Therapeutic Advances in Gastroenterology最新文献

{"title":"Single and multiple switches, swap and retransitioning among 28,073 biological drug users with inflammatory bowel diseases: results from the Italian VALORE network.","authors":"Giorgia Pellegrini, Andrea Spini, Chiara Bellitto, Luca L'Abbate, Ylenia Ingrasciotta, Federica Soardo, Olivia Leoni, Arianna Mazzone, Domenica Ancona, Paolo Stella, Anna Cavazzana, Angela Scapin, Sara Lopes, Valeria Belleudi, Stefano Ledda, Paolo Carta, Paola Rossi, Lucian Ejlli, Ester Sapigni, Aurora Puccini, Rita Francesca Scarpelli, Giovambattista De Sarro, Marco Tuccori, Rosa Gini, Alessandra Allotta, Sebastiano Addario Pollina, Roberto Da Cas, Giampaolo Bucaneve, Antea Maria Pia Mangano, Francesco Balducci, Carla Sorrentino, Ilenia Senesi, Francesca Futura Bernardi, Ugo Trama, Stefania Spila Alegiani, Flavia Mayer, Marco Massari, Edoardo Vincenzo Savarino, Angela Variola, Gianluca Trifirò","doi":"10.1177/17562848251378080","DOIUrl":"10.1177/17562848251378080","url":null,"abstract":"<p><strong>Background: </strong>The increasing availability of biological drugs (originators and biosimilars) in the last decade for inflammatory bowel diseases (IBD), such as Crohn's disease (CD) and ulcerative colitis (UC), has led to complex switching patterns in real-world settings.</p><p><strong>Objectives: </strong>To describe the switching/swapping patterns of biological drugs in IBD patients in Italy over the last decade.</p><p><strong>Design: </strong>A retrospective cohort study was conducted using administrative data from 14 Italian regions (2010-2023) in the VALORE distributed database network.</p><p><strong>Methods: </strong>Patients with at least 1 year of look-back and follow-up, who initiated biological therapy with ⩾2 dispensations for IBD, were included. Switches, swaps (between biologic classes), multiple switches (⩾2), switch-backs, and re-transitioning (biosimilar to originator) were described. Predictors of multiple switches at 3 years were identified through COX regression analysis.</p><p><strong>Results: </strong>Among 28,073 first-ever users (55.8% Crohn's disease and 44.2% ulcerative colitis), most started with adalimumab (45.3%) or infliximab (39.6%). The F/M ratio was 0.79, with a median age of 41.0 years (IQR: 27.0-54.0). At 1, 3, and 5 years, switch/swap rates were 12.0%, 35.6%, and 52.6%, respectively, while multiple switches occurred in 18.7% at 5 years. Re-transitioning from biosimilar to originator occurred in 10% of patients who initially switched from originator to biosimilar of the same molecule. Tumor necrosis factor alpha (TNF-α) inhibitors switched more frequently and more rapidly than ustekinumab or vedolizumab. Depression and corticosteroid use were identified as predictors of multiple switches at 3 years of follow-up.</p><p><strong>Conclusion: </strong>About half of first-ever users of biological drugs who were treated because of IBDs switched or swapped within 5 years from treatment start. TNF-α drugs were more likely to switch or swap. They also swapped or switched more rapidly than vedolizumab and ustekinumab. Notably, 1 out of 5 had changed biologic therapy more than once at 5 years and, among those who switched to a biosimilar, 1 out of 10 re-transitioned to the originator.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251378080"},"PeriodicalIF":3.4,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201846","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 Risankizumab for moderate-to-severe Crohn's disease: first Asian real-world data (STAR trial).","authors":"Chen-Shuan Chung, Chung-Hsin Chang, Chia-Jung Kuo, Jen-Wei Chou, Tien-Yu Huang, Wen-Hung Hsu, Chen-Wang Chang, Puo-Hsien Le","doi":"10.1177/17562848251375844","DOIUrl":"10.1177/17562848251375844","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) remains a challenging condition, especially in patients with moderate-to-severe disease. Risankizumab (RZB), an anti-IL-23p19 monoclonal antibody, has shown efficacy in clinical trials. However, real-world data (RWD) in Asian populations are limited.</p><p><strong>Objectives: </strong>To assess the effectiveness and safety of Risankizumab in Asian patients with CD.</p><p><strong>Design: </strong>Multicenter cohort study.</p><p><strong>Methods: </strong>This study enrolled adult patients with moderate-to-severe CD who received Risankizumab between September 2024 and May 2025 in Taiwan. Efficacy was assessed at weeks 4, 8, and 12 using CD Activity Index (CDAI), patient-reported outcomes-2 (PRO2), and inflammatory bowel disease (IBD)-disk scores. Safety outcomes and treatment response by prior biologic exposure, including Ustekinumab (UST), were evaluated.</p><p><strong>Results: </strong>Forty-nine patients (mean age 41.5 years, 69.4% male) were included. Clinical response rates were 53.1%, 75.5%, and 91.8% at weeks 4, 8, and 12, respectively; clinical remission was achieved in 12.2%, 22.4%, and 42.9%. PRO2 remission reached 53.5% by week 12. Both CDAI and IBD-Disk scores improved at weeks 4, 8, and 12 with statistical significance (<i>p</i> < 0.0001). Transmural healing was observed in 16.3% of patients at week 12. Clinical remission at week 12 was consistent regardless of prior Ustekinumab exposure (exposed 36.36% vs naïve 44.74%, <i>p</i> = 0.630) or biologic-naïve status (exposed 36.84% vs naïve 63.63%, <i>p</i> = 0.119). No severe adverse events were reported, but mild events included headache and transient liver enzyme elevation (each 2.04%).</p><p><strong>Conclusion: </strong>Risankizumab may demonstrate significant short-term efficacy and favorable safety in real-world treatment of moderate-to-severe CD in an Asian cohort. Long-term data are needed to confirm sustained outcomes and guide their optimal use across diverse CD populations.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251375844"},"PeriodicalIF":3.4,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12475345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187336","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 and safety of vonoprazan versus esomeprazole-based high-dose dual therapies for first-line <i>Helicobacter pylori</i> eradication: a randomized controlled trial.","authors":"Wei-Chen Tai, Lung-Sheng Lu, Shih-Cheng Yang, Hsin-Ming Wang, Cheng-Kun Wu, Chih-Chien Yao, Pao-Yuan Huang, Yu-Chi Lee, Seng-Kee Chuah, Chih-Ming Liang","doi":"10.1177/17562848251378066","DOIUrl":"10.1177/17562848251378066","url":null,"abstract":"<p><strong>Background: </strong>Effective <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication depends on maintaining intragastric pH >6 and overcoming antibiotic resistance. High-dose dual therapy (HDDT) with a proton pump inhibitor (PPI) and amoxicillin has shown promising results.</p><p><strong>Objectives: </strong>To compare the efficacy of 14-day vonoprazan-based (VA) and esomeprazole-based (EA) HDDT for <i>H. pylori</i> eradication and evaluate the impact of antibiotic resistance.</p><p><strong>Design: </strong>Randomized controlled trial (RCT).</p><p><strong>Methods: </strong>A total of 121 patients with confirmed <i>H. pylori</i> infection were randomized to receive either VA therapy (vonoprazan 20 mg twice daily plus amoxicillin 750 mg four times daily (QID)) or EA therapy (esomeprazole 40 mg three times daily plus amoxicillin 750 mg QID) for 14 days. Eradication was assessed by the ¹³C-urea breath test at week 8. Antibiotic susceptibility testing was performed on cultured isolates.</p><p><strong>Results: </strong>Baseline demographic and clinical characteristics were comparable between the VA and EA groups. In the intention-to-treat analysis, eradication rates were 86.9% (95% confidence interval (CI): 78.4%-95.4%) in the VA group and 81.7% (95% CI: 71.3%-89.4%) in the EA group (<i>p</i> = 0.430). Per-protocol (PP) analysis showed eradication rates of 93.0% (95% CI: 86.4%-99.6%) for VA and 84.5% (95% CI: 73.8%-92.1%) for EA (<i>p</i> = 0.150), indicating no statistically significant difference. Adverse events (AEs) were mild and similar between groups (5.3% in VA vs 5.2% in EA, <i>p</i> = 0.983), with constipation and diarrhea being the most reported. Both groups achieved 100% compliance. Antibiotic resistance patterns did not significantly affect outcomes.</p><p><strong>Conclusion: </strong>Both VA and EA-HDDT regimens demonstrated comparable efficacy, excellent compliance, and minimal AEs. Although VA therapy achieved a >90% eradication rate in the PP analysis, our study was underpowered to confirm superiority. Therefore, larger, adequately powered RCTs are warranted to validate the potential superiority of VA.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT06811207.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251378066"},"PeriodicalIF":3.4,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145125793","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":"EUS-guided gallbladder drainage versus percutaneous gallbladder drainage in high-risk patients with acute cholecystitis: a propensity score-matched analysis.","authors":"Rishi Pawa, Nicholas Koutlas, Alexa Cecil, Robert Dorrell, Gregory Russell, Swati Pawa","doi":"10.1177/17562848251375376","DOIUrl":"10.1177/17562848251375376","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen apposing metal stent (LAMS) has emerged as a treatment option in patients with acute cholecystitis (AC) deemed unfit for surgery. Prior to this technique, percutaneous transhepatic gallbladder drainage (PT-GBD) was the only drainage modality available for these patients.</p><p><strong>Objectives: </strong>This study compares clinical outcomes of EUS-GBD versus PT-GBD in high-risk surgical patients with AC.</p><p><strong>Design: </strong>From July 2019 to October 2023, all consecutive patients with AC undergoing EUS-GBD (using LAMS) and PT-GBD at a single academic medical center were retrospectively reviewed and analyzed.</p><p><strong>Methods: </strong>A propensity score-matched analysis using age, sex, and Charlson Comorbidity Index was performed. This was used to obtain a 1:1 ratio of PT-GBD:EUS-GBD patients. Technical success was defined as successful placement of LAMS or percutaneous cholecystostomy tube in the gallbladder. Clinical success was defined as resolution of patients' symptoms and normalization of white cell count within 96 h post procedure without recurrence of AC. Outcomes were analyzed using Fisher's exact test and Student's <i>t</i> test.</p><p><strong>Results: </strong>Following propensity score matching, 57 EUS-GBD patients were matched with 57 PT-GBD patients. Technical success was seen in 96% (55/57) in the EUS-GBD group and 98% (56/57) in the PT-GBD group (<i>p</i> > 0.99). Clinical success was observed in 93% (52/56) in EUS-GBD group and 80% (45/56) in PT-GBD group (<i>p</i> = 0.093). PT-GBD patients underwent more procedures than the EUS-GBD group (median 3 vs 2, <i>p</i> < 0.0001) and had more complications (44% vs 16%, <i>p</i> = 0.0010). The median survival was 573 days for EUS-GBD and 452 days for PT-GBD (<i>p</i> = 0.77).</p><p><strong>Conclusion: </strong>EUS-GBD is superior to PT-GBD, requiring fewer gallbladder-related procedures and lower rates of adverse events. Given these benefits, it has emerged as the preferred non-surgical alternative in the management of patients with AC who are poor surgical candidates.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251375376"},"PeriodicalIF":3.4,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114785","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":"Comment on: Risk of malnutrition increases in the year prior to surgery among patients with inflammatory bowel disease.","authors":"James R Burmeister","doi":"10.1177/17562848251379966","DOIUrl":"10.1177/17562848251379966","url":null,"abstract":"","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251379966"},"PeriodicalIF":3.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087854","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":"Cost-effectiveness analysis of ramucirumab plus paclitaxel as switch maintenance versus continuation of first-line oxaliplatin-based chemotherapy for advanced HER2-negative gastric or gastro-esophageal junction cancer.","authors":"Yitian Lang, Weican Cao, Yan Lin, Min Liu, Hui Zhao","doi":"10.1177/17562848251375836","DOIUrl":"10.1177/17562848251375836","url":null,"abstract":"<p><strong>Background: </strong>Ramucirumab in combination with paclitaxel has demonstrated substantial antitumor activity in the treatment of advanced human epidermal growth factor receptor-2 (HER2)-negative gastric cancer (GC) or gastro-esophageal junction cancer (GEJC). However, the cost-effectiveness of this regimen in this patient population remains uncertain, particularly within the Chinese healthcare context.</p><p><strong>Objective: </strong>This study aimed to assess the cost-effectiveness of ramucirumab plus paclitaxel as a switch maintenance regimen compared to continuing first-line chemotherapy for patients with advanced HER2-negative GC or GEJC, from the perspective of the Chinese healthcare system.</p><p><strong>Design: </strong>A health economic evaluation was conducted to compare two treatment strategies.</p><p><strong>Methods: </strong>A partitioned survival model was developed to project the disease progression of HER2-negative GC or GEJC. Data for overall survival and progression-free survival were extracted from the ARMANI trial and were extrapolated to project long-term survival outcomes. Direct medical costs and utility values were gathered. The main outcome measures, including the cost, utility, and incremental cost-utility ratio (ICUR), were used to determine the cost-effectiveness of the ramucirumab plus paclitaxel as switch maintenance regimen. Sensitivity analyses, including one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA), were performed to evaluate the robustness of the findings.</p><p><strong>Results: </strong>The base-case analysis revealed that the ICUR for ramucirumab plus paclitaxel as a switch maintenance regimen was ¥1,097,535 per quality-adjusted life-year (QALY) compared to the continuation of first-line chemotherapy. OWSA showed that the ICUR was sensitive to variations in the cost of ramucirumab, patient weight, and the cost of subsequent treatments in the continuation of first-line chemotherapy group. Results from the PSA indicated that the switch maintenance regimen had a very low probability of cost-effectiveness, at just 0.4%. In contrast, the continuation of the first-line regimen demonstrated a high likelihood of being cost-effective, with a 99.6% probability.</p><p><strong>Conclusion: </strong>The cost-effectiveness analysis suggested that from the Chinese healthcare system perspective, the switch maintenance regimen at current price is unlikely to be an advantageous regimen in terms of cost-effectiveness for patients with advanced HER2-negative gastric or GEJC at a willingness-to-pay threshold of ¥287,247/QALY.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251375836"},"PeriodicalIF":3.4,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of intestinal ultrasound scores in predicting long-term endoscopic outcomes in ulcerative colitis.","authors":"Li Ma, Zhaojue Wang, Xiaoyan Zhang, Mengsu Xiao, Jing Qin, Mengyuan Zhou, Hong Yang, Qingli Zhu, Wenbo Li","doi":"10.1177/17562848251375374","DOIUrl":"10.1177/17562848251375374","url":null,"abstract":"<p><strong>Background: </strong>The value of intestinal ultrasound (IUS) in predicting treatment outcomes in ulcerative colitis (UC) remains underexplored.</p><p><strong>Objectives: </strong>To compare the predictive accuracy of representative IUS scores for long-term endoscopic outcomes in UC.</p><p><strong>Design: </strong>A retrospective observational study.</p><p><strong>Methods: </strong>Consecutive UC patients initiating biologics/small-molecule drugs were enrolled. IUS examinations were performed at baseline, 4-6 months, and at the first colonoscopy reassessment (12-30 months). IUS images were reviewed, and bowel wall thickness (BWT), Milan ultrasound criteria (MUC), and International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) were recorded. Endoscopic response was assessed using the Mayo Endoscopic Score (MES), with remission defined as MES = 0 and improvement as MES ⩽1.</p><p><strong>Results: </strong>Forty-nine patients were included. All three IUS scores showed significant correlations with concurrent MES, with IBUS-SAS demonstrating the strongest association (BWT, ρ = 0.54; MUC, ρ = 0.55; IBUS-SAS, ρ = 0.69). IBUS-SAS at 4-6 months was the most accurate predictor of long-term endoscopic remission (area under the curve (AUC) 0.767) and endoscopic improvement (AUC 0.770). On multivariable analysis, an IBUS-SAS score <25.5 at 4-6 months was the only independent predictor of endoscopic remission (odds ratio (OR) 7.6, <i>p</i> = 0.005), while an IBUS-SAS score <38.0 was the only independent predictor of endoscopic improvement (OR 5.8, <i>p</i> = 0.006).</p><p><strong>Conclusion: </strong>The IBUS-SAS score at early follow-up may serve as a valuable predictor of long-term endoscopic outcomes in UC.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251375374"},"PeriodicalIF":3.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12432316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066093","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":"Tofacitinib in acute severe ulcerative colitis: review addressing seven key unmet needs.","authors":"Chuong Dinh Nguyen, Luan Minh Dang, Thong Duy Vo, Hoang Huu Bui, Eun Soo Kim, Joyce Wing Yan Mak, Choon Jin Ooi","doi":"10.1177/17562848251374638","DOIUrl":"10.1177/17562848251374638","url":null,"abstract":"<p><p>Tofacitinib, an oral Janus kinase (JAK) inhibitor, shows promise as a rescue therapy for acute severe ulcerative colitis (ASUC), a life-threatening condition marked by high colectomy rates. This narrative review synthesizes evidence from randomized controlled trials (RCTs), observational studies, and systematic reviews. The efficacy of tofacitinib has been documented, with an 83.01% day-7 response rate in the TACOS trial and 79.9%-86% 90-day colectomy-free survival in steroid-refractory ASUC. However, seven unmet needs impede the adoption of tofacitinib treatment for managing ASUC: (1) a lack of head-to-head RCTs comparing tofacitinib not only to standard rescue therapies like infliximab and ciclosporin but also to other JAK inhibitors like upadacitinib, (2) uncertainty in optimal dosing and duration, (3) ambiguity in positioning tofacitinib in the treatment algorithm, (4) undefined patient selection criteria, notably for those with prior biologic exposure, (5) limited long-term efficacy and cost-utilization data, (6) unresolved safety risks (e.g., infections, thrombosis), and (7) underexplored potential for combination therapy. These gaps undermine the widespread use of tofacitinib in reducing surgical burden and improving outcomes. Collaborative research-especially multi-center RCTs comparing tofacitinib to infliximab, ciclosporin, and next-generation JAK inhibitors-is vital for establishing evidence-based protocols. Addressing these needs could optimize tofacitinib-based ASUC management, offering a rapid, oral alternative to enhance patient care.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251374638"},"PeriodicalIF":3.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066159","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":"Determining the optimal portal pressure gradient after small-diameter TIPS for ascites: a retrospective study.","authors":"Guofeng Liu, Songchi Xiao, Xiaoze Wang, Yi Shen, Yuping He, Li Yang, Xuefeng Luo","doi":"10.1177/17562848251372265","DOIUrl":"10.1177/17562848251372265","url":null,"abstract":"<p><strong>Background: </strong>The optimal hemodynamic threshold for portal pressure gradient (PPG) following transjugular intrahepatic portosystemic shunt (TIPS) for ascites remains uncertain.</p><p><strong>Objective: </strong>This study aimed to elucidate the relationship between post-TIPS PPG and clinical outcomes in patients undergoing small-diameter (8-mm) TIPS for ascites.</p><p><strong>Design: </strong>Single-center retrospective study.</p><p><strong>Methods: </strong>From June 2015 to June 2023, consecutive patients receiving small-diameter (8-mm) TIPS for refractory or recurrent ascites were considered for inclusion retrospectively. The impact of PPG on clinical outcomes-including ascites response, overt hepatic encephalopathy (OHE), further decompensation, and mortality-was evaluated using Fine and Gray competing risk regression models, both unadjusted and adjusted for potential confounders.</p><p><strong>Results: </strong>A total of 143 patients were included in the analysis, of whom 65.7% had refractory ascites, with a median Child-Pugh score of 9. Receiver operating characteristic (ROC) curve analysis identified post-TIPS PPG as a reliable predictor of ascites response (cutoff: 10.5 mmHg, area under curves (AUC): 0.733, <i>p</i> < 0.001) and OHE (cutoff: 7.5 mmHg, AUC: 0.716, <i>p</i> < 0.001). Univariate and multivariate Fine and Gray competing risk regression analyses further revealed that patients with PPG between 8 and 10 mmHg had favorable outcomes, including a lower incidence of ascites (>10 vs 8-10 mmHg: hazard ratio (HR) = 5.74, 95% confidence interval (CI) 2.11-15.58, <i>p</i> < 0.001), a reduced risk of OHE (<8 vs 8-10 mmHg: HR = 2.87, 95% CI 1.29-6.35, <i>p</i> = 0.010), and a decreased risk of further decompensation (>10 vs 8-10 mmHg: HR = 2.78, 95% CI 1.43-5.41, <i>p</i> = 0.003; <8 vs 8-10 mmHg: HR = 2.42, 95% CI 1.20-4.90, <i>p</i> = 0.014) after TIPS placement.</p><p><strong>Conclusion: </strong>This study revealed that post-TIPS PPG was associated with clinical outcomes in patients with refractory or recurrent ascites undergoing small-diameter TIPS. A post-TIPS PPG of 8-10 mmHg seems to be the optimal range, effectively controlling ascites without significantly increasing the risk of shunt-related hepatic encephalopathy, while also reducing the risk of further decompensation.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251372265"},"PeriodicalIF":3.4,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact social support and its different types have upon Crohn's disease: a double, case-control study on patients experiencing a flare-up or in remission, and healthy individuals.","authors":"María José de Dios Duarte, Andrés Arias, Juan Brea Iglesias, Iria de la Osa Subtil, Ana Barrón","doi":"10.1177/17562848251372274","DOIUrl":"10.1177/17562848251372274","url":null,"abstract":"<p><strong>Background: </strong>The influence of social support upon several diseases has been studied and has been found to be beneficial, either by facilitating adjustment to the disease and improving its management, or by influencing the biological responses that lead to disorders.</p><p><strong>Objective: </strong>The aim of this study was to investigate the role of received social support and its different types (informational, material and emotional) in people with varying stages of Crohn's disease (CD), compared to a sample of healthy individuals.</p><p><strong>Design: </strong>An observational, double case-control study was conducted using validated scales to assess the impact of received social support and its different types upon CD.</p><p><strong>Methods: </strong>The sample was divided into three groups: healthy individuals, CD patients experiencing a flare-up and CD patients in remission. Study variables were measured in the three groups, and a multivariate analysis of variance was performed to examine statistical significance. In addition, post hoc analyses were performed using either Tukey's test or the Games-Howell test (depending on the homogeneity of variances) to determine which groups differed.</p><p><strong>Results: </strong>The principal results revealed statistically significant differences between the groups studied regarding received social support (<i>p</i> = 0.001), satisfaction with this support (<i>p</i> = 0.018), material support type (<i>p</i> = 0.002) and informational support type (<i>p</i> = 0.016). In the majority of cases, the most significant differences were observed between the group of healthy individuals and CD patients in remission, and between the latter group and CD patients experiencing a flare-up.</p><p><strong>Conclusion: </strong>We propose directly engaging with CD patients in remission to thereby increase their perceived level of received social support, to consequently increase their satisfaction with such support. We also suggest specific interactions to increase the perception of material and informational support. This approach is also directly linked to the type of support provided by healthcare professionals.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251372274"},"PeriodicalIF":3.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066079","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}