Digestive Diseases and Sciences最新文献

{"title":"Role of Alcohol in Steatotic Liver Disease: Impact on Patients with Cardiometabolic Risk Factors.","authors":"Francisco Capinha, Sofia Carvalhana, Helena Cortez-Pinto","doi":"10.1007/s10620-025-08912-4","DOIUrl":"10.1007/s10620-025-08912-4","url":null,"abstract":"<p><p>The new definition of steatotic liver disease (SLD), as a broader concept, was a step forward in the increasing recognition of the substantial overlap between alcohol and cardiometabolic risk factors (CMRFs), in a continuum way. The spectrum of pathophysiological aspects, ranging from liver steatosis to fibrosis, has similarities in MASLD and ALD. Also, there is now considerable evidence that the association of metabolic dysfunction with increased alcohol consumption impacts on the risk of severe liver disease and prognosis. The new MetALD class, as recently proposed, shows clear differences in prognosis when comparing with MASLD and ALD groups. However, there is room for improvement, such as considering the role of previous alcohol intake, fluctuations of consumption over time, including binge drinking, refinement of alcohol assessment, and better understanding of the role of biomarkers. In summary, SLD is no doubt a significant improvement, but the new classification needs to be dynamic and adapting to patients needing frequent reassessment. Furthermore, it brings opportunities for research on the interaction between alcohol consumption and CMRFs.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1746-1756"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536894","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":"Splitting the Difference: What Is the Best Colonoscopy Prep?","authors":"David P Gerard","doi":"10.1007/s10620-025-09081-0","DOIUrl":"https://doi.org/10.1007/s10620-025-09081-0","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964384","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":"A Novel Aberrant Anatomical Configuration of Bile Duct and Pancreatic Duct Diagnosed with ERCP.","authors":"Suyan Qiu, Yang Li, Hailin Jin, Hui Li, Tingsheng Ling","doi":"10.1007/s10620-025-08862-x","DOIUrl":"10.1007/s10620-025-08862-x","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1728-1730"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522816","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":"It's All About the Bubbles: Assessing the Effects of Simethicone on Safety and Efficacy During Colonoscopy.","authors":"Michael A Perrin, Theresa H Nguyen Wenker, Scott A Larson","doi":"10.1007/s10620-025-08938-8","DOIUrl":"10.1007/s10620-025-08938-8","url":null,"abstract":"<p><strong>Background: </strong>Theoretical infection concerns prompted national Department of Veterans Affairs guidance prohibiting simethicone use in colonoscope reservoirs on January 1, 2024.</p><p><strong>Aims: </strong>We sought to determine if reservoir simethicone is associated with post-procedure infection and impact on procedure time, sedation usage, and adenoma detection rate.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all-comers undergoing colonoscopy at Houston's Veterans Affairs hospital during September 1-30, 2023 (reservoir simethicone) and April 1-30, 2024 (aliquots administered on request [channel simethicone]). Primary outcomes were mean withdrawal and cecal intubation times. Secondary outcomes were adenoma detection rate, post-procedure 30-day infection rate, and sedation usage. We adjusted for covariates and used linear regression to determine significant predictors for mean withdrawal and intubation times.</p><p><strong>Results: </strong>Of 446 total colonoscopies, 211 used reservoir simethicone (47.3%) and 235 (52.7%) used channel simethicone. Mean intubation time was 8.3 min [SD ± 6.5] in the reservoir group and 9.9 min [SD ± 8.4] in the channel group (p = 0.03). Mean withdrawal time was 17.4 min [SD ± 10.2] in the reservoir group and 20.9 min [SD ± 11.9] in the channel group (p = < 0.01). Reservoir group procedures required less midazolam (p = 0.01) and fentanyl (p = 0.02). Post-operative infection (n = 1 vs n = 0; p = 0.47) and adenoma detection rate (p = 0.92) differences were not significant.</p><p><strong>Conclusions: </strong>Reservoir simethicone was significantly associated with shorter intubation and withdrawal times and lower sedation usage, even after adjusting for covariates, suggesting increased efficiency with comparable infection risk.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1832-1837"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490426","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":"HIF-1α Enhances Intestinal Injury and Inflammation in Severe Acute Pancreatitis Through NLRP3 Inflammasome Activation.","authors":"Tao Gao, Huaisheng Zhang, Yuan Xu, Guosong He, Huicong Ma, Chuanming Zheng, Lei Li, Feng Cheng, Hehe Dou, Fulong Zhang, Heng Zhao, Zhaolei Qiu","doi":"10.1007/s10620-025-08926-y","DOIUrl":"10.1007/s10620-025-08926-y","url":null,"abstract":"<p><strong>Background: </strong>Severe Acute Pancreatitis (SAP) is associated with significant intestinal injury and inflammation. Hypoxia-Inducible Factor-1α (HIF-1α) and NLRP3 inflammasome have been implicated in this process, but their specific roles remain unclear.</p><p><strong>Objective: </strong>This study aims to elucidate the roles of HIF-1α and NLRP3 in the pathogenesis of SAP and their effects on intestinal injury, barrier function, and inflammatory responses.</p><p><strong>Methods: </strong>A SAP rat model was established, and histological changes were assessed via HE staining. Western blot was used to analyze HIF-1α and NLRP3 expression in intestinal mucosa. The effects of HIF-1α modulation were examined using the activator DMOG and inhibitor BAY87-2243. Immunohistochemistry, ELISA, and TUNEL staining were used to evaluate intestinal barrier function, permeability markers, and apoptosis.</p><p><strong>Results: </strong>HIF-1α and NLRP3 expression significantly increased in SAP rats, peaking at 72 h. HIF-1α activation aggravated intestinal injury and barrier dysfunction, decreasing tight junction protein levels and increasing epithelial apoptosis. Enhanced intestinal permeability and elevated pro-inflammatory cytokines were also observed. Furthermore, HIF-1α activation promoted NLRP3 inflammasome assembly, resulting in increased caspase-1 and IL-1β expression.</p><p><strong>Conclusion: </strong>HIF-1α exacerbates intestinal injury and inflammation in SAP, likely through NLRP3 inflammasome activation. Targeting HIF-1α may offer a potential therapeutic approach for SAP-induced damage and inflammation.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1813-1823"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490470","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":"Daily Vitamin D3 Versus Stoss Vitamin D3 for Correction of 25OHD Deficiency in Children with Inflammatory Bowel Disease, a Randomised Controlled Trial.","authors":"Jonathan E M O'Donnell, Steven T Leach, Nerissa L Bowcock, Siying Chen, Nitin Gupta, Kevin Jiang, Robert N Lopez, Rachel Messenger, Lily Nahidi, Amanda Shapiro, Andrew S Day, Daniel A Lemberg","doi":"10.1007/s10620-025-08913-3","DOIUrl":"10.1007/s10620-025-08913-3","url":null,"abstract":"<p><strong>Introduction: </strong>Vitamin D deficiency is common in Paediatric Inflammatory Bowel Disease (PIBD) and has been implicated in disease pathogenesis and disease exacerbation. Current guidelines recommend oral vitamin D supplementation when 25OHD levels are below 50 nmol/L. Supplementation comes in two forms: either a daily supplement of a low dose of vitamin D3 (2000 IU) for several months or a single high dose of oral vitamin D3-termed 'stoss' therapy, with no consensus regarding optimum treatment.</p><p><strong>Methods: </strong>A randomised controlled trial was conducted in children with a prior diagnosis of PIBD with 25OHD deficiency (< 50 nmol/L), comparing 2000 IU oral D3 daily to a stoss protocol (oral D3 dosage 400,000 IU for 3-12 years of age or 800,000 IU for > 12 years). Children were followed for 12 months, with biochemistry (25OHD, calcium, magnesium, phosphate, parathyroid hormone, haemoglobin, haematocrit, platelets, albumin), stool markers (calprotectin, S100A12), anthropometrics (weight, height, body mass index) as well as clinical disease indices (Paediatric Crohn's Disease Activity Index, Paediatric Ulcerative Colitis Activity Index) and medication use collected at 3, 6, 9 and 12 months.</p><p><strong>Results: </strong>74 children aged 5-18 years completed the study. Both 2000 IU daily and stoss protocol significantly increased 25OHD from baseline values at 3, 6, 9 and 12 months. One patient randomised to stoss protocol had a 25OHD level of 263 nmol/L with normal serum calcium. There was no difference in biochemical, stool or clinical markers between groups at any time point, nor was there any correlation between 25OHD level and calprotectin or 25OHD level and clinical disease activity scores.</p><p><strong>Conclusion: </strong>Stoss protocol was non-inferior to 2000 IU daily vitamin D3 in raising 25OHD levels at 12 months. There was also no difference between 25OHD levels at 3, 6 and 9 months between groups.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":"1844-1853"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531342","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":"Best Practices for the Gastroenterologist: Trauma-Informed Care in the Endoscopy Suite.","authors":"Yesenia Greeff, Christopher Vélez, Lauren D Feld, Nikki Duong","doi":"10.1007/s10620-025-08993-1","DOIUrl":"https://doi.org/10.1007/s10620-025-08993-1","url":null,"abstract":"<p><p>Trauma is a risk factor for several gastrointestinal illnesses, especially disorders related to the gut-brain axis. Gastroenterology (GI) care environments, particularly endoscopy units, put patients at risk of unintentional re-traumatization due to the sensitive nature of the questions, examinations, and procedures. Trauma-informed care has six pillars outlined by the Substance Abuse and Mental Health Services Administration: safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment voice and choice, and cultural historical and gender issues. Adopting these pillars for trauma-informed GI care can transform the patient and staff experience. Traumatic or potentially traumatic experiences are common, and therefore a universal trauma precautions approach is useful in a busy GI environment. There are considerations for each of the pre-, peri-, and post-procedural settings that are simple to implement, which can increase the sense of safety, trust, and autonomy for each patient in the endoscopy suite.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987238","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":"Frailty Prevalence and Evaluation of the FRAIL Scale Questionnaire in Patients with Inflammatory Bowel Disease.","authors":"Janak Bahirwani, Joshua Elmer, Hany Eskarous, Suruchi Jai Kumar Ahuja, Madhav Changela, Dushyant Singh Dahiya, Jill Stoltzfus, Yecheskel Schneider","doi":"10.1007/s10620-025-09073-0","DOIUrl":"https://doi.org/10.1007/s10620-025-09073-0","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) predisposes individuals to frailty, linked with adverse outcomes. While the Fried Frailty Index (FFI) is a well-established phenotypic tool to assess frailty, its administration is cumbersome. The FRAIL scale, simpler but not widely used in patients with IBD, presents an alternative. We aimed to assess the prevalence of frailty and compare the FRAIL scale with the FFI.</p><p><strong>Methods: </strong>A cohort of patients with IBD underwent assessment using both the FFI and the FRAIL scale. Patients were categorized as non-frail, pre-frail, or frail. The primary outcome was frailty prevalence, while secondary outcomes included comparison of FFI and FRAIL scale and associations between frailty and disease-related factors. Statistical analyses included chi-square tests, ANOVA, Kruskal-Wallis tests, and ROC curve analysis using SPSS v27, with p < 0.05 indicating significance.</p><p><strong>Results: </strong>Among participants (53.5% female, median age 44), 37% were non-frail, 50% pre-frail, and 13% frail. The FRAIL scale exhibited strong correlation with the FFI for all three categories. Age showed no significant association with frailty. Frail individuals displayed higher inflammatory markers and more severe clinical disease, with frailty more prevalent in patients with UC than CD. Frail individuals also exhibited lower hemoglobin, creatinine, and albumin levels.</p><p><strong>Conclusion: </strong>Frailty and pre-frailty are prevalent in patients with IBD and not necessarily linked with older age. The FRAIL scale demonstrated excellent correlation with the FFI, offering a practical tool for identifying frailty in IBD without physical measurements. Future studies should explore multivariable models incorporating frailty risk factors and interventions to mitigate adverse outcomes in patients with IBD.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957532","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":"Graying of IBD in the US-An Urgent Call to Action.","authors":"Aaron Rips, Adam S Faye","doi":"10.1007/s10620-025-09082-z","DOIUrl":"https://doi.org/10.1007/s10620-025-09082-z","url":null,"abstract":"","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976662","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":"Annual Therapeutic Drug Monitoring in Patients with Inflammatory Bowel Disease During Infliximab Maintenance Therapy: Balancing Efficacy with Risk of Pharmacokinetic Failure.","authors":"Yujin Lim, Boram Park, Kyeongman Jeon, Ok Soon Jeong, Eun Ran Kim, Young-Ho Kim, Dong Kyung Chang, Sung Noh Hong","doi":"10.1007/s10620-025-09032-9","DOIUrl":"https://doi.org/10.1007/s10620-025-09032-9","url":null,"abstract":"<p><strong>Background and aims: </strong>Recent studies indicate that proactive therapeutic drug monitoring (TDM) can improve clinical outcomes in patients with inflammatory bowel disease (IBD) treated with infliximab. Repetitive infliximab trough level (IFX TL) measurements for proactive TDM may increase patient inconvenience and medical costs. Therefore, we aimed to determine the optimal interval for TDM during infliximab maintenance therapy in patients with IBD.</p><p><strong>Methods: </strong>A prospective cohort study was performed on the patients with IBD who were in clinical remission on infliximab maintenance therapy and had IFX TL ≥ 3 μg/mL after one-time dose optimization. Infliximab TL were measured before each infliximab infusion to identify the pharmacokinetic (PK) relapse (two consecutive IFX TL < 3 μg/mL). Kaplan-Meier method was used to calculate the time to PK relapse.</p><p><strong>Results: </strong>A total of 103 patients were enrolled and followed for a median of 18.5 months. PK relapse occurred in 19 patients (18.5%), with a higher rate of PK relapse in patients with IFX TL 3-5 μg/mL (16/60, 26.7%) compared to those with IFX TL ≥ 5 μg/mL (3/43, 7.0%). Kaplan-Meier survival time to maintain 95%, 90%, 85%, 80%, and 75% therapeutic IFX TL persistence rate without PK relapse was 4.1, 10.3, 13.3, 14.3, and 19.8 months, respectively. Log-rank test showed that therapeutic IFX TL persistence rates were significantly lower in patients with IFX TL 3-5 μg/mL group compared to those with IFX TL ≥ 5 μg/mL group (p = 0.010). Kaplan-Meier retention time to maintain 85% therapeutic IFX TL persistence rate without PK relapse was 10.3 months in IFX TL 3-5 μg/mL group and 20.2 months in IFX TL ≥ 5 μg/mL group, respectively.</p><p><strong>Conclusions: </strong>Proactive TDM measuring with IFX TL annually may be helpful in maintaining therapeutic IFX TL ≥ 3 μg/mL in 85% of patients with IBD and clinical remission on infliximab maintenance therapy.</p>","PeriodicalId":11378,"journal":{"name":"Digestive Diseases and Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971727","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}