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Utility of modified endoscopic radial incision and selective cutting combined with short-term stenting for refractory stricture in patients undergoing endoscopic submucosal dissection of superficial esophageal carcinoma.
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-31 eCollection Date: 2025-01-01 DOI: 10.1177/17562848251315416
Lu Chen, Xiajiao Tang, Jingjing Jiang, XiaoChun Yin, Yuxin Wang, Mingyue Li, Ruihua Shi

Background: Refractory esophageal stricture is the common complication of extensive endoscopic submucosal dissection (ESD), without satisfactory endoscopic treatment strategies. We evaluated the efficacy, safety, and long-term patency of the modified endoscopic radial incision and selective cutting combined with short-term stenting (RISC-STS) for the treatment of refractory esophageal stenosis.

Methods: This was a retrospective study. Patients diagnosed with refractory esophageal stricture from June 2016 to June 2023 were enrolled. Efficacy, safety, and risk factors for dysphagia after RISC-STS operation were assessed.

Results: Compared with clinical symptoms before RISC-STS, there was no significant improvement in the times of stricture recurred (p = 0.75). However, the narrowest diameter of esophageal stenosis was significantly larger after RISC-STS treatment (p = 0.04). Corresponding dysphagia scores after RISC-STS were obviously lowered according to the Mellow-Pinkas grading scale (p = 0.002). More cases ((14 (60.87%) vs 5 (21.74%)) received valid symptom-relief periods after RISC-STS (p = 0.0004). The complications of RISC-STS include perforation (4.35%), fever (4.35%), and pain (30.43%). Univariate Cox analysis suggested that resection length >7 cm of scar tissue was a risk factor for refractory dysphagia after RISC-STS.

Conclusion: The present study revealed that RISC-STS is an effective and safe technique for refractory esophageal stricture with lower restenosis, higher valid symptom-relief rate, and fewer complications.

{"title":"Utility of modified endoscopic radial incision and selective cutting combined with short-term stenting for refractory stricture in patients undergoing endoscopic submucosal dissection of superficial esophageal carcinoma.","authors":"Lu Chen, Xiajiao Tang, Jingjing Jiang, XiaoChun Yin, Yuxin Wang, Mingyue Li, Ruihua Shi","doi":"10.1177/17562848251315416","DOIUrl":"https://doi.org/10.1177/17562848251315416","url":null,"abstract":"<p><strong>Background: </strong>Refractory esophageal stricture is the common complication of extensive endoscopic submucosal dissection (ESD), without satisfactory endoscopic treatment strategies. We evaluated the efficacy, safety, and long-term patency of the modified endoscopic radial incision and selective cutting combined with short-term stenting (RISC-STS) for the treatment of refractory esophageal stenosis.</p><p><strong>Methods: </strong>This was a retrospective study. Patients diagnosed with refractory esophageal stricture from June 2016 to June 2023 were enrolled. Efficacy, safety, and risk factors for dysphagia after RISC-STS operation were assessed.</p><p><strong>Results: </strong>Compared with clinical symptoms before RISC-STS, there was no significant improvement in the times of stricture recurred (<i>p</i> = 0.75). However, the narrowest diameter of esophageal stenosis was significantly larger after RISC-STS treatment (<i>p</i> = 0.04). Corresponding dysphagia scores after RISC-STS were obviously lowered according to the Mellow-Pinkas grading scale (<i>p</i> = 0.002). More cases ((14 (60.87%) vs 5 (21.74%)) received valid symptom-relief periods after RISC-STS (<i>p</i> = 0.0004). The complications of RISC-STS include perforation (4.35%), fever (4.35%), and pain (30.43%). Univariate Cox analysis suggested that resection length >7 cm of scar tissue was a risk factor for refractory dysphagia after RISC-STS.</p><p><strong>Conclusion: </strong>The present study revealed that RISC-STS is an effective and safe technique for refractory esophageal stricture with lower restenosis, higher valid symptom-relief rate, and fewer complications.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251315416"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081792","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}
引用次数: 0
Innovative approaches in colorectal cancer screening: advances in detection methods and the role of artificial intelligence.
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-31 eCollection Date: 2025-01-01 DOI: 10.1177/17562848251314829
Changwei Duan, Jianqiu Sheng, Xianzong Ma

Colorectal cancer (CRC) is the third most prevalent cancer globally and poses a significant health threat, making early detection crucial. This review paper explored emerging detection methods for early screening of CRC, including gut microbiota, metabolites, genetic markers, and artificial intelligence (AI)-based technologies. Current screening methods have their respective advantages and limitations, particularly in detecting precursors. First, the importance of the gut microbiome in CRC progression is discussed, highlighting how specific microbial alterations can serve as biomarkers for early detection, potentially enhancing diagnostic accuracy when combined with traditional screening methods. Next, research on metabolic reprogramming illustrates the relationship between metabolic changes and CRC, with studies developing metabolite-based detection models that show good sensitivity for early diagnosis. In terms of genetic markers, methylated DNA markers like SEPTIN9 have demonstrated high sensitivity, although further validation across diverse populations is necessary. Lastly, AI technology has shown immense potential in improving adenoma detection rates, significantly enhancing the quality of colonoscopic examinations through image recognition techniques. This review aims to provide a comprehensive perspective on new strategies for CRC screening, emphasizing the potential of noninvasive detection technologies and the prospects of AI and genomics in clinical applications. Despite several challenges, this review advocates for future large-scale prospective studies to validate the effectiveness and cost-effectiveness of these new screening methods while promoting the implementation of screening protocols tailored to individual characteristics.

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引用次数: 0
The efficacy and safety of Vonoprazan and Tegoprazan in Helicobacter pylori eradication: a comprehensive systematic review and meta-analysis of randomized controlled trials.
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-31 eCollection Date: 2025-01-01 DOI: 10.1177/17562848251314801
Ting Jin, Wei Wu, Lei Zhang, Han Xuan, Haixiang Zhang, Li Zhong

Background: Potassium-competitive acid blocker (P-CAB)-based therapies are emerging as promising alternatives for eradicating Helicobacter pylori infection. However, the comparative efficacy of P-CAB-based therapy versus proton-pump inhibitor (PPI)-based therapy in treating H. pylori infection remains uncertain.

Objectives: This meta-analysis evaluated the efficacy and safety of P-CAB-based therapies, including Vonoprazan (VPZ) and Tegoprazan (TPZ), compared to PPI-based therapies for H. pylori infection. Subgroup analysis assessed the influence of drug history, experimental drug, treatment duration, combination therapies, and geographic regions on treatment outcomes.

Design: Meta-analysis.

Data sources and methods: Comprehensive searches were conducted in major databases, including PubMed, Embase, the Cochrane Library, and Web of Science, up to January 1, 2024. The primary outcome was the eradication rate, analyzed by intention-to-treat (ITT). Secondary outcomes included adverse events. Heterogeneity among studies was assessed using the χ2 test and the I 2 test. I 2 > 50% or p < 0.05 indicated significant heterogeneity.

Results: The analysis totally included 28 randomized controlled trials (RCTs) comprising 37 studies and 8818 patients diagnosed with H. pylori infection. Of these, 14 RCTs, including 20 studies and 4286 patients, compared P-CAB-based therapy with 14-day bismuth-based quadruple therapy (BQT). P-CAB-based therapy exhibited superior eradication rates compared to both 14-day BQT and PPI-based therapy (ITT analysis: 87.0% vs 79.8%, risk ratio (RR) = 1.08, 95% CI: 1.04-1.12, p < 0.0001; and 85.6% vs 77.8%, RR = 1.09, 95% CI: 1.05-1.12, p < 0.00001, respectively). This enhanced efficacy was particularly pronounced in patients with clarithromycin-resistant infections (73.7% vs 41.5%, RR = 1.53, 95% CI: 1.07-2.20, p = 0.02). Subgroup analysis demonstrated higher eradication rates with P-CAB-based therapy in treatment-naïve participants, VPZ recipients, and those receiving 7- or 14-day regimens (dual, triple, or quadruple therapy). However, no significant differences were observed in treatment-experienced subgroups, TPZ recipients, or those on 10-day regimens. In addition, P-CAB-based therapy showed a lower incidence of adverse events than PPI-based treatments (RR = 0.73, 95% CI: 0.63-0.86, p < 0.0001).

Conclusion: P-CAB-based therapies are more effective than traditional PPI-based treatments for eradicating H. pylori infection, with a reduced incidence of adverse events.

Prospero registration: CRD42024503665.

{"title":"The efficacy and safety of Vonoprazan and Tegoprazan in <i>Helicobacter pylori</i> eradication: a comprehensive systematic review and meta-analysis of randomized controlled trials.","authors":"Ting Jin, Wei Wu, Lei Zhang, Han Xuan, Haixiang Zhang, Li Zhong","doi":"10.1177/17562848251314801","DOIUrl":"https://doi.org/10.1177/17562848251314801","url":null,"abstract":"<p><strong>Background: </strong>Potassium-competitive acid blocker (P-CAB)-based therapies are emerging as promising alternatives for eradicating <i>Helicobacter pylori</i> infection. However, the comparative efficacy of P-CAB-based therapy versus proton-pump inhibitor (PPI)-based therapy in treating <i>H. pylori</i> infection remains uncertain.</p><p><strong>Objectives: </strong>This meta-analysis evaluated the efficacy and safety of P-CAB-based therapies, including Vonoprazan (VPZ) and Tegoprazan (TPZ), compared to PPI-based therapies for <i>H. pylori</i> infection. Subgroup analysis assessed the influence of drug history, experimental drug, treatment duration, combination therapies, and geographic regions on treatment outcomes.</p><p><strong>Design: </strong>Meta-analysis.</p><p><strong>Data sources and methods: </strong>Comprehensive searches were conducted in major databases, including PubMed, Embase, the Cochrane Library, and Web of Science, up to January 1, 2024. The primary outcome was the eradication rate, analyzed by intention-to-treat (ITT). Secondary outcomes included adverse events. Heterogeneity among studies was assessed using the χ<sup>2</sup> test and the <i>I</i> <sup>2</sup> test. <i>I</i> <sup>2</sup> > 50% or <i>p</i> < 0.05 indicated significant heterogeneity.</p><p><strong>Results: </strong>The analysis totally included 28 randomized controlled trials (RCTs) comprising 37 studies and 8818 patients diagnosed with <i>H. pylori</i> infection. Of these, 14 RCTs, including 20 studies and 4286 patients, compared P-CAB-based therapy with 14-day bismuth-based quadruple therapy (BQT). P-CAB-based therapy exhibited superior eradication rates compared to both 14-day BQT and PPI-based therapy (ITT analysis: 87.0% vs 79.8%, risk ratio (RR) = 1.08, 95% CI: 1.04-1.12, <i>p</i> < 0.0001; and 85.6% vs 77.8%, RR = 1.09, 95% CI: 1.05-1.12, <i>p</i> < 0.00001, respectively). This enhanced efficacy was particularly pronounced in patients with clarithromycin-resistant infections (73.7% vs 41.5%, RR = 1.53, 95% CI: 1.07-2.20, <i>p</i> = 0.02). Subgroup analysis demonstrated higher eradication rates with P-CAB-based therapy in treatment-naïve participants, VPZ recipients, and those receiving 7- or 14-day regimens (dual, triple, or quadruple therapy). However, no significant differences were observed in treatment-experienced subgroups, TPZ recipients, or those on 10-day regimens. In addition, P-CAB-based therapy showed a lower incidence of adverse events than PPI-based treatments (RR = 0.73, 95% CI: 0.63-0.86, <i>p</i> < 0.0001).</p><p><strong>Conclusion: </strong>P-CAB-based therapies are more effective than traditional PPI-based treatments for eradicating <i>H. pylori</i> infection, with a reduced incidence of adverse events.</p><p><strong>Prospero registration: </strong>CRD42024503665.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251314801"},"PeriodicalIF":3.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11783504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081790","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}
引用次数: 0
Pouchitis unveiled: exploring clinical features, diagnosis, and cutting-edge treatments.
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-27 eCollection Date: 2025-01-01 DOI: 10.1177/17562848251316412
Francesca Lusetti, Camilla Almeida Martins Helfenberger, Munique Kurtz de Mello, Natália Sousa Freitas Queiroz

Last decades led to a revolution in the management of ulcerative colitis (UC), due to the development of novel advanced therapies and the identification of increasingly ambitious therapeutic goals. Nevertheless, a subset of patients, refractory to available therapies, still requires proctocolectomy with ileal pouch-anal anastomosis (IPAA). Pouchitis, an inflammatory condition of the ileal pouch, is the most common long-term complication of IPAA, affecting almost one-half of patients in the first 10 years after surgery. Symptoms of pouchitis include increased stool frequency, urgency, and abdominal discomfort, significantly affecting patients' quality of life. Traditionally the mainstay treatment of acute pouchitis involves the use of antibiotics, but one-fifth of patients develop chronic pouchitis (CP), which may be dependent or resistant to antibiotics, posing significant challenges in the management of this condition. Currently, there is still no consensus on the optimal management for CP, though recent progress in understanding the pathophysiology of pouchitis has paved the way for innovative therapeutic approaches, based on biological therapies and small molecules. This review aims to discuss the recent advanced therapies available for pouchitis and provide a comprehensive review on the topic to guide physicians in their clinical practice.

{"title":"Pouchitis unveiled: exploring clinical features, diagnosis, and cutting-edge treatments.","authors":"Francesca Lusetti, Camilla Almeida Martins Helfenberger, Munique Kurtz de Mello, Natália Sousa Freitas Queiroz","doi":"10.1177/17562848251316412","DOIUrl":"10.1177/17562848251316412","url":null,"abstract":"<p><p>Last decades led to a revolution in the management of ulcerative colitis (UC), due to the development of novel advanced therapies and the identification of increasingly ambitious therapeutic goals. Nevertheless, a subset of patients, refractory to available therapies, still requires proctocolectomy with ileal pouch-anal anastomosis (IPAA). Pouchitis, an inflammatory condition of the ileal pouch, is the most common long-term complication of IPAA, affecting almost one-half of patients in the first 10 years after surgery. Symptoms of pouchitis include increased stool frequency, urgency, and abdominal discomfort, significantly affecting patients' quality of life. Traditionally the mainstay treatment of acute pouchitis involves the use of antibiotics, but one-fifth of patients develop chronic pouchitis (CP), which may be dependent or resistant to antibiotics, posing significant challenges in the management of this condition. Currently, there is still no consensus on the optimal management for CP, though recent progress in understanding the pathophysiology of pouchitis has paved the way for innovative therapeutic approaches, based on biological therapies and small molecules. This review aims to discuss the recent advanced therapies available for pouchitis and provide a comprehensive review on the topic to guide physicians in their clinical practice.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848251316412"},"PeriodicalIF":3.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061151","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}
引用次数: 0
Association between alkaline phosphatase levels and mortality in Chinese patients with colorectal cancer with liver metastases: a retrospective cohort study.
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-22 eCollection Date: 2025-01-01 DOI: 10.1177/17562848241311114
ZhaoXi Liu, ZiQing Zhang, GuoFang Yu, MingJiang Mo, ChuanYu Xie, DangHan Xu, JieTao Lin, YuChen Zhang, Li Deng, YiChang Luo, YingFeng Huang, Cui Shao

Background: Alkaline phosphatase (ALP) is a potential cancer biomarker. However, its prognostic value in patients with colorectal liver metastasis remains unclear.

Objectives: This study aimed to investigate the association between ALP levels and mortality risk in patients with colorectal liver metastases (CRLM), providing insights for enhancing prognostic assessments.

Design: Retrospective cohort study.

Methods: This study included 195 patients with CRLM from a single centre in China. ALP level was the primary exposure variable, with demographic, clinical and pathological factors serving as covariates. Multivariate Cox regression analyses were used to evaluate the impact of ALP on mortality over a 4-year follow-up period. Covariates included the number of liver metastases, T stage, N stage, chemotherapy, tumour location, primary surgery, topical treatment, apolipoprotein A1, targeted therapy, tumour type, CA-199 levels, metastatic surgery, sex, Karnofsky Performance Status and age.

Results: Of 195 enrolled patients, 134 (68.72%) were male, and 61 (31.28%) were female, with ages ranging from January 2008 to December 2019. A total of 147 patients (76.96%) were diagnosed with left hemicolon cancer and 44 (23.04%) with right hemicolon cancer. After adjusting for the covariates, elevated ALP levels were significantly associated with an increased risk of mortality (hazard ratio = 1.24, 95% confidence interval: 1.08-1.43, p = 0.0029). Sensitivity analyses confirmed the robustness of these findings, reinforcing the association across different analytical approaches.

Conclusion: ALP level is a valuable prognostic indicator in patients with CRLM. Integrating ALP measurement into clinical practice may enhance risk stratification and patient management. Future research should explore the role of ALP in broader populations and explore its implications for treatment strategies.

{"title":"Association between alkaline phosphatase levels and mortality in Chinese patients with colorectal cancer with liver metastases: a retrospective cohort study.","authors":"ZhaoXi Liu, ZiQing Zhang, GuoFang Yu, MingJiang Mo, ChuanYu Xie, DangHan Xu, JieTao Lin, YuChen Zhang, Li Deng, YiChang Luo, YingFeng Huang, Cui Shao","doi":"10.1177/17562848241311114","DOIUrl":"10.1177/17562848241311114","url":null,"abstract":"<p><strong>Background: </strong>Alkaline phosphatase (ALP) is a potential cancer biomarker. However, its prognostic value in patients with colorectal liver metastasis remains unclear.</p><p><strong>Objectives: </strong>This study aimed to investigate the association between ALP levels and mortality risk in patients with colorectal liver metastases (CRLM), providing insights for enhancing prognostic assessments.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>This study included 195 patients with CRLM from a single centre in China. ALP level was the primary exposure variable, with demographic, clinical and pathological factors serving as covariates. Multivariate Cox regression analyses were used to evaluate the impact of ALP on mortality over a 4-year follow-up period. Covariates included the number of liver metastases, T stage, N stage, chemotherapy, tumour location, primary surgery, topical treatment, apolipoprotein A1, targeted therapy, tumour type, CA-199 levels, metastatic surgery, sex, Karnofsky Performance Status and age.</p><p><strong>Results: </strong>Of 195 enrolled patients, 134 (68.72%) were male, and 61 (31.28%) were female, with ages ranging from January 2008 to December 2019. A total of 147 patients (76.96%) were diagnosed with left hemicolon cancer and 44 (23.04%) with right hemicolon cancer. After adjusting for the covariates, elevated ALP levels were significantly associated with an increased risk of mortality (hazard ratio = 1.24, 95% confidence interval: 1.08-1.43, <i>p</i> = 0.0029). Sensitivity analyses confirmed the robustness of these findings, reinforcing the association across different analytical approaches.</p><p><strong>Conclusion: </strong>ALP level is a valuable prognostic indicator in patients with CRLM. Integrating ALP measurement into clinical practice may enhance risk stratification and patient management. Future research should explore the role of ALP in broader populations and explore its implications for treatment strategies.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848241311114"},"PeriodicalIF":3.9,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025105","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}
引用次数: 0
Therapeutic regimens against Helicobacter pylori infection without proton pump inhibitors in patients with corpus atrophic gastritis: a real-life single-centre longitudinal observational study. 萎缩性胃炎患者无质子泵抑制剂抗幽门螺杆菌感染的治疗方案:一项真实的单中心纵向观察研究
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-14 eCollection Date: 2025-01-01 DOI: 10.1177/17562848241308035
Emanuele Dilaghi, Lorenzo Mosciatti, Ludovica Dottori, Irene Ligato, Gianluca Esposito, Emanuela Pilozzi, Bruno Annibale, Edith Lahner

Background: Efficacy of eradication regimens in Helicobacter pylori (Hp) infection is commonly reported with proton pump inhibitors (PPIs). In patients with corpus atrophic gastritis, characterized by impaired acid secretion, PPI treatment is questionable.

Objectives: The current study aimed to assess in clinical practice the tolerability and eradication rate of modified eradication regimens without PPI as first-line treatment in patients with histologically Hp-positive corpus atrophic gastritis.

Design: Real-life longitudinal observational study.

Methods: Overall, 76 patients (77.6% females, age 58.5 (26-88) years) with histologically Hp-positive corpus atrophic gastritis were consecutively diagnosed (2001-2022). First-line eradication treatment was prescribed without PPIs: concomitant or sequential amoxicillin-based therapy (ABT) until 2016 (n = 30), then single-pill bismuth treatment (SPBT; n = 46). Treatment adherence and adverse events were clinically evaluated and treatment efficacy was assessed by histopathology (updated Sydney system) at 6 ± 3 months after treatment.

Results: Only mild adverse events not requiring medical treatment were observed in four patients treated with SPBT without PPIs (vomiting, self-limiting diarrhoea, nausea, abdominal discomfort) and in two treated with ABT without PPIs (vomiting and abdominal discomfort). Overall, 71/76 (93.4%) corpus atrophic gastritis patients completed the treatment: 43/46 (93.5%) SPBT without PPIs and 28/30 (93.3%) ABT without PPIs. Successful cure of Hp was observed in 64/71 patients: overall eradication rate 90.1%, 95%CI 69.4%-115.1%. 42/43 corpus atrophic gastritis patients treated with SPBT without PPIs were successfully cured against 22/28 of those treated with ABT without PPIs. The eradication rate was higher for SPBT than ABT: 97.7%, 95%CI 70.4%-132.0% vs 78.6%, 95%CI 49.2%-118.9%, p = 0.013.

Conclusion: In clinical practice, Hp cure can be achieved without PPIs as first-line treatment in about 90% of patients with corpus atrophic gastritis.

背景:质子泵抑制剂(PPIs)对幽门螺杆菌(Hp)感染的根除方案的疗效通常被报道。对于以酸分泌受损为特征的萎缩性胃炎患者,PPI的治疗是值得怀疑的。目的:本研究旨在临床实践中评估不加PPI的改良根除方案作为hp组织学阳性的萎缩性胃炎患者一线治疗的耐受性和根除率。设计:真实的纵向观察研究。方法:2001-2022年连续诊断组织学hp阳性的萎缩性胃炎76例(女性77.6%,年龄58.5(26-88)岁)。在没有PPIs的情况下进行一线根除治疗:在2016年之前(n = 30),同时或顺序使用基于阿莫西林的治疗(ABT),然后使用单片铋治疗(SPBT;n = 46)。治疗后6±3个月,临床评估治疗依从性和不良事件,并采用组织病理学(更新的Sydney系统)评估治疗效果。结果:4例接受SPBT治疗而不使用PPIs的患者仅观察到不需要药物治疗的轻度不良事件(呕吐、自限性腹泻、恶心、腹部不适),2例接受ABT治疗而不使用PPIs的患者(呕吐和腹部不适)。总体而言,71/76(93.4%)的萎缩性胃炎患者完成了治疗:43/46(93.5%)的SPBT未使用PPIs, 28/30(93.3%)的ABT未使用PPIs。71例患者中64例成功治愈Hp,总根除率90.1%,95%CI 69.4% ~ 115.1%。应用SPBT治疗的萎缩性胃炎患者有42/43成功治愈,而应用ABT治疗的患者有22/28成功治愈。SPBT的根除率为97.7%,95%CI 70.4% ~ 132.0%比78.6%,95%CI 49.2% ~ 118.9%, p = 0.013。结论:在临床实践中,约90%的萎缩性胃炎患者不使用质子泵抑制剂作为一线治疗,Hp可以治愈。
{"title":"Therapeutic regimens against <i>Helicobacter pylori</i> infection without proton pump inhibitors in patients with corpus atrophic gastritis: a real-life single-centre longitudinal observational study.","authors":"Emanuele Dilaghi, Lorenzo Mosciatti, Ludovica Dottori, Irene Ligato, Gianluca Esposito, Emanuela Pilozzi, Bruno Annibale, Edith Lahner","doi":"10.1177/17562848241308035","DOIUrl":"10.1177/17562848241308035","url":null,"abstract":"<p><strong>Background: </strong>Efficacy of eradication regimens in <i>Helicobacter pylori</i> (Hp) infection is commonly reported with proton pump inhibitors (PPIs). In patients with corpus atrophic gastritis, characterized by impaired acid secretion, PPI treatment is questionable.</p><p><strong>Objectives: </strong>The current study aimed to assess in clinical practice the tolerability and eradication rate of modified eradication regimens without PPI as first-line treatment in patients with histologically Hp-positive corpus atrophic gastritis.</p><p><strong>Design: </strong>Real-life longitudinal observational study.</p><p><strong>Methods: </strong>Overall, 76 patients (77.6% females, age 58.5 (26-88) years) with histologically Hp-positive corpus atrophic gastritis were consecutively diagnosed (2001-2022). First-line eradication treatment was prescribed without PPIs: concomitant or sequential amoxicillin-based therapy (ABT) until 2016 (<i>n</i> = 30), then single-pill bismuth treatment (SPBT; <i>n</i> = 46). Treatment adherence and adverse events were clinically evaluated and treatment efficacy was assessed by histopathology (updated Sydney system) at 6 ± 3 months after treatment.</p><p><strong>Results: </strong>Only mild adverse events not requiring medical treatment were observed in four patients treated with SPBT without PPIs (vomiting, self-limiting diarrhoea, nausea, abdominal discomfort) and in two treated with ABT without PPIs (vomiting and abdominal discomfort). Overall, 71/76 (93.4%) corpus atrophic gastritis patients completed the treatment: 43/46 (93.5%) SPBT without PPIs and 28/30 (93.3%) ABT without PPIs. Successful cure of Hp was observed in 64/71 patients: overall eradication rate 90.1%, 95%CI 69.4%-115.1%. 42/43 corpus atrophic gastritis patients treated with SPBT without PPIs were successfully cured against 22/28 of those treated with ABT without PPIs. The eradication rate was higher for SPBT than ABT: 97.7%, 95%CI 70.4%-132.0% vs 78.6%, 95%CI 49.2%-118.9%, <i>p</i> = 0.013.</p><p><strong>Conclusion: </strong>In clinical practice, Hp cure can be achieved without PPIs as first-line treatment in about 90% of patients with corpus atrophic gastritis.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848241308035"},"PeriodicalIF":3.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013644","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}
引用次数: 0
Risk factors associated with complications of palliative drainage of ascites with tunneled peritoneal catheters. 隧道腹膜导管姑息性腹水引流并发症的相关危险因素
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-10 eCollection Date: 2025-01-01 DOI: 10.1177/17562848241310183
Domenique Machnik, Sarah Fischer, Marcel Vetter, Ricarda Lamprecht-Bailer, Rachel Rouse-Merkel, Daniel Klett, Markus F Neurath, Deike Strobel, Sebastian Zundler, Sophie Haberkamp

Background: Medically intractable ascites causes substantial distress in patients with palliative disease. Tunneled peritoneal catheters have been established as a feasible treatment option allowing patient-controlled paracentesis in a homecare setting. However, while a range of complications is associated with these drainages, risk factors for complications have not been identified so far.

Objectives: To explore potential risk factors associated with complications of tunneled peritoneal catheters.

Design: Retrospective observational cohort study.

Methods: Single-center cohort comprising 49 patients with palliative disease receiving 57 tunneled peritoneal catheters at a tertiary care hospital.

Results: Catheter placement was successful in all patients and associated with low numbers of severe complications. Our data suggest a higher risk for severe late complications in patients with benign disease, with drainage replacement, and when performed by less experienced physicians.

Conclusion: Tunneled peritoneal catheters are an effective and safe option to treat symptomatic ascites in patients with end-stage palliative disease. The indication should be carefully considered in patients with benign disease and after removal or dislocation of a previous catheter.

背景:医学上难治性腹水给姑息性疾病患者带来巨大痛苦。隧道腹膜导管已被确立为一种可行的治疗选择,允许在家庭护理设置患者控制穿刺。然而,尽管一系列并发症与这些引流有关,但迄今为止尚未确定并发症的危险因素。目的:探讨隧道式腹膜导管并发症的潜在危险因素。设计:回顾性观察队列研究。方法:单中心队列包括49例姑息性疾病患者,在三级医院接受57根隧道腹膜导管。结果:所有患者置管成功,严重并发症发生率低。我们的数据表明,在良性疾病患者中,当由经验不足的医生进行引流替代时,发生严重晚期并发症的风险更高。结论:隧道式腹膜导尿管是治疗晚期姑息性疾病患者症状性腹水的一种有效且安全的选择。对于患有良性疾病的患者,以及以前的导管切除或脱位后,应仔细考虑适应症。
{"title":"Risk factors associated with complications of palliative drainage of ascites with tunneled peritoneal catheters.","authors":"Domenique Machnik, Sarah Fischer, Marcel Vetter, Ricarda Lamprecht-Bailer, Rachel Rouse-Merkel, Daniel Klett, Markus F Neurath, Deike Strobel, Sebastian Zundler, Sophie Haberkamp","doi":"10.1177/17562848241310183","DOIUrl":"10.1177/17562848241310183","url":null,"abstract":"<p><strong>Background: </strong>Medically intractable ascites causes substantial distress in patients with palliative disease. Tunneled peritoneal catheters have been established as a feasible treatment option allowing patient-controlled paracentesis in a homecare setting. However, while a range of complications is associated with these drainages, risk factors for complications have not been identified so far.</p><p><strong>Objectives: </strong>To explore potential risk factors associated with complications of tunneled peritoneal catheters.</p><p><strong>Design: </strong>Retrospective observational cohort study.</p><p><strong>Methods: </strong>Single-center cohort comprising 49 patients with palliative disease receiving 57 tunneled peritoneal catheters at a tertiary care hospital.</p><p><strong>Results: </strong>Catheter placement was successful in all patients and associated with low numbers of severe complications. Our data suggest a higher risk for severe late complications in patients with benign disease, with drainage replacement, and when performed by less experienced physicians.</p><p><strong>Conclusion: </strong>Tunneled peritoneal catheters are an effective and safe option to treat symptomatic ascites in patients with end-stage palliative disease. The indication should be carefully considered in patients with benign disease and after removal or dislocation of a previous catheter.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848241310183"},"PeriodicalIF":3.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972866","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}
引用次数: 0
Effectiveness and safety of oral vancomycin for the treatment of inflammatory bowel disease associated with primary sclerosing cholangitis: a systematic review and pooled analysis. 口服万古霉素治疗原发性硬化性胆管炎相关炎症性肠病的有效性和安全性:一项系统综述和汇总分析
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-09 eCollection Date: 2025-01-01 DOI: 10.1177/17562848241312766
Wassel Sannaa, Mazen Almasry, Mustafa Peedikayil, Alyssa A Grimshaw, Mashary Attamimi, Abdulelah AlMutairdi, Badr Al-Bawardy

Background: Inflammatory bowel disease (IBD) occurs in up to 70%-80% of patients with primary sclerosing cholangitis (PSC). Oral vancomycin therapy (OVT) has been reported to be effective in the treatment of IBD associated with PSC (IBD-PSC).

Objectives: To examine the effectiveness and safety of OVT in the treatment of IBD-PSC by performing a systematic review and pooled analysis of the literature.

Design: We performed a systematic review and pooled analysis of studies reporting IBD clinical response to OVT in IBD-PSC.

Data sources and methods: A systematic search was conducted in Cochrane Library, Embase, Google Scholar, Medline, PubMed, Scopus, and Web of Science from database inception to June 3, 2024. We included adult and pediatric studies that reported on clinical response (defined as any improvement in IBD-related clinical symptoms) of IBD-PSC patients treated with OVT (including pre- and post-liver transplantation cohorts). Pooled analyses of OVT response and safety were performed.

Results: A total of 21 (open-label, non-controlled) studies including 290 patients with IBD-PSC treated with OVT were included. The median duration of OVT to treat IBD-PSC was 32.5 weeks (interquartile range (IQR): 19-83 weeks). The total daily dose of OVT ranged from 250 to 1500 mg. Concomitant treatment included the following: mesalamine in 14.5% (n = 42), advanced therapies in 10.7% (n = 31), and immunosuppressive agents in 14.1% (n = 41). Clinical response was noted in 47.6% (138/290) and clinical remission in 43.5% (100/230). The biochemical remission rate post-OVT was 68.8% (55/80) and endoscopic remission was 39.4% (80/203). Three studies (n = 11) reported no episodes of acute cholangitis while on OVT. Five studies (n = 69) reported an incidence rate of 8.7% of vancomycin-resistant enterococci post-OVT to treat IBD-PSC.

Conclusion: OVT was associated with clinical response/remission in almost half of patients with IBD-PSC with a favorable side effect profile. Further prospective randomized trials are needed to confirm the dosing, efficacy, treatment duration, and long-term safety of OVT for the treatment of IBD-PSC.

Trial registration: The study protocol was registered with PROSPERO a priori (no. CRD42023438341).

背景:炎性肠病(IBD)发生在高达70%-80%的原发性硬化性胆管炎(PSC)患者中。据报道,口服万古霉素治疗(OVT)对IBD合并PSC (IBD-PSC)有效。目的:通过对文献进行系统回顾和汇总分析,研究OVT治疗IBD-PSC的有效性和安全性。设计:我们对报告IBD- psc患者OVT临床反应的研究进行了系统回顾和汇总分析。数据来源和方法:系统检索Cochrane Library、Embase、谷歌Scholar、Medline、PubMed、Scopus和Web of Science,检索时间为数据库建立至2024年6月3日。我们纳入了报告接受OVT治疗的IBD-PSC患者(包括肝移植前和肝移植后队列)的临床反应(定义为ibd相关临床症状的任何改善)的成人和儿科研究。对OVT反应和安全性进行了汇总分析。结果:共纳入21项(开放标签,非对照)研究,包括290例接受OVT治疗的IBD-PSC患者。OVT治疗IBD-PSC的中位持续时间为32.5周(四分位数间距(IQR): 19-83周)。OVT的总日剂量为250至1500毫克。伴随治疗包括:美沙拉胺占14.5% (n = 42),高级治疗占10.7% (n = 31),免疫抑制剂占14.1% (n = 41)。临床缓解率为47.6%(138/290),临床缓解率为43.5%(100/230)。ovt后生化缓解率为68.8%(55/80),内镜下缓解率为39.4%(80/203)。3项研究(n = 11)报告OVT治疗期间未发生急性胆管炎。5项研究(n = 69)报道,ovt治疗IBD-PSC后万古霉素耐药肠球菌的发病率为8.7%。结论:OVT与近一半IBD-PSC患者的临床反应/缓解相关,且副作用良好。需要进一步的前瞻性随机试验来确认OVT治疗IBD-PSC的剂量、疗效、治疗时间和长期安全性。试验注册:研究方案在普洛斯彼罗(PROSPERO)进行了先验注册。CRD42023438341)。
{"title":"Effectiveness and safety of oral vancomycin for the treatment of inflammatory bowel disease associated with primary sclerosing cholangitis: a systematic review and pooled analysis.","authors":"Wassel Sannaa, Mazen Almasry, Mustafa Peedikayil, Alyssa A Grimshaw, Mashary Attamimi, Abdulelah AlMutairdi, Badr Al-Bawardy","doi":"10.1177/17562848241312766","DOIUrl":"10.1177/17562848241312766","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) occurs in up to 70%-80% of patients with primary sclerosing cholangitis (PSC). Oral vancomycin therapy (OVT) has been reported to be effective in the treatment of IBD associated with PSC (IBD-PSC).</p><p><strong>Objectives: </strong>To examine the effectiveness and safety of OVT in the treatment of IBD-PSC by performing a systematic review and pooled analysis of the literature.</p><p><strong>Design: </strong>We performed a systematic review and pooled analysis of studies reporting IBD clinical response to OVT in IBD-PSC.</p><p><strong>Data sources and methods: </strong>A systematic search was conducted in Cochrane Library, Embase, Google Scholar, Medline, PubMed, Scopus, and Web of Science from database inception to June 3, 2024. We included adult and pediatric studies that reported on clinical response (defined as any improvement in IBD-related clinical symptoms) of IBD-PSC patients treated with OVT (including pre- and post-liver transplantation cohorts). Pooled analyses of OVT response and safety were performed.</p><p><strong>Results: </strong>A total of 21 (open-label, non-controlled) studies including 290 patients with IBD-PSC treated with OVT were included. The median duration of OVT to treat IBD-PSC was 32.5 weeks (interquartile range (IQR): 19-83 weeks). The total daily dose of OVT ranged from 250 to 1500 mg. Concomitant treatment included the following: mesalamine in 14.5% (<i>n</i> = 42), advanced therapies in 10.7% (<i>n</i> = 31), and immunosuppressive agents in 14.1% (<i>n</i> = 41). Clinical response was noted in 47.6% (138/290) and clinical remission in 43.5% (100/230). The biochemical remission rate post-OVT was 68.8% (55/80) and endoscopic remission was 39.4% (80/203). Three studies (<i>n</i> = 11) reported no episodes of acute cholangitis while on OVT. Five studies (<i>n</i> = 69) reported an incidence rate of 8.7% of vancomycin-resistant enterococci post-OVT to treat IBD-PSC.</p><p><strong>Conclusion: </strong>OVT was associated with clinical response/remission in almost half of patients with IBD-PSC with a favorable side effect profile. Further prospective randomized trials are needed to confirm the dosing, efficacy, treatment duration, and long-term safety of OVT for the treatment of IBD-PSC.</p><p><strong>Trial registration: </strong>The study protocol was registered with PROSPERO a priori (no. CRD42023438341).</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848241312766"},"PeriodicalIF":3.9,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972865","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}
引用次数: 0
Racecadotril in the management of diarrhea: an underestimated therapeutic option? 消旋卡多曲治疗腹泻:一种被低估的治疗选择?
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-06 eCollection Date: 2025-01-01 DOI: 10.1177/17562848241310423
Marco Manfredi, Gianmarco Marcianò, Silvia Iuliano, Francesco Leo, Luca Gallelli

Acute infectious diarrhea (AID) represents an important clinical entity both regarding morbidity and mortality rates, even in industrialized countries, and it leads to one of the major public health burdens, among gastroenterological diseases, with significant healthcare costs. Oral rehydration solution is the cornerstone of the therapy, but despite its proven efficacy in avoiding dehydration, it is still underused as it does not reduce the duration of diarrhea; hence, it is perceived as ineffective by caregivers. In this narrative review, we collected literature regarding the use of racecadotril, deeply discussing its role in the treatment of AID in both adults and children. Racecadotril has been studied in wide populations of patients, in many countries, and in different clinical settings. Its effectiveness in reducing the stool output and the duration of diarrhea has been proven, not only in the early phase of the disease. Racecadotril has been shown to increase the likelihood of home management of AID, to reduce hospitalizations and parenteral rehydration needs resulting in healthcare costs reduction. The current new formulations require only two-daily doses for adults and the pediatric syrup should simplify its use.

急性感染性腹泻(AID)在发病率和死亡率方面都是一个重要的临床实体,即使在工业化国家也是如此,它是胃肠病中主要的公共卫生负担之一,需要大量的医疗费用。口服补液是治疗的基础,但尽管它在避免脱水方面已被证明有效,但它仍然没有得到充分利用,因为它不能缩短腹泻的持续时间;因此,护理人员认为这是无效的。在这篇叙述性综述中,我们收集了有关消旋卡多曲使用的文献,深入讨论了它在成人和儿童艾滋病治疗中的作用。在许多国家和不同的临床环境中,在广泛的患者人群中研究了消旋卡多曲。它在减少排便量和腹泻持续时间方面的有效性已被证明,而不仅仅是在疾病的早期阶段。racecadtril已被证明可以增加家庭管理艾滋病的可能性,减少住院和肠外补液需求,从而降低医疗费用。目前的新配方只要求成人每天服用两次,儿科糖浆应简化其使用。
{"title":"Racecadotril in the management of diarrhea: an underestimated therapeutic option?","authors":"Marco Manfredi, Gianmarco Marcianò, Silvia Iuliano, Francesco Leo, Luca Gallelli","doi":"10.1177/17562848241310423","DOIUrl":"https://doi.org/10.1177/17562848241310423","url":null,"abstract":"<p><p>Acute infectious diarrhea (AID) represents an important clinical entity both regarding morbidity and mortality rates, even in industrialized countries, and it leads to one of the major public health burdens, among gastroenterological diseases, with significant healthcare costs. Oral rehydration solution is the cornerstone of the therapy, but despite its proven efficacy in avoiding dehydration, it is still underused as it does not reduce the duration of diarrhea; hence, it is perceived as ineffective by caregivers. In this narrative review, we collected literature regarding the use of racecadotril, deeply discussing its role in the treatment of AID in both adults and children. Racecadotril has been studied in wide populations of patients, in many countries, and in different clinical settings. Its effectiveness in reducing the stool output and the duration of diarrhea has been proven, not only in the early phase of the disease. Racecadotril has been shown to increase the likelihood of home management of AID, to reduce hospitalizations and parenteral rehydration needs resulting in healthcare costs reduction. The current new formulations require only two-daily doses for adults and the pediatric syrup should simplify its use.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848241310423"},"PeriodicalIF":3.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957307","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}
引用次数: 0
Hepatobiliary and pancreatic manifestations in inflammatory bowel disease: an umbrella review of meta-analyses. 炎症性肠病的肝胆胰表现:荟萃分析综述
IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2025-01-06 eCollection Date: 2025-01-01 DOI: 10.1177/17562848241311165
Runsheng Hong, Zhixue Li, Meng Li, Yun Dai

Background: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), can affect the hepatobiliary system and pancreas, substantially impacting the life quality of patients.

Objectives: To evaluate the quality of evidence and comprehensively assess the validity of associations of IBD with hepatobiliary and pancreatic diseases.

Design: We performed an umbrella review of existing meta-analyses in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) recommendations.

Data sources and methods: We systematically searched PubMed, Embase, and Web of Science from inception to April 2024, to identify and appraise meta-analyses examining IBD and risk of hepatobiliary and pancreatic manifestations. Methodologic quality was assessed with A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the strength of evidence was graded according to prespecified criteria.

Results: A total of 14 meta-analyses of observational studies were included. The strongest-validity evidence suggested the significant associations between IBD and risk of gallstones (odds ratio (OR) = 1.72; 95% confidence interval (CI) = 1.40-2.12) and acute pancreatitis (OR = 3.11; 95% CI = 2.93-3.30). Highly suggestive evidence indicated a significantly increased risk of hepatobiliary cancer in UC (incidence rate ratio (IRR) = 2.05; 95% CI = 1.52-2.76) and CD (IRR = 2.31; 95% CI = 1.25-4.28). In addition, highly suggestive evidence indicated that IBD was associated with portal venous system thrombosis. Suggestive evidence showed a significantly higher prevalence of primary sclerosing cholangitis, non-alcoholic fatty liver disease, autoimmune hepatitis, and autoimmune pancreatitis in IBD patients than in the general population.

Conclusion: The associations between IBD and multiple hepatobiliary and pancreatic disorders showed varying levels of evidence and magnitude of risk. Further high-quality primary studies are needed to identify IBD patients who are more at risk and would benefit the most from screening and prevention programs.

Trial registration prospero: CRD42023451461.

背景:炎症性肠病(IBD),包括溃疡性结肠炎(UC)和克罗恩病(CD),可影响肝胆系统和胰腺,严重影响患者的生活质量。目的:评价证据质量,综合评价IBD与肝胆胰疾病相关性的有效性。设计:我们按照系统评价和荟萃分析首选报告项目(PRISMA)的建议,对现有的荟萃分析进行了综合评价。数据来源和方法:我们系统地检索了PubMed, Embase和Web of Science从成立到2024年4月,以确定和评估检查IBD和肝胆胰表现风险的荟萃分析。采用评估系统评价的测量工具(AMSTAR 2)对方法学质量进行评估,并根据预先规定的标准对证据的强度进行分级。结果:共纳入14项观察性研究的meta分析。最强效度证据表明IBD与胆结石风险之间存在显著关联(优势比(OR) = 1.72;95%可信区间(CI) = 1.40-2.12)和急性胰腺炎(OR = 3.11;95% ci = 2.93-3.30)。高度提示性证据表明UC患者肝胆癌风险显著增加(发病率比(IRR) = 2.05;95% CI = 1.52-2.76)和CD (IRR = 2.31;95% ci = 1.25-4.28)。此外,极具启发性的证据表明IBD与门静脉系统血栓形成有关。暗示性证据显示,IBD患者的原发性硬化性胆管炎、非酒精性脂肪性肝病、自身免疫性肝炎和自身免疫性胰腺炎的患病率明显高于普通人群。结论:IBD与多种肝胆胰疾病之间的关联显示出不同程度的证据和风险程度。需要进一步的高质量的初步研究来确定IBD患者的风险更高,并从筛查和预防计划中获益最多。试验注册号:CRD42023451461。
{"title":"Hepatobiliary and pancreatic manifestations in inflammatory bowel disease: an umbrella review of meta-analyses.","authors":"Runsheng Hong, Zhixue Li, Meng Li, Yun Dai","doi":"10.1177/17562848241311165","DOIUrl":"https://doi.org/10.1177/17562848241311165","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), can affect the hepatobiliary system and pancreas, substantially impacting the life quality of patients.</p><p><strong>Objectives: </strong>To evaluate the quality of evidence and comprehensively assess the validity of associations of IBD with hepatobiliary and pancreatic diseases.</p><p><strong>Design: </strong>We performed an umbrella review of existing meta-analyses in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) recommendations.</p><p><strong>Data sources and methods: </strong>We systematically searched PubMed, Embase, and Web of Science from inception to April 2024, to identify and appraise meta-analyses examining IBD and risk of hepatobiliary and pancreatic manifestations. Methodologic quality was assessed with A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the strength of evidence was graded according to prespecified criteria.</p><p><strong>Results: </strong>A total of 14 meta-analyses of observational studies were included. The strongest-validity evidence suggested the significant associations between IBD and risk of gallstones (odds ratio (OR) = 1.72; 95% confidence interval (CI) = 1.40-2.12) and acute pancreatitis (OR = 3.11; 95% CI = 2.93-3.30). Highly suggestive evidence indicated a significantly increased risk of hepatobiliary cancer in UC (incidence rate ratio (IRR) = 2.05; 95% CI = 1.52-2.76) and CD (IRR = 2.31; 95% CI = 1.25-4.28). In addition, highly suggestive evidence indicated that IBD was associated with portal venous system thrombosis. Suggestive evidence showed a significantly higher prevalence of primary sclerosing cholangitis, non-alcoholic fatty liver disease, autoimmune hepatitis, and autoimmune pancreatitis in IBD patients than in the general population.</p><p><strong>Conclusion: </strong>The associations between IBD and multiple hepatobiliary and pancreatic disorders showed varying levels of evidence and magnitude of risk. Further high-quality primary studies are needed to identify IBD patients who are more at risk and would benefit the most from screening and prevention programs.</p><p><strong>Trial registration prospero: </strong>CRD42023451461.</p>","PeriodicalId":48770,"journal":{"name":"Therapeutic Advances in Gastroenterology","volume":"18 ","pages":"17562848241311165"},"PeriodicalIF":3.9,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957306","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}
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Therapeutic Advances in Gastroenterology
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