Daily Brief

What Did the Study Find?

The SOFT Preop trial randomized 98 patients with resectable, borderline-resectable or selected locally advanced pancreatic ductal adenocarcinoma (PDAC) to preoperative stereotactic body radiotherapy (SBRT) or conventional chemoradiation, usually after induction chemotherapy.

• Treatment duration: SBRT required only 5 fractions, compared with 28 fractions of conventional chemoradiation.
• Primary endpoint—node positivity: Similar between SBRT and chemoradiation (41% vs 38%).
• Pathological response and surgical complications: No significant differences between groups.
• Local/regional recurrence: Numerically higher with SBRT (6 vs 2 patients).
• Median overall survival: 26 vs 43 months, numerically favoring chemoradiation, but not statistically significant.
• Three-year survival: 42.6% vs 57.5%, respectively.
• Median progression-free survival: 14.3 vs 21.6 months, also numerically favoring chemoradiation.
• Quality of life: SBRT significantly better preserved physical function and global physical health and reduced fatigue.

Why Does It Matter?

SBRT offers a major practical advantage: five treatment sessions instead of 28, reducing treatment burden and preserving quality of life without an observed increase in surgical complications.

However, the numerical differences in overall survival, progression-free survival and local recurrence raise questions about whether shorter treatment provides equivalent long-term cancer control.

GastroAGI Takeaway

SBRT offers convenience and better quality of life—but has not demonstrated oncological equivalence to conventional chemoradiation before pancreatic cancer surgery.

The trial provides reassuring evidence regarding surgical safety and pathological response, but the 17-month numerical overall-survival difference warrants further investigation.

What Did the Study Find?

The five-centre FIT trial enrolled adults experiencing at least four faecal-incontinence episodes over two weeks despite medical and behavioural therapy. Two hundred nonresponders—176 women and 24 men—were randomised to anorectal biofeedback or anal dextranomer–hyaluronic-acid injection.

At three months, the prespecified clinically stringent endpoint of at least a 75% reduction in incontinence episodes occurred in 29/99 patients receiving biofeedback and 28/101 receiving injection: 29.3% versus 27.7%. Injection was not superior (adjusted OR 0.9; 95% CI 0.5–1.7). Relevant adverse events occurred in five injection recipients and two biofeedback recipients, without a significant difference. Injection cost payers an average US$1,563 more per patient and society US$1,579 more. Most participants were women, and longer-term comparative effectiveness remains uncertain. ScienceDirect

Why Does It Matter?

The trial supplies the direct comparison previously missing from management pathways. Since efficacy was modest and essentially equivalent, treatment burden, local expertise, availability and cost should drive shared decision-making; where accessible, biofeedback is the more economical initial escalation.

GastroAGI Takeaway

After optimised conservative treatment fails, consider anorectal biofeedback before injectable bulking therapy: approximately three in ten achieved major improvement, with no efficacy advantage—and substantially higher cost—for injection.

What Did the Study Find?

Investigators pooled three prospective cohorts of 99 patients starting or optimising biologic therapy, with capsule endoscopy at baseline, after induction at 14–26 weeks and at one year. Treatment comprised anti-TNF therapy in 53 patients, vedolizumab in 43 and ustekinumab in only three; 82 completed post-induction imaging and 59 completed one-year assessment.

Using a Lewis score ≥135, proximal small-bowel inflammation declined from 63% at baseline to 44% after induction and 41% at one year. Distal inflammation fell from 95% to 78% and 71%, respectively. The degree of mucosal healing did not differ significantly by location: risk difference 7% after induction and 0% at one year. With the more stringent Lewis-score threshold of 350, distal inflammation decreased from 76% to 19% at one year and proximal inflammation from 38% to 19%. pubmed.ncbi.nlm.nih.gov

Why Does It Matter?

Proximal disease is associated with poorer outcomes and may be missed by ileocolonoscopy. These findings argue against assuming that currently used biologics inherently heal distal disease better. However, treatment was not randomised, attrition was substantial, and the study cannot compare individual biologic classes.

GastroAGI Takeaway

Biologic response appears geographically consistent across the small bowel—but capsule or cross-sectional assessment remains important because substantial inflammation persisted at one year.

What Did the Study Find?

Investigators analysed nearly 200,000 participants from the Nurses’ Health Study, Nurses’ Health Study II and Health Professionals Follow-Up Study. Late-night eating was defined from self-reported consumption after dinner or after going to bed and was compared with not reporting this behaviour.

Across follow-up, researchers documented 4,477 incident MASLD cases and 312 incident cirrhosis cases. After multivariable adjustment for metabolic, dietary and lifestyle factors, late-night eating was associated with approximately 31% higher MASLD risk (adjusted HR 1.31; 95% CI 1.24–1.39) and 28% higher cirrhosis risk (adjusted HR 1.28; 95% CI 1.02–1.62). These are relative—not absolute—risk increases. Meal timing was self-reported, liver outcomes were not uniformly imaging- or biopsy-defined, and residual confounding by sleep, shift work or other behaviours remains possible. pubmed.ncbi.nlm.nih.gov

Why Does It Matter?

The large longitudinal dataset strengthens the signal that circadian eating patterns may contribute independently to metabolic liver risk. It supports asking about meal timing during lifestyle assessment, but does not establish a therapeutic fasting interval or prove that changing eating time prevents MASLD.

GastroAGI Takeaway

Earlier, consistent meal timing is reasonable low-risk counselling, but late-night eating should be treated as a modifiable risk marker—not yet as a proven causal target.