International Journal of Colorectal Disease最新文献

{"title":"Inhibition of TFF3 improves the infiltration and function of CD8⁺ T cells by downregulating the expression of PD-L1 in colorectal cancer.","authors":"Xiaoxue Pan, Jichang Li, Jing Zhu, Xin Wang, Yucun Liu, Shanwen Chen, Pengyuan Wang","doi":"10.1007/s00384-025-04964-0","DOIUrl":"10.1007/s00384-025-04964-0","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is a common malignant tumor of the digestive tract with a high mortality rate. TFF3 is a secreted protein expressed in various cancers. The aim of the study is to report that inhibiting TFF3 increases the function and infiltration of CD8⁺ T cells in colorectal tumor tissues.</p><p><strong>Methods: </strong>The proteomics analysis confirmed the high expression of secreted TFF3 in the supernatant of colorectal cancer cells, and databases were used to analyze the immune infiltration in tumor tissues. qPCR test was used to demonstrate the high levels of secreted TFF3 affecting the function of CD8⁺ T cells. In vivo experiments were used to observe the effects of TFF3 knockdown on tumor growth and immune cell infiltration. Tumor-infiltrating T lymphocytes were sorted for RNA sequencing and mechanism explanation.</p><p><strong>Results: </strong>Inhibiting the expression of TFF3 in tumor tissues improved immune cell infiltration and enhanced anti-tumor effects. TFF3 knockdown downregulated the expression of PD-L1 in tumor tissues through the AKT/mTOR pathway, which enhanced the function of CD8⁺ T cells.</p><p><strong>Conclusion: </strong>Knockdown of TFF3 improved the infiltration of CD8⁺ T cells and anti-tumor capabilities.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"170"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12325462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784182","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":"Therapeutic strategies for low anterior resection syndrome: an umbrella review of systematic reviews.","authors":"Tingting Liu, Xueping Jiao, Congli Hu, Rui Su, Jiangfeng Dong, Qiaohong Niu","doi":"10.1007/s00384-025-04965-z","DOIUrl":"10.1007/s00384-025-04965-z","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this umbrella review was to systematically evaluate the effectiveness of therapeutic strategies for managing low anterior resection syndrome following sphincter-preserving surgery for rectal cancer and to provide evidence-based recommendations for clinical practice.</p><p><strong>Methods: </strong>A systematic literature search was performed across five electronic databases. Two independent reviewers screened titles/abstracts, assessed full-text studies, and extracted data, with discrepancies resolved by consensus. The study adhered to AMSTAR-2 and GRADE frameworks for methodological quality and evidence certainty assessments.</p><p><strong>Results: </strong>Sixteen systematic reviews (including nine meta-analyses) published between 2018 and 2025 were analyzed, covering therapeutic strategies such as transanal irrigation, pelvic floor rehabilitation, sacral nerve stimulation, percutaneous tibial nerve stimulation, pelvic floor muscle training, and biofeedback therapy. For quality assessment, two studies were evaluated as moderate quality, five as low, and nine as critically low.</p><p><strong>Conclusion: </strong>TAI and PFR are recommended as first-line therapies for LARS, while SNS or PTNS may be considered for refractory cases, especially those with predominant fecal incontinence. Future research should focus on standardizing protocols, improving patient compliance, and conducting high-quality randomized controlled trials to strengthen the evidence base.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"171"},"PeriodicalIF":2.3,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12325548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784183","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":"A systematic review on biomarkers implemented to measure surgical stress response in patients undergoing colorectal surgery.","authors":"Alaa El-Hussuna, Mohammad Iqbal Hussain, Pedja Cuk, Mark Bremholm Ellebæk","doi":"10.1007/s00384-025-04950-6","DOIUrl":"10.1007/s00384-025-04950-6","url":null,"abstract":"<p><strong>Background: </strong>Measuring the surgical stress response (SSR) involves assessing physiological and biochemical markers that indicate the extent of the body's reaction to surgical trauma. The study aims to evaluate biomarkers used to measure (SSR) and to explore their potential clinical applicability. Mapping the existing literature may help address current limitations and inspire the development of new methods for measurement of SSR to measure SSR.</p><p><strong>Methods: </strong>This systematic review was conducted per the Cochrane Handbook for Reviews of Interventions and reported following PRISMA guidelines. The research question was: What biomarkers are used to measure SSR in colorectal surgery, and is their benefit justified? A systematic literature search querying seven electronic databases (MEDLINE, Embase, Scopus, The Cochrane Database of Systematic Reviews, ScienceDirect Virtual Health Library, Google Scholar and Copenhagen University Library database) in addition one register (ClinicalTrials.gov) was conducted. The quality of bias control in the studies was assessed by 2 authors independent of each other using MINORS for non-randomized surgical studies and Cochrane risk-of-bias tool for randomized trials.</p><p><strong>Results: </strong>Forty-nine studies met the inclusion criteria, encompassing 9,108 patients, mostly undergoing elective colorectal surgeries. The studies were categorized into four groups according to the aim of measuring SSR. The sample size in the included studies ranged from 14 to 1474. C-reactive protein was the most frequently assessed biomarker. Variations in sampling time points across studies made comparisons challenging. Many studies did not adjust for confounders or differentiate surgical contexts, raising concerns about their conclusions. There was a high heterogeneity in interventions, timing, and confounding adjustments.</p><p><strong>Conclusion: </strong>Various biomarkers have been employed to measure SSR, with C-reactive protein being the most common. However, methodological heterogeneity hinders direct comparisons.</p><p><strong>Trial registration: </strong>International Prospective Register of Systematic Reviews with reference (ID 515700).</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"168"},"PeriodicalIF":2.3,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12321657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784181","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":"Clinical impact of diverting ileostomy and high-output stoma on adjuvant chemotherapy for rectal cancer: a retrospective cohort study.","authors":"Takuki Yagyu, Manabu Yamamoto, Kei Urakami, Kotaro Osaki, Chiharu Yasui, Yusuke Kono, Kyoichi Kihara, Tomoyuki Matsunaga, Naruo Tokuyasu, Teruhisa Sakamoto, Yoshiyuki Fujiwara","doi":"10.1007/s00384-025-04971-1","DOIUrl":"10.1007/s00384-025-04971-1","url":null,"abstract":"<p><strong>Purpose: </strong>Diverting ileostomy (DI) may cause fluid and electrolyte loss, potentially impairing the tolerability of adjuvant chemotherapy (ACT) in patients with rectal cancer. However, its clinical impact, especially in the presence of high-output stoma (HOS), remains unclear. This study aimed to evaluate the effects of DI and perioperative HOS on chemotherapy completion, dose intensity, and the incidence of severe adverse events (AEs).</p><p><strong>Methods: </strong>We retrospectively analyzed 107 patients with rectal cancer who underwent curative resection and received postoperative ACT between June 2012 and December 2024 at Tottori University. Chemotherapy completion, relative dose intensity (RDI), and grade ≥ 3 AEs were compared between patients with and without DI. A subgroup analysis assessed the influence of HOS among DI patients.</p><p><strong>Results: </strong>Chemotherapy completion rate and RDI were comparable between patients with and without DI. However, the incidence of grade ≥ 3 AEs was significantly higher in the DI group than in the non-DI group (18.2% vs. 4.1%, P = 0.015), and DI was identified as an independent risk factor in multivariate analysis (odds ratio [OR] 5.749, P = 0.022). Among patients with DI, those with HOS had a significantly lower oxaliplatin RDI than those without HOS (37.5% vs. 75.0%, P = 0.007), and HOS independently predicted failure to complete oxaliplatin-based regimens (OR 13.423, P = 0.039).</p><p><strong>Conclusions: </strong>While DI does not impair overall chemotherapy delivery, it is associated with increased early toxicity. HOS may compromise oxaliplatin administration and should prompt early recognition and targeted supportive interventions.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"167"},"PeriodicalIF":2.3,"publicationDate":"2025-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12317863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768629","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":"Early results of modified anorectal mucopexy and hemorrhoidoplasty with transanal suture: a 21 patient case report of \"Salinas-Cabrera procedure\".","authors":"Gustavo I Cabrera-Oñate, Carlos A Salinas-González","doi":"10.1007/s00384-025-04960-4","DOIUrl":"10.1007/s00384-025-04960-4","url":null,"abstract":"<p><strong>Background: </strong>Transanal suture mucopexy was first described in 2012 by S. Chivate.</p><p><strong>Methods: </strong>A 21 patient with grade I to IV of Goligher scale hemorrhoids was subjected to a modified snitch procedure and hemorrhoidoplasty adapted to Mexican population.</p><p><strong>Results: </strong>PROM-HISS survey at 90 days after surgery, obtaining satisfactory clinical outcomes.</p><p><strong>Conclusions: </strong>The anorrectal mucopexy procedure modified by Dr. Salinas and Dr. Cabrera and hemorrhoidoplasty with transanal suture is proposed as an effective, efficient, and a low-cost surgical option. Promises to be an accessible, painless, low rate of symptomatic recurrence at 90 days after surgery and easily reproducible procedure in the hands of experts.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"166"},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753292","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":"Practice patterns of paediatric surgeons on treating pilonidal sinus disease - a national survey study.","authors":"Giada Corturillo, Marko Jovanovic, Stephan Rohleder, Andreas C Heydweiller, Oliver J Muensterer, Dietrich Doll, Christina Oetzmann von Sochaczewski","doi":"10.1007/s00384-025-04959-x","DOIUrl":"10.1007/s00384-025-04959-x","url":null,"abstract":"<p><strong>Purpose: </strong>Paediatric pilonidal sinus disease is considered a separate entity of disease due to differing recurrence dynamics. However, there are almost no data on real-world surgical care and practice patterns for children and adolescents. We therefore aimed to gather such data surveying a representative sample of German paediatric surgeons.</p><p><strong>Methods: </strong>Some 101 German paediatric surgical departments and surgeries with inpatient beds were surveyed for their surgical approach to paediatric pilonidal sinus disease. The survey included demographics, information on practice setting, as well as the primary and secondary approach to pilonidal disease and three virtual patient scenarios.</p><p><strong>Results: </strong>A total of 40 institutions (33 departments and 7 office-based paediatric surgeons) responded (recall rate 40%). Of these, 18/40 reported performing 10-20, and 9/40 perform 5-10 pilonidal sinus operations annually. 17/39 respondents have less than 10% recurrences among their patient cohort and 15/39 operate on 11-20% recurrences among their patients. The most frequently reported surgical approach was excision and secondary closure with 17/39, followed by excision and vacuum-assisted closure (13/39), and pit-picking (12/39). Intraoperative use of blue dyes report 15/39 and 29/39 continue postoperative outpatient care at their institution. Acute pilonidal sinus with abscess is treated with a two-staged approach within four weeks by 15/39 while 11 institutions wait more than four weeks until definitive surgery. In recurrent cases, the majority of 20/39 does not switch their approach, while 13/39 switch to excision and secondary closure, and 11/39 switch to excision and vacuum-assisted closure.</p><p><strong>Conclusion: </strong>German paediatric surgeons prefer traditional approaches to pilonidal sinus diseases, but pit-picking is frequently used. Neither the adult-based national guideline recommendations nor paediatric treatment algorithms have been widely implemented. The reasons for these deviations from recommendations and favouring traditional approaches remain unclear.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"165"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730302","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":"Inverse effects of lymph node count on oncological outcomes in rectal cancer based on lymph node positivity status post-neoadjuvant CRT: a large-volume Chinese center experience.","authors":"Xiaojie Wang, Jingyu Zou, Yanwu Sun, Zhifang Zheng, Yongqin Tang, Shenghui Huang, Ying Huang, Pan Chi","doi":"10.1007/s00384-025-04913-x","DOIUrl":"10.1007/s00384-025-04913-x","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemoradiation therapy (CRT) followed by total mesorectal excision (TME) is the standard of care for locally advanced rectal cancer (LARC). Current guidelines recommend dissecting at least 12 lymph nodes (LNs). However, the impact of LN count post-CRT on survival outcomes remains controversial. This study aimed to evaluate the relationship between LN count and oncologic outcomes in LARC patients treated with neoadjuvant CRT followed by surgery.</p><p><strong>Methods: </strong>This retrospective analysis was conducted on 1483 patients with cT3-4N + LARC who underwent neoadjuvant CRT and curative resection. Univariate and multivariate analyses were performed to identify factors associated with achieving 12 or more LNs. Restricted cubic spline (RCS) and Cox proportional hazards models were used to assess the relationship between LN count and oncologic outcomes, including disease-free survival (DFS) and overall survival (OS). Exploratory subgroup analyses stratified patients by ypN positivity status.</p><p><strong>Results: </strong>The mean number of LNs retrieved was 12.9 ± 6.8, with 55.7% of patients having 12 or more LNs examined. Laparoscopic surgery, tumor location (mid rectum), younger age, and lymph node status (pN2) were independent factors associated with achieving 12 or more LNs. RCS analysis revealed an inverse relationship between LN count and tumor response to CRT, but no association with OS and DFS in the overall cohort. ypN-negative patients tended to have a higher rate of liver metastases with an increased LN count (P = 0.010). However, in ypN-positive patients, a higher LN count was associated with improved DFS (P = 0.007) and a lower likelihood of lung metastases (P = 0.001). Using X-tile software, a cutoff value of 10 LNs was identified as optimal for DFS in stage 3 rectal cancer patients. Patients with 11 or more LNs examined had significantly better 5-year DFS (66.7% vs. 55.8%, P = 0.035) compared to those with fewer than 11 LNs.</p><p><strong>Conclusion: </strong>Our study challenges the guideline of examining at least 12 LNs during rectal cancer surgery after CRT, as we observed an inverse relationship between LN count and tumor response to CRT. The inverse effects of LN count on oncological outcomes across various stages of LN positivity highlight the need for individualized treatment strategies based on lymph node positivity status. For ypN-negative patients, understanding that an increased LN count is associated with a higher risk of liver metastases can help identify high-risk stage 0-2 patients who may benefit from adjuvant therapy. For ypN-positive (stage 3) patients, achieving at least 11 LNs is necessary to ensure better oncological outcomes.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"163"},"PeriodicalIF":2.3,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717891","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":"Cancer cachexia onset and survival outcomes in metastatic colorectal cancer: Comparative assessment of the asian working group for cachexia and the European palliative care research collaborative criteria, and utility of modified glasgow prognostic score.","authors":"Hironori Fujii, Misato Kani, Daichi Watanabe, Yuto Miura, Wakana Chikaishi, Jesse Yu Tajima, Akitaka Makiyama, Yunami Yamada, Koichi Ohata, Chiemi Hirose, Hirotoshi Iihara, Ryo Kobayashi, Nobuhisa Matsuhashi, Akio Suzuki","doi":"10.1007/s00384-025-04962-2","DOIUrl":"10.1007/s00384-025-04962-2","url":null,"abstract":"<p><strong>Objective: </strong>Cachexia substantially affects the prognosis of patients with advanced cancer. While both the Asian Working Group for Cachexia (AWGC) and European Palliative Care Research Collaborative (EPCRC) criteria are widely used for diagnosis, their comparative effectiveness in diagnostic timing and prognostic value remain understudied.</p><p><strong>Methods: </strong>This retrospective study included patients with metastatic colorectal cancer (mCRC) who received first-line chemotherapy between 2013 and 2023. Cachexia was assessed using three distinct criteria: AWGC criteria, defined as either weight loss > 2%, or body mass index (BMI) < 21 kg/m² accompanied by at least one of the following: anorexia or elevated C-reactive protein level; EPCRC criteria, requiring weight loss > 5% (or weight loss > 2% if BMI is < 20); and Modified Glasgow Prognostic Score (mGPS). Analyses were performed using cumulative incidence and survival with a time-dependent Cox regression model.</p><p><strong>Results: </strong>We enrolled 313 patients with metastatic CRC. The 1-year cumulative incidence of cachexia showed marked variation across the different diagnostic criteria. Using the AWGC criteria, the incidence rate was 69%, whereas the EPCRC criteria identified 44% of the cases. The mGPS evaluation revealed incidence rates of 73% and 39% for scores of 1 and 2, respectively. Both AWGC- and EPCRC-defined cachexia correlated with significantly shorter overall survival (AWGC: hazard ratio (HR) = 2.41, P < 0.001; EPCRC: HR = 2.02, P < 0.001). Similarly, the mGPS scores indicated a poor prognosis.</p><p><strong>Conclusion: </strong>The AWGC criteria identified a higher incidence of cachexia earlier in the disease course compared to the EPCRC criteria and showed a stronger association with overall survival. The mGPS shows promise as an alternative diagnostic tool to traditional weight-based assessments. These findings suggest new opportunities for early diagnosis of cachexia and intervention strategies in patients with mCRC.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"164"},"PeriodicalIF":2.3,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717890","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":"Management of ileocolic anastomotic strictures in Crohn's disease: endoscopic or surgical intervention? A systematic review and meta-analysis.","authors":"Mohamed Talaat Issa, Shafquat Zaman, Ali Yasen Mohamedahmed, Mohammed Hamid, Omar Mostafa, Sangara Narayanasamy, Diwakar Sarma, Rajeev Peravali, Akinfemi Akingboye, Peter Waterland","doi":"10.1007/s00384-025-04958-y","DOIUrl":"10.1007/s00384-025-04958-y","url":null,"abstract":"<p><strong>Background: </strong>Intestinal strictures are one of the most intractable and common complications of Crohn's disease (CD), and their optimal management remains debatable. Endoscopic balloon dilatation (EBD) and stricturoplasty are advanced minimally invasive therapeutic tools in the management of Crohn's strictures and offer an alternative to surgery. We evaluated outcomes following endoscopic intervention compared with surgical resection in the management of ileocolic anastomotic strictures in patients with CD.</p><p><strong>Methods: </strong>A comprehensive and systematic search of various electronic databases was conducted. All studies comparing endoscopic intervention with surgical resection for ileocolic anastomotic strictures in patients with CD were included. Our primary outcomes were re-operation or re-dilatation post-intervention and complications including haemorrhage, perforation, leak, and surgical site infection. Other evaluated parameters included the need to escalate medical treatment following primary intervention. RevMan 5.3 was used to perform the data analysis.</p><p><strong>Results: </strong>Four observational studies with a total of 625 patients were identified and included. This consisted of 355 patients treated surgically and 270 undergoing endoscopic procedures. No significant difference in the risk of re-operation [OR, 0.13; P = 0.19], re-stenosis [OR, 0.58; P = 0.37], or total complications [OR, 1.86; P = 0.34] was seen between the two groups. However, escalation of medical therapy post-intervention was significantly lower in the surgical group compared with those managed endoscopically [OR, 0.19; P = 0.0001].</p><p><strong>Conclusion: </strong>Both surgical and endoscopic treatments are safe and efficacious in managing patients with anastomotic strictures. However, this review emphasises the need for rationally designed, well-powered, randomised controlled trials to establish best practices in treating these challenging patients.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"162"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12289779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707413","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":"Clostridioides difficile co-infection worsens prognosis in inflammatory bowel disease in patients with cytomegalovirus colitis.","authors":"Ching-Reigh Hsieh, Chyi-Liang Chen, Chia-Jung Kuo, Ren-Chin Wu, Pai-Jui Yeh, Chien-Ming Chen, Cheng-Tang Chiu, Cheng-Hsun Chiu, Ming-Yao Su, Ming-Ling Chang, Yuan-Ming Yeh, Yu-Bin Pan, Puo-Hsien Le","doi":"10.1007/s00384-025-04954-2","DOIUrl":"10.1007/s00384-025-04954-2","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV) colitis and Clostridioides difficile infection (CDI) are both linked to disease exacerbation and poor prognosis in patients with inflammatory bowel disease (IBD). Nonetheless, the effect of co-infection on clinical outcomes in individuals with IBD remains underexplored. This retrospective study was designed to assess the clinical outcomes and determine predictors of co-infection with CMV and CDI in individuals with IBD.</p><p><strong>Methods: </strong>This analysis involved hospitalized patients with IBD and confirmed CMV colitis (based on intestinal CMV immunohistochemical staining) and Clostridioides difficile toxin A/B test results, collected at the Linkou branch of Chang Gung Memorial Hospital between January 2001 and September 2023. The individuals in the study cohort were divided into two categories: those with CMV infection alone and those with CMV/CDI co-infection. Clinical manifestations, outcomes, and independent predictors of co-infection were assessed between the two groups.</p><p><strong>Results: </strong>Overall, 53 IBD inpatients were enrolled in this study, with 37 assigned to the CMV group and 16 to the CMV/CDI co-infection group. The co-infection group experienced significantly more diarrhea (54.1% vs. 93.8%, p = 0.005) and abdominal pain (54.1% vs. 87.5%, p = 0.020) compared to the CMV group. Hospitalization duration (1 vs. 2.5 admissions, p = 0.005) and CMV recurrence (0 vs. 1 recurrences, p < 0.001) were higher in the co-infection group. Additionally, co-infection prolonged the time to clinical (1 vs. 5 months, p < 0.001), steroid-free (4 vs. 10 months, p = 0.001), endoscopic (8.3 vs. 17.5 months, p = 0.011), and histological remission (11 vs. 18 months, p = 0.021) compared to CMV infection alone. The cumulative incidence of clinical, steroid-free, endoscopic, and histological remission showed a delayed course in the co-infection group. Multivariable analysis revealed that biologic therapy was an independent predictor for CMV/CDI co-infection (OR 13.33, 95% CI 1.52-117.15, p = 0.02).</p><p><strong>Conclusion: </strong>Co-infection of CMV and CDI among individuals with IBD results in more frequent hospitalizations, higher CMV recurrence rates, and prolonged disease remission compared to CMV colitis alone. The administration of biologic therapy increases the risk of co-infection, emphasizing the importance of careful management in this patient population.</p>","PeriodicalId":13789,"journal":{"name":"International Journal of Colorectal Disease","volume":"40 1","pages":"161"},"PeriodicalIF":2.5,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12287193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690114","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}