Liver fibrosis is a pathological feature of biliary atresia (BA). However, both histological fibrosis stage and existing biomarkers fail to predict prognosis at the time of hepatoportonterostomy (HPE).
Aims
To explore the role of collagen triple- helix repeat containing-1 (CTHRC1) in BA.
Methods
CTHRC1 expression levels were detected and its association with liver fibrosis stage was analyzed in patients with BA. Immunohistochemistry and immunofluorescent analyses were performed to detect the expression and localization of CTHRC1. Epithelial-mesenchymal transition (EMT) and proliferation were analyzed in cholangiocytes treated with recombinant human CTHRC1 protein. Survival analyses were performed to assess the prognostic value of CTHRC1 in patients with BA.
Results
CTHRC1 was upregulated in BA, and its expression level was positively correlated with fibrosis-related markers and the severity of liver fibrosis. In liver tissue CTHRC1 was co-localized with CK19 and highly expressed in patients with severe liver fibrosis. Further experiments revealed that CTHRC1 promoted cholangiocyte EMT and proliferation. Additionally, CTHRC1 expression levels at HPE could predict the 2-year native liver survival (NLS).
Conclusions
CTHRC1 promotes the EMT and proliferation of cholangiocytes and indicate the stage of liver fibrosis. The CTHRC1 expression levels can predict outcomes of BA.
背景：肝纤维化是胆道闭锁（BA）的病理特征：肝纤维化是胆道闭锁（BA）的病理特征之一。然而，组织学纤维化分期和现有的生物标志物都无法预测肝门部造口术（HPE）时的预后：方法：检测 BA 患者中 CTHRC1 的表达水平，并分析其与肝纤维化分期的关系。免疫组化和免疫荧光分析检测了CTHRC1的表达和定位。分析了用重组人 CTHRC1 蛋白处理的胆管细胞的上皮-间质转化（EMT）和增殖情况。进行了生存分析，以评估CTHRC1在胆管癌患者中的预后价值：结果：CTHRC1在胆汁淤积症中上调，其表达水平与肝纤维化相关标志物和肝纤维化严重程度呈正相关。在肝组织中，CTHRC1与CK19共定位，并在严重肝纤维化患者中高表达。进一步的实验发现，CTHRC1 能促进胆管细胞的 EMT 和增殖。此外，CTHRC1在HPE中的表达水平可预测2年原肝存活率（NLS）：结论：CTHRC1能促进胆管细胞的EMT和增殖，并预示肝纤维化的阶段。结论：CTHRC1能促进胆管细胞的EMT和增殖，并预示肝纤维化的阶段，CTHRC1的表达水平能预测BA的结果。
{"title":"CTHRC1 serves as an indicator in biliary atresia for evaluating the stage of liver fibrosis and predicting prognosis","authors":"Zequan Ding , Ruyi Zhang , Wei Zhu, Yao Lu, Zhongxian Zhu, Hua Xie, Weibing Tang","doi":"10.1016/j.dld.2024.07.004","DOIUrl":"10.1016/j.dld.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Liver fibrosis<span> is a pathological feature of biliary atresia (BA). However, both histological fibrosis stage and existing biomarkers fail to predict prognosis at the time of hepatoportonterostomy (HPE).</span></div></div><div><h3>Aims</h3><div>To explore the role of collagen triple- helix repeat containing-1 (CTHRC1) in BA.</div></div><div><h3>Methods</h3><div><span>CTHRC1 expression levels were detected and its association with liver fibrosis stage was analyzed in patients with BA. Immunohistochemistry and immunofluorescent analyses were performed to detect the expression and localization of CTHRC1. Epithelial-mesenchymal transition (EMT) and proliferation were analyzed in </span>cholangiocytes treated with recombinant human CTHRC1 protein. Survival analyses were performed to assess the prognostic value of CTHRC1 in patients with BA.</div></div><div><h3>Results</h3><div>CTHRC1 was upregulated in BA, and its expression level was positively correlated with fibrosis-related markers and the severity of liver fibrosis. In liver tissue CTHRC1 was co-localized with CK19 and highly expressed in patients with severe liver fibrosis. Further experiments revealed that CTHRC1 promoted cholangiocyte EMT and proliferation. Additionally, CTHRC1 expression levels at HPE could predict the 2-year native liver survival (NLS).</div></div><div><h3>Conclusions</h3><div>CTHRC1 promotes the EMT and proliferation of cholangiocytes and indicate the stage of liver fibrosis. The CTHRC1 expression levels can predict outcomes of BA.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 385-393"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751256","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 : 2025-02-01DOI: 10.1016/j.dld.2024.10.001
Aymeric Becq , Annouk Bisdorff , Maria Elena Riccioni , Sophie Blaise , Stéphanie Mallet , Ervin Toth , Annabel Maruani , Edward Despott , Christine Labreze , Pablo Cortegoso Valdivia , Emmanuele Rondonotti , Cristina Carrretero Ribón , Laetitia Goffinet , Elise Coffin , Bruno Rosa , Cynthia Medlij , Jean-Christophe Saurin , Xavier Dray , iCARE group and FAVA-Multi
Background and aim
Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare congenital vascular entity, mainly characterized by cutaneous and gastrointestinal venous malformations. BRBNS remains relatively unexplored and only limited descriptive data is available. The aim of this study was to evaluate the clinical features, diagnostic work-up and therapeutic management in current practice.
Methods
A multicenter, European, cohort study was performed to investigate the BRBNS population. Patient demographics, clinical presentation and management data were collected.
Results
In this multicenter cohort study including 44 patients, BRBNS is diagnosed at a median age of 12 years, mainly based on clinical presentation (65.9 %). The majority of patients present cutaneous (68.2 %) and digestive (79.5 %) lesions, mainly in the colon and small bowel. d-dimer and fibrinogen levels are checked in <50 % of patients at diagnosis. Tie2/TEK mutation testing is rarely performed. Gastrointestinal bleeding is the most common complication (54.3 %), requiring endoscopic treatment (36.4 %) by various techniques.
Conclusions
This is the largest cohort study on BRBNS. Diagnosis is mainly based on clinical presentation. d-dimer, fibrinogen and Tie2/TEK mutation testing should be performed in case of suspected BRBNS as it could help confirm the diagnosis.
{"title":"Blue rubber bleb nevus syndrome: A European multicenter cohort study","authors":"Aymeric Becq , Annouk Bisdorff , Maria Elena Riccioni , Sophie Blaise , Stéphanie Mallet , Ervin Toth , Annabel Maruani , Edward Despott , Christine Labreze , Pablo Cortegoso Valdivia , Emmanuele Rondonotti , Cristina Carrretero Ribón , Laetitia Goffinet , Elise Coffin , Bruno Rosa , Cynthia Medlij , Jean-Christophe Saurin , Xavier Dray , iCARE group and FAVA-Multi","doi":"10.1016/j.dld.2024.10.001","DOIUrl":"10.1016/j.dld.2024.10.001","url":null,"abstract":"<div><h3>Background and aim</h3><div>Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare congenital vascular entity, mainly characterized by cutaneous and gastrointestinal venous malformations. BRBNS remains relatively unexplored and only limited descriptive data is available. The aim of this study was to evaluate the clinical features, diagnostic work-up and therapeutic management in current practice.</div></div><div><h3>Methods</h3><div>A multicenter, European, cohort study was performed to investigate the BRBNS population. Patient demographics, clinical presentation and management data were collected.</div></div><div><h3>Results</h3><div>In this multicenter cohort study including 44 patients, BRBNS is diagnosed at a median age of 12 years, mainly based on clinical presentation (65.9 %). The majority of patients present cutaneous (68.2 %) and digestive (79.5 %) lesions, mainly in the colon and small bowel. <span>d</span>-dimer and fibrinogen levels are checked in <50 % of patients at diagnosis. Tie2/TEK mutation testing is rarely performed. Gastrointestinal bleeding is the most common complication (54.3 %), requiring endoscopic treatment (36.4 %) by various techniques.</div></div><div><h3>Conclusions</h3><div>This is the largest cohort study on BRBNS. Diagnosis is mainly based on clinical presentation. <span>d</span>-dimer, fibrinogen and Tie2/TEK mutation testing should be performed in case of suspected BRBNS as it could help confirm the diagnosis.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 603-608"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142460421","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}
Pub Date : 2025-02-01DOI: 10.1016/j.dld.2024.11.018
Matteo Bramuzzo , Fabiola Di Dato , Flavio Labriola , Luca Scarallo , Giovanna Zambrano , Claudia Mandato
{"title":"Diagnosis and management of sclerosing cholangitis and inflammatory bowel disease in children: A survey by SIGENP","authors":"Matteo Bramuzzo , Fabiola Di Dato , Flavio Labriola , Luca Scarallo , Giovanna Zambrano , Claudia Mandato","doi":"10.1016/j.dld.2024.11.018","DOIUrl":"10.1016/j.dld.2024.11.018","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 659-661"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827655","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 : 2025-02-01DOI: 10.1016/j.dld.2025.01.177
Marcello Maida, Antonio Facciorusso, Giovanni Marasco, Giulio Calabrese, Gianluca Ianiro, Jérémie Jacques, Roberta Maselli, Cesare Hassan, Alessandro Repici, Roberto Di Mitri, Sandro Sferrazza
Background: Endoscopic submucosal dissection (ESD) is an advanced technique that can provide successful 'en-bloc' and R0 resection rate for large gastrointestinal lesions. To date, several ESD techniques have been proposed, but their comparative efficacy is still unclear.
Methods: Major databases were systematically searched for RCTs comparing the efficacy and safety of different ESD techniques for the resection of colonic lesions. The primary outcomes were 'en-bloc' and R0 resection rates. The secondary outcome was the incidence of procedure-related AEs.
Results: After selection of studies, 9 RCTs were included in the systematic review. On network meta-analysis for 'en-bloc' resection, pocked with traction ESD (PT-ESD) (RR=1.02; 95%CI=0.96-1.07) and pocket ESD (P-ESD) (RR=1.02; 95%CI=0.98-1.05) showed higher efficacy, whereas hybrid ESD (H-ESD) (RR=0.94; 95%CI=0.87-1.02) lower efficacy compared to conventional ESD (C-ESD). With regard to R0 resection, PT-ESD (RR=1.05; 95%CI=0.96-1.16) showed higher efficacy, and H-ESD (RR=0.97; 95%CI=0.84-1.13) lower efficacy compared to C-ESD. Concerning safety PT-ESD (RR=0.35; 95%CI=0.05-2.48) was associated with lower incidence of AEs, and H-ESD (RR=1.22; 95%CI=0.30-5.01) with higher incidence of AEs, compared to C-ESD.
Conclusions: The results of this network meta-analysis show a trend towards greater effectiveness and safety of PT-ESD for the removal of colonic lesions. H-ESD was associated with worse results and should be reserved as a rescue treatment, preferring other techniques.
{"title":"Comparative efficacy of different techniques for colonic endoscopic submucosal dissection: A network meta-analysis of randomized controlled trials.","authors":"Marcello Maida, Antonio Facciorusso, Giovanni Marasco, Giulio Calabrese, Gianluca Ianiro, Jérémie Jacques, Roberta Maselli, Cesare Hassan, Alessandro Repici, Roberto Di Mitri, Sandro Sferrazza","doi":"10.1016/j.dld.2025.01.177","DOIUrl":"https://doi.org/10.1016/j.dld.2025.01.177","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic submucosal dissection (ESD) is an advanced technique that can provide successful 'en-bloc' and R0 resection rate for large gastrointestinal lesions. To date, several ESD techniques have been proposed, but their comparative efficacy is still unclear.</p><p><strong>Methods: </strong>Major databases were systematically searched for RCTs comparing the efficacy and safety of different ESD techniques for the resection of colonic lesions. The primary outcomes were 'en-bloc' and R0 resection rates. The secondary outcome was the incidence of procedure-related AEs.</p><p><strong>Results: </strong>After selection of studies, 9 RCTs were included in the systematic review. On network meta-analysis for 'en-bloc' resection, pocked with traction ESD (PT-ESD) (RR=1.02; 95%CI=0.96-1.07) and pocket ESD (P-ESD) (RR=1.02; 95%CI=0.98-1.05) showed higher efficacy, whereas hybrid ESD (H-ESD) (RR=0.94; 95%CI=0.87-1.02) lower efficacy compared to conventional ESD (C-ESD). With regard to R0 resection, PT-ESD (RR=1.05; 95%CI=0.96-1.16) showed higher efficacy, and H-ESD (RR=0.97; 95%CI=0.84-1.13) lower efficacy compared to C-ESD. Concerning safety PT-ESD (RR=0.35; 95%CI=0.05-2.48) was associated with lower incidence of AEs, and H-ESD (RR=1.22; 95%CI=0.30-5.01) with higher incidence of AEs, compared to C-ESD.</p><p><strong>Conclusions: </strong>The results of this network meta-analysis show a trend towards greater effectiveness and safety of PT-ESD for the removal of colonic lesions. H-ESD was associated with worse results and should be reserved as a rescue treatment, preferring other techniques.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078798","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 : 2025-02-01DOI: 10.1016/j.dld.2025.01.187
Luca Sorrentino, Giorgio Bogani, Gianluca M Sampietro
{"title":"It is not the surgical approach, but the R0 margins to drive survival after rectal cancer surgery.","authors":"Luca Sorrentino, Giorgio Bogani, Gianluca M Sampietro","doi":"10.1016/j.dld.2025.01.187","DOIUrl":"https://doi.org/10.1016/j.dld.2025.01.187","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078800","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}
{"title":"Erratum to “Pioneering applications of immunotherapy in the early stages of hepatocellular carcinoma” [Digestive and Liver Disease 56 (2024) 2011-2021]","authors":"Eleonora Alimenti , Erica Nicola Lynch , Leonardo Antonio Natola , Massimo Iavarone","doi":"10.1016/j.dld.2024.12.001","DOIUrl":"10.1016/j.dld.2024.12.001","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Page 662"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846085","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 : 2025-02-01DOI: 10.1016/j.dld.2024.10.010
Fabiana Zingone , Gary L. Norman , Edgardo Smecuol , Daria Maniero , Antonio Carroccio , Federico Biagi , Juan P. Stefanolo , Sonia Niveloni , Geoffrey Holmes , Vincenzo Villanacci , Antonella Santonicola , Julio C. Bai , Carolina Ciacci
Background
Gastroenterologists still raise concerns about adopting a non-biopsy strategy for diagnosing celiac disease (CeD) in adults.
Aim
To assess the performance of the concurrent detection of two autoantibodies targeting two independent antigens, tissue transglutaminase (tTG) and deamidated gliadin peptides (DGP).
Methods
This prospective, multicenter, binational study collected consecutive patients with a high pre-test probability for CeD. Between 2018 and 2020, adults were enrolled at four Italian and one Argentinian center. Serology was also blindly analyzed by a central laboratory (Werfen, San Diego, USA) for tTG IgA and DGP IgG by Aptiva Particle-based multi-analyte technology (PMAT) assays. CeD diagnosis required histological confirmation of Marsh 3 damage.
Results
181 adult patients with suspected CeD were enrolled (134 with histological diagnosis of CeD and 47 not histologically confirmed as CeD). Patients positive for both tTG IgA and DGP IgG (double positive) were predictive of CeD in 92.5 % of patients at >1x upper limit of normal (ULN). Double positivity for tTG IgA and DGP IgG, both at >10x ULN, had a 100 % positive predictive value for the presence of Marsh 3 histology.
Conclusions
Incorporating DGP IgG alongside tTG IgA in a single-step approach can be considered a valid confirmatory strategy for definitive non-biopsy diagnosis of CeD.
{"title":"Utilizing both IgA tissue transglutaminase and IgG-deamidated gliadin peptide antibodies offers accurate celiac disease diagnosis without duodenal biopsy","authors":"Fabiana Zingone , Gary L. Norman , Edgardo Smecuol , Daria Maniero , Antonio Carroccio , Federico Biagi , Juan P. Stefanolo , Sonia Niveloni , Geoffrey Holmes , Vincenzo Villanacci , Antonella Santonicola , Julio C. Bai , Carolina Ciacci","doi":"10.1016/j.dld.2024.10.010","DOIUrl":"10.1016/j.dld.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Gastroenterologists still raise concerns about adopting a non-biopsy strategy for diagnosing celiac disease (CeD) in adults.</div></div><div><h3>Aim</h3><div>To assess the performance of the concurrent detection of two autoantibodies targeting two independent antigens, tissue transglutaminase (tTG) and deamidated gliadin peptides (DGP).</div></div><div><h3>Methods</h3><div>This prospective, multicenter, binational study collected consecutive patients with a high pre-test probability for CeD. Between 2018 and 2020, adults were enrolled at four Italian and one Argentinian center. Serology was also blindly analyzed by a central laboratory (Werfen, San Diego, USA) for tTG IgA and DGP IgG by Aptiva Particle-based multi-analyte technology (PMAT) assays. CeD diagnosis required histological confirmation of Marsh 3 damage.</div></div><div><h3>Results</h3><div>181 adult patients with suspected CeD were enrolled (134 with histological diagnosis of CeD and 47 not histologically confirmed as CeD). Patients positive for both tTG IgA and DGP IgG (double positive) were predictive of CeD in 92.5 % of patients at >1x upper limit of normal (ULN). Double positivity for tTG IgA and DGP IgG, both at >10x ULN, had a 100 % positive predictive value for the presence of Marsh 3 histology.</div></div><div><h3>Conclusions</h3><div>Incorporating DGP IgG alongside tTG IgA in a single-step approach can be considered a valid confirmatory strategy for definitive non-biopsy diagnosis of CeD.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 609-615"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544246","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}
Pub Date : 2025-02-01DOI: 10.1016/j.dld.2024.11.007
Mario Romeo, Fiammetta Di Nardo, Carmine Napolitano, Paolo Vaia, Alessandro Federico, Marcello Dallio
{"title":"Primary biliary cholangitis, Celiac Disease, and MASLD: the triumvirate of steatosis. How should we manage this triple overlap?","authors":"Mario Romeo, Fiammetta Di Nardo, Carmine Napolitano, Paolo Vaia, Alessandro Federico, Marcello Dallio","doi":"10.1016/j.dld.2024.11.007","DOIUrl":"10.1016/j.dld.2024.11.007","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 2","pages":"Pages 651-652"},"PeriodicalIF":4.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767288","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 : 2025-01-30DOI: 10.1016/j.dld.2025.01.186
Shubham Kumar, Ahmad Neyazi, Rachana Mehta, Sanjit Sah
{"title":"Comment on \"Comparative efficacy of different bowel preparations for colonoscopy: A network meta-analysis\".","authors":"Shubham Kumar, Ahmad Neyazi, Rachana Mehta, Sanjit Sah","doi":"10.1016/j.dld.2025.01.186","DOIUrl":"https://doi.org/10.1016/j.dld.2025.01.186","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074330","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}
Background: Ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) can incur in complications. The impact of histological activity on the development of pouch-related complications is poorly studied.
Aim: To assess the association between histology and long-term outcomes in UC-IPAA.
Methods: Single-center, ambidirectional cohort study including UC-IPAA patients undergoing pouchscopy after ileostomy closure. Histological activity was defined as a Pouchitis Disease Activity Index histology subscore ≥2. The primary outcomes were: (i) development of chronic pouchitis, (ii) need of therapy escalation (azathioprine/biologics), and (iii) a composite outcome of treatment with biologics/azathioprine, pouch-related hospitalization or pouch failure.
Results: A total of 104 patients were included. After pouchoscopy, the median patient follow-up was 2.3 years (IQR, 1.3-4.0). Eighteen patients (17.3 %) developed chronic pouchitis, 20 (19.2 %) initiated biologics/azathioprine, and 25 (24 %) experienced the composite outcome. After adjusting for confounders, histological activity was significantly associated with development of chronic pouchitis (aHR=4.44; 95 % CI, 1.43-13.80; p=0.010), the treatment with biologics/azathioprine (aHR=4.74; 95 % CI, 1.53-14.71; p=0.007), and the composite outcome (aHR=3.94; 95 % CI, 1.53-10.13; p=0.004).
Conclusion: Histological activity is associated with the development of chronic pouchitis and the need for azathioprine/biologics in UC-IPAA patients, highlighting its potential role in guiding long-term management.
{"title":"Impact of histologic disease activity on long-term outcomes in patients with ileal pouch-anal anastomosis for ulcerative colitis.","authors":"Roberto Gabbiadini, Paola Spaggiari, Gisella Figlioli, Martina Iuzzolino, Arianna Dal Buono, Cristina Bezzio, Alessandro Repici, Antonino Spinelli, Daniele Piovani, Stefanos Bonovas, Alessandro Armuzzi","doi":"10.1016/j.dld.2025.01.180","DOIUrl":"https://doi.org/10.1016/j.dld.2025.01.180","url":null,"abstract":"<p><strong>Background: </strong>Ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) can incur in complications. The impact of histological activity on the development of pouch-related complications is poorly studied.</p><p><strong>Aim: </strong>To assess the association between histology and long-term outcomes in UC-IPAA.</p><p><strong>Methods: </strong>Single-center, ambidirectional cohort study including UC-IPAA patients undergoing pouchscopy after ileostomy closure. Histological activity was defined as a Pouchitis Disease Activity Index histology subscore ≥2. The primary outcomes were: (i) development of chronic pouchitis, (ii) need of therapy escalation (azathioprine/biologics), and (iii) a composite outcome of treatment with biologics/azathioprine, pouch-related hospitalization or pouch failure.</p><p><strong>Results: </strong>A total of 104 patients were included. After pouchoscopy, the median patient follow-up was 2.3 years (IQR, 1.3-4.0). Eighteen patients (17.3 %) developed chronic pouchitis, 20 (19.2 %) initiated biologics/azathioprine, and 25 (24 %) experienced the composite outcome. After adjusting for confounders, histological activity was significantly associated with development of chronic pouchitis (aHR=4.44; 95 % CI, 1.43-13.80; p=0.010), the treatment with biologics/azathioprine (aHR=4.74; 95 % CI, 1.53-14.71; p=0.007), and the composite outcome (aHR=3.94; 95 % CI, 1.53-10.13; p=0.004).</p><p><strong>Conclusion: </strong>Histological activity is associated with the development of chronic pouchitis and the need for azathioprine/biologics in UC-IPAA patients, highlighting its potential role in guiding long-term management.</p>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":" ","pages":""},"PeriodicalIF":4.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064503","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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