Therapeutic Advances in Gastroenterology最新文献

{"title":"Anti-TNF therapy attenuates the diagnostic utility of leucine-rich α2-Glycoprotein 1 for endoscopic activity in ulcerative colitis.","authors":"Akihiro Dejima, Hajime Takatori, Masaki Miyazawa, Hirofumi Okafuji, Tomoyuki Hayashi, Akihiro Seki, Kouki Nio, Noriho Iida, Shinya Yamada, Tetsuro Shimakami, Tadashi Toyama, Taro Yamashita","doi":"10.1177/17562848261489192","DOIUrl":"10.1177/17562848261489192","url":null,"abstract":"<p><strong>Background: </strong>Serum leucine-rich α2-glycoprotein1 (LRG1) is a promising biomarker for mucosal inflammation in ulcerative colitis (UC). However, because systemic LRG1 expression is partly tumor necrosis factor-α (TNF-α)-dependent, anti-TNF therapy may pharmacologically suppress its levels independently of mucosal status.</p><p><strong>Objectives: </strong>To evaluate whether anti-TNF therapy is associated with false-negative serum LRG1 results, attenuates diagnostic accuracy for endoscopic activity (MES ≧ 2), and impairs diagnostic granularity to differentiate strict healing targets (MES 0 vs. 1) compared to other therapies.</p><p><strong>Design: </strong>A retrospective, single-center diagnostic accuracy study conducted in accordance with the STARD 2015 guidelines.</p><p><strong>Methods: </strong>We analyzed 127 paired colonoscopy-LRG1 evaluations (49 under anti-TNF, 78 without) from 50 patients receiving advanced therapies (April 2021-March 2025). Endoscopic activity was defined as Mayo Endoscopic Subscore (MES) ≥2. Diagnostic performance was evaluated using ROC analysis; AUC differences were compared using a cluster bootstrap approach. Factors associated with false-negative LRG1 (<16 μg/mL despite MES ≥2) were identified using generalized estimating equations.</p><p><strong>Results: </strong>Overall, LRG1 demonstrated satisfactory discrimination (AUC 0.81), but performed significantly lower under anti-TNF than non-anti-TNF therapy (AUC 0.44 vs. 0.91; ΔAUC=0.46). Among active evaluations, 45% (24/53) showed false-negatives. Anti-TNF was a strong independent predictor of false-negatives (OR 9.3, 95% CI 1.68-51.9), while JAK inhibitor use was protective (OR 0.09, 95% CI 0.01-0.80, P<0.03) with high accuracy (AUC 0.95 vs. 0.75, P<0.01). LRG1 failed to differentiate MES 0 and MES 1 in the anti-TNF cohort (p=0.63), whereas a marginal trend was observed in the non-anti-TNF cohort (p=0.06).</p><p><strong>Conclusion: </strong>Anti-TNF therapy may selectively attenuate serum LRG1 performance, potentially causing frequent false-negatives and obscuring the distinction between complete healing (MES 0) and mild residual inflammation (MES 1). Clinicians must consider the therapeutic context when interpreting LRG1 for disease monitoring.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261489192"},"PeriodicalIF":3.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957032","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":"Acceptability and tolerability of risankizumab maintenance therapy administered via on-body injector in patients with Crohn's disease: Results of the ACCEPT-OBI study.","authors":"Anthony Buisson, Karim Gebara, Bénédicte Caron, Gilles Boschetti, Cyrielle Gilletta de Saint Joseph, Maria Nachury, Hedia Brixi, Pascal Juillerat, Mélanie Serrero, Lucine Vuitton, Xavier Hebuterne, Ludovic Caillo, Antoine Blain, David Laharie, Laurent Peyrin-Biroulet, Romain Altwegg, Guillaume Le Cosquer, Bruno Pereira, Mathurin Fumery","doi":"10.1177/17562848261489118","DOIUrl":"10.1177/17562848261489118","url":null,"abstract":"<p><strong>Background: </strong>Risankizumab is administered via a new modality, so-called on-body injector (OBI).</p><p><strong>Objectives: </strong>To assess the acceptability and the tolerability of OBI-risankizumab therapy, and compare its acceptability with other available modalities in Crohn's disease (CD).</p><p><strong>Design: </strong>Longitudinal multicenter prospective study.</p><p><strong>Methods: </strong>All CD patients from an early access cohort treated with OBI-risankizumab were assessed from the first OBI use (week 0 = W0), W8, W16, and W24. The primary endpoint was acceptability (acceptability numerical scale = ANS). Patients were asked to grade the acceptability of OBI-risankizumab and other modalities of therapeutic maintenance regimen.</p><p><strong>Results: </strong>Among 58 CD patients (79.4% with at least four prior advanced therapies), OBI-risankizumab acceptability was 9.5±1.2 at W0 and remained stable until W24 (p=0.97). OBI-risankizumab acceptability showed a higher acceptability than intravenous infusions (p<0.0001), pen injectors (p<0.001), and syringes (p<0.001), and ranked as the preferred route in 64% of patients. OBI-risankizumab Q8 was the most accepted maintenance regimen (ANS = 9.2 ± 2.0), compared to long interval subcutaneous injections (Q12, Q8 or Q4), more frequent injections (weekly or eow), or intravenous infusions every 4-8 weeks (p < 0.05 for all comparisons). While 57.4% of patients did not experience any adverse event within 24 weeks, the two most frequent adverse events were mild application-site pain (19.0%) and localized erythema (20.7%) with no need for risankizumab discontinuation.</p><p><strong>Conclusion: </strong>OBI-risankizumab therapy is highly accepted and could be the most preferred maintenance regimen in patients with CD.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261489118"},"PeriodicalIF":3.8,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13562852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957025","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 tolerability of janus kinase inhibition strategies for moderate-to-severe Crohn's disease: A systematic review and bayesian network meta-analysis.","authors":"Hakim Ullah Wazir, Kartik Mehta, Muhammad Shikaib Shabbir, M Rafiqul Islam, Muhammad Maaz, Maryam Muzaffar, Nimra Ehsan, Saba Aliha, Anchit Chauhan, Abdul Khurram, George Saffouri","doi":"10.1177/17562848261485778","DOIUrl":"10.1177/17562848261485778","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease is a chronic inflammatory bowel disease with an expanding therapeutic landscape for moderate-to-severe disease. Janus kinase (JAK) inhibitors have emerged as effective oral treatment options by modulating intracellular inflammatory signalling pathways.</p><p><strong>Objectives: </strong>This systematic review and Bayesian Network meta-analysis aimed to synthesize randomized trial evidence evaluating JAK inhibition strategies in moderate-to-severe Crohn's disease. Given the lack of head-to-head trials, indirect comparisons were considered exploratory.</p><p><strong>Design: </strong>Systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Data sources and methods: </strong>Cochrane Central Register of Controlled Trials, MEDLINE (PubMed), Embase, Scopus, and ClinicalTrials.gov were systematically searched from inception to April 2025. A Bayesian NMA was conducted in R. Hazard ratios (HRs) with 95% credible intervals (CrIs) were estimated. Surface under the cumulative ranking curve (SUCRA) values were calculated to rank interventions across efficacy and safety outcomes. The protocol is registered with PROSPERO.</p><p><strong>Results: </strong>Twelve RCTs comprising 25 treatment arms and 5129 patients were included. The network evaluated upadacitinib across six dosing regimens and filgotinib across two. Upadacitinib 45 mg once daily (OD) showed significant efficacy in achieving clinical remission compared to placebo (HR: 2.47; 95% CrI: 1.51-4.10). For endoscopic remission, upadacitinib 24 mg OD ranked highest, followed by upadacitinib 24 mg BID. For endoscopic response, upadacitinib 24 mg OD ranked highest. No statistically significant differences were observed for clinical response. These estimates were associated with very wide credible intervals indicating statistical imprecision. For safety outcomes, no statistically significant differences were observed among various regimens. For Inflammatory Bowel Disease Questionnaire (IBDQ) ≥ 16, all upadacitinib dosing regimens showed a clinically meaningful response.</p><p><strong>Conclusion: </strong>In this NMA, upadacitinib-containing regimens showed the most consistent efficacy signal among evaluated JAK inhibition strategies. However, the evidence network was sparse, limiting the clinical applicability. Treatment rankings should therefore be interpreted as exploratory.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261485778"},"PeriodicalIF":3.8,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13558925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931717","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":"Endoscopic sleeve gastroplasty versus intragastric balloon insertion as bridge-to-surgery procedures for patients with BMI ≥50 kg/m² or contraindications to primary metabolic bariatric surgery.","authors":"Sandra Nagl, Susanne Wasserberg, Bernd Geißler, Anna Muzalyova, Helmut Messmann, Cora Aubele, Stefan Karl Goelder, Alanna Ebigbo","doi":"10.1177/17562848261489119","DOIUrl":"10.1177/17562848261489119","url":null,"abstract":"<p><strong>Background: </strong>Metabolic bariatric surgery is the most effective obesity treatment, but high body mass index (BMI) and associated medical problems often pose surgical risks.</p><p><strong>Objectives: </strong>This study compares the safety, feasibility, and efficacy of endoscopic sleeve gastroplasty (ESG) versus intragastric balloon (IGB) as bridge-to-surgery (BTS) procedures in patients with BMI ≥50 kg/m² and/or contraindications to primary metabolic bariatric surgery.</p><p><strong>Design: </strong>A retrospective analysis (2017 - 2024) included patients with BMI ≥50 kg/m² undergoing ESG or IGB as a BTS procedure in a two-step approach at two German centers.</p><p><strong>Methods: </strong>The primary outcome was total body weight loss (TBWL, %) at 6 months. Secondary outcomes included absolute weight loss, BMI reduction, excess body weight loss (EBWL, %), and adverse events between the two BTS procedures.</p><p><strong>Results: </strong>Fourteen patients underwent ESG, 15 underwent IGB insertion as an intended BTS procedure. At 6 months, median %TBWL and %EBWL were significantly higher in the ESG group (17.8% (IQR, 14.5 - 22.1) vs. 8.99% (IQR, 4.6 - 14.0), p = 0.018; and 28.0% (IQR, 22.8 - 40.0) vs. 16.7% (IQR, 10.8 - 22.4), p = 0.035, respectively). IGB insertion was performed significantly faster (25 (IQR, 20.0 - 30.0) minutes (min) vs. 76 (IQR, 63.2 - 80.8) min; p < 0.01) but was associated with more mild-to-moderate adverse events (60.0% vs. 0%; p < 0.01).</p><p><strong>Conclusion: </strong>In this retrospective cohort, ESG was associated with greater short-term weight loss and fewer mild-to-moderate adverse events than IGB as a BTS procedure for patients with BMI ≥50 kg/m² and/or contraindications to primary metabolic bariatric surgery (MBS).</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261489119"},"PeriodicalIF":3.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921362","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":"Preoperative myopenia is associated with postoperative complications and endoscopic recurrence after ileocolic resection in Crohn's disease.","authors":"Angelo Del Gaudio, Guia Becherucci, Federica Di Vincenzo, Teodoro Pietro Di Certo, Fabio Cascella, Marco Murgiano, Simone Parello, Flavio Fiaccavento, Francesca Bice D'Angelo, Gaetano Coppola, Irene Mignini, Elisa Foscarini, Francesca Profeta, Lucrezia Laterza, Daniele Napolitano, Elisa Schiavoni, Massimo Musumeci, Franco Sacchetti, Paola Caprino, Luigi Sofo, Antonio Gasbarrini, Daniela Pugliese, Alfredo Papa, Franco Scaldaferri, Laura Maria Minordi, Loris Riccardo Lopetuso","doi":"10.1177/17562848261477206","DOIUrl":"10.1177/17562848261477206","url":null,"abstract":"<p><strong>Background: </strong>Low muscle mass is increasingly recognised in patients with Crohn's disease, particularly among those requiring intestinal surgery. While reduced muscle mass has been associated with adverse early surgical outcomes, its relationship with postoperative endoscopic recurrence remains poorly defined.</p><p><strong>Objectives: </strong>To evaluate the association between preoperative low muscle mass, postoperative complications and endoscopic recurrence after ileocolic resection for Crohn's disease.</p><p><strong>Design: </strong>We conducted a retrospective cohort study including consecutive adult patients with Crohn's disease undergoing ileocolic resection between 2017 and 2024.</p><p><strong>Methods: </strong>Muscle mass was assessed on preoperative computed tomography or magnetic resonance imaging using the total psoas area index (TPAI) with sex-specific cut-offs. The primary outcome was early postoperative complications (Clavien-Dindo grade ≥II). Secondary outcomes included endoscopic recurrence, defined as Rutgeerts score ≥i2 at follow-up endoscopy (6-12 months after surgery), and clinical factors associated with low muscle mass.</p><p><strong>Results: </strong>A total of 152 patients were included, of whom 61 (40.1%) were classified as having low muscle mass. Postoperative complications occurred in 25.7% of patients and endoscopic recurrence in 50.7% at 6-12 months. Low muscle mass was independently associated with early postoperative complications (OR 2.80, 95% CI 1.24-6.29) and with endoscopic recurrence (OR 2.20, 95% CI 1.13-4.57). Upper gastrointestinal involvement was independently associated with low muscle mass, whereas prior exposure to biologic therapy showed an inverse association. Body mass index showed only a weak correlation with imaging-based muscle mass.</p><p><strong>Conclusion: </strong>Preoperative low muscle mass is common in patients with Crohn's disease undergoing ileocolic resection and was independently associated with both early postoperative complications and endoscopic recurrence. Imaging-based body composition assessment may improve perioperative risk stratification.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261477206"},"PeriodicalIF":3.8,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13554609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921449","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 real-world effectiveness and safety of mirikizumab in ulcerative colitis: 52-Week results from an expanded international two-center retrospective cohort study.","authors":"Asaf Levartovsky, Martin Lukáš, Chaya Mushka Abitbol, Kateřina Vlková, Shomron Ben-Horin, Milan Lukáš, Uri Kopylov","doi":"10.1177/17562848261487334","DOIUrl":"10.1177/17562848261487334","url":null,"abstract":"<p><strong>Background: </strong>Mirikizumab, a selective interleukin-23p19 inhibitor, has demonstrated efficacy in randomized controlled trials for moderate-to-severe ulcerative colitis (UC). However, long-term real-world data remain limited, particularly in treatment-experienced populations.</p><p><strong>Objectives: </strong>To evaluate the 52-week real-world effectiveness and safety of mirikizumab in a treatment-experienced UC cohort.</p><p><strong>Design: </strong>Two-center international retrospective observational cohort study of adults with active UC initiating mirikizumab.</p><p><strong>Methods: </strong>This study expands a previously published 12-week real-world cohort from the same centers, adding patients and extending follow-up to 52 weeks. The primary outcome was clinical remission (SCCAI ≤2) at week 52 using non-responder imputation. Secondary outcomes included clinical response, corticosteroid-free remission, and drug persistence at weeks 12, 26, and 52, as well as safety.</p><p><strong>Results: </strong>The cohort included 120 patients with prior anti-TNF, vedolizumab, and JAK inhibitor exposure in 75.8%, 75.0%, and 42.5%, respectively. Clinical response rates were 67.5%, 52.3%, and 41.3% at weeks 12, 26, and 52, with corresponding remission rates of 14.2%, 19.8%, and 28.3% (modified NRI: 35.6%). Corticosteroid-free remission at 52 weeks was 26.1%. Drug persistence at 52 weeks was 64.6% (95% CI 54.9-72.7%), without significant differences by prior biologic exposure class. Among 60 patients (50.0%) receiving extended induction, week-26 remission was lower than in standard induction recipients (10.7% vs. 29.1%; p=0.018). Adverse events occurred in 13 patients (10.8%), leading to discontinuation in 5 (4.2%).</p><p><strong>Conclusion: </strong>In this large treatment-experienced real-world UC cohort, mirikizumab achieved 52-week clinical remission in 28.3% and drug persistence of 64.6%, with no new safety signals identified, supporting its role across lines of therapy in UC.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261487334"},"PeriodicalIF":3.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913859","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 of nutritional indices with early clinical remission in patients with moderate-to-severe ulcerative colitis treated with vedolizumab.","authors":"Hao Zhang, Yueyuan Wang, Jun Wu, Hongying Wang, Congcong Min, Pin Meng, Hua Liu, Tao Mao, Yonghong Xu, Lixin Jin, Baihui Wang, Xiaonan Han, Ailing Liu, Xueli Ding","doi":"10.1177/17562848261486841","DOIUrl":"10.1177/17562848261486841","url":null,"abstract":"<p><strong>Background: </strong>The relationship between nutritional indices and treatment response in ulcerative colitis (UC) remains poorly characterized.</p><p><strong>Objectives: </strong>To assess the discriminatory ability of Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST), and Prognostic Nutritional Index (PNI) in evaluating the clinical efficacy of vedolizumab (VDZ) in patients with moderate-to-severe UC.</p><p><strong>Design: </strong>A retrospective multicenter study.</p><p><strong>Methods: </strong>This study enrolled moderate-to-severe UC patients receiving VDZ at three centers in northern China from 2021 to 2025. The relationship between baseline nutritional indices and clinical remission, alongside conventional biomarkers, was analyzed. Discriminatory performance was evaluated using receiver operating characteristic curves and area under the curve (AUC) analysis.</p><p><strong>Results: </strong>A total of 184 patients were included. At week 14, multivariable logistic regression identified GNRI, PNI and MUST as factors significantly associated with clinical remission. GNRI showed the strongest correlation with clinical remission (r=0.340, <i>p<</i>0.001), followed by HGB (r=0.316, <i>p<</i>0.001), PNI (r=0.308, <i>p<</i>0.001), PLR (r=-0.271, <i>p<</i>0.001), MUST (r=-0.216, <i>p=</i>0.003), and NLR (r=-0.163, <i>p=</i>0.027). GNRI had the highest AUC (0.697), followed by HGB (0.683), PNI (0.678), Alb (0.660), PLR (0.657) and MUST (0.614). GNRI exhibited significantly greater discriminatory ability for 14-week clinical remission than Alb (<i>p</i>=0.018) and MUST (<i>p=</i>0.041). No significant differences in diagnostic accuracy were found between GNRI, HGB, PNI, PLR, and NLR (<i>p></i>0.05). At week 30 and 54, multivariate analysis showed that only baseline HGB remained independently associated with remission.</p><p><strong>Conclusions: </strong>Patients with lower nutritional risk-as reflected by higher GNRI and PNI scores, alongside lower MUST scores-were significantly more likely to achieve clinical remission at week 14.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261486841"},"PeriodicalIF":3.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13550860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148913863","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":"Pregnancy safety of biologics in inflammatory bowel disease: A systematic review and network meta-analysis.","authors":"Chih-Wen Huang, Hsu-Heng Yen, Yang-Yuan Chen, Pei-Yuan Su, Yen-Chih Lin","doi":"10.1177/17562848261486844","DOIUrl":"10.1177/17562848261486844","url":null,"abstract":"<p><strong>Background: </strong>Biologic safety during pregnancy in patients with inflammatory bowel disease (IBD) remains a clinical concern, particularly with the increasing use of novel agents such as ustekinumab (UST) and vedolizumab (VDZ).</p><p><strong>Objectives: </strong>A network meta-analysis (NMA) was performed to compare pregnancy-related outcomes among various biological agents and nonbiologic-exposed patients.</p><p><strong>Design: </strong>Systematic review and frequentist random-effects NMA of comparative observational studies.</p><p><strong>Data sources and methods: </strong>This study systematically searched from inception to 23 March 2025 for comparative studies reporting pregnancy outcomes in biologics or conventional therapies (CT)-exposed patients with IBD. Outcomes included preterm birth, congenital malformation (CM), low birth weight (LBW), and spontaneous abortion. An NMA model was applied. Subgroup analysis was conducted for studies with comparable baseline disease activity between the treatment groups.</p><p><strong>Results: </strong>This NMA included 12 studies. Anti-tumor necrosis factor alpha (TNF-α) agents were not associated with an increased risk of any adverse pregnancy outcomes. UST and VDZ were associated with increased CM risks (UST: odds ratio [OR]: 2.32 [1.31-4.10]; VDZ: OR: 1.98 [1.11-3.52]), and VDZ was associated with LBW (OR: 2.17 [1.15-4.11]). These associations were not significant in the subgroup analyses limited to studies with similar disease activity. Sensitivity analysis revealed that a single important study influenced the CM risk of UST/VDZ, whereas the LBW risk with VDZ remained consistent.</p><p><strong>Conclusions: </strong>This is the first NMA to comprehensively assess the pregnancy-related safety of biologic therapies, including the novel biologics VDZ and UST, in patients with IBD. Anti-TNF agents have the most robust pregnancy safety evidence and were not associated with an increased risk of adverse pregnancy outcomes in this analysis. The findings for UST and VDZ should be framed as exploratory and potentially affected by residual confounding, as the observed risk signals were not consistently maintained in the additional analyses.</p><p><strong>Registration: </strong>INPLASY202540012.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261486844"},"PeriodicalIF":3.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13542539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898212","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":"Prevalence of dysphagia and eosinophilic esophagitis in patients with inflammatory bowel disease or type 2 inflammation: a cross-sectional multicenter screening study.","authors":"Martin Bäuerle, Jurij Maurer, Jagoda Pokryszka, Gottfried Novacek, Christian Primas, Lili Kazemi-Shirazi, Stefanie Dabsch, Adrian Frick, Walter Reinisch, Clemens Dejaco, Michael Trauner, Slagjana Stoshikj, Christine Bangert, Sven Schneider, Stefan Wöhrl, Philipp Schreiner","doi":"10.1177/17562848261470325","DOIUrl":"10.1177/17562848261470325","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic esophagitis (EoE) is a chronic, type-2 inflammation-driven disease causing dysphagia. Although patients with other type-2 inflammatory diseases (type-2 ID) or inflammatory bowel disease (IBD) may have an increased risk of EoE, there is limited information about the prevalence of EoE in these specific populations.</p><p><strong>Objectives: </strong>This study aims to assess the prevalence of clinically relevant dysphagia as well as underlying EoE in patients with type-2 ID or IBD.</p><p><strong>Design: </strong>This is a cross-sectional, multicenter study of patients with type-2 ID (asthma, rhinosinusitis with polyposis nasi, allergic rhinitis, atopic dermatitis, Immunoglobulin E (IgE)-mediated food allergies) or IBD from the Medical University of Vienna and Floridsdorf Allergy Center.</p><p><strong>Methods: </strong>Patients were screened for esophageal dysphagia using the Brief Esophageal Dysphagia Questionnaire (BEDQ). Relevant dysphagia was defined as a BEDQ score ⩾4, or having a history of bolus impaction or emergency department visit due to dysphagia within the past year. Endoscopy with esophageal biopsies was offered to all patients with relevant dysphagia to screen for EoE.</p><p><strong>Results: </strong>A total of 687 patients (45.9% female, median age 45 years, 53.9% with IBD, 48.5% with a type 2 ID) were screened. Overall, 8.9% (<i>n</i> = 61) reported relevant dysphagia. Endoscopy with biopsies was performed in 22 patients, and 18 patients had undergone endoscopy the year prior to the study. In total, 6 newly diagnosed cases of EoE were observed, while 7 patients had a known history of EoE, resulting in an overall prevalence of 13 patients (1.9%). Patients with any type-2 ID had numerically more EoE (2.7%) than patients with IBD (1.9%).</p><p><strong>Conclusion: </strong>While the prevalence of dysphagia among patients with type-2 ID and IBD may not exceed that of the general population, the prevalence of EoE in these populations may be higher than previously recognized.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261470325"},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857882","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":"Combined endoscopic ultrasound and conventional endoscopy improves outcomes in bleeding GOV2 and IGV1 gastric varices: A multicenter retrospective propensity-matched cohort study.","authors":"Fangfang Yu, Zhihong Wang, Xuecan Mei, Wei Zhang, Mingkai Chen, Derun Kong","doi":"10.1177/17562848261483777","DOIUrl":"10.1177/17562848261483777","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound (EUS)-guided cyanoacrylate injection for gastric varices (GVs) may leave residual untreated vessels due to incomplete visualization of distal collateral channels. Whether adding conventional endoscopic injection improves outcomes remains unclear.</p><p><strong>Objectives: </strong>This multicenter retrospective study evaluated a combined EUS-guided and conventional endoscopic approach in patients with bleeding GOV2 or IGV1 varices.</p><p><strong>Design: </strong>This retrospective study (February 2022-December 2024) included 141 cirrhotic patients with acute gastric variceal bleeding from three Chinese tertiary centers.</p><p><strong>Methods: </strong>Patients received either EUS-guided therapy alone or combined therapy with supplementary conventional endoscopic injection per institutional practice. Propensity score matching (1:1) and multivariable Cox regression were used to reduce selection bias. Primary outcome was variceal rebleeding; secondary outcomes included technical success, variceal recurrence, reintervention, mortality, and adverse events.</p><p><strong>Results: </strong>Technical success was achieved in all patients (100%). After matching, variceal recurrence rates were comparable between groups (5.36% vs. 12.50%, P = 0.185), whereas rebleeding occurred less frequently in the combination group than in the EUS group (7.14% vs. 25.00%, P = 0.010). This association appeared more pronounced in IGV1 varices (2.70% vs. 27.03%, P = 0.016), although the subgroup finding should be interpreted cautiously because the interaction test was not statistically significant. Reintervention was also less frequent in the combination group (12.50% vs. 35.71%, P = 0.004). Mortality and adverse event rates were comparable between groups.</p><p><strong>Conclusion: </strong>Supplementary conventional endoscopic injection after EUS-guided therapy was associated with lower risks of rebleeding and reintervention without an apparent increase in adverse events. This combineds strategy may be a feasible option to improve treatment durability in selected patients with high-risk GOV2 or IGV1 gastric varices, but prospective randomized studies are needed for confirmation.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261483777"},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857790","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}