Therapeutic Advances in Gastroenterology最新文献

Background: Inflammatory digestive diseases can majorly impact the physical and mental well-being of affected patients.

Objectives: This meta-analysis aimed to assess the efficacy of psychological interventions (including psychotherapy, mindfulness, cognitive-behavioral therapy, relaxation techniques, meditation, stress management, self-help strategies, psychoeducation, motivational interviewing, hypnotherapy, solution-based therapy, and counseling) on mental parameters and disease-related outcomes in this population.

Design: This was a systematic review and meta-analysis.

Data sources and methods: The systematic search was conducted on July 31, 2025. Randomized controlled trials (RCTs) were eligible. Outcomes were assessed at the end of therapy and at various time points during the follow-up period (short-, mid-, and long-term follow-up). Owing to the differences in scales and questionnaires, the standardized mean difference (SMD) was used to pool effect sizes, along with corresponding 95% confidence interval (CI). Higgins and Thompson's I ² statistics were used to assess heterogeneity.

Results: We included 24 RCTs that investigated the effect of psychological interventions on depressive symptoms in inflammatory digestive diseases, totaling 1572 participants. The pooled analysis found that psychological interventions resulted in a moderate reduction of depression compared to controls (SMD -0.46; CI: -0.75; -0.18). Data from 19 RCTs with 1593 patients also demonstrated a moderate reduction in anxiety symptoms in subjects undergoing psychological interventions (SMD -0.58; CI: -0.94; -0.22). The pooled analysis of 13 RCTs with 772 participants found that psychological therapy was associated with a moderate decrease in stress (SMD -0.53; CI: -1.04; -0.03). The additional analysis of follow-up data showed that benefits resulting from treatment gradually decreased, showing no significant difference at the end of the long-term follow-up period.

Conclusion: Psychological interventions effectively improve mental health-related outcomes in patients with inflammatory digestive diseases. Since benefits from therapy seem to decrease during the follow-up period, repeated interventions may be necessary.

Trial registration: The study protocol was prospectively registered on PROSPERO (CRD42021282965).

Background: Patients with inflammatory bowel disease (IBD) are at heightened risk of infection for several reasons.

Objectives: To evaluate the factors predisposing IBD patients to gastrointestinal (GI) infections, the elements influencing the severity of these infections and the likelihood of hospitalization, and the impact of GI bacterial infections on the progression of IBD.

Design: Retrospective, single-center, case-control study of IBD patients with GI infection and matched controls.

Methods: Patients with ulcerative colitis (UC) or Crohn's disease who tested positive for Campylobacter spp., Yersinia spp., Salmonella spp., or enterohemorrhagic Escherichia coli were enrolled. Clostridioides difficile was excluded due to its distinct epidemiology. For each patient with a GI bacterial infection, a control patient with IBD but without the infection was matched by sex and proximity in calendar age. Data were collected from electronic patient records spanning from January 2008 to June 2023. Various risk factors for medical consultations and hospitalizations due to GI bacterial infections were evaluated. Fisher's exact test and logistic regression were used to assess the associations between GI infections and clinical outcomes.

Results: Of the 5194 IBD patients in the IBD registry, 123 patients had a confirmed GI infection, the majority having UC (n = 79, 64%). Patients who experienced GI infection had a higher likelihood of experiencing an IBD flare within 1-6 months post-infection, often requiring intensification of medication, than the control group. However, such factors as age, IBD phenotype, disease activity, comorbidities, IBD pharmacological treatment, and prior travel to countries with lower hygiene standards did not increase the risk of severe bacterial infection or the likelihood of requiring hospitalization.

Conclusion: Our study indicates that IBD patients diagnosed with GI infections may be at elevated risk of experiencing an IBD flare within 1-6 months post-infection, often necessitating the intensification of their pharmacological treatment.

Background: Upadacitinib (UPA) is a new small-molecule drug for treating inflammatory bowel disease (IBD); however, its therapeutic use in China remains limited.

Objectives: This study aimed to explore Chinese physicians' treatment preferences for UPA in IBD and analyze experience-related decision-making differences.

Design: A nationwide cross-sectional study conducted among Chinese physicians.

Methods: The study was conducted among Chinese physicians using a 69-item questionnaire on physicians' backgrounds and UPA preferences, covering (1) Physician backgrounds (12 items), (2) Therapeutic preferences regarding physicians' attention to different characteristics of UPA and physicians (24 items), and (3) clinical application practices (33 items). Physicians were categorized into experienced and inexperienced groups, and preference differences were compared and analyzed using chi-square or Fisher's exact tests.

Results: Of 583 participating physicians, 182 were classified as experienced and 401 as inexperienced. Safety and efficacy were prioritized by 63.8% and 61.6% of physicians, respectively. UPA was preferred for patients with IBD aged 18-60 years (452/583, 77.5%) and with moderate-to-severe disease activity (486/583, 83.4%). For clinical application, experienced physicians preferred efficacy assessments at week 8 (63/182, 34.6%), while inexperienced physicians preferred week 12 (133/401, 33.2%) for patients with ulcerative colitis. Both groups preferred week 12 for efficacy assessments (251/583, 43.0%) and evaluation of perianal involvement (269/583, 46.1%) and extraintestinal manifestations (271/583, 46.5%) in Crohn's disease. Safety concerns included thrombosis, opportunistic infections, and severe infections, with discontinuation recommended for severe infections, cardiovascular events, or thrombosis.

Conclusion: This was the first nationwide cross-sectional study to investigate the therapeutic preferences of Chinese physicians for UPA in patients with IBD. These findings provide evidence-based support for UPA applications in China but require further real-world validation.

Background: Magnetic resonance enterography (MRE) is a noninvasive and radiation-free option for managing Crohn's disease (CD), for which various predictors have been reported to show significant prognostic value.

Objectives: The aim of this review was to summarize MRE predictors that indicated poor prognosis, including surgeries, complications, relapses, therapeutic escalations, and persistent pathological changes in patients with CD.

Design: Systematic review with meta-analysis.

Data sources and methods: Web of Science and PubMed were systematically searched for articles exploring the predictive performance of MRE in patients with luminal CD, with the latest search performed on July 21, 2025. Pooled analyses of odds ratios (OR) and hazard ratios for predicting poor prognosis were conducted using a random-effects model when available.

Results: Thirty articles were included in this study. Meta-analysis identified five significant MRE predictors for predicting CD poor prognosis over 12 months, including inflammation (OR 3.40, 95% confidence interval (CI 1.96-5.89)), bowel wall thickening (OR 2.88, 95% CI (1.95-4.25)), strictures (OR 4.95, 95% CI (1.99-12.34)), edema (OR 2.67, 95% CI (1.25-5.69)), and fistula (OR 5.15, 95% CI (2.72-9.76)). Furthermore, scoring systems, such as the Magnetic Resonance Index of Activity (MaRIA) and Clermont scores, showed significant predictive values.

Conclusion: MRE is effective in predicting the prognosis of patients with CD, with significant predictors including inflammation, bowel wall thickening, strictures, edema, fistula, and MaRIA score.

Trial registration: The study protocol was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42022365965).

Background: Optimal management of peptic ulcer bleeding remains a clinical challenge.

Objectives: To evaluate the efficacy and safety of endoscopic glue injection (EGI) for acute peptic ulcer bleeding.

Design: Single-center retrospective study.

Methods: This study (October 2015-December 2024) included adults (⩾18 years) with high-risk peptic ulcer bleeding (Forrest Ia-IIa) treated with EGI using n-butyl α-cyanoacrylate ester or standard endoscopic treatment (SET) involving contact thermal therapy and hemoclips. The primary endpoint was the rebleeding within 7 days, and the secondary endpoints included rebleeding within 30 days, 30-day all-cause mortality rate, occurrence of adverse events (AEs), and length of hospital stay and intensive care unit (ICU) stay. Risk factors for rebleeding within 7 days were also analyzed.

Results: A total of 148 patients were included (EGI: 57; SET: 91). The rates of rebleeding within 7 days were 8.77% (EGI) versus 20.88% (SET; p = 0.067), and within 30 days were 8.77% versus 21.98%, respectively (p = 0.043). The 30-day all-cause mortality rate was 0.0% for EGI versus 1.1% for SET (p = 1.000). AEs-including Mallory-Weiss syndrome, esophageal blood blister, pulmonary embolism, hemorrhagic shock, cardiovascular or cerebrovascular events, infections, multiple organ failure, and lower limb thrombosis-did not differ significantly between groups (all p > 0.05). Mean hospital stay was shorter in the EGI group (10.91 ± 12.40 vs 15.38 ± 10.91 days; p = 0.002); ICU stay was similar (p = 0.153). Forrest classification Ia (odds ratio (OR) = 8.294; p = 0.013) and kidney disease (OR = 24.257; p = 0.003) were independent risk factors for rebleeding within 7 days.

Conclusion: EGI may be an effective and safe treatment for acute peptic ulcer bleeding, significantly reducing 30-day rebleeding and shortening hospital stay compared with SET. Clinicians should exercise heightened vigilance and consider more intensive monitoring or preventive strategies for patients with Forrest classification Ia ulcers or underlying kidney disease, who are at increased risk of early rebleeding.

Background: Esophageal distensibility, measured by endoluminal functional lumen imaging probe (EndoFLIP), identifies esophageal fibrostenotic changes and is impaired in patients with eosinophilic esophagitis (EoE). Early-phase clinical trials suggested dupilumab could increase esophageal distensibility. However, there are limited data on the long-term impact of dupilumab treatment on fibrostenosis.

Objectives: To evaluate the long-term efficacy of dupilumab, including its impact on esophageal fibrostenotic progression, in adult patients with EoE.

Design: The phase IV study is comprised of a randomized, double-blind, placebo-controlled trial period for 24 weeks, followed by an open-label extension for 104 weeks.

Methods and analysis: In total, 69 adult patients with endoscopically and histologically active EoE have been recruited from 30 global sites and randomized 2:1 to receive dupilumab 300 mg once weekly (qw) or placebo during the double-blind treatment period. Eligible patients continuing into the open-label extension period will receive dupilumab 300 mg qw. The primary endpoint is absolute change from baseline in esophageal distensibility plateau at week (W)24 measured by EndoFLIP. Secondary endpoints include change in esophageal distensibility plateau at W76 and W128; histologic, endoscopic, and molecular features of EoE at W24, W76, and W128; and long-term safety. After the double-blind treatment period, endpoints will be summarized with descriptive statistics.

Ethics: REMODEL will be conducted in accordance with the Declaration of Helsinki, the Council for International Organizations of Medical Sciences international ethical guidelines, and the International Council for Harmonisation Good Clinical Practice guidelines. The protocol was approved by an institutional review board before study initiation.

Discussion: REMODEL will address whether long-term dupilumab treatment can mitigate fibrostenotic progression in patients with EoE and may provide new insights into the roles of interleukin-4 and -13 in the pathophysiology and progression of EoE.

Trial registration: All patients will provide informed consent. REMODEL was registered on ClinicalTrials.gov (NCT06101095) on October 19, 2023.

Background: Colorectal cancer (CRC) remains a multifaceted disease with variations in aetiology, clinical presentation and prognostic factors.

Objectives: This study explores the features and outcomes of sporadic (S-CRC), inflammatory bowel disease-associated CRC (IBD-CRC), early-onset CRC (EO-CRC) and late-onset CRC (LO-CRC).

Design: This is a systematic review and meta-analysis performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Statement, comparing S-CRC versus IBD-CRC and EO-CRC versus LO-CRC.

Data sources and methods: The literature search was conducted on PubMed and Embase databases. The primary endpoint was the overall 5-year survival rate of CRC. Secondary aims included the features of CRC at diagnosis.

Results: Fifty studies and 6,148,851 patients with CRC were included in the analysis. Comparing S-CRC and IBD-CRC, the overall survival was higher in S-CRC (61.88 (range 41.3-78.7) vs 55.54 (51.9-80.9) months). IBD-CRC showed a minor mean age of diagnosis (63.5 (45-78) vs 69.1 ((40-78) years), a minor risk of stage IV (odd ratio (OR) 1.091; 95%CI 1.031-1.155, p = 0.003, I ² 60.24%), higher risk of mucinous tumour (OR 3.150 95%CI 2.797-3.548, p < 0.001, I ² 96.56%), emergency diagnosis (OR 1.598, 95%CI 1.509-1.693, p < 0.001, I ² 77.40%), and synchronous neoplasia (OR 1.942 95%CI 1.705-2.211, p < 0.001, I ² 0.00%). Comparing EO-CRC and LO-CRC, OS was longer in EO-CRC (79.42 (54-96) vs 77.58 (32-92) months). EO-CRC had a higher risk of being diagnosed at stage IV (OR 1.471, 95%CI 1.456-1.486, p < 0.001, I ² 97.12%), and of having mucinous tumours (OR 1.0142, 95%CI 1.015-1.070, p = 0.002, I ² 60.48%) versus LO-CRC. Comparing IBD-CRC, EO-CRC and LO-CRC, IBD-CRC had the shortest OS (61.88 months), the highest rate of mucinous cancer (13%) and emergency diagnosis (24%), whereas metastatic disease at diagnosis was more common in EO-CRC (22.6%).

Conclusion: IBD-CRC was associated with a younger mean age at diagnosis, higher risk of mucinous cancers, emergency presentation, and synchronous neoplasia compared to S-CRC. EO-CRC had a higher risk of being diagnosed at stage IV and of mucinous tumours versus LO-CRC. IBD-CRC seemed to have an overall shorter survival rate and a higher prevalence of mucinous cancers, suggesting different pathways of progression and more aggressive features.

Trial registration: Prospero Registration ID1021182.

Background: When performing endoscopic ultrasound (EUS) using a miniature probe, filling the lumen with water is necessary. However, because of gravity and peristalsis, satisfactory images are often not obtained. Recently, it has been reported that injecting a viscous gel instead of water could facilitate EUS imaging.

Objectives: To determine if EUS performed with rehydration jelly returned interpretable images when the standard method did not.

Design: Prospective cohort study.

Methods: EUS was first attempted in 50 patients using the conventional water-filling method; in cases where satisfactory images were not obtained, EUS was additionally performed using oral rehydration jelly (OS-1). Five endoscopists evaluated the obtained images, and their outcomes were examined.

Results: Satisfactory images were not obtained in 34 cases when using the water-filling method. The images obtained using the jelly method were improved compared to the water-filling method in 29 cases, with a significant improvement in 18 cases. No complications were observed with the jelly method.

Conclusion: For EUS, the jelly method will likely yield good images when satisfactory image quality cannot be obtained using the water-filling method.

Background: To standardize the treatment of inflammatory bowel disease (IBD) by establishing clear treatment targets and optimizing management strategies, the International Organization for the Study of IBD has proposed a treat-to-target (T2T) approach, which is now a popular management paradigm for IBD. However, this paradigm, which was derived primarily from Western countries with a high prevalence of IBD, has not been adopted universally. There is limited information on how T2T strategies are implemented around the world, and particularly in countries where IBD is a more recent phenomenon and has lower prevalence.

Objectives: The aim of this study was to take advantage of the existence of the BRICS IBD Consortium (Brazil, Russia, India, China, and South Africa), a newly formed multinational organization, to get a realistic appraisal of gastroenterologists' attitudes concerning the IBD treatment strategies.

Design: A 59-question online questionnaire was distributed to 227 gastroenterologists from the BRICS countries between February and April 2024.

Methods: Data on gastroenterologists' characteristics, treatment strategies, and adoption of the STRIDE (Selecting Therapeutic Targets in Inflammatory Bowel Disease)-II consensus were collected, focusing primarily on viewpoints and challenges toward IBD T2T strategies.

Results: More than 70% of respondents considered clinical and endoscopic remission, improved quality of life, absence of disability, and restoration of normal growth in children as the most important goals for IBD treatment. Concerns and challenges raised toward the International Organization for the Study of IBD (IOIBD) T2T strategy were the lack of a validated definition of mucosal healing (66.1%), guidelines conflicted with clinical experience (40.1%), psychological comorbidities (89.4%), loss of response to medical therapy (74.9%), complications associated with penetrating Crohn's disease (CD; 74%), fistulising perianal CD (67.4%), and high out-of-pocket costs of therapeutic drug monitoring (69.6%). A step-up strategy was preferred (89%) in mild-to-moderate ulcerative colitis, whereas a top-down strategy was selected by the majority (72.2%) of respondents for CD management. Overall, the BRICS survey indicated that most of the participants had relatively high confidence in the IOIBD T2T recommendations.

Conclusion: Although various concerns were identified, the BRICS survey showed that T2T strategies for IBD have been generally well received but not universally adopted by most gastroenterologists in countries with the more recent emergence of IBD.

Background: Functional abdominal pain disorders (FAPDs) are disorders of the gut-brain interaction. FAPDs are common in children and adolescents (global prevalence 12%) and are associated with psychiatric comorbidity. Internet-delivered cognitive-behavioral therapy (iCBT) is effective for FAPDs, but it's unclear whether children with psychiatric comorbidities benefit equally from the treatment.

Objectives: In this study, we assessed whether having a comorbid psychiatric diagnosis results in different rates of change in iCBT for children with FAPDs.

Design: Between-groups design.

Methods: Participants were 120 children with FAPDs (age 8-12 years) taking part in one of two clinical trials testing 10 weeks of iCBT. For the analyses, participants were divided into groups: presence or absence of psychiatric disorder. The primary outcome was gastrointestinal symptoms, assessed weekly using the Pediatric Quality of Life Gastrointestinal Symptom Scale. Secondary outcomes included health-related quality of life, gastrointestinal-specific anxiety, and pain intensity. Multilevel modeling was used to assess differences in rates of change between groups from baseline to follow-up directly after treatment, and then to 6-month follow-up.

Results: We observed significant improvements in the rates of change for both groups for the primary outcome (gastrointestinal symptoms) and all secondary outcomes during treatment. Children with psychiatric comorbidity had significantly more severe symptoms at baseline on all measures, but there was no difference in the rates of change for the primary outcome (-0.29, 95% confidence interval (CI): -0.70, 0.11, p = 0.159) or any of the secondary outcomes compared to the non-comorbid group. Treatment benefits were sustained at 6-month follow-up.

Conclusion: ICBT seems to be beneficial for children with FAPDs, also in the presence of psychiatric comorbidity. Given the high prevalence of psychiatric comorbidity in this patient group, the results will aid the clinical assessment and treatment planning for these patients.