Therapeutic Advances in Gastroenterology最新文献

{"title":"Short- and long-term follow-up after fecal microbiota transplantation as treatment for recurrent <i>Clostridioides difficile</i> infection in patients with inflammatory bowel disease.","authors":"Emilie E van Lingen,&nbsp;Simon S M D Baunwall,&nbsp;Simone S C Lieberknecht,&nbsp;Nicolas N Benech,&nbsp;Gianluca G Ianiro,&nbsp;Harry H Sokol,&nbsp;Alessandro A Gasbarrini,&nbsp;Giovanni G Cammarota,&nbsp;Marcel M K Eriksen,&nbsp;Andrea A E van der Meulen-de Jong,&nbsp;Elizabeth E M Terveer,&nbsp;Hein H W Verspaget,&nbsp;Maria M Vehreschild,&nbsp;Christian C L Hvas,&nbsp;Josbert J J Keller","doi":"10.1177/17562848231156285","DOIUrl":"https://doi.org/10.1177/17562848231156285","url":null,"abstract":"<p><strong>Background: </strong>Patients with inflammatory bowel disease (IBD) are at an increased risk of developing <i>Clostridioides difficile</i> infection (CDI). Treatment of CDI in patients with IBD is challenging due to higher failure rates and concomitant IBD activity.</p><p><strong>Objectives: </strong>We performed a multicentre cohort study in patients with IBD who received fecal microbiota transplantation (FMT) for recurrent CDI (rCDI), to further investigate factors that influence the clinical outcome and course of both rCDI and IBD.</p><p><strong>Design: </strong>This is a multicentre cohort study conducted in five European FMT centres.</p><p><strong>Methods: </strong>Adult IBD patients treated with FMT for rCDI were studied. Cure was defined as clinical resolution of diarrhoea or diarrhoea with a negative <i>C. difficile</i> test. The definition of an IBD flare was record based. Long-term follow-up data were collected including new episodes of CDI, IBD flares, infections, hospital admissions, and death.</p><p><strong>Results: </strong>In total, 113 IBD patients underwent FMT because of rCDI. Mean age of the patients was 48 years; 64% had ulcerative colitis. Concomitant rCDI was associated with an IBD flare in 54%, of whom 63% had received IBD remission-induction therapy prior to FMT. All FMT procedures were preceded by vancomycin treatment, 40% of patients received FMT <i>via</i> colonoscopy. CDI cure rate was 71%. Long-term follow-up data were available in 90 patients with a median follow-up of 784 days (402-1251). IBD activity decreased in 39% of patients who had active IBD at baseline, whereas an IBD flare occurred in only 5%. During follow-up of up to 2 years, 27% of the patients had infections, 39% were hospitalized, 5% underwent colectomy, and 10% died (median age of these latter patients: 72 years).</p><p><strong>Conclusion: </strong>FMT for rCDI in IBD patients is safe and effective, and IBD exacerbation after FMT is infrequent. Further studies should investigate the effects on IBD course following FMT.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/22/10.1177_17562848231156285.PMC9998411.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9096041","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 significance of neoadjuvant chemotherapy for locally advanced colorectal cancer patients with deficient mismatch repair: possibly residual value in the era of immunotherapy.","authors":"Mian Chen,&nbsp;Junguo Chen,&nbsp;Jun Huang,&nbsp;Huashan Liu,&nbsp;Wuteng Cao,&nbsp;Shuangling Luo,&nbsp;Zhanzhen Liu,&nbsp;Huanxin Hu,&nbsp;Sicong Lai,&nbsp;Yujie Hou,&nbsp;Liang Kang,&nbsp;Liang Huang","doi":"10.1177/17562848221150306","DOIUrl":"https://doi.org/10.1177/17562848221150306","url":null,"abstract":"<p><strong>Background: </strong>Deficient mismatch repair (dMMR) or microsatellite instability is one of the well-established molecular biomarkers in colorectal cancer (CRC). The efficiency of neoadjuvant chemotherapy (NAC) in locally advanced colorectal cancer (LACC) patients with dMMR is unclear.</p><p><strong>Objectives: </strong>We assessed the tumor response and clinical outcome in LACC patients with dMMR received NAC.</p><p><strong>Design: </strong>Retrospective, single-center analysis.</p><p><strong>Methods: </strong>From 2013 to 2018, a total of 577 LACC patients with dMMR who underwent radical surgery were identified. Among them, 109 patients who received adjuvant chemotherapy were further screened out for analysis. According to whether receiving NAC or not, 109 patients were divided into two groups with the purpose of retrospectively analyzing their characteristics, treatment, and survival results, especially the 5-year disease-free survival (DFS) and 5-year overall survival.</p><p><strong>Results: </strong>Baseline characteristics were matched between the two groups. One of 40 patients in NAC group recurred, while 13 of 69 patients in non-NAC group recurred. Univariate and multivariate analyses showed that NAC (hazard ratio: 0.115; 95% confidence interval: 0.015-0.897; <i>p</i> = 0.039) was independent influence factor for DFS. In NAC group, there were 13/40 (32.5%) patients for tumor regression grade 1 and 27/40 (67.5%) patients converted clinical positive N-stage into negative N-stage.</p><p><strong>Conclusion: </strong>In this study, NAC was associated with better tumor downstaging and longer 5-year DFS in LACC patients with dMMR. Consequently, NAC might be an additional treatment choice when it comes to such patients in the future.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/ba/10.1177_17562848221150306.PMC9893354.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9214091","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":"The yield of dysplasia and serrated lesions in a single-centre tertiary inflammatory bowel disease cohort.","authors":"Fiona Yeaman,&nbsp;Lena Thin","doi":"10.1177/17562848231167280","DOIUrl":"https://doi.org/10.1177/17562848231167280","url":null,"abstract":"<p><strong>Background: </strong>Chromoendoscopy is preferred over high-definition white light endoscopy (HDWLE) for dysplasia surveillance in inflammatory bowel disease (IBD) patients, but is more time-consuming to perform and real-world evidence is limited. The prevalence of sessile serrated lesions (SSLs) in IBD patients is also unknown.</p><p><strong>Objective: </strong>To determine the yield of polypoid and non-polypoid dysplasia and SSLs in IBD patients undergoing dysplasia surveillance and the associations for these lesions.</p><p><strong>Design: </strong>A retrospective cohort study from a tertiary IBD centre.</p><p><strong>Methods: </strong>A keyword search of the colonoscopy reporting system was performed. IBD patients with colonic disease that underwent colonoscopy for surveillance between 1 February 2015 and 1 February 2018 were included. Clinical, endoscopic and histopathological outcomes were extracted for the analysis.</p><p><strong>Results: </strong>Of 2114 patients identified, 276 eligible colonoscopies in 126 patients were analysed. The median age at colonoscopy was 51 years (interquartile range: 42-58 years). 71/126 (56%) of colonoscopies were performed in male patients, with 57/126 (45%) having ulcerative colitis, 68/126 (54%) Crohn's colitis and 1/126 (0.79%) IBD-unspecified. The prevalence for any neoplasia was 75/276 (27%). The prevalence for all serrated lesions was 43/276 (16%). Increased age was a risk factor for finding a neoplastic lesion on both univariate and multivariate analyses. Chromoendoscopy was associated with twice the odds of finding a neoplastic lesion (odds ratio: 1.99, 95% confidence interval: 1.13-3.51, <i>p</i> = 0.02), on multivariate analysis. No factor was associated with an increased risk of finding a serrated lesion.</p><p><strong>Conclusion: </strong>Significant neoplastic lesions and serrated lesions were detected in 27% and 16% of colonoscopies performed in IBD patients, respectively, with the highest yield in older patients. Chromoendoscopy significantly increased neoplasia yield compared to HDWLE and still has a robust utility in this pragmatic real-world study.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/6f/10.1177_17562848231167280.PMC10161306.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9433057","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":"Can we change the natural course of inflammatory bowel disease?","authors":"Catherine Le Berre,&nbsp;Silvio Danese,&nbsp;Laurent Peyrin-Biroulet","doi":"10.1177/17562848231163118","DOIUrl":"https://doi.org/10.1177/17562848231163118","url":null,"abstract":"<p><p>Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are lifelong diseases characterized by chronic inflammation of the gastrointestinal tract leading to its progressive and irreversible destruction. Whether early initiation of IBD-specific therapy impacts the long-term course of the disease remains unclear and has to be further explored in prospective disease-modification trials. Historically, surgery and hospitalization rates have been the surrogate markers to measure disease progression in IBD, providing an overview of the effectiveness of medical therapies. However, neither surgery nor hospitalization necessarily reflects a fail in therapeutic medical management, and many confounding factors make them biased outcomes. The Selecting Endpoints for Disease-Modification Trials consensus has defined the disease-modification endpoints required for these trials, including the impact of the disease on patient's life (health-related quality of life, disability, and fecal incontinence), the mid-term disease complications (bowel damage in CD, IBD-related surgery and hospitalizations, disease extension in UC, extra-intestinal manifestations, permanent stoma, short bowel syndrome), and the development of dysplasia/cancer and mortality in the long term. Most available data in the literature regarding the impact of current therapies on disease progression focused on anti-tumor necrosis factor agents and are based on retrospective or post-hoc studies. Thus, prospective disease-modification trials are pressingly required to explore the effectiveness of early intensified treatment in patients with severe disease or at risk for disease progression.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/19/10.1177_17562848231163118.PMC10159495.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9433059","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 medical therapies in microscopic colitis: a systematic review and network meta-analysis.","authors":"Aditi Kumar,&nbsp;George Hiner,&nbsp;Matthew J Brookes,&nbsp;Jonathan P Segal","doi":"10.1177/17562848231154319","DOIUrl":"https://doi.org/10.1177/17562848231154319","url":null,"abstract":"<p><strong>Background: </strong>The mainstay of treatment for microscopic colitis (MC) is budesonide. However, the optimal formulation and dosage of budesonide to induce and maintain remission has not yet been clearly demonstrated.</p><p><strong>Objectives: </strong>To compare the data for efficacy and safety of treatments to induce and maintain remission for MC.</p><p><strong>Design: </strong>We conducted a meta-analysis of randomised controlled trials (RCTs) comparing treatment with each other or placebo for induction and maintenance of clinical and histological remission in MC.</p><p><strong>Data sources and methods: </strong>We searched MEDLINE (1946 to May 2021), EMBASE and EMBASE Classis (1947 to May 2021), the Cochrane central register of controlled trials (Issue 2, May 2021) and conference proceedings between 2006 and 2020. Results were reported as pooled relative risks (RRs) with 95% confidence intervals (CIs) to summarise the effect of each comparison tested, with treatments ranked according to p score.</p><p><strong>Results: </strong>We identified 15 RCTs in total for the treatment of MC. Entocort 9 mg ranked first for clinical (RR: 4.89, CI: 2.43-9.83; p score: 0.86) and histological (RR: 13.39, CI: 1.92-93.44; p score 0.94) induction of remission, whilst VSL#3 ranked second for clinical induction (RR: 5.30, CI: 0.68-41.39; p score 0.81). Budenofalk 6 mg/3 mg alternate day dosing ranked first for clinical maintenance of remission (RR: 3.68, CI: 0.08-159.92, p-score 0.65). Entocort and Budenofalk were associated with the greatest adverse events for induction and maintenance of clinical remission, respectively, although the overall withdrawal numbers for treatment <i>versus</i> placebo groups were 10.9% (22/201) and 10.5% (20/190), respectively.</p><p><strong>Conclusion: </strong>Entocort 9 mg/day ranked first among the treatment options in inducing remission and Budenofalk 6 mg/3 mg alternate day dosing for maintaining remission in the treatment of MC. Moving forward, mechanistic studies exploring the differences between Entocort and Budenofalk would be valuable whilst future RCT studies are needed in non-corticosteroidal maintenance, particularly looking into immunomodulators, biologics and probiotics.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/a0/10.1177_17562848231154319.PMC9969448.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10829731","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 nomogram based on clinical factors to predict calendar year readmission in patients with ulcerative colitis.","authors":"Ying Xiang,&nbsp;Ying Yuan,&nbsp;Jinyan Liu,&nbsp;Xinwen Xu,&nbsp;Zhenyu Wang,&nbsp;Shahzeb Hassan,&nbsp;Yue Wu,&nbsp;Qi Sun,&nbsp;Yonghua Shen,&nbsp;Lei Wang,&nbsp;Hua Yang,&nbsp;Jing Sun,&nbsp;Guifang Xu,&nbsp;Qin Huang","doi":"10.1177/17562848231189124","DOIUrl":"https://doi.org/10.1177/17562848231189124","url":null,"abstract":"<p><strong>Background: </strong>Readmission shortly after discharge is indicative of an increased disease severity for patients with ulcerative colitis (UC) and ineffectiveness to medical therapy, which may contribute to a dismal prognosis.</p><p><strong>Objectives: </strong>This study aimed to explore prognostic variables with a nomogram to predict unplanned UC-related readmission within 1 year after discharge.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Methods: </strong>Electronic medical records of all UC patients treated at our center between 1 January 2014 and 31 June 2021 were reviewed. A comprehensive analysis of various characteristics, such as demographics, comorbidities, medical history, follow-up appointments, admission endoscopy, histopathologic features, etc., was used to determine the primary end point, which was unplanned UC-related calendar year readmission.</p><p><strong>Results: </strong>We found that the unplanned UC-related readmission rate within 1 year was 20.8%. In multivariable cox analysis, the predictors of the Elixhauser comorbidity index [Hazard ratio (HR): 3.50, 95% confidence interval (CI): 1.93-6.37], regular follow-up (HR: 0.29, 95% CI: 0.16-0.53), any history of corticosteroid use (HR: 3.38, 95% CI: 1.83-6.27), seral level of C-reactive protein (HR: 1.01, 95% CI: 1.00-1.02), and the UC endoscopic index of severity (HR: 1.29, 95% CI: 1.05-1.57) independently predicted calendar year readmission after discharge. The established nomogram had a consistently high accuracy in predicting calendar year readmission in the training cohort, with a concordance index of 0.784, 0.825, and 0.837 at 13, 26, and 52 weeks, respectively, which was validated in both the internal and external validation cohorts. Therefore, UC patients were divided into clinically low-, high-, and extremely high-risk groups for readmission, based on the calculated score of 272.5 and 378.</p><p><strong>Conclusion: </strong>The established nomogram showed good discrimination and calibration powers in predicting calendar year readmission in high-risk UC patients, who may need intensive treatment and regular outpatient visits.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4f/96/10.1177_17562848231189124.PMC10392194.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305493","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 oral beclomethasone dipropionate and budesonide MMX <i>versus</i> 5-aminosalicylates or placebo in ulcerative colitis: a systematic review and meta-analysis.","authors":"Brigida Barberio,&nbsp;Ilaria Marsilio,&nbsp;Andrea Buda,&nbsp;Luisa Bertin,&nbsp;Gianluca Semprucci,&nbsp;Annalisa Zanini,&nbsp;Martina Crepaldi,&nbsp;Fabiana Zingone,&nbsp;Edoardo Savarino","doi":"10.1177/17562848231188549","DOIUrl":"https://doi.org/10.1177/17562848231188549","url":null,"abstract":"<p><strong>Background: </strong>Low bioavailability steroids, including beclomethasone dipropionate (BDP) and budesonide MMX, have been developed to ensure colonic targeting and low systemic activity than systematic corticosteroids in treating patients with ulcerative colitis (UC).</p><p><strong>Objectives: </strong>This systematic review and meta-analysis evaluated the efficacy and safety of BDP and budesonide MMX® compared with 5-aminosalicylic acid (5-ASAs) or placebo, in patients with mild-to-moderate UC.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, and the Cochrane central register of controlled trials from inception to December 2021. We included all available randomized controlled trials (RCTs) comparing oral BDP or budesonide MMX with 5-ASAs or with placebo in induction of remission of mild-to-moderate UC. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.</p><p><strong>Results: </strong>We identified two RCTs comparing BDP 5 mg with 5-ASA, one RCTs comparing BDP 10 mg with 5-ASA, two RCTs BDP 5 mg <i>versus</i> placebo, one RCT BDP 10 mg <i>versus</i> placebo, two RCTs budesonide MMX 9 mg <i>versus</i> 5-ASA, and six RCTs budesonide MMX 9 mg <i>versus</i> placebo. In terms of achieving clinical remission or improvement, BDP 5 mg, BDP 10 mg, and budesonide MMX 9 mg were more effective than placebo (OR 2.36, 95% CI 1.37-4.08; OR 2.23, 95% CI 1.02-4.87; and OR 2.03, 95% CI 1.45-2.85, respectively). The drugs were also more effective than placebo in achieving endoscopic remission. Regarding the comparisons with 5-ASA, we found no differences between 5-ASA and BDP 5 mg or BDP 10 mg or budesonide MMX 9 mg in achieving clinical remission or improvement (OR 0.90, 95% CI 0.51-1.57; OR 1.54, 95% CI 0.42-5.64; and OR 1.17, 95% CI 0.82-1.66). However, 5-ASA was more effective than budesonide MMX 9 mg in achieving histological remission (OR 0.33, 95% CI 0.16-0.70). Overall, all the drugs were safe and well tolerated.</p><p><strong>Conclusion: </strong>Low bioavailability steroids were more effective than placebo in achieving clinical remission, clinical and endoscopic remission, and histological remission. No differences were found between 5-ASA and BDP or budesonide MMX. Surely, more RCTs, also comparing BDP and budesonide MMX, are mandatory to confirm or not these results.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/2f/10.1177_17562848231188549.PMC10395162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9939462","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":"Comparison of high-flow nasal cannula and conventional nasal cannula during sedation for endoscopic submucosal dissection: a retrospective study.","authors":"Seungwon Lee,&nbsp;Ji Won Choi,&nbsp;In Sun Chung,&nbsp;Duk Kyung Kim,&nbsp;Woo Seog Sim,&nbsp;Tae Jun Kim","doi":"10.1177/17562848231189957","DOIUrl":"https://doi.org/10.1177/17562848231189957","url":null,"abstract":"<p><strong>Background: </strong>The high-flow nasal cannula (HFNC) is a relatively recent method that provides high-flow, heated, humidified gas delivery.</p><p><strong>Objectives: </strong>We compared HFNC (group HF) and conventional nasal cannula (NC) (group CO) during deep sedation with propofol and remifentanil for endoscopic submucosal dissection (ESD).</p><p><strong>Design: </strong>Single-center, retrospective observational cohort study.</p><p><strong>Methods: </strong>In this study, a total of 159 cases were analyzed (group CO, 71 and group HF, 88). We collected the data from electronic medical records from September 2020 to June 2021. The lowest oxygen saturation (SpO₂), incidence of hypoxia (SpO₂ < 90%), rescue interventions, and adverse events between the two groups were investigated.</p><p><strong>Results: </strong>There were significant differences between the two groups in lowest SpO₂ and incidence of hypoxia [group CO <i>versus</i> group HF; 90.3 ± 9.7% <i>versus</i> 95.7 ± 9.0%, 25 (35.2%) <i>versus</i> 10 (11.4%); <i>p</i> < 0.001, <i>p</i> < 0.001; respectively]. Among the rescue interventions, the number of jaw thrust, patient stimulation, O₂ flow increase, and nasal airway insertion were significantly higher in the CO group than in the HF group. However, postprocedural chest X-ray showed higher rates of abnormal findings (atelectasis, aspiration, and pneumoperitoneum) in group HF than in group CO [group CO: 8 (11.3%) <i>versus</i> group HF: 26 (29.5%), <i>p</i> = 0.005]. In multivariable analysis, besides group CO, difficult type of lesion was the risk factor for hypoxia.</p><p><strong>Conclusions: </strong>Compared to the conventional NC, HFNC provided adequate oxygenation and a stable procedure without significant adverse events during sedation for ESD. However, caution is needed to avoid complications associated with deep sedation and difficult type of lesions.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/83/c9/10.1177_17562848231189957.PMC10467296.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10128082","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":"Free antibodies-to-infliximab are biomarker for predicting the effect of dose intensification in pediatric Crohn's disease patients with secondary loss of response.","authors":"Eun Sil Kim,&nbsp;Yiyoung Kwon,&nbsp;Yon Ho Choe,&nbsp;Mi Jin Kim","doi":"10.1177/17562848231170948","DOIUrl":"https://doi.org/10.1177/17562848231170948","url":null,"abstract":"<p><strong>Background: </strong>Immunogenicity to antitumor necrosis factor alpha agents, such as infliximab (IFX), may lead to therapeutic failure.</p><p><strong>Objectives: </strong>This study evaluated the relationship between free and total antibodies-to-infliximab (ATIs), trough levels (TLs) of IFX, and the response to dose intensification.</p><p><strong>Design: </strong>We performed a prospective, observational study including pediatric patients with Crohn's disease (CD) receiving IFX maintenance therapy without dose intensification.</p><p><strong>Methods: </strong>We compared clinical and laboratory outcomes according to the presence of free and total ATIs. Factors associated with response to IFX dose intensification were investigated by analyzing IFX TLs and free and total ATIs.</p><p><strong>Results: </strong>Of the 98 patients, 9 patients had detectable free ATIs and 38 patients had total ATIs. Patients with free ATIs had significantly lower TLs (0.7 <i>versus</i> 5.1 µg/mL, <i>p</i> < 0.001) than patients without free ATIs. However, there was no difference in the IFX TLs according to the presence of total ATIs (<i>p</i> = 0.2523). Analysis of the 38 samples with total ATIs showed that response to dose intensification was significantly lower in patients with free ATIs than those without free ATIs (22.2% <i>versus</i> 65.5%, <i>p</i> < 0.001). In addition, free ATIs were the only factor with poor response to dose intensification [odds ratio (OR): 14.15, 95% confidence interval (CI): 1.31-151.97, <i>p</i> = 0.0140]. According to the receiver operating characteristic analysis, the optimal cutoff level indicating non-response to IFX dose intensification was 30.0 AU/mL for free ATIs concentration (area under curve, 0.792; 95% CI: 0.590-0.942; sensitivity, 60.0%; specificity, 96.7%; <i>p</i> = 0.0241).</p><p><strong>Conclusion: </strong>Free ATIs, but not total ATIs, have a negative impact on the course of CD. Free ATIs are potential reliable biomarker for predicting the effect of dose intensification in patients with loss of response to IFX. Future studies based on serial and proactive therapeutic drug monitoring are required in the future.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/9e/10.1177_17562848231170948.PMC10164862.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10300605","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":"Evaluation of serum cytokines and acute phase proteins as possible pharmacodynamic biomarkers to monitor endoscopic remission during ustekinumab therapy in patients with Crohn's disease.","authors":"Nathalie Van den Berghe,&nbsp;Dahham Alsoud,&nbsp;Bram Verstockt,&nbsp;Séverine Vermeire,&nbsp;Paul Declerck,&nbsp;Debby Thomas","doi":"10.1177/17562848231189110","DOIUrl":"https://doi.org/10.1177/17562848231189110","url":null,"abstract":"<p><strong>Background: </strong>Since not all Crohn's disease (CD) patients respond adequately to ustekinumab therapy, biomarkers could aid to monitor treatment response and optimize therapeutic outcomes.</p><p><strong>Objectives: </strong>To explore the dynamics of serum biomarker concentrations to monitor the response to ustekinumab treatment in CD patients.</p><p><strong>Design: </strong>Retrospective, exploratory study to evaluate concentrations of serum cytokines and acute phase proteins and their relation to endoscopic remission in CD patients during ustekinumab treatment.</p><p><strong>Methods: </strong>Serum concentrations of 16 proteins including cytokines and acute phase proteins were measured using the Mesoscale Discovery Platform in serum of healthy controls (<i>n</i> = 13), and CD patients (<i>n</i> = 61) at baseline (week 0), week 8 and week 24 during ustekinumab treatment. Endoscopic remission was defined as simple endoscopic score for CD (SES-CD) <3 after 6 months of therapy.</p><p><strong>Results: </strong>Absolute concentrations of serum amyloid A protein (SAA; week 8), IL-6 (week 24), AGP (weeks 8 and 24), interferon (IFN)-γ (weeks 8 and 24), lipopolysaccharide binding protein (LBP; weeks 8 and 24) and IL-22 (weeks 8 and 24) were significantly lower in endoscopic remitters compared to non-responders (<i>p</i>-values ranging between <0.001 and <0.05). SAA (week 8) and AGP (week 24) were the biomarkers with the highest area under the ROC curve (AUROC; 0.761 and 0.760, respectively) for identifying patients in endoscopic remission, though their performance was not superior to C-reactive protein (CRP) or faecal calprotectin. AUROCs of the predictive probability of biomarker combinations showed superiority in discriminating endoscopic remitters from non-responders in comparison to single biomarker measurements, but not as compared to faecal calprotectin.</p><p><strong>Conclusion: </strong>Although not superior to faecal calprotectin, measurement of AGP, SAA, LBF, IFN-γ, IL-6 and IL-22 concentrations, and combinations thereof with or without CRP and faecal calprotectin, during ustekinumab therapy might contribute to adequate monitoring of treatment response in CD patients.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/28/16/10.1177_17562848231189110.PMC10467236.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10306827","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}