World Journal of Gastroenterology最新文献

{"title":"Preoperative risk stratification of early recurrence in resected pancreatic ductal adenocarcinoma: Novel equilibrium-phase-computed tomography biomarker of extracellular volume.","authors":"Zhi-Wei Zhang, Hao-Tian Liu, Zhuo-Hang Zhou, Hong-Fan Liao, Lan-Ling Zhang, Yong-Mei Li, Hong-Wei Liang","doi":"10.3748/wjg.v31.i35.109687","DOIUrl":"10.3748/wjg.v31.i35.109687","url":null,"abstract":"<p><strong>Background: </strong>Predicting early recurrence (ER), (≤ 12 months) after pancreatic ductal adenocarcinoma (PDAC) resection remains challenging. Preoperative biomarkers such as carbohydrate antigen 19-9 (CA19-9) and computed tomography (CT) lack optimal specificity and reproducibility. Extracellular volume (ECV), measured on equilibrium-phase CT to quantify stromal fibrosis, correlates with PDAC progression but its utility for ER prediction is unknown. This study evaluates preoperative CT-ECV as a novel biomarker to predict ER following curative-intent PDAC resection.</p><p><strong>Aim: </strong>To investigate the utility of CT-ECV for preoperative prediction of ER in PDAC patients after R0 resection.</p><p><strong>Methods: </strong>This retrospective study included 93 PDAC patients undergoing R0 resection and preoperative pancreatic CT from January 2020 to November 2023. Clinical and CT features were analyzed. ECV was calculated using unenhanced and equilibrium-phase CT. Univariable and multivariable Cox regression identified ER predictors, followed by receiver operating characteristic analysis. Recurrence-free survival (RFS) was assessed by the Kaplan-Meier method.</p><p><strong>Results: </strong>Multivariable analysis identified elevated CT-ECV [hazard ratio (HR) = 1.05; 95% confidence interval (CI): 1.02-1.09; <i>P</i> = 0.003], high preoperative CA19-9 (HR = 1.00; 95%CI: 1.00-1.00; <i>P</i> = 0.002), and poor tumor grade (HR = 2.51; 95%CI: 1.20-5.22; <i>P</i> = 0.014) as independent ER predictors. CT-ECV demonstrated comparable predictive accuracy to tumor grade [areas under the curve (AUC): 0.736 <i>vs</i> 0.650; <i>P</i> = 0.202]. Combining CT-ECV and CA19-9 achieved a higher AUC than tumor grade alone (0.759 <i>vs</i> 0.650; <i>P</i> < 0.05). Kaplan-Meier analysis revealed significantly shorter RFS in patients with low CT-ECV (≤ 35.37%), elevated CA19-9 (> 55 U/mL), or poorly differentiated tumors compared to those with high CT-ECV (> 35.37%), low CA19-9 (≤ 55 U/mL), or moderately/well-differentiated tumors.</p><p><strong>Conclusion: </strong>CT-derived ECV is a promising non-invasive biomarker for preoperative ER prediction in PDAC. Combined with CA19-9, it outperforms tumor grade in stratifying recurrence risk, offering a clinically actionable tool for optimizing postoperative management.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"109687"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193294","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":"Comparative evaluation of three traditional herbal formulas on gastrointestinal motility in a mouse model of cold stress-induced dyspepsia.","authors":"Jing-Hua Wang, Song-Yi Han, Liangliang Wu, Uijeong Han, Si-Kyung Cho, Chan-Woong Park, Young-Won Chin, Mi Young Lim, Hojun Kim","doi":"10.3748/wjg.v31.i35.109808","DOIUrl":"10.3748/wjg.v31.i35.109808","url":null,"abstract":"<p><strong>Background: </strong>Cold exposure has traditionally been considered a pathological factor that can easily impair gastrointestinal (GI) digestion. Shihosogan-tang (ST), Yijung-tang (YT), and Pyeongwi-san (PS) are well-known herbal formulas frequently used to treat GI disorders in East Asia.</p><p><strong>Aim: </strong>To compare the effects of these herbal formulas on GI motility and investigate their mechanisms of action using a cold stress (CS)-induced dyspepsia mouse model.</p><p><strong>Methods: </strong>C57BL/6J mice were exposed to CS by immersion in cold water (10 ± 1 °C) while being restrained in conical tubes for 1 hour. This procedure was repeated six times over 2 weeks. Herbal formulas or mosapride (positive control) were administered orally five times per week over a 2-week period.</p><p><strong>Results: </strong>The pre-test results revealed that CS, rather than restraint stress, significantly delayed gut motility in mice. However, PS and ST notably improved gastric emptying and intestinal transit, surpassing YT. Additionally, PS and ST significantly reduced gastric potential of hydrogen and increased pepsin and lipase gene expression compared to CS. The observed mechanisms likely involved increased gastric acidity and enhanced levels of digestive enzymes, such as pepsin and lipase. Furthermore, PS administration elevated GI hormone levels and metabolites related to the gut microbiota (5-hydroxytryptamine and short-chain fatty acid) more effectively than ST and YT treatments.</p><p><strong>Conclusion: </strong>PS more effectively alleviated CS-induced GI dysfunction than both YT and ST. These comparative findings offer valuable insights for clinical applications in the treatment of cold-related digestive disorders.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"109808"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193313","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":"Inflammatory bowel disease in paediatrics: Navigating the old challenges and emerging frontiers.","authors":"Mohammed Al-Beltagi, Nermin K Saeed, Prabu Kumar Chokkalingam Mani, Adel S Bediwy, Reem Elbeltagi","doi":"10.3748/wjg.v31.i35.111934","DOIUrl":"10.3748/wjg.v31.i35.111934","url":null,"abstract":"<p><p>Pediatric inflammatory bowel disease (IBD), encompassing Crohn's disease, ulcerative colitis, and IBD-unclassified, has become increasingly prevalent worldwide, including in previously low-incidence regions. Children often present with more extensive and aggressive disease, creating unique diagnostic and management challenges that differ significantly from adult-onset IBD. This review aims to synthesize current knowledge on pediatric IBD, highlighting historical challenges while exploring emerging frontiers in diagnosis, treatment, and long-term care strategies. A narrative synthesis of global and regional epidemiological data, clinical classifications, diagnostic advancements, management approaches, and psychosocial considerations was conducted, with a particular emphasis on innovations in precision medicine, microbiome-targeted therapy, and multidisciplinary care models. Pediatric IBD continues to rise globally, driven by environmental and genetic interactions, especially in rapidly industrializing regions. Novel diagnostic tools, age-specific treatment protocols, biologics, nutritional strategies, and psychosocial support are reshaping care. Emphasis on very early-onset IBD, transition care, and regional policy adaptations underscores the evolving complexity of managing pediatric IBD. The landscape of pediatric IBD care is rapidly evolving. Addressing the distinct pathophysiology, developmental impact, and healthcare challenges of pediatric patients requires an integrated, child-centered approach. Ongoing research into genetics, immune pathways, and the microbiome will be essential in tailoring precision therapies and improving outcomes globally.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"111934"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476641/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193307","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":"Beyond corticosteroids: A systematic review of novel therapeutic strategies in severe alcoholic hepatitis and 90-day survival.","authors":"Marta Quiñones-Calvo, Rubén Alvarado-Jara, Paula García-Renedo, Elena Stallings, Eulalia Grifol-Clar, Conrado M Fernández-Rodríguez","doi":"10.3748/wjg.v31.i35.109987","DOIUrl":"10.3748/wjg.v31.i35.109987","url":null,"abstract":"<p><strong>Background: </strong>Severe alcoholic hepatitis (SAH) carries a 90-day mortality rate approaching 50%. Management includes corticosteroids, nutritional support, and early liver transplantation in selected cases. However, the mid-term impact of available therapies remains unclear. This systematic review provides a critical evaluation of treatments for SAH, specifically focusing on survival or mortality at 90 days as an essential window that captures short- and mid-term outcomes. The 90-day window is clinically significant, as it reflects the remission of systemic inflammation, early liver recovery, and minimizes confounding long-term behaviors such as alcohol relapse.</p><p><strong>Aim: </strong>To review the effect of different treatments for SAH on survival and mortality at 90 days.</p><p><strong>Methods: </strong>A systematic search of PubMed and EMBASE (last updated March 2025) was performed without language restrictions, focusing on studies published in the last decade. Study selection and data extraction were performed independently by at least two reviewers. Risk of bias was assessed using RoB 2.0 and Risk-of Bias in Non-Randomized Studies of Interventions tools. Due to heterogeneity in study designs and interventions, a meta-analysis was not feasible. A qualitative synthesis was conducted using narrative summaries and evidence tables.</p><p><strong>Results: </strong>Searches in the databases yielded 645 citations in PubMed and 1516 in EMBASE. Of these 2161 studies, 618 were duplicates and therefore removed. A total of eight studies were included in qualitative synthesis. Among the included publications, six were randomized control trials (RCT) and two were retrospective cohort studies. These studies evaluated 90-day mortality or survival in SAH patients treated with corticosteroids (<i>n</i> = 2), pentoxifylline (<i>n</i> = 1), anakinra plus zinc (<i>n</i> = 2), granulocyte colony-stimulating factor (<i>n</i> = 1), amoxicillin-clavulanate (<i>n</i> = 1), fecal microbiota transplantation (<i>n</i> = 1) or extracorporeal liver assist device (<i>n</i> = 1). While most studies were conducted in Western countries, two had a global scope.</p><p><strong>Conclusion: </strong>Steroids remain the first-line therapy for SAH despite reports of them not having any 90-day survival benefit. These results highlight the need for multicenter, biomarker-guided RCTs evaluating emerging treatments to improve mid-term survival in SAH.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"109987"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193340","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":"Explainable artificial intelligence for personalized management of inflammatory bowel disease: A minireview of recent advances.","authors":"Uchenna E Okpete, Haewon Byeon","doi":"10.3748/wjg.v31.i35.111033","DOIUrl":"10.3748/wjg.v31.i35.111033","url":null,"abstract":"<p><p>Personalized management of inflammatory bowel disease (IBD) is crucial due to the heterogeneity in disease presentation, variable therapeutic response, and the unpredictable nature of disease progression. Although artificial intelligence (AI) and machine learning algorithms offer promising solutions by analyzing complex, multidimensional patient data, the \"black-box\" nature of many AI models limits their clinical adoption. Explainable AI (XAI) addresses this challenge by making data-driven predictions more transparent and clinically actionable. This minireview focuses on recent advancements and clinical relevance of integrating XAI for personalized IBD management. We explore the importance of XAI in prioritizing treatment and highlight how XAI techniques, such as feature-attribution explanations and interpretable model architectures, enhance transparency in AI models. In recent years, XAI models have been applied to diagnose IBD anomalies by prioritizing the predictive features for gastrointestinal bleeding and dietary intake patterns. Furthermore, studies have revealed that XAI application enhances IBD risk stratification and improves the prediction of drug efficacy and patient responses with high accuracy. By transforming opaque AI models into interpretable tools, XAI fosters clinician trust, supports personalized decision-making, and enables the safe deployment of AI systems in sensitive, individualized IBD care pathways.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"111033"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193323","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":"Expanding the genetic landscape of colorectal polyposis: Progress and challenges.","authors":"Arkadeep Dhali, Rick Maity, Jyotirmoy Biswas","doi":"10.3748/wjg.v31.i35.112220","DOIUrl":"10.3748/wjg.v31.i35.112220","url":null,"abstract":"<p><p>The study by Dos Santos <i>et al</i> marks a significant advancement in understanding the genetics of colorectal polyposis, particularly within the underrepresented Brazilian population. Utilizing whole-exome sequencing in 27 patients with unexplained polyposis, the researchers identified 16 candidate genes in 44.4% of cases-an impressive outcome given strict exclusion criteria. Many identified variants were linked to the Wnt/β-catenin signaling pathway, reinforcing their biological relevance. However, the study underscores key challenges in genomic medicine, especially the gap between gene discovery and clinical application. A substantial proportion of variants (60.1%) were classified as of uncertain significance, and the absence of functional validation or segregation analysis limits clinical interpretation. Notably, the potential for oligogenic inheritance complicates traditional monogenic models of hereditary cancer risk. The study's focus on a genetically diverse Brazilian cohort emphasizes the need for population-specific genomic resources and interpretation guidelines. Moving forward, functional studies, including organoid models, loss-of-heterozygosity analyses, and genotype-phenotype correlations, are essential to validate findings. Clinically, discovering novel candidate genes may inform future screening and testing protocols, though careful consideration is needed to manage uncertain results. Overall, the study represents a critical step in polyposis genetics, highlighting both progress made and the work still required for clinical translation.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"112220"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193327","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":"Second United Arab Emirates consensus guidance on the diagnosis and management of inflammatory bowel disease.","authors":"Sameer Al Awadhi, Abdulla Al Hassani, Sara El Ouali, Mohammad Badre Alam, Cecilio Azar, Filippos Georgopoulos, Ahmad N Jazzar, Ahmed M Khassouan, Zaher Koutoubi, Rahul A Nathwani, Mohammed Nabil Quraishi","doi":"10.3748/wjg.v31.i35.109882","DOIUrl":"10.3748/wjg.v31.i35.109882","url":null,"abstract":"<p><p>The second edition of the United Arab Emirates inflammatory bowel disease (IBD) consensus guidance provides updated recommendations for diagnosing, treating, and monitoring IBD. Significant therapeutic advances and evolving treatment paradigms since 2020 (including risk stratification and treat-to-target approaches) necessitated this comprehensive update to standardize care across the United Arab Emirates. Developed <i>via</i> Delphi consensus methodology, this guidance incorporates a systematic literature review and key international guidelines. It presents 188 summary statements covering the full spectrum of IBD care, including complex scenarios like perianal disease and pregnancy. Key updates feature guidance on newer pharmacologic therapies - interleukin-23, Janus kinase, and sphingosine-1-phosphate receptor inhibitors - with refined therapeutic positioning informed by recent head-to-head trials. The consensus emphasizes early, effective treatment to prevent irreversible bowel damage, optimization strategies like therapeutic drug monitoring, and achieving objective treat-to-target goals to improve long-term outcomes. Recognizing local healthcare system challenges, it offers practical recommendations on reducing variability and enhancing equitable access to IBD care. By integrating current clinical evidence with United Arab Emirates-specific considerations, the second edition United Arab Emirates IBD consensus guidance aims to standardize care across sectors, provide a benchmark for payers and policymakers, optimize treatment outcomes, and improve IBD outcomes, aligning national practice with international standards.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"109882"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193364","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":"Machine learning as an artificial intelligence application in management of chronic hepatitis B virus infection.","authors":"Wafaa Mohamed Ezzat","doi":"10.3748/wjg.v31.i35.109776","DOIUrl":"10.3748/wjg.v31.i35.109776","url":null,"abstract":"<p><p>Let's review the role of gut microbiota in pathogenesis of chronic hepatitis B infection as addressed in by Zhu <i>et al</i>. Zhu <i>et al</i> used high-throughput technology to characterize the microbial ecosystems, which led to an explosion of various types of molecular profiling data, such as metagenomics, metatranscriptomics, and metabolomics. To analyze such data, machine learning (ML) algorithms have shown to be useful for identifying key molecular signatures, discovering potential patient stratifications, and, particularly, for generating models that can accurately predict phenotypes. Strong evidence suggests that such gut microbiome-based stratification could guide customized interventions to benefit human health. Supervised learning includes designing an algorithm to fix a pre-identified problem. To get an answer, ML software must access data that have been nominated. On the other hand, unsupervised learning does not address any pre-defined problems. Bias should be eliminated as much as possible. In unsupervised learning, an ML algorithm works to identify data patterns without any prior operator input. This can subsequently lead to elements being identified that could not be conceived by the operator. At the intersection between supervised and unsupervised learning is semi-supervised ML. Semi-supervised learning includes using a partially labeled data set. The ML algorithm utilizes unsupervised learning to label data (that has not yet been labelled) by drawing findings from the labeled data. Then, supervised techniques can be used to solve defined problems involving the labeled data. Reinforcement learning, which is similar to supervised learning in the meaning, is goal-oriented. Reinforcement learning does not need labeled data, instead, it is provided with a set of regulations on a problem. An algorithm will carry out operations to try to answer questions involving the problem. Based on obtained data of gut microbiota, various therapeutic modalities can be applied: Prebiotics, probiotics, postbiotics, engineered bacteria, bacteriophage, and novel microbe-materials therapeutic system and fecal transplantation. In conclusion, ML is an artificial intelligence application that helps in providing new perspectives on tailored therapy. Furthermore, assessing the impact of gut microbiota modification is a critical step in advanced liver disease management. These new artificial intelligence techniques although promising, still require further analysis and validation in future studies.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"109776"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193375","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":"Radiofrequency ablation with or without capecitabine maintenance therapy for lung oligometastases from colorectal cancer.","authors":"Ke-Ning Li, Lei-Lei Ying, Nan Du, Ying Wang, Hao-Zhe Huang, Yao-Hui Wang, Li-Chao Xu, Qing Zhao, Ge Song, Yu-Bin Hu, Wen-Tao Li, Yan Yan, Chao Chen, Xin-Hong He","doi":"10.3748/wjg.v31.i35.110152","DOIUrl":"10.3748/wjg.v31.i35.110152","url":null,"abstract":"<p><strong>Background: </strong>No clear guidelines for long-term postoperative maintenance therapy have been established for patients with lung oligometastases from colorectal cancer (CRC) who achieve radiological no evidence of disease after radiofrequency ablation (RFA) treatment. We compared the outcomes of patients with lung oligometastases from CRC after RFA plus maintenance capecitabine with RFA alone.</p><p><strong>Aim: </strong>To determine whether adding capecitabine to RFA improves prognosis compared with RFA alone.</p><p><strong>Methods: </strong>This multicenter retrospective study included consecutive patients from two tertiary cancer centers treated for pulmonary oligometastases from CRC between 2016 and 2023. Subjects were assigned to RFA plus capecitabine (combined) or RFA alone (only RFA) groups. Primary outcomes included overall survival (OS) and progression-free survival (PFS) survival and the secondary outcome was local tumor progression (LTP). The OS, PFS, and LTP rates were compared between the two groups. In addition, prognostic factors were identified using univariate and multivariate analyses.</p><p><strong>Results: </strong>Combination therapy (RFA + capecitabine, <i>n</i> = 148) and RFA monotherapy (<i>n</i> = 99) were compared in patients with CRC and lung metastases. The median OS was 37.8 months (22.4, 50.3), the PFS was 18.7 months (13.0, 36.5), and the LTP was 31.5 months (20.0, 52.4) in the Only RFA group. The OS increased significantly (<i>P</i> = 0.011) and the LTP decreased at all time points (<i>P</i> < 0.001) in the combined group. The multivariate cox analysis revealed that combined chemotherapy significantly improved OS, with hazard ratios ranging from 0.29 to 0.35 (all <i>P</i> < 0.015) after adjusting for demographic, tumor, and treatment-related factors. The risk of death was consistently lower in the combination therapy group compared to RFA monotherapy.</p><p><strong>Conclusion: </strong>RFA prolongs survival and local control in patients with CRC pulmonary oligometastases. Adjuvant capecitabine increases OS and reduces LTP compared to RFA alone, but PFS did not significantly change.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"110152"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193335","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":"Advances in portal hypertension management: Evolution of the Baveno guidelines.","authors":"Michał Brzdęk, Krystyna Dobrowolska, Jakub Janczura, Małgorzata Wajdowicz, Kinga Brzdęk, Dorota Zarębska-Michaluk, Anita Gąsiorowska, Alessandra Mangia","doi":"10.3748/wjg.v31.i35.110241","DOIUrl":"10.3748/wjg.v31.i35.110241","url":null,"abstract":"<p><p>Management of portal hypertension has been the focus of the Baveno guidelines since 1990. This article explores the evolution of these recommendations and their impact on clinical practice. Initially reliant on invasive diagnostics such as the hepatic venous pressure gradient, later editions have incorporated non-invasive methods such as elastography and serum biomarkers. Management strategies have evolved substantially. Endoscopic surveillance has shifted from routine annual endoscopy to an individualized approach based on liver stiffness and platelet count. The role of non-selective beta-blockers (NSBBs) in primary prophylaxis has expanded. Endoscopic band ligation has become the preferred alternative for patients intolerant to NSBBs. In secondary prophylaxis, Baveno II replaced sclerotherapy with band ligation, and later guidelines confirmed the superiority of NSBBs combined with ligation. Transjugular intrahepatic portosystemic shunt emerged as the preferred rescue therapy, with early use emphasized in high-risk patients. Ongoing advancements continue to refine diagnostic and therapeutic strategies, further improving patient outcomes.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 35","pages":"110241"},"PeriodicalIF":5.4,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193372","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}