Gastroenterology Insights

13 pages, 709 KB

Open AccessArticle

Role of Endoscopy and EUS in the Staging of Superficial GI Neoplastic Lesions

by Thomas Togliani, Andrea Lisotti, Francesco Tomba, Arianna Massella, Anna Granato, Marina Mastromauro, Morena Tebaldi, Pietro Fusaroli and Vincenzo Giorgio Mirante

Gastroenterol. Insights 2026, 17(2), 23; https://doi.org/10.3390/gastroent17020023 - 1 Apr 2026

Abstract

Aims/Purpose: In case of superficial neoplastic GI lesions the depth of infiltration is associated with the risk of nodal metastasis and guides the choice between minimally invasive endoscopic treatments and resective surgery. The aim of the study was to compare the performance of [...] Read more.

Aims/Purpose: In case of superficial neoplastic GI lesions the depth of infiltration is associated with the risk of nodal metastasis and guides the choice between minimally invasive endoscopic treatments and resective surgery. The aim of the study was to compare the performance of the endoscopic evaluation and EUS in identifying early tumors fit for endoscopic resection. Methods: Retrospective study on patients affected by early-appearing neoplastic GI lesions. We compared the high-definition endoscopic assessment of the lesions according to the Paris classification (classifying them as fit or unfit for endoscopic resection, according to guidelines) and the EUS staging (classifying them as intramucosal or submucosal) to the histological staging after resection. Results: From 4/2022 to 6/2025 57 patients were included. Lesions were located in the esophagus (19), stomach (29), and rectum (9); they underwent EMR—endoscopic mucosal resection—(six), ESD—endoscopic submucosal dissection—(29), upfront surgical resection (18), or upfront TEM—transanal endoscopic microsurgery (four); thereafter, 11 patients underwent surgery or TEM after not-radical endoscopic treatment or complications. After endoscopic assessment 42 lesions were considered fit for endoscopic resection: nine (21.4%) yielded HGD, 19 (45.3%) T1a, and 14 (33.3%) T1b; 15 were considered unfit for endoscopic resection: one (6.7%) yielded T1a, 14 (93.3%) T1b. Endoscopic accuracy for identifying intramucosal lesions (HGD or T1a) thus fit for endoscopic resection was 73.7%. EUS staged 29 lesions as uT1a: eight (27.6%) yielded HGD, 8 (27.6%) T1a, and 13 (44.8%) T1b; EUS staged 28 lesions as uT1 b: one (3.6%) yielded HGD, 12 (42.8%) T1a, and 15 (53.6%) T1b. EUS accuracy for identifying intramucosal lesions (HGD or T1a) was 54.4%, but it showed a 91.7% PPV for the N0 status. Conclusions: The endoscopic evaluation was more accurate than EUS (73.7% vs. 54.4%, p < 0.05) in distinguishing GI intraepithelial or intramucosal lesions fit for endoscopic resection, with a markedly higher NPV. EUS could rather be considered as a complementary tool to exclude suspicious lymph nodes before endoscopic resection. Full article

(This article belongs to the Section Gastrointestinal and Hepato-Biliary Imaging)

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13 pages, 660 KB

Open AccessArticle

Predictive Factors and Treatment Outcomes in Patients with Acute Variceal Bleeding

by Mirta Perković, Josip Vrdoljak, Joško Božić and Antonio Meštrović

Gastroenterol. Insights 2026, 17(2), 22; https://doi.org/10.3390/gastroent17020022 - 1 Apr 2026

Abstract

Background/Objectives: The study aimed to determine the demographic and clinical characteristics of patients with acute variceal bleeding and identify predictive factors associated with treatment outcomes. Methods: The retrospective study included 91 adults hospitalised for oesophageal and/or gastric variceal bleeding at the Department of [...] Read more.

Background/Objectives: The study aimed to determine the demographic and clinical characteristics of patients with acute variceal bleeding and identify predictive factors associated with treatment outcomes. Methods: The retrospective study included 91 adults hospitalised for oesophageal and/or gastric variceal bleeding at the Department of Gastroenterology, University Hospital of Split. Data were collected on patients’ demographics, clinical characteristics and laboratory findings, as well as treatment outcomes, including length of hospital stay, need for repeat endoscopy, rebleeding, infection incidence, and six-week mortality. Results: Of the 91 patients included, 85.7% were male, and the mean age was 61 ± 9 years. Liver cirrhosis was present in 94.5% of patients, with alcoholic aetiology in 76.7% of cases. The median MELD-Na score was 15 (IQR 11–21), and more than 40% of patients were classified as Child–Pugh B. The median length of hospital stay was 8 days (IQR 5–10.5). Diagnostic EGD was performed in 94.5% of patients, with 80.2% undergoing the procedure within 12 h of admission. Vasoactive therapy was administered to 65.9% of patients, while antibiotic prophylaxis was given in 82.4%. In-hospital mortality was 16.5%, and the cumulative six-week mortality was 25.3%. The severity of liver disease (expressed by MELD-Na and Child–Pugh scores) was associated with a higher risk of in-hospital mortality (p = 0.0045 and p = 0.009, respectively). Early endoscopic intervention did not result in a statistically significant reduction in in-hospital mortality (8.7% vs. 23.5%; p = 0.104). The use of antibiotic prophylaxis, vasoactive drugs, and endoscopic ligation was not associated with lower rates of infections, repeated endoscopies, or mortality. Conclusions: There was a positive correlation between the severity of decompensated liver cirrhosis and in-hospital mortality. Early endoscopic intervention (within 12 h of admission) was not statistically significant in reducing mortality. The use of antibiotic prophylaxis was not associated with reduced mortality or lower incidence of infections. Vasoactive therapy did not significantly reduce the need for repeat endoscopic intervention. Endoscopic ligation did not decrease the likelihood of rebleeding during hospitalisation, in-hospital mortality, or the length of hospital stay. Full article

(This article belongs to the Section Gastrointestinal Disease)

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11 pages, 257 KB

Open AccessArticle

Assessing Intestinal Inflammation: A Comparison of Immunochromatographic Tests and ELISA for Fecal Calprotectin Detection

by Hassan Ali, Milena Peruhova, Antoaneta Mihova, Georgi V. Vasilev and Tsvetelina Velikova

Gastroenterol. Insights 2026, 17(2), 21; https://doi.org/10.3390/gastroent17020021 - 24 Mar 2026

Abstract

Background: Fecal calprotectin (FC) is a well-established, non-invasive biomarker of intestinal inflammation and is widely used to differentiate inflammatory bowel disease (IBD) from functional gastrointestinal disorders. Although enzyme-linked immunosorbent assays (ELISA) remain the reference method, rapid immunochromatographic tests (ICTs) offer important operational [...] Read more.

Background: Fecal calprotectin (FC) is a well-established, non-invasive biomarker of intestinal inflammation and is widely used to differentiate inflammatory bowel disease (IBD) from functional gastrointestinal disorders. Although enzyme-linked immunosorbent assays (ELISA) remain the reference method, rapid immunochromatographic tests (ICTs) offer important operational advantages for point-of-care (POC) diagnostics. However, variability in analytical performance among available ICTs remains a concern. Objective: This study aimed to evaluate the diagnostic accuracy of the CerTest Calprotectin one-step card (CerTest Biotec S.L., Zaragoza, Spain) in comparison with the Actim^® Calprotectin lateral flow assay and the reference Calprest^® ELISA (Eurospital Diagnostics, Italy). Methods: A total of 128 fresh stool samples from patients clinically suspected of IBD were analyzed in parallel using all three assays. For the reference ELISA (Calprest^®), a cutoff value of >40 µg/g was applied according to the manufacturer’s instructions. For discrepant results between assays, a cutoff of 200 ng/mL (equivalent to 200 µg hCp/g stool) was employed for ELISA Calprest^® to resolve inconsistencies. The results of the lateral flow assays (CerTest^® Calprotectin ICT and Actim^® Calprotectin) were interpreted using their respective manufacturer-recommended thresholds. Diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using ELISA as the reference standard. Agreement between methods was assessed using Cohen’s κ coefficient. Results: Using ELISA, 47 of 128 samples (36.7%) exceeded the 40 µg/g cutoff. Compared with the Actim^® assay, the CerTest card demonstrated a sensitivity of 88.0% (95% CI: 75.7–95.5), a specificity of 100.0% (95% CI: 95.4–100), and a strong agreement (κ = 0.90). When compared with ELISA, the CerTest assay showed a sensitivity of 87.2% (95% CI: 74.3–95.2), a specificity of 96.3% (95% CI: 89.6–99.2), a PPV of 93.2%, an NPV of 93.2%, and a strong agreement (κ = 0.85). Conclusions: The CerTest Calprotectin one-step card provides a rapid and reliable detection of fecal calprotectin, demonstrating a high sensitivity and specificity that are comparable to both other lateral flow assays and the ELISA reference method. These findings support the use of rapid immunochromatographic testing as a valuable tool for preliminary screening and clinical decision-making in patients suspected of IBD, while acknowledging that histology remains the gold standard for definitive diagnosis. Full article

(This article belongs to the Special Issue Immunological Aspects of Gastrointestinal Diseases)

23 pages, 1239 KB

Open AccessReview

Immune-Mediated Colitis in the Era of Immune Checkpoint Inhibition: From Mechanisms to Clinical Management

by Cristina Polo Cuadro, Pilar Corsino Roche, Marta Gascón Ruiz, Santiago García López, Carmen Yagüe Caballero, Ana Royo Esteban, Laura Almenara Michelena and Diego Casas Deza

Gastroenterol. Insights 2026, 17(1), 20; https://doi.org/10.3390/gastroent17010020 - 10 Mar 2026

Abstract

Immunotherapy with immune checkpoint inhibitors (ICIs) has represented a major breakthrough in the treatment of multiple solid and hematological malignancies, significantly improving survival and tumor control. However, the blockade of immune regulatory pathways such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell [...] Read more.

Immunotherapy with immune checkpoint inhibitors (ICIs) has represented a major breakthrough in the treatment of multiple solid and hematological malignancies, significantly improving survival and tumor control. However, the blockade of immune regulatory pathways such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) is associated with the development of immune-related adverse events, among which immune-mediated colitis (IMC) constitutes one of the most relevant gastrointestinal complications due to its frequency, potential severity, and impact on the continuation of oncologic treatment. IMC typically presents with diarrhea, abdominal pain, and gastrointestinal bleeding, and may progress to severe, life-threatening forms. Its incidence varies according to the type of ICI, and is higher with CTLA-4 inhibitors and particularly elevated with combination therapies. The pathophysiology is complex and multifactorial, involving dysregulated activation of proinflammatory T lymphocytes, impairment of immune regulatory mechanisms, disruption of the intestinal epithelial barrier, and a key modulatory role of the gut microbiota. Diagnosis requires a high index of clinical suspicion and relies on endoscopy with biopsies, given the poor correlation between clinical severity and endoscopic or histological findings. Fecal biomarkers, such as calprotectin and lactoferrin, are useful for risk stratification and disease monitoring. Treatment is based on a stepwise immunosuppressive approach, with corticosteroids as first-line therapy and biologic agents such as infliximab or vedolizumab in refractory cases. Emerging strategies, including fecal microbiota transplantation, offer new therapeutic perspectives. This article provides a comprehensive review of the current evidence on the epidemiology, pathophysiology, diagnosis, and management of IMC, as well as future challenges and opportunities in its clinical management. Full article

(This article belongs to the Special Issue Immunological Aspects of Gastrointestinal Diseases)

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18 pages, 461 KB

Open AccessArticle

Nutritional Risk and Persistent Gastrointestinal Symptoms in COVID-19 Survivors: A Retrospective–Prospective Cohort Study

by Albandari Bin Ammar, Nagat Eltoum, Leo Rathinaraj Antony Soundararajan, Nagwan Elhussein, Sayeda Fatima, Majid Alkhalaf, Momen Elshazley, Abdullah Alammar, Sreeja Mannickal Thankappan, Ghosoun Al-Faqiri and Abd Elmoneim Elkhalifa

Gastroenterol. Insights 2026, 17(1), 19; https://doi.org/10.3390/gastroent17010019 - 4 Mar 2026

Abstract

Background/Objectives: Gastrointestinal (GI) manifestations may persist in COVID-19 survivors, potentially worsening pre-existing conditions and increasing the risk of malnutrition. Understanding the long-term association between GI symptoms and nutritional risk is essential. This study aimed to investigate this relationship in COVID-19 survivors, regardless of [...] Read more.

Background/Objectives: Gastrointestinal (GI) manifestations may persist in COVID-19 survivors, potentially worsening pre-existing conditions and increasing the risk of malnutrition. Understanding the long-term association between GI symptoms and nutritional risk is essential. This study aimed to investigate this relationship in COVID-19 survivors, regardless of comorbidities. Methods: A retrospective cohort study with prospective follow-up was conducted among 103 adults (52 males and 51 females) with PCR-confirmed COVID-19 admitted to King Salman Specialist Hospital, Ha’il, Saudi Arabia, between January 2021 and January 2023. Participants were grouped based on the presence of comorbidities, mainly type 2 diabetes mellitus (DM) and hypertension (HTN), and GI symptoms. Demographic characteristics, COVID-19 severity, and clinical data were obtained from medical records and structured interviews. Nutritional risk was assessed using the Malnutrition Screening Tool (MST). Statistical analysis was performed using Chi-Square tests, with p < 0.05 considered significant. Results: Over a mean follow-up of 26.6 months, 40.8% of participants reported at least one persistent GI symptom. Patients with comorbidities were older than those without comorbidities (mean age 58.24 ± 13.23 vs. 48.22 ± 14.83 years), and malnutrition risk was commonly observed in both groups during hospitalization and follow-up. The most frequently reported symptoms were abdominal pain (15.5%), diarrhea (12.6%), appetite loss (9.7%), and vomiting (7.8%), with no significant differences between groups. GI symptoms were significantly associated with reduced food intake, weight loss, and increased malnutrition risk (p < 0.05). Conclusions: Some COVID-19 survivors reported persistent GI symptoms during long-term follow-up, with no significant differences based on comorbidity status. GI symptoms were associated with nutritional risk and lifestyle changes, supporting the need for nutritional screening in post-COVID-19 care. Full article

(This article belongs to the Section Gastrointestinal Disease)

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15 pages, 981 KB

Open AccessArticle

Risk Factors of Adverse Outcomes for Colorectal ESD After Generalization of the Technique—A Multi-Centre Retrospective Study in Hong Kong

by Sophie Sok Fei Hon, Michael Chi Ming Poon, Louis Ho Shing Lau, Henry Kin Ming Joeng, Kong Ling Ting, Po Yan Wong, Lok Ping Si, Michelle Hau Ching Lo, Wing Fung Ng, Wing Yan Chan, Cherry Yee Ni Wong, Philip Ching Tak Ip, Simon Siu Man Ng and Philip Wai Yan Chiu

Gastroenterol. Insights 2026, 17(1), 18; https://doi.org/10.3390/gastroent17010018 - 3 Mar 2026

Abstract

Background: Most of the public hospitals in Hong Kong provide a regular colorectal endoscopic submucosal dissection (ESD) service. The current retrospective study aims to review the long- and short-term outcomes of these services, so as to identify areas for improvement. Method and Results: [...] Read more.

Background: Most of the public hospitals in Hong Kong provide a regular colorectal endoscopic submucosal dissection (ESD) service. The current retrospective study aims to review the long- and short-term outcomes of these services, so as to identify areas for improvement. Method and Results: From January 2017 to March 2020, 634 lesions in 623 patients were removed by an ESD technique in seven endoscopic units. The mean lesion size was 31 mm (SD 13 mm, range 10–95 mm), and the mean procedure time was 121 min (SD 67 min). En bloc resection and R0 resection could be achieved in 91.3% and 79.3% of the lesions, respectively. The intra-procedure perforation rate was 12.3%. The delayed bleeding rate was 2.1%, and the delayed perforation rate was 0.8%. Only 0.9% (6/634) of the procedures needed emergency surgical salvage due to complications. Most of the lesions were adenomas (564/634), and 55 of them were adenocarcinomas. The cumulative local recurrence rate was 4.0% at a mean follow-up of 34 months. In multivariate analysis, longer procedure time, submucosal fibrosis, hybrid ESD and piecemeal removal were associated with intra-procedure perforation. Risk factors for failed en bloc resection included non-granular and polypoid morphology, colonic location, longer procedure time and low centre volume. Malignant pathology without salvage surgery was the only independent risk factor for local recurrence. Conclusions: Colorectal ESD has been carried out in Hong Kong with acceptable short-and long-term outcomes despite the technique still being in the learning phase in some centres. Potential areas for improvement should include targeted training to speed up the procedure and enable better handling of difficult cases, aiming to decrease the perforation rate and local recurrence. Full article

(This article belongs to the Special Issue Novelties in Colorectal Surgery and Proctology)

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21 pages, 775 KB

Open AccessReview

Advances in the Pharmacologic Management of MASLD

by Savita Madhankumar and Arif Asma

Gastroenterol. Insights 2026, 17(1), 17; https://doi.org/10.3390/gastroent17010017 - 3 Mar 2026

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its inflammatory subtype metabolic dysfunction-associated steatohepatitis (MASH) are now the most common types of chronic liver disease worldwide and major contributors to cirrhosis, hepatocellular carcinoma, and liver transplantation. The disease develops from systemic metabolic dysfunction, including [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its inflammatory subtype metabolic dysfunction-associated steatohepatitis (MASH) are now the most common types of chronic liver disease worldwide and major contributors to cirrhosis, hepatocellular carcinoma, and liver transplantation. The disease develops from systemic metabolic dysfunction, including obesity, insulin resistance, and dyslipidemia. These factors increase hepatic fatty acid influx and de novo lipogenesis, driving steatosis, inflammation, and progressive fibrosis. Lifestyle modification is the foundation of treatment. Even modest weight loss can improve steatosis and inflammatory activity, although long-term adherence is often limited. These challenges have accelerated interest in targeted pharmacologic therapy. Thyroid hormone receptor beta agonists such as resmetirom reduce hepatic fat, improve lipid parameters, and show histologic benefit. Peroxisome proliferator activated receptor (PPAR) agents have progressed from single isoform approaches to pan-PPAR activation. Lanifibranor has demonstrated dose-dependent improvements in steatosis, activity, and fibrosis and has achieved key regulatory endpoints. Additional metabolic therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), offer complementary benefits for weight, insulin sensitivity, and liver inflammation. These emerging options represent a promising shift toward disease modifying treatment for MASLD. Full article

(This article belongs to the Special Issue Advances in the Management of Gastrointestinal and Liver Diseases)

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19 pages, 485 KB

Open AccessArticle

Clinicopathological Features of Autoimmune Hepatitis Stratified by Extrahepatic Autoimmune Diseases

by Tatsuma Murakami, Yuichi Yamazaki, Yumeo Tateyama, Hiroki Tojima, Satoru Kakizaki and Toshio Uraoka

Gastroenterol. Insights 2026, 17(1), 16; https://doi.org/10.3390/gastroent17010016 - 3 Mar 2026

Abstract

Background/Objectives: Autoimmune hepatitis (AIH) often coexists with extrahepatic autoimmune diseases (EADs); however, the clinical significance of EAD comorbidity and its subtypes remains incompletely understood. In addition, an increasing proportion of AIH without EAD (NEAD-AIH) has been suggested but not systematically evaluated. Methods: We [...] Read more.

Background/Objectives: Autoimmune hepatitis (AIH) often coexists with extrahepatic autoimmune diseases (EADs); however, the clinical significance of EAD comorbidity and its subtypes remains incompletely understood. In addition, an increasing proportion of AIH without EAD (NEAD-AIH) has been suggested but not systematically evaluated. Methods: We retrospectively analyzed 46 patients diagnosed with AIH between 2014 and 2023. Clinical features were compared between EAD-associated AIH (EAD-AIH) and NEAD-AIH. Analyses were performed focusing on major EAD subtypes, including Sjögren’s syndrome (SS), autoimmune thyroid disease (AITD), and systemic sclerosis (SSc). Steroid-treated cases were further evaluated for treatment response and renal outcomes. Results: Among the 46 patients (median age, 63 years; 89% female), 61% had concomitant EADs. Compared with EAD-AIH, NEAD-AIH showed significantly higher AST, ALT, IgG, and bilirubin levels, together with lower albumin and prothrombin activity. Acute-onset hepatitis and corticosteroid use were more frequent in NEAD-AIH, and all cases of liver failure occurred in this group. The proportion of NEAD-AIH increased over time (from 21% to 54%). A small number of recent NEAD-AIH cases occurred after COVID-19 vaccination or immune checkpoint inhibitor therapy, although causality could not be established. Among EAD subtypes, SSc-AIH was characterized by relatively low IgG levels, whereas SS-AIH showed favorable biochemical profiles with low relapse rates. No excess renal deterioration was observed in SSc-AIH after steroid therapy. Conclusions: AIH exhibits substantial clinical heterogeneity according to EAD status and subtype. NEAD-AIH tends to present with a more acute and severe phenotype and appears to be increasing, whereas EAD-AIH shows distinct immunologic characteristics. These findings underscore the importance of considering autoimmune background in the clinical evaluation of AIH. Full article

(This article belongs to the Special Issue Advances in the Management of Gastrointestinal and Liver Diseases)

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20 pages, 1271 KB

Open AccessArticle

Helicobacter pylori Colonization and Intestinal Metaplasia Risk in an Andean Population: A Cross-Sectional Study from Peru

by Yeny Uscamayta, Mercy Carolina Merejildo Vera and Jesús D. Rojas

Gastroenterol. Insights 2026, 17(1), 15; https://doi.org/10.3390/gastroent17010015 - 13 Feb 2026

Abstract

Background: Helicobacter pylori infection is recognized as a Group I carcinogen and a primary driver of the gastric precancerous cascade. Andean populations in Peru experience disproportionately high rates of gastric cancer, yet data characterizing the association between H. pylori colonization and intestinal [...] Read more.

Background: Helicobacter pylori infection is recognized as a Group I carcinogen and a primary driver of the gastric precancerous cascade. Andean populations in Peru experience disproportionately high rates of gastric cancer, yet data characterizing the association between H. pylori colonization and intestinal metaplasia remain limited in this setting. Methods: A cross-sectional analytical study was conducted among 169 patients undergoing upper gastrointestinal endoscopy at Hospital II EsSalud Abancay, Apurímac, Peru, between January and August 2025. Histopathological assessment determined H. pylori status, colonization intensity (negative, +, ++, +++) and intestinal metaplasia presence using the Updated Sydney System. Binary logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals. Results: H. pylori infection was detected in 71 patients (42.0%), and intestinal metaplasia was present in 78 (46.2%). A dose–response pattern was observed: metaplasia prevalence increased from 18.4% in uninfected patients to 70.0%, 87.0%, and 92.9% across increasing colonization intensities (Cochran–Armitage p < 0.001). In multivariable analysis, colonization intensity (aOR = 10.19; 95% CI: 4.38–23.71), smoking (aOR = 11.70; 95% CI: 1.98–69.03), and alcohol consumption (aOR = 6.32; 95% CI: 1.74–22.95) remained independently associated with metaplasia. The primary binary logistic regression model demonstrated excellent discrimination (AUC = 0.921). Conclusions: H. pylori colonization intensity is strongly associated with intestinal metaplasia in this Andean population, with a clear dose–response gradient. These findings support prioritizing H. pylori screening and eradication strategies for gastric cancer prevention in highland Peru. Full article

(This article belongs to the Section Gastrointestinal Disease)

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12 pages, 530 KB

Open AccessArticle

The Value of Boey, PULP and ASA Scores in Predicting 30-Day Mortality and Morbidity: A Single-Center Retrospective Study

by Diogo Acosta, Teresa Elói, Ana Martins, Pedro Ponte, Rayanne Silva, Pilar Ferreira, Miguel Catarino, Gonçalo Reis, Joana Rodrigues and Maria Leite

Gastroenterol. Insights 2026, 17(1), 14; https://doi.org/10.3390/gastroent17010014 - 13 Feb 2026

Abstract

Background/Objectives: A perforated peptic ulcer (PPU) is a life-threatening surgical emergency, with high levels of mortality and morbidity reported in the literature. Recognizing which patients are at most risk of developing complications or losing their life is of great importance and, as [...] Read more.

Background/Objectives: A perforated peptic ulcer (PPU) is a life-threatening surgical emergency, with high levels of mortality and morbidity reported in the literature. Recognizing which patients are at most risk of developing complications or losing their life is of great importance and, as such, several scoring systems have been developed to try to predict it. This study aims to compare the predictive value of three of the most used scores (Boey, PULP and ASA scores) in assessing 30-day morbidity and mortality in patients with PPU at our hospital. Methods: This single-center retrospective study included all the patients that were surgically treated for PPU at our hospital between 1 January 2020 and 31 December 2024 (n = 76). Results: Within 30 days of index surgery, a total of 5 patients (7%) died and 24 (32%) suffered from some form of complication. Both the Boey and PULP scores demonstrated good predictive ability, with an area under curve (AUC) of >0.95 for mortality. With regard to morbidity, the Boey score achieved the best results (being the only one with AUC > 0.9), followed closely by the PULP score. Meanwhile, the ASA classification fell short of the other scores but still showed good results. Conclusions: The Boey score demonstrated the most balanced and reliable performance in predicting both mortality and morbidity. The PULP score also showed good accuracy for the mortality prediction, but at the cost of a slightly lower specificity. Altogether, both the Boey and PULP scores appear to be robust tools for short-term risk stratification for PPU complications. Full article

(This article belongs to the Special Issue Advances in the Management of Gastrointestinal and Liver Diseases)

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27 pages, 4306 KB

Open AccessReview

Endoscopic and Hybrid Approaches for Gastric Subepithelial Tumors: Expanding the Frontiers of Minimally Invasive Therapy

by Francesco Bombaci, Angelo Bruni, Michele Dota, Massimo Del Gaudio, Giuseppe Dell’Anna, Francesco Vito Mandarino, Francesco Azzolini, Emanuele Sinagra, Lorenzo Fuccio, Rocco Maurizio Zagari, Giovanni Barbara and Paolo Cecinato

Gastroenterol. Insights 2026, 17(1), 13; https://doi.org/10.3390/gastroent17010013 - 10 Feb 2026

Abstract

Per-oral flexible endoscopy has expanded minimally invasive options for the management of gastric subepithelial tumors (G-SETs). This narrative review appraises conventional and advanced endoscopic resections alongside hybrid laparoscopic–endoscopic procedures, within a size- and layer-based clinical framework. Endoscopic mucosal resection (EMR) and endoscopic submucosal [...] Read more.

Per-oral flexible endoscopy has expanded minimally invasive options for the management of gastric subepithelial tumors (G-SETs). This narrative review appraises conventional and advanced endoscopic resections alongside hybrid laparoscopic–endoscopic procedures, within a size- and layer-based clinical framework. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) achieve high en bloc resection rates for small, intraluminal tumors arising from mucosa or submucosa. Traction strategies and dedicated traction devices may improve submucosal exposure, shorten procedure time, and reduce adverse events. Submucosal tunneling endoscopic resection (STER) has been developed to enucleate tumors originating from the muscularis propria while preserving mucosal integrity. However, tunnel creation and specimen retrieval become challenging for large tumors or for those located in the cardia or fundus. Endoscopic full-thickness resection (EFTR) enables controlled transmural excision of G-SETs arising from deeper wall layers. Exposed EFTR, combined with secure endoscopic closure, provides high en bloc and complete (R0) resection rates. Closure options range from through-the-scope clips—for small defects—to over-the-scope clips, endoloop-clip purse-string methods, reopenable-clip over-the-line techniques and endoscopic suturing systems—for larger defects. Non-exposed EFTR and device-assisted systems reduce the risk of peritoneal contamination, although complete resection rates are more variable. Hybrid approaches, including classical laparoscopic–endoscopic cooperative surgery (LECS) and non-exposure variants, combine endoscopic precision with the safety and closure capabilities of laparoscopic surgery, minimizing the amount of resected gastric wall. They are particularly suited to larger, awkwardly located or ulcerated G-SETs. Emerging traction platforms, flexible robotic systems, and AI-based tools may further broaden the role of per-oral flexible endoscopy for the treatment of G-SETs. However, evidence remains preliminary, and surgery continues to play a key role for large, extraluminal or anatomically prohibitive G-SETs. Full article

(This article belongs to the Collection Advances in Gastrointestinal Cancer)

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21 pages, 1752 KB

Open AccessArticle

The Resistance to Traction Forces Differs Substantially Between Intestinal Parts, but Not Between In- and Outbred Strains of Mice

by Berkan Ertim, Ejder Akinci, Maximiliane von Stumberg, David Katzer, Rainer Ganschow, Tim O. Vilz and Christina Oetzmann von Sochaczewski

Gastroenterol. Insights 2026, 17(1), 12; https://doi.org/10.3390/gastroent17010012 - 7 Feb 2026

Abstract

Background/Objectives: Anastomoses under tension are associated with anastomotic leaks and strictures. In experimental surgery, anastomoses are frequently tested for their resistance to traction forces, but without the surgically untouched organ as a comparator. We therefore investigated whether and to what extent the breaking [...] Read more.

Background/Objectives: Anastomoses under tension are associated with anastomotic leaks and strictures. In experimental surgery, anastomoses are frequently tested for their resistance to traction forces, but without the surgically untouched organ as a comparator. We therefore investigated whether and to what extent the breaking forces along the gastrointestinal tract differed in the intact intestinal organs to provide some data for the comparison of anastomoses to it and guide sample size estimation in the mouse. Methods: We included 54 mice of the Crl:CD1(ICR) stock and, as a comparator, 10 mice of the C57Bl/6J and 10 mice of the C57Bl/6NCrl strain of both sexes. We determined breaking forces using a motorised test stand. Results were compared via estimated marginal means with a control of the false-discovery rate by the Benjamini–Hochberg procedure. Results: In all mice strains, the resistance to traction forces was in a descending manner: stomach (mean (µ) ≥ 1.87 Newtons, standard deviation (σ) ≤ 0.63) > rectum(µ > 1.31 Newtons, σ ≤ 0.63) > caecum (µ > 1.1 Newtons, σ ≤ 0.37) > colon(µ > 0.93 Newtons, σ ≤ 0.31) > duodenum (µ > 0.65 Newtons, σ ≤ 0.28) > jejunum (µ > 0.5 N, σ ≤ 0.16) > ileum (µ ≥ 0.43 Newtons, σ ≤ 0.13). The analysis of variance showed a statistically significant effect of the mouse strain on breaking forces (F(2,497) = 16.81, p < 0.001). This was also the case for the investigated organ (F(6,497) = 104.18, p < 0.001) and the interaction between strain and organ (F(12,497) = 2, p = 0.022), indicating a difference between strains. Only the stomachs differed between the included strains; the stomach of Crl:CD1(ICR) sustained −0.81 Newtons (t = −6.23, p < 0.001) compared to those of C57Bl/6J, and −0.37 Newtons (t = −2.88, p = 0.006) compared to those of C57Bl/6NCrl. Other statistically significant differences were absent. Conclusions: Differences in breaking forces between inbred strains and outbred stock were only present for the stomach. Our results may provide a first baseline of breaking force measurements for other studies investigating anastomoses and the respective sample size analyses. Full article

(This article belongs to the Section Alimentary Tract)

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17 pages, 982 KB

Open AccessReview

The Role of Primary Care and Noninvasive Testing in the Early Diagnosis of Metabolic-Associated Steatotic Liver Disease (MASLD)

by Alina Mihaela Constantin, Mirela Maria Nedelescu, Raluca Tatar, Corina Silvia Pop, Andrea Elena Neculau, Sorina Maria Aurelian, Corina Oancea, Justin Aurelian, Sandra Monica Gîdei and Irina Mihaela Stoian

Gastroenterol. Insights 2026, 17(1), 11; https://doi.org/10.3390/gastroent17010011 - 6 Feb 2026

Abstract

Chronic liver disease is one of the leading causes of morbidity and mortality worldwide. Cirrhosis of the liver is the most advanced form of chronic liver disease and the 12th leading cause of death worldwide. The incidence of liver cirrhosis is increasing significantly [...] Read more.

Chronic liver disease is one of the leading causes of morbidity and mortality worldwide. Cirrhosis of the liver is the most advanced form of chronic liver disease and the 12th leading cause of death worldwide. The incidence of liver cirrhosis is increasing significantly each year due to the increased prevalence of metabolic syndrome associated with fatty liver disease. Liver biopsy has been traditionally considered the “gold standard” method for the evaluation of tissue lesions (e.g., liver fibrosis in patients with chronic liver disease), and it is still accepted as such. However, it is an invasive and costly method with potential risks for patients. Thus, we decided to evaluate the importance of non-invasive tests (NIT) and the combinations of NIT used for the diagnosis and staging of liver fibrosis in metabolic-associated steatotic liver disease—MASLD—and how the primary care physician is involved in these stages. In this context, primary care physicians will be the first in contact with these patients, who could initiate early, well-targeted treatment to prevent disease progression and complications, which could reduce the number of costly consultations and specialist investigations. Full article

(This article belongs to the Section Liver)

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11 pages, 629 KB

Open AccessArticle

How Do Immigration Status and Cultural Factors Influence Rates of H. pylori Among Self-Identified Hispanics Living in the United States?

by Amanda Blanco, Anna Distler, Julian A. Abrams, Peter Distler and Daniel E. Freedberg

Gastroenterol. Insights 2026, 17(1), 10; https://doi.org/10.3390/gastroent17010010 - 3 Feb 2026

Abstract

Background/Objectives: Prior studies suggest that rates of Helicobacter pylori colonization are higher among Hispanic immigrants compared to U.S.-born Hispanics. It is unknown whether differences in H. pylori colonization rates among Hispanics are related to immigration status or to cultural factors such as [...] Read more.

Background/Objectives: Prior studies suggest that rates of Helicobacter pylori colonization are higher among Hispanic immigrants compared to U.S.-born Hispanics. It is unknown whether differences in H. pylori colonization rates among Hispanics are related to immigration status or to cultural factors such as diet. Methods: This was a survey study, conducted among self-identified Hispanics who had an endoscopy for symptoms of gastroesophageal reflux disease (GERD). Qualifying patients completed a telephone survey which included questions about immigration status and the 12-item Short Acculturation Scale for Hispanics (SASH), a validated instrument which measures cultural factors such as language preference and diet. We examined the relationship between SASH factors and H. pylori status, classified based on endoscopic biopsy results. Results: We called 400 patients and 186 completed the survey. Median age was 65 (interquartile range 21 to 82) and 81% were female. Thirty of 186 (16%) respondents were born in the U.S. while 156/186 (84%) were immigrants, primarily from the Dominican Republic. Among immigrants, 69% had immigrated before 1990. Rates of H. pylori were 8/30 (27%) among U.S. born Hispanics compared to 51/156 (33%) among Hispanic immigrants (p = 0.67). Rates of H. pylori were 51/147 (35%) among those with a mostly Latino diet vs. 8/39 (21%) among those with a U.S or mixed diet (p = 0.05). In a multivariable model predicting H. pylori status, a mostly Latino diet was the only cultural predictor which approached statistical significance (p = 0.05) (aOR 2.61, 95% CI 0.94–7.20). Conclusions: Rates of H. pylori colonization were modestly higher among Hispanic immigrants compared to U.S.-born Hispanics. A novel preliminary finding was that higher rates of H. pylori colonization were observed among those who ate a predominantly Latino diet. Full article

(This article belongs to the Section Gastrointestinal Disease)

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33 pages, 885 KB

Open AccessReview

Gut Dysbiosis and Arrhythmogenesis: The Potential Role of Microbial Alterations and Small Intestinal Bacterial Overgrowth in Cardiac Arrhythmias

by Julia Soczyńska, Kamila Butyńska, Maja Ickiewicz, Oskar Soczyński, Kacper Pluta, Agnieszka Frątczak, Wiktor Gawełczyk and Sławomir Woźniak

Gastroenterol. Insights 2026, 17(1), 9; https://doi.org/10.3390/gastroent17010009 - 26 Jan 2026

Abstract

The gut microbiota is one of the key elements responsible for maintaining the body’s homeostasis. Its diverse composition affects, among others, the digestive and immune systems and also the circulatory system. Imbalances within the microbial community, referred to as dysbiosis, may lead to [...] Read more.

The gut microbiota is one of the key elements responsible for maintaining the body’s homeostasis. Its diverse composition affects, among others, the digestive and immune systems and also the circulatory system. Imbalances within the microbial community, referred to as dysbiosis, may lead to increased intestinal barrier permeability, chronic inflammation, and abnormal immune responses, which can be associated with the development of numerous diseases. Gut dysbiosis results in disturbances in the production of short-chain fatty acids, which exert anti-inflammatory effects, regulate blood pressure, and inhibit cardiac fibrosis. At the same time, it promotes the increased synthesis of trimethylamine N-oxide, a metabolite linked to inflammation, endothelial dysfunction, a higher risk of thrombosis, and the occurrence of arrhythmias. Additionally, small intestinal bacterial overgrowth (SIBO) may increase inflammation and contribute to metabolic and cardiovascular diseases (CVDs). The gut microbiota also influences the immune system through the production of neurotransmitters and modulation of T-cell activity, which may play a role in the development of autoimmune diseases. Reduced microbial diversity and an increased abundance of pathogenic bacteria are observed in individuals with hypertension and CVD, underscoring the importance of the microbiota as both a preventive and therapeutic factor. These findings highlight the crucial role of the gut microbiota in maintaining cardiovascular health and emphasize the need for further research into its modulation in the treatment of chronic diseases. Full article

(This article belongs to the Section Gastrointestinal Disease)

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13 pages, 2357 KB

Open AccessArticle

Real-World Evidence on the Safe and Effective Use of a Medical Device Made of Natural Substances for the Treatment of Irritable Bowel Syndrome

by Valeria Idone, Maria Chiara Moretti, Roberto Cioeta, Paola Muti, Marta Rigoni, Piero Portincasa, Roberta La Salvia and Emiliano Giovagnoni

Gastroenterol. Insights 2026, 17(1), 8; https://doi.org/10.3390/gastroent17010008 - 26 Jan 2026

Abstract

Background/Objectives: Irritable Bowel Syndrome (IBS) is a widely prevalent chronic disorder of brain–gut interaction which represents a clinical challenge due to its complex underlying causes and the lack of a standardized treatment approach. This cross-sectional research collected real-world data (RWD) on the [...] Read more.

Background/Objectives: Irritable Bowel Syndrome (IBS) is a widely prevalent chronic disorder of brain–gut interaction which represents a clinical challenge due to its complex underlying causes and the lack of a standardized treatment approach. This cross-sectional research collected real-world data (RWD) on the effectiveness, safety, and usage pattern of a natural substance-based medical device, Colilen IBS, indicated for the treatment of IBS. Methods: Surveys were conducted both in Italy and Germany with 6101 participants, including 4425 patients, 1014 pharmacists, and 662 physicians using a structured GxP web platform that allows voluntary participants to share their experiences with the device. The validated platform was designed to comply with post-market surveillance requirements of EU Regulation 2017/745. Statistical analyses included descriptive evaluations of responses to gauge overall effectiveness and safety of the device. Results: The effectiveness reported with the medical device was judged extreme or great by 79.2% of patients, with 89.2% of whom observed symptom improvement within one month. Both safety and tolerability were rated extreme or great by 90.7% of patients. Healthcare professionals reported a similar rate on the overall effectiveness, with 94.9% of pharmacists and 95.9% of physicians indicating it extreme or great. Similarly, the safety profile was corroborated by nearly all pharmacists (97.0%) and physicians (98.2%) reporting extreme or great satisfaction with both safety and tolerability of the medical device. Conclusions: This research provides RWD supporting the effectiveness and safety of the product for treating IBS. The strong coherence among patients, pharmacists, and physicians in positively rating the device’s performance suggests that this medical device represents a therapeutic option that effectively addresses patient needs while minimizing safety concerns. Continuous RWD collection is essential, as it offers insights into real-world practice and ensures ongoing confirmation of the product’s safety and effectiveness. Ultimately, this will advance IBS patient care by integrating real-world evidence into clinical management. Full article

(This article belongs to the Section Gastrointestinal Disease)

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15 pages, 316 KB

Open AccessReview

New Definition, New Point of View: Sex and Gender Interpretation of MASLD—Interpretation of Guidelines and Review of the Literature

by Massimo De Luca, Rita Verdoliva, Anna Lombardi and Antonio Giorgio

Gastroenterol. Insights 2026, 17(1), 7; https://doi.org/10.3390/gastroent17010007 - 23 Jan 2026

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a spectrum from simple steatosis to steatohepatitis (MASH), including liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). The 2023 EASL–EASD–EASO guidelines provide updated definitions and emphasize personalized management, yet do not explicitly address sex- and gender-related differences. [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a spectrum from simple steatosis to steatohepatitis (MASH), including liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). The 2023 EASL–EASD–EASO guidelines provide updated definitions and emphasize personalized management, yet do not explicitly address sex- and gender-related differences. This review highlights the impact of biological sex and gender on MASLD epidemiology, pathogenesis, clinical presentation, and therapeutic response. Men show earlier peak prevalence, greater visceral obesity, higher insulin resistance, and increased risk of fibrosis, HCC, and cardiovascular mortality. Women of childbearing age benefit from estrogen-mediated protection, which diminishes after menopause, leading to disease risk similar to men. Genetic variants (PNPLA3, TM6SF2), hormonal factors, platelet parameters, liver biomarkers, and environmental exposures contribute to sex-specific susceptibility and disease progression. Lifestyle interventions and pharmacological therapies exhibit differential efficacy across sexes, influenced by hormonal status. Integrating biological sex, gender identity, and sociocultural factors into diagnostic and therapeutic strategies is essential to optimize MASLD management and reduce its global burden. Full article

(This article belongs to the Section Gastrointestinal Disease)

12 pages, 851 KB

Open AccessArticle

Reaching the Unreachable: Hepatitis C virus (HCV) Microelimination in Prisons and Addiction Centers

by Rui Gaspar, Rui Morgado, Jorge Tavares, Paula Portela and Guilherme Macedo

Gastroenterol. Insights 2026, 17(1), 6; https://doi.org/10.3390/gastroent17010006 - 19 Jan 2026

Abstract

Background & Aims: Hepatitis C virus (HCV) infection remains one of the most significant and lethal infectious diseases worldwide. Since the approval of the first direct-acting antiviral agent in 2013, the therapeutic landscape has changed dramatically, with SVR rates exceeding 95%. The [...] Read more.

Background & Aims: Hepatitis C virus (HCV) infection remains one of the most significant and lethal infectious diseases worldwide. Since the approval of the first direct-acting antiviral agent in 2013, the therapeutic landscape has changed dramatically, with SVR rates exceeding 95%. The WHO set the ambitious goal of achieving global HCV elimination in 2030. High-risk populations remain among the most challenging yet essential groups to treat in order to reach this objective. The aim of this study is to describe two distinct approaches targeting high-risk populations to advance HCV elimination. Methods: An observational study was conducted from April 2017 to August 2025, including patients evaluated and treated at Porto’s correctional facility and Porto’s addiction centers. All patients received DAA therapy, and the primary outcome was sustained virological response at 12 weeks post-treatment. Results: A total of 124 patients from the prison setting were included. Their mean age was 43.0 ± 8.4 years, and all were males. Treatment with DAA resulted in an SVR of 99.2%. In addition, 43 patients from the addiction centers were included, with a mean age of 54.9 ± 5.9 years, and the majority were males (86%). These patients achieved an SVR 12 of 97.7%. Conclusions: In two distinct and difficult-to-reach high-risk populations, we demonstrated that a tailored approach involving on-site evaluation and treatment of HCV infection is highly effective and may be crucial to achieving HCV elimination. Full article

(This article belongs to the Section Liver)

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13 pages, 1443 KB

Open AccessArticle

Self-Reported Prevalence Rates of Gluten-Related Disorders and Gluten-Free Diet Adherence Are Increasing in a Mexican Population: A Seven-Year Follow-Up Study

by Oscar Gerardo Figueroa-Salcido, José Antonio Mora-Melgem, Raúl Tinoco-Narez-Gil, Noé Ontiveros and Jesús Gilberto Arámburo-Gálvez

Gastroenterol. Insights 2026, 17(1), 5; https://doi.org/10.3390/gastroent17010005 - 8 Jan 2026

Abstract

Background/Objectives: Temporal trends in the prevalence rates of gluten-free diet (GFD) adherence and gluten-related disorders (GRDs) have not been evaluated in Latin America. This study aimed to conduct a 7-year comparison of self-reported prevalence rates of GFD adherence and GRDs in a [...] Read more.

Background/Objectives: Temporal trends in the prevalence rates of gluten-free diet (GFD) adherence and gluten-related disorders (GRDs) have not been evaluated in Latin America. This study aimed to conduct a 7-year comparison of self-reported prevalence rates of GFD adherence and GRDs in a Mexican population. Methods: A cross-sectional survey-based study was conducted, and the prevalence estimates were compared with those from a previous study (2015/n = 1238 vs. 2022/n = 1214). Motivations for GFD adherence and the role of medical advice were also assessed. Results: The estimated prevalence rates were (2015/2022): recurrent adverse reactions to wheat- and/or gluten 7.83%/11.7% (p = 0.001), self-reported gluten sensitivity 1.53%/3.29% (p = 0.0045), celiac disease 0.08%/0.24% (p = 0.3699), wheat allergy 0.08%/0.57% (p = 0.037), non-celiac gluten sensitivity 1.37%/2.47% (p = 0.0474), GFD adherence 3.63%/7.16% (p = 0.0001), and self-reported physician-diagnosed CD 0.08%/0.24% (p = 0.3699). In the 2022 cohort, most people on GFD did not meet the criteria for SR-GS (60.91%), and their main motivations for GFD adherence were weight control (74.42%) and the perception that a GFD is healthier (22.64%) than a conventional one. Among those on GFD, 45.97% reported no medical or dietitian supervision. Conclusions: The prevalence rates of self-reported GFD adherence and GRDs increased significantly over 7 years. Although this finding could imply greater awareness of GRDs, a high proportion of those adhering to the diet are still doing so without medical/dietitian supervision and for reasons other than a medical condition. Full article

(This article belongs to the Section Gastrointestinal Disease)

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