Digestive Diseases and Sciences最新文献

{"title":"Evaluation of Acute Severe Ulcerative Colitis Predictors for Steroid Therapy Refractoriness.","authors":"Alaa Abdelmeguid, Amany Ahmed El Banna, Wafaa Elsheikh, Ahmed Ismail Ellakany, Shaji Sebastian","doi":"10.1007/s10620-025-08982-4","DOIUrl":"https://doi.org/10.1007/s10620-025-08982-4","url":null,"abstract":"<p><strong>Background: </strong>One-third of patients presenting with acute severe ulcerative colitis (ASUC) are steroid-refractory and require either colectomy or rescue therapy. Timely identification of risk factors predictive of steroid non-response in ASUC patients is crucial for initiating early rescue therapy.</p><p><strong>Aim: </strong>To identify factors predicting steroid failure or colectomy in ASUC.</p><p><strong>Methods: </strong>Records of ASUC admissions over a six-year period in a tertiary inflammatory bowel disease center were included. Clinical variables, laboratory markers, and endoscopic scores at admission were obtained. The primary outcome was non-response to intravenous (IV) steroids. Univariate and multivariate regression analyses were performed to identify factors associated with steroid non-response. Day-one and day-three composite indices were calculated. Their predictive value was assessed against the outcomes of steroid failure and requiring colectomy.</p><p><strong>Results: </strong>One hundred and three ASUC patients were included, of which 51 were steroid non-responders. Among non-responders, 48 received rescue therapy, and 6 underwent colectomy at index admission (3 after rescue therapy and 3 without). Day-one albumin (OR 0.906, P = 0.043) and being on oral steroids at entry (OR 3.009, P = 0.014) predicted non-response to steroids in both univariate and multivariate analyses. Admission hemoglobin level predicted steroid non-response only in univariate (OR 0.982, P = 0.047). Although an old score, Travis criteria predicted both steroid non-response (OR 8.4, P = 0.001) and requiring colectomy (OR 22.19, P = 0.006).</p><p><strong>Conclusion: </strong>Lower albumin levels and being on oral steroids at admission for ASUC can predict IV steroid failure, and we suggest the possibility of early initiation of advanced therapy in this subgroup.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Upper Gastrointestinal Cancer Detection: A Single-Center Pilot Study Exploring the Potential of Electrical Impedance Spectroscopy in Endoscopic Procedures.","authors":"Hadi Mokhtari Dowlatabad, Reihane Mahdavi, Seyed Rouhollah Miri, Mohammad Reza Fattahi, Hossein Ataee, Narges Yousefpour, Navid Manoochehri, Reza Taslimi, Mohammad Abdolahad","doi":"10.1007/s10620-025-08983-3","DOIUrl":"https://doi.org/10.1007/s10620-025-08983-3","url":null,"abstract":"<p><strong>Purpose: </strong>Early detection of GI cancer mass is of utmost importance due to the risks of misdiagnoses that occur through standard endoscopic evaluation.</p><p><strong>Methods: </strong>In this research, a real-time intra-endoscopic electrical diagnostic probe has been introduced to discriminate high-risk excision-required lesions utilizing a modified endoscopic biopsy forceps as a non-invasive method.</p><p><strong>Results: </strong>By testing on 52 patients who had undergone endoscopic biopsy with a total of 18 high-risk lesions, the invented device named Electrical Endoscopic Mass Characterizer (EEMC), showed %94.7 sensitivity, %93.9 specificity, and %94.2 accuracy (p < 0.01) based on histopathological evaluations of removed specimens as the gold standard.</p><p><strong>Conclusions: </strong>EEMC can be utilized as a precise complementary device during endoscopic evaluation for improving the accuracy of early-stage GI cancer detection with no interruptions in the routine procedure.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seeing Is Believing: Does Red Dichromatic Imaging (RDI) Predict Histological Remission and Clinical Outcomes in Ulcerative Colitis Patients?","authors":"Vedran Tomašić","doi":"10.1007/s10620-025-09027-6","DOIUrl":"https://doi.org/10.1007/s10620-025-09027-6","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes of Carvedilol Plus Endoscopic Variceal Ligation in Secondary Prophylaxis of Variceal Bleeding.","authors":"Xiao Liu, Yifu Xia, Junyuan Zhu, Xiaochen Liu, Lixia Xin, Guangchuan Wang, Mingyan Zhang, Zhen Li, Guangjun Huang, Chunqing Zhang","doi":"10.1007/s10620-025-09000-3","DOIUrl":"https://doi.org/10.1007/s10620-025-09000-3","url":null,"abstract":"<p><strong>Background: </strong>Carvedilol is key for primary prophylaxis of high-risk variceal bleeding but is less studied for secondary prophylaxis with EVL. This study compares the long-term outcomes of carvedilol plus EVL versus propranolol plus EVL in secondary prophylaxis.</p><p><strong>Methods: </strong>The long-term follow-up data regarding rebleeding, ascites recurrence, and survival of patients who were treated with EVL plus carvedilol (n = 147) or propranolol (n = 53) for secondary prophylaxis of variceal bleeding were compared.</p><p><strong>Results: </strong>Patients in the carvedilol group (n = 147) exhibited lower rebleeding rates (23.8% vs. 47.2%; hazard ratio(HR): 1.844; 95% confidence interval (CI) 1.099-3.096; p = 0.019) and ascites rates (7.5% vs. 30.2%; HR: 2.975; 95% CI 1.349-6.557; p = 0.003) compared to the propranolol group (n = 53). Cumulative mortality rates were similar between groups (12.2% vs. 30.2%; HR: 1.292; 95% CI 0.632-2.642; p = 0.48). In patients with viral cirrhosis, carvedilol resulted in lower rebleeding rates (HR: 2.236; 95% CI 1.188-4.208; p = 0.013) and improved ascites control (HR: 3.698; 95% CI 1.363-10.032; p = 0.010). Adjusted survival curves and 1:1 propensity score matching analyses confirmed these findings.</p><p><strong>Conclusions: </strong>Our findings suggest that carvedilol combined with EVL may reduce rebleeding and ascites recurrence compared to propranolol in patients with cirrhosis, particularly those with viral etiologies. However, the lack of mortality benefit and limited generalizability to non-viral cirrhosis necessitate further validation in prospective trials.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Broth Benefits: How Its Nutrients Fortify Gut Barrier in Health and Disease.","authors":"Ayah Matar, Nada Abdelnaem, Michael Camilleri","doi":"10.1007/s10620-025-08997-x","DOIUrl":"https://doi.org/10.1007/s10620-025-08997-x","url":null,"abstract":"<p><p>Bone broth is a traditional nutrient revered by different people from ancient times to the modern era as a remedy for various illnesses. This review investigates the nutritional components of bone broth, focusing primarily on the most abundant amino acids and minerals saturated in bone broth and their impact on health, particularly in the context of intestinal barrier integrity, intestinal permeability, inflammation, and their application in inflammatory bowel disease. Through comprehensive reviews of animal and human studies, this research highlights that bone broth includes amino acids (glutamine, glycine, proline, histidine, arginine), minerals (Ca, P, K, Mg, Zn) that are beneficial and not just a traditional remedy, resolving questions that have been posed for generations. The benefits documented for components in bone broth support the enhancement of gut health, alleviate inflammation in the intestinal barrier, improve intestinal barrier function in health and disease states, particularly in inflammatory bowel disease, as well as enhancing nutrient absorption. Bone broth offers a nutrient-dense option for enhancing overall health and may offer an alternative to dietary supplements with claims for enhanced gut health. We aim to foster interest in and provide evidence to substantiate claims for bone broth as a potential remedy, particularly for maintaining remission in conditions like IBD and possibly functional diarrhea and to encourage further research.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143779424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will Rogers Paradox in Gastroenterology.","authors":"Amnon Sonnenberg, Anna M Buchner","doi":"10.1007/s10620-025-09028-5","DOIUrl":"https://doi.org/10.1007/s10620-025-09028-5","url":null,"abstract":"<p><p>The use of various classifications to grade and differentiate appearances of digestive diseases has enhanced precision and provided better means for their clinical evaluation and comparison. Staging systems abound to classify erosive esophagitis, gastro-esophageal varices, upper gastrointestinal hemorrhage, histopathology of celiac disease, various types of gastrointestinal neoplasia, and colitis associated with Crohn's disease or ulcerative colitis. The present review serves to highlight how potential bias may become introduced when comparing clinical outcomes based on varying and continuously evolving staging systems of digestive diseases.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pseudoaneurysms Post-biliary Stenting: A Comprehensive Literature Review.","authors":"Erica Loon, Mohanad Awadalla, Abdellatif Ismail, Monzer Abdalla, Hazem Abosheaishaa, Shaikhoon Mohammed, Chukwunonso Ezeani, Natalie Wilson, Mohammad Bilal, Prabhleen Chahal, Mohamed Abdallah","doi":"10.1007/s10620-025-09017-8","DOIUrl":"https://doi.org/10.1007/s10620-025-09017-8","url":null,"abstract":"<p><strong>Purpose: </strong>Pseudoaneurysms (PSA) following endoscopic biliary stenting are a rare, potentially life-threatening adverse event. Incidence, diagnostic approach, treatment, and prevention of PSA remain unknown. In this comprehensive literature review, we aimed to evaluate the association of developing PSA following biliary stent placement.</p><p><strong>Methods: </strong>We conducted a comprehensive search of databases for studies that reported development of PSA after placement of a biliary stent. Full text review and data extraction were performed according to the PRISMA guidelines.</p><p><strong>Results: </strong>From 386 initial studies, 32 (n = 36 patients) met inclusion criteria. Thirty-one patients had stents placed in the common bile duct, four in the right or left hepatic ducts, and one in the cystic duct. The most common indication for stent placement was biliary obstruction from pancreatic adenocarcinoma with 69.4% of patients having primary pancreaticobiliary malignancy or metastases. 52.0% had received prior chemotherapy with or without localized radiation. Metal stents were used in 60.5% of cases and plastic stents in 37.2%. Average time to PSA presentation was 114 days, with gastrointestinal bleeding as the most common sign/symptom (75%). PSAs were most often located in the hepatic artery (55.6%), diagnosed by diagnostic angiography (55.6%), and treated with embolization (86.1%). No immediate deaths were reported and 83.3% of patients fully recovered.</p><p><strong>Conclusion: </strong>The majority of PSAs presented with gastrointestinal bleeding and developed in patients who had metal stents placed for pancreaticobiliary malignancy. Prior history of previous chemotherapy/radiation or biliary procedures was common in this population. Angiography and embolization were used to diagnose and manage most cases.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Severe Ulcerative Colitis in the Modern Era Spotlight on Opioids, Small Molecule Therapy, and Interdisciplinary Communication.","authors":"Catalina Mulanax, Fernando S Velayos","doi":"10.1007/s10620-025-08947-7","DOIUrl":"https://doi.org/10.1007/s10620-025-08947-7","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automobile Accident Injury Leading to Cryptic Bowel Perforation.","authors":"Bangfa Xiong, Qianfeng Wei, Guangming Yang, Jiahui Wang, Qian Liu, Erqing Chai","doi":"10.1007/s10620-025-08922-2","DOIUrl":"https://doi.org/10.1007/s10620-025-08922-2","url":null,"abstract":"<p><strong>Background: </strong>Blunt abdominal trauma poses diagnostic challenges, particularly in identifying cryptic gastrointestinal perforations. This case report highlights the critical role of meticulous imaging analysis and timely surgical intervention in managing occult bowel injuries following automobile accidents.</p><p><strong>Case presentation: </strong>A 48-year-old male presented with acute abdominal discomfort, muscular rigidity, and peritoneal signs 12 hours after a nighttime traffic collision. Initial abdominal computed tomography (CT) demonstrated ileocecal contusion and ascending colon hematoma, but suboptimal window settings initially obscured evidence of perforation.</p><p><strong>Methods: </strong>Emergency laparoscopic exploration revealed turbid bloody fluid, ileocecal laceration, and extensive colonic edema, necessitating conversion to open surgery. Surgical interventions included ileocecal repair, double-barrel colostomy, saline irrigation, and drainage tube placement. Postoperative care emphasized infection control and wound management.</p><p><strong>Results: </strong>Intraoperative findings confirmed gastrointestinal perforation, corroborated by subsequent CT re-evaluation with adjusted window parameters. The patient recovered uneventfully, with discharge achieved two weeks postoperatively. Follow-up imaging indicated resolution of colonic edema and successful stoma function.</p><p><strong>Conclusion: </strong>This case underscores the diagnostic pitfalls of suboptimal CT settings in occult bowel perforation and advocates for proactive surgical exploration in equivocal trauma scenarios. Multidisciplinary collaboration, precision in imaging interpretation, and tailored surgical strategies are pivotal for favorable outcomes in blunt abdominal trauma. The findings reinforce the necessity of integrating clinical suspicion with advanced diagnostic modalities to mitigate delayed complications.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Per-oral Pancreatoscopy-Guided Lithotripsy Versus Extracorporeal Shock Wave Lithotripsy in Pancreatic Stone: A Meta-Analysis.","authors":"Noppachai Siranart, Landon Kozai, Daniel Martin Simadibrata, Nawan Pornananrat, Peerada Roongphornchai, Patavee Pajareya, Rinrada Worapongpaiboon, Somkiat Phutinart, Wichapol Dendumrongsup, Yanisa Chumpangern, Aunchalee Jaroenlapnopparat, Kornpong Vantanasiri, Kittithat Tantitanawat","doi":"10.1007/s10620-025-08952-w","DOIUrl":"https://doi.org/10.1007/s10620-025-08952-w","url":null,"abstract":"<p><strong>Introduction: </strong>Pancreatic duct stones (PDS) pose a significant clinical challenge, and choosing treatment modality is crucial to achieving optimal outcomes. Extracorporeal shock wave lithotripsy (ESWL) has long been regarded as the primary intervention for PDS. However, per-oral pancreatoscopy-guided lithotripsy (POP), both electrohydraulic lithotripsy (EHL-POP) and laser lithotripsy (LL-POP), has emerged as a promising endoscopic alternative. This meta-analysis compares the efficacy and safety profiles of EHL-POP, LL-POP, and ESWL for treating PDS.</p><p><strong>Methods: </strong>A search of MEDLINE, EMBASE, and Cochrane databases until November 2023 was conducted to identify studies assessing the use of EHL-POP, LL-POP, or ESWL for the treatment of PDS. Primary outcomes were technical success and clinical success of stones. Secondary outcomes were any adverse events (AEs) and the incidence of post-intervention pancreatitis.</p><p><strong>Results: </strong>A total of 45 observational studies were included. Among the 9624 patients with PDS analyzed, 373 underwent POP (238 EHL-POP and 135 LL-POP), while 9,251 underwent ESWL. The pooled technical and clinical success rates of ESWL versus POP were 85.5% (95% CI: 79.1-90.2%) vs. 88.1% (95% CI: 75.1-94.8%) (p = 0.66) and 78.5% (95% CI: 70.9-84.5%) vs. 81.6% (95% CI: 65.1-91.4%) (p = 0.69), respectively. The pooled technical success rate of EHL-POP was 85.2% (95% CI: 68.5-93.9%, I² = 63%), which was comparable to LL-POP at 92.7% (95% CI: 64.4-98.9%, I² = 0%) (p = 0.48). The clinical success rates of EHL-POP and LL-POP were 74.4% (95% CI: 50.7-89.2%, I² = 48%) and 85.7% (95% CI: 63.9-95.3%, I² = 68%), respectively (p = 0.38). The rates of any adverse events and post-intervention pancreatitis for ESWL vs. POP were 10.1% (95% CI: 5.5-17.6%, I² = 95%) vs. 9.3% (95% CI: 4.1-19.6%, I² = 55%) (p = 0.87) and 4.3% (95% CI: 3.1-5.9%, I² = 85%) vs. 2.8% (95% CI: 1.3-6.1%, I² = 0%) (p = 0.32), respectively.</p><p><strong>Conclusion: </strong>Both EHL-POP and LL-POP, emerges as highly effective and safe alternatives for managing PDS, with safety profiles comparable to ESWL. POP could be considered as an alternative first-line option to ESWL for PDS.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}