Therapeutic Advances in Gastroenterology最新文献

{"title":"Assessment of real-world disease severity in patients with eosinophilic esophagitis in the United States.","authors":"Evan S Dellon, Glenn T Furuta, Paul Feuerstadt, Priya Bansal, Todor I Totev, Oscar Patterson-Lomba, Hongjue Wang, Sanjana Sundaresan, Rajeev Ayyagari, Tao Fan, Jeanne Jiang, Mena Boules, Brian Terreri","doi":"10.1177/17562848251347361","DOIUrl":"10.1177/17562848251347361","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic esophagitis (EoE) disease severity is not typically reported in clinical practice.</p><p><strong>Objectives: </strong>To assess real-world EoE disease severity (assessed by physicians and using an adapted Index of Severity for EoE (I-SEE)), physician/patient characteristics, healthcare resource utilization (HCRU), and treatment patterns among adolescents and adults with EoE in the USA.</p><p><strong>Design: </strong>A noninterventional, retrospective, physician-reported medical chart review.</p><p><strong>Methods: </strong>Gastroenterologists and allergists/immunologists from a US nationwide panel completed a chart review of medical records (December 2021-January 2022) of patients aged ⩾11 years with a histologically confirmed diagnosis of EoE. Baseline data were collected ⩾6 months before diagnosis of EoE (index date), and study outcomes were collected ⩾6 months after the index date. The study outcomes assessed the EoE diagnostic process, disease severity, treatment patterns, and EoE-related HCRU. All data were stratified by physician-assessed EoE disease severity (mild, moderate, or severe (clinical severity and markers of severity)); index date data were also mapped to an adapted I-SEE scoring system post hoc.</p><p><strong>Results: </strong>Overall, 74 adolescents (11-17 years old) and 325 adults with EoE (⩾18 years old) were included; patient demographics were generally similar across severity levels. The presence of some symptoms (e.g., food impaction), allergic comorbidities (e.g., allergic rhinitis and food allergy (adults only)), duration between first symptom and index date, and the number of treatment lines received by patients increased with increasing physician-assessed EoE disease severity. However, fewer than 10% of adolescents and adults with EoE were assessed as having severe disease, and physician-assessed EoE disease severity was generally higher than the adapted I-SEE-assessed severity.</p><p><strong>Conclusion: </strong>Real-world US data indicated that most patients with EoE had mild or moderate EoE disease severity. The duration between first symptom and index date and the number of treatment lines received by patients with EoE increased with worsening EoE disease severity.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251347361"},"PeriodicalIF":3.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530582","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":"Contemporary approaches in the peri-endoscopic management of antithrombotic agents: current paradigms, challenges, and prognostications.","authors":"Jiaxuan Zuo, Wei Jiang, Lumei Wang, Kaiqi Yang, Peng Li, Shutian Zhang, Rui Cheng","doi":"10.1177/17562848251346869","DOIUrl":"10.1177/17562848251346869","url":null,"abstract":"<p><p>With the increasing prevalence of endoscopic procedures, peri-endoscopic management of antithrombotic agents remains challenging due to inconsistent guideline adherence. This review highlights barriers to suboptimal guideline adherence, which include inadequate guideline education, delayed regional guideline updates, ambiguous anticoagulation responsibility, drug cost disparities, and uneven international resource allocation. Proposed strategies to improve compliance include: (1) Enhanced education for physicians and patients to align practices with evidence-based recommendations; (2) Digital tools such as clinical decision aids to standardize risk stratification and medication management; (3) Unified antithrombotic management teams to clarify responsibilities and reduce inter-specialty discrepancies; and (4) International collaboration to harmonize guidelines and address regional disparities in healthcare access and practice patterns. Existing guidelines from societies such as the European Society of Gastrointestinal Endoscopy, the American Society for Gastrointestinal Endoscopy, and the British Society of Gastrointestinal Endoscopy provide risk-stratified frameworks for procedure-specific antithrombotic management, yet their adoption varies globally. Eastern practices often prioritize shorter warfarin cessation windows (e.g., 3 days for routine colonoscopies in China), contrasting with Western protocols that align more closely with international guidelines. Future directions emphasize integrating artificial intelligence into clinical workflows to personalize risk assessments and adopting telemedicine platforms for real-time decision support. Addressing these gaps is critical to reducing thromboembolic and hemorrhagic complications in high-risk patients undergoing endoscopic procedures.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251346869"},"PeriodicalIF":3.9,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530539","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 impact of artificial intelligence on the endoscopic assessment of inflammatory bowel disease-related neoplasia.","authors":"Siri A Urquhart, Michael Christof, Nayantara Coelho-Prabhu","doi":"10.1177/17562848251348574","DOIUrl":"10.1177/17562848251348574","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract resulting from an inappropriate immune response to an altered gut microbiome in genetically predisposed individuals. Endoscopy plays a central role in IBD management, aiding in diagnosis, disease staging, monitoring, and therapeutic guidance. Patients with IBD face an increased risk of colorectal neoplasia due to chronic inflammation. Artificial intelligence (AI)-based systems show promise in detecting and classifying dysplasia and neoplasia during endoscopic evaluation. While there have been several studies on the application of AI to detect and diagnose various types of neoplasia in the non-IBD population, the literature in patients with IBD is limited. We aim to summarize the current evidence on the application of AI technologies to detect IBD-associated neoplasia, highlighting potential benefits, limitations, and future directions. A comprehensive literature search was performed using the PubMed database to identify relevant studies from January 2010 to February 2025. Additional references were identified from the relevant articles' bibliographies. AI-assisted endoscopy, particularly using machine learning and deep learning techniques, has shown promise in improving lesion detection rates and supporting real-time decision-making. Computer-aided detection systems may increase the sensitivity of dysplasia identification, while computer-aided diagnosis tools can aid in lesion characterization. Early studies suggest that AI can reduce interobserver variability, improve targeting of biopsies, and potentially lead to more personalized surveillance strategies. Although clinical data specific to IBD-related neoplasia remain limited compared to sporadic colorectal neoplasia, the integration of AI into endoscopic practice holds significant potential to enhance dysplasia detection and improve patient outcomes. Continued research, validation in IBD-specific cohorts, and integration with clinical workflows are essential to realize the full impact of AI in this setting.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251348574"},"PeriodicalIF":3.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486736","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":"Laparoscopic liver parenchymal transection using CUSA versus harmonic scalpel: a protocol for a prospective randomized controlled trial.","authors":"Bin Liang, Yufu Peng, Wugui Yang, Yubo Yang, Bo Li, Yonggang Wei, Fei Liu","doi":"10.1177/17562848251348974","DOIUrl":"10.1177/17562848251348974","url":null,"abstract":"<p><strong>Background: </strong>The harmonic scalpel (HS) and cavitron ultrasonic surgical aspirator (CUSA) are two common techniques for liver parenchymal transection (LPT). The second International Consensus Conference on laparoscopic liver resection (LLR) recommended the utilization of the HS for superficial layer LPT and the CUSA for deep layer LPT. Some centers currently employ the HS for deep-layer LPT. However, the potential effect of HS during deep layer transection in LLR remains unclear.</p><p><strong>Objectives: </strong>The study aims to investigate the feasibility, safety, and efficiency of HS in LLR compared with CUSA.</p><p><strong>Design: </strong>This is a study protocol for a randomized controlled trial (RCT).</p><p><strong>Methods and analysis: </strong>This RCT will be carried out at West China Hospital of Sichuan University from January 2024 to December 2025. Consecutive patients who underwent LLRs during this period will be recruited based on the specified inclusion and exclusion criteria. The participants will be randomly allocated to the HS group or the CUSA group. The primary outcome is intraoperative blood loss. Secondary outcomes include parenchymal transection velocity, operative time, conversion rate, postoperative hospital stays, hospital cost, morbidity, and mortality. Subgroup analysis will be performed according to liver cirrhosis. The corresponding statistical approach will be used for statistical analysis.</p><p><strong>Ethics: </strong>The trial has been reviewed and approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University, on January 19, 2024.</p><p><strong>Discussion: </strong>This study will clarify the feasibility, safety, and efficiency of HS for LPT in LLRs. The results will provide more reliable clinical evidence for the selection of LPT devices in LLRs.</p><p><strong>Trial registration: </strong>The study protocol was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn) on April 26, 2024, ChiCTR2400083493. The protocol version is V2.0.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251348974"},"PeriodicalIF":3.9,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12202911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530540","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":"Real-world use of bezlotoxumab to prevent recurrent <i>Clostridioides difficile</i> infections: a single-center experience and meta-analysis.","authors":"Kanika Sehgal, Parul Berry, Raseen Tariq, Darrell S Pardi, Sahil Khanna","doi":"10.1177/17562848251346593","DOIUrl":"10.1177/17562848251346593","url":null,"abstract":"<p><strong>Background: </strong><i>Clostridioides difficile</i> infection (CDI) treated with bezlotoxumab (BEZ) has been demonstrated to have a lower recurrence rate than placebo in clinical trials. However, real-world data on BEZ's effectiveness remain limited and heterogeneous.</p><p><strong>Objectives: </strong>To evaluate the real-world effectiveness of BEZ in preventing CDI recurrence through a single-center retrospective cohort and a meta-analysis.</p><p><strong>Design: </strong>A retrospective cohort study and a meta-analysis.</p><p><strong>Methods: </strong>A retrospective study of patients treated with BEZ from 2017 to 2021 was performed at the Mayo Clinic. Demographics, CDI diagnostics, and several prespecified risk factors were analyzed. A literature search was conducted in August 2024 utilizing the Cochrane Central Register of Controlled Trials, Embase, Medline, Scopus, and Web of Science Core Collection. Studies reporting CDI resolution rates with BEZ were included. The random-effects model described by DerSimonian and Laird was used to calculate weighted pooled resolution rates (WPR) with 95% confidence intervals (CI). We assessed heterogeneity with the inconsistency index (<i>I</i> ²) statistic.</p><p><strong>Results: </strong>Across 28 studies and our retrospective cohort, 2639 CDI patients were analyzed. Among 1786 patients treated with BEZ, 1450 achieved clinical resolution (WPR: 81.6%, 95% CI 77.2-85.6%), with significant heterogeneity (<i>I</i>² = 77.3%). In subgroup analysis, the pooled relative risk of recurrence was 0.56 (95% CI 0.36-0.88; <i>p</i> < 0.01) for BEZ with SoC compared to SoC alone. A WPR of 83.3% (95% CI 75.5%-91.1%) for patients receiving BEZ with SoC was observed when compared with a WPR of 70.8% (95% CI 62.7%-78.8%) in patients receiving SoC alone on subgroup analysis. In our cohort of 47 patients, the CDI resolution rate was 72.3% (34/47).</p><p><strong>Conclusion: </strong>Our retrospective study and meta-analysis demonstrate the real-world efficacy of BEZ in reducing CDI recurrence. The higher recurrence rates in our cohort likely reflect the high-risk nature of the population, including a greater proportion of immunocompromised patients.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251346593"},"PeriodicalIF":3.9,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477416","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":"\"It's a tool, it's got hardships\": a qualitative study of patient experience of colonoscopy and implications for trauma-informed care.","authors":"Katrina S Hacker, Michael A Curley, Corey A Siegel, Jessica K Salwen-Deremer","doi":"10.1177/17562848251346250","DOIUrl":"10.1177/17562848251346250","url":null,"abstract":"<p><strong>Background: </strong>About half of the patients having colonoscopies experience procedure-related anxiety and emotional distress, which are associated with negative outcomes, including pain, higher sedation needs, longer procedure times, and avoidance of future care.</p><p><strong>Objectives: </strong>To improve procedure quality, we sought to understand from the patient's perspective the emotional and psychological aspects of undergoing a colonoscopy and recommendations for improving care.</p><p><strong>Design: </strong>Qualitative interview study.</p><p><strong>Methods: </strong>We conducted semi-structured interviews with patients after colonoscopy. Questions were informed by the theoretical frame of trauma-informed care and fieldwork and collaborative discussions with endoscopists, multidisciplinary staff, and patients. Patients were recruited through purposive sampling to reflect a range of indications for colonoscopy, demographics, and health backgrounds. Interviews and data analysis were conducted in overlapping phases to ensure a diversity of perspectives. Thematic analysis was used to identify shared patterns across the data.</p><p><strong>Results: </strong>Nine patients completed interviews, and analysis generated the central dialectic \"it's a tool, it's got hardships,\" reflecting a shared belief that colonoscopies are both stressful and important to one's health. Within this uniting concept, we identified themes of patient, provider, and process factors that have the potential to reduce or promote distress. Subthemes related to patients' past experiences/expectations, coping, and access to support; providers' communication and behavior; and process factors including prep/wait times, sedation and anesthesia, and team-based care. Factors that buffered against distress included perceived trust, transparency, and confidence; positive expectations rooted in prior healthcare experiences; flexible coping and feeling supported. Factors that contributed to increased vulnerability included having a minoritized identity, a history of past medical trauma, and uncertainty in communication and the colonoscopy process.</p><p><strong>Conclusion: </strong>Efforts to improve the colonoscopy experience should continue to address the interplay of these complex factors. Given that identification of those at the highest risk for distress may not always be possible, we recommend a universal trauma-informed approach and provide specific suggestions for implementation in endoscopy.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251346250"},"PeriodicalIF":3.4,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477414","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":"Discordance between patients' perception and endoscopic assessment of disease activity in ulcerative colitis.","authors":"Boilève Juliette, Trang-Poisson Caroline, Flamant Mathurin, Bouguen Guillaume, Goronflot Thomas, Freyssinet Marie, Kerdreux Elise, Bourreille Arnaud, Le Berre Catherine","doi":"10.1177/17562848251346258","DOIUrl":"10.1177/17562848251346258","url":null,"abstract":"<p><strong>Background: </strong>Discrepancies between symptoms and endoscopy exist in patients with ulcerative colitis (UC). Most studies focused on patient-reported outcomes-2 rather than their overall perception of disease activity.</p><p><strong>Objectives: </strong>The objectives were to assess the concordance between the patient global assessment (PtGA) and the endoscopic evaluation, to analyse the factors associated with agreement and to describe the concordance between the patient's and the physician's perception of UC activity.</p><p><strong>Design: </strong>Prospective, observational study.</p><p><strong>Methods: </strong>Patients with UC were consecutively included at the time of flexible sigmoidoscopy. The concordance between the Mayo endoscopic subscore (MES) and the PtGA was evaluated. The factors related to concordance were investigated, including the inflammatory bowel disease (IBD)-Disk items that were completed by all patients.</p><p><strong>Results: </strong>Out of 104 analysable patients, 32.7% demonstrated complete alignment with the MES. The more the disease was objectively active, the more the patients were concordant, as reflected by the statistically significant differences between concordant and discordant patients in the median (interquartile range) MES (2 (1-2) vs 1 (0-2), respectively (<i>p</i> = 0.002)), Ulcerative Colitis Endoscopic Index of Severity (3 (2-5) vs 1 (0-3), respectively (<i>p</i> = 0.001)) and physician global assessment (whether on a qualitative scale as part of the Mayo score (<i>p</i> = 0.003) or on a 10 cm-visual analogue scale: (4 (1-6) vs 1 (0-3), respectively (<i>p</i> < 0.001)). Over two-thirds of discordant patients perceived their disease as more severe than the endoscopy suggested. While stool frequency did not differ between concordant and discordant patients (<i>p</i> = 0.093), rectal bleeding (<i>p</i> = 0.002) - predictably - and more interestingly, abdominal pain (<i>p</i> = 0.006) and bowel urgency (<i>p</i> = 0.006), emerged as symptoms strongly associated with improved concordance between patient perception and endoscopic evaluation.</p><p><strong>Conclusion: </strong>Discrepancies between patient-reported disease activity and endoscopy are prevalent in UC. In addition to rectal bleeding, abdominal pain and bowel urgency may be more accurate to reflect clinical disease activity than stool frequency.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251346258"},"PeriodicalIF":3.9,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477415","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":"Real-life management of nonobstructive esophageal dysphagia: analysis of a prospective multicentric Portuguese cohort.","authors":"Raquel R Mendes, José Pedro Rodrigues, Inês Simão, Helena Lima, Tiago Guedes, Sílvia Barrias, Mara Sarmento Costa, Paulo Souto, João Carlos Silva, João Correia, Bárbara Morão, Joana Revés, Carina Leal, José Dias Curto, Rui Tato Marinho, Miguel Mascarenhas Saraiva","doi":"10.1177/17562848251345340","DOIUrl":"10.1177/17562848251345340","url":null,"abstract":"<p><strong>Background: </strong>Nonobstructive esophageal dysphagia (NOD) is a common benign condition that significantly impacts quality of life. Management requires a motility-focused approach and consideration for concomitant comorbidities such as gastroesophageal reflux, visceral hypersensitivity, and psychological factors. Currently, esophagogastric junction (EGJ) outflow disorders have the most studied and effective treatments. Data on patient-reported dysphagia and quality of life in this population, and their evolution over time and treatment, are scarce.</p><p><strong>Objective: </strong>This study aims to evaluate the real-world management and behavior of NOD, focusing on motility profiles and the implementation of specific treatments.</p><p><strong>Design: </strong>This is a multicenter prospective observational study that follows the management and evolution of NOD in a Portuguese cohort for 6 months, focusing on dysphagia and quality of life, to evaluate its clinical behavior.</p><p><strong>Methods: </strong>Dysphagia and quality of life were assessed in 195 patients using validated patient-reported questionnaires at baseline and follow-up.</p><p><strong>Results: </strong>From 195 patients, 61% (<i>n</i> = 119) were female, with a mean age of 61 (SD 15) years. According to Chicago classification 4.0, 32.3% (<i>n</i> = 63) had EGJ outflow disorders, 12.8% (<i>n</i> = 25) spastic disorders, 16.4% (<i>n</i> = 32) hypomotile disorders, 35.9% (<i>n</i> = 70) normal motility, and 2.6% (<i>n</i> = 5) were inconclusive. At baseline, the mean PROMIS Gastrointestinal Disrupted Swallowing (PDS) T-score, EQ-5D-3L, and Visual Analog Scale (VAS) scores were 61.7 (SD 7.4), 0.61 (SD 0.26), and 69 (SD 18), respectively. Overall, at 6 months, there were significant improvements in the Eckardt, PDS, and EQ-5D-3L scores, with no difference in VAS. In EGJ disorders, myotomy significantly improved all measurements. In the remaining subgroups, a favorable evolution of dysphagia was observed, without differences between treated and untreated patients.</p><p><strong>Conclusion: </strong>NOD tends to follow a benign course. Apart from achalasia, which has the most defined treatments with documented benefits, decisions for the remaining motility profiles should follow a comprehensive and personalized approach.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251345340"},"PeriodicalIF":3.9,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12205188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530541","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":"Second malignancies in patients with deficient mismatch repair system/microsatellite instability-high colorectal cancer.","authors":"Paul Franques, Pierre Moreau, Camille Evrard, Arnaud Chong-Si-Tsaon, Éric Frouin, Marie-Luce Auriault, Valérie Moulin, Audelaure Junca, Julie Godet, Lucie Lebeau, Roxane Aguillon, Gaëlle Tachon, Lucie Karayan-Tapon, David Tougeron","doi":"10.1177/17562848251347375","DOIUrl":"10.1177/17562848251347375","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancers (CRC) with deficient mismatch repair system and/or microsatellite instability-high (dMMR/MSI-H) phenotype represent about 12% of CRC. dMMR/MSI-H CRC is due to a germline mutation (Lynch syndrome, LS) or an age-related epigenetic mechanism, mostly by hypermethylation of <i>MLH1</i> promoter (sporadic cases). It is well recognized that patients with LS have a high lifetime risk of various dMMR/MSI-H cancers, but there are no data concerning the risk of a second cancer in sporadic dMMR/MSI-H CRC.</p><p><strong>Objectives: </strong>The main objective of this study was to determine the risk of having another primary cancer (APC) in patients with dMMR/MSI-H CRC. We also collected these tumors to determine their MMR phenotype.</p><p><strong>Design: </strong>We used a prospective cohort of 484 well-characterized patients with dMMR/MSI-H CRC to describe their risk of having APC.</p><p><strong>Methods: </strong>We evaluated the occurrence of APC (before or after the occurrence of the dMMR/MSI-H CRC) according to LS versus sporadic status, whatever the stage or the tumor site. The characteristics of the two groups, with and without APC, and LS versus sporadic status were compared.</p><p><strong>Results: </strong>Among the 484 patients with dMMR/MSI-H CRC, we identified 116 patients with a previous or a second primary tumor (24.0%), with an average of 1.4 tumors per patient in addition to the dMMR/MSI-H CRC. The most frequent tumor sites were skin (24.7%) and breast (18.5%). Regarding the occurrence of APC, we found no difference between patients with LS-related dMMR/MSI-H CRC group (25.0%) and those with sporadic dMMR/MSI-H CRC (24.8%). No risk factor was associated with the occurrence of APC in our cohort, in the LS or sporadic cases subgroup. In the sporadic group, 3.8% of APC had a dMMR/MSI-H phenotype as compared to 50.0% in the LS group.</p><p><strong>Conclusion: </strong>It seems important to follow patients with a history of dMMR/MSI-H CRC due to the high risk of second tumors, even in sporadic cases. Second cancers in patients with sporadic dMMR/MSI-H CRC are rarely associated with a dMMR/MSI-H phenotype.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251347375"},"PeriodicalIF":3.9,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12182622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477417","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":"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}