United European Gastroenterology Journal最新文献

Background: Early advanced inflammatory bowel disease (IBD) therapy is emphasised to prevent disease progression and restore quality of life.

Aims: To evaluate the potential advantages of early versus late anti-tumour necrosis factor (TNF) therapy in patients with IBD.

Methods: This retrospective study included patients with newly diagnosed IBD (2004-2018) who received anti-TNF therapy and had at least 1 year of follow-up. Patients were categorised as early or late users based on a 2-year post-diagnosis cut-off for first anti-TNF exposure. Outcomes included IBD-related surgeries, hospitalizations, emergency department (ED) visits, and drug persistence. Subgroup analysis examined concurrent immunomodulator use, and sensitivity analyses were employed 6 months or 1 year post-diagnosis cut-offs.

Results: Among 8105 patients with ulcerative colitis (UC) and 8465 with Crohn's disease (CD), distinct outcomes emerged. Early anti-TNF users with UC had significantly higher hospitalization (hazard ratio [HR] 1.34, 95% confidence interval [CI] 0.91-1.96) and ED visit rates (HR 1.30, 95% CI 1.16-1.46) compared with late users. In CD, early users showed a non-significant trend toward fewer event rates. Drug persistence was longer among late users for both UC and CD. In UC, combining immunomodulators with early anti-TNF increased hospitalization and ED visits but not in CD. Sensitivity analyses confirmed the primary findings.

Conclusions: While early anti-TNF use was associated with differential outcomes in CD, the relationship between treatment timing and clinical course diverged in UC, challenging the assumption that early intervention is universally advantageous across IBD subtypes. These findings underscore the need for further research to identify patient subgroups that might benefit most from early intervention.

Background: Chronic pancreatitis is a risk factor for pancreatic cancer. Autoimmune pancreatitis is a unique form of chronic pancreatitis that is primarily characterized by its immune mediate etiology, clinically resembling pancreatic cancer, yet uniquely responsive to steroid treatment.

Objective: Early and accurate diagnosis of autoimmune pancreatitis is vital for effective treatment and patient prognosis, for which new diagnostic tools are urgently required. Gut microbiota dysbiosis has been identified to correlate with the development of pancreatic diseases, which provides new opportunities for the discovery of disease biomarkers.

Methods: We utilized a mass spectrometric global metabolomics investigation of patient autoimmune pancreatitis and chronic pancreatitis fecal samples, investigating microbiome, dietary and human metabolism.

Results: We discovered a series of newly identified metabolic signatures between both patient groups including enterolactone, 4-guanidinobutanoic acid, and methylthioadenosine sulfoxide. Additionally, the analysis revealed significant differences in several metabolic pathways such as fatty acids, alkaloids, amino acids and peptides.

Conclusion: Our observations provide novel insights into important metabolic human pathways and microbiome-derived metabolites to distinguish autoimmune pancreatitis from chronic pancreatitis. These findings reveal systemic metabolic responses and the identified metabolites may be developed into potential biomarkers for future diagnosis to distinguish between autoimmune pancreatitis and chronic pancreatitis.

Objectives: A novel partially self-expandable metal stent (PCSEMS) with an anti-migration system has recently become available during Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) but requires tract dilation. No previous study has compared the performance of dilation devices during EUS-HGS. The aim of this randomized controlled trial was to evaluate the technical success rate of tract dilation between a balloon catheter and drill dilator technique during EUS-HGS prior to insertion of SEMS with an anti-migration system.

Methods: A single-center, randomized controlled trial comparing the balloon dilation and drill dilator techniques for first-line tract dilation during EUS-HGS. The primary outcome was the initial technical success rate of tract dilation for each technique during EUS-HGS. The secondary outcome was adverse events associated with the procedures.

Results: Of 54 randomized patients who underwent EUS-HGS at our center, there were 27 in the balloon dilation group and 27 in the drill dilation group. The initial technical success rate was 92.6% (25/27) in the balloon dilation group and 100% (27/27) in the drill dilation group (p = 0.1495). The technical success rate of stent delivery system insertion was significantly higher in the balloon dilation group (88%, 22/25) than in the drill dilation group (45%, 13/27; p = 0.0013). Procedure time was significantly shorter in the balloon dilation group (mean, 9.7 min) than in the drill dilation group (mean, 14.0 min; p = 0.047). Adverse events were more frequent in the drill dilation group (7.4% vs. 29.6%, p = 0.038).

Conclusions: Balloon dilation appears more suitable than drill dilation for PCSEMS with 8.5 Fr stent delivery system deployment.

Clinical trial registration number: University Hospital Medical Information Network 000049550.

Objective: The objective of this study was to investigate the efficacy of transcutaneous auricular vagal nerve stimulation (taVNS) in adult patients with chronic constipation.

Design: Consecutive patients who met the Rome IV criteria for chronic constipation were enrolled and randomly assigned to either the taVNS group or the sham-taVNS group. Treatment consisted of 30 min of therapy twice a day for 4 weeks. The primary outcome was the response rate at week 1-4, defined as the proportion of patients with a weekly complete spontaneous bowel movement (CSBM) of ≥ 3 and weekly excessive use of rescue medication ≤ 3 times. Secondary outcomes included spontaneous bowel movements, anxiety and depression scores, abdominal symptoms, and adverse events.

Results: The study was terminated due to lack of efficacy revealed by the interim analysis. A total of 106 patients were randomized, with 52 participants in the taVNS group and 54 participants in the sham-taVNS group. After 4 weeks of treatment, the response rates were 17% (9/52) in the taVNS group and 19% (10/54) in the sham-taVNS group. There was no significant difference between the two groups in intention-to-treat (ITT) analysis (RR 0.92, 95% CI 0.30-2.80, p = 1) or in the per-protocol (PP) analysis. No serious adverse events were reported.

Conclusion: Our study did not support the effectiveness of 4-week 25 Hz taVNS for the treatment of adult chronic constipation patients.

Trial registration: clinicaltrials.gov number: NCT05723731.