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Advances in Gastroenterology and Hepatology: Bridging Basic Science, Clinical Insights, and Translational Medicine

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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: 25 June 2026 | Viewed by 5998

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Special Issue Editors

Dr. Abdulrahman Ismaiel

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Guest Editor

2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
Interests: chronic liver disease; MASLD; liver cirrhosis; IBS; disorders of gut–brain interaction; non-invasive markers

Dr. Ștefan Lucian Popa

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Guest Editor

2nd Department of Internal Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
Interests: disorders of gut–brain interaction; artificial intelligence; esophageal motility disorders; high-resolution esophageal ma-nometry

Special Issue Information

Dear Colleagues,

Gastroenterology and hepatology are dynamic fields that integrate basic science, clinical innovation, and translational research to enhance patient outcomes. The growing burden of gastrointestinal and liver diseases worldwide underscores the urgency of advancing diagnostic approaches, therapeutic strategies, and preventive measures.

This Special Issue aims to provide a comprehensive platform for researchers and clinicians to showcase cutting-edge developments in gastroenterology and hepatology. We welcome submissions that explore innovative research, clinical trials, and multidisciplinary approaches to the following topics:

Emerging biomarkers for gastrointestinal and liver diseases.
Advances in endoscopic and imaging techniques.
Novel therapeutic strategies for inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS).
Hepatocellular carcinoma: Early detection and personalized treatment.
Gut microbiota and its implications in systemic diseases.
Advances in the management of liver fibrosis and cirrhosis.
Translational approaches for autoimmune and metabolic liver disorders.
Integration of artificial intelligence in diagnostic and therapeutic tools in gastroenterology.

We encourage submissions of original research articles, reviews, and perspectives that foster collaboration across disciplines. By featuring contributions that span basic science, translational studies, and clinical practice, this Special Issue seeks to bridge gaps in knowledge and promote innovative solutions to pressing challenges in gastroenterology and hepatology.

Dr. Abdulrahman Ismaiel
Dr. Ștefan Lucian Popa
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

hepatology
gastroenterology
IBD
IBS
MASLD
liver cirrhosis
artificial intelligence
disorders of gut–brain interaction
cancer
gut microbiota
diagnosis
management

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Published Papers (6 papers)

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Research

14 pages, 574 KB

Open AccessArticle

Prognostic Value of the Neutrophil Percentage-to-Albumin Ratio in Acute Non-Variceal Upper Gastrointestinal Bleeding

by Ahmet Yavuz, Ümit Karabulut, Berat Ebik, Mustafa Zanyar Akkuzu and Ferhat Bingöl

J. Clin. Med. 2026, 15(8), 2854; https://doi.org/10.3390/jcm15082854 - 9 Apr 2026

Viewed by 259

Abstract

Background: Early risk assessment in non-variceal upper gastrointestinal bleeding (NVUGIB) is essential for guiding clinical management. The neutrophil percentage-to-albumin ratio (NPAR) has recently been proposed as a marker reflecting both inflammatory response and physiological reserve. This study aimed to evaluate the prognostic value of NPAR for in-hospital mortality and its relationship with established risk scores in patients with NVUGIB. Methods: This retrospective observational study included 94 patients hospitalized with NVUGIB. NPAR was calculated using laboratory parameters obtained at admission. Patients were stratified according to AIMS65 (<2 vs. ≥2) and Rockall (<5 vs. ≥5) scores. In addition, inflammation-based indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were calculated. Predictive performance was evaluated using receiver operating characteristic (ROC) curve analysis, and associations with clinical outcomes were assessed. Results: The in-hospital mortality rate was 12.8%. NPAR values were significantly higher in patients with AIMS65 ≥ 2 and Rockall ≥ 5 (p < 0.001 for both). NPAR demonstrated good discriminative ability for AIMS65 ≥ 2 (AUC: 0.843) and moderate performance for Rockall ≥ 5 (AUC: 0.714). For mortality prediction, NPAR showed excellent performance (AUC: 0.900). A cut-off value of 27.4 yielded a sensitivity of 91.7% and a specificity of 75.6%. Higher NPAR values were associated with increased mortality risk (OR 31.9, 95% CI: 3.88–102.59, p < 0.001), while the negative predictive value was high (98.4%). In contrast, NLR, PLR, and SII showed limited predictive value for in-hospital mortality. Conclusions: NPAR shows promise as a potential prognostic biomarker for assessing disease severity and in-hospital mortality in NVUGIB. Its high negative predictive value and association with established risk scores suggest that it may complement current risk stratification approaches. However, these findings should be considered preliminary, given the retrospective design and limited sample size, and require validation in larger prospective studies. Full article

(This article belongs to the Special Issue Advances in Gastroenterology and Hepatology: Bridging Basic Science, Clinical Insights, and Translational Medicine)

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14 pages, 684 KB

Open AccessArticle

Observational Study of the Association Between Oral Helicobacter pylori, Fixed Orthodontic Appliances, and Gastric Cancer Risk

by Ioana Maria Crișan, Alex Crețu and Sorana-Maria Bucur

J. Clin. Med. 2026, 15(7), 2785; https://doi.org/10.3390/jcm15072785 - 7 Apr 2026

Viewed by 355

Abstract

Background: Helicobacter pylori is a well-established risk factor for gastric carcinogenesis. Increasing evidence suggests that the oral cavity may serve as an extragastric reservoir for the bacterium, potentially contributing to persistent infection and reinfection. Orthodontic appliances can modify oral biofilm ecology and may facilitate bacterial colonization. This study aimed to investigate the association between oral H. pylori colonization and gastric cancer, while exploring the potential modifying role of fixed orthodontic appliances. Materials and Methods: In this cross-sectional observational study, 212 participants were recruited from gastroenterology and dental clinics between January 2023 and March 2025. Oral samples were collected and analyzed for H. pylori DNA using polymerase chain reaction (PCR). Gastric diagnoses were established through endoscopic examination and histopathological evaluation, classifying participants into gastric cancer, precancerous gastric lesions, non-atrophic gastritis, and control groups. Demographic, clinical, and oral health variables were recorded. Multivariable logistic regression models were used to evaluate the association between oral H. pylori detection and gastric cancer while adjusting for potential confounders, including age, sex, smoking status, oral hygiene indicators, and socioeconomic factors. Results: Oral Helicobacter pylori DNA was detected in 35/54 (64.8%) patients with gastric cancer, 30/56 (53.6%) with precancerous lesions, 21/52 (40.4%) with non-atrophic gastritis, and 15/50 (30.0%) controls. Gastric H. pylori infection was identified in 41/54 (75.9%) gastric cancer cases compared with 18/50 (36.0%) controls. Oral H. pylori positivity was more frequent among patients undergoing active orthodontic treatment (22/36, 61.1%) than among those without orthodontic appliances (79/188, 42.0%). In multivariable analysis, oral H. pylori positivity remained independently associated with gastric cancer (adjusted OR 3.02, 95% CI 1.51–6.03, p = 0.002). Conclusions: Our findings support an association between oral–gastric microbial interactions and H. pylori–associated disease, and suggest that the oral cavity may serve as a potential reservoir for gastric infection dynamics. The presence of orthodontic appliances may be associated with altered oral microbial ecology and could be linked to sustained H. pylori colonization. Full article

(This article belongs to the Special Issue Advances in Gastroenterology and Hepatology: Bridging Basic Science, Clinical Insights, and Translational Medicine)

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15 pages, 1514 KB

Open AccessArticle

Palliative Healthy Donor Stool Transplantation (pFMT) in Patients with End-Stage Alcohol-Related Cirrhosis and Severe Unstable Decompensations—A Cohort Study

by Tharun Tom Oommen, Cyriac Abby Philips, Rizwan Ahamed, Arif Hussain Theruvath, Ajit Tharakan, Sasidharan Rajesh and Philip Augustine

J. Clin. Med. 2026, 15(7), 2607; https://doi.org/10.3390/jcm15072607 - 29 Mar 2026

Viewed by 898

Abstract

Background and Aims: Severe alcohol-associated hepatitis (SAH) can trigger unstable decompensations in cirrhosis patients. They experience high rates of emergency department visits and hospitalization. We evaluated real-world clinical outcomes following palliative-faecal microbiota transplantation (pFMT) compared to best supportive care (BSC) in this critically ill population. Patients and Methods: From July 2021 to April 2024, 28 patients on pFMT were compared with 37 on BSC. Patients on pFMT received nasoduodenal healthy donor stool infusion daily for 5-days. Patients were followed up for portal hypertension-related events, infections, hospitalizations, extrahepatic organ failure and 6- and 12-months survival. 16S rRNA sequencing on stool samples collected at baseline and on follow up were analysed for changes in relative abundance (RA) of bacterial communities. Results: Patients were matched for age, type of decompensation and liver disease severity at enrolment. Twelve-month survival was 64.3% in pFMT versus 51.4% in BSC groups. pFMT dramatically reduced hospital readmissions (mean 0.76 ± 0.76 vs. 2.29 ± 1.27, p < 0.001). Unstable decompensations beyond 3 months occurred in 14.3% of pFMT versus 64.9% of BSC (p < 0.001). Organ failures were lesser with pFMT: acute kidney injury 7.7% versus 93.8% (p < 0.001), hepatic encephalopathy 7.1% versus 68.2% (p < 0.001). Infection burden was significantly lower (53.6% vs. 83.8%, p = 0.008), particularly infections requiring admission (17.4% vs. 66.7%, p < 0.001) with pFMT. Microbiome analysis revealed progressive expansion of Gram-negative genera in BSC, and beneficial Actinobacteria in pFMT-treated patients at 3, 6, and 12 months. Conclusions: Palliative FMT represents a unique disease-modifying intervention in end-stage alcohol-related cirrhosis, preventing organ failure progression, reducing healthcare utilization, and improving survival trajectories. Full article

(This article belongs to the Special Issue Advances in Gastroenterology and Hepatology: Bridging Basic Science, Clinical Insights, and Translational Medicine)

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17 pages, 746 KB

Open AccessArticle

Serum SCFA and Nesfatin-1 Patterns in Inflammatory Bowel Disease: A Pilot Exploratory Study

by Paul Grama, Tamás Ilyés, Naomi-Adina Ciurea, Radu-Alexandru Fărcaș and Simona Bățagă

J. Clin. Med. 2026, 15(7), 2581; https://doi.org/10.3390/jcm15072581 - 27 Mar 2026

Viewed by 350

Abstract

Background: Short-chain fatty acids (SCFAs) support mucosal integrity and reduce inflammation, while nesfatin-1 is a neuropeptide with antiapoptotic, anti-inflammatory, antioxidant, and anorexigenic actions. Their roles in inflammatory bowel disease (IBD) and links to quality of life (QoL) are unclear. Methods: We conducted a cross-sectional study including adults with Crohn’s disease (CD), ulcerative colitis (UC), and healthy controls (HC). Serum total short-chain fatty acids and nesfatin-1 were measured using enzyme-linked immunosorbent assays (ELISA). Quality of life was assessed using the Inflammatory Bowel Disease Questionnaire (IBDQ). Group comparisons and correlation analyses were performed using non-parametric statistical methods. Results: Serum total SCFA concentrations did not differ significantly between patients with CD, UC, and HC (p = 0.29). Nesfatin-1 levels showed between-group variability, with lower values in CD compared with healthy controls, while patients with UC showed intermediate and variable levels (p = 0.064). An inverse correlation between SCFAs and nesfatin-1 was observed in UC and in the combined IBD cohort, but not in CD. Quality of life was comparably impaired in CD and UC. No statistically significant associations were observed between serum SCFAs or nesfatin-1 and IBDQ scores. Conclusions: In this pilot exploratory study, circulating SCFAs and nesfatin-1 showed distinct patterns across IBD subtypes, with evidence of subtype-specific associations between these biomarkers. However, no relationship with quality of life was demonstrated. Larger longitudinal studies are required to confirm these findings and clarify their clinical relevance. Full article

(This article belongs to the Special Issue Advances in Gastroenterology and Hepatology: Bridging Basic Science, Clinical Insights, and Translational Medicine)

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16 pages, 765 KB

Open AccessArticle

Combined Model for the Diagnosis of Hepatocellular Carcinoma: A Pilot Study Comparing the Liver to Spleen Volume Ratio and Liver Vein to Cava Attenuation

by Ludovico Abenavoli, Giuseppe Guido Maria Scarlata, Maria Luisa Gambardella, Caterina Battaglia, Massimo Borelli, Francesco Manti and Domenico Laganà

J. Clin. Med. 2025, 14(12), 4306; https://doi.org/10.3390/jcm14124306 - 17 Jun 2025

Cited by 2 | Viewed by 1277

Abstract

Background/Objectives: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality and often develops in the context of liver cirrhosis (LC). Its detection remains a clinical challenge, particularly with limited sensitivity of the current serum biomarkers and qualitative imaging tools. The aim of this pilot study is to evaluate the application of a combined model based on the use of Liver to Spleen Volume Ratio (LSVR), a score of regional liver remodeling, and Liver Vein to Cava Attenuation (LVCA), a computed tomography (CT)-based perfusion-related parameter, to diagnose HCC in patients with LC. Methods: In this observational retrospective pilot study, 36 patients with LC, with or without HCC, were enrolled from a single tertiary care center between 2021 and 2024. Demographic, clinical, biochemical, and imaging data were collected. LSVR and LVCA were calculated from contrast-enhanced CT scans. Predictors of HCC were assessed using conditional inference trees and multivariate logistic regression. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). A p-value < 0.05 was considered statistically significant. Results: LVCA and LSVR levels were significantly higher in the HCC group (p < 0.001). In multivariate analysis, LVCA was significantly associated with HCC onset (Odds Ratio = 2.88, p = 0.0075). The final model incorporating both LVCA and LSVR achieved excellent discrimination (AUC = 0.967), with 91% sensitivity and 88% specificity. The combined model outperformed LSVR alone (p = 0.030), though not LVCA alone. Conclusions: Our pilot study suggests the utility of LVCA and LSVR as potential non-invasive imaging tools for HCC diagnosis. External validation in multicenter cohorts and longitudinal studies assessing the temporal evolution of LSVR and LVCA are necessary to better evaluate their application in clinical practice. Full article

(This article belongs to the Special Issue Advances in Gastroenterology and Hepatology: Bridging Basic Science, Clinical Insights, and Translational Medicine)

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16 pages, 580 KB

Open AccessArticle

The Impact of Non-Invasive Scores and Hemogram-Derived Ratios in Differentiating Chronic Liver Disease from Cirrhosis

by Abdulrahman Ismaiel, Evrard Katell, Daniel-Corneliu Leucuta, Stefan-Lucian Popa, Cristina Sorina Catana, Dan L. Dumitrascu and Teodora Surdea-Blaga

J. Clin. Med. 2025, 14(9), 3072; https://doi.org/10.3390/jcm14093072 - 29 Apr 2025

Cited by 6 | Viewed by 2064

Abstract

Background: Chronic liver disease (CLD) is a major global health concern, contributing significantly to morbidity and mortality. Cirrhosis and liver cancer are the leading causes of liver-related deaths, with various etiological factors, such as metabolic disorders and alcohol-related and viral hepatitis, driving its global prevalence. Non-invasive biomarkers and scoring systems have emerged as key tools for assessing liver disease severity and differentiating CLD from cirrhosis. This study evaluates biomarkers and non-invasive scores and their utility in distinguishing CLD from cirrhosis. Methods: This retrospective observational study included 250 adult patients hospitalized between January 2021 and December 2023 at Cluj County Emergency Clinical Hospital, Romania. Patients were diagnosed with either cirrhosis or CLD of viral, autoimmune, or primary biliary cholangitis (PBC) etiology. Non-invasive biomarkers, scores, and various hemogram-derived ratios were evaluated. Statistical analysis involved descriptive statistics, comparative tests, and receiver operating characteristic (ROC) curve analysis. Results: Among the 250 patients, 137 had liver cirrhosis (54.8%) and 113 had CLD without cirrhosis (45.2%). Significant differences were observed in laboratory parameters, with cirrhosis patients showing lower hemoglobin, platelet count, and albumin levels alongside higher liver enzymes and INR values. Non-invasive scores such as APRI, FIB-4, and NFS demonstrated higher values in the cirrhosis group, indicating more advanced liver damage. Hemogram-derived ratios, particularly the neutrophil-to-lymphocyte ratio (NLR), were higher in cirrhosis patients. ROC analysis revealed that the Lok index had the highest discriminatory power (AUC 0.89), followed by the King score (AUC 0.864) and the Fibrosis index (AUC 0.856), which effectively distinguished cirrhosis from CLD. Conclusions: This study underscores the utility of non-invasive biomarkers and scoring systems in differentiating CLD from cirrhosis. The Lok index, King score, and Fibrosis index demonstrated excellent diagnostic accuracy, while hemogram-derived ratios, such as NLR, offer insights into systemic inflammation associated with liver disease progression. These findings support the integration of non-invasive markers into clinical practice for improved risk stratification and management of liver diseases. Full article

(This article belongs to the Special Issue Advances in Gastroenterology and Hepatology: Bridging Basic Science, Clinical Insights, and Translational Medicine)

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