Pub Date : 2025-12-01DOI: 10.1016/j.dld.2025.09.029
Pierfrancesco Visaggi , Daniel L. Cohen , Elisa Marabotto , Andrea Pasta , Francesco Calabrese , Nicola de Bortoli , Amir Farah , Alessia Gargani , Jawad Hindy , Basem Hijazi , Wisam Abboud , Mentore Ribolsi , Luisa Bertin , Edoardo V. Savarino , Amir Mari
{"title":"Corrigendum to “Esophageal motility disorders among elderly patients: An international multicenter study” [Digestive and Liver Disease 57 (2025) 1615-1621]","authors":"Pierfrancesco Visaggi , Daniel L. Cohen , Elisa Marabotto , Andrea Pasta , Francesco Calabrese , Nicola de Bortoli , Amir Farah , Alessia Gargani , Jawad Hindy , Basem Hijazi , Wisam Abboud , Mentore Ribolsi , Luisa Bertin , Edoardo V. Savarino , Amir Mari","doi":"10.1016/j.dld.2025.09.029","DOIUrl":"10.1016/j.dld.2025.09.029","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Page 2515"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318332","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 : 2025-12-01DOI: 10.1016/j.dld.2025.09.020
Hanna Blaney , Wanyu Zhang , Prabha Bandhari , Mohamed Elfeki , Chencheng Xie , Winston Dunn , Robert Wong , Zobair Younossi , Yong-Fang Kuo , Maiying Kong , Ashwani Singal
Background and Aim
Alcohol and metabolic risk factors have an additive effect on the progression of steatotic liver diseases. The aim of this study is to examine the impact of T2DM and obesity on outcomes in patients with ALD.
Methods and Results
We performed a retrospective cohort study of US adults with ALD using NHANES (2017–2020), Nationwide Inpatient Sample (2016-2019), and UNOS (2016-2023) databases. In the NHANES database, patients with ALD and T2DM had higher rates of fibrosis defined by FIB-4 ≥2.67 than patients with ALD without T2DM or obesity, and ALD with obesity, with 17.1% vs. 9.8% vs. 2.3%, respectively (p<0.001). There were no differences in advanced fibrosis between groups. In the NIS database, patients with ALD with obesity and those with T2DM had lower inpatient mortality vs. ALD without obesity or T2DM by 29% and 4% respectively. The length of hospital stay in days was higher in patients with ALD and obesity vs. ALD without T2DM or obesity vs. ALD with T2DM (5 ± 7.8 vs 4±7.7 vs. 4±6.8, p<0.001). In the UNOS registry, patients with ALD with T2DM had 38% higher 90-d waitlist mortality vs. ALD without T2DM or obesity. Among liver transplant recipients, patient survival at 3 yrs. was 40% and 17% worse in patients with T2DM and in those with obesity respectively vs. ALD patients without T2DM or obesity.
Conclusions
Diabetes and obesity comorbidities are differently associated with patient outcomes across the spectrum of liver disease in patients with ALD.
{"title":"Impact of diabetes and obesity on patient outcomes in alcohol-associated liver disease: Analysis of 3 databases","authors":"Hanna Blaney , Wanyu Zhang , Prabha Bandhari , Mohamed Elfeki , Chencheng Xie , Winston Dunn , Robert Wong , Zobair Younossi , Yong-Fang Kuo , Maiying Kong , Ashwani Singal","doi":"10.1016/j.dld.2025.09.020","DOIUrl":"10.1016/j.dld.2025.09.020","url":null,"abstract":"<div><h3>Background and Aim</h3><div>Alcohol and metabolic risk factors have an additive effect on the progression of steatotic liver diseases. The aim of this study is to examine the impact of T2DM and obesity on outcomes in patients with ALD.</div></div><div><h3>Methods and Results</h3><div>We performed a retrospective cohort study of US adults with ALD using NHANES (2017–2020), Nationwide Inpatient Sample (2016-2019), and UNOS (2016-2023) databases. In the NHANES database, patients with ALD and T2DM had higher rates of fibrosis defined by FIB-4 ≥2.67 than patients with ALD without T2DM or obesity, and ALD with obesity, with 17.1% vs. 9.8% vs. 2.3%, respectively (p<0.001). There were no differences in advanced fibrosis between groups. In the NIS database, patients with ALD with obesity and those with T2DM had lower inpatient mortality vs. ALD without obesity or T2DM by 29% and 4% respectively. The length of hospital stay in days was higher in patients with ALD and obesity vs. ALD without T2DM or obesity vs. ALD with T2DM (5 ± 7.8 vs 4±7.7 vs. 4±6.8, p<0.001). In the UNOS registry, patients with ALD with T2DM had 38% higher 90-d waitlist mortality vs. ALD without T2DM or obesity. Among liver transplant recipients, patient survival at 3 yrs. was 40% and 17% worse in patients with T2DM and in those with obesity respectively vs. ALD patients without T2DM or obesity.</div></div><div><h3>Conclusions</h3><div>Diabetes and obesity comorbidities are differently associated with patient outcomes across the spectrum of liver disease in patients with ALD.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2390-2398"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274162","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 : 2025-12-01DOI: 10.1016/j.dld.2025.09.032
Ahmad Albshesh , Piotr Kucha , Daniela Pugliese , Aurélien Amiot , Hussein Mahajna , Piotr Eder , Edoardo Vincenzo Savarino , Stephan Vavricka , Fabiana Castiglione , Nicola Imperatore , Zeljko Krznaric , Chaya Mushka Abitbol , Or Hen , Marta Zaborowska , Franck Carbonnel , Giuseppe Cuccia , Greta Lorenzon , Eran Zittan , Edyta Zagórowicz , Daria Maniero , Uri Kopylov
Background and aims
Approximately half of patients with IBD in clinical remission flare within 12 months of withdrawing anti-TNF therapy. However, the risk following non-anti-TNF withdrawal is poorly studied. The aim of this study was to assess the clinical relapse rate following the withdrawal of non-anti-TNF therapy.
Methods
This retrospective, observational, multicenter study included adult IBD patients who withdrew anti-TNF or non-anti-TNF therapy (vedolizumab, ustekinumab) after achieving clinical remission and had available follow-up data for at least one year following treatment withdrawal or until relapse occurred.
Results
A total of 223 patients were included [50.2 % with Crohn’s disease (CD) and 49.8 % with ulcerative colitis (UC)], of these 106 withdrew non-anti-TNF therapy and 117 withdrew anti-TNF therapy. Relapse occurred in 72 % within a median time to relapse of 13 months [6,27] and was higher in the non-anti-TNF vs. the anti-TNF groups (80 % vs. 65 %, p = 0.016), with shorter time to relapse (11 vs. 15 months, p = 0.002). In CD patients, the relapse rate was 71 % (82 % vs 63 %, respectively, p = 0.019). The response rate after therapy reinduction was 83.5 % (86.1 % vs 81 %, respectively; p = 0.81). Among UC patients the relapse rate was 74 % (79 % vs 68 %, respectively; p = 0.28). The response rate after therapy reinduction was 77.4 % (87.8 % vs 63.3 %, respectively; p = 0.25). Longer treatment duration before remission was the strongest predictor, significantly reducing relapse risk (HR 0.93 per month, 95 % CI 0.92–0.94, p < 0.001).
Conclusion
High relapse rates were observed following the withdrawal of biologic therapies in IBD patients, particularly among those withdrawing non-anti-TNF in CD. Relapse risk appears driven more by disease course and treatment history than drug class, underscoring the need for individualized withdrawal decisions.
背景和目的：大约一半的IBD患者在停止抗tnf治疗的12个月内出现临床缓解。然而，非抗tnf停药后的风险研究很少。本研究的目的是评估停止非抗肿瘤坏死因子治疗后的临床复发率。方法：这项回顾性、观察性、多中心研究纳入了在临床缓解后退出抗tnf或非抗tnf治疗（维多单抗、乌斯特金单抗）的成年IBD患者，这些患者在退出治疗后或复发前至少有一年的随访数据。结果：共纳入223例患者[50.2%为克罗恩病（CD）， 49.8%为溃疡性结肠炎（UC）]，其中106例退出非抗tnf治疗，117例退出抗tnf治疗。72%的患者在13个月的中位复发时间内复发[6,27]，非抗tnf组比抗tnf组复发率更高（80%比65%，p = 0.016），复发时间更短（11比15个月，p = 0.002）。在CD患者中，复发率为71%（分别为82% vs 63%， p = 0.019）。再诱导治疗后的有效率为83.5%（分别为86.1% vs 81%; p = 0.81）。UC患者复发率为74%（分别为79% vs 68%； p = 0.28）。再诱导治疗后的有效率为77.4%（分别为87.8% vs 63.3%; p = 0.25）。缓解前较长的治疗时间是最强的预测因子，显著降低复发风险（HR 0.93 /月，95% CI 0.92-0.94, p < 0.001）。结论：IBD患者停药后复发率高，特别是停药的非抗肿瘤坏死因子患者。复发风险似乎更多地由病程和治疗史驱动，而不是药物类别，强调了个体化停药决定的必要性。
{"title":"Relapse rate following withdrawal of vedolizumab and ustekinumab in patients with inflammatory bowel disease - a multicenter retrospective controlled study. The VEDUST-EXIT Study","authors":"Ahmad Albshesh , Piotr Kucha , Daniela Pugliese , Aurélien Amiot , Hussein Mahajna , Piotr Eder , Edoardo Vincenzo Savarino , Stephan Vavricka , Fabiana Castiglione , Nicola Imperatore , Zeljko Krznaric , Chaya Mushka Abitbol , Or Hen , Marta Zaborowska , Franck Carbonnel , Giuseppe Cuccia , Greta Lorenzon , Eran Zittan , Edyta Zagórowicz , Daria Maniero , Uri Kopylov","doi":"10.1016/j.dld.2025.09.032","DOIUrl":"10.1016/j.dld.2025.09.032","url":null,"abstract":"<div><h3>Background and aims</h3><div>Approximately half of patients with IBD in clinical remission flare within 12 months of withdrawing anti-TNF therapy. However, the risk following non-anti-TNF withdrawal is poorly studied. The aim of this study was to assess the clinical relapse rate following the withdrawal of non-anti-TNF therapy.</div></div><div><h3>Methods</h3><div>This retrospective, observational, multicenter study included adult IBD patients who withdrew anti-TNF or non-anti-TNF therapy (vedolizumab, ustekinumab) after achieving clinical remission and had available follow-up data for at least one year following treatment withdrawal or until relapse occurred.</div></div><div><h3>Results</h3><div>A total of 223 patients were included [50.2 % with Crohn’s disease (CD) and 49.8 % with ulcerative colitis (UC)], of these 106 withdrew non-anti-TNF therapy and 117 withdrew anti-TNF therapy. Relapse occurred in 72 % within a median time to relapse of 13 months [6,27] and was higher in the non-anti-TNF vs. the anti-TNF groups (80 % vs. 65 %, <em>p</em> = 0.016), with shorter time to relapse (11 vs. 15 months, <em>p</em> = 0.002). In CD patients, the relapse rate was 71 % (82 % vs 63 %, respectively, <em>p</em> = 0.019). The response rate after therapy reinduction was 83.5 % (86.1 % vs 81 %, respectively; <em>p</em> = 0.81). Among UC patients the relapse rate was 74 % (79 % vs 68 %, respectively; <em>p</em> = 0.28). The response rate after therapy reinduction was 77.4 % (87.8 % vs 63.3 %, respectively; <em>p</em> = 0.25). Longer treatment duration before remission was the strongest predictor, significantly reducing relapse risk (HR 0.93 per month, 95 % CI 0.92–0.94, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>High relapse rates were observed following the withdrawal of biologic therapies in IBD patients, particularly among those withdrawing non-anti-TNF in CD. Relapse risk appears driven more by disease course and treatment history than drug class, underscoring the need for individualized withdrawal decisions.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2321-2330"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145388042","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 : 2025-12-01DOI: 10.1016/j.dld.2025.08.077
Yangyuxiao Lu , Mengqi Fang , Xuan Huang
{"title":"Comment on “Diagnostic delay at diagnosis and time-to-treatment influence overall survival of pancreatic cancer patients”","authors":"Yangyuxiao Lu , Mengqi Fang , Xuan Huang","doi":"10.1016/j.dld.2025.08.077","DOIUrl":"10.1016/j.dld.2025.08.077","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2496-2497"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946636","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 : 2025-12-01DOI: 10.1016/j.dld.2025.09.027
Jiansheng Wang , Yi Xu , Tenghui Zhang , Sizhe Zheng , Song Luo , Yan Ma , Feng Zhu , Changsheng Zhou , Jianfeng Gong
Background
Ulcerative colitis (UC) patients undergoing ileal pouch anal anastomosis (IPAA) will potentially have abnormal pouch function, which seriously affects their quality of life. It is usually attributed to postoperative pouch structural complications. However, symptoms of poor pouch function also occur in patients with “normal pouch”. Few objective tools have been used to evaluate the pouch function with non-optimal pouch physiology.
Aim
To investigate the validity of dynamic magnetic resonance defecography (DMRD) and its relationship with pouch function in UC patients undergoing IPAA.
Methods
UC patients who had IPAA surgery were recruited. Patients with structural complications were excluded. Patients were assessed by questionnaires for pouch function including ileal pouch syndrome severity (IPSS) score. DMRD was performed at resting, raising, and defecation phase. The correlation between DMRD data and pouch function was investigated. Poor pouch function was defined as IPSS score >15.
Results
A total of 33 patients were included. The results showed that distance from anastomosis to pubococcygeal line (PCL) at rest phase was an independent risk factor for poor pouch function ([OR] 5.65, 95 % CI 1.02–31.16, P = 0.047). The length of cuff at raising phase was an independent risk factor for urgency ([OR] 12.55, 95 % CI 1.06–148.32, P = 0.045). In addition, M-line length—a reference for assessing pelvic floor descent (normal ≤2 cm)—during defecation was an independent risk factor for incomplete defecation ([OR] 2.47, 95 % CI 1.11–5.47, P = 0.027), while M-line length at rest was an independent risk factor for stool leakage ([OR] 10.16, 95 % CI 1.15–90.07, P = 0.037).
Conclusions
Magnetic resonance defecography is a potentially useful imaging modality for evaluating pouch function. Our study presented a series of DMRD parameters for functional assessment and their association with defecation disorders during dynamic monitoring. Therefore, DMRD provides information, in addition to clinical parameters, in symptomatic pouch patients.
背景：溃疡性结肠炎（UC）患者行回肠袋肛管吻合术（IPAA）后，可能出现袋功能异常，严重影响其生活质量。这通常归因于术后眼袋结构并发症。然而，“正常”的患者也会出现眼袋功能差的症状。很少有客观的工具用于评价非最佳眼袋生理学的眼袋功能。目的：探讨动态磁共振排便成像（DMRD）在UC患者行IPAA手术中的有效性及其与眼袋功能的关系。方法：招募行IPAA手术的UC患者。排除有结构性并发症的患者。通过问卷调查评估患者的眼袋功能，包括回肠眼袋综合征严重程度（IPSS）评分。DMRD分别在静息期、哺乳期和排便期进行。研究DMRD数据与眼袋功能的相关性。眼袋功能差定义为IPSS评分bbb15。结果：共纳入33例患者。结果显示，静息期吻合口到耻骨尾骨线（PCL）的距离是术后术后眼袋功能差的独立危险因素（[OR] 5.65, 95% CI 1.02 ~ 31.16, P = 0.047）。抬高期袖带长度是发生急症的独立危险因素（[OR] 12.55, 95% CI 1.06-148.32, P = 0.045）。此外，排便时m线长度——评估盆底下降（正常≤2 cm）的参考——是排便不全的独立危险因素（[OR] 2.47, 95% CI 1.11-5.47, P = 0.027），而静止时m线长度是大便漏的独立危险因素（[OR] 10.16, 95% CI 1.15-90.07, P = 0.037）。结论：磁共振排粪成像是一种潜在的有用的成像方式来评估袋功能。我们的研究提出了一系列的DMRD参数的功能评估及其与排便障碍的关系在动态监测。因此，DMRD为有症状的眼袋患者提供了除临床参数外的信息。
{"title":"Pouch function assessment with dynamic magnetic resonance defecography after ileal pouch anal anastomosis for ulcerative colitis","authors":"Jiansheng Wang , Yi Xu , Tenghui Zhang , Sizhe Zheng , Song Luo , Yan Ma , Feng Zhu , Changsheng Zhou , Jianfeng Gong","doi":"10.1016/j.dld.2025.09.027","DOIUrl":"10.1016/j.dld.2025.09.027","url":null,"abstract":"<div><h3>Background</h3><div>Ulcerative colitis (UC) patients undergoing ileal pouch anal anastomosis (IPAA) will potentially have abnormal pouch function, which seriously affects their quality of life. It is usually attributed to postoperative pouch structural complications. However, symptoms of poor pouch function also occur in patients with “normal pouch”. Few objective tools have been used to evaluate the pouch function with non-optimal pouch physiology.</div></div><div><h3>Aim</h3><div>To investigate the validity of dynamic magnetic resonance defecography (DMRD) and its relationship with pouch function in UC patients undergoing IPAA.</div></div><div><h3>Methods</h3><div>UC patients who had IPAA surgery were recruited. Patients with structural complications were excluded. Patients were assessed by questionnaires for pouch function including ileal pouch syndrome severity (IPSS) score. DMRD was performed at resting, raising, and defecation phase. The correlation between DMRD data and pouch function was investigated. Poor pouch function was defined as IPSS score >15.</div></div><div><h3>Results</h3><div>A total of 33 patients were included. The results showed that distance from anastomosis to pubococcygeal line (PCL) at rest phase was an independent risk factor for poor pouch function ([OR] 5.65, 95 % CI 1.02–31.16, <em>P</em> = 0.047). The length of cuff at raising phase was an independent risk factor for urgency ([OR] 12.55, 95 % CI 1.06–148.32, <em>P</em> = 0.045). In addition, M-line length—a reference for assessing pelvic floor descent (normal ≤2 cm)—during defecation was an independent risk factor for incomplete defecation ([OR] 2.47, 95 % CI 1.11–5.47, <em>P</em> = 0.027), while M-line length at rest was an independent risk factor for stool leakage ([OR] 10.16, 95 % CI 1.15–90.07, <em>P</em> = 0.037).</div></div><div><h3>Conclusions</h3><div>Magnetic resonance defecography is a potentially useful imaging modality for evaluating pouch function. Our study presented a series of DMRD parameters for functional assessment and their association with defecation disorders during dynamic monitoring. Therefore, DMRD provides information, in addition to clinical parameters, in symptomatic pouch patients.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2354-2361"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274196","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 : 2025-12-01DOI: 10.1016/j.dld.2025.09.031
Olivier Boillot , Emma Wischlen , Valérie Dubois , Sophie Chopinet , Noémie Laverdure , Valérie Hervieu , Sophie Collardeau-Frachon , Christine Rivet , Alain Lachaux , Jérôme Dumortier
Background
The progression of allograft fibrosis and its causes after pediatric liver transplantation (PedLT) remain under investigation.
Methods
This study evaluated long-term graft fibrosis progression and its associated risk factors in 137 liver grafts in 133 patients who survived at least one-year post-transplantation.
Results
A total of 517 protocol liver biopsies (PLBs) scored using the METAVIR system were performed at 1, 5, 10-, 15-, 25-, and 30-years post-LT. The mean fibrosis progression over time was 0.82 ± 0.7, 1.12 ± 0.76, 1.44 ± 0.88, 1.59 ± 1.01, 1.50 ± 0.86, 1.46 ± 0.9, and 1.88 ± 1.16, respectively. In multivariate analysis, significant fibrosis (≥F2) was associated with biliary stenosis (HR 2.07 [1.14–3.75], p = 0.017), while induction therapy was protective against severe fibrosis (≥F3) (HR 0.24 [0.07–0.76], p = 0.015). Among 114 patients tested for de novo donor-specific antibodies (dnDSAs), 42.9 % developed class II DSAs after an average of 12.4 ± 6.6 years. DSA-positive recipients were more likely to have undergone LT for acute liver failure, had less induction therapy, more fibrosis progression, chronic rejection, and worse graft survival.
Conclusions
Progressive fibrosis remains the leading cause of graft loss in PedLT. However, its progression was slow over three decades. PLBs are useful for identifying patients at risk of graft loss and adjusting immunosuppression to reduce the development of dnDSAs and the progression of chronic injury.
背景：儿童肝移植（PedLT）后同种异体移植纤维化的进展及其原因仍在研究中。方法：本研究评估了133例移植后存活至少一年的137例肝移植患者的长期移植物纤维化进展及其相关危险因素。结果：在肝移植后1年、5年、10年、15年、25年和30年，共进行了517例使用METAVIR系统评分的肝活检（PLBs）。随着时间的推移，平均纤维化进展分别为0.82±0.7,1.12±0.76,1.44±0.88,1.59±1.01,1.50±0.86,1.46±0.9和1.88±1.16。在多因素分析中，显著纤维化（≥F2）与胆道狭窄相关（HR 2.07 [1.14-3.75], p = 0.017），而诱导治疗对严重纤维化（≥F3）有保护作用（HR 0.24 [0.07-0.76], p = 0.015）。在114名接受新供体特异性抗体（dndsa）检测的患者中，42.9%的患者在平均12.4±6.6年后发展为II类dsa。dsa阳性受体更有可能因急性肝衰竭而接受肝移植，诱导治疗较少，纤维化进展更多，慢性排斥反应更严重，移植物存活率更差。结论：进行性纤维化仍然是PedLT移植损失的主要原因。然而，在过去的三十年里，它的进展缓慢。plb可用于识别移植物丢失风险的患者，并调节免疫抑制以减少ddnsa的发生和慢性损伤的进展。
{"title":"Dynamics and risk factors for long term pediatric liver graft fibrosis progression according to protocol liver biopsies over a 30-years follow-up","authors":"Olivier Boillot , Emma Wischlen , Valérie Dubois , Sophie Chopinet , Noémie Laverdure , Valérie Hervieu , Sophie Collardeau-Frachon , Christine Rivet , Alain Lachaux , Jérôme Dumortier","doi":"10.1016/j.dld.2025.09.031","DOIUrl":"10.1016/j.dld.2025.09.031","url":null,"abstract":"<div><h3>Background</h3><div>The progression of allograft fibrosis and its causes after pediatric liver transplantation (PedLT) remain under investigation.</div></div><div><h3>Methods</h3><div>This study evaluated long-term graft fibrosis progression and its associated risk factors in 137 liver grafts in 133 patients who survived at least one-year post-transplantation.</div></div><div><h3>Results</h3><div>A total of 517 protocol liver biopsies (PLBs) scored using the METAVIR system were performed at 1, 5, 10-, 15-, 25-, and 30-years post-LT. The mean fibrosis progression over time was 0.82 ± 0.7, 1.12 ± 0.76, 1.44 ± 0.88, 1.59 ± 1.01, 1.50 ± 0.86, 1.46 ± 0.9, and 1.88 ± 1.16, respectively. In multivariate analysis, significant fibrosis (≥F2) was associated with biliary stenosis (HR 2.07 [1.14–3.75], <em>p</em> = 0.017), while induction therapy was protective against severe fibrosis (≥F3) (HR 0.24 [0.07–0.76], <em>p</em> = 0.015). Among 114 patients tested for <em>de novo</em> donor-specific antibodies (dnDSAs), 42.9 % developed class II DSAs after an average of 12.4 ± 6.6 years. DSA-positive recipients were more likely to have undergone LT for acute liver failure, had less induction therapy, more fibrosis progression, chronic rejection, and worse graft survival.</div></div><div><h3>Conclusions</h3><div>Progressive fibrosis remains the leading cause of graft loss in PedLT. However, its progression was slow over three decades. PLBs are useful for identifying patients at risk of graft loss and adjusting immunosuppression to reduce the development of dnDSAs and the progression of chronic injury.</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2419-2427"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400160","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}
Advanced pancreatic ductal adenocarcinoma (PDAC) remains among the most lethal cancers, with >95 % of patients dying from the disease. Chemotherapy is the standard of care in advanced stages, with FOLFIRINOX and Gemcitabine-Nab-Paclitaxel (Gem-NabP) as the main first-line regimens. Both show moderate efficacy and significant toxicity. Except for the PASS-01 trial, no direct comparison exists, though observational studies suggest that specific subgroups may benefit differently. Given the modest outcomes and rapid clinical decline, most patients are ineligible for second-line therapy after progression. The PANThEON study evaluates whether switching from modified FOLFIRINOX (mFOLFIRINOX) to Gem-NabP after three months of induction with mFOLFIRINOX improves outcomes for PDAC.
Methods
PANThEON is a no-profit, phase III, randomized, open-label, multicenter trial. The primary endpoint is overall survival (OS). Secondary endpoints include progression-free survival (PFS), time to treatment failure (TTF), overall response rate (ORR), and quality of life (QoL). Exploratory analyses will assess tumor profiling, circulating tumor DNA (ctDNA), and radiomics to identify predictive markers. A total of 220 patients will be randomized 1:1 to Gem-NabP (arm B) or continued mFOLFIRINOX (arm A).
Discussion
The PANThEON trial addresses two challenges: improving efficacy while reducing toxicity. Switching to Gem-NabP may enhance tolerability without compromising benefit, prolonging survival and refining PDAC treatment strategies.
Trial registration
PANThEON is registered at ClinicalTrials.gov (NCT06897644) and EuCT (2024-515214-41-00).
{"title":"A phase III randomized clinical trial of Gemcitabine and Nab-Paclitaxel as switch maintenance versus continuation of modified FOLFIRINOX as first-line chemotherapy in patients with advanced pancreatic cancer: The PANThEON Study","authors":"Carolina Sciortino , Federico Nichetti , Francesca Bergamo , Federica Palermo , Stefano Tamberi , Caterina Vivaldi , Elena Ongaro , Giuseppina Arcangeli , Silvia Marchesi , Elisa Giommoni , Chiara Alessandra Cella , Chiara Pircher , Anna Chiaramonte , Katia Bencardino , Elisa Sottotetti , Antonia Martinetti , Ilario Giovanni Rapposelli , Salvatore Corallo , Samantha Di Donato , Roberto Murialdo , Monica Niger","doi":"10.1016/j.dld.2025.11.007","DOIUrl":"10.1016/j.dld.2025.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Advanced pancreatic ductal adenocarcinoma (PDAC) remains among the most lethal cancers, with >95 % of patients dying from the disease. Chemotherapy is the standard of care in advanced stages, with FOLFIRINOX and Gemcitabine-Nab-Paclitaxel (Gem-NabP) as the main first-line regimens. Both show moderate efficacy and significant toxicity. Except for the PASS-01 trial, no direct comparison exists, though observational studies suggest that specific subgroups may benefit differently. Given the modest outcomes and rapid clinical decline, most patients are ineligible for second-line therapy after progression. The PANThEON study evaluates whether switching from modified FOLFIRINOX (mFOLFIRINOX) to Gem-NabP after three months of induction with mFOLFIRINOX improves outcomes for PDAC.</div></div><div><h3>Methods</h3><div>PANThEON is a no-profit, phase III, randomized, open-label, multicenter trial. The primary endpoint is overall survival (OS). Secondary endpoints include progression-free survival (PFS), time to treatment failure (TTF), overall response rate (ORR), and quality of life (QoL). Exploratory analyses will assess tumor profiling, circulating tumor DNA (ctDNA), and radiomics to identify predictive markers. A total of 220 patients will be randomized 1:1 to Gem-NabP (arm B) or continued mFOLFIRINOX (arm A).</div></div><div><h3>Discussion</h3><div>The PANThEON trial addresses two challenges: improving efficacy while reducing toxicity. Switching to Gem-NabP may enhance tolerability without compromising benefit, prolonging survival and refining PDAC treatment strategies.</div></div><div><h3>Trial registration</h3><div>PANThEON is registered at ClinicalTrials.gov (NCT06897644) and EuCT (2024-515214-41-00).</div></div>","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2470-2477"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145631145","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 : 2025-12-01DOI: 10.1016/j.dld.2025.08.075
Ruolin Wang , Chunwei Wu , Ze He
{"title":"Comment on “Multiomics insights into functional constipation: Exploring microbiome, metabolome, and lipidome independent of transit time”","authors":"Ruolin Wang , Chunwei Wu , Ze He","doi":"10.1016/j.dld.2025.08.075","DOIUrl":"10.1016/j.dld.2025.08.075","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Pages 2502-2503"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946644","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 : 2025-12-01DOI: 10.1016/j.dld.2025.09.016
Junyuan You , Shuyue Yang , Xiaochen Geng
{"title":"The last embrace: A CT scout image of love and loss","authors":"Junyuan You , Shuyue Yang , Xiaochen Geng","doi":"10.1016/j.dld.2025.09.016","DOIUrl":"10.1016/j.dld.2025.09.016","url":null,"abstract":"","PeriodicalId":11268,"journal":{"name":"Digestive and Liver Disease","volume":"57 12","pages":"Page 2480"},"PeriodicalIF":3.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211879","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号