Gastroenterology Insights

30 pages, 1130 KB

Open AccessReview

From Dysbiosis to Prediction: AI-Powered Microbiome Insights into IBD and CRC

by Minkwan Kim, Donghyeon Gim, Sunghan Kim, Sungsu Park, Tehyun Phillip Eom, Jaehoon Seol, Junyeong Yeo, Changmin Jo, Gunha Seo, Hyungjune Ku and Jae Hyun Kim

Gastroenterol. Insights 2025, 16(3), 34; https://doi.org/10.3390/gastroent16030034 - 11 Sep 2025

Abstract

Recent advances in the integration of artificial intelligence (AI) and microbiome analysis have expanded our understanding of gastrointestinal diseases, particularly in inflammatory bowel disease (IBD), colitis-associated colorectal cancer (CAC), and sporadic colorectal cancer (CRC). While IBD and CAC are mechanistically linked, recent evidence [...] Read more.

Recent advances in the integration of artificial intelligence (AI) and microbiome analysis have expanded our understanding of gastrointestinal diseases, particularly in inflammatory bowel disease (IBD), colitis-associated colorectal cancer (CAC), and sporadic colorectal cancer (CRC). While IBD and CAC are mechanistically linked, recent evidence also implicates dysbiosis in sporadic CRC. The progression from IBD to CAC is mechanistically linked through chronic inflammation and microbial dysbiosis, whereas distinct dysbiotic patterns are also observed in sporadic CRC. In this review, we examined how machine learning (ML) and AI were applied to the microbiome and multi-omics data, which enabled the discovery of non-invasive microbial biomarkers, refined risk stratification, and prediction of treatment response. We highlighted how emerging computational frameworks, including explainable AI (xAI), graph-based models, and integrative multi-omics, were advancing the field from descriptive profiling toward predictive and prescriptive analytics. While emphasizing these innovations, we also critically assessed current limitations, including data variability, the lack of methodological standardization, and challenges in clinical translation. Collectively, these developments enabled AI-powered microbiome research as a driving force for precision medicine in IBD, CAC, and sporadic CRC. Full article

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

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13 pages, 1190 KB

Open AccessArticle

Influence of Aspirin on Hospital and Clinical Outcomes in Hepatocellular Carcinoma: Insights from National Data

by Manasa Ginjupalli, Praneeth Bandaru, Anuj Raj Sharma, Jayalekshmi Jayakumar, Raissa Nana Sede Mbakop Forlemu, Ali Wakil, Arnold Forlemu and Madhavi Reddy

Gastroenterol. Insights 2025, 16(3), 33; https://doi.org/10.3390/gastroent16030033 - 28 Aug 2025

Abstract

Background: Hepatocellular carcinoma (HCC) is a major global health burden and a leading cause of cancer-related deaths. While aspirin has shown potential chemopreventive effects in chronic liver disease, its impact on clinical outcomes among patients hospitalized with HCC remains under-investigated. Methods: Using the [...] Read more.

Background: Hepatocellular carcinoma (HCC) is a major global health burden and a leading cause of cancer-related deaths. While aspirin has shown potential chemopreventive effects in chronic liver disease, its impact on clinical outcomes among patients hospitalized with HCC remains under-investigated. Methods: Using the National Inpatient Sample (NIS) from 2016 to 2022, we conducted a retrospective cohort study to evaluate the association between aspirin use and clinical outcomes in adult HCC hospitalizations. Patients were stratified based on documented aspirin use, and propensity score matching with inverse probability of treatment weighting (IPTW) was applied to minimize confounding. The primary outcome was in-hospital mortality; secondary outcomes included morbidity-related complications, hospital length of stay, and total charges. Results: Among 337,730 hospitalizations with HCC, 8.37% involved aspirin use. Aspirin users demonstrated significantly lower in-hospital mortality (5.2% vs. 10.09%), with an adjusted odds ratio (OR) of 0.58 (95% CI: 0.50–0.68; p < 0.001). Aspirin use was also associated with shorter hospital stays (5.42 vs. 6.39 days), lower total charges ($80,310 vs. $95,098), and reduced incidence of complications, including acute liver failure, hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, sepsis, ICU admission, and acute kidney injury. Importantly, no statistically significant increase in gastrointestinal or variceal bleeding was observed among aspirin users. Conclusions: These findings suggest that aspirin use may reduce mortality, morbidity, and healthcare burden in patients hospitalized with HCC. Full article

(This article belongs to the Special Issue Novelties in Diagnostics and Therapeutics in Hepatology: 2nd Edition)

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12 pages, 1231 KB

Open AccessArticle

Leptin, Nesfatin-1, Glucagon-like Peptide 1, and Short-Chain Fatty Acids in Colon Cancer and Inflammatory Bowel Disease

by Tamás Ilyés, Paul Grama, Simona R. Gheorghe, Vlad Anton, Ciprian N. Silaghi and Alexandra M. Crăciun

Gastroenterol. Insights 2025, 16(3), 32; https://doi.org/10.3390/gastroent16030032 - 27 Aug 2025

Abstract

Background: Short-chain fatty acids (SCFAs) are produced by the colon microbiome and bind to specific G-protein coupled receptors GPR 41 and GPR 43. Leptin and glucagon-like peptide 1 (GLP-1) are produced mainly in the intestinal lumen as a result of SCFAs binding to [...] Read more.

Background: Short-chain fatty acids (SCFAs) are produced by the colon microbiome and bind to specific G-protein coupled receptors GPR 41 and GPR 43. Leptin and glucagon-like peptide 1 (GLP-1) are produced mainly in the intestinal lumen as a result of SCFAs binding to their receptors at this level. Inflammatory bowel diseases (IBD) such as Crohn’s disease (CD) and ulcerative colitis (UC), and their major complication, colorectal cancer (CRC), can disturb the dynamics of the colonic microenvironment thus influencing SCFAs production and effects. Our study aimed to investigate serum levels of SCFAs and SCFAs-mediated production of circulating leptin, GLP-1, and Nesfatin-1 in patients with IBD and CRC. Methods: A total of 88 subjects (29 with CRC, 29 with IBD, and 30 controls) were included in this pilot study. Serum SCFAs, leptin, Nesfatin-1, and GLP-1 levels were analyzed. Results: Nesfatin-1 levels were significantly higher in CRC patients (p < 0.05) compared to IBD and controls. Leptin levels were positively correlated with Nesfatin-1 levels in CRC, IBD, and control groups (CRC: R² = 0.6585, p < 0.01; IBD: R² = 0.2984, p < 0.01; Control: R² = 0.2087, p < 0.05). Serum SCFAs levels were negatively correlated with GLP-1 levels in CRC and IBD (CRC: R² = 0.3324, p < 0.01; IBD: R² = 0.1756, p < 0.05) and negatively correlated with Nesfatin-1 levels in CRC (R² = 0.2375, p < 0.05). Conclusions: These findings suggest that alterations in gut microenvironment may influence systemic metabolic regulators involved in appetite control and inflammation, potentially influencing IBD and CRC pathogenesis. This is the first study to evaluate the relationships between Nesfatin-1, leptin, GLP-1, and SCFAs in CRC and IBD patients; further research is needed to clarify their mechanistic links and therapeutic potential. Full article

(This article belongs to the Section Gastrointestinal Disease)

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8 pages, 259 KB

Open AccessArticle

Comparative Effects of Flurbiprofen—Lidocaine Spray Versus Lidocaine Spray Alone as Topical Pharyngeal Anesthesia Before Unsedated Upper Gastrointestinal Endoscopy

by Ciocîrlan Mihai, Busuioc Denisa, Pasăre Mihaela, Bilous Dana, Buză Bogdan and Vlăduț Cătălina

Gastroenterol. Insights 2025, 16(3), 31; https://doi.org/10.3390/gastroent16030031 - 26 Aug 2025

Abstract

Objectives: Esophagogastroduodenoscopy (EGD) performed with topical pharyngeal anesthesia presents less adverse events and post-procedural impairment associated with sedation. The aim of this study was to evaluate if by combining Flurbiprofen and Lidocaine sprays for topical pharyngeal anesthesia there is an improvement in [...] Read more.

Objectives: Esophagogastroduodenoscopy (EGD) performed with topical pharyngeal anesthesia presents less adverse events and post-procedural impairment associated with sedation. The aim of this study was to evaluate if by combining Flurbiprofen and Lidocaine sprays for topical pharyngeal anesthesia there is an improvement in patient tolerance and endoscopist satisfaction in comparison to using Lidocaine spray alone. Methods: We conducted a single center, double blind, randomized controlled trial designed to compare unsedated EGD using topical Flurbiprofen spray (Strepsils Intensive^®) plus Lidocaine spray versus Lidocaine spray alone. We assessed patients’ tolerance and endoscopist satisfaction through a 0 to 10 points visual numerical rating scale. Results: A total of 36 patients were included and randomized in two equal groups: Lidocaine and Flurbiprofen spray group (FL) and Lidocaine spray group (L). No significant differences were found amongst groups for patient discomfort score (FL 5.33 ± 2.42, L 5.56 ± 2.12, p = 0.708), pain score (FL 1.77 ± 2.17, L 1.89 ± 0.74, p = 0.119), gag reflex intensity score (FL 1.61 ± 0.82, L 1.83 ± 0.68, p = 0.418), patient satisfaction score (FL 7.78 ± 2.46, L 7.22 ± 1.78, p = 0.428), and endoscopist satisfaction score (FL 7.5 ± 2.87, L 7.58 ± 1.45, p = 0.312). Conclusions: During unsedated EGD, both Lidocaine plus Strepsils spray and Lidocaine spray alone were safe and well tolerated. The combination of Flurbiprofen and Lidocaine did not significantly improve patients’ level of discomfort, pain, gag reflex, and satisfaction and endoscopist satisfaction. Full article

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

16 pages, 2292 KB

Open AccessSystematic Review

Ileal Bile Acid Transporter Inhibitors for Adult Patients with Autoimmune Cholestatic Liver Diseases: A Systematic Review and Meta-Analysis

by Igor Boechat Silveira, Rodolfo Augusto Assis Rezende, Carlos Alberto Monteiro Leitão Neto, Yohanna Idsabella Rossi, Marina de Assis Bezerra Cavalcanti Leite and Guilherme Grossi Lopes Cançado

Gastroenterol. Insights 2025, 16(3), 30; https://doi.org/10.3390/gastroent16030030 - 25 Aug 2025

Abstract

Background: Autoimmune cholestatic liver diseases (AICLDs), including primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), are characterized by progressive biliary injury and cholestasis, leading to an impaired quantity/quality of life. Pruritus affects 20–70% of patients and is often refractory to current treatments. [...] Read more.

Background: Autoimmune cholestatic liver diseases (AICLDs), including primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), are characterized by progressive biliary injury and cholestasis, leading to an impaired quantity/quality of life. Pruritus affects 20–70% of patients and is often refractory to current treatments. Ileal bile acid transporter (IBAT) inhibitors reduce bile acid reabsorption and may alleviate cholestatic pruritus. This systematic review and meta-analysis evaluates their efficacy and safety in adults with AICLD. Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane-CENTRAL for studies assessing IBAT inhibitors in adult AICLD patients with pruritus for ≥12 weeks. The primary outcome was the change in the 5-D Pruritus Scale. Secondary outcomes included sleep quality, serum bile acids, liver biochemistry, and safety. Heterogeneity was assessed using Cochrane Q and I² statistics. Results: Three studies (n = 180) met inclusion criteria, including two RCTs and one single-arm study. Patients (78% female; 85% PBC; 77% linerixibat) showed a significant pruritus reduction (MD = −4.93, 95%CI [−6.26, −3.59], p < 0.0001), accompanied by improved sleep quality (MD = −8.12, 95%CI [−13.54, −2.70], p = 0.0033). Serum bile acids, FGF19, and autotaxin decreased significantly, with increased C4 levels. AST and GGT declined, while ALP, ALT, and bilirubin remained stable. Adverse events occurred in 89.7%, mainly diarrhea (22.7%), nausea (12.2%), and abdominal pain (18.2%); serious events were rare (2.2%). Conclusions: IBAT inhibitors significantly reduce pruritus and improve sleep in AICLD, with a favorable safety profile. These findings support their potential as a novel therapeutic option for cholestatic pruritus in adults with AICLD. Full article

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

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13 pages, 1365 KB

Open AccessFeature PaperArticle

Relationship Between Hepatitis B Viral Load and Laboratory Parameters in HBsAg-Positive Patients: Insights from the Sub-Himalayan Region

by Ashish Negi, Priyal Anand, Diksha Diksha, Shailender Negi, Shailesh Kumar Gupta, Deepjyoti Kalita and Yogendra Pratap Mathuria

Gastroenterol. Insights 2025, 16(3), 29; https://doi.org/10.3390/gastroent16030029 - 16 Aug 2025

Abstract

Introduction: Hepatitis B is the most prevalent virus that causes severe liver infection worldwide. According to the current guidelines, the HBV viral load and other factors can help in treatment decisions. Therefore, the present study explores the relationship between the HBV viral load [...] Read more.

Introduction: Hepatitis B is the most prevalent virus that causes severe liver infection worldwide. According to the current guidelines, the HBV viral load and other factors can help in treatment decisions. Therefore, the present study explores the relationship between the HBV viral load and blood-based laboratory parameters. Methods: The HBV viral load was evaluated in blood samples from 159 HBsAg-positive patients (ICT-positive). The viral load was categorized as high (above 200,000 IU/mL), moderate (between 2000 and 200,000 IU/mL), or low (below 2000 IU/mL). The viral load was then compared with laboratory parameters. Results: A significant association was observed between the Hepatitis B viral load and the patient’s age (p < 0.01). The males showed a substantially higher viral load, with 29.2% of the male patients exhibiting elevated levels, compared to 11% of the females. A statistically significant correlation was found between the viral load and liver enzymes, specifically AST (p < 0.005) and ALT (p < 0.04), as well as calcium (p < 0.01). Notably, the elevated ALT and AST levels were more pronounced in the patients with moderate and high viral loads, suggesting a potential link to liver dysfunction. A remarkable insight uncovered in our study revolves around the notable increase in the serum calcium levels (p < 0.01). Conclusions: The AST, ALT, and serum calcium levels were the most altered parameters with high HBV viral load. Though limited reports are available on altered serum calcium levels, they could serve as potential laboratory markers for assessing disease progression in HBV infection. Moreover, focusing on potential therapies to normalize the AST, ALT, and serum calcium levels could offer promising avenues for combating HBV infection. Full article

(This article belongs to the Section Liver)

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13 pages, 873 KB

Open AccessArticle

Impact of Endoscopic Band Ligation on Gastric Complications Associated with Portal Hypertension

by Maria Luisa Gambardella, Giulia Fabiano, Rocco Spagnuolo, Rosanna De Marco, Ileana Luppino, Giusi Franco, Francesco Rettura, Mario Verta, Francesco Luzza and Ludovico Abenavoli

Gastroenterol. Insights 2025, 16(3), 28; https://doi.org/10.3390/gastroent16030028 - 6 Aug 2025

Abstract

Background/Objectives: Clinically significant portal hypertension (CSPH) in cirrhotic patients impacts mortality rates and quality of life. CSPH increases the risk of systemic decompensation and could predispose to the deterioration of portal hypertension (PH)–gastric complications, such as portal hypertensive gastropathy (PHG) and portal hypertensive [...] Read more.

Background/Objectives: Clinically significant portal hypertension (CSPH) in cirrhotic patients impacts mortality rates and quality of life. CSPH increases the risk of systemic decompensation and could predispose to the deterioration of portal hypertension (PH)–gastric complications, such as portal hypertensive gastropathy (PHG) and portal hypertensive polyps (PHPs). In the management of CSPH with high-risk varices, endoscopic band ligation (EBL) is effective in preventing variceal bleeding. However, this procedure has several drawbacks, ranging from its inability to treat PH to the potential development of significant PH–gastric complications. The aim of our study is to evaluate endoscopic changes in PHG, PHPs, and gastric varices before and after the obliteration of esophageal varices, highlighting the potential risks of EBL. Methods: We retrospectively evaluated forty-four patients who underwent EBL for esophageal varices in emergency and elective settings, according to Baveno VII guidelines. We assessed the presence and severity of PHG, the status of gastric varices, and the number of PHPs before and after the eradication of esophageal varices. We used Fisher’s exact test and t-tests to compare the endoscopic and clinical-laboratory data statistically. A p-value < 0.05 was considered statistically significant. Results: This study found that after the eradication of varices, there was a significant worsening of PHG in 28 patients (63%) compared to before the procedure (p < 0.05). The condition remained stable in 14 patients (31%). However, it is worth noting that 90% of the patients exhibited severe PHG at baseline. Additionally, the absence of ascites and the non-administration of beta blockers at baseline were independent risk factors for worsening PHG (p < 0.05). Along with the deterioration of PHG, three patients (7%) developed gastric varices, all classified as type 1 gastroesophageal varices, and in two patients (4.5%), PHPs were formed. In particular, out of these two cases, the number of PHPs increased from one to two compared to the baseline. Conclusions: Our study underscores the association of EBL with a general worsening of PH–gastric complications and the protective effect of beta blockers in this context. Despite these promising results, future studies are needed to assess whether the worsening of PH–gastric complications is sustained over time and whether it is associated with a deterioration in clinical outcomes in patients with cirrhosis. Such evidence could help guide a more informed therapeutic decision between EBL and beta blockers. Full article

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

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11 pages, 936 KB

Open AccessArticle

Endoscopic Ultrasound-Guided Drainage for Post-Pancreatitis and Post-Surgical Peripancreatic Collections: A Retrospective Evaluation of Outcomes and Predictors of Success

by Nadica Shumka and Petko Ivanov Karagyozov

Gastroenterol. Insights 2025, 16(3), 27; https://doi.org/10.3390/gastroent16030027 - 1 Aug 2025

Abstract

Background: Peripancreatic collections (PPCs) are a frequent and severe complication of acute and chronic pancreatitis, as well as pancreatic surgery, often requiring interventions to treat and prevent infection, gastric obstruction, and other complications. Endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive [...] Read more.

Background: Peripancreatic collections (PPCs) are a frequent and severe complication of acute and chronic pancreatitis, as well as pancreatic surgery, often requiring interventions to treat and prevent infection, gastric obstruction, and other complications. Endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to surgical and percutaneous approaches, offering reduced morbidity and shorter recovery times. However, the effectiveness of EUS-guided drainage in post-surgical PPCs remains underexplored. Methods: This retrospective, single-center study evaluated the technical and clinical outcomes of EUS-guided drainage in patients with PPCs between October 2021 and December 2024. Patients were categorized as having post-pancreatitis or post-surgical PPCs. Technical success, clinical success, complications, recurrence rates, and the need for reintervention were assessed. Results: A total of 50 patients underwent EUS-guided drainage, including 42 (84%) with post-pancreatitis PPCs and 8 (16%) with post-surgical PPCs. The overall technical success rate was 100%, with clinical success achieved in 96% of cases. Lumen-apposing metal stents (LAMSs) were used in 84% of patients, including 7.1% as a dual-gate salvage strategy after the failure of double-pigtail drainage. The complication rate was 24%, with infection being the most common (16%). The recurrence rate was 25%, with no significant difference between post-pancreatitis and post-surgical cases. Patients with walled-off necrosis had a significantly higher reintervention rate (35%) than those with pseudocysts (18%; p = 0.042). Conclusions: EUS-guided drainage is a highly effective and safe intervention for PPCs, including complex post-surgical cases. The 100% technical success rate reinforces its reliability, even in anatomically altered post-surgical collections. While recurrence rates remain a consideration, EUS-guided drainage offers a minimally invasive alternative to surgery, with comparable outcomes in both post-pancreatitis and post-surgical patients. Future multi-center studies should focus on optimizing treatment strategies and reducing recurrence in high-risk populations. Full article

(This article belongs to the Section Pancreas)

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12 pages, 294 KB

Open AccessReview

Targeting Advanced Pancreatic Ductal Adenocarcinoma: A Practical Overview

by Chiara Citterio, Stefano Vecchia, Patrizia Mordenti, Elisa Anselmi, Margherita Ratti, Massimo Guasconi and Elena Orlandi

Gastroenterol. Insights 2025, 16(3), 26; https://doi.org/10.3390/gastroent16030026 - 30 Jul 2025

Abstract

Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest solid tumors, with a five-year overall survival rate below 10%. While the introduction of multi-agent chemotherapy regimens has improved outcomes marginally, most patients with advanced disease continue to have limited therapeutic options. Molecular [...] Read more.

Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest solid tumors, with a five-year overall survival rate below 10%. While the introduction of multi-agent chemotherapy regimens has improved outcomes marginally, most patients with advanced disease continue to have limited therapeutic options. Molecular profiling has uncovered actionable genomic alterations in select subgroups of PDAC, yet the clinical impact of targeted therapies remains modest. This review aims to provide a clinically oriented synthesis of emerging molecular targets in PDAC, their therapeutic relevance, and practical considerations for biomarker testing, including current FDA and EMA indications. Methods: A narrative review was conducted using data from PubMed, Embase, Scopus, and international guidelines (NCCN, ESMO, ASCO). The selection focused on evidence published between 2020 and 2025, highlighting molecularly defined PDAC subsets and the current status of targeted therapies. Results: Actionable genomic alterations in PDAC include KRAS G12C mutations, BRCA1/2 and PALB2-associated homologous recombination deficiency, MSI-H/dMMR status, and rare gene fusions involving NTRK, RET, and NRG1. While only a minority of patients are eligible for targeted treatments, early-phase trials and real-world data have shown promising results in these subgroups. Testing molecular profiling is increasingly standard in advanced PDAC. Conclusions: Despite the rarity of targetable mutations, systematic molecular profiling is critical in advanced PDAC to guide off-label therapy or clinical trial enrollment. A practical framework for identifying and acting on molecular targets is essential to bridge the gap between precision oncology and clinical management. Full article

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

18 pages, 529 KB

Open AccessArticle

Perspectives on Mail-Based Fecal Testing for Colorectal Cancer Screening in Bulgaria: A Survey of Gastroenterologists

by Kostadin Yordanov Dimitrov, Vladislav Velchev, Nely Danailova, Elena Staneva, Teodor Koparanov, Trifon Diankov, Teodora Gencheva, Bozhidar Valkov, Eleonora Hristova-Atanasova, Georgi Iskrov and Rumen Stefanov

Gastroenterol. Insights 2025, 16(3), 25; https://doi.org/10.3390/gastroent16030025 - 26 Jul 2025

Abstract

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess [...] Read more.

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives. Full article

(This article belongs to the Section Gastrointestinal Disease)

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16 pages, 266 KB

Open AccessReview

Risk Scores in Acute Lower Gastrointestinal Bleeding: Current Evidence and Clinical Applications

by Truong Thi Do, Dung Thi My Vo and Thong Duy Vo

Gastroenterol. Insights 2025, 16(3), 24; https://doi.org/10.3390/gastroent16030024 - 8 Jul 2025

Abstract

Lower gastrointestinal bleeding (LGIB) is a frequent and potentially life-threatening clinical condition. Over the past two decades, several prognostic scoring systems have been developed to stratify risk and guide the management of patients with LGIB. This comprehensive review aims to summarize and compare [...] Read more.

Lower gastrointestinal bleeding (LGIB) is a frequent and potentially life-threatening clinical condition. Over the past two decades, several prognostic scoring systems have been developed to stratify risk and guide the management of patients with LGIB. This comprehensive review aims to summarize and compare the current evidence on the utility, accuracy, and limitations of key LGIB scoring systems, including the Glasgow-Blatchford Score (GBS), AIMS65, ABC score, Oakland score, SALGIB, CHAMPS, and Rockall score. We conducted a structured literature review of studies evaluating these scores in adult patients with LGIB. For each scoring system, we analyzed its origin, components, intended use, and predictive performance regarding clinical outcomes such as severe bleeding, transfusion requirement, in-hospital mortality, rebleeding, and safe discharge. Comparative analyses of diagnostic accuracy were extracted where available. Our findings indicate that while no single score offers comprehensive predictive accuracy across all outcomes, certain tools are particularly effective for specific endpoints. The Oakland and GBS scores are useful for identifying patients at low risk who may be managed safely as outpatients. The ABC and CHAMPS scores demonstrate superior performance in predicting mortality, especially in elderly or comorbid populations. SALGIB, a newer score developed in Vietnam, shows promising performance for early triage but requires further validation. The Rockall score, although historically valuable in upper GI bleeding, offers limited applicability in LGIB due to its reliance on post-endoscopic findings. In conclusion, multiple prognostic tools are now available to support early decision-making in LGIB. Their optimal use requires understanding their strengths, limitations, and appropriate clinical contexts. Integrating these scores into routine practice, along with clinical judgment, can enhance patient outcomes and resource allocation. Full article

(This article belongs to the Section Gastrointestinal Disease)

17 pages, 2953 KB

Open AccessArticle

Effects of Aronia melanocarpa-Based Fruit Juices on Metabolic Dysfunction-Associated Fatty Liver Disease in Rats

by Antoaneta Georgieva, Miroslav Eftimov, Nadezhda Stefanova, Maria Tzaneva, Petko Denev and Stefka Valcheva-Kuzmanova

Gastroenterol. Insights 2025, 16(3), 23; https://doi.org/10.3390/gastroent16030023 - 8 Jul 2025

Abstract

Background/Objective: Metabolic dysfunction-associated fatty liver disease (MAFLD) is defined by the presence of hepatic steatosis, and is associated with obesity, diabetes, and other metabolic alterations. Feeding rats with a high-fat high-fructose (HFHF) diet is a reproducible experimental model of obesity/metabolic syndrome and [...] Read more.

Background/Objective: Metabolic dysfunction-associated fatty liver disease (MAFLD) is defined by the presence of hepatic steatosis, and is associated with obesity, diabetes, and other metabolic alterations. Feeding rats with a high-fat high-fructose (HFHF) diet is a reproducible experimental model of obesity/metabolic syndrome and the related MAFLD. Aronia melanocarpa, Rosa canina, and Alchemilla vulgaris are polyphenol-rich plants with proven health benefits. The aim of this study was to reveal the effects of four Aronia melanocarpa-based fruit juices (AMBFJs) in HFHF-fed rats. Methods: The AMBFJs were AM20 and AM60 (produced from aronia berries at 20 °C and 60 °C, respectively), AMRC (aronia juice with Rosa canina), and AMAV (aronia juice with Alchemilla vulgaris). Male Wistar rats were allocated to 6 groups. Except for the Control, the rest of the groups were fed an HFHF diet for 60 days. Throughout the experiment, each of the AMBFJs was administered to one HFHF-fed group. Results: HFHF-fed rats had an increased calorie intake on the background of increased liquid and decreased food consumption. At the end of the experiment, they had similar body weights, slightly increased fat indices, increased levels of blood lipids and liver enzymes, as well as typical histopathological changes in liver and adipose tissue. AMBFJs-treated animals showed improvement in most of these parameters, especially in triglyceride levels, liver enzymes, and the histopathological changes in the liver and fat. AMAV, the juice with the highest polyphenolic content, had the highest effect on adiposity. Conclusion: In HFHF-fed rats, AMBFJs exerted beneficial effects on MAFLD probably due to their polyphenolic ingredients. Full article

(This article belongs to the Section Gastrointestinal Disease)

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Graphical abstract

15 pages, 499 KB

Open AccessSystematic Review

From in Utero to Gut: The Unseen Impact of Early-Life Vitamin D Deficiency on the Gastrointestinal System—A Systematic Review

by Artemisia Kokkinari, Evangelia Antoniou, Kleanthi Gourounti, Eirini Orovou, Maria Dagla, Antigoni Sarantaki and Georgios Iatrakis

Gastroenterol. Insights 2025, 16(3), 22; https://doi.org/10.3390/gastroent16030022 - 4 Jul 2025

Abstract

Background: Vitamin D is increasingly recognized not only for its role in skeletal development but also for its immunomodulatory and gastrointestinal effects. Maternal and neonatal vitamin D deficiency (VDD) has been associated with alterations in gut microbiota, impaired intestinal barrier integrity, and increased [...] Read more.

Background: Vitamin D is increasingly recognized not only for its role in skeletal development but also for its immunomodulatory and gastrointestinal effects. Maternal and neonatal vitamin D deficiency (VDD) has been associated with alterations in gut microbiota, impaired intestinal barrier integrity, and increased susceptibility to inflammatory conditions in neonates. However, the exact mechanisms linking perinatal vitamin D status to neonatal gastrointestinal morbidity remain incompletely understood. Methods: This review synthesizes current evidence (2015–2024) from clinical studies, animal models, and mechanistic research on the impact of VDD during pregnancy and the neonatal period on gastrointestinal health. Databases such as PubMed, Scopus, and Web of Science were systematically searched using keywords, including “vitamin D”, “neonate”, “gut microbiome”, “intestinal barrier”, and “necrotizing enterocolitis”. Results: Emerging data suggest that VDD in utero and postnatally correlates with dysbiosis, increased intestinal permeability, and elevated inflammatory responses in neonates. Notably, low 25(OH)D levels in mothers and newborns have been linked with a higher incidence of necrotizing enterocolitis (NEC), delayed gut maturation, and altered mucosal immunity. Vitamin D appears to modulate the expression of tight junction proteins, regulate antimicrobial peptides, and maintain microbial diversity through the vitamin D receptor (VDR). Conclusions: Understanding the gastrointestinal implications of early-life VDD opens a potential window for preventive strategies in neonatal care. Timely maternal supplementation and targeted neonatal interventions may mitigate gut-related morbidities and improve early-life health outcomes. Further longitudinal and interventional studies are warranted to clarify causality and optimal intervention timing. Full article

(This article belongs to the Section Gastrointestinal Disease)

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10 pages, 2812 KB

Open AccessCase Report

Hiccups as the First Symptom of a Complication of Total Gastrectomy for Gastric Cancer with a Negative Objective Abdominal Examination: A Case Report and Review of the Literature

by Francesco Lamacchia, Genny Mattara, Francesca Tolin, Beatrice Maddalon and Pierluigi Pilati

Gastroenterol. Insights 2025, 16(3), 21; https://doi.org/10.3390/gastroent16030021 - 3 Jul 2025

Abstract

Total gastrectomy with D2 lymphadenectomy for gastric cancer is a complex surgical procedure with a moderate complication rate. Sometimes, some complications may have a misleading onset without a clear clinical presentation and blood test changes. In this case report, hiccups were the main [...] Read more.

Total gastrectomy with D2 lymphadenectomy for gastric cancer is a complex surgical procedure with a moderate complication rate. Sometimes, some complications may have a misleading onset without a clear clinical presentation and blood test changes. In this case report, hiccups were the main symptom of subdiaphragmatic fluid collection after total gastrectomy. Full article

(This article belongs to the Section Gastrointestinal Disease)

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17 pages, 2241 KB

Open AccessSystematic Review

Increased Overall Mortality in Patients Admitted for Gastrointestinal Bleeding and COVID-19 Infection Compared to No COVID-19 Infection: A Systematic Review and Meta-Analysis

by Sergiu Marian Cazacu, Adina Turcu-Stiolica, Cristina Maria Marginean and Ion Rogoveanu

Gastroenterol. Insights 2025, 16(3), 20; https://doi.org/10.3390/gastroent16030020 - 30 Jun 2025

Abstract

(1) Background: Patients admitted for gastrointestinal bleeding (GIB) who are diagnosed with COVID-19 at presentation may face significant therapeutic challenges. The delicate balance between the use of anticoagulant and anti-inflammatory therapy to address COVID-19 and hemostasis targets can, in turn, lead to delays [...] Read more.

(1) Background: Patients admitted for gastrointestinal bleeding (GIB) who are diagnosed with COVID-19 at presentation may face significant therapeutic challenges. The delicate balance between the use of anticoagulant and anti-inflammatory therapy to address COVID-19 and hemostasis targets can, in turn, lead to delays in COVID-19 treatment until bleeding is controlled. The published systematic reviews and meta-analyses that were reviewed included patients with both GIB and COVID-19 regardless of GIB presence at admission, and a separate analysis of patients admitted for GIB and tested for COVID-19 infection during hospitalization was not performed. (2) Methods: PubMed, Web of Science, and Scopus databases were used to access articles published from 1 December 2019 to 20 December 2024. Retrospective studies involving human subjects with GIB and COVID-19 were included in the final analysis. The exclusion criteria were as follows: pediatric population studies; the absence of a GIB control group; reviews, conference abstracts, expert opinions, and letters. The risk of bias in the included studies was assessed using the rank correlation test and Begg’s and Egger’s regression tests. We estimated the outcomes using the pooled odds ratio (OR) and the 95% confidence interval (95% CI). (3) Results: Seven studies, which included 3291 patients admitted for GIB who tested positive for COVID-19 infection, were included in our systematic review; four studies with a control group of patients with GIB but without COVID-19 infection were included in our meta-analysis. The odds of mortality among COVID-19-infected patients admitted for GIB were 3.80. There was heterogeneity regarding the site of GIB (some studies included all forms of GIB, others included only UGIB) and the study period (most studies included only patients from the first pandemic wave, and only one study reported cases from the first 2 years of the pandemic, including the delta pandemic wave). (4) Conclusions: COVID-19 infection in patients admitted for GIB was associated with a higher overall mortality rate. Full article

(This article belongs to the Section Gastrointestinal Disease)

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13 pages, 499 KB

Open AccessArticle

Point-of-Care Ultrasound for the Early Detection of Intrahepatic Biliary Tract Dilatation: A Local Study in a Basic Emergency Service

by Sergio Miravent, Bruna Vaz, Manuel Duarte Lobo, Cármen Jimenez, Pedro Pablo, Teresa Figueiredo, Narciso Barbancho, Miguel Ventura and Rui Pedro de Almeida

Gastroenterol. Insights 2025, 16(3), 19; https://doi.org/10.3390/gastroent16030019 - 29 Jun 2025

Abstract

Background/Objectives: Ultrasonography is a diagnostic modality characterized by high sensitivity in detecting hepato-biliary pathology, particularly intrahepatic biliary duct dilation. This study compares the sonographic findings obtained by a radiographer/sonographer in a Basic Emergency Service (BES) using Point-of-Care Ultrasonography (POCUS) in Portugal with the [...] Read more.

Background/Objectives: Ultrasonography is a diagnostic modality characterized by high sensitivity in detecting hepato-biliary pathology, particularly intrahepatic biliary duct dilation. This study compares the sonographic findings obtained by a radiographer/sonographer in a Basic Emergency Service (BES) using Point-of-Care Ultrasonography (POCUS) in Portugal with the sonographic findings from the same patients acquired by radiologists at a referral hospital (RH) for suspected intrahepatic biliary dilatation. Methods: Nineteen patients presenting with right upper quadrant (RUQ) pain and suspected abdominal pathology underwent sonographic screening using POCUS in the BES. Subsequently, the same patients were referred to the RH, where a radiologist performed a comprehensive ultrasound. Both examinations were compared to determine whether the findings obtained in the BES were confirmed by radiologists in the RH. Results: Cholestasis, cholangitis, lithiasis, pancreatitis, peri-ampullary lithiasis, and neoplasms were observed in association with intrahepatic biliary dilation in this study sample. All six variables showed a strong association between the BES and RH findings (Cramer’s V > 0.6; p < 0.006). A strong kappa measure of agreement between the radiographer and radiologist findings was obtained in “cholelithiasis/sludge/gallbladder acute sonographic changes” (k = 0.802; p = 0.000). A moderate kappa value was obtained for the variable “abdominal free fluid”, (k = 0.706; p = 0.001). Conclusions: In this study, all patients referred from the BES to the RH required hospitalization for treatment and additional imaging exams. Although pre-hospital screening ultrasound is not intended for definitive diagnoses, the early detection of intrahepatic biliary tract dilatation through screening sonography played a significant role in the clinical referral of patients, with a sensitivity of 94% and specificity of 75%. Full article

(This article belongs to the Section Liver)

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16 pages, 1262 KB

Open AccessSystematic Review

A Systematic Review and Meta-Analysis on the Role of Somatostatin Therapy in Non-Variceal Gastrointestinal Bleeding

by Magnus Chun, Tahne Vongsavath, Sneh Sonaiya, Lily Liu, Kyaw Min Tun, Kavita Batra and Robert G. Gish

Gastroenterol. Insights 2025, 16(2), 18; https://doi.org/10.3390/gastroent16020018 - 13 Jun 2025

Cited by 1

Abstract

Background and Aims: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalizations, with proton pump inhibitors (PPIs) being the mainstay treatment. However, there is a lack of high-level evidence to show if adjunctive medical therapy (somatostatin and its analogs) can improve [...] Read more.

Background and Aims: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalizations, with proton pump inhibitors (PPIs) being the mainstay treatment. However, there is a lack of high-level evidence to show if adjunctive medical therapy (somatostatin and its analogs) can improve outcomes. This systematic review and meta-analysis aim to evaluate the outcomes of PPIs with adjunctive therapy versus PPI monotherapy in treating NVUGIB in an in-patient setting. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, major databases were systematically searched to retrieve English-only, original studies, published from 1 January 2000 to 31 December 2023, investigating NVUGIB only. The primary outcomes included the mortality rate within 7 days of therapy, rebleeding rate within 7 days of therapy, and length of hospital stay. Results: Seven studies with 789 patients had a pooled mortality rate of 2.0% (95% CI, 0–4.0%), and the pooled risk ratio was 1.11 (95% CI, 0.50–2.48; p = 0.79) between PPI monotherapy and PPIs with adjunctive medical therapy. The pooled rebleeding rate was 13% (95% CI, 6–20%) and the risk ratio was 1.04 (95% CI, 0.73–1.48; p = 0.83). The pooled average length of stay in the hospital was 5.47 days (95% CI, 3.72–7.21 days), with insignificant weighted differences between the two groups. No statistically significant differences were noted in surgical management risk ratios or amount of blood transfusion. Conclusions: Among patients with NVUGIB, adjunctive medical therapy offered no clinical benefits given the statistically insignificant differences in the primary outcomes. However, this conclusion is limited by the considerable variability in treatment protocols, weak control of confounding variables, and missing clinical information in the original studies. Therefore, better-quality, large-scale randomized controlled trials are needed, ideally using standardized somatostatin dosing, timing, delivery routes, and clearly defined inclusion criteria to more accurately evaluate the role of somatostatin in NVUGIB management. Full article

(This article belongs to the Section Gastrointestinal Disease)

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12 pages, 326 KB

Open AccessArticle

Serum Albumin as an Early Predictor of Severity in Patients with Acute Pancreatitis

by Oscar Francisco Iniestra-Ayllón, José Antonio Morales-González, Karina Sánchez-Reyes and Elda Victoria Rodríguez-Negrete

Gastroenterol. Insights 2025, 16(2), 17; https://doi.org/10.3390/gastroent16020017 - 27 May 2025

Abstract

Acute pancreatitis (AP) is one of the gastrointestinal pathologies that most frequently requires hospital admission; about half of all deaths occur within the first two weeks and are caused by multi-organ failure. Predicting the degree of severity of AP before 48 h is [...] Read more.

Acute pancreatitis (AP) is one of the gastrointestinal pathologies that most frequently requires hospital admission; about half of all deaths occur within the first two weeks and are caused by multi-organ failure. Predicting the degree of severity of AP before 48 h is a challenge. Background/Objectives: Having an early marker, before 48 h after admission, could be useful to avoid or diagnose early complications such as organ failure (OF). A few sentences could place the question addressed in a broader context and highlight the purpose of the study. Methods: A retrospective study conducted in a third-level hospital, during the period from August 2019 to June 2021. Patients aged >18 years, with a diagnosis of PA, who had a complete clinical history and complete biochemical and imaging data were included. The scores of the APACHE II, BISAP, revised Atlanta classification, and modified Marshall scales were recorded. Results: Of the 103 patients included, 60% were women, the mean age was 47.76 years, and the hospital stay was 8 days (IQR 6–12); the most frequent etiology was biliary in 46 (44.7%) patients; the most frequent BMI was overweight with 34 (33%) patients; and 38 (36.9%) patients had a systemic inflammatory response at admission. Hypoalbuminemia was observed in 34 (33%) of the 103 patients at admission; of these, 42 (40.8%) had an APACHE II score > 8 points, 17 (16.3%) a BISAP score > 2, 57 (54.8%) patients were classified as moderate AP according to the revised Atlanta classification, and 54 patients had a score according to the modified Marshall score > 2. A statistically significant difference in the development of death was observed between patients with hypoalbuminemia versus those with normal serum albumin levels. Conclusions: In this study, we show the usefulness of hipoalbuminemia (<3.5 g/dL) at hospital admission in patients with AP, as a severity and mortality indicator. With the results obtained, we conclude that low albumin levels are a good predictor of severity and are useful for establishing timely treatment and close follow-up. Full article

(This article belongs to the Section Pancreas)

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15 pages, 1809 KB

Open AccessArticle

Clinical Characteristics of Alcohol-Related Liver Disease in Albanian Patients: A Cross-Sectional Study

by Dorina Osmanaj, Floreta Kurti, Klerida Shehu, Yllka Themeli, Gentian Stroni, Erand Llanaj and Adriana Babameto

Gastroenterol. Insights 2025, 16(2), 16; https://doi.org/10.3390/gastroent16020016 - 30 Apr 2025

Cited by 1

Abstract

Background/Objectives: Alcohol-related liver disease (ARLD) is a major cause of chronic liver disease, yet its clinical profile in Albania, a region with high HBV prevalence and rising alcohol consumption, remains poorly characterized. This study evaluates the clinical markers of advanced ARLD as [...] Read more.

Background/Objectives: Alcohol-related liver disease (ARLD) is a major cause of chronic liver disease, yet its clinical profile in Albania, a region with high HBV prevalence and rising alcohol consumption, remains poorly characterized. This study evaluates the clinical markers of advanced ARLD as noninvasive fibrosis indicators, acknowledging limitations in observational data and the need for validation in diverse populations. Methods: In this cross-sectional study, 200 patients with ARLD were classified as having mild or advanced disease based on clinical, biochemical, and imaging criteria. Associations between socioeconomic factors, nutritional status, and fibrosis markers with advanced ARLD were assessed using multivariate logistic regression, adjusted for age, sex, smoking status, and duration of alcohol use. Results: Lower Prognostic Nutritional Index (PNI) score was significantly associated with advanced ARLD (OR 0.95, 95% CI 0.91–0.99; p = 0.014), suggesting a potential role of nutritional status in disease progression. Higher APRI and FIB-4 scores were associated with an increased risk of advanced ARLD (APRI: OR 1.27, 95% CI 0.71–2.26; FIB-4: OR 1.10, 95% CI 0.81–1.51), though these associations did not reach statistical significance. Conclusions: This study provides a first clinical assessment of ARLD in Albania, highlighting the potential role of nutritional and fibrosis markers in risk stratification. While the study design limits definitive conclusions, our findings underscore the need for larger prospective studies to validate these associations and further investigate the influence of metabolic and socioeconomic factors on ARLD progression in Albania. Full article

(This article belongs to the Section Liver)

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