Gastroenterology

Pediatric IBD lags adult standards; only three advanced therapies approved

Pediatric IBD treatment options for advanced therapies remain limited to infliximab, adalimumab, and ustekinumab approved for children. Most pediatric practice relies on off-label use and extrapolation from adult trials, owing to few pediatric RCTs. Safety data beyond anti-TNF agents are sparse for serious infections, malignancy, and VTE in children. Authors recommend integrating real-world pediatric data and predictive models to move toward precision pediatric care. 1

Augmented clinician encounters improve outcomes in adult DGBI

Systematic review of 12 studies found empathy, warmth, and active listening improved symptoms and quality of life in DGBI, notably IBS. Confident positive diagnosis plus gut-brain psychoeducation increased adherence in functional dyspepsia versus exclusionary approaches. Multidisciplinary models and non-deceptive placebo approaches enhanced therapeutic context across studies. Evidence is heterogeneous and partly indirect, aligning with Rome V Level 1 psychosocial care but needing direct RCT confirmation. 2

Oral and colonoscopic MTT yield similar donor engraftment after ileocecal resection

In a single-blind pilot randomized trial of postoperative Crohn's patients, oral capsules and colonoscopic liquid MTT produced similar stool and ileal donor engraftment at week 8. Stool and mucosal engraftment levels were correlated, but engraftment did not predict clinical outcomes. Harvey-Bradshaw Index scores improved after MTT overall, with no difference by administration route. Oral MTT was well tolerated, supporting further study of oral delivery earlier in the postoperative course. 3