Digestive Diseases and Sciences最新文献

{"title":"An Esophageal Luminal Diameter of 16 mm Predicts Dysphagia Resolution in Eosinophilic Esophagitis.","authors":"Claire A Beveridge, Christina Hermanns, Shivani Thanawala, Qijun Yang, Yi Qin, Prashanthi N Thota, Matthew Hoscheit, J Mark Brown, Andrei I Ivanov, Anthony Lembo, Scott Gabbard, Florian Rieder","doi":"10.1007/s10620-025-08874-7","DOIUrl":"https://doi.org/10.1007/s10620-025-08874-7","url":null,"abstract":"<p><strong>Goals and background: </strong>Eosinophilic Esophagitis (EoE) is a chronic inflammatory esophageal disorder, often complicated by strictures requiring dilation. There is limited information on the target esophageal luminal diameter (ELD) post-treatment to relieve symptoms. The aim of this study was to determine the ELD threshold associated with dysphagia resolution in EoE patients in histologic remission.</p><p><strong>Study: </strong>We performed a retrospective cohort study of adult EoE patients with a stricture in histologic remission. Patients were excluded if symptoms, EoE endoscopic reference score (EREFS), and ELD were missing. ELD was estimated by dilator diameter, endoscope passage, or functional lumen imaging probe. Symptoms, demographics, EREFS, and histology were recorded. Univariate and multivariable logistic regression analyses were performed. The ELD threshold for dysphagia was determined using receiver operating characteristics analyses.</p><p><strong>Results: </strong>Of the 76 patients who met criteria, 63 (82.9%) reported dysphagia. For every one-millimeter decrease in ELD, there was an increased odds of having dysphagia (OR 9.12, 95% CI 33.4, p < 0.001). The threshold ELD for having dysphagia was less than 16 mm (sensitivity: 96.8%, specificity: 92.3%). In a subcohort analysis of patients who were dilated (n = 58, 76.3%), the main predictor for persistent dysphagia post-dilation was the pre-dilation ELD (aOR 0.77, 95% CI 0.65-0.87, p < 0.001).</p><p><strong>Conclusion: </strong>A decrease in ELD is associated with a higher odds of dysphagia in EoE patients in histologic remission. ELD of 16 mm or greater provided the strongest threshold for which symptoms were absent. This may present a reasonable dilation target.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536892","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":"Calling in Your Markers: Can Biomarkers Predict the Response to Anti-TNF Therapy in Pediatric Patients with Crohn's Disease?","authors":"Kevin L Watson","doi":"10.1007/s10620-025-08856-9","DOIUrl":"10.1007/s10620-025-08856-9","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"888-889"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037601","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":"Endoscopic Stenting of a Fully Covered Self-Expandable Metal Stent with a Hole in Each Cavity in Malignant Hilar Biliary Obstruction: A Preclinical Proof-of-Concept Study and Initial Human Experience.","authors":"Jungnam Lee, Seok Jeong, Don Haeng Lee, Jung-Hyun Lim, Makoto Kobayashi, Mamoru Takenaka, Chang-Il Kwon","doi":"10.1007/s10620-024-08810-1","DOIUrl":"10.1007/s10620-024-08810-1","url":null,"abstract":"<p><strong>Background and aim: </strong>Stent placement for biliary drainage in patients with malignant hilar biliary obstruction (MHBO) has been a topic of long-standing debate, and the best approach remains controversial. Therefore, we aimed to evaluate the efficacy, safety, and removability of multi-hole fully covered self-expandable metal stents (MH-FCSEMSs) in a preclinical experiment using swine hilar bile duct obstruction (HBDO) models and to assess the feasibility and safety of stent placement in patients with MHBO.</p><p><strong>Methods: </strong>Three minipigs underwent endoscopic retrograde cholangiopancreatography (ERCP)-guided endobiliary-radio frequency ablation (EB-RFA) to establish Bismuth type II hilar bile duct stenosis models. Four weeks after EB-RFA, 10-mm diameter and 4-cm length MH-FCSEMSs were endoscopically inserted into the left intrahepatic bile duct of the models. Stent patency and migration, as well as adverse events including cholangitis and endoscopic stent removability, were assessed three months after stent placement. Additionally, clinical applications of MH-FCSEMS were performed in two patients with MHBO to determine feasibility, safety, and stent patency.</p><p><strong>Results: </strong>MH-FCSEMSs were successfully inserted into the left main intrahepatic bile duct and common hepatic duct of the models under ERCP in all three animals without any technical difficulties. Cholangiograms performed 12 weeks after MH-FCSEMS placement showed no stent migration, and all were successfully removed from the animal models. The functional success rate, defined as a decrease in serum total bilirubin level of more than 50% at 12 weeks after stent placement, was 100%. Moreover, MH-FCSEMSs were successfully inserted in two patients with hilar cholangiocarcinoma. The procedures were technically feasible, and no major periprocedural complications were noted.</p><p><strong>Conclusion: </strong>The preliminary long-term results of both preclinical and clinical pilot studies suggest that endoscopic biliary drainage using MH-FCSEMS may be a safe and effective treatment option for stenting and stent revision in the management of HBDO. Further studies comparing clinical outcomes to those of MH-FCSEMS without multi-hole in malignant hilar biliary obstruction will be needed to verify the clinical benefits.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1215-1222"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037603","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":"Re-intervention Utility After Endoscopic Ultrasound-Guided Hepaticogastrostomy Using a Partially Covered Stent with Anchoring Flange.","authors":"Il Sang Shin, Jong Ho Moon, Yun Nah Lee, Jae Woo Park, Tae Hoon Lee, Jae Kook Yang, Young Deok Cho, Sang-Heum Park","doi":"10.1007/s10620-025-08852-z","DOIUrl":"10.1007/s10620-025-08852-z","url":null,"abstract":"<p><strong>Background and aim: </strong>Although long self-expandable metal stent (SEMS) with a sufficient intragastric portion is typically preferred for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), this design can complicate endoscopic re-intervention for recurrent biliary obstruction (RBO). We evaluated the efficacy and safety of endoscopic re-intervention for RBO through the stent after EUS-HGS using a novel partially covered SEMS with an anchoring flange.</p><p><strong>Methods: </strong>The partially covered SEMS was designed with a intrahepatic uncovered portion measuring 1.5 cm in length and a resilient fold-back wide distal anchoring flange with a 2.0 cm diameter. Re-interventions were performed through the stent lumen while the stent was in situ. The primary outcomes were technical and clinical success, and secondary outcomes were procedure time, adverse events, and the median time to RBO after re-intervention.</p><p><strong>Results: </strong>In total, 35 re-interventions were performed in 19 patients. Re-intervention was successfully conducted in 97.1% (34/35) of cases via the intragastric end of the stent in a retroflexed position. Technical and clinical success were 94.3% (33/35) and 88.6% (31/35). Re-intervention methods included stent cleaning (18.2%), additional HGS stent placement (33.3%), and antegrade stent placement (48.5%). Mild cholangitis occurred in 5.7% (2/35) of patients and was managed conservatively. The median time to RBO after re-intervention was 148 days.</p><p><strong>Conclusion: </strong>Endoscopic re-interventions can be effectively and safely performed through the lumen of the novel partially covered SEMS with an anchoring flange.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1116-1125"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045975","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":"Clinical Ethics Consultations in Cirrhosis Care.","authors":"Alexis Holman, Quintin Solano, Janice Firn, Elliot Tapper","doi":"10.1007/s10620-025-08866-7","DOIUrl":"10.1007/s10620-025-08866-7","url":null,"abstract":"<p><strong>Background: </strong>Ethics consultations may reflect the nature and frequency of conflicts in clinical care. Data regarding consultations for patients with cirrhosis, however, are limited.</p><p><strong>Aims: </strong>To understand the reasons and context for ethics consultations and identify areas for improvement.</p><p><strong>Methods: </strong>We evaluated inpatient ethics consultations from 06/2015 to 08/2023. Consults for people with severe liver, heart, and lung diseases were examined for the reasons and contextual factors for consultation. These were coded according to a qualitative conceptual content analysis by two independent reviewers. The rate of consultations was derived from the denominator of hospitalized patients with each condition over the same time.</p><p><strong>Results: </strong>During the study period, there were 38 ethics consults from 17,460 patients with liver disease (incidence 0.2%) and 96 among 48,394 patients with heart/lung disease (incidence 0.2%). The primary ethical issue was surrogate decision-making related to the lack of an identified durable power of attorney or when surrogate decision-making went against care team recommendations. These conflicts were twice as likely for patients with cirrhosis. The second most common primary ethical issues were code status and futility. Medical error, symptom management, and withdrawal of life supports were not associated with ethics consults. Legal issues were more common in patients without cirrhosis. Communication disputes with the team, intra-family disputes, and quality of life concerns were the most common contextual factors.</p><p><strong>Conclusion: </strong>Ethics consultations for patients with cirrhosis occur for 0.2% of hospitalizations and are linked to deficits in advanced care planning, poor communication, and poor patient quality of life.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1008-1015"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373830","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":"Correction to: Pedigree Analysis of Nonclassical Cholesteryl Ester Storage Disease with Dominant Inheritance in a LIPA I378T Heterozygous Carrier.","authors":"Jian-Hui Zhang, Ai-Ping Lin, Li Zhang, Dan-Dan Ruan, Mei-Zhu Gao, Qian Chen, Hong-Ping Yu, Li-Sheng Liao, Xin-Fu Lin, Zhu-Ting Fang, Fan Lin, Shi-Yun Lu, Jie-Wei Luo, Xiao-Ling Zheng, Meng-Shi Chen","doi":"10.1007/s10620-025-08905-3","DOIUrl":"10.1007/s10620-025-08905-3","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1253"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476355","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":"Spontaneous Hepatoduodenal Fistula Due to Ruptured Amoebic Liver Abscess.","authors":"Sanjeev Sachdeva, Venkatesh Vaithiyam, Aarushi Ahuja, Ravi Teja Reddy","doi":"10.1007/s10620-025-08924-0","DOIUrl":"https://doi.org/10.1007/s10620-025-08924-0","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536895","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":"The Impact of Concomitant Hypothyroid Disease on the Course of Inflammatory Bowel Disease.","authors":"Maaz Ahsan, Jahnavi Udaikumar, Simon Hong, Adam S Faye, Seymour Katz, Olivia Delau, Jordan Axelrad","doi":"10.1007/s10620-025-08956-6","DOIUrl":"https://doi.org/10.1007/s10620-025-08956-6","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) is a chronic, immune-mediated inflammatory disorder of the gastrointestinal tract. In IBD, systemic inflammation and immune dysregulation may also impact extraintestinal organs, such as the thyroid gland. Despite this, little is known about the influence of concomitant hypothyroidism on the clinical course of IBD.</p><p><strong>Methods: </strong>A retrospective analysis was conducted among adult patients with IBD and at least one thyroid stimulating hormone (TSH) measurement within a large healthcare network. Patient charts were reviewed, and baseline demographics, disease characteristics, biomarkers, healthcare utilization, medication use, and other comorbidities were extracted. Patients were stratified by those with IBD only and those with concomitant IBD and hypothyroidism. Multivariable logistic regression was used to identify factors associated with concomitant hypothyroidism. Concomitant disease as an independent predictor for lab abnormalities and increased healthcare utilization was also assessed using multivariable logistic and negative binomial regression.</p><p><strong>Results: </strong>We identified 287 adult patients with IBD, including 146 (50.9%) with Crohn's disease (CD) and 141 (49.1%) with ulcerative colitis (UC). Among this sample, 178 (62.0%) patients had concomitant hypothyroidism. Concomitant disease was associated with older age (_adjOR 1.04, 95% CI 1.02, 1.06), female sex (_adjOR 1.78, 95% CI 1.01, 3.16), and the presence of other extraintestinal manifestations (_adjOR 2.30, 95% CI 1.06, 5.00). Concomitant disease was also found to be a significant predictor for increased healthcare utilization, specifically, higher number of radiation-based abdominal imaging (RBAI) studies (_adjIRR: 1.89, 95% CI 1.08, 3.32).</p><p><strong>Conclusion: </strong>Patients with both IBD and hypothyroidism have an increased likelihood of other extraintestinal manifestations compared to individuals who have IBD without hypothyroidism. Furthermore, patients with concomitant disease exhibited greater healthcare utilization, specifically, increased rates of RBAI studies. The presence of concomitant hypothyroidism may be associated with a more severe course of IBD.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536896","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":"Proton-Pump Inhibitors and Fat Absorption in Cystic Fibrosis and Pancreatic Insufficiency: A Randomized Crossover Pilot Trial.","authors":"Anna Evans Phillips, Jefferson N Brownell, Alyssa Tindall, Bridget Dowd Kiernan, Dhiren Patel, Daniel Gelfond, Virginia A Stallings","doi":"10.1007/s10620-024-08728-8","DOIUrl":"10.1007/s10620-024-08728-8","url":null,"abstract":"<p><strong>Background: </strong>Dietary fat malabsorption contributes to poor nutritional status in patients with cystic fibrosis (CF) and exocrine pancreatic insufficiency (EPI). Prescribing gastric acid-reducing agents such as proton-pump inhibitors (PPI) as an adjunct to pancreatic enzyme replacement therapy (PERT) to improve dietary fat absorption has been accepted in clinical practice despite limited evidence.</p><p><strong>Aims: </strong>This was a pilot randomized, double-blind, placebo-controlled crossover trial of subjects aged 12 and older with CF and EPI assessed on placebo and omeprazole to determine if PPI improved the efficacy of PERT as indicated by measures of dietary fat absorption.</p><p><strong>Methods: </strong>Fat malabsorption via stool coefficient of fat absorption (CFA) and malabsorption blood test (MBT), gastrointestinal pH (wireless motility capsule [WMC]), and quality of life (QOL) were assessed after 14 days on both placebo or PPI (omeprazole).</p><p><strong>Results: </strong>Total 19 subjects enrolled, 13 were randomized, and 9 provided paired results on placebo and PPI. The 3 subject results for CFA were as follows: 1 increased, 1 decreased, and 1 was within the reference range in both tests for fat absorption. For 9 MBT subjects, 7 decreased and 2 increased fat absorption. For the 4 WMC studies, no change in transit times, nor in pH profiles were noted. No differences were seen in the domains of the two QOL questionnaires comparing placebo and PPI.</p><p><strong>Conclusions: </strong>These limited descriptive pilot study results in participants with CF and EPI on PERT evaluated by stool, blood, and QOL tests did not suggest improvement in fat absorption attributable to PPI.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"968-977"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Development and Validation of a Colorectal Cancer Prediction Model: A Nationwide Cohort‑Based Study.","authors":"Ofer Isakov, Dan Riesel, Michael Leshchinsky, Galit Shaham, Ben Y Reis, Dan Keret, Zohar Levi, Baruch Brenner, Ran Balicer, Noa Dagan, Samah Hayek","doi":"10.1007/s10620-025-08902-6","DOIUrl":"10.1007/s10620-025-08902-6","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1250"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}