Therapeutic Advances in Gastroenterology最新文献

{"title":"A decade of clinical data with vedolizumab: the past, present, and future.","authors":"Vipul Jairath, Alessandro Armuzzi, Christian Agboton, Brian Bressler, Silvio Danese, Parambir S Dulai, Marlies Meyer, Itzel Romo Bautista, Raja Atreya, Brian G Feagan","doi":"10.1177/17562848261448962","DOIUrl":"10.1177/17562848261448962","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) is a chronic inflammatory disorder of the gastrointestinal tract, typically classified as either ulcerative colitis (UC) or Crohn's disease (CD). The treatment approaches for both UC and CD have changed substantially over the last 10 years, going from step-up to top-down approaches and culminating in treat-to-target algorithms. In addition to the evolution of treatment strategies for IBD, disease endpoints have also changed from symptom-based outcomes to more objective measures, including endoscopy, with histology and transmural healing currently under investigation. In this narrative review, we describe recent advances in the treatment of patients with IBD, with a focus on vedolizumab, the first and only anti-lymphocyte trafficking agent approved as a gut-selective biologic for induction and maintenance therapy in IBD. Furthermore, with the approval of more biologic agents, there remains a need to determine the sequence in which biologics should be used, both individually and in combination. Substantial progress has been made in the last decade, and even though biomarkers and algorithmic trials have been largely disappointing, other avenues, such as clinical decision support tools, prognostic tools, and new approaches incorporating computational biology, have the potential to more effectively curate a tailored approach to IBD therapy in the coming years.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261448962"},"PeriodicalIF":3.8,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13201942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148044295","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":"Eosinophilic esophageal myositis: a comparative study of distinguishing features, diagnostic challenges, and therapeutic insights.","authors":"Rui Wu, Yunyun Zhang, Wei Zhao, Huaqing Zhu, Hongjiao Wu, Xinyi Lu, Wei Zhang, Xiaoping Zou, Nina Zhang","doi":"10.1177/17562848261449690","DOIUrl":"10.1177/17562848261449690","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic esophageal myositis (EoEM) involves eosinophilic infiltration of muscle layers but spares the epithelium, differing from eosinophilic esophagitis (EoE). EoEM is rare and underrecognized, with challenges in diagnosis and treatment.</p><p><strong>Objectives: </strong>To compare the clinical, endoscopic, pathological, and manometric characteristics of EoEM with mucosal-predominant and muscle-predominant EoE, and to elucidate differences and interconnections between these conditions.</p><p><strong>Design: </strong>Retrospective cohort study with literature review.</p><p><strong>Methods: </strong>The retrospective study included patients diagnosed with mucosal-predominant EoE (<i>n</i> = 21), muscle-predominant EoE (<i>n</i> = 6), and EoEM (<i>n</i> = 7) at Nanjing Drum Tower Hospital from 2019 to 2024, along with a review of EoEM cases reported in the literature (<i>n</i> = 11). Muscle thickness was measured using endoscopic ultrasonography and computed tomography (CT). High-resolution esophageal manometry was performed to evaluate esophageal motility and diagnose motility disorders according to the Chicago Classification v4.0 criteria. Clinical, endoscopic, pathological, manometric, and treatment data were analyzed.</p><p><strong>Results: </strong>EoEM patients were older and had more severe dysphagia, food impaction, and weight loss. Endoscopic findings revealed a distinct corkscrew-like appearance and luminal compression without typical mucosal inflammation. High immunoglobulin E (IgE) may be a marker of EoEM. Compared with muscle-predominant EoE, EoEM patients had higher maximum distal contractile integral values and a higher frequency of Jackhammer esophagus, although they exhibited similar muscle thickness. EoEM patients resisted proton pump inhibitors but responded favorably to oral steroids and Per-Oral Endoscopic Myotomy (POEM).</p><p><strong>Conclusion: </strong>EoEM is characterized by severe esophageal motility dysfunction. Muscle biopsy should be considered in patients with frequent dysphagia, motility disorders, and high serum IgE levels. Oral steroids and POEM effectively relieve symptoms.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261449690"},"PeriodicalIF":3.8,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13199704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148036935","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":"Optimal endoscopic drainage strategy for concomitant biliary and gastric outlet obstruction: a multicenter retrospective study (ENDO-GOBO).","authors":"Thomas Beuchard, Jean-Philippe Ratone, Marion Schaefer, Marc Barthet, Thomas Guilmoteau, Timothée Wallenhorst, Sharif Yassin, Farimah Fayyaz, Enrique Perez-Cuadrado-Robles, Antoine Debourdeau, Sarah Leblanc, Romain Legros, Hugo Lepetit, Martin Dahan, Fabrice Caillol, Marc Giovannini, Jean-Baptiste Chevaux, Ivann Bouteiller, Mohamed Gasmi, Diane Lorenzo, Laurent Poincloux, Thomas Grainville, Yen-I Chen, Mouen Khashab, Vincent Lepilliez, Bertrand Napoleon, Marco Spadaccini, Yanis Dahel, Jean-Michel Gonzalez, Jérémie Jacques, Jérémie Albouys","doi":"10.1177/17562848261446493","DOIUrl":"10.1177/17562848261446493","url":null,"abstract":"<p><strong>Background: </strong>Concomitant malignant gastric outlet obstruction (MGOO) and malignant biliary obstruction (MBO) represent a challenging clinical scenario in which the optimal endoscopic strategy remains unclear.</p><p><strong>Objectives: </strong>This study aimed to compare real-life combinations of endoscopic ultrasound-guided biliary drainage-hepatogastrostomy (EUS-HGS) or choledochoduodenostomy (EUS-CDS)-with gastric outlet obstruction management-EUS-guided gastroenterostomy (EUS-GE) or enteral stenting (ES).</p><p><strong>Design: </strong>This was an international multicenter retrospective cohort study involving 11 tertiary centers (2017-2023).</p><p><strong>Methods: </strong>Consecutive patients with MBO and MGOO were included. All patients underwent both biliary and gastric outlet drainage using one of four combinations: EUS-HGS/EUS-GE, EUS-HGS/ES, EUS-CDS/EUS-GE, or EUS-CDS/ES. The primary outcome was stent dysfunction (biliary or digestive). Secondary outcomes included clinical success and adverse events.</p><p><strong>Results: </strong>A total of 159 patients were included (median age 70 years; pancreatic cancer 64.8%). Stent dysfunction occurred in 12.0% of patients treated with EUS-HGS/EUS-GE versus 26.6% with EUS-CDS/ES, 36.7% with EUS-HGS/ES, and 50.0% with EUS-CDS/EUS-GE (<i>p</i> = 0.059). At 12 months, stent obstruction-free survival was significantly higher with EUS-HGS/EUS-GE (84.0%) compared with EUS-CDS/ES (51.2%, <i>p</i> = 0.0466), EUS-CDS/EUS-GE (42.0%, <i>p</i> = 0.0377), and EUS-HGS/ES (52.3%, <i>p</i> = 0.0512). Severe adverse events were more frequent with EUS-HGS (15.0% in HGS/ES; 8.0% in HGS/EUS-GE) compared with EUS-CDS (1.6% in CDS/ES; 0% in CDS/EUS-GE; <i>p</i> = 0.014).</p><p><strong>Conclusion: </strong>In malignant obstruction, the choice of gastric outlet strategy appears to markedly influence biliary stent patency. When EUS-GE is performed, EUS-HGS may provide superior durability but at the cost of higher morbidity. Conversely, when ES is selected, EUS-CDS appears safer. These findings support a tailored approach integrating anatomical considerations and center expertise when selecting the optimal endoscopic double-drainage strategy.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261446493"},"PeriodicalIF":3.8,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13198645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018300","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":"Conversion of endoscopic nasobiliary drainage into internal drainage versus endoscopic biliary stenting for benign biliary obstruction: a retrospective propensity score-matched comparative study.","authors":"Yan Zhao, Yongqiu Wei, Junxiong Wang, Can Sun, Wenkun Li, Yongjun Wang, Peng Li, Wenhai Wang","doi":"10.1177/17562848261451341","DOIUrl":"10.1177/17562848261451341","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic nasobiliary drainage (ENBD) conversion to internal drainage using scissor forceps is a specialized technique primarily explored in malignant obstructions. This study evaluates its efficacy, radiation safety, and long-term durability in patients with benign biliary obstruction (BBO) compared to conventional endoscopic retrograde biliary drainage (ERBD).</p><p><strong>Objectives: </strong>To evaluate the efficacy, radiation safety, and long-term durability of scissor forceps conversion compared to conventional endoscopic retrograde biliary drainage (ERBD) in patients with BBO.</p><p><strong>Design: </strong>A retrospective comparative study using 1:1 propensity score matching (PSM).</p><p><strong>Methods: </strong>We retrospectively analyzed BBO patients who underwent either scissor forceps conversion (Experimental group) or conventional ERBD (Control group) between 2018 and 2025. To ensure rigorous comparison, 1:1 propensity score matching (PSM) was performed, balancing baseline characteristics including age, etiology, and inflammatory markers. Primary endpoints were dose area product (DAP), fluoroscopy time, and long-term stent patency.</p><p><strong>Results: </strong>After 1:1 matching (<i>n</i> = 43 per group), the experimental group demonstrated a significant reduction in radiation exposure and procedural duration. The mean DAP was substantially lower in the experimental group compared to the control group (<i>p</i> < 0.001), alongside a shorter total fluoroscopy time (<i>p</i> < 0.001). Although the early biochemical recovery showed a more favorable downward trend in total bilirubin for the experimental group, the difference was not statistically significant. Perioperative adverse events, including post-ERCP pancreatitis (4.65% vs 2.3%), were comparable, with all cases occurring prior to the conversion maneuver. During the follow-up, the experimental group exhibited a favorable trend toward sustained patency (Median Patency: Not Reached vs 13.0 months; <i>p</i> = 0.419).</p><p><strong>Conclusion: </strong>In BBO management, converting ENBD to internal drainage significantly enhances radiation safety and procedural efficiency without compromising clinical safety or long-term stent durability. This \"mini-invasive\" approach aligns with the ALARA principle and represents a refined evidence-based strategy for patients requiring cumulative biliary interventions.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261451341"},"PeriodicalIF":3.8,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13198633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018341","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":"Prevalence, patient characteristics, and outcomes of high-dose upadacitinib in inflammatory bowel disease.","authors":"Julian Azar, Rofina Johnkennedy, Louis J Levine, Ibrahim AlOmar, Abdulelah AlMutairdi, Mashary Attamimi, Deborah D Proctor, Jill K J Gaidos, Badr Al-Bawardy","doi":"10.1177/17562848261451333","DOIUrl":"10.1177/17562848261451333","url":null,"abstract":"<p><strong>Background: </strong>Off-label high-dose upadacitinib (UPA) may be necessary for select inflammatory bowel disease (IBD) patients.</p><p><strong>Objectives: </strong>To evaluate the rates, patient characteristics, and outcomes of extended induction and high-dose UPA maintenance in IBD.</p><p><strong>Design: </strong>We conducted a two-center, retrospective cohort study of IBD patients treated with UPA from January 1, 2022, to March 1, 2025.</p><p><strong>Methods: </strong>Extended induction was defined as receiving UPA 45 mg for 16 weeks in ulcerative colitis (UC) and 24 weeks in Crohn's disease (CD). High-dose maintenance was defined as continuing UPA 45 mg after induction/extended induction. Primary outcomes included rates and characteristics of high-dose maintenance. Secondary outcomes included clinical response (CR), steroid-free clinical remission (SFCR), endoscopic remission (ER), and adverse events, comparing standard and high-dose UPA groups.</p><p><strong>Results: </strong>Among 128 patients (46.9% CD, 48.4% UC, 4.7% IBD-unclassified), 51.6% (<i>n</i> = 66) received extended induction and 34.4% (<i>n</i> = 44) continued high-dose UPA maintenance. On multivariate analysis, UPA high-dose maintenance patients were more likely to have a higher number of prior biologic exposures (odds ratio (OR) 1.84, 95% confidence interval (CI) 1.05-3.19, <i>p</i> = 0.022) and concomitant biologic use (OR 6.18, 95% CI 1.15-33.18, <i>p</i> = 0.034). In the high-dose maintenance group, rates of CR were 73.7%, SFCR 65.8%, and ER 36.7%. Adverse event rates were similar between high- and standard-dose maintenance groups (25% vs 26.8%), with no cases of herpes zoster, venous thromboembolism, or major adverse cardiovascular events.</p><p><strong>Conclusion: </strong>One-third of patients remained on high-dose UPA maintenance, reflecting more refractory disease and modest response rates. Treatment was generally well tolerated. Larger, long-term studies are needed to validate safety.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261451333"},"PeriodicalIF":3.8,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13195219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018362","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":"Second-look endoscopy does not reduce delayed bleeding after endoscopic papillectomy: a multicenter propensity score-matched analysis.","authors":"Yuki Fujii, Kazuyuki Matsumoto, Toru Ueki, Hitomi Himei, Ichiro Sakakihara, Eijiro Ueta, Tatsuya Toyokawa, Ryo Harada, Taiji Ogawa, Takeshi Tomoda, Hironari Kato, Toshiharu Mitsuhashi, Ryosuke Sato, Akihiro Matsumi, Kazuya Miyamoto, Daisuke Uchida, Shigeru Horiguchi, Koichiro Tsutsumi, Motoyuki Otsuka","doi":"10.1177/17562848261439231","DOIUrl":"10.1177/17562848261439231","url":null,"abstract":"<p><strong>Background: </strong>Delayed bleeding is a frequent and serious complication after endoscopic papillectomy (EP). Second-look endoscopy (SLE) is often scheduled on the following day for wound assessment and prophylactic hemostasis, but its clinical value remains unclear.</p><p><strong>Objectives: </strong>This study evaluated the effectiveness of SLE in preventing delayed bleeding after EP.</p><p><strong>Design: </strong>This study was a multicenter, retrospective cohort study.</p><p><strong>Methods: </strong>We retrospectively reviewed 132 consecutive patients who underwent EP at nine high-volume centers between 2003 and 2024 (SLE group, <i>n</i> = 73; non-SLE group, <i>n</i> = 59). Propensity score matching was performed to balance baseline characteristics. The primary outcome was delayed bleeding, and secondary outcomes were risk factors, the impact of prophylactic hemostasis during SLE, and hospital stay.</p><p><strong>Results: </strong>After matching, 43 patients were included in each group. The incidence of delayed bleeding did not differ between the SLE and non-SLE groups (14% vs 9%, <i>p</i> = 0.50). Multivariate analysis identified a lack of preventive clipping closure as the only independent risk factor (odds ratio 15, 95% confidence interval 1.3-177, <i>p</i> = 0.030). Prophylactic hemostasis during SLE did not reduce bleeding but was associated with prolonged hospitalization (13 vs 9 days, <i>p</i> = 0.012).</p><p><strong>Conclusion: </strong>Routine SLE after EP does not reduce delayed bleeding. Moreover, prophylactic hemostasis in asymptomatic patients may unnecessarily prolong hospitalization. Hemostasis should be reserved for patients who develop clinical signs of bleeding.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261439231"},"PeriodicalIF":3.8,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989264","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":"Evaluation of human leukocyte antigen histocompatibility and its impact on liver transplant graft outcomes.","authors":"Dorothy Liu, Kate Collins, Marcos V Perini, Graham Starkey, Michael Fink, Robert Jones, Adam Testro, Marie Sinclair, Avik Majumdar","doi":"10.1177/17562848261447157","DOIUrl":"10.1177/17562848261447157","url":null,"abstract":"<p><strong>Background: </strong>The impact of human leukocyte antigen (HLA) histocompatibility on graft survival is well established in kidney and haematopoietic stem cell transplantation; however, its role in liver transplantation (LT) remains uncertain. Prior studies have reported inconsistent associations between HLA mismatching and LT graft outcomes. Given emerging evidence linking HLA mismatch to post-transplant complications, this relationship warrants reassessment.</p><p><strong>Objectives: </strong>To investigate the effect of HLA Class I (A, B, C) and Class II (DRB1, DQA, DQB) mismatching on LT graft survival in a single-centre retrospective analysis.</p><p><strong>Design: </strong>A retrospective, single-centre cohort study.</p><p><strong>Methods: </strong>610 patients who underwent their first deceased donor LT between January 2010 and March 2021 were included. The primary outcome was graft failure. Donor and recipient HLA typing was available at HLA-A, HLA-B and HLA-DRB1 loci in 610 patients, HLA-C in 38 patients, HLA-DQA in 63 patients and HLA-DQB in 63 patients. Graft survival was assessed using Kaplan-Meier analysis and predictors identified using Cox regression.</p><p><strong>Results: </strong>HLA-C mismatching was associated with reduced graft survival on Kaplan-Meier analysis (<i>p</i> = 0.02); however, this was based on a small subgroup (<i>n</i> = 38), and the univariate Cox estimate was imprecise (HR 9.24, 95% CI 1.01-83.48, <i>p</i> = 0.047). HLA-DRB1 mismatching was associated with improved graft survival (<i>p</i> = 0.047) and reduced graft failure risk on multivariate Cox regression (aHR 0.34, 95% CI 0.14-0.87, <i>p</i> = 0.02), although limited by the small number of matched transplants (<i>n</i> = 9). There was no association between mismatches at other loci and graft survival. Hepatic artery thrombosis worsened graft survival (aHR 3.42, 95% CI 2.44-4.80, <i>p</i> < 0.001) but was not associated with HLA mismatch.</p><p><strong>Conclusion: </strong>These results suggest that the effect of HLA histocompatibility in LT may be locus-specific. Associations were observed for differential graft outcomes at the HLA-C and HLA-DRB1 loci; however, given the small sample sizes and imprecision of estimates, these findings should be considered hypothesis-generating and require validation in larger prospective cohorts.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261447157"},"PeriodicalIF":3.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976574","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":"Revolutionizing Crohn's disease detection: integrating AI with intestinal ultrasound for superior diagnosis.","authors":"Ruo Huang, Minying Zhong, Chengjie Hong, Zhixing Liu, Kexin Chen, Xiaoyu Li, Qinghua Lu, Qinxue Liu, Zhaotao Li, Chuntao Jiang, Guoliang Jian, Peizhu Su","doi":"10.1177/17562848261446568","DOIUrl":"10.1177/17562848261446568","url":null,"abstract":"<p><strong>Background: </strong>Intestinal ultrasound (IUS) is increasingly utilized by healthcare providers for the diagnosis of Crohn's disease (CD), which has highlighted new challenges related to standardized image interpretation and its limitations as a research instrument. The application of artificial intelligence methodologies may offer solutions to these challenges. This study aimed to assess the feasibility of integrating IUS with clinical features to enhance the diagnostic accuracy of CD. We compared the performance of five machine learning (ML) models to diagnose the most effective model for this purpose.</p><p><strong>Objective: </strong>To evaluate and compare the diagnostic performance of five ML models in identifying CD using IUS features alone and in combination with clinical features; to determine the optimal ML approach for improving diagnostic accuracy in patients presenting with chronic diarrhea and to establish a framework for automated diagnosis of CD through the integration of imaging and clinical data.</p><p><strong>Design: </strong>Retrospective diagnostic accuracy study using ML methodology.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of clinical features and ultrasound data from a cohort of 1119 patients presenting with chronic diarrhea, categorized according to the diagnostic criteria recommended by the World Health Organization (WHO). Approximately 80% of the dataset was allocated for training purposes, while the remaining 20% was reserved for testing.</p><p><strong>Results: </strong>The logistic regression model that utilized ultrasound features exclusively demonstrated superior diagnostic performance compared to the other four models, achieving an accuracy of 78%, sensitivity of 85%, and specificity of 84.9%, with an Area Under the Curve (AUC) of 0.89 in the test set. This model accurately identified CD in patients presenting with chronic diarrhea. The integration of clinical features further enhanced the diagnostic performance of the XGBoost model, achieving an accuracy of 92%, sensitivity of 89%, specificity of 88.7%, and an AUC of 0.98 in the test set.</p><p><strong>Conclusion: </strong>This study not only illustrates the feasibility of employing ultrasound analysis in patients with diarrhea but also highlights the potential for developing a methodology that integrates ultrasound data with clinical indicators. Our findings provide a framework for automated diagnosis of CD.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261446568"},"PeriodicalIF":3.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976504","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 of immune checkpoint inhibitor plus chemotherapy in ARID1A-mutated advanced gastric cancer.","authors":"Ji Eun Shin, Eunbyeol Lee, Sung Hee Lim, Jeeyun Lee, Seung Tae Kim","doi":"10.1177/17562848261446862","DOIUrl":"10.1177/17562848261446862","url":null,"abstract":"<p><strong>Background: </strong>ARID1A mutations are frequent in gastric cancer (GC) and may indicate an immune-active tumor microenvironment.</p><p><strong>Objectives: </strong>This study aimed to assess the efficacy of the immune checkpoint inhibitor (ICI) plus chemotherapy as first-line therapy in advanced GC and explore its association with key molecular features according to the status of ARID1A-mutation.</p><p><strong>Design: </strong>This was a retrospective, single-center cohort study.</p><p><strong>Methods: </strong>We analyzed 258 patients with advanced HER2-negative GC who received ICI plus chemotherapy between 2022 and 2024. ARID1A mutation status and other molecular features were assessed using next-generation sequencing. Also, the status for Epstein-Barr virus (EBV), programmed death-ligand 1 (PD-L1), and claudin 18.2 was done. Treatment outcomes were evaluated between ARID1A-mutant and wild-type groups.</p><p><strong>Results: </strong>Among 258 patients, 67 (26.0%) harbored at least one ARID1A mutation. ARID1A mutant tumors (MT) showed significantly higher tumor mutational burden (median 18.0 vs 6.7 mut/Mb), EBV positivity (11.8% vs 0.6%), MSI-H status (10.6% vs 6.3%), and PD-L1 CPS ⩾50 (14.9% vs 1.0%) compared to wild-type (WT). The median progression-free survival (PFS) was numerically longer in the ARID1A MT group (9.7 vs 8.5 months; HR 0.75; 95% CI, 0.53-1.10), though not statistically significant. There was no significant difference for the ORR (55.2% vs 64.4%, <i>p</i> = 0.19), and the overall survival (27.4 vs 31.1 months; HR 0.83; 95% CI, 0.58-1.20) between the two groups.</p><p><strong>Conclusion: </strong>ARID1A mutations were associated with immune-active molecular features and a trend toward improved PFS to ICI plus chemotherapy. Further research for ARID1A as a potential biomarker for ICI is warranted in advanced GC.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261446862"},"PeriodicalIF":3.8,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13180195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976559","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":"Diagnostic performance of indigo carmine-assisted texture and color enhanced magnified imaging for superficial non-ampullary duodenal epithelial tumors.","authors":"Kenichiro Okimoto, Keisuke Matsusaka, Tomoaki Matsumura, Tsubasa Ishikawa, Takuya Ohashi, Chihiro Goto, Ryosuke Horio, Akane Kurosugi, Michiko Sonoda, Hirotaka Oura, Tatsuya Kaneko, Yuki Ohta, Takashi Taida, Jun-Ichiro Ikeda, Jun Kato","doi":"10.1177/17562848261447809","DOIUrl":"10.1177/17562848261447809","url":null,"abstract":"<p><strong>Background: </strong>Superficial non-ampullary duodenal epithelial tumors (SNADETs) are increasingly detected with advances in endoscopic imaging. However, the preoperative diagnosis remains challenging. Indigo carmine-assisted texture and color enhancement imaging (IC-TXI) is a novel modality that enhances mucosal contrast and topography.</p><p><strong>Objectives: </strong>To evaluate the diagnostic performance of IC-TXI for identifying Vienna classification (VCL) C4/5 SNADETs based on surface morphology.</p><p><strong>Design: </strong>Single-center retrospective study.</p><p><strong>Methods: </strong>This study analyzed 111 consecutive SNADETs resected between March 2021 and August 2024. IC-TXI images were assessed for abnormal surface structure, component size difference (>3-fold), and invisible surface pattern. Significant findings were defined as the coexistence of abnormal surface structure and component size or invisibility. Diagnostic performance was evaluated using histopathological VCL classification as the reference.</p><p><strong>Results: </strong>Ten (9.0%) lesions were classified as VCL C4/5. IC-TXI demonstrated a sensitivity of 50.0%, specificity of 97.0%, positive predictive value of 62.5%, negative predictive value of 95.1%, and accuracy of 92.8% for identifying VCL C4/5 lesions. Abnormal surface structure alone was observed in 5/10 (50.0%) VCL C4/5 lesions, abnormal size difference alone in 6/29 (20.7%), and invisible surface structure in 1/3 (33.3%). These findings suggest that abnormal surface structure may be diagnostically relevant than component size variation, and invisibility may have malignant potential.</p><p><strong>Conclusion: </strong>IC-TXI may serve as a practical method for the real-time exclusion of VCL C4/5 SNADETs. Given its high specificity and negative predictive value (NPV), this method may have the potential to reduce unnecessary biopsies and shorten observation time. However, rather than being considered a standard modality, IC-TXI should be regarded as an adjunctive tool to support clinical decision-making in combination with other clinical and endoscopic factors, particularly in light of its relatively low sensitivity (50.0%) observed in this study.</p><p><strong>Clinical trial registration: </strong>UMIN000041436.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"19 ","pages":"17562848261447809"},"PeriodicalIF":3.8,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13172719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964943","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}