Gastroenterology Insights

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.

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.

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.