Sage Publications

Therapeutic Advances in Gastroenterology

Published by SAGE Publications Inc

Online ISSN: 1756-2848

Journal websiteAuthor guidelines

Top-read articles

385 reads in the past 30 days

LLMs within the AI taxonomy. LLMs exist as a subset of deep learning models, which are a subset of machine learning models. Machine learning models are a subset of AI. Depending on their size, LLMs can also be considered generative AI models.
AI, artificial intelligence; LLM, large language model.
Training a chat-based LLM. Training a chat-based LLM requires a multi-stage learning process. In the pre-training phase, massive quantities of text are fed into a language model that aims to predict sequences of words. To enable instruction-following, the initial model is fine-tuned on a dataset of paired instructions and human responses. The resulting instruction model is used to generate a dataset of responses, which are then ranked by humans. The ranking dataset is then used to train a model that can rank the quality of generated responses. This ‘reward model’ is linked to the instruction-tuned model to create the final chat LLM that prioritizes the generation of high-quality text outputs.
Source: The figure was created with BioRender.com.
LLM, large language model.
Schematic overview of LLM functionality in healthcare. LLMs leverage their knowledge base and reasoning capabilities to integrate data inputs from the user, environment, and the electronic health record. On their own, they produce responses in the form of text or audio. If augmented with tools or additional artificial intelligence models, LLMs can also produce images, data visualization, video, or video overlays. LLM data streams and outputs can be customized to accomplish each task.
Source: The figure was created with BioRender.com.
LLM, large language model.
A research roadmap for LLMs in gastroenterology. Many obstacles stand in the way of implementing LLMs in clinical practice. Additional research is needed at each phase of the translational science spectrum. Basic research is needed to improve model performance and safety. Preclinical research is needed to translate general-purpose models to the gastroenterology domain. Finally, clinical research and implementation are needed to define how to integrate LLMs into practice.
Source: The figure was created with BioRender.com.
LLM, large language model.
Potential use cases for LLMs in clinical gastroenterology.
Large language models: a primer and gastroenterology applications

February 2024

·

9,289 Reads

·

27 Citations

Omer Shahab

·

·

Aasma Shaukat

·

[...]

·

Ali Soroush
Download

Aims and scope


Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area.

Recent articles


Flowchart illustrating the randomization and flow of study participants.
CUSA, cavitron ultrasonic surgical aspirator; HS, harmonic scalpel.
Participant timeline.
Laparoscopic liver parenchymal transection using CUSA versus harmonic scalpel: a protocol for a prospective randomized controlled trial
  • Article
  • Full-text available

June 2025

·

7 Reads

Bin Liang

·

Yufu Peng

·

Wugui Yang

·

[...]

·

Fei Liu

Background The harmonic scalpel (HS) and cavitron ultrasonic surgical aspirator (CUSA) are two common techniques for liver parenchymal transection (LPT). The second International Consensus Conference on laparoscopic liver resection (LLR) recommended the utilization of the HS for superficial layer LPT and the CUSA for deep layer LPT. Some centers currently employ the HS for deep-layer LPT. However, the potential effect of HS during deep layer transection in LLR remains unclear. Objectives The study aims to investigate the feasibility, safety, and efficiency of HS in LLR compared with CUSA. Design This is a study protocol for a randomized controlled trial (RCT). Methods and analysis This RCT will be carried out at West China Hospital of Sichuan University from January 2024 to December 2025. Consecutive patients who underwent LLRs during this period will be recruited based on the specified inclusion and exclusion criteria. The participants will be randomly allocated to the HS group or the CUSA group. The primary outcome is intraoperative blood loss. Secondary outcomes include parenchymal transection velocity, operative time, conversion rate, postoperative hospital stays, hospital cost, morbidity, and mortality. Subgroup analysis will be performed according to liver cirrhosis. The corresponding statistical approach will be used for statistical analysis. Ethics The trial has been reviewed and approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University, on January 19, 2024. Discussion This study will clarify the feasibility, safety, and efficiency of HS for LPT in LLRs. The results will provide more reliable clinical evidence for the selection of LPT devices in LLRs. Trial registration The study protocol was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn) on April 26, 2024, ChiCTR2400083493. The protocol version is V2.0.


Representative endoscopic image of an elevated lesion in a patient with IBD, captured using high-definition white light endoscopy (a). The lesion appears subtly nodular with surface irregularities, features that may suggest dysplasia. Such lesions can be difficult to detect and characterize due to their often flat morphology and inflammation-related mucosal changes. Adjunct imaging techniques such as narrow band imaging (b), alongside emerging AI tools, may aid in improving lesion detection and differentiation during surveillance colonoscopy.
Source: Image used with permission from the authors.
AI, artificial intelligence; IBD, inflammatory bowel disease.
Endoscopic image of a lesion in a patient with IBD, captured using high-definition white light endoscopy with a CADe system. The CADe overlay highlights the lesion with a blue bounding box and an alert score of 0.77, indicating a high level of suspicion for neoplasia. Such real-time visual cues can assist endoscopists in detecting subtle or flat lesions that may otherwise be missed, supporting more effective dysplasia surveillance in IBD.
Source: Image used with permission from the authors.
CADe, computer-aided detection; IBD, inflammatory bowel disease.
of artificial intelligence tools in IBD.
The impact of artificial intelligence on the endoscopic assessment of inflammatory bowel disease-related neoplasia

June 2025

·

13 Reads

Siri A. Urquhart

·

Michael Christof

·

Nayantara Coelho-Prabhu

Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract resulting from an inappropriate immune response to an altered gut microbiome in genetically predisposed individuals. Endoscopy plays a central role in IBD management, aiding in diagnosis, disease staging, monitoring, and therapeutic guidance. Patients with IBD face an increased risk of colorectal neoplasia due to chronic inflammation. Artificial intelligence (AI)-based systems show promise in detecting and classifying dysplasia and neoplasia during endoscopic evaluation. While there have been several studies on the application of AI to detect and diagnose various types of neoplasia in the non-IBD population, the literature in patients with IBD is limited. We aim to summarize the current evidence on the application of AI technologies to detect IBD-associated neoplasia, highlighting potential benefits, limitations, and future directions. A comprehensive literature search was performed using the PubMed database to identify relevant studies from January 2010 to February 2025. Additional references were identified from the relevant articles’ bibliographies. AI-assisted endoscopy, particularly using machine learning and deep learning techniques, has shown promise in improving lesion detection rates and supporting real-time decision-making. Computer-aided detection systems may increase the sensitivity of dysplasia identification, while computer-aided diagnosis tools can aid in lesion characterization. Early studies suggest that AI can reduce interobserver variability, improve targeting of biopsies, and potentially lead to more personalized surveillance strategies. Although clinical data specific to IBD-related neoplasia remain limited compared to sporadic colorectal neoplasia, the integration of AI into endoscopic practice holds significant potential to enhance dysplasia detection and improve patient outcomes. Continued research, validation in IBD-specific cohorts, and integration with clinical workflows are essential to realize the full impact of AI in this setting.


Real-life management of nonobstructive esophageal dysphagia: analysis of a prospective multicentric Portuguese cohort

June 2025

·

5 Reads

Background Nonobstructive esophageal dysphagia (NOD) is a common benign condition that significantly impacts quality of life. Management requires a motility-focused approach and consideration for concomitant comorbidities such as gastroesophageal reflux, visceral hypersensitivity, and psychological factors. Currently, esophagogastric junction (EGJ) outflow disorders have the most studied and effective treatments. Data on patient-reported dysphagia and quality of life in this population, and their evolution over time and treatment, are scarce. Objective This study aims to evaluate the real-world management and behavior of NOD, focusing on motility profiles and the implementation of specific treatments. Design This is a multicenter prospective observational study that follows the management and evolution of NOD in a Portuguese cohort for 6 months, focusing on dysphagia and quality of life, to evaluate its clinical behavior. Methods Dysphagia and quality of life were assessed in 195 patients using validated patient-reported questionnaires at baseline and follow-up. Results From 195 patients, 61% (n = 119) were female, with a mean age of 61 (SD 15) years. According to Chicago classification 4.0, 32.3% (n = 63) had EGJ outflow disorders, 12.8% (n = 25) spastic disorders, 16.4% (n = 32) hypomotile disorders, 35.9% (n = 70) normal motility, and 2.6% (n = 5) were inconclusive. At baseline, the mean PROMIS Gastrointestinal Disrupted Swallowing (PDS) T-score, EQ-5D-3L, and Visual Analog Scale (VAS) scores were 61.7 (SD 7.4), 0.61 (SD 0.26), and 69 (SD 18), respectively. Overall, at 6 months, there were significant improvements in the Eckardt, PDS, and EQ-5D-3L scores, with no difference in VAS. In EGJ disorders, myotomy significantly improved all measurements. In the remaining subgroups, a favorable evolution of dysphagia was observed, without differences between treated and untreated patients. Conclusion NOD tends to follow a benign course. Apart from achalasia, which has the most defined treatments with documented benefits, decisions for the remaining motility profiles should follow a comprehensive and personalized approach.


Real-world use of bezlotoxumab to prevent recurrent Clostridioides difficile infections: a single-center experience and meta-analysis

Background Clostridioides difficile infection (CDI) treated with bezlotoxumab (BEZ) has been demonstrated to have a lower recurrence rate than placebo in clinical trials. However, real-world data on BEZ’s effectiveness remain limited and heterogeneous. Objectives To evaluate the real-world effectiveness of BEZ in preventing CDI recurrence through a single-center retrospective cohort and a meta-analysis. Design A retrospective cohort study and a meta-analysis. Methods A retrospective study of patients treated with BEZ from 2017 to 2021 was performed at the Mayo Clinic. Demographics, CDI diagnostics, and several prespecified risk factors were analyzed. A literature search was conducted in August 2024 utilizing the Cochrane Central Register of Controlled Trials, Embase, Medline, Scopus, and Web of Science Core Collection. Studies reporting CDI resolution rates with BEZ were included. The random-effects model described by DerSimonian and Laird was used to calculate weighted pooled resolution rates (WPR) with 95% confidence intervals (CI). We assessed heterogeneity with the inconsistency index (I²) statistic. Results Across 28 studies and our retrospective cohort, 2639 CDI patients were analyzed. Among 1786 patients treated with BEZ, 1450 achieved clinical resolution (WPR: 81.6%, 95% CI 77.2–85.6%), with significant heterogeneity (I² = 77.3%). In subgroup analysis, the pooled relative risk of recurrence was 0.56 (95% CI 0.36–0.88; p < 0.01) for BEZ with SoC compared to SoC alone. A WPR of 83.3% (95% CI 75.5%–91.1%) for patients receiving BEZ with SoC was observed when compared with a WPR of 70.8% (95% CI 62.7%–78.8%) in patients receiving SoC alone on subgroup analysis. In our cohort of 47 patients, the CDI resolution rate was 72.3% (34/47). Conclusion Our retrospective study and meta-analysis demonstrate the real-world efficacy of BEZ in reducing CDI recurrence. The higher recurrence rates in our cohort likely reflect the high-risk nature of the population, including a greater proportion of immunocompromised patients.


Discordance between patients’ perception and endoscopic assessment of disease activity in ulcerative colitis

Background Discrepancies between symptoms and endoscopy exist in patients with ulcerative colitis (UC). Most studies focused on patient-reported outcomes-2 rather than their overall perception of disease activity. Objectives The objectives were to assess the concordance between the patient global assessment (PtGA) and the endoscopic evaluation, to analyse the factors associated with agreement and to describe the concordance between the patient’s and the physician’s perception of UC activity. Design Prospective, observational study. Methods Patients with UC were consecutively included at the time of flexible sigmoidoscopy. The concordance between the Mayo endoscopic subscore (MES) and the PtGA was evaluated. The factors related to concordance were investigated, including the inflammatory bowel disease (IBD)-Disk items that were completed by all patients. Results Out of 104 analysable patients, 32.7% demonstrated complete alignment with the MES. The more the disease was objectively active, the more the patients were concordant, as reflected by the statistically significant differences between concordant and discordant patients in the median (interquartile range) MES (2 (1–2) vs 1 (0–2), respectively (p = 0.002)), Ulcerative Colitis Endoscopic Index of Severity (3 (2–5) vs 1 (0–3), respectively (p = 0.001)) and physician global assessment (whether on a qualitative scale as part of the Mayo score (p = 0.003) or on a 10 cm-visual analogue scale: (4 (1–6) vs 1 (0–3), respectively (p < 0.001)). Over two-thirds of discordant patients perceived their disease as more severe than the endoscopy suggested. While stool frequency did not differ between concordant and discordant patients (p = 0.093), rectal bleeding (p = 0.002) – predictably – and more interestingly, abdominal pain (p = 0.006) and bowel urgency (p = 0.006), emerged as symptoms strongly associated with improved concordance between patient perception and endoscopic evaluation. Conclusion Discrepancies between patient-reported disease activity and endoscopy are prevalent in UC. In addition to rectal bleeding, abdominal pain and bowel urgency may be more accurate to reflect clinical disease activity than stool frequency.


Flow diagram.
Characteristics of patients with and without APC.
Characteristics of patients with and without APC in the sporadic group.
Location of second primary tumors in each dMMR/MSI-H CRC population.
MMR IHC and MSI status of APC.
Second malignancies in patients with deficient mismatch repair system/microsatellite instability-high colorectal cancer

June 2025

·

5 Reads

Background Colorectal cancers (CRC) with deficient mismatch repair system and/or microsatellite instability-high (dMMR/MSI-H) phenotype represent about 12% of CRC. dMMR/MSI-H CRC is due to a germline mutation (Lynch syndrome, LS) or an age-related epigenetic mechanism, mostly by hypermethylation of MLH1 promoter (sporadic cases). It is well recognized that patients with LS have a high lifetime risk of various dMMR/MSI-H cancers, but there are no data concerning the risk of a second cancer in sporadic dMMR/MSI-H CRC. Objectives The main objective of this study was to determine the risk of having another primary cancer (APC) in patients with dMMR/MSI-H CRC. We also collected these tumors to determine their MMR phenotype. Design We used a prospective cohort of 484 well-characterized patients with dMMR/MSI-H CRC to describe their risk of having APC. Methods We evaluated the occurrence of APC (before or after the occurrence of the dMMR/MSI-H CRC) according to LS versus sporadic status, whatever the stage or the tumor site. The characteristics of the two groups, with and without APC, and LS versus sporadic status were compared. Results Among the 484 patients with dMMR/MSI-H CRC, we identified 116 patients with a previous or a second primary tumor (24.0%), with an average of 1.4 tumors per patient in addition to the dMMR/MSI-H CRC. The most frequent tumor sites were skin (24.7%) and breast (18.5%). Regarding the occurrence of APC, we found no difference between patients with LS-related dMMR/MSI-H CRC group (25.0%) and those with sporadic dMMR/MSI-H CRC (24.8%). No risk factor was associated with the occurrence of APC in our cohort, in the LS or sporadic cases subgroup. In the sporadic group, 3.8% of APC had a dMMR/MSI-H phenotype as compared to 50.0% in the LS group. Conclusion It seems important to follow patients with a history of dMMR/MSI-H CRC due to the high risk of second tumors, even in sporadic cases. Second cancers in patients with sporadic dMMR/MSI-H CRC are rarely associated with a dMMR/MSI-H phenotype.


Patient demographics.
Themes and representative quotations.
Recommendations for patient-centered, trauma-informed endoscopy care.
“It’s a tool, it’s got hardships”: a qualitative study of patient experience of colonoscopy and implications for trauma-informed care

June 2025

·

3 Reads

Background About half of the patients having colonoscopies experience procedure-related anxiety and emotional distress, which are associated with negative outcomes, including pain, higher sedation needs, longer procedure times, and avoidance of future care. Objectives To improve procedure quality, we sought to understand from the patient’s perspective the emotional and psychological aspects of undergoing a colonoscopy and recommendations for improving care. Design Qualitative interview study. Methods We conducted semi-structured interviews with patients after colonoscopy. Questions were informed by the theoretical frame of trauma-informed care and fieldwork and collaborative discussions with endoscopists, multidisciplinary staff, and patients. Patients were recruited through purposive sampling to reflect a range of indications for colonoscopy, demographics, and health backgrounds. Interviews and data analysis were conducted in overlapping phases to ensure a diversity of perspectives. Thematic analysis was used to identify shared patterns across the data. Results Nine patients completed interviews, and analysis generated the central dialectic “it’s a tool, it’s got hardships,” reflecting a shared belief that colonoscopies are both stressful and important to one’s health. Within this uniting concept, we identified themes of patient, provider, and process factors that have the potential to reduce or promote distress. Subthemes related to patients’ past experiences/expectations, coping, and access to support; providers’ communication and behavior; and process factors including prep/wait times, sedation and anesthesia, and team-based care. Factors that buffered against distress included perceived trust, transparency, and confidence; positive expectations rooted in prior healthcare experiences; flexible coping and feeling supported. Factors that contributed to increased vulnerability included having a minoritized identity, a history of past medical trauma, and uncertainty in communication and the colonoscopy process. Conclusion Efforts to improve the colonoscopy experience should continue to address the interplay of these complex factors. Given that identification of those at the highest risk for distress may not always be possible, we recommend a universal trauma-informed approach and provide specific suggestions for implementation in endoscopy.


The interaction between gut microbiota and radiation injuries: the red arrow represents “direct interaction” and the blue arrows represent “indirect interaction.”
Possible mechanisms of “direct interaction” between gut microbiota and radiation injuries.
Literature summary on the interaction mechanism between gut microbiota and radiation-induced injuries.
Radiation-induced injury and the gut microbiota: insights from a microbial perspective

Plain language summary Exploring how gut bacteria may influence radiation damage Cancer is a major health threat worldwide, and many patients undergo radiation therapy to treat tumors. However, radiation can also harm healthy organs, limiting the radiation dose that doctors can safely use. Currently, there are no specific treatments to prevent this type of damage, known as radiation-induced injury (RII). Recent research suggests that gut bacteria, also called gut microbiota (GM), may play a role in how radiation affects the body, but we do not yet fully understand this relationship. In this review, we explore two ways in which gut bacteria might interact with radiation damage. The first, known as “direct interaction”, occurs when radiation directly affects the gut microbiota. This can lead to changes in the types of bacteria present, affect substances produced by these bacteria, damage the gut barrier, trigger inflammation in the intestines, and influence the body’s immune system. The second, known as “indirect interaction”, involves the communication between the gut microbiota and other parts of the body, such as the brain, heart, lungs, and mouth. We also discuss potential treatments to help restore a healthy balance of gut bacteria, including probiotics (helpful bacteria), prebiotics (substances that help good bacteria grow), and fecal microbiota transplantation (a method of transferring bacteria from a healthy person’s stool). Understanding how gut bacteria and radiation-induced injury interact is more complex than previously thought, and further research could lead to better ways to protect patients from radiation damage during cancer treatment.


Prospective observational study of tofacitinib in ulcerative colitis – analysis of clinical data, fatigue and health-related quality of life during the induction phase

June 2025

·

15 Reads

Background Tofacitinib is a Janus kinase inhibitor for the treatment of ulcerative colitis (UC). Prospective real-world data are scarce. Objectives To collect data on clinical outcomes, including health-related quality of life (HRQoL) and fatigue during treatment with tofacitinib. Design This is a prospective observational multicentre study in Sweden. In this analysis, outcomes at weeks 2, 8 and 16 are reported. Methods Patients with active UC confirmed with endoscopy or faecal calprotectin (FC) were enrolled during 2020–2023 when starting tofacitinib therapy. Results In total, 103 patients were included. After 2 weeks of treatment, 50% (39/78) had achieved symptomatic response and at week 16, 39% (35/89) had achieved corticosteroid-free clinical remission according to the partial Mayo score. At week 16, a reduction in FC by ⩾50% was seen in 49% (35/71) and 24% (11/46) were in endoscopic remission. The frequency of arthralgia decreased from 29% (30/103) at baseline to 11% (10/89) at week 16. Regarding HRQoL at week 16; each of the four Short Health Scale dimensions (symptoms, social function, disease-related worry and general well-being) had improved by a median of 1 point (p < 0.01) and the European Quality of Life 5 Dimensions 5 Levels index improved from 0.80 to 0.87. Finally, the Inflammatory Bowel Disease Fatigue score measuring occurrence and severity showed an improvement with a decrease from 9 points at baseline to 6 at week 16 (p < 0.05). Conclusion Induction therapy with tofacitinib therapy was associated with improvements in patient-reported outcome measures of symptoms, endoscopic activity, arthralgia, HRQoL and fatigue. These real-world data illustrate that tofacitinib is a fast-acting drug with broad therapeutic effects in UC. ClinicalTrial registration number NCT04338204.


Role of medico-administrative database in the selection of the target population in colorectal cancer screening program

June 2025

·

9 Reads

Background Colorectal cancer (CRC) screening in average-risk populations requires filtering a target population based on medical information in population-based CRC screening programs (CRCSP). This study describes the level of consensus in medical exclusion practice and the role of the medico-administrative databases (MADB) in accurately targeting the eligible individuals for CRCSP screening campaigns. Design The descriptive study combined a cross-sectional survey and a non-systematic literature review. Methods A cross-sectional survey was conducted among CRCSPs worldwide. Information was collected on the use of MADB for identifying consensus-based exclusion criteria (applied by >50% of CRCSPs). When a MADB was used, the study assessed whether the definition (code lists, medical terminologies) of the exclusion criteria was available. These definitions were compared between programs to evaluate the degree of consensus. Results In all, 20 out of the 31 CRCSPs (Australia, England, Manitoba, Ontario, Washington State, 26 European countries) participating in the survey implemented medical exclusions. Five consensus-based exclusion criteria were identified (personal history of CRC, inflammatory bowel disease, adenoma, recent colonoscopy, genetic risk). However, these criteria were not uniformly defined in MADBs (i.e., CRC phenotype includes ICD-10 codes C18–C21 in Catalonia, while the C21 code was excluded elsewhere). Furthermore, although the MADBs exist and contain relevant information, they remain inaccessible to screening management structures in some countries (e.g., in France). Conclusion The number of consensus-based criteria was limited, and they were the least nuanced, likely because they are easier to collect using the current CRCSPs management resources. These consensual criteria can be queried in most MADBs. However, the use of MADBs was not standardized across programs for various reasons (absence of a database, unavailability of information in the database when it exists, inaccessibility of the database when it exists), limiting comparability between them. Standardizing the five consensus criteria across all programs would only be effective if the disparity caused by systemic failures in the organization of each program was controlled.


Schematic representation of postulated mechanisms for the role of IL-33 in the process of esophageal inflammation and diseases. Under the stimulation of different pathogens, the release of IL-33 from esophageal epithelial cells is significantly increased, and then affects the IL-33 receptor ST2 expressed in target cells such as Th2 cells or immunosuppressive cells (MDSCs and Tregs) or stromal cells, or macrophages. In the development of EoE, IL-33 can stimulate Th2 cells to further release downstream cytokines, for example, IL-4, IL-5, and IL-13, to promote the development of inflammation and the recruitment of eosinophils in the esophageal mucosa to induce EoE. In the development of GERD, mucosal damage induce-IL-33 stimulates Th2 cells to increase the release of IL-6, IL-8, and MCP-1 to enhance esophageal inflammation and GERD. In esophageal cancer, cancer risk factor-induced IL-33 can act on immunosuppressive cells (MDSCs and Tregs) to cause an immunosuppressive milieu, stromal cells to remodel the tumor stroma, and macrophages to cause an M2-type differentiation. All these changes contribute to the creation of a permissive microenvironment that might facilitate the progression of esophageal cancer.
EoE, eosinophilic esophagitis; GERD, gastroesophageal reflux disease; IL-33, interleukin-33; MCP-1, monocyte chemoattractant protein 1; MDSCs, myeloid-derived suppressor cells; ST2, suppression of tumorigenicity 2.
The cell types in human esophagus that have been documented to express IL-33/ST2.
Main studies of the IL-33/ST2 axis in esophageal inflammatory diseases.
Main studies of the IL-33/ST2 axis in esophageal cancers.
The role of IL-33/ST2 axis in esophageal inflammatory diseases and cancers: implications for the immunopathogenesis and immunotherapeutic target?

Considerable scientific evidence confirms that interleukin (IL)-33 and its main receptor, suppression of tumorigenicity 2 (ST2), form a functional axis to modulate the development of esophageal inflammatory disorders, such as eosinophilic esophagitis and gastroesophageal reflux disease. Recently, studies have also revealed that the IL-33/ST2 axis is implicated in the immunopathogenesis of both esophageal adenocarcinoma and squamous cell carcinoma. In view of the importance of the IL-33/ST2 axis in the immunopathogenesis of esophageal inflammatory diseases and cancers, this review summarizes recent progress in this research field based on current published data. Moreover, the translational potential of the IL-33/ST2 axis as a promising immunotherapeutic target in esophageal inflammatory disorders and cancers was discussed.


Mediterranean diet adherence and incident acute pancreatitis: a prospective cohort study

June 2025

·

9 Reads

Background The relationship between Mediterranean diet (MedDiet) adherence and acute pancreatitis (AP) risk is largely unknown. Objectives To investigate the associations between MedDiet adherence and AP risk and joint associations of genetic risk and MedDiet adherence with AP risk. Design A prospective cohort study using data from UK Biobank, a large population-based prospective study that recruited over 500,000 participants aged 40–69 between 2006 and 2010 across the United Kingdom. Methods We included 103,449 participants free of AP with typical dietary intake from 24-h dietary recalls. MedDiet adherence was measured via the Mediterranean Diet Adherence Screener (MEDAS) continuous score. Genetic predisposition to AP was estimated by polygenic risk score (PRS). Incident AP cases were identified via electronic medical records. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated by Cox proportional hazards models. Mediation analyses were further applied to explore the mediating effects of the low-grade inflammation (INFLA) score and metabolic status. Results Over a mean follow-up period of 10.4 years, 371 AP cases were documented. Higher MedDiet adherence defined by MEDAS continuous score was inversely associated with lower AP risk (highest vs lowest tertiles: HR 0.60, 95% CI 0.46–0.79, p < 0.001), with the INFLA score and metabolic status mediating 10% and 7.1% of the association, respectively. Although no interaction was observed between PRS and MedDiet adherence, participants with combined low genetic risk and the highest MedDiet adherence had the lowest risk of AP (HR 0.54, 95% CI 0.36–0.80, p = 0.002). Conclusion The study suggests that higher adherence to the MedDiet is associated with a decreased risk of AP, which is partially mediated by inflammation and metabolic status, and may attenuate the deleterious impact of genetics on AP risk.


Clinical presentation of gastroesophageal reflux disease: typical and atypical symptoms.
Phenotypic varieties of gastroesophageal reflux disease. In clinical practice, overlap between subgroups is possible.
Medical devices with esophageal mucosal protective activity. Formulations and suggested therapeutic use in patients with gastroesophageal reflux disease.
Hyaluronic acid and chondroitin sulfate-based medical devices: formulations, esophageal mucosal protection, and their place in the management of GERD

Gastroesophageal reflux disease (GERD) remains a challenging condition, even in the third millennium. For much of the past century, Schwartz’s dictum—“No acid, no ulcer”—has shaped our approach to acid-related diseases, making acid suppression the cornerstone of therapy. Proton pump inhibitors (PPIs) are widely regarded as the standard treatment for GERD. However, they provide only symptomatic relief and do not address the underlying disease. Moreover, nearly 50% of patients experience limited or no response to PPIs in clinical practice. Recent advances in understanding GERD’s pathophysiology, particularly the role of impaired mucosal integrity, have led to innovative therapeutic strategies. Among these, medical devices designed to prevent reflux or coat the esophageal mucosa and form a stable protective barrier represent a significant breakthrough. Esophageal mucosal protection is emerging as a promising approach, especially for patients who do not respond adequately to PPIs. While mucosal-protective agents such as sucralfate and irsogladine have long been available, their formulations have not been well-suited for esophageal protection. The rapid transit time of liquids through the esophagus (typically just a few seconds, even in a supine position) limits the duration of contact between active ingredients and the mucosa. However, hyaluronic acid and chondroitin sulfate-based medical devices have revolutionized the field by enabling active ingredients to adhere to the esophageal lining, ensuring prolonged contact and enhanced protection. Further advancements have led to the development of three distinct formulations (Esoxx™ One, Esoxx Defence, and Esoxx Protection), incorporating additional components, that is, Poloxamer 407, aluminum hydroxide, or natural remedies such as Aloe vera and honey. Each of these formulations offers unique physicochemical properties tailored to address both typical and atypical GERD symptoms. By leveraging the novel therapeutic approach of mucosal protection, these innovations aim to improve treatment outcomes and enhance patients’ overall quality of life.


Intestinal ultrasound measurement of bowel wall thickness can be used as a sole marker for defining anti-TNF maintenance therapy failure in Crohn’s disease

June 2025

·

8 Reads

Introduction Bowel wall thickness (BWT) measurements in intestinal ultrasound (IUS) are recognized indicators of inflammatory activity in Crohn’s disease (CD). However, the added value of other ultrasonographic parameters for monitoring and predicting treatment failure during anti-tumor necrosis factors’ (TNF) maintenance therapy is still not absolutely defined. Objectives To determine whether BWT, as measured by IUS, can serve as a reliable single marker for predicting treatment failure in CD patients under anti-TNF therapy, compared to a combination of ultrasonographic parameters. Design This study was a single-center, retrospective cohort study. Methods This study included 103 CD patients in clinical remission on anti-TNF therapy, who had an IUS examination within 10 months following therapy initiation. We investigated the correlation of these ultrasonographic parameters with subsequent treatment failures, defined by disease flares, and the need for surgery, hospitalization, corticosteroid use, dose escalation, and drug discontinuation. Results Treatment failure occurred in 59.2% of patients within a median of 5 months post-index IUS. Significant differences were observed in BWT (3.9 mm in the failure group vs 3 mm in the remission group, p = 0.007), bowel wall flow (BWF; 49.2% vs 23.8%, p = 0.009), and mesenteric hypertrophy (20.4% vs 7.1%, p = 0.006). In receiver operating characteristic analysis for BWT, the area under the curve (AUC) of BWT >3 mm was 0.66, with a sensitivity of 67.2% and specificity of 69.1%. The combined (BWT, BWF, and mesenteric hypertrophy) AUC was 0.68 (sensitivity of 62.9%, specificity of 61.9%). Delong’s test showed no significant difference in AUC (p = 0.137). BWT emerged as the most significant parameter in stepwise regression analysis. Conclusion Our findings suggest that BWT alone may be used as a single ultrasonographic marker of treatment, therefore simplifying the use of IUS. Using a single objective ultrasonographic parameter simplifies the use of IUS, an important factor that can facilitate the use of this important imaging technique.


Upper gastrointestinal bleeding differences between older and younger adults: should bleeding in non-cirrhotic patients be considered a geriatric syndrome?

June 2025

·

21 Reads

Background Upper gastrointestinal bleeding (UGIB) is a major medical emergency. Although older citizens have an increased risk of UGIB, guidelines do not fully address specific concerns in this population. Objectives We aimed to report characteristics/differences between the older (⩾65 years) and the younger adult patients (<65 years) with UGIB. Design Retrospective multicenter cohort study. Methods Adult patients consecutively admitted due to evidence of UGIB at six participating centers or who developed UGIB while hospitalized for another reason during a 6-month enrollment period, were eligible for this study. Results Of 600 patients included, 58.2% were men. Patients aged ⩾65 years comprised 72.8% of the cohort; in this group, most comorbidities (except liver cirrhosis) and use of antiplatelet/anticoagulant therapy were more frequent (p < 0.001). Variceal UGIB was more common in the younger group and non-variceal UGIB in the older (p < 0.001). The risk scores Glasgow–Blatchford (p = 0.003) and Complete Rockall (p < 0.001) were higher in the older group. Peptic ulcer disease was the most common cause in both groups, and angiodysplasia was an almost exclusive diagnosis in the elderly. Overall mortality was 15% (n = 90), with 76 deaths attributed to non-bleeding causes. In a post hoc subgroup analysis excluding cirrhotic patients, older adults required hospitalization (p = 0.007) and longer hospital stays (p = 0.005) more frequently, while younger patients had higher intensive care unit admission rates (p = 0.018). Multivariate analysis in this subgroup suggested that antiplatelet (p = 0.047) or anticoagulant use (p = 0.021), Rockall score (p < 0.001), and Charlson Comorbidity Index (CCI, p = 0.011) were independently associated with in-hospital mortality. The CCI, higher in older patients, also correlated with the need for blood transfusions (p = 0.001), rebleeding (p = 0.013), second-look endoscopy (p < 0.001), and re-hospitalization (p = 0.028). Conclusion Older adults with UGIB exhibit clinical features associated with higher healthcare resource utilization and worse outcomes. Cirrhosis was linked to adverse outcomes in younger patients. In non-cirrhotic patients, UGIB may share features of geriatric syndromes, reflecting multifactorial risks in this population.


Flowchart study of participants. According to the inclusion and exclusion criteria, 1241 patients with CBDS who underwent ERCP between 2013 and 2023 were finally included.
CBD, common bile duct; CBDS, common bile duct stone; ERCP, endoscopic retrograde cholangiopancreatography; ENBD, endoscopic nasobiliary drainage; EUS-BD, endoscopic ultrasound-guided biliary drainage.
Demographic and baseline characteristics of the enrolled patients.
ERCP-related technique parameters and post-ERCP variables in the repeated and unrepeated ERCP groups.
Analysis of risk factors for unplanned repeated ERCP in patients with CBDS.
Analysis of risk factors for long-term adverse events in patients undergoing ERCP for CBDS.
Long-term prognosis and risk factors associated with 30-day unplanned repeated ERCP in patients with common bile duct stones

June 2025

·

7 Reads

Background The unplanned repeated endoscopic retrograde cholangiopancreatography (ERCP) in patients with common bile duct stone (CBDS) remains unclear. Objectives To identify risk factors of unplanned repeated ERCP and its impact on clinical outcomes. Design Retrospective cohort study. Methods Patients who underwent ERCP for CBDSs from January 2013 to October 2023 were consecutively reviewed. Risk factors for unplanned repeated ERCP within 1 month were evaluated using logistic regression. The impact of unplanned repeated ERCP on adverse events, including ampullary bleeding, CBDSs recurrence, and biliary infection, was explored. Results A total of 1241 patients were included, of which 50 patients underwent unplanned repeated ERCP in 1 month primarily because of unrelieved biliary obstruction or cholangitis. The repeated ERCP group had higher proportions of irregular papilla (42.0% vs 21.7%, p < 0.001), stones locating in superior common bile duct (CBD; 18.0% vs 8.8%, p = 0.05), larger CBD diameter (median 1.2 vs 1.0 cm, p = 0.002), or larger CBDS diameter (median 1.0 vs 0.8 cm, p = 0.004) than the unrepeated group. In the multivariate analysis, irregular papilla (odds ratio (OR) 3.494, p = 0.024), post-ERCP fever (OR 7.532, p < 0.001), post-ERCP abdominal pain (OR 2.810, p = 0.05), post-/pre-ERCP total bilirubin levels ⩾1.2 times (OR 6.973, p = 0.007), and post-/pre-ERCP transaminase levels ⩾1.2 times (OR 3.944, p = 0.026) were independent risk factors for unplanned repeated ERCP. The incidence of adverse events in the long term was higher in the repeated group than the unrepeated group (12.0% vs 5.0%, p = 0.068). Unplanned repeated ERCP, although not an independent factor, is partially relevant with increased likelihood of long-term adverse events (univariate OR 2.570, p = 0.038). Conclusion Papillary morphology, post-ERCP symptoms, and serum biochemical parameters may help predict the occurrence of unplanned repeated ERCP in patients with CBDS. Unplanned repeated ERCP does not have a significant impact on the long-term prognosis.


Impact of antithrombotic therapy resumption in patients with gastrointestinal bleeding: a multicenter retrospective cohort study

Background Gastrointestinal bleeding (GIB) is a critical clinical emergency associated with high morbidity and mortality. The widespread use of antithrombotic agents, including antiplatelet and anticoagulant medications, has increased the incidence of GIB. Objectives Our study aims to address this gap by evaluating the impact of antithrombotic therapy on both 28-day mortality and rebleeding risk. Design Retrospective cohort study using propensity score-based methods to address confounding. Methods Data were extracted from three independent databases (MIMIC-IV, NWICU, and Xuanwu Hospital) spanning 2008–2022. inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. Weighted logistic regression models assessed outcomes across antiplatelet, anticoagulant, and combination therapy subgroups. Results After inverse probability of treatment weighting (IPTW) adjustment, the antithrombotic group maintained a significantly elevated rebleeding rate (19.9% vs 10.5%, p < 0.001) and an increased risk of rebleeding (odds ratio (OR) = 2.118, 95% confidence interval (CI): 1.577–2.845, p < 0.001). Conversely, the 28-day mortality was significantly lower in the antithrombotic group postadjustment (8.2% vs 12.5%, p = 0.022; OR = 0.621, 95% CI: 0.412–0.935, p = 0.023). Notably, early resumption of antithrombotic therapy (within 3 days) significantly increased the risk of mortality. Conclusion Our study suggests that while antithrombotic therapy reduces 28-day mortality, it significantly increases rebleeding risk. Notably, the use of anticoagulants or combination therapy is linked to the highest rebleeding risk, compared to antiplatelets. Additionally, resuming antithrombotic therapy too early (i.e., within 3 days) may further elevate the risk of mortality.


Risk factors for recurrence after endoscopic papillectomy in ampullary adenomas: a retrospective case–control study

June 2025

·

2 Reads

Background Endoscopic papillectomy (EP) has emerged as a preferred treatment modality for ampullary adenomas, offering a less-invasive alternative to surgical resection. However, concerns persist regarding the potential for incomplete resection and subsequent recurrence. Objectives This study aims to evaluate the efficacy of EP in treating ampullary adenomas and to identify risk factors associated with recurrence. Design This study was a single-center, retrospective case–control study. Methods We retrospectively analyzed patients who underwent EP at Nanjing Drum Tower Hospital between January 2010 and December 2022. Recurrence rates were assessed, and potential risk factors for recurrence were analyzed using univariate and multivariate Cox proportional hazards models. Hazard ratios (HR) with corresponding 95% confidence intervals (CI) were calculated. Results Among the 137 patients who achieved complete resection, 21 (15.3%) experienced recurrence. The median follow-up period was 17.7 months (interquartile range (IQR) 11.7–37.5), and the median time-to-recurrence was 16.2 months (IQR 9.9–33.9). Of the 21 recurrence cases, 11 (52.3%) were managed successfully with repeat endoscopic intervention, while 6 (28.6%) required pancreatoduodenectomy. Significant risk factors for recurrence included familial adenomatous polyposis (FAP; HR = 9.3; 95% CI: 2.8–30.4; p < 0.001), pancreaticobiliary (PB) subtype (HR = 3.2; 95% CI: 1.5–11.3; p = 0.006), and high-grade dysplasia (HGD; HR = 2.6; 95% CI: 1.1–6.2; p = 0.036). Comprehensive sensitivity and subgroup analyses consistently confirmed the stability of these risk factors. Conclusion EP is an effective treatment for ampullary adenomas; however, recurrence remains a significant concern, particularly among patients with FAP, PB subtype, and HGD.


Progressing or preserving, disease extent evolution in hospitalized patients with ulcerative colitis in China: a real-world study

June 2025

·

7 Reads

Background Disease extent of ulcerative colitis (UC) is dynamic, often shows progression or regression over time. However, factors associated with disease progression in long-term follow-ups remain underexplored. Objectives This study aimed to examine disease extent progression in Chinese patients in a long-term follow-up cohort and identify associated risk factors. Design Retrospective analysis. Methods We retrospectively analyzed 800 hospitalized UC patients from 1980 to 2021, and followed up to December 2023. The disease extent was categorized according to the Montreal classification. The Cox regression model was used to identify factors associated with progression. Results At diagnosis, 19.1% had E1 (ulcerative proctitis), 29.8% had E2 (left-sided UC), and 51.1% had E3 (extensive UC). By the end of follow-up, the proportion of maximum disease extent of E3 cases increased to 74.9%, while E1 and E2 patients decreased to 6.6% and 18.5%, respectively. Cox regression analysis revealed that patients with a history of appendectomy before the onset of disease were at higher risk of disease progression in those initially diagnosed with E1. Lower usage of glucocorticoids, immunosuppressants, and biologics were found in progression to the E3 group than initial E3 group. Lower usage of immunosuppressants and biologics before progression were found in the progressed to E3 group than not progressed to E3 group. Conclusion Disease extent progression was common in Chinese UC patients. We suggest the necessity of aggressive treatment strategies, especially for early-stage UC patients, to mitigate disease progression and reduce the risk of related complications.


Study the flowchart. The same colonoscopy test may have more than one criterion for exclusion.
Cecal withdrawal timer usage. The CWVT was used in 67% of the tests performed from its introduction to the end of the study. (a) The proportion of tests performed with the cecal withdrawal timer in each month during the period following its introduction. (b) The proportion of tests performed with the cecal withdrawal timer by each endoscopist during the period following its introduction. Each letter denotes a different endoscopist.
CWVT, cecal withdrawal vocal timer.
Changes in the ADR with the cecal withdrawal timer. (a) The ADR of colonoscopies performed with and without the cecal withdrawal timer during the period after its introduction. (b) The ADR of different endoscopists with and without the cecal withdrawal timer during the period after its introduction. Only endoscopists who performed at least 15 colonoscopies with and 15 colonoscopies without the cecal withdrawal timer during this period were included. (c) The overall ADR of the department before and after the introduction of the cecal withdrawal timer.
ADR, adenoma detection rate.
Evaluation of the cecal withdrawal vocal timer in screening colonoscopies for optimizing withdrawal time and adenoma detection rate

Background Longer cecal withdrawal time has been linked to a higher adenoma detection rate (ADR), with a minimum duration of 6 min recommended. Therefore, we developed the cecal withdrawal vocal timer (CWVT), a novel software tool that is command-activated at cecal intubation and vocally informs the endoscopist of the withdrawal duration every minute. Objectives Evaluating the efficacy of the CWVT in enhancing adenoma detection. Design A retrospective, single-center study of screening colonoscopies with adequate preparation and documented cecal intubation. Methods The primary endpoint was the change in the department’s ADR before (2022) and after the CWVT introduction (January 2023–February 2024). Secondary endpoints included the ADR change between procedures with and without CWVT after its introduction and the ADR change among individual endoscopists. Results The study included 1098 and 1330 eligible colonoscopies pre- and post-CWVT introduction, respectively. Following CWVT introduction, 67.3% of colonoscopies were performed with activated CWVT, with a median withdrawal time of 8.7 (interquartile range: 6.9–11.8) min. The department ADR was 25.5% following CWVT introduction, without a significant difference compared to the year before (26.2%, p = 0.71). During the post-CWVT implementation period, colonoscopies with activated CWVT had higher ADR than those without (28.4% vs 19.5%, respectively, p < 0.001). The improvement was mainly driven by the detection of adenomas smaller than 10 mm and was consistent across 11 out of 12 months in this period and among most endoscopists. Conclusion While an overall ADR improvement was not achieved with the CWVT, the ADR was higher in post-CWVT procedures that utilized the CWVT than those that did not, warranting further prospective studies to evaluate CWVT’s contribution to screening colonoscopy performance.


Workflow diagram.
Kaplan–Meier survival curve for survival analysis in patients with ypT0 colorectal cancer treated with neoadjuvant treatment according to residual lymph node status. (a) Disease-free survival. (b) Overall survival.
ypT0, a yield pathological T0 classification.
Basic clinicopathological characteristics of patients with ypT0 rectal cancer.
Uni- and multivariate Cox analyses of the clinicopathological factors for DFS in ypT0 rectal cancer patients.
Prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy

Background A yield pathological T0 (ypT0) classification usually indicates the pathologically complete response of rectal cancer to neoadjuvant therapy. However, lymph node metastasis may still be present. Objectives In this study, we aimed to evaluate the prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy. Design Retrospective cohort study. Methods Patients with locally advanced rectal cancer (LARC) who had undergone preoperative therapy and were pathologically classified as having ypT0 disease at Fudan University Shanghai Cancer Center between December 2012 and September 2022 were retrospectively analyzed. Uni- and multivariate analyses were performed to evaluate the effect of the residual lymph node status on disease-free survival (DFS) and overall survival (OS). Results A total of 457 patients had ypT0 disease; this included 413 patients with ypT0N0 and 44 with ypT0N1–2. Inadequate lymph node retrieval (<12, p = 0.002) and adenocarcinoma (p = 0.009) were more common in the ypT0N0 group than in the ypT0N1–2 group. The ypT0N1–2 group showed marginal evidence of a higher probability of elevated pretreatment carcinoembryonic antigen levels and adjuvant chemotherapy than the ypT0N0 group (p = 0.076 and p = 0.077, respectively). Patients with ypT0N0 had significantly better 5-year DFS than those with ypT0N1–2 (84.8% vs 68.4%, p = 0.016). However, no significant difference was observed in the 5-year OS between the two groups (93.9% vs 88.8%, p = 0.602). Multivariate analysis revealed that residual lymph node status was an independent prognostic factor for DFS (hazard ratio, 2.285; 95% confidence interval: 1.246–4.192, p = 0.008). Conclusion Residual lymph node metastasis may affect DFS, but not OS, in pathological T0 patients who receive neoadjuvant therapy followed by radical surgery for LARC.


MASLD and liver fibrosis in patients with psoriasis receiving IL-17 or IL-23 inhibitors: a systematic review

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is more prevalent in patients with psoriasis compared to healthy individuals. Interleukin (IL)-17 and IL-23 inhibitors may have beneficial effects on MASLD by reducing systemic inflammation and improving metabolic parameters. Objectives To assess the effect of IL-17 and IL-23 inhibitors on MASLD and liver fibrosis in patients with psoriasis. Design We performed a systematic review that followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data sources and methods A literature search was conducted across four databases: MEDLINE, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from database inception to September 27, 2024. Observational studies and clinical trials that reported the presence of MASLD and/or liver fibrosis in patients with psoriasis/psoriatic arthritis treated with IL-17 or IL-23 inhibitors were included. The Newcastle Ottawa Scale (NOS) was used for risk of bias assessment in cohort studies, the Revised Cochrane Risk of Bias Tool (RoB2.0) in randomized controlled trials, and the Risk of Bias in non-randomized studies-of Interventions (ROBINS-I v.2) tool in non-randomized trials. Results Fourteen studies were included: four clinical trials, five retrospective cohort studies, three prospective cohort studies, and two post hoc studies. Two cohort studies and one clinical trial showed a low risk of bias. Both post hoc studies had a high risk of bias. Eleven studies assessed the effect of IL-17 inhibitors on MASLD or liver fibrosis; six reported a neutral effect, while five demonstrated improvements in liver tests. Three studies evaluated IL-23 inhibitors; one showed neutral effects, another reported improvement in fibrosis-4 index (FIB-4) scores at 6 months, and the third was still in the recruitment phase. Conclusion IL-17 and IL-23 inhibitors may provide beneficial effects on MASLD and liver fibrosis in patients with psoriasis. Larger, well-designed studies are needed to confirm these findings. Trial registration PROSPERO CRD42024599350.


ROC curve for mean nocturnal basal impedance for GERD diagnosis.
GERD, gastroesophageal reflux disease; ROC, receiver operating characteristic.
ROC curve for different complementary tests for GERD diagnosis.
GERD, gastroesophageal reflux disease; ROC, receiver operating characteristic.
Lyon consensus 2.0 for the diagnosis of GERD.
Description of sociodemographic, endoscopic, and pH-metry characteristics according to GERD diagnosis.
Cutoff values and operating characteristics of different diagnostic tests for GERD diagnosis.
Diagnostic accuracy of mean nocturnal basal impedance and other complementary tests for the diagnosis of gastroesophageal reflux disease according to the new Lyon criteria

May 2025

·

13 Reads

Background In 2023, the diagnostic criteria for gastroesophageal reflux disease (GERD) were updated in the Lyon Consensus 2.0. It is important to investigate the diagnostic accuracy of complementary tests used for GERD diagnosis. Objectives To determine the diagnostic accuracy of mean nocturnal basal impedance (MNBI) measured by pH-metry in patients with suspected GERD compared to the updated 2023 Lyon Consensus Diagnostic Criteria and to identify the optimal cutoff point for diagnosis. Design Diagnostic test study based on a retrospective cohort of patients with suspected GERD. Methods Diagnosis was confirmed using the updated Lyon criteria as the gold standard. We evaluated sensitivity, specificity, and discriminatory ability via area under the receiver operating characteristic curve (AUC-ROC). The best cutoff point was determined using Liu’s method for MNBI, number of reflux episodes, number of acid reflux episodes, DeMeester score, and bolus exposure time. ROC curves were compared using DeLong’s method. Results A total of 55 patients were included, with 26 diagnosed positive and 29 negative for GERD. MNBI yielded an AUC-ROC of 0.77 (95% confidence interval (CI): 0.64–0.89); at 1590 ohms, sensitivity and specificity were 69.2% and 72.4%, respectively. The DeMeester score demonstrated superior discriminatory ability over MNBI (p = 0.03), with an AUC-ROC of 0.90 (95% CI: 0.80–1.00), sensitivity of 92%, and specificity of 93% at a cutoff of 15.6. No significant differences in discriminatory ability were observed when comparing MNBI with other complementary tests (p < 0.05). Conclusion MNBI and other complementary tests showed suboptimal characteristics for GERD diagnosis. These tests should be interpreted alongside clinical, endoscopic, and pH-metry findings. The DeMeester score seems promising, but further prospective studies are needed to prove its utility.


Clinical insights into IL-23 inhibition: risankizumab for Crohn’s disease through a systematic review and meta-analysis of randomized controlled trials

May 2025

·

16 Reads

Background and aims Crohn’s disease is a chronic inflammatory disorder with rising global prevalence, marked by abdominal pain, diarrhea, and fatigue. Interleukin (IL)-23 plays a pivotal role in Crohn’s disease pathogenesis, making it a therapeutic target. Risankizumab, a monoclonal antibody targeting the IL-23 p19 subunit, has shown potential in clinical trials. Objectives This meta-analysis evaluates the efficacy and safety of Risankizumab in achieving clinical remission, clinical response, and endoscopic remission in patients with moderate-to-severe Crohn’s disease. Design A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Data sources and methods A comprehensive search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and ClinicalTrials.gov was performed to identify randomized controlled trials (RCTs) assessing Risankizumab in Crohn’s disease. Primary outcomes were clinical remission, clinical response, and endoscopic remission, with secondary outcomes focusing on treatment-related adverse events. A random-effects model estimated odds ratios (ORs) with 95% confidence intervals. Meta-regression analyzed dose- and duration-dependent effects. Results Four RCTs involving 1774 participants showed that Risankizumab significantly improved clinical remission (OR = 2.223), clinical response (OR = 2.483), and endoscopic remission (OR = 4.112). Dose-dependent improvements were observed, with treatment duration affecting clinical remission (p = 0.0158) but not clinical response or endoscopic remission. Adverse event rates were comparable between Risankizumab and placebo groups (OR = 0.872, p = 0.592). Conclusion Risankizumab is effective in achieving clinical and endoscopic outcomes in moderate-to-severe Crohn’s disease, demonstrating dose-dependent benefits and a favorable safety profile, supporting its use as a therapeutic option. However, the limited number of studies may affect the robustness of these findings. Further large-scale RCTs are needed to validate its long-term efficacy, safety in elderly populations, and effectiveness in biologic-naïve patients. Trial registration This systematic review and meta-analysis were registered with the INPLASY database under registration number INPLASY202530014. The full protocol is accessible at DOI: 10.37766/inplasy2025.3.0014.


Overview of the study visits, samples, and study procedures during the 10-year follow-up and according to the cohort.
Natural history, immunological and genetic characteristics of preclinical inflammatory bowel disease (EARLY): study protocol for a prospective cohort study

May 2025

·

23 Reads

·

1 Citation

Background The period prior to the diagnosis of inflammatory bowel disease (IBD), defined as the preclinical phase, has emerged as a potential target for disease modification strategies. Despite the relevance of an early diagnosis to the prognosis of the disease, only a limited number of patients are diagnosed during this window of opportunity. Objectives To determine the risk of developing symptoms after an incidental diagnosis of IBD and to describe the clinical, genetic, and immunological characteristics of IBD during its preclinical phase. Design This study protocol describes a prospective, multicenter cohort study in which incidental (i.e., asymptomatic) IBD within the colorectal cancer screening program will be characterized from a clinical and multi-omic perspective and compared with symptomatic patients and healthy non-IBD controls. Methods Samples from blood, urine, stool, and intestinal endoscopic biopsies will be obtained at baseline. A second sample set will be obtained after 52 weeks from those who remain asymptomatic; samples will also be obtained in those with new-onset symptoms. Medical treatment will be prescribed in all patients following current guidelines. Follow-up visits will be performed every 6 months for 10 years, and all new-onset symptoms, changes in disease behavior, extraintestinal manifestations, IBD-related medical therapies, or surgeries will be recorded. Two control cohorts will be included: one including recently diagnosed symptomatic IBD patients (<3 months), and another with healthy non-IBD controls after a normal ileocolonoscopy, in whom samples will be obtained at baseline. Samples from patients and controls will undergo genetic, proteomic, transcriptomic, single-cell RNA sequencing, metabolomic, and microbiome analyses, and integration of data between the different omic perspectives will also be performed. The study has been approved by the Basque Country Ethics Committee (PI2021116). Conclusion EARLY will generate a unique dataset addressing a previously unexplored area of IBD, with the final aim of describing the prognosis of patients from its earlier phases on the disease and integrating clinical and omic data into useful tools for the long-term prediction of disease outcomes. Trial registration NCT05698745.


Journal metrics


3.9 (2023)

Journal Impact Factor™


20%

Acceptance rate


6.7 (2023)

CiteScore™


57 days

Submission to first decision


$2,800

Article processing charge

Editors