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Pancreatic, Liver, Biliary Tract and Intestinal Diseases: Pathogenesis, Diagnostics and Therapy—2nd Edition

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A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: closed (30 June 2026) | Viewed by 7483

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Dr. Beata Jabłońska

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Guest Editor

Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
Interests: gastrointestinal surgery; oncological surgery; vascular surgery; gastroenterology; angiology; oncology; nutritional status; nutrition
Special Issues, Collections and Topics in MDPI journals

Dr. Sławomir Mrowiec

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Guest Editor

Department of Digestive Tract Surgery, Medical University of Silesia, Katowice, Poland
Interests: pancreaticoduodenectomy; vascular resection; distal and total pancreatectomy; middle segment pancreatectomy; pancreaticojejunostomy; POPF; drainage operations in chronic pancreatitis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Gastrointestinal diseases involve various benign and malignant pathologies affecting the digestive tract, liver, biliary tract and pancreas. Their diagnosis and treatment are usually very challenging and require the involvement of a multidisciplinary team comprising gastroenterologists, radiologists, oncologists and surgeons. The diagnosis of gastrointestinal diseases involves laboratory, imaging, endoscopic, non-invasive and invasive investigations. Furthermore, their management encompasses a wide spectrum: from observation and conservative treatment to invasive radiological, endoscopic and surgical procedures. Recently, advancements in both the diagnosis and treatment of gastrointestinal diseases have significantly improved, including molecular laboratory tests, gastrointestinal endoscopy with artificial intelligence, targeted and immunological oncological therapy, as well as robotic surgery.

This Special Issue entitled “Pancreatic, Liver, Biliary Tract and Intestinal Diseases: Pathogenesis, Diagnostics and Therapy 2.0” will focus on new aspects regarding laboratory diagnostics as well as the pharmacological, immunological, and targeted treatment of these diseases. We invite original research and review papers related to all novel aspects of the diagnosis and treatment of gastrointestinal diseases.

Dr. Beata Jabłońska
Dr. Sławomir Mrowiec
Guest Editors

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Keywords

inflammatory bowel disease
gastrointestinal tumor
gastrointestinal cancer
acute pancreatitis
chronic pancreatitis
pancreatic cyst
biliary cyst
liver disease
biliary tract disease

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Published Papers (5 papers)

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14 pages, 1037 KB

Open AccessArticle

Evaluation of the Admission Neutrophil Percentage-to-Albumin Ratio for Predicting the Severity of Acute Pancreatitis

by Ahmet Yavuz, Berat Ebik, Ümit Karabulut, Mustafa Zanyar Akkuzu, Çiğdem Budak Ece, Ferhat Bacaksız, Muharrem Keskin, Murat Bıyık and Mehmet Asıl

Biomedicines 2026, 14(7), 1543; https://doi.org/10.3390/biomedicines14071543 - 9 Jul 2026

Viewed by 374

Abstract

Background: Early identification of disease severity in acute pancreatitis (AP) remains a major clinical challenge. The neutrophil percentage-to-albumin ratio (NPAR) is a novel inflammatory index that reflects systemic inflammation, but evidence regarding its role in predicting AP severity remains limited. This study aimed to evaluate the association between admission NPAR and AP severity and to compare its predictive performance with other inflammatory indices. Methods: This retrospective study included 261 patients with AP. NPAR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the systemic immune inflammation index (SII) were calculated using laboratory parameters obtained at hospital admission. Disease severity was assessed according to the revised Atlanta classification and the Bedside Index for Severity in Acute Pancreatitis (BISAP) score. Receiver operating characteristic (ROC) curve analysis was performed to compare predictive performance, and logistic regression analyses were used to identify independent predictors of disease severity. Results: Admission NPAR values were significantly higher in patients with moderately severe/severe AP according to the revised Atlanta classification and in patients with BISAP scores ≥ 3 (both p < 0.001). Among the evaluated inflammatory indices, NPAR demonstrated the highest predictive performance for disease severity according to both the revised Atlanta classification (AUC: 0.808) and BISAP score (AUC: 0.841). In multivariate logistic regression analysis, admission NPAR remained independently associated with AP severity (OR: 1.279, 95% CI: 1.174–1.393, p < 0.001). Admission NPAR levels were also significantly higher in non-survivors than in survivors (p = 0.017). Conclusions: Admission NPAR appears to be a simple, inexpensive, and readily available inflammatory index associated with disease severity in patients with AP. These findings suggest that NPAR may serve as a useful adjunctive tool for early risk stratification. However, larger prospective multicenter studies are required to validate these findings and confirm the proposed admission cut-off value before routine clinical implementation. Full article

(This article belongs to the Special Issue Pancreatic, Liver, Biliary Tract and Intestinal Diseases: Pathogenesis, Diagnostics and Therapy—2nd Edition)

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13 pages, 3791 KB

Open AccessArticle

Elevated Serum Soluble CD137 in Inflammatory Bowel Disease and Primary Sclerosing Cholangitis Highlights a Shared Immunoregulatory Signature

by Tanja Elger, Muriel Huss, Johanna Loibl, Patricia Mester, Petra Stoeckert, Arne Kandulski, Martina Müller, Hauke Christian Tews and Christa Buechler

Biomedicines 2026, 14(7), 1483; https://doi.org/10.3390/biomedicines14071483 - 30 Jun 2026

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Abstract

Background: Soluble CD137 (sCD137) has immunoregulatory properties and is increased in chronic inflammatory and autoimmune diseases, as well as in liver cirrhosis. Its relevance in inflammatory bowel disease (IBD) and primary sclerosing cholangitis associated with IBD (PSC-IBD) remains unclear. We measured serum sCD137 levels in IBD, PSC-IBD, PSC without IBD, and metabolic dysfunction-associated steatotic liver disease (MASLD, as a liver disease control) and assessed whether sCD137 is associated with intestinal inflammatory activity or liver disease severity. Methods: Serum sCD137 levels were measured in 77 patients with IBD, 33 with PSC-IBD, 11 with PSC without IBD, 26 with MASLD, and 78 healthy controls. In IBD, associations with serum C-reactive protein, fecal calprotectin, and symptom burden were examined. In PSC and PSC-IBD, associations with liver dysfunction and fibrosis stage, assessed by measurement of liver stiffness, were analyzed. Results: Serum sCD137 levels were higher in IBD than in controls, with similar levels in Crohn’s disease and ulcerative colitis. In IBD, sCD137 was not associated with C-reactive protein, fecal calprotectin, stool consistency, symptom extent, disease duration, or disease localization. Serum sCD137 levels were higher in PSC/PSC-IBD than in controls, patients with MASLD, and patients with isolated IBD. Patients with PSC without IBD showed similar levels to those with PSC-IBD. In PSC/PSC-IBD, serum sCD137 levels did not increase with a higher fibrosis stage. Conclusions: Serum sCD137 is a disease-associated systemic immune marker in IBD and PSC, with a stronger signal in PSC-associated disease than in isolated IBD. However, sCD137 does not reflect intestinal inflammatory activity or liver fibrosis severity in this cohort, suggesting that it captures disease-associated immune dysregulation rather than current inflammatory or fibrotic burden. Full article

(This article belongs to the Special Issue Pancreatic, Liver, Biliary Tract and Intestinal Diseases: Pathogenesis, Diagnostics and Therapy—2nd Edition)

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21 pages, 10848 KB

Open AccessArticle

S100 Calcium-Binding Protein P and Cathepsin E as Key Mediators in Pancreatic Cancer Tumorigenesis

by Yu Meng, Qian Deng, Ye Zhang, Fang Wei, Jun Wu and Haijiao Yan

Biomedicines 2025, 13(11), 2780; https://doi.org/10.3390/biomedicines13112780 - 14 Nov 2025

Cited by 2 | Viewed by 2973

Abstract

Background/Objectives: Pancreatic cancer (PC) remains one of the deadliest malignancies, with challenges that hinder early detection and few actionable molecular targets. In this study, we aimed to identify biomarkers predictive of PC to support its diagnosis and treatment. Methods: Proteins from formalin-fixed, paraffin-embedded pooled samples of PC (n = 15; 5 pools) and chronic pancreatitis (n = 10; 5 pools) tissues were analyzed via label-free quantitative proteomics using liquid chromatography-tandem mass spectrometry. Immunohistochemistry (IHC) was performed on PC tissue microarrays to assess S100 calcium-binding protein P (S100P) and cathepsin E (CTSE) expression (IHC evaluable pairs: n = 78 for S100P; n = 82 for CTSE). Transwell invasion assays were conducted to evaluate the effects of these proteins on PC cell invasiveness, and Western blotting was used to validate protein expression and elucidate associated molecular mechanisms. Results: Both S100P and CTSE were overexpressed in PC tissues compared with those in adjacent normal tissues. Elevated S100P expression correlated with poor prognosis, whereas higher CTSE expression predicted favorable outcomes; both served as independent prognostic factors in PC. Functionally, S100P promoted PC cell invasion, whereas CTSE suppressed it. Mechanistically, both proteins appeared to regulate epithelial–mesenchymal transition (EMT) and invasive capacity through activation or inhibition of the phosphoinositide 3-kinase (PI3K)–protein kinase B (AKT) signaling pathway. Conclusions: Elevated expression of S100P and CTSE in PC tissues serves as independent indicators in our model of patient survival. Both proteins regulate EMT and invasion, potentially via the PI3K–AKT pathway, and hold significant promise as prognostic biomarkers and therapeutic targets in PC. Full article

(This article belongs to the Special Issue Pancreatic, Liver, Biliary Tract and Intestinal Diseases: Pathogenesis, Diagnostics and Therapy—2nd Edition)

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12 pages, 960 KB

Open AccessArticle

First Spanish Experience with Stereotactic MR-Guided Adaptive Radiotherapy (SMART) in Borderline Resectable and Locally Advanced Pancreatic Cancer: A Prospective Study

by Daniela Gonsalves, Abrahams Ocanto, Eduardo Meilan, Alberto Gomez, Jesus Dominguez, Lisselott Torres, Castalia Fernández, Macarena Teja, Isabel Garrido, Maria Gonzalez, Miren Gaztañaga, Daniel Herrero, Israel J. Thuissard, Cristina Andreu, Tomas Gonzalez, Jose Antonio González, Jon Andreescu Yagüe, Esther Holgado, Diego Alcaraz, Escarlata López, Maia Dzhugashbli, Luis Glaria, Fernando Lopez-Campos, Esther Dominguez, Jesús Rodriguez Pascual, Eva Maria Lozano Martin, David Sanz-Rosa, Michael D. Chuong, Olivier Riou and Felipe Couñago Show full author list Hide full author list

Biomedicines 2025, 13(10), 2390; https://doi.org/10.3390/biomedicines13102390 - 29 Sep 2025

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Abstract

Background/Objectives: In Spain, pancreatic ductal adenocarcinoma (PDAC) is the seventh leading cause of cancer-related death, with only 20% of patients eligible for surgery at diagnosis. For the remaining majority, prognosis is poor and effective non-surgical strategies are needed. Stereotactic MR-guided adaptive radiotherapy (SMART) may facilitate the delivery of ablative doses of radiation safely with low toxicity. This study reports the first national experience in Spain with SMART for patients with borderline resectable (BRPC) or locally advanced pancreatic cancer and evaluates its feasibility, safety, and early clinical outcomes. Methods: A prospective observational study was conducted including 28 patients with histologically confirmed BRPC or LAPC treated between August 2023 and December 2024. All patients received induction chemotherapy—mainly FOLFIRINOX (57.1%)—followed by SMART delivered in five fractions (40–50 Gy) using a 0.35T MR-guided linear accelerator. Daily online adaptive recontouring and replanning were performed for all 140 treatment fractions. Toxicities were assessed using CTCAE v5.0, and survival outcomes were estimated using Kaplan–Meier analysis. Results: The median patient age was 67 years, and 71.4% of tumors were located in the pancreatic head. At a median follow-up of 7.4 months after SMART (12.25 months from diagnosis), 6-month local progression-free survival (LPFS) was 89.3% from the start of SMART and 82.1% from diagnosis. Distant progression-free survival (DPFS) at 6 and 12 months was 92.9% and 68.2%, respectively. Median progression-free survival (PFS) was 11.5 months, and the median treatment-free interval was 5.7 months. Median overall survival (OS) was not reached; 6- and 12-month OS rates were 89.3% and 74.1%, respectively. Treatment-related toxicity was limited to grade 2 abdominal pain in 14.3% of patients, with no grade ≥3 adverse events attributed to SMART. Conclusions: SMART is a feasible and safe treatment modality for BRPC and LAPC in real-world clinical practice. These encouraging early outcomes support further clinical investigation and broader implementation. Full article

(This article belongs to the Special Issue Pancreatic, Liver, Biliary Tract and Intestinal Diseases: Pathogenesis, Diagnostics and Therapy—2nd Edition)

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13 pages, 256 KB

Open AccessArticle

Pancreatic Solid Pseudopapillary Neoplasms—Clinicopathological Characteristics and Surgical Outcomes: A 10-Year Single-Centre Observational Study

by Agnieszka Partyka, Wiktoria Bajek, Paulina Wietrzycka, Beata Jabłońska and Sławomir Mrowiec

Biomedicines 2025, 13(9), 2050; https://doi.org/10.3390/biomedicines13092050 - 22 Aug 2025

Cited by 4 | Viewed by 1415

Abstract

Background: Pancreatic solid pseudopapillary neoplasms (SPNs) are rare exocrine tumours with predominance in young women. These tumours are of low malignant potential, become considerably large before causing symptoms and are associated with good prognosis. This study aimed to present and analyse clinicopathological features and surgical outcome of SPNs. Methods: A retrospective analysis of 22 patients who underwent pancreatic surgery for SPNs in a single high-volume surgical centre in 2014–2023 was performed. Results: SPN was the most frequent in females (n = 21, 95.45%) in a mean age of 34 ± 11.09 (18–55) years. Fourteen (63.64%) patients were asymptomatic, and eight (36.36%) presented with symptoms. The most common clinical symptom was abdominal pain (n = 7, 31.82%). The majority of tumours were located in the pancreatic body (n = 8, 36.36%), and most patients underwent distal pancreatectomy (n = 11, 50%). The median tumour size was 3.6 cm (IQR = 4.9; range: 1.3–14). The median duration of hospitalisation was 12.5 days, and the postoperative complication rate was 40.91%. R0 resection was achieved in 18 (81.82%) patients. Postpancreatectomy acute pancreatitis (PPAP) was the most common postoperative complication. No adjuvant therapy in any patient was needed. One-year overall survival (OS) equalled 100% and five-year OS reached 85%. None of the patients developed diabetes or signs of impaired pancreatic secretion in the follow-up period. Histopathology showed features like perineural invasion in 72.73% of cases, pseudocapsule (59.09%), haemorrhage (45.45%), vascular invasion (40.91%), mucosal metaplasia (40.91%), necrosis (31.82%), and calcification in the capsule (31.82%). Ki67 did not exceed 7%. In one case (4.55%), metastasis to a lymph node was found. Clinical suspicion agreed with histopathological results in only 10 (45.45%) cases. Conclusions: SPN most often occurs in young females. The majority of cases are asymptomatic accidental findings. The final diagnosis of SPN can be based just on analysis of histopathological examination results. Full article

(This article belongs to the Special Issue Pancreatic, Liver, Biliary Tract and Intestinal Diseases: Pathogenesis, Diagnostics and Therapy—2nd Edition)

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