Gastroenterology Insights

17 pages, 982 KB

Open AccessReview

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

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

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

Abstract

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

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

(This article belongs to the Section Liver)

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11 pages, 629 KB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Gastrointestinal Disease)

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33 pages, 885 KB

Open AccessReview

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

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

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

Abstract

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

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

(This article belongs to the Section Gastrointestinal Disease)

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13 pages, 2357 KB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Gastrointestinal Disease)

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15 pages, 316 KB

Open AccessReview

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

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

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

Abstract

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

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

(This article belongs to the Section Gastrointestinal Disease)

12 pages, 851 KB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Liver)

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13 pages, 1443 KB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Gastrointestinal Disease)

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11 pages, 1217 KB

Open AccessArticle

Endoscopic Findings for Patients with Primary Biliary Cholangitis: A Single-Center Experience

by Hsuan-Wei Chen, Pei-Tzu Chen and Yao-Jen Liang

Gastroenterol. Insights 2026, 17(1), 4; https://doi.org/10.3390/gastroent17010004 - 7 Jan 2026

Abstract

Background/Objectives: It is recommended that patients with cirrhosis receive endoscopic screening for esophageal varices because of portal hypertension. However, patients with primary biliary cholangitis (PBC) do not routinely undergo endoscopic examinations. Nevertheless, although bile acids may increase the incidence rate of colon [...] Read more.

Background/Objectives: It is recommended that patients with cirrhosis receive endoscopic screening for esophageal varices because of portal hypertension. However, patients with primary biliary cholangitis (PBC) do not routinely undergo endoscopic examinations. Nevertheless, although bile acids may increase the incidence rate of colon polyps by inducing colonic epithelium cell damage, only a few studies have discussed colonic findings in PBC patients, which are believed to be related to cholestasis. The issues regarding PBC patients’ endoscopic characteristics are still unclear. Methods: This retrospective study was conducted at the Tri-Service General Hospital, Taiwan, and comprised data from patients aged >20 years diagnosed with primary biliary cholangitis between January 2000 and December 2018 after approval from the institutional review board. In these PBC patients, endoscopic findings were recorded, including esophagogastroduodenoscopy (EGD) and colonoscopy. Conclusions: In the PBC group, only 28 patients received EGD examinations. Among the 28 PBC patients who underwent EGD, 13 (46.4%) had EV, and there were no varices in the control group (p < 0.05). Patients with PBC also presented a higher incidence rate of colon polyps (50% vs. 14%; p < 0.001). The findings regarding the higher risks of esophageal varices and colon polyps support the rationale for endoscopic examination in PBC patients. Full article

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

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16 pages, 892 KB

Open AccessReview

Role of Endoscopic Ultrasound in Pancreatic Metastases: A Comprehensive Review

by Mario Ricchiuti, Alberto Martino, Michele Amata, Francesco Paolo Zito, Roberto Fiorentino, Daniela Scimeca, Severo Campione, Ferdinando Riccardi, Carlo Molino, Roberto Di Mitri, Giovanni Sarnelli, Luca Barresi and Giovanni Lombardi

Gastroenterol. Insights 2026, 17(1), 3; https://doi.org/10.3390/gastroent17010003 - 31 Dec 2025

Abstract

Metastases to the pancreas (PM), although rare, have been increasingly identified in recent years, especially among high-volume pancreatic centers. They are often asymptomatic and incidentally detected during follow-up examinations, even several years after the treatment of the primary tumor. In this scenario, endoscopic [...] Read more.

Metastases to the pancreas (PM), although rare, have been increasingly identified in recent years, especially among high-volume pancreatic centers. They are often asymptomatic and incidentally detected during follow-up examinations, even several years after the treatment of the primary tumor. In this scenario, endoscopic ultrasound (EUS) has emerged as a crucial diagnostic tool for PM, being capable of providing a detailed morphological characterization and safe and effective tissue acquisition for cytohistological examination. The aim of our study was to extensively review the current evidence concerning the role of EUS in the diagnosis of PM, specifically focusing on its morphological features, contrast-enhancement patterns, and tissue acquisition techniques. Full article

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

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8 pages, 3406 KB

Open AccessCase Report

Elastography and Contrast-Guided Sampling Using Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Evaluation of Large Gastric Subepithelial Lesions: A Case Report

by Giacomo Emanuele Maria Rizzo, Serena Russo, Maria Cristina Saffioti, Lucio Mandalà, Giuseppe Infantino, Mario Traina, Elio D’Amore, Dario Quintini, Gabriele Rancatore, Marco Giachetto, Dario Ligresti, Margherita Pizzicannella, Giuseppe Rizzo, Nicoletta Belluardo, Piergiorgio Mezzatesta and Ilaria Tarantino

Gastroenterol. Insights 2026, 17(1), 2; https://doi.org/10.3390/gastroent17010002 - 23 Dec 2025

Abstract

Endoscopic ultrasound (EUS) with fine-needle biopsy (FNB) is one of the techniques applied for sampling subepithelial lesions (SELs) of the gastrointestinal tract. Elastography and contrast-enhanced evaluation could permit identification of different patterns among areas of the lesions, depending on their consistence and the [...] Read more.

Endoscopic ultrasound (EUS) with fine-needle biopsy (FNB) is one of the techniques applied for sampling subepithelial lesions (SELs) of the gastrointestinal tract. Elastography and contrast-enhanced evaluation could permit identification of different patterns among areas of the lesions, depending on their consistence and the presence of vital cells or necrosis. Targeting a specific area when performing FNB in the case of large lesions could potentially permit an increase in accuracy and reduce the need for re-sampling. A 61-year-old woman was admitted reporting severe abdominal pain. The patient underwent cholecystectomy many years ago. She had no known family history of gastrointestinal, hepatic, biliary, or pancreatic disease. Laboratory tests were normal. A computed tomography scan showed a large lesion between the stomach and the pancreatic body, suspected to originate from the gastric wall. An endoscopic view showed a large bulging into the gastric lumen and EUS identified a lesion originating from the muscular layer of the gastric wall. Elastography and contrast-enhanced EUS identified two different areas, one softer with lower enhancement (A) and the other harder with higher enhancement after contrast injection (B). FNB was performed targeting both the areas, sending samples for separate histological evaluation. Histology showed a gastrointestinal stromal tumor (GIST), finding differences in amount of necrotic and neoplastic cells between the two areas. EUS-FNB guided by elastography and/or contrast-enhanced EUS could identify differences within large SELs, allowing targeting of areas more likely to collect diagnostic samples. Full article

(This article belongs to the Section Gastrointestinal Disease)

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14 pages, 500 KB

Open AccessArticle

Directional Association Between Irritable Bowel Syndrome and Dermatological Disease: A Large-Scale Retrospective Study

by Alex Y. Liu, Naomi T. Matsuno, Houston Nelson, David Johnson and David Pariser

Gastroenterol. Insights 2026, 17(1), 1; https://doi.org/10.3390/gastroent17010001 - 19 Dec 2025

Abstract

Background/Objectives: Microbial dysbiosis is implicated with a pathogenic role in both irritable bowel syndrome (IBS) and several dermatological conditions. Yet, few studies have assessed a potential overlapping epidemiologic association. We aimed to assess the 1-year prevalence of common dermatologic conditions following an [...] Read more.

Background/Objectives: Microbial dysbiosis is implicated with a pathogenic role in both irritable bowel syndrome (IBS) and several dermatological conditions. Yet, few studies have assessed a potential overlapping epidemiologic association. We aimed to assess the 1-year prevalence of common dermatologic conditions following an initial IBS diagnosis and to evaluate the reverse association using reciprocal analyses. Methods: We conducted a retrospective study using TriNetX. Patients aged 18–50 with no history of inflammatory bowel disease, celiac disease, or infectious intestinal disease were matched 1:1 to healthy controls by demographics and comorbidities. The primary outcome was the prevalence of acne vulgaris, psoriasis, atopic dermatitis, hidradenitis suppurativa, rosacea, vitiligo, alopecia areata, and urticaria 1 year after IBS diagnosis, measured using Odds Ratios (ORs) and 95% confidence intervals. To confirm bidirectionality, reciprocal analyses were performed. Results: Over a 1-year period, IBS patients were less likely to have acne vulgaris (OR: 0.78, CIs: 0.75–0.80) and vitiligo (OR: 0.78, CIs: 0.64–0.95) compared to those without. IBS patients were more likely to have psoriasis (OR: 1.14, CIs: 1.08–1.21), hidradenitis suppurativa (OR: 1.11, CIs: 1.03–1.20), rosacea (OR: 1.10, CIs: 1.03–1.18), and urticaria (OR: 1.27, CIs: 1.21–1.34) compared to healthy controls. No association was found for atopic dermatitis or alopecia areata. In the reciprocal analysis, alopecia areata patients (OR: 0.76, CIs: 0.64–0.90) had a lower prevalence of IBS compared to healthy controls. IBS was shown to occur more frequently in patients with psoriasis (OR: 1.15, CIs: 1.07–1.23), rosacea (OR: 1.23, CIs: 1.15–1.31), and urticaria (OR: 1.06, CIs: 1.01–1.12) compared to healthy controls. No association was seen in patients with acne, atopic dermatitis, hidradenitis suppurativa, and vitiligo. Conclusions: IBS shows a bilateral positive overlapping association with psoriasis, rosacea, and urticaria. Hidradenitis suppurativa showed a positive association only among IBS patients, with no reciprocal relationship. Moreover, our findings suggest that acne and vitiligo were inversely associated with IBS; however, this was not supported in our reciprocal analysis. Although no association was initially found between IBS and alopecia areata, the reciprocal analysis suggests a potential inverse association. No association was seen with atopic dermatitis bilaterally. Clinicians who treat these disorders should be aware of the potential bidirectional association. Full article

(This article belongs to the Section Gastrointestinal Disease)

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12 pages, 704 KB

Open AccessArticle

Vitamin D Insufficiency and Deficiency in Chronic Pancreatitis: Association with Disease Progression and Cardiovascular Risk

by Mila Kovacheva-Slavova, Plamen Gecov, Neli Georgieva, Victor Dimitrov, Nikolay Penkov and Borislav Vladimirov

Gastroenterol. Insights 2025, 16(4), 49; https://doi.org/10.3390/gastroent16040049 - 16 Dec 2025

Abstract

Background: Vitamin D (VD) insufficiency is present in chronic pancreatitis (CP), leading to increased cardiovascular risk, bone complications, impaired quality of life, and increased mortality. This study aimed to determine the prevalence of VD deficiency in patients with CP and to assess its [...] Read more.

Background: Vitamin D (VD) insufficiency is present in chronic pancreatitis (CP), leading to increased cardiovascular risk, bone complications, impaired quality of life, and increased mortality. This study aimed to determine the prevalence of VD deficiency in patients with CP and to assess its relationship to CP progression and associated cardiovascular complications. Methods: Seventy patients were enrolled and evaluated for pancreatic exocrine insufficiency by fecal elastase-1, CP severity by M-ANNHEIM classification, cardiovascular risk by 10-year risk mortality scores (SCORE and FRS), and for arterial stiffness using pulse wave velocity (PWV) at a. carotis and a. femoralis. Determination of 25-hydroxyvitamin D was performed by an LC-MS/MS method. Resting energy expenditure was calculated using the Harris–Benedict formula. Results: Mean VD levels were 37.86 ± 24.36 nmol/L (range 3.854–99.874 nmol/L); only five patients were in sufficiency status. VD levels correlated significantly with body mass index (BMI) and resting energy expenditure. In patients with severe structural changes, we observed lower VD levels regardless of etiology (p < 0.01). VD levels were lower in patients with pancreatic exocrine insufficiency (PEI), p < 0.05. Patients with mild CP by M-ANNHEIM had lower levels of VD compared to moderate and advanced CP, p < 0.05. At a cut-off of VD 11.95 nmol/L, we verified pancreatic lithiasis with 89.4% sensitivity, 83.3% specificity, and AUC of 0.826 ± 0.113 (95% CI, 0.61–1). VD status worsened with the increase in the 10-year risk mortality by both SCORE and FRS and PWV, p < 0.05. Conclusions: Most of our patients with CP were VD insufficient. Monitoring of nutritional status in patients with CP is mandatory to prevent the development of malnutrition complications and the associated morbidity and mortality. Full article

(This article belongs to the Section Gastrointestinal Disease)

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13 pages, 783 KB

Open AccessArticle

Clinical and Endoscopic Features of Upper Gastrointestinal Bleeding Associated with Helicobacter pylori Infection: A Retrospective Cohort Study in the Colombian Caribbean (2021–2023)

by Lizeth Garzón-Guerron, Carlos Jiménez-Lacouture, Andrés Cadena Bonfanti, Alex Dominguez Vargas and Henry J. González-Torres

Gastroenterol. Insights 2025, 16(4), 48; https://doi.org/10.3390/gastroent16040048 - 4 Dec 2025

Abstract

Background/Objectives: Helicobacter pylori infection is a key etiological factor in upper gastrointestinal bleeding (UGIB) due to its role in mucosal injury and ulcer formation. Despite its clinical relevance, data from the Colombian Caribbean are limited. This study aimed to describe the incidence [...] Read more.

Background/Objectives: Helicobacter pylori infection is a key etiological factor in upper gastrointestinal bleeding (UGIB) due to its role in mucosal injury and ulcer formation. Despite its clinical relevance, data from the Colombian Caribbean are limited. This study aimed to describe the incidence and clinical–endoscopic features of H. pylori-associated UGIB in a high-complexity hospital in Barranquilla, Colombia. Methods: A retrospective cohort study was conducted including adults (≥18 years) admitted for UGIB between 2021 and 2023. Demographic, clinical, and endoscopic variables were obtained from institutional records. Non-parametric tests (Fisher’s exact, Wilcoxon rank-sum) were applied to compare sex and admission diagnosis. Multiple-correspondence analysis explored associations among clinical and pathological parameters. Significance was set at p < 0.05. Results: Among 329 patients with UGIB, 44 (13%) tested positive for H. pylori. The median age was 60 years, and 57% were male. Melena (48%) and hematemesis (45%) were the main presenting symptoms. Hypertension was significantly more frequent in men (45% vs. 15%, p = 0.04), while chronic gastritis was the most common histopathological finding (75%), followed by gastrointestinal ulcer (23%) and intestinal adenocarcinoma (16%). The majority of ulcers were Forrest IIA (50%), followed by III (40%) and IB (10%), with no sex differences (p > 0.92). Multiple correspondence analysis revealed that male patients tended to present melena and chronic gastritis, whereas females and older adults were more likely to exhibit hematemesis. Conclusions: H. pylori-associated UGIB in this cohort primarily affected older adults with chronic gastritis and hypertension. Recognition of these clinical–pathological profiles may guide early detection, targeted therapy, and prevention strategies in similar regional contexts. Full article

(This article belongs to the Section Gastrointestinal Disease)

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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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