Therapeutic Advances in Gastroenterology最新文献

{"title":"Early predictive value of scoring systems and routine laboratory tests in severity and prognosis of acute pancreatitis in pregnancy.","authors":"Yu Wang, Guangbo Qu, Zhangbi Wu, Dongmei Tian, Wenbei Yang, Hongye Li, Yu Lu, GuangJun Meng, Hong Zhang","doi":"10.1177/17562848231167277","DOIUrl":"10.1177/17562848231167277","url":null,"abstract":"<p><strong>Background: </strong>Currently, no guidelines specifically recommend scoring systems and biomarkers for early evaluation of the severity and prognosis of acute pancreatitis in pregnancy (APIP).</p><p><strong>Objectives: </strong>This study aimed to explore the early predictive value of scoring systems and routine laboratory tests on APIP severity and maternofetal prognosis.</p><p><strong>Design: </strong>This study retrospectively analyzed 62 APIP cases in a 6-year period.</p><p><strong>Methods: </strong>The predictive value of scoring systems and routine laboratory tests that were collected 24 h and 48 h after admission, for APIP severity and fetal loss, were analyzed.</p><p><strong>Results: </strong>To detect severe acute pancreatitis (SAP), a 24-h Bedside Index for severity in acute pancreatitis (BISAP) achieved a higher area under the curve (AUC) value of 0.910 than the Acute Physiology and Chronic Health Evaluation II (AUC = 0.898) and Ranson score (AUC = 0.880). The combination of BISAP, glucose, neutrophil-to-lymphocyte ratio (NLR), hematocrit (Hct), and serum creatinine (Scr) provided an AUC value of 0.984, which had greater predictive power than BISAP (<i>p</i> = 0.015). 24-h BISAP and Hct were independent risk factors for predicting SAP of APIP. The cutoff values of Hct and blood urea nitrogen (BUN) to predict SAP were 35.60% and 3.75 mmol/l in the APIP. Furthermore, 24-h BISAP had the highest predictive power (AUC = 0.958) for fetal loss.</p><p><strong>Conclusion: </strong>BISAP is a convenient and reliable indicator for the early prediction of SAP and fetal loss in APIP. The combination of BISAP, glucose, NLR, Hct and Scr proved to be the optimal early markers for the prediction of SAP in APIP within 24 h after admission. In addition, Hct > 35.60% and BUN > 3.75 mmol/l may be suitable thresholds for predicting SAP in APIP.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231167277"},"PeriodicalIF":4.2,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/75/10.1177_17562848231167277.PMC10126706.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9733150","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":"Real-life effectiveness and safety of tofacitinib treatment in patients with ulcerative colitis: a KASID multicenter cohort study.","authors":"Seung Hwan Shin, Kyunghwan Oh, Sung Noh Hong, Jungbok Lee, Shin Ju Oh, Eun Soo Kim, Soo-Young Na, Sang-Bum Kang, Seong-Joon Koh, Ki Bae Bang, Sung-Ae Jung, Sung Hoon Jung, Kyeong Ok Kim, Sang Hyoung Park, Suk-Kyun Yang, Chang Hwan Choi, Byong Duk Ye","doi":"10.1177/17562848231154103","DOIUrl":"10.1177/17562848231154103","url":null,"abstract":"<p><strong>Background: </strong>Tofacitinib is a small molecule that inhibits Janus kinase and has been reported to be effective in Western patients with ulcerative colitis (UC). However, the real-life data on tofacitinib in Asian UC patients are limited.</p><p><strong>Objective: </strong>To investigate the real-life effectiveness and safety of tofacitinib induction and maintenance treatment in Korean patients with UC.</p><p><strong>Design: </strong>This was a retrospective study on patients with UC who received tofacitinib treatment at 12 hospitals in Korea between January 2018 and November 2020.</p><p><strong>Methods: </strong>Clinical remission at week 52, defined as a partial Mayo score of ⩽2 with a combined rectal bleeding subscore and stool frequency subscore of ⩽1, was used as the primary outcome. Adverse events (AEs), including herpes zoster and deep vein thrombosis, were also evaluated.</p><p><strong>Results: </strong>A total of 148 patients with UC were started on tofacitinib. Clinical remission rates of 60.6%, 54.9%, and 52.8% were reported at weeks 16, 24, and 52, respectively. Clinical response rates of 71.8%, 67.6%, and 59.9% were reported at weeks 16, 24, and 52, respectively. Endoscopic remission rates at weeks 16 and 52 were 52.4% and 30.8% based on the Mayo endoscopic subscore and 20.7% and 15.2% based on the UC endoscopic index of severity (UCEIS), respectively. A higher UCEIS at baseline was negatively associated with clinical response [adjusted odds ratio (aOR): 0.774, <i>p</i> = 0.029] and corticosteroid-free clinical response (aOR: 0.782, <i>p</i> = 0.035) at week 52. AEs occurred in 19 patients (12.8%) and serious AEs in 12 patients (8.1%). Herpes zoster occurred in four patients (2.7%). One patient (0.7%) suffered from deep vein thrombosis.</p><p><strong>Conclusions: </strong>Tofacitinib was an effective induction and maintenance treatment with an acceptable safety profile in Korean patients with UC.</p><p><strong>Plain language summary: </strong><b>Real-life effectiveness and safety of tofacitinib treatment in Korean patients with ulcerative colitis</b> Ulcerative colitis (UC) is an idiopathic, chronic inflammatory disorder of the colonic mucosa that usually presents with bloody diarrhea and abdominal pain. Tofacitinib is a small molecule that inhibits Janus kinase and has been reported to be effective in Western patients with UC. However, real-life data on the effectiveness of tofacitinib in Asian patients with UC are limited. To investigate the real-life effectiveness and safety of tofacitinib treatment in Korean patients with UC, we retrospectively analyzed the data of 148 patients with UC who received tofacitinib treatment at 12 hospitals in Korea between January 2018 and November 2020. Clinical remission (i.e. complete improvement of symptoms) was achieved in 60.6% and 52.8% of patients at weeks 16 and 52, respectively. Endoscopic remission was achieved in 52.4% and 30.8% of patients at weeks 16 and 52, respectively","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231154103"},"PeriodicalIF":4.2,"publicationDate":"2023-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/07/10.1177_17562848231154103.PMC10026122.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9534639","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":"Implications of the paradigm shift in management of <i>Helicobacter pylori</i> infections.","authors":"David Y Graham","doi":"10.1177/17562848231160858","DOIUrl":"10.1177/17562848231160858","url":null,"abstract":"<p><p>The recent availability of susceptibility testing for <i>Helicobacter pylori</i> infections in the United Sates has resulted in paradigm shifts in the diagnosis, therapy, and follow-up of <i>H. pylori</i> infections. Here, we reviewed the English literature concerning changes in <i>H. pylori</i> diagnosis and therapy with an emphasis on the last 3 years. We focus on the new methods that offer rapid and convenient susceptibility testing using either invasive (endoscopic) or noninvasive (stool) methods of obtaining test material. We also discuss the implications of this availability on therapy and follow-up after therapy. The approach to therapy was categorized into four groups: (1) therapies that can be used empirically, (2) therapies that should be restricted to those that are susceptibility-based, (3) potentially effective therapies that have yet to be optimized for local use, and (4), therapies that contain unneeded antibiotics that should not be prescribed. The most convenient and efficient method of susceptibility testing is by using reflexive stool testing in which if the sample is positive, it is automatically also used for determination of susceptibility. Reflexive testing can also be done via reflexive ordering (e.g., for all positive urea breath tests). The post therapy test-of-cure has emerged as a critical component of therapy as it not only provides feedback regarding treatment success but when combined with susceptibility testing also provide evidence regarding the cause of failure (e.g., poor adherence <i>versus</i> emergence of resistance during therapy. Susceptibility testing has made even the most current <i>H. pylori</i> guidelines for diagnosis and therapy generally obsolete. Clarithromycin, metronidazole, and levofloxacin triple therapies should only be administered as susceptibility-based therapy. Regimens containing unneeded antibiotics should not be given. We provide recommendations regarding the details and indications for all current therapies.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231160858"},"PeriodicalIF":3.4,"publicationDate":"2023-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/bc/10.1177_17562848231160858.PMC10026128.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9518648","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":"Pursuing neutrophils: systematic scoping review on blood-based biomarkers as predictors of treatment outcomes in inflammatory bowel disease.","authors":"Diogo Magalhaes, Laurent Peyrin-Biroulet, Maria Manuela Estevinho, Silvio Danese, Fernando Magro","doi":"10.1177/17562848231155987","DOIUrl":"10.1177/17562848231155987","url":null,"abstract":"<p><strong>Background: </strong>Long-term management of inflammatory bowel diseases (IBD) is challenging and the identification of reliable predictors for treatment outcomes is an unmet need. Neutrophil-related biomarkers have been mainly studied in the feces, but blood analyses have inherent advantages.</p><p><strong>Objective: </strong>To review the recent learnings on the ability of blood-based neutrophil-expressed biomarkers to predict treatment outcomes in IBD.</p><p><strong>Design: </strong>Systematic scoping review.</p><p><strong>Data sources and methods: </strong>We performed a literature search in Pubmed, EMBASE, SCOPUS, Web of Science, ScienceDirect, and Cochrane Central Register of Controlled Trials from inception until May 2022 according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. All human studies associating blood-based neutrophil-related compounds with the prediction of disease progression, complication onset, or treatment outcomes were included.</p><p><strong>Results: </strong>From 1032 retrieved entries, 34 studies were selected, 32 published in 2013 or later. In all, 17 biomarkers from granules, cytoplasm, plasmatic membrane, and plasma were explored. In total, 1850 Crohn's disease (CD) and 1122 ulcerative colitis non-duplicated patients were included. The most mentioned biomarkers were nCD64, serum calprotectin (SC), oncostatin M (OSM), neutrophil elastase-generated calprotectin fragment (CPa9-HNE), and triggering receptor expressed on myeloid cells 1 (TREM1). Six biomarkers showed promising results: OSM, SC, eNAMPT, nCD64, TREM1, and CPa9-HNE. Variable positive signals were found for human neutrophil peptide 1-3, LL-37, S100A12, and neutrophil gelatinase-associated lipocalin. No predictive ability was found for the remaining markers. Sharing a neutrophil compartment did not indicate similar behavior.</p><p><strong>Conclusion: </strong>Advances in the last decade began to unveil the untapped potential of the readily accessible blood neutrophil-expressed biomarkers, especially nCD64, TREM1, and CPa9-HNE. Current evidence suggests that future research should focus on well-defined subpopulations instead of a one-size-fits-all biomarker.</p><p><strong>Registration: </strong>https://osf.io/kes9a.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231155987"},"PeriodicalIF":3.4,"publicationDate":"2023-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/73/10.1177_17562848231155987.PMC10009059.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9122045","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":"Update on the role of upadacitinib in the treatment of adults with moderately to severely active ulcerative colitis.","authors":"Kenneth Ernest-Suarez, Remo Panaccione","doi":"10.1177/17562848231158235","DOIUrl":"10.1177/17562848231158235","url":null,"abstract":"<p><p>With further knowledge of the pathogenesis of inflammatory bowel disease, small oral molecules have become available, including the Janus kinase (JAK) inhibitors. Upadacitinib (UPA) is a selective JAK1 inhibitor and has become the newest drug in this class, with recent approval for the management of moderate-to-severe ulcerative colitis. The large phase III program (including the U-ACHIEVE and U-ACCOMPLISH parallel induction trials and the U-ACHIEVE Maintenance trial) demonstrated superiority over placebo, for all primary and secondary endpoints including key clinical, endoscopic, and histological outcomes utilizing 45 mg orally (po) once daily (OD) during induction and either 30 mg or 15 mg po OD in maintenance. From a safety perspective, UPA has proven to be a safe and well-tolerated medication across immune-mediated diseases with manageable adverse risks such as an increase in herpes zoster. Proper discussion and patient profiling are essential when positioning UPA, considering efficacy and potential risks associated with this highly effective medication.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231158235"},"PeriodicalIF":4.2,"publicationDate":"2023-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/98/a3/10.1177_17562848231158235.PMC10009038.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9116663","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":"Vedolizumab more likely to be discontinued than ustekinumab in anti-TNF-experienced patients with fistulizing Crohn's disease.","authors":"Kira L Newman, Laura A Johnson, Ryan W Stidham, Peter D R Higgins","doi":"10.1177/17562848221148254","DOIUrl":"10.1177/17562848221148254","url":null,"abstract":"<p><strong>Background: </strong>Data on the performance of newer biologics in patients with fistulizing Crohn's disease (CD) are limited.</p><p><strong>Objective: </strong>Our study's objective was to evaluate the response to ustekinumab (UST) and vedolizumab (VDZ) in patients with fistulizing CD.</p><p><strong>Design: </strong>Retrospective cohort.</p><p><strong>Methods: </strong>We used natural language processing of electronic medical record data to identify a retrospective cohort of individuals with fistulizing CD at a single academic tertiary-care referral center and then performed a chart review. Individuals were eligible for inclusion if a fistula was present at the time of UST or VDZ initiation. Outcomes included medication discontinuation, surgical intervention, development of a new fistula, and fistula closure. Groups were compared with unadjusted analyses and competing risk analyses using multi-state survival models.</p><p><strong>Results: </strong>In all, 68 patients were included (48 UST and 20 VDZ). Most patients had one fistula (79%) and had prior anti-tumor necrosis factor-α treatment (98% in UST group, 80% in VDZ group, <i>p</i> = 0.01). VDZ was significantly more likely to be discontinued than UST (<i>p</i> < 0.0001), most frequently due to inadequate clinical response. Those on UST had a longer median time to surgery for CD than those on VDZ (<i>p</i> = 0.008). In those without surgical fistula repair, 79% on UST and 100% on VDZ still had an active fistula at 1 year (<i>p</i> = 0.30).</p><p><strong>Conclusion: </strong>In individuals with fistulizing CD, our data suggest that UST has better clinical utility than VDZ based on lower rates of discontinuation, though the sample size is small. These findings highlight the importance of further research on the treatment of perianal fistulizing Crohn's disease.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848221148254"},"PeriodicalIF":4.2,"publicationDate":"2023-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/f0/10.1177_17562848221148254.PMC9989393.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9085827","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 efficacy and safety of <i>Saccharomyces boulardii</i> in addition to antofloxacin-based bismuth quadruple therapy for <i>Helicobacter pylori</i> eradication: a single-center, prospective randomized-control study.","authors":"Xiao-Jian He, Xiao-Ling Wang, Dong-Jie Sun, Xiao-Yan Huang, Gang Liu, Da-Zhou Li, Hai-Lan Lin, Xiang-Peng Zeng, Dong-Liang Li, Wen Wang","doi":"10.1177/17562848221147763","DOIUrl":"10.1177/17562848221147763","url":null,"abstract":"<p><strong>Background: </strong>We previously reported that antofloxacin-based bismuth quadruple therapy was safe and effective for <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication. It is not clear whether the addition of <i>Saccharomyces boulardii</i> (<i>S. boulardii</i>) to antofloxacin-based quadruple therapy can improve the eradication rate of <i>H. pylori</i> and reduce adverse events.</p><p><strong>Objective: </strong>To investigate the effect of adding <i>S. boulardii</i> to antofloxacin-based quadruple therapy on the eradication rate of <i>H. pylori</i> and the adverse events.</p><p><strong>Design: </strong>Single-center, prospective randomized controlled study.</p><p><strong>Methods: </strong>A total of 172 patients with <i>H. pylori</i> infection were randomly assigned to the test and control groups. Patients in the control group (<i>n</i> = 86) received antofloxacin-based bismuth quadruple therapy for 14 days. On this basis, cases in the test group (<i>n</i> = 86) received <i>S. boulardii</i> 500 mg b.i.d. The eradication rate of <i>H. pylori</i> and adverse events were observed 4 weeks after the treatment.</p><p><strong>Results: </strong>There were no statistically significant differences in the eradication rates of <i>H. pylori</i> and frequency of diarrhea between the test group and control group (<i>p</i> > 0.05). The duration of diarrhea in the test group was significantly shorter than in the control group (<i>p</i> < 0.001). In addition, the two groups exhibited similar adverse event rates for epigastric pain, abdominal distention, dizzy, vomiting, and rash (<i>p</i> > 0.05). The severity of adverse reactions was similar between the two groups (<i>p</i> > 0.05), and most of them had mild adverse events.</p><p><strong>Conclusion: </strong>Although the addition of <i>S. boulardii</i> to antofloxacin-based quadruple therapy could not improve the eradication rate of <i>H. pylori</i>, it could shorten the time of antibiotic-associated diarrhea and reduce the incidence of diarrhea.</p><p><strong>Trial registration number: </strong>ChiCTR2200056931.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848221147763"},"PeriodicalIF":4.2,"publicationDate":"2023-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4f/f5/10.1177_17562848221147763.PMC9893347.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10716637","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":"High-dose dual therapy <i>versus</i> bismuth-containing quadruple therapy for <i>Helicobacter pylori</i> eradication: a systematic review and meta-analysis with trial sequential analysis.","authors":"Ben-Gang Zhou, Yu-Zhou Mei, Min Zhang, Xin Jiang, Yao-Yao Li, Yan-Bing Ding","doi":"10.1177/17562848221147756","DOIUrl":"10.1177/17562848221147756","url":null,"abstract":"<p><strong>Background and objective: </strong>Recently, a large number of trials on proton pump inhibitor-amoxicillin-containing high-dose dual therapy (HDDT) <i>versus</i> bismuth-containing quadruple therapy (BQT) for <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication have been published with controversial and inconsistent conclusions. The aim of this meta-analysis was to determine the effects of HDDT for <i>H. pylori</i> eradication compared to BQT.</p><p><strong>Design: </strong>A systematic review and meta-analysis was conducted.</p><p><strong>Methods: </strong>PubMed, Embase, and the Cochrane library database were searched to collect all randomized controlled trials (RCTs) assessing the effects of HDDT <i>versus</i> BQT to <i>H. pylori</i> eradication from inception to September 2022. Meta-analysis was conducted to estimate the pooled relative risk (RR) with 95% confidence intervals (CIs) using a random-effects model. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis (TSA) was performed to determine the reliability and conclusiveness.</p><p><strong>Results: </strong>A total of 14 RCTs with 5121 patients were included. The results of meta-analysis showed that there was no statistical significance in the eradication rate between HDDT and BQT (intention-to-treat analysis: 86.7% <i>versus</i> 85.1%, RR = 1.01, 95% CI: 0.98-1.04; per-protocol analysis: 89.9% <i>versus</i> 89.4%, RR = 1.01, 95% CI: 0.98-1.03; moderate-quality evidence). The incidence of total adverse effects in HDDT group was significantly lower than in BQT group (5.9% <i>versus</i> 34.1%, RR = 0.42, 95% CI: 0.34-0.50; low-quality evidence). No statistical significance was observed in compliance between HDDT and BQT (RR = 1.01, 95% CI, 1.00-1.03, <i>p</i> = 0.07; low-quality evidence). The TSA result for <i>H. pylori</i> eradication rate indicated that the effect was conclusive.</p><p><strong>Conclusions: </strong>Evidence from our updated meta-analysis suggests that HDDT is as effective as BQT in eradicating <i>H. pylori</i>, with fewer adverse effects and similar compliance.</p><p><strong>Registration: </strong>Open Science Framework registries (No: osf.io/th4vd).</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848221147756"},"PeriodicalIF":3.4,"publicationDate":"2023-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/23/10.1177_17562848221147756.PMC9837272.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536353","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 impact of the COVID-19 pandemic on <i>Clostridioides difficile</i> infection and utilization of fecal microbiota transplantation.","authors":"Salam P Bachour,&nbsp;Rahul Dalal,&nbsp;Jessica R Allegretti","doi":"10.1177/17562848231165581","DOIUrl":"https://doi.org/10.1177/17562848231165581","url":null,"abstract":"<p><p>Previous research has demonstrated that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) gains cell entry through the angiotensin-converting enzyme 2 receptor, which is abundantly found throughout the gastrointestinal (GI) tract, resulting in a wide array of GI manifestations of coronavirus disease 2019 (COVID-19). By gaining entry into the intestinal epithelial and stromal cells, SARS-CoV-2 has been observed to cause intestinal inflammation and gut dysbiosis. Alterations in gut microbiota are known to be involved in the pathophysiology of <i>Clostridioides difficile</i> infection (CDI). During the initial stages of the COVID-19 pandemic, rates of CDI were similar to historical data despite the increased use of antibiotics. This may be due to increased emphasis on hygiene and protective equipment and reduced <i>C. difficile</i> testing as diarrhea was presumed to be COVID-19 related. Studies also demonstrated additional risk factors for CDI in COVID-19 patients, including length of hospitalization and new abdominal pain during admission. Although not associated with increased mortality, CDI was associated with increased length of hospital stay among patients admitted with COVID-19. Due to fecal viral shedding and concern of oral-fecal transmission of SARS-CoV-2, increased safety regulations were introduced to fecal microbiota transplantation (FMT) leading to reduced rates of this procedure during the COVID-19 pandemic. FMT for recurrent CDI during the COVID-19 pandemic remained highly effective without any reports of SARS-CoV-2 transmission. In addition, limited data show that FMT may be effective in treating COVID-19 and restoring healthy gut microbiota. The goal of this article is to review the impact that the COVID-19 pandemic has had on hospital-acquired CDI and the utilization of FMT.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231165581"},"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/20/47/10.1177_17562848231165581.PMC10107020.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9388659","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":"Neutrophil-to-lymphocyte ratio for predicting postoperative recurrence in Crohn's disease patients with isolated anastomotic lesions.","authors":"Rirong Chen,&nbsp;Chao Li,&nbsp;Kang Chao,&nbsp;Yizhe Tie,&nbsp;Jieqi Zheng,&nbsp;Huili Guo,&nbsp;Zhirong Zeng,&nbsp;Li Li,&nbsp;Minhu Chen,&nbsp;Shenghong Zhang","doi":"10.1177/17562848231165129","DOIUrl":"https://doi.org/10.1177/17562848231165129","url":null,"abstract":"<p><strong>Background: </strong>Patients with isolated anastomotic lesions (iAL) are common in postoperative Crohn's disease (CD) and have heterogeneous prognosis.</p><p><strong>Objectives: </strong>To investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in CD patients with iAL.</p><p><strong>Design: </strong>A bicenter retrospective cohort study.</p><p><strong>Methods: </strong>CD patients who received ileocolonic resection from 2013 and 2020 and had a modified Rutgeerts score of i2a were recruited. NLR was determined within 1 week around the initial endoscopy after ileocolectomy. The primary outcome was clinical recurrence. Kaplan-Meier method and Cox hazard regression analysis were utilized to assess the association between candidate variables and outcomes of interest.</p><p><strong>Results: </strong>In total, 411 postoperative CD patients were preliminarily reviewed and 83 patients were eligible. In total, 36 (48.6%) patients experienced clinical recurrence with a median follow-up time of 16.3 (interquartile range, 9.7-26.3) months. NLR > 2.45 and age at surgery >45 years had higher cumulative incidence of clinical recurrence in the Kaplan-Meier analysis. After adjusted for potential confounders, NLR > 2.45 was the only independent risk factor for clinical recurrence, with an adjusted hazard ratio (HR) of 2.88 [95% confidence interval (CI), 1.39-6.00; <i>p</i> = 0.005]. Furthermore, a risk score based on NLR and age at surgery were built to further stratify patients. Compared to those who scored 0, patients with a score of 1 and 2 had an adjusted HR of 2.48 (95% CI, 1.22-5.02) and 6.97 (95% CI, 2.19-22.16) for developing clinical recurrence, respectively.</p><p><strong>Conclusions: </strong>NLR is a promising prognostic biomarker for CD patients with iAL. The utilization of NLR and the risk score to stratify patients may facilitate the personalized management in patients with iAL.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231165129"},"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/2e/fe/10.1177_17562848231165129.PMC10071151.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9276727","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}