Background: Few studies have compared the efficacy and safety of second-line biological therapies in ulcerative colitis (UC) patients with prior exposure to anti-tumor necrosis factor (TNF) therapy. We aim to compare the efficacy and safety between ustekinumab, vedolizumab, and tofacitinib, a current option as second-line biological therapy with different mechanisms in those patients. Methods: This retrospective multi-center study was conducted across five institutions from 2011 to 2022. We enrolled patients with moderate to severe UC who failed anti-TNF therapy and subsequently received ustekinumab, vedolizumab, or tofacitinib as second-line biological therapy. The outcomes were analyzed for clinical response/remission and endoscopic improvement/remission rates after induction therapy, drug persistency, and adverse events. Results: A total of 70 UC patients were included and grouped into ustekinumab (11 patients), vedolizumab (40 patients), and tofacitinib (19 patients) treatments. The clinical response/remission rates after induction therapy were similar between ustekinumab (90.9/81.8%), vedolizumab (92.5/65.0%), and tofacitinib (94.7/73.7%). There were no significant differences in the endoscopic improvement/remission rates between the three groups: 90.9/18.2% for ustekinumab, 72.5/12.5% for vedolizumab, and 84.2/26.3% for tofacitinib. Drug persistence was similar across the three agents (p = 0.130). Three patients of the tofacitinib group experienced adverse events (herpes zoster and hypertriglyceridemia). Conclusions: Based on real-world data, second-line biological therapy with ustekinumab, vedolizumab, and tofacitinib showed comparable efficacy in patients with moderate to severe UC with prior exposure to anti-TNF therapy.

Background: Esophageal squamous cell carcinoma (ESCC) typically occurs in older individuals. The etiology and clinical characteristics of ESCC in relatively younger patients under 60 years of age remain unclear. Understanding whether age affects tumor behavior or prognosis is important for improving patient management. This study aimed to analyze the characteristics of ESCC diagnosed before the age of 60. Methods: We retrospectively reviewed the medical records of ESCC patients diagnosed between December 2008 and May 2025. A total of 516 patients were divided into two groups based on whether they were aged 60 or above. Medical history, clinical features, and outcomes were compared between the two groups. Results: There were 100 patients under 60 years and 416 patients aged 60 and above. The median ages were 55 (range 41–59) and 72 (range 60–95), respectively. Younger patients had a significantly stronger association with heavy drinking (72.0% vs. 39.2%, p < 0.001) and smoking (76.0% vs. 55.0%, p < 0.001). There was a trend toward more advanced disease (Stage IV: 26.0% vs. 18.5%, p = 0.094) and metastatic presentation (18.0% vs. 13.9%, p = 0.305) in the under-60 group. Despite being younger with better performance status and fewer comorbidities, their overall survival did not differ from that of older patients (HR 0.92; 95% CI, 0.67–1.26; p = 0.593). Conclusions: Patients diagnosed with ESCC under the age of 60 showed a stronger association with heavy alcohol consumption and smoking and more frequent presentation with advanced-stage disease compared with older patients. Younger age did not confer a better prognosis, highlighting the importance of early detection and timely intervention regardless of patient age.

This study aimed to compare the long-term clinical characteristics, treatment patterns, and prognosis of inflammatory bowel disease (IBD) in patients diagn

Background: Endoscopic submucosal dissection (ESD) is widely used for the treatment of gastric neoplasia; however, the large artificial ulcer created during the procedure requires several weeks to heal. Although proton pump inhibitors (PPIs) are routinely administered after ESD, evidence comparing individual PPIs for artificial ulcer healing in real-world practice remains limited. This study compared the effectiveness of oral ilaprazole and oral esomeprazole as maintenance therapy after gastric ESD. Methods: This retrospective single-center study included patients who underwent gastric ESD between January 2020 and December 2024. All patients received intravenous PPI therapy for two days after ESD and were subsequently prescribed either oral ilaprazole 20 mg once daily or esomeprazole 40 mg once daily for 8 weeks. The primary outcome was complete artificial ulcer healing at 8 weeks. The secondary outcome was post-discharge delayed bleeding. Results: A total of 229 patients were analyzed (147 in the esomeprazole group and 82 in the ilaprazole group). The overall 8-week ulcer healing rate was 94.3%, with no significant difference between the ilaprazole and esomeprazole groups (97.5% vs. 92.5%, p = 0.114). In multivariate analysis, artificial ulcer size ≥ 30 mm was the only independent predictor of incomplete ulcer healing (odds ratio 20.850, 95% confidence interval 1.884–230.712, p = 0.013). Post-discharge delayed bleeding occurred in 8 patients (3.4%), all in the esomeprazole group (p = 0.032). No treatment-related adverse events were observed. Conclusions: Ilaprazole demonstrated ulcer-healing efficacy comparable to esomeprazole after gastric ESD. Artificial ulcer size ≥ 30 mm was the principal determinant of delayed healing, whereas the treatment group was not independently associated with healing outcomes. Ilaprazole may be considered a reasonable maintenance PPI option in routine post-ESD management.