International Journal of Colorectal Disease最新文献

{"title":"Re-screening adherence to multi-target stool DNA test for colorectal cancer: real-world study in a large national population.","authors":"Mallik Greene, Timo Pew, Michael Dore, Derek W Ebner, A Burak Ozbay, William K Johnson, John B Kisiel, A Mark Fendrick, Paul Limburg","doi":"10.1007/s00384-025-04837-6","DOIUrl":"10.1007/s00384-025-04837-6","url":null,"abstract":"<p><strong>Purpose: </strong>Adherence to colorectal cancer (CRC) re-screening is essential to maximize screening effectiveness. This study assessed adherence to a multi-target stool DNA (mt-sDNA) test among previous users in the USA across different payer types.</p><p><strong>Methods: </strong>Data from Exact Sciences Laboratories LLC (01/01/2023-12/31/2023) were used. Insured patients (45-85 years) who were shipped an mt-sDNA test during the data coverage period and had previously completed mt-sDNA screening with a negative result ≥ 2.5 years prior were included. Mt-sDNA re-screening adherence rate and mean time to test return were compared across payer types, and their associations with patient characteristics were assessed using multivariable regression models.</p><p><strong>Results: </strong>Of 793,567 patients (50-75 years: 89.0%; female: 62.0%), the re-screening adherence rate was 84.0% (from 66.5% for Medicaid to 90.2% for Medicare); mean (standard deviation) time to test return was 20.7 (20.8) days (from 19.2 [19.7] for Medicare to 22.4 [22.2] for Medicaid). Characteristics associated with higher likelihood of re-screening adherence included older ages (odds ratio [OR] = 1.25 and 1.11 for 65-75 and 76-85 years, respectively, relative to 45-49 years), living in a ZIP code with higher median household income (OR = 1.80 for > $200,000 relative to < $50,000), full digital outreach (OR = 1.84 relative to no digital outreach), and ≥ 3rd rounds of screening (OR = 2.44 relative to 2nd round of screening).</p><p><strong>Conclusion: </strong>Adherence to CRC re-screening with mt-sDNA test was high across payer types, with sustained adherence in later rounds of screening. Strategies to improve re-screening rates in subgroups associated with lower re-screening adherence are warranted.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"48"},"PeriodicalIF":2.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of laser ablation for recurrent pilonidal sinus: a systematic review and meta‑analysis.","authors":"Jialin Qin, Xingli Xu, Zhicheng Li, Lei Jin, Zhenyi Wang, Jiong Wu","doi":"10.1007/s00384-025-04832-x","DOIUrl":"10.1007/s00384-025-04832-x","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Recurrence remains a significant challenge following the surgical treatment of sacrococcygeal pilonidal sinus. Unlike patients with primary pilonidal sinus, those with recurrent cases often present with more complex sinus tracts, and scarring from previous surgeries increases the complexity of subsequent procedures. Therefore, selecting the appropriate surgical method for patients with recurrent pilonidal sinus requires greater caution. It is essential to reassess these patients to determine whether surgical techniques suitable for primary pilonidal sinus are equally effective for recurrent cases. Laser ablation, an innovative and minimally invasive technique, has emerged as a promising option for managing pilonidal sinus. This procedure uses a circular laser at the tip of a catheter to deliver energy, effectively destroying and ablating the sinus tract while promoting its closure. Previous studies have demonstrated the safety and efficacy of laser ablation in treating primary pilonidal sinus. The objective of this systematic review and meta-analysis is to assess the efficacy and safety of laser ablation in the management of recurrent pilonidal sinus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was carried out using PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. Additionally, the references of all retrieved studies were screened to identify further eligible data. The search included studies published up to June 11, 2024. The primary outcome measure was the healing rate after laser ablation, which served as the metric for evaluating the efficacy of this technique in treating recurrent pilonidal sinus. Secondary outcome measures included the incidence of severe postoperative complications, which were assessed to determine the safety profile of laser ablation. According to the Clavien-Dindo classification of postoperative complications, we define severe complications as those classified as grade IIIb or higher.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;A total of seven studies were included in this meta-analysis. With the exception of one study published in 2018, the remaining six were published within the past 3 years. Two studies originated from Middle Eastern countries, while the other five were from European countries. In total, 137 patients with recurrent pilonidal sinus were included, of whom 112 achieved healing following laser ablation treatment. The pooled healing rate across these studies was 81.9% (95% CI, 65.4-94.6%; I&lt;sup&gt;2&lt;/sup&gt; = 69.12%; p &lt; 0.01). A subgroup analysis based on follow-up duration was also performed. The pooled healing rate for studies with a follow-up period of 12 months or less was 87.2% (95% CI, 63.2-100%; I&lt;sup&gt;2&lt;/sup&gt; = 78.57%; p &lt; 0.01), while for studies with a follow-up duration exceeding 12 months, the pooled","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"47"},"PeriodicalIF":2.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of a clinical activity index in comparison to frequently measured laboratory values in inflammatory bowel disease.","authors":"Marja Rapo, Pauliina Molander, Clas-Göran Af Björkesten, Suvi Pakarinen, Perttu Arkkila","doi":"10.1007/s00384-025-04829-6","DOIUrl":"10.1007/s00384-025-04829-6","url":null,"abstract":"<p><strong>Purpose: </strong>Several laboratory tests are used to monitor disease activity and possible complications in patients with inflammatory bowel disease (IBD). Due to limited resources, it is important to identify patients who benefit the most from tight laboratory testing and follow-up. We sought to assess the correlation between a symptom-based clinical activity index and commonly monitored laboratory tests in a large patient population.</p><p><strong>Methods: </strong>The Finnish IBD registry records a validated IBD symptom index questionnaire (IBD-SI) that measures disease activity and the influence of IBD on daily life in patients with ulcerative colitis (UC) and Crohn's disease (CD). The activity index was compared with the commonly measured laboratory values of fecal calprotectin (FC), hemoglobin (Hb), ferritin, and C-reactive protein (CRP).</p><p><strong>Results: </strong>A total of 5044 IBD patients with 171,967 activity index measurement pairs were included. FC, Hb, and CRP correlated significantly with the activity index in both UC (Spearman's r 0.383, -0.212, 0.175; p < 0.001) and CD (Spearman's r 0.156, -0.176, 0.152; p < 0.001). No correlation between the activity index and ferritin (Spearman's r 0.038 [UC], 0.005 [CD]; p = 0.020, p = 0.825) was found.</p><p><strong>Conclusion: </strong>The activity index is a useful tool in the assessment of IBD activity. Active or inactive disease can be identified better, which may be beneficial in planning more personalized follow-up strategies. Tight monitoring of disease can be better targeted to the correct patient population, and the onset of disease flare may be caught at an earlier stage.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"45"},"PeriodicalIF":2.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global burden of colorectal cancer attributable to metabolic risks from 1990 to 2021, with projections of mortality to 2035.","authors":"Maolang He, Ruru Gu, Xin Huang, Aifang Zhao, Shuxin Tian, Yong Zheng","doi":"10.1007/s00384-025-04817-w","DOIUrl":"10.1007/s00384-025-04817-w","url":null,"abstract":"<p><strong>Background: </strong>The global burden of colorectal cancer (CRC) attributable to metabolic risk factors is increasing. It is crucial to analyze the global epidemiological patterns of CRC attributable to metabolic risk factors and predict future trends.</p><p><strong>Methods: </strong>Detailed data on CRC mortality and disability-adjusted life years (DALYs) attributable to metabolic risk factors were extracted for this study using data from the Global Burden of Diseases (GBD) 2021 study to assess the burden of CRC from 1990 to 2021 by global, regional, national, and sociodemographic index (SDI) regions and quantify the time trend using the estimated annual percentage change (EAPC). Bayesian age-period-cohort (BAPC) models projected the global mortality from 2022 to 2035.</p><p><strong>Results: </strong>The global number of CRC deaths due to metabolic risk factors increased from 70,916 in 1990 to 172,993 in 2021, a 2.4-fold increase. CRC mortality and DALYs attributable to high body mass index (BMI) and fasting plasma glucose (FPG) increased significantly at the global level from 1990 to 2021. In 2021, the GBD regions with the highest CRC age-standardized mortality rate (ASMR) due to high BMI and high FPG were in Central Europe. The ASMR of CRC attributable to high BMI and high FPG among males is expected to increase from 2022 to 2035.</p><p><strong>Conclusion: </strong>CRC mortality and DALYs attributable to metabolic factors are increasing. Reducing the burden of CRC due to high BMI and FPG levels is critically needed.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"46"},"PeriodicalIF":2.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing and morbidity of loop ileostomy closure after rectal cancer resection: a prospective observational multicentre snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO).","authors":"Gianluca Rizzo, Francesco Ferrara, Dario Parini, Francesco Pata, Cristiana Forni, Gabriele Anania, Alessandro Anastasi, Gian Luca Baiocchi, Luigi Boccia, Diletta Cassini, Marco Catarci, Giovanni Cestaro, Nicola Cillara, Francesco Cobellis, Raffaele De Luca, Paola De Nardi, Simona Deidda, Daniele Delogu, Massimo Fedi, Maria Carmela Giuffrida, Ugo Grossi, Harmony Impellizzeri, Antonio Langone, Andrea Lauretta, Francesca Lo Celso, Anna Maffioli, Michele Manigrasso, Chiara Marafante, Luigi Marano, Peter Marinello, Paolo Massucco, David Merlini, Luca Morelli, Marta Mozzon, Donato Paolo Pafundi, Gianluca Pellino, Roberto Peltrini, Adolfo Petrina, Diego Piazza, Claudio Rabuini, Aridai Resendiz, Beatrice Salmaso, Mauro Santarelli, Giuseppe Sena, Leandro Siragusa, Nicolò Tamini, Vincenzo Tondolo, Roberta Tutino, Alberto Vannelli, Marco Veltri, Leonardo Vincenti, Andrea Bondurri","doi":"10.1007/s00384-025-04827-8","DOIUrl":"10.1007/s00384-025-04827-8","url":null,"abstract":"<p><strong>Purpose: </strong>Time to closure and morbidity are significant issues associated with ileostomy reversal after rectal cancer resection. This study aimed to investigate the rate, time, and morbidity associated with ileostomy closure procedure.</p><p><strong>Methods: </strong>Between February and December 2022, patients who underwent protective ileostomy after rectal cancer surgery across 45 Italian surgical centres were prospectively included. Data on ileostomy closure times, surgical methods, and complications were collected and analyzed. Both univariate and multivariate statistical tests were employed to assess stoma closure rates and the occurrence of post-operative complications.</p><p><strong>Results: </strong>A total of 287 patients participated in the study. Ileostomy closure was achieved in 241 patients, yielding overall and 6-month closure rates of 84% and 62%, respectively. The median time for ileostomy closure was 146 days. Direct sutures were used to close approximately 70% of skin defects, while purse-string sutures were applied in around 20%. The overall morbidity rate was 17%, with complications including skin suture dehiscence (7%), small bowel obstruction (6%), and anastomotic leakage (2%). Multivariate analysis revealed that an American Society of Anesthesiologists (ASA) score > 2 (p = 0.028), advanced age (p = 0.048), and previous stoma complications (p = 0.048) were independently linked to failure of stoma closure; hypertension (p = 0.036) was found to be a significant independent risk factor for post-operative complications.</p><p><strong>Conclusion: </strong>This study demonstrated that a delay and a significant no-closure rate exist in ileostomy reversal after rectal cancer surgery. Post-operative complications remain high but can be prevented with adequate pre-operative assessment and post-operative care.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"43"},"PeriodicalIF":2.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dissecting the rising tide of inflammatory bowel disease among youth in a changing world: insights from GBD 2021.","authors":"Libin Chen, Yifu Xu, Feiyan Ai, Shourong Shen, Yanwei Luo, Xiayu Li","doi":"10.1007/s00384-025-04821-0","DOIUrl":"10.1007/s00384-025-04821-0","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the alarming epidemiological trends of inflammatory bowel disease (IBD) among children and young adults, highlighting the associated disease burden on global health.</p><p><strong>Materials and methods: </strong>Utilizing data from the Global Burden of Disease (GBD) study 2021, we conducted a comprehensive analysis of age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPC). Future trends were forecasted using the Bayesian age-period-cohort model.</p><p><strong>Results: </strong>From 1990 to 2021, IBD incidence and DALY rates remained persistently high, with a concerning upward trend noted among children and young adults. While men experienced a decline in DALY rates, women faced increasing burdens. In 2021, high-income regions, particularly North America, reported the highest incidence and DALY rates, contrasting sharply with Central Latin America, which exhibited the lowest ASIR. Southeast Asia presented the most favorable DALY rates. A notable negative correlation was identified between DALY rates and socio-demographic index (SDI) at the national level, with high and high-middle SDI countries continuing to bear a substantial burden, while low and middle SDI nations faced rising challenges.</p><p><strong>Conclusions: </strong>The persistent high burden of IBD in children and young adults signifies a critical public health concern. The marked geographical and gender disparities underscore the urgent need for tailored regional and population-based strategies aimed at primary prevention and effective management. This study illuminates the pressing necessity for policy interventions to address the growing epidemic of IBD among vulnerable populations.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"44"},"PeriodicalIF":2.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of rectal MRI variables for pathological complete response in locally advanced rectal cancer following neoadjuvant chemoradiotherapy.","authors":"Ganbin Li, Yang An, Xiao Zhang, Chentong Wang, Xiaoyuan Qiu, Guannan Zhang, Beizhan Niu, Lai Xu, Junyang Lu, Bin Wu, Yi Xiao, Guole Lin","doi":"10.1007/s00384-024-04801-w","DOIUrl":"10.1007/s00384-024-04801-w","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the predictive value of MRI-determined variables for pathological complete response (pCR) in locally advanced rectal cancer (LARC) patients following neoadjuvant chemoradiotherapy (NCRT).</p><p><strong>Methods: </strong>Clinical data were collected from patients who received NCRT between January 2019 and 2022. Patients with rectal adenocarcinoma, cT3-4N0, or TanyN1-2 were included. pCR was defined pT0N0. Patients were divided into pCR and non-pCR group. Logistic regression analysis was performed to identify factors associated with pCR. A nomogram model was constructed to validate its predictive ability and accuracy.</p><p><strong>Results: </strong>A total of 585 patients were identified, with 144 (24.6%) in the pCR group and 441 (75.4%) in the non-pCR group. Patients with mrT2-3 (OR 6.41, P < 0.001), mrN0 (OR 2.17, P < 0.001), circumferential occupation range < 1/2 cycles (OR 2.11, P < 0.001), tumor vertical diameter < 36 mm (OR 2.10, P < 0.001), negative mesorectal fascia (OR 3.21, P < 0.001), and extramural vascular invasion (OR 5.68, P < 0.001) were more likely to achieve higher pCR rates. Logistic regression analysis revealed that mrT2-3 (OR 3.50, P < 0.001), tumor vertical diameter < 36 mm (OR 2.57, P < 0.001), and negative extramural vascular invasion (OR 4.03, P < 0.001) were independent protective factors for pCR. A nomogram was developed to predict pCR, achieving a C-index of 0.778.</p><p><strong>Conclusion: </strong>Patients with mrT2-3, tumor vertical diameter < 36 mm, and negative extramural vascular invasion are more likely to achieve pCR after NCRT.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"42"},"PeriodicalIF":2.5,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and clinical outcomes of hospitalized Hispanic patients with IBD: results of a large national cohort study.","authors":"Alex Zhornitskiy, Felicia Zhornitsky, Waqas Rasheed, Eric J Mao","doi":"10.1007/s00384-025-04822-z","DOIUrl":"10.1007/s00384-025-04822-z","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory bowel disease (IBD) has historically been seen as predominantly affecting non-Hispanic Whites (NHW). Hispanics are the largest minority group in the USA, yet they remain grossly underrepresented in studies of IBD. With this study, we aimed to better understand the epidemiology of hospitalized Hispanic patients with IBD in the US.</p><p><strong>Methods: </strong>This was a retrospective cohort study utilizing the National Inpatient Sample, the largest publicly available all-payer inpatient care database in the United States. We compared demographics, hospitalization characteristics, clinical outcomes, and year-to-year trends from 2016 to 2020 in Hispanic and NHW with a primary diagnosis of inflammatory bowel disease, Crohn's disease, or ulcerative colitis.</p><p><strong>Results: </strong>NHWs hospitalized with a primary diagnosis of IBD had significantly higher rates of hospitalization than Hispanics (122.67 vs 71.12, P < 0.01). While hospitalized Hispanics with IBD are more likely to be in the lowest quartile for household income (31.6% vs 19.3%, P < 0.01), have a younger median age (37.0 vs 45.0, P < 0.01), and be uninsured (4.3% vs 8.8%, P < 0.01) compared to NHW. Length of admission was similar, yet NHWs had higher rates of mortality (0.3% vs 0.2%, P = 0.01), while total charges for hospitalizations were significantly higher for Hispanic patients (P < 0.01).</p><p><strong>Discussion: </strong>To our knowledge, this is one of the largest US-based studies of Hispanics with IBD. Our findings suggest that among hospitalized IBD patients, Hispanics are more likely to be younger, uninsured, have a lower household income, and are less likely to undergo surgery while having higher hospital charges.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"41"},"PeriodicalIF":2.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spastic pelvic floor syndrome and puborectalis syndrome: the different stages of the same disease.","authors":"Yu Xiong, Tiankun Wang, Dazhen Jiang, Yanyan Chen, Wenzhe Li, Mengqi Tu, Qun Qian, Congqing Jiang, Weicheng Liu","doi":"10.1007/s00384-025-04834-9","DOIUrl":"10.1007/s00384-025-04834-9","url":null,"abstract":"<p><strong>Purpose: </strong>The diagnosis and treatment of puborectalis syndrome (PRS) and spastic pelvic floor syndrome (SPFS) are still up for debate. This study aims to investigate and examine the similarities and differences between PRS and SPFS.</p><p><strong>Methods: </strong>This study recruited 13 PRS cases, 10 SPFS cases, and 16 controls. Pelvic magnetic resonance imaging (MRI), histology, and ultrastructural pathology were explored. Additionally, anorectal manometry was performed prior to surgery, and Wexner constipation scores and patient assessment of constipation quality of life (PAC-QOL) scores monitored before surgery and 6 and 12 months post-surgery.</p><p><strong>Results: </strong>The puborectalis thickness in the pelvic MRIs of the SPFS and control groups did not appear to differ (4.62 ± 0.38 vs 4.56 ± 0.47, p = 0.378); however, the puborectalis in the PRS group was substantially thicker than that of the SPFS (8.65 ± 1.17 vs 4.62 ± 0.38, p < 0.001). The SPFS group showing atrophy and degeneration of muscle fibers and the PRS group exhibiting necrosis of muscle fibers, both groups had distorted texture myofibrils, disorganized arrangement, and rough Z lines; however, in severe cases of PRS group, localized myofibrils fracture and myofilament dissolution presenting as vacuolation. Patients with normal preoperative rectal propulsion force had improvements in postoperative Wexner constipation scores and PAC-QOL scores.</p><p><strong>Conclusion: </strong>Histological and ultrastructural pathological evidence suggests that SPFS and PRS are distinct phases of paradoxical puborectalis syndrome (PPS). Furthermore, one indication for PPS surgical treatment is normal rectal evacuation pressure.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"40"},"PeriodicalIF":2.5,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and surgical outcomes of small intestine-rectal fistulas in patients with Crohn's disease.","authors":"Dengyu Feng, Ming Wen, Pingping Huang, Feng Zhu, Enhao Wu, Shixian Wang, Tenghui Zhang, Lili Gu, Ming Duan, Jianfeng Gong, Yi Li","doi":"10.1007/s00384-025-04830-z","DOIUrl":"10.1007/s00384-025-04830-z","url":null,"abstract":"<p><strong>Purpose: </strong>Small intestine-rectal fistulas are a rare and complex complication in Crohn's disease, posing significant diagnostic and management challenges. This study aims to investigate their distinctive features and evaluates surgical outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of Crohn's disease patients with small intestine-rectal fistulas who underwent surgery from January 2019 to March 2023. Data on disease characteristics, postoperative quality of life, and functional outcomes were collected.</p><p><strong>Results: </strong>A total of 92 patients were included, predominantly male (75%). The average time from Crohn's disease diagnosis to small intestine-rectal fistula diagnosis was 5.18 years. Most fistulas originated in the ileum (84.79%), followed by the rectum (9.78%) and both sites (5.43%). Nearly half had perianal lesions (48.91%), with some also having entero-vesical fistulas (22.83%) and entero-vaginal fistulas (1.09%). Significant risk factors for the creation of temporary protective ileostomy included preoperative hemoglobin levels below 100 g/L, albumin levels below 35 g/L, and the presence of perianal disease. Fistulas originating from the rectum and rectal lesions of 3 cm or longer were significant risk factors for rectal resection. No small intestine-rectal fistula recurrence was observed over an average follow-up of 2.35 years. Patients without a permanent sigmoidostomy after small intestine-rectal fistula resection had better stool scores and improved quality of life, especially in emotional and social functioning.</p><p><strong>Conclusions: </strong>Small intestine-rectal fistulas in Crohn's disease have distinct characteristics. Surgical repair and resection effectively restore intestinal continuity and improve quality of life, particularly when anal function is preserved.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"37"},"PeriodicalIF":2.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11821751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}