Gastroenterology Insights

10 pages, 2650 KB

Open AccessArticle

Clinical Value of Ultrasound Fat Fraction in Grading Hepatic Steatosis: Preliminary Cut-Off Values in Obese Patients

by Francesca Ibba, Carlo Airola, Tommaso Rozera, Lucrezia Petrucci, Giorgio Carlino, Simone Varca, Chiara Cavallaro, Nicoletta De Matthaeis and Fabrizio Pizzolante

Gastroenterol. Insights 2025, 16(4), 47; https://doi.org/10.3390/gastroent16040047 - 1 Dec 2025

Abstract

Objectives: Liver steatosis is one of the main causes of liver disease with several clinical implications, such as steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. It is associated with increased cardiovascular risk. Reliable, non-invasive methods to classify and evaluate improvement or worsening of [...] Read more.

Objectives: Liver steatosis is one of the main causes of liver disease with several clinical implications, such as steatohepatitis, liver cirrhosis, and hepatocellular carcinoma. It is associated with increased cardiovascular risk. Reliable, non-invasive methods to classify and evaluate improvement or worsening of liver steatosis at the diagnosis and during follow-up are therefore essential. This study aims to evaluate the accuracy of ultrasound fat fraction (USFF) in a population of patients with moderate to morbid obesity. Method: A total of 95 obese patients were evaluated for liver steatosis with ultrasound visual assessment and USFF measurement using the Samsung RS85 Prestige system. 84 patients were included (exclusion criteria were morphological features of advanced liver disease or cirrhosis, active viral hepatitis, alcohol use disorder, liver enzymes alteration and heart failure) Based on the visual assessment, patients were classified into four categories: absent, mild, moderate, and severe steatosis. The distribution of USFF values across groups was analyzed using one-way ANOVA with post-hoc comparisons. Receiver Operating Characteristic (ROC) curves were generated, and the Youden index was applied to determine optimal USFF cut-off points for each steatosis grade. Results: Mean USFF values increased progressively across the severity spectrum and significant differences in mean USFF values were observed across all four steatosis grades groups (p < 0.001). Based on the Youden index, the following cut-offs have been proposed: no steatosis USFF < 7.33, mild steatosis USFF < 11.66, moderate steatosis USFF < 16.30. Conclusions: Our findings suggest that USFF may offer a valuable tool for objectively quantifying liver fat content with a more easily comparable parameter, improving the accuracy of steatosis grading and follow-up. Full article

(This article belongs to the Section Liver)

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39 pages, 43744 KB

Open AccessReview

Frozen Section Studies of Gastrointestinal and Hepatobiliary Systems: A Review Article

by Abed M. Zaitoun and Sayed Ali Almahari

Gastroenterol. Insights 2025, 16(4), 46; https://doi.org/10.3390/gastroent16040046 - 27 Nov 2025

Abstract

Frozen section (FS) analysis is a rapid intraoperative tool that provides real-time pathological assessment, guiding surgical decisions in gastrointestinal and hepatobiliary disease. Its main applications include confirming diagnoses, assessing resection margins, staging lymph nodes, and evaluating unexpected intraoperative findings. Drawing on a 14-year [...] Read more.

Frozen section (FS) analysis is a rapid intraoperative tool that provides real-time pathological assessment, guiding surgical decisions in gastrointestinal and hepatobiliary disease. Its main applications include confirming diagnoses, assessing resection margins, staging lymph nodes, and evaluating unexpected intraoperative findings. Drawing on a 14-year experience at Queen’s Medical Centre, Nottingham, this review highlights the strengths and limitations of FS in gastrointestinal and hepatopancreato-biliary surgery. Concordance with final paraffin diagnoses exceeded 97%, underscoring its reliability when performed under optimal conditions. FS is particularly valuable in complex scenarios such as distinguishing benign from malignant hepatic or pancreatic lesions, identifying metastatic disease, and evaluating conditions like Hirschsprung disease. Although interpretive artefacts and sampling errors remain challenges, careful technique and close clinical–pathological communication mitigate these issues. Beyond diagnosis, FS also supports molecular applications through targeted tissue selection for genomic testing. Overall, FS remains an essential adjunct to modern surgical pathology, enhancing intraoperative decision-making and contributing to precision oncology. Looking ahead, the integration of FS with artificial intelligence, telepathology, and minimally invasive surgical platforms is poised to expand its accuracy, accessibility, and impact in real-time precision surgery. Full article

(This article belongs to the Section Gastrointestinal Disease)

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8 pages, 239 KB

Open AccessArticle

Beyond H. pylori: Streptococcal Co-Infections and Their Hidden Impact on Gastric Lesions in Vietnam

by Nghiem Xuan Hoan, Dao Phuong Giang, Nguyen Minh Trang, Nguyen Thi Loan, Le Huu Song and Mai Thanh Binh

Gastroenterol. Insights 2025, 16(4), 45; https://doi.org/10.3390/gastroent16040045 - 24 Nov 2025

Abstract

Background/Objectives: Helicobacter pylori (H. pylori) is a well-established pathogen associated with chronic gastritis and gastric malignancies. Recent studies suggest that members of the Streptococcus anginosus group (SAG), particularly S. anginosus and S. constellatus, may also contribute to gastric mucosal damage, [...] Read more.

Background/Objectives: Helicobacter pylori (H. pylori) is a well-established pathogen associated with chronic gastritis and gastric malignancies. Recent studies suggest that members of the Streptococcus anginosus group (SAG), particularly S. anginosus and S. constellatus, may also contribute to gastric mucosal damage, especially when co-infecting with H. pylori. This study aimed to evaluate the prevalence of these three bacterial species and their associations with gastric lesions in Vietnamese patients. Methods: A cross-sectional study was conducted on 200 adult patients with gastritis diagnosed by endoscopy and biopsy. PCR analysed gastric tissue samples from the antrum and corpus for H. pylori, S. anginosus, and S. constellatus. Gastric lesions were classified histologically, and associations with bacterial infections were assessed using odds ratios (OR) and 95% confidence intervals. Results: Infection rates were 62.5% for H. pylori, 62% for S. constellatus, and 48.5% for S. anginosus. Coinfections were frequent, with 25% of patients infected by all three bacteria. Atrophic gastritis was the most common lesion (80%) and was significantly associated with all three bacteria, particularly H. pylori (OR = 7.7), and in co-infections (e.g., H. pylori + S. constellatus, OR = 7.4, p < 0.0001). Triple infection was strongly linked to both atrophy (OR = 5.1) and intestinal metaplasia/dysplasia (OR = 3.4, p = 0.007). Conclusions: Polymicrobial infections involving H. pylori and SAG bacteria are common in Vietnamese patients with gastritis and are significantly associated with more severe gastric lesions. These findings highlight the need for broader microbial screening and integrated management strategies to improve gastritis treatment and gastric cancer prevention in high-prevalence settings. Full article

(This article belongs to the Section Gastrointestinal Disease)

13 pages, 356 KB

Open AccessArticle

Cytopenias in Compensated Versus Decompensated Liver Function: Is There a Difference?

by Elda Victoria Rodríguez-Negrete, Lourdes Andrea Arriaga Pizano, Karina Sánchez-Reyes, Liliana Anguiano-Robledo, Ángel Morales-González, Raúl Rojas-Martínez, Eduardo Osiris Madrigal-Santillán and José Antonio Morales-González

Gastroenterol. Insights 2025, 16(4), 44; https://doi.org/10.3390/gastroent16040044 - 20 Nov 2025

Abstract

Background/Objectives: Patients with liver cirrhosis (LC) present hematological abnormalities with multiple etiologies. As liver function deteriorates, these abnormalities become more evident, conferring a higher risk of morbidity and mortality. The objective of this study was to determine the hematological alterations present in [...] Read more.

Background/Objectives: Patients with liver cirrhosis (LC) present hematological abnormalities with multiple etiologies. As liver function deteriorates, these abnormalities become more evident, conferring a higher risk of morbidity and mortality. The objective of this study was to determine the hematological alterations present in patients with compensated vs. decompensated liver cirrhosis. Methods: This study is a prospective study conducted in a tertiary hospital with patients diagnosed with compensated liver cirrhosis monitored by the Gastroenterology Department, in addition to patients hospitalized for decompensated liver cirrhosis. Serum samples were taken after an informed consent form was signed, and clinical and biochemical data were recorded. Results: Seventy-three percent of patients with decompensated liver cirrhosis (DLC) suffered from anemia and thrombocytopenia at the start of the study. Patients with LC are at greater risk of developing leukopenia/lymphopenia if they are in a more advanced stage of the disease, and the erythrocyte sedimentation rate (ESR) and C-reactive protein levels are higher in this group than in patients with compensated LC. Twenty-eight percent (4/14) of patients with DLC were admitted due to evidence of acute gastrointestinal bleeding; the remaining 18 patients suffering from CLC and DLC were recorded as having an average hemoglobin level of 11 g/dL with no evidence of bleeding. Conclusions: Hematological abnormalities are common in patients with LC, particularly in the advanced stages of the disease, and these abnormalities increase the risk of morbidity and mortality. The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised in accordance. Full article

(This article belongs to the Section Gastrointestinal Disease)

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13 pages, 960 KB

Open AccessSystematic Review

The New Horizon for Non-Metastatic dMMR Colorectal Cancer: A Systematic Review of the Adjuvant Chemoimmunotherapy and Neoadjuvant Immunotherapy Revolution

by Nabil Ismaili

Gastroenterol. Insights 2025, 16(4), 43; https://doi.org/10.3390/gastroent16040043 - 16 Nov 2025

Abstract

Background: The management of resected stage III colorectal cancer (CRC) has long been reliant on fluoropyrimidine-based adjuvant chemotherapy. However, the 10–15% of patients with mismatch repair-deficient (dMMR) tumors derive limited benefit from this approach. While immunotherapy has revolutionized the treatment of metastatic dMMR [...] Read more.

Background: The management of resected stage III colorectal cancer (CRC) has long been reliant on fluoropyrimidine-based adjuvant chemotherapy. However, the 10–15% of patients with mismatch repair-deficient (dMMR) tumors derive limited benefit from this approach. While immunotherapy has revolutionized the treatment of metastatic dMMR CRC, its role in the early-stage setting is rapidly evolving, creating a paradigm shift. Methods: A systematic literature review was conducted to identify pivotal clinical trials evaluating therapeutic strategies for non-metastatic dMMR CRC. Databases including PubMed/MEDLINE and conference proceedings from the American Society of Clinical Oncology (ASCO) and European Society for Medical Oncology (ESMO) were searched up to June 2025. The review focused on phase II and III trials reporting on disease-free survival (DFS), pathological complete response (pCR), and safety. Study selection followed PRISMA guidelines. Results: The systematic review identified 14 key studies that were included for narrative synthesis. The evidence base encompassed three areas: (1) Foundational adjuvant chemotherapy trials (e.g., MOSAIC, IDEA); (2) Pivotal metastatic trials (e.g., KEYNOTE-177) validating immunotherapy efficacy in dMMR CRC; and (3) Modern trials in non-metastatic disease. The phase III ATOMIC trial demonstrated that adding atezolizumab to mFOLFOX significantly improved 3-year DFS versus chemotherapy alone (86.4% vs. 76.6%; Hazard Ratio [HR] 0.50, 95% Confidence Interval [CI] 0.34–0.72; p < 0.001). Concurrently, phase II neoadjuvant immunotherapy trials (e.g., NICHE-2) reported remarkable pCR rates of 68% and a 3-year DFS of 100%, with a more favorable safety profile compared to chemoimmunotherapy. Conclusions: The landscape for non-metastatic dMMR CRC is shifting from a chemotherapy-based model to an immunotherapy paradigm. The ATOMIC trial establishes adjuvant chemoimmunotherapy as a new standard, while robust neoadjuvant data suggest a potential future where short-course, chemotherapy-free immunotherapy could become a preferred strategy. Ongoing trials directly comparing these approaches are awaited. Full article

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

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29 pages, 1739 KB

Open AccessReview

Effects of Nutrients and Alcoholic Beverages on Gastrointestinal Tract Morphology

by Marta Elizabete Vītola, Rūta Anna Eisāne, Sofija Iļičuka, Krista Anna Kļaviņa, Anna Junga and Māra Pilmane

Gastroenterol. Insights 2025, 16(4), 42; https://doi.org/10.3390/gastroent16040042 - 4 Nov 2025

Abstract

This study aimed to review the effects of simple carbohydrates (SCs), fibre, proteins, fats, and alcoholic beverages on human gastrointestinal tract (GIT) morphology. Additional objectives included describing normal human GIT morphology, the mentioned dietary components, and their connection to GIT pathologies. An extensive [...] Read more.

This study aimed to review the effects of simple carbohydrates (SCs), fibre, proteins, fats, and alcoholic beverages on human gastrointestinal tract (GIT) morphology. Additional objectives included describing normal human GIT morphology, the mentioned dietary components, and their connection to GIT pathologies. An extensive literature review was conducted using PubMed, Scopus, ScienceDirect, and Google Scholar. This study revealed that excessive SC intake can increase intestinal permeability, modify gut microbiota, and cause tooth decay. Dietary fibre, through microbiota modulation, can enhance epithelium proliferation, improve intestinal barrier integrity, and prevent or manage GIT pathologies. Excessive protein consumption can decrease tight junction protein expression and increase inflammation, while insufficient intake can result in villi atrophy and increased permeability. A high-saturated-fat diet can increase intestinal permeability, increase inflammation, and promote gut dysbiosis, whereas omega-3 fatty acids can reduce inflammation and improve epithelial integrity. Immoderate alcohol use damages the GIT epithelium, causing inflammation and increasing the risk of cancer. The reviewed dietary components notably impact GIT morphology and are linked to various GIT pathologies. These findings highlight a balanced diet’s substantial role in preserving GIT health. Full article

(This article belongs to the Section Gastrointestinal Disease)

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14 pages, 494 KB

Open AccessReview

Management of Antithrombotic Therapy in Acute Gastrointestinal Bleeding

by Konstantinos Papantoniou, Christos Michailides, Dimitrios Velissaris and Konstantinos Thomopoulos

Gastroenterol. Insights 2025, 16(4), 41; https://doi.org/10.3390/gastroent16040041 - 23 Oct 2025

Abstract

The management of antithrombotic agents in patients undergoing urgent gastrointestinal (GI) endoscopy presents a common and complex clinical challenge. The use of anticoagulants and antiplatelet therapies, especially in older patients with significant comorbidities, has increased substantially in recent decades due to the rising [...] Read more.

The management of antithrombotic agents in patients undergoing urgent gastrointestinal (GI) endoscopy presents a common and complex clinical challenge. The use of anticoagulants and antiplatelet therapies, especially in older patients with significant comorbidities, has increased substantially in recent decades due to the rising prevalence of cardiovascular and thromboembolic diseases. Balancing the risk of ongoing hemorrhage against the potentially life-threatening consequences of thrombosis remains a delicate and critical clinical decision. This review provides a practical, evidence-based approach to the periprocedural management of antithrombotic therapy in urgent endoscopy, particularly in the context of acute GI bleeding. We summarize the indications, pharmacokinetics, and reversal strategies for commonly used agents, including warfarin, direct oral anticoagulants (DOACs), low-molecular-weight heparin, aspirin, and P2Y12 inhibitors. Risk stratification is discussed in detail, considering both the urgency and bleeding risk of endoscopic procedures, as well as the thromboembolic risk associated with temporary drug interruption. Special considerations are given to high-risk patients, such as those with recent coronary stents, mechanical heart valves, or atrial fibrillation with elevated stroke risk scores. Close consultation and collaboration with other specialties, including cardiology and hematology, is often essential to optimize patient outcomes. Recommendations based on real-world clinical experience alongside formal guideline directives aim to support safe and timely endoscopic intervention without compromising systemic thrombotic protection, especially in emergent situations. Full article

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

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10 pages, 249 KB

Open AccessArticle

African and Hispanic Americans Have Higher Healthcare-Related Burden Without Higher Mortality When Admitted with Acute Diverticulitis

by Luis M. Nieto, Sharon I. Narvaez, Kenneth J. Vega, Do Han Kim, Donghyun Ko, Frank J. Lukens and Pedro Palacios-Argueta

Gastroenterol. Insights 2025, 16(4), 40; https://doi.org/10.3390/gastroent16040040 - 21 Oct 2025

Abstract

Background: Health disparities between racial groups continue to exist. There is a paucity of data regarding presentation severity for acute diverticulitis (AD) and surgery need by race. This study’s aim was to evaluate outcomes of AD in United States racial groups. Methods: A [...] Read more.

Background: Health disparities between racial groups continue to exist. There is a paucity of data regarding presentation severity for acute diverticulitis (AD) and surgery need by race. This study’s aim was to evaluate outcomes of AD in United States racial groups. Methods: A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample of adult patients discharged for AD. Patients were classified into six racial and ethnic groups: Caucasian, African American (AA), Hispanic, Asian, Native American (NA), and other. Multivariate regression analysis adjusted for patient and hospital characteristics was performed for primary and secondary outcomes. Results: A total of 647,119 admissions with acute diverticulitis (AD) were identified. Most patients were Caucasian (about three-quarters), followed by Hispanics (11%), AA (9%), Asians (1%), Native Americans (<1%), and other (2%). Minority groups were generally younger than Caucasians and less likely to undergo colonoscopy or surgical procedures such as partial or total colectomy. In the multivariable analysis, both Hispanics and AA were less likely to present with complicated diverticulitis. Despite this, their hospitalizations were associated with higher overall charges and costs. No significant differences were found across groups in terms of inpatient mortality or the need for percutaneous abscess drainage. Conclusions: Hispanic and AA have higher healthcare- related charges and costs compared to Caucasians when admitted with AD. Further studies are needed to understand the healthcare-related spending variations seen in these groups despite them often having less complicated AD. Full article

(This article belongs to the Section Gastrointestinal Disease)

19 pages, 888 KB

Open AccessReview

Liquid Biopsy in Pancreatic Ductal Adenocarcinoma: Clinical Utility, Trials, and Future Directions

by Ahmed Bendari, Oana Vele, Brett Baskovich, Alaa Bendari, Mona Sebika, Juan Luis Gomez Marti, Kritika Krishnamurthy and Saeed Asiry

Gastroenterol. Insights 2025, 16(4), 39; https://doi.org/10.3390/gastroent16040039 - 19 Oct 2025

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy marked by late diagnosis, rapid progression, and poor prognosis, with a 5-year survival rate of 2–9%. Traditional tissue biopsy faces limitations in accessibility and real-time monitoring. Liquid biopsy—a minimally invasive technique analyzing tumor-derived materials such [...] Read more.

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy marked by late diagnosis, rapid progression, and poor prognosis, with a 5-year survival rate of 2–9%. Traditional tissue biopsy faces limitations in accessibility and real-time monitoring. Liquid biopsy—a minimally invasive technique analyzing tumor-derived materials such as circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, tumor-educated platelets (TEPs), and cell-free RNAs (cfRNAs)—offers dynamic insights into PDAC biology. This review advances beyond the prior literature by offering a unified synthesis that bridges molecular mechanisms, biomarker dynamics, and clinical translation within the context of PDAC. It also summarizes key clinical trials evaluating liquid biopsy in PDAC, underscoring its growing impact on precision oncology. Full article

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

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11 pages, 230 KB

Open AccessArticle

Outcomes of EUS-Guided Gallbladder Drainage: A Case Series from a Tertiary Referral Center in Ireland

by Mohamed Wael Mohamed, Olufemi Aoko and Danny Cheriyan

Gastroenterol. Insights 2025, 16(4), 38; https://doi.org/10.3390/gastroent16040038 - 16 Oct 2025

Abstract

Background/Objectives: Cholecystectomy remains the gold-standard treatment for acute cholecystitis. However, in patients deemed unfit for surgery, alternative gallbladder drainage techniques are required. These include percutaneous gallbladder drainage (PT-GBD), endoscopic transpapillary gallbladder drainage (ET-GBD), and the more recently adopted endoscopic ultrasound-guided gallbladder drainage [...] Read more.

Background/Objectives: Cholecystectomy remains the gold-standard treatment for acute cholecystitis. However, in patients deemed unfit for surgery, alternative gallbladder drainage techniques are required. These include percutaneous gallbladder drainage (PT-GBD), endoscopic transpapillary gallbladder drainage (ET-GBD), and the more recently adopted endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). EUS-GBD has emerged as a promising minimally invasive option, offering high technical and clinical success with fewer complications and need for reinterventions. The objective of this study was to evaluate the clinical outcomes of EUS-GBD in high-risk surgical patients with acute cholecystitis. Methods: We conducted a single-center retrospective study evaluating outcomes of EUS-GBD in a tertiary referral center in Ireland. Data from ten high-risk patients with acute cholecystitis who underwent EUS-GBD using a 15 mm × 10 mm HOT AXIOS lumen-apposing metal stent (LAMS) between October 2017 and September 2018 were analyzed. Parameters assessed included technical and clinical success, adverse events, and 1-year mortality. Results: The mean age of patients was 79.5 years (range 65–95). Technical success of stent placement was achieved in all patients with no immediate complications. A trans-gastric approach was used in 7 patients while a trans-duodenal route was employed in the remaining 3. 1–year mortality following EUS-GBD was 20%. Stents were not removed in any patient in this series. No patient experienced stent-related adverse events, re-occurrence of cholecystitis, or the need for re-intervention. Conclusions: EUS-GBD has very high technical and clinical success rates, with low risk of complications and need for re-intervention in comparison to other options of GB decompression. It is, however, not widely available, and it requires a skilled endoscopist with experience in interventional EUS. Full article

(This article belongs to the Section Gastrointestinal Disease)

15 pages, 1013 KB

Open AccessArticle

Divergent Trends in Esophageal Adenocarcinoma and Squamous Cell Carcinoma Incidence, 2000–2022

by Vinit H. Majmudar, Kyle Nguyen-Ngo and Michael Tadros

Gastroenterol. Insights 2025, 16(4), 37; https://doi.org/10.3390/gastroent16040037 - 9 Oct 2025

Abstract

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns [...] Read more.

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns of EAC and ESCC from 2000 through 2022—stratified by age, sex, and race/ethnicity—and to place these in the context of changing behavioral exposures. Methods: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results SEER 21 registry data (covering 48% of the U.S. population). We included first-primary, histologically confirmed EAC (ICD-O-3 codes 8140–8576) and ESCC (8050–8084) in individuals aged ≥ 15 years diagnosed between 2000 and 2022. Age-adjusted incidence rates (per 100,000 person-years; 2000 U.S. standard) and annual percent changes (APCs) were estimated via Joinpoint regression models. Results: A total of 90,290 EAC and 47,916 ESCC cases were identified. EAC incidence increased from 2.3 to 2.8 per 100,000 (APC +0.90%; 95% CI, 0.45–1.35), with the largest relative rises in ages 15–39 years (APC +1.50%) and among women (APC +2.65%). Non-Hispanic Black and American Indian/Alaska Native populations experienced the most pronounced EAC increases. Overall ESCC incidence declined (APC −0.78%; 95% CI, −1.10 to −0.46), though Asian/Pacific Islander (+3.59%) and American Indian/Alaska Native (+1.58%) groups saw rising rates. Conclusions: EAC incidence continues to climb—especially in younger adults, women, and select racial/ethnic minorities—while ESCC declines are uneven. These histology-specific patterns highlight the urgency of tailored prevention, targeted early-detection efforts, and mechanistic studies on emerging exposures such as vaping. Full article

(This article belongs to the Section Gastrointestinal Disease)

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15 pages, 1274 KB

Open AccessArticle

Impact of Hypoglycemia on Morbidity, Mortality, and Resource Utilization in Gastrointestinal Stromal Tumor: A Nationwide Analysis

by Manasa Ginjupalli, Jayalekshmi Jayakumar, Arnold Forlemu, Anuj Raj Sharma, Praneeth Bandaru, Vikash Kumar, Kameswara Santosh Dheeraj Nalluri and Madhavi Reddy

Gastroenterol. Insights 2025, 16(4), 36; https://doi.org/10.3390/gastroent16040036 - 25 Sep 2025

Abstract

Background: Non-islet cell tumor hypoglycemia is increasingly reported with gastrointestinal stromal tumors (GIST), but population-level estimates of its clinical impact are limited. We evaluated associations between hypoglycemia and inpatient outcomes among GIST hospitalizations. Methods: We conducted a retrospective cross-sectional study of the National [...] Read more.

Background: Non-islet cell tumor hypoglycemia is increasingly reported with gastrointestinal stromal tumors (GIST), but population-level estimates of its clinical impact are limited. We evaluated associations between hypoglycemia and inpatient outcomes among GIST hospitalizations. Methods: We conducted a retrospective cross-sectional study of the National Inpatient Sample (NIS) 2018–2020. Adult GIST discharges were identified by ICD-10-CM codes and stratified by hypoglycemia. Primary outcomes were in-hospital mortality and resource utilization—length of stay (LOS) and total hospital charge. Secondary outcomes included malnutrition, sepsis, ascites, peritonitis, bowel perforation, intestinal obstruction, gastrointestinal bleeding, and iron deficiency anemia. Analyses used survey-weighted logistic regression for binary outcomes and generalized linear models for continuous outcomes. A propensity score-matched sensitivity analysis balanced sepsis and malnutrition. Results: Among 61,725 GIST hospitalizations, 0.72% had hypoglycemia. Mortality was 12.6% with hypoglycemia vs. 3.1% without; adjusted odds of death were higher (aOR 4.16, 95% CI 2.06–8.37; p < 0.001). Hypoglycemia was also associated with malnutrition (aOR 5.63, 3.37–9.40), sepsis (aOR 4.00, 2.24–7.14), ascites (aOR 3.43, 1.63–7.19), and peritonitis (aOR 2.91, 1.17–7.22). LOS was 4.61 days longer on average (not significant; p = 0.185), and total hospital charge was $5218 higher (β = 19,116.8; p = 0.95). In the matched cohort, the mortality association attenuated but persisted (aOR 1.38, 1.27–1.49; p < 0.001); peritonitis remained significant (aOR 1.10, 1.04–1.17), intestinal obstruction (aOR 4.91, 3.44–7.05) and iron deficiency anemia (aOR 3.54, 1.62–7.74) became significant, while ascites and gastrointestinal bleeding were not significant. Conclusions: Hypoglycemia in GIST, although uncommon, marks a higher-risk inpatient trajectory with increased mortality and several complications; these signals largely persist after balancing severity proxies. Resource-use differences were directionally higher but not statistically significant. Recognition of hypoglycemia may aid risk stratification and inpatient management in GIST. Full article

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

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24 pages, 557 KB

Open AccessReview

A Novel Approach to H. pylori Eradication: A Narrative Review of Vonoprazan-Based Therapies

by Karolina Kornatowska, Edyta Hańczyk, Dawid Piecuch, Szymon Kopciał, Natalia Pawelec, Weronika Mazur, Mateusz Tyniec and Kamal Morshed

Gastroenterol. Insights 2025, 16(3), 35; https://doi.org/10.3390/gastroent16030035 - 13 Sep 2025

Abstract

Helicobacter pylori is a primary cause of several gastrointestinal diseases, including chronic gastritis and gastric cancer. Unfortunately, standard treatments are increasingly failing due to rising antimicrobial resistance, particularly to clarithromycin. This necessitates the development of optimized H. pylori management strategies that minimize antibiotic [...] Read more.

Helicobacter pylori is a primary cause of several gastrointestinal diseases, including chronic gastritis and gastric cancer. Unfortunately, standard treatments are increasingly failing due to rising antimicrobial resistance, particularly to clarithromycin. This necessitates the development of optimized H. pylori management strategies that minimize antibiotic use, reduce adverse effects, lower costs, and improve compliance. Vonoprazan-based regimens seem to be a viable option, as vonoprazan (VPZ) offers more consistent and potent acid suppression because it is not significantly affected by CYP2C19 genetic variations. This review comprehensively analyzed 43 clinical studies from the past five years in PubMed, evaluating the efficacy and safety of vonoprazan-based regimens for H. pylori eradication, including comparisons with established and novel therapies of varying doses and durations. The findings consistently demonstrate that VPZ-based therapies achieve comparable or superior eradication rates, alongside a more favorable safety profile and enhanced cost-effectiveness. While high-dose vonoprazan-amoxicillin (VA) therapy temporarily impacts gut microbiota and can persistently affect the antibiotic resistome, low-dose VA regimens show negligible effects. This highlights VA therapy as a promising candidate for an optimal H. pylori eradication strategy, though further long-term research, particularly in diverse global populations, is essential to definitively establish the best possible regimens. Full article

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

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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

Cited by 1

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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