Therapeutic Advances in Gastroenterology最新文献

{"title":"Prospective observational study of tofacitinib in ulcerative colitis - analysis of clinical data, fatigue and health-related quality of life during the induction phase.","authors":"Lisa Nyberg, Jonas Halfvarson, Jonas Söderling, Ola Olén, Hans Strid, Charlotte R H Hedin, Sara B Jónsdóttir, Henrik Hjortswang, Susanna Jäghult, Joseph C Cappelleri, Dan Henrohn, Maria Seddighzadeh, Jan Marsal, Olof Grip","doi":"10.1177/17562848251343427","DOIUrl":"10.1177/17562848251343427","url":null,"abstract":"<p><strong>Background: </strong>Tofacitinib is a Janus kinase inhibitor for the treatment of ulcerative colitis (UC). Prospective real-world data are scarce.</p><p><strong>Objectives: </strong>To collect data on clinical outcomes, including health-related quality of life (HRQoL) and fatigue during treatment with tofacitinib.</p><p><strong>Design: </strong>This is a prospective observational multicentre study in Sweden. In this analysis, outcomes at weeks 2, 8 and 16 are reported.</p><p><strong>Methods: </strong>Patients with active UC confirmed with endoscopy or faecal calprotectin (FC) were enrolled during 2020-2023 when starting tofacitinib therapy.</p><p><strong>Results: </strong>In total, 103 patients were included. After 2 weeks of treatment, 50% (39/78) had achieved symptomatic response and at week 16, 39% (35/89) had achieved corticosteroid-free clinical remission according to the partial Mayo score. At week 16, a reduction in FC by ⩾50% was seen in 49% (35/71) and 24% (11/46) were in endoscopic remission. The frequency of arthralgia decreased from 29% (30/103) at baseline to 11% (10/89) at week 16. Regarding HRQoL at week 16; each of the four Short Health Scale dimensions (symptoms, social function, disease-related worry and general well-being) had improved by a median of 1 point (<i>p</i> < 0.01) and the European Quality of Life 5 Dimensions 5 Levels index improved from 0.80 to 0.87. Finally, the Inflammatory Bowel Disease Fatigue score measuring occurrence and severity showed an improvement with a decrease from 9 points at baseline to 6 at week 16 (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Induction therapy with tofacitinib therapy was associated with improvements in patient-reported outcome measures of symptoms, endoscopic activity, arthralgia, HRQoL and fatigue. These real-world data illustrate that tofacitinib is a fast-acting drug with broad therapeutic effects in UC.</p><p><strong>Clinicaltrial registration number: </strong>NCT04338204.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251343427"},"PeriodicalIF":3.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327452","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":"Radiation-induced injury and the gut microbiota: insights from a microbial perspective.","authors":"Qiaoli Wang, Guoqiang Xu, Ouying Yan, Shang Wang, Xin Wang","doi":"10.1177/17562848251347347","DOIUrl":"10.1177/17562848251347347","url":null,"abstract":"<p><p>Although radiotherapy is the second most effective cancer treatment, radiation injuries limit its use. About 80% of abdominal-pelvic radiotherapy patients develop acute radiation enteritis, with 20% discontinuing radiotherapy. The lack of effective mitigation measures restricts its clinical application. Recent studies have proposed gut microbiota as a potential biomarker for radiation injuries. However, the interaction between gut microbiota and radiation injuries remains poorly understood. This review summarizes two forms of interaction between gut microbiota and radiation injuries based on the location of the radiation field. One type of interaction, referred to as \"direct interaction,\" involves changes in the diversity and composition of gut microbiota, alterations in microbiota-derived metabolites, disruption of the intestinal barrier, activation of inflammatory responses within the intestine, and involvement of the host's immune system. The second form, called \"indirect interaction,\" includes the influence of the gut microbiota on various body systems, such as gut microbiota-brain axis, gut microbiota-cardiopulmonary axis, and gut microbiota-oral axis. Additionally, we examine promising interventions aimed at reshaping the gut microbiota, including the use of probiotics, prebiotics, and fecal microbiota transplantation. The interaction between radiation injuries and gut microbiota is more complex than previously understood. Therefore, further clarification of the underlying mechanisms will facilitate the application of gut microbiota in preventing and alleviating radiation injuries.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251347347"},"PeriodicalIF":3.9,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12174693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327453","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":"Mediterranean diet adherence and incident acute pancreatitis: a prospective cohort study.","authors":"Chunhua Zhou, Jiawei Geng, Zhipeng Wu, Lintao Dan, Hanyi Huang, Xixian Ruan, Jie Chen, Yao Zhang, Duowu Zou","doi":"10.1177/17562848251346291","DOIUrl":"10.1177/17562848251346291","url":null,"abstract":"<p><strong>Background: </strong>The relationship between Mediterranean diet (MedDiet) adherence and acute pancreatitis (AP) risk is largely unknown.</p><p><strong>Objectives: </strong>To investigate the associations between MedDiet adherence and AP risk and joint associations of genetic risk and MedDiet adherence with AP risk.</p><p><strong>Design: </strong>A prospective cohort study using data from UK Biobank, a large population-based prospective study that recruited over 500,000 participants aged 40-69 between 2006 and 2010 across the United Kingdom.</p><p><strong>Methods: </strong>We included 103,449 participants free of AP with typical dietary intake from 24-h dietary recalls. MedDiet adherence was measured via the Mediterranean Diet Adherence Screener (MEDAS) continuous score. Genetic predisposition to AP was estimated by polygenic risk score (PRS). Incident AP cases were identified via electronic medical records. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by Cox proportional hazards models. Mediation analyses were further applied to explore the mediating effects of the low-grade inflammation (INFLA) score and metabolic status.</p><p><strong>Results: </strong>Over a mean follow-up period of 10.4 years, 371 AP cases were documented. Higher MedDiet adherence defined by MEDAS continuous score was inversely associated with lower AP risk (highest vs lowest tertiles: HR 0.60, 95% CI 0.46-0.79, <i>p</i> < 0.001), with the INFLA score and metabolic status mediating 10% and 7.1% of the association, respectively. Although no interaction was observed between PRS and MedDiet adherence, participants with combined low genetic risk and the highest MedDiet adherence had the lowest risk of AP (HR 0.54, 95% CI 0.36-0.80, <i>p</i> = 0.002).</p><p><strong>Conclusion: </strong>The study suggests that higher adherence to the MedDiet is associated with a decreased risk of AP, which is partially mediated by inflammation and metabolic status, and may attenuate the deleterious impact of genetics on AP risk.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251346291"},"PeriodicalIF":3.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303394","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":"Role of medico-administrative database in the selection of the target population in colorectal cancer screening program.","authors":"Akoï Koïvogui, Robert Benamouzig, Christian Balamou, Gemma Binefa, Sarah Hoeck, Dominika Novak-Mlakar, Catherine Duclos","doi":"10.1177/17562848251342340","DOIUrl":"10.1177/17562848251342340","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) screening in average-risk populations requires filtering a target population based on medical information in population-based CRC screening programs (CRCSP). This study describes the level of consensus in medical exclusion practice and the role of the medico-administrative databases (MADB) in accurately targeting the eligible individuals for CRCSP screening campaigns.</p><p><strong>Design: </strong>The descriptive study combined a cross-sectional survey and a non-systematic literature review.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among CRCSPs worldwide. Information was collected on the use of MADB for identifying consensus-based exclusion criteria (applied by >50% of CRCSPs). When a MADB was used, the study assessed whether the definition (code lists, medical terminologies) of the exclusion criteria was available. These definitions were compared between programs to evaluate the degree of consensus.</p><p><strong>Results: </strong>In all, 20 out of the 31 CRCSPs (Australia, England, Manitoba, Ontario, Washington State, 26 European countries) participating in the survey implemented medical exclusions. Five consensus-based exclusion criteria were identified (personal history of CRC, inflammatory bowel disease, adenoma, recent colonoscopy, genetic risk). However, these criteria were not uniformly defined in MADBs (i.e., CRC phenotype includes ICD-10 codes C18-C21 in Catalonia, while the C21 code was excluded elsewhere). Furthermore, although the MADBs exist and contain relevant information, they remain inaccessible to screening management structures in some countries (e.g., in France).</p><p><strong>Conclusion: </strong>The number of consensus-based criteria was limited, and they were the least nuanced, likely because they are easier to collect using the current CRCSPs management resources. These consensual criteria can be queried in most MADBs. However, the use of MADBs was not standardized across programs for various reasons (absence of a database, unavailability of information in the database when it exists, inaccessibility of the database when it exists), limiting comparability between them. Standardizing the five consensus criteria across all programs would only be effective if the disparity caused by systemic failures in the organization of each program was controlled.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251342340"},"PeriodicalIF":3.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303395","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 IL-33/ST2 axis in esophageal inflammatory diseases and cancers: implications for the immunopathogenesis and immunotherapeutic target?","authors":"Gaofeng Lu, Guanglin Cui","doi":"10.1177/17562848251344049","DOIUrl":"10.1177/17562848251344049","url":null,"abstract":"<p><p>Considerable scientific evidence confirms that interleukin (IL)-33 and its main receptor, suppression of tumorigenicity 2 (ST2), form a functional axis to modulate the development of esophageal inflammatory disorders, such as eosinophilic esophagitis and gastroesophageal reflux disease. Recently, studies have also revealed that the IL-33/ST2 axis is implicated in the immunopathogenesis of both esophageal adenocarcinoma and squamous cell carcinoma. In view of the importance of the IL-33/ST2 axis in the immunopathogenesis of esophageal inflammatory diseases and cancers, this review summarizes recent progress in this research field based on current published data. Moreover, the translational potential of the IL-33/ST2 axis as a promising immunotherapeutic target in esophageal inflammatory disorders and cancers was discussed.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251344049"},"PeriodicalIF":3.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303396","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":"Hyaluronic acid and chondroitin sulfate-based medical devices: formulations, esophageal mucosal protection, and their place in the management of GERD.","authors":"Carmelo Scarpignato, Nicola De Bortoli, Paola Iovino, Andrea Nacci, Giovanni Sarnelli, Edoardo Vincenzo Savarino","doi":"10.1177/17562848251337822","DOIUrl":"10.1177/17562848251337822","url":null,"abstract":"<p><p>Gastroesophageal reflux disease (GERD) remains a challenging condition, even in the third millennium. For much of the past century, Schwartz's dictum-\"No acid, no ulcer\"-has shaped our approach to acid-related diseases, making acid suppression the cornerstone of therapy. Proton pump inhibitors (PPIs) are widely regarded as the standard treatment for GERD. However, they provide only symptomatic relief and do not address the underlying disease. Moreover, nearly 50% of patients experience limited or no response to PPIs in clinical practice. Recent advances in understanding GERD's pathophysiology, particularly the role of impaired mucosal integrity, have led to innovative therapeutic strategies. Among these, medical devices designed to prevent reflux or coat the esophageal mucosa and form a stable protective barrier represent a significant breakthrough. Esophageal mucosal protection is emerging as a promising approach, especially for patients who do not respond adequately to PPIs. While mucosal-protective agents such as sucralfate and irsogladine have long been available, their formulations have not been well-suited for esophageal protection. The rapid transit time of liquids through the esophagus (typically just a few seconds, even in a supine position) limits the duration of contact between active ingredients and the mucosa. However, hyaluronic acid and chondroitin sulfate-based medical devices have revolutionized the field by enabling active ingredients to adhere to the esophageal lining, ensuring prolonged contact and enhanced protection. Further advancements have led to the development of three distinct formulations (Esoxx™ One, Esoxx Defence, and Esoxx Protection), incorporating additional components, that is, Poloxamer 407, aluminum hydroxide, or natural remedies such as <i>Aloe vera</i> and honey. Each of these formulations offers unique physicochemical properties tailored to address both typical and atypical GERD symptoms. By leveraging the novel therapeutic approach of mucosal protection, these innovations aim to improve treatment outcomes and enhance patients' overall quality of life.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251337822"},"PeriodicalIF":3.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303393","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 for recurrence after endoscopic papillectomy in ampullary adenomas: a retrospective case-control study.","authors":"Kun Liu, Yuhang Zhuang, Ningjing Gao, Muhan Ni, Xiang Zhang, Peng Yan, Quan Zhou, Zhao Shi, Pin Wang, Dehua Tang, Ying Lv, Lei Wang, Shanshan Shen","doi":"10.1177/17562848251343419","DOIUrl":"10.1177/17562848251343419","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic papillectomy (EP) has emerged as a preferred treatment modality for ampullary adenomas, offering a less-invasive alternative to surgical resection. However, concerns persist regarding the potential for incomplete resection and subsequent recurrence.</p><p><strong>Objectives: </strong>This study aims to evaluate the efficacy of EP in treating ampullary adenomas and to identify risk factors associated with recurrence.</p><p><strong>Design: </strong>This study was a single-center, retrospective case-control study.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent EP at Nanjing Drum Tower Hospital between January 2010 and December 2022. Recurrence rates were assessed, and potential risk factors for recurrence were analyzed using univariate and multivariate Cox proportional hazards models. Hazard ratios (HR) with corresponding 95% confidence intervals (CI) were calculated.</p><p><strong>Results: </strong>Among the 137 patients who achieved complete resection, 21 (15.3%) experienced recurrence. The median follow-up period was 17.7 months (interquartile range (IQR) 11.7-37.5), and the median time-to-recurrence was 16.2 months (IQR 9.9-33.9). Of the 21 recurrence cases, 11 (52.3%) were managed successfully with repeat endoscopic intervention, while 6 (28.6%) required pancreatoduodenectomy. Significant risk factors for recurrence included familial adenomatous polyposis (FAP; HR = 9.3; 95% CI: 2.8-30.4; <i>p</i> < 0.001), pancreaticobiliary (PB) subtype (HR = 3.2; 95% CI: 1.5-11.3; <i>p</i> = 0.006), and high-grade dysplasia (HGD; HR = 2.6; 95% CI: 1.1-6.2; <i>p</i> = 0.036). Comprehensive sensitivity and subgroup analyses consistently confirmed the stability of these risk factors.</p><p><strong>Conclusion: </strong>EP is an effective treatment for ampullary adenomas; however, recurrence remains a significant concern, particularly among patients with FAP, PB subtype, and HGD.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251343419"},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267731","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":"Impact of antithrombotic therapy resumption in patients with gastrointestinal bleeding: a multicenter retrospective cohort study.","authors":"Ding Peng, Huihong Zhai","doi":"10.1177/17562848251342864","DOIUrl":"10.1177/17562848251342864","url":null,"abstract":"<p><strong>Background: </strong>Gastrointestinal bleeding (GIB) is a critical clinical emergency associated with high morbidity and mortality. The widespread use of antithrombotic agents, including antiplatelet and anticoagulant medications, has increased the incidence of GIB.</p><p><strong>Objectives: </strong>Our study aims to address this gap by evaluating the impact of antithrombotic therapy on both 28-day mortality and rebleeding risk.</p><p><strong>Design: </strong>Retrospective cohort study using propensity score-based methods to address confounding.</p><p><strong>Methods: </strong>Data were extracted from three independent databases (MIMIC-IV, NWICU, and Xuanwu Hospital) spanning 2008-2022. inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. Weighted logistic regression models assessed outcomes across antiplatelet, anticoagulant, and combination therapy subgroups.</p><p><strong>Results: </strong>After inverse probability of treatment weighting (IPTW) adjustment, the antithrombotic group maintained a significantly elevated rebleeding rate (19.9% vs 10.5%, <i>p</i> < 0.001) and an increased risk of rebleeding (odds ratio (OR) = 2.118, 95% confidence interval (CI): 1.577-2.845, <i>p</i> < 0.001). Conversely, the 28-day mortality was significantly lower in the antithrombotic group postadjustment (8.2% vs 12.5%, <i>p</i> = 0.022; OR = 0.621, 95% CI: 0.412-0.935, <i>p</i> = 0.023). Notably, early resumption of antithrombotic therapy (within 3 days) significantly increased the risk of mortality.</p><p><strong>Conclusion: </strong>Our study suggests that while antithrombotic therapy reduces 28-day mortality, it significantly increases rebleeding risk. Notably, the use of anticoagulants or combination therapy is linked to the highest rebleeding risk, compared to antiplatelets. Additionally, resuming antithrombotic therapy too early (i.e., within 3 days) may further elevate the risk of mortality.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251342864"},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267728","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":"Long-term prognosis and risk factors associated with 30-day unplanned repeated ERCP in patients with common bile duct stones.","authors":"Mengmeng Zhang, Xi Wu, Dongsheng Wu, Qingwei Jiang, Yunlu Feng, Qiang Wang, Shengyu Zhang, Aiming Yang","doi":"10.1177/17562848251342342","DOIUrl":"10.1177/17562848251342342","url":null,"abstract":"<p><strong>Background: </strong>The unplanned repeated endoscopic retrograde cholangiopancreatography (ERCP) in patients with common bile duct stone (CBDS) remains unclear.</p><p><strong>Objectives: </strong>To identify risk factors of unplanned repeated ERCP and its impact on clinical outcomes.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Patients who underwent ERCP for CBDSs from January 2013 to October 2023 were consecutively reviewed. Risk factors for unplanned repeated ERCP within 1 month were evaluated using logistic regression. The impact of unplanned repeated ERCP on adverse events, including ampullary bleeding, CBDSs recurrence, and biliary infection, was explored.</p><p><strong>Results: </strong>A total of 1241 patients were included, of which 50 patients underwent unplanned repeated ERCP in 1 month primarily because of unrelieved biliary obstruction or cholangitis. The repeated ERCP group had higher proportions of irregular papilla (42.0% vs 21.7%, <i>p</i> < 0.001), stones locating in superior common bile duct (CBD; 18.0% vs 8.8%, <i>p</i> = 0.05), larger CBD diameter (median 1.2 vs 1.0 cm, <i>p</i> = 0.002), or larger CBDS diameter (median 1.0 vs 0.8 cm, <i>p</i> = 0.004) than the unrepeated group. In the multivariate analysis, irregular papilla (odds ratio (OR) 3.494, <i>p</i> = 0.024), post-ERCP fever (OR 7.532, <i>p</i> < 0.001), post-ERCP abdominal pain (OR 2.810, <i>p</i> = 0.05), post-/pre-ERCP total bilirubin levels ⩾1.2 times (OR 6.973, <i>p</i> = 0.007), and post-/pre-ERCP transaminase levels ⩾1.2 times (OR 3.944, <i>p</i> = 0.026) were independent risk factors for unplanned repeated ERCP. The incidence of adverse events in the long term was higher in the repeated group than the unrepeated group (12.0% vs 5.0%, <i>p</i> = 0.068). Unplanned repeated ERCP, although not an independent factor, is partially relevant with increased likelihood of long-term adverse events (univariate OR 2.570, <i>p</i> = 0.038).</p><p><strong>Conclusion: </strong>Papillary morphology, post-ERCP symptoms, and serum biochemical parameters may help predict the occurrence of unplanned repeated ERCP in patients with CBDS. Unplanned repeated ERCP does not have a significant impact on the long-term prognosis.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251342342"},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267730","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":"Intestinal ultrasound measurement of bowel wall thickness can be used as a sole marker for defining anti-TNF maintenance therapy failure in Crohn's disease.","authors":"Ahmad Albshesh, Shadi Haj, Ido Veisman, Lior Dar, Shomron Ben-Horin, Ohad Regev, Uri Kopylov, Dan Carter","doi":"10.1177/17562848251343008","DOIUrl":"10.1177/17562848251343008","url":null,"abstract":"<p><strong>Introduction: </strong>Bowel wall thickness (BWT) measurements in intestinal ultrasound (IUS) are recognized indicators of inflammatory activity in Crohn's disease (CD). However, the added value of other ultrasonographic parameters for monitoring and predicting treatment failure during anti-tumor necrosis factors' (TNF) maintenance therapy is still not absolutely defined.</p><p><strong>Objectives: </strong>To determine whether BWT, as measured by IUS, can serve as a reliable single marker for predicting treatment failure in CD patients under anti-TNF therapy, compared to a combination of ultrasonographic parameters.</p><p><strong>Design: </strong>This study was a single-center, retrospective cohort study.</p><p><strong>Methods: </strong>This study included 103 CD patients in clinical remission on anti-TNF therapy, who had an IUS examination within 10 months following therapy initiation. We investigated the correlation of these ultrasonographic parameters with subsequent treatment failures, defined by disease flares, and the need for surgery, hospitalization, corticosteroid use, dose escalation, and drug discontinuation.</p><p><strong>Results: </strong>Treatment failure occurred in 59.2% of patients within a median of 5 months post-index IUS. Significant differences were observed in BWT (3.9 mm in the failure group vs 3 mm in the remission group, <i>p</i> = 0.007), bowel wall flow (BWF; 49.2% vs 23.8%, <i>p</i> = 0.009), and mesenteric hypertrophy (20.4% vs 7.1%, <i>p</i> = 0.006). In receiver operating characteristic analysis for BWT, the area under the curve (AUC) of BWT >3 mm was 0.66, with a sensitivity of 67.2% and specificity of 69.1%. The combined (BWT, BWF, and mesenteric hypertrophy) AUC was 0.68 (sensitivity of 62.9%, specificity of 61.9%). Delong's test showed no significant difference in AUC (<i>p</i> = 0.137). BWT emerged as the most significant parameter in stepwise regression analysis.</p><p><strong>Conclusion: </strong>Our findings suggest that BWT alone may be used as a single ultrasonographic marker of treatment, therefore simplifying the use of IUS. Using a single objective ultrasonographic parameter simplifies the use of IUS, an important factor that can facilitate the use of this important imaging technique.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251343008"},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267729","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}