Therapeutic Advances in Gastroenterology最新文献

{"title":"Peripheral T lymphocyte immune characteristics dictate response to transarterial chemoembolization in unresectable hepatocellular carcinoma.","authors":"Lei Peng, Qi Liang, Peng Fei Rong, Shengwang Zhang, Huan Chen, Huaping Liu, Xiaoqian Ma, Wei Wang","doi":"10.1177/17562848251333295","DOIUrl":"https://doi.org/10.1177/17562848251333295","url":null,"abstract":"<p><strong>Background: </strong>Although transcatheter arterial chemoembolization (TACE) is one of the first-line treatments for unresectable HCC (uHCC) patients, its overall efficacy varies significantly. Therefore, the identification of reliable biomarkers capable of effectively distinguishing TACE-responsive populations is clinically critical.</p><p><strong>Objectives: </strong>Our research aims to investigate T-lymphocyte subpopulations and associated pathways in peripheral blood that contribute to TACE refractoriness, as well as to develop effective methods for predicting TACE efficacy.</p><p><strong>Design: </strong>This is an observational study.</p><p><strong>Methods: </strong>A total of 50 patients who underwent standard TACE-based therapy between January 2020 and December 2022 were included in this study. TACE response was evaluated within 1-3 months following two consecutive TACE sessions. Patients with TACE failure were assigned to the Non-Response group, whereas the remaining were categorized into the Response group. Blood samples were collected prior to treatment and subsequently analyzed using flow cytometry and RNA sequencing. Predictors were analyzed using univariate and multivariate analyses within the bivariate logistic regression models. Pathway enrichment analysis was performed using gene set enrichment analysis (GSEA).</p><p><strong>Results: </strong>A total of 24 of 50 (48%) exhibited TACE failure (Non-Response). Baseline peripheral T-lymphocyte analysis revealed that the Non-Response group had a higher abundance of senescent phenotype (T<sub>Senescence</sub>, CD27<sup>-</sup>CD28<sup>-</sup>) in both CD4/CD8<sup>+</sup> T cells (<i>p</i> < 0.0001), but a lower proportion of memory stem cell (T<sub>SCM</sub>) subpopulation (CD4<sup>+</sup> T<sub>SCM</sub>: p = 0.0411; CD8<sup>+</sup> T<sub>SCM</sub>: <i>p</i> < 0.0001). Furthermore, in CD8<sup>+</sup> T cells, they exhibited higher expression of exhaustion marks (PD-1: <i>p</i> = 0.0005; LAG-3: <i>p</i> = 0.0026; TIGIT: <i>p</i> = 0.0014) and significantly lower production of effector molecules (TNF-α: <i>p</i> < 0.0001; IFN-γ: <i>p</i> = 0.0018; GZMB: <i>p</i> < 0.0001). Transcriptomics revealed that the Response group was enriched in pathways associated with energy and drug metabolism. Univariate and multivariate analyses demonstrated that the baseline CD8<sup>+</sup> T<sub>SCM</sub> and CD8<sup>+</sup> T<sub>Senescence</sub> subpopulations were significant predictive factors for TACE efficacy.</p><p><strong>Conclusion: </strong>Our study demonstrated significant differences in the immune characteristics of peripheral T lymphocytes between the Non-Response and Response groups. The CD8<sup>+</sup> T<sub>SCM</sub> and CD8<sup>+</sup> T<sub>Senescence</sub> subsets are potential predictors of TACE efficacy and long-term survival. These insights into peripheral blood T lymphocytes offer valuable evidence to help clinicians more effectively identify potential TACE-responsive p","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251333295"},"PeriodicalIF":3.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12059425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041328","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":"IBD-related disability among patients with ulcerative colitis in China: a cross-sectional study.","authors":"Mengyuan Zhang, Xiaojuan Liu, Shichen Min, Hong Shen, Lei Zhu","doi":"10.1177/17562848251333989","DOIUrl":"https://doi.org/10.1177/17562848251333989","url":null,"abstract":"<p><strong>Background: </strong>Ulcerative colitis (UC) is a chronic inflammatory disorder that can lead to physical, psychological, and social disabilities among patients.</p><p><strong>Objectives: </strong>To evaluate the disability level in a cross-sectional study of Chinese patients with UC and identify factors associated with disability.</p><p><strong>Design: </strong>This was a cross-sectional study.</p><p><strong>Methods: </strong>Between April 2022 and March 2023, UC patients from the Affiliated Hospital of Nanjing University of Chinese Medicine responded to questionnaires including the Inflammatory Bowel Disease Disability Index (IBD-DI), Fatigue Severity Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7. In addition, demographic characteristics and clinical data of the patients were collected. Associated factors were identified by univariate and multivariate logistic regression analyses.</p><p><strong>Results: </strong>A total of 345 patients completed the questionnaires. The median (interquartile range) IBD-DI score was 16.2 (9.6-26.5), and the overall prevalence of disability was 39.7%. IBD-DI correlated with Mayo score, fatigue, anxiety, depression, hemoglobin (HGB), albumin (ALB), and erythrocyte sedimentation rate (ESR). Furthermore, the self-reported disability (IBD-DI > 20) was associated with lower BMI, active UC, disease severity of moderate and severe, disease location of left-sided UC (E2), using corticosteroids or biologics for treatment, Mayo score, fatigue, depression, anxiety, HGB, ALB, complement 3 (C3), and ESR. Notably, lower BMI, higher Mayo score, fatigue, and depression were identified as independent risk factors of disability in UC patients.</p><p><strong>Conclusion: </strong>This study revealed a significant level of disability among the Chinese UC population. Several clinical factors were identified to affect the level of disability, notably the risk factors including BMI, disease severity, fatigue, and depression.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251333989"},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12046165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002337","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":"Anticholinergic agents and impaired cognitive function: is there a risk for patients with irritable bowel syndrome?","authors":"Peter J Whorwell","doi":"10.1177/17562848251338479","DOIUrl":"https://doi.org/10.1177/17562848251338479","url":null,"abstract":"","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251338479"},"PeriodicalIF":3.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007723","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":"Managing <i>Helicobacter pylori</i>: elimination challenges.","authors":"Farid Rahimi, Amin Talebi Bezmin Abadi","doi":"10.1177/17562848251336293","DOIUrl":"https://doi.org/10.1177/17562848251336293","url":null,"abstract":"","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251336293"},"PeriodicalIF":3.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12041718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of early tumor shrinkage on survival outcomes in patients with HER2-positive advanced gastric cancer treated with trastuzumab deruxtecan in third- or later-line settings.","authors":"Koshiro Fukuda, Hiroki Osumi, Keitaro Shimozaki, Keisho Chin, Mariko Ogura, Shota Fukuoka, Shohei Udagawa, Koichiro Yoshino, Mikako Tamba, Takeru Wakatsuki, Eiji Shinozaki, Kensei Yamaguchi, Akira Ooki","doi":"10.1177/17562848251333538","DOIUrl":"https://doi.org/10.1177/17562848251333538","url":null,"abstract":"<p><strong>Background: </strong>Trastuzumab deruxtecan (T-DXd) has been approved for a third- or later-line treatment of HER2-positive advanced gastric cancer (AGC) in Japan. However, clinical data on the use of T-DXd in real-world practice remain insufficient. Although early tumor shrinkage (ETS) serves as an early on-treatment indicator of high treatment sensitivity, the use of ETS in predicting T-DXd efficacy remains unclear.</p><p><strong>Objectives: </strong>This study aimed to evaluate the clinical efficacy and safety of T-DXd and investigate the clinical utility of ETS as a predictor of long-term efficacy and survival.</p><p><strong>Design: </strong>Single-center retrospective cohort study.</p><p><strong>Methods: </strong>This study consecutively enrolled patients with HER2-positive AGC who received T-DXd as a third- or later-line treatment between March 2018 and December 2023. Data on patient characteristics, adverse events (AEs), and clinical outcomes were obtained from electronic medical records. Clinical efficacy was assessed using progression-free survival (PFS) and overall survival (OS). In patients with measurable lesions, the overall response rate (ORR), ETS, and depth of response (DpR) were evaluated. Prognostic outcomes were assessed using the log-rank test and the Cox proportional hazards model.</p><p><strong>Results: </strong>A total of 65 patients received T-DXd, with a median age of 66 years (range, 31-82 years); 77% had HER2 immunohistochemistry score of 3+, 71% received T-DXd as a third-line treatment, and 32% required initial dose reduction. At a median follow-up of 33.6 months, the median PFS and OS were 4.5 months and 7.7 months, respectively. Among the 47 patients with measurable lesions, the ORR was 36%. A median DpR of 15.8% was observed, with higher DpR correlating with longer OS. ETS was achieved in 38% of the patients and was an independent predictor of favorable PFS (hazard ratio (HR), 0.21; 95% confidence interval (CI), 0.09-0.49; <i>p</i> < 0.01) and OS (HR, 0.23; 95% CI, 0.10-0.52; <i>p</i> < 0.01). Longer second-line treatment duration was independently associated with improved OS. Overall, grade ⩾ 3 AEs occurred in 37% of the patients. Initial dose reduction reduced AE-induced discontinuation of treatment without compromising efficacy.</p><p><strong>Conclusion: </strong>T-DXd demonstrated notable efficacy and a manageable safety profile in patients with HER2-positive AGC. Rapid and deep tumor shrinkage may have a significant impact on survival.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251333538"},"PeriodicalIF":3.9,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055626","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":"Delayed endoscopic retrograde cholangiopancreatography: a game-changer for acute cholangitis patients in a resource-limited setting.","authors":"Nguyen Thi Hue, Nguyen Thi Huyen Trang, Nguyen Anh Tuan, Pham Minh Ngoc Quang, Mai Thu Hoai, Mai Thanh Binh","doi":"10.1177/17562848251329868","DOIUrl":"https://doi.org/10.1177/17562848251329868","url":null,"abstract":"<p><strong>Background: </strong>Acute cholangitis (AC) is a critical biliary infection caused by gallstones that can progress to systemic inflammation, sepsis, and organ failure. The 2018 Tokyo Guidelines advocate for early endoscopic retrograde cholangiopancreatography (ERCP) in moderate-to-severe AC, but its timing in resource-limited settings remains debated. In Vietnam, where healthcare resources may be limited, the timing of ERCP in patients with AC caused by gallstones has not been extensively studied.</p><p><strong>Objectives: </strong>To compare outcomes of early ERCP (eERCP, ⩽48 h) versus delayed ERCP (dERCP, >48 h) in managing stone-induced AC.</p><p><strong>Design: </strong>This was a retrospective cohort study analyzing outcomes of early versus dERCP in 708 patients with stone-induced AC. The study aimed to evaluate procedural efficacy, complications, and long-term outcomes, particularly in a resource-limited setting. Patients were stratified based on ERCP timing (⩽48 h for eERCP and >48 h for dERCP) to enable direct comparisons.</p><p><strong>Methods: </strong>Data on demographics, clinical features, laboratory findings, and procedural outcomes were analyzed.</p><p><strong>Results: </strong>The eERCP group exhibited higher rates of severe cholangitis and elevated inflammatory markers compared to the dERCP group. Intensive care unit admission rates were also higher in the eERCP group (3.1% vs 0.8%, <i>p</i> = 0.02). Perforation complications occurred more frequently in the dERCP group (1.2% vs 0%, <i>p</i> = 0.01), while stone treatment outcomes were comparable between the two groups. The eERCP group had a shorter hospital stay (6.5 vs 9.3 days, <i>p</i> < 0.05), although there were no significant differences in readmission or 1-year mortality rates. For patients with severe cholangitis, the treatment outcomes for stones, complications after intervention, and the 1-year mortality and readmission rates are similar between the two groups.</p><p><strong>Conclusion: </strong>In resource-limited settings, dERCP following resuscitation provides outcomes comparable to eERCP, offering a viable alternative when resources are constrained.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251329868"},"PeriodicalIF":3.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007726","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":"Comparative efficacy of subcutaneous infliximab switching in remission and non-remission patients with inflammatory bowel disease after intravenous maintenance: 1-year outcome from a multicentre cohort study.","authors":"June Hwa Bae, Yoo Jin Lee, Jung-Bin Park, Ji Eun Baek, Seung Wook Hong, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Kyeong Ok Kim, Byung Ik Jang, Eun Soo Kim, Hyeong Ho Jo, Eun Young Kim, Sung Wook Hwang","doi":"10.1177/17562848251333516","DOIUrl":"https://doi.org/10.1177/17562848251333516","url":null,"abstract":"<p><strong>Background: </strong>Elective switching from intravenous (IV) to subcutaneous (SC) infliximab (IFX) has shown efficacy in patients with inflammatory bowel disease (IBD). However, long-term outcomes for patients not in remission remain unclear.</p><p><strong>Objectives: </strong>We evaluated the effectiveness of SC IFX switching in both remission and non-remission patients.</p><p><strong>Design: </strong>This study was a retrospective multicentre study conducted across five tertiary hospitals in Korea.</p><p><strong>Methods: </strong>Patients with IBD who switched to SC IFX between January 2021 and January 2023 were included. Clinical remission was defined as a Crohn's Disease Activity Index of <150 or a partial Mayo score of <2. Biochemical remission was defined as faecal calprotectin of <250 µg/g and C-reactive protein of <0.5 mg/dL. We investigated the treatment persistence rate of SC IFX and trends in pharmacokinetics, clinical indices and biomarkers over 1 year of follow-up, analysing the data based on the baseline remission state.</p><p><strong>Results: </strong>Among 127 patients included, 90 (70.9%) were in clinical remission, and 37 (29.1%) were not at the time of switching. The one-year treatment persistence rate was 92.1%, with no significant difference between the clinical remission and non-remission groups (<i>p</i> = 0.139). Persistence was also unaffected by baseline biochemical remission status. IFX pharmacokinetics and biomarkers improved significantly in both clinical groups over 12 months (<i>p</i> < 0.005). Disease activity indices remained stable in the remission group and decreased in the non-remission group after switching. Previous biologics exposure was the only significant predictor of treatment persistence (hazard ratio, 5.634; 95% confidence interval, 1.357-23.384; <i>p</i> = 0.017). Adverse events related to SC IFX occurred in 15.7% of patients. The optimal SC IFX cutoff levels associated with clinical and biochemical remission were 11 and 17 μg/mL, respectively.</p><p><strong>Conclusion: </strong>Switching from IV to SC IFX during maintenance therapy demonstrated high treatment persistence and safety, irrespective of clinical and biochemical remission status.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251333516"},"PeriodicalIF":3.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993458","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":"Switch acceptance and persistence of adalimumab biosimilars in IBD patients: a prospective observational study.","authors":"Gabrielle D'Abbundo, Maria Nachury, Alice Wartski, Aurélie Blondeaux, Sofia Hambli, Romain Gérard, Pierre Desreumaux, Nicolas Duveau, Pauline Wils","doi":"10.1177/17562848251332025","DOIUrl":"https://doi.org/10.1177/17562848251332025","url":null,"abstract":"<p><strong>Background: </strong>Prospective data about the acceptance and outcomes of switching from the adalimumab (ADA) reference product (RP) to multiple ADA biosimilars in inflammatory bowel disease (IBD) patients are lacking.</p><p><strong>Objectives: </strong>To evaluate the acceptance rate of switching from the ADA RP to ADA biosimilars, identify factors associated with non-acceptance, assess persistence at 6 and 12 months, determine reasons for discontinuation, analyze changes in disease activity, and explore patient perceptions at 12 months.</p><p><strong>Design: </strong>A prospective study was conducted at a French tertiary center between July 2020 and September 2021, including consecutive IBD outpatients treated with ADA RP for over 6 weeks.</p><p><strong>Methods: </strong>Patients were offered a switch to five different ADA biosimilars, with the presence of a trained nurse. Data were collected on acceptance rates, persistence at 6 and 12 months, discontinuation reasons, disease activity, and patient perceptions using a 5-item questionnaire at 12 months.</p><p><strong>Results: </strong>Of the 97 patients included, 91.8% accepted the switch. The only factor linked to non-acceptance was a poor opinion of generic drugs. Persistence with the initial ADA biosimilar was 68.6% at 6 months and 60.4% at 12 months. The overall survival rate without biosimilar discontinuation was 76.7% at 6 months and 71% at 12 months. Injection site pain (24.7%) was the leading cause of discontinuation, and 22 patients switched back to the ADA originator. Clinical remission was maintained in 90.4% of patients at 12 months. Among respondents, 65.8% reported a positive experience with the switch.</p><p><strong>Conclusion: </strong>The study demonstrates high acceptance and favorable outcomes for switching to ADA biosimilars in IBD patients, including sustained efficacy and good treatment persistence. These findings suggest that switching to ADA biosimilars is a viable option for IBD patients, with positive results in terms of both clinical effectiveness and patient adherence.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251332025"},"PeriodicalIF":3.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052769","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":"Complete closure utilizing titanium clips minimizes delayed postpolypectomy bleeding after colorectal endoscopic mucosal resection: a retrospective analysis.","authors":"Wei-Feng Li, Bing Lai, Li Lv, Xi-Qiu Yu, Jia-Le Fan, Zhi-Wei Zhou, Jing-Wen Xu, Ruo-Yu Gao, Ze-Ming Chen, Bi-Xia Xu","doi":"10.1177/17562848251332836","DOIUrl":"https://doi.org/10.1177/17562848251332836","url":null,"abstract":"<p><strong>Background: </strong>Delayed postpolypectomy bleeding (DPPB) constitutes one of the most prevalent complications following endoscopic mucosal resection (EMR) for colonic polyps and can be life-threatening. It has been affirmed that prophylactic clip closure can effectively diminish the risk of DPPB for colonic polyps exceeding 20 mm in the right half of the colon after EMR. Nevertheless, there remains controversy regarding whether prophylactic clip closure can prevent postoperative bleeding for polyps measuring less than 20 mm. To date, no literature has reported whether the complete closure of titanium clips following EMR for colorectal polyps ⩽20 mm can effectively prevent delayed bleeding.</p><p><strong>Objectives: </strong>The aim of this study is to determine whether complete closure can prevent delayed postoperative bleeding and analyze the related factors that might influence delayed postoperative bleeding.</p><p><strong>Design: </strong>In this retrospective study, a total of 1259 colorectal polyps detected in 1025 patients between January 2020 and October 2024 were evaluated for EMR.</p><p><strong>Methods: </strong>Univariate and logistic regression analyses were conducted to assess patient-related, polyp-related, and procedure-related factors.</p><p><strong>Results: </strong>DPPB was observed in 37 patients, representing an incidence rate of 3.6%. Logistic regression analysis indicated that male (odds ratio, 3.870; 95% confidence interval (CI), 1.594-9.396; <i>p</i> = 0.003), presence of large polyps (OR, 1.158; 95% CI, 1.044-1.285; <i>p</i> = 0.006), and partial closure (OR, 5.447; 95% CI, 2.250-13.186; <i>p</i> < 0.001) are significant risk factors for the development of DPPB.</p><p><strong>Conclusion: </strong>Male, polyp size, and partial closure have been identified as potential risk factors for the development of DPPB. While gender and polyp size are immutable factors, partial closure is particularly associated with an increased risk of DPPB. Therefore, it is imperative to ensure complete closure of the wound following EMR to minimize the occurrence of DPPB.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251332836"},"PeriodicalIF":3.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057861","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":"Factors associated with failure of fecal microbiota transplant for recurrent <i>Clostridioides difficile</i> infection.","authors":"Joseph D K Nguyen, Kibret G Yohannes, Initha Setiady, Emma C Phillips, Rachel Ann Hays, Brian W Behm, Cirle A Warren, Jae Hyun Shin","doi":"10.1177/17562848251334517","DOIUrl":"https://doi.org/10.1177/17562848251334517","url":null,"abstract":"<p><strong>Background: </strong><i>Clostridioides difficile</i> infection (CDI) has emerged as a prevalent and recurrent antibiotic-associated infection. Fecal microbiota transplantation (FMT) is the most effective treatment for recurrent CDI (rCDI). Despite high success rates, FMT is ineffective in 5%-20% of cases. Factors associated with failure have not been clearly defined.</p><p><strong>Objectives: </strong>In this study, we seek to identify factors predictive of FMT failure.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on adult patients who were screened at the Complicated <i>C. difficile</i> Clinic at the University of Virginia Health System and received FMT for rCDI between 2013 and 2022. The primary outcome was failure of FMT, defined as either rCDI or all-cause death within 1 year.</p><p><strong>Results: </strong>In total, 240 patients underwent FMT: 70.4% were female, the median age was 68, and the median episode of CDI was 4. A total of 24.6% experienced failure within 1 year (18.3% had rCDI and 7.1% died). Age 70 or older (odds ratio (OR) = 2.66 (1.29-5.67)), ⩾4 episodes of CDI (OR = 3.13 (1.47-7.09)), and diabetes mellitus (OR = 2.82 (1.25-6.50)) were associated with failure on multivariate analysis.</p><p><strong>Conclusion: </strong>Our study shows that FMT remains an effective treatment for rCDI. We highlight several factors associated with FMT failure, such as older age, ⩾4 episodes of CDI, and diabetes mellitus, and the need for additional research to clearly define causality.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251334517"},"PeriodicalIF":3.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007122","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}