BMJ Open Gastroenterology最新文献

{"title":"Proton-pump inhibitor exposure and prevalence of colorectal adenoma: a retrospective analysis from the Sakkopi study.","authors":"Hannah Hofer, Sarah Wernly, Andreas Völkerer, Georg Semmler, Maria Flamm, Laurenz Hauptmann, Bernhard Wernly, Elmar Aigner, Christian Datz","doi":"10.1136/bmjgast-2025-002117","DOIUrl":"10.1136/bmjgast-2025-002117","url":null,"abstract":"<p><strong>Objective: </strong>Proton-pump inhibitors (PPIs) are among the most widely prescribed long-term medications worldwide, yet concerns remain about their potential role in colorectal carcinogenesis. Experimental data suggest that PPI-induced hypergastrinaemia may promote colonic epithelial proliferation, but epidemiological findings are inconsistent, and colonoscopy-based evidence is limited.</p><p><strong>Methods: </strong>We studied 4476 asymptomatic adults who underwent structured screening colonoscopy in Austria between 2007 and 2020 as part of the Sakkopi study. Regular PPI use, including dose stratification, was evaluated in this retrospective analysis in relation to adenoma prevalence, burden and anatomical distribution. Multivariable logistic regression was adjusted for age, sex, metabolic syndrome, smoking status and family history of colorectal cancer. Multinomial models examined non-advanced and advanced adenomas separately.</p><p><strong>Results: </strong>A total of 322 (7.2%) participants reported regular PPI use. Compared with non-users, PPI users were older, had higher body mass index and more frequently fulfilled metabolic syndrome criteria. Adenomas were detected in 39% of PPI users and 33% of non-users (p=0.032). In adjusted analyses, PPI use was not associated with adenoma presence (OR 1.05; 95% CI 0.83 to 1.35), number or distribution. Dose stratification showed no gradient effect: adjusted ORs were 0.85 (0.58 to 1.26) for half-dose and 1.19 (0.83 to 1.7) for standard-dose therapy. Multinomial analyses yielded consistent null results for both non-advanced and advanced adenomas in adjusted analysis.</p><p><strong>Conclusion: </strong>In this large and well-characterised screening cohort, regular PPI therapy was not associated with colorectal adenoma prevalence, irrespective of dose or lesion characteristics.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12778339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MOdel-informed precision dosing (MIPD) of ustekinumab and VEdolizumab in inflammatory bowel disease: protocol for an Independent randomised, controlled, multicentre Trial (MOVE-IT).","authors":"Camilla Frimor, Casper Steenholdt, Ella Signe Kassandra Widigson, Jens Kjeldsen, Lone Larsen, Johan Burisch, Maiken Thyregod Joergensen, Morten Lee Halling, Charlotte Kloft, Mark Andrew Ainsworth","doi":"10.1136/bmjgast-2025-001985","DOIUrl":"10.1136/bmjgast-2025-001985","url":null,"abstract":"<p><strong>Introduction: </strong>Biologic therapies, such as vedolizumab (VDZ) and ustekinumab (UST), offer effective treatment options for inflammatory bowel disease. In spite of limited evidence, it is common practice to escalate the dosing regimen if clinical symptoms or biomarkers give suspicion of loss of response. This study aims to determine whether model-informed precision dosing (MIPD) can provide equal efficacy and possibly superior cost-effectiveness compared with symptom-based management.</p><p><strong>Methods and analysis: </strong>This study is an unblinded, randomised controlled trial, conducted at six centres in Denmark. A total of 166 patients diagnosed with Crohn's disease or ulcerative colitis who have been on stable VDZ or UST therapy for at least 3 months will be enrolled. Participants will be randomised to receive either continued symptom and biomarker-based dosing (control group) or dosing guided by therapeutic drug monitor using pharmacokinetic (PK) models together with PK-pharmacodynamic targets (=MIPD; intervention group). The primary endpoint is the fraction of patients in steroid-free remission at the end of the observation period. Secondary endpoints include mucosal healing, clinical remission, biochemical disease control, PK assessment and cost-effectiveness.</p><p><strong>Ethics and dissemination: </strong>The trial has been approved by the Danish Medicines Agency and The Medical Research Ethics Committee. No study-related procedures will take place before patients have signed written informed consent. Results will be published in peer-reviewed journals and presented at international conferences.</p><p><strong>Trial registration numbers: </strong>EUCT, 2024-517123-39-00; NCT06788340.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12742169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145843127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobile endoscopy in rural South Africa: outcomes of a decentralised outreach programme to improve gastrointestinal healthcare access.","authors":"Michael Deal, Joseph Karam, Shannon Rychener, Dania Hailat, Aleeza Masood, Sydney Bertram, Mike Mallah, Hugo Stark","doi":"10.1136/bmjgast-2025-002040","DOIUrl":"10.1136/bmjgast-2025-002040","url":null,"abstract":"<p><strong>Introduction: </strong>Gastrointestinal (GI) endoscopy is a valuable diagnostic tool for identifying upper and lower GI pathologies yet is rarely available in resource-limited settings. This project evaluates the impact of a mobile endoscopy outreach effort implemented across five district hospitals in the Western Cape of South Africa.</p><p><strong>Methods: </strong>A mobile endoscopy outreach programme was created and implemented at five district hospitals within the Western Cape of South Africa. Health records of patients who presented for endoscopy across these five hospitals were then retrospectively reviewed. Descriptive statistics were used as part of data analysis.</p><p><strong>Results: </strong>A total of 515 procedures (486 oesophagogastroduodenoscopies (94%), 28 colonoscopies (5%) and one proctoscopy (0.2%)) were performed at five district hospitals between January and November of 2024 (323 female (63%), 192 male (37%); mean (SD) age 56 (14) years). The most common pathologies identified across all sites included gastritis (76%), hiatal hernia (70%) and oesophagitis (69%). For all patients, the average distance travelled to their nearest district hospital (Beaufort West, Oudtshoorn, Riversdale, Mossel Bay or Knysna) was 13.6 km (SD (26.6)), compared with the average distance they would have needed to travel to the regional referral centre (mean (SD) 102.1 (66.8) km) in George, South Africa, for the same endoscopy services.</p><p><strong>Conclusion: </strong>Implementing a mobile, cost-conscious endoscopy outreach programme can offer diagnostic and therapeutic opportunities to patients in international resource-limited settings, while also alleviating resource strain on regional referral centres. This approach can improve healthcare access and can be replicated in other resource-limited settings.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12750763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for maintenance of surgically induced remission in Crohn's disease: a systematic review and network meta-analysis.","authors":"Morris Gordon, Shiyao Liu, Vassiliki Sinopoulou, Daniel Arruda Navarro Albuquerque, Gordon Moran","doi":"10.1136/bmjgast-2025-002086","DOIUrl":"10.1136/bmjgast-2025-002086","url":null,"abstract":"<p><strong>Objectives: </strong>Approximately 50% of patients with Crohn's disease (CD) undergo surgery, and a significant proportion suffer from a post-surgical recurrence. We conducted a network meta-analysis to compare the efficacy of various interventions.</p><p><strong>Design: </strong>Systematic review and network meta-analysis.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE and Cochrane Library were searched from inception up to February 2025.</p><p><strong>Eligibility criteria: </strong>Randomised controlled trials (RCTs), reported in any language, comparing treatments used for maintaining surgically induced remission in CD were included. The primary outcomes were clinical relapse, endoscopic relapse and withdrawal due to adverse events.</p><p><strong>Data extraction and synthesis: </strong>Two reviewers independently extracted data and assessed risk of bias. Certainty of evidence was rated with GRADE (Grading of Recommendations Assessment, Development and Evaluation), and SUCRA (surface under the cumulative ranking curve) was used to rank treatments.</p><p><strong>Results: </strong>There were 34 RCTs (n=3197). For clinical relapse, adalimumab reduced the risk of relapse compared with placebo (moderate certainty), risk ratio (RR) 0.31 (95% CI 0.16 to 0.60), moderate effect size. Two treatments may reduce the risk of clinical relapse (low certainty): 5-aminosalicylic acid (RR 0.79, 95% CI 0.66 to 0.94; trivial effect size) and purine analogues (RR 0.79, 95% CI 0.66 to 0.96; trivial effect size). All other treatments were of very low certainty. For endoscopic relapse, vedolizumab probably reduced the risk of relapse (moderate certainty), RR 0.37 (95% CI 0.17 to 0.80), large effect size. Adalimumab may reduce the risk of endoscopic relapse (low certainty), RR 0.47 (95% CI 0.27 to 0.80), large effect size. All other treatments were of very low certainty.</p><p><strong>Conclusions: </strong>Adalimumab and vedolizumab reduce endoscopic relapse with moderate to large effects supported by moderate to low certainty evidence. Adalimumab also prevents clinical relapse with moderate certainty. Other therapies either had evidence of trivial effect size or very low certainty evidence. Postoperative maintenance should be individualised based on patient risk and treatment profile.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12718597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pruritus and health-related quality of life in chronic liver disease: a longitudinal, survey-based cohort study.","authors":"Usha Gungabissoon, Jake Hunnicutt, Eleanor J McDermott, Andrew Lovley, Monica S Frazer, Kaitlin M LaGasse, Mark Kosinski, Kristen L McCausland, Ashleigh McGirr, Helen T Smith, Gideon M Hirschfield, Palak Trivedi","doi":"10.1136/bmjgast-2025-001809","DOIUrl":"10.1136/bmjgast-2025-001809","url":null,"abstract":"<p><strong>Objective: </strong>Cholestatic pruritus is commonly reported in primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC); however, information on pruritus in other chronic liver diseases (CLDs) is limited. This survey-based cohort study characterised the severity, persistence and impact of pruritus in PBC, PSC, chronic hepatitis B or C virus infection (HBV/HCV), drug-induced liver injury, autoimmune hepatitis (AIH) and metabolic dysfunction-associated steatohepatitis (MASH). Here, we focus on groups that recruited the most participants: PSC, MASH and HCV. Results are presented in the context of PBC.</p><p><strong>Methods: </strong>Adults with a CLD of interest from the USA, the UK, Canada and Germany were screened for the presence of pruritus via the worst-itch numerical rating scale (WI-NRS, 3-month recall) between January 2021 and January 2022. Enrolled participants (single liver disease, non-transplant recipients) self-reporting pruritus with no extrahepatic causes in the past 3 months (WI-NRS≥1) were eligible for further health-related quality-of-life (HRQoL) assessments, including WI-NRS (2-week recall), 5-dimensional itch scale and version two of the 36-Item Short-Form Health Survey. Questionnaires were administered at baseline (month 0), month 3 and month 6.</p><p><strong>Results: </strong>Of 717 screened participants, 40.4% (AIH)-72.7% (HCV) reported any pruritus. Of 403 eligible participants, 357 were enrolled. Time since onset of pruritus to enrolment ranged from 28.0 (MASH) to 77.5 months (PBC). Baseline WI-NRS scores ranged from 3.8 (MASH) to 5.1 (PSC). The most selected terms used to describe pruritus across all CLDs were 'deep itch' and 'urgent itch' (range: 53.7% (HCV)-77.0% (PSC)). Participants with more severe pruritus had worse HRQoL. Intimate relationships, emotional well-being and ability to concentrate were negatively impacted by pruritus. Pruritus persisted over the 6-month study period across all CLDs.</p><p><strong>Conclusion: </strong>Our study highlights the burden of pruritus experienced by participants across CLDs, highlighting a need to improve symptom recognition and treatments focused on improving HRQoL.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12699617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pouch excision, dysplasia and polypectomy in familial adenomatous polyposis ileal pouch anal anastomosis: a retrospective analysis.","authors":"Iain Blake, Hina Aslam, Shakil Ahmed, Muhammad Ahsan Javed, Paul Collins","doi":"10.1136/bmjgast-2025-001758","DOIUrl":"10.1136/bmjgast-2025-001758","url":null,"abstract":"<p><strong>Introduction: </strong>Familial adenomatous polyposis (FAP) is a rare autosomal dominant syndrome that, if untreated, carries a 100% lifetime risk of developing colorectal cancer. Proctocolectomy with ileal pouch-anal anastomosis (IPAA) is a surgical approach for FAP management, but data on long-term outcomes remain limited. This study aimed to assess IPAA-associated pouch excision, dysplasia, polyp management and pouchitis in patients with FAP post IPAA.</p><p><strong>Methods: </strong>Single-centre retrospective review of patients with FAP with IPAA at a tertiary referral centre. Data on demographics, pouch excision, endoscopic and histopathological records were collected. Statistical analysis was performed using Excel and GraphPad.</p><p><strong>Results: </strong>Forty patients with FAP with IPAA were included. The median age was 48 years (IQR 33-58.5), with a median age of 22 years at pouch formation (IQR 18-30.5) and a median pouch age of 217 months (IQR 143-279). A total of 230 lower gastrointestinal endoscopies were assessed. Low-grade dysplasia was identified in 70 endoscopies, and polyps in 82, with the pouch being the most common site. One case of rectal adenocarcinoma was identified, with no cases of high-grade dysplasia. There were 35 episodes involving polypectomy, with cold snare being the most common method (50%). Endoscopic management had a lower complication rate than surgical management (p=0.0474). Eight (20%) patients underwent pouch excision, with poor function being as common as pouch-related complications (37.5%), with a median pouch age at excision of 167 months (IQR 115.5-286.5). Endoscopic pouchitis was significantly more common in those who underwent pouch excision (p=0.0231).</p><p><strong>Conclusion: </strong>Patients with FAP and IPAA require surveillance due to a high incidence of dysplasia and polyp formation, although malignancy remains rare. There is a significant rate of pouch excision, for which pouchitis appears to be a risk factor. Early and aggressive endoscopic management of polyps is recommended to prevent advanced disease and minimise complications associated with surgical approaches.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12699754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative evaluation of a hybrid machine learning-human adjudication paradigm for endoscopic scoring in ulcerative colitis.","authors":"Klaus T Gottlieb, Chakib Battioui, Yeli Wang, Pavel A Brodskiy, Mohammad Haft-Javaherian, Daniel R Colucci, Darren Thomason, Shrujal Baxi","doi":"10.1136/bmjgast-2025-001959","DOIUrl":"10.1136/bmjgast-2025-001959","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic scoring of disease activity is essential in ulcerative colitis trials but is limited by inter-reader variability and operational complexity. We evaluated a novel central reading paradigm integrating two independently developed machine learning models with human adjudication for discordant cases ('2M+1H') to determine whether it is statistically non-inferior to the traditional two-reader-plus-adjudicator model.</p><p><strong>Methods: </strong>A total of 150 full-length endoscopic videos were retrospectively scored using both the conventional central reading approach and the 2M+1H paradigm. Each machine learning model was developed independently using distinct algorithms and datasets. When the two model-generated scores disagreed, a board-certified gastroenterologist adjudicated the final score. The primary endpoint was agreement with the reference standard, measured by quadratic weighted kappa. Secondary endpoints included agreement on binary outcomes (endoscopic improvement and remission), reduction in human reads and evaluation of outcome variability due to human reader mix.</p><p><strong>Results: </strong>The 2M+1H approach achieved a quadratic weighted kappa of 0.78 with the reference standard, meeting the prespecified threshold for non-inferiority. Agreement with the reference standard was 82.7% for endoscopic improvement and 89.3% for remission. Compared with the traditional method, the 2M+1H paradigm reduced human reads per video by 81%. Notably, 16% of cases in the human-only approach yielded different final scores depending on reader assignment.</p><p><strong>Conclusion: </strong>The 2M+1H central reading paradigm provides statistically non-inferior accuracy with greater operational efficiency and potentially enhanced reproducibility. Prospective validation against clinical, biomarker and histological outcomes is warranted.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12684144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parasitic colitis misdiagnosis as inflammatory bowel disease in high-income settings and association with poor clinical outcomes when exposed to corticosteroids: a systematic review of case reports.","authors":"Robert D Lees, Jenna Fyfe, Laura M Woods, R Alexander Speight, Christopher J Stewart, Richard C G Pollok, Christopher A Lamb","doi":"10.1136/bmjgast-2025-002080","DOIUrl":"10.1136/bmjgast-2025-002080","url":null,"abstract":"<p><strong>Objectives: </strong>Parasitic colitis is highly prevalent worldwide, may mimic inflammatory bowel disease (IBD) and is encountered by non-specialist physicians in high-income, non-endemic settings. In this context, patients may be at risk of misdiagnosis and poor outcomes. However, cases are not routinely reported, limiting the evidence base to individual case reports. We aimed to systematically describe and evaluate the diagnosis, clinical course and outcomes of affected patients whose cases have been reported in high-income settings.</p><p><strong>Design: </strong>A systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses framework.</p><p><strong>Data sources: </strong>PubMed and Scopus databases were searched for publications from between 1 January 2012 and 10 January 2025.</p><p><strong>Eligibility criteria: </strong>Case reports of undifferentiated colitis presenting in high-income settings, where the aetiological agent was ultimately found to be parasitological, were eligible for inclusion. Key exclusion criteria included a history of travel to an endemic area within 4 weeks of presentation. No language restrictions were applied.</p><p><strong>Data extraction and synthesis: </strong>Key components of each case report, encompassing patient presentation, diagnosis and management, were standardised as categorical descriptors. Key themes were identified, and a thematic synthesis approach was employed.</p><p><strong>Results: </strong>52 articles, describing 54 patients, were included in the final analysis: 33 cases of amoebiasis, 15 cases of strongyloidiasis and 6 cases of schistosomiasis. Misdiagnosis occurred in 37 out of 54 patients (69%), with 28 out of 37 (76%) of these misdiagnosed as IBD. Substantial harm was reported in 31 out of 54 (57%) patients, including death in seven patients. Major morbidity (defined as strongyloides hyperinfection syndrome, fulminant amoebic colitis, emergency surgery or sepsis) or death was associated with administration of corticosteroids in cases of strongyloidiasis and amoebiasis, occurring in 8 out of 9 (89%) and 1 out of 6 (17%) patients with strongyloidiasis who received/did not receive corticosteroids, and 10 out of 13 (77%) and 2 out of 20 (10%) patients with amoebiasis, respectively.</p><p><strong>Conclusions: </strong>Parasitic colitis poses a diagnostic challenge in high-income settings. Misdiagnosis as IBD is commonly reported, with poor outcomes related to corticosteroid treatment. Awareness of parasitic colitis aetiologies, at-risk groups and diagnostic tests is essential among generalist clinicians assessing undifferentiated colitis to avoid poor outcomes.</p><p><strong>Prospero registration number: </strong>CRD420251033374.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12684204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serrated polyps in the colorectum: clinical significance and future directions.","authors":"Taha Rashid Mallick, Mahera Hasan","doi":"10.1136/bmjgast-2025-001927","DOIUrl":"10.1136/bmjgast-2025-001927","url":null,"abstract":"<p><p>Serrated polyps are believed to play an important role in the development of colorectal cancer (CRC). They share molecular characteristics and proximal colonic location with postcolonoscopy colorectal cancer (PCCRC), indicating that they may give rise to a disproportionately high proportion of PCCRC. In this narrative literature review, we aimed to synthesise the current understanding of serrated polyps and their role in the development of CRC. Our review focuses on the prevalence of serrated lesions in various populations, risk of progression to advanced colorectal neoplasia and cancer, and the effect of serrated polyp detection on PCCRC rates. Serrated polyp detection is noted to be variable between studies based on the type of serrated polyps studied and the patient population in question. In addition, low-risk sessile serrated lesions (SSLs) do not seem to have a higher risk for progression to advanced neoplasia than conventional adenomas, while more advanced lesions (10 mm or larger, those with dysplasia and traditional serrated adenomas) do seem to have a higher malignant potential, particularly in combination with traditional adenomas. Finally, several studies demonstrate a decrease in PCCRC rates among endoscopists with higher serrated polyp detection metrics. We identified a need for standardising the definition of clinically significant serrated polyps for future monitoring and benchmarking of serrated polyp detection metrics, further research to determine the surveillance interval for patients with concomitant adenomas and serrated polyps, and widespread education and training for endoscopists and pathologists to improve detection, diagnosis and management of serrated lesions.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12682197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilisation and real-world effectiveness of advanced therapies for inflammatory bowel disease in Middle Eastern populations: a systematic review.","authors":"Mohammed Nabil Quraishi, Maryam A Alahmad, Ala I Sharara, Palak J Trivedi, Badr Al-Bawardy, Laith Alrubaiy","doi":"10.1136/bmjgast-2025-002034","DOIUrl":"10.1136/bmjgast-2025-002034","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to systematically review the real-world evidence (RWE) on the effectiveness and utilisation of advanced therapies for inflammatory bowel disease (IBD) in Middle Eastern populations.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Data sources: </strong>PubMed/MEDLINE, Embase, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were searched up to May 2025.</p><p><strong>Eligibility criteria: </strong>Observational RWE studies investigating biologics or small molecules in Middle Eastern IBD patients (adult and paediatric) were included. Randomised controlled trials and case series with fewer than 10 patients were excluded. No language restrictions were applied.</p><p><strong>Data extraction and synthesis: </strong>Data were independently extracted by two reviewers. Due to significant heterogeneity in study design, populations and outcome reporting, a narrative synthesis was performed.</p><p><strong>Results: </strong>From 884 records, 23 studies were included, originating primarily from Saudi Arabia (n=8) and Iran (n=4). For anti-tumour necrosis factor (TNF) therapy, a Kuwaiti study of biologic-naive patients found 12-month endoscopic remission rates with infliximab of 56% for ulcerative colitis (UC) and 53% for Crohn's disease (CD), while a Saudi study reported higher odds of treatment failure with adalimumab versus infliximab (OR=26.91). Ustekinumab demonstrated strong efficacy, achieving 76.9% clinical remission at 52 weeks in a Saudi paediatric anti-TNF refractory IBD cohort and showing higher probability of effectiveness than vedolizumab in another Saudi study. In contrast, vedolizumab remission rates in advanced therapy-experienced UC patients were 89.3% with intensified dosing. Newer agents also showed promise; risankizumab induction led to 43.2% clinical remission in an Emirati CD cohort, while tofacitinib achieved clinical remission rates of 56.4% and 61.1% at 52 weeks in Lebanese and Iranian UC cohorts, respectively.</p><p><strong>Conclusions: </strong>Advanced therapies for IBD appear to be effective in Middle Eastern cohorts; however, the available evidence is methodologically diverse, with substantial heterogeneity in study design, population characteristics and outcome reporting, which limits the ability to draw strong conclusions and highlights the need for further robust evaluation. Prospective, collaborative regional registries are imperative to address these gaps and inform local guidelines.</p><p><strong>Prospero registration number: </strong>CRD420251083256.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12673545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145660498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}