Background Paraoesophageal hernia repair has a high recurrence rate, necessitating improved techniques. Gastropexy has emerged as an adjunct to standard repair to address this issue. Objectives Assessing the role of anterior gastropexy to posterior sheath of anterior abdominal wall in PEH recurrence. Design A retrospective single center, single surgeon analysis of minimally invasive Paraoesophageal hernia repair. Methods Overall 85 patients who underwent laparoscopic paraoesophageal hernia repair between 2016 and 2023 were included. Patients were grouped by whether gastropexy was performed, with intracorporeal posterior sheath of anterior abdominal wall gastropexy used. Eighteen months recurrence rates, operative times, and complications were analyzed. Results The gastropexy group (n=22) had significantly lower 18 months recurrence rates (4.5% vs. 36.5%, p=0.005) compared to the non-gastropexy group (n=63). No significant differences in early postoperative outcomes or complications were observed. Conclusions Adding posterior sheath of anterior abdominal wall gastropexy to paraoesophageal hernia repair seems to reduce recurrence rates without increasing complications or operative time. This may supports its role as a valuable adjunct in routine paraoesophageal hernia repair.
Background Extraintestinal manifestations are common in inflammatory bowel disease (IBD), with erythema nodosum (EN) and pyoderma gangrenosum (PG) among the most frequent cutaneous manifestations. Objectives To characterize EN and PG in patients with IBD and describe their management, impact on IBD treatment, and long-term outcomes. Design Retrospective, multicentre study based on data from the prospectively maintained nationwide ENEIDA registry in Spain. Methods Patients with IBD and dermatologist-confirmed EN or PG diagnosed between January 2013 and February 2023 were included. Clinical characteristics, lesion distribution, treatments, response at week 8, impact on IBD management, and recurrence during follow-up were assessed. Results Overall, 528 patients were included (394 EN; 134 PG). EN occurred predominantly in women and patients with Crohn’s disease, whereas PG showed a less pronounced female predominance (60% vs 77%) and no clear association with IBD type. EN was more frequently diagnosed during clinically active IBD than PG (64% vs 48%; p=0.006). Lesions mainly involved the lower limbs (93% EN; 79% PG); EN was more often multiple and bilateral. Most lesions developed after IBD diagnosis, although 14% of EN and 8% of PG preceded it. At week 8, remission (complete resolution of nodules or ulcerated lesions) was achieved in 77% of patients with EN and 43% with PG. PG more frequently required advanced therapies than EN (39% vs 15%; p<0.001) and showed a longer time to lesion resolution. Anti-TNF agents were the most frequently used biologics, followed by ustekinumab. Cutaneous manifestations led to modification of IBD treatment in 18% of EN and 29% of PG cases. After a median follow-up of approximately 70 months, recurrence occurred in 21% and 22% of patients, respectively, and more than half of those with recurrence experienced multiple episodes. Conclusion In this retrospective cohort, EN and PG in IBD differed in their patient characteristics, association with IBD activity and treatment requirements. PG showed a slower short-term response and more often required advanced therapy, while both conditions had similar long-term recurrence rates. These findings suggest that multidisciplinary management and long-term follow-up may be beneficial, and they should be confirmed in prospective studies.
Background Comparing intravenous (IV) infliximab (IFX) with subcutaneous (SC) CT-P13 in inflammatory bowel disease (IBD) may inform clinical practice, particularly in patients in stable remission receiving maintenance therapy. Objectives To compare IV IFX and SC CT-P13 as maintenance therapy in patients with IBD. Design Retrospective, single-centre, observational cohort study using propensity score weighting. Methods Adult patients with Crohn’s disease (CD) or ulcerative colitis (UC) in stable steroid-free remission while receiving maintenance IV IFX, 5 mg/kg every 8 weeks, were included. Patients switched to SC CT-P13 were compared with patients who continued IV IFX. A propensity score-weighted analysis using inverse probability of treatment weighting was applied. The primary endpoint was time to treatment failure, defined as a composite endpoint including re-switch from SC to IV IFX, IV IFX dose intensification, steroid-requiring flare, switch to another advanced therapy, or IBD-related surgery. Results Among 251 patients, 135 had CD (53.8%) and 116 had UC (46.2%); 134 remained on IV IFX and 117 switched to SC CT-P13. Mean follow-up was 24.7 ± 29.8 months in the IV group and 20.9 ± 14.9 months in the SC group. Time to treatment failure was not significantly different between groups (log-rank p = 0.10; HR 0.71, 95% CI 0.45–1.12). A significant time-dependent effect was observed (p = 0.005): discontinuation risk was initially higher after switching, but progressively decreased over time, becoming lower after approximately 8 months. Conclusion In patients with IBD in stable steroid-free remission, switching to SC CT-P13 may provide treatment persistence, safety, and disease control comparable to continued IV IFX.
Background Gastroesophageal cancers are associated with poor prognosis, necessitating effective adjunctive strategies. Renin–angiotensin system (RAS) inhibitors have demonstrated potential antineoplastic effects in preclinical models, but their clinical impact remains uncertain. Objectives To evaluate the association between RAS inhibitor exposure and survival outcomes in patients with gastroesophageal cancers. Design Meta-analysis of observational studies. Data Sources and Methods PubMed, Embase, and Web of Science were searched from inception to May 5, 2026. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Prespecified subgroup and sensitivity analyses were performed to explore heterogeneity and robustness. Publication bias was assessed by funnel plots and Egger’s test, with trim-and-fill analysis used as an exploratory assessment of the potential impact of funnel-plot asymmetry. Results Twelve studies comprising 14 cohort-level estimates ( N = 15,062) were included. RAS inhibitor exposure was associated with improved overall survival (HR = 0.79, 95% CI: 0.71–0.88; I 2 = 40.8%). Consistent associations were observed for cancer-specific survival (HR = 0.83, 95% CI: 0.75–0.91; I 2 = 0%) and disease-free survival (HR = 0.67, 95% CI: 0.49–0.90; I 2 = 0%). Subgroup analyses showed directionally consistent associations in both gastric and esophageal cancers. Evidence of small-study effects was detected ( p = 0.003), and trim-and-fill analysis attenuated the pooled OS estimate to HR 0.84 (95% CI: 0.74–0.96). Conclusions RAS inhibitor exposure was associated with improved survival outcomes in gastroesophageal cancers. However, given the observational nature of the evidence, substantial heterogeneity in exposure definitions and treatment settings, and evidence of small-study effects, these findings should be interpreted as hypothesis-generating. They do not support routine clinical use of RAS inhibitors for anticancer purposes outside established indications. Prospective studies are warranted to determine whether these associations reflect causal effects and to identify clinical contexts in which RAS inhibition may be beneficial.
Background Long-term outcomes following liver transplantation (LT) continue to improve with post-transplant survival approximately 75% at 10 years. Excessive weight gain following LT is a well-documented phenomenon and is a known contributing factor to morbidity and mortality in LT recipients. Objectives To identify risk factors and predictors of post-LT weight gain Design : Single-centre retrospective cohort study at the Victorian Liver Transplant Unit including all adult liver transplant recipients between 1/1/2010 and 31/12/2019. Method This study included 501 consecutive adult patients who received a LT over a 10-year period. Data were collected on patient demographics, weight change over time, body composition, and functional and nutritional assessment. Results LT recipients gained an average of 1.1kg every year after transplant. On multivariable hierarchical analysis to adjust for weight change over time, male gender, age and years from LT were independently associated with weight gain after LT. Multivariable analysis to assess for risk factors for obesity (BMI≥30kg/m2) post-LT demonstrated severe pre-LT malnutrition as a significant negative predictor for obesity (OR 0.55, p=0.039). Conversely, transplant indication of metabolic dysfunction-associated steatotic liver disease (MASLD) was the only significant risk factor for obesity at 5 years post-LT (OR 3.78, p<0.001). Conclusion MASLD is associated with post-transplant obesity, a finding of particular importance given its emergence as the most common indication for liver transplantation. Post-LT obesity was less common in patients with pre-LT malnutrition. Prospective multi-centre studies are warranted including comprehensive body composition analysis to better understand predictors of post-transplant obesity to allow for early targeted interventions to minimise the risk of obesity-related disease in this growing cohort.
