Background Metabolic bariatric surgery is the most effective obesity treatment, but high body mass index (BMI) and associated medical problems often pose surgical risks. Objectives This study compares the safety, feasibility, and efficacy of endoscopic sleeve gastroplasty (ESG) versus intragastric balloon (IGB) as bridge-to-surgery (BTS) procedures in patients with BMI ≥50 kg/m 2 and/or contraindications to primary metabolic bariatric surgery. Design A retrospective analysis (2017 – 2024) included patients with BMI ≥50 kg/m 2 undergoing ESG or IGB as a BTS procedure in a two-step approach at two German centers. Methods The primary outcome was total body weight loss (TBWL, %) at 6 months. Secondary outcomes included absolute weight loss, BMI reduction, excess body weight loss (EBWL, %), and adverse events between the two BTS procedures. Results Fourteen patients underwent ESG, 15 underwent IGB insertion as an intended BTS procedure. At 6 months, median %TBWL and %EBWL were significantly higher in the ESG group (17.8% (IQR, 14.5 – 22.1) vs. 8.99% (IQR, 4.6 – 14.0), p = 0.018; and 28.0% (IQR, 22.8 – 40.0) vs. 16.7% (IQR, 10.8 – 22.4), p = 0.035, respectively). IGB insertion was performed significantly faster (25 (IQR, 20.0 – 30.0) minutes (min) vs. 76 (IQR, 63.2 – 80.8) min; p < 0.01) but was associated with more mild-to-moderate adverse events (60.0% vs. 0%; p < 0.01). Conclusion In this retrospective cohort, ESG was associated with greater short-term weight loss and fewer mild-to-moderate adverse events than IGB as a BTS procedure for patients with BMI ≥50 kg/m 2 and/or contraindications to primary metabolic bariatric surgery (MBS).
Background Low muscle mass is increasingly recognised in patients with Crohn’s disease, particularly among those requiring intestinal surgery. While reduced muscle mass has been associated with adverse early surgical outcomes, its relationship with postoperative endoscopic recurrence remains poorly defined. Objectives To evaluate the association between preoperative low muscle mass, postoperative complications and endoscopic recurrence after ileocolic resection for Crohn’s disease. Design We conducted a retrospective cohort study including consecutive adult patients with Crohn’s disease undergoing ileocolic resection between 2017 and 2024. Methods Muscle mass was assessed on preoperative computed tomography or magnetic resonance imaging using the total psoas area index (TPAI) with sex-specific cut-offs. The primary outcome was early postoperative complications (Clavien–Dindo grade ≥II). Secondary outcomes included endoscopic recurrence, defined as Rutgeerts score ≥i2 at follow-up endoscopy (6–12 months after surgery), and clinical factors associated with low muscle mass. Results A total of 152 patients were included, of whom 61 (40.1%) were classified as having low muscle mass. Postoperative complications occurred in 25.7% of patients and endoscopic recurrence in 50.7% at 6–12 months. Low muscle mass was independently associated with early postoperative complications (OR 2.80, 95% CI 1.24–6.29) and with endoscopic recurrence (OR 2.20, 95% CI 1.13–4.57). Upper gastrointestinal involvement was independently associated with low muscle mass, whereas prior exposure to biologic therapy showed an inverse association. Body mass index showed only a weak correlation with imaging-based muscle mass. Conclusion Preoperative low muscle mass is common in patients with Crohn’s disease undergoing ileocolic resection and was independently associated with both early postoperative complications and endoscopic recurrence. Imaging-based body composition assessment may improve perioperative risk stratification.
Background Mirikizumab, a selective interleukin-23p19 inhibitor, has demonstrated efficacy in randomized controlled trials for moderate-to-severe ulcerative colitis (UC). However, long-term real-world data remain limited, particularly in treatment-experienced populations. Objectives To evaluate the 52-week real-world effectiveness and safety of mirikizumab in a treatment-experienced UC cohort. Design Two-center international retrospective observational cohort study of adults with active UC initiating mirikizumab. Methods This study expands a previously published 12-week real-world cohort from the same centers, adding patients and extending follow-up to 52 weeks. The primary outcome was clinical remission (SCCAI ≤2) at week 52 using non-responder imputation. Secondary outcomes included clinical response, corticosteroid-free remission, and drug persistence at weeks 12, 26, and 52, as well as safety. Results The cohort included 120 patients with prior anti-TNF, vedolizumab, and JAK inhibitor exposure in 75.8%, 75.0%, and 42.5%, respectively. Clinical response rates were 67.5%, 52.3%, and 41.3% at weeks 12, 26, and 52, with corresponding remission rates of 14.2%, 19.8%, and 28.3% (modified NRI: 35.6%). Corticosteroid-free remission at 52 weeks was 26.1%. Drug persistence at 52 weeks was 64.6% (95% CI 54.9–72.7%), without significant differences by prior biologic exposure class. Among 60 patients (50.0%) receiving extended induction, week-26 remission was lower than in standard induction recipients (10.7% vs. 29.1%; p=0.018). Adverse events occurred in 13 patients (10.8%), leading to discontinuation in 5 (4.2%). Conclusion In this large treatment-experienced real-world UC cohort, mirikizumab achieved 52-week clinical remission in 28.3% and drug persistence of 64.6%, with no new safety signals identified, supporting its role across lines of therapy in UC.
Background The relationship between nutritional indices and treatment response in ulcerative colitis (UC) remains poorly characterized. Objectives To assess the discriminatory ability of Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST), and Prognostic Nutritional Index (PNI) in evaluating the clinical efficacy of vedolizumab (VDZ) in patients with moderate-to-severe UC. Design A retrospective multicenter study. Methods This study enrolled moderate-to-severe UC patients receiving VDZ at three centers in northern China from 2021 to 2025. The relationship between baseline nutritional indices and clinical remission, alongside conventional biomarkers, was analyzed. Discriminatory performance was evaluated using receiver operating characteristic curves and area under the curve (AUC) analysis. Results A total of 184 patients were included. At week 14, multivariable logistic regression identified GNRI, PNI and MUST as factors significantly associated with clinical remission. GNRI showed the strongest correlation with clinical remission (r=0.340, p< 0.001), followed by HGB (r=0.316, p< 0.001), PNI (r=0.308, p< 0.001), PLR (r=-0.271, p< 0.001), MUST (r=-0.216, p= 0.003), and NLR (r=-0.163, p= 0.027). GNRI had the highest AUC (0.697), followed by HGB (0.683), PNI (0.678), Alb (0.660), PLR (0.657) and MUST (0.614). GNRI exhibited significantly greater discriminatory ability for 14-week clinical remission than Alb ( p =0.018) and MUST ( p= 0.041). No significant differences in diagnostic accuracy were found between GNRI, HGB, PNI, PLR, and NLR ( p> 0.05). At week 30 and 54, multivariate analysis showed that only baseline HGB remained independently associated with remission. Conclusions Patients with lower nutritional risk—as reflected by higher GNRI and PNI scores, alongside lower MUST scores-were significantly more likely to achieve clinical remission at week 14.
Background Biologic safety during pregnancy in patients with inflammatory bowel disease (IBD) remains a clinical concern, particularly with the increasing use of novel agents such as ustekinumab (UST) and vedolizumab (VDZ). Objectives A network meta-analysis (NMA) was performed to compare pregnancy-related outcomes among various biological agents and nonbiologic-exposed patients. Design Systematic review and frequentist random-effects NMA of comparative observational studies. Data Sources and Methods This study systematically searched from inception to 23 March 2025 for comparative studies reporting pregnancy outcomes in biologics or conventional therapies (CT)-exposed patients with IBD. Outcomes included preterm birth, congenital malformation (CM), low birth weight (LBW), and spontaneous abortion. An NMA model was applied. Subgroup analysis was conducted for studies with comparable baseline disease activity between the treatment groups. Results This NMA included 12 studies. Anti-tumor necrosis factor alpha (TNF-α) agents were not associated with an increased risk of any adverse pregnancy outcomes. UST and VDZ were associated with increased CM risks (UST: odds ratio [OR]: 2.32 [1.31–4.10]; VDZ: OR: 1.98 [1.11–3.52]), and VDZ was associated with LBW (OR: 2.17 [1.15–4.11]). These associations were not significant in the subgroup analyses limited to studies with similar disease activity. Sensitivity analysis revealed that a single important study influenced the CM risk of UST/VDZ, whereas the LBW risk with VDZ remained consistent. Conclusions This is the first NMA to comprehensively assess the pregnancy-related safety of biologic therapies, including the novel biologics VDZ and UST, in patients with IBD. Anti-TNF agents have the most robust pregnancy safety evidence and were not associated with an increased risk of adverse pregnancy outcomes in this analysis. The findings for UST and VDZ should be framed as exploratory and potentially affected by residual confounding, as the observed risk signals were not consistently maintained in the additional analyses. Registration INPLASY202540012.
Background Endoscopic ultrasound (EUS)-guided cyanoacrylate injection for gastric varices (GVs) may leave residual untreated vessels due to incomplete visualization of distal collateral channels. Whether adding conventional endoscopic injection improves outcomes remains unclear. Objectives This multicenter retrospective study evaluated a combined EUS-guided and conventional endoscopic approach in patients with bleeding GOV2 or IGV1 varices. Design This retrospective study (February 2022–December 2024) included 141 cirrhotic patients with acute gastric variceal bleeding from three Chinese tertiary centers. Methods Patients received either EUS-guided therapy alone or combined therapy with supplementary conventional endoscopic injection per institutional practice. Propensity score matching (1:1) and multivariable Cox regression were used to reduce selection bias. Primary outcome was variceal rebleeding; secondary outcomes included technical success, variceal recurrence, reintervention, mortality, and adverse events. Results Technical success was achieved in all patients (100%). After matching, variceal recurrence rates were comparable between groups (5.36% vs. 12.50%, P = 0.185), whereas rebleeding occurred less frequently in the combination group than in the EUS group (7.14% vs. 25.00%, P = 0.010). This association appeared more pronounced in IGV1 varices (2.70% vs. 27.03%, P = 0.016), although the subgroup finding should be interpreted cautiously because the interaction test was not statistically significant. Reintervention was also less frequent in the combination group (12.50% vs. 35.71%, P = 0.004). Mortality and adverse event rates were comparable between groups. Conclusion Supplementary conventional endoscopic injection after EUS-guided therapy was associated with lower risks of rebleeding and reintervention without an apparent increase in adverse events. This combineds strategy may be a feasible option to improve treatment durability in selected patients with high-risk GOV2 or IGV1 gastric varices, but prospective randomized studies are needed for confirmation.
Background:Eosinophilic esophagitis (EoE) is a chronic, type-2 inflammation-driven disease causing dysphagia. Although patients with other type-2 inflammatory diseases (type-2 ID) or inflammatory bowel disease (IBD) may have an increased risk of EoE, there is limited information about the prevalence of EoE in these specific populations. Objectives:This study aims to assess the prevalence of clinically relevant dysphagia as well as underlying EoE in patients with type-2 ID or IBD. Design:This is a cross-sectional, multicenter study of patients with type-2 ID (asthma, rhinosinusitis with polyposis nasi, allergic rhinitis, atopic dermatitis, Immunoglobulin E (IgE)-mediated food allergies) or IBD from the Medical University of Vienna and Floridsdorf Allergy Center. Methods:Patients were screened for esophageal dysphagia using the Brief Esophageal Dysphagia Questionnaire (BEDQ). Relevant dysphagia was defined as a BEDQ score ⩾4, or having a history of bolus impaction or emergency department visit due to dysphagia within the past year. Endoscopy with esophageal biopsies was offered to all patients with relevant dysphagia to screen for EoE. Results:A total of 687 patients (45.9% female, median age 45 years, 53.9% with IBD, 48.5% with a type 2 ID) were screened. Overall, 8.9% (n = 61) reported relevant dysphagia. Endoscopy with biopsies was performed in 22 patients, and 18 patients had undergone endoscopy the year prior to the study. In total, 6 newly diagnosed cases of EoE were observed, while 7 patients had a known history of EoE, resulting in an overall prevalence of 13 patients (1.9%). Patients with any type-2 ID had numerically more EoE (2.7%) than patients with IBD (1.9%). Conclusion:While the prevalence of dysphagia among patients with type-2 ID and IBD may not exceed that of the general population, the prevalence of EoE in these populations may be higher than previously recognized.
Background Chronic pancreatitis (CP) is a progressive fibroinflammatory disease associated with substantial long-term morbidity. Synthesized evidence on mortality remains limited. Objectives To systematically review all-cause and cause-specific mortality in adults with CP compared with individuals without CP. Design This systematic review of observational studies adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Data sources and methods We searched PubMed, Web of Science, Embase, Scopus, and Cochrane Central Register of Controlled Trials from database inception to May 29, 2025. Reference list screening, citation tracking, and targeted author- and consortium-based searches were also conducted. Eligible studies included adults with CP that reported mortality outcomes with a non-CP comparator. Data extraction was conducted by one reviewer while another confirmed accuracy. Quality assessment was done by two independent reviewers and conflicts resolved by a third reviewer. Narrative synthesis was done due to high heterogeneity across studies. Results Of 11,957 records screened through title and abstract, 347 underwent full-text review, and 12 met inclusion criteria. Four additional studies were found through reference list, citation tracking, and targeted searches, yielding a total of 16 included studies with cohort design. Across seven comparative studies, CP was consistently associated with higher all-cause mortality, with standardized mortality ratios ranging from 1.20 to 5.50 and hazard ratios ranging from 1.25 to 5.00. Malignancy was the most frequently reported cause of death. Other causes included cardiovascular, suicide, infectious, liver-related, gastrointestinal, endocrine, renal, respiratory, and accidental. Conclusion CP is associated with excess all-cause mortality and a broad cause-specific mortality burden extending beyond pancreas-related complications alone. These findings support recognizing CP as a systemic, high-risk chronic disease and highlight the need for more consistent mortality reporting and better-designed studies to clarify which patients are at highest risk. Registration (PROSPERO) CRD420251041174.
Chronic gastrointestinal diseases, including inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), and irritable bowel syndrome (IBS), impose a growing global burden. Their relapsing-remitting nature and variable clinical course challenge the paradigm of long-term continuous therapy, which is associated with adverse effects, poor adherence, and high costs. While dynamic precision therapy (DPT) has emerged as an intuitive solution, its conventional definition—symptom-driven, intermittent drug use—is too narrow and fails to harness the full potential of precision medicine. As a narrative review and perspective article, this paper proposes a paradigm shift by introducing a novel, multidimensional framework for DPT that integrates four synergistic dimensions: symptom-guided relief for acute episodes, disease subtype-guided baseline therapy, pathophysiology-guided dynamic adjustments using biomarkers and smart technologies, and individual patient context-guided shared decision-making. Applying this framework to IBD, GERD, and IBS, we demonstrate how it transforms precision treatment from a simple dosing strategy into a comprehensive platform for precision management. We review cutting-edge tools enabling this vision, from 24-hour pH-impedance monitoring and therapeutic drug monitoring to smart drug delivery systems like MMP-responsive hydrogels. This framework provides a practical guide for transitioning from empirical methods to mechanism-based, patient-centered care, presenting a forward-looking model that could transform future treatment approaches in gastroenterology.
Background Patient and clinical interest in dietary management of inflammatory bowel disease (IBD) is growing, yet a comprehensive overview mapping how dietary interventions are defined, composed, and evaluated across Crohn’s disease (CD) and ulcerative colitis (UC) remains scarce. Objectives This scoping review aims to map current evidence on dietary interventions that may have an impact on the disease course in adults with CD or UC, thereby providing guidance for the design of forthcoming dietary interventions. Eligibility criteria Included are English articles published between 2000-2025 investigating dietary treatments for adults (+18) reporting on symptoms, remission, or disease activity. Excluded are paediatric studies, single food/supplement-only interventions, and studies combining new medications with diet. Sources of evidence Systematic searches of PubMed, CINAHL, Scopus, and Web of Science, originally conducted in January 2025 and updated in May 2026, identified 49 eligible studies. Charting methods Data were charted using Covidence with a form guided by the TIDieR checklist. Dietary composition across interventions was visualised using heatmap analysis. Results A range of dietary approaches were identified. Most improved patient-reported outcomes and disease activity indices, though a disconnect often persisted between symptomatic relief and inflammatory biomarker normalization. Despite variability even among nominally identical diets, heatmap analysis of diet composition revealed strong consensus around elimination of processed foods and added sugars, alongside emphasis on whole foods, fruits, vegetables, and unsaturated fats. Conclusions Evidence points toward several possible diets for IBD, and clearly toward the Mediterranean diet and shared whole-food principles as a well-supported, safe, and guideline-endorsed foundation. Next step is designing rigorous research with standardised outcomes, disease-specific populations, mechanistic sub-studies, and the implementation support that adherence requires.
Background:The optimal sequencing of advanced therapy in ulcerative colitis (UC) remains unclear. Data comparing different sequencing including the use of tofacitinib as first-line therapy remain scarce. Objectives:We compared the treatment persistence of two therapeutic strategies: anti-tumor necrosis factor (anti-TNF) agents to tofacitinib (A→T) versus tofacitinib to anti-TNF agents (T→A). Design:We conducted a retrospective, nationwide, claims-based cohort study using data from the Korean Health Insurance Review and Assessment database. Methods:We included adult UC patients initiating anti-TNF agents or tofacitinib as first-line therapy. The primary outcome was second-line treatment persistence, using Kaplan-Meier method and multivariable Cox models to estimate adjusted hazard ratios (aHRs). Propensity score matching balanced baseline characteristics. Results:A total of 314 patients were included (A→T, n=273; T→A, n=41). The T→A group was younger (33.0 vs 42.0 years; P=0.02), had lower concomitant use of corticosteroids at first-line therapy (36.59% vs 65.57%; P<0.01), and had shorter duration of total advanced therapy (3.50 vs 4.29 years; P<0.01). After propensity score matching, the persistence of second-line therapy was significantly longer in the A→T group compared with the T→A group (aHR, 2.48; 95% CI, 1.18-5.21; P=0.02), whereas the persistence of first-line therapy did not differ significantly between the two sequences (aHR, 1.18; 95% CI, 0.76-1.85; P=0.46). Progression to third-line therapy occurred more frequently in the T→A group than in the A→T group (41.5% vs 19.8%). Conclusion:In Korean UC patients, switching from anti-TNF agents to tofacitinib was associated with longer second-line treatment persistence than the reverse sequence.
Background Sclerosing mesenteritis (SM) is a rare fibroinflammatory disease of unknown etiology that primarily affects the root of the small bowel mesentery. Associated diseases that contribute to or predispose to the development of SM have not been well-documented. Objectives We aimed to describe the clinical associations of patients diagnosed with symptomatic SM, their clinical features, outcomes, and therapeutic management. Design We performed a prospective cohort study from 2014 to 2025. Methods Eligible patients were those aged ≥ 18 years who presented at two tertiary Medical Centers in Greece with SM-specific symptoms after ruling out other causes of abdominal pain and radiographic signs indicative of the Coulier criteria on computed tomography scans ( N =58). SM cases lost to follow-up were excluded ( n =3). Descriptive statistics and comparative statistical analysis were used. Results In total, 55 patients with symptomatic SM were included, of whom 25.5% developed severe intra-abdominal complications, with even fatal outcomes. Colchicine in combination with corticosteroid tapering was the most frequently administered therapy (47.3%). SM improved in most patients after treatment (72.9%). During the disease course, 23.6% of patients were diagnosed with immunoglobulin G4-related disease (IgG4-RD), 9.1% had co-existing systemic autoimmune rheumatic diseases, and 9.1% were diagnosed with an abdominal/pelvic malignancy within 6 months of initial SM presentation. In the remaining cases (58.2%), an association with metabolic syndrome conditions and excessive accumulation of visceral adipose tissue was observed. Conclusion In this prospective cohort study, we identified a correlation of symptomatic SM with chronic inflammatory diseases. Certain SM cases are probably part of the IgG4 disease spectrum or systemic autoimmune rheumatic diseases. These results should be taken into account when consulting patients with symptomatic SM, as the clinical management, prognosis, and therapeutic approach may differ according to the underlying systemic disorder.
Background Impaired diffusing capacity of the lung for carbon monoxide (DL CO ) has been frequently described among patients with inflammatory bowel diseases, but longitudinal data of DL CO impairment and its association with IBD activity remain unclear. Objectives To describe the longitudinal report of prevalence and clinical characteristics of chronic DL CO impairment among patients with IBD reporting respiratory symptoms. Design We conducted a prospective single-center study including consecutive patients with confirmed IBD and respiratory symptoms. Methods Patients underwent longitudinal evaluation with chest CT scans and pulmonary function tests. Results Among 75 patients with DL CO measurements, 12 (16%) showed persistently reduced DL CO over a median follow-up of 26.9 [IQR 24.9–30.6] months. Median DL CO was 63.4% of predicted value. All patients had mild or inactive IBD and were on biologics. Imaging abnormalities were mild and did not explain the DL CO reduction. Conclusions Chronic DL CO impairment was observed in 16.0% of IBD patients and no obvious association with clinically active IBD was observed in this selected symptomatic cohort.
The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) is an international scientific organization that has shaped the framework for inflammatory bowel disease (IBD) research, clinical management strategy, therapeutic development, and clinical trial methodology for more than four decades. Formally constituted in April 1981 in Lyon, France, IOIBD was created to address fundamental barriers to scientific and clinical progress in IBD, including inconsistent definitions of disease activity and outcomes across studies and countries. Since the establishment of the IOIBD Foundation for Research and Education in 1997, IOIBD has combined a highly engaged global membership of experts with structured governance, continuously active thematic clusters, and an annual rotating international meeting to deliver consensus frameworks and collaborative initiatives that translate directly to clinical practice and regulatory and translational science. Key outputs include studies of global epidemiology of IBD, the Selecting Therapeutic Targets in IBD (Selecting Therapeutic Targets in Inflammatory Bowel Disease, STRIDE) treat-to-target programs; the SPIRIT consensus initiative addressing long-term disease impact and endpoints for disease-modification trials; validated approaches to capturing disability and patient-reported outcomes; consensus guidance on nutrition and diet as modifiable and potentially disease-modifying factors; recommendations to optimize IBD clinical trial design and endpoints; reclassification of IBD initiative; rapid international guidance during the COVID-19 pandemic; and educational initiatives including topic-focused satellite symposia, the Helmsley-IOIBD Clinical Experience Exchange Program, and the Empowering Women in IBD Leadership Program (EMPOWHER). This manuscript reviews IOIBD's history, operational model, selected scientific contributions, educational mission, and evolving strategy as the field moves toward precision medicine, globalization of care, and data-intensive approaches, including artificial intelligence.
Background:The association of Helicobacter pylori (H. pylori) infection with non-alcoholic fatty liver disease (NAFLD) remains controversial. Additionally, its associations with metabolic dysfunction-associated fatty liver disease (MAFLD), metabolic dysfunction-associated steatotic liver disease (MASLD), and Chinese MAFLD using the most recent diagnostic criteria were unclear. Objective:To analyze the associations of H. pylori infection with NAFLD, MAFLD, MASLD, and Chinese MAFLD. Design:Cross-sectional study. Methods:This study screened 1172 inpatients who underwent both H. pylori test and liver computed tomography or ultrasound examination between June 2020 and May 2024. Multivariate Logistic regression analyses were performed to evaluate the associations of H. pylori infection with the severity of hepatic steatosis and risk of hepatic fibrosis. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated after adjusting for gender, hypertension, hyperlipidemia, body mass index (BMI), fasting plasma glucose (FPG), and high-sensitivity C-reactive protein (HsCRP) in NAFLD analyses; age, gender, drinking, hypertension, diabetes, hyperlipidemia, BMI, and HsCRP in MAFLD analyses; and gender, drinking, hypertension, hyperlipidemia, BMI, FPG, and HsCRP in MASLD and Chinese MAFLD analyses. Results:Overall, 875, 982, 869, and 869 patients were included in NAFLD, MAFLD, MASLD, and Chinese MAFLD analyses, respectively. In NAFLD, MAFLD, MASLD, and Chinese MAFLD analyses, 257, 302, 257, and 257 patients had H. pylori infection, respectively. H. pylori infection was independently associated with severe hepatic steatosis in NAFLD (aOR = 3.956; 95% CI = 1.171-13.359, p = 0.027), MAFLD (aOR = 3.730; 95% CI = 1.083-12.850, p = 0.037), and MASLD (aOR = 3.962; 95% CI = 1.158-13.557, p = 0.028) analyses, but not Chinese MAFLD analyses. However, H. pylori infection was not independently associated with the risk of hepatic fibrosis. Conclusion:H. pylori infection may increase the severity of NAFLD, MAFLD, and MASLD, but not the risk of liver fibrosis.
Background: The pros and cons of incorporating radiotherapy (RT) into chemotherapy (CT) for locally advanced unresectable pancreatic cancer (LAPC) have been debated for decades. Recently, particle (proton and carbon-ion) therapy has emerged as a new radiotherapy modality. Given the unclear benefits of this approach, we summarized clinical outcomes of LAPC treated with concurrent chemoradiotherapy (CRT) using particle therapy to compare outcomes with current treatments. Objectives: To evaluate the efficacy and safety of particle therapy-based CRT in patients with LAPC and compare survival outcomes with photon CRT, combination CT, and single-agent CT. Design: Systematic review and single-arm meta-analysis. Data sources and methods: Studies evaluating LAPC treated with first-line particle CRT, photon CRT, combination CT, and single-agent CT were included. A single-arm meta-analysis was performed to calculate a pooled effect size using the DerSimonian and Laird random-effects model. The primary outcome was overall survival (OS). Secondary outcomes included progression-free survival (PFS), response rate, and adverse events. Results: Across 42 studies and 3161 patients with LAPC, particle CRT achieved a pooled 1-year OS of 75.8% (95% confidence interval (CI) 71.3–79.7), 2-year OS of 41.3% (95% CI 35.6–47.3), and 1-year PFS of 51.7% (95% CI 43.2–60.0). Photon CRT achieved a 1-year OS of 59.4% and 2-year OS of 21.0%; combination chemotherapy 64.4% and 30.8%; and single-agent chemotherapy 37.2% and 13.1%. Pooled response rate after particle CRT was 48.8%. Grade ⩾3 upper gastrointestinal events (ulcer/bleeding) were more frequent after particle CRT (4.3%) than after photon CRT (2.1%). Conclusion: Particle therapy CRT might have comparable survival outcomes in treating LAPC with combination CT, photon CRT, and single-agent CT. These findings support considering particle CRT as a valuable first-line treatment option for LAPC, which should be validated in randomized clinical trials. Trial registration: The final search was conducted on December 31, 2024. The review protocol was registered in PROSPERO with the registration number CRD42023493665.
Inflammatory bowel disease (IBD) is a chronic and progressive disorder of the digestive tract, including Crohn’s disease and ulcerative colitis. Over the last decade, IBD has been extensively studied due to its association with dysregulated intestinal microbiota, increased mucosal permeability, and immune imbalance. Despite available pharmacological treatments, there is no definitive cure. Mucosal healing (MH) has emerged as a crucial therapeutic target, as it aims to restore the integrity of inflamed mucosae and is associated with improved clinical outcomes. However, most clinical studies rely primarily on clinical indices rather than direct endoscopic or histologic assessment of MH, and the optimal vitamin D (VD) dosing required to achieve true MH remains unclear. This review aims to examine the diverse functions of VD in modulating pathways relevant to MH within the context of IBD, highlighting its role in immune modulation, intestinal barrier integrity, and gut microbiota composition, and to discuss its potential therapeutic value in IBD management. Relevant experimental, translational, and human clinical studies focusing on VD status, supplementation, and mechanisms related to MH, immune regulation, and intestinal barrier function in IBD were considered. MH involves epithelial restitution, cell proliferation, and differentiation, and its achievement has been associated with reduced symptoms, lower relapse rates, and decreased need for surgical interventions. Beyond its traditional role in bone health, VD plays a critical role in preserving intestinal barrier integrity and regulating immune homeostasis. While biological evidence indicates that VD modulates immune responses, enhances tight junction integrity, and influences gut microbiota composition, clinical data primarily support its role in improving clinical and biochemical disease activity rather than definitively inducing mucosal repair. This review highlights VD as a relevant immunomodulatory and barrier-protective factor with potential complementary value in the clinical management of patients with IBD.
Background: Failure of stent delivery remains a major technical limitation of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), often necessitating additional tract dilation and increasing procedural complexity and cost. Objectives: The aim of this study was to evaluate whether the guidewire–bile duct angle is associated with stent delivery success in EUS-HGS, and to explore whether a double-lumen dilator (DLD) is associated with procedural improvement consistent with an angle-mediated mechanism rather than direct mechanical advantage. Design: Prospective observational study with a propensity score-matched historical control. Methods: This was a prospective single-arm observational study of patients undergoing EUS-HGS using a DLD, compared with a propensity score-matched historical (retrospective) cohort that underwent conventional dilation. The main outcome was successful stent delivery without additional tract dilation. Results: A total of 25 patients in the DLD group were compared with 25 matched controls. Successful stent delivery without additional dilation was significantly higher in the DLD group than in the conventional group (92% vs 48%, p = 0.001). The guidewire–bile duct angle measured immediately before stent delivery-system insertion was significantly larger in the DLD group than in the conventional group (153.4° vs 123.3°, p < 0.001). On multivariable analysis, a larger guidewire–bile duct angle remained independently associated with successful stent delivery without additional tract dilation (odds ratio per 10-degree increase, 5.49; 95% confidence interval, 2.79–10.83; p < 0.001), whereas DLD use itself was not independently associated with success after adjustment for angle. Device-related costs were lower in the DLD group due to reduced need for additional dilation. The guidewire–bile duct angle showed excellent apparent discrimination in this cohort, with an exploratory threshold of 126° (AUC 0.969), requiring external validation before clinical implementation. Conclusion: In conclusion, the improvement associated with DLD use was consistent with an angle-mediated mechanism rather than a direct effect of dilation force; these findings should be regarded as hypothesis-generating mechanistic evidence rather than mechanistic proof.
Hypertriglyceridemic acute pancreatitis (HTG-AP) is an acute, noninfectious inflammatory disease caused by excessively high levels of serum triglycerides, leading to an overproduction of free fatty acids. This damages the pancreas and disrupts pancreatic microcirculation, leading ultimately to HTG-AP. Clinically, HTG-AP is associated with increasing incidence, multiple complications, and a higher risk of severe disease or adverse outcomes. There is a lack of unified standards, both domestically and internationally, for the clinical management of HTG-AP. This presents challenges for HTG-AP treatment while also offering opportunities to explore more effective interventional approaches. Preliminary research suggests the importance of the gut microbiota in the development and progression of HTG-AP, potentially mediated by influencing lipid metabolism and inflammatory responses. However, little is known of the potential function of the gut microbiota in the etiology of HTG-AP. This review summarizes current evidence on gut microbiota alterations in HTG-AP, with emphasis on lipid metabolism, intestinal barrier injury, and immune-inflammatory pathways. We also discuss microbiota-targeted interventions as investigational strategies that require HTG-AP-specific clinical validation.
