Shu Xiang Li, Bu Er Li, Min Li, Sha Chen, Ting Ting Lyu, Qian Yi Wang, Xiao Ming Wang, Yu Wang, Hong Ma, Xiao Juan Ou, Yuan Yuan Kong, Xin Yan Zhao, Hong You, Wei Jia Duan, Ji Dong Jia
Objectives
Fenofibrate is widely used as add-on therapy for patients with primary biliary cholangitis (PBC) who have a suboptimal response to ursodeoxycholic acid (UDCA). We aimed to evaluate whether the UDCA biochemical response criteria, especially the GLOBE and UK-PBC risk scoring systems, could predict the long-term prognosis of PBC patients who received fenofibrate add-on therapy.
Methods
PBC patients receiving fenofibrate add-on therapy were included in this retrospective–prospective study. We compared the utility of nine biochemical response criteria and two scoring systems to predict clinical outcomes by Kaplan–Meier plots and the receiver operating characteristic (ROC) curve analysis.
Results
Sixty-three patients were included in this study, of whom 11 had a poor outcome (hepatic decompensation, liver-related death, or liver transplantation) and 52 had a good outcome. After a median follow-up of 45 months, fenofibrate add-on therapy steadily decreased the serum levels of alkaline phosphatase, γ-glutamyl transferase, and alanine aminotransferase in both groups. The patients with poor outcomes had a higher GLOBE score and UK-PBC risk score than those with good outcomes after 12 months of treatment. More importantly, both scores had better predictive performance for hepatic decompensation- and transplant-free survival than the other criteria. The areas under the ROC curve of the GLOBE and UK-PBC risk scores at 12 months were 0.878 (95% confidence interval [CI] 0.751–0.955) and 0.919 (95% CI 0.803–0.978), respectively.
Conclusion
The GLOBE and UK-PBC risk scores outperformed the other biochemical response criteria in predicting the clinical outcomes of PBC patients with suboptimal response to UDCA and receiving fenofibrate add-on therapy.
目的：非诺贝特被广泛用于对熊去氧胆酸（UDCA）反应不佳的原发性胆管炎（PBC）患者的附加治疗。我们的目的是评估UDCA生化反应标准，特别是GLOBE和UK-PBC风险评分系统是否可以预测接受非诺贝特辅助治疗的PBC患者的长期预后。方法：本回顾性前瞻性研究纳入了接受非诺贝特辅助治疗的PBC患者。我们通过Kaplan-Meier图和受试者工作特征（ROC）曲线分析比较了九种生化反应标准和两种评分系统预测临床结果的效用。结果：本研究纳入63例患者，其中11例预后不良（肝失代偿、肝脏相关死亡或肝移植），52例预后良好。中位随访45个月后，非诺贝特加药治疗稳定降低了两组患者血清碱性磷酸酶、γ-谷氨酰转移酶和丙氨酸转氨酶的水平。治疗12个月后，预后较差的患者GLOBE评分和UK-PBC风险评分高于预后良好的患者。更重要的是，与其他标准相比，这两个评分对肝失代偿和无移植生存有更好的预测效果。12个月GLOBE和UK-PBC风险评分的ROC曲线下面积分别为0.878（95%可信区间[CI] 0.751-0.955）和0.919 （95% CI 0.803-0.978）。结论：GLOBE和UK-PBC风险评分在预测对UDCA反应不佳并接受非诺贝特辅助治疗的PBC患者的临床结果方面优于其他生化反应标准。
{"title":"GLOBE Score and UK-PBC Risk Score Predict Long-Term Clinical Outcomes of Patients With Primary Biliary Cholangitis and Receiving Ursodeoxycholic Acid and Fenofibrate","authors":"Shu Xiang Li, Bu Er Li, Min Li, Sha Chen, Ting Ting Lyu, Qian Yi Wang, Xiao Ming Wang, Yu Wang, Hong Ma, Xiao Juan Ou, Yuan Yuan Kong, Xin Yan Zhao, Hong You, Wei Jia Duan, Ji Dong Jia","doi":"10.1111/1751-2980.13359","DOIUrl":"10.1111/1751-2980.13359","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Fenofibrate is widely used as add-on therapy for patients with primary biliary cholangitis (PBC) who have a suboptimal response to ursodeoxycholic acid (UDCA). We aimed to evaluate whether the UDCA biochemical response criteria, especially the GLOBE and UK-PBC risk scoring systems, could predict the long-term prognosis of PBC patients who received fenofibrate add-on therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PBC patients receiving fenofibrate add-on therapy were included in this retrospective–prospective study. We compared the utility of nine biochemical response criteria and two scoring systems to predict clinical outcomes by Kaplan–Meier plots and the receiver operating characteristic (ROC) curve analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-three patients were included in this study, of whom 11 had a poor outcome (hepatic decompensation, liver-related death, or liver transplantation) and 52 had a good outcome. After a median follow-up of 45 months, fenofibrate add-on therapy steadily decreased the serum levels of alkaline phosphatase, γ-glutamyl transferase, and alanine aminotransferase in both groups. The patients with poor outcomes had a higher GLOBE score and UK-PBC risk score than those with good outcomes after 12 months of treatment. More importantly, both scores had better predictive performance for hepatic decompensation- and transplant-free survival than the other criteria. The areas under the ROC curve of the GLOBE and UK-PBC risk scores at 12 months were 0.878 (95% confidence interval [CI] 0.751–0.955) and 0.919 (95% CI 0.803–0.978), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The GLOBE and UK-PBC risk scores outperformed the other biochemical response criteria in predicting the clinical outcomes of PBC patients with suboptimal response to UDCA and receiving fenofibrate add-on therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 5-6","pages":"250-259"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760215","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}
Hui Bo Wu, Zhao Yuan Xu, Wei Wang, Qi Zhang, Jue Lin, Yi Tong Cui, Jun Hu, Tao Liu, Xiang Peng, Jun Deng, Jia Yin Yao, Min Zhang, Xi Xi Chen, Min Zhi
Objectives
Difficult-to-treat Crohn's disease (DTT-CD) represents a critical unmet need in inflammatory bowel disease (IBD) management. However, its genetic architectures remain poorly understood. We aimed to evaluate the genetic characteristics and clinical manifestations of DTT-CD cases through integrated trio-based whole exome sequencing (WES) and longitudinal phenotyping.
Methods
In this cross-sectional cohort study, DTT-CD patients who met the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) criteria and their first-degree relatives underwent trio-WES analysis. Treatment persistence and remission rates were analyzed. Genetic variants were prioritized via cosegregation analysis, the American College of Medical Genetics and Genomics (ACMG) guidelines, and functional prediction algorithms.
Results
Among the 24 patients with DTT-CD, 87.5% failed at least two biologics, 33.3% required dual targeted therapy, and drug persistence declined across treatment lines (p = 0.0193). Remission rates were suboptimal (clinical: 41.7%; endoscopic: 50.0%). Trio-WES analysis identified 15 likely pathogenic candidate variants across 12 genes, including the established monogenic IBD gene XIAP (two novel variants: p.Asp247Glufs*19, p.Ser43X; two known variants: p.Arg381X, p.Arg238X), genome-wide association studies-implicated IBD risk genes (MAML2 and PLA2R1), and novel candidate variants (KIZ, LAMA5, SAMD9, etc.) that were potentially linked to epithelial-immune dysregulation.
Conclusions
This is the first trio-WES study of DTT-CD that reveals a high prevalence of monogenic XIAP deficiency (16.7%), advocating for genetic screening in refractory cases. Novel candidate genes implicate polygenic mechanisms of therapeutic resistance. Family-based sequencing may be used to elucidate the genetic background of DTT-CD cases to guide molecular diagnosis and personalized therapy.
{"title":"Genetic and Clinical Characteristics of Difficult-To-Treat Crohn's Disease: Trio-Based Exome Sequencing in 24 Families","authors":"Hui Bo Wu, Zhao Yuan Xu, Wei Wang, Qi Zhang, Jue Lin, Yi Tong Cui, Jun Hu, Tao Liu, Xiang Peng, Jun Deng, Jia Yin Yao, Min Zhang, Xi Xi Chen, Min Zhi","doi":"10.1111/1751-2980.13358","DOIUrl":"10.1111/1751-2980.13358","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Difficult-to-treat Crohn's disease (DTT-CD) represents a critical unmet need in inflammatory bowel disease (IBD) management. However, its genetic architectures remain poorly understood. We aimed to evaluate the genetic characteristics and clinical manifestations of DTT-CD cases through integrated trio-based whole exome sequencing (WES) and longitudinal phenotyping.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional cohort study, DTT-CD patients who met the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) criteria and their first-degree relatives underwent trio-WES analysis. Treatment persistence and remission rates were analyzed. Genetic variants were prioritized via cosegregation analysis, the American College of Medical Genetics and Genomics (ACMG) guidelines, and functional prediction algorithms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 24 patients with DTT-CD, 87.5% failed at least two biologics, 33.3% required dual targeted therapy, and drug persistence declined across treatment lines (<i>p</i> = 0.0193). Remission rates were suboptimal (clinical: 41.7%; endoscopic: 50.0%). Trio-WES analysis identified 15 likely pathogenic candidate variants across 12 genes, including the established monogenic IBD gene <i>XIAP</i> (two novel variants: p.Asp247Glufs*19, p.Ser43X; two known variants: p.Arg381X, p.Arg238X), genome-wide association studies-implicated IBD risk genes (<i>MAML2</i> and <i>PLA2R1</i>), and novel candidate variants (<i>KIZ</i>, <i>LAMA5</i>, <i>SAMD9</i>, etc.) that were potentially linked to epithelial-immune dysregulation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first trio-WES study of DTT-CD that reveals a high prevalence of monogenic <i>XIAP</i> deficiency (16.7%), advocating for genetic screening in refractory cases. Novel candidate genes implicate polygenic mechanisms of therapeutic resistance. Family-based sequencing may be used to elucidate the genetic background of DTT-CD cases to guide molecular diagnosis and personalized therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 5-6","pages":"230-240"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760214","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}
Chao Li, Xi Zhang, Jie Qi Zheng, Yi Zhe Tie, Zhi Rong Zeng, Min Hu Chen, Ri Rong Chen, Sheng Hong Zhang
Objectives
To develop a nomogram with easily available parameters to predict the risk of Crohn's disease (CD)-related bowel resection in patients with newly diagnosed CD.
Methods
We performed a retrospective cohort study by recruiting patients with newly diagnosed CD between 2005 and 2022. The patients were divided into the training and internal test sets in a 7:3 ratio. Adjusted multivariate Cox regression and least absolute shrinkage and selection operator analyses were used for feature selection. A nomogram was developed and evaluated using 10-fold cross-validation.
Results
Altogether 490 patients were included, among whom 67 (13.7%) received CD-related bowel resection during a median follow-up of 45.2 months. Stricturing or penetrating behavior, perianal involvement, and higher C-reactive protein (CRP) were independently associated with a higher risk of CD-related bowel resection, while higher white blood cell (WBC) and lymphocyte levels and hemoglobin levels were protective factors. The nomogram including disease behavior, hemoglobin, CRP, and lymphocyte and WBC counts yielded a C-statistic of 0.80 (95% confidence interval [CI] 0.74–0.86) in 10-fold cross-validation of the training set. Using the internal test set, the robust performance was verified with C-statistic, calibration slope, and calibration-in-the-large of 0.80 (95% CI 0.70–0.89), 1.10 (95% CI 0.61–1.56), and 0.28 (95% CI −0.17 to 0.67). Decision curve analyses indicated its potential clinical utility.
Conclusion
The nomogram integrating disease behavior and laboratory data might be a promising approach for early risk stratification of CD-related bowel resection, hence facilitating personalized treatment for newly diagnosed CD.
目的：开发一种具有易于获得参数的nomogram （nomogram）方法来预测新诊断的克罗恩病（CD）相关肠切除术的风险。方法：我们进行了一项回顾性队列研究，招募了2005年至2022年间新诊断的CD患者。患者按7:3的比例分为训练组和内测组。校正多变量Cox回归、最小绝对收缩和选择算子分析用于特征选择。使用10倍交叉验证开发和评估了nomogram。结果：共纳入490例患者，其中67例（13.7%）接受了cd相关肠切除术，中位随访时间为45.2个月。狭窄或穿透行为、肛周受累和较高的c反应蛋白（CRP）与cd相关性肠切除术的高风险独立相关，而较高的白细胞（WBC）、淋巴细胞水平和血红蛋白水平是保护因素。在训练集的10倍交叉验证中，包括疾病行为、血红蛋白、CRP、淋巴细胞和白细胞计数在内的nomogram c -统计量为0.80（95%可信区间[CI] 0.74-0.86）。使用内部测试集，通过c统计量、校准斜率和校准-in-the-large分别为0.80 （95% CI 0.70-0.89）、1.10 （95% CI 0.61-1.56）和0.28 （95% CI -0.17至0.67）验证了稳健性。决策曲线分析表明该方法具有潜在的临床应用价值。结论：结合疾病行为和实验室数据的nomogram方法可能是一种很有前景的方法，用于CD相关性肠切除术的早期风险分层，从而促进对新诊断的CD的个性化治疗。
{"title":"Development and Validation of a Clinical Nomogram for Predicting Surgery in Newly Diagnosed Crohn's Disease","authors":"Chao Li, Xi Zhang, Jie Qi Zheng, Yi Zhe Tie, Zhi Rong Zeng, Min Hu Chen, Ri Rong Chen, Sheng Hong Zhang","doi":"10.1111/1751-2980.13357","DOIUrl":"10.1111/1751-2980.13357","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To develop a nomogram with easily available parameters to predict the risk of Crohn's disease (CD)-related bowel resection in patients with newly diagnosed CD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study by recruiting patients with newly diagnosed CD between 2005 and 2022. The patients were divided into the training and internal test sets in a 7:3 ratio. Adjusted multivariate Cox regression and least absolute shrinkage and selection operator analyses were used for feature selection. A nomogram was developed and evaluated using 10-fold cross-validation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 490 patients were included, among whom 67 (13.7%) received CD-related bowel resection during a median follow-up of 45.2 months. Stricturing or penetrating behavior, perianal involvement, and higher C-reactive protein (CRP) were independently associated with a higher risk of CD-related bowel resection, while higher white blood cell (WBC) and lymphocyte levels and hemoglobin levels were protective factors. The nomogram including disease behavior, hemoglobin, CRP, and lymphocyte and WBC counts yielded a C-statistic of 0.80 (95% confidence interval [CI] 0.74–0.86) in 10-fold cross-validation of the training set. Using the internal test set, the robust performance was verified with C-statistic, calibration slope, and calibration-in-the-large of 0.80 (95% CI 0.70–0.89), 1.10 (95% CI 0.61–1.56), and 0.28 (95% CI −0.17 to 0.67). Decision curve analyses indicated its potential clinical utility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The nomogram integrating disease behavior and laboratory data might be a promising approach for early risk stratification of CD-related bowel resection, hence facilitating personalized treatment for newly diagnosed CD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 5-6","pages":"203-211"},"PeriodicalIF":2.3,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553643","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}
Hai Bo Zhang, Huai Bin Zou, Yun Yi Gao, Li Wang, Yuan Gao, Ming Kong, Wei Wei Kang, Rui Zhong, Xian Shan Yang, Yan Ren, Li Li Feng, Lu Li, Shuang Li, Zhong Ping Duan, Yu Tao Zhan, Yu Chen
Objective
To compare the efficacy and safety profile of arginine glutamate and L-ornithine-L-aspartate (LOLA) in treating mild hepatic encephalopathy (HE) and hyperammonemia in cirrhotic patients.
Methods
This single-center, open-label, non-inferiority, randomized controlled trial (RCT) enrolled patients aged 18–75 years with cirrhosis and mild HE. The patients were randomly allocated in the ratio of 1:1 using a randomization table to be treated with intravenous administration of arginine glutamate or LOLA for 7 days. The primary end-point was the clinical improvement of mild HE. Secondary end-points included post-treatment change in blood ammonia level and the time to complete the number connection test (NCT)-A. Adverse events and adverse drug reactions were documented.
Results
From July 2020 to June 2021, 108 cirrhotic patients with mild HE were included and randomized to receive either arginine glutamate or LOLA for 7 days. Clinical improvement was observed in 88.9% of the patients receiving arginine glutamate and 90.7% of those having LOLA (between-group difference −1.9%, 95% confidence interval −13.3% to 9.6%), indicating non-inferiority of arginine glutamate to LOLA. The two groups showed comparable reductions in blood ammonia levels and improvements in time to complete NCT-A. The rate of adverse events was similar between the two groups, with only four cases reported adverse drug reactions.
Conclusions
Both regimens effectively alleviated mild HE symptoms and reduced ammonia levels. Arginine glutamate showed non-inferiority to LOLA in terms of clinical improvement, ammonia reduction, and time to complete NCT-A, with no significant adverse events.
目的：比较精氨酸谷氨酸和l -鸟氨酸- l -天冬氨酸（LOLA）治疗肝硬化患者轻度肝性脑病（HE）和高氨血症的疗效和安全性。方法：这项单中心、开放标签、非劣效性随机对照试验（RCT）纳入了18-75岁肝硬化和轻度HE患者。采用随机表法按1:1的比例随机分配，分别给予精氨酸谷氨酸静脉滴注或LOLA治疗，疗程7 d。主要终点为轻度HE的临床改善。次要终点包括治疗后血氨水平的变化和完成数字连接试验(NCT)-A的时间。记录了不良事件和药物不良反应。结果：从2020年7月到2021年6月，108名肝硬化轻度HE患者被纳入研究，随机接受精氨酸谷氨酸或LOLA治疗7天。88.9%接受精氨酸谷氨酸治疗的患者和90.7%接受LOLA治疗的患者临床改善（组间差异为-1.9%，95%可信区间为-13.3% ~ 9.6%），表明精氨酸谷氨酸对LOLA治疗无劣效性。两组患者的血氨水平下降幅度相当，完成NCT-A的时间也有所改善。两组不良事件发生率相似，仅有4例报告药物不良反应。结论：两种方案均可有效缓解轻度HE症状，降低氨水平。精氨酸谷氨酸在临床改善、氨还原和完成NCT-A的时间方面与LOLA无劣效性，无明显不良事件。
{"title":"An Open-Label Randomized Controlled Non-Inferiority Trial of Arginine Glutamate Injection for the Treatment of Mild Hepatic Encephalopathy","authors":"Hai Bo Zhang, Huai Bin Zou, Yun Yi Gao, Li Wang, Yuan Gao, Ming Kong, Wei Wei Kang, Rui Zhong, Xian Shan Yang, Yan Ren, Li Li Feng, Lu Li, Shuang Li, Zhong Ping Duan, Yu Tao Zhan, Yu Chen","doi":"10.1111/1751-2980.13355","DOIUrl":"10.1111/1751-2980.13355","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the efficacy and safety profile of arginine glutamate and L-ornithine-L-aspartate (LOLA) in treating mild hepatic encephalopathy (HE) and hyperammonemia in cirrhotic patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center, open-label, non-inferiority, randomized controlled trial (RCT) enrolled patients aged 18–75 years with cirrhosis and mild HE. The patients were randomly allocated in the ratio of 1:1 using a randomization table to be treated with intravenous administration of arginine glutamate or LOLA for 7 days. The primary end-point was the clinical improvement of mild HE. Secondary end-points included post-treatment change in blood ammonia level and the time to complete the number connection test (NCT)-A. Adverse events and adverse drug reactions were documented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From July 2020 to June 2021, 108 cirrhotic patients with mild HE were included and randomized to receive either arginine glutamate or LOLA for 7 days. Clinical improvement was observed in 88.9% of the patients receiving arginine glutamate and 90.7% of those having LOLA (between-group difference −1.9%, 95% confidence interval −13.3% to 9.6%), indicating non-inferiority of arginine glutamate to LOLA. The two groups showed comparable reductions in blood ammonia levels and improvements in time to complete NCT-A. The rate of adverse events was similar between the two groups, with only four cases reported adverse drug reactions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Both regimens effectively alleviated mild HE symptoms and reduced ammonia levels. Arginine glutamate showed non-inferiority to LOLA in terms of clinical improvement, ammonia reduction, and time to complete NCT-A, with no significant adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 5-6","pages":"241-249"},"PeriodicalIF":2.3,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368880","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}
Sai Nan Shi, Bin Bin Zhu, Mei Feng Wang, Lin Lin, Liu Qin Jiang
Objective
We aimed to investigate the prevalence of alexithymia in patients with functional defecation disorder (FDD) and its impact on treatment outcomes.
Methods
FDD patients who underwent high-resolution anorectal manometry and balloon expulsion test were enrolled. Symptoms, anorectal function, and treatment efficacy were assessed at baseline and after 4-week medication.
Results
Alexithymia was present in 29.5% of all 129 FDD patients. Compared to the non-alexithymia group, the alexithymia group had higher baseline scores for the Patient Assessment of Constipation-Symptoms (PAC-SYM) (19.0 vs. 15.0, p = 0.03), Patient Assessment of Constipation-Quality of Life (PAC-QOL) (67.0 vs. 26.0, p < 0.001), Zung's Self-Rating Anxiety Scale (SAS) (44.5 vs. 30.0, p < 0.001), and Self-Rating Depression Scale (SDS) (48.0 vs. 33.0, p < 0.001). Moreover, the improvements in post-treatment complete spontaneous bowel movements (CSBMs) (0.0 vs. 1.5, p = 0.041), PAC-SYM (0.0 vs. −11.5, p < 0.001), PAC-QOL (0.0 vs. −16.0, p < 0.001), SAS (0.0 vs. −1.0, p < 0.001), and SDS (0.0 vs. −3.0, p < 0.001) scores were less significant in the alexithymia group than in the non-alexithymia group. A high Toronto Alexithymia Scale-20 score was an independent risk factor for drug therapy failure in FDD patients (odds ratio 0.949, 95% confidence interval 0.919–0.980, p = 0.001).
Conclusion
Alexithymia is prevalent in FDD patients and significantly affects symptom severity, quality of life, mental state, and treatment outcomes.
{"title":"Alexithymia in Functional Defecation Disorder: The Incidence and the Effect on Treatment","authors":"Sai Nan Shi, Bin Bin Zhu, Mei Feng Wang, Lin Lin, Liu Qin Jiang","doi":"10.1111/1751-2980.13356","DOIUrl":"10.1111/1751-2980.13356","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to investigate the prevalence of alexithymia in patients with functional defecation disorder (FDD) and its impact on treatment outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>FDD patients who underwent high-resolution anorectal manometry and balloon expulsion test were enrolled. Symptoms, anorectal function, and treatment efficacy were assessed at baseline and after 4-week medication.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Alexithymia was present in 29.5% of all 129 FDD patients. Compared to the non-alexithymia group, the alexithymia group had higher baseline scores for the Patient Assessment of Constipation-Symptoms (PAC-SYM) (19.0 vs. 15.0, <i>p</i> = 0.03), Patient Assessment of Constipation-Quality of Life (PAC-QOL) (67.0 vs. 26.0, <i>p</i> < 0.001), Zung's Self-Rating Anxiety Scale (SAS) (44.5 vs. 30.0, <i>p</i> < 0.001), and Self-Rating Depression Scale (SDS) (48.0 vs. 33.0, <i>p</i> < 0.001). Moreover, the improvements in post-treatment complete spontaneous bowel movements (CSBMs) (0.0 vs. 1.5, <i>p</i> = 0.041), PAC-SYM (0.0 vs. −11.5, <i>p</i> < 0.001), PAC-QOL (0.0 vs. −16.0, <i>p</i> < 0.001), SAS (0.0 vs. −1.0, <i>p</i> < 0.001), and SDS (0.0 vs. −3.0, <i>p</i> < 0.001) scores were less significant in the alexithymia group than in the non-alexithymia group. A high Toronto Alexithymia Scale-20 score was an independent risk factor for drug therapy failure in FDD patients (odds ratio 0.949, 95% confidence interval 0.919–0.980, <i>p</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Alexithymia is prevalent in FDD patients and significantly affects symptom severity, quality of life, mental state, and treatment outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 5-6","pages":"212-220"},"PeriodicalIF":2.3,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333187","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}
Imogen Hartley, Babak Sarraf, Helen Wilding, Jonathan P. Segal, Nik Sheng Ding
Objectives
Perianal fistulizing Crohn's disease (pfCD) is a severe type of inflammatory bowel disease resulting in significant patient morbidity. Despite advancements in treatments, pfCD remains challenging to manage with low healing rates. Fecal diversion (FD) has previously demonstrated clinical improvement for patients with refractory disease. Our meta-analysis aimed to explore the clinical response to FD, rates of successful restoration of bowel continuity after FD, rates of re-diversion, and factors affecting the success of FD in pfCD.
Methods
A systematic review and meta-analysis was carried out of adult patients who had undergone FD for pfCD, with detailed patient outcome data. Studies were identified through a literature search of six bibliographic databases and one trial register, all run on February 28, 2025, including MEDLINE ALL, EMBASE, Emcare, APA PsycInfo, CINAHL, Cochrane Library, and Clinicaltrials.gov.
Results
Seventeen studies encompassing 714 adult pfCD patients were included. FD resulted in a 65% clinical improvement rate, yet considerable heterogeneity existed in study methodologies and outcome definitions. While 29% of patients achieved bowel restoration within a median follow-up of 58.2 months, challenges in sustaining the effects were evident, with 10% requiring repeat diversion and a 37% overall proctectomy/proctocolectomy rate. Factors associated with diversion success included the absence of rectal involvement and quiescent luminal disease, with biologic use showing no impact on outcomes.
Conclusions
FD offers symptom control in pfCD, although restoration rates remain low. These findings emphasize the need for individualized patient counseling. Future research should strive for uniform measures and refined approaches to enhance pfCD management.
目的：肛周瘘管性克罗恩病（pfCD）是一种严重的炎症性肠病，患者发病率很高。尽管在治疗方面取得了进步，但由于治愈率低，pfCD仍然具有挑战性。粪便转移（FD）先前已证明对难治性疾病患者的临床改善。我们的荟萃分析旨在探讨FD的临床反应、FD后成功恢复肠道连续性的比率、再分流率以及影响FD在pfCD中成功的因素。方法：对因pfCD而接受FD治疗的成年患者进行系统回顾和荟萃分析，并提供详细的患者结局数据。研究通过对六个文献数据库和一个试验注册库的文献检索来确定，这些文献检索均于2025年2月28日运行，包括MEDLINE all， EMBASE, Emcare, APA PsycInfo， CINAHL， Cochrane Library和clinicaltrials .gov.结果：包括714名成年pfCD患者的17项研究被纳入。FD导致65%的临床改善率，但在研究方法和结果定义上存在相当大的异质性。虽然29%的患者在中位58.2个月的随访期内实现了肠道恢复，但维持效果的挑战很明显，10%的患者需要重复转移，37%的患者需要进行直肠切除术/直结肠切除术。与转移成功相关的因素包括直肠不受累性和静止性管腔疾病，生物使用对结果没有影响。结论：FD可以控制pfCD的症状，但恢复率仍然很低。这些发现强调了个体化患者咨询的必要性。未来的研究应努力寻求统一的措施和完善的方法来加强pfCD的管理。
{"title":"Outcomes of Fecal Diversion in Perianal Crohn's Disease: A Systematic Review and Meta-Analysis","authors":"Imogen Hartley, Babak Sarraf, Helen Wilding, Jonathan P. Segal, Nik Sheng Ding","doi":"10.1111/1751-2980.13354","DOIUrl":"10.1111/1751-2980.13354","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Perianal fistulizing Crohn's disease (pfCD) is a severe type of inflammatory bowel disease resulting in significant patient morbidity. Despite advancements in treatments, pfCD remains challenging to manage with low healing rates. Fecal diversion (FD) has previously demonstrated clinical improvement for patients with refractory disease. Our meta-analysis aimed to explore the clinical response to FD, rates of successful restoration of bowel continuity after FD, rates of re-diversion, and factors affecting the success of FD in pfCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and meta-analysis was carried out of adult patients who had undergone FD for pfCD, with detailed patient outcome data. Studies were identified through a literature search of six bibliographic databases and one trial register, all run on February 28, 2025, including MEDLINE ALL, EMBASE, Emcare, APA PsycInfo, CINAHL, Cochrane Library, and Clinicaltrials.gov.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventeen studies encompassing 714 adult pfCD patients were included. FD resulted in a 65% clinical improvement rate, yet considerable heterogeneity existed in study methodologies and outcome definitions. While 29% of patients achieved bowel restoration within a median follow-up of 58.2 months, challenges in sustaining the effects were evident, with 10% requiring repeat diversion and a 37% overall proctectomy/proctocolectomy rate. Factors associated with diversion success included the absence of rectal involvement and quiescent luminal disease, with biologic use showing no impact on outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>FD offers symptom control in pfCD, although restoration rates remain low. These findings emphasize the need for individualized patient counseling. Future research should strive for uniform measures and refined approaches to enhance pfCD management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 5-6","pages":"180-192"},"PeriodicalIF":2.3,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1751-2980.13354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302209","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}
Tian Shi, Sheng Long Xue, Wei Dong Liu, Yan Feng, Ting Li, Na Li, Kuerbanjiang Aihemaijiang, Xiao Ling Huang, Wen Jia Hui, Qi Jiang, Ying Xuan Chen, Feng Gao
Objective
We aimed to evaluate the prevalence of celiac disease (CeD) autoimmunity among young adult individuals in northwest China based on their relevant demographics, clinical characteristics, and laboratory data.
Methods
We conducted a cross-sectional survey of serum CeD prevalence among young students aged 18–23 years who underwent routine physical examinations at the Xinjiang Second Medical College from September 2022 to December 2023. All subjects were tested for total serum immunoglobulin (Ig) A levels. Those with normal total IgA levels were tested for anti-tissue transglutaminase (tTG)-IgA and anti-endomysial antibody (EMA)-IgA. Individuals with IgA deficiency were tested for anti-deamidated gliadin peptide (DGP) IgG and anti-EMA-IgG. CeD autoimmunity was defined as positivity for both EMA and tTG/DGP antibodies.
Results
Among the 1464 participants, CeD seropositivity rates were 0.41% for tTG-IgA and 0.55% for EMA-IgA, and CeD autoimmunity was prevalent in 0.34%. All seropositive patients had a normal body mass index. The incidence of seropositivity was highest in Tajiks (1.28%), followed by Kazakhs (0.97%), Hans (0.29%), and Uygurs (0.22%) (p > 0.05). CeD was most frequently associated with elevated transaminase levels (1.87%; p = 0.005). Biochemical tests showed significantly higher alanine aminotransferase levels in CeD-positive patients (p = 0.027).
Conclusions
The prevalence of CeD autoimmunity in the young adult population of northwest China was 0.34%. Since young individuals often lack typical clinical and laboratory features, screening for CeD in the population with gastrointestinal symptoms, related comorbidities, or atypical manifestations is essential for early diagnosis and effective management of the disease.
{"title":"Screening and Analysis of the Clinical Characteristics of Celiac Disease Autoimmunity in the Young Population in Northwest China","authors":"Tian Shi, Sheng Long Xue, Wei Dong Liu, Yan Feng, Ting Li, Na Li, Kuerbanjiang Aihemaijiang, Xiao Ling Huang, Wen Jia Hui, Qi Jiang, Ying Xuan Chen, Feng Gao","doi":"10.1111/1751-2980.13351","DOIUrl":"10.1111/1751-2980.13351","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>We aimed to evaluate the prevalence of celiac disease (CeD) autoimmunity among young adult individuals in northwest China based on their relevant demographics, clinical characteristics, and laboratory data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional survey of serum CeD prevalence among young students aged 18–23 years who underwent routine physical examinations at the Xinjiang Second Medical College from September 2022 to December 2023. All subjects were tested for total serum immunoglobulin (Ig) A levels. Those with normal total IgA levels were tested for anti-tissue transglutaminase (tTG)-IgA and anti-endomysial antibody (EMA)-IgA. Individuals with IgA deficiency were tested for anti-deamidated gliadin peptide (DGP) IgG and anti-EMA-IgG. CeD autoimmunity was defined as positivity for both EMA and tTG/DGP antibodies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 1464 participants, CeD seropositivity rates were 0.41% for tTG-IgA and 0.55% for EMA-IgA, and CeD autoimmunity was prevalent in 0.34%. All seropositive patients had a normal body mass index. The incidence of seropositivity was highest in Tajiks (1.28%), followed by Kazakhs (0.97%), Hans (0.29%), and Uygurs (0.22%) (<i>p</i> > 0.05). CeD was most frequently associated with elevated transaminase levels (1.87%; <i>p</i> = 0.005). Biochemical tests showed significantly higher alanine aminotransferase levels in CeD-positive patients (<i>p</i> = 0.027).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The prevalence of CeD autoimmunity in the young adult population of northwest China was 0.34%. Since young individuals often lack typical clinical and laboratory features, screening for CeD in the population with gastrointestinal symptoms, related comorbidities, or atypical manifestations is essential for early diagnosis and effective management of the disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 3-4","pages":"143-149"},"PeriodicalIF":2.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284901","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}
Brittany Pass, Michelle Neice, Karan Sachdeva, Natalie Roppolo, Ahmad Alkurd, Farhan Mohuiddin, Elizabeth Armstrong, Ross Dies, Victoria Andrus, Ashely Deville, David Okuampa, Lena Kawji, Michael P. Tran, Omar Khan, Qiang Cai
Objectives
Gastric per-oral endoscopic myotomy (G-POEM) is a promising treatment for gastroparesis. Our previous pilot study has indicated that about 50% of patients could be safely discharged home on the same day as the procedure. In this study, we presented more data on this topic and divided admission into medical and non-medical admissions to assess the safety of same-day discharge after the G-POEM procedure.
Methods
All patients who underwent G-POEM for gastroparesis at our institution from April 2022 to June 2023 were included. After undergoing G-POEM, patients who met the following four criteria would be discharged on the same day: (i) no major complications during the procedure; (ii) patient having abdominal pain scored 4 or less on a pain scale from 0 to 10, or > 4 but improved after having one dose of intravenous pain medication; (iii) no vomiting after the procedure; and (iv) the patient had someone at home to help them access medical care when necessary. The admitted patients were divided into two groups: those with medical issues, and those with non-medical issues.
Results
Altogether 61 consecutive patients were included in this study, among whom 40 (65.6%) were discharged on the same day. Among the 21 (34.4%) patients who were admitted to the hospital for observation, 12 were admitted for non-medical issues. The remaining nine (14.8%) patients were admitted for medical issues.
Conclusions
After about 10 years of practice, G-POEM is a safe endoscopic therapeutic modality. This study shows that 85.2% of patients undergoing G-POEM can be discharged on the same day.
{"title":"Same-Day Discharge, Medical and Non-Medical Admission After Per-Oral Endoscopic Pyloromyotomy","authors":"Brittany Pass, Michelle Neice, Karan Sachdeva, Natalie Roppolo, Ahmad Alkurd, Farhan Mohuiddin, Elizabeth Armstrong, Ross Dies, Victoria Andrus, Ashely Deville, David Okuampa, Lena Kawji, Michael P. Tran, Omar Khan, Qiang Cai","doi":"10.1111/1751-2980.13353","DOIUrl":"10.1111/1751-2980.13353","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Gastric per-oral endoscopic myotomy (G-POEM) is a promising treatment for gastroparesis. Our previous pilot study has indicated that about 50% of patients could be safely discharged home on the same day as the procedure. In this study, we presented more data on this topic and divided admission into medical and non-medical admissions to assess the safety of same-day discharge after the G-POEM procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All patients who underwent G-POEM for gastroparesis at our institution from April 2022 to June 2023 were included. After undergoing G-POEM, patients who met the following four criteria would be discharged on the same day: (i) no major complications during the procedure; (ii) patient having abdominal pain scored 4 or less on a pain scale from 0 to 10, or > 4 but improved after having one dose of intravenous pain medication; (iii) no vomiting after the procedure; and (iv) the patient had someone at home to help them access medical care when necessary. The admitted patients were divided into two groups: those with medical issues, and those with non-medical issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 61 consecutive patients were included in this study, among whom 40 (65.6%) were discharged on the same day. Among the 21 (34.4%) patients who were admitted to the hospital for observation, 12 were admitted for non-medical issues. The remaining nine (14.8%) patients were admitted for medical issues.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>After about 10 years of practice, G-POEM is a safe endoscopic therapeutic modality. This study shows that 85.2% of patients undergoing G-POEM can be discharged on the same day.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 3-4","pages":"135-142"},"PeriodicalIF":2.3,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144284900","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}
June Hwa Bae, Jung-Bin Park, Ji Eun Baek, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
Objectives
Endoscopic ultrasound-guided fine-needle aspiration and/or biopsy (EUS-FNA/B) is a diagnostic tool for gastrointestinal (GI) lesions. However, its effectiveness in the lower GI tract remains underreported. In this study, we aimed to evaluate the clinical utility of EUS-FNA/B for rectal and perirectal lesions.
Methods
Seventy-seven consecutive patients with rectal or perirectal lesions underwent EUS-FNA/B between 2009 and 2023. The histological diagnoses by EUS-FNA/B were compared with the final diagnoses to assess the former's diagnostic performance. Additionally, the therapeutic utility of EUS-FNA/B and its clinical applicability across various scenarios were investigated.
Results
Twenty-nine of the 77 patients had rectal lesions, with gastrointestinal stromal tumor (GIST) being the most common in 15 patients. Of the 48 patients with perirectal lesions, 27 and 21 had malignant and benign lesions, respectively. EUS-FNA/B was diagnostic in 61 (79.2%) patients, with the rates of 79.3% and 79.2% for rectal and perirectal lesions. EUS-FNA/B enabled timely treatment decisions by confirming malignancy (n = 32) and prevented unnecessary surgeries/procedures by establishing the benign nature of the lesions (n = 14). A definitive diagnosis of rectal GIST was made using EUS-FNA/B, thereby facilitating the initiation of neoadjuvant chemotherapy followed by anus-saving surgery (n = 10). EUS-FNA/B enabled the implementation of minimally invasive interventions such as EUS-guided drainage (n = 5). Adverse events occurred in five (6.5%) patients, with only one requiring hospitalization.
Conclusion
EUS-FNA/B is a valuable modality for patients with rectal or perirectal lesions, which facilitates accurate histological diagnosis, appropriate treatment, and favorable safety profiles.
{"title":"Clinical Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Biopsy for Rectal and Perirectal Lesions With Categorization of Their Indications","authors":"June Hwa Bae, Jung-Bin Park, Ji Eun Baek, Seung Wook Hong, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon","doi":"10.1111/1751-2980.13352","DOIUrl":"10.1111/1751-2980.13352","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Endoscopic ultrasound-guided fine-needle aspiration and/or biopsy (EUS-FNA/B) is a diagnostic tool for gastrointestinal (GI) lesions. However, its effectiveness in the lower GI tract remains underreported. In this study, we aimed to evaluate the clinical utility of EUS-FNA/B for rectal and perirectal lesions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seventy-seven consecutive patients with rectal or perirectal lesions underwent EUS-FNA/B between 2009 and 2023. The histological diagnoses by EUS-FNA/B were compared with the final diagnoses to assess the former's diagnostic performance. Additionally, the therapeutic utility of EUS-FNA/B and its clinical applicability across various scenarios were investigated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-nine of the 77 patients had rectal lesions, with gastrointestinal stromal tumor (GIST) being the most common in 15 patients. Of the 48 patients with perirectal lesions, 27 and 21 had malignant and benign lesions, respectively. EUS-FNA/B was diagnostic in 61 (79.2%) patients, with the rates of 79.3% and 79.2% for rectal and perirectal lesions. EUS-FNA/B enabled timely treatment decisions by confirming malignancy (<i>n</i> = 32) and prevented unnecessary surgeries/procedures by establishing the benign nature of the lesions (<i>n</i> = 14). A definitive diagnosis of rectal GIST was made using EUS-FNA/B, thereby facilitating the initiation of neoadjuvant chemotherapy followed by anus-saving surgery (<i>n</i> = 10). EUS-FNA/B enabled the implementation of minimally invasive interventions such as EUS-guided drainage (<i>n</i> = 5). Adverse events occurred in five (6.5%) patients, with only one requiring hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EUS-FNA/B is a valuable modality for patients with rectal or perirectal lesions, which facilitates accurate histological diagnosis, appropriate treatment, and favorable safety profiles.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 5-6","pages":"193-202"},"PeriodicalIF":2.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258182","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}
Cui Chen, Wen Chao Zhao, Ming Xing Xia, Jia Hui Zhu, Ting Ting Fu, Jun Wu, Zhi Yuan Yao, Bing Hu
Objectives
Hilar-type intrahepatic cholangiocarcinoma (H-ICC), which originates from the large bile ducts, tends to invade the hepatic hilus and results in malignant hilar biliary obstruction (MHBO). Compared with hilar cholangiocarcinoma (HC), H-ICC exhibits a more aggressive biological behavior and a dismal prognosis. We aimed to investigate the optimal biliary stenting strategy for the treatment of unresectable H-ICC.
Methods
Patients with unresectable H-ICC who received endoscopic biliary stenting (EBS) between January 2012 and June 2019 were retrospectively included in this study. The prognostic factors of survival outcome, clinical success, duration of stent patency, and EBS-related adverse events were analyzed.
Results
Altogether 70 patients were enrolled, including 72.9% patients with multiple intrahepatic lesions and 44.3% with lymphatic metastasis. Jaundice control was achieved in 81.4% of the patients. Early cholangitis was the main treatment-related complication (17.1%). After successful stenting, systematic antitumor therapy was the only independent factor related to overall survival (hazard ratio [HR] 0.381, 95% confidence interval [CI] 0.218–0.668, p = 0.001). Plastic stenting was associated with clinical success (odds ratio [OR] 0.012, 95% CI 0.008–0.549, p = 0.012), stent patency (HR 6.773, 95% CI 2.221–20.653, p = 0.001), and early cholangitis (OR 5.000, 95% CI 1.006–24.841, p = 0.049). Bismuth classification IV was independently related to stent patency (HR 4.956, 95% CI 1.245–19.730, p = 0.023).
Conclusion
For H-ICC-induced MHBO, metal stent placement may achieve better biliary drainage and, combined with systemic antitumor therapies, may further improve patient survival.
目的：肝门型肝内胆管癌（H-ICC）起源于大胆管，易侵犯肝门，形成恶性肝门胆管梗阻（MHBO）。与肝门胆管癌（HC）相比，H-ICC表现出更具侵袭性的生物学行为和较差的预后。我们的目的是研究治疗不可切除H-ICC的最佳胆道支架置入策略。方法：回顾性纳入2012年1月至2019年6月期间接受内镜胆道支架植入术（EBS）的不可切除H-ICC患者。分析生存结局、临床成功、支架通畅时间和ebs相关不良事件的预后因素。结果：共纳入70例患者，其中72.9%为多发肝内病变，44.3%为淋巴转移。81.4%的患者黄疸得到控制。早期胆管炎是主要的治疗相关并发症（17.1%）。支架置入术成功后，系统抗肿瘤治疗是唯一与总生存相关的独立因素（风险比[HR] 0.381, 95%可信区间[CI] 0.218-0.668, p = 0.001）。塑料支架置入与临床成功（比值比[OR] 0.012, 95% CI 0.008-0.549, p = 0.012）、支架通畅（比值比[HR] 6.773, 95% CI 2.221-20.653, p = 0.001）和早期胆管炎（比值比[OR] 5.000, 95% CI 1.006-24.841, p = 0.049）相关。铋IV级与支架通畅独立相关（HR 4.956, 95% CI 1.245-19.730, p = 0.023）。结论：对于h - icc诱导的MHBO，金属支架置入可获得更好的胆道引流，并结合全身抗肿瘤治疗，可进一步提高患者生存率。
{"title":"The Biliary Stenting Strategy for the Unresectable Hilar Type of Intrahepatic Cholangiocarcinoma: A Single-Center Experience","authors":"Cui Chen, Wen Chao Zhao, Ming Xing Xia, Jia Hui Zhu, Ting Ting Fu, Jun Wu, Zhi Yuan Yao, Bing Hu","doi":"10.1111/1751-2980.13350","DOIUrl":"10.1111/1751-2980.13350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Hilar-type intrahepatic cholangiocarcinoma (H-ICC), which originates from the large bile ducts, tends to invade the hepatic hilus and results in malignant hilar biliary obstruction (MHBO). Compared with hilar cholangiocarcinoma (HC), H-ICC exhibits a more aggressive biological behavior and a dismal prognosis. We aimed to investigate the optimal biliary stenting strategy for the treatment of unresectable H-ICC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with unresectable H-ICC who received endoscopic biliary stenting (EBS) between January 2012 and June 2019 were retrospectively included in this study. The prognostic factors of survival outcome, clinical success, duration of stent patency, and EBS-related adverse events were analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 70 patients were enrolled, including 72.9% patients with multiple intrahepatic lesions and 44.3% with lymphatic metastasis. Jaundice control was achieved in 81.4% of the patients. Early cholangitis was the main treatment-related complication (17.1%). After successful stenting, systematic antitumor therapy was the only independent factor related to overall survival (hazard ratio [HR] 0.381, 95% confidence interval [CI] 0.218–0.668, <i>p</i> = 0.001). Plastic stenting was associated with clinical success (odds ratio [OR] 0.012, 95% CI 0.008–0.549, <i>p</i> = 0.012), stent patency (HR 6.773, 95% CI 2.221–20.653, <i>p</i> = 0.001), and early cholangitis (OR 5.000, 95% CI 1.006–24.841, <i>p</i> = 0.049). Bismuth classification IV was independently related to stent patency (HR 4.956, 95% CI 1.245–19.730, <i>p</i> = 0.023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For H-ICC-induced MHBO, metal stent placement may achieve better biliary drainage and, combined with systemic antitumor therapies, may further improve patient survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15564,"journal":{"name":"Journal of Digestive Diseases","volume":"26 3-4","pages":"170-178"},"PeriodicalIF":2.3,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208685","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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