Therapeutic Advances in Gastroenterology最新文献

{"title":"Efficacy of different modalities of faecal microbiota transplantation in ulcerative colitis: systematic review and network meta-analysis.","authors":"Julia Chapon, Julien Scanzi, Harry Sokol, Bruno Pereira, Anthony Buisson","doi":"10.1177/17562848251369624","DOIUrl":"10.1177/17562848251369624","url":null,"abstract":"<p><strong>Background: </strong>While several small sample size randomized controlled trials suggested the superiority of faecal microbiota transplantation (FMT) over placebo in ulcerative colitis (UC), the most effective modality to perform FMT remains unknown.</p><p><strong>Objectives: </strong>To compare the efficacy of different modalities of FMT to induce clinical remission in patients with UC.</p><p><strong>Data sources and methods: </strong>We performed a systematic review and network analysis (sources: MEDLINE, Embase, Cochrane CENTRAL; random effects model) of randomized controlled trials including at least one arm of FMT in adult patients with active UC. The primary endpoint, that is, clinical remission (total Mayo score ⩽2 with Mayo endoscopic score ⩽1), was assessed between weeks 6 and 12. Results are expressed as relative risks with 95% confidence intervals, adjusted for bowel cleansing and pre-FMT antibiotics. Ranking of FMT modalities was calculated as their surface under the cumulative ranking (SUCRA).</p><p><strong>Results: </strong>Among the 12 selected studies, patients were exclusively bio-naïve in 4 studies (4/12), while between 9% and 32% had prior biologics exposure in the other trials. The risk of bias was low across all domains in seven studies. Contrary to upper gastrointestinal tract (GI) FMT (Relative risk (RR) = 1.1 (0.2-7.7)), oral capsule (RR = 7.1 (1.8-33.3)), lower GI FMT (RR = 4.5 (1.7-12.5) and combination of both (RR = 12.5 (2.1-100)) are more effective than placebo to induce clinical remission. The combination of lower GI FMT and oral capsule was significantly more effective than upper GI FMT to induce clinical remission (RR = 10.7 (1.1-104.2)). Combination of lower GI FMT and oral capsule ranked the highest for the induction of clinical remission (SUCRA = 0.93). Multidonor FMT did not perform better than single donor FMT. Autologous FMT ranked lower than placebo (SUCRA = 0.12 vs 0.22).</p><p><strong>Conclusion: </strong>The combination of lower GI and oral capsule FMT seems to be the best modality of FMT for patients with UC. In clinical trials, autologous FMT should be avoided due to a potential detrimental effect.</p><p><strong>Trial registration: </strong>PROSPERO registration number: CRD42023385511.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251369624"},"PeriodicalIF":3.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12378343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975341","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":"A literature survey on follow-up definitions on the use of infliximab in Crohn's disease.","authors":"Andy Wai Kan Yeung","doi":"10.1177/17562848251370099","DOIUrl":"10.1177/17562848251370099","url":null,"abstract":"<p><p>Many clinical studies arbitrarily define follow-up durations as short-term, mid-term, or long-term, without standardized criteria. To examine existing research on the use of infliximab in Crohn's disease to understand how these terms are defined and applied, a literature survey was conducted. Relevant studies were identified by querying Web of Science and Scopus with predefined keywords, focusing on articles that mentioned \"short-term,\" \"mid-term,\" or \"long-term\" in their title, abstract, or author keywords. The majority of the papers were published in gastroenterology and hepatology journals (75.6%), since 2010 (77.3%), and primarily involved retrospective data (64.8%). Most studies measured follow-up duration from the first infliximab infusion (65.3%). The mean follow-up durations were 4.06 months for short-term (based on 46 papers), 9.47 months for mid-term (based on 3 papers), and 37.58 months for long-term studies (based on 155 papers). Retrospective studies tended to have significantly longer mean durations for long-term follow-up than prospective studies. Notably, the ranges for short-term and long-term follow-ups overlapped, indicating inconsistent definitions across studies. Currently, there is no consensus on the durations associated with these terms. Standardized reporting with explicit timeframes in months or years is essential to improve comparability and clarity in future research.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251370099"},"PeriodicalIF":3.4,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975277","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":"Vonoprazan-minocycline dual therapy as a first-line treatment of <i>Helicobacter pylori</i> infection compared with empirical bismuth-containing quadruple therapy.","authors":"Meng Li, Xiaolei Wang, Xinhong Dong, Guigen Teng, Yun Dai, Weihong Wang","doi":"10.1177/17562848251366156","DOIUrl":"10.1177/17562848251366156","url":null,"abstract":"<p><strong>Background: </strong>Increasing antibiotic resistance compromises therapeutic options for <i>Helicobacter pylori</i> (<i>H. pylori</i>) infection, especially in penicillin-allergic individuals.</p><p><strong>Objectives: </strong>This trial aimed to assess the efficacy and safety of 14-day vonoprazan-minocycline (VM) dual therapy against bismuth-containing quadruple therapy (B-quadruple therapy), as initial treatment for <i>H. pylori</i> infection.</p><p><strong>Design: </strong>This study was a single-center, open-label, and non-inferiority randomized controlled trial.</p><p><strong>Methods: </strong>In this study, 240 individuals with <i>H. pylori</i> infection who have not received therapy were randomly assigned 1:1 to either the VM dual therapy group (vonoprazan 20 mg plus minocycline 100 mg, administered twice daily) or the B-quadruple therapy group (rabeprazole 10 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth potassium citrate 220 mg, all administered twice daily). The primary outcome was to evaluate the non-inferiority of eradication rates between the two groups. Secondary outcomes included assessments of AEs and compliance.</p><p><strong>Results: </strong>The eradication rates of VM dual group and B-quadruple therapy group were 87.5% and 88.3%, respectively, by intention-to-treat (ITT) analysis; 92.1% and 94.6% by modified ITT (mITT) analysis; and 92.0% and 95.5% by per-protocol (PP) analysis. The eradication rates of the VM group were non-inferior to those of the B-quadruple therapy group in ITT, mITT, and PP analyses (one-sided <i>p</i>-values were 0.02, 0.01, and 0.02). The incidence of AEs was higher in the B-quadruple therapy group (28.3%) than in the VM group (16.7%, <i>p</i> = 0.03). Good compliance was achieved in both groups (<i>p</i> = 0.60).</p><p><strong>Conclusion: </strong>The VM dual therapy was not inferior to the B-quadruple therapy in the initial treatment of <i>H. pylori</i> infection, and the incidence of AEs was lower compared to B-quadruple therapy.</p><p><strong>Trial registration: </strong>This trial was registered on the Chinese Clinical Trial Registry with the registration number ChiCTR2400081461.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251366156"},"PeriodicalIF":3.4,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975311","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":"Outcome of adding percutaneous transhepatic cholangial drainage to DEB-TACE in patients with unresectable cholangiocarcinoma with obstructive jaundice: comparison with sole DEB-TACE.","authors":"Jiajia Xu, Chao Chen, Yanhua Ye, Yanqiao Ren, Ke Chen, Guofeng Zhou, Chuan Cheng, Yuexiang Peng","doi":"10.1177/17562848251360114","DOIUrl":"10.1177/17562848251360114","url":null,"abstract":"<p><strong>Background: </strong>Intrahepatic cholangiocarcinoma (ICC) with obstructive jaundice presents a therapeutic challenge, as most patients are ineligible for surgery. While FOLFOX chemotherapy offers limited survival benefits, drug-eluting bead transarterial chemoembolization (DEB-TACE) combined with percutaneous transhepatic cholangial drainage (PTCD) may improve outcomes by addressing both tumor burden and biliary obstruction.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of DEB-TACE + PTCD versus DEB-TACE alone in unresectable ICC patients with obstructive jaundice.</p><p><strong>Design: </strong>Retrospective cohort study of 209 patients treated between January 2015 and November 2024.</p><p><strong>Methods: </strong>A total of 209 patients with ICC and obstructive jaundice were included, with 95 patients in the DEB-TACE + PTCD group (D + P group) and 114 patients in the DEB-TACE alone group (DEB group). Tumor responses were evaluated at 3 months to assess treatment efficacy, while statistical analyses of adverse events were conducted to evaluate treatment safety. Kaplan-Meier method was utilized to generate survival curves. Cox analysis was performed to identify factors influencing prognosis.</p><p><strong>Results: </strong>The median progression-free survival and OS were 6 and 14 months in D + P group and 5 and 11 months in the DEB group. The 3-month objective response rate (ORR) and disease control rate (DCR) were 36.2% and 76.6% in the D + P group. While in the DEB group, the ORR and DCR were 34.2% (<i>p</i> = 0.772) and 62.2% (<i>p</i> = 0.026). Multivariate Cox regression analysis revealed that lymph node metastasis (hazard ratio (HR) = 0.727, confidence interval (CI: 0.535-0.987), <i>p</i> = 0.041), level of cancer antigen (CA)-125 (HR = 0.670, CI (0.503-0.894), <i>p</i> = 0.006), and treatment (HR = 1.335, CI (1.002-1.780), <i>p</i> = 0.049) were predictors for prognosis.</p><p><strong>Conclusion: </strong>For patients with unresectable cholangiocarcinoma complicated by obstructive jaundice, DEB-TACE following PTCD may be a safer and more effective treatment.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251360114"},"PeriodicalIF":3.4,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12374100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975313","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":"Author response to \"Comment on: Burden of coeliac disease in Germany: real world insights from a large retrospective health insurance claims database analysis\".","authors":"Bernd Bokemeyer, Leonarda Serdani-Neuhaus, Juliane Sünwoldt, Christina Dünweber, Svitlana Schnaidt, Detlef Schuppan","doi":"10.1177/17562848251365852","DOIUrl":"10.1177/17562848251365852","url":null,"abstract":"","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251365852"},"PeriodicalIF":3.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12368407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975271","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":"Asia Pacific association of gastroenterology consensus statements on histopathological evaluation of inflammatory bowel diseases.","authors":"Rupert W Leong, Thanaboon Chaemsupaphan, Huiyu Lin, Wee Chian Lim, Choon Jin Ooi, John D Chetwood, Ren Mao, Hsin Yun Wu, Shu Chen Wei, Govind Makharia, Vineet Ahuja, Rupa Banerjee, Raja Atreya, Julajak Limsrivilai, Satimai Aniwan, Pises Pisespongsa, Ida Hilmi, Raja Affendi Raja Ali, Wai Keung Leung, Siew C Ng, Byong Duk Ye, Taku Kobayashi, Katsuyoshi Matsuoka, Cora Chau, Anapat Sanpavat, Chia-Tung Shun, Pavitratha Puspanathan, Richard B Gearry, Silvio Danese, Christopher Ma, Aviv Pudipeddi, Sudarshan Paramsothy","doi":"10.1177/17562848251363703","DOIUrl":"10.1177/17562848251363703","url":null,"abstract":"<p><strong>Background: </strong>Mucosal histological activity is increasingly valued as a treatment endpoint in inflammatory bowel diseases (IBD). In the Asia Pacific region, the utility and acceptability of IBD histology as a treatment endpoint are uncertain due to the heterogeneity of IBD prevalence, resourcing and level of knowledge among practitioners. There is an opportunity to engage clinicians to harmonise histology reporting and collaborate with pathologists in this field.</p><p><strong>Objectives: </strong>We aimed to develop consensus statements through anonymous voting on histological features, processing, reporting and relevance to treatment outcomes in IBD, including ulcerative colitis (UC) and Crohn's disease (CD).</p><p><strong>Design: </strong>The consensus document was developed through a comprehensive literature review, followed by a deliberation process among experts in the field.</p><p><strong>Methods: </strong>Representatives of the Asia Pacific Association of Gastroenterology, in collaboration with pathologists, voted anonymously in accordance with modified Delphi methodology on statements relevant to IBD and histology. Domains of interest were histological features of UC and CD, relevance to clinical management and the potential utility of artificial intelligence (AI) in grading histological disease severity. Level of evidence and recommendation grade were included in accordance with the National Health and Medical Research Council, Australia guidelines of Australia.</p><p><strong>Results: </strong>Consensus was reached on 37 out of 38 statements concerning definitions, pathology processing and reporting, scoring system and relevance to clinical outcomes. Knowledge gaps were identified with uncertainty over the role of AI.</p><p><strong>Conclusion: </strong>These consensus statements provide recommendations, with specific relevance to the Asia Pacific region, on the role of histology in IBD to harmonise its use. The statements will promote understanding and applicability in research and in the routine management of IBD.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251363703"},"PeriodicalIF":3.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365448/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975274","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":"Performance of serum gelsolin as a biomarker for mucosal activity in Crohn's disease: a comparison with C-reactive protein.","authors":"Keiko Maeda, Takeshi Yamamura, Masanao Nakamura, Tsunaki Sawada, Eri Ishikawa, Kentaro Murate, Tatsuya Kawamura, Takashi Hirose, Kazuhiro Furukawa, Hiroki Kawashima","doi":"10.1177/17562848251362570","DOIUrl":"10.1177/17562848251362570","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) is a chronic inflammatory bowel disease. Monitoring the disease activity and providing appropriate treatment are essential for improving long-term prognosis. Endoscopy remains the gold standard for assessing disease activity; however, it is invasive and costly. Recently, we identified gelsolin as a promising serum biomarker for endoscopic disease activity in ulcerative colitis.</p><p><strong>Objective: </strong>To investigate serum gelsolin levels as a potential biomarker for mucosal activity in the small bowel and colon of patients with CD. Furthermore, we aimed to compare the performance of gelsolin with that of C-reactive protein (CRP) in detecting mucosal activity.</p><p><strong>Design: </strong>A retrospective observational study at a single tertiary care center.</p><p><strong>Methods: </strong>Serum gelsolin and CRP were measured in 82 patients with CD and 16 healthy controls. Endoscopic disease activity was assessed using the Applied Simple Endoscopic Score for CD (aSES-CD). We conducted receiver operating characteristic curves and correlation analyses. In addition, subgroup analyses were performed to evaluate differences in the biomarker performance between ileal and ileocolonic types of CD.</p><p><strong>Results: </strong>Serum gelsolin levels were significantly lower in patients with CD than in healthy controls (<i>p</i> < 0.001). Gelsolin levels were negatively correlated with aSES-CD, particularly in patients with the ileocolonic-type CD, and showed a stronger correlation with endoscopic activity than CRP. The area under the curve for gelsolin was 0.8377, with a cutoff of 13 µg/mL, yielding 75% and 83% sensitivity and specificity, respectively.</p><p><strong>Conclusion: </strong>Serum gelsolin is a prospective noninvasive biomarker that outperforms CRP in detecting endoscopic disease activity in patients with ileocolonic-type CD.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251362570"},"PeriodicalIF":3.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975254","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":"Risk of malnutrition increases in the year prior to surgery among patients with inflammatory bowel disease.","authors":"Vasantham Chaudhary, Frank R Chung, Olivia Delau, Bari Dane, Irving Levine, Xucong Meng, Joshua Chodosh, Andre da Luz Moreira, Jessica N Simon, Jordan E Axelrad, Seymour Katz, John Dodson, Aasma Shaukat, Adam S Faye","doi":"10.1177/17562848251365036","DOIUrl":"10.1177/17562848251365036","url":null,"abstract":"<p><strong>Background: </strong>In patients with inflammatory bowel disease (IBD) who need intestinal resection, prior data suggest that earlier surgical intervention may be associated with improved outcomes. However, surgery is often deferred for additional trials of advanced therapies, which potentially shifts patients from a fit to a frail preoperative state.</p><p><strong>Objectives: </strong>This study aimed to evaluate clinical changes that occur in the year prior to intestinal resection in patients with IBD.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>This was a multi-hospital retrospective study of patients ⩾18 years old who underwent initial IBD-related intestinal resection between January 1, 2018 and May 31, 2023. Clinical characteristics and radiographical skeletal muscle mass were compared using the Wilcoxon Signed-Rank test for continuous variables and McNemar's test for categorical variables.</p><p><strong>Results: </strong>A total of 170 patients were included (120 with Crohn's disease, 40 with ulcerative colitis, and 10 with indeterminate colitis), with a median disease duration of 7.4 years (interquartile range (IQR) 3.3-13.8). Median age at surgery was 32.6 years (IQR 25.9-44.9), and 51% were female. In the month prior to surgery as compared to the 6-12 months prior, individuals were more likely to have an IBD-related hospitalization (31% vs 5%, <i>p</i> < 0.01), malnutrition (30% vs 18%, <i>p</i> < 0.01), or an infection (74% vs 28%, <i>p</i> < 0.01). Though not statistically significant, there was an increase in the proportion of individuals who developed a venous thromboembolism in the month prior to surgery, and a decrease in skeletal muscle mass among those with two computerized tomography scans in the year prior to surgery (<i>n</i> = 6, 126 vs 111 cm2; <i>p</i> = 0.06).</p><p><strong>Conclusion: </strong>In the 6-12 months prior to an IBD-related intestinal resection, as compared to the month prior, individuals were less likely to be malnourished, have an infection, or need hospitalization for IBD. This suggests that minimizing delays to surgery may lead to improved outcomes.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251365036"},"PeriodicalIF":3.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975264","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":"Rare complications after esophagectomy: incidence, clinical features, risk factors, management, and prevention.","authors":"Guoqing Zhang, Jia Jiao, Long Qiu, Zheng Ding, Jia Zhao, Xue Pan, Xiangnan Li","doi":"10.1177/17562848251366238","DOIUrl":"10.1177/17562848251366238","url":null,"abstract":"<p><p>In recent years, common postoperative complications after esophagectomy have received increasing attention. However, the attention paid to rare complications, which often lead to serious consequences if they are not diagnosed in a timely manner, has not been sufficient. In this article, we present both the clinical and imaging features of rare complications following esophagectomy and strategies for their prevention and management. These rare complications are classified into four groups: esophageal substitute-related complications, thoracic duct-related complications, hernia-related complications, and transmural Hem-o-lok clip migration. Esophageal substitute-related complications include redundant conduits and conduit necrosis. We further classify redundant conduits as length-redundant conduits, width-redundant conduits, or a combination of both redundancies. Thoracic duct-related complications include refractory chylothorax and chylomediastinum. Refractory chylothorax is chylothorax refractory to well-established medical, interventional, and even surgical strategies, whereas chylomediastinum is a rare condition characterized by the accumulation of chyle in the mediastinum. Hernia-related complications are subclassified as hiatal hernias, retrocardiac lung hernias, intercostal lung hernias, trocar-site hernias, hernias internal to the retrosternal space or pericardium, and mesenteric defects. Transmural Hem-o-lok clip migration includes penetration of the trachea, conduit, or both. Thoracic surgeons should familiarize themselves with the rare complications of esophagectomy, most of which are serious conditions that require early and accurate diagnosis for proper management. The choice of intervention for rare complications depends on factors such as the patient's general condition, the specific type of complication, the complication severity, the reconstruction route, the available medical resources, and the surgeon's preference. To minimize the risk of these complications, esophagectomy and prevention methods need to be standardized.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251366238"},"PeriodicalIF":3.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12365439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975259","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":"Defining partial response in inflammatory bowel disease: a Delphi consensus and economic evaluation.","authors":"Iago Rodríguez-Lago, Luis Menchén, José Germán Sánchez-Hernández, Jordi Guardiola, Vicente Merino-Bohórquez, Beatriz Garcillán, Elia Moreno-Cubero, Eugenia Vispo, Eugeni Domènech","doi":"10.1177/17562848251360907","DOIUrl":"10.1177/17562848251360907","url":null,"abstract":"<p><strong>Background: </strong>Therapeutic goals in inflammatory bowel disease (IBD) are constantly evolving due to novel medical options and diagnostic tools, yet unmet clinical needs persist.</p><p><strong>Objectives: </strong>We aimed to establish a consensus definition for partial responders in clinical practice, considered as patients failing to meet defined objectives within the desired time frame.</p><p><strong>Design: </strong>A two-round Delphi consultation was held with IBD-specialized gastroenterologists.</p><p><strong>Methods: </strong>The 22-item questionnaire covered four clinical scenarios: (1) moderate ulcerative colitis (UC); (2) acute severe UC; (3) luminal Crohn's disease (CD); and (4) perianal CD. Consensus was defined when ⩾70% of panellists agreed with a statement, rated using a 7-point Likert scale. We also analysed the associated annual costs for partial responders and patients in remission according to the agreed long-term definitions, based on a literature review and the experience of the scientific committee. Medication costs were excluded from the analysis.</p><p><strong>Results: </strong>Sixty Spanish gastroenterologists with extensive experience in IBD management participated in the consultation. Consensus was achieved on partial response definitions with different criteria over time, including clinical scores, biomarkers and imaging or endoscopic examinations. The annual cost for partial responders and patients in remission was estimated at €2570.40 and €820.20 for UC, €1607.30 and €718.0 for luminal CD and €2886.70 and €888.80 for perianal CD, respectively.</p><p><strong>Conclusion: </strong>The concept of partial responders has been defined in four clinical scenarios. Patients achieving prolonged remission could provide 55%-70% savings in non-pharmacological resource use and associated costs. Our study could help healthcare professionals in decision-making, ultimately improving patient care.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251360907"},"PeriodicalIF":3.4,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12361732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144975328","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}