Gastroenterology Insights

17 pages, 2241 KiB

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 KiB

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 KiB

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

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 KiB

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 KiB

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

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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19 pages, 1172 KiB

Open AccessArticle

Colonic Dysbiosis Is Associated with Gastrointestinal Disorders More than Mother–Child Epidemiological Traits in Mexican Children with Autism Spectrum Disorders

by Julián Herrera-Mejía, Abraham Wall-Medrano, Arnulfo Ramos-Jiménez, Aarón F. González-Córdova, Florinda Jiménez-Vega and Rocio Campos-Vega

Gastroenterol. Insights 2025, 16(2), 15; https://doi.org/10.3390/gastroent16020015 - 17 Apr 2025

Abstract

Introduction: Functional gastrointestinal disorders (FGIDs) are common comorbidities that affect the life quality of children with autism. Objective: This study investigated the link between clinical history and specific colonic fecal microbiota (CFM) markers with the pathophysiology of FGIDs in young children with autism [...] Read more.

Introduction: Functional gastrointestinal disorders (FGIDs) are common comorbidities that affect the life quality of children with autism. Objective: This study investigated the link between clinical history and specific colonic fecal microbiota (CFM) markers with the pathophysiology of FGIDs in young children with autism patients. Methods: Thirty-nine young patients (2 and 18 years) were included in the study of FGIDs (+) cases (n = 18) and FGIDs (-) (n = 21) controls. Gastrointestinal disorders were diagnosed by standardized clinical tools (ROMA-IV and six-item gastrointestinal severity index), while bacterial markers, including Bacteroidetes, Firmicutes, Actinomycetes (Phyla); Lactobacillales, Clostridiales, Bifidobacteriales (Orders); B. fragilis, F. prausnitzii, B. longum, D. vulgaris and A. muciniphila (Species), were detected by targeting 16S rRNA and two-step PCR protocol. Results: The overall prevalence of FGIDs was significantly (p < 0.05) associated with cesarean delivery, the duration of milk formula consumption, and the presence of early intestinal symptoms during infancy. Furthermore, Bacteroidetes, Lactobacillales, B. longum, D. vulgaris, and A. muciniphila concentrations were significantly (p ≤ 0.03) higher in stool of patients with moderate symptoms, compared to those who were asymptomatic. Conclusions: Our results suggest that the CFM composition is a potential physiological predictor of FGID pathophysiology in a severity-dependent way in children with autism. Full article

(This article belongs to the Section Gastrointestinal Disease)

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10 pages, 227 KiB

Open AccessArticle

Right-Sided Dysplasia in Inflammatory Bowel Disease Is Not Associated with Conventional Risk Factors for Neoplasia

by Sumona Bhattacharya, William Beaty, Adam S. Faye and Jordan E. Axelrad

Gastroenterol. Insights 2025, 16(2), 14; https://doi.org/10.3390/gastroent16020014 - 7 Apr 2025

Abstract

Introduction: In the general population, right I-sided dysplasia presents a higher risk for colorectal cancer (CRC) and metachronous dysplasia compared to left (L)-sided dysplasia. Given that patients with inflammatory bowel disease (IBD) are at higher risk for dysplasia than the general population, we [...] Read more.

Introduction: In the general population, right I-sided dysplasia presents a higher risk for colorectal cancer (CRC) and metachronous dysplasia compared to left (L)-sided dysplasia. Given that patients with inflammatory bowel disease (IBD) are at higher risk for dysplasia than the general population, we sought to assess the risk factors as well as the differences in outcomes between patients with R-sided, L-sided, and both R- and L-sided dysplasia. Methods: A retrospective chart review was performed on patients at NYU Langone Health who had evidence of dysplasia on a colonoscopy between 2011 and 2021. Demographics and pertinent medical history were compiled. Cohorts were based on the dysplasia location (R-sided, L-sided, or R- and L-sided) and the IBD-related outcomes were analyzed. Results: A total of 71 patients had colonic dysplasia. The mean age was 54 years old (SD ± 17). The majority were male (72%), white (69%), and non-Hispanic (94%). A total of 76% had ulcerative colitis (UC) and 24% had Crohn’s disease (CD). Of all dysplastic lesions, 57 (80%) patients had unifocal disease and the remainder had multifocal disease. A total of 39 (55%) patients had R-sided dysplasia, 24 (34%) had L-sided dysplasia, and 8 (11%) had both R- and L-sided dysplasia. Patients with UC were more likely to have L-sided dysplasia (92% vs. 8% in CD; p = 0.04). Pseudopolyps were more likely associated with R- and L-sided dysplasia (38% in R- and L-sided dysplasia, 10% in R-sided dysplasia, and 4% in L-sided dysplasia; p = 0.03). Conclusions: Patients with UC had a higher risk for L-sided colonic dysplasia compared to patients with CD; however, there were no differences in the progression of dysplasia between those who had R-sided and those who had L-sided dysplasia. Larger studies are needed to assess the risk factors and outcomes related to the laterality of dysplasia and further validate these findings among patients with IBD. Full article

(This article belongs to the Section Gastrointestinal Disease)

11 pages, 975 KiB

Open AccessArticle

Effect of Weekend Alcohol Consumption on Hepatic Antioxidant Enzyme Activity: Role of Concentration and Gender

by Elda Victoria Rodríguez-Negrete, Jazmín García-Machorro, Eduardo Osiris Madrigal-Santillán, Ángel Morales-González and José A. Morales-González

Gastroenterol. Insights 2025, 16(2), 13; https://doi.org/10.3390/gastroent16020013 - 2 Apr 2025

Abstract

Background/Objectives: It is known that chronic alcohol consumption causes alterations to various organs of the body, mainly the liver, but there are no reports of the damage that weekend alcohol consumption can cause to the liver. The liver is the main organ responsible [...] Read more.

Background/Objectives: It is known that chronic alcohol consumption causes alterations to various organs of the body, mainly the liver, but there are no reports of the damage that weekend alcohol consumption can cause to the liver. The liver is the main organ responsible for metabolizing ethanol and therefore experiences the most significant adverse effects of this xenobiotic’s toxicity. In this study, we evaluated the effect of weekend alcohol consumption on the activity of hepatic antioxidant enzymes. Methods: Wistar rats weighing 170–200 g were divided into the following groups: (1) control group and (2) weekend alcohol consumption group, 2 days per week for 12 weeks at two different concentrations: (1) group of males and females consuming a 40% alcohol solution and (2) group of males and females consuming a 5% alcohol solution. At the end of the experiment, liver samples were obtained. The activity of the enzymes catalase, superoxide dismutase, glutathione reductase, and glutathione peroxidase, as well as the levels of total antioxidant capacity and thiobarbituric acid reactive substances, were determined. Results: surprisingly, the results showed an increase in the activity of antioxidant enzymes, as well as a decrease in thiobarbituric acid reactive substances. Conclusions: weekend alcohol consumption for a period of 3 months led to an elevation in antioxidant enzyme activity, but it was not sufficient to prevent the damage caused to the liver by weekend alcohol consumption. Full article

(This article belongs to the Section Liver)

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19 pages, 2151 KiB

Open AccessSystematic Review

Comparative Efficacy of Subcutaneous Compared to Intravenous Biologics for Inflammatory Bowel Disease: Systematic Review and Meta-Analysis

by Nouran Alwisi, Rana Ismail, Hissa Al-Kuwari, Khalifa H. Al-Ansari, Mohammed A. Al-Matwi, Noor A. Aweer, Wejdan N. Al-Marri, Yousif Al-Kubaisi, Muneera Al-Mohannadi, Shahd Hamran, Habib H. Farooqui and Tawanda Chivese

Gastroenterol. Insights 2025, 16(2), 12; https://doi.org/10.3390/gastroent16020012 - 21 Mar 2025

Abstract

Background and Aims: There is still uncertainty about the efficacy and safety of subcutaneous compared to intravenous administration of biologics for inflammatory bowel disease (IBD) remission. Methods: In this systematic review and meta-analysis, we searched Cochrane, PubMed, SCOPUS, CINHAL, and preprint archives for [...] Read more.

Background and Aims: There is still uncertainty about the efficacy and safety of subcutaneous compared to intravenous administration of biologics for inflammatory bowel disease (IBD) remission. Methods: In this systematic review and meta-analysis, we searched Cochrane, PubMed, SCOPUS, CINHAL, and preprint archives for trials that compared the efficacy and safety of subcutaneous and intravenous biologics for the induction and maintenance of IBD remission. Meta-analysis was carried out with a subgroup analysis for Crohn’s disease (CD) and Ulcerative Colitis (UC), heterogeneity using I², and publication bias using funnel plots. Results: A total of 14 randomized controlled trials, 9 on CD, 4 on UC, and 1 with data on both were included Subcutaneous, compared to intravenous administration, was less efficacious for the induction of remission; overall (OR 0.68, 95%CI 0.35–1.31, I² = 83%), worse in UC (OR 0.35, 95%CI 0.07–1.79, I² = 91.2%), and showed similar efficacy in CD (OR 0.97, 95%CI 0.73–1.30, I² = 0%). For the maintenance of remission, subcutaneous biologics were almost similar to intravenous biologics; overall (OR 0.97, 95%CI 0.63–1.49, I² = 57.1%), with less efficacy in UC (OR 0.82, 95%CI 0.54–1.23, I² = 52%), but superior efficacy in CD (OR 1.81, 95%CI 1.09–3.01, I² = 0%). Subcutaneous, compared to intravenous biologics, showed slightly higher odds of treatment discontinuation (OR 1.32, 95%CI 1.02–1.71, I² = 14.2%), worse in UC (OR 1.52, 95%CI 1.17–1.98, I² = 13%), and was similar to intravenous for CD (OR 1.03, 95%CI 0.65–1.62, I² = 0%). Conclusion: Subcutaneous administration has lower efficacy for the induction of remission but can achieve almost similar efficacy and safety in maintaining remission in IBD. Subcutaneous injection has better efficacy and safety in CD than in UC. Full article

(This article belongs to the Special Issue Basic and Translational Research in Inflammatory Bowel Disease)

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7 pages, 1920 KiB

Open AccessCase Report

Celiac Disease Presented as Plummer–Vinson Syndrome: A Case Report

by Irina Ciortescu, Roxana Nemțeanu, Ilinca-Maria Chiriac, Gheorghe Bălan, George Aurelian Cocu, Ionuț Alexandru Coșeru, Catalina Mihai and Alina Pleșa

Gastroenterol. Insights 2025, 16(1), 11; https://doi.org/10.3390/gastroent16010011 - 20 Mar 2025

Abstract

Background and Clinical significance: Plummer–Vinson (PV) syndrome is a rare medical entity diagnosed when iron-deficiency anemia, dysphagia, and esophageal webs occur in the same patient. PV syndrome has been associated with different autoimmune diseases, such as celiac disease (CD). CD is a chronic [...] Read more.

Background and Clinical significance: Plummer–Vinson (PV) syndrome is a rare medical entity diagnosed when iron-deficiency anemia, dysphagia, and esophageal webs occur in the same patient. PV syndrome has been associated with different autoimmune diseases, such as celiac disease (CD). CD is a chronic multisystemic disorder affecting the small intestine, but it is recognized as having a plethora of clinical manifestations secondary to the malabsorption syndrome that accompanies the majority of cases. However, similar to PV syndrome, a high percentage of CD patients are asymptomatic, and those who are symptomatic may present with a wide variety of gastrointestinal and extraintestinal symptoms, including iron-deficiency anemia, making the diagnosis challenging. Case presentation: We present the case of a 43-year-old Caucasian female patient with a 7-year history of iron-deficiency anemia and increased bowel movements (3–4 stools/day). Upper endoscopy demonstrated a narrowing at the proximal cervical esophagus from a tight esophageal stricture caused by a smooth mucosal diaphragm. A 36F Savary–Gilliard dilator was used to manage the stenosis. The distal esophagus and stomach were normal, but scalloping of the duodenal folds was noted, and CD was confirmed by villous atrophy and positive tissue transglutaminase antibodies. Dysphagia was immediately resolved, and a glute-free diet was implemented. Conclusions: The relationship between PV syndrome and CD is still a matter of debate. Some might argue that PV syndrome is a complication of an undiagnosed CD. In cases of PV syndrome, a CD diagnosis should be considered even in the absence of typical symptoms of malabsorption. Full article

(This article belongs to the Special Issue Feature Papers in Celiac Disease)

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14 pages, 2218 KiB

Open AccessReview

Exploring Perianal Fistulas: Insights into Biochemical, Genetic, and Epigenetic Influences—A Comprehensive Review

by Maciej Przemysław Kawecki, Agnieszka Marianna Kruk, Mateusz Drążyk, Zygmunt Domagała and Sławomir Woźniak

Gastroenterol. Insights 2025, 16(1), 10; https://doi.org/10.3390/gastroent16010010 - 7 Mar 2025

Abstract

The development of perianal fistulas leads to a significant decrease in the quality of patients’ lives. The onset of this condition is dependent on many factors, including inflammation or trauma. In the occurrence of Crohn’s disease-associated fistulas, numerous molecular factors and metabolic pathways [...] Read more.

The development of perianal fistulas leads to a significant decrease in the quality of patients’ lives. The onset of this condition is dependent on many factors, including inflammation or trauma. In the occurrence of Crohn’s disease-associated fistulas, numerous molecular factors and metabolic pathways are involved. To integrate the current knowledge on the biochemical, genetic, and epigenetic factors taking part in the development of perianal fistulas, we conducted a literature review. We gathered and analyzed 45 articles on this subject. The pathophysiology of fistulas associated with Crohn’s disease (CD) involves epithelial–mesenchymal transition (EMT) and matrix remodeling enzymes, with key regulators including transforming growth factor β (TGF-β), tumor necrosis factor α (TNFα), and interleukin-13 (IL-13). Genetic factors, such as mutations in receptor-interacting serine/threonine-protein kinase 1 (RIPK1), interleukin-10 receptor (IL-10R), and the MEFV gene, contribute to the onset and severity of perianal fistulas, suggesting potential therapeutic targets. Understanding the complex interplay of molecular pathways and genetic predispositions offers insights into personalized treatment strategies for this challenging condition. Further research is necessary to elucidate the intricate mechanisms underlying the pathogenesis of perianal fistulas and to identify new therapeutic interventions. Full article

(This article belongs to the Section Gastrointestinal Disease)

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20 pages, 7524 KiB

Open AccessReview

Strategies to Enhance the Adenoma Detection Rate (ADR) and the Serrated Polyp Detection Rate (SPDR) in Colonoscopy: A Comprehensive Review

by Davide Scalvini, Simona Agazzi, Stiliano Maimaris, Laura Rovedatti, Daniele Brinch, Alessandro Cappellini, Carlo Ciccioli, Michele Puricelli, Erica Bartolotta, Daniele Alfieri, Elena Giulia Strada, Lodovica Pozzi, Marco Bardone, Stefano Mazza, Aurelio Mauro and Andrea Anderloni

Gastroenterol. Insights 2025, 16(1), 9; https://doi.org/10.3390/gastroent16010009 - 3 Mar 2025

Abstract

Introduction: High-quality colonoscopy is influenced by several factors, with the adenoma detection rate (ADR) being one of the most studied indicators. A strong inverse relationship exists between ADR and the risk of developing post-colonoscopy colorectal cancer (PCCRC), prompting the European Society of Gastrointestinal [...] Read more.

Introduction: High-quality colonoscopy is influenced by several factors, with the adenoma detection rate (ADR) being one of the most studied indicators. A strong inverse relationship exists between ADR and the risk of developing post-colonoscopy colorectal cancer (PCCRC), prompting the European Society of Gastrointestinal Endoscopy guidelines to recommend a minimum ADR of 25%. In contrast, there is limited evidence supporting the clinical significance of the serrated polyp detection rate (SPDR), and no specific benchmark was established until a very recent update from the American societies. Main paper: This review examines the factors that influence ADR and SPDR, offering tips to improve these metrics. Effective interventions for enhancing ADR include training, colonoscopy feedback, adequate bowel preparation, longer withdrawal time, water-aided colonoscopy, right colon second look, and chromoendoscopy. The use of cap, devices, and specialized scopes also show promise, though these are often at higher costs. Artificial intelligence has generated great optimism, especially following positive results from early randomized controlled trials; however, its effectiveness has been less pronounced in real-world settings. Conclusions: Many of these approaches require further trials and meta-analyses to establish their ultimate efficacy. Moreover, future clinical head-to-head studies will help to identify the most effective interventions for reducing colorectal cancer incidence and the risk of PCCRC. Full article

(This article belongs to the Section Gastrointestinal Disease)

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13 pages, 551 KiB

Open AccessSystematic Review

Gastrointestinal Pathologies Associated with Thalassemia: A Systematic Review

by Sara Fakeh, Ahmad Masoud, Raneem Abuqtaish, Bayan Salman, Layth Al-Ramahi, Omar AlWahkyan and Dua Abuquteish

Gastroenterol. Insights 2025, 16(1), 8; https://doi.org/10.3390/gastroent16010008 - 27 Feb 2025

Abstract

Background/Objectives: Thalassemia, a hereditary blood disorder, leads to reduced hemoglobin levels, impairing oxygen transport and negatively impacting patient health. Recent research suggests a possible association between thalassemia and gastrointestinal (GI) symptoms, such as abdominal pain, diarrhea, and GI bleeding, potentially due to immune [...] Read more.

Background/Objectives: Thalassemia, a hereditary blood disorder, leads to reduced hemoglobin levels, impairing oxygen transport and negatively impacting patient health. Recent research suggests a possible association between thalassemia and gastrointestinal (GI) symptoms, such as abdominal pain, diarrhea, and GI bleeding, potentially due to immune compromise and iron overload. This systematic review aims to explore the prevalence and underlying factors of GI pathologies in thalassemia patients, excluding treatment-related effects and iron overload. Methods: A comprehensive search following the PRISMA guidelines was conducted to identify the prevalence and causes of GI disorders in thalassemia patients. Studies assessing non-treatment-related GI symptoms and their links to thalassemia were analyzed. After screening 1902 studies, 13 were included to investigate gastrointestinal manifestations in thalassemia patients. Results: Evidence indicates potential associations between thalassemia and GI disorders, including malabsorption, inflammatory bowel disease, Heliobacter pylori (H. pylori) infection, and celiac disease. Findings highlight immune compromise and iron dysregulation as possible contributing factors. Conclusions: This review highlights the importance of further research into the GI manifestations of thalassemia to enable early detection and improve patient health outcomes and quality of life. Addressing this gap may provide insights into better clinical management strategies for thalassemia patients. Full article

(This article belongs to the Section Gastrointestinal Disease)

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11 pages, 462 KiB

Open AccessSystematic Review

The Effect of Inspiratory Muscle Training on Gastroesophageal Reflux Disease Characteristics: A Systematic Review

by Stylianos Syropoulos, Maria Moutzouri, Eirini Grammatopoulou and Irini Patsaki

Gastroenterol. Insights 2025, 16(1), 7; https://doi.org/10.3390/gastroent16010007 - 12 Feb 2025

Abstract

Background/Objective: Gastroesophageal reflux disease (GERD) is multifactorial and affects an increasing number of people. It is a common condition in which the stomach contents move up into the esophagus; thus, its main cause is found in the antireflux valve mechanism of the gastroesophageal [...] Read more.

Background/Objective: Gastroesophageal reflux disease (GERD) is multifactorial and affects an increasing number of people. It is a common condition in which the stomach contents move up into the esophagus; thus, its main cause is found in the antireflux valve mechanism of the gastroesophageal junction. This consists of two sphincters, the lower oesophageal and the diaphragmatic. The disease has been related to diaphragm dysfunction, either due to the de-coordination of the diaphragms’ contractility or due to decreased strength. Breathing exercises seem to have a positive effect in this population. The aim of this study was to systematically examine the effects of inspiratory muscle training (IMT) on GERD characteristics. Methods: We conducted a systematic review of research up to April 2024 in Scopus, PubMed, and Science Direct. We included randomized controlled trials (RCTs) and clinical trials assessing the effects of IMT on GERD characteristics. Methodological quality was assessed with the PEDro scale (Physiotherapy Evidence Database) and the Newcastle Ottawa scale (NOC). Results: Among the 1984 studies identified from the search, only three studies (one study with a post-COVID-19 population and two with GERD and healthy subjects) were included in this study, as they presented a fair to high methodological quality. Significant improvements in maximal inspiratory pressure (p < 0.001) and diaphragmatic excursion (p < 0.001) were revealed in one study. No significant differences between groups were mentioned for the reflux symptoms and for LES–EGJ pressure in the studies included. Conclusions: IMT seems to provide promising effects in strengthening the antireflux valve mechanism, as it increases MIP and diaphragmatic excursion. This systematic review established a bibliographic gap for the contribution of IMT in the antireflux valve mechanism. More evidence is needed to support the importance of IMT as a non-pharmacological intervention for GERD patients. Full article

(This article belongs to the Section Gastrointestinal Disease)

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9 pages, 223 KiB

Open AccessArticle

Correlation Between Interleukin IL-6/IL-6 Receptor Polymorphisms (IL6–174C>G and IL6R 1073A>C) and RAS/BRAF Mutations in Patients with Colorectal Cancer

by Ekaterina Smagina, Dar’ya Polit’ko, Vadim Kumeiko, Lyudmila Gurina and Anna Stenkova

Gastroenterol. Insights 2025, 16(1), 6; https://doi.org/10.3390/gastroent16010006 - 6 Feb 2025

Abstract

Background: Chronic inflammation is an important factor in the development and progression of colorectal cancer (CRC). One of the key participants of chronic inflammation is interleukin-6 (IL-6), which enhances tumor malignancy. Some of the genetic markers characterizing the IL-6/STAT3/JAK pathway are functional polymorphisms [...] Read more.

Background: Chronic inflammation is an important factor in the development and progression of colorectal cancer (CRC). One of the key participants of chronic inflammation is interleukin-6 (IL-6), which enhances tumor malignancy. Some of the genetic markers characterizing the IL-6/STAT3/JAK pathway are functional polymorphisms in IL6 and IL6R genes. Hyperexpression of IL-6 and increasing concentrations of the soluble form, IL-6R, may be one possible option for cross-activation of MAPK signaling. Methods: Detection of rs1800795 and rs2228145 SNPs was carried out using allele-specific PCR. The mutations of RAS and BRAF genes in tumors were determined by pyrosequencing. Results: The allele and genotype distributions of IL6 rs1800795 (−174C>G) and IL6R rs2228145 (1073A>C) were significantly different between the CRC and control groups. Thus, the risks of CRC developing in carriers of the homozygous G/G rs1800795 and C/C rs2228145 genotypes were 2.05- and 1.85-fold higher. Also, we identified a relationship between the studied SNPs and somatic activating mutations in the RAS and BRAF genes. It was found that the G/G rs1800795 and C/C rs2228145 genotypes are significantly more common in the group of patients without activating mutations in the RAS and BRAF genes. Conclusions: Understanding the impact of genetic factors not only on cancer predisposition but the evolution of cancer cells will help to derive novel predictive markers and therapy options. Full article

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

13 pages, 3108 KiB

Open AccessArticle

MicroRNA 133A Regulates Squalene Epoxidase Expression in Colorectal Cancer Cells to Control Cell Proliferation and Cholesterol Production

by Ji-Su Mo, Santosh Lamichhane, Grinsun Sharma and Soo-Cheon Chae

Gastroenterol. Insights 2025, 16(1), 5; https://doi.org/10.3390/gastroent16010005 - 9 Jan 2025

Abstract

Background/Objectives: Colorectal cancer (CRC) is one of the most common cancers worldwide, with high incidence and mortality rates. MicroRNAs are endogenous and non-coding RNAs that play a pivotal role in the development and progression of various cancers by targeting specific genes. Previously, we [...] Read more.

Background/Objectives: Colorectal cancer (CRC) is one of the most common cancers worldwide, with high incidence and mortality rates. MicroRNAs are endogenous and non-coding RNAs that play a pivotal role in the development and progression of various cancers by targeting specific genes. Previously, we identified MIR133A to be significantly decreased in human CRC tissues. This study aims to identify the relationship with SQLE, one of the candidate target genes of MIR133A, and study their interaction in CRC cells. Methods: Through the luciferase reporter assay, quantitative RT-PCR (qRT-PCR), and Western blot analysis. Results: We identified SQLE as a direct target gene of MIR133A. Using the MIR133A KI cell lines, which knocked-in MIR133A1 or MIR133A2 in CRC cell lines, and CRC cells transfected with siSQLE, we found that MIR133A regulated the proliferation and migration of CRC cells by modulating SQLE-mediated PIK3CA-AKT1 and CYP24A1 signaling. We also found that cholesterol production was regulated by MIR133A in CRC cells. Conclusions: Our results suggest that MIR133A is an important therapeutic target for colorectal cancer. Full article

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

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11 pages, 734 KiB

Open AccessArticle

Temporal Trends in Biologic Prescriptions for Patient with Inflammatory Bowel Disease: A Retrospective Cohort Study

by Sunimal Fernando, Reeham Abu-Rgeef, Shankar Menon, Kenji So, Kannan Venugopal and Sherman Picardo

Gastroenterol. Insights 2025, 16(1), 4; https://doi.org/10.3390/gastroent16010004 - 9 Jan 2025

Abstract

Background: Biologic therapies, such antitumour necrosis factor-alpha agents (infliximab and adalimumab), as well as newer agents (ustekinumab and vedolizumab), all have well-demonstrated safety and efficacy profiles in the management of inflammatory bowel disease (IBD). The choice of an optimal first-line biologic remains unclear [...] Read more.

Background: Biologic therapies, such antitumour necrosis factor-alpha agents (infliximab and adalimumab), as well as newer agents (ustekinumab and vedolizumab), all have well-demonstrated safety and efficacy profiles in the management of inflammatory bowel disease (IBD). The choice of an optimal first-line biologic remains unclear due to a lack of comparative randomised trials and real-world studies; however, certain patient and disease characteristics may influence this choice. The aims of this study were to explore temporal trends in the choice of a first-line biologic therapy and the factors that influence this choice. Methodology: This study is a retrospective observational cohort study of all patients with IBD who commenced induction and completed at least one maintenance dose of a biologic therapy between 1 January 2015 and 31 December 2021. Relevant patient and disease-specific factors were collected, including history of malignancy and opportunistic infections at time of diagnosis, for each eligible patient. Factors affecting the choice of biologic therapy were compared using ANOVA and chi-square tests. Results: 280 patients were included in the study. Ustekinumab has overtaken infliximab and adalimumab as the first-line choice for Crohn’s disease since its introduction in 2018. Infliximab has remained the preferred first-line therapy for ulcerative colitis over adalimumab and vedolizumab. Ustekinumab has become he preferred biologic agent for older patients and those with a history of malignancy. Conclusions: Whilst an older agent such as infliximab is still preferred for the management of UC, novel agents such as ustekinumab are now more readily considered as a first-line agent for the management of CD. Full article

(This article belongs to the Section Gastrointestinal Disease)

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14 pages, 2417 KiB

Open AccessArticle

Reevaluation of an Established In Vivo Gastric Vessel Bleed Model for Hemostatic Device Safety and Efficacy Testing

by Jessica L. Grimsby, Matthew D. Szkolnicki and Kevin A. Wood

Gastroenterol. Insights 2025, 16(1), 3; https://doi.org/10.3390/gastroent16010003 - 7 Jan 2025

Abstract

Background: For over a decade, endoscopic hemostatic powders have been used to manage upper gastrointestinal bleeding (UGIB). Various preclinical benchtop and animal models have been developed to evaluate these devices. Multiple companies have released hemostatic powders to market, assessing their safety and efficacy [...] Read more.

Background: For over a decade, endoscopic hemostatic powders have been used to manage upper gastrointestinal bleeding (UGIB). Various preclinical benchtop and animal models have been developed to evaluate these devices. Multiple companies have released hemostatic powders to market, assessing their safety and efficacy using an established porcine gastric vessel bleed model. The model requires inserting an artery segment into the gastric lumen, which is then punctured to produce a bleed. This simulates an aggressive arterial bleed, allowing hemostatic prototype devices to be tested under challenging conditions. Methods: We aimed to evaluate the relationship between intragastric pressure and bleed severity by injecting the gas used to deliver hemostatic powder to the bleed site without administering the hemostatic powder. Results: Our results indicate that elevated intragastric pressures alone can cause bleed cessation. Additional findings suggest that other factors in the model can lead to false positive hemostasis. Conclusions: This study highlights limitations in the current state porcine gastric vessel bleed model. The results underscore the importance of vetting preclinical models before acquiring efficacy data and the need to develop more robust and effective bleed models for testing hemostatic devices. Full article

(This article belongs to the Section Gastrointestinal Disease)

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10 pages, 420 KiB

Open AccessArticle

Screening Colonoscopy Uptake Among Adult Stroke Survivors: Findings from the 2022 BRFSS Data

by Benjamin E. Ansa, Alaina Head, Zola Johnson, Wonder King Selassie Hatekah, Beulah Ansa and Darryl Nettles

Gastroenterol. Insights 2025, 16(1), 2; https://doi.org/10.3390/gastroent16010002 - 6 Jan 2025

Abstract

Background/Objectives: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally. Screening for cancer helps to prevent comorbid conditions among individuals with chronic medical conditions, such as stroke. The gold standard for CRC screening is colonoscopy. Stroke is the fifth [...] Read more.

Background/Objectives: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally. Screening for cancer helps to prevent comorbid conditions among individuals with chronic medical conditions, such as stroke. The gold standard for CRC screening is colonoscopy. Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability. This study examined the prevalence of screening colonoscopy among individuals who reported ever having had a stroke (stroke survivors). Methods: The 2022 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for the weighted prevalence and odds of screening colonoscopy uptake among adults aged 45 years and older, based on having had a stroke and socioeconomic status. Results: Almost 6% (n = 16,371) of the adults included in the analysis (N = 285,329) reported having had a stroke, and the weighted prevalence of screening colonoscopy for this group was 73.3% compared to 67.8% for those without stroke. Stroke survivors were 1.3 times more likely to have had a screening colonoscopy compared to those without a history of stroke. Higher odds of screening colonoscopy uptake were observed among stroke survivors that were older than 45–49 years old, with high school or greater than high school education. Stroke survivors that were multiracial and without health insurance coverage had lower odds of screening colonoscopy uptake compared to those that were white and had health insurance coverage, respectively. Conclusions: Though adult stroke survivors, compared to those without a stroke, are more likely to report having had a screening colonoscopy, differences in screening colonoscopy uptake were observed among subgroups of this population based on sociodemographic status. Tailored interventions are needed for increasing screening colonoscopy uptake among disadvantaged subgroups. Full article

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

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