Therapeutic Advances in Gastroenterology最新文献

{"title":"Real-time microscopic visualisation: current applications and challenges of confocal laser endomicroscopy in the diagnosis and treatment of small bowel disorders.","authors":"Wenhui Xia, Qianqian Wang, Qin Zeng, Liwen Feng, Mi Zhou, Shuo Zhang","doi":"10.1177/17562848261437448","DOIUrl":"10.1177/17562848261437448","url":null,"abstract":"<p><p>Small bowel disorders often present insidiously, with early symptoms being non-specific. Moreover, the small intestine's unique anatomical position renders it difficult to access using conventional examination methods, frequently leading to delays in the diagnosis and treatment of small bowel disorders. Confocal laser endomicroscopy (CLE), as an emerging technique based on confocal microscopy, enables high-resolution assessment of gastrointestinal mucosa at cellular and subcellular levels. It provides real-time imaging, thereby achieving an 'optical biopsy'. The application of this technology not only enhances the ability to identify early lesions and dysplasia but also addresses the limitations of traditional endoscopic biopsy techniques - such as poor targeting and low efficiency of random biopsies - by guiding targeted biopsies. While its potential in digestive diseases is significant, particularly as an adjunct to histopathology, its application in the small intestine is still emerging. Current obstacles, such as procedural complexity, high equipment costs and a lack of specific diagnostic criteria, limit its widespread use. This narrative review synthesises findings from studies published since 2005 to critically evaluate the role of CLE in conditions including inflammatory bowel disease, functional bowel disorders and small bowel polyps, providing a balanced perspective for future research and clinical translation.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261437448"},"PeriodicalIF":3.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724452","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":"Advancements in targeted therapy for gastric cancer.","authors":"Yihua Wang, Jie Li, Guanmo Liu, Chenggang Zhang, Pan Li, Weiming Kang, Xin Ye","doi":"10.1177/17562848261439234","DOIUrl":"10.1177/17562848261439234","url":null,"abstract":"<p><p>Gastric cancer (GC) ranks among the most prevalent malignancies of the gastrointestinal system. For patients with advanced-stage disease undergoing surgical resection, postoperative 5-year survival rates remain critically low, typically below 20%. Contemporary therapeutic strategies encompass surgical intervention, cytotoxic chemotherapy, immune checkpoint blockade, and molecularly-targeted agents. Targeted therapeutics exert their effects by exploiting molecular vulnerabilities such as human epidermal growth factor receptor-2, Claudin 18.2, vascular endothelial growth factor/vascular endothelial growth factor receptor, fibroblast growth factor receptor 2, and N6-methyladenosine modification pathways, thereby suppressing tumor proliferation and offering improved clinical outcomes for advanced GC. These agents demonstrate significant potential in extending overall survival durations, underscoring their translational value and substantial research implications. This comprehensive review delineates recent advancements in GC-targeted therapies to inform precision oncology paradigms and guide future drug discovery initiatives.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261439234"},"PeriodicalIF":3.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724366","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":"Patterns of conventional therapy use and advanced therapy initiation drivers in inflammatory bowel disease.","authors":"Tim Raine, Christian Agboton, Alex Geddes, Tom Halmos, David Laharie, Bram Verstockt","doi":"10.1177/17562848261428791","DOIUrl":"https://doi.org/10.1177/17562848261428791","url":null,"abstract":"<p><strong>Background: </strong>Accumulating evidence and conditional regional guidelines support early initiation of advanced therapy (AT) in Crohn's disease (CD) and ulcerative colitis (UC). Nonetheless, AT utilization in real-world clinical practice remains limited.</p><p><strong>Objectives: </strong>The aim of this study was to assess barriers for AT initiation among surveyed gastroenterologists.</p><p><strong>Design: </strong>Quantitative survey with a multimodal approach.</p><p><strong>Methods: </strong>In total, 142 gastroenterologists (30 each from Germany, Italy, and the United Kingdom; 52 from the United States) were surveyed from June to November 2023 to capture drivers of AT initiation. They were classified as low or high conventional therapy (CT) cyclers (using 0-1 or ⩾2 CT cycles before initiating AT, respectively). Behavioral analysis was performed employing a COM-B (Capability, Opportunity, Motivation, Behavior) model.</p><p><strong>Results: </strong>Across countries, 67.3%-90.0% of surveyed gastroenterologists agreed that AT initiation should be early enough to modify the trajectory of disease. Nonetheless, the majority (51.9%-80.0%) of surveyed gastroenterologists were high CT cyclers (except those in the United States treating CD (36.5%)). When surveyed about the importance of factors for initiating AT in patients with UC, high cyclers placed greater importance on treatment familiarity (+8.1%) than low cyclers and preferred to exhaust other treatment options first (+8.9%). Alternatively, low cyclers placed more importance on patient preference (+15.7%) and peer recommendations (+12.9%) than high cyclers. There were fewer differences in AT prescription drivers between low and high CT cyclers for CD than UC.</p><p><strong>Conclusion: </strong>High CT cyclers placed an overall lower value on AT, suggesting clinical beliefs played a determining role in AT initiation among surveyed gastroenterologists.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261428791"},"PeriodicalIF":3.4,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13084038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724450","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":"Increased treatment options and improved survival in real-world patients with HER2-positive advanced gastric cancer from 2011 to 2023.","authors":"Keitaro Shimozaki, Akira Ooki, Kaoru Yoshikawa, Koichiro Yoshino, Shohei Udagawa, Hiroki Osumi, Shota Fukuoka, Takeru Wakatsuki, Mariko Ogura, Daisuke Takahari, Eiji Shinozaki, Keisho Chin, Kensei Yamaguchi","doi":"10.1177/17562848261441026","DOIUrl":"https://doi.org/10.1177/17562848261441026","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Although the emergence of multiple therapeutic agents has benefited patients with human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer (AGC), chronological improvements in treatment outcomes for real-world patients remain unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The present study aimed to evaluate the treatment features of various agents according to their approval periods and investigate outcomes in daily practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Retrospective observational study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively evaluated the clinical outcomes of patients with HER2-positive AGC who received first-line fluoropyrimidine-containing chemotherapy between 2011 and 2023 according to the approval period of each agent in Japan: group A (pre-immunotherapy approval), 2011-2016; group B (nivolumab approval for third-line or later treatment), 2017-2019; and group C (trastuzumab deruxtecan approval for third-line treatment), 2020-2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 309 patients were enrolled (&lt;i&gt;n&lt;/i&gt; = 159, 69, and 81 in groups A, B, and C, respectively). Significant differences were observed among the three groups in terms of the proportion of patients with Eastern Cooperative Oncology Group performance status of 0 or ⩾1 (&lt;i&gt;p&lt;/i&gt; = 0.02), HER2 status of 3+ or 2+/FISH+ (&lt;i&gt;p&lt;/i&gt; = 0.03), prior gastrectomy (&lt;i&gt;p&lt;/i&gt; = 0.008), diffuse-type histology (&lt;i&gt;p&lt;/i&gt; = 0.016), peritoneal metastases (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001), and lymph node metastases (&lt;i&gt;p&lt;/i&gt; = 0.007). The median overall survival (OS) rates were 19.5, 20.6, and 23.5 months in groups A, B, and C, respectively, with no significant difference among the groups. Progression-free survival in the first-line setting did not significantly differ among the three groups. Multivariate analyses revealed primary tumor location, prior gastrectomy, peritoneal metastases, and liver metastases as independent prognostic factors for OS. Inverse probability of treatment weighting analysis showed no significant difference in OS between groups A and B (hazard ratio (HR), 0.86; 95% confidence interval (CI): 0.70-1.05) but superior OS in group C over group A (HR, 0.54; 95% CI: 0.43-0.68) and group B (HR, 0.72; 95% CI: 0.55-0.95). Moreover, 53.3%, 61.4%, and 66.1% of patients in groups A, B, and C, respectively, received third-line treatment. The most commonly administered third-line treatments were irinotecan (63%) in group A, immunotherapy (43%) in group B, and trastuzumab deruxtecan (70%) in group C. The proportion of patients receiving trastuzumab deruxtecan at any line gradually increased across the three groups (7.5%, 30.4%, 44.4%; &lt;i&gt;p&lt;/i&gt; &lt; 0.0001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The emergence of novel agents and treatment modalities may have contributed to improvements in the survival of patients with HER2-positive AGC. This highlights the benefits of effective treatment strategies, including efforts to identify biomarkers and","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261441026"},"PeriodicalIF":3.4,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13077138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693062","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":"Lack of disparities in postoperative care after ileocecal resection in patients with Crohn's disease at tertiary inflammatory bowel diseases centers.","authors":"Shannon Coombs, Molly Powell, Kemmian Johnson, Jessica Hu, Mollie Webb, Philip McDaniel, Parakkal Deepak, Edward L Barnes","doi":"10.1177/17562848261436999","DOIUrl":"https://doi.org/10.1177/17562848261436999","url":null,"abstract":"<p><strong>Background: </strong>Prior studies suggest that longer drive time (DT) to specialists and higher area deprivation index (ADI) are linked to worse outcomes in inflammatory bowel disease (IBD), but their impact on postileocolic resection (ICR) care in patients with Crohn's disease (CD) is not well defined.</p><p><strong>Objectives: </strong>We aimed to evaluate disparities in post-ICR care based on DT and ADI.</p><p><strong>Methods: </strong>Spatial analysis was performed with ArcGIS Pro to geocode patient and medical facility addresses with StreetMap Premium locators. High DT was defined as >60 min from the center. Data were analyzed using basic statistics and multivariate logistic regression.</p><p><strong>Design: </strong>A retrospective cohort study was performed of CD patients' post-ICR care at two tertiary-care IBD centers (January 2018-March 2023).</p><p><strong>Results: </strong>Our study included 293 patients; 44% had high DT. High DT had a higher median number of preoperative advanced therapy (2 vs 1, <i>p</i> = 0.007). Despite this, there was no difference between cohorts in median days to postop ileocolonoscopy (IOE; 257 vs 332, <i>p</i> = 0.59) and surgical recurrence rate (21% vs 27%, <i>p</i> = 0.278). Tobacco use and perianal disease were associated with increased odds of postoperative IOE (adjusted odds ratio (aOR) 2.09) and advanced therapy initiation (aOR 2.00).</p><p><strong>Conclusion: </strong>We identified no differences in postoperative colonoscopy timing or surgical recurrence in patients with CD at two tertiary IBD centers based on DT or ADI. Given the lack of disparities in care delivery among patients treated in tertiary IBD centers, further comparative studies to care outside of specialized networks are needed to evaluate whether centralization to IBD centers is superior.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261436999"},"PeriodicalIF":3.4,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677936","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":"Topical tranexamic acid and sucralfate prevent delayed bleeding after endoscopic sphincterotomy: a randomized controlled trial (with video).","authors":"Hsueh-Chien Chiang, Jui-Wen Kang, Wei-Lun Chang, Tzu-Ling Kuo, Chien-Ming Chiang, Juei-Seng Wu, Po-Jun Chen, Chiao-Hsiung Chuang, Chiung-Yu Chen, Xi-Zhang Lin, Meng-Ying Lin","doi":"10.1177/17562848261438597","DOIUrl":"https://doi.org/10.1177/17562848261438597","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic sphincterotomy (EST) is a standard treatment for choledocholithiasis. However, this approach carries a risk of delayed bleeding, which occurs in 2%-12% of all patients within 14 days postoperatively. Despite this risk, few effective measures are currently available for preventing delayed bleeding.</p><p><strong>Objectives: </strong>Tranexamic acid (TXA) is an antifibrinolytic agent that promotes hemostasis, and sucralfate is an antiulcer agent that forms a protective barrier over wounds. In this study, we investigated whether topical TXA and sucralfate application on post-EST wounds reduces the risk of delayed bleeding.</p><p><strong>Design: </strong>This prospective randomized controlled trial was conducted between December 2023 and December 2024 at a tertiary center.</p><p><strong>Methods: </strong>This study included patients with a naïve biliary major papilla and choledocholithiasis who were scheduled for EST. Patients who had unsuccessful common bile duct cannulation, were scheduled for biliary stent insertion without a sphincterotomy, underwent endoscopic papillary balloon dilatation instead of EST, or had any known biliary or pancreatic malignancies were excluded. The final cohort comprised 120 patients. After EST and stone removal, patients were randomized to an intervention group (<i>n</i> = 60) or a control group (<i>n</i> = 60) using a sealed envelope approach. In the intervention group, TXA (1 g) and sucralfate (2 g) were directly sprayed onto the wound. All patients were monitored for 14 days. The primary outcome was the occurrence of delayed post-EST bleeding during the observation period.</p><p><strong>Results: </strong>Freedom from delayed bleeding within 14 days was significantly longer in the intervention group than in the control group (<i>p</i> = 0.023). TXA and sucralfate application reduced the incidence of delayed post-EST bleeding (0% and 8.3%, respectively) and substantial blood loss (1.6% and 16.6%, respectively).</p><p><strong>Conclusion: </strong>Topical TXA and sucralfate application holds promise for preventing delayed post-EST bleeding.</p><p><strong>Trial registration: </strong>This study was registered at ClinicalTrials.gov (NCT06107504).</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261438597"},"PeriodicalIF":3.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647147","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":"1 versus 2 L PEG/Asc for bowel preparation in patients with hematochezia: a multicenter, prospective, randomized, non-inferiority study.","authors":"Su Young Kim, Sang Hoon Lee, Jundeok Lee, Hyunil Kim, Hong Jun Park, Hyun-Soo Kim","doi":"10.1177/17562848261438238","DOIUrl":"https://doi.org/10.1177/17562848261438238","url":null,"abstract":"<p><strong>Background: </strong>Patients with hematochezia often present with inadequate bowel preparation, which compromises the accuracy of colonoscopy. Despite this clinical challenge, evidence guiding optimal preparation strategies for this population is limited.</p><p><strong>Objectives: </strong>We directly compared the efficacy and safety of ultra-low-volume (1 L) polyethylene glycol/ascorbic acid (PEG/Asc) versus low-volume (2 L) PEG/Asc in patients undergoing colonoscopy for hematochezia.</p><p><strong>Design: </strong>In a prospective, randomized, multicenter non-inferiority trial, patients received either 1 or 2 L PEG/Asc using standard split-dose regimens.</p><p><strong>Methods: </strong>Bowel preparation quality was assessed using the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included patient satisfaction, adverse events, colonic bleeding source identification rate, and adenoma detection rate (ADR).</p><p><strong>Results: </strong>In total, 184 patients were analyzed. Successful bowel cleansing was achieved in 78.3% of the 1 L PEG/Asc group and 76.1% of the 2 L PEG/Asc group, confirming non-inferiority. The mean BBPS score was higher with 1 L PEG/Asc (6.87 vs 6.30; <i>p</i> = 0.053). Patient satisfaction favored the 1 L PEG/Asc group, although the difference was not statistically significant. Colonic bleeding source identification was slightly higher in the 1 L PEG/Asc group than in the 2 L PEG/Asc group, but the difference did not reach statistical significance (82.4% vs 73.6%; <i>p</i> = 0.165). Completion rates, adverse events, and ADR were similar between groups.</p><p><strong>Conclusion: </strong>Ultra-low-volume (1 L) PEG/Asc is as effective and safe as 2 L PEG/Asc for bowel preparation in patients with hematochezia. Bowel cleansing and satisfaction were higher with the 1 L PEG/Asc regimen without statistically significant differences, supporting its use as a practical alternative.</p><p><strong>Trial registration: </strong>The study was registered with the Clinical Research Information Service, Republic of Korea, a primary registry in the WHO Registry Network (registration number: KCT0006124).</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261438238"},"PeriodicalIF":3.4,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647129","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":"One therapy, many targets: redefining ulcerative colitis treatment through fecal microbiota transplantation.","authors":"Maria Rynikova, Viktoria Bojcukova, Vlasta Demeckova","doi":"10.1177/17562848261437918","DOIUrl":"https://doi.org/10.1177/17562848261437918","url":null,"abstract":"<p><p>Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease driven by a multifactorial interplay between gut microbiota dysbiosis, immune dysregulation, and epithelial barrier dysfunction. Accurate diagnosis and a deeper understanding of UC pathogenesis are essential for developing durable and mechanism-based therapies. Despite major advances, conventional treatments such as immunosuppressants and biologics often fail to achieve sustained remission and carry significant adverse effects, underscoring the need for novel, multi-target interventions. This review synthesizes current insights into UC pathogenesis, diagnostic approaches, and therapeutic strategies, with a particular focus on fecal microbiota transplantation (FMT) as a single therapy acting on multiple disease axes. By restoring microbial equilibrium, FMT can modulate host immunity and reinforce epithelial integrity, collectively promoting mucosal healing. We summarize mechanistic evidence, findings from preclinical and clinical studies, and key variables influencing FMT efficacy, including donor selection, preparation, and delivery routes. While evidence supports the therapeutic promise of FMT, challenges remain regarding standardization, long-term engraftment, and sustained safety. Nonetheless, FMT represents a transformative therapeutic platform that redefines UC treatment by bridging microbial restoration, immune modulation, and barrier repair. Future research should aim to refine FMT protocols and develop next-generation microbiota-based therapeutics, such as defined microbial consortia and live biotherapeutic products, to enable safer, more consistent, and personalized modulation of the gut ecosystem in UC.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261437918"},"PeriodicalIF":3.4,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of non-invasive transcutaneous nerve stimulation in patients with irritable bowel syndrome: a systematic review and meta-analysis.","authors":"Yanbin Wei, Zihe Shi, Shanshan Wu, Xin Yao","doi":"10.1177/17562848261436121","DOIUrl":"https://doi.org/10.1177/17562848261436121","url":null,"abstract":"<p><strong>Background: </strong>Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder worldwide, characterized by recurrent abdominal pain and altered bowel habits, which significantly impair quality of life and impose a socioeconomic burden. Traditional pharmacological treatments have limited efficacy and are often associated with side effects, highlighting the need for effective non-pharmacological interventions. Non-invasive transcutaneous nerve stimulation (NITNS) has shown potential in improving IBS symptoms and autonomic function, but systematic evidence is lacking.</p><p><strong>Objectives: </strong>To systematically evaluate the efficacy and safety of NITNS in IBS and explore its potential mechanisms.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources and methods: </strong>Randomized controlled trials (RCTs) were identified through <i>PubMed</i>, <i>Embase</i>, <i>Cochrane Library</i>, and <i>Web of Science</i> from database inception to September 28, 2025. Studies included patients aged 18-75 years who met IBS diagnostic criteria. Interventions involved NITNS, with sham-NITNS as the control. Primary outcomes were IBS symptom severity scale (IBS-SSS) and IBS quality of life (IBS-QOL). Secondary outcomes included visual analogue scale (VAS), Bristol stool form scale (BSFS), heart rate variability (HRV), and adverse events (AEs). Data extraction and risk-of-bias assessment were independently performed by two reviewers.</p><p><strong>Results: </strong>Four RCTs, including 170 patients, were analyzed. NITNS significantly reduced IBS-SSS scores (<i>p</i> = 0.0001) and increased IBS-QOL scores (<i>p</i> < 0.0001). VAS (<i>p</i> = 0.0003) and BSFS (<i>p</i> < 0.00001) scores also improved significantly. HRV results suggested NITNS might influence the autonomic nervous system function. The incidence of AEs did not differ significantly between NITNS and sham-NITNS groups (<i>p</i> = 0.64). Exploratory subgroup analysis indicated that differences in NITNS stimulation modalities and IBS subtypes might influence the therapeutic efficacy of NITNS. Overall evidence quality ranged from low to very low.</p><p><strong>Conclusion: </strong>NITNS is a safe and effective non-pharmacological intervention with potential value in the management of IBS. However, further large-scale, high-quality RCTs are needed to confirm their long-term efficacy and safety.</p><p><strong>Trial registration: </strong>PROSPERO CRD420251157617.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261436121"},"PeriodicalIF":3.4,"publicationDate":"2026-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13051232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147634814","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":"Increased failure of budesonide MMX for ulcerative colitis during the COVID-19 pandemic: a population-based study.","authors":"Stephanie Coward, Karen J B Martins, Scott Klarenbach, Lawrence P Richer, Christopher Ma, Remo Panaccione, Cynthia H Seow, Karen Kroeker, Frank Hoentjen, Laura E Targownik, Gilaad G Kaplan","doi":"10.1177/17562848261434442","DOIUrl":"https://doi.org/10.1177/17562848261434442","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids induce remission in ulcerative colitis (UC) but are associated with adverse effects, including prednisone ⩾20 mg/day associated with serious COVID-19 outcomes.</p><p><strong>Objectives: </strong>To evaluate the risk of rescue prednisone use following budesonide multimatrix system (MMX) initiation in newly diagnosed individuals with UC before and during the COVID-19 pandemic.</p><p><strong>Design: </strong>Population-based cohort study.</p><p><strong>Methods: </strong>We conducted a population-based study in Alberta, Canada, identifying adults with incident UC (2018-2022). Courses of budesonide MMX were examined for treatment failure, defined as prednisone rescue or inflammatory bowel disease-specific hospitalization within 90 days. Outcomes were compared between prepandemic (before April 2020) and pandemic periods using Cox proportional hazards models.</p><p><strong>Results: </strong>Among 269 dispensings of budesonide MMX (38 with multiple courses), 30.5% required rescue prednisone and 6.7% resulted in hospitalization. Budesonide MMX dispensing declined during the pandemic wherein, the hazard of prednisone rescue increased (HR 1.64; 95% CI: 1.01-2.67).</p><p><strong>Conclusion: </strong>Budesonide MMX was prescribed less frequently during the COVID-19 pandemic, with increased treatment failure, underscoring pandemic-related disruptions in UC management.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261434442"},"PeriodicalIF":3.4,"publicationDate":"2026-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13036333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147595779","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}