEESCC lesions.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988723","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":"Gastrointestinal Bleeding after Particle Radiotherapy for Pancreatic Cancer.","authors":"Takeshi Okamoto, Takafumi Mie, Tsuyoshi Takeda, Keito Suzuki, Yoichiro Sato, Tatsuki Hirai, Yuri Maegawa, Jun Hamada, Takaaki Furukawa, Takashi Sasaki, Masato Ozaka, Naoki Sasahira","doi":"10.1159/000550483","DOIUrl":"10.1159/000550483","url":null,"abstract":"<p><strong>Introduction: </strong>Particle radiotherapy (PRT) is a new option for the treatment of unresectable pancreatic cancer (PC). While gastrointestinal bleeding (GIB) is a feared adverse event, real-world evidence in this setting is limited.</p><p><strong>Methods: </strong>We conducted a single-center retrospective study to evaluate the frequency and outcomes of GIB and to elucidate the risk factors for GIB after PRT for PC.</p><p><strong>Results: </strong>Thirty-four patients were included. Twenty-nine received PRT to the pancreatic primary, while five received PRT for metastases. Concurrent chemotherapy was given to 26 patients (76%). Eleven patients (32%) experienced acute GIB symptoms after PRT. Median time from PRT to GIB was 13.2 months. Endoscopic signs of hemorrhage were observed in 8 patients (24%), and endoscopic hemostasis was performed in six (18%). Three cases presented with ruptured pseudoaneurysms, of which two were treated with transarterial embolization. Hemostasis was ultimately achieved in all cases, and no deaths occurred directly as a result of GIB. However, overall survival after GIB was short (median: 1.9 months). Median overall survival after PRT tended to be longer in bleeders than in non-bleeders (26.8 vs. 22.7 months, p = 0.03). Concurrent chemotherapy was associated with a lower risk of GIB in univariate analysis (p = 0.05).</p><p><strong>Conclusion: </strong>GIB after PRT may not be as rare as previously believed, particularly in the terminal stages of PC.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145988801","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":"Gastric Epithelial Neoplasms in <italic>Helicobacter pylori</italic>-Uninfected Patients.","authors":"Hiroya Ueyama, Takashi Yao, Shunsuke Nakamura, Yasuko Uemura, Tomoyo Iwano, Momoko Yamamoto, Daiki Abe, Shotaro Oki, Tsutomu Takeda, Yoichi Akazawa, Kumiko Ueda, Mariko Hojo, Akihito Nagahara","doi":"10.1159/000550411","DOIUrl":"10.1159/000550411","url":null,"abstract":"<p><strong>Background: </strong>In recent years, several studies have described the clinicopathological characteristics of Helicobacter pylori (H. pylori)-uninfected gastric cancer. This entity is now recognized as one of the major topics in gastric cancer research and clinical practice.</p><p><strong>Summary: </strong>Currently, H. pylori-uninfected gastric epithelial neoplasms (HpUGENs; excluding adenocarcinomas of the esophagogastric junction and gastric neuroendocrine tumors) are classified into seven subtypes in our research results: raspberry-type gastric epithelial neoplasm (GEN; foveolar-type adenoma), whitish flat elevated-type GEN (GEN with gastric phenotype), gastric adenocarcinoma of fundic gland type (GA-FG), gastric adenocarcinoma of the fundic gland mucosa type (GA-FGM), other GEN with a gastric phenotype (complex type of GEN with gastric phenotype), GEN with an intestinal or gastrointestinal mixed phenotype arising in the pyloric gland region, and signet ring cell carcinoma.</p><p><strong>Key messages: </strong>This study outlines our analysis of current cases, detailing the endoscopic and clinicopathological characteristics of HpUGENs, and provides practical insights for their endoscopic and pathological diagnosis. Since many of these neoplasms histologically show low-grade atypia, they are sometimes diagnosed as gastric adenoma or gastric dysplasia rather than adenocarcinoma in the World Health Organization classification, highlighting the need for standardized histopathological diagnostic criteria of GENs with low-grade atypia. Moreover, as no clinical practice guidelines have yet been established for HpUGENs, future research should aim to elucidate the relationship between early and advanced lesions, perform comprehensive analyses of H. pylori-uninfected advanced gastric cancer, and conduct molecular biological studies to achieve a better understanding of the entire disease spectrum and to establish evidence-based clinical guidelines.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-16"},"PeriodicalIF":3.4,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Very Early Biologic Therapy within Six Months of Crohn's Disease Diagnosis Improves One-Year Steroid-Free Clinical Remission: A Retrospective Cohort Study.","authors":"Yen-Cheng Chang, Shih-Hua Lin, Tai-Di Chen, Chia-Jung Kuo, Chien-Ming Chen, Chen-Wang Chang, Jen-Wei Chou, Cheng-Tang Chiu, Ming-Yao Su, Yu-Bin Pan, Puo-Hsien Le","doi":"10.1159/000550394","DOIUrl":"10.1159/000550394","url":null,"abstract":"<p><strong>Introduction: </strong>Early use of biologics improves outcomes for Crohn's disease (CD). Evidence now indicates that initiating therapy within 6 months of diagnosis - the \"very early\" window - may yield additional benefits over the traditional ≤2-year target. We therefore compared 1-year outcomes after very early (<6 months) versus early (6-24 months) biologic initiation in routine practice.</p><p><strong>Methods: </strong>In this retrospective cohort (March 2018 to June 2025), biologic-naïve adults with CD and ≥52 weeks of follow-up were stratified by time from diagnosis to first biologic: very early (<6 months) or early (6-24 months). The primary endpoint was steroid-free clinical remission at week 52. Multivariate logistic regression identified variables independently associated with remission.</p><p><strong>Results: </strong>Ninety-six patients were analyzed (very early = 52; early = 44). Baseline characteristics were comparable except for a higher proportion of corticosteroid use in the very early group (67.3% vs. 43.2%; p = 0.018). At week 52, very early initiation was associated with a lower mean CD Activity Index (64.82 ± 6.79 vs. 96.10 ± 13.03; p = 0.038) and a higher steroid-free clinical remission rate (71.2% vs. 45.5%; p = 0.011). Concomitant corticosteroid use fell to 11.4% in the very early group versus 30.6% in the early group (p = 0.033). Very early initiation remained the strongest independent predictor of steroid-free remission (adjusted OR 3.537, 95% CI: 1.417-8.824; p = 0.007).</p><p><strong>Conclusions: </strong>Initiating biologic therapy within 6 months of CD diagnosis significantly increases 1-year steroid-free clinical remission and reduces corticosteroid dependence compared with initiation at 6-24 months. These real-world data support adopting a standardized \"very early\" biologic treatment strategy to optimize clinical outcomes in newly diagnosed, biologic-naïve CD.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145943105","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":"Continuous versus Intermittent Midazolam Sedation in Balloon-Assisted Enteroscopy: A Multicenter Randomized Trial.","authors":"Yuko Sakakibara, Tomohiko Mannami, Toshio Kuwai, Takashi Kagaya, Tatsuya Toyokawa, Shinji Katsushima, Toshihiro Kanda, Masaaki Shimada, Mizuki Kuramochi, Shohei Hamada, Hiroyuki Fujii, Noriko Watanabe, Toshiyuki Wakatsuki, Yuzuru Tamaru, Naoki Esaka, Yoshihiro Sasaki, Kimitoshi Kubo, Katsuhiro Mabe, Takuya Yamada, Akio Ishihara, Toshio Uraoka, Mototsugu Kato, Akiko Kada, Akiko M Saito, Naohiko Harada","doi":"10.1159/000550292","DOIUrl":"10.1159/000550292","url":null,"abstract":"<p><strong>Introduction: </strong>Sedation protocols for balloon-assisted enteroscopy (BAE) are not yet standardized. The aim of this study was to compare the efficacy and safety between continuous infusion and intermittent bolus administration of midazolam for sedation during BAE. The study hypothesis was that continuous infusion would provide a greater proportion of time under conscious sedation than would intermittent bolus administration.</p><p><strong>Methods: </strong>We conducted a multicenter, prospective, double-blind, randomized controlled trial at 15 institutions of the National Hospital Organization in Japan. Patients scheduled for diagnostic or therapeutic BAE were randomly assigned to receive continuous infusion or intermittent bolus administration of intravenous midazolam. The primary endpoint was the proportion of time under conscious sedation, defined as a Ramsay Sedation Scale score of 3-4. Secondary endpoints included body movements causing procedure interruption, endoscopist and patient satisfaction, total drug dosage, adverse events, and termination of the procedure.</p><p><strong>Results: </strong>Of 76 enrolled patients (39 continuous infusion group, 37 intermittent bolus group), one from each group discontinued before treatment, leaving 74 patients (38 continuous group, 36 intermittent bolus group) for analysis. The proportion of time under conscious sedation was comparable between groups (mean ± SD: 0.637 ± 0.315 vs. 0.609 ± 0.272, p = 0.721). However, the continuous infusion group showed a lower incidence of body movements causing procedure interruption (7.9% vs. 25.0%, p = 0.091). The total midazolam dose was higher in the continuous infusion group, whereas the incidence of adverse events was comparable between the two groups.</p><p><strong>Conclusion: </strong>Continuous infusion of midazolam did not demonstrate superiority over intermittent bolus administration with regard to the proportion of time under conscious sedation. However, continuous infusion suppressed body movements during BAE without increasing adverse events; thus, it could be one of the feasible sedation options for BAE in clinical practice.</p>","PeriodicalId":11315,"journal":{"name":"Digestion","volume":" ","pages":"1-13"},"PeriodicalIF":3.4,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12956316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}