Digestive Diseases and Sciences最新文献

{"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}

{"title":"Unmet Healthcare Needs Among People with Inflammatory Bowel Disease: A Canadian Cross-Sectional Population-Representative Study.","authors":"Gemma Postill, James H B Im, Furong Tang, Eric I Benchimol, M Ellen Kuenzig","doi":"10.1007/s10620-025-09015-w","DOIUrl":"https://doi.org/10.1007/s10620-025-09015-w","url":null,"abstract":"<p><strong>Purpose: </strong>Despite current standards of care, many people with inflammatory bowel disease (IBD) experience significant disease complications and gaps in care. To better understand and address unmet healthcare needs, we need population-level evidence on perceived unmet healthcare needs in people with IBD. Our objective was to compare self-reported unmet healthcare needs among individuals with and without IBD and determine whether accessing medical care attenuates such need.</p><p><strong>Methods: </strong>We used the 2014 Canadian Community Health Survey, a population-representative cross-sectional survey with a multi-stage cluster randomized design. We compared perceived unmet healthcare needs among individuals with and without IBD using multilevel logistic regression, clustering by respondents' health regions and accounting for sociodemographic variables and non-IBD chronic conditions. In a second model, we additionally controlled for access to medical care (family physician, specialists, and psychologists).</p><p><strong>Results: </strong>Eighteen percent of people with IBD (n = 114/632) reported an unmet healthcare need within the preceding 12 months, compared with 11% (n = 5446/53,333) of those without IBD (SMD: 0.18). Those with IBD were more likely to have an unmet healthcare need (adjusted OR: 1.84, 95% CI 1.19-1.85). Additionally adjusting for respondent-reported recent access to medical care slightly attenuated the association between IBD and unmet healthcare needs (adjusted OR: 1.38, 95% CI 1.10-1.72).</p><p><strong>Conclusion: </strong>We provide a population-level perspective on unmet healthcare needs, demonstrating the extent and prominence of gaps in the healthcare provided to individuals living with IBD. Our findings underscore the need for improved access to multidisciplinary healthcare teams, and enhanced patient-physician dialog surrounding perceived healthcare needs.</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":"143771473","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":"Using Machine Learning Methods to Develop Diagnostic and Prognostic mRNA Signatures for Pancreatic Cancer in Plasma Small Extracellular Vesicles.","authors":"Zhen Liu, Shengnan Jia, Liping Cao","doi":"10.1007/s10620-025-08867-6","DOIUrl":"https://doi.org/10.1007/s10620-025-08867-6","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic ductal adenocarcinoma (PDAC) is frequently diagnosed in advanced stage due to the absence of effective diagnostic biomarkers. Small extracellular vesicles (sEVs) have recently emerged as potential clinical biomarkers in liquid biopsy. Our study aimed to explore sEV mRNA biomarkers for PDAC diagnosis and identify relevant markers that could guide the prognosis of PDAC patients.</p><p><strong>Methods: </strong>We analyzed mRNA sequencing of plasma sEVs from 100 participants and employed four machine learning techniques to create and assess the diagnostic models. Partial plasma sEV mRNAs were identified by all four feature extraction methods and used to construct diagnostic model. We also evaluated the predictive value of the model for the survival prognosis of PDAC patients.</p><p><strong>Results: </strong>Combined with carbohydrate antigen 19-9 (CA19-9), the 4 sEV mRNAs diagnostic signature (d-signature) could well differentiate PDAC patients from non-PDAC individuals, healthy control individuals, and benign pancreatic disease patients with an area under the curve (AUC) of 0.902, 0.971, and 0.845 in training cohort and AUC of 0.803, 0.938, and 0.762 in validation cohort. Furthermore, Cox regression analysis indicated that the score constructed based on the sEV mRNA signature was an independent adverse prognostic factor for survival prognosis of PDAC.</p><p><strong>Conclusions: </strong>Our study demonstrated the potential utility of the sEV mRNA d-signature in the diagnosis of PDAC via machine learning methods. Simultaneously, the score from this diagnostic model exhibited a significant correlation with adverse outcome in PDAC patients. This provided a novel non-invasive sEV mRNA signature for clinical diagnosis and prognostic evaluation of PDAC patients.</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":"143763082","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":"Hepatocellular Carcinoma in Acute Porphyria: Incidence and Risk Factors.","authors":"Ashwani K Singal","doi":"10.1007/s10620-025-09003-0","DOIUrl":"https://doi.org/10.1007/s10620-025-09003-0","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":"143763144","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":"Constipation in the Elderly: Is it Age, Slow Colonic Transit, Defecatory Dysfunction, or All of the Above?","authors":"Leila Neshatian, George Triadafilopoulos","doi":"10.1007/s10620-025-09001-2","DOIUrl":"https://doi.org/10.1007/s10620-025-09001-2","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":"143771391","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":"Chronic Stenosing Enteritis: A Variant of Chronic Non-specific Stenosing Ulceration (CNSU) that Is Distinct from Crohn's Disease.","authors":"David R Cave, Mark Hanscom, Jacob Bledsoe, Sepideh Madahian, Benjamin Hyatt, Neil Marya, Veronica Baptista, Douglas Schneider, George Reed, Betty Albo, May Min, Bruce Barton","doi":"10.1007/s10620-024-08815-w","DOIUrl":"10.1007/s10620-024-08815-w","url":null,"abstract":"<p><strong>Objective: </strong>Chronic non-specific stenosing ulcers (CNSU) of the small intestine is an under-recognized syndrome characterized by iron-deficiency anemia, superficial ulcerations, and stenoses of the small intestine. Despite the recent identification of a gene mutation SLCO2A1 in some Japanese patients that plays an etiological role, much remains uncertain about the etiology and pathogenesis of CNSU in the Western Hemisphere. We report a similar pattern of non-specific ulceration that is nontransmural and often associated with small intestinal stenosis and iron deficiency but not hypoalbuminemia, and that appears to be distinct from Crohn's disease, and compare the demographic, clinic, and histopathologic features.</p><p><strong>Methods: </strong>This was a retrospective, single-center study performed at a tertiary care hospital between 2007 and 2019. Forty patients were included, of whom 20 were diagnosed with CNSU and 20 with small intestinal CD. Demographic, clinical, and histopathologic data were collected and compared.</p><p><strong>Results: </strong>Patients with CNSU were significantly older than patients with CD (56.9-years vs. 33.6-years, p < 0.0001), and had significantly lower rates of diarrhea (10% vs 90%; p < 0.01) and weight loss (5% vs 40%; p = 0.005) and greater rates of blood transfusions (50% vs 10%, p = 0.005) and iron infusions (35% vs. 0%, p = 0.001). In addition, qualitative descriptions of endoscopic findings and histopathologic features differed between the two groups.</p><p><strong>Conclusion: </strong>CNSU is an uncommon small intestinal disease with clinical and pathologic features that distinguish it from CD. However, the immunology of both conditions is similar, suggesting a generic immune response. Further research is needed to better define the pathogenesis and prognosis of the disease.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1449-1456"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476354","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":"Digital Gut-Directed CBT May Improve Fecal Incontinence in IBS.","authors":"Sanskriti Varma, Luisa L Scott, Alice Sibelli, Mythili Pathipati, Allen Cameron Griser, Kyle Staller","doi":"10.1007/s10620-025-08871-w","DOIUrl":"10.1007/s10620-025-08871-w","url":null,"abstract":"<p><strong>Introduction: </strong>Fecal incontinence (FI) occurs in up to 20% of irritable bowel syndrome (IBS) patients, with a negative impact on quality of life, psychologic symptoms, and work impairment. We aimed to evaluate the impact of an app-based gut-directed cognitive behavioral therapy (CBT) program on IBS-associated fecal incontinence (FI) using real-world evidence from user data.</p><p><strong>Methods: </strong>The study population was selected from 1,383 Mahana™ IBS users who had completed a 3-month access period for a prescription CBT program between August 2021 and February 2024. Patients completed at least one of the 10-session program, completed ≥ 2 symptom log entries, reported ≥ 1 FI episode during the program, and completed assessments of symptom severity (IBS Symptom Severity Scoring System; IBS-SSS). Mixed-effects linear regression models analyzed the number of FI episodes/user during each session and changes in IBS-SSS as a function of session progression.</p><p><strong>Results: </strong>Sixty-six patients met inclusion criteria with mean age of 49 ± 18 years and a baseline IBS-SSS of 286 ± SD 104. IBS-SSS decreased to 206 ± 125 and 193 ± 129 at sessions 5 and 10, respectively (p < 0.0001). Mean FI episodes/user decreased from 5 ± 11 in session 1 to 0.5 ± 1.5 and 0.1 ± 0.3 in sessions 5 and 10, respectively (p < 0.0001). Responder analysis found that 100% of patients who completed 2 + sessions met the criteria of ≥ 50% reduction in FI episodes between their first and last session.</p><p><strong>Discussion: </strong>Our findings suggest that gut-directed digital CBT may reduce the frequency of IBS-associated FI. Future studies should evaluate how brain-gut behavioral therapies can affect anorectal mechanosensory phenomena.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1441-1448"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425119","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}