Therapeutic Advances in Gastroenterology最新文献

{"title":"Baseline characteristics, treatment patterns, and long-term outcomes in patients with eosinophilic esophagitis initiating dupilumab in routine clinical practice: study protocol of a phase IV, prospective, observational, multicenter registry (EDESIA).","authors":"Evan S Dellon, Mirna Chehade, Emily C McGowan, Elizabeth T Jensen, John Leung, Devrim Eren, James T Angello, Amr Radwan, Sandy R Durrani, Sabina deMarchi","doi":"10.1177/17562848261443887","DOIUrl":"https://doi.org/10.1177/17562848261443887","url":null,"abstract":"<p><strong>Background: </strong>Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and -13 signaling, is approved for the treatment of eosinophilic esophagitis (EoE) based on phase III clinical trials. However, real-world data on dupilumab use for EoE are lacking.</p><p><strong>Objectives: </strong>To assess the characteristics, treatment patterns, and outcomes among patients with EoE aged 12 years or older who receive treatment with dupilumab for EoE as prescribed under the US prescribing information.</p><p><strong>Design: </strong>This study protocol describes a phase IV, prospective, observational, multicenter patient registry, EDESIA, which will enroll approximately 300 patients aged 12 years or older who initiate dupilumab treatment as part of routine care across approximately 50 sites in the USA.</p><p><strong>Methods and analysis: </strong>Baseline data collection will include demographics, disease characteristics, medical history, and prior/concomitant therapies. Data will be collected at baseline (day 1 of treatment) and at follow-up visits through 36 months. Key primary outcomes assessed will include details of food elimination diet, history of food impaction and esophageal dilation, histologic and endoscopic findings, and patient-reported outcomes. Adverse events will be monitored throughout the study.</p><p><strong>Ethics: </strong>The EDESIA registry will be conducted in accordance with the Declaration of Helsinki, the International Council for Harmonization guidelines for Good Clinical Practice, and applicable regulatory requirements. The local institutional review board at each study center will approve the study. Written informed consent will be obtained from all patients and/or a parent/legal guardian.</p><p><strong>Discussion: </strong>EDESIA will address the safety and tolerability of long-term weekly dupilumab treatment in patients with EoE, and inform future treatment guidelines.</p><p><strong>Trial registration: </strong>A US registry of EoE adolescent and adult patients treated with DUPIXENT® as standard of care (EDESIA), NCT06693531 (https://www.clinicaltrials.gov/study/NCT06693531).</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261443887"},"PeriodicalIF":3.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13145017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844732","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 glucocorticoids for acute drug-induced liver injury with hyperbilirubinemia: protocol of a multicenter randomized controlled trial.","authors":"Qianqian Li, Yong Lin, Xin Zeng, Lu Zhou, Fengmei Wang, Qing Ye, Yanjing Gao, Lianyi Guo, Jin Zhu, Jia Li, Yiling Li, Lichun Shao, Yiling Hu, Jiancun Xiao, Ao Jia, Dongsheng Wang, Lijun Chang, Jian Wang, Jianzhong Zhang, Ran Wang, Fei Gao, Qinke Wu, Pingfang Hu, Changpeng Zhu, Lingyan Cai, Ying Ran, Yueyue Li, Jiayuan Zhang, Yupeng Ran, Chunyan Wang, Ningning Wang, Jian Zhang, Xiehua Zhang, Juan Li, Jing Sun, Yunxiang Chu, Yali Ma, Tingting Wang, Zheng Zheng, Yue Shen, Xingshun Qi, Weifen Xie","doi":"10.1177/17562848261440777","DOIUrl":"https://doi.org/10.1177/17562848261440777","url":null,"abstract":"<p><strong>Background: </strong>Drug-induced liver injury (DILI) can lead to potentially fatal complications, such as acute liver failure and even death. In clinical practice, glucocorticoids have been considered in some cases of DILI, especially those with hyperbilirubinemia. However, the available evidence remains controversial and its quality is also very limited.</p><p><strong>Objectives: </strong>To explore the efficacy and safety of glucocorticoids in patients with acute DILI and hyperbilirubinemia.</p><p><strong>Design: </strong>An open-label, multicenter, randomized controlled trial (RCT).</p><p><strong>Methods and analysis: </strong>Overall, 232 patients with acute DILI with hyperbilirubinemia will be enrolled, and then, randomly assigned at a ratio of 1:1 to the conventional treatment alone or combined with glucocorticoids groups. The primary endpoint is the improvement of DILI, which is defined as total bilirubin level decreased by 50% after treatment, at the 2nd week. Secondary endpoints include the improvement of DILI at the 4th week and rates of progressive liver injury, liver failure, liver transplantation, survival, and adverse events. As for exploratory endpoints, we will also identify the beneficial population and assess the changes of inflammatory factors following glucocorticoids treatment.</p><p><strong>Ethics: </strong>The study has been approved by the Medical Ethical Committee of the General Hospital of Northern Theater Command (ethical approval number Y2024-226) as well as 11 other participating centers.</p><p><strong>Discussion: </strong>This RCT will provide solid evidence to clarify the benefits of glucocorticoids in patients with acute DILI and hyperbilirubinemia.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT06922669.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261440777"},"PeriodicalIF":3.4,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822581","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":"Responsible use of large language models in gastroenterology and hepatology.","authors":"Sahil Khanna","doi":"10.1177/17562848261441693","DOIUrl":"https://doi.org/10.1177/17562848261441693","url":null,"abstract":"<p><p>Large language models (LLMs) and related generative artificial intelligence (AI) systems are rapidly entering clinical workflows, including in gastroenterology and hepatology, where text-heavy documentation, guideline-driven care, and high-volume patient messaging create a strong demand for decision support and automation. Deployment raises distinctive risks: hallucinations and unsafe recommendations, automation bias, privacy and confidentiality threats, inequitable care, intellectual property and licensing uncertainty, and unclear allocation of responsibility across clinicians, institutions, and vendors. Regulators are increasingly emphasizing a lifecycle approach to trustworthy AI, including validation, risk management, human oversight, cybersecurity, monitoring, and transparency. Frameworks for healthcare protection regulate how health information may be shared with external model providers and how outputs should be logged, audited, and retained. This review synthesizes practical guidance for responsible LLM use, organized around (1) tiered use cases and risk stratification; (2) ethical principles (beneficence, non-maleficence, autonomy, justice, and accountability); (3) core legal and regulatory considerations; and (4) operational governance, evaluation, and monitoring strategies. Actionable checklists to support institutional adoption, use, and transparency are provided. Responsible use requires aligning LLM capabilities with risk, preventing inappropriate data sharing, validating performance in representative populations, ensuring human oversight and clear accountability, mitigating harm, and maintaining an evidence-based, continuously monitored deployment lifecycle.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261441693"},"PeriodicalIF":3.4,"publicationDate":"2026-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13129269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822564","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 GETAID: over 40 years of academic research in IBD.","authors":"David Laharie, Arnaud Bourreille, Mathurin Fumery, Charlotte Mailhat, Lucine Vuitton","doi":"10.1177/17562848251408408","DOIUrl":"https://doi.org/10.1177/17562848251408408","url":null,"abstract":"<p><p>Founded in 1983 in Paris by Professor R. Modigliani, the Groupe d'ETude des Affections Inflammatoires Digestives (GETAID) was established to develop collaborative clinical research on inflammatory bowel disease (IBD). This was innovative 40 years ago and remains challenging today. From the beginning, this multicenter group has aimed to address clinical questions arising from patients, physicians, and the IBD community by conducting clinical research on treatments through randomized controlled trials, prospective cohorts, index creation, and observational studies. GETAID has advanced IBD knowledge by publishing over 140 original articles in peer-reviewed journals. This review explores the history of the GETAID, how it functions, and its contribution to IBD knowledge over the past four decades. It illustrates the disruptive and innovative academic research conducted by an independent group of researchers and its potential future impact through examples.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848251408408"},"PeriodicalIF":3.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822554","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 role of metabolomics in enhancing diagnosis and management of inflammatory bowel disease: a systematic review.","authors":"Samer H Sharkiya, Rnin Namni, Omar Wattad, Fadi Abu Baker","doi":"10.1177/17562848261441018","DOIUrl":"https://doi.org/10.1177/17562848261441018","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) is a chronic, relapsing condition associated with diagnostic delays, disease misclassification, and variable treatment response. Conventional diagnostic and monitoring tools remain limited in capturing the biological complexity of IBD, prompting growing interest in metabolomics as a complementary approach.</p><p><strong>Objectives: </strong>This systematic review aimed to examine the role of metabolomics in enhancing the diagnosis and management of IBD across adult and pediatric populations.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Data sources and methods: </strong>The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. PubMed, Web of Science Core Collection, ScienceDirect, Cochrane Library, and Google Scholar were searched from inception to identify eligible studies. Observational studies and clinical trials assessing metabolomics in IBD diagnosis or management were included. Methodological quality was appraised using the Newcastle-Ottawa Scale, RoB 2, and ROBINS-I. Due to substantial heterogeneity, a narrative synthesis was performed.</p><p><strong>Results: </strong>Fourteen studies involving approximately 3700 participants met the inclusion criteria. Metabolomic analyses of serum, feces, urine, and plasma consistently identified disease-associated metabolic perturbations, particularly in amino acids, bile acids, lipids, and short-chain fatty acids. Only two studies reported formal diagnostic performance, with sensitivity and specificity exceeding 80% for distinguishing IBD subtypes. Several studies demonstrated metabolomic changes associated with treatment response and remission; however, outcome definitions varied widely across studies.</p><p><strong>Conclusion: </strong>Metabolomics shows significant potential to enhance IBD diagnosis and management, particularly for disease differentiation and treatment monitoring. Nonetheless, clinical translation is constrained by methodological heterogeneity and limited diagnostic validation. Future research should prioritize standardized protocols and robust diagnostic accuracy studies.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261441018"},"PeriodicalIF":3.4,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147822517","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":"Survival impact of pancreatic stenting in unresected pancreatic head cancer with obstructive jaundice: a retrospective cohort study.","authors":"Weng-Fai Wong, Yu-Ting Kuo, Ming-Lun Han, Chieh-Chang Chen, Hsiu-Po Wang","doi":"10.1177/17562848261437173","DOIUrl":"https://doi.org/10.1177/17562848261437173","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is common in patients with pancreatic head cancer, which can diminish their tolerance to anti-cancer treatments. Pancreatic duct blockage is one of the contributing factors leading to malnutrition.</p><p><strong>Objectives: </strong>This study aimed to clarify whether pancreatic stenting offers a survival benefit in patients with unresected pancreatic head cancer.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>Patients with newly diagnosed pancreatic cancers who received endoscopic retrograde cholangiopancreatography (ERCP) because of biliary tract obstruction were collected from a hospital-based cancer registry between 2007 and 2021. Individuals who underwent tumor resection or bypass surgery following ERCP were excluded. The primary outcome was the 1-year survival rate in patients with and without a pancreatic stent. Secondary outcomes included overall survival, cancer-specific survival, and changes in weight and nutritional markers following ERCP.</p><p><strong>Results: </strong>Among 562 patients, 39 (6.9%) received pancreatic stent placement. Most of the patients (90%) did not receive tumor resection because of advanced-stage disease. The stent group had a lower 1-year survival rate than the non-stent group (18% vs 30%; <i>p</i> = 0.047). The median survival time appeared to be shorter in the stent group (170 vs 217 days; <i>p</i> = 0.077). The adjusted hazard ratio of pancreatic stent placement was 1.42 (95% confidence interval, 0.75-2.67; <i>p</i> = 0.282). In addition, changes in weight and nutritional markers after ERCP did not differ significantly between the groups.</p><p><strong>Conclusion: </strong>Pancreatic stent placement in unresected pancreatic head cancer with obstructive jaundice does not improve survival or nutritional status.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261437173"},"PeriodicalIF":3.4,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13111871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786608","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":"Comment on: Final results from the vedolizumab extended access program multinational study demonstrate long-term treatment persistence and safety.","authors":"Joaquín Borrás-Blasco, Alejandro Valcuende-Rosique, Silvia Cornejo-Uixeda","doi":"10.1177/17562848261441701","DOIUrl":"https://doi.org/10.1177/17562848261441701","url":null,"abstract":"","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261441701"},"PeriodicalIF":3.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786486","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":"Idiopathic chronic pancreatitis: clinical highlights.","authors":"Kinga Knopczyk, Ewa Małecka-Wojciesko","doi":"10.1177/17562848261441954","DOIUrl":"https://doi.org/10.1177/17562848261441954","url":null,"abstract":"<p><p>Chronic pancreatitis (CP) is a fibro-inflammatory syndrome associated with environmental, genetic, autoimmune, and metabolic factors. Although the main burden of CP is chronic pain and pancreatic insufficiency, epidemiological data indicate that CP patients are at significantly higher risk of developing pancreatic ductal adenocarcinoma (PDAC). CP is a disease that requires complex management based on reducing the severity of symptoms, as there is no curative treatment available. Idiopathic chronic pancreatitis (ICP) is diagnosed after ruling out other possible causes and remains the second most common type of CP-8%-30% of cases. A distinction is made between early-onset ICP (EO-ICP) and late-onset ICP (LO-ICP) based on the age of onset. ICP is characterized by a milder course than CP of other etiologies. In particular, considering the subtypes of ICP, there is a tendency that pain occurs significantly more frequently in EO-ICP compared to alcoholic CP (ACP) and LO-ICP. In turn, diabetes and exocrine pancreatic insufficiency seem to develop much faster in patients with LO-ICP than in patients with ACP and EO-ICP. However, in CP associated with genetic causes, especially mutations in the serine protease 1 (<i>PRSS1</i>) and serine protease inhibitor Kazal type 1 (<i>SPINK1</i>) genes, a significantly higher PDAC risk is observed than in both ICP and ACP. Moreover, patients with ICP are considerably less likely to require intensive pain treatment, including gabapentinoids and opioids. All this translates into a lower frequency of hospitalizations and need for interventional treatment, both endoscopic and surgical. Given that ICP represents a substantial proportion of CP cases, this review highlights possible factors underlying the idiopathic etiology, clinical presentation, and diagnostic features. It summarizes the clinical management of ICP, including the treatment of pain, steatorrhea, diabetes, as well as pancreatic cysts and the risk of PDAC, highlighting differences in treatment patterns and the relative use of specific therapeutic modalities in comparison to other types of CP.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261441954"},"PeriodicalIF":3.4,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13110326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786636","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":"Continuous versus intermittent anticoagulation during endoscopic treatment of esophageal varices in cirrhosis: a randomized controlled trial.","authors":"Yingying He, Zhihong Wang, Jiayi Zhang, Qianqian Zhang, Yaxian Kuai, Yuchuan Bai, Xuecan Mei, Derun Kong","doi":"10.1177/17562848261439217","DOIUrl":"https://doi.org/10.1177/17562848261439217","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic variceal treatment (EVT) in cirrhotic patients carries a risk of periprocedural bleeding, making anticoagulation management challenging in those with acute portal vein thrombosis (PVT).</p><p><strong>Objectives: </strong>The first randomized controlled trial to evaluate the safety and efficacy of continuous versus intermittent anticoagulation during EVT in cirrhotic patients with acute PVT.</p><p><strong>Methods: </strong>In this trial, cirrhotic patients with acute PVT and esophageal varices requiring EVT were assigned to either a continuous or intermittent anticoagulation group. In the continuous anticoagulation group, anticoagulation began immediately after PVT diagnosis and continued during EVT. In the intermittent group, anticoagulation was resumed 1 week post-procedurally. Incidences of post-procedural bleeding and hepatic decompensation events were observed during a 1-year follow-up period. Potential confounders were adjusted for using multivariable binary logistic regression.</p><p><strong>Results: </strong>Among 120 enrolled patients, 112 were analyzed (continuous anticoagulation group, <i>n</i> = 55; intermittent anticoagulation group, <i>n</i> = 57). The rate of early rebleeding within 6 weeks did not differ between groups (<i>p</i> > 0.99). However, continuous anticoagulation significantly reduced the incidence of late rebleeding (<i>p</i> = 0.037) and all-cause bleeding (<i>p</i> = 0.020). The cumulative incidences of late rebleeding (hazard ratio (HR) = 0.386, 95% confidence interval (CI): 0.150-0.994; log-rank <i>p</i> = 0.041) and all-cause bleeding (HR = 0.396, 95% CI: 0.173-0.904; log-rank <i>p</i> = 0.023) were significantly lower in the continuous anticoagulation group. The continuous anticoagulation group had significantly lower incidences of hepatic decompensation events (<i>p</i> = 0.006), and ascites (<i>p</i> = 0.015). After adjustment for liver function, indications for EVT, and history of splenectomy, continuous anticoagulation remained significantly associated with superior outcomes compared with intermittent anticoagulation.</p><p><strong>Conclusion: </strong>Continuous anticoagulation during EVT in cirrhotic patients with acute PVT is safe and does not increase early rebleeding risk. It significantly reduces late and overall bleeding events and may improve long-term outcomes.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry, ChiCTR1800017430.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261439217"},"PeriodicalIF":3.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786455","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":"Association between a 24-h increase in blood urea nitrogen and clinical outcomes in acute non-variceal upper gastrointestinal bleeding: a dual-center retrospective cohort study.","authors":"Kanit Bunnag, Arunchai Chang, Weeraporn Chuaypetch, Nataree Rujipattanapong, Kittiphan Chienwichai, Manus Rugivarodom, Sakkarin Chirapongsathorn, Varayu Prachayakul","doi":"10.1177/17562848261438594","DOIUrl":"https://doi.org/10.1177/17562848261438594","url":null,"abstract":"<p><strong>Background and aim: </strong>Blood urea nitrogen (BUN) is incorporated into admission-based risk scores for acute non-variceal upper gastrointestinal bleeding (NVUGIB); however, the clinical relevance of early in-hospital BUN kinetics remains unclear.</p><p><strong>Objectives: </strong>To evaluate whether a 24-h increase in BUN is independently associated with adverse clinical outcomes in patients with acute NVUGIB.</p><p><strong>Design: </strong>Dual-center retrospective cohort study.</p><p><strong>Methods: </strong>We conducted a dual-center retrospective cohort study of adult patients with endoscopically confirmed NVUGIB admitted between 2018 and 2023. The exposure was defined as any absolute increase in BUN within 18-30 h after the baseline measurement at presentation. The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, in-hospital rebleeding, red blood cell transfusion, length of hospital stay, and need for radiologic or surgical intervention. Multivariable regression was performed in a propensity score-matched cohort with confirmatory analyses in the original cohort.</p><p><strong>Results: </strong>Among 611 patients, 218 (35.7%) demonstrated a 24-h increase in BUN. Propensity score matching yielded 400 patients (200 per group). In the matched cohort, a 24-h BUN increase was independently associated with higher 30-day mortality (adjusted odds ratio (aOR) 3.307; 95% confidence interval (CI) 1.604-6.819) and in-hospital mortality (aOR 2.732; 95% CI 1.208-6.178). No independent associations were observed with rebleeding, transfusion requirements, or radiologic/surgical intervention.</p><p><strong>Conclusion: </strong>An increase in BUN within the first 24 h of hospitalization is independently associated with higher short-term mortality in acute NVUGIB. Early BUN kinetics may serve as a complementary risk marker, but prospective validation and formal predictive-performance testing are needed before clinical integration.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261438594"},"PeriodicalIF":3.4,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13100366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147786456","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}