Therapeutic Advances in Gastroenterology最新文献

{"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":"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":4.2,"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}

{"title":"Systematic review: efficacy of therapies for cholestatic pruritus.","authors":"Ebehiwele Ebhohon,&nbsp;Raymond T Chung","doi":"10.1177/17562848231172829","DOIUrl":"https://doi.org/10.1177/17562848231172829","url":null,"abstract":"<p><strong>Background: </strong>Pruritus is a symptom of several cholestatic liver diseases (CLDs) that can impair health-related quality of life (HRQoL). Despite evidence-based guideline therapy, managing cholestatic pruritus (CP) remains challenging, thus making the need for newer, more effective therapeutic agents more evident.</p><p><strong>Objective: </strong>Our study evaluated the efficacy of existing CP therapies.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Data sources: </strong>From inception until March 2023, we conducted a comprehensive search of MEDLINE, Cochrane, EMBASE, Scopus, ClinicalTrial.gov, and other sources, including pharmaceutical webpages and conference proceedings published in English that reported on CP interventions.</p><p><strong>Methods: </strong>Two reviewers independently conducted screening and full-text review of articles with extraction conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The methodological quality of studies included in our qualitative synthesis was assessed by using the Cochrane ROBINS-I and ROBINS-II tools for interventional studies and the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome assessed in our systematic review was the severity of CP after therapy.</p><p><strong>Results: </strong>Of 3293 screened articles, 92 studies were eligible for inclusion in the qualitative synthesis. Some patients' HRQoL improved with evidence-based standard therapy. Others, particularly those with severe and refractory CP, often required conversion to or addition of experimental noninvasive (e.g., ondansetron) or extracorporeal liver support to alleviate CP. In addition, studies investigating a newer class drug, the ileal bile acid transporter inhibitor (IBATi), demonstrate its effectiveness in reducing serum bile acid and alleviating CP with sustained improvement noted in patients with the inherited childhood cholestatic disorders - progressive familial intrahepatic cholestasis and Alagille syndrome.</p><p><strong>Conclusion: </strong>Our findings consolidate data on the efficacy of guideline-based approaches and newer therapies for CP. While the initial findings are promising, additional clinical trials will be needed to determine the full extent of IBATi's efficacy and potential use in treating other common CLDs. These results provide a foundation for future research and highlight the need for continued investigation into the management and treatment of CLDs.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231172829"},"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/07/0a/10.1177_17562848231172829.PMC10226044.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9924294","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 vonoprazan-amoxicillin dual therapy for <i>Helicobacter pylori</i> first-line treatment: a single-center, randomized, controlled trial.","authors":"Xiaolei Wang,&nbsp;Guigen Teng,&nbsp;Xinhong Dong,&nbsp;Yun Dai,&nbsp;Weihong Wang","doi":"10.1177/17562848231190976","DOIUrl":"https://doi.org/10.1177/17562848231190976","url":null,"abstract":"<p><strong>Background: </strong>With the increase in antibiotic resistance, the success rate of <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication therapy has declined in recent years. Vonoprazan-amoxicillin (VA) dual therapy has been reported to be a promising regimen.</p><p><strong>Objectives: </strong>To compare the efficacy and safety of VA dual therapy and bismuth quadruple therapy containing amoxicillin and clarithromycin for <i>H. pylori</i> first-line eradication, and to further analyze the effects of clarithromycin resistance on eradication rate.</p><p><strong>Design: </strong>This study was a single-center, open-label, randomized controlled trial.</p><p><strong>Methods: </strong>Treatment-naïve <i>H. pylori</i>-infected patients were randomly allocated 1:1 to the VA group (vonoprazan 20 mg twice daily and amoxicillin 750 mg four times daily, for 14 days) or the RBAC group (rabeprazole 10 mg, bismuth potassium citrate 220 mg, amoxicillin 1000 mg and clarithromycin 500 mg twice daily, for 14 days). <i>H. pylori</i> clarithromycin resistance and CYP2C19 gene polymorphisms were detected with real-time polymerase chain reaction (PCR) technique. The eradication rates and adverse events were analyzed.</p><p><strong>Results: </strong>A total of 151 patients were enrolled. The intention-to-treat (ITT), modified intention-to-treat (mITT), and per-protocol (PP) eradication rates and their 95% confidence intervals (95% CIs) were 94.6% (86.0-98.3%), 98.6% (91.3-99.9%), and 98.5% (90.9-99.9%) for VA group and 87.0% (77.0-93.3%), 91.8% (82.3-96.6%), and 93% (83.7-97.4%) for RBAC group. The eradication rate of the VA group was noninferior to the RBAC group in ITT, mITT, and PP analyses (<i>p</i> < 0.0001). In patients infected with strains of clarithromycin resistance point mutation, the eradication rate of the RBAC group decreased to lower than 90%, but the difference from the VA group did not achieve statistical significance (ITT eradication rate: 81.5% in the RBAC group and 96.2% in the VA group, <i>p</i> = 0.192). The incidence of adverse events in the VA group was 39.2%, which was significantly lower than that in the RBAC group (79.2%, <i>p</i> = 0.000).</p><p><strong>Conclusion: </strong>The efficacy of VA dual therapy is noninferior to RBAC in <i>H. pylori</i> first-line eradication, with fewer adverse reactions.</p><p><strong>Registration: </strong>This study was registered at the Chinese Clinical Trial Registry (ChiCTR2100052550) on 30 October 2021.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231190976"},"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/d5/08/10.1177_17562848231190976.PMC10469240.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10153750","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":"NOD-like receptors mediate homeostatic intestinal epithelial barrier function: promising therapeutic targets for inflammatory bowel disease.","authors":"Feng Zhou,&nbsp;Guo Dong Zhang,&nbsp;Yang Tan,&nbsp;Shi An Hu,&nbsp;Qun Tang,&nbsp;Gang Pei","doi":"10.1177/17562848231176889","DOIUrl":"https://doi.org/10.1177/17562848231176889","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) is a chronic gastrointestinal inflammatory disease that involves host genetics, the microbiome, and inflammatory responses. The current consensus is that the disruption of the intestinal mucosal barrier is the core pathogenesis of IBD, including intestinal microbial factors, abnormal immune responses, and impaired intestinal mucosal barrier. Cumulative data show that nucleotide-binding and oligomerization domain (NOD)-like receptors (NLRs) are dominant mediators in maintaining the homeostasis of the intestinal mucosal barrier, which play critical roles in sensing the commensal microbiota, maintaining homeostasis, and regulating intestinal inflammation. Blocking NLRs inflammasome activation by botanicals may be a promising way to prevent IBD progression. In this review, we systematically introduce the multiple roles of NLRs in regulating intestinal mucosal barrier homeostasis and focus on summarizing the activities and potential mechanisms of natural products against IBD. Aiming to propose new directions on the pathogenesis and precise treatment of IBD.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231176889"},"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/78/10.1177_17562848231176889.PMC10493068.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10239715","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":"Effects of visceral adipose tissue on anti-tumour necrosis factor-α in Crohn's disease.","authors":"Kangrong Li,&nbsp;Pan Gong,&nbsp;Yongbin Zhang,&nbsp;Minji Liu,&nbsp;Zinan Zhang,&nbsp;Xiaoyu Yu,&nbsp;Mingmei Ye,&nbsp;Li Tian","doi":"10.1177/17562848231171962","DOIUrl":"https://doi.org/10.1177/17562848231171962","url":null,"abstract":"<p><strong>Background: </strong>It remains unclear whether visceral adipose tissue (VAT) can predict the response of patients with Crohn's disease (CD) to anti-tumour necrosis factor-α (anti-TNF-α) therapy.</p><p><strong>Objectives: </strong>This study aimed to investigate whether VAT predicts the efficacy of infliximab (IFX) for different sites of CD and its relationship with serum TNF-α levels and IFX serum trough concentration.</p><p><strong>Design: </strong>This is a multicentre retrospective study.</p><p><strong>Methods: </strong>Patients with CD treated with IFX from January 2014 to January 2021 were included. The perimeter of the visceral adipose area was obtained by a Computed Tomography (CT) scan. Participants were classified according to the lesion site (L₁, L₂, and L₃) and visceral fat area. The participants were divided into colon-uninvolved non-visceral obesity (L₁-VAT_L), colon-uninvolved visceral obesity (L₁-VAT_H), colon-involved non-visceral obesity (L₂ + L₃-VAT_L), and colon involved visceral obesity (L₂ + L₃-VAT_H) groups. The end points of this study were set as disease remission status at 6 and 12 months.</p><p><strong>Results: </strong>The final cohort included 140 patients. Regarding efficacy at 6 and 12 months, there was a significant difference between L₁-VAT_L (73.8% <i>versus</i> 36.8%, <i>p</i> = 0.006) and L₁-VAT_H (81.0% <i>versus</i> 47.4%, <i>p</i> = 0.008) groups. In the analysis of serum TNF-α levels and IFX serum trough concentrations, there was a significant difference between L₁-VAT_L and L₁-VAT_H (59.5 pg/mL <i>versus</i> 236.0 pg/mL, <i>p</i>_TNF-α = 0.006), (10.0 μg/mL <i>versus</i> 0.4 μg/mL, <i>p</i>_IFX = 0.000), and L₁-VAT_H and L₂ + L₃-VAT_H (78.7 pg/mL <i>versus</i> 118.6 pg/mL, <i>p</i>_TNF-α = 0.031), (0.4 μg/mL <i>versus</i> 6.40 μg/mL, <i>p</i>_IFX = 0.017).</p><p><strong>Conclusion: </strong>In L₁ patients, the VAT level predicted the efficacy of IFX, with high VAT values indicating poor efficacy. The VAT level may be a useful radiological marker to predict the efficacy of IFX in patients with various types of CD.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231171962"},"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/c1/46/10.1177_17562848231171962.PMC10164858.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10296446","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":"Coronavirus disease 2019 and gastrointestinal disorders in children.","authors":"Anna Röckert Tjernberg,&nbsp;Petter Malmborg,&nbsp;Karl Mårild","doi":"10.1177/17562848231177612","DOIUrl":"https://doi.org/10.1177/17562848231177612","url":null,"abstract":"<p><p>During the past 3 years, the coronavirus disease 2019 (COVID-19) pandemic has had a great impact on people all over the world. However, it has become evident that disease manifestations and severity differ across age groups. Most children have a milder disease course than adults but possibly more pronounced gastrointestinal (GI) symptoms. Given the child's developing immune system, the impact of COVID-19 on disease development may differ compared to adults. This study reviews the potential bi-directional relationship between COVID-19 and GI diseases in children, focusing on common pediatric conditions such as functional GI disorders (FGID), celiac disease (CeD), and inflammatory bowel disease (IBD). Children with GI diseases, in general, and CeD and IBD, in particular, do not seem to have an increased risk of severe COVID-19, including risks of hospitalization, critical care need, and death. While infections are considered candidate environmental factors in both CeD and IBD pathogenesis, and specific infectious agents are known triggers for FGID, there is still not sufficient evidence to implicate COVID-19 in the development of either of these diseases. However, given the scarcity of data and the possible latency period between environmental triggers and disease development, future investigations in this field are warranted.</p>","PeriodicalId":23022,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"16 ","pages":"17562848231177612"},"PeriodicalIF":4.2,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10243097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10297995","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}