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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 27 April 2026 | Viewed by 10851

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Dr. Ahamed Khalyfa

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University of Iowa Health Care, 200 Hawkins Dr, Lowa City, IA 52242, USA
Interests: GI disorders; advanced endoscopy; third space endoscopy; colorectal cancer; hepatology disorders
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In recent years, there have been remarkable advances in the diagnosis and treatment of gastrointestinal diseases. These have ranged from physiologic advancements, such as our improved understanding of the pathobiology of inflammatory bowel disease and biologic therapy, to endoscopic advancements that are minimally invasive compared to conventional surgical management. Some examples include endoscopic suturing devices, which are used to close large defects or perforations; peroral endoscopic myotomy POEM for achalasia; endoscopic submucosal dissection and full thickness resection for complex GI lesions and early cancers; and transoral incisionless fundoplication to treat refractory GERD, to name a few.

With this Special Issue, we encourage all types of original research submissions, such as retrospective and prospective studies and review articles that highlight recent advances in the diagnosis and/or treatment of gastrointestinal and hepatology disorders.

Dr. Ahamed Khalyfa
Guest Editor

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Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

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Keywords

advanced endoscopy
innovation in GI
pathophysiology of GI disorders
artificial intelligence in GI
gastrointestinal diseases

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Published Papers (8 papers)

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Research

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10 pages, 496 KB

Open AccessArticle

Use of an Algo-Based Decision-Making Tool to Compare Real-Life Clinical Practice in a Single Tertiary Center with the Kyoto IPMN Surveillance Recommendations

by Roie Tzadok, Rivka Kessner, Omer Ben-Ami Sher, Hila Yashar, Sapir Lazar, Yuval Katz, Zur Ronen-Amsalem, Arthur Chernomorets and Dana Ben-Ami Shor

J. Clin. Med. 2026, 15(3), 1180; https://doi.org/10.3390/jcm15031180 - 3 Feb 2026

Viewed by 567

Abstract

Background/Objectives: Intraductal papillary mucinous neoplasms (IPMN) are the most common pancreatic cystic lesions and are established precancerous entities. Side-branch IPMN (SB-IPMN) is the most prevalent subtype and generally carries a low risk of malignant transformation. The revised 2024 Kyoto guidelines define management and surveillance strategies based on high-risk stigmata and worrisome features; however, real-life adherence to these recommendations remains variable. To compare real-world management of SB-IPMN at a tertiary medical center with Kyoto guideline-based recommendations using an AIgo-based decision-support tool. Methods: SB-IPMN cases were retrospectively analyzed. An algorithm implementing the Kyoto guidelines was used to generate recommended management strategies based on imaging, clinical, and laboratory data, and these recommendations were compared with actual clinical decisions. Long-term clinical and radiological follow-up data were collected, including development of pancreatic ductal adenocarcinoma (PDAC). Results: A total of 368 patients (69% male; median age 69.5 years) were followed for a median of 48.5 months radiologically and 64 months clinically. Median cyst size at presentation was 10 (6–14) mm. Only 58 patients (15.8%) were managed in accordance with the Kyoto guidelines; most underwent more intensive surveillance (60.3%), while 23.9% received less intensive monitoring (p = 0.04). Larger cyst size (>2 cm) was associated with higher concordance with current guidelines. Younger patients, including all patients under 50 years of age, were more frequently over-surveilled. Over-surveillance resulted in an excess of 0.42 MRI/MRCP examinations per patient-year. Only one PDAC case occurred, arising after more than five years of cyst stability. Conclusions: Fewer than 20% of patients with SB-IPMN were managed according to Kyoto guidelines. Over-surveillance was common, particularly in younger patients, without apparent oncologic benefit. AIgo-based decision-support tools may help standardize care and optimize resource utilization. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

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15 pages, 987 KB

Open AccessArticle

Predicting Mortality in Non-Variceal Upper Gastrointestinal Bleeding: Machine Learning Models Versus Conventional Clinical Risk Scores

by İzzet Ustaalioğlu and Rohat Ak

J. Clin. Med. 2025, 14(20), 7425; https://doi.org/10.3390/jcm14207425 - 21 Oct 2025

Cited by 2 | Viewed by 1024

Abstract

Background/Objectives: Non-variceal upper gastrointestinal bleeding (NVUGIB) is associated with considerable morbidity and mortality, particularly in emergency department (ED) settings. While traditional clinical scores such as the Glasgow-Blatchford Score (GBS), AIMS65, and Pre-Endoscopic Rockall are widely used for risk stratification, their accuracy in mortality prediction is limited. This study aimed to evaluate the performance of multiple supervised machine learning (ML) models in predicting 30-day all-cause mortality in NVUGIB and to compare these models with established risk scores. Methods: A retrospective cohort study was conducted on 1233 adult patients with NVUGIB who presented to the ED of a tertiary center between January 2022 and January 2025. Clinical and laboratory data were extracted from electronic records. Seven supervised ML algorithms—logistic regression, ridge regression, support vector machine, random forest, extreme gradient boosting (XGBoost), naïve Bayes, and artificial neural networks—were trained using six feature selection techniques generating 42 distinct models. Performance was assessed using AUROC, F1-score, sensitivity, specificity, and calibration metrics. Traditional scores (GBS, AIMS65, Rockall) were evaluated in parallel. Results: Among the cohort, 96 patients (7.8%) died within 30 days. The best-performing ML model (XGBoost with univariate feature selection) achieved an AUROC > 0.80 and F1-score of 0.909, significantly outperforming all traditional scores (highest AUROC: Rockall, 0.743; p < 0.001). ML models demonstrated higher sensitivity and specificity, with improved calibration. Key predictors consistently included age, comorbidities, hemodynamic parameters, and laboratory markers. The best-performing ML models demonstrated very high apparent AUROC values (up to 0.999 in internal analysis), substantially exceeding conventional scores. These results should be interpreted as apparent performance estimates, likely optimistic in the absence of external validation. Conclusions: While machine-learning models showed markedly higher apparent discrimination than conventional scores, these findings are based on a single-center retrospective dataset and require external multicenter validation before clinical implementation. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

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17 pages, 2609 KB

Open AccessFeature PaperArticle

Tranilast Reduces Intestinal Ischemia Reperfusion Injury in Rats Through the Upregulation of Heme-Oxygenase (HO)-1

by Emilio Canovai, Ricard Farré, Gert De Hertogh, Antoine Dubois, Tim Vanuytsel, Jacques Pirenne and Laurens J. Ceulemans

J. Clin. Med. 2025, 14(9), 3254; https://doi.org/10.3390/jcm14093254 - 7 May 2025

Cited by 4 | Viewed by 1764

Abstract

Background: Intestinal ischemia reperfusion injury (IRI) is a harmful process that occurs during intestinal infarction and intestinal transplantation (ITx). It is characterized by severe inflammation which disrupts the mucosal barrier, causing bacterial translocation and sepsis. Tranilast (N-[3,4-dimethoxycinnamoyl]-anthranilic acid) (TL) is a synthetic compound with powerful anti-inflammatory properties. Objective: To investigate the effect of pretreatment with TL in a validated rat model of intestinal IRI (60 min of ischemia). Methods: TL (650 mg/kg) was administered by oral gavage 24 and 2 h before the onset of ischemia. Experiment 1 examined 7-day survival in 3 study groups (sham, vehicle+IRI and TL+IRI, n = 10/group). In Experiment 2, the effects on the intestinal wall integrity and inflammation were studied after 60 min of reperfusion using 3 groups (sham, IRI and TL+IRI, n = 6/group). The following end-points were studied: L-lactate, intestinal fatty acid-binding protein (I-FABP), histology, intestinal permeability, endotoxin translocation, pro- and anti-inflammatory cytokines and heme oxygenase-1 (HO-1) levels. Experiment 3 examined the role of HO-1 upregulation in TL pretreatment, by blocking its expression using Zinc protoporphyrin (ZnPP) at 20 mg/kg vs. placebo (n = 6/group). Results: Intestinal IRI resulted in severe damage of the intestinal wall and a 10% 7-day survival. These alterations led to endotoxin translocation and upregulation of pro-inflammatory cytokines. TL pretreatment improved survival up to 50%, significantly reduced inflammation and protected the intestinal barrier. The HO-1 inhibitor ZnPP, abolished the protective effect of TL. Conclusions: TL pretreatment improves survival by protecting the intestinal barrier function, decreasing inflammation and endotoxin translocation, through upregulation of HO-1.This rat study of severe intestinal ischemia reperfusion injury demonstrates a novel role for Tranilast as a potential therapy. Administration of Tranilast led to a marked reduction in mortality, inflammation and intestinal permeability and damage. The study proved that Tranilast functions through upregulation of heme oxygenase-1. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

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13 pages, 524 KB

Open AccessArticle

Clinical and Endoscopic Characteristics of Patients with Oligopolyposis

by Ali Abu-Juma, Fahmi Abu-Galion, Zlata Lerner, Sarah Weissmann, Liza Ben-Shoshan, Waleed Alamour, Muhammad Abu-Arar and Naim Abu-Freha

J. Clin. Med. 2025, 14(5), 1562; https://doi.org/10.3390/jcm14051562 - 26 Feb 2025

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Abstract

Background/Objectives: Oligopolyposis is a rare condition characterized by 10 to 100 adenomas in the colon. We aimed to investigate the clinical and endoscopic features of patients with oligopolyposis by comparing patients who carried pathogenic mutations and those who did not. Methods: This retrospective study included patients with a cumulative count of 10–100 adenomas found in the colon, at a single center. Clinical, endoscopic, and genetic data were analyzed. Results: A total of 155 patients were identified as having oligopolyposis. Genetic testing using a multigene panel was performed among 85 (55%) patients, while founder or family mutation testing was performed among 7 (4.5%) patients. No genetic testing was carried out in 63 (40.5%) patients. Pathogenic polyposis-related mutations were identified in 14 (16%) out of 85 patients who underwent genetic testing. Among these, seven (50%) mutations were found in the APC gene and seven (50%) in the MUTYH gene. A significantly higher proportion of mutation carriers were of Arab ethnicity (35.7% vs. 4.2%, p < 0.001). There was no significant difference between carriers and non-carriers with regard to family history of polyps or cancer. Colorectal cancer was found to be the initial presentation in three (21%) carriers and five (7%) non-carriers. Colonic surgeries were reported among 4 (28.6%) carriers and 13 (18.6%) non-carriers. No significant differences in the rates of colorectal cancer or death were observed between carriers and non-carriers. Conclusions: Only a small proportion of patients with oligopolyposis were found to be mutation carriers, with significant ethnic differences in mutation frequency but no notable differences in clinical features, colorectal cancer rates, or mortality. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

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8 pages, 209 KB

Open AccessArticle

Endoscopic Resection of Large Non-Pedunculated Colonic Polyps Without Submucosal Injection Is Safe and Effective with Adequate Technique

by Melis Gokce Celdir, Gilles Jadd Hoilat, Alp Serhat Kahveci, Rami El Abiad and Henning Gerke

J. Clin. Med. 2025, 14(2), 642; https://doi.org/10.3390/jcm14020642 - 20 Jan 2025

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Abstract

Background/Objectives: Endoscopic resection with lift polypectomy using submucosal injection (SI) for large non-pedunculated colorectal polyps is recommended to facilitate complete mucosal resection and decrease the risk of perforation; however, there are no studies comparing the safety and efficacy of large polypectomies with and without lift polypectomy. We aimed to evaluate the feasibility and safety of the polypectomy technique without SI compared to the routine use of SI. Methods: We performed a single tertiary center retrospective study evaluating all consecutive large non-pedunculated colorectal polyps (≥20 mm) referred to expert endoscopists in polypectomy from 2018 through 2021. We collected and analyzed data on demographics, polyp characteristics, resection technique, complications, and polyp recurrence in 6–12 months. Results: In 200 large non-pedunculated colonic polyp resections, 110 (55%) were performed with SI. The median polyp size was slightly larger in SI (30 mm IQR [20, 40] vs. 25 mm IQR [20, 30] in no-SI, p < 0.05), with a range of 20 to 130 mm. There were no differences in delayed bleeding rates. No perforation was noted in the no-SI group, and five perforations occurred in the SI group, without a statistically significant difference between groups. There was no statistically significant difference in the polyp recurrence rate at 6–12 months between the no-SI and SI groups (12% vs. 8% in no-SI vs. SI, respectively, p = 0.48). Conclusions: Complete removal of large non-pedunculated polyps without SI is feasible and safe in this large series. This approach had similar rates of clinically significant post-polypectomy bleeding and a non-significant difference in perforation rate compared to polyp resection with routine use of SI. Randomized trials are warranted to further assess the safety and efficacy of this approach. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

Review

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20 pages, 1750 KB

Open AccessReview

Diagnostic–Therapeutic Care Pathway in Chronic Constipation: AIGO (Italian Association of Gastroenterologists and Gastrointestinal Endoscopists) Position Paper

by Maria Cristina Neri, Edda Battaglia, Francesca Galeazzi, Lucia d’Alba, Christian Lambiase, Paolo Usai Satta, Massimo Bellini, Gabrio Bassotti and on behalf of the AIGO Neurogastroenterology Commitee

J. Clin. Med. 2026, 15(7), 2571; https://doi.org/10.3390/jcm15072571 - 27 Mar 2026

Viewed by 366

Abstract

Chronic constipation (CC) is one of the most common disorders of gut–brain interaction, affecting more than 11% of adults in Western countries, with higher prevalence in women and in the elderly. Despite its significant impact on quality of life, most patients self-manage their symptoms, while only a minority seek medical attention from general practitioners (GPs) or specialists. Proper assessment not only often requires a multidimensional approach but also accurate diagnostic and therapeutic pathways that define the exact role of GPs and specialists. This paper describes a comprehensive Diagnostic–Therapeutic Care Pathway (DTCP) for CC, focusing on the full spectrum of diagnostic and therapeutic methodologies required for accurate patient assessment and management. The pathway involves a primary care physician intervention phase, responsible for first-line diagnostic and therapeutic management and evaluation using objective parameters, as well as reassessment at appropriate time points to identify patients requiring further specialist evaluation. Advanced diagnostic methodologies are described as being performed in specialized gastroenterology or neurogastroenterology settings. These include colonic transit studies with radiopaque markers, high-resolution anorectal manometry, balloon expulsion testing, magnetic resonance imaging or conventional defecography, ultrasonography, and neurophysiological assessments such as anal sphincter EMG and pudendal nerve latency testing. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

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19 pages, 646 KB

Open AccessReview

The Relevance of Experimental Models in Assessing the Impact of Oxidative Stress on Intestinal Pathology

by Cristian Dan Pavel, Cristina Gales, Irina Andreea Pavel and Carmen Lăcrămioara Zamfir

J. Clin. Med. 2025, 14(18), 6569; https://doi.org/10.3390/jcm14186569 - 18 Sep 2025

Cited by 2 | Viewed by 1398

Abstract

Oxidative stress is a state of imbalance between the process of producing and removing reactive oxygen species (ROS). With advancing age or in certain situations where oxidative stress cannot be combated, various pathologies such as inflammatory bowel diseases or neoplasia may occur. Over the past decade, a surge of intriguing discoveries has linked subtoxic levels of oxidative stress to key processes, including the maintenance of mucosal homeostasis, regulation of protective inflammation, and even the control of tissue wound healing. Given the complexity and limited understanding of oxidative mechanisms involved in human intestinal pathology, the relevance of experimental models becomes a critical consideration in efforts to elucidate these processes. Although diverse, none of these models fully replicate human digestive pathology; however, they remain valuable for developing new therapeutic strategies. This paper examines the main markers of oxidative stress and its mechanism and their impact on the intestinal tract, as well as the most widely used animal models that have contributed valuable insights into the pathogenesis of inflammatory bowel diseases (IBD). Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

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Other

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26 pages, 5653 KB

Open AccessSystematic Review

Strain-Specific Systematic Review with Meta-Analysis of Probiotics Efficacy in the Treatment of Irritable Bowel Syndrome

by Roman Maslennikov, Eva Gosteeva, Vera Ananeva, Lada Korshunova, Anastasya Kravtsowa, Elena Poluektova, Anatoly Ulyanin, Alexey Sigidaev, Patimat Kikhasurova and Vladimir Ivashkin

J. Clin. Med. 2026, 15(3), 1152; https://doi.org/10.3390/jcm15031152 - 2 Feb 2026

Cited by 1 | Viewed by 1807

Abstract

Background: Many probiotic strains have been studied in relation to irritable bowel syndrome (IBS). The aim of this study was to identify probiotic strains demonstrating efficacy in the management of IBS based on meta-analyses of randomized placebo-controlled trials (RPCTs). Methods: This systematic review was registered in the PROSPERO database (CRD420251047092). Searches were conducted in PubMed and Scopus on 8 April 2025. Additional completed studies with available results were identified through ClinicalTrials.gov. An additional search of the Cochrane Central Register of Controlled Trials (CENTRAL), including records indexed in EMBASE, was conducted in December 2025 and did not identify any additional studies. RPCTs were included if they evaluated single-strain probiotics without additional active components compared with a placebo in patients with IBS. Studies whose results could not be meta-analyzed were excluded. Results: A total of 2643 records were identified; 32 articles evaluating 10 probiotic strains were included in the meta-analyses. Meta-analyses demonstrated the efficacy of Bifidobacterium longum (formerly Bifidobacterium infantis) 35624, Lactobacillus rhamnosus GG, Lactiplantibacillus plantarum 299v (DSM 9843), Saccharomyces cerevisiae CNCM I-3856, and Bacillus coagulans Unique IS2 (MTCC 5260) in improving key IBS symptoms. Meta-analyses also demonstrated that Bacillus coagulans MTCC 5856 improved quality of life for those with IBS. Conflicting results were observed for Saccharomyces boulardii CNCM I-745. Meta-analyses did not demonstrate the efficacy of Escherichia coli Nissle 1917, Lactobacillus gasseri BNR17, or Lactobacillus casei Shirota. Conclusions: Several probiotic strains demonstrated efficacy in the treatment of IBS in meta-analyses of RPCTs. Full article

(This article belongs to the Special Issue Recent Advances in the Diagnosis and Treatment of Gastrointestinal Diseases)

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