Gastrointest. Disord., Volume 7, Issue 4 (December 2025) – 7 articles

Background/Objectives: Superficial gastric neoplasms, including dysplasia and early adenocarcinoma, are increasingly managed by endoscopic submucosal dissection (ESD). Preoperative assessment relies on endoscopic forceps biopsy (EFB), despite its limited ability to predict final histology. The diagnostic value of repeat biopsy, the influence of the endoscopy setting where biopsies were taken, and the clinical relevance of histologic discrepancies remain incompletely defined. Methods: We conducted a retrospective, single-center study of 270 superficial gastric lesions resected by ESD between 2015 and 2024. Histologic concordance between EFB and ESD was evaluated, including comparisons between initial and repeated biopsies, and between community- and hospital-based settings. Multivariable models identified predictors of histologic discrepancy and assessed the impact of underestimation on curative resection. The association between biopsy repetition and submucosal fibrosis was also explored. Results: Histologic concordance between EFB and ESD was 54.1%, with underestimation in 41.1% and severe underestimation in 8.9%. Repeat biopsy improved concordance from 39.3% to 60.7% (p = 0.007) and increased adenocarcinoma sensitivity from 12.5% to 56.3%, without increasing submucosal fibrosis. Hospital-based biopsies outperformed community-based ones across all diagnostic metrics. In multivariable analysis, older age and larger lesion size were independent predictors of discrepancy. Histologic underestimation was independently associated with a lower likelihood of curative resection (OR = 0.148; p = 0.003), although only six lesions ultimately exceeded formal ESD criteria due to undetected high-risk features. Conclusions: EFB frequently underestimates histological severity in superficial gastric neoplasia. Repeat biopsy and centralized evaluation significantly improve diagnostic accuracy without increasing procedural risk. However, the role of biopsy lies primarily in excluding high-risk features rather than providing definitive staging. In this context, ESD serves not only as curative therapy but also as a key diagnostic step for accurate staging and treatment planning. Full article

Background: Achalasia is a rare primary esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and progressive loss of peristalsis. Although its pathogenesis remains incompletely understood, autoimmune mechanisms have been repeatedly proposed. Thyroid disorders, particularly autoimmune thyroiditis and Graves’ disease, have been reported as frequent comorbidities, suggesting a shared autoimmune background. Methods: We conducted a narrative review of PubMed, Scopus, and Web of Science from January 2005 to August 2025. Eligible studies included observational cohorts, case–control analyses, and case reports describing thyroid disease in achalasia. Mechanistic and immunological studies relevant to thyroid autoimmunity were also considered. Data were synthesized narratively and summarized in tables and figures. Results: Despite heterogeneity, evidence consistently indicates an increased prevalence of thyroid disease in achalasia. Early reports described dysfunction in up to one quarter of cases, while Romero-Hernández et al. demonstrated a threefold higher risk of autoimmune thyroid disease. Multicenter data confirmed thyroid autoimmunity in about one fifth of patients. Although thyroid disease did not alter short-term procedural outcomes, unrecognized dysfunction may complicate postoperative evaluation. Immunological findings, including human leukocyte antigen (HLA) susceptibility and lymphocytic infiltration of myenteric plexus, further support a shared autoimmune predisposition. Conclusions: Thyroid disorders, particularly autoimmune hypothyroidism, are more common in achalasia than in the general population. Although the evidence remains limited, the consistent signal suggests a non-random association. Early recognition may improve patient management, while prospective multicenter studies are needed to clarify causality and to determine whether achalasia should be considered part of a broader autoimmune spectrum. Full article

Background: Over the years, surgical techniques have evolved, resulting in an abundance of available procedures in the armamentarium of metabolic and bariatric surgeons, and the technology has also advanced in a similar way. Significant steps have been made in stapling technology especially, introducing artificial intelligence (AI) in optimizing this technology for better treatment outcomes. The introduction of AI in stapling technology showed a decrease in potential stapling complications not only in MBS, but also in other (surgical) specialties. Areas Covered: This review will cover the general principles of stapling in surgery, but with an emphasis on both the technical and anatomical considerations. We will also discuss the mechanisms of staplers and potential safety hazards. Finally, we will focus on how AI is integrated in stapling technology, potential pros and cons, and areas for future development of stapling technology and the integration of AI. Conclusions: In metabolic and bariatric surgery, stapling is a technical procedure that requires a comprehensive understanding of the anatomical and physiological characteristics of the target tissue. Variability in tissue thickness, vascularity, elasticity, and mechanical load, compounded by patient-specific factors and intraoperative dynamics, demands constant vigilance and adaptability from the surgeon. The integration of AI and digital technologies offers potential improvements in refining this process. By providing real-time feedback on tissue properties and supporting intraoperative decision-making, these tools can assist surgeons in optimizing staple-line integrity and minimizing complications. The ongoing combination of surgical expertise with intelligent technology may contribute to advancing precision stapling in metabolic and bariatric surgery. Full article

Background: The human gut microbiome—a diverse ecosystem of trillions of microorganisms—plays an essential role in metabolic, immune, and neurological regulation. However, modern lifestyle factors such as antibiotic overuse, cesarean delivery, reduced breastfeeding, processed and high-sodium diets, alcohol intake, smoking, and exposure to environmental toxins (e.g., glyphosate) significantly reduce microbial diversity. Loss of keystone species like Bifidobacterium infantis (B. infantis) and Lactobacillus reuteri (L. reuteri) contributes to gut dysbiosis, which has been implicated in chronic metabolic, autoimmune, cardiovascular, and neurodegenerative conditions. Materials and Methods: This Qualitative Systematic Review (QualSR) synthesized data from over 547 studies involving human participants and standardized microbiome analysis techniques, including 16S rRNA sequencing and metagenomics. Studies were reviewed for microbial composition, immune and metabolic biomarkers, and clinical outcomes related to microbiome restoration strategies. Results: Multiple cohort studies have consistently reported a 40–60% reduction in microbial diversity among Western populations compared to traditional societies, particularly affecting short-chain fatty acid (SCFA)-producing bacteria. Supplementation with B. infantis is associated with a significant reduction in systemic inflammation—including a 50% decrease in C-reactive protein (CRP) and reduced tumor necrosis factor-alpha (TNF-α) levels—alongside increases in regulatory T cells and anti-inflammatory cytokines interleukin-10 (IL-10) and transforming growth factor-beta 1 (TGF-β1). L. reuteri demonstrates immunomodulatory and neurobehavioral benefits in preclinical models, while both probiotics enhance epithelial barrier integrity in a strain- and context-specific manner. In murine colitis, B. infantis increases ZO-1 expression by ~35%, and L. reuteri improves occludin and claudin-1 localization, suggesting that keystone restoration strengthens barrier function through tight-junction modulation. Conclusions: Together, these findings support keystone species restoration with B. infantis and L. reuteri as a promising adjunctive strategy to reduce systemic inflammation, reinforce gut barrier integrity, and modulate gut–brain axis (GBA) signaling, indicating translational potential in metabolic and neuroimmune disorders. Future research should emphasize personalized microbiome profiling, long-term outcomes, and transgenerational effects of early-life microbial disruption. Full article

Background: Timely diagnostic colonoscopy (DC) after a positive fecal immunochemical test (FIT+) is essential for effective colorectal cancer (CRC) screening. In Flanders, 16% of FIT+ participants in 2022 had no DC in the 24 months following the FIT+ result. This study evaluated the impact of a failsafe reminder letter—sent 24 months after a FIT+ result without registered correct follow-up—on DC completion and identified factors associated with correct follow-up. Methods: We included all individuals in the Flemish CRC screening program who had a FIT+ result between 2017 and 2019 and later received a failsafe letter due to lacking correct follow-up within 24 months. Correct follow-up was defined as a complete colonoscopy, virtual colonoscopy, or cancer diagnosis. We calculated the proportion of individuals completing correct follow-up within 24 months of the letter. Multivariable logistic regression examined associations between odds of correct follow-up and individual and area-level characteristics. Results: Of the 7175 individuals who received a failsafe letter, 16.1% completed correct follow-up within 24 months. Individuals aged 70–74 had significantly lower odds of correct follow-up than those aged 60–64 (odd ratio (OR) = 0.59; 95% confidence interval (CI): 0.48–0.72). Living in areas with a higher proportion of young adults in higher education was associated with higher odds of correct follow-up (OR = 1.041; 95% CI: 1.002–1.080). Conclusions: The failsafe letter modestly improved follow-up among a hard-to-reach group. Older age and lower area-level educational attainment were linked to reduced odds of correct follow-up. Targeted efforts are needed to improve DC completion in these subgroups. Full article

Background/Objectives: The role of the intestinal microbiota in gastroenterological diseases has gained increasing relevance in general medicine. The study aimed to evaluate the knowledge and awareness of Italian general practitioners regarding gut microbiota, as well as the clinical applications of probiotics and prebiotics. Methods: The survey research involved 457 Italian general practitioners, who anonymously filled an online structured questionnaire. Results: Most respondents identified antibiotics, diet, gastrointestinal infections, and stress as factors that can modulate the gut microbiota, while a smaller proportion recognized the role of physical activity. A comparable number acknowledged the influence of obesity, smoking, and immunosuppressant drugs. Although most participants correctly defined probiotics, the concept of prebiotics was less widely understood. Probiotics were primarily prescribed for irritable bowel syndrome, suspected dysbiosis, or during antibiotic therapy, and only a portion of physicians reported routinely combining them with prebiotics. The selection of probiotic strains was mainly based on personal experience, while fecal microbiota analysis was seldom used in clinical practice. Conclusions: These findings provide an updated snapshot of current knowledge and practices regarding the microbiota in Italian general medicine and highlight critical gaps, particularly in the understanding of prebiotics and less recognized modulatory factors. Full article

Background: Patients with ulcerative colitis (UC) and Crohn’s disease (CD) have an increased cardiovascular risk (CVR). The aim of the present study was to stratify the CVR of patients with UC and CD according to the most recent guidelines via carotid ultrasound (US) to detect subclinical atherosclerotic disease. Methods: Demographic and disease-related data of consecutive patients with IBD were prospectively collected along with information on blood pressure, body mass index, lipid profile, and concomitant medications. CVR was stratified at inclusion according to the most recent version of Systematic Coronary Risk Evaluation 2 (SCORE2) and re-stratified after carotid US when subclinical atherosclerotic disease was detected. Results: A total of 166 patients aged ≥ 40 years with IBD were included. Before carotid US evaluation, 43.4% of patients with IBD were at moderate risk, 40.3% at high risk, and 16.3% at very high risk. With carotid US, subclinical atherosclerosis was diagnosed in 48% of patients, leading to CVR re-stratification from moderate to high in 18% of patients and from high to very high in 4% of patients. The only predictive factor for re-stratification was failure with more than two biologics (p = 0.047; OR 2.187, 95% CI: 1.004–4.741). Conclusions: CVR is considerably prevalent in patients with IBD. Carotid US may help to re-classify CVR and should be considered as a risk modifier in patients at intermediate risk. Screening for CVD risk factors should be recommended in IBD. Full article