Clinical Gastroenterology and Hepatology最新文献

英文中文

The Future of Inflammatory Bowel Disease Care 第十三期 CGH 引言炎症性肠病护理的未来。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.10.004

Edward V. Loftus Jr MD , Joana Torres MD, PhD , Jason K. Hou MD, MS , Charles J. Kahi MD, MS , Siddharth Singh MD, MS

引用次数: 0

Comparative Efficacy of Biologics and Small Molecule in Ulcerative Colitis: A Systematic Review and Network Meta-analysis 生物制剂和小分子药物在溃疡性结肠炎中的疗效比较：系统综述与网络 Meta 分析》。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.07.033

Mohammad Shehab , Fatema Alrashed , Abdulwahab Alsayegh , Usama Aldallal , Christopher Ma , Neeraj Narula , Vipul Jairath , Siddharth Singh , Talat Bessissow

Background & Aims

Treatment options for moderate to severe ulcerative colitis (UC) are increasing rapidly, but the lack of comparative efficacy trials makes treatment choices a clinical challenge. This network-meta-analysis aimed to compare the relative efficacy of biologics and small molecules in achieving remission in patients with moderate to severe UC.

Methods

The literature was searched up to May 2024. Phase 3 placebo or active comparator randomized controlled trials were included. The primary outcome was induction and maintenance of endoscopic improvement (Mayo Endoscopic Score [MES] ≤1). Secondary outcomes were the induction and maintenance of clinical remission, endoscopic (MES = 0) and histological remission. A sub-analysis was performed based on the randomized controlled trial design and previous exposure to biologic therapy.

Results

We identified 36 studies that met our inclusion criteria, with 14,270 patients with UC. Upadacitinib ranked highest in inducing clinical remission (99.6%), and endoscopic improvement (99.2%), followed by risankizumab (91.4%) and (82.3%), respectively. In maintenance of endoscopic improvement, upadacitinib ranked first (98.6%) followed by filgotinib 200 mg (79.2%). Risankizumab ranked first in the induction of histological remission (89.4%), followed by guselkumab (88.3%). Upadacitinib ranked first (93.1%) in maintaining histological remission, followed by guselkumab (89.5%).

Conclusion

Upadacitinib appears to be superior to other therapies in achieving clinical remission, endoscopic improvement and remission, and histological remission. Furthermore, novel biologics such as risankizumab and guselkumab ranked high in achieving these outcomes. This study highlights the efficacy of small molecule drugs and novel selective interleukin-23s as alternatives to other biologics.

背景与目的：中度至重度溃疡性结肠炎（UC）的治疗方案正在迅速增加，但由于缺乏疗效比较试验，治疗选择成为临床难题。这项网络-荟萃分析旨在比较生物制剂和小分子药物对中重度溃疡性结肠炎患者获得缓解的相对疗效：方法：检索截至 2024 年 5 月的文献。方法：检索了截至2024年5月的文献，纳入了3期安慰剂或活性对比剂随机对照试验（RCT）。主要结果是诱导和维持内镜改善（梅奥内镜评分 [MES] ≤1）。次要结果是诱导和维持临床缓解、内镜（MES = 0）和组织学缓解。根据 RCT 设计和既往接受生物疗法的情况进行了子分析：我们确定了符合纳入标准的 36 项研究，共纳入 14,270 名 UC 患者。在诱导临床缓解（99.6%）和内镜改善（99.2%）方面，乌达替尼排名第一，其次分别是利桑珠单抗（91.4%）和（82.3%）。在维持内镜改善方面，达帕替尼排名第一（98.6%），其次是菲戈替尼 200 毫克（79.2%）。在诱导组织学缓解方面，利桑珠单抗排名第一（89.4%）。其次是 Guselkumab（88.3%）。在维持组织学缓解方面，乌达替尼排名第一（93.1%），其次是古谢库单抗（89.5%）：结论：在实现临床缓解、内镜改善和缓解以及组织学缓解方面，乌达替尼似乎优于其他疗法。此外，新型生物制剂，如利桑珠单抗和古舍库单抗，在取得这些疗效方面也名列前茅。这项研究强调了小分子药物和新型选择性 IL-23s 作为其他生物制剂替代品的疗效。

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引用次数: 0

How to Incorporate Subcutaneous Infliximab and Vedolizumab in Your Practice 如何将皮下注射英夫利西单抗和维多珠单抗纳入临床实践？

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.07.042

Sara N. Horst , Melissa Kirkpatrick , Elizabeth Scoville , Anthony Buisson

引用次数: 0

Elsewhere in the AGA Journals

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/S1542-3565(24)01109-1

引用次数: 0

The IBD Clinic of Tomorrow: Holistic, Patient-Centric, and Value-based Care 未来的 IBD 诊所：全面、以患者为中心、以价值为基础的医疗服务。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.04.042

Benjamin Click , Raymond K. Cross , Miguel Regueiro , Laurie Keefer

There is increasing recognition of the associated bi-directional impact of inflammatory bowel disease (IBD) on patient well-being and the potential benefit of multidisciplinary teams to address these unique needs. At certain IBD centers, there has been an evolution towards patient-centric, holistic care to enhance well-being and improve health-related outcomes. Multiple models, incorporating various disciplines, care modalities, digital tools and care delivery, and resource support have arisen in IBD. Although most IBD centers of excellence are now incorporating such multidisciplinary care models, many practices still practice IBD-limited specialty care, limiting evaluations and interventions to the IBD itself and its direct consequences (eg, extraintestinal manifestations). In this piece, we seek to review the evolution of IBD care towards a patient-centric, holistic model (termed 360 IBD Care) including the role and impact of digital health tools, monitoring, and delivery in IBD, and a shift towards value-based care models with discussion of payor priorities in IBD. We also suggest potential opportunities for IBD practitioners to incorporate elements of holistic care on a local scale. Together, we hope such care models will enhance not only IBD-specific health outcomes, but also improve the general well-being of our patients with IBD today and tomorrow.

越来越多的人认识到 IBD 对患者健康的相关双向影响，以及多学科团队满足这些独特需求的潜在益处。在某些 IBD 中心，已经开始向以患者为中心的整体护理发展，以提高患者的健康水平并改善与健康相关的结果。在 IBD 领域出现了多种模式，包括各种学科、护理方式、数字工具和护理服务以及资源支持。虽然大多数 IBD 高级研究中心现在都采用了这种多学科护理模式，但许多医疗机构仍在开展仅限于 IBD 的专科护理，将评估和干预局限于 IBD 本身及其直接后果（如肠道外表现）。在这篇文章中，我们试图回顾 IBD 护理向以患者为中心的整体模式（称为 360 IBD 护理）的演变，包括数字健康工具、监测和交付在 IBD 中的作用和影响，以及向基于价值的护理模式的转变，并讨论支付方在 IBD 中的优先事项。我们还为 IBD 从业人员提出了在当地范围内纳入整体护理元素的潜在机会。我们希望这些护理模式不仅能改善 IBD 患者的健康状况，还能改善 IBD 患者现在和未来的总体健康状况。

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引用次数: 0

IBD Matchmaking: Rational Combination Therapy IBD 媒介--合理的联合疗法。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.05.051

Robert Battat , John T. Chang , Edward V. Loftus Jr. , Bruce E. Sands

A growing number of patients with Crohn’s disease and ulcerative colitis have disease that is refractory to multiple advanced therapies, have undergone multiple surgeries, and require further treatment options. For this reason, there has been increasing use of multiple simultaneous advanced targeted therapies. Although the knowledge on combined advanced targeted therapy (CATT) in inflammatory bowel disease (IBD) has been largely limited to observational data and early-phase randomized controlled trials, combination of therapies is commonplace in many other diseases. This review discusses conceptual frameworks of CATT in IBD, provides context of combined therapies in other diseases, provides current evidence for CATT in IBD, and projects future applications and positioning of CATT using existing, novel, and orthogonal mechanisms of action. CATT aims to address the need to overcome low efficacy rates and frequent loss of response of current individual therapies. Both treatment exposure and disease duration are major determinants of response to therapy. Identification of safe and effective CATT may impact positioning of this strategy to apply to a broader IBD population.

越来越多的克罗恩病和溃疡性结肠炎患者对多种先进疗法难治，接受过多次手术，需要进一步的治疗方案。因此，越来越多的患者开始同时使用多种先进的靶向疗法。虽然对炎症性肠病联合晚期靶向疗法（CATT）的了解主要局限于观察性数据和早期随机对照试验，但联合疗法在许多其他疾病中已司空见惯。本综述讨论了炎症性肠病（IBD）中 CATT 的概念框架，介绍了其他疾病中联合疗法的背景，提供了 IBD 中 CATT 的现有证据，并利用现有、新型和正交作用机制预测了 CATT 的未来应用和定位。CATT 旨在解决目前个别疗法疗效低和经常失去反应的问题。治疗暴露和疾病持续时间是治疗反应的主要决定因素。确定安全有效的 CATT 可能会影响该策略的定位，使其适用于更广泛的 IBD 患者。

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引用次数: 0

Blue Notes

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.11.004

Charles J. Kahi MD, MS, AGAF

引用次数: 0

Continuing the Commitment to Diversity, Equity, and Inclusion Within AGA Journals

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.11.003

Sandra M. Quezada, Folasade P. May

引用次数: 0

Update on the Epidemiology and Management of Microscopic Colitis 微小结肠炎的流行病学和管理最新进展。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.08.026

Anne F. Peery , Hamed Khalili , Andreas Münch , Darrell S. Pardi

Microscopic colitis is an inflammatory bowel disease that commonly presents with debilitating chronic watery diarrhea. Recent epidemiologic studies and randomized trials of therapeutics have improved the understanding of the disease. Medications, such as nonsteroidal anti-inflammatories, proton pump inhibitors, and antidepressants, have traditionally been considered as the main risk factors for microscopic colitis. However, recent studies have challenged this observation. Additionally, several epidemiologic studies have identified other risk factors for the disease including older age, female sex, smoking, alcohol use, immune-mediated diseases, and select gastrointestinal infections. The diagnosis of microscopic colitis requires histologic assessment of colon biopsies with findings including increased in intraepithelial lymphocytes with or without expansion of the subepithelial collagen band. The pathophysiology is poorly understood but is thought to be related to an aberrant immune response to the luminal microenvironment in genetically susceptible individuals. Antidiarrheal medications, such as loperamide or bismuth subsalicylate, may be sufficient in patients with mild symptoms. In patients with more severe symptoms, treatment with budesonide is recommended. Maintenance therapy is often necessary and several potential treatment strategies are available. Biologic and small molecule treatments seem to be effective in patients who have failed budesonide. There is an unmet need to further define the pathophysiology of microscopic colitis. Additionally, trials with novel therapies, particularly in patients with budesonide-refractory disease, are needed.

显微镜下结肠炎是一种炎症性肠病，通常表现为令人衰弱的慢性水样腹泻。最近的流行病学研究和随机治疗试验增进了我们对该疾病的了解。非甾体抗炎药、质子泵抑制剂和抗抑郁药等药物历来被认为是微小结肠炎的主要危险因素。然而，最近的研究对这一观点提出了质疑。此外，一些流行病学研究还发现了该疾病的其他风险因素，包括年龄偏大、女性、吸烟、饮酒、免疫介导疾病和特定的胃肠道感染。诊断显微镜下结肠炎需要对结肠活组织进行组织学评估，评估结果包括上皮内淋巴细胞增多，上皮下胶原带扩张或不扩张。病理生理学尚不十分清楚，但认为与易感基因个体对管腔微环境的异常免疫反应有关。症状轻微的患者服用洛哌丁胺或水杨酸铋等止泻药就可以了。对于症状较重的患者，建议使用布地奈德治疗。维持治疗通常是必要的，目前有几种潜在的治疗策略。生物制剂和小分子疗法似乎对布地奈德治疗失败的患者有效。进一步明确显微镜下结肠炎的病理生理学的需求尚未得到满足。此外，还需要对新型疗法进行试验，尤其是对布地奈德难治性疾病患者。

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引用次数: 0

Neoplastic Progression Risk in Females With Barrett’s Esophagus: A Systematic Review and Meta-Analysis of Individual Patient Data 女性巴雷特食管癌患者的肿瘤进展风险：对患者个体数据的系统回顾和荟萃分析。

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology

Pub Date : 2025-02-01 DOI: 10.1016/j.cgh.2024.06.053

Pauline A. Zellenrath , Laurelle van Tilburg , Roos E. Pouw , Rena Yadlapati , Yonne Peters , Michael B. Ujiki , Prashanthi N. Thota , Norihisa Ishimura , Stephen J. Meltzer , Noam Peleg , Won-Tak Choi , John V. Reynolds , Alexandros D. Polydorides , Arjun D. Koch , Judith Honing , Manon C.W. Spaander

Background and Aims

Females with Barrett’s esophagus (BE) have a lower risk of neoplastic progression than males, but sufficiently powered risk analyses are lacking. This systematic review and meta-analysis of individual patient data (IPD) aimed to provide more robust evidence on neoplastic progression risk in females.

Methods

We conducted a systematic literature search of 3 electronic databases (Medline, Embase, Google Scholar) from inception until August 2023. Eligible studies (1) reported original data on progression from nondysplastic BE, indefinite for dysplasia, or low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma; and (2) included female and male patients. IPD were quality controlled by 2 independent reviewers. The primary outcome was the association between sex and neoplastic progression risk, adjusted for risk factors using multivariable Cox regression analysis. Secondary outcomes were sex differences in time to progression and annual progression rate.

Results

IPD were obtained from 11 of 66 eligible studies, including 2196 (31%) females. Neoplastic progression risk was lower in females (hazard ratio for males vs females, 1.44; 95% confidence interval, 1.13–1.82) after adjusting for age, smoking, medication use, hiatal hernia, BE length, and baseline pathology. The annual progression rate was 0.88% in females vs 1.29% in males. Time to progression was similar in both sexes: 3.7 years (interquartile range, 2.1–7.7 years) in females and 4.2 years (interquartile range, 2.0–8.1 years) in males.

Conclusion

Although females had a lower neoplastic progression risk, sex differences were smaller than previously reported, and time to progression was similar for both sexes. Future research should focus on other factors than sex to identify low- and high-risk BE patients.

背景和目的：女性巴雷特食管（Barrett's esophagus，BE）患者的肿瘤进展风险低于男性，但目前缺乏足够的风险分析。本研究对患者个体数据（IPD）进行系统回顾和荟萃分析，旨在为女性肿瘤进展风险提供更有力的证据：对三个电子数据库（Medline、Embase、Google Scholar）进行系统文献检索，检索时间从开始到 2023 年 8 月。符合条件的研究(1)报告了从非增生异常BE（NDBE）、增生异常不定期（IND）或低度增生异常（LGD）到高级别增生异常（HGD）或食管腺癌（EAC）进展的原始数据，(2)纳入了女性和男性患者。IPD由两名独立审稿人进行质量控制。主要结果是性别与肿瘤进展风险之间的关系，使用多变量考克斯回归分析对风险因素进行调整。次要结果是进展时间和年进展率的性别差异：从11/66项符合条件的研究中获得了IPD，其中包括2 196名女性（31%）。在对年龄、吸烟、用药、食道裂孔疝、BE长度和基线病理学进行调整后，女性的肿瘤进展风险较低（男性与女性的HR为1.44，95%CI为1.13-1.82）。女性的年进展率为 0.88%，男性为 1.29%。男女肿瘤进展时间相似：女性为3.7年（IQR 2.1-7.7），男性为4.2年（IQR 2.0-8.1）：结论：虽然女性肿瘤恶化的风险较低，但性别差异小于之前的报道，而且男女肿瘤恶化的时间相似。未来的研究应关注性别以外的其他因素，以识别低风险和高风险的 BE 患者。

{"title":"Neoplastic Progression Risk in Females With Barrett’s Esophagus: A Systematic Review and Meta-Analysis of Individual Patient Data","authors":"Pauline A. Zellenrath , Laurelle van Tilburg , Roos E. Pouw , Rena Yadlapati , Yonne Peters , Michael B. Ujiki , Prashanthi N. Thota , Norihisa Ishimura , Stephen J. Meltzer , Noam Peleg , Won-Tak Choi , John V. Reynolds , Alexandros D. Polydorides , Arjun D. Koch , Judith Honing , Manon C.W. Spaander","doi":"10.1016/j.cgh.2024.06.053","DOIUrl":"10.1016/j.cgh.2024.06.053","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Females with Barrett’s esophagus (BE) have a lower risk of neoplastic progression than males, but sufficiently powered risk analyses are lacking. This systematic review and meta-analysis of individual patient data (IPD) aimed to provide more robust evidence on neoplastic progression risk in females.</div></div><div><h3>Methods</h3><div>We conducted a systematic literature search of 3 electronic databases (Medline, Embase, Google Scholar) from inception until August 2023. Eligible studies (1) reported original data on progression from nondysplastic BE, indefinite for dysplasia, or low-grade dysplasia to high-grade dysplasia or esophageal adenocarcinoma; and (2) included female and male patients. IPD were quality controlled by 2 independent reviewers. The primary outcome was the association between sex and neoplastic progression risk, adjusted for risk factors using multivariable Cox regression analysis. Secondary outcomes were sex differences in time to progression and annual progression rate.</div></div><div><h3>Results</h3><div>IPD were obtained from 11 of 66 eligible studies, including 2196 (31%) females. Neoplastic progression risk was lower in females (hazard ratio for males vs females, 1.44; 95% confidence interval, 1.13–1.82) after adjusting for age, smoking, medication use, hiatal hernia, BE length, and baseline pathology. The annual progression rate was 0.88% in females vs 1.29% in males. Time to progression was similar in both sexes: 3.7 years (interquartile range, 2.1–7.7 years) in females and 4.2 years (interquartile range, 2.0–8.1 years) in males.</div></div><div><h3>Conclusion</h3><div>Although females had a lower neoplastic progression risk, sex differences were smaller than previously reported, and time to progression was similar for both sexes. Future research should focus on other factors than sex to identify low- and high-risk BE patients.</div></div>","PeriodicalId":10347,"journal":{"name":"Clinical Gastroenterology and Hepatology","volume":"23 2","pages":"Pages 225-235.e8"},"PeriodicalIF":11.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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