Gastrointestinal Disorders

Background: Dysbiosis, mucosal inflammation and increased intestinal permeability have been implicated in the pathophysiology of irritable bowel syndrome (IBS). Objective: To evaluate the effectiveness of a sequential butyrate–probiotic administration in reducing symptoms and improving stool consistency in patients with diarrhea-predominant (IBS-D) or mixed-type IBS (IBS-M). Methods: Two hundred adult patients were allocated to intervention (n = 105) or control (n = 95). The intervention group received ColonLife formulation (Εuro-Pharma S.r.l., Torino—Italy), consisting of two distinct capsules: the first containing butyric acid and grapefruit seed extract, and the second containing microencapsulated probiotic strains together with fructooligosaccharides (FOSs). Symptom severity, quality of life and stool consistency (Bristol Stool Scale) were assessed at baseline and three follow-up visits. Results: Baseline characteristics were comparable between groups (p > 0.05). Diarrhea severity decreased significantly in the intervention group (3.78 ± 1.01 to 3.31 ± 1.21; Δ − 0.47) compared with minimal change in controls (3.71 ± 1.05 to 3.62 ± 1.14; Δ − 0.08; p = 0.015). Stool consistency improved more in the intervention group (−1.18 ± 1.46 vs. −0.64 ± 1.41; p = 0.028), with normal stools increasing from 1.0% to 65.7% versus 4.2% to 36.8% in controls (p < 0.001). The degree of change in pain scores was similar between the two groups (p > 0.05). The degree of reduction in bloating scores was also similar between groups (p > 0.05). Quality of life improved in both groups (intervention: +0.68 ± 1.43; control: +0.71 ± 1.64; both p < 0.01), with no significant difference between groups (p > 0.05). Conclusions: Sequential butyrate–probiotic administration significantly improves diarrhea, stool consistency and gastrointestinal symptoms in IBS-D and IBS-M, supporting its role as a microbiota-targeted treatment. Full article

Background: Orodispersible budesonide tablets (OBTs, Jorveza) are approved by the EMA as a therapy option in eosinophilic esophagitis (EoE) in adults. However, data on their use in pediatric patients remain limited and no approved pediatric OBT formulation is currently available in Europe. Therefore, real-world data on off-label use of OBTs in children is needed. Methods: We retrospectively analyzed data on the off-label use of OBTs in eight children (five girls) at a median age of 10.5 years (ranging from 5 to 14). Clinical, histological and safety outcomes were assessed descriptively. Results: Treatment with OBTs was associated with clinical improvement and a reduction in eosinophil counts. Specifically, the median eosinophil count decreased from 38.5 (ranging from 20 to 100) to 0 (ranging from 0 to 20) eosinophils per high-power field. Histological remission, defined as <15 eosinophils per high-power field, was achieved in six of eight patients (75%). Clinical remission was reached in seven of eight patients (87.5%). No severe side effects could be detected. Conclusions: OBTs showed promising clinical and histological responses in this small retrospective pediatric case series. However, larger prospective studies are required before efficacy and safety can be established. Further clinical studies are needed to assess whether OBTs could become an approved pediatric therapy. Full article

Patients with inflammatory bowel disease (IBD) often require long-term immunosuppressive or advanced therapy, raising concerns about treatment-associated malignancy risk. This systematic review evaluated malignancy outcomes associated with biologic, advanced small-molecule, and thiopurine therapies in adults with IBD. PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through June 2025, with supplementary screening of Google Scholar and reference lists. Eligible primary studies included randomized controlled trials and prospective or retrospective cohort studies evaluating malignancy outcomes. Thiopurines were included because they remain clinically important comparators and are central to combination-therapy risk. The Newcastle–Ottawa Scale and the Cochrane risk-of-bias tool were used for observational studies and randomized trials, respectively. Because of substantial clinical and methodological heterogeneity, we did not perform a de novo meta-analysis; pooled estimates from previously published meta-analyses are reported only as contextual evidence. Twenty-eight studies met the inclusion criteria. Thiopurines showed the most consistent malignancy associations, including lymphoma, non-melanoma skin cancer (NMSC), acute myeloid leukemia/myelodysplastic syndrome, and urinary tract cancer. Anti-tumor necrosis factor (anti-TNF) monotherapy was not associated with a clear increase in overall cancer incidence, although a modest lymphoma signal was reported in some datasets. Combination anti-TNF plus thiopurine therapy showed the strongest lymphoma signal. Current evidence has not demonstrated an increased malignancy risk with vedolizumab or ustekinumab, including in available cohorts of patients with prior malignancy; however, confidence is limited by observational designs, small event numbers, heterogeneous cancer histories, and limited follow-up. IBD-specific data for Janus kinase inhibitors and sphingosine-1-phosphate receptor modulators remain comparatively immature, and long-term surveillance is required. Overall, treatment decisions should integrate absolute baseline risk, age, smoking, prior malignancy, prior NMSC, Epstein–Barr virus-related risk, disease-related cancer risk, and cumulative immunosuppressive exposure. Full article

Introduction: Anatomical gastrointestinal reconstruction following metabolic bariatric surgery (MBS) is a revisional procedure used for refractory complications, including malnutrition, intractable reflux, recurrent marginal ulcer disease, and post-bariatric hyperinsulinemic hypoglycemia (PBHH). Objective: This study aims to describe the indications, perioperative outcomes, and short-term results of laparoscopic anatomical reconstruction in a single-center series, focusing on patients with PBHH. Methods: We retrospectively reviewed 11 consecutive patients who underwent reconstruction following MBS at a single tertiary center. Perioperative outcomes, weight changes, and biochemical responses to standardized dual-modality (oral and intravenous) glucose suppression testing were analyzed. Results: Between 2018 and 2025, 11 patients completed laparoscopic anatomical reconstruction. The anatomy immediately preceding reconstruction was OAGB in nine patients (81.8%) and RYGB in two (18.2%). The indications overlapped; the most common were severe malnutrition (n = 9), marginal ulcer disease (n = 6), and PBHH (n = 4; three biochemically confirmed, one clinically diagnosed). Ten of eleven procedures (90.9%) were completed laparoscopically, with no 30-day Clavien–Dindo grade III–IV complications. Among the four PBHH patients, symptomatic resolution was achieved in all four, with residual asymptomatic biochemical hypoglycemia in one. Weight gain occurred in 10 of the 11 patients (mean 8.1 ± 4.9 kg) at a median follow-up of 7 months (IQR 3–12). Conclusions: In this preliminary series, laparoscopic anatomical reconstruction was feasible, though the small sample precludes conclusions regarding safety. Incretin hormones were not measured; the mechanistic contribution of restored foregut anatomy is inferred from prior literature rather than demonstrated here. Standardized dual-modality glucose suppression testing was central to patient selection and to documenting the biochemical response. Full article

Background: Bile leaks complicate 5–25% of liver transplants and are among the most common early postoperative biliary events. Their management within the first 14 postoperative days has traditionally been framed around the timing of intervention. Objective: To evaluate whether leak characteristics and patient stability provide more consistent guidance than intervention timing for early post-transplant bile leaks. Methods: A structured narrative review using a dual-source search (AI-assisted semantic search [Elicit Plus] and PubMed/MEDLINE) was conducted. A PICO-informed (Population, Intervention, Comparator, Outcome) framework guided inclusion; two independent reviewers preformed screening, with senior adjudication, yielding 37 sources. Because “early” was defined heterogeneously—by leak onset in most studies (definitions exceeding 14 days) and by intervention timing in others—and no study compared timing within a 14-day window, quantitative pooling was not undertaken. Results: No included study directly compared intervention timing within the first 14 postoperative days. In the largest available analysis of ERCP timing, resolution and adverse event rates did not differ by whether endoscopy was performed within one day, on days two to three, or after three days; endoscopic success was consistently high (80–98%) across temporal windows. Leak type was a consistent correlate of management intensity and resolution: anastomotic leaks were associated with higher surgical-intervention rates (40% vs. 8.3% for T-tube exit-site leaks in one cohort) and lower resolution rates (58–69%) than non-anastomotic leaks (90–100%). Within endoscopic therapy, bridging stent placement—not leak location—was the strongest independent predictor of resolution, and any bile leak, irrespective of subtype, independently predicted subsequent biliary stricture (pooled adjusted OR ≈ 4). Ultra-early leaks (≤72 h), frequently technical failures, formed the one subset favoring early surgical re-exploration. Conclusions: The absence of a demonstrated timing effect reflects a lack of direct comparative data rather than proof that timing is unimportant. Leak type, patient stability, and management modality offer more consistent and actionable guidance than temporal urgency, forming the basis for a leak-stratified framework. Prospective multicenter registries with standardized timing strata and leak type stratification are needed to test whether timing independently influences outcomes. Full article

Background and Aim: Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease (IBD) associated with increased susceptibility to enteric infections, which may mimic or exacerbate disease flares. The C-reactive protein (CRP)-to-albumin ratio (CAR) has emerged as a simple indicator of systemic inflammation in UC. This study aimed to assess the prevalence of stool infections in active UC and to further evaluate CAR as a potential predictive marker. Methods: This retrospective study included 42 patients with active UC (Mayo score ≥ 6) from April 2024 to February 2025. Stool samples were analyzed using multiplex polymerase chain reaction (PCR) for 25 bacterial, viral, and parasitic pathogens. Serum CRP and albumin levels were measured to calculate the CAR. Patients were categorized as infected or non-infected. Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate CAR predictive performance. Results: Enteric infections were identified in 35.7% of patients, with Escherichia coli species predominating. CAR was significantly higher in infected than in non-infected patients [0.21 (0.02–0.62) vs. 0.06 (0.02–0.15), p = 0.028]. CAR was significantly associated with enteric infection in logistic regression analysis (OR = 240.0, 95% CI 2.7–21,555.6; p = 0.017). ROC analysis yielded an AUC of 0.706, with a cut-off value of 0.669 providing 100% specificity and 40% sensitivity. Conclusions: Enteric infections are prevalent in patients with active UC. CAR may serve as a simple, rapid, and accessible adjunctive marker to identify patients who warrant further evaluation for enteric infection. Thus, it may aid in differentiating UC flares from superimposed infection. Full article

Background: Heller myotomy (HM) is the standard surgical treatment for achalasia. Complete muscular division while preserving mucosal integrity is essential for optimal outcomes. Indocyanine green fluorescence (ICG) imaging has recently emerged as a potential intraoperative adjunct during minimally invasive HM, although evidence remains limited and heterogeneous. Methods: A scoping review was conducted according to PRISMA-ScR recommendations. PubMed, Scopus, and Web of Science were systematically searched to identify clinical studies reporting intraoperative ICG use during laparoscopic or robotic HM. Data regarding surgical approach, fluorescence technique, intraoperative applications, and outcomes were extracted and descriptively synthesized. Results: Four clinical studies published between 2022 and 2024 were included, involving 58 patients overall, of whom 41 underwent minimally invasive HM with intraoperative ICG fluorescence assessment. Two main fluorescence strategies were identified. Intravenous ICG administration was exclusively evaluated during robotic Heller myotomy, whereas all laparoscopic studies employed intraluminal ICG instillation through a nasogastric tube. Fluorescence imaging was used to assess myotomy completeness, identify residual muscle fibers, and detect mucosal perforation. Intraluminal ICG enabled direct visualization of the mucosal tube and facilitated leak detection, whereas intravenous administration enhanced tissue contrast and identification of residual muscular bundles. No ICG-related adverse events were reported. However, the available evidence was limited to small observational series with heterogeneous protocols and inconsistent outcome reporting. Conclusions: ICG fluorescence appears technically feasible during minimally invasive HM and may support intraoperative assessment of myotomy completeness and mucosal integrity. Although early clinical experience is encouraging, the available evidence remains insufficient to support routine implementation of ICG-guided assessment during Heller myotomy, highlighting the need for standardized prospective comparative studies. Full article

Background: Faecal incontinence (FI) may occur in patients with irritable bowel syndrome (IBS), particularly when loose stool, urgency, reduced warning time, fluctuating bowel habits, or constipation with retention interferes with timely defaecation. However, IBS-related FI should be distinguished from FI caused primarily by structural sphincter injury, neurological disease, advanced frailty, or other organic gastrointestinal disorders. This focused narrative review examines IBS-specific mechanisms and conservative care considerations relevant to FI risk. Methods: This article is a focused narrative review rather than a systematic review, scoping review, clinical guideline, or formal GRADE assessment. PubMed and the Ichushi-Web/Japanese Medical Abstracts Society were searched for studies published from January 2000 to June 2026. Search terms were combined and included irritable bowel syndrome with faecal/fecal incontinence, urgency, diarrhoea/diarrhea, constipation, stool form, bowel diaries, diet, FODMAP, fibre/fiber, pelvic floor rehabilitation, biofeedback, skin care, absorbent products, ultrasound, and conservative management. Studies directly addressing IBS mechanisms or symptom management, FI assessment or conservative FI care, or implementation issues relevant to IBS-related FI were deemed eligible. Results: Direct studies of FI prevention in IBS patients are scarce. The most defensible IBS-specific targets are loose stool, urgency, reduced warning time, alternating bowel habits, constipation with retention or incomplete evacuation, diet- or medication-related triggers, stress-related exacerbation, and toilet access. Broader FI evidence supports supportive measures such as skin protection, absorbent products, pelvic floor rehabilitation, biofeedback, transanal irrigation, and referral, but these measures are not IBS-specific unless they are connected to IBS-related symptom pathways. Synthesis: Evidence was organized into three categories: direct IBS evidence, general FI evidence, and indirect implementation evidence from continence-care settings. No formal certainty ratings or recommendation strengths were assigned; statements are therefore framed as clinical considerations and areas for future study rather than guideline-level recommendations. Conclusions: IBS-related FI should be discussed as a symptom-risk pathway within IBS rather than as FI in general. Available evidence suggests the value of assessing IBS subtype, stool form, urgency, triggers, warning time, and toileting circumstances before applying general FI support. Because direct preventive trials are limited, conclusions should be interpreted as practice-informing clinical considerations rather than firm recommendations. Full article

Cholangiocarcinoma (CCA) is a highly malignant tumor originating from the epithelium of the bile ducts. It has an insidious onset, is difficult to diagnose in its early stages, has a low rate of curative resection, and carries an extremely poor prognosis. Among these, intrahepatic cholangiocarcinoma (iCCA), as the most representative subtype, is a classic “immunologically cold tumor.” The response rate to single-agent immunotherapy is only 5–10%, and the mechanisms of immune resistance are complex and not yet fully elucidated. The tumor microenvironment, serving as the core site of immune resistance, forms a highly immunosuppressive network composed of cancer-associated fibroblasts, hypoxia, metabolic reprogramming, and epigenetic abnormalities; a population of immunosuppressive cells centered on tumor-associated macrophages further amplifies tolerance signals; and the gut–biliary microbiome exerts systemic immune regulation via the gut–liver axis. Based on mutant mouse models generated via tail vein injection and in-depth studies of mutations in key signaling pathways, our understanding of the mechanisms underlying iCCA’s immune resistance is deepening at both the molecular and systems levels. This article reviews the local and systemic regulatory mechanisms of immune resistance in primary iCCA, summarizes the research value of experimental and preclinical models, and reviews novel strategies such as tumor microenvironment remodeling, activation of immune cell networks, microbiome interventions, and multidimensional combination therapies. It analyzes current research bottlenecks and clinical challenges and outlines the future direction of precision immunotherapy, aiming to provide a theoretical basis and new insights for overcoming iCCA immunotherapy resistance and advancing clinical translation. Full article

Background: Gastroparesis presents with frequently debilitating symptoms of nausea, vomiting, abdominal pain, bloating and early satiety, resulting in high healthcare utilization. Resilience, defined as the inherent and modifiable ability of an individual to adapt and recover positively to stress, is crucial for patients with chronic diseases but has not been studied in gastroparesis. We aimed to investigate if resilience correlates with acute care utilization and symptom severity in patients with gastroparesis. Methods: We conducted a single-center prospective observational study of patients with gastroparesis. Resilience was assessed using the 10-item Connor–Davidson Resilience scale (CD-RISC). Symptom severity was assessed through the Gastroparesis Cardinal Symptom Index (GCSI). Gastric emptying severity using scintigraphy or wireless motility capsule was categorized as mild, moderate, or severe based on consensus recommendations. Acute care utilization and hospitalizations in the last 12 months, comorbidities, medications, and demographic information were collected. Count outcomes were modeled using negative binomial regression due to overdispersion. Models were adjusted for age, sex, and symptom severity. Results: Among 40 consecutive patients (mean age 39 ± 16, 88% female), gastric emptying severity was mild in 35%, moderate in 15%, severe in 30%, and unknown in 20%. Mean resilience score was 29 ± 8 and mean GCSI was 2.96 ± 1.14. Gastroparesis symptoms did not correlate with gastric emptying severity (p = 0.5). In a linear regression model, no statistically significant correlation was observed between resilience and mean GCSI score in unadjusted or adjusted models. In negative binomial regression models, greater symptom severity was strongly associated with higher Emergency Department (ED)/urgent care visits (IRR 3.12; 95% CI 1.60–6.98; p < 0.001) and hospitalization rates (IRR 3.36; 95% CI 1.62–8.57, p = 0.006). Resilience was not a significant predictor of either (IRR 1.07; 0.95–1.22; p = 0.2 and IRR 1.02; 0.89–1.18; p = 0.7). Conclusions: Among patients with gastroparesis, no statistically significant association was detected between resilience and symptom severity, gastric emptying, or acute-care utilization after accounting for clinical and demographic factors. Symptom severity was the dominant predictor of ED visits and hospitalizations. These findings suggest that symptomatic disease burden, rather than objective gastric emptying severity, is the primary driver of acute healthcare utilization in this cohort. Full article

Background: Liver cancer is a major global public health challenge, with substantial morbidity, mortality, and economic costs. Growing attention has turned to sleep-related behaviors, including daytime napping, as potential risk factors for cancer. Evidence regarding the association between daytime napping and liver cancer remains inconsistent. We, therefore, conducted a systematic review and meta-analysis to investigate this association. Methods: Several databases were searched up to 1 October 2025, for studies assessing the association between daytime napping and liver cancer. Study quality was evaluated using the Newcastle–Ottawa Scale (NOS). Pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated with random-effects models. Results: Four prospective cohort studies, involving 1,281,628 participants, were included. All studies were of high methodological quality according to NOS. The pooled analysis showed a significant association between daytime napping and liver cancer risk (HR = 1.24; 95% CI: 1.07, 1.43). The results did not significantly vary by sex or region. Exploratory subgroup analyses showed similar findings across sex and region. Sensitivity analyses, performed by sequentially removing each study and recombining the remaining studies, yielded pooled HRs ranging from 1.20 to 1.29. Conclusions: Daytime napping was associated with a higher risk of liver cancer. However, residual confounding and reverse causation cannot be excluded, and whether this association reflects a causal relationship or underlying health conditions remains uncertain. Further large-scale prospective studies with detailed assessments of the frequency and duration of daytime napping are needed to confirm this association. Full article

Background/Objectives: Tordylium trachycarpum Boiss. (Apiaceae) is traditionally used in Kurdish ethnomedicine for the management of gastrointestinal disorders; however, its pharmacological efficacy and safety profile remain insufficiently investigated. This study evaluated, for the first time, the gastroprotective activity and associated antioxidant, inflammatory, and apoptotic responses of the methanolic extract of T. trachycarpum using an ethanol-induced gastric ulcer model in Sprague–Dawley rats. Methods: Preliminary phytochemical screening revealed the presence of phenolics, flavonoids, terpenoids, tannins, coumarins, and glycosides. Acute oral toxicity testing demonstrated no signs of toxicity at doses up to 5 g/kg. Gastric ulceration was induced by absolute ethanol, and animals were pretreated with the extract (250 and 500 mg/kg) or omeprazole (20 mg/kg). Results: The extract significantly decreased the gastric lesion area from 258.50 ± 6.38 mm² in the ulcer control group to 143.70 ± 0.76 mm² and 115.50 ± 0.76 mm², corresponding to ulcer inhibition rates of 44.41% and 55.31%. Additionally, the extract increased mucus production, maintained mucosal structure, and raised stomach pH. Biochemical analysis showed a significant increase in antioxidant enzymes [superoxide dismutase (SOD) and catalase (CAT)] and a reduction in malondialdehyde (MDA) levels, indicating attenuation of oxidative stress. In addition, the extract modulated pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, and IL-10). Blood-based ELISA analysis demonstrated increased expression of heat shock protein 70 (HSP70) and reduced Bax levels, suggesting anti-apoptotic activity. Conclusions: These findings indicate that T. trachycarpum exerts significant gastroprotective activity through antioxidant, anti-inflammatory, and anti-apoptotic mechanisms, supporting its traditional use and highlighting its potential as a natural therapeutic candidate for the management of gastric ulcers. Full article

Background/Objectives: Variceal bleeding (VB) is a major complication of cirrhosis, marking a progression from a compensated to a decompensated stage of the disease. Previous research has suggested that HMG-CoA reductase inhibitors, commonly called statins, may have therapeutic benefits for those living with cirrhosis, though their exact benefits and role have yet to be elucidated. This scoping review evaluates the potential role of statins in the primary prevention of variceal bleeding in patients with cirrhosis, and if there exists a difference between hydrophilic and lipophilic statins for this indication. Methods: Publications from the last 10 years with primary or secondary outcomes reporting variceal bleeding among statin users and non-users were included. A search via PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library was conducted, identifying nine studies. Results: Findings related to the benefit of statin use for the prevention of variceal bleeding were inconsistent among study designs. Retrospective studies suggest a lower incidence of VB among statin users compared to non-users. However, this finding has not been borne out in prospective studies. Conclusions: Given the conflicting findings, there is insufficient evidence at present to suggest the routine use of statins for the prevention of variceal bleeding in patients with cirrhosis. Full article

Background: Alcoholic hepatitis (AH) is associated with high short-term morbidity and mortality, but contemporary national data on hospital readmissions remain limited. Methods: Using the Nationwide Readmissions Database (2016–2022), we identified adult non-elective AH index admissions and characterized readmission burden, predictors, and outcomes using survey-weighted Cox proportional hazards and Fine-Gray competing risks models. Results: Among 121,984 weighted AH index hospitalizations, 25.0% experienced a 30-day readmission. The most common readmission diagnoses were alcoholic cirrhosis with ascites (18.9%), recurrent alcoholic hepatitis with (12.5%) and without ascites (8.9%), sepsis (11.3%), and alcohol withdrawal (5.7%). Liver-related, other/systemic, and alcohol-related non-liver diagnoses accounted for 53.6%, 36.6%, and 9.8% of 30-day readmissions. Readmissions carried higher in-hospital mortality (8.6% vs. 3.3%; aOR 2.75), longer length of stay (7.1 vs. 6.4 days), higher mean charges ($77,606 vs. $60,491), and higher liver transplantation rates (all p < 0.001). Independent predictors of 30-day readmission included age (HR 0.9954 per additional year, p < 0.001), female sex (HR 1.13), discharge against medical advice (HR 1.89), higher comorbidity burden (Category 4 HR 1.30), diabetes (HR 1.13), chronic kidney disease (HR 1.13), acute kidney injury (HR 1.23), and blood transfusion (HR 1.23). Index ICU admission was paradoxically associated with lower readmission rates (OR 0.77) but higher mortality when readmitted (OR 2.38, p < 0.001). Conclusions: One in four AH survivors experienced a 30-day readmission, predominantly liver-related and carrying nearly threefold higher in-hospital mortality. Readmission risk was concentrated among patients with high comorbidity burden, identifying high-yield targets for early risk stratification and post-discharge intervention. Full article

The gut microbiome has emerged as one of the most promising sources of non-invasive biomarkers for colorectal cancer (CRC). Over the past decade, fecal metagenomic studies have consistently identified a core CRC-associated signature enriched with oral-typical, biofilm-forming species, most notably Fusobacterium nucleatum, Parvimonas micra, Peptostreptococcus stomatis, and Bacteroides fragilis. The recent landmark pooled analysis by Piccinno et al., which combined 3741 metagenomes from 18 international cohorts, offers the most methodologically solid confirmation of this signature to date. It achieved a leave-one-dataset-out area under the curve (AUC) of around 0.85 and expanded resolution to previously unclassified species-level genome bins (SGBs) and strain-level phylogenies. In this narrative review, we critically evaluate the evidence supporting current universal CRC microbiome signatures, explore the mechanistic basis of the oral-to-gut microbial axis and the immunometabolic tumor microenvironment, and argue that increasing evidence indicates the field is nearing a point where investigating patient-level heterogeneity could be the most valuable next step. Because a strong average CRC signal has been convincingly established, an important next direction is to examine how much these signatures’ impact varies among individual patients, considering tumor molecular subtype, immune environment, metabolic profile, and host genetics. We review emerging evidence of such patient-level heterogeneity, outline analytical methods to assess it, and discuss its importance for developing microbiome-based screening, prognostics, and therapeutic strategies in CRC. Full article

Minimally invasive pancreas-preserving duodenal resection (MIPPDR) encompasses laparoscopic, robotic, and intentionally hybrid duodenal resections performed without pancreatic parenchymal excision, ranging from transduodenal local excision or ampullectomy to sleeve, segmental, subtotal, near-total, and total duodenectomy. This targeted narrative review was designed to provide a clinically oriented synthesis of the available literature on indications, operative strategies, platform selection, reconstruction, perioperative outcomes, oncological adequacy, and functional considerations. A structured literature search was performed in PubMed/MEDLINE, Scopus, and Web of Science up to March 2026. The review focused on minimally invasive or intentionally hybrid pancreas-preserving duodenal resections reporting operative technique, perioperative outcomes, oncological outcomes, or functional sequelae. The minimally invasive literature consisted predominantly of case reports, technical notes, video articles, and small retrospective series, with substantial heterogeneity in lesion type, anatomical location, procedure extent, reconstruction, and outcome reporting. Laparoscopy appeared most reproducible for distal, infra-papillary, and limited resections with relatively low reconstructive burden, whereas robotics appeared to offer specific technical advantages for periampullary dissection, ductal identification, and intracorporeal reconstruction. However, the available evidence was insufficient to define firm comparative indications between platforms or to demonstrate superiority of one minimally invasive approach over another. Functional outcomes, despite their central relevance to the rationale of pancreas preservation, were poorly standardized and inconsistently reported. MIPPDR was therefore interpreted as a selective pancreas-preserving strategy positioned between advanced endoscopic therapy and pancreaticoduodenectomy. Future studies should adopt anatomy-based reporting, distinguish ampullary, periampullary, and distal duodenal disease, and include standardized functional endpoints. Full article

Background: Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease. Intestinal barrier impairment represents a core pathogenic mechanism and a key therapeutic target for achieving mucosal healing and sustained remission. Methods: This narrative review summarizes intestinal barrier structure, disruption mechanisms, barrier-targeted therapies, and non-invasive monitoring approaches. A reproducible literature search was conducted in PubMed, Web of Science, and ClinicalTrials.gov from 2015 to 2026. Results: Barrier disruption in UC involves genetic susceptibility, proinflammatory cytokines, zonulin-mediated tight junction injury, gut microbiota dysbiosis, decreased short-chain fatty acids and secondary bile acids, impaired autophagy, and an abnormal mucin 2 (MUC2)-dependent mucus layer. Validated non-invasive monitoring tools include fecal calprotectin/lactoferrin, intestinal ultrasound, diffusion-weighted magnetic resonance imaging (MRI), and intravoxel incoherent motion (IVIM). Emerging therapies focus on tight junction stabilization, epithelial regeneration, autophagy regulation, MUC2 restoration, and microbiota modulation. Conclusions: Intestinal barrier dysfunction drives the initiation and progression of UC. Barrier-based monitoring and targeted repair strategies improve UC management. Future studies should develop personalized therapies, precise microbiota engineering, and multi-dimensional digital evaluation systems. Full article

Background: Artificial intelligence (AI) has shown growing potential in the diagnosis of H. pylori infection, particularly through automated analysis of endoscopic images. Emerging studies have also explored treatment-related predictive applications, although this evidence remains limited. The aim of this systematic review was to synthesize current evidence on the use of AI in H. pylori infection, with the primary emphasis on diagnosis and secondary consideration of predictive therapeutic applications. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines through searches in PubMed, ScienceDirect, EBSCO, and the Cochrane Library, including articles published between 2020 and 2025. Six studies that employed deep learning or machine learning models, primarily convolutional neural networks and predictive classifiers, were selected. Results: Artificial intelligence models showed consistent diagnostic performance, with accuracies ranging from 79.2% to 94%, sensitivities from 62.5% to 96%, and specificities from 79.4% to 93.4%. Convolutional neural network-based systems generally demonstrated diagnostic performance comparable to or better than that of human endoscopists, particularly among less experienced operators. Limited evidence suggests a possible role for artificial intelligence in predicting treatment failure; however, this finding is based on a single included study. Conclusions: Artificial intelligence appears to be a promising complementary tool for the diagnosis of H. pylori infection, particularly in endoscopic imaging. However, evidence regarding treatment-related and resistance-related applications remains limited and indirect, and these potential uses should therefore be considered preliminary. Full article

Background/Objectives: Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. Emerging evidence highlights the role of the gut microbiota in the development and progression of CRC. Microbial dysbiosis is hypothesized to contribute to chronic inflammation through a variety of mechanisms, such as the production of free radicals, which induce mutagenesis and immune dysregulation in the host, ultimately leading to diseases such as cancer. Methods: Tumor tissue samples or healthy mucosa tissue were collected for bacterial DNA extraction. The V3–V4 region of the 16S rRNA gene was amplified and sequenced using the Illumina MiSeq platform. Bioinformatics analysis was performed with QIIME2, including quality control, DADA2 denoising, alpha and beta diversity calculation, and taxonomic classification using the SILVA database. Results: Differences in microbial composition were observed between groups. The healthy controls exhibited high relative abundances of beneficial genera such as Faecalibacterium, Bacteroides, and Asteroleplasma, whereas the patients with CRC showed enrichment of atypical genera including Novosphingobium, Bradyrhizobium, and Undibacterium. Alpha diversity was lower in the CRC group, and clear clustering by group was observed in the beta diversity analysis. LEfSe analysis identified potential bacterial biomarkers associated with CRC at both the species and genus levels. Conclusions: The findings of this study support the hypothesis that colorectal cancer is associated with distinct alterations in gut microbiota composition, such as an increase in the Novosphingobium genus and a decrease in the Bacteroides genus. An exploratory description of these microbial profiles may aid in the development of microbiome-based diagnostic and therapeutic strategies and contribute to current knowledge of the role of the gut microbiota in CRC in southern Peru. Full article