Digestive Diseases and Sciences最新文献

{"title":"Comparative Cleansing Efficacy, Safety, and Tolerability of Bowel Preparation Agents in Pediatric Patients: A Network and Proportional Meta-Analyses of Randomized Controlled Trials.","authors":"Wei-Ti Hsu, Tao-Wei Ke, Chein-Yu Kuo, Mei-Ling Shen, Shih-Ya Hung","doi":"10.1007/s10620-025-09442-9","DOIUrl":"https://doi.org/10.1007/s10620-025-09442-9","url":null,"abstract":"<p><strong>Background/aims: </strong>Efficient bowel preparation is essential for high-quality visualization and lesion detection during colonoscopy. In children, bowel cleansing is often challenging due to age-related physiology, poor palatability of agents, and low tolerability. The optimal regimen remains uncertain. We aimed to compare the efficacy, safety, and tolerability of bowel-cleansing agents in children.</p><p><strong>Methods: </strong>We conducted a network and proportional meta-analysis of randomized controlled trials (RCTs) retrieved through May 2025 from PubMed and Embase. The primary outcome was bowel cleansing efficacy, measured by validated preparation scales. Secondary outcomes included safety and tolerability. Polyethylene glycol electrolyte lavage solution (PEG-ELS) served as the reference comparator.</p><p><strong>Results: </strong>Twenty RCTs (2,468 subjects) were included. Polyethylene glycol 3350 (PEG-3350 or Miralax) demonstrated the highest cleansing efficacy (92.3%). Other regimens, including PEG-ELS + bisacodyl, sodium picosulfate with magnesium citrate, PEG-ELS + enema, PEG-ELS + ascorbic acid, and normal saline, also achieved adequate bowel preparation (> 80%) in the proportional meta-analysis; however, the latter two were evaluated in single studies. The network meta-analysis of safety outcomes revealed no significant differences in abdominal pain among agents. Furthermore, sodium picosulfate with magnesium citrate exhibited the lowest rates of nausea/vomiting and ranked highest in tolerability. Notably, the two small RCTs evaluating PEG-3350 (Miralax) reported safety outcomes but did not include tolerability data.</p><p><strong>Conclusion: </strong>Sodium picosulfate with magnesium citrate offers the most favorable balance of efficacy, safety, and tolerability for pediatric colonoscopy preparation. PEG-3350 (Miralax) may be considered when maximized cleansing is the goal, but additional efficacy and tolerability data in children are needed. PROSPERO registration number: CRD42024508556.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212009","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":"Comparison of Traction and Pocket Creation Methods for Facilitating Colorectal Endoscopic Submucosal Dissection.","authors":"Abdulrahman Qatomah, Daryl Ramai, Hiroyuki Aihara","doi":"10.1007/s10620-025-09444-7","DOIUrl":"https://doi.org/10.1007/s10620-025-09444-7","url":null,"abstract":"<p><strong>Background and aim: </strong>Endoscopic submucosal dissection (ESD) offers high en bloc and R0 resection rates for large colorectal lesions. This study aims to compare the efficacy, safety, and treatment outcomes of the traction method (TM) versus the pocket creation method (PCM) in colorectal ESD.</p><p><strong>Method: </strong>Consecutive patients undergoing colorectal ESD at a tertiary referral center from 2014 to 2024 were included. Outcomes included en bloc resection, R0 resection, curative resection, and adverse events (AE).</p><p><strong>Results: </strong>The study included 668 patients, 50.7% of whom were females with a mean age of 63 years (SD 12). The mean diameter of the lesions was 50.4 mm (SD 23). A total of 94.8% (n = 663) of lesions were removed via en bloc resection, achieving R0 resection rate of 89.1%, and curative resection rate at 87.9%. Multivariable analysis showed that TM was linked to fourfolds increase in en bloc resection rates (OR 4.187, P = 0.001) and significantly higher R0 resection rates (OR 39.874, P < 0.001) compared to PCM. Left-sided colon lesions also had higher en bloc rates (OR 2.747, P = 0.018). TM was associated with significantly shorter dissection time than PCM (50.6 min vs 72.0 min; P < 0.001). Muscle injury was significantly more common in PCM (P = 0.012), while no differences other AE.</p><p><strong>Conclusion: </strong>TM appears to have a higher chance of complete resection, offering shorter dissection times, while both methods have similar risks of major adverse event rates. Both techniques are good options with comparable safety profiles for colorectal ESD.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225212","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":"Assessment of the Risk of Musculoskeletal Disorders Associated with the Practice of Endoscopic Retrograde Cholangiopancreatography (ERCP).","authors":"Marie Loubeyre, Thomas Chaigneau, Benoit Dupont, Marie Astrid Piquet, Antoine Desvergée, Thierry Collet","doi":"10.1007/s10620-025-09449-2","DOIUrl":"https://doi.org/10.1007/s10620-025-09449-2","url":null,"abstract":"<p><strong>Purpose: </strong>Musculoskeletal disorders are a major public health concern. Digestive endoscopy exposes practitioners to a high risk of musculoskeletal disorders, with an estimated prevalence ranging from 40 to 90%, a figure likely to increase as procedures become more complex. The available studies are mainly observational and self-reported. Quantitative studies assessing the impact of digestive endoscopy, particularly endoscopic retrograde cholangiopancreatography, on musculoskeletal disorders risk under real working conditions remain scarce.</p><p><strong>Methods: </strong>We used the KIMEA® tool to quantify the musculoskeletal strain endured by two skilled endoscopists during ten endoscopic retrograde cholangiopancreatography procedures. This system estimates musculoskeletal disorders risk using the RULA method by analyzing movements with a depth camera and inertial sensors placed on the wrists.</p><p><strong>Results: </strong>The analysis of the movements yielded an average global RULA score of 4.2, indicating a moderate risk of musculoskeletal disorders. Musculoskeletal strain was predominant in the forearms, particularly in the wrists, which maintained constrained postures for over 50% of the intervention duration. The strain was asymmetrical, with a predominance on the left wrist. Results were consistent across procedures.</p><p><strong>Conclusions: </strong>This study highlights the excessive musculoskeletal strain placed on endoscopists' forearms during endoscopic retrograde cholangiopancreatography. The KIMEA® tool represents an interesting tool in quantifying ergonomic stress in digestive endoscopy. Further studies with larger sample sizes are needed to confirm these findings, evaluate the influence of factors such as age, experience, and gender, and to promote the integration of ergonomic measures to prevent musculoskeletal disorders.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211977","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":"Gastroesophageal Reflux Disease Incidence in Adolescents and Young Adults Aged 10-24 Years: Results from the Global Burden of Disease Study.","authors":"Zhijie Tang, Jie Ling, Xiaofei Tang","doi":"10.1007/s10620-025-09446-5","DOIUrl":"https://doi.org/10.1007/s10620-025-09446-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the global incidence and temporal trends of gastroesophageal reflux disease (GERD) in adolescents and young adults. It also sought to identify demographic and socio-economic factors associated with these trends.</p><p><strong>Methods: </strong>GERD incidence data for individuals aged 10-24 were extracted from the Global Burden of Disease Study, covering 204 countries. Temporal trends were assessed using estimated annual percentage change (EAPC). Incidence was stratified by age group, sex, region, and socio-demographic index (SDI). Spearman correlation was used to examine associations between EAPC and baseline incidence or SDI.</p><p><strong>Results: </strong>Globally, GERD incidence in youth rose from 30.07 million cases in 1990 to 40.36 million in 2021, with the rate increasing from 1943.27 to 2137.83 per 100,000 population (EAPC: 0.36). The highest burden occurred in the 20-24 age group, and females had consistently higher rates than males. Low and low-middle SDI regions showed the greatest increase in case numbers, with over 140% growth in the low SDI group. In 2021, the highest country-specific rates were in Chile, Colombia, and Costa Rica, while Japan, Norway, and China had the lowest. EAPC was positively correlated with baseline incidence in 1990 (ρ = 0.209, P = 0.003), suggesting greater increases in countries with initially high burden. No significant association was found between EAPC and SDI (ρ =  - 0.024, P = 0.732).</p><p><strong>Conclusion: </strong>GERD is increasingly prevalent among adolescents and young adults, particularly in low- and middle-income regions. These trends highlight the need for early clinical recognition and context-specific public health interventions.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206019","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":"Histopathologic Characteristics in Per-oral Endoscopic Myotomy Biopsy Among Achalasia Subtypes.","authors":"Simao Liu, Junnan Gu, Wenyan Li, Peng Li, Yongjun Wang, Li Yu, Yinglin Niu, Fujing Lv, Fandong Meng","doi":"10.1007/s10620-025-09445-6","DOIUrl":"https://doi.org/10.1007/s10620-025-09445-6","url":null,"abstract":"<p><strong>Background: </strong>Achalasia is an esophageal motility disorder categorized into three subtypes based on esophageal motility patterns assessed by high-resolution manometry (HRM). This study aimed to evaluate and compare the histopathological characteristics of the muscularis propria at the lower esophageal sphincter (LES) and the esophageal body among different achalasia subtypes.</p><p><strong>Methods: </strong>A total of 26 patients initially diagnosed with achalasia and undergoing peroral endoscopic myotomy (POEM) between May 2021 and November 2022 were prospectively enrolled. During POEM, biopsy specimens of the muscularis propria were obtained from the LES and the distal esophagus (approximately 5 cm above the LES). Tissue sections were stained with hematoxylin and eosin (H&E) and Masson's trichrome, and immunohistochemical staining was performed for CD117, S100, CD3, CD20, CD4, and CD8. Control samples of histologically normal LES tissue were obtained from five patients undergoing surgery for gastric malignancy.</p><p><strong>Results: </strong>Of the 26 patients, 14 (53.8%) were classified as type I and 12 (46.2%) as type II achalasia. The esophageal diameter was significantly larger in type I than in type II achalasia (4.57 ± 1.09 cm vs. 3.25 ± 0.88 cm, p = 0.005). At the LES, the degree of fibrosis and the proportion of severe ganglion loss in the muscularis propria were significantly higher in type I achalasia than in controls (p < 0.05). The number of interstitial cells of Cajal (ICCs) was significantly lower in type I achalasia compared to controls (p = 0.031). Although a difference was observed in CD4 + T cell counts among type I, type II, and control groups (p = 0.045), post-hoc pairwise comparisons did not reveal significant differences. No significant differences were observed in the distal esophagus and the LES regarding inflammation, fibrosis, ganglion loss, ICC density, or counts of CD3 + , CD4 + , CD8 + , or CD20 + cells (p > 0.05). Mild fibrosis was more frequently observed in the distal esophagus than in the LES, but this difference was not statistically significant (p > 0.05).</p><p><strong>Conclusion: </strong>Compared to controls, type I achalasia is associated with significantly greater fibrosis, more severe ganglion loss, and a reduced number of ICCs in the muscularis propria at the LES. These findings suggest that type I achalasia may represent an advanced stage of the disease, characterized by inflammation-driven ganglion degeneration, loss of ICCs, and progressive fibrosis.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211994","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":"Response to the Comment on \"Evaluation of a Predictive Model and Clinical Outcomes in Mild Acute Pancreatitis: Towards Evidence-Based Early Discharge\".","authors":"Niels Kant, B W Marcel Spanier, Bart Witjes, Carine J M Doggen","doi":"10.1007/s10620-025-09405-0","DOIUrl":"https://doi.org/10.1007/s10620-025-09405-0","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205971","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":"Beyond the Scope and Scan: A Case of Adult-Onset IgA Vasculitis Presenting with Gastrointestinal Predominance.","authors":"XiaoYun Zhu, XiuJing Si, Gang Yang","doi":"10.1007/s10620-025-09439-4","DOIUrl":"https://doi.org/10.1007/s10620-025-09439-4","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198708","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":"Pollution, Alcohol, and Money: The Complex Relationship Between Environmental Exposures, Social Determinants of Health, and MASLD Outcomes.","authors":"Mark A Mandak, David C Clark, Andrew D Schreiner","doi":"10.1007/s10620-025-09441-w","DOIUrl":"https://doi.org/10.1007/s10620-025-09441-w","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198676","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":"Small but Powerful: MicroRNAs Link Pattern Receptors to Junctional Complexes in Intestinal Barrier Regulation.","authors":"Arturo Raya-Sandino","doi":"10.1007/s10620-025-09397-x","DOIUrl":"https://doi.org/10.1007/s10620-025-09397-x","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198670","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":"Uncovering the Mechanisms of Failure of Proton Pump Inhibitors in GERD: The Role of Esophageal Acid Sensitivity.","authors":"Jerry D Gardner, George Triadafilopoulos","doi":"10.1007/s10620-025-09450-9","DOIUrl":"https://doi.org/10.1007/s10620-025-09450-9","url":null,"abstract":"<p><strong>Purpose: </strong>For unclear reasons, up to 50% of subjects with gastroesophageal reflux disease have an inadequate symptomatic response to treatment with a proton pump inhibitor. Our primary objective was to examine esophageal acid in subjects who experienced heartburn following a standard meal that failed to respond to a proton pump inhibitor.</p><p><strong>Methods: </strong>We analyzed data from a previous randomized crossover trial of proton pump inhibitors in 27 subjects with gastroesophageal reflux disease and baseline esophageal pH < 4 for more than 10% of a 24-h recording. Esophageal pH and heartburn severity were measured over 3 h following a standard meal at baseline and after omeprazole.</p><p><strong>Results: </strong>Relationships between heartburn severity and esophageal acid were identified using the quadrant method. Twelve subjects had high values for heartburn severity with omeprazole, indicating a failed response; 75% of these subjects had low esophageal acid reflecting esophageal hyperalgesia or a cause other than esophageal acid. In subjects with high esophageal acid that failed to improve with omeprazole, heartburn severity improved with omeprazole in 57%, reflecting esophageal hypoalgesia or silent esophageal reflux.</p><p><strong>Conclusions: </strong>Failure of heartburn to respond to omeprazole was common in subjects with gastroesophageal reflux disease who exhibited high baseline esophageal acid exposure and most of these failures were associated with low esophageal acid.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198706","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}