Therapeutic Advances in Gastroenterology最新文献

{"title":"Upper gastrointestinal bleeding differences between older and younger adults: should bleeding in non-cirrhotic patients be considered a geriatric syndrome?","authors":"Francisco Vara-Luiz, Ivo Mendes, Carolina Palma, Paulo Mascarenhas, Diogo Simas, Plácido Gomes, André Ruge Gonçalves, Inês Simão, Madalena Teixeira, Sara Ramos Lopes, Francisca Côrte-Real, Maria Antónia Duarte, Catarina Bravo, Marta Patita, Gonçalo Nunes, Pedro Pinto-Marques, Jorge Fonseca","doi":"10.1177/17562848251343416","DOIUrl":"10.1177/17562848251343416","url":null,"abstract":"<p><strong>Background: </strong>Upper gastrointestinal bleeding (UGIB) is a major medical emergency. Although older citizens have an increased risk of UGIB, guidelines do not fully address specific concerns in this population.</p><p><strong>Objectives: </strong>We aimed to report characteristics/differences between the older (⩾65 years) and the younger adult patients (<65 years) with UGIB.</p><p><strong>Design: </strong>Retrospective multicenter cohort study.</p><p><strong>Methods: </strong>Adult patients consecutively admitted due to evidence of UGIB at six participating centers or who developed UGIB while hospitalized for another reason during a 6-month enrollment period, were eligible for this study.</p><p><strong>Results: </strong>Of 600 patients included, 58.2% were men. Patients aged ⩾65 years comprised 72.8% of the cohort; in this group, most comorbidities (except liver cirrhosis) and use of antiplatelet/anticoagulant therapy were more frequent (<i>p</i> < 0.001). Variceal UGIB was more common in the younger group and non-variceal UGIB in the older (<i>p</i> < 0.001). The risk scores Glasgow-Blatchford (<i>p</i> = 0.003) and Complete Rockall (<i>p</i> < 0.001) were higher in the older group. Peptic ulcer disease was the most common cause in both groups, and angiodysplasia was an almost exclusive diagnosis in the elderly. Overall mortality was 15% (<i>n</i> = 90), with 76 deaths attributed to non-bleeding causes. In a post hoc subgroup analysis excluding cirrhotic patients, older adults required hospitalization (<i>p</i> = 0.007) and longer hospital stays (<i>p</i> = 0.005) more frequently, while younger patients had higher intensive care unit admission rates (<i>p</i> = 0.018). Multivariate analysis in this subgroup suggested that antiplatelet (<i>p</i> = 0.047) or anticoagulant use (<i>p</i> = 0.021), Rockall score (<i>p</i> < 0.001), and Charlson Comorbidity Index (CCI, <i>p</i> = 0.011) were independently associated with in-hospital mortality. The CCI, higher in older patients, also correlated with the need for blood transfusions (<i>p</i> = 0.001), rebleeding (<i>p</i> = 0.013), second-look endoscopy (<i>p</i> < 0.001), and re-hospitalization (<i>p</i> = 0.028).</p><p><strong>Conclusion: </strong>Older adults with UGIB exhibit clinical features associated with higher healthcare resource utilization and worse outcomes. Cirrhosis was linked to adverse outcomes in younger patients. In non-cirrhotic patients, UGIB may share features of geriatric syndromes, reflecting multifactorial risks in this population.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251343416"},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276344","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":"Progressing or preserving, disease extent evolution in hospitalized patients with ulcerative colitis in China: a real-world study.","authors":"Yinghao Sun, Gechong Ruan, Mingyue Guo, Yuge Wei, Xiaoyin Bai, Wei Han, Bei Tan, Ji Li, Yue Li, Hong Yang, Jiaming Qian","doi":"10.1177/17562848251339878","DOIUrl":"10.1177/17562848251339878","url":null,"abstract":"<p><strong>Background: </strong>Disease extent of ulcerative colitis (UC) is dynamic, often shows progression or regression over time. However, factors associated with disease progression in long-term follow-ups remain underexplored.</p><p><strong>Objectives: </strong>This study aimed to examine disease extent progression in Chinese patients in a long-term follow-up cohort and identify associated risk factors.</p><p><strong>Design: </strong>Retrospective analysis.</p><p><strong>Methods: </strong>We retrospectively analyzed 800 hospitalized UC patients from 1980 to 2021, and followed up to December 2023. The disease extent was categorized according to the Montreal classification. The Cox regression model was used to identify factors associated with progression.</p><p><strong>Results: </strong>At diagnosis, 19.1% had E1 (ulcerative proctitis), 29.8% had E2 (left-sided UC), and 51.1% had E3 (extensive UC). By the end of follow-up, the proportion of maximum disease extent of E3 cases increased to 74.9%, while E1 and E2 patients decreased to 6.6% and 18.5%, respectively. Cox regression analysis revealed that patients with a history of appendectomy before the onset of disease were at higher risk of disease progression in those initially diagnosed with E1. Lower usage of glucocorticoids, immunosuppressants, and biologics were found in progression to the E3 group than initial E3 group. Lower usage of immunosuppressants and biologics before progression were found in the progressed to E3 group than not progressed to E3 group.</p><p><strong>Conclusion: </strong>Disease extent progression was common in Chinese UC patients. We suggest the necessity of aggressive treatment strategies, especially for early-stage UC patients, to mitigate disease progression and reduce the risk of related complications.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251339878"},"PeriodicalIF":3.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235679","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":"Evaluation of the cecal withdrawal vocal timer in screening colonoscopies for optimizing withdrawal time and adenoma detection rate.","authors":"Adam Goldman, Alon Lang, Asaf Levartovsky, Idan Levy, Ido Laish, Shomron Ben-Horin, Uri Kopylov","doi":"10.1177/17562848251341752","DOIUrl":"10.1177/17562848251341752","url":null,"abstract":"<p><strong>Background: </strong>Longer cecal withdrawal time has been linked to a higher adenoma detection rate (ADR), with a minimum duration of 6 min recommended. Therefore, we developed the cecal withdrawal vocal timer (CWVT), a novel software tool that is command-activated at cecal intubation and vocally informs the endoscopist of the withdrawal duration every minute.</p><p><strong>Objectives: </strong>Evaluating the efficacy of the CWVT in enhancing adenoma detection.</p><p><strong>Design: </strong>A retrospective, single-center study of screening colonoscopies with adequate preparation and documented cecal intubation.</p><p><strong>Methods: </strong>The primary endpoint was the change in the department's ADR before (2022) and after the CWVT introduction (January 2023-February 2024). Secondary endpoints included the ADR change between procedures with and without CWVT after its introduction and the ADR change among individual endoscopists.</p><p><strong>Results: </strong>The study included 1098 and 1330 eligible colonoscopies pre- and post-CWVT introduction, respectively. Following CWVT introduction, 67.3% of colonoscopies were performed with activated CWVT, with a median withdrawal time of 8.7 (interquartile range: 6.9-11.8) min. The department ADR was 25.5% following CWVT introduction, without a significant difference compared to the year before (26.2%, <i>p</i> = 0.71). During the post-CWVT implementation period, colonoscopies with activated CWVT had higher ADR than those without (28.4% vs 19.5%, respectively, <i>p</i> < 0.001). The improvement was mainly driven by the detection of adenomas smaller than 10 mm and was consistent across 11 out of 12 months in this period and among most endoscopists.</p><p><strong>Conclusion: </strong>While an overall ADR improvement was not achieved with the CWVT, the ADR was higher in post-CWVT procedures that utilized the CWVT than those that did not, warranting further prospective studies to evaluate CWVT's contribution to screening colonoscopy performance.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251341752"},"PeriodicalIF":3.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12123124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200564","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":"Diagnostic accuracy of mean nocturnal basal impedance and other complementary tests for the diagnosis of gastroesophageal reflux disease according to the new Lyon criteria.","authors":"Carlos Lombo-Moreno, David La Rotta, Manuelita Pardo-Ortiz, Fredy Alexander Avila, Raul Antonio Cañadas, Óscar Muñoz, Albis Cecilia Hani","doi":"10.1177/17562848251340495","DOIUrl":"10.1177/17562848251340495","url":null,"abstract":"<p><strong>Background: </strong>In 2023, the diagnostic criteria for gastroesophageal reflux disease (GERD) were updated in the Lyon Consensus 2.0. It is important to investigate the diagnostic accuracy of complementary tests used for GERD diagnosis.</p><p><strong>Objectives: </strong>To determine the diagnostic accuracy of mean nocturnal basal impedance (MNBI) measured by pH-metry in patients with suspected GERD compared to the updated 2023 Lyon Consensus Diagnostic Criteria and to identify the optimal cutoff point for diagnosis.</p><p><strong>Design: </strong>Diagnostic test study based on a retrospective cohort of patients with suspected GERD.</p><p><strong>Methods: </strong>Diagnosis was confirmed using the updated Lyon criteria as the gold standard. We evaluated sensitivity, specificity, and discriminatory ability via area under the receiver operating characteristic curve (AUC-ROC). The best cutoff point was determined using Liu's method for MNBI, number of reflux episodes, number of acid reflux episodes, DeMeester score, and bolus exposure time. ROC curves were compared using DeLong's method.</p><p><strong>Results: </strong>A total of 55 patients were included, with 26 diagnosed positive and 29 negative for GERD. MNBI yielded an AUC-ROC of 0.77 (95% confidence interval (CI): 0.64-0.89); at 1590 ohms, sensitivity and specificity were 69.2% and 72.4%, respectively. The DeMeester score demonstrated superior discriminatory ability over MNBI (<i>p</i> = 0.03), with an AUC-ROC of 0.90 (95% CI: 0.80-1.00), sensitivity of 92%, and specificity of 93% at a cutoff of 15.6. No significant differences in discriminatory ability were observed when comparing MNBI with other complementary tests (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>MNBI and other complementary tests showed suboptimal characteristics for GERD diagnosis. These tests should be interpreted alongside clinical, endoscopic, and pH-metry findings. The DeMeester score seems promising, but further prospective studies are needed to prove its utility.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251340495"},"PeriodicalIF":3.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy.","authors":"Dakui Luo, Zhen Wang, Yufei Yang, Qingguo Li, Xinxiang Li","doi":"10.1177/17562848251340494","DOIUrl":"10.1177/17562848251340494","url":null,"abstract":"<p><strong>Background: </strong>A yield pathological T0 (ypT0) classification usually indicates the pathologically complete response of rectal cancer to neoadjuvant therapy. However, lymph node metastasis may still be present.</p><p><strong>Objectives: </strong>In this study, we aimed to evaluate the prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Patients with locally advanced rectal cancer (LARC) who had undergone preoperative therapy and were pathologically classified as having ypT0 disease at Fudan University Shanghai Cancer Center between December 2012 and September 2022 were retrospectively analyzed. Uni- and multivariate analyses were performed to evaluate the effect of the residual lymph node status on disease-free survival (DFS) and overall survival (OS).</p><p><strong>Results: </strong>A total of 457 patients had ypT0 disease; this included 413 patients with ypT0N0 and 44 with ypT0N1-2. Inadequate lymph node retrieval (<12, <i>p</i> = 0.002) and adenocarcinoma (<i>p</i> = 0.009) were more common in the ypT0N0 group than in the ypT0N1-2 group. The ypT0N1-2 group showed marginal evidence of a higher probability of elevated pretreatment carcinoembryonic antigen levels and adjuvant chemotherapy than the ypT0N0 group (<i>p</i> = 0.076 and <i>p</i> = 0.077, respectively). Patients with ypT0N0 had significantly better 5-year DFS than those with ypT0N1-2 (84.8% vs 68.4%, <i>p</i> = 0.016). However, no significant difference was observed in the 5-year OS between the two groups (93.9% vs 88.8%, <i>p</i> = 0.602). Multivariate analysis revealed that residual lymph node status was an independent prognostic factor for DFS (hazard ratio, 2.285; 95% confidence interval: 1.246-4.192, <i>p</i> = 0.008).</p><p><strong>Conclusion: </strong>Residual lymph node metastasis may affect DFS, but not OS, in pathological T0 patients who receive neoadjuvant therapy followed by radical surgery for LARC.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251340494"},"PeriodicalIF":3.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MASLD and liver fibrosis in patients with psoriasis receiving IL-17 or IL-23 inhibitors: a systematic review.","authors":"José González Fernández, Lucía Prieto-Torres, Mariano Ara Martín, Samuel J Martínez-Domínguez","doi":"10.1177/17562848251335824","DOIUrl":"10.1177/17562848251335824","url":null,"abstract":"<p><strong>Background: </strong>Metabolic dysfunction-associated steatotic liver disease (MASLD) is more prevalent in patients with psoriasis compared to healthy individuals. Interleukin (IL)-17 and IL-23 inhibitors may have beneficial effects on MASLD by reducing systemic inflammation and improving metabolic parameters.</p><p><strong>Objectives: </strong>To assess the effect of IL-17 and IL-23 inhibitors on MASLD and liver fibrosis in patients with psoriasis.</p><p><strong>Design: </strong>We performed a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.</p><p><strong>Data sources and methods: </strong>A literature search was conducted across four databases: MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from database inception to September 27, 2024. Observational studies and clinical trials that reported the presence of MASLD and/or liver fibrosis in patients with psoriasis/psoriatic arthritis treated with IL-17 or IL-23 inhibitors were included. The Newcastle Ottawa Scale (NOS) was used for risk of bias assessment in cohort studies, the Revised Cochrane Risk of Bias Tool (RoB2.0) in randomized controlled trials, and the Risk of Bias in non-randomized studies-of Interventions (ROBINS-I v.2) tool in non-randomized trials.</p><p><strong>Results: </strong>Fourteen studies were included: four clinical trials, five retrospective cohort studies, three prospective cohort studies, and two post hoc studies. Two cohort studies and one clinical trial showed a low risk of bias. Both post hoc studies had a high risk of bias. Eleven studies assessed the effect of IL-17 inhibitors on MASLD or liver fibrosis; six reported a neutral effect, while five demonstrated improvements in liver tests. Three studies evaluated IL-23 inhibitors; one showed neutral effects, another reported improvement in fibrosis-4 index (FIB-4) scores at 6 months, and the third was still in the recruitment phase.</p><p><strong>Conclusion: </strong>IL-17 and IL-23 inhibitors may provide beneficial effects on MASLD and liver fibrosis in patients with psoriasis. Larger, well-designed studies are needed to confirm these findings.</p><p><strong>Trial registration: </strong>PROSPERO CRD42024599350.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251335824"},"PeriodicalIF":3.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12099134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical insights into IL-23 inhibition: risankizumab for Crohn's disease through a systematic review and meta-analysis of randomized controlled trials.","authors":"Po-Feng Huang, Tien-Yu Huang, Yi-Chiao Cheng, Peng-Jen Chen, Wei-Kuo Chang, Chao-Feng Chang","doi":"10.1177/17562848251338743","DOIUrl":"10.1177/17562848251338743","url":null,"abstract":"<p><strong>Background and aims: </strong>Crohn's disease is a chronic inflammatory disorder with rising global prevalence, marked by abdominal pain, diarrhea, and fatigue. Interleukin (IL)-23 plays a pivotal role in Crohn's disease pathogenesis, making it a therapeutic target. Risankizumab, a monoclonal antibody targeting the IL-23 p19 subunit, has shown potential in clinical trials.</p><p><strong>Objectives: </strong>This meta-analysis evaluates the efficacy and safety of Risankizumab in achieving clinical remission, clinical response, and endoscopic remission in patients with moderate-to-severe Crohn's disease.</p><p><strong>Design: </strong>A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines.</p><p><strong>Data sources and methods: </strong>A comprehensive search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov was performed to identify randomized controlled trials (RCTs) assessing Risankizumab in Crohn's disease. Primary outcomes were clinical remission, clinical response, and endoscopic remission, with secondary outcomes focusing on treatment-related adverse events. A random-effects model estimated odds ratios (ORs) with 95% confidence intervals. Meta-regression analyzed dose- and duration-dependent effects.</p><p><strong>Results: </strong>Four RCTs involving 1774 participants showed that Risankizumab significantly improved clinical remission (OR = 2.223), clinical response (OR = 2.483), and endoscopic remission (OR = 4.112). Dose-dependent improvements were observed, with treatment duration affecting clinical remission (<i>p</i> = 0.0158) but not clinical response or endoscopic remission. Adverse event rates were comparable between Risankizumab and placebo groups (OR = 0.872, <i>p</i> = 0.592).</p><p><strong>Conclusion: </strong>Risankizumab is effective in achieving clinical and endoscopic outcomes in moderate-to-severe Crohn's disease, demonstrating dose-dependent benefits and a favorable safety profile, supporting its use as a therapeutic option. However, the limited number of studies may affect the robustness of these findings. Further large-scale RCTs are needed to validate its long-term efficacy, safety in elderly populations, and effectiveness in biologic-naïve patients.</p><p><strong>Trial registration: </strong>This systematic review and meta-analysis were registered with the INPLASY database under registration number INPLASY202530014. The full protocol is accessible at DOI: 10.37766/inplasy2025.3.0014.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251338743"},"PeriodicalIF":3.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural history, immunological and genetic characteristics of preclinical inflammatory bowel disease (EARLY): study protocol for a prospective cohort study.","authors":"Iago Rodríguez-Lago, Urko M Marigorta, Beatriz Mateos, Míriam Mañosa, Lucía Márquez-Mosquera, Luis Menchén, Francisco Rodríguez-Moranta, Inmaculada Alonso, Mariam Aguas, Horacio Alonso-Galán, Pere Borràs, Beatriz Castro, Eugeni Domènech, Rocío Ferreiro-Iglesias, Ruth de Francisco, Francisco Javier García-Alonso, Natalia García, Orlando García-Bosch, Carla Gargallo, Javier P Gisbert, Eva Iglesias, Francisco Mesonero, Jone Ortiz de Zárate, Laura Ramos, Empar Sáinz, Pablo Ladrón, Carles Suria, Cristina Suárez Ferrer, Coral Tejido, Pilar Varela, Raquel Vicente, Yamile Zabana, Gisela Castany, Eva Rodríguez, Ana Gutiérrez, Manuel Barreiro-de Acosta","doi":"10.1177/17562848251338647","DOIUrl":"10.1177/17562848251338647","url":null,"abstract":"<p><strong>Background: </strong>The period prior to the diagnosis of inflammatory bowel disease (IBD), defined as the preclinical phase, has emerged as a potential target for disease modification strategies. Despite the relevance of an early diagnosis to the prognosis of the disease, only a limited number of patients are diagnosed during this window of opportunity.</p><p><strong>Objectives: </strong>To determine the risk of developing symptoms after an incidental diagnosis of IBD and to describe the clinical, genetic, and immunological characteristics of IBD during its preclinical phase.</p><p><strong>Design: </strong>This study protocol describes a prospective, multicenter cohort study in which incidental (i.e., asymptomatic) IBD within the colorectal cancer screening program will be characterized from a clinical and multi-omic perspective and compared with symptomatic patients and healthy non-IBD controls.</p><p><strong>Methods: </strong>Samples from blood, urine, stool, and intestinal endoscopic biopsies will be obtained at baseline. A second sample set will be obtained after 52 weeks from those who remain asymptomatic; samples will also be obtained in those with new-onset symptoms. Medical treatment will be prescribed in all patients following current guidelines. Follow-up visits will be performed every 6 months for 10 years, and all new-onset symptoms, changes in disease behavior, extraintestinal manifestations, IBD-related medical therapies, or surgeries will be recorded. Two control cohorts will be included: one including recently diagnosed symptomatic IBD patients (<3 months), and another with healthy non-IBD controls after a normal ileocolonoscopy, in whom samples will be obtained at baseline. Samples from patients and controls will undergo genetic, proteomic, transcriptomic, single-cell RNA sequencing, metabolomic, and microbiome analyses, and integration of data between the different omic perspectives will also be performed. The study has been approved by the Basque Country Ethics Committee (PI2021116).</p><p><strong>Conclusion: </strong>EARLY will generate a unique dataset addressing a previously unexplored area of IBD, with the final aim of describing the prognosis of patients from its earlier phases on the disease and integrating clinical and omic data into useful tools for the long-term prediction of disease outcomes.</p><p><strong>Trial registration: </strong>NCT05698745.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251338647"},"PeriodicalIF":3.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Work-life conflict and its health effects on Moroccan gastroenterologists: a cross-sectional study.","authors":"Benayad Aourarh, Tarik Adioui, Sanaa Berrag, Fouad Nejjari, Aziz Aourarh, Mouna Tamzaourte","doi":"10.1177/17562848251340264","DOIUrl":"10.1177/17562848251340264","url":null,"abstract":"<p><strong>Background: </strong>Gastroenterologists are exposed to various health-related risks due to their diverse professional roles, including endoscopy, clinical care, and academic responsibilities.</p><p><strong>Objectives: </strong>This study aims to assess the work-life balance (WLB), the prevalence of work-related physical and mental symptoms among gastroenterologists practicing in Morocco, and the effects of WLB on their health.</p><p><strong>Design: </strong>Survey study.</p><p><strong>Methods: </strong>A total of 152 gastroenterologists from various Moroccan cities participated in an anonymous electronic questionnaire regarding their daily activities and symptoms. A WLB ratio was calculated, and musculoskeletal, gastrointestinal, and mental symptoms were recorded. The Maslach Burnout Inventory (MBI) was used to measure the burnout score. Data were analyzed using JAMOVI 2.5 software. The reporting of this study conforms to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) statement.</p><p><strong>Results: </strong>This study included 152 gastroenterologists (72.4% female; sex ratio = 0.38) with a median age of 31 years (range: 26-64). Among participants, 61.8% were married, and 70.2% were married to physicians. The average working hours were 50.2 ± 12.7 h/week. Health-related symptoms were common: 86.8% reported musculoskeletal disorders, and 71.1% reported digestive disorders. Regarding mental symptoms, 23.7% reported anxiety, and 46.1% reported depression, with 21.1% experiencing both. The median WLB ratio was 0.42 (range: 0.32-0.55). In univariate analysis, the ratio was correlated with age (<i>p</i> < 0.001) and mental symptoms (depression, <i>p</i> < 0.001; anxiety, <i>p</i> = 0.007). Multivariate analysis revealed age as the only significant associated factor (beta = -0.24 (95% confidence interval: -0.46 to -0.013)). Using the MBI scale, 72.4% of respondents experienced burnout, which correlated with the WLB ratio (<i>p</i> = 0.04). In addition, depersonalization (DP) showed a moderate negative correlation with age (<i>p</i> = 0.002, <i>r</i> = -0.32), while personal accomplishment (PA) showed a moderate positive correlation with age (<i>p</i> = 0.003, <i>r</i> = 0.31).</p><p><strong>Conclusion: </strong>Moroccan gastroenterologists suffer from musculoskeletal, digestive, and mental symptoms, and are prone to burnout likely due to long and labor-intensive. Our study found that younger individuals worked more and were more likely to experience burnout, particularly with increased DP toward patients and diminished PA. The mechanisms behind this observation may be linked to higher workloads, less autonomy, and limited coping strategies, factors that should be explored further.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251340264"},"PeriodicalIF":3.9,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12069949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Italian EoExpert panel recommendation for disease control, switching criteria, and follow-up in eosinophilic esophagitis from pediatric to adult age.","authors":"Edoardo Vincenzo Savarino, Matteo Fassan, Nicola de Bortoli, Claudio Romano, Antonio Di Sabatino, Roberto Penagini, Francesca Racca, Giovanni Sarnelli, Salvatore Oliva","doi":"10.1177/17562848251337515","DOIUrl":"https://doi.org/10.1177/17562848251337515","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic esophagitis (EoE) is a chronic, progressive type 2 inflammatory disorder of the esophagus, characterized by abnormal eosinophil accumulation in esophageal epithelium. Undiagnosed or undertreated EoE leads to increased risk of fibrostenosis, strictures, and food impaction due to persistent inflammation, deeply impacting patients' health-related quality of life (HRQoL).</p><p><strong>Objectives: </strong>To gather insights on comprehensive assessment of EoE, comprising clinical, endoscopic, histological outcomes, adaptive behaviors and HRQoL; to define proper evaluation of disease control and impact of continuous versus noncontinuous treatment to reach full disease control. Finally, to validate an algorithm for disease control, switching criteria, and follow-up.</p><p><strong>Design: </strong>Literature review, survey, and panel expert opinion building by a multidisciplinary Italian EoExpert Panel (EoExpert) of nine specialists from various Italian institutions.</p><p><strong>Methods: </strong>Non-systematic literature review, followed by a survey including 21 questions on the different topics. Results were then discussed and validated by EoExpert.</p><p><strong>Results: </strong>The current diagnostic pathway often does not allow early detection of EoE patients, especially in the presence of adaptive behaviors and unawareness of EoE best practices. In addition, there is a lack of a shared \"control\" definition. EoExpert reviewed, shared, and recommended two novel management tools for EoE, represented by I.M.P.A.C.T. Questionnaire to uncover adaptive behaviors and S.C.O.P.E. (Symptoms Control, Observation, Pathological Evaluation) scheme for comprehensive treatment efficacy evaluation. EoExpert's recommendations were gathered and turned into a therapeutic management algorithm for the definition of disease control and switching criteria.</p><p><strong>Conclusion: </strong>This document provides a standardized approach to EoE management in pediatric and adult settings, highlighting the importance of timely diagnosis in a multidisciplinary setting, of using unified criteria for assessment of disease control through the adoption of a comprehensive approach and of following up patients. These recommendations highlight the critical role of increased awareness and standardized care in EoE clinical setting for lifelong management.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251337515"},"PeriodicalIF":3.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}