Therapeutic Advances in Gastroenterology最新文献

{"title":"Associations of <i>Helicobacter pylori</i> infection with NAFLD, MAFLD, MASLD, and Chinese MAFLD.","authors":"Honglu Yu, Yuting Gao, Xiaomin Wang, Lan Chen, Yongguo Zhang, Hongyu Li, Nahum Méndez-Sánchez, Xingshun Qi","doi":"10.1177/17562848261465720","DOIUrl":"10.1177/17562848261465720","url":null,"abstract":"<p><strong>Background: </strong>The association of <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection with non-alcoholic fatty liver disease (NAFLD) remains controversial. Additionally, its associations with metabolic dysfunction-associated fatty liver disease (MAFLD), metabolic dysfunction-associated steatotic liver disease (MASLD), and Chinese MAFLD using the most recent diagnostic criteria were unclear.</p><p><strong>Objective: </strong>To analyze the associations of <i>H. pylori</i> infection with NAFLD, MAFLD, MASLD, and Chinese MAFLD.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Methods: </strong>This study screened 1172 inpatients who underwent both <i>H. pylori</i> test and liver computed tomography or ultrasound examination between June 2020 and May 2024. Multivariate Logistic regression analyses were performed to evaluate the associations of <i>H. pylori</i> infection with the severity of hepatic steatosis and risk of hepatic fibrosis. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated after adjusting for gender, hypertension, hyperlipidemia, body mass index (BMI), fasting plasma glucose (FPG), and high-sensitivity C-reactive protein (HsCRP) in NAFLD analyses; age, gender, drinking, hypertension, diabetes, hyperlipidemia, BMI, and HsCRP in MAFLD analyses; and gender, drinking, hypertension, hyperlipidemia, BMI, FPG, and HsCRP in MASLD and Chinese MAFLD analyses.</p><p><strong>Results: </strong>Overall, 875, 982, 869, and 869 patients were included in NAFLD, MAFLD, MASLD, and Chinese MAFLD analyses, respectively. In NAFLD, MAFLD, MASLD, and Chinese MAFLD analyses, 257, 302, 257, and 257 patients had <i>H. pylori</i> infection, respectively. <i>H. pylori</i> infection was independently associated with severe hepatic steatosis in NAFLD (aOR = 3.956; 95% CI = 1.171-13.359, <i>p</i> = 0.027), MAFLD (aOR = 3.730; 95% CI = 1.083-12.850, <i>p</i> = 0.037), and MASLD (aOR = 3.962; 95% CI = 1.158-13.557, <i>p</i> = 0.028) analyses, but not Chinese MAFLD analyses. However, <i>H. pylori</i> infection was not independently associated with the risk of hepatic fibrosis.</p><p><strong>Conclusion: </strong><i>H. pylori</i> infection may increase the severity of NAFLD, MAFLD, and MASLD, but not the risk of liver fibrosis.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261465720"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654769","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":"Guidewire-bile duct angle as a determinant of stent delivery success in EUS-guided hepaticogastrostomy: a prospective double-lumen dilator cohort with propensity score-matched historical controls.","authors":"Naoto Aoyama, Takeshi Ogura, Yoshitaro Yamamoto, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Junichi Nakamura, Nobuhiro Hattori, Kimi Bessho, Takafumi Kanadani, Nga Nguyen Trong, Ly Kim Chhun, Ahmad F Aboelezz, Yi-Jun Liao, Szu-Chia Liao, Hiroki Nishikawa","doi":"10.1177/17562848261470177","DOIUrl":"10.1177/17562848261470177","url":null,"abstract":"<p><strong>Background: </strong>Failure of stent delivery remains a major technical limitation of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), often necessitating additional tract dilation and increasing procedural complexity and cost.</p><p><strong>Objectives: </strong>The aim of this study was to evaluate whether the guidewire-bile duct angle is associated with stent delivery success in EUS-HGS, and to explore whether a double-lumen dilator (DLD) is associated with procedural improvement consistent with an angle-mediated mechanism rather than direct mechanical advantage.</p><p><strong>Design: </strong>Prospective observational study with a propensity score-matched historical control.</p><p><strong>Methods: </strong>This was a prospective single-arm observational study of patients undergoing EUS-HGS using a DLD, compared with a propensity score-matched historical (retrospective) cohort that underwent conventional dilation. The main outcome was successful stent delivery without additional tract dilation.</p><p><strong>Results: </strong>A total of 25 patients in the DLD group were compared with 25 matched controls. Successful stent delivery without additional dilation was significantly higher in the DLD group than in the conventional group (92% vs 48%, <i>p</i> = 0.001). The guidewire-bile duct angle measured immediately before stent delivery-system insertion was significantly larger in the DLD group than in the conventional group (153.4° vs 123.3°, <i>p</i> < 0.001). On multivariable analysis, a larger guidewire-bile duct angle remained independently associated with successful stent delivery without additional tract dilation (odds ratio per 10-degree increase, 5.49; 95% confidence interval, 2.79-10.83; <i>p</i> < 0.001), whereas DLD use itself was not independently associated with success after adjustment for angle. Device-related costs were lower in the DLD group due to reduced need for additional dilation. The guidewire-bile duct angle showed excellent apparent discrimination in this cohort, with an exploratory threshold of 126° (AUC 0.969), requiring external validation before clinical implementation.</p><p><strong>Conclusion: </strong>In conclusion, the improvement associated with DLD use was consistent with an angle-mediated mechanism rather than a direct effect of dilation force; these findings should be regarded as hypothesis-generating mechanistic evidence rather than mechanistic proof.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261470177"},"PeriodicalIF":3.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148654780","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 efficacy and safety of etrasimod as a first-line advanced therapy for ulcerative colitis: prespecified and post hoc subgroup data from the ELEVATE UC clinical program.","authors":"David T Rubin, Charlie W Lees, Filip Baert, Maria Kudela, Abhishek Bhattacharjee, Krisztina Lazin, Martina Goetsch, Arcangelo M Abbatemarco, Karolina Wosik, John K Marshall","doi":"10.1177/17562848261470909","DOIUrl":"10.1177/17562848261470909","url":null,"abstract":"<p><strong>Background: </strong>Many patients show inadequate response or intolerance to conventional therapies for ulcerative colitis (UC), including 5-aminosalicylates (5-ASA), thiopurines, and corticosteroids (CS). Etrasimod is an oral, once daily (QD), selective sphingosine 1-phosphate (S1P) receptor modulator for the treatment of UC.</p><p><strong>Objectives: </strong>We assessed efficacy and safety as a first-line advanced therapy following different scenarios of conventional treatment.</p><p><strong>Design: </strong>In the phase III, multicenter, double-blind, placebo-controlled ELEVATE UC trials, eligible patients were randomized 2:1 to etrasimod 2 mg QD or placebo.</p><p><strong>Methods: </strong>Subgroups of patients post-5-ASA failure (prespecified), post-5-ASA/CS (post hoc), and post-thiopurine/5-ASA/CS (post hoc) were assessed for clinical, endoscopic, and histologic endpoints. Safety was assessed throughout the trials.</p><p><strong>Results: </strong>In ELEVATE UC 52, 74 patients (45 receiving etrasimod 2 mg QD and 29 receiving placebo) had prior failure of 5-ASA only. Among these patients, a greater proportion of those treated with etrasimod versus placebo met clinical, endoscopic, and histologic endpoints at week 12 and week 52 (all <i>p</i> < 0.01). In complementary analyses using data pooled from ELEVATE UC 52 and ELEVATE UC 12, among those exposed to 5-ASA/CS (<i>N</i> = 197), a greater proportion receiving etrasimod versus placebo met all clinical efficacy endpoints assessed at week 12 and week 52 (all <i>p</i> < 0.001). In those exposed to thiopurine/5-ASA/CS (<i>N</i> = 104), similar efficacy was observed with statistically significant differences at week 12 and numerical differences that did not reach statistical significance at week 52. Subgroup safety outcomes were similar to those in the overall population.</p><p><strong>Conclusion: </strong>Etrasimod is an effective first-line advanced treatment option for patients with UC early in their treatment journey, after 5-ASA, thiopurine, or CS use.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT03945188, NCT03996369.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261470909"},"PeriodicalIF":3.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609060","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":"Immunomodulators and advanced therapies for maintenance of remission in Crohn's disease: systematic review and network meta-analysis.","authors":"Vassiliki Sinopoulou, Morris Gordon, Shiyao Liu, Daniel Arruda Navarro Albuquerque, Aderonke Ajiboye, Sudheer Kumar Vuyyuru, Shellie Jane Radford, Gordon William Moran","doi":"10.1177/17562848261470683","DOIUrl":"10.1177/17562848261470683","url":null,"abstract":"<p><strong>Background: </strong>With the range of options available for the treatment of Crohn's disease, therapy selection can be challenging in clinical practice. Comparative efficacy data are needed to clarify the relative position of the increasingly complex portfolio of advanced therapies and guide decision-making.</p><p><strong>Objectives: </strong>Our aim was to compare all advanced and immunomodulator treatments for efficacy and safety in maintenance of remission.</p><p><strong>Design: </strong>Systematic review and network meta-analysis.</p><p><strong>Data sources and methods: </strong>We searched databases up to June 2025. Our outcomes were clinical relapse, loss of response, endoscopic relapse, and safety outcomes. We estimated risk ratio (RR) and 95% confidence interval (CI). We used GRADE to assess certainty of results, and surface under the cumulative ranking curve for ranking treatments.</p><p><strong>Results: </strong>A total of 37 randomised controlled trials with 7415 participants were included. Interventions ranged between 22 weeks and 2 years. Adalimumab probably prevents clinical relapse over placebo (RR 0.68, 95% CI 0.54-0.84, Number Needed to Treat (NNT) = 2, moderate effect magnitude). CT-P13 (RR 0.52, 95% CI 0.38-0.71) and infliximab (RR 0.61, 95% CI 0.49-0.76) may prevent clinical relapse. Upadacitinib is more effective than placebo at preventing loss of clinical response (RR 0.64, 95% CI 0.57-0.72, NNT = 2, small magnitude), while CT-P13 (RR 0.46, 95% CI 0.35-0.53, NNT = 1, large magnitude), natalizumab (RR 0.54, 95% CI 0.43-0.68, NNT = 2, moderate magnitude), certolizumab (RR 0.57, 95% CI 0.47-0.7), NNT = 2, moderate magnitude), adalimumab (RR 0.68, 95% CI 0.61-0.75, NNT = 2, small effect magnitude) and ustekinumab (RR 0.73, 95% CI 0.61-0.86, NNT = 2, small magnitude) probably prevent loss of clinical response. Infliximab (RR 0.7, 95% CI 0.59-0.82) and vedolizumab (RR 0.82, 95% CI 0.68-0.99) may prevent loss of clinical response. Endoscopic relapse could not be analysed. Safety evidence is uncertain, but treatments appear generally safe in the short term.</p><p><strong>Conclusion: </strong>Adalimumab has moderate certainty for maintaining clinical remission with a moderate effect size. Novel therapies seem to have similar effect sizes, though imprecision due to limited evidence precludes further conclusions.</p><p><strong>Trial registration: </strong>https://knowledge.lancashire.ac.uk/id/eprint/53237/.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261470683"},"PeriodicalIF":3.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148609015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world evidence of water exchange colonoscopy improving adenoma detection rates: A propensity score-matched analysis.","authors":"Ying-Ju Chao, Yu-Hsi Hsieh, Chia-Pei Tang, Ping-Hung Ko, Yen-Chun Chen, Chia-Hsin Cheng, Chih-Wei Tseng","doi":"10.1177/17562848261473395","DOIUrl":"10.1177/17562848261473395","url":null,"abstract":"<p><strong>Background: </strong>Randomized trials show that water exchange (WE) colonoscopy improves adenoma detection rate (ADR), but its effectiveness and workflow trade-offs in routine, high-volume practice remain uncertain.</p><p><strong>Objectives: </strong>To evaluate the real-world performance of WE versus conventional air insufflation for adenoma detection, bowel preparation quality, and procedure efficiency.</p><p><strong>Design: </strong>Retrospective propensity score matched cohort study.</p><p><strong>Methods: </strong>Outpatient colonoscopies performed from January 2019 through October 2024 at a high-volume Taiwanese center were analyzed. WE procedures were matched 1:1 with air insufflation controls on prespecified covariates. The primary outcome was ADR. Secondary outcomes included segment-specific detection, advanced adenomas detection, sessile serrated lesion detection, bowel preparation quality, and procedure times.</p><p><strong>Results: </strong>The matched cohort included 4,322 colonoscopies (2,161 per group). WE increased ADR by 14.0 percentage points (57.9% vs 44.0%; <i>P</i> < 0.001), corresponding to a number needed to treat of 8. The largest gain occurred in the right colon (right-sided ADR 31.8% vs 18.0%; <i>P</i> < 0.001). WE increased detection of adenomas ≥ 10 mm (8.7% vs 6.7%; <i>P</i> = 0.014) and sessile serrated lesions (1.9% vs 1.0%; <i>P</i> = 0.011). WE improved bowel preparation (adequate preparation 97.4% vs 88.4%; <i>P</i> < 0.001; total BBPS 7.5 vs 6.4; <i>P</i><.001). Total procedure time was longer with WE (22.6 vs 15.6 minutes; <i>P</i> < 0.001), primarily due to longer insertion (11.0 vs 6.0 minutes; <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>In real-world, high-volume practice, WE substantially improved neoplasia detection and bowel cleansing, with the greatest benefit in the right colon and persistence of effect against a high-performing air insufflation baseline. The time cost was predictable, supporting WE as an effective insertion technique when maximizing diagnostic yield is prioritized.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261473395"},"PeriodicalIF":3.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622076","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":"Role of the gut microbiota in hypertriglyceridemic acute pancreatitis: potential mechanisms and therapeutic implications.","authors":"Zi-Yi Zhang, Zhao-Dong Li, Chang-Wei Peng, Hong Peng, Xin-Sen Zou, Yuan-Xia Zhu, Wen-Li Liao, Tian-Ke Li, Li Rong","doi":"10.1177/17562848261467814","DOIUrl":"10.1177/17562848261467814","url":null,"abstract":"<p><p>Hypertriglyceridemic acute pancreatitis (HTG-AP) is an acute, noninfectious inflammatory disease caused by excessively high levels of serum triglycerides, leading to an overproduction of free fatty acids. This damages the pancreas and disrupts pancreatic microcirculation, leading ultimately to HTG-AP. Clinically, HTG-AP is associated with increasing incidence, multiple complications, and a higher risk of severe disease or adverse outcomes. There is a lack of unified standards, both domestically and internationally, for the clinical management of HTG-AP. This presents challenges for HTG-AP treatment while also offering opportunities to explore more effective interventional approaches. Preliminary research suggests the importance of the gut microbiota in the development and progression of HTG-AP, potentially mediated by influencing lipid metabolism and inflammatory responses. However, little is known of the potential function of the gut microbiota in the etiology of HTG-AP. This review summarizes current evidence on gut microbiota alterations in HTG-AP, with emphasis on lipid metabolism, intestinal barrier injury, and immune-inflammatory pathways. We also discuss microbiota-targeted interventions as investigational strategies that require HTG-AP-specific clinical validation.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261467814"},"PeriodicalIF":3.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13392340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148580919","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":"Subcutaneous infliximab in the treatment of patients with perianal fistulizing Crohn's disease: current evidence and emerging roles.","authors":"Axel Dignass, Catherine Reenaers, Anthony Buisson, Fernando Magro, Lucine Vuitton, Soyeon Park, Meoung Jun Park, Bruce E Sands","doi":"10.1177/17562848261461042","DOIUrl":"10.1177/17562848261461042","url":null,"abstract":"<p><p>Perianal fistulizing Crohn's disease (pfCD), a frequent and serious manifestation of Crohn's disease (CD), is characterized by perianal inflammation and fistula formation and severely impacts patient quality of life. Due to its complex and progressive nature, pfCD requires effective, multidisciplinary management combining both medical and surgical approaches. Infliximab (IFX), a tumor necrosis factor inhibitor, remains the preferred treatment of pfCD. It is recommended in several international clinical guidelines and supported by extensive clinical evidence demonstrating its efficacy and safety in this patient population. Higher IFX serum concentrations have been associated with improved clinical outcomes in CD, reinforcing the need for optimized therapeutic strategies. Subcutaneous (SC) IFX is a more recently available alternative to intravenous (IV) IFX, offering comparable efficacy and safety in patients with CD and greater convenience through self-administration. Although SC IFX has not been evaluated in randomized controlled trials specifically in patients with pfCD, its use has been explored in real-world prospective and retrospective studies. SC IFX treatment in patients with pfCD has achieved sustained clinical and radiological remission with low recurrence rates, and high treatment persistence was observed without new safety issues, supporting its potential as a therapeutic option for pfCD. SC IFX may provide additional advantages over IV IFX, including reduced treatment burden for patients. However, evidence from prospective studies specifically investigating SC IFX in pfCD remains limited. Further research, particularly studies evaluating pfCD-specific clinical and radiological outcomes, are needed to better define the role of SC IFX in pfCD treatment. In summary, this review underscores the well-established role of IV IFX in pfCD, highlights the emerging evidence supporting SC IFX, and identifies key knowledge gaps that require further investigation to inform future treatment strategies in pfCD.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261461042"},"PeriodicalIF":3.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563339","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":"Additional chemoradiotherapy versus esophagectomy for early esophageal cancer: an integrated analysis of reconstructed time-to-event data.","authors":"Po-Feng Huang, Yu-Guang Chen, Meng-Chuan Lu, Chi-Wei Yang","doi":"10.1177/17562848261454202","DOIUrl":"10.1177/17562848261454202","url":null,"abstract":"<p><strong>Background: </strong>Management of early-stage esophageal squamous cell carcinoma (ESCC) following non-curative endoscopic resection remains controversial, particularly for patients with pathological risk factors like deep submucosal invasion (pT1b) or lymphovascular invasion (LVI). While surgery is the standard for ensuring oncological clearance, it carries significant morbidity. Additional chemoradiotherapy (CRT) offers an organ-preserving alternative, yet previous meta-analyses have failed to clarify its efficacy in specific high-risk subgroups.</p><p><strong>Objectives: </strong>This study aimed to compare the long-term survival of additional CRT versus esophagectomy using reconstructed time-to-event data.</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Data sources and methods: </strong>A systematic review of major databases was conducted from inception to September 2025. Comparative studies evaluating additional CRT versus surgery post-endoscopic resection were included. Individual patient data were reconstructed from published Kaplan-Meier curves to estimate hazard ratios (HRs). Primary outcomes were recurrence-free survival (RFS) and overall survival (OS). Stratified analyses evaluated the modifying effects of pT1b depth and LVI.</p><p><strong>Results: </strong>Seven retrospective studies comprising 616 patients were included. Quantitative synthesis revealed no significant difference between CRT and surgery in RFS (HR = 1.020, 95% CI 0.856-1.214) or OS (HR = 1.031, 95% CI 0.886-1.200). Crucially, subgroup analyses demonstrated that this therapeutic equivalence was robust and not significantly modified by the proportion of pT1b invasion, tumor location, or LVI status.</p><p><strong>Conclusion: </strong>Additional CRT provides long-term survival outcomes comparable to radical esophagectomy for non-curative ESCC, even in high-risk subgroups defined by deep submucosal invasion or LVI. CRT should be considered a potential, organ-preserving alternative to surgery in selected patients.</p><p><strong>Trial registration: </strong>INPLASY2025110080.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261454202"},"PeriodicalIF":3.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563413","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":"Development of a tissue-based risk prediction model combining histology and barrier biomarkers for clinical relapse in ulcerative colitis with endoscopic healing.","authors":"Yubin Cao, Xiaowei Xue, Xiaoyin Bai, Zhonglin Yang, Wenyang Guo, Lingjuan Jiang, Hong Yang","doi":"10.1177/17562848261465757","DOIUrl":"10.1177/17562848261465757","url":null,"abstract":"<p><strong>Background: </strong>Although endoscopic remission is a primary therapeutic target in ulcerative colitis (UC), a meaningful proportion of patients with endoscopic healing still experience clinical relapse (CR). Histologic activity and epithelial barrier dysfunction may help explain this residual risk.</p><p><strong>Objectives: </strong>To develop and internally assess an exploratory tissue-based risk prediction model combining histologic activity with epithelial barrier and immunoregulatory markers for relapse risk stratification in UC patients with endoscopic healing.</p><p><strong>Design: </strong>Multicenter prospective observational cohort study with internal model assessment.</p><p><strong>Methods: </strong>Consecutive UC patients with confirmed endoscopic remission (Mayo Endoscopic Subscore 0 or 1) were followed for 12 months. Baseline colonic biopsies were assessed using the Nancy Histological Index (NHI) and immunohistochemical quantification of vitamin D receptor (VDR), Claudin-2, and mucin-2 (MUC-2). A prespecified four-marker logistic regression model was developed using these tissue-based predictors. Model performance was described by receiver operating characteristic analysis, calibration assessment, 1000-sample bootstrap internal validation, and exploratory therapeutic subgroup analyses.</p><p><strong>Results: </strong>Among 145 patients, 36 (24.8%) experienced CR within 12 months. In the final four-marker model, higher Claudin-2 and NHI were associated with increased relapse risk, whereas higher VDR and MUC-2 expression were protective. The model showed high apparent discrimination in the development cohort (area under the curve (AUC) = 0.968, 95% confidence interval: 0.943-0.992). Bootstrap internal validation yielded an optimism-corrected AUC of 0.957, Brier score of 0.075, calibration intercept of -0.067, and calibration slope of 0.827. A data-derived Youden cut-off of 0.379 classified 39 patients as higher risk, of whom 32 relapsed, and 106 patients as lower risk, of whom 4 relapsed. These estimates reflect internal model performance and should be interpreted cautiously because of the limited number of events and absence of external validation.</p><p><strong>Conclusion: </strong>A tissue-based model integrating Claudin-2, VDR, MUC-2, and NHI may help identify UC patients with different relapse risks despite endoscopic healing. These findings are exploratory and hypothesis-generating, and external validation with standardized biomarker quantification is required before clinical implementation.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261465757"},"PeriodicalIF":3.8,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13522426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851693","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":"Abdominal binders improve colonoscopy outcomes: a systematic review and meta-analysis of randomized controlled trials with BMI-stratified subgroup analysis.","authors":"Yu-Kuang Kang, Tien-Yu Huang, Meng-Chuan Lu, Peng-Jen Chen, Po-Feng Huang","doi":"10.1177/17562848261466908","DOIUrl":"10.1177/17562848261466908","url":null,"abstract":"<p><strong>Background: </strong>Abdominal binders have been studied as an adjunctive device for colonoscopy, but trial-level evidence is heterogeneous and existing meta-analyses have either not stratified by body-mass index (BMI) or used only linear meta-regression, leaving BMI dependence of binder benefit unresolved.</p><p><strong>Objectives: </strong>To quantify the effect of abdominal binders on cecal intubation time (CIT), post-procedural pain, manual pressure, and position change during adult colonoscopy and to examine BMI dependence using a pre-specified stratified approach.</p><p><strong>Design: </strong>Systematic review and meta-analysis of randomized controlled trials.</p><p><strong>Methods: </strong>Seven academic databases plus ClinicalTrials.gov were searched (primary April 30, 2025; updated February 28, 2026). Two reviewers screened records and assessed risk of bias (Cochrane RoB 2) independently. Effects were pooled with random-effects (DerSimonian-Laird) models: mean difference (CIT), Hedges's <i>g</i> (pain), and risk ratio (manual pressure, position change). BMI was a pre-specified stratified subgroup across three study-level tertiles (<26, 26-28, >28 kg/m²); robustness was assessed by leave-one-out sensitivity analyses.</p><p><strong>Results: </strong>Fourteen RCTs (<i>n</i> = 2834) were included after two post hoc exclusions (predatory publication; unverifiable randomization). Abdominal binders significantly reduced CIT (MD -1.576 min; <i>p</i> < 0.001; <i>k</i> = 14), pain (Hedges's <i>g</i> -0.853; <i>p</i> < 0.001; <i>k</i> = 8), manual pressure (RR 0.522; <i>p</i> < 0.001; <i>k</i> = 11), and position change (RR 0.569; <i>p</i> < 0.001; <i>k</i> = 11). BMI-stratified analysis revealed a non-monotonic pattern for CIT and manual pressure (with a parallel pattern for pain whose intermediate stratum rests on a single trial): lean (<26) and obese (>28) strata showed benefit while the intermediate stratum (26-28) did not. Position-change benefit reached significance only in the lean stratum. Effects were robust on leave-one-out.</p><p><strong>Conclusion: </strong>Abdominal binders consistently improve four colonoscopy-related outcomes; the non-monotonic BMI response pattern suggests two distinct mechanistic pathways and is hypothesis-generating, warranting confirmation in BMI-stratified randomized trials.</p><p><strong>Trial registration: </strong>Prospectively registered with International Platform of Registered Systematic Review and Meta-Analysis Protocols on May 15, 2025 (registration number INPLASY202550043; DOI: 10.37766/inplasy2025.5.0043).</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261466908"},"PeriodicalIF":3.8,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551097","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}