Gastroenterology

Accelerated step‑up therapy with early anti‑TNF showed favorable 1‑year IBD outcomes in Vietnam

In a Vietnamese inception cohort (N=126; Outcome Cohort N=66), accelerated step‑up care increased anti‑TNF use to 45.5% at one year. Among patients with ≥12 months follow‑up, 63.6% achieved steroid‑free clinical remission and 62.3% had mucosal healing on endoscopy. Serious infections occurred in 9.1%, with tuberculosis reactivation in 4.5%, after mandatory TB screening before biologics. Authors conclude early biologic escalation can be feasible in TB‑endemic, resource‑constrained settings with structured TB monitoring. 1

Umbrella review: biotics provide condition‑specific benefits with generally favorable safety

This umbrella review synthesized 128 systematic reviews/meta‑analyses of probiotics, prebiotics, and synbiotics published since 2023. Certain probiotics reduced necrotizing enterocolitis and improved glycemic, lipid, and inflammatory measures in type 2 diabetes, and showed benefits in IBS, IBD, and constipation. Safety was generally acceptable, but increased sepsis risk was noted in vulnerable pediatric populations. Heterogeneity by strain, population, and condition limits generalizability and calls for standardized trials. 2

GLP‑1RAs show a favorable but low‑certainty signal for advanced liver outcomes in T2D

A systematic review and exploratory meta‑analysis of comparative real‑world cohorts found pooled HR 0.85 (95% CI 0.74–0.98) for GLP‑1RAs versus DPP‑4 inhibitors for incident cirrhosis or serious liver events. The pooled estimate had I²=0% but the certainty was rated very low because all studies were observational and definitions varied. Authors emphasize this is hypothesis‑supporting evidence and not definitive causal proof due to residual confounding and potential bias. 3