Therapeutic Advances in Gastroenterology最新文献

{"title":"Indoor radon concentration and risk and severity of inflammatory bowel diseases: a case-control study.","authors":"Violeta Mauriz-Barreiro, Alberto Ruano-Raviña, Rocío Ferreiro-Iglesias, Iria Bastón-Rey, Cristina Calviño-Suárez, Laura Nieto-García, Sol Porto-Silva, Xurxo Martínez-Seara, Lucía Martín-Gisbert, J Enrique Domínguez-Muñoz, Manuel Barreiro-de Acosta","doi":"10.1177/17562848251374190","DOIUrl":"10.1177/17562848251374190","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) develops from a dysregulated immune response influenced by environmental exposures. Radon, a radioactive gas, has known biological effects, but its role in IBD remains unexplored.</p><p><strong>Objectives: </strong>To examine the association between residential radon exposure and the risk and clinical course of IBD.</p><p><strong>Design: </strong>A case-control study with 1-year prospective follow-up of cases.</p><p><strong>Methods: </strong>We included 178 newly diagnosed IBD patients and 178 age- and sex-matched controls in Santiago de Compostela, Spain, from June 2020 to September 2023. Residential radon levels were measured using passive detectors for 3 months. Outcomes included IBD diagnosis, disease extent, hospitalizations, and flares. Logistic regression was used to estimate odds ratios adjusted for age and sex.</p><p><strong>Results: </strong>Median residential radon was 144.5 Bq/m³ in IBD cases and 189.5 Bq/m³ in controls. Higher radon levels were associated with reduced odds of IBD (OR 0.5 for 100-299 and >299 Bq/m³ vs 0-99 Bq/m³). No significant association was found between radon levels and hospitalizations or flares. Among ulcerative colitis patients, higher radon was linked to more extensive disease.</p><p><strong>Conclusion: </strong>Higher residential radon exposure might be inversely associated with IBD risk. However, it does not appear to influence disease progression. Further studies are needed to confirm these findings, since this is the first study on this topic, and chance or selection bias might be present.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251374190"},"PeriodicalIF":3.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066087","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":"Commentary on: \"Different perceptions on the diagnosis and treatment of Crohn's disease between patients and gastroenterologists: a multicenter retrospective study\".","authors":"Nelson Song, Jonathan P Segal","doi":"10.1177/17562848251375860","DOIUrl":"10.1177/17562848251375860","url":null,"abstract":"","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251375860"},"PeriodicalIF":3.4,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12423524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066090","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":"Improving the efficacy of late-line immunotherapy for advanced esophageal cancer: the addition of local radiotherapy.","authors":"Yicong Chen, Yalin He, Xiaojuan Zhou, Ruixuan Yu, Yong Xu, Feng Peng, Bingwen Zou, Lin Zhou, Youling Gong, Jin Wang, Yongsheng Wang, Meijuan Huang, You Lu, Yongmei Liu","doi":"10.1177/17562848251371785","DOIUrl":"10.1177/17562848251371785","url":null,"abstract":"<p><strong>Background: </strong>The advent of immunotherapy has significantly revolutionized therapies for advanced esophageal cancer (EC). However, clinical data on combining immune checkpoint inhibitors (ICIs) and radiotherapy (RT) in advanced EC remain insufficient.</p><p><strong>Objectives: </strong>This study aimed to evaluate the effectiveness and safety of combining immunotherapy and radiation as a second or subsequent line of treatment for advanced EC.</p><p><strong>Design and methods: </strong>We retrospectively analyzed patients with advanced EC who received late-line ICIs and categorized them into two subgroups based on whether they received RT. The differences in survival and adverse events (AEs) were evaluated. Inverse probability of treatment weighting (IPTW) and 1:1 propensity-score matching (PSM) analysis were used to minimize confounding.</p><p><strong>Results: </strong>The analysis included data from 131 patients. The median progression-free survival (mPFS) was 9.1 months in the RT group, compared to 4.3 months in the non-radiotherapy (NRT) group (<i>p</i> = 0.0087). The median overall survival (mOS) was 13.5 months in the RT group, which is longer than the 7.3 months in the NRT group (<i>p</i> = 0.014). IPTW and 1:1 PSM analysis also showed that the RT group has longer mOS and mPFS. Among them, a higher biologically effective dose (BED) was associated with better survival than the lower dose group (16.1 months vs 10.2 months, <i>p</i> = 0.048). RT was an independent factor of better overall survival and progression-free survival in multivariable analysis, regardless of whether IPTW was used. For any grade of AE, any grade neutropenia (60.7% vs 41.4%, <i>p</i> = 0.028) and esophagitis (21.3% vs 1.4%, <i>p</i> < 0.001) were more common in the RT group. However, the incidence of grade 3-4 AEs did not differ significantly.</p><p><strong>Conclusion: </strong>Adding RT to second-line or later immunotherapy regimens for EC correlates with enhanced survival outcomes and manageable toxicity.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251371785"},"PeriodicalIF":3.4,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145041943","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 PPAR agonists in primary biliary cholangitis: a systematic review and meta-analysis.","authors":"Wanying Liao, Siyang Fu, Aiming Yang, Yingyun Yang","doi":"10.1177/17562848251370111","DOIUrl":"10.1177/17562848251370111","url":null,"abstract":"<p><strong>Background: </strong>Managing patients with primary biliary cholangitis (PBC) who demonstrate an inadequate response to ursodeoxycholic acid or experience intolerable side effects remains a significant clinical challenge.</p><p><strong>Objectives: </strong>This study aims to investigate the efficacy and safety of peroxisome proliferator-activated receptor (PPAR) agonists in the treatment of PBC.</p><p><strong>Design: </strong>Meta-analysis and systematic review.</p><p><strong>Methods: </strong>A systematic search of publications in PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials was performed. Randomized controlled trials published in English that involved the treatment of PPAR agonists and reported on the levels of alkaline phosphatase (ALP), biochemical response rates, pruritus score, or severe and serious adverse events (AEs) were selected. The primary outcomes assessed were the effects of PPAR agonists on ALP levels and biochemical response rates. Secondary outcomes included the rates of severe or serious AEs and relief of pruritus.</p><p><strong>Results: </strong>Fourteen studies with 1137 patients were included. Compared to the control group, PPAR agonists significantly reduced ALP levels by a mean difference of -155.87 U/L (95% confidence interval (CI): -208.30 to -103.44; random-effects). Patients who received PPAR agonists showed a significantly higher biochemical response rate (risk ratio (RR), 4.42; 95% CI: 2.37-8.26; random-effects). Furthermore, there was no significant difference in the rate of severe (RR, 1.05; 95% CI, 0.49-2.28) or serious AEs (RR, 1.02; 95% CI, 0.65-1.60) between the PPAR agonists and placebo groups.</p><p><strong>Conclusion: </strong>PPAR agonists are effective and safe to treat patients with PBC.</p><p><strong>Prospero trial registration: </strong>CRD42024545743.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251370111"},"PeriodicalIF":3.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12409031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016466","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":"Current status and further directions of endoscopic ultrasound-directed transgastric ERCP and endoscopic ultrasound-directed transenteric ERCP in the management of pancreaticobiliary diseases in surgically altered anatomy: a comprehensive review.","authors":"Giuseppe Dell'Anna, Angelo Bruni, Jacopo Fanizza, Paolo Biamonte, Sarah Bencardino, Francesco Vito Mandarino, Ernesto Fasulo, Alberto Barchi, Camilla Gallo, Jahnvi Dhar, Jayanta Samanta, Antonio Facciorusso, Ivo Boskoski, Sara Massironi, Vito Annese, Alberto Malesci, Lorenzo Fuccio, Andrew A Gumbs, Silvio Danese, Gianfranco Donatelli","doi":"10.1177/17562848251359006","DOIUrl":"10.1177/17562848251359006","url":null,"abstract":"<p><p>Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (EDGE) and endoscopic ultrasound-directed transenteric endoscopic retrograde cholangiopancreatography (EDEE) are innovative endoscopic techniques developed to overcome the challenges of biliary access in patients with surgically altered gastrointestinal anatomy. EDGE facilitates the creation of a gastro-gastric anastomosis, enabling endoscopic access to the excluded stomach and subsequent duodenum for endoscopic retrograde cholangiopancreatography (ERCP) procedures. Similarly, EDEE involves creating a gastro-jejunal anastomosis, allowing endoscopic access to the jejunum and hepaticojejunostomy for ERCP. These procedures are primarily indicated for patients with Roux-en-Y gastric bypass or other complex gastrointestinal surgeries that render traditional ERCP unfeasible. The major advantages of EDGE and EDEE include minimally invasive access to the biliary system, reduced procedural morbidity, and the ability to perform complex biliary interventions without additional surgeries. Using lumen-apposing metal stents in these procedures has further improved their safety and efficacy. This comprehensive review delves into EDGE and EDEE's technical nuances, clinical outcomes, and safety profiles. Our extensive literature searches reveal high procedural success rates and low complication incidences, establishing these methods as viable alternatives to traditional surgical and percutaneous approaches. We also discuss recent technological advancements, including developing enhanced stents and endoscopic ultrasound-guided instruments, which have refined these techniques and expanded their applications. Moreover, the review examines the integration of EDGE and EDEE with other therapeutic modalities, such as cholangioscopy and intraductal lithotripsy, to optimize treatment outcomes. Future directions emphasize the need for larger, multicenter trials to validate these findings further and create standardized protocols to ensure consistent procedural efficacy and safety. This review highlights the transformative potential of EDGE and EDEE in therapeutic endoscopy, advocating for their broader adoption in clinical practice and ongoing innovation in this rapidly evolving field.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251359006"},"PeriodicalIF":3.4,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994259","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: OLGA and OLGIM staging systems on the risk assessment of gastric cancer: a systematic review and meta-analysis of prospective cohorts.","authors":"Eoghan Burke","doi":"10.1177/17562848251371790","DOIUrl":"10.1177/17562848251371790","url":null,"abstract":"","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251371790"},"PeriodicalIF":3.4,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12399816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994178","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":"Endoscopic nasobiliary drainage is superior to biliary stent placement in preventing postendoscopic papillary balloon dilation pancreatitis.","authors":"Junlong Lin, Baifeng Qian, Zhichao Li, Jialin Chen, Kai Gao, Jianpeng Cai, Yunpeng Hua","doi":"10.1177/17562848251365025","DOIUrl":"10.1177/17562848251365025","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic papillary balloon dilation (EPBD) has been recommended as a potential alternative to endoscopic sphincterotomy for common bile duct stones (CBDS), due to protecting the sphincter function.</p><p><strong>Objectives: </strong>This retrospective study aims to evaluate the safety and efficacy of endoscopic nasobiliary drainage (ENBD) versus endoscopic retrograde biliary drainage (ERBD) after EPBD for CBDS.</p><p><strong>Design: </strong>This study is a retrospective analysis of patients with CBDS who underwent EPBD followed by either ENBD or ERBD. It enrolled 283 patients, who underwent slow dilation and long-duration EPBD for CBDS with ENBD (eNbd group, <i>n</i> = 154) or ERBD (eRbd group, <i>n</i> = 129) from January 2022 to September 2023.</p><p><strong>Methods: </strong>Propensity score matching (PSM) was used to balance preoperative baselines and intraoperative specifics, resulting in 220 matched patients (110 patients per group). The incidence rate of post-ERCP pancreatitis (PEP) was compared between the two groups, and risk factors for PEP were analyzed.</p><p><strong>Results: </strong>After PSM, there were no significant differences in the baseline between the eNbd group and the eRbd group. The eNbd group exhibited significantly greater reduction in serum bilirubin levels compared to the eRbd group. Before PSM, the incidence rate of PEP was 2.6% (4/154) in the eNbd group and 8.5% (11/129) in the eRbd group (<i>p</i> = 0.027). After PSM, the incidence rate of PEP was 2.7% (3/110) in the eNbd group and 9.1% (10/110) in the eRbd group (<i>p</i> = 0.045). In addition, subgroup analysis revealed that patients with multiple stones may have a higher likelihood of developing PEP.</p><p><strong>Conclusion: </strong>ENBD may be an optimal choice for patients with CBDS undergoing EPBD, and the presence of multiple stones may be particularly relevant when considering the risk of PEP.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251365025"},"PeriodicalIF":3.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975289","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 CROCO (CROhn's Disease COhort Study) - study design and protocol.","authors":"Joana Revés, Anthony Buisson, Johan Burisch, Naila Arebi, Ryan Ungaro, Sophie Vieujean, Marília Cravo, Pierre Ellul, Dana Duricova, Shaji Sebastian, Iago Rodríguez-Lago, Ingrid Ordás, Ioannis Kaimakliotis, Vicent Hernández, Irina Mocanu, Maria Nachury, Adrian Goldis, Mathurin Fumery, Daniel Conceição, Natalia Konstantinovich Pedersen, Ana F Guedes, Raquel Ribeiro, Noémie Bigot, Jean-Yves Mary, Jérome Lambert, Jean-Frédéric Colombel, Joana Torres","doi":"10.1177/17562848251362594","DOIUrl":"10.1177/17562848251362594","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) is a chronic, relapsing and remitting inflammatory bowel disease that can be associated with significant bowel damage and disability. The Lémann Index (LI) is a validated tool for measuring cumulative bowel damage in CD patients through a comprehensive assessment of stricturing, penetrating and surgical lesions. However, prospective studies evaluating bowel damage progression in recently diagnosed CD patients remain limited.</p><p><strong>Objectives: </strong>To characterise the absolute and longitudinal variations in bowel damage progression, as measured by the LI, in a cohort of recently diagnosed CD patients, and to assess its association with relevant disease features, including disease phenotype, treatment strategies, biomarkers and disability.</p><p><strong>Design: </strong>Study protocol for the Crohn's Disease Cohort Study (CROCO Study), a multicentre, European, prospective cohort study.</p><p><strong>Methods and analysis: </strong>Patients with recently diagnosed CD (within the previous 12 months) will be enrolled and followed up for 5 years. Patients will receive standard-of-care treatment determined by the practising gastroenterologist. Morphological assessments to measure the LI and to evaluate bowel damage progression will be performed at years 1, 3 and 5 after the diagnosis. Disability will be assessed annually using the Inflammatory Bowel Disease - Disability Index (IBD-DI). The primary outcome will be the absolute LI at year 3 following diagnosis. Predictors of bowel damage progression and the association between bowel damage and disability will be analysed.</p><p><strong>Discussion: </strong>The CROCO study represents a unique multicentre cohort of recently diagnosed CD patients, designed to advance the understanding of CD's natural history and evolution. It will facilitate the development of composite scores for predicting bowel damage progression and provide valuable tools for designing future disease-modification trials.</p><p><strong>Trial registration: </strong>NCT05420233.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251362594"},"PeriodicalIF":3.4,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12397584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975336","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 Effectiveness of Tofacitinib on Ulcerative Colitis-Associated Spondyloarthropathy: a multicenter prospective study from the Italian Group for the Study of Inflammatory Bowel Diseases (IG-IBD).","authors":"Fabio Salvatore Macaluso, Mauro Grova, Fabrizio Bossa, Sonia Carparelli, Daniela Pugliese, Giuseppe Cuccia, Maria Cappello, Stefano Muscarella, Simone Saibeni, Cristina Bezzio, Alessandro Armuzzi, Antonietta Gerarda Gravina, Raffaele Pellegrino, Flavio Andrea Caprioli, Andrea Sorge, Alessandra Soriano, Davide Giuseppe Ribaldone, Stefano Festa, Angela Variola, Concetta Ferracane, Sara Onali, Massimo Claudio Fantini, Ambrogio Orlando","doi":"10.1177/17562848251367559","DOIUrl":"10.1177/17562848251367559","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of tofacitinib (TOFA) in various rheumatic diseases has generated interest in its potential benefits for treating spondyloarthritis (SpA) associated with ulcerative colitis (UC).</p><p><strong>Objectives: </strong>RETUCAS (Real-world Effectiveness of Tofacitinib on Ulcerative Colitis-Associated Spondyloarthropathy) is the first study designed to evaluate the effectiveness of TOFA in UC-associated SpA.</p><p><strong>Design: </strong>This was a prospective, multicentre, single-arm, observational study promoted by the Italian Group for the Study of Inflammatory Bowel Disease. Effectiveness was assessed using standardized rheumatologic scores.</p><p><strong>Methods: </strong>Patients with UC and a confirmed diagnosis of active axial or peripheral SpA at baseline were enrolled. The primary endpoint was steroid-free joint response (SFJR) at weeks 8 and 52, defined as a decrease of ⩾1.1 units in Ankylosing Spondylitis Disease Activity Score-C-Reactive Protein (CRP) for axial SpA, or a decrease of >0.6 units in Disease Activity Score 28-CRP for peripheral SpA, without the use of corticosteroids.</p><p><strong>Results: </strong>A total of 44 patients were enrolled: axial SpA: 9.1%; peripheral SpA: 70.4%; mixed axial and peripheral SpA: 20.5% All but two patients had previous exposure to biologic therapies, with more than half having failed two or more biologics. At week 8, SFJR was achieved in 52.3% of patients, with a significant difference between those with peripheral SpA and those with axial or mixed forms (67.7% vs 15.4%; <i>p</i> = 0.001). At week 52, SFJR was maintained in 59.1% of patients overall, again with better outcomes in peripheral SpA compared to axial/mixed SpA (71.0% vs 30.8%; <i>p</i> = 0.01).</p><p><strong>Conclusion: </strong>This is the first prospective study specifically designed to assess Inflammatory Bowel Diseases-associated SpA. In patients with UC and refractory SpA-many of whom had previously failed multiple biologic therapies-TOFA demonstrated effectiveness, particularly in those with peripheral SpA.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251367559"},"PeriodicalIF":3.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975296","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":"Multiple substance use and the risk of pancreatitis: a systematic review.","authors":"Esther A Adeniran, Yi Jiang, Dhiraj Yadav, Judy Tan, Samuel Han, Simon K Lo, Stephen J Pandol, Christie Y Jeon","doi":"10.1177/17562848251365030","DOIUrl":"10.1177/17562848251365030","url":null,"abstract":"<p><strong>Background: </strong>The impact of multiple substance use on the risk of pancreatitis remains underexplored.</p><p><strong>Objective: </strong>To systematically review peer-reviewed observational studies assessing the association of multiple substance use with the risk of acute pancreatitis (AP) or chronic pancreatitis (CP) in adults.</p><p><strong>Design: </strong>We conducted a systematic review informed by the Preferred Reporting Items for Systematic Review and Meta-Analyses guideline.</p><p><strong>Data sources and methods: </strong>EMBASE, MEDLINE, and PsycINFO were searched up to March 2024. Reference lists of included studies were reviewed. From 5205 records identified, 181 relevant records were evaluated in full text. Studies evaluating the association of ⩾2 substances, including tobacco, alcohol, cannabis, and illicit substances, with AP or CP were included. Data were extracted by one reviewer, with quality control by a second reviewer. Quality assessments were independently conducted by two reviewers, with differences resolved by a third.</p><p><strong>Results: </strong>Of 11 included studies, 6 investigated AP as the outcome and 5 examined CP. Among AP studies, 5 comparing smoking and alcohol to alcohol-only use showed high heterogeneity (<i>I</i> ² = 90.9%), with relative risks (RRs) from 1.40 to 11.40. One study examining cannabis and alcohol versus alcohol found a lower risk of AP in cannabis users. Among CP studies, four comparing smoking and alcohol to alcohol-only use were heterogeneous (<i>I</i> ² = 81%) with odds ratios 1.21-31.50. Where examined, smoking increases the risk of AP and CP in a dose-dependent fashion. Heavy alcohol users demonstrated a significant increase in CP risk across all smoking categories in one study.</p><p><strong>Conclusion: </strong>Combined alcohol and tobacco use increases pancreatitis risk compared to single substance use, despite heterogeneity in RRs and exposure definitions. Evidence suggests a dose-dependent impact of smoking on pancreatitis risk when added to alcohol. Studies on the impact of a combination of other substance use on pancreatitis risk are needed.</p><p><strong>Trial registration prospero: </strong>CRD42024503677.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251365030"},"PeriodicalIF":3.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975325","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}