Therapeutic Advances in Gastroenterology最新文献

{"title":"Diagnostic accuracy of mean nocturnal basal impedance and other complementary tests for the diagnosis of gastroesophageal reflux disease according to the new Lyon criteria.","authors":"Carlos Lombo-Moreno, David La Rotta, Manuelita Pardo-Ortiz, Fredy Alexander Avila, Raul Antonio Cañadas, Óscar Muñoz, Albis Cecilia Hani","doi":"10.1177/17562848251340495","DOIUrl":"10.1177/17562848251340495","url":null,"abstract":"<p><strong>Background: </strong>In 2023, the diagnostic criteria for gastroesophageal reflux disease (GERD) were updated in the Lyon Consensus 2.0. It is important to investigate the diagnostic accuracy of complementary tests used for GERD diagnosis.</p><p><strong>Objectives: </strong>To determine the diagnostic accuracy of mean nocturnal basal impedance (MNBI) measured by pH-metry in patients with suspected GERD compared to the updated 2023 Lyon Consensus Diagnostic Criteria and to identify the optimal cutoff point for diagnosis.</p><p><strong>Design: </strong>Diagnostic test study based on a retrospective cohort of patients with suspected GERD.</p><p><strong>Methods: </strong>Diagnosis was confirmed using the updated Lyon criteria as the gold standard. We evaluated sensitivity, specificity, and discriminatory ability via area under the receiver operating characteristic curve (AUC-ROC). The best cutoff point was determined using Liu's method for MNBI, number of reflux episodes, number of acid reflux episodes, DeMeester score, and bolus exposure time. ROC curves were compared using DeLong's method.</p><p><strong>Results: </strong>A total of 55 patients were included, with 26 diagnosed positive and 29 negative for GERD. MNBI yielded an AUC-ROC of 0.77 (95% confidence interval (CI): 0.64-0.89); at 1590 ohms, sensitivity and specificity were 69.2% and 72.4%, respectively. The DeMeester score demonstrated superior discriminatory ability over MNBI (<i>p</i> = 0.03), with an AUC-ROC of 0.90 (95% CI: 0.80-1.00), sensitivity of 92%, and specificity of 93% at a cutoff of 15.6. No significant differences in discriminatory ability were observed when comparing MNBI with other complementary tests (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>MNBI and other complementary tests showed suboptimal characteristics for GERD diagnosis. These tests should be interpreted alongside clinical, endoscopic, and pH-metry findings. The DeMeester score seems promising, but further prospective studies are needed to prove its utility.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251340495"},"PeriodicalIF":3.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143965","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":"Prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy.","authors":"Dakui Luo, Zhen Wang, Yufei Yang, Qingguo Li, Xinxiang Li","doi":"10.1177/17562848251340494","DOIUrl":"10.1177/17562848251340494","url":null,"abstract":"<p><strong>Background: </strong>A yield pathological T0 (ypT0) classification usually indicates the pathologically complete response of rectal cancer to neoadjuvant therapy. However, lymph node metastasis may still be present.</p><p><strong>Objectives: </strong>In this study, we aimed to evaluate the prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Patients with locally advanced rectal cancer (LARC) who had undergone preoperative therapy and were pathologically classified as having ypT0 disease at Fudan University Shanghai Cancer Center between December 2012 and September 2022 were retrospectively analyzed. Uni- and multivariate analyses were performed to evaluate the effect of the residual lymph node status on disease-free survival (DFS) and overall survival (OS).</p><p><strong>Results: </strong>A total of 457 patients had ypT0 disease; this included 413 patients with ypT0N0 and 44 with ypT0N1-2. Inadequate lymph node retrieval (<12, <i>p</i> = 0.002) and adenocarcinoma (<i>p</i> = 0.009) were more common in the ypT0N0 group than in the ypT0N1-2 group. The ypT0N1-2 group showed marginal evidence of a higher probability of elevated pretreatment carcinoembryonic antigen levels and adjuvant chemotherapy than the ypT0N0 group (<i>p</i> = 0.076 and <i>p</i> = 0.077, respectively). Patients with ypT0N0 had significantly better 5-year DFS than those with ypT0N1-2 (84.8% vs 68.4%, <i>p</i> = 0.016). However, no significant difference was observed in the 5-year OS between the two groups (93.9% vs 88.8%, <i>p</i> = 0.602). Multivariate analysis revealed that residual lymph node status was an independent prognostic factor for DFS (hazard ratio, 2.285; 95% confidence interval: 1.246-4.192, <i>p</i> = 0.008).</p><p><strong>Conclusion: </strong>Residual lymph node metastasis may affect DFS, but not OS, in pathological T0 patients who receive neoadjuvant therapy followed by radical surgery for LARC.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251340494"},"PeriodicalIF":3.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143997","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":"MASLD and liver fibrosis in patients with psoriasis receiving IL-17 or IL-23 inhibitors: a systematic review.","authors":"José González Fernández, Lucía Prieto-Torres, Mariano Ara Martín, Samuel J Martínez-Domínguez","doi":"10.1177/17562848251335824","DOIUrl":"10.1177/17562848251335824","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is more prevalent in patients with psoriasis compared to healthy individuals. Interleukin (IL)-17 and IL-23 inhibitors may have beneficial effects on MASLD by reducing systemic inflammation and improving metabolic parameters.</p><p><strong>Objectives: </strong>To assess the effect of IL-17 and IL-23 inhibitors on MASLD and liver fibrosis in patients with psoriasis.</p><p><strong>Design: </strong>We performed a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.</p><p><strong>Data sources and methods: </strong>A literature search was conducted across four databases: MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from database inception to September 27, 2024. Observational studies and clinical trials that reported the presence of MASLD and/or liver fibrosis in patients with psoriasis/psoriatic arthritis treated with IL-17 or IL-23 inhibitors were included. The Newcastle Ottawa Scale (NOS) was used for risk of bias assessment in cohort studies, the Revised Cochrane Risk of Bias Tool (RoB2.0) in randomized controlled trials, and the Risk of Bias in non-randomized studies-of Interventions (ROBINS-I v.2) tool in non-randomized trials.</p><p><strong>Results: </strong>Fourteen studies were included: four clinical trials, five retrospective cohort studies, three prospective cohort studies, and two post hoc studies. Two cohort studies and one clinical trial showed a low risk of bias. Both post hoc studies had a high risk of bias. Eleven studies assessed the effect of IL-17 inhibitors on MASLD or liver fibrosis; six reported a neutral effect, while five demonstrated improvements in liver tests. Three studies evaluated IL-23 inhibitors; one showed neutral effects, another reported improvement in fibrosis-4 index (FIB-4) scores at 6 months, and the third was still in the recruitment phase.</p><p><strong>Conclusion: </strong>IL-17 and IL-23 inhibitors may provide beneficial effects on MASLD and liver fibrosis in patients with psoriasis. Larger, well-designed studies are needed to confirm these findings.</p><p><strong>Trial registration: </strong>PROSPERO CRD42024599350.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251335824"},"PeriodicalIF":3.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144025","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":"Clinical insights into IL-23 inhibition: risankizumab for Crohn's disease through a systematic review and meta-analysis of randomized controlled trials.","authors":"Po-Feng Huang, Tien-Yu Huang, Yi-Chiao Cheng, Peng-Jen Chen, Wei-Kuo Chang, Chao-Feng Chang","doi":"10.1177/17562848251338743","DOIUrl":"10.1177/17562848251338743","url":null,"abstract":"<p><strong>Background and aims: </strong>Crohn's disease is a chronic inflammatory disorder with rising global prevalence, marked by abdominal pain, diarrhea, and fatigue. Interleukin (IL)-23 plays a pivotal role in Crohn's disease pathogenesis, making it a therapeutic target. Risankizumab, a monoclonal antibody targeting the IL-23 p19 subunit, has shown potential in clinical trials.</p><p><strong>Objectives: </strong>This meta-analysis evaluates the efficacy and safety of Risankizumab in achieving clinical remission, clinical response, and endoscopic remission in patients with moderate-to-severe Crohn's disease.</p><p><strong>Design: </strong>A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines.</p><p><strong>Data sources and methods: </strong>A comprehensive search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov was performed to identify randomized controlled trials (RCTs) assessing Risankizumab in Crohn's disease. Primary outcomes were clinical remission, clinical response, and endoscopic remission, with secondary outcomes focusing on treatment-related adverse events. A random-effects model estimated odds ratios (ORs) with 95% confidence intervals. Meta-regression analyzed dose- and duration-dependent effects.</p><p><strong>Results: </strong>Four RCTs involving 1774 participants showed that Risankizumab significantly improved clinical remission (OR = 2.223), clinical response (OR = 2.483), and endoscopic remission (OR = 4.112). Dose-dependent improvements were observed, with treatment duration affecting clinical remission (<i>p</i> = 0.0158) but not clinical response or endoscopic remission. Adverse event rates were comparable between Risankizumab and placebo groups (OR = 0.872, <i>p</i> = 0.592).</p><p><strong>Conclusion: </strong>Risankizumab is effective in achieving clinical and endoscopic outcomes in moderate-to-severe Crohn's disease, demonstrating dose-dependent benefits and a favorable safety profile, supporting its use as a therapeutic option. However, the limited number of studies may affect the robustness of these findings. Further large-scale RCTs are needed to validate its long-term efficacy, safety in elderly populations, and effectiveness in biologic-naïve patients.</p><p><strong>Trial registration: </strong>This systematic review and meta-analysis were registered with the INPLASY database under registration number INPLASY202530014. The full protocol is accessible at DOI: 10.37766/inplasy2025.3.0014.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251338743"},"PeriodicalIF":3.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112479","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":"Natural history, immunological and genetic characteristics of preclinical inflammatory bowel disease (EARLY): study protocol for a prospective cohort study.","authors":"Iago Rodríguez-Lago, Urko M Marigorta, Beatriz Mateos, Míriam Mañosa, Lucía Márquez-Mosquera, Luis Menchén, Francisco Rodríguez-Moranta, Inmaculada Alonso, Mariam Aguas, Horacio Alonso-Galán, Pere Borràs, Beatriz Castro, Eugeni Domènech, Rocío Ferreiro-Iglesias, Ruth de Francisco, Francisco Javier García-Alonso, Natalia García, Orlando García-Bosch, Carla Gargallo, Javier P Gisbert, Eva Iglesias, Francisco Mesonero, Jone Ortiz de Zárate, Laura Ramos, Empar Sáinz, Pablo Ladrón, Carles Suria, Cristina Suárez Ferrer, Coral Tejido, Pilar Varela, Raquel Vicente, Yamile Zabana, Gisela Castany, Eva Rodríguez, Ana Gutiérrez, Manuel Barreiro-de Acosta","doi":"10.1177/17562848251338647","DOIUrl":"10.1177/17562848251338647","url":null,"abstract":"<p><strong>Background: </strong>The period prior to the diagnosis of inflammatory bowel disease (IBD), defined as the preclinical phase, has emerged as a potential target for disease modification strategies. Despite the relevance of an early diagnosis to the prognosis of the disease, only a limited number of patients are diagnosed during this window of opportunity.</p><p><strong>Objectives: </strong>To determine the risk of developing symptoms after an incidental diagnosis of IBD and to describe the clinical, genetic, and immunological characteristics of IBD during its preclinical phase.</p><p><strong>Design: </strong>This study protocol describes a prospective, multicenter cohort study in which incidental (i.e., asymptomatic) IBD within the colorectal cancer screening program will be characterized from a clinical and multi-omic perspective and compared with symptomatic patients and healthy non-IBD controls.</p><p><strong>Methods: </strong>Samples from blood, urine, stool, and intestinal endoscopic biopsies will be obtained at baseline. A second sample set will be obtained after 52 weeks from those who remain asymptomatic; samples will also be obtained in those with new-onset symptoms. Medical treatment will be prescribed in all patients following current guidelines. Follow-up visits will be performed every 6 months for 10 years, and all new-onset symptoms, changes in disease behavior, extraintestinal manifestations, IBD-related medical therapies, or surgeries will be recorded. Two control cohorts will be included: one including recently diagnosed symptomatic IBD patients (<3 months), and another with healthy non-IBD controls after a normal ileocolonoscopy, in whom samples will be obtained at baseline. Samples from patients and controls will undergo genetic, proteomic, transcriptomic, single-cell RNA sequencing, metabolomic, and microbiome analyses, and integration of data between the different omic perspectives will also be performed. The study has been approved by the Basque Country Ethics Committee (PI2021116).</p><p><strong>Conclusion: </strong>EARLY will generate a unique dataset addressing a previously unexplored area of IBD, with the final aim of describing the prognosis of patients from its earlier phases on the disease and integrating clinical and omic data into useful tools for the long-term prediction of disease outcomes.</p><p><strong>Trial registration: </strong>NCT05698745.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251338647"},"PeriodicalIF":3.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017851","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":"Work-life conflict and its health effects on Moroccan gastroenterologists: a cross-sectional study.","authors":"Benayad Aourarh, Tarik Adioui, Sanaa Berrag, Fouad Nejjari, Aziz Aourarh, Mouna Tamzaourte","doi":"10.1177/17562848251340264","DOIUrl":"10.1177/17562848251340264","url":null,"abstract":"<p><strong>Background: </strong>Gastroenterologists are exposed to various health-related risks due to their diverse professional roles, including endoscopy, clinical care, and academic responsibilities.</p><p><strong>Objectives: </strong>This study aims to assess the work-life balance (WLB), the prevalence of work-related physical and mental symptoms among gastroenterologists practicing in Morocco, and the effects of WLB on their health.</p><p><strong>Design: </strong>Survey study.</p><p><strong>Methods: </strong>A total of 152 gastroenterologists from various Moroccan cities participated in an anonymous electronic questionnaire regarding their daily activities and symptoms. A WLB ratio was calculated, and musculoskeletal, gastrointestinal, and mental symptoms were recorded. The Maslach Burnout Inventory (MBI) was used to measure the burnout score. Data were analyzed using JAMOVI 2.5 software. The reporting of this study conforms to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) statement.</p><p><strong>Results: </strong>This study included 152 gastroenterologists (72.4% female; sex ratio = 0.38) with a median age of 31 years (range: 26-64). Among participants, 61.8% were married, and 70.2% were married to physicians. The average working hours were 50.2 ± 12.7 h/week. Health-related symptoms were common: 86.8% reported musculoskeletal disorders, and 71.1% reported digestive disorders. Regarding mental symptoms, 23.7% reported anxiety, and 46.1% reported depression, with 21.1% experiencing both. The median WLB ratio was 0.42 (range: 0.32-0.55). In univariate analysis, the ratio was correlated with age (<i>p</i> < 0.001) and mental symptoms (depression, <i>p</i> < 0.001; anxiety, <i>p</i> = 0.007). Multivariate analysis revealed age as the only significant associated factor (beta = -0.24 (95% confidence interval: -0.46 to -0.013)). Using the MBI scale, 72.4% of respondents experienced burnout, which correlated with the WLB ratio (<i>p</i> = 0.04). In addition, depersonalization (DP) showed a moderate negative correlation with age (<i>p</i> = 0.002, <i>r</i> = -0.32), while personal accomplishment (PA) showed a moderate positive correlation with age (<i>p</i> = 0.003, <i>r</i> = 0.31).</p><p><strong>Conclusion: </strong>Moroccan gastroenterologists suffer from musculoskeletal, digestive, and mental symptoms, and are prone to burnout likely due to long and labor-intensive. Our study found that younger individuals worked more and were more likely to experience burnout, particularly with increased DP toward patients and diminished PA. The mechanisms behind this observation may be linked to higher workloads, less autonomy, and limited coping strategies, factors that should be explored further.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251340264"},"PeriodicalIF":3.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041440","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":"Italian EoExpert panel recommendation for disease control, switching criteria, and follow-up in eosinophilic esophagitis from pediatric to adult age.","authors":"Edoardo Vincenzo Savarino, Matteo Fassan, Nicola de Bortoli, Claudio Romano, Antonio Di Sabatino, Roberto Penagini, Francesca Racca, Giovanni Sarnelli, Salvatore Oliva","doi":"10.1177/17562848251337515","DOIUrl":"https://doi.org/10.1177/17562848251337515","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic esophagitis (EoE) is a chronic, progressive type 2 inflammatory disorder of the esophagus, characterized by abnormal eosinophil accumulation in esophageal epithelium. Undiagnosed or undertreated EoE leads to increased risk of fibrostenosis, strictures, and food impaction due to persistent inflammation, deeply impacting patients' health-related quality of life (HRQoL).</p><p><strong>Objectives: </strong>To gather insights on comprehensive assessment of EoE, comprising clinical, endoscopic, histological outcomes, adaptive behaviors and HRQoL; to define proper evaluation of disease control and impact of continuous versus noncontinuous treatment to reach full disease control. Finally, to validate an algorithm for disease control, switching criteria, and follow-up.</p><p><strong>Design: </strong>Literature review, survey, and panel expert opinion building by a multidisciplinary Italian EoExpert Panel (EoExpert) of nine specialists from various Italian institutions.</p><p><strong>Methods: </strong>Non-systematic literature review, followed by a survey including 21 questions on the different topics. Results were then discussed and validated by EoExpert.</p><p><strong>Results: </strong>The current diagnostic pathway often does not allow early detection of EoE patients, especially in the presence of adaptive behaviors and unawareness of EoE best practices. In addition, there is a lack of a shared \"control\" definition. EoExpert reviewed, shared, and recommended two novel management tools for EoE, represented by I.M.P.A.C.T. Questionnaire to uncover adaptive behaviors and S.C.O.P.E. (Symptoms Control, Observation, Pathological Evaluation) scheme for comprehensive treatment efficacy evaluation. EoExpert's recommendations were gathered and turned into a therapeutic management algorithm for the definition of disease control and switching criteria.</p><p><strong>Conclusion: </strong>This document provides a standardized approach to EoE management in pediatric and adult settings, highlighting the importance of timely diagnosis in a multidisciplinary setting, of using unified criteria for assessment of disease control through the adoption of a comprehensive approach and of following up patients. These recommendations highlight the critical role of increased awareness and standardized care in EoE clinical setting for lifelong management.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251337515"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035205","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":"Partial response to posterior line immunotherapy for more than 15 months in a pMMR patient with cutaneous metastasis of rectal carcinoma: a case report.","authors":"Jing-Jing Li, Peng-Fei Xu, Yan-Li Nie","doi":"10.1177/17562848251338673","DOIUrl":"https://doi.org/10.1177/17562848251338673","url":null,"abstract":"<p><p>The vast majority of colorectal cancers (CRCs) are proficient mismatch repair (pMMR) and microsatellite stable, and their immune microenvironment appears as a \"cold tumor,\" which is not sensitive to single immunotherapy based on immune checkpoint inhibitors (ICIs). The utilization of ICIs in pMMR advanced CRC is still in the exploratory phase. Cutaneous metastasis from colorectal carcinoma is extremely rare, presenting with diverse clinical manifestations, and there is a lack of standard treatment options for such cases. Patients with skin metastasis from CRC usually progress rapidly and are associated with a dismal prognosis. Herein, we report the case of a 66-year-old woman with extensive cutaneous metastasis of pMMR advanced rectal carcinoma. The patient presented to the abdominal oncology clinic with a complaint of erythema on the right lower limb, perineum, and abdominal skin. The patient underwent radical surgery for rectal carcinoma 3 years before the presentation. The histologic examination revealed low-grade squamous cell subepithelial adenocarcinoma. The patient was treated with sintilizumab in combination with fruquintinib, which exhibited remarkable efficacy and improved the patient's quality of life significantly. Previous cases of cutaneous metastasis of colorectal carcinoma were retrieved to characterize the clinicopathological features. For the rare subset of patients with skin metastasis from CRC, immunotherapy combined with anti-angiogenic targeted therapy may be considered.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251338673"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004698","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":"New chapter in precision medicine: strategies for endoscopic resection of 10-20 mm non-pedunculated colorectal polyps.","authors":"Changwei Duan, Zhen Liu, Xin Wang, Mingjie Zhang, Jianqiu Sheng, Yuqi He, Xianzong Ma","doi":"10.1177/17562848251338672","DOIUrl":"https://doi.org/10.1177/17562848251338672","url":null,"abstract":"<p><p>The preferred resection methods for 10-20 mm non-pedunculated lesions remain unclear. This review summarizes the current methods and novel technologies for resecting 10-20 mm non-pedunculated colorectal polyps, mainly focusing on hot snare polypectomy, cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD). The application of novel techniques involving bipolar snares and low-power pure-cut is expected to reduce adverse events (AEs) related to thermal damage, but prospective studies are needed to confirm their reliability. CSP, including conventional CSP and submucosal injection CSP (SI-CSP), maintains resection efficacy with dedicated snares or submucosal injection for regular non-pedunculated polyps and serrated lesions with a low AE rate of 0.0%-3.4%. Modified EMR techniques such as underwater EMR, tip-in EMR, and EMR-circumferential precutting demonstrate a 15.0%-20.0% increase in en bloc resection rates compared with conventional EMR while also reducing AEs. ESD is recommended as the preferred method for medium-sized colorectal lesions with suspected submucosal invasion, fibrosis, particularly when the procedure is technically challenging. In addition, optical diagnosis is essential for pathological assessment and precise resection. Also, postoperative follow-up is needed for high-risk lesions and cases with unsatisfactory resection.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251338672"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046757","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":"Nonlinear associations of serum vitamin D levels with advanced liver disease and mortality: a US Cohort Study.","authors":"Yuan-Tsung Tseng, Chun-Hsiang Wang, Jung-Der Wang, Kow-Tong Chen, Chung-Yi Li","doi":"10.1177/17562848251338669","DOIUrl":"https://doi.org/10.1177/17562848251338669","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D deficiency is prevalent and linked to chronic diseases; its association with advanced liver disease progression requires clarification.</p><p><strong>Objectives: </strong>To investigate the association between vitamin D levels and risks of liver cirrhosis, hepatocellular carcinoma (HCC), and mortality, and assess risk changes after achieving sufficiency post-supplementation.</p><p><strong>Design: </strong>This was a retrospective cohort study.</p><p><strong>Methods: </strong>Utilized TriNetX US data (3,905,594 patients, 2000-2024). Adults with vitamin D deficiency (20.00-30.00 ng/mL) were compared with those with sufficient levels (30.01-80.00 ng/mL). Follow-up was initiated from the first vitamin D test or start of supplementation to minimize immortal time bias. Propensity score matching (1:1) balanced >20 baseline confounders.</p><p><strong>Results: </strong>After matching, 1,204,760 patients with vitamin D deficiency and 1,204,760 with sufficient vitamin D levels were included. Vitamin D deficiency was associated with an increased risk of liver cirrhosis (hazard ratio (HR), 1.30; 95% confidence interval (CI), 1.25-1.36), HCC (HR, 1.22; 95% CI, 1.08-1.37), and all-cause mortality (HR, 1.14; 95% CI, 1.13-1.16). Achieving sufficient vitamin D levels reduced the risk of all-cause mortality (HR, 0.93; 95% CI, 0.88-0.99) and aligned HCC outcomes (HR, 1.16; 95% CI, 0.68-2.00). However, it did not significantly reduce the risk of liver cirrhosis (HR, 2.05; 95% CI, 1.69-2.50). Dose-response analysis showed a U-shaped relationship for liver cirrhosis and HCC, with the lowest risks at 40-60 ng/mL.</p><p><strong>Conclusion: </strong>Serum vitamin D levels showed a nonlinear association with liver cirrhosis and HCC risk; deficiency independently increased the risks for cirrhosis, HCC, and mortality. Supplementation achieving sufficiency reduced mortality and normalized HCC risk but not cirrhosis risk, potentially reflecting limitations in reversing established disease. The lowest liver disease risk was associated with vitamin D levels of 40-60 ng/mL in this cohort, although causality and the clinical benefit of targeting this specific range require confirmation.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251338669"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055069","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}