Diet and risk of developing inflammatory bowel disease (IBD) has been extensively studied.
Aims
To investigate the association between diet and IBD activity.
Methods
Consecutive outpatients in 40 French and Belgian centers completed diet and IBD activity questionnaire between April and May 2023 in a cross-sectional study. Associations between diet and clinical remission were adjusted for gender, age, body mass index, education, smoking, and past CD-surgery.
Results
Among 2514 patients included, 1715 had Crohn’s disease (CD) and 799 had ulcerative colitis (UC). Overall, the mean age was 42.4 years, 52.3 % were women, and 56.4 % were in clinical remission. Among CD patients, clinical remission was associated with a higher intake of fruits (aOR 1.60 [1.20–2.14]) and coffee (aOR 1.57 [1.17–2.11]). Among UC patients, clinical remission was associated with a higher intake of fruits (aOR 1.72 [1.15–2.56]) and salad (aOR 1.73 [1.12–2.66]). A higher adherence to a Mediterranean diet was associated with CD (aOR 1.39 [1.06–1.84]) but not UC remission. A higher adherence to a healthy diet was not associated with either CD nor UC remission.
Conclusions
CD remission was associated with higher intakes of fruits, coffee and a Mediterranean diet, while UC remission was associated with higher intakes of fruits and salad. As this was a cross-sectional study, the main limitation was the possibility of reverse causality.
{"title":"Diet and clinical remission in patients with inflammatory bowel disease: A multicenter cross-sectional study","authors":"Lucile Fontaine , Philippe Seksik , Carmen Stefanescu , Maria Nachury , Stéphane Nancey , Guillaume Savoye , Matthieu Allez , Romain Altwegg , David Laharie , Mélanie Serrero , Denis Franchimont , Nicolas Mathieu , Mathurin Fumery , Lucine Vuitton , Stéphane Nahon , Cyrielle Gilletta , Cléa Rouillon , Alexandre Nuzzo , Arnaud Bourreille , Bénédicte Caron , Sophie Geyl","doi":"10.1016/j.dld.2025.12.001","DOIUrl":"10.1016/j.dld.2025.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Diet and risk of developing inflammatory bowel disease (IBD) has been extensively studied.</div></div><div><h3>Aims</h3><div>To investigate the association between diet and IBD activity.</div></div><div><h3>Methods</h3><div>Consecutive outpatients in 40 French and Belgian centers completed diet and IBD activity questionnaire between April and May 2023 in a cross-sectional study. Associations between diet and clinical remission were adjusted for gender, age, body mass index, education, smoking, and past CD-surgery.</div></div><div><h3>Results</h3><div>Among 2514 patients included, 1715 had Crohn’s disease (CD) and 799 had ulcerative colitis (UC). Overall, the mean age was 42.4 years, 52.3 % were women, and 56.4 % were in clinical remission. Among CD patients, clinical remission was associated with a higher intake of fruits (aOR 1.60 [1.20–2.14]) and coffee (aOR 1.57 [1.17–2.11]). Among UC patients, clinical remission was associated with a higher intake of fruits (aOR 1.72 [1.15–2.56]) and salad (aOR 1.73 [1.12–2.66]). A higher adherence to a Mediterranean diet was associated with CD (aOR 1.39 [1.06–1.84]) but not UC remission. A higher adherence to a healthy diet was not associated with either CD nor UC remission.</div></div><div><h3>Conclusions</h3><div>CD remission was associated with higher intakes of fruits, coffee and a Mediterranean diet, while UC remission was associated with higher intakes of fruits and salad. As this was a cross-sectional study, the main limitation was the possibility of reverse causality.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"58 2","pages":"Pages 220-231"},"PeriodicalIF":3.8,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-29DOI: 10.1016/j.dld.2025.12.010
Mattia Brigida , Marco Spadaccini , Marcello Maida , Aymen Almuhaidb , Eyad Gadour , Stefano Francesco Crinò , Giuseppe Dell’Anna , Gianfranco Donatelli , Gianluca Andrisani , Elisa Stasi , Armando Dell’Anna , Cesare Hassan , Yuichi Mori , Antonio Facciorusso
Background
It is unknown if mucosal exposure device improves the adenoma detection rate (ADR) of computer-aided detection (CAD)-assisted colonoscopy.
Aims
We performed a meta-analysis of randomized-controlled trials (RCTs) to compare the diagnostic outcomes of these two approaches.
Methods
We identified 4 RCTs (2968 patients). ADR was the primary outcome. Advanced ADR (aADR), sessile serrated ADR (SSDR) and adenoma per colonoscopy (APC) were also compared. The results were expressed in terms of mean difference (MD) or risk ratio (RR) and 95% confidence intervals (CIs), and we used trial sequential analysis (TSA) to assess if the required information size (RIS) was reached.
Results
There was no difference in terms of ADR both in the overall series (RR 1.05, 0.98-1.12; p=0.16) and in screening colonoscopy (RR 1.15, 0.72-1.82; p=0.56). Although the RIS (3829 participants) was not reached, the futility boundaries were crossed suggesting a high likelihood of futility in further comparison of ADR. No difference was observed in terms of aADR (RR 1.13, 0.90-1.44; p=0.30) and SSDR (RR 1.11, 0.92-1.35; p=0.27). APC was significantly higher in the combined group (MD 0.14, 0.05 to 0.22; p=0.002).
Conclusions
The addition of mucosal exposure devices does not increase ADR, aADR, and SSDR but increases APC.
{"title":"Incremental value of mucosal exposure device to computer-aided detection in colonoscopy: A meta-analysis and trial sequential analysis","authors":"Mattia Brigida , Marco Spadaccini , Marcello Maida , Aymen Almuhaidb , Eyad Gadour , Stefano Francesco Crinò , Giuseppe Dell’Anna , Gianfranco Donatelli , Gianluca Andrisani , Elisa Stasi , Armando Dell’Anna , Cesare Hassan , Yuichi Mori , Antonio Facciorusso","doi":"10.1016/j.dld.2025.12.010","DOIUrl":"10.1016/j.dld.2025.12.010","url":null,"abstract":"<div><h3>Background</h3><div>It is unknown if mucosal exposure device improves the adenoma detection rate (ADR) of computer-aided detection (CAD)-assisted colonoscopy.</div></div><div><h3>Aims</h3><div>We performed a meta-analysis of randomized-controlled trials (RCTs) to compare the diagnostic outcomes of these two approaches.</div></div><div><h3>Methods</h3><div>We identified 4 RCTs (2968 patients). ADR was the primary outcome. Advanced ADR (aADR), sessile serrated ADR (SSDR) and adenoma per colonoscopy (APC) were also compared. The results were expressed in terms of mean difference (MD) or risk ratio (RR) and 95% confidence intervals (CIs), and we used trial sequential analysis (TSA) to assess if the required information size (RIS) was reached.</div></div><div><h3>Results</h3><div>There was no difference in terms of ADR both in the overall series (RR 1.05, 0.98-1.12; p=0.16) and in screening colonoscopy (RR 1.15, 0.72-1.82; p=0.56). Although the RIS (3829 participants) was not reached, the futility boundaries were crossed suggesting a high likelihood of futility in further comparison of ADR. No difference was observed in terms of aADR (RR 1.13, 0.90-1.44; p=0.30) and SSDR (RR 1.11, 0.92-1.35; p=0.27). APC was significantly higher in the combined group (MD 0.14, 0.05 to 0.22; p=0.002).</div></div><div><h3>Conclusions</h3><div>The addition of mucosal exposure devices does not increase ADR, aADR, and SSDR but increases APC.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"58 2","pages":"Pages 206-211"},"PeriodicalIF":3.8,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Management of gastrointestinal (GI) cancers has shifted from conventional chemotherapy to biomarker-based precision oncology. Biomarker assessment requires adequate endoscopic biopsy tissue both in gastro-esophageal/gastric and colorectal carcinomas.
Aims
This study evaluated real-world endoscopic biopsy adequacy, focusing on tissue quality and suitability for biomarker analysis.
Methods
We retrospectively reviewed 819 endoscopic procedures (274 upper-GI and 545 lower-GI; time-window: January 2021-2024). Gastrointestinal pathologists reviewed 4,908 biopsies to assess diagnostic yield, number of invasive carcinoma-containing biopsies, and tumor cellularity. Biopsy adequacy was evaluated against European Society of Gastrointestinal Endoscopy (ESGE) recommendations and biomarker-specific cellularity thresholds.
Results
A histologic diagnosis of invasive carcinoma was established in 96 % of upper-GI and 84 % of lower-GI procedures (p<0.001). However, 41–43 % of procedures yielded fewer than six biopsies, which is below ESGE guidance. Importantly, only 66.7 % of upper-GI and 49.7 % of lower-GI biopsies contained invasive carcinoma, while the rest were composed of samples inadequate for biomarker testing (such as non-invasive lesions, mucin, necrosis, granulation tissue, and normal mucosa). Low neoplastic cellularity (<1000 tumor cells) was observed in 27 % of upper-GI and 5 % of lower-GI cases, while <20 % tumor cellularity was present in 41.7 % of colorectal biopsies.
Conclusion
Optimizing sampling strategies and ensuring representative, high-cellularity specimens are essential to support precision oncology in GI cancers.
{"title":"Number/quality of endoscopic biopsy samples in gastrointestinal cancers for biomarker testing: All that glitters is not gold","authors":"Federica Grillo , Alessandro Gambella , Silvia Bozzano , Michele Paudice , Nataniele Piol , Manuele Furnari , Stefania Sciallero , Alessandro Pastorino , Anna Maria Pessino , Paola Parente , Alessandro Vanoli , Matteo Fassan , Luca Mastracci","doi":"10.1016/j.dld.2025.12.005","DOIUrl":"10.1016/j.dld.2025.12.005","url":null,"abstract":"<div><h3>Background</h3><div>Management of gastrointestinal (GI) cancers has shifted from conventional chemotherapy to biomarker-based precision oncology. Biomarker assessment requires adequate endoscopic biopsy tissue both in gastro-esophageal/gastric and colorectal carcinomas.</div></div><div><h3>Aims</h3><div>This study evaluated real-world endoscopic biopsy adequacy, focusing on tissue quality and suitability for biomarker analysis.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 819 endoscopic procedures (274 upper-GI and 545 lower-GI; time-window: January 2021-2024). Gastrointestinal pathologists reviewed 4,908 biopsies to assess diagnostic yield, number of invasive carcinoma-containing biopsies, and tumor cellularity. Biopsy adequacy was evaluated against European Society of Gastrointestinal Endoscopy (ESGE) recommendations and biomarker-specific cellularity thresholds.</div></div><div><h3>Results</h3><div>A histologic diagnosis of invasive carcinoma was established in 96 % of upper-GI and 84 % of lower-GI procedures (p<0.001). However, 41–43 % of procedures yielded fewer than six biopsies, which is below ESGE guidance. Importantly, only 66.7 % of upper-GI and 49.7 % of lower-GI biopsies contained invasive carcinoma, while the rest were composed of samples inadequate for biomarker testing (such as non-invasive lesions, mucin, necrosis, granulation tissue, and normal mucosa). Low neoplastic cellularity (<1000 tumor cells) was observed in 27 % of upper-GI and 5 % of lower-GI cases, while <20 % tumor cellularity was present in 41.7 % of colorectal biopsies.</div></div><div><h3>Conclusion</h3><div>Optimizing sampling strategies and ensuring representative, high-cellularity specimens are essential to support precision oncology in GI cancers.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"58 2","pages":"Pages 265-272"},"PeriodicalIF":3.8,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145846422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.dld.2025.12.007
Mingqing Liu, Ying Li, Jiawei Fan, Nan Zhang, Hong Xu
{"title":"Authors’ reply: Comment on “comparison of the diagnostic performance of narrow-band imaging endocytoscopy and staining-based endocytoscopy for colorectal lesions”","authors":"Mingqing Liu, Ying Li, Jiawei Fan, Nan Zhang, Hong Xu","doi":"10.1016/j.dld.2025.12.007","DOIUrl":"10.1016/j.dld.2025.12.007","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"58 2","pages":"Page 286"},"PeriodicalIF":3.8,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.dld.2025.11.023
S. Cosentino , C. Bezzio , D. Gilardi , N. Di Pasquale , Alice De Bernardi , G. Manes , S. Saibeni
Inflammatory bowel disease is a chronic, relapsing–remitting condition with profound physical, psychological, and social consequences. Conventional therapies are essential for controlling intestinal inflammation but often fail to address behavioral and motivational dimensions critical for adherence, stress management, and quality of life. Health Coaching has emerged as a patient-centered intervention that fosters self-efficacy, resilience, and sustainable behavior change. This narrative review synthesizes current evidence on Health Coaching in chronic disease management and explores its potential application in Inflammatory bowel disease care. Across chronic conditions, Health Coaching has shown benefits in promoting behavioral change, improving self-management, and enhancing quality of life. Evidence in Inflammatory bowel disease, although limited, suggests Health Coaching may improve psychological well-being, treatment adherence, and coping. Early studies demonstrate feasibility, high satisfaction, and promising effects on stress, fatigue, and Inflammatory bowel disease-related disability. Health Coaching represents a promising adjunct to conventional Inflammatory bowel disease care by integrating medical, psychosocial, and behavioral competencies within a patient-centered framework. Future research should focus on standardizing protocols, clarifying the professional role of health coaches, and conducting rigorous trials to establish long-term clinical and economic impact. Integrating Health Coaching into multidisciplinary Inflammatory bowel disease management could optimize outcomes and advance holistic, value-based care.
{"title":"Is it time to introduce health coaching in inflammatory bowel disease management?","authors":"S. Cosentino , C. Bezzio , D. Gilardi , N. Di Pasquale , Alice De Bernardi , G. Manes , S. Saibeni","doi":"10.1016/j.dld.2025.11.023","DOIUrl":"10.1016/j.dld.2025.11.023","url":null,"abstract":"<div><div>Inflammatory bowel disease is a chronic, relapsing–remitting condition with profound physical, psychological, and social consequences. Conventional therapies are essential for controlling intestinal inflammation but often fail to address behavioral and motivational dimensions critical for adherence, stress management, and quality of life. Health Coaching has emerged as a patient-centered intervention that fosters self-efficacy, resilience, and sustainable behavior change. This narrative review synthesizes current evidence on Health Coaching in chronic disease management and explores its potential application in Inflammatory bowel disease care. Across chronic conditions, Health Coaching has shown benefits in promoting behavioral change, improving self-management, and enhancing quality of life. Evidence in Inflammatory bowel disease, although limited, suggests Health Coaching may improve psychological well-being, treatment adherence, and coping. Early studies demonstrate feasibility, high satisfaction, and promising effects on stress, fatigue, and Inflammatory bowel disease-related disability. Health Coaching represents a promising adjunct to conventional Inflammatory bowel disease care by integrating medical, psychosocial, and behavioral competencies within a patient-centered framework. Future research should focus on standardizing protocols, clarifying the professional role of health coaches, and conducting rigorous trials to establish long-term clinical and economic impact. Integrating Health Coaching into multidisciplinary Inflammatory bowel disease management could optimize outcomes and advance holistic, value-based care.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"58 2","pages":"Pages 163-170"},"PeriodicalIF":3.8,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-22DOI: 10.1016/j.dld.2025.11.026
Maida M , Papaefthymiou A , Gupta S , Voiosu T , Lau LHS , Baraldo S , Pal P , Mwachiro M , Zuchelli T , Uchima H , Aguila EJT , Bouberra D , Degroote H , Düzenli T , Gameel A , Khurelbaatar T , Lakkasani S , Luvsandagva B , Maulahela H , Nobre R , Voiosu A
Background
Colorectal cancer (CRC) screening reduces incidence and mortality, yet patient adherence remains suboptimal. Large language models may improve participation by addressing patient questions in native languages, but their multilingual performance has not been systematically assessed.
Methods
From April to June 2025, we conducted a cross-continental study involving 28 countries and 23 languages. A standardized set of 15 CRC screening-related questions was translated into each language and submitted to ChatGPT (GPT-4o). Responses were independently evaluated by 140 gastroenterologists (five per country) for accuracy, completeness, and comprehensibility on a 5-point Likert scale. Statistical analyses included t-test, Chi-square, and two-way ANOVA.
Results
The study included experts and data from Europe, Asia, Africa, America, and Oceania. Mean scores (±SD) for accuracy, completeness, and comprehensibility were 4.1 ± 1.0, 4.1 ± 1.0, and 4.2 ± 0.9, respectively. Most languages achieved high ratings, with 73.9%, 86.9%, and 82.6% scoring ≥4 for accuracy, completeness, and comprehensibility. However, lower scores were observed in Chinese, Dutch, and Greek. Variability was also noted between countries sharing the same language, highlighting language- and context-dependent performance.
Discussion
ChatGPT showed strong ability to answer CRC screening questions across multiple languages, supporting its promise as a multilingual patient education tool. Nonetheless, regional variability requires careful validation before clinical integration.
{"title":"Performance of large language models in addressing patient queries on colorectal cancer screening in different languages: An international study across 28 countries","authors":"Maida M , Papaefthymiou A , Gupta S , Voiosu T , Lau LHS , Baraldo S , Pal P , Mwachiro M , Zuchelli T , Uchima H , Aguila EJT , Bouberra D , Degroote H , Düzenli T , Gameel A , Khurelbaatar T , Lakkasani S , Luvsandagva B , Maulahela H , Nobre R , Voiosu A","doi":"10.1016/j.dld.2025.11.026","DOIUrl":"10.1016/j.dld.2025.11.026","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer (CRC) screening reduces incidence and mortality, yet patient adherence remains suboptimal. Large language models may improve participation by addressing patient questions in native languages, but their multilingual performance has not been systematically assessed.</div></div><div><h3>Methods</h3><div>From April to June 2025, we conducted a cross-continental study involving 28 countries and 23 languages. A standardized set of 15 CRC screening-related questions was translated into each language and submitted to ChatGPT (GPT-4o). Responses were independently evaluated by 140 gastroenterologists (five per country) for accuracy, completeness, and comprehensibility on a 5-point Likert scale. Statistical analyses included <em>t</em>-test, Chi-square, and two-way ANOVA.</div></div><div><h3>Results</h3><div>The study included experts and data from Europe, Asia, Africa, America, and Oceania. Mean scores (±SD) for accuracy, completeness, and comprehensibility were 4.1 ± 1.0, 4.1 ± 1.0, and 4.2 ± 0.9, respectively. Most languages achieved high ratings, with 73.9%, 86.9%, and 82.6% scoring ≥4 for accuracy, completeness, and comprehensibility. However, lower scores were observed in Chinese, Dutch, and Greek. Variability was also noted between countries sharing the same language, highlighting language- and context-dependent performance.</div></div><div><h3>Discussion</h3><div>ChatGPT showed strong ability to answer CRC screening questions across multiple languages, supporting its promise as a multilingual patient education tool. Nonetheless, regional variability requires careful validation before clinical integration.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"58 2","pages":"Pages 250-257"},"PeriodicalIF":3.8,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145818274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-20DOI: 10.1016/j.dld.2025.11.025
Fabiola Di Dato , Raffaele Iorio , Eirini Kyrana , Yun Ma , Tassos Grammatikopoulos
Portal hypertension is a clinical syndrome with potentially life-threatening complications. Diagnosis and management in children are complex due to the invasiveness of hepatic venous pressure gradient measurement and the limited number of definitive treatment options, so that liver transplantation often remains the only definitive treatment. The influence of the immune system on the development of portal hypertension has recently received attention; however, the connection between portal hypertension, impaired immune response, and the development of liver changes has not yet been fully elucidated. This review provides an overview of the main current knowledge on the role of cytokines, immune cells, and other molecules involved in the inflammation and vascular changes associated with portal hypertension. A better understanding of the pathogenesis of portal hypertension could address the need to identify non-invasive markers for the diagnosis of portal hypertension and predictors of its complications in children. Furthermore, understanding the strong interaction between the immune system and the development of portal hypertension could be useful for identifying new potential therapeutic options, orienting therapeutic management towards immunomodulatory approaches.
{"title":"The immunological profile of children with portal hypertension","authors":"Fabiola Di Dato , Raffaele Iorio , Eirini Kyrana , Yun Ma , Tassos Grammatikopoulos","doi":"10.1016/j.dld.2025.11.025","DOIUrl":"10.1016/j.dld.2025.11.025","url":null,"abstract":"<div><div>Portal hypertension is a clinical syndrome with potentially life-threatening complications. Diagnosis and management in children are complex due to the invasiveness of hepatic venous pressure gradient measurement and the limited number of definitive treatment options, so that liver transplantation often remains the only definitive treatment. The influence of the immune system on the development of portal hypertension has recently received attention; however, the connection between portal hypertension, impaired immune response, and the development of liver changes has not yet been fully elucidated. This review provides an overview of the main current knowledge on the role of cytokines, immune cells, and other molecules involved in the inflammation and vascular changes associated with portal hypertension. A better understanding of the pathogenesis of portal hypertension could address the need to identify non-invasive markers for the diagnosis of portal hypertension and predictors of its complications in children. Furthermore, understanding the strong interaction between the immune system and the development of portal hypertension could be useful for identifying new potential therapeutic options, orienting therapeutic management towards immunomodulatory approaches.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"58 2","pages":"Pages 171-181"},"PeriodicalIF":3.8,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The optimal strategy for preventing nonsteroidal anti-inflammatory drug-induced peptic ulcers in patients with prior peptic ulcers remains uncertain. We performed a systematic review and network meta-analysis of 22 randomized controlled trials (7,768 patients) on nonsteroidal anti-inflammatory drug users with a documented ulcer history to compare the efficacy and safety of medications for the prevention of these ulcers. The eligible interventions included proton pump inhibitors, potassium-competitive acid blockers, cyclooxygenase-2 inhibitors, prostaglandin analogs, histamine-2 receptor antagonists, and gastric mucosal protective agents. The primary outcomes were ulcer recurrence and bleeding. The safety outcomes included treatment-emergent adverse events and discontinuation owing to adverse events. Random-effects network models estimated the relative and absolute risks, numbers needed to treat, and rankings. Compared with placebo, cyclooxygenase-2 inhibitor plus proton pump inhibitor, potassium-competitive acid blocker, cyclooxygenase-2 inhibitor alone, and proton pump inhibitor monotherapy markedly reduced ulcer recurrence (numbers needed to treat = 5–6). Similar patterns were observed for bleeding prevention. Prostaglandin analogs increased adverse events and discontinuations. Proton pump inhibitor monotherapy remains the most evidence-based first-line strategy for these patients. Cyclooxygenase-2 inhibitor plus proton pump inhibitors or potassium-competitive acid blockers may provide additional benefits in very high-risk patients, but safety and cost considerations warrant caution.
{"title":"Comparing the efficacy and safety of medications to prevent nonsteroidal anti-inflammatory drug-induced ulcers in high-risk patients: A network meta-analysis","authors":"Xu Huang , Qingying Fang , Liwei Zhou , Chenxi Gong , Dongmei Pei","doi":"10.1016/j.dld.2025.11.012","DOIUrl":"10.1016/j.dld.2025.11.012","url":null,"abstract":"<div><div>The optimal strategy for preventing nonsteroidal anti-inflammatory drug-induced peptic ulcers in patients with prior peptic ulcers remains uncertain. We performed a systematic review and network meta-analysis of 22 randomized controlled trials (7,768 patients) on nonsteroidal anti-inflammatory drug users with a documented ulcer history to compare the efficacy and safety of medications for the prevention of these ulcers. The eligible interventions included proton pump inhibitors, potassium-competitive acid blockers, cyclooxygenase-2 inhibitors, prostaglandin analogs, histamine-2 receptor antagonists, and gastric mucosal protective agents. The primary outcomes were ulcer recurrence and bleeding. The safety outcomes included treatment-emergent adverse events and discontinuation owing to adverse events. Random-effects network models estimated the relative and absolute risks, numbers needed to treat, and rankings. Compared with placebo, cyclooxygenase-2 inhibitor plus proton pump inhibitor, potassium-competitive acid blocker, cyclooxygenase-2 inhibitor alone, and proton pump inhibitor monotherapy markedly reduced ulcer recurrence (numbers needed to treat = 5–6). Similar patterns were observed for bleeding prevention. Prostaglandin analogs increased adverse events and discontinuations. Proton pump inhibitor monotherapy remains the most evidence-based first-line strategy for these patients. Cyclooxygenase-2 inhibitor plus proton pump inhibitors or potassium-competitive acid blockers may provide additional benefits in very high-risk patients, but safety and cost considerations warrant caution.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"58 2","pages":"Pages 197-205"},"PeriodicalIF":3.8,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145803413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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