Therapeutic Advances in Gastroenterology最新文献

{"title":"Evolutionary relationship between antimitochondrial antibody positivity and primary biliary cholangitis in Taiwan: a 16-year hospital cohort study.","authors":"Ming-Ling Chang, Jur-Shan Cheng, Puo-Hsien Le, Wei-Ting Chen, Hsin-Ping Ku, Rong-Nan Chien","doi":"10.1177/17562848241241227","DOIUrl":"10.1177/17562848241241227","url":null,"abstract":"<p><strong>Background: </strong>How antimitochondrial antibody (AMA)-positive patients evolve to have primary biliary cholangitis (PBC) in viral hepatitis-endemic areas is unknown.</p><p><strong>Objectives: </strong>We aimed to investigate this evolution in Taiwan.</p><p><strong>Design/methods: </strong>A 16-year medical center-based cohort study of 2,095,628 subjects was conducted in Taiwan, an Asian country endemic to viral hepatitis. AMA-positive subjects were those with positive AMA with alkaline phosphatase (ALP) ⩽1.5 times the upper limit of normal (ULN), and PBC was defined as positive AMA with ALP >1.5 × ULN.</p><p><strong>Results: </strong>AMA-positive subjects had a lower average age- and sex-adjusted prevalence than PBC patients (4.68/10⁵ <i>versus</i> 11.61/10⁵, <i>p</i> = 0.0002), but their incidence was comparable (0.99/10⁵ <i>versus</i> 1.12/10⁵, <i>p</i> = 0.36). The former group had a borderline significantly lower mean age (56.59 years <i>versus</i> 58.10 years, <i>p</i> = 0.06) and a lower female-to-male ratio (2.85:1 <i>versus</i> 5.44:1, <i>p</i> < 0.0001). Both AMA-positive subjects (prevalence change: 20.0%, <i>p</i> < 0.01; incidence change: -9.2%, <i>p</i> < 0.01) and PBC patients (prevalence change: 14.6%, <i>p</i> < 0.01; incidence change: -4.7%, <i>p</i> <i><</i> 0.01) prevalence rate increased but the incidence rate decreased. Among the 423 AMA-positive subjects, 77 (18.2%) developed PBC, for a mean duration of 1.757 years. Compared with AMA-positive subjects, PBC patients had similar concurrent chronic hepatitis B (CHB) rates (2.7% <i>versus</i> 4.3%, <i>p</i> = 0.197) but lower chronic hepatitis C (CHC) rates (3.69% <i>versus</i> 15.60%, <i>p</i> < 0.01).</p><p><strong>Conclusion: </strong>PBC was more prevalent than AMA-positive subjects, and PBC patients had a higher female-to-male ratio than AMA-positive subjects, of whom 18.2% developed PBC (mean lag: 1.757 years). Upward trends in prevalence rates and downward trends in incidence rates were noted for both AMA-positive subjects and PBC. CHB was rare, CHC was more prevalent among PBC patients than the general population, and CHC was less prevalent among PBC than among AMA-positive subjects.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10981211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337343","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":"Retrospective subgroup analysis of fecal microbiota, live-jslm (REBYOTA^®) administered by colonoscopy under enforcement discretion for the prevention of recurrent <i>Clostridioides difficile</i> infection.","authors":"Whitfield L Knapple, David S Yoho, Alexander Sheh, Joan Thul, Paul Feuerstadt","doi":"10.1177/17562848241239547","DOIUrl":"10.1177/17562848241239547","url":null,"abstract":"<p><strong>Background: </strong>Fecal microbiota, live-jslm (RBL; REBYOTA^®), is the first Food and Drug Administration (FDA)-approved, single-dose, rectally administered, microbiota-based live biotherapeutic product for preventing <i>Clostridioides difficile</i> infection (CDI) recurrence. Alternative routes of administration are of clinical interest.</p><p><strong>Objectives: </strong>Evaluate the safety and efficacy of RBL administration <i>via</i> colonoscopy.</p><p><strong>Design: </strong>Retrospective analysis of electronic medical records of participants administered RBL <i>via</i> colonoscopy under FDA enforcement discretion.</p><p><strong>Methods: </strong>The number of participants with treatment and/or procedure-emergent adverse events (TEAEs) was evaluated. Treatment success and sustained clinical response, defined as the absence of CDI recurrence within 8 weeks and 6 months, respectively, were evaluated.</p><p><strong>Results: </strong>TEAEs were experienced by 75% (6/8) of participants; most were mild to moderate in severity, and none due to RBL or its administration. Most participants had treatment success (80%; 8/10); 75% (6/8) had sustained clinical response.</p><p><strong>Conclusion: </strong>Real-world safety and efficacy of RBL administered <i>via</i> colonoscopy were consistent with clinical trials of rectally administered RBL.</p><p><strong>Graphical abstract: </strong></p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10962041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140289354","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":"Patient journey in gastroesophageal reflux disease: real-world perspectives from Italian gastroenterologists, primary care physicians, and ENT specialists.","authors":"Andrea Pasta, Filippo Pelizzaro, Elisa Marabotto, Francesco Calabrese, Elena Formisano, Shirin Djahandideh Sheijani, Giovanni Brandimarte, Giampiero Manes, Antonietta Gerarda Gravina, Edoardo Vincenzo Savarino","doi":"10.1177/17562848241239590","DOIUrl":"10.1177/17562848241239590","url":null,"abstract":"<p><strong>Background: </strong>Gastroesophageal reflux disease (GERD) is a challenging condition that involves different physicians, such as general practitioners (GPs), gastroenterologists, and ears, nose and throat (ENT) specialists. A common approach consists of proton-pump inhibitors (PPIs) administration. Adjunctive pharmacological treatment may have a role in the management of non-responders to PPIs.</p><p><strong>Objectives: </strong>We aimed to survey GPs and different medical specialists to investigate the medical approaches to patients reporting GERD symptoms. In addition, we examined the use of adjunctive pharmacological treatments in patients with GERD symptoms who do not respond to PPIs.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>A survey was conducted among a large sample of gastroenterologists, GPs, and ENT specialists. Symptoms were divided into typical and extraesophageal, and their severity and impact on quality of life were explored with the GERD Impact Scale and with Reflux Symptom Index (RSI). All therapies administered usually for GERD were investigated.</p><p><strong>Results: </strong>A total of 6211 patients were analyzed in this survey. Patients with typical symptoms were 53.5%, while those with extraesophageal symptoms were 46.5%. The latter were more frequently reported by ENT patients (53.6%, <i>p</i> < 0.0001). The GSI was higher in patients followed by gastroenterologists (9 points) and GPs (9 points) than ENT specialists (8 points), but the RSI was higher in the ENT group (14.3 ± 6.93) than in GPs and gastroenterologist groups (10.36 ± 6.36 and 10.81 ± 7.30, <i>p</i> < 0.0001). Chest pain had the highest negative impact on quality of life (<i>p</i> < 0.0001). Of the 3025 patients who used PPIs, non-responders showed a lower GSI when treated with a combination of adjunctive pharmacological treatments and bioadhesive compounds, than with single-component drugs.</p><p><strong>Conclusion: </strong>Patients with GERD referred to a gastroenterologist had more severe disease and poorer quality of life. The combination of adjunctive pharmacological treatments and bioadhesive compounds seems to be effective in the management of PPI refractory patients.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10960349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207935","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":"Accuracy of the Pancolonic Modified Mayo Score in predicting the long-term outcomes of ulcerative colitis: a promising scoring system.","authors":"Péter Bacsur, Panu Wetwittayakhlang, Tamás Resál, Emese Földi, Béla Vasas, Bernadett Farkas, Mariann Rutka, Talat Bessissow, Waqqas Afif, Anita Bálint, Anna Fábián, Renáta Bor, Zoltán Szepes, Klaudia Farkas, Peter L Lakatos, Tamás Molnár","doi":"10.1177/17562848241239606","DOIUrl":"10.1177/17562848241239606","url":null,"abstract":"<p><strong>Background: </strong>Different endoscopic scoring systems for assessing ulcerative colitis (UC) severity are available. However, most of them are not correlated with disease extent.</p><p><strong>Objectives: </strong>Our study aimed to compare the predictive value of the PanMay score <i>versus</i> the endoscopic Mayo (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and Dublin score in predicting long-term outcomes of UC.</p><p><strong>Design: </strong>This retrospective study enrolled consecutive UC patients who underwent colonoscopy before at least a 3-year follow-up.</p><p><strong>Methods: </strong>The PanMayo, MES, UCEIS, and Dublin scores and the baseline clinical and demographic characteristics of the participants were assessed. Endpoints were disease flare that required novel biological therapy, colectomy, and hospitalization. Patients were stratified using baseline clinical activity.</p><p><strong>Results: </strong>Approximately 62.8% of the 250 enrolled patients were in clinical remission. In these patients, the PanMayo, MES, and Dublin scores were positively associated with the risk of clinical flare. The MES score increased with clinical flare. The PanMayo score (>12 points), but not the MES score, was associated with the need for novel biological initiation and biological escalation. Furthermore, the Dublin and UCEIS scores of patients in remission who need novel biological treatment had a similar trend. Colectomy risk was associated with PanMayo and Dublin scores.</p><p><strong>Conclusion: </strong>The combined endoscopic assessment of disease extent and severity can be more accurate in predicting outcomes among patients with UC. PanMayo score can be utilized in addition to the existing scoring systems, thereby leading to a more accurate examination.</p><p><strong>Summary: </strong>UC endoscopic scores do not assess extension. Our study aimed to analyze the predictive value of the PanMayo score. Based on 250 patients, results showed that the long-term disease outcomes of UC could be predicted with the PanMayo score more accurately.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10958809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207934","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":"Comparison of long-term outcomes of endoscopic ultrasound-guided hepaticogastrostomy and choledochoduodenostomy for distal malignant biliary obstruction: a multicenter retrospective study.","authors":"Dongwook Oh, Sung Yong Han, Sang Hyub Lee, Seong-Hun Kim, Woo Hyun Paik, Hyung-Ku Chon, Tae Jun Song, Se Woo Park, Jae Hee Cho","doi":"10.1177/17562848241239551","DOIUrl":"10.1177/17562848241239551","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic ultrasound-guided biliary drainage (EUS-BD), classified as choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS), is a feasible and effective alternative for distal malignant biliary obstruction (MBO) in failed endoscopic retrograde cholangiopancreatography. However, the preferred technique for better outcomes has not yet been evaluated.</p><p><strong>Objectives: </strong>We compared the long-term outcomes between the techniques.</p><p><strong>Design: </strong>Retrospective comparative study.</p><p><strong>Methods: </strong>We reviewed consecutive patients who underwent EUS-CDS or EUS-HGS with transmural stent placement for distal MBO between 2009 and 2022. The primary outcome was the stent patency. The secondary outcomes were technical and clinical success, adverse events (AEs) of each technique, and independent risk factors for stent dysfunction.</p><p><strong>Results: </strong>In all, 115 patients were divided into EUS-CDS (<i>n</i> = 56) and EUS-HGS (<i>n</i> = 59) groups. Among them, technical success was achieved in 98.2% of EUS-CDS and 96.6% of EUS-HGS groups. Furthermore, clinical success was 96.4% in EUS-CDS and 88.1% in EUS-HGS groups, without significant difference (<i>p</i> = 0.200). The mean duration of stent patency for EUS-CDS was 770.3 days while that for EUS-HGS was 164.9 days (<i>p</i> = 0.010). In addition, the only independent risk factor for stent dysfunction was systematic treatment after EUS-BD [hazard ratio and 95% confidence interval 0.238 (0.066-0.863), <i>p</i> = 0.029]. The incidence of stent dysfunction of EUS-HGS was higher than EUS-CDS (35.1% <i>versus</i> 18.2%, 0.071), despite no significant differences even in late AEs.</p><p><strong>Conclusion: </strong>In distal MBO, EUS-CDS may be better than EUS-HGS with longer stent patency and fewer AEs. Furthermore, systematic treatment after EUS-BD is recommended for the improvement of stent patency.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10953094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177326","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 association between drugs and repeated treatment with budesonide in patients with microscopic colitis: a retrospective observational study.","authors":"Oliver Bjurström, Pontus Karling","doi":"10.1177/17562848241240640","DOIUrl":"10.1177/17562848241240640","url":null,"abstract":"<p><strong>Background: </strong>Smoking and the use of non-steroidal anti-inflammatory drugs (NSAIDs) acetylsalicylic acid (ASA), proton pump inhibitors (PPIs), serotonin reuptake inhibitors (SSRIs), and statins have been associated with microscopic colitis (MC).</p><p><strong>Objectives: </strong>We investigated whether these factors were associated with repeated budesonide treatments in patients diagnosed with MC.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>All patients with a histologically verified diagnosis of MC at our clinic between the years 2006 and 2022 were identified. Baseline factors and drugs prescribed before and after diagnosis were registered. The influence of risk factors on the odds of having a prescription of oral budesonide and the odds of having a second course of budesonide was studied.</p><p><strong>Results: </strong>Patients with MC (<i>n</i> = 183) with a mean age of 62.3 years [standard deviation (SD): 13.3 years] were followed for a median of 5 years (25th-75th percentile 4-10 years) after diagnosis. In all, 138 patients (75%) had at least one prescription of budesonide after diagnosis, and 90 patients (49%) had at least one clinical relapse treated with budesonide. Patients who had been prescribed NSAIDs within 1 year before clinical relapse had higher odds for clinical relapse [odds ratio (OR): 3.70, 95% confidence interval (CI): 1.06-12.9] but there was no increased risk for clinical relapse for the use of ASA (OR: 0.99, 95% CI: 0.39-2.90), PPIs (OR: 1.09, 95% CI: 0.45-2.63), SSRI (OR: 1.41, 95% CI: 0.82-2.44), or statins (OR: 0.83, 95% CI: 0.35-1.99). No association was seen between being a smoker and/or being prescribed NSAID, ASA, PPI, SSRI, and statins at baseline and the odds of having a prescription of oral budesonide within 1 year after diagnosis.</p><p><strong>Conclusion: </strong>The risk of being prescribed a second course of budesonide is associated with receiving a prescription of NSAIDs but not with the use of ASA, PPIs, SSRIs, and statins.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10953108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177327","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 synergy of dual faecal immunochemical and faecal calprotectin testing for accurate assessment of endoscopic and histological activity in inflammatory bowel disease.","authors":"Anuj Bohra, Nicholas Batt, Krishneel Dutt, Diana Lewis, Jonathan P Segal, Olga Newiadomski, Abhinav Vasudevan, Daniel R Van Langenberg","doi":"10.1177/17562848241237895","DOIUrl":"10.1177/17562848241237895","url":null,"abstract":"<p><strong>Background: </strong>Faecal biomarkers are increasingly utilized for disease assessment in inflammatory bowel disease (IBD).</p><p><strong>Objectives: </strong>To characterize the relative and combined accuracy of faecal calprotectin (FC) and faecal immunochemical testing (FIT) for detecting endoscopic and histologically active disease in Crohn's disease (CD) and ulcerative colitis (UC), subdivided by disease location.</p><p><strong>Design: </strong>A prospective cohort study.</p><p><strong>Methods: </strong>Patients with confirmed IBD undergoing routine ileocolonoscopy for activity assessment were prospectively recruited and performed both FC and FIT ±30 days of ileocolonoscopy. Endoscopic activity was assessed <i>via</i> the simplified endoscopic score for CD, Mayo endoscopic score for UC and histological activity graded as nil/mild/moderate. Receiver-operator curve analyses were utilized to assess the performance of FC and FIT per disease subtype and location.</p><p><strong>Results: </strong>In all, 137 (79 CD, 57 UC) patients were recruited. FC was more sensitive than FIT in detecting active endoscopic (CD: 91% <i>versus</i> 69%, UC: 94% <i>versus</i> 82%) and histological (CD: 86% <i>versus</i> 55%, UC 88% <i>versus</i> 56%) disease. However, FIT was more specific than FC in detecting active endoscopic (CD: 94% <i>versus</i> 56%, UC: 85% <i>versus</i> 69%) and histological (CD: 93% <i>versus</i> 55%, UC: 96% <i>versus</i> 70%) diseases. FIT was more sensitive and specific than FC in detecting active colonic CD (endoscopic activity: 94% <i>versus</i> 93%, histological activity: 92% <i>versus</i> 77%, respectively); however, it was poorly sensitive for active ileal CD (43% <i>versus</i> 89%).</p><p><strong>Conclusion: </strong>FC demonstrated higher sensitivity and FIT higher specificity for active IBD. Hence, dual testing was synergistic, displaying excellent performance characteristics across most IBD locations and subtypes, holding promise for future clinical application.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10938618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132914","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":"Splenectomy <i>versus</i> non-splenectomy for gastrointestinal bleeding from left-sided portal hypertension: a systematic review and meta-analysis.","authors":"Minghui Liu, Ning Wei, Yuhu Song","doi":"10.1177/17562848241234501","DOIUrl":"10.1177/17562848241234501","url":null,"abstract":"<p><strong>Objectives: </strong>Left-sided portal hypertension (LSPH) leads to life-threatening gastrointestinal (GI) bleeding. There are no recommendations or consensus about the management of GI bleeding caused by LSPH. This systematic review and meta-analysis were conducted to evaluate the incidence of GI bleeding and the mortality of patients with LSPH receiving different therapeutic strategies.</p><p><strong>Design: </strong>A systematic review and meta-analysis were performed to determine the efficacy of different therapeutic strategies for GI bleeding caused by LSPH.</p><p><strong>Data sources and methods: </strong>All relevant studies were searched from PubMed, Embase, Web of Science, Cochrane Library, Scopus, ScienceDirect, MEDLINE, Google Scholar, CNKI, and Wanfang Data without language restriction through 15 November 2023. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated through RevMan5.3 software. (The Cochrane Collaboration, Copenhagen, Denmark).</p><p><strong>Results: </strong>Seventeen retrospective studies and one prospective study involving 624 patients were included. This systematic review and meta-analysis found that: (1) splenectomy was more effective than non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding caused by LSPH (OR: 0.12; 95% CI: 0.06-0.27); (2) splenectomy was superior to partial splenic artery embolism (PSAE) (OR: 0.06; 95% CI: 0.01-0.62) or endoscopic interventions (OR: 0.04; 95% CI: 0.01-0.19) in the prevention of GI bleeding, respectively; (3) no significant difference in the mortality was observed between splenectomy and non-splenectomy therapeutic strategies (OR: 0.46; 95% CI: 0.20-1.08); and (4) patients receiving preoperative PSAE followed by splenectomy had less intraoperative bleeding and shorter operative time than those receiving splenectomy.</p><p><strong>Conclusion: </strong>This meta-analysis demonstrated that splenectomy is superior to non-splenectomy therapeutic strategies in reducing the incidence of GI bleeding from LSPH, which revealed that splenectomy should be recommended in the management of these patients.</p><p><strong>Trial registration: </strong>This study has been registered on the PROSPERO database with the registration number CRD42023483764.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10916482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050761","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 and patterns of laxative use in subjects with self-reported constipation: results from a multinational digestive health survey.","authors":"Brian E Lacy, Régis Delfini, Bernward Fladung, Robert Lange","doi":"10.1177/17562848241232605","DOIUrl":"10.1177/17562848241232605","url":null,"abstract":"<p><strong>Background: </strong>Constipation is characterized by symptoms of straining, hard stool, difficult evacuation, and infrequent bowel movements. Online surveys provide valuable information about patients' perspectives, symptoms, management, treatment satisfaction, and risk factors.</p><p><strong>Methods: </strong>This survey explored subject experiences involving 20 gastrointestinal (GI) conditions. In total, 20,099 respondents in seven countries with varied cultural and socioeconomic backgrounds participated. <i>Post hoc</i> analysis of 'self-reported constipation' and related symptoms experienced within the past 6 months and the last episode of constipation provided data on prevalence, demographics, frequency and duration of episodes and related symptoms, impact on quality of life (QoL), management with or without laxatives, and resulting treatment satisfaction.</p><p><strong>Results: </strong>In total, 10,425 subjects reported constipation within 6 months and 2637 at the last episode. Prevalence was highest in females and younger adults. Most subjects reported various coexisting GI symptoms. Almost 80% of 6865 episodes reported by 5337 subjects occurred every 2-3 months to every 2-3 weeks. A higher frequency of constipation correlated with a greater impact on QoL. On a 10-point scale, the mean impact was 6.4. More than 90% of respondents had episodes ranging from 1 day to 1 week. More than 90% took action; 16% used laxatives, of whom 80.3% were satisfied.</p><p><strong>Conclusion: </strong>Constipation, a highly prevalent disorder, spans cultures and socioeconomic classes. Its chronic recurrence has a significant impact on QoL, resulting in symptom self-management in >90% of subjects. Significantly higher satisfaction rates in subjects treated with than without laxatives reflect subjects' reports that self-reported constipation can be treated effectively with laxatives.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10913501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040652","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":"Effectiveness and safety of azathioprine for inflammatory pouch disorders: results from the RESERVO study of GETECCU.","authors":"Francisco Mesonero, Yamile Zabana, Agnès Fernández-Clotet, Eduardo Leo-Carnerero, Berta Caballol, Andrea Núñez-Ortiz, María José García, Federico Bertoletti, Alejandro Mínguez, Gerard Suris, Begoña Casis, Rocío Ferreiro-Iglesias, Margalida Calafat, Itxaso Jiménez, José Miranda-Bautista, Luis Javier Lamuela, Ingrid Fajardo, Leyanira Torrealba, Rodrigo Nájera, Rosa María Sáiz-Chumillas, Irene González, Miren Vicuña, Natalia García-Morales, Ana Gutiérrez, Alicia López-García, José Manuel Benítez, Cristina Rubín de Célix, Coral Tejido, Eduard Brunet, Alejandro Hernández-Camba, Cristina Suárez, Iago Rodríguez-Lago, Marta Piqueras, Andrés Castaño, Laura Ramos, Ana Sobrino, María Carmen Rodríguez-Grau, Alfonso Elosua, Miguel Montoro, Ruth Baltar, José María Huguet, Benito Hermida, Antonio Caballero-Mateos, Luis Sánchez-Guillén, Abdel Bouhmidi, Ramón Pajares, Iria Baston-Rey, Antonio López-Sanromán, Agustin Albillos, Manuel Barreiro-de Acosta","doi":"10.1177/17562848241234476","DOIUrl":"10.1177/17562848241234476","url":null,"abstract":"<p><strong>Background: </strong>The usefulness of thiopurines has been poorly explored in pouchitis and other pouch disorders.</p><p><strong>Objective: </strong>To evaluate the effectiveness and safety of azathioprine as maintenance therapy in inflammatory pouch disorders.</p><p><strong>Design: </strong>This was a retrospective and multicentre study.</p><p><strong>Methods: </strong>We included patients diagnosed with inflammatory pouch disorders treated with azathioprine in monotherapy. Effectiveness was evaluated at 1 year and in the long term based on normalization of stool frequency, absence of pain, faecal urgency or fistula discharge (clinical remission), or any improvement in these symptoms (clinical response). Endoscopic response was evaluated using the Pouchitis Disease Activity Index (PDAI).</p><p><strong>Results: </strong>In all, 63 patients were included [54% males; median age, 49 (28-77) years]. The therapy was used to treat pouchitis (<i>n</i> = 37) or Crohn's disease of the pouch (<i>n</i> = 26). The rate of clinical response, remission and non-response at 12 months were 52%, 30% and 18%, respectively. After a median follow-up of 23 months (interquartile range 11-55), 19 patients (30%) were in clinical remission, and 45 (66%) stopped therapy. Endoscopic changes were evaluated in 19 cases. PDAI score decreased from 3 (range 2-4) to 1 (range 0-3). In all, 21 patients (33%) presented adverse events and 16 (25%) needed to stop therapy.</p><p><strong>Conclusion: </strong>Azathioprine may be effective in the long term for the treatment of inflammatory pouch disorders and could be included as a therapeutic option.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10913517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040651","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}