JGH Open最新文献

{"title":"Comparison of Changes in Biomarkers With Changes in Endoscopic Scores in Patients With Ulcerative Colitis: A Single-Center, Retrospective, Observational Study.","authors":"Yosuke Yamada, Natsuki Ishida, Tomohiro Takebe, Kenichi Takahashi, Yusuke Asai, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Takanori Yamada, Satoshi Osawa, Ken Sugimoto","doi":"10.1002/jgh3.70405","DOIUrl":"https://doi.org/10.1002/jgh3.70405","url":null,"abstract":"<p><strong>Aim: </strong>Fecal occult blood concentration, fecal calprotectin (FC) level, serum C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) are valuable biomarkers for ulcerative colitis (UC). However, their clinical utility for longitudinal disease assessment remains unclear. This retrospective, observational study assessed correlations between biomarker changes and endoscopic activity scores in UC.</p><p><strong>Methods: </strong>Spearman's rank correlation coefficient analysis was applied to examine the relationship between longitudinal variations in endoscopic activity scores, including the Mayo endoscopic subscore (MES), ulcerative colitis endoscopic index of severity (UCEIS), and sum of Mayo endoscopic subscores (S-MES), and corresponding biomarker changes in patients with UC.</p><p><strong>Results: </strong>The study included 97 patients, contributing to 145 observation intervals (48 contributed two intervals each and 49 contributed one each). All endoscopic scores and biomarkers were significantly correlated with disease activity, with corresponding increases or decreases (<i>p</i> < 0.05). Changes in MES and S-MES correlated most strongly with FC level changes (<i>r</i> = 0.62 and 0.66, respectively). Changes in the UCEIS exhibited the strongest correlation with fecal occult blood concentration changes (<i>r</i> = 0.67). Changes in fecal occult blood and FC (<i>r</i> = 0.55) and in serum CRP and ESR (<i>r</i> = 0.58) were strongly correlated.</p><p><strong>Conclusions: </strong>All four biomarkers reflected endoscopic activity in UC. Changes in fecal occult blood concentration and FC level had stronger correlations with endoscopic score changes than blood biomarker concentration changes. FC assessment is valuable for monitoring inflammatory activity during remission maintenance, whereas fecal occult blood concentration reflects mucosal bleeding. Serum CRP level and ESR are useful adjunctive biomarkers, particularly in cases of increased disease activity.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 ","pages":"e70405"},"PeriodicalIF":1.5,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Switching From Intravenous to Subcutaneous Vedolizumab in Japanese Patients With Ulcerative Colitis: A Study Focusing on Injection-Site Reactions.","authors":"Makoto Furuya, Kiichiro Yoza, Takeshi Yonezawa, Ken Takeuchi","doi":"10.1002/jgh3.70407","DOIUrl":"https://doi.org/10.1002/jgh3.70407","url":null,"abstract":"<p><strong>Background/aims: </strong>The subcutaneous (SC) formulation of vedolizumab is available as an alternative to the intravenous (IV) formulation in patients with ulcerative colitis (UC). However, data from Asian patients are limited, and the clinical course of injection-site reactions (ISRs) remains unclear. This study evaluated the efficacy and safety of switching from IV to SC vedolizumab in Japanese patients with UC, focusing on ISRs.</p><p><strong>Methods: </strong>This retrospective study included patients who switched from IV to SC vedolizumab. The primary outcomes were the incidence and clinical course of ISRs. The secondary outcomes included adverse events other than ISRs, disease activity, remission rates, and treatment persistence.</p><p><strong>Results: </strong>In total, 48 patients were included. The median fecal calprotectin levels remained stable from baseline to 12 months after switching (46.0 vs. 46.0 μg/g), with the fecal calprotectin remission rate remaining stable (41/45, 91% vs. 39/45, 87%). The persistence rate of SC vedolizumab was 98%, and the persistence rate without additional therapy was 94%. ISRs occurred in 29 patients (60%), most frequently within 3-6 months, with a median duration of 4 months. More than half of ISRs improved or resolved by 12 months, and only 11 patients (23%) experienced persistent ISRs. No adverse events other than ISRs were considered likely or probably related to SC vedolizumab.</p><p><strong>Conclusions: </strong>In Asian patients with UC, disease activity was maintained after switching from IV to SC vedolizumab. Although ISRs were common after switching, most were self-limiting. Therefore, switching back to IV formulation solely for ISR management should be cautiously considered.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 4","pages":"e70407"},"PeriodicalIF":1.5,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stricturing Diseases of the Gastrointestinal Tract-Current Clinical Practice.","authors":"Monjur Ahmed","doi":"10.1002/jgh3.70411","DOIUrl":"https://doi.org/10.1002/jgh3.70411","url":null,"abstract":"<p><p>Gastrointestinal stricture can occur in the esophagus, stomach, small intestine, colon, and anorectum. Most of the strictures are benign. The prevalence of esophageal strictures (ES) secondary to eosinophilic esophagitis has increased. Pyloric stenosis (PS) is rarely seen in clinical practice. Sleeve stenosis (SS) and stomal stenosis or gastrojejunal anastomotic stricture (GJAS) are increasingly seen due to bariatric surgery. Crohn's disease (CD) remains a significant challenge even in the biologic era. The symptomatology of strictures depends on the location, severity, and underlying cause. Imaging studies and endoscopic procedures are the primary investigations to diagnose and evaluate strictures. Various treatment modalities are available to treat gastrointestinal strictures. Successful stricture treatment can significantly improve a patient's quality of life. Benign strictures carry a much better prognosis than malignant strictures. Multiple other factors influence response to treatment.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 ","pages":"e70411"},"PeriodicalIF":1.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147784874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Cholecystectomy After Acute Biliary Severe Pancreatitis: A Systematic Review-Time for A Clinical Trial?","authors":"Carlos Eduardo Rey Chaves, Juan Pablo Diaz Amarís, Maria Alejandra Diaz Tarazona, Laura Sarmiento, Danny Conde, Isabella Alarcón, David Gómez Garnica","doi":"10.1002/jgh3.70368","DOIUrl":"https://doi.org/10.1002/jgh3.70368","url":null,"abstract":"<p><strong>Background: </strong>There is a lack of evidence about the optimal timing for cholecystectomy in patients with severe acute pancreatitis. The discussion centers on evaluating the benefits of performing early versus delayed cholecystectomy, looking for better outcomes. This systematic review aimed to assess the postoperative outcomes after cholecystectomy in patients with severe pancreatitis regarding the timing of the surgery.</p><p><strong>Methods: </strong>A systematic review was conducted, and the inclusion criteria included original, peer-reviewed retrospective or prospective studies involving humans > 18 years old with acute severe pancreatitis due to gallstone disease who underwent laparoscopic cholecystectomy. Newcastle Ottawa score was used to perform quality and bias assessment. The search was conducted from January 2004 to December 2023 within Pubmed, EMBASE, and Scopus.</p><p><strong>Results: </strong>A total of 1198 studies were found; after screening for duplicates, eligibility criteria and conducting quality assessment, three articles met the inclusion criteria and were included in the systematic review, involving a total of 598 patients. Early cholecystectomy (Defined < 15 days or 6 weeks) was performed in 30.10% (<i>n</i> = 179) and delayed cholecystectomy in 70.06% (<i>n</i> = 419), with a morbidity rate of 33% (<i>n</i> = 60) and 20% (<i>n</i> = 86), respectively. Mortality was most frequent when cholecystectomy was performed earlier (2.39% <i>n</i> = 10 vs. 0.23% <i>n</i> = 1).</p><p><strong>Conclusion: </strong>Despite limitations regarding the small sample size and the small amount of research published to date, this systematic review suggests that there is a higher risk of morbidity and mortality in patients with severe pancreatitis undergoing early cholecystectomy compared to those undergoing delayed cholecystectomy.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 4","pages":"e70368"},"PeriodicalIF":1.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tegoprazan in Gastroesophageal Reflux Disease and Related Acid-Mediated Conditions: A Systematic Review and Meta-Analysis.","authors":"Sanjay Bandyopadhyay, Mahesh Goenka, Debapratim Routh, G N Ramesh, Parimal Lawate","doi":"10.1002/jgh3.70406","DOIUrl":"10.1002/jgh3.70406","url":null,"abstract":"<p><p>Gastroesophageal reflux disease (GERD) is a chronic relapsing disorder often inadequately controlled with proton pump inhibitors (PPIs), particularly in patients with nocturnal acid breakthrough (NAB) or non-erosive reflux disease (NERD). Tegoprazan, a potassium-competitive acid blocker (PCAB), offers rapid, potent, and CYP2C19-independent acid suppression. This systematic review and meta-analysis evaluated randomized controlled trials comparing Tegoprazan with PPIs in adults with GERD and related disorders. Databases searched included PubMed, Cochrane, Wiley, and ClinicalTrials.gov (2015-2026). Eighteen studies met inclusion criteria. In erosive esophagitis, Tegoprazan 50 mg once daily achieved mucosal healing rates of 91.1%-99.1%, non-inferior to PPIs (93.5%-98.9%; pooled RR = 1.01, 95% CI 0.98-1.05). Pharmacodynamic and clinical studies demonstrated faster acid suppression and improved nocturnal pH control versus PPIs, achieving pH ≥ 4 within 30-60 min and maintaining levels throughout the 12-h period. In nocturnal symptom analyses, Tegoprazan achieved earlier relief (1.5 vs. 3 days to first heartburn-free night) and higher proportions of heartburn-free nights (57.8% vs. 43.1%), with significantly greater complete (<i>p</i> = 0.038) and partial (<i>p</i> = 0.034) nighttime symptom resolution than Esomeprazole. In NERD, symptom resolution ranged from 42.5% to 48.9% versus 24.2% with placebo. In open-label functional dyspepsia cohorts, improvements ranged from 74.6% to 86.7% in open-label cohorts. Seven trials (<i>n</i> = 2492) showed higher <i>Helicobacter pylori</i> eradication with Tegoprazan-based therapy (RR = 1.05, 95% CI 1.01-1.09; <i>p</i> = 0.006; <i>I</i> ² = 0%). Adverse events were mild and comparable to PPIs. Tegoprazan provides rapid, sustained acid suppression, effective nocturnal symptom control, and a modest but statistically significant improvement in <i>H. pylori</i> eradication, representing a potential alternative to PPIs for patients with persistent or CYP2C19-related variable response.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 4","pages":"e70406"},"PeriodicalIF":1.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13090113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Magnetic Resonance Enterography Predicts Long-Term Outcomes in Crohn's Disease: A Systematic Review and Meta-Analysis.","authors":"Shanshan Wu, Jiayi Yang, Seniu Jizhi, Aniu Liu, Xingyu Chen, Zhonglu Chen, Shumei Zheng","doi":"10.1002/jgh3.70408","DOIUrl":"10.1002/jgh3.70408","url":null,"abstract":"<p><strong>Background and aims: </strong>Crohn's disease (CD) is characterized by chronic transmural inflammation, which often leads to bowel damage. While mucosal healing (MH) is an established treatment target, transmural healing (TH) has emerged as a more comprehensive goal. Magnetic resonance enterography (MRE) provides excellent soft-tissue resolution for assessing TH. This meta-analysis evaluates the prognostic value of MRE in predicting surgery, hospitalization, and treatment escalation in adults with CD.</p><p><strong>Methods: </strong>A total of 16 studies involving adult CD patients with ≥ 12 months of follow-up (with a mean duration of 4.42 ± 3.90 years) were included if they incorporated pre- and posttreatment MRE, reported baseline MRE phenotypes (e.g., penetrating/stenosing lesions), and documented posttreatment TH. Hazard ratios (HRs) were used to compare associations between baseline MRE features, TH achievement, and long-term outcomes.</p><p><strong>Results: </strong>Baseline MRE-defined penetrating lesions were associated with increased risks of surgery (HR = 1.62, 95% CI: 1.37-1.91, <i>p</i> < 0.00001) and hospitalization (HR = 1.34, 95% CI: 1.18-1.53, <i>p</i> < 0.0001). Similarly, stricturing lesions were associated with an elevated risk of surgery (HR = 1.65, 95% CI: 1.39-1.96, <i>p</i> < 0.00001). Achieving TH was linked to lower risks of surgery (HR = 0.55, 95% CI: 0.44-0.68, <i>p</i> < 0.00001), hospitalization (HR = 0.54, 95% CI: 0.45-0.64, <i>p</i> < 0.00001), and treatment escalation (HR = 0.51, 95% CI: 0.46-0.57, <i>p</i> < 0.00001). Notably, TH achieved significantly greater risk reduction than MH alone, as evidenced by two direct comparative studies of these two treatment targets (HR = 0.28 and 0.26, respectively).</p><p><strong>Conclusion: </strong>MRE-identified penetrating/stenosing lesions at baseline predict higher risks of surgery and hospitalization. Conversely, TH achievement was associated with a marked reduction in adverse outcomes. Incorporating MRE into CD management facilitates early identification of high-risk patients for timely treatment intensification, thereby supporting personalized therapeutic strategies.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 ","pages":"e70408"},"PeriodicalIF":1.5,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13086639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interpretable Machine Learning for LPR Risk Estimation: A Single-Center Retrospective Case-Control Study.","authors":"Chunrou Long, Yuan Li, Xiaoxue Zhang, Jianhui Li, Xin Hao, Haiyang Hua","doi":"10.1002/jgh3.70404","DOIUrl":"https://doi.org/10.1002/jgh3.70404","url":null,"abstract":"<p><strong>Objective: </strong>Based on RSI and RFS scores, an interpretable machine learning model was constructed to identify risk factors for LPR, aiming to screen high-risk patients requiring 24-h pH-impedance monitoring and provide reference for clinical decision-making.</p><p><strong>Methods: </strong>A retrospective case-control study included 537 patients who underwent painless gastroscopy (June 2024-June 2025), split into training (<i>n</i> = 376) and validation (<i>n</i> = 161) sets at 7:3. Nested cross-validation-based Boruta algorithm screened key predictors. Nine machine learning models were built, with performance evaluated via F1 score, recall, accuracy, precision, AUC, and Brier score in the validation set. AUC stability was validated by 1000 Bootstrap resamplings. Decision curve analysis assessed clinical net benefit, SHAP method interpreted the optimal model, and a web-based risk calculator was developed.</p><p><strong>Results: </strong>Six independent LPR predictors were identified: arytenoid IPCL dilation, abdominal circumference, reflux esophagitis, alcohol consumption history, right lateral sleeping position, and GEFV grade III/IV. The random forest model performed best (F1 = 0.725, recall = 0.716, accuracy = 0.727, precision = 0.734), with Bootstrap-validated AUC of 0.815 (95% CI: 0.753-0.873). Calibration curve showed good fit, decision curve analysis confirmed clinical net benefit across thresholds. SHAP analysis ranked feature contributions as: arytenoid IPCL dilation, abdominal circumference, reflux esophagitis, alcohol consumption history, right lateral sleeping position, GEFV grade III/IV. A web-based calculator was deployed (URL: http://127.0.0.1:7292).</p><p><strong>Conclusion: </strong>This study constructed and validated an interpretable machine learning model integrating endoscopic and clinical indicators. The model demonstrates good discriminative ability and calibration and can serve as an auxiliary screening tool for patients with suspected LPR to help clinicians identify high-risk individuals who require priority 24-h MII-pH monitoring.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 4","pages":"e70404"},"PeriodicalIF":1.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary Vitamin B6 Intake and Gastroesophageal Reflux Disease: A Case-Control Study.","authors":"Amirhesam Mehrara, Saba Moradi, Masoumeh Dorosti, Leila Dehghanian, Masoumeh Sadat MirShafaie, Mohammadreza Esfahanian, Bita Moradi, Ali Nouri, Sara Khoshdooz, Parsa Bahmani, Saeid Doaei, Maryam Gholamalizadeh","doi":"10.1002/jgh3.70398","DOIUrl":"https://doi.org/10.1002/jgh3.70398","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder influenced by various dietary factors. This study aimed to evaluate the association between dietary intake of vitamin B6 and the risk of GERD.</p><p><strong>Methods: </strong>This case-control study included 150 women with GERD and 300 controls in Tehran, Iran. Dietary intake of vitamin B6 was assessed using a validated food frequency questionnaire (FFQ) and analyzed with Nutritionist IV software. Logistic regression models were applied to determine the association between GERD risk and dietary intake of vitamin B6, adjusting for age, education, marital status, occupation, physical activity, BMI, and calorie intake.</p><p><strong>Results: </strong>Compared with participants in the lowest tertile of vitamin B6 intake, those in the highest tertile had significantly higher odds of GERD in age-adjusted models (OR = 1.98, 95% CI: 1.12-3.51) and this association remained significant after further adjustment for sociodemographic factors, physical activity, BMI (OR = 2.05, 95% CI: 1.10-3.83), and total energy intake (OR = 2.02, 95% CI: 1.06-3.81). No significant association was observed for the middle tertile.</p><p><strong>Conclusion: </strong>The findings of this case-control study indicate a positive association between higher dietary vitamin B6 intake and the risk of GERD. Further prospective research would be helpful to confirm these observations and to shed light on possible biological mechanisms.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 4","pages":"e70398"},"PeriodicalIF":1.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13079406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147699904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency, Predictive Factors, and Burden of Gastrointestinal Symptoms in Patients With Type 2 Diabetes","authors":"Wah-Loong Chan,&nbsp;Sarmila Sathiya Seelan,&nbsp;Jeyakantha Ratnasingam,&nbsp;Christine Shamala Selvaraj,&nbsp;Kee-Huat Chuah,&nbsp;Sanjiv Mahadeva","doi":"10.1002/jgh3.70403","DOIUrl":"10.1002/jgh3.70403","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Gastrointestinal (GI) symptoms are common in diabetes, but their prevalence and impact in Asian adults with type 2 diabetes (T2D) remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>A cross-sectional study of diabetes patients from a primary care clinic and a diabetes specialized clinic from this institution was conducted. Demographic and clinical data were obtained using validated questionnaires and electronic medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 297 patients, 245 (82.5%) reported GI symptoms, 207 (69.7%) had upper GI symptoms and 183 (61.6%) had lower GI symptoms. Anxiety and depression were identified in 11.4% and 8.1% of patients, respectively. Women had a two-fold increased risk of upper GI symptoms (aOR 2.02; 95% CI 1.22–3.33; <i>p</i> = 0.006). Anxiety was linked to upper GI symptoms (88.2% vs. 67.3%; <i>p</i> = 0.018), with adjusted analysis showing a threefold increased risk (aOR 3.45; 95% CI 1.17–10.16; <i>p</i> = 0.025). Participants older than 50 years had more frequent lower GI symptoms (64.3% vs. 47.9%; <i>p</i> = 0.035), with multivariate analysis indicating a trend toward independent risk (aOR 1.92; 95% CI 0.99–3.69; <i>p</i> = 0.051). Antiplatelet therapy was also associated with lower GI symptoms (aOR 1.74; 95% CI 1.00–3.01; <i>p</i> = 0.047). Diabetes patients with GI symptoms were more likely to undergo upper GI endoscopy (18.8% vs. 9.6%; <i>p</i> = 0.07), lower GI endoscopy (13.9% vs. 5.8%; <i>p</i> = 0.07), abdominal ultrasound (20.4% vs. 15.4%; <i>p</i> = 0.26) and require proton pump inhibitor (22.9% vs. 7.7%; <i>p</i> = 0.007).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>GI symptoms are very frequent in Asian patients with diabetes, increasing the burden on healthcare utilization. They appear to be influenced by demographic and psychological factors more than the underlying DM per se.</p>\u0000 </section>\u0000 </div>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgh3.70403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147668521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selective Drug-Free Active Surveillance in Ulcerative Colitis: Biomarker-Guided, Patient-Centered Approach","authors":"Tsutomu Nishida,&nbsp;Naoto Osugi,&nbsp;Takahiro Amano,&nbsp;Takeo Yoshihara","doi":"10.1002/jgh3.70399","DOIUrl":"10.1002/jgh3.70399","url":null,"abstract":"<p>Ulcerative colitis (UC) is traditionally managed with long-term 5-aminosalicylic acid (5-ASA) administration. However, in real-world practice, carefully selected low-risk patients in sustained deep remission may remain stable without continuous therapy. Randomized trials have shown only modest differences in relapse between 5-ASA and placebo treatment, and real-world experience indicates that requests to discontinue 5-ASA during sustained remission are not uncommon. Importantly, symptom-based assessments can be misleading. Psychosocial factors and a disconnect between symptoms and inflammation, including irritable bowel syndrome overlap, may explain the observed differences. Noninvasive biomarkers, such as fecal calprotectin and serum leucine-rich alpha-2 glycoprotein, allow the early detection of subclinical inflammation, supporting the feasibility of a drug-free active surveillance (DFAS) strategy in selected patients. Biomarker-guided monitoring can reduce the reliance on colonoscopy and make DFAS more acceptable in practice. Consistent with treat-to-target and disease clearance strategies, prioritizing endoscopic and histologic remission, stable biomarkers, and favorable psychosocial conditions may help identify appropriate candidates. A patient-centered implementation strategy that integrates patient-reported outcomes, mental health assessments, and shared decision-making can ensure that DFAS reflects proactive, individualized care rather than therapeutic neglect. Given the growing UC population and disease burden, increasing healthcare costs, and patient preferences to minimize long-term medication, this review defines the clinical rationale, candidate selection criteria, and a pragmatic biomarker-guided algorithm for selective DFAS after 5-ASA in UC and outlines a research agenda to validate safety, feasibility, and cost-effectiveness. We propose that DFAS be reserved for low-risk patients under structured surveillance with predefined relapse triggers and rapid rescue pathways.</p>","PeriodicalId":45861,"journal":{"name":"JGH Open","volume":"10 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147646875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}