World Journal of Gastroenterology最新文献

{"title":"Redefining the albumin-bilirubin score: Predictive modeling and multidimensional integration in liver and systemic disease.","authors":"Berkay Demirors, Ramin Shekouhi, Paola Berrios Jimenez, Anjali Yadav, Guido Chiriboga, Vishal A Mahesh, Harsheen K Manaise, Jade Bowers, Angel Aguayo Merly, Emmanuel Gabriel","doi":"10.3748/wjg.v31.i34.110602","DOIUrl":"10.3748/wjg.v31.i34.110602","url":null,"abstract":"<p><p>This editorial comment is on the article by Xu <i>et al</i>. It offers an in-depth analysis of liver function assessment tools and their prognostic roles in non-malignant liver diseases, with a focus on the albumin-bilirubin (ALBI) score. ALBI's components, grading system, and clinical relevance across various liver conditions are reviewed and compared with traditional models such as the Child-Pugh and model for end-stage liver disease scores. We included recent studies evaluating ALBI's role in estimating liver function, suggesting it may help differentiate patients who appear similar under other staging systems, and assist in guiding clinical decisions. Although ALBI is primarily used as an indicator of hepatic reservoir in hepatocellular carcinoma, it has been demonstrated a positive correlation with overall survival, tumor recurrence, and post-hepatectomy liver failure in patients undergoing potentially curative treatments such as liver resection, liver transplantation, and local ablation. Moreover, several studies suggest that ALBI can also predict survival outcomes, treatment-related toxicity, and liver-related complications in patients receiving trans-arterial chemoembolization, radioembolization, external-beam radiotherapy, or systemic therapies. Its growing use in non-malignant liver diseases, including primary biliary cholangitis, cirrhosis, acute and chronic liver failure, and viral hepatitis highlights the need for large, prospective studies. Further studies are warranted to validate the integration of ALBI into routine clinical practice and to clarify its role in guiding prognosis and treatment planning.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 34","pages":"110602"},"PeriodicalIF":5.4,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041521","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":"Complications of single-balloon enteroscopy: A nine-year multicenter experience of 2865 procedures.","authors":"Saif Ullah, Yang-Qiu Bai, Nicha Wareesawetsuwan, Ling-Ling Cui, Yong-Ji Danzhu, Ke Wang, Shan-Shan Zhu, Xiliya He, Xin-Guang Cao, Chang-Qing Guo, Fang-Bin Zhang","doi":"10.3748/wjg.v31.i34.110548","DOIUrl":"10.3748/wjg.v31.i34.110548","url":null,"abstract":"<p><strong>Background: </strong>Single-balloon enteroscopy (SBE) is an established procedure for evaluating small bowel lesions. While its efficacy is well recognized, the incidence of major complications and their associated risk factors in a large population remain unclear.</p><p><strong>Aim: </strong>To investigate the complications and risk factors associated with diagnostic SBE.</p><p><strong>Methods: </strong>This multicenter retrospective study included consecutive patients who underwent diagnostic SBE at three tertiary care hospitals between January 2016 and September 2024. Data on baseline characteristics, procedural parameters, indications, findings, and major complications were collected and analyzed.</p><p><strong>Results: </strong>A total of 2865 SBE procedures were performed in 1840 patients. The mean age was 51 ± 18 years, and 64.5% were male. The most common indication was obscure gastrointestinal bleeding (57.1%), followed by abdominal pain (30.5%). The major complication rate was 0.4% (7/1840), all of which involved acute intestinal perforation identified during the procedure. Among the perforation cases, 6 occurred in patients undergoing SBE for abdominal pain and 1 for obscure gastrointestinal bleeding. The perforation sites included the ileum (6/7) and duodenum (1/7). All cases were successfully managed surgically. Previous abdominal surgery and the use of abdominal compression were significantly associated with an increased risk of perforation (<i>P</i> value < 0.001 for both). In subgroup analysis, perforation rates were 2.1% (6/288) in patients with prior abdominal surgery and 1.6% (7/428) with abdominal compression.</p><p><strong>Conclusion: </strong>Acute intestinal perforation is a rare but serious complication. Prior abdominal surgery and abdominal compression are important risk factors, and careful patient selection is recommended to minimize complications.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 34","pages":"110548"},"PeriodicalIF":5.4,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065750","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":"Dual therapy with vildagliptin and sacubitril/valsartan alleviates portal hypertension and inhibits soluble epoxide hydrolase in cirrhotic rats.","authors":"Masafumi Oyama, Kosuke Kaji, Norihisa Nishimura, Junichi Hanatani, Tatsuya Nakatani, Naoki Nishimura, Akihiko Shibamoto, Shohei Asada, Yuki Tsuji, Koh Kitagawa, Shinya Sato, Tadashi Namisaki, Hitoshi Yoshiji","doi":"10.3748/wjg.v31.i33.109562","DOIUrl":"10.3748/wjg.v31.i33.109562","url":null,"abstract":"<p><strong>Background: </strong>Portal hypertension (PH), a major complication of cirrhosis, arises from increased intrahepatic resistance and splanchnic vasodilation. Epoxyeicosatrienoic acids (EETs) improve hepatic microcirculation, but their effects are rapidly inactivated by soluble epoxide hydrolase (sEH), an enzyme upregulated in the cirrhotic liver. Inhibiting sEH increases EET levels, reducing portal pressure and fibrosis. Dipeptidyl peptidase-4 inhibitors (DPP4-Is) and angiotensin II blockers have been reported to suppress sEH and enhance EET activity. Angiotensin receptor-neprilysin inhibitors (ARNIs) also lower portal pressure. However, the combined effect of DPP4-I and ARNI on the sEH-EET axis in PH and liver fibrosis remains uninvestigated.</p><p><strong>Aim: </strong>To study the effects of vildagliptin, a DPP4-I and sacubitril/valsartan, an ARNI on PH and liver fibrosis in cirrhotic rats.</p><p><strong>Methods: </strong>Two rodent models of liver cirrhosis: (1) Choline-deficient, L-amino acid-defined, high-fat diet (CDAHFD) diet-fed rats; and (2) Bile duct ligation-induced rats were treated with vildagliptin (10 mg/kg/day), sacubitril/valsartan (30 mg/kg/day), or a combination of both drugs. Hemodynamic parameters, sEH activity, EET levels, vascular remodeling, and fibrosis were assessed using enzyme-linked immunosorbent assay, quantitative real-time polymerase chain reaction, Western blotting, histology, and immunofluorescence.</p><p><strong>Results: </strong>In CDAHFD-fed models, both DPP4-I and ARNI significantly reduced portal pressure in cirrhotic rats by decreasing intrahepatic vascular resistance without affecting systemic hemodynamics. These agents downregulated sEH expression and activity, increasing EET levels, and improved endothelial function <i>via</i> nitric oxide signaling enhancement. They also suppressed sinusoidal capillarization, pathological angiogenesis, and Hedgehog signaling, while restoring sinusoidal endothelial markers. Additionally, DPP4-I and ARNI attenuated liver fibrosis and stellate cell activation, reducing profibrotic gene expression. These effects were additive by the combination of both drugs. Similar effects were observed in bile duct ligation-induced PH, confirming their therapeutic potential in managing both PH and liver fibrosis through modulation of the sEH-EET pathway.</p><p><strong>Conclusion: </strong>Combined DPP4-I with ARNI therapy ameliorates PH and fibrosis <i>via</i> sEH suppression and EET restoration, offering a promising treatment strategy for cirrhosis-related PH.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 33","pages":"109562"},"PeriodicalIF":5.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041423","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":"Risk factors and long-term prognosis for colorectal strictures in ulcerative colitis.","authors":"Yu-Pei Shao, Tao-Tao Han, Hong Lv, Sun-Ting Yang, Qing-Li Zhu, Ji Li, Jing-Nan Li","doi":"10.3748/wjg.v31.i33.109938","DOIUrl":"10.3748/wjg.v31.i33.109938","url":null,"abstract":"<p><strong>Background: </strong>Strictures in ulcerative colitis (UC) are relatively uncommon but are associated with increased risk of malignancy and complications. Until recently, fibrogenesis and strictures have remained largely unexplored in UC.</p><p><strong>Aim: </strong>To investigate the incidence, long-term prognosis and risk factors of colorectal strictures in a large cohort of UC patients.</p><p><strong>Methods: </strong>A total of 938 hospitalized UC patients at Peking Union Medical College Hospital were included from 2014 to 2024. Stricture was defined as a fixed localized narrowing of the colorectal lumen. Risk factors for stricture formation were identified by multivariable Cox regression. Prognosis was analyzed using the Kaplan-Meier or Fine-Gray method. Sensitivity analysis excluded malignant strictures due to their distinct pathophysiology.</p><p><strong>Results: </strong>The overall incidence of stricture was 12.4% over a median follow-up of 8.70 years, with a 10-year cumulative probability of 11.3%. Malignancy occurred in 8.6% of stricture cases. UC patients with strictures were at higher risk for intestinal complications, surgery and malignancy (<i>P</i> < 0.05). The 10-year cumulative probabilities of surgery and all-cause mortality were 37.6% and 1.6%, respectively. Age ≥ 40 years at diagnosis [hazard ratio (HR) = 2.197, 95% confidence interval (CI): 1.487-3.242] and extraintestinal manifestations (HR = 2.072, 95%CI: 1.326-3.239) were associated with higher stricture risk, while the use of biological agents such as vedolizumab (HR = 0.382, 95%CI: 0.203-0.720) was protective against strictures (<i>P</i> < 0.05). Sensitivity analysis on benign strictures showed consistent findings, with similar risk factors and worse long-term outcomes.</p><p><strong>Conclusion: </strong>UC patients with strictures had worse long-term prognostic outcomes. Earlier endoscopic surveillance and biologic treatment should be considered in patients ≥ 40 years or those with extraintestinal manifestations.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 33","pages":"109938"},"PeriodicalIF":5.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041489","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":"Noninvasive model based on liver and spleen stiffness for predicting clinical decompensation in patients with cirrhosis.","authors":"Long-Bao Yang, Xin Gao, Meng Xu, Yong Li, Lei Dong, Xin-Di Huang, Xiao She, Dan-Yang Zhang, Qian-Wen Zhang, Chen-Yu Liu, Shu-Ting Fan, Yan Wang","doi":"10.3748/wjg.v31.i33.107408","DOIUrl":"10.3748/wjg.v31.i33.107408","url":null,"abstract":"<p><strong>Background: </strong>The hepatic venous pressure gradient serves as a crucial parameter for assessing portal hypertension and predicting clinical decompensation in individuals with cirrhosis. However, owing to its invasive nature, there has been growing interest in identifying noninvasive alternatives. Transient elastography offers a promising approach for measuring liver stiffness and spleen stiffness, which can help estimate the likelihood of decompensation in patients with chronic liver disease.</p><p><strong>Aim: </strong>To investigate the predictive ability of the liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) in conjunction with other noninvasive indicators for clinical decompensation in patients suffering from compensatory cirrhosis and portal hypertension.</p><p><strong>Methods: </strong>This study was a retrospective analysis of the clinical data of 200 patients who were diagnosed with viral cirrhosis and who received computed tomography, transient elastography, ultrasound, and endoscopic examinations at The Second Affiliated Hospital of Xi'an Jiaotong University between March 2020 and November 2022. Patient classification was performed in accordance with the Baveno VI consensus. The area under the curve was used to evaluate and compare the predictive accuracy across different patient groups. The diagnostic effectiveness of several models, including the liver stiffness-spleen diameter-platelet ratio, variceal risk index, aspartate aminotransferase-alanine aminotransferase ratio, Baveno VI criteria, and newly developed models, was assessed. Additionally, decision curve analysis was carried out across a range of threshold probabilities to evaluate the clinical utility of these predictive factors.</p><p><strong>Results: </strong>Univariate and multivariate analyses demonstrated that SSM, LSM, and the spleen length diameter (SLD) were linked to clinical decompensation in individuals with viral cirrhosis. On the basis of these findings, a predictive model was developed <i>via</i> logistic regression: Ln [P/(1-P)] = -4.969 - 0.279 × SSM + 0.348 × LSM + 0.272 × SLD. The model exhibited strong performance, with an area under the curve of 0.944. At a cutoff value of 0.56, the sensitivity, specificity, positive predictive value, and negative predictive value for predicting clinical decompensation were 85.29%, 88.89%, 87.89%, and 86.47%, respectively. The newly developed model demonstrated enhanced accuracy in forecasting clinical decompensation among patients suffering from viral cirrhosis when compared to four previously established models.</p><p><strong>Conclusion: </strong>Noninvasive models utilizing SSM, LSM, and SLD are effective in predicting clinical decompensation among patients with viral cirrhosis, thereby reducing the need for unnecessary hepatic venous pressure gradient testing.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 33","pages":"107408"},"PeriodicalIF":5.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early postnatal characteristics and differential diagnosis of choledochal cyst and cystic biliary atresia.","authors":"Yu Tian, Shuai Chen, Can Ji, Xin-Ping Wang, Mao Ye, Xin-Yuan Chen, Jian-Feng Luo, Xu Li, Long Li","doi":"10.3748/wjg.v31.i33.108369","DOIUrl":"10.3748/wjg.v31.i33.108369","url":null,"abstract":"<p><strong>Background: </strong>Choledochal cysts (CC) and cystic biliary atresia (CBA) present similarly in early infancy but require different treatment approaches. While CC surgery can be delayed until 3-6 months of age in asymptomatic patients, CBA requires intervention within 60 days to prevent cirrhosis.</p><p><strong>Aim: </strong>To develop a diagnostic model for early differentiation between these conditions.</p><p><strong>Methods: </strong>A total of 319 patients with hepatic hilar cysts (< 60 days old at surgery) were retrospectively analyzed; these patients were treated at three hospitals between 2011 and 2022. Clinical features including biochemical markers and ultrasonographic measurements were compared between CC (<i>n</i> = 274) and CBA (<i>n</i> = 45) groups. Least absolute shrinkage and selection operator regression identified key diagnostic features, and 11 machine learning models were developed and compared.</p><p><strong>Results: </strong>The CBA group showed higher levels of total bile acid, total bilirubin, γ-glutamyl transferase, aspartate aminotransferase, and alanine aminotransferase, and direct bilirubin, while longitudinal diameter of the cysts and transverse diameter of the cysts were larger in the CC group. The multilayer perceptron model demonstrated optimal performance with 95.8% accuracy, 92.9% sensitivity, 96.3% specificity, and an area under the curve of 0.990. Decision curve analysis confirmed its clinical utility. Based on the model, we developed user-friendly diagnostic software for clinical implementation.</p><p><strong>Conclusion: </strong>Our machine learning approach differentiates CC from CBA in early infancy using routinely available clinical parameters. Early accurate diagnosis facilitates timely surgical intervention for CBA cases, potentially improving patient outcomes.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 33","pages":"108369"},"PeriodicalIF":5.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041457","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":"Exosomes derived from human umbilical cord mesenchymal stem cells attenuate hepatic ischaemia-reperfusion injury <i>via</i> the let-7i-5p/Faslg axis.","authors":"Yao Gao, Min He, Cong-Wen Bian, Rui Yu, Jia-Jiao Luo, Yin-Ming Xiang, Yun-Xin Yang, Han-Fei Huang, Zhong Zeng","doi":"10.3748/wjg.v31.i33.108653","DOIUrl":"10.3748/wjg.v31.i33.108653","url":null,"abstract":"<p><strong>Background: </strong>Hepatic ischaemia-reperfusion injury (HIRI) is an unavoidable process in liver transplantation, where apoptosis plays a critical role. Human umbilical cord mesenchymal stem cell-derived exosomes (hucMSC-exos), which constitute a cell-free therapeutic approach, have garnered extensive attention in alleviating HIRI. However, the potential of hucMSC-exos in mitigating apoptosis and their underlying mechanisms remain largely unknown.</p><p><strong>Aim: </strong>To investigate the effects of hucMSC-exos on apoptosis after HIRI and explore the underlying mechanisms.</p><p><strong>Methods: </strong>The therapeutic effects of hucMSC-exos on HIRI and hypoxia/reoxygenation injury in L02 cells were investigated. RNA sequencing was used to detect differentially expressed genes in L02 cells after hucMSC-exo treatment, and the expression of apoptosis markers in L02 cells was analyzed. MicroRNA (miRNA) sequencing was performed to analyse the miRNA expression profiles of hucMSC-exos and L02 cells after hucMSC-exo treatment. Through a miRNA-mRNA integrated analysis, candidate miRNAs and their regulated target genes were identified. We subsequently studied the roles of these candidate miRNAs in mouse HIRI and L02 cell hypoxia/reoxygenation injury.</p><p><strong>Results: </strong>Fluorescence confocal microscopy revealed that hucMSC-exos effectively homed to the liver and were taken up by hepatocytes, likely due to the presence of anti-very late antigen-4 and anti-lymphocyte function-associated antigen-1 on the surface of hucMSC-exos. HucMSC-exos alleviate hepatocyte damage by inhibiting apoptosis. Specifically, let-7i-5p within hucMSC-exos inhibited the expression of the factor-related apoptosis ligand protein in L02 cells, leading to the upregulation of B-cell lymphoma-2 and the downregulation of B-cell lymphoma-2-associated X protein and cysteinyl aspartate specific proteinase-3, thereby inhibiting L02 cell apoptosis and enhancing cell proliferation activity. The overexpression of let-7i-5p effectively enhanced the antiapoptotic effects of hucMSC-exos both <i>in vitro</i> and <i>in vivo</i>.</p><p><strong>Conclusion: </strong>Our findings indicate that hucMSC-exos alleviate HIRI by inhibiting apoptosis. We demonstrated that hucMSC-exos target apoptosis in L02 cells and mediate the let-7i-5p/factor-related apoptosis ligand pathway, thereby ameliorating HIRI. This study provides new insights into the role of hucMSC-exos in hepatocyte apoptosis and highlights the potential of hucMSC-exos as a therapeutic strategy for HIRI.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 33","pages":"108653"},"PeriodicalIF":5.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12418009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041438","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":"Transperineal ultrasound: Role in inflammatory bowel disease management.","authors":"Partha Pal, Mohammad Abdul Mateen, Kanapuram Pooja, Rajesh Gupta, Manu Tandan, Duvvuru Nageshwar Reddy","doi":"10.3748/wjg.v31.i33.109811","DOIUrl":"10.3748/wjg.v31.i33.109811","url":null,"abstract":"<p><p>Transperineal ultrasound (TPUS) is a non-invasive, real-time imaging technique increasingly utilized for the evaluation of anorectal and pelvic floor disorders in patients with inflammatory bowel disease (IBD). In ulcerative colitis, it enables accurate assessment of rectal wall thickness and vascularity, which correlate closely with both endoscopic and histological inflammation. This makes it a practical alternative to sigmoidoscopy, especially in settings such as pregnancy, childhood, or long-term disease monitoring. In Crohn's disease, TPUS offers high diagnostic accuracy for detecting, classifying, and monitoring perianal fistulas and abscesses. It is also effective for evaluating rectovaginal fistulas and pouch-related complications following restorative proctocolectomy. Advancements such as color Doppler imaging, contrast-enhanced ultrasound, three-dimensional reconstruction, and computer-assisted grayscale analysis further enhance its diagnostic and functional capabilities. Compared to magnetic resonance imaging and endoscopic ultrasound, TPUS serves as a practical, patient-friendly, and cost-effective frontline or complementary imaging tool for comprehensive disease evaluation and treatment planning-particularly useful in children, pregnant women, and resource-limited settings. Its bedside feasibility, repeatability, and expanding role in treatment monitoring underscore its value in modern IBD care pathways.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 33","pages":"109811"},"PeriodicalIF":5.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041445","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":"Methotrexate in the management of Crohn's disease: A practice survey of gastroenterologists in France.","authors":"Guillaume Bonnaud, Jennifer Becker, Myriam Chebbah, Agnès Courbeyrette, Patrick Faure","doi":"10.3748/wjg.v31.i33.108872","DOIUrl":"10.3748/wjg.v31.i33.108872","url":null,"abstract":"<p><strong>Background: </strong>Second-line treatment of Crohn's disease (CD) commonly involves immunosuppressants such as azathioprine, mercaptopurine, or methotrexate (MTX), used either alone or in combination.</p><p><strong>Aim: </strong>To investigate the current use of MTX among French gastroenterologists.</p><p><strong>Methods: </strong>An online questionnaire was distributed between March and August 2023 to 116 French gastroenterologists managing CD. A total of 87 respondents completed the survey and were included in the analysis.</p><p><strong>Results: </strong>Respondents reported a mean annual caseload of 140 CD patients (median: 50). Overall, 71% prescribed MTX, predominantly in injectable form (92%), either as monotherapy or in combination with biologics or cyclosporin. MTX was prescribed for mild-to-moderate CD by 64% of respondents, and for severe CD by 58%, often in combination with an anti-tumor necrosis factor agent (89% and 94%, respectively). Injectable MTX was favored (84%) in specific clinical scenarios: Patients with articular manifestations (77%), Epstein-Barr virus-negative status (65%), or aged over 65 years (58%). Among the 29% of non-prescribers, the primary reason cited was lack of familiarity with MTX use (60%). Both prescribers and non-prescribers expressed the need for clearer guidelines and real-world data to support MTX use.</p><p><strong>Conclusion: </strong>Regardless of prescribing habits, most respondents had a favorable opinion of MTX and recognized its good long-term safety profile. French learned societies and medical associations should provide consensus guidelines on MTX use, supported by validated real-world safety and effectiveness data.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 33","pages":"108872"},"PeriodicalIF":5.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041450","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":"Incidence, disease course, therapeutic strategies and outcomes of inflammatory bowel disease-unclassified patients in Western Hungary: A population-based cohort.","authors":"Fruzsina Balogh, Lorant Gonczi, Dorottya Angyal, Petra Anna Golovics, Tunde Pandur, Gyula David, Zsuzsanna Erdelyi, Istvan Szita, Akos Ilias, Laszlo Lakatos, Peter Laszlo Lakatos","doi":"10.3748/wjg.v31.i33.109800","DOIUrl":"10.3748/wjg.v31.i33.109800","url":null,"abstract":"<p><strong>Background: </strong>The number of population-based studies on unclassified inflammatory bowel disease (IBD-U) is very limited.</p><p><strong>Aim: </strong>To evaluate the long-term incidence, disease course and surgery rates of IBD-U in a prospective population-based cohort.</p><p><strong>Methods: </strong>The present study is a continuation of the well-established Veszprem IBD cohort with patient inclusion between 1977 and 2018. Both in-hospital and outpatient records were collected. The source of age- and gender-specific demographic data was derived from the Hungarian Central Statistical Office. Medical therapy, surgery and change in disease phenotype were analyzed.</p><p><strong>Results: </strong>Data of 119 incident IBD-U patients were analyzed [male/female: 55/64; median age at diagnosis: 34 years (interquartile range: 24-47.5)]. Adjusted mean incidence rate was 0.76 (95%CI: 0.63-0.9)/10⁵ person-years in the total study period. Disease extent at diagnosis was extensive (pancolitis) in 56.3%. Twenty-two of 119 (18.5%) patients were reclassified to Crohn's disease during follow up, the probability of developing terminal ileum involvement was 6.8%, while perianal disease developed in 5% (<i>n</i> = 6). The probability of receiving biological therapy in patients diagnosed after the year 2000 (<i>n</i> = 62), was 15.5% (SD: 4.8) at 5 years. The overall resective surgery rate was 16.8%. Segment resection was performed in 5.0% of the patients, and 11.8% underwent subtotal or total colectomy. The cumulative probability of resective surgery was 7.6% (SD: 2.4) at 1 year, 9.3% (SD: 2.7) at 5 years, 13.5% (SD: 3.3) at 10 years, and 18.5% (SD: 3.9) at 20 years.</p><p><strong>Conclusion: </strong>These data extend our knowledge on the overall burden of IBD-U. Colonic involvement was extensive in a high proportion of IBD-U. Disease reclassification to Crohn's disease was relatively high. High rates of biological therapy and surgery rates support a relatively severe disease course of IBD-U.</p>","PeriodicalId":23778,"journal":{"name":"World Journal of Gastroenterology","volume":"31 33","pages":"109800"},"PeriodicalIF":5.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417946/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041468","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}