Gastroenterology Insights doi: 10.3390/gastroent17020033

Authors: Karolina Kornatowska Szymon Kopciał Mateusz Wiekiera Adrianna Wiekiera Paweł Budzik Mateusz Tyniec Kamal Morshed

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of global chronic liver disease, with a prevalence of approximately 30%. This review outlines the diagnostic transition from the exclusionary non-alcoholic fatty liver disease (NAFLD) framework to the affirmative MASLD nomenclature, which mandates the presence of at least one of five specific cardiometabolic risk factors (CMRFs) to prioritize active pathophysiology. Beyond hepatic complications, MASLD drives systemic metabolic failure, significantly elevating risks for type 2 diabetes, hepatocellular carcinoma, and cardiovascular disease, the primary cause of mortality in this cohort. Clinical management relies on a standardized, two-tier risk-stratification pathway for advanced fibrosis. Primary care triage utilizes the Fibrosis–4 (FIB–4) index; a score < 1.3 excludes advanced disease via a high negative predictive value, whereas indeterminate or high scores require secondary validation via vibration-controlled transient elastography (VCTE) or the enhanced liver fibrosis (ELF) test to guide specialist referral. Although lifestyle modifications, principally a 7–10% weight reduction and Mediterranean diet adherence, remain foundational, management has transitioned toward disease-modifying pharmacotherapies. A pivotal breakthrough occurred with the 2024 FDA approval of resmetirom, a selective thyroid hormone receptor-beta (THR-β) agonist, for non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced fibrosis. Concurrently, the emergence of GLP-1 receptor agonists and multi-incretin mimetics offers a personalized, multi-target approach simultaneously addressing hepatic inflammation, glycemic control, and adiposity.

Gastroenterology Insights doi: 10.3390/gastroent17020032

Authors: Carmen Yagüe Caballero Cristina Polo Cuadro Laura Almenara Michelena Ana Royo Esteban Santiago García-López Pilar Corsino Roche Diego Casas Deza

Crohn’s disease (CD) is a chronic immune-mediated inflammatory disorder characterized by transmural inflammation and a progressive course that frequently leads to structural complications such as intestinal fibrosis. Fibrostenosing disease represents a major clinical challenge, affecting up to 50% of patients over time and often requiring surgical intervention. Despite advances in anti-inflammatory therapies, no effective treatments currently exist to prevent or reverse established fibrosis. Intestinal fibrosis arises from a dysregulated tissue remodeling process driven by excessive extracellular matrix deposition and persistent activation of mesenchymal cells, particularly fibroblasts and myofibroblasts. This process is orchestrated through complex interactions between immune and non-immune cells and mediated by key signaling pathways, including transforming growth factor beta (TGF-β1) and the TL1A/DR3 axis. Genetic susceptibility, notably variants in NOD2 and other fibrosis-related genes, contributes not only to disease risk but also to phenotype progression. Epigenetic mechanisms, particularly microRNAs such as the miR-29 and miR-200 families, further modulate fibrogenesis and represent promising non-invasive biomarkers. Additionally, intestinal dysbiosis and specific microbial signatures, including reduced short-chain fatty acid-producing bacteria and the presence of adherent-invasive Escherichia coli, play a critical role in promoting fibrotic pathways. Mesenteric adipose tissue, especially creeping fat, also contributes to fibrosis through immune and metabolic signaling. Emerging biomarkers related to collagen metabolism and advances in molecular profiling are improving early detection strategies. Novel therapeutic approaches targeting fibrogenic pathways, including anti-TL1A agents, show promising preliminary results. A deeper understanding of these mechanisms is essential to develop effective antifibrotic therapies and improve long-term outcomes in CD.

Gastroenterology Insights doi: 10.3390/gastroent17020031

Authors: Martin Tobi Fadi Antaki Noreen F. Rossi Mary-Pat Moyer James Hatfield Suzanne Fligiel Mike Lawson

Background: Historically, diverticulosis and its complications emerged with the industrial revolution and subsequent socioeconomic changes, including dietary, which went from an agrarian high-fiber to a low-fiber, processed food product. Corporeal body habitus basal metabolic index (BMI) increased exponentially, and colonic diverticulosis now involves 70% of the population at >80 years of age. The correlation of severity in diverticulosis was predictive of diverticulitis (DIV). Methods: In the individual patient, this is very difficult to predict, so we turned to a database of patients from a colorectal neoplasia database to compare parameters those who had experienced diverticulitis with those who had no documented diverticulitis. We were able to ascertain 28 patients and compare them to 2256 controls. We used an antibody (Adnab-9) that recognizes an epitope on the p87 molecule, a product of the innate immune system (InImS) and as a denominator of serum ferritin yield the FERAD ratio and directly evaluated the expression of p87 by immunohistochemistry (IHC) in six contiguous regions of the colon. Results: The FERAD ratio was significantly lower in the diverticulitis patients, 2567 versus 18,989. IHC showed significant lower p87 in the rectosigmoid regions (p < 0.01). Significant differences were also seen in blood platelets (p < 0.036); serum creatinine (p < 0.005); 65.6% DIV smokers versus 38% controls (p < 0.008). Surprisingly there were no differences in BMI, mortality, or age. Conclusions: The InImS appears not to be active in DIV patients as compared to controls, which may predispose to DIV. Smoking also appears to predispose to DIV. Platelets are lower and creatinine higher as has been described in the literature.

Gastroenterology Insights doi: 10.3390/gastroent17020030

Authors: Balqees Al-Mahrizi Arwa Al-Mujaini Younis Al-Mufargi Hamdan Al Balushi Ahmed Mohammed Alidaroos Eiman Al-Ajmi Halima Albalushi Humoud Al-Dhuhli Srinivasa Rao Sirasanagandla

Background: The distance and angle between the superior mesenteric artery (SMA) and abdominal aorta play a role in the etiology of SMA syndrome. Retroperitoneal fat has been reported to affect both the distance and angle. Very few studies have reported the normal range of these measurements. The present study aimed to evaluate the reference values of the aortomesenteric angle (AMA) and aortomesenteric distance (AMD) in asymptomatic patients, as well as to determine the influence of age, sex, and anthropometric variables on these values. Methods: A retrospective cross-sectional study was conducted at Sultan Qaboos University Hospital. Computed tomography angiography scans of the abdomen from 141 Omani adult patients (aged ≥18 years) were included in the study. The morphometric data of the AMA and AMD were measured at the third part of the duodenum using sagittal and axial multiplanar reconstruction of CTA images. Patient data, including age, sex, height, weight, and BMI, were collected from the medical records. Statistical analyses included the Mann–Whitney U, Kruskal–Wallis H and Jonckheere–Terpstra J-T tests with significance set at p < 0.05. Results: The mean AMA was 57.16 ± 22.06°, and the mean AMD was 21.35 ± 10.25 mm. The AMD varied significantly across age groups (H = 17.29, p < 0.001) and showed a positive trend with increasing age (p = 0.001). Both AMA (p = 0.001) and AMD (p < 0.001) differed significantly across BMI categories, with significant increasing trends (p = 0.033 and p ≤ 0.001, respectively). No statistically significant differences were observed between sexes and study parameters (p > 0.05). Conclusions: The present study demonstrates that the reference values of the AMA and AMD are within the range of those reported in other populations. The variations in these values with BMI and age underscore the importance of individualized imaging interpretation and preoperative planning. The reported baseline data may enhance diagnostic accuracy and assist with surgical planning and radiological evaluation of suspected SMA syndrome.

Gastroenterology Insights doi: 10.3390/gastroent17020029

Authors: Qianle Cheng Dengke Jia Yawu Zhang

Objectives: To investigate the predictive value of the peripheral blood neutrophil percentage and serum albumin ratio (NPAR) for overall survival after radical resection of hepatocellular carcinoma, and to construct a nomogram prediction model. Methods: A retrospective cohort study was performed, including patients who underwent radical resection of hepatocellular carcinoma at the Second Hospital of Lanzhou University from 2013 to 2023. The optimal cut-off value of the NPAR was determined by a ROC curve. Kaplan–Meier and log-rank tests were used for grouping. Cox regression was used to analyze prognostic factors and construct a nomogram. Results: A total of 207 patients were included in this study. ROC curve analysis was conducted using preoperative NPAR values, and the results showed an area under the curve (AUC) of 0.72, the optimal cut-off value of the NPAR was 14.83, and the high NPAR (≥14.83) group had better overall survival and disease-free survival. Multivariable analysis showed that an NPAR ≥ 14.83, tumor diameter > 5 cm, multiple tumors, and low tumor differentiation were independent risk factors for overall survival. The C-index of the nomogram for overall survival (OS) was 0.77, indicating a moderate but clinically acceptable discriminative ability for predicting overall survival. Conclusions: Preoperative NPAR is an effective prognostic marker, and the established nomogram can accurately predict the overall survival of patients.

Gastroenterology Insights doi: 10.3390/gastroent17020028

Authors: Elisabetta Dell’Unto Maria Rinzivillo Gianluca Esposito Francesco Panzuto

Gastric neuroendocrine tumors (NETs) are increasingly diagnosed as incidental findings during upper gastrointestinal endoscopy. For the gastroenterologist, the crucial challenge is not only at the time of endoscopic recognition but also when the pathology report states “well-differentiated gastric NET”. At that moment, the key clinical question is how to manage it correctly. Gastric NETs are biologically heterogeneous, and their management depends primarily on the pathophysiological setting in which they arise. Type 1 tumors develop in chronic atrophic gastritis and are usually indolent; type 2 tumors arise in the context of gastrinoma and MEN1; type 3 tumors are sporadic and carry a substantially higher metastatic risk. Consequently, the same histological label may correspond to profoundly different clinical scenarios. This review addresses what the gastroenterologist should do after receiving an incidental histological diagnosis of gastric NET, how to reconstruct the gastric background, when to suspect a sporadic type 3 lesion, how to select patients for endoscopic treatment versus staging or surgery, and how to interpret incomplete endoscopic resection. Particular attention is devoted to the emerging concept of proton pump inhibitor-associated gastric NETs, which may represent a distinct gastrin-driven subgroup with lower malignant potential than truly sporadic type 3 tumors. A practical algorithm and a clinicopathological comparison of the classic three gastric NET types are provided to support decision-making in daily practice.

Gastroenterology Insights doi: 10.3390/gastroent17020027

Authors: Patrycja Krynicka Ariel Liebert Luiza Frańczak Wiktoria Moncznikowska Marianna Hoffman Amelia Żuchlińska Wiktoria Dalak Maria Kłopocka

Colonoscopy is the gold standard for diagnosing and monitoring gastrointestinal diseases. However, bowel preparation, rather than the procedure itself, appears to be the main driver of transient gut microbiota disruption. Available evidence suggests that microbiota alterations after bowel preparation and colonoscopy may persist for days to weeks and may be associated with changes in barrier function, microbial metabolism, and symptom burden in susceptible individuals. This review summarizes current knowledge on the mechanisms underlying microbial disruption induced by bowel preparation, including loss of diversity, shifts in key taxa, impairment of metabolic pathways, and alterations in immunomodulatory metabolites. It also discusses potential clinical consequences and highlights nutritional strategies that may support microbiota recovery, including dietary fiber, polyphenols, and microbiota-targeted approaches. This review also highlights current research gaps and the need for well-designed clinical studies in this field.

Gastroenterology Insights doi: 10.3390/gastroent17020026

Authors: Nicoletta Nandi Priya Oka Mohamed G. Shiha Mark E. McAlindon Reena Sidhu

Background/Objectives: Non-steroidal anti-inflammatory drug (NSAID)-induced small bowel (SB) injuries have a variable clinical and endoscopic presentation. Limited data exists regarding their long-term outcomes, natural course, and discerning factors and differentiation from Crohn’s disease (CD). This study aims to evaluate the spectrum of presentation at capsule endoscopy (CE) and outcome in patients with documented NSAID use. Methods: We retrospectively evaluated all CEs performed at our hospital from 2014 to July 2023 in patients with documented NSAID use and with SB injury on CE. Patients’ demographics, clinical and endoscopic data, CE findings and outcome were recorded. Results: A total of 52 patients (33 females; median age 54 years, IQR 41–65) with documented NSAID use who underwent CE were included. The most prominent findings were erosions (56%) and superficial (46%) and deep ulcers (21%). Median follow-up time was 16 months (IQR 4–57). A total of 26 (50%) patients underwent repeat CE after a median interval of 12 months (IQR 10–15). In 77% (n = 20) of patients, SB injury was still present, with the majority (80%) having a Lewis score of < 790. Overall, compared to the previous CE, there were no changes in 35% of cases, worse appearance in 35%, and an improvement in 30%. SB CD was diagnosed in 7 out of 26 patients on follow-up. There were no statistically significant clinical or endoscopic differences between those with NSAID enteropathy and those diagnosed with CD. Conclusions: NSAID enteropathy presents with a wide spectrum of SB injuries, which cannot be differentiated on CE images alone. This highlights the importance of the clinical picture in the diagnostic process of these patients. Furthermore, our study demonstrated that a percentage of patients still exhibit some degree of SB damage despite cessation of NSAIDs for several months.

Gastroenterology Insights doi: 10.3390/gastroent17020025

Authors: Nikoletta T. Karavasili Konstantinos H. Katsanos Ioanna Nefeli Mastorogianni Maria Veatriki Christodoulou Georgios Manomenidis Dimitrios Kosmidis Anastasios Tzenalis Albani Eleni Stavroula Tsiara Dimitrios K. Christodoulou

Introduction: Clostridioides difficile (C. difficile) is a major cause of antibiotic-associated diarrhea and healthcare-associated infections, with rising global incidence and severity due to the emergence of hypervirulent strains. Methods: This review synthesizes recent literature on the epidemiology, pathogenesis, diagnostic approaches, and therapeutic strategies related to C. difficile infection (CDI). Sources were selected from peer-reviewed journals, clinical guidelines, and emerging research between 2020 and 2025. Results: Advances in molecular diagnostics have improved the accuracy and speed of CDI detection. New therapeutic options such as fidaxomicin offer narrower-spectrum antibiotic activity with reduced recurrence rates. Fecal microbiota transplantation (FMT) has emerged as a highly effective option for recurrent CDI. Preventive efforts, including antibiotic stewardship programs and early-phase vaccine trials, show potential in reducing infection rates. Discussion: The management of CDI is evolving rapidly with the integration of precision diagnostics, targeted therapies, and microbiome-based interventions. Preventive strategies are critical, particularly in healthcare settings where C. difficile persists in the environment. Continued research and coordinated public health efforts are essential to reduce disease burden, improve outcomes, and limit transmission. Conclusions: Clostridioides difficile infections remain a major healthcare challenge with rising incidence and recurrent cases. Fidaxomicin has become the preferred first-line therapy. Microbiota-based therapies (like FMT, Rebyota, and Vowst) and Lipopolysaccharide Binding Protein (LBP) are highly effective for recurrent CDI prevention. Diagnostic strategies have improved with multi-step testing, enhancing accuracy and reducing overtreatment. Future focus lies in vaccines, targeted antimicrobials, and stricter prevention through antibiotic stewardship and hygiene.

Gastroenterology Insights doi: 10.3390/gastroent17020024

Authors: Yisong Hong Puning Wang Yuanhui Wu Xiaoqiong Chen Chuanwei Yuan Rongzhao He Jinxin Lin Zhipeng Jiang Jingjing Wu Meijin Huang

Objectives: This study aimed to investigate the impact of TDs on the survival of patients with locally advanced rectal cancer (LARC). Additionally, we propose a novel staging method that combines TDs and lymph node metastases (LNMs) to enhance prognostic accuracy. Methods: Patients with LARC were retrospectively identified from the Surveillance, Epidemiology, and End Results (SEER) database and a Sun Yat-sen University (SYSU) cohort. Propensity score matching (PSM) was utilized to minimize selection bias when evaluating TDs. We quantitatively stratified TDs counts and integrated them with regional LNMs to formulate a novel tumor node metastasis (TNM) staging system. Furthermore, a prognostic nomogram incorporating TDs was constructed and validated to predict survival. Results: Overall, 19,991 patients were included in the SEER database, with 2667 (13.3%) TDs-positive and 17,324 (86.7%) TDs-negative tumors. After PSM, multivariate Cox analysis reveals that TDs are an independent adverse prognostic factor (HR = 1.521, 95% CI: 1.366–1.693, p < 0.001). Patients with high-risk group (TDs > 4) at any TNM stage exhibit OS comparable to or worse than that of stage IIIC disease. For patients staged as T4N2M0, the high-risk group (TDs > 4) demonstrates OS equivalent to stage IV disease. The nomogram achieved C-indices of 0.713 (training cohort, n = 8586) and 0.789 (external validation cohort, n = 304), with AUCs of 0.774 (3-year) and 0.710 (5-year). Conclusions: The presence of TDs is associated with poorer OS, and integrating TDs with LNMs improves the accuracy of TNM staging. The nomogram (C-index = 0.789) provides enhanced prognostic stratification and survival prediction.

Gastroenterology Insights doi: 10.3390/gastroent17020023

Authors: Thomas Togliani Andrea Lisotti Francesco Tomba Arianna Massella Anna Granato Marina Mastromauro Morena Tebaldi Pietro Fusaroli Vincenzo Giorgio Mirante

Aims/Purpose: In case of superficial neoplastic GI lesions the depth of infiltration is associated with the risk of nodal metastasis and guides the choice between minimally invasive endoscopic treatments and resective surgery. The aim of the study was to compare the performance of the endoscopic evaluation and EUS in identifying early tumors fit for endoscopic resection. Methods: Retrospective study on patients affected by early-appearing neoplastic GI lesions. We compared the high-definition endoscopic assessment of the lesions according to the Paris classification (classifying them as fit or unfit for endoscopic resection, according to guidelines) and the EUS staging (classifying them as intramucosal or submucosal) to the histological staging after resection. Results: From 4/2022 to 6/2025 57 patients were included. Lesions were located in the esophagus (19), stomach (29), and rectum (9); they underwent EMR—endoscopic mucosal resection—(six), ESD—endoscopic submucosal dissection—(29), upfront surgical resection (18), or upfront TEM—transanal endoscopic microsurgery (four); thereafter, 11 patients underwent surgery or TEM after not-radical endoscopic treatment or complications. After endoscopic assessment 42 lesions were considered fit for endoscopic resection: nine (21.4%) yielded HGD, 19 (45.3%) T1a, and 14 (33.3%) T1b; 15 were considered unfit for endoscopic resection: one (6.7%) yielded T1a, 14 (93.3%) T1b. Endoscopic accuracy for identifying intramucosal lesions (HGD or T1a) thus fit for endoscopic resection was 73.7%. EUS staged 29 lesions as uT1a: eight (27.6%) yielded HGD, 8 (27.6%) T1a, and 13 (44.8%) T1b; EUS staged 28 lesions as uT1 b: one (3.6%) yielded HGD, 12 (42.8%) T1a, and 15 (53.6%) T1b. EUS accuracy for identifying intramucosal lesions (HGD or T1a) was 54.4%, but it showed a 91.7% PPV for the N0 status. Conclusions: The endoscopic evaluation was more accurate than EUS (73.7% vs. 54.4%, p < 0.05) in distinguishing GI intraepithelial or intramucosal lesions fit for endoscopic resection, with a markedly higher NPV. EUS could rather be considered as a complementary tool to exclude suspicious lymph nodes before endoscopic resection.

Gastroenterology Insights doi: 10.3390/gastroent17020022

Authors: Mirta Perković Josip Vrdoljak Joško Božić Antonio Meštrović

Background/Objectives: The study aimed to determine the demographic and clinical characteristics of patients with acute variceal bleeding and identify predictive factors associated with treatment outcomes. Methods: The retrospective study included 91 adults hospitalised for oesophageal and/or gastric variceal bleeding at the Department of Gastroenterology, University Hospital of Split. Data were collected on patients’ demographics, clinical characteristics and laboratory findings, as well as treatment outcomes, including length of hospital stay, need for repeat endoscopy, rebleeding, infection incidence, and six-week mortality. Results: Of the 91 patients included, 85.7% were male, and the mean age was 61 ± 9 years. Liver cirrhosis was present in 94.5% of patients, with alcoholic aetiology in 76.7% of cases. The median MELD-Na score was 15 (IQR 11–21), and more than 40% of patients were classified as Child–Pugh B. The median length of hospital stay was 8 days (IQR 5–10.5). Diagnostic EGD was performed in 94.5% of patients, with 80.2% undergoing the procedure within 12 h of admission. Vasoactive therapy was administered to 65.9% of patients, while antibiotic prophylaxis was given in 82.4%. In-hospital mortality was 16.5%, and the cumulative six-week mortality was 25.3%. The severity of liver disease (expressed by MELD-Na and Child–Pugh scores) was associated with a higher risk of in-hospital mortality (p = 0.0045 and p = 0.009, respectively). Early endoscopic intervention did not result in a statistically significant reduction in in-hospital mortality (8.7% vs. 23.5%; p = 0.104). The use of antibiotic prophylaxis, vasoactive drugs, and endoscopic ligation was not associated with lower rates of infections, repeated endoscopies, or mortality. Conclusions: There was a positive correlation between the severity of decompensated liver cirrhosis and in-hospital mortality. Early endoscopic intervention (within 12 h of admission) was not statistically significant in reducing mortality. The use of antibiotic prophylaxis was not associated with reduced mortality or lower incidence of infections. Vasoactive therapy did not significantly reduce the need for repeat endoscopic intervention. Endoscopic ligation did not decrease the likelihood of rebleeding during hospitalisation, in-hospital mortality, or the length of hospital stay.

Gastroenterology Insights doi: 10.3390/gastroent17020021

Authors: Hassan Ali Milena Peruhova Antoaneta Mihova Georgi V. Vasilev Tsvetelina Velikova

Background: Fecal calprotectin (FC) is a well-established, non-invasive biomarker of intestinal inflammation and is widely used to differentiate inflammatory bowel disease (IBD) from functional gastrointestinal disorders. Although enzyme-linked immunosorbent assays (ELISA) remain the reference method, rapid immunochromatographic tests (ICTs) offer important operational advantages for point-of-care (POC) diagnostics. However, variability in analytical performance among available ICTs remains a concern. Objective: This study aimed to evaluate the diagnostic accuracy of the CerTest Calprotectin one-step card (CerTest Biotec S.L., Zaragoza, Spain) in comparison with the Actim® Calprotectin lateral flow assay and the reference Calprest® ELISA (Eurospital Diagnostics, Italy). Methods: A total of 128 fresh stool samples from patients clinically suspected of IBD were analyzed in parallel using all three assays. For the reference ELISA (Calprest®), a cutoff value of >40 µg/g was applied according to the manufacturer’s instructions. For discrepant results between assays, a cutoff of 200 ng/mL (equivalent to 200 µg hCp/g stool) was employed for ELISA Calprest® to resolve inconsistencies. The results of the lateral flow assays (CerTest® Calprotectin ICT and Actim® Calprotectin) were interpreted using their respective manufacturer-recommended thresholds. Diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using ELISA as the reference standard. Agreement between methods was assessed using Cohen’s κ coefficient. Results: Using ELISA, 47 of 128 samples (36.7%) exceeded the 40 µg/g cutoff. Compared with the Actim® assay, the CerTest card demonstrated a sensitivity of 88.0% (95% CI: 75.7–95.5), a specificity of 100.0% (95% CI: 95.4–100), and a strong agreement (κ = 0.90). When compared with ELISA, the CerTest assay showed a sensitivity of 87.2% (95% CI: 74.3–95.2), a specificity of 96.3% (95% CI: 89.6–99.2), a PPV of 93.2%, an NPV of 93.2%, and a strong agreement (κ = 0.85). Conclusions: The CerTest Calprotectin one-step card provides a rapid and reliable detection of fecal calprotectin, demonstrating a high sensitivity and specificity that are comparable to both other lateral flow assays and the ELISA reference method. These findings support the use of rapid immunochromatographic testing as a valuable tool for preliminary screening and clinical decision-making in patients suspected of IBD, while acknowledging that histology remains the gold standard for definitive diagnosis.

Gastroenterology Insights doi: 10.3390/gastroent17010020

Authors: Cristina Polo Cuadro Pilar Corsino Roche Marta Gascón Ruiz Santiago García López Carmen Yagüe Caballero Ana Royo Esteban Laura Almenara Michelena Diego Casas Deza

Immunotherapy with immune checkpoint inhibitors (ICIs) has represented a major breakthrough in the treatment of multiple solid and hematological malignancies, significantly improving survival and tumor control. However, the blockade of immune regulatory pathways such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) is associated with the development of immune-related adverse events, among which immune-mediated colitis (IMC) constitutes one of the most relevant gastrointestinal complications due to its frequency, potential severity, and impact on the continuation of oncologic treatment. IMC typically presents with diarrhea, abdominal pain, and gastrointestinal bleeding, and may progress to severe, life-threatening forms. Its incidence varies according to the type of ICI, and is higher with CTLA-4 inhibitors and particularly elevated with combination therapies. The pathophysiology is complex and multifactorial, involving dysregulated activation of proinflammatory T lymphocytes, impairment of immune regulatory mechanisms, disruption of the intestinal epithelial barrier, and a key modulatory role of the gut microbiota. Diagnosis requires a high index of clinical suspicion and relies on endoscopy with biopsies, given the poor correlation between clinical severity and endoscopic or histological findings. Fecal biomarkers, such as calprotectin and lactoferrin, are useful for risk stratification and disease monitoring. Treatment is based on a stepwise immunosuppressive approach, with corticosteroids as first-line therapy and biologic agents such as infliximab or vedolizumab in refractory cases. Emerging strategies, including fecal microbiota transplantation, offer new therapeutic perspectives. This article provides a comprehensive review of the current evidence on the epidemiology, pathophysiology, diagnosis, and management of IMC, as well as future challenges and opportunities in its clinical management.

Gastroenterology Insights doi: 10.3390/gastroent17010019

Authors: Albandari Bin Ammar Nagat Eltoum Leo Rathinaraj Antony Soundararajan Nagwan Elhussein Sayeda Fatima Majid Alkhalaf Momen Elshazley Abdullah Alammar Sreeja Mannickal Thankappan Ghosoun Al-Faqiri Abd Elmoneim Elkhalifa

Background/Objectives: Gastrointestinal (GI) manifestations may persist in COVID-19 survivors, potentially worsening pre-existing conditions and increasing the risk of malnutrition. Understanding the long-term association between GI symptoms and nutritional risk is essential. This study aimed to investigate this relationship in COVID-19 survivors, regardless of comorbidities. Methods: A retrospective cohort study with prospective follow-up was conducted among 103 adults (52 males and 51 females) with PCR-confirmed COVID-19 admitted to King Salman Specialist Hospital, Ha’il, Saudi Arabia, between January 2021 and January 2023. Participants were grouped based on the presence of comorbidities, mainly type 2 diabetes mellitus (DM) and hypertension (HTN), and GI symptoms. Demographic characteristics, COVID-19 severity, and clinical data were obtained from medical records and structured interviews. Nutritional risk was assessed using the Malnutrition Screening Tool (MST). Statistical analysis was performed using Chi-Square tests, with p < 0.05 considered significant. Results: Over a mean follow-up of 26.6 months, 40.8% of participants reported at least one persistent GI symptom. Patients with comorbidities were older than those without comorbidities (mean age 58.24 ± 13.23 vs. 48.22 ± 14.83 years), and malnutrition risk was commonly observed in both groups during hospitalization and follow-up. The most frequently reported symptoms were abdominal pain (15.5%), diarrhea (12.6%), appetite loss (9.7%), and vomiting (7.8%), with no significant differences between groups. GI symptoms were significantly associated with reduced food intake, weight loss, and increased malnutrition risk (p < 0.05). Conclusions: Some COVID-19 survivors reported persistent GI symptoms during long-term follow-up, with no significant differences based on comorbidity status. GI symptoms were associated with nutritional risk and lifestyle changes, supporting the need for nutritional screening in post-COVID-19 care.

Gastroenterology Insights doi: 10.3390/gastroent17010018

Authors: Sophie Sok Fei Hon Michael Chi Ming Poon Louis Ho Shing Lau Henry Kin Ming Joeng Kong Ling Ting Po Yan Wong Lok Ping Si Michelle Hau Ching Lo Wing Fung Ng Wing Yan Chan Cherry Yee Ni Wong Philip Ching Tak Ip Simon Siu Man Ng Philip Wai Yan Chiu

Background: Most of the public hospitals in Hong Kong provide a regular colorectal endoscopic submucosal dissection (ESD) service. The current retrospective study aims to review the long- and short-term outcomes of these services, so as to identify areas for improvement. Method and Results: From January 2017 to March 2020, 634 lesions in 623 patients were removed by an ESD technique in seven endoscopic units. The mean lesion size was 31 mm (SD 13 mm, range 10–95 mm), and the mean procedure time was 121 min (SD 67 min). En bloc resection and R0 resection could be achieved in 91.3% and 79.3% of the lesions, respectively. The intra-procedure perforation rate was 12.3%. The delayed bleeding rate was 2.1%, and the delayed perforation rate was 0.8%. Only 0.9% (6/634) of the procedures needed emergency surgical salvage due to complications. Most of the lesions were adenomas (564/634), and 55 of them were adenocarcinomas. The cumulative local recurrence rate was 4.0% at a mean follow-up of 34 months. In multivariate analysis, longer procedure time, submucosal fibrosis, hybrid ESD and piecemeal removal were associated with intra-procedure perforation. Risk factors for failed en bloc resection included non-granular and polypoid morphology, colonic location, longer procedure time and low centre volume. Malignant pathology without salvage surgery was the only independent risk factor for local recurrence. Conclusions: Colorectal ESD has been carried out in Hong Kong with acceptable short-and long-term outcomes despite the technique still being in the learning phase in some centres. Potential areas for improvement should include targeted training to speed up the procedure and enable better handling of difficult cases, aiming to decrease the perforation rate and local recurrence.

Gastroenterology Insights doi: 10.3390/gastroent17010017

Authors: Savita Madhankumar Arif Asma

Metabolic dysfunction-associated steatotic liver disease (MASLD) and its inflammatory subtype metabolic dysfunction-associated steatohepatitis (MASH) are now the most common types of chronic liver disease worldwide and major contributors to cirrhosis, hepatocellular carcinoma, and liver transplantation. The disease develops from systemic metabolic dysfunction, including obesity, insulin resistance, and dyslipidemia. These factors increase hepatic fatty acid influx and de novo lipogenesis, driving steatosis, inflammation, and progressive fibrosis. Lifestyle modification is the foundation of treatment. Even modest weight loss can improve steatosis and inflammatory activity, although long-term adherence is often limited. These challenges have accelerated interest in targeted pharmacologic therapy. Thyroid hormone receptor beta agonists such as resmetirom reduce hepatic fat, improve lipid parameters, and show histologic benefit. Peroxisome proliferator activated receptor (PPAR) agents have progressed from single isoform approaches to pan-PPAR activation. Lanifibranor has demonstrated dose-dependent improvements in steatosis, activity, and fibrosis and has achieved key regulatory endpoints. Additional metabolic therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs), offer complementary benefits for weight, insulin sensitivity, and liver inflammation. These emerging options represent a promising shift toward disease modifying treatment for MASLD.

Gastroenterology Insights doi: 10.3390/gastroent17010016

Authors: Tatsuma Murakami Yuichi Yamazaki Yumeo Tateyama Hiroki Tojima Satoru Kakizaki Toshio Uraoka

Background/Objectives: Autoimmune hepatitis (AIH) often coexists with extrahepatic autoimmune diseases (EADs); however, the clinical significance of EAD comorbidity and its subtypes remains incompletely understood. In addition, an increasing proportion of AIH without EAD (NEAD-AIH) has been suggested but not systematically evaluated. Methods: We retrospectively analyzed 46 patients diagnosed with AIH between 2014 and 2023. Clinical features were compared between EAD-associated AIH (EAD-AIH) and NEAD-AIH. Analyses were performed focusing on major EAD subtypes, including Sjögren’s syndrome (SS), autoimmune thyroid disease (AITD), and systemic sclerosis (SSc). Steroid-treated cases were further evaluated for treatment response and renal outcomes. Results: Among the 46 patients (median age, 63 years; 89% female), 61% had concomitant EADs. Compared with EAD-AIH, NEAD-AIH showed significantly higher AST, ALT, IgG, and bilirubin levels, together with lower albumin and prothrombin activity. Acute-onset hepatitis and corticosteroid use were more frequent in NEAD-AIH, and all cases of liver failure occurred in this group. The proportion of NEAD-AIH increased over time (from 21% to 54%). A small number of recent NEAD-AIH cases occurred after COVID-19 vaccination or immune checkpoint inhibitor therapy, although causality could not be established. Among EAD subtypes, SSc-AIH was characterized by relatively low IgG levels, whereas SS-AIH showed favorable biochemical profiles with low relapse rates. No excess renal deterioration was observed in SSc-AIH after steroid therapy. Conclusions: AIH exhibits substantial clinical heterogeneity according to EAD status and subtype. NEAD-AIH tends to present with a more acute and severe phenotype and appears to be increasing, whereas EAD-AIH shows distinct immunologic characteristics. These findings underscore the importance of considering autoimmune background in the clinical evaluation of AIH.

Gastroenterology Insights doi: 10.3390/gastroent17010015

Authors: Yeny Uscamayta Mercy Carolina Merejildo Vera Jesús D. Rojas

Background: Helicobacter pylori infection is recognized as a Group I carcinogen and a primary driver of the gastric precancerous cascade. Andean populations in Peru experience disproportionately high rates of gastric cancer, yet data characterizing the association between H. pylori colonization and intestinal metaplasia remain limited in this setting. Methods: A cross-sectional analytical study was conducted among 169 patients undergoing upper gastrointestinal endoscopy at Hospital II EsSalud Abancay, Apurímac, Peru, between January and August 2025. Histopathological assessment determined H. pylori status, colonization intensity (negative, +, ++, +++) and intestinal metaplasia presence using the Updated Sydney System. Binary logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals. Results: H. pylori infection was detected in 71 patients (42.0%), and intestinal metaplasia was present in 78 (46.2%). A dose–response pattern was observed: metaplasia prevalence increased from 18.4% in uninfected patients to 70.0%, 87.0%, and 92.9% across increasing colonization intensities (Cochran–Armitage p < 0.001). In multivariable analysis, colonization intensity (aOR = 10.19; 95% CI: 4.38–23.71), smoking (aOR = 11.70; 95% CI: 1.98–69.03), and alcohol consumption (aOR = 6.32; 95% CI: 1.74–22.95) remained independently associated with metaplasia. The primary binary logistic regression model demonstrated excellent discrimination (AUC = 0.921). Conclusions: H. pylori colonization intensity is strongly associated with intestinal metaplasia in this Andean population, with a clear dose–response gradient. These findings support prioritizing H. pylori screening and eradication strategies for gastric cancer prevention in highland Peru.

Gastroenterology Insights doi: 10.3390/gastroent17010014

Authors: Diogo Acosta Teresa Elói Ana Martins Pedro Ponte Rayanne Silva Pilar Ferreira Miguel Catarino Gonçalo Reis Joana Rodrigues Maria Leite

Background/Objectives: A perforated peptic ulcer (PPU) is a life-threatening surgical emergency, with high levels of mortality and morbidity reported in the literature. Recognizing which patients are at most risk of developing complications or losing their life is of great importance and, as such, several scoring systems have been developed to try to predict it. This study aims to compare the predictive value of three of the most used scores (Boey, PULP and ASA scores) in assessing 30-day morbidity and mortality in patients with PPU at our hospital. Methods: This single-center retrospective study included all the patients that were surgically treated for PPU at our hospital between 1 January 2020 and 31 December 2024 (n = 76). Results: Within 30 days of index surgery, a total of 5 patients (7%) died and 24 (32%) suffered from some form of complication. Both the Boey and PULP scores demonstrated good predictive ability, with an area under curve (AUC) of >0.95 for mortality. With regard to morbidity, the Boey score achieved the best results (being the only one with AUC > 0.9), followed closely by the PULP score. Meanwhile, the ASA classification fell short of the other scores but still showed good results. Conclusions: The Boey score demonstrated the most balanced and reliable performance in predicting both mortality and morbidity. The PULP score also showed good accuracy for the mortality prediction, but at the cost of a slightly lower specificity. Altogether, both the Boey and PULP scores appear to be robust tools for short-term risk stratification for PPU complications.

Gastroenterology Insights doi: 10.3390/gastroent17010013

Authors: Francesco Bombaci Angelo Bruni Michele Dota Massimo Del Gaudio Giuseppe Dell’Anna Francesco Vito Mandarino Francesco Azzolini Emanuele Sinagra Lorenzo Fuccio Rocco Maurizio Zagari Giovanni Barbara Paolo Cecinato

Per-oral flexible endoscopy has expanded minimally invasive options for the management of gastric subepithelial tumors (G-SETs). This narrative review appraises conventional and advanced endoscopic resections alongside hybrid laparoscopic–endoscopic procedures, within a size- and layer-based clinical framework. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) achieve high en bloc resection rates for small, intraluminal tumors arising from mucosa or submucosa. Traction strategies and dedicated traction devices may improve submucosal exposure, shorten procedure time, and reduce adverse events. Submucosal tunneling endoscopic resection (STER) has been developed to enucleate tumors originating from the muscularis propria while preserving mucosal integrity. However, tunnel creation and specimen retrieval become challenging for large tumors or for those located in the cardia or fundus. Endoscopic full-thickness resection (EFTR) enables controlled transmural excision of G-SETs arising from deeper wall layers. Exposed EFTR, combined with secure endoscopic closure, provides high en bloc and complete (R0) resection rates. Closure options range from through-the-scope clips—for small defects—to over-the-scope clips, endoloop-clip purse-string methods, reopenable-clip over-the-line techniques and endoscopic suturing systems—for larger defects. Non-exposed EFTR and device-assisted systems reduce the risk of peritoneal contamination, although complete resection rates are more variable. Hybrid approaches, including classical laparoscopic–endoscopic cooperative surgery (LECS) and non-exposure variants, combine endoscopic precision with the safety and closure capabilities of laparoscopic surgery, minimizing the amount of resected gastric wall. They are particularly suited to larger, awkwardly located or ulcerated G-SETs. Emerging traction platforms, flexible robotic systems, and AI-based tools may further broaden the role of per-oral flexible endoscopy for the treatment of G-SETs. However, evidence remains preliminary, and surgery continues to play a key role for large, extraluminal or anatomically prohibitive G-SETs.

Gastroenterology Insights doi: 10.3390/gastroent17010012

Authors: Berkan Ertim Ejder Akinci Maximiliane von Stumberg David Katzer Rainer Ganschow Tim O. Vilz Christina Oetzmann von Sochaczewski

Background/Objectives: Anastomoses under tension are associated with anastomotic leaks and strictures. In experimental surgery, anastomoses are frequently tested for their resistance to traction forces, but without the surgically untouched organ as a comparator. We therefore investigated whether and to what extent the breaking forces along the gastrointestinal tract differed in the intact intestinal organs to provide some data for the comparison of anastomoses to it and guide sample size estimation in the mouse. Methods: We included 54 mice of the Crl:CD1(ICR) stock and, as a comparator, 10 mice of the C57Bl/6J and 10 mice of the C57Bl/6NCrl strain of both sexes. We determined breaking forces using a motorised test stand. Results were compared via estimated marginal means with a control of the false-discovery rate by the Benjamini–Hochberg procedure. Results: In all mice strains, the resistance to traction forces was in a descending manner: stomach (mean (µ) ≥ 1.87 Newtons, standard deviation (σ) ≤ 0.63) > rectum(µ > 1.31 Newtons, σ ≤ 0.63) > caecum (µ > 1.1 Newtons, σ ≤ 0.37) > colon(µ > 0.93 Newtons, σ ≤ 0.31) > duodenum (µ > 0.65 Newtons, σ ≤ 0.28) > jejunum (µ > 0.5 N, σ ≤ 0.16) > ileum (µ ≥ 0.43 Newtons, σ ≤ 0.13). The analysis of variance showed a statistically significant effect of the mouse strain on breaking forces (F(2,497) = 16.81, p < 0.001). This was also the case for the investigated organ (F(6,497) = 104.18, p < 0.001) and the interaction between strain and organ (F(12,497) = 2, p = 0.022), indicating a difference between strains. Only the stomachs differed between the included strains; the stomach of Crl:CD1(ICR) sustained −0.81 Newtons (t = −6.23, p < 0.001) compared to those of C57Bl/6J, and −0.37 Newtons (t = −2.88, p = 0.006) compared to those of C57Bl/6NCrl. Other statistically significant differences were absent. Conclusions: Differences in breaking forces between inbred strains and outbred stock were only present for the stomach. Our results may provide a first baseline of breaking force measurements for other studies investigating anastomoses and the respective sample size analyses.

Gastroenterology Insights doi: 10.3390/gastroent17010011

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

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.

Gastroenterology Insights doi: 10.3390/gastroent17010010

Authors: Amanda Blanco Anna Distler Julian A. Abrams Peter Distler Daniel E. Freedberg

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.

Gastroenterology Insights doi: 10.3390/gastroent17010009

Authors: Julia Soczyńska Kamila Butyńska Maja Ickiewicz Oskar Soczyński Kacper Pluta Agnieszka Frątczak Wiktor Gawełczyk Sławomir Woźniak

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.

Gastroenterology Insights doi: 10.3390/gastroent17010008

Authors: Valeria Idone Maria Chiara Moretti Roberto Cioeta Paola Muti Marta Rigoni Piero Portincasa Roberta La Salvia Emiliano Giovagnoni

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.

Gastroenterology Insights doi: 10.3390/gastroent17010007

Authors: Massimo De Luca Rita Verdoliva Anna Lombardi Antonio Giorgio

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.

Gastroenterology Insights doi: 10.3390/gastroent17010006

Authors: Rui Gaspar Rui Morgado Jorge Tavares Paula Portela Guilherme Macedo

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.

Gastroenterology Insights doi: 10.3390/gastroent17010005

Authors: Oscar Gerardo Figueroa-Salcido José Antonio Mora-Melgem Raúl Tinoco-Narez-Gil Noé Ontiveros Jesús Gilberto Arámburo-Gálvez

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.

Gastroenterology Insights doi: 10.3390/gastroent17010004

Authors: Hsuan-Wei Chen Pei-Tzu Chen Yao-Jen Liang

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.

Gastroenterology Insights doi: 10.3390/gastroent17010003

Authors: 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 Giovanni Lombardi

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.

Gastroenterology Insights doi: 10.3390/gastroent17010002

Authors: 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 Ilaria Tarantino

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.

Gastroenterology Insights doi: 10.3390/gastroent17010001

Authors: Alex Y. Liu Naomi T. Matsuno Houston Nelson David Johnson David Pariser

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.

Gastroenterology Insights doi: 10.3390/gastroent16040049

Authors: Mila Kovacheva-Slavova Plamen Gecov Neli Georgieva Victor Dimitrov Nikolay Penkov Borislav Vladimirov

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.

Gastroenterology Insights doi: 10.3390/gastroent16040048

Authors: Lizeth Garzón-Guerron Carlos Jiménez-Lacouture Andrés Cadena Bonfanti Alex Dominguez Vargas Henry J. González-Torres

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.

Gastroenterology Insights doi: 10.3390/gastroent16040047

Authors: Francesca Ibba Carlo Airola Tommaso Rozera Lucrezia Petrucci Giorgio Carlino Simone Varca Chiara Cavallaro Nicoletta De Matthaeis Fabrizio Pizzolante

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.

Gastroenterology Insights doi: 10.3390/gastroent16040046

Authors: Abed M. Zaitoun Sayed Ali Almahari

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.

Gastroenterology Insights doi: 10.3390/gastroent16040045

Authors: Nghiem Xuan Hoan Dao Phuong Giang Nguyen Minh Trang Nguyen Thi Loan Le Huu Song Mai Thanh Binh

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.

Gastroenterology Insights doi: 10.3390/gastroent16040044

Authors: Elda Victoria Rodríguez-Negrete Lourdes Andrea Arriaga Pizano Karina Sánchez-Reyes Liliana Anguiano-Robledo Ángel Morales-González Raúl Rojas-Martínez Eduardo Osiris Madrigal-Santillán José Antonio Morales-González

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.

Gastroenterology Insights doi: 10.3390/gastroent16040043

Authors: Nabil Ismaili

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.

Gastroenterology Insights doi: 10.3390/gastroent16040042

Authors: Marta Elizabete Vītola Rūta Anna Eisāne Sofija Iļičuka Krista Anna Kļaviņa Anna Junga Māra Pilmane

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.

Gastroenterology Insights doi: 10.3390/gastroent16040041

Authors: Konstantinos Papantoniou Christos Michailides Dimitrios Velissaris Konstantinos Thomopoulos

The management of antithrombotic agents in patients undergoing urgent gastrointestinal (GI) endoscopy presents a common and complex clinical challenge. The use of anticoagulants and antiplatelet therapies, especially in older patients with significant comorbidities, has increased substantially in recent decades due to the rising prevalence of cardiovascular and thromboembolic diseases. Balancing the risk of ongoing hemorrhage against the potentially life-threatening consequences of thrombosis remains a delicate and critical clinical decision. This review provides a practical, evidence-based approach to the periprocedural management of antithrombotic therapy in urgent endoscopy, particularly in the context of acute GI bleeding. We summarize the indications, pharmacokinetics, and reversal strategies for commonly used agents, including warfarin, direct oral anticoagulants (DOACs), low-molecular-weight heparin, aspirin, and P2Y12 inhibitors. Risk stratification is discussed in detail, considering both the urgency and bleeding risk of endoscopic procedures, as well as the thromboembolic risk associated with temporary drug interruption. Special considerations are given to high-risk patients, such as those with recent coronary stents, mechanical heart valves, or atrial fibrillation with elevated stroke risk scores. Close consultation and collaboration with other specialties, including cardiology and hematology, is often essential to optimize patient outcomes. Recommendations based on real-world clinical experience alongside formal guideline directives aim to support safe and timely endoscopic intervention without compromising systemic thrombotic protection, especially in emergent situations.

Gastroenterology Insights doi: 10.3390/gastroent16040040

Authors: Luis M. Nieto Sharon I. Narvaez Kenneth J. Vega Do Han Kim Donghyun Ko Frank J. Lukens Pedro Palacios-Argueta

Background: Health disparities between racial groups continue to exist. There is a paucity of data regarding presentation severity for acute diverticulitis (AD) and surgery need by race. This study’s aim was to evaluate outcomes of AD in United States racial groups. Methods: A retrospective cohort study was performed using the 2016–2019 National Inpatient Sample of adult patients discharged for AD. Patients were classified into six racial and ethnic groups: Caucasian, African American (AA), Hispanic, Asian, Native American (NA), and other. Multivariate regression analysis adjusted for patient and hospital characteristics was performed for primary and secondary outcomes. Results: A total of 647,119 admissions with acute diverticulitis (AD) were identified. Most patients were Caucasian (about three-quarters), followed by Hispanics (11%), AA (9%), Asians (1%), Native Americans (<1%), and other (2%). Minority groups were generally younger than Caucasians and less likely to undergo colonoscopy or surgical procedures such as partial or total colectomy. In the multivariable analysis, both Hispanics and AA were less likely to present with complicated diverticulitis. Despite this, their hospitalizations were associated with higher overall charges and costs. No significant differences were found across groups in terms of inpatient mortality or the need for percutaneous abscess drainage. Conclusions: Hispanic and AA have higher healthcare- related charges and costs compared to Caucasians when admitted with AD. Further studies are needed to understand the healthcare-related spending variations seen in these groups despite them often having less complicated AD.

Gastroenterology Insights doi: 10.3390/gastroent16040039

Authors: Ahmed Bendari Oana Vele Brett Baskovich Alaa Bendari Mona Sebika Juan Luis Gomez Marti Kritika Krishnamurthy Saeed Asiry

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy marked by late diagnosis, rapid progression, and poor prognosis, with a 5-year survival rate of 2–9%. Traditional tissue biopsy faces limitations in accessibility and real-time monitoring. Liquid biopsy—a minimally invasive technique analyzing tumor-derived materials such as circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, tumor-educated platelets (TEPs), and cell-free RNAs (cfRNAs)—offers dynamic insights into PDAC biology. This review advances beyond the prior literature by offering a unified synthesis that bridges molecular mechanisms, biomarker dynamics, and clinical translation within the context of PDAC. It also summarizes key clinical trials evaluating liquid biopsy in PDAC, underscoring its growing impact on precision oncology.

Gastroenterology Insights doi: 10.3390/gastroent16040038

Authors: Mohamed Wael Mohamed Olufemi Aoko Danny Cheriyan

Background/Objectives: Cholecystectomy remains the gold-standard treatment for acute cholecystitis. However, in patients deemed unfit for surgery, alternative gallbladder drainage techniques are required. These include percutaneous gallbladder drainage (PT-GBD), endoscopic transpapillary gallbladder drainage (ET-GBD), and the more recently adopted endoscopic ultrasound-guided gallbladder drainage (EUS-GBD). EUS-GBD has emerged as a promising minimally invasive option, offering high technical and clinical success with fewer complications and need for reinterventions. The objective of this study was to evaluate the clinical outcomes of EUS-GBD in high-risk surgical patients with acute cholecystitis. Methods: We conducted a single-center retrospective study evaluating outcomes of EUS-GBD in a tertiary referral center in Ireland. Data from ten high-risk patients with acute cholecystitis who underwent EUS-GBD using a 15 mm × 10 mm HOT AXIOS lumen-apposing metal stent (LAMS) between October 2017 and September 2018 were analyzed. Parameters assessed included technical and clinical success, adverse events, and 1-year mortality. Results: The mean age of patients was 79.5 years (range 65–95). Technical success of stent placement was achieved in all patients with no immediate complications. A trans-gastric approach was used in 7 patients while a trans-duodenal route was employed in the remaining 3. 1–year mortality following EUS-GBD was 20%. Stents were not removed in any patient in this series. No patient experienced stent-related adverse events, re-occurrence of cholecystitis, or the need for re-intervention. Conclusions: EUS-GBD has very high technical and clinical success rates, with low risk of complications and need for re-intervention in comparison to other options of GB decompression. It is, however, not widely available, and it requires a skilled endoscopist with experience in interventional EUS.

Gastroenterology Insights doi: 10.3390/gastroent16040037

Authors: Vinit H. Majmudar Kyle Nguyen-Ngo Michael Tadros

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns of EAC and ESCC from 2000 through 2022—stratified by age, sex, and race/ethnicity—and to place these in the context of changing behavioral exposures. Methods: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results SEER 21 registry data (covering 48% of the U.S. population). We included first-primary, histologically confirmed EAC (ICD-O-3 codes 8140–8576) and ESCC (8050–8084) in individuals aged ≥ 15 years diagnosed between 2000 and 2022. Age-adjusted incidence rates (per 100,000 person-years; 2000 U.S. standard) and annual percent changes (APCs) were estimated via Joinpoint regression models. Results: A total of 90,290 EAC and 47,916 ESCC cases were identified. EAC incidence increased from 2.3 to 2.8 per 100,000 (APC +0.90%; 95% CI, 0.45–1.35), with the largest relative rises in ages 15–39 years (APC +1.50%) and among women (APC +2.65%). Non-Hispanic Black and American Indian/Alaska Native populations experienced the most pronounced EAC increases. Overall ESCC incidence declined (APC −0.78%; 95% CI, −1.10 to −0.46), though Asian/Pacific Islander (+3.59%) and American Indian/Alaska Native (+1.58%) groups saw rising rates. Conclusions: EAC incidence continues to climb—especially in younger adults, women, and select racial/ethnic minorities—while ESCC declines are uneven. These histology-specific patterns highlight the urgency of tailored prevention, targeted early-detection efforts, and mechanistic studies on emerging exposures such as vaping.

Gastroenterology Insights doi: 10.3390/gastroent16040036

Authors: Manasa Ginjupalli Jayalekshmi Jayakumar Arnold Forlemu Anuj Raj Sharma Praneeth Bandaru Vikash Kumar Kameswara Santosh Dheeraj Nalluri Madhavi Reddy

Background: Non-islet cell tumor hypoglycemia is increasingly reported with gastrointestinal stromal tumors (GIST), but population-level estimates of its clinical impact are limited. We evaluated associations between hypoglycemia and inpatient outcomes among GIST hospitalizations. Methods: We conducted a retrospective cross-sectional study of the National Inpatient Sample (NIS) 2018–2020. Adult GIST discharges were identified by ICD-10-CM codes and stratified by hypoglycemia. Primary outcomes were in-hospital mortality and resource utilization—length of stay (LOS) and total hospital charge. Secondary outcomes included malnutrition, sepsis, ascites, peritonitis, bowel perforation, intestinal obstruction, gastrointestinal bleeding, and iron deficiency anemia. Analyses used survey-weighted logistic regression for binary outcomes and generalized linear models for continuous outcomes. A propensity score-matched sensitivity analysis balanced sepsis and malnutrition. Results: Among 61,725 GIST hospitalizations, 0.72% had hypoglycemia. Mortality was 12.6% with hypoglycemia vs. 3.1% without; adjusted odds of death were higher (aOR 4.16, 95% CI 2.06–8.37; p < 0.001). Hypoglycemia was also associated with malnutrition (aOR 5.63, 3.37–9.40), sepsis (aOR 4.00, 2.24–7.14), ascites (aOR 3.43, 1.63–7.19), and peritonitis (aOR 2.91, 1.17–7.22). LOS was 4.61 days longer on average (not significant; p = 0.185), and total hospital charge was $5218 higher (β = 19,116.8; p = 0.95). In the matched cohort, the mortality association attenuated but persisted (aOR 1.38, 1.27–1.49; p < 0.001); peritonitis remained significant (aOR 1.10, 1.04–1.17), intestinal obstruction (aOR 4.91, 3.44–7.05) and iron deficiency anemia (aOR 3.54, 1.62–7.74) became significant, while ascites and gastrointestinal bleeding were not significant. Conclusions: Hypoglycemia in GIST, although uncommon, marks a higher-risk inpatient trajectory with increased mortality and several complications; these signals largely persist after balancing severity proxies. Resource-use differences were directionally higher but not statistically significant. Recognition of hypoglycemia may aid risk stratification and inpatient management in GIST.

Gastroenterology Insights doi: 10.3390/gastroent16030035

Authors: Karolina Kornatowska Edyta Hańczyk Dawid Piecuch Szymon Kopciał Natalia Pawelec Weronika Mazur Mateusz Tyniec Kamal Morshed

Helicobacter pylori is a primary cause of several gastrointestinal diseases, including chronic gastritis and gastric cancer. Unfortunately, standard treatments are increasingly failing due to rising antimicrobial resistance, particularly to clarithromycin. This necessitates the development of optimized H. pylori management strategies that minimize antibiotic use, reduce adverse effects, lower costs, and improve compliance. Vonoprazan-based regimens seem to be a viable option, as vonoprazan (VPZ) offers more consistent and potent acid suppression because it is not significantly affected by CYP2C19 genetic variations. This review comprehensively analyzed 43 clinical studies from the past five years in PubMed, evaluating the efficacy and safety of vonoprazan-based regimens for H. pylori eradication, including comparisons with established and novel therapies of varying doses and durations. The findings consistently demonstrate that VPZ-based therapies achieve comparable or superior eradication rates, alongside a more favorable safety profile and enhanced cost-effectiveness. While high-dose vonoprazan-amoxicillin (VA) therapy temporarily impacts gut microbiota and can persistently affect the antibiotic resistome, low-dose VA regimens show negligible effects. This highlights VA therapy as a promising candidate for an optimal H. pylori eradication strategy, though further long-term research, particularly in diverse global populations, is essential to definitively establish the best possible regimens.

Gastroenterology Insights doi: 10.3390/gastroent16030034

Authors: Minkwan Kim Donghyeon Gim Sunghan Kim Sungsu Park Tehyun Phillip Eom Jaehoon Seol Junyeong Yeo Changmin Jo Gunha Seo Hyungjune Ku Jae Hyun Kim

Recent advances in the integration of artificial intelligence (AI) and microbiome analysis have expanded our understanding of gastrointestinal diseases, particularly in inflammatory bowel disease (IBD), colitis-associated colorectal cancer (CAC), and sporadic colorectal cancer (CRC). While IBD and CAC are mechanistically linked, recent evidence also implicates dysbiosis in sporadic CRC. The progression from IBD to CAC is mechanistically linked through chronic inflammation and microbial dysbiosis, whereas distinct dysbiotic patterns are also observed in sporadic CRC. In this review, we examined how machine learning (ML) and AI were applied to the microbiome and multi-omics data, which enabled the discovery of non-invasive microbial biomarkers, refined risk stratification, and prediction of treatment response. We highlighted how emerging computational frameworks, including explainable AI (xAI), graph-based models, and integrative multi-omics, were advancing the field from descriptive profiling toward predictive and prescriptive analytics. While emphasizing these innovations, we also critically assessed current limitations, including data variability, the lack of methodological standardization, and challenges in clinical translation. Collectively, these developments enabled AI-powered microbiome research as a driving force for precision medicine in IBD, CAC, and sporadic CRC.

Gastroenterology Insights doi: 10.3390/gastroent16030033

Authors: Manasa Ginjupalli Praneeth Bandaru Anuj Raj Sharma Jayalekshmi Jayakumar Raissa Nana Sede Mbakop Forlemu Ali Wakil Arnold Forlemu Madhavi Reddy

Background: Hepatocellular carcinoma (HCC) is a major global health burden and a leading cause of cancer-related deaths. While aspirin has shown potential chemopreventive effects in chronic liver disease, its impact on clinical outcomes among patients hospitalized with HCC remains under-investigated. Methods: Using the National Inpatient Sample (NIS) from 2016 to 2022, we conducted a retrospective cohort study to evaluate the association between aspirin use and clinical outcomes in adult HCC hospitalizations. Patients were stratified based on documented aspirin use, and propensity score matching with inverse probability of treatment weighting (IPTW) was applied to minimize confounding. The primary outcome was in-hospital mortality; secondary outcomes included morbidity-related complications, hospital length of stay, and total charges. Results: Among 337,730 hospitalizations with HCC, 8.37% involved aspirin use. Aspirin users demonstrated significantly lower in-hospital mortality (5.2% vs. 10.09%), with an adjusted odds ratio (OR) of 0.58 (95% CI: 0.50–0.68; p < 0.001). Aspirin use was also associated with shorter hospital stays (5.42 vs. 6.39 days), lower total charges ($80,310 vs. $95,098), and reduced incidence of complications, including acute liver failure, hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, sepsis, ICU admission, and acute kidney injury. Importantly, no statistically significant increase in gastrointestinal or variceal bleeding was observed among aspirin users. Conclusions: These findings suggest that aspirin use may reduce mortality, morbidity, and healthcare burden in patients hospitalized with HCC.

Gastroenterology Insights doi: 10.3390/gastroent16030032

Authors: Tamás Ilyés Paul Grama Simona R. Gheorghe Vlad Anton Ciprian N. Silaghi Alexandra M. Crăciun

Background: Short-chain fatty acids (SCFAs) are produced by the colon microbiome and bind to specific G-protein coupled receptors GPR 41 and GPR 43. Leptin and glucagon-like peptide 1 (GLP-1) are produced mainly in the intestinal lumen as a result of SCFAs binding to their receptors at this level. Inflammatory bowel diseases (IBD) such as Crohn’s disease (CD) and ulcerative colitis (UC), and their major complication, colorectal cancer (CRC), can disturb the dynamics of the colonic microenvironment thus influencing SCFAs production and effects. Our study aimed to investigate serum levels of SCFAs and SCFAs-mediated production of circulating leptin, GLP-1, and Nesfatin-1 in patients with IBD and CRC. Methods: A total of 88 subjects (29 with CRC, 29 with IBD, and 30 controls) were included in this pilot study. Serum SCFAs, leptin, Nesfatin-1, and GLP-1 levels were analyzed. Results: Nesfatin-1 levels were significantly higher in CRC patients (p < 0.05) compared to IBD and controls. Leptin levels were positively correlated with Nesfatin-1 levels in CRC, IBD, and control groups (CRC: R2 = 0.6585, p < 0.01; IBD: R2 = 0.2984, p < 0.01; Control: R2 = 0.2087, p < 0.05). Serum SCFAs levels were negatively correlated with GLP-1 levels in CRC and IBD (CRC: R2 = 0.3324, p < 0.01; IBD: R2 = 0.1756, p < 0.05) and negatively correlated with Nesfatin-1 levels in CRC (R2 = 0.2375, p < 0.05). Conclusions: These findings suggest that alterations in gut microenvironment may influence systemic metabolic regulators involved in appetite control and inflammation, potentially influencing IBD and CRC pathogenesis. This is the first study to evaluate the relationships between Nesfatin-1, leptin, GLP-1, and SCFAs in CRC and IBD patients; further research is needed to clarify their mechanistic links and therapeutic potential.

Gastroenterology Insights doi: 10.3390/gastroent16030031

Authors: Ciocîrlan Mihai Busuioc Denisa Pasăre Mihaela Bilous Dana Buză Bogdan Vlăduț Cătălina

Objectives: Esophagogastroduodenoscopy (EGD) performed with topical pharyngeal anesthesia presents less adverse events and post-procedural impairment associated with sedation. The aim of this study was to evaluate if by combining Flurbiprofen and Lidocaine sprays for topical pharyngeal anesthesia there is an improvement in patient tolerance and endoscopist satisfaction in comparison to using Lidocaine spray alone. Methods: We conducted a single center, double blind, randomized controlled trial designed to compare unsedated EGD using topical Flurbiprofen spray (Strepsils Intensive®) plus Lidocaine spray versus Lidocaine spray alone. We assessed patients’ tolerance and endoscopist satisfaction through a 0 to 10 points visual numerical rating scale. Results: A total of 36 patients were included and randomized in two equal groups: Lidocaine and Flurbiprofen spray group (FL) and Lidocaine spray group (L). No significant differences were found amongst groups for patient discomfort score (FL 5.33 ± 2.42, L 5.56 ± 2.12, p = 0.708), pain score (FL 1.77 ± 2.17, L 1.89 ± 0.74, p = 0.119), gag reflex intensity score (FL 1.61 ± 0.82, L 1.83 ± 0.68, p = 0.418), patient satisfaction score (FL 7.78 ± 2.46, L 7.22 ± 1.78, p = 0.428), and endoscopist satisfaction score (FL 7.5 ± 2.87, L 7.58 ± 1.45, p = 0.312). Conclusions: During unsedated EGD, both Lidocaine plus Strepsils spray and Lidocaine spray alone were safe and well tolerated. The combination of Flurbiprofen and Lidocaine did not significantly improve patients’ level of discomfort, pain, gag reflex, and satisfaction and endoscopist satisfaction.

Gastroenterology Insights doi: 10.3390/gastroent16030030

Authors: Igor Boechat Silveira Rodolfo Augusto Assis Rezende Carlos Alberto Monteiro Leitão Neto Yohanna Idsabella Rossi Marina de Assis Bezerra Cavalcanti Leite Guilherme Grossi Lopes Cançado

Background: Autoimmune cholestatic liver diseases (AICLDs), including primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC), are characterized by progressive biliary injury and cholestasis, leading to an impaired quantity/quality of life. Pruritus affects 20–70% of patients and is often refractory to current treatments. Ileal bile acid transporter (IBAT) inhibitors reduce bile acid reabsorption and may alleviate cholestatic pruritus. This systematic review and meta-analysis evaluates their efficacy and safety in adults with AICLD. Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane-CENTRAL for studies assessing IBAT inhibitors in adult AICLD patients with pruritus for ≥12 weeks. The primary outcome was the change in the 5-D Pruritus Scale. Secondary outcomes included sleep quality, serum bile acids, liver biochemistry, and safety. Heterogeneity was assessed using Cochrane Q and I2 statistics. Results: Three studies (n = 180) met inclusion criteria, including two RCTs and one single-arm study. Patients (78% female; 85% PBC; 77% linerixibat) showed a significant pruritus reduction (MD = −4.93, 95%CI [−6.26, −3.59], p < 0.0001), accompanied by improved sleep quality (MD = −8.12, 95%CI [−13.54, −2.70], p = 0.0033). Serum bile acids, FGF19, and autotaxin decreased significantly, with increased C4 levels. AST and GGT declined, while ALP, ALT, and bilirubin remained stable. Adverse events occurred in 89.7%, mainly diarrhea (22.7%), nausea (12.2%), and abdominal pain (18.2%); serious events were rare (2.2%). Conclusions: IBAT inhibitors significantly reduce pruritus and improve sleep in AICLD, with a favorable safety profile. These findings support their potential as a novel therapeutic option for cholestatic pruritus in adults with AICLD.

Gastroenterology Insights doi: 10.3390/gastroent16030029

Authors: Ashish Negi Priyal Anand Diksha Diksha Shailender Negi Shailesh Kumar Gupta Deepjyoti Kalita Yogendra Pratap Mathuria

Introduction: Hepatitis B is the most prevalent virus that causes severe liver infection worldwide. According to the current guidelines, the HBV viral load and other factors can help in treatment decisions. Therefore, the present study explores the relationship between the HBV viral load and blood-based laboratory parameters. Methods: The HBV viral load was evaluated in blood samples from 159 HBsAg-positive patients (ICT-positive). The viral load was categorized as high (above 200,000 IU/mL), moderate (between 2000 and 200,000 IU/mL), or low (below 2000 IU/mL). The viral load was then compared with laboratory parameters. Results: A significant association was observed between the Hepatitis B viral load and the patient’s age (p < 0.01). The males showed a substantially higher viral load, with 29.2% of the male patients exhibiting elevated levels, compared to 11% of the females. A statistically significant correlation was found between the viral load and liver enzymes, specifically AST (p < 0.005) and ALT (p < 0.04), as well as calcium (p < 0.01). Notably, the elevated ALT and AST levels were more pronounced in the patients with moderate and high viral loads, suggesting a potential link to liver dysfunction. A remarkable insight uncovered in our study revolves around the notable increase in the serum calcium levels (p < 0.01). Conclusions: The AST, ALT, and serum calcium levels were the most altered parameters with high HBV viral load. Though limited reports are available on altered serum calcium levels, they could serve as potential laboratory markers for assessing disease progression in HBV infection. Moreover, focusing on potential therapies to normalize the AST, ALT, and serum calcium levels could offer promising avenues for combating HBV infection.

Gastroenterology Insights doi: 10.3390/gastroent16030028

Authors: Maria Luisa Gambardella Giulia Fabiano Rocco Spagnuolo Rosanna De Marco Ileana Luppino Giusi Franco Francesco Rettura Mario Verta Francesco Luzza Ludovico Abenavoli

Background/Objectives: Clinically significant portal hypertension (CSPH) in cirrhotic patients impacts mortality rates and quality of life. CSPH increases the risk of systemic decompensation and could predispose to the deterioration of portal hypertension (PH)–gastric complications, such as portal hypertensive gastropathy (PHG) and portal hypertensive polyps (PHPs). In the management of CSPH with high-risk varices, endoscopic band ligation (EBL) is effective in preventing variceal bleeding. However, this procedure has several drawbacks, ranging from its inability to treat PH to the potential development of significant PH–gastric complications. The aim of our study is to evaluate endoscopic changes in PHG, PHPs, and gastric varices before and after the obliteration of esophageal varices, highlighting the potential risks of EBL. Methods: We retrospectively evaluated forty-four patients who underwent EBL for esophageal varices in emergency and elective settings, according to Baveno VII guidelines. We assessed the presence and severity of PHG, the status of gastric varices, and the number of PHPs before and after the eradication of esophageal varices. We used Fisher’s exact test and t-tests to compare the endoscopic and clinical-laboratory data statistically. A p-value < 0.05 was considered statistically significant. Results: This study found that after the eradication of varices, there was a significant worsening of PHG in 28 patients (63%) compared to before the procedure (p < 0.05). The condition remained stable in 14 patients (31%). However, it is worth noting that 90% of the patients exhibited severe PHG at baseline. Additionally, the absence of ascites and the non-administration of beta blockers at baseline were independent risk factors for worsening PHG (p < 0.05). Along with the deterioration of PHG, three patients (7%) developed gastric varices, all classified as type 1 gastroesophageal varices, and in two patients (4.5%), PHPs were formed. In particular, out of these two cases, the number of PHPs increased from one to two compared to the baseline. Conclusions: Our study underscores the association of EBL with a general worsening of PH–gastric complications and the protective effect of beta blockers in this context. Despite these promising results, future studies are needed to assess whether the worsening of PH–gastric complications is sustained over time and whether it is associated with a deterioration in clinical outcomes in patients with cirrhosis. Such evidence could help guide a more informed therapeutic decision between EBL and beta blockers.

Gastroenterology Insights doi: 10.3390/gastroent16030027

Authors: Nadica Shumka Petko Ivanov Karagyozov

Background: Peripancreatic collections (PPCs) are a frequent and severe complication of acute and chronic pancreatitis, as well as pancreatic surgery, often requiring interventions to treat and prevent infection, gastric obstruction, and other complications. Endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to surgical and percutaneous approaches, offering reduced morbidity and shorter recovery times. However, the effectiveness of EUS-guided drainage in post-surgical PPCs remains underexplored. Methods: This retrospective, single-center study evaluated the technical and clinical outcomes of EUS-guided drainage in patients with PPCs between October 2021 and December 2024. Patients were categorized as having post-pancreatitis or post-surgical PPCs. Technical success, clinical success, complications, recurrence rates, and the need for reintervention were assessed. Results: A total of 50 patients underwent EUS-guided drainage, including 42 (84%) with post-pancreatitis PPCs and 8 (16%) with post-surgical PPCs. The overall technical success rate was 100%, with clinical success achieved in 96% of cases. Lumen-apposing metal stents (LAMSs) were used in 84% of patients, including 7.1% as a dual-gate salvage strategy after the failure of double-pigtail drainage. The complication rate was 24%, with infection being the most common (16%). The recurrence rate was 25%, with no significant difference between post-pancreatitis and post-surgical cases. Patients with walled-off necrosis had a significantly higher reintervention rate (35%) than those with pseudocysts (18%; p = 0.042). Conclusions: EUS-guided drainage is a highly effective and safe intervention for PPCs, including complex post-surgical cases. The 100% technical success rate reinforces its reliability, even in anatomically altered post-surgical collections. While recurrence rates remain a consideration, EUS-guided drainage offers a minimally invasive alternative to surgery, with comparable outcomes in both post-pancreatitis and post-surgical patients. Future multi-center studies should focus on optimizing treatment strategies and reducing recurrence in high-risk populations.

Gastroenterology Insights doi: 10.3390/gastroent16030026

Authors: Chiara Citterio Stefano Vecchia Patrizia Mordenti Elisa Anselmi Margherita Ratti Massimo Guasconi Elena Orlandi

Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest solid tumors, with a five-year overall survival rate below 10%. While the introduction of multi-agent chemotherapy regimens has improved outcomes marginally, most patients with advanced disease continue to have limited therapeutic options. Molecular profiling has uncovered actionable genomic alterations in select subgroups of PDAC, yet the clinical impact of targeted therapies remains modest. This review aims to provide a clinically oriented synthesis of emerging molecular targets in PDAC, their therapeutic relevance, and practical considerations for biomarker testing, including current FDA and EMA indications. Methods: A narrative review was conducted using data from PubMed, Embase, Scopus, and international guidelines (NCCN, ESMO, ASCO). The selection focused on evidence published between 2020 and 2025, highlighting molecularly defined PDAC subsets and the current status of targeted therapies. Results: Actionable genomic alterations in PDAC include KRAS G12C mutations, BRCA1/2 and PALB2-associated homologous recombination deficiency, MSI-H/dMMR status, and rare gene fusions involving NTRK, RET, and NRG1. While only a minority of patients are eligible for targeted treatments, early-phase trials and real-world data have shown promising results in these subgroups. Testing molecular profiling is increasingly standard in advanced PDAC. Conclusions: Despite the rarity of targetable mutations, systematic molecular profiling is critical in advanced PDAC to guide off-label therapy or clinical trial enrollment. A practical framework for identifying and acting on molecular targets is essential to bridge the gap between precision oncology and clinical management.

Gastroenterology Insights doi: 10.3390/gastroent16030025

Authors: Kostadin Yordanov Dimitrov Vladislav Velchev Nely Danailova Elena Staneva Teodor Koparanov Trifon Diankov Teodora Gencheva Bozhidar Valkov Eleonora Hristova-Atanasova Georgi Iskrov Rumen Stefanov

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives.

Gastroenterology Insights doi: 10.3390/gastroent16030024

Authors: Truong Thi Do Dung Thi My Vo Thong Duy Vo

Lower gastrointestinal bleeding (LGIB) is a frequent and potentially life-threatening clinical condition. Over the past two decades, several prognostic scoring systems have been developed to stratify risk and guide the management of patients with LGIB. This comprehensive review aims to summarize and compare the current evidence on the utility, accuracy, and limitations of key LGIB scoring systems, including the Glasgow-Blatchford Score (GBS), AIMS65, ABC score, Oakland score, SALGIB, CHAMPS, and Rockall score. We conducted a structured literature review of studies evaluating these scores in adult patients with LGIB. For each scoring system, we analyzed its origin, components, intended use, and predictive performance regarding clinical outcomes such as severe bleeding, transfusion requirement, in-hospital mortality, rebleeding, and safe discharge. Comparative analyses of diagnostic accuracy were extracted where available. Our findings indicate that while no single score offers comprehensive predictive accuracy across all outcomes, certain tools are particularly effective for specific endpoints. The Oakland and GBS scores are useful for identifying patients at low risk who may be managed safely as outpatients. The ABC and CHAMPS scores demonstrate superior performance in predicting mortality, especially in elderly or comorbid populations. SALGIB, a newer score developed in Vietnam, shows promising performance for early triage but requires further validation. The Rockall score, although historically valuable in upper GI bleeding, offers limited applicability in LGIB due to its reliance on post-endoscopic findings. In conclusion, multiple prognostic tools are now available to support early decision-making in LGIB. Their optimal use requires understanding their strengths, limitations, and appropriate clinical contexts. Integrating these scores into routine practice, along with clinical judgment, can enhance patient outcomes and resource allocation.

Gastroenterology Insights doi: 10.3390/gastroent16030023

Authors: Antoaneta Georgieva Miroslav Eftimov Nadezhda Stefanova Maria Tzaneva Petko Denev Stefka Valcheva-Kuzmanova

Background/Objective: Metabolic dysfunction-associated fatty liver disease (MAFLD) is defined by the presence of hepatic steatosis, and is associated with obesity, diabetes, and other metabolic alterations. Feeding rats with a high-fat high-fructose (HFHF) diet is a reproducible experimental model of obesity/metabolic syndrome and the related MAFLD. Aronia melanocarpa, Rosa canina, and Alchemilla vulgaris are polyphenol-rich plants with proven health benefits. The aim of this study was to reveal the effects of four Aronia melanocarpa-based fruit juices (AMBFJs) in HFHF-fed rats. Methods: The AMBFJs were AM20 and AM60 (produced from aronia berries at 20 °C and 60 °C, respectively), AMRC (aronia juice with Rosa canina), and AMAV (aronia juice with Alchemilla vulgaris). Male Wistar rats were allocated to 6 groups. Except for the Control, the rest of the groups were fed an HFHF diet for 60 days. Throughout the experiment, each of the AMBFJs was administered to one HFHF-fed group. Results: HFHF-fed rats had an increased calorie intake on the background of increased liquid and decreased food consumption. At the end of the experiment, they had similar body weights, slightly increased fat indices, increased levels of blood lipids and liver enzymes, as well as typical histopathological changes in liver and adipose tissue. AMBFJs-treated animals showed improvement in most of these parameters, especially in triglyceride levels, liver enzymes, and the histopathological changes in the liver and fat. AMAV, the juice with the highest polyphenolic content, had the highest effect on adiposity. Conclusion: In HFHF-fed rats, AMBFJs exerted beneficial effects on MAFLD probably due to their polyphenolic ingredients.

Gastroenterology Insights doi: 10.3390/gastroent16030022

Authors: Artemisia Kokkinari Evangelia Antoniou Kleanthi Gourounti Eirini Orovou Maria Dagla Antigoni Sarantaki Georgios Iatrakis

Background: Vitamin D is increasingly recognized not only for its role in skeletal development but also for its immunomodulatory and gastrointestinal effects. Maternal and neonatal vitamin D deficiency (VDD) has been associated with alterations in gut microbiota, impaired intestinal barrier integrity, and increased susceptibility to inflammatory conditions in neonates. However, the exact mechanisms linking perinatal vitamin D status to neonatal gastrointestinal morbidity remain incompletely understood. Methods: This review synthesizes current evidence (2015–2024) from clinical studies, animal models, and mechanistic research on the impact of VDD during pregnancy and the neonatal period on gastrointestinal health. Databases such as PubMed, Scopus, and Web of Science were systematically searched using keywords, including “vitamin D”, “neonate”, “gut microbiome”, “intestinal barrier”, and “necrotizing enterocolitis”. Results: Emerging data suggest that VDD in utero and postnatally correlates with dysbiosis, increased intestinal permeability, and elevated inflammatory responses in neonates. Notably, low 25(OH)D levels in mothers and newborns have been linked with a higher incidence of necrotizing enterocolitis (NEC), delayed gut maturation, and altered mucosal immunity. Vitamin D appears to modulate the expression of tight junction proteins, regulate antimicrobial peptides, and maintain microbial diversity through the vitamin D receptor (VDR). Conclusions: Understanding the gastrointestinal implications of early-life VDD opens a potential window for preventive strategies in neonatal care. Timely maternal supplementation and targeted neonatal interventions may mitigate gut-related morbidities and improve early-life health outcomes. Further longitudinal and interventional studies are warranted to clarify causality and optimal intervention timing.

Gastroenterology Insights doi: 10.3390/gastroent16030021

Authors: Francesco Lamacchia Genny Mattara Francesca Tolin Beatrice Maddalon Pierluigi Pilati

Total gastrectomy with D2 lymphadenectomy for gastric cancer is a complex surgical procedure with a moderate complication rate. Sometimes, some complications may have a misleading onset without a clear clinical presentation and blood test changes. In this case report, hiccups were the main symptom of subdiaphragmatic fluid collection after total gastrectomy.

Gastroenterology Insights doi: 10.3390/gastroent16030020

Authors: Sergiu Marian Cazacu Adina Turcu-Stiolica Cristina Maria Marginean Ion Rogoveanu

(1) Background: Patients admitted for gastrointestinal bleeding (GIB) who are diagnosed with COVID-19 at presentation may face significant therapeutic challenges. The delicate balance between the use of anticoagulant and anti-inflammatory therapy to address COVID-19 and hemostasis targets can, in turn, lead to delays in COVID-19 treatment until bleeding is controlled. The published systematic reviews and meta-analyses that were reviewed included patients with both GIB and COVID-19 regardless of GIB presence at admission, and a separate analysis of patients admitted for GIB and tested for COVID-19 infection during hospitalization was not performed. (2) Methods: PubMed, Web of Science, and Scopus databases were used to access articles published from 1 December 2019 to 20 December 2024. Retrospective studies involving human subjects with GIB and COVID-19 were included in the final analysis. The exclusion criteria were as follows: pediatric population studies; the absence of a GIB control group; reviews, conference abstracts, expert opinions, and letters. The risk of bias in the included studies was assessed using the rank correlation test and Begg’s and Egger’s regression tests. We estimated the outcomes using the pooled odds ratio (OR) and the 95% confidence interval (95% CI). (3) Results: Seven studies, which included 3291 patients admitted for GIB who tested positive for COVID-19 infection, were included in our systematic review; four studies with a control group of patients with GIB but without COVID-19 infection were included in our meta-analysis. The odds of mortality among COVID-19-infected patients admitted for GIB were 3.80. There was heterogeneity regarding the site of GIB (some studies included all forms of GIB, others included only UGIB) and the study period (most studies included only patients from the first pandemic wave, and only one study reported cases from the first 2 years of the pandemic, including the delta pandemic wave). (4) Conclusions: COVID-19 infection in patients admitted for GIB was associated with a higher overall mortality rate.

Gastroenterology Insights doi: 10.3390/gastroent16030019

Authors: Sergio Miravent Bruna Vaz Manuel Duarte Lobo Cármen Jimenez Pedro Pablo Teresa Figueiredo Narciso Barbancho Miguel Ventura Rui Pedro de Almeida

Background/Objectives: Ultrasonography is a diagnostic modality characterized by high sensitivity in detecting hepato-biliary pathology, particularly intrahepatic biliary duct dilation. This study compares the sonographic findings obtained by a radiographer/sonographer in a Basic Emergency Service (BES) using Point-of-Care Ultrasonography (POCUS) in Portugal with the sonographic findings from the same patients acquired by radiologists at a referral hospital (RH) for suspected intrahepatic biliary dilatation. Methods: Nineteen patients presenting with right upper quadrant (RUQ) pain and suspected abdominal pathology underwent sonographic screening using POCUS in the BES. Subsequently, the same patients were referred to the RH, where a radiologist performed a comprehensive ultrasound. Both examinations were compared to determine whether the findings obtained in the BES were confirmed by radiologists in the RH. Results: Cholestasis, cholangitis, lithiasis, pancreatitis, peri-ampullary lithiasis, and neoplasms were observed in association with intrahepatic biliary dilation in this study sample. All six variables showed a strong association between the BES and RH findings (Cramer’s V > 0.6; p < 0.006). A strong kappa measure of agreement between the radiographer and radiologist findings was obtained in “cholelithiasis/sludge/gallbladder acute sonographic changes” (k = 0.802; p = 0.000). A moderate kappa value was obtained for the variable “abdominal free fluid”, (k = 0.706; p = 0.001). Conclusions: In this study, all patients referred from the BES to the RH required hospitalization for treatment and additional imaging exams. Although pre-hospital screening ultrasound is not intended for definitive diagnoses, the early detection of intrahepatic biliary tract dilatation through screening sonography played a significant role in the clinical referral of patients, with a sensitivity of 94% and specificity of 75%.

Gastroenterology Insights doi: 10.3390/gastroent16020018

Authors: Magnus Chun Tahne Vongsavath Sneh Sonaiya Lily Liu Kyaw Min Tun Kavita Batra Robert G. Gish

Background and Aims: Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalizations, with proton pump inhibitors (PPIs) being the mainstay treatment. However, there is a lack of high-level evidence to show if adjunctive medical therapy (somatostatin and its analogs) can improve outcomes. This systematic review and meta-analysis aim to evaluate the outcomes of PPIs with adjunctive therapy versus PPI monotherapy in treating NVUGIB in an in-patient setting. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, major databases were systematically searched to retrieve English-only, original studies, published from 1 January 2000 to 31 December 2023, investigating NVUGIB only. The primary outcomes included the mortality rate within 7 days of therapy, rebleeding rate within 7 days of therapy, and length of hospital stay. Results: Seven studies with 789 patients had a pooled mortality rate of 2.0% (95% CI, 0–4.0%), and the pooled risk ratio was 1.11 (95% CI, 0.50–2.48; p = 0.79) between PPI monotherapy and PPIs with adjunctive medical therapy. The pooled rebleeding rate was 13% (95% CI, 6–20%) and the risk ratio was 1.04 (95% CI, 0.73–1.48; p = 0.83). The pooled average length of stay in the hospital was 5.47 days (95% CI, 3.72–7.21 days), with insignificant weighted differences between the two groups. No statistically significant differences were noted in surgical management risk ratios or amount of blood transfusion. Conclusions: Among patients with NVUGIB, adjunctive medical therapy offered no clinical benefits given the statistically insignificant differences in the primary outcomes. However, this conclusion is limited by the considerable variability in treatment protocols, weak control of confounding variables, and missing clinical information in the original studies. Therefore, better-quality, large-scale randomized controlled trials are needed, ideally using standardized somatostatin dosing, timing, delivery routes, and clearly defined inclusion criteria to more accurately evaluate the role of somatostatin in NVUGIB management.

Gastroenterology Insights doi: 10.3390/gastroent16020017

Authors: Oscar Francisco Iniestra-Ayllón José Antonio Morales-González Karina Sánchez-Reyes Elda Victoria Rodríguez-Negrete

Acute pancreatitis (AP) is one of the gastrointestinal pathologies that most frequently requires hospital admission; about half of all deaths occur within the first two weeks and are caused by multi-organ failure. Predicting the degree of severity of AP before 48 h is a challenge. Background/Objectives: Having an early marker, before 48 h after admission, could be useful to avoid or diagnose early complications such as organ failure (OF). A few sentences could place the question addressed in a broader context and highlight the purpose of the study. Methods: A retrospective study conducted in a third-level hospital, during the period from August 2019 to June 2021. Patients aged >18 years, with a diagnosis of PA, who had a complete clinical history and complete biochemical and imaging data were included. The scores of the APACHE II, BISAP, revised Atlanta classification, and modified Marshall scales were recorded. Results: Of the 103 patients included, 60% were women, the mean age was 47.76 years, and the hospital stay was 8 days (IQR 6–12); the most frequent etiology was biliary in 46 (44.7%) patients; the most frequent BMI was overweight with 34 (33%) patients; and 38 (36.9%) patients had a systemic inflammatory response at admission. Hypoalbuminemia was observed in 34 (33%) of the 103 patients at admission; of these, 42 (40.8%) had an APACHE II score > 8 points, 17 (16.3%) a BISAP score > 2, 57 (54.8%) patients were classified as moderate AP according to the revised Atlanta classification, and 54 patients had a score according to the modified Marshall score > 2. A statistically significant difference in the development of death was observed between patients with hypoalbuminemia versus those with normal serum albumin levels. Conclusions: In this study, we show the usefulness of hipoalbuminemia (<3.5 g/dL) at hospital admission in patients with AP, as a severity and mortality indicator. With the results obtained, we conclude that low albumin levels are a good predictor of severity and are useful for establishing timely treatment and close follow-up.

Gastroenterology Insights doi: 10.3390/gastroent16020016

Authors: Dorina Osmanaj Floreta Kurti Klerida Shehu Yllka Themeli Gentian Stroni Erand Llanaj Adriana Babameto

Background/Objectives: Alcohol-related liver disease (ARLD) is a major cause of chronic liver disease, yet its clinical profile in Albania, a region with high HBV prevalence and rising alcohol consumption, remains poorly characterized. This study evaluates the clinical markers of advanced ARLD as noninvasive fibrosis indicators, acknowledging limitations in observational data and the need for validation in diverse populations. Methods: In this cross-sectional study, 200 patients with ARLD were classified as having mild or advanced disease based on clinical, biochemical, and imaging criteria. Associations between socioeconomic factors, nutritional status, and fibrosis markers with advanced ARLD were assessed using multivariate logistic regression, adjusted for age, sex, smoking status, and duration of alcohol use. Results: Lower Prognostic Nutritional Index (PNI) score was significantly associated with advanced ARLD (OR 0.95, 95% CI 0.91–0.99; p = 0.014), suggesting a potential role of nutritional status in disease progression. Higher APRI and FIB-4 scores were associated with an increased risk of advanced ARLD (APRI: OR 1.27, 95% CI 0.71–2.26; FIB-4: OR 1.10, 95% CI 0.81–1.51), though these associations did not reach statistical significance. Conclusions: This study provides a first clinical assessment of ARLD in Albania, highlighting the potential role of nutritional and fibrosis markers in risk stratification. While the study design limits definitive conclusions, our findings underscore the need for larger prospective studies to validate these associations and further investigate the influence of metabolic and socioeconomic factors on ARLD progression in Albania.

Gastroenterology Insights doi: 10.3390/gastroent16020015

Authors: Julián Herrera-Mejía Abraham Wall-Medrano Arnulfo Ramos-Jiménez Aarón F. González-Córdova Florinda Jiménez-Vega Rocio Campos-Vega

Introduction: Functional gastrointestinal disorders (FGIDs) are common comorbidities that affect the life quality of children with autism. Objective: This study investigated the link between clinical history and specific colonic fecal microbiota (CFM) markers with the pathophysiology of FGIDs in young children with autism patients. Methods: Thirty-nine young patients (2 and 18 years) were included in the study of FGIDs (+) cases (n = 18) and FGIDs (-) (n = 21) controls. Gastrointestinal disorders were diagnosed by standardized clinical tools (ROMA-IV and six-item gastrointestinal severity index), while bacterial markers, including Bacteroidetes, Firmicutes, Actinomycetes (Phyla); Lactobacillales, Clostridiales, Bifidobacteriales (Orders); B. fragilis, F. prausnitzii, B. longum, D. vulgaris and A. muciniphila (Species), were detected by targeting 16S rRNA and two-step PCR protocol. Results: The overall prevalence of FGIDs was significantly (p < 0.05) associated with cesarean delivery, the duration of milk formula consumption, and the presence of early intestinal symptoms during infancy. Furthermore, Bacteroidetes, Lactobacillales, B. longum, D. vulgaris, and A. muciniphila concentrations were significantly (p ≤ 0.03) higher in stool of patients with moderate symptoms, compared to those who were asymptomatic. Conclusions: Our results suggest that the CFM composition is a potential physiological predictor of FGID pathophysiology in a severity-dependent way in children with autism.

Gastroenterology Insights doi: 10.3390/gastroent16020014

Authors: Sumona Bhattacharya William Beaty Adam S. Faye Jordan E. Axelrad

Introduction: In the general population, right I-sided dysplasia presents a higher risk for colorectal cancer (CRC) and metachronous dysplasia compared to left (L)-sided dysplasia. Given that patients with inflammatory bowel disease (IBD) are at higher risk for dysplasia than the general population, we sought to assess the risk factors as well as the differences in outcomes between patients with R-sided, L-sided, and both R- and L-sided dysplasia. Methods: A retrospective chart review was performed on patients at NYU Langone Health who had evidence of dysplasia on a colonoscopy between 2011 and 2021. Demographics and pertinent medical history were compiled. Cohorts were based on the dysplasia location (R-sided, L-sided, or R- and L-sided) and the IBD-related outcomes were analyzed. Results: A total of 71 patients had colonic dysplasia. The mean age was 54 years old (SD ± 17). The majority were male (72%), white (69%), and non-Hispanic (94%). A total of 76% had ulcerative colitis (UC) and 24% had Crohn’s disease (CD). Of all dysplastic lesions, 57 (80%) patients had unifocal disease and the remainder had multifocal disease. A total of 39 (55%) patients had R-sided dysplasia, 24 (34%) had L-sided dysplasia, and 8 (11%) had both R- and L-sided dysplasia. Patients with UC were more likely to have L-sided dysplasia (92% vs. 8% in CD; p = 0.04). Pseudopolyps were more likely associated with R- and L-sided dysplasia (38% in R- and L-sided dysplasia, 10% in R-sided dysplasia, and 4% in L-sided dysplasia; p = 0.03). Conclusions: Patients with UC had a higher risk for L-sided colonic dysplasia compared to patients with CD; however, there were no differences in the progression of dysplasia between those who had R-sided and those who had L-sided dysplasia. Larger studies are needed to assess the risk factors and outcomes related to the laterality of dysplasia and further validate these findings among patients with IBD.

Gastroenterology Insights doi: 10.3390/gastroent16020013

Authors: Elda Victoria Rodríguez-Negrete Jazmín García-Machorro Eduardo Osiris Madrigal-Santillán Ángel Morales-González José A. Morales-González

Background/Objectives: It is known that chronic alcohol consumption causes alterations to various organs of the body, mainly the liver, but there are no reports of the damage that weekend alcohol consumption can cause to the liver. The liver is the main organ responsible for metabolizing ethanol and therefore experiences the most significant adverse effects of this xenobiotic’s toxicity. In this study, we evaluated the effect of weekend alcohol consumption on the activity of hepatic antioxidant enzymes. Methods: Wistar rats weighing 170–200 g were divided into the following groups: (1) control group and (2) weekend alcohol consumption group, 2 days per week for 12 weeks at two different concentrations: (1) group of males and females consuming a 40% alcohol solution and (2) group of males and females consuming a 5% alcohol solution. At the end of the experiment, liver samples were obtained. The activity of the enzymes catalase, superoxide dismutase, glutathione reductase, and glutathione peroxidase, as well as the levels of total antioxidant capacity and thiobarbituric acid reactive substances, were determined. Results: surprisingly, the results showed an increase in the activity of antioxidant enzymes, as well as a decrease in thiobarbituric acid reactive substances. Conclusions: weekend alcohol consumption for a period of 3 months led to an elevation in antioxidant enzyme activity, but it was not sufficient to prevent the damage caused to the liver by weekend alcohol consumption.

Gastroenterology Insights doi: 10.3390/gastroent16020012

Authors: Nouran Alwisi Rana Ismail Hissa Al-Kuwari Khalifa H. Al-Ansari Mohammed A. Al-Matwi Noor A. Aweer Wejdan N. Al-Marri Yousif Al-Kubaisi Muneera Al-Mohannadi Shahd Hamran Habib H. Farooqui Tawanda Chivese

Background and Aims: There is still uncertainty about the efficacy and safety of subcutaneous compared to intravenous administration of biologics for inflammatory bowel disease (IBD) remission. Methods: In this systematic review and meta-analysis, we searched Cochrane, PubMed, SCOPUS, CINHAL, and preprint archives for trials that compared the efficacy and safety of subcutaneous and intravenous biologics for the induction and maintenance of IBD remission. Meta-analysis was carried out with a subgroup analysis for Crohn’s disease (CD) and Ulcerative Colitis (UC), heterogeneity using I2, and publication bias using funnel plots. Results: A total of 14 randomized controlled trials, 9 on CD, 4 on UC, and 1 with data on both were included Subcutaneous, compared to intravenous administration, was less efficacious for the induction of remission; overall (OR 0.68, 95%CI 0.35–1.31, I2 = 83%), worse in UC (OR 0.35, 95%CI 0.07–1.79, I2 = 91.2%), and showed similar efficacy in CD (OR 0.97, 95%CI 0.73–1.30, I2 = 0%). For the maintenance of remission, subcutaneous biologics were almost similar to intravenous biologics; overall (OR 0.97, 95%CI 0.63–1.49, I2 = 57.1%), with less efficacy in UC (OR 0.82, 95%CI 0.54–1.23, I2 = 52%), but superior efficacy in CD (OR 1.81, 95%CI 1.09–3.01, I2 = 0%). Subcutaneous, compared to intravenous biologics, showed slightly higher odds of treatment discontinuation (OR 1.32, 95%CI 1.02–1.71, I2 = 14.2%), worse in UC (OR 1.52, 95%CI 1.17–1.98, I2 = 13%), and was similar to intravenous for CD (OR 1.03, 95%CI 0.65–1.62, I2 = 0%). Conclusion: Subcutaneous administration has lower efficacy for the induction of remission but can achieve almost similar efficacy and safety in maintaining remission in IBD. Subcutaneous injection has better efficacy and safety in CD than in UC.

Gastroenterology Insights doi: 10.3390/gastroent16010011

Authors: Irina Ciortescu Roxana Nemțeanu Ilinca-Maria Chiriac Gheorghe Bălan George Aurelian Cocu Ionuț Alexandru Coșeru Catalina Mihai Alina Pleșa

Background and Clinical significance: Plummer–Vinson (PV) syndrome is a rare medical entity diagnosed when iron-deficiency anemia, dysphagia, and esophageal webs occur in the same patient. PV syndrome has been associated with different autoimmune diseases, such as celiac disease (CD). CD is a chronic multisystemic disorder affecting the small intestine, but it is recognized as having a plethora of clinical manifestations secondary to the malabsorption syndrome that accompanies the majority of cases. However, similar to PV syndrome, a high percentage of CD patients are asymptomatic, and those who are symptomatic may present with a wide variety of gastrointestinal and extraintestinal symptoms, including iron-deficiency anemia, making the diagnosis challenging. Case presentation: We present the case of a 43-year-old Caucasian female patient with a 7-year history of iron-deficiency anemia and increased bowel movements (3–4 stools/day). Upper endoscopy demonstrated a narrowing at the proximal cervical esophagus from a tight esophageal stricture caused by a smooth mucosal diaphragm. A 36F Savary–Gilliard dilator was used to manage the stenosis. The distal esophagus and stomach were normal, but scalloping of the duodenal folds was noted, and CD was confirmed by villous atrophy and positive tissue transglutaminase antibodies. Dysphagia was immediately resolved, and a glute-free diet was implemented. Conclusions: The relationship between PV syndrome and CD is still a matter of debate. Some might argue that PV syndrome is a complication of an undiagnosed CD. In cases of PV syndrome, a CD diagnosis should be considered even in the absence of typical symptoms of malabsorption.

Gastroenterology Insights doi: 10.3390/gastroent16010010

Authors: Maciej Przemysław Kawecki Agnieszka Marianna Kruk Mateusz Drążyk Zygmunt Domagała Sławomir Woźniak

The development of perianal fistulas leads to a significant decrease in the quality of patients’ lives. The onset of this condition is dependent on many factors, including inflammation or trauma. In the occurrence of Crohn’s disease-associated fistulas, numerous molecular factors and metabolic pathways are involved. To integrate the current knowledge on the biochemical, genetic, and epigenetic factors taking part in the development of perianal fistulas, we conducted a literature review. We gathered and analyzed 45 articles on this subject. The pathophysiology of fistulas associated with Crohn’s disease (CD) involves epithelial–mesenchymal transition (EMT) and matrix remodeling enzymes, with key regulators including transforming growth factor β (TGF-β), tumor necrosis factor α (TNFα), and interleukin-13 (IL-13). Genetic factors, such as mutations in receptor-interacting serine/threonine-protein kinase 1 (RIPK1), interleukin-10 receptor (IL-10R), and the MEFV gene, contribute to the onset and severity of perianal fistulas, suggesting potential therapeutic targets. Understanding the complex interplay of molecular pathways and genetic predispositions offers insights into personalized treatment strategies for this challenging condition. Further research is necessary to elucidate the intricate mechanisms underlying the pathogenesis of perianal fistulas and to identify new therapeutic interventions.

Gastroenterology Insights doi: 10.3390/gastroent16010009

Authors: Davide Scalvini Simona Agazzi Stiliano Maimaris Laura Rovedatti Daniele Brinch Alessandro Cappellini Carlo Ciccioli Michele Puricelli Erica Bartolotta Daniele Alfieri Elena Giulia Strada Lodovica Pozzi Marco Bardone Stefano Mazza Aurelio Mauro Andrea Anderloni

Introduction: High-quality colonoscopy is influenced by several factors, with the adenoma detection rate (ADR) being one of the most studied indicators. A strong inverse relationship exists between ADR and the risk of developing post-colonoscopy colorectal cancer (PCCRC), prompting the European Society of Gastrointestinal Endoscopy guidelines to recommend a minimum ADR of 25%. In contrast, there is limited evidence supporting the clinical significance of the serrated polyp detection rate (SPDR), and no specific benchmark was established until a very recent update from the American societies. Main paper: This review examines the factors that influence ADR and SPDR, offering tips to improve these metrics. Effective interventions for enhancing ADR include training, colonoscopy feedback, adequate bowel preparation, longer withdrawal time, water-aided colonoscopy, right colon second look, and chromoendoscopy. The use of cap, devices, and specialized scopes also show promise, though these are often at higher costs. Artificial intelligence has generated great optimism, especially following positive results from early randomized controlled trials; however, its effectiveness has been less pronounced in real-world settings. Conclusions: Many of these approaches require further trials and meta-analyses to establish their ultimate efficacy. Moreover, future clinical head-to-head studies will help to identify the most effective interventions for reducing colorectal cancer incidence and the risk of PCCRC.

Gastroenterology Insights doi: 10.3390/gastroent16010008

Authors: Sara Fakeh Ahmad Masoud Raneem Abuqtaish Bayan Salman Layth Al-Ramahi Omar AlWahkyan Dua Abuquteish

Background/Objectives: Thalassemia, a hereditary blood disorder, leads to reduced hemoglobin levels, impairing oxygen transport and negatively impacting patient health. Recent research suggests a possible association between thalassemia and gastrointestinal (GI) symptoms, such as abdominal pain, diarrhea, and GI bleeding, potentially due to immune compromise and iron overload. This systematic review aims to explore the prevalence and underlying factors of GI pathologies in thalassemia patients, excluding treatment-related effects and iron overload. Methods: A comprehensive search following the PRISMA guidelines was conducted to identify the prevalence and causes of GI disorders in thalassemia patients. Studies assessing non-treatment-related GI symptoms and their links to thalassemia were analyzed. After screening 1902 studies, 13 were included to investigate gastrointestinal manifestations in thalassemia patients. Results: Evidence indicates potential associations between thalassemia and GI disorders, including malabsorption, inflammatory bowel disease, Heliobacter pylori (H. pylori) infection, and celiac disease. Findings highlight immune compromise and iron dysregulation as possible contributing factors. Conclusions: This review highlights the importance of further research into the GI manifestations of thalassemia to enable early detection and improve patient health outcomes and quality of life. Addressing this gap may provide insights into better clinical management strategies for thalassemia patients.

Gastroenterology Insights doi: 10.3390/gastroent16010007

Authors: Stylianos Syropoulos Maria Moutzouri Eirini Grammatopoulou Irini Patsaki

Background/Objective: Gastroesophageal reflux disease (GERD) is multifactorial and affects an increasing number of people. It is a common condition in which the stomach contents move up into the esophagus; thus, its main cause is found in the antireflux valve mechanism of the gastroesophageal junction. This consists of two sphincters, the lower oesophageal and the diaphragmatic. The disease has been related to diaphragm dysfunction, either due to the de-coordination of the diaphragms’ contractility or due to decreased strength. Breathing exercises seem to have a positive effect in this population. The aim of this study was to systematically examine the effects of inspiratory muscle training (IMT) on GERD characteristics. Methods: We conducted a systematic review of research up to April 2024 in Scopus, PubMed, and Science Direct. We included randomized controlled trials (RCTs) and clinical trials assessing the effects of IMT on GERD characteristics. Methodological quality was assessed with the PEDro scale (Physiotherapy Evidence Database) and the Newcastle Ottawa scale (NOC). Results: Among the 1984 studies identified from the search, only three studies (one study with a post-COVID-19 population and two with GERD and healthy subjects) were included in this study, as they presented a fair to high methodological quality. Significant improvements in maximal inspiratory pressure (p < 0.001) and diaphragmatic excursion (p < 0.001) were revealed in one study. No significant differences between groups were mentioned for the reflux symptoms and for LES–EGJ pressure in the studies included. Conclusions: IMT seems to provide promising effects in strengthening the antireflux valve mechanism, as it increases MIP and diaphragmatic excursion. This systematic review established a bibliographic gap for the contribution of IMT in the antireflux valve mechanism. More evidence is needed to support the importance of IMT as a non-pharmacological intervention for GERD patients.

Gastroenterology Insights doi: 10.3390/gastroent16010006

Authors: Ekaterina Smagina Dar’ya Polit’ko Vadim Kumeiko Lyudmila Gurina Anna Stenkova

Background: Chronic inflammation is an important factor in the development and progression of colorectal cancer (CRC). One of the key participants of chronic inflammation is interleukin-6 (IL-6), which enhances tumor malignancy. Some of the genetic markers characterizing the IL-6/STAT3/JAK pathway are functional polymorphisms in IL6 and IL6R genes. Hyperexpression of IL-6 and increasing concentrations of the soluble form, IL-6R, may be one possible option for cross-activation of MAPK signaling. Methods: Detection of rs1800795 and rs2228145 SNPs was carried out using allele-specific PCR. The mutations of RAS and BRAF genes in tumors were determined by pyrosequencing. Results: The allele and genotype distributions of IL6 rs1800795 (−174C>G) and IL6R rs2228145 (1073A>C) were significantly different between the CRC and control groups. Thus, the risks of CRC developing in carriers of the homozygous G/G rs1800795 and C/C rs2228145 genotypes were 2.05- and 1.85-fold higher. Also, we identified a relationship between the studied SNPs and somatic activating mutations in the RAS and BRAF genes. It was found that the G/G rs1800795 and C/C rs2228145 genotypes are significantly more common in the group of patients without activating mutations in the RAS and BRAF genes. Conclusions: Understanding the impact of genetic factors not only on cancer predisposition but the evolution of cancer cells will help to derive novel predictive markers and therapy options.

Gastroenterology Insights doi: 10.3390/gastroent16010005

Authors: Ji-Su Mo Santosh Lamichhane Grinsun Sharma Soo-Cheon Chae

Background/Objectives: Colorectal cancer (CRC) is one of the most common cancers worldwide, with high incidence and mortality rates. MicroRNAs are endogenous and non-coding RNAs that play a pivotal role in the development and progression of various cancers by targeting specific genes. Previously, we identified MIR133A to be significantly decreased in human CRC tissues. This study aims to identify the relationship with SQLE, one of the candidate target genes of MIR133A, and study their interaction in CRC cells. Methods: Through the luciferase reporter assay, quantitative RT-PCR (qRT-PCR), and Western blot analysis. Results: We identified SQLE as a direct target gene of MIR133A. Using the MIR133A KI cell lines, which knocked-in MIR133A1 or MIR133A2 in CRC cell lines, and CRC cells transfected with siSQLE, we found that MIR133A regulated the proliferation and migration of CRC cells by modulating SQLE-mediated PIK3CA-AKT1 and CYP24A1 signaling. We also found that cholesterol production was regulated by MIR133A in CRC cells. Conclusions: Our results suggest that MIR133A is an important therapeutic target for colorectal cancer.

Gastroenterology Insights doi: 10.3390/gastroent16010004

Authors: Sunimal Fernando Reeham Abu-Rgeef Shankar Menon Kenji So Kannan Venugopal Sherman Picardo

Background: Biologic therapies, such antitumour necrosis factor-alpha agents (infliximab and adalimumab), as well as newer agents (ustekinumab and vedolizumab), all have well-demonstrated safety and efficacy profiles in the management of inflammatory bowel disease (IBD). The choice of an optimal first-line biologic remains unclear due to a lack of comparative randomised trials and real-world studies; however, certain patient and disease characteristics may influence this choice. The aims of this study were to explore temporal trends in the choice of a first-line biologic therapy and the factors that influence this choice. Methodology: This study is a retrospective observational cohort study of all patients with IBD who commenced induction and completed at least one maintenance dose of a biologic therapy between 1 January 2015 and 31 December 2021. Relevant patient and disease-specific factors were collected, including history of malignancy and opportunistic infections at time of diagnosis, for each eligible patient. Factors affecting the choice of biologic therapy were compared using ANOVA and chi-square tests. Results: 280 patients were included in the study. Ustekinumab has overtaken infliximab and adalimumab as the first-line choice for Crohn’s disease since its introduction in 2018. Infliximab has remained the preferred first-line therapy for ulcerative colitis over adalimumab and vedolizumab. Ustekinumab has become he preferred biologic agent for older patients and those with a history of malignancy. Conclusions: Whilst an older agent such as infliximab is still preferred for the management of UC, novel agents such as ustekinumab are now more readily considered as a first-line agent for the management of CD.

Gastroenterology Insights doi: 10.3390/gastroent16010003

Authors: Jessica L. Grimsby Matthew D. Szkolnicki Kevin A. Wood

Background: For over a decade, endoscopic hemostatic powders have been used to manage upper gastrointestinal bleeding (UGIB). Various preclinical benchtop and animal models have been developed to evaluate these devices. Multiple companies have released hemostatic powders to market, assessing their safety and efficacy using an established porcine gastric vessel bleed model. The model requires inserting an artery segment into the gastric lumen, which is then punctured to produce a bleed. This simulates an aggressive arterial bleed, allowing hemostatic prototype devices to be tested under challenging conditions. Methods: We aimed to evaluate the relationship between intragastric pressure and bleed severity by injecting the gas used to deliver hemostatic powder to the bleed site without administering the hemostatic powder. Results: Our results indicate that elevated intragastric pressures alone can cause bleed cessation. Additional findings suggest that other factors in the model can lead to false positive hemostasis. Conclusions: This study highlights limitations in the current state porcine gastric vessel bleed model. The results underscore the importance of vetting preclinical models before acquiring efficacy data and the need to develop more robust and effective bleed models for testing hemostatic devices.

Gastroenterology Insights doi: 10.3390/gastroent16010002

Authors: Benjamin E. Ansa Alaina Head Zola Johnson Wonder King Selassie Hatekah Beulah Ansa Darryl Nettles

Background/Objectives: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally. Screening for cancer helps to prevent comorbid conditions among individuals with chronic medical conditions, such as stroke. The gold standard for CRC screening is colonoscopy. Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability. This study examined the prevalence of screening colonoscopy among individuals who reported ever having had a stroke (stroke survivors). Methods: The 2022 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for the weighted prevalence and odds of screening colonoscopy uptake among adults aged 45 years and older, based on having had a stroke and socioeconomic status. Results: Almost 6% (n = 16,371) of the adults included in the analysis (N = 285,329) reported having had a stroke, and the weighted prevalence of screening colonoscopy for this group was 73.3% compared to 67.8% for those without stroke. Stroke survivors were 1.3 times more likely to have had a screening colonoscopy compared to those without a history of stroke. Higher odds of screening colonoscopy uptake were observed among stroke survivors that were older than 45–49 years old, with high school or greater than high school education. Stroke survivors that were multiracial and without health insurance coverage had lower odds of screening colonoscopy uptake compared to those that were white and had health insurance coverage, respectively. Conclusions: Though adult stroke survivors, compared to those without a stroke, are more likely to report having had a screening colonoscopy, differences in screening colonoscopy uptake were observed among subgroups of this population based on sociodemographic status. Tailored interventions are needed for increasing screening colonoscopy uptake among disadvantaged subgroups.

Gastroenterology Insights doi: 10.3390/gastroent16010001

Authors: Moonhyung Lee Seung-Kwon Myung Sang Hee Lee Yoosoo Chang

Background/Objectives: It remains inconclusive whether or not smoking is associated with an increased risk of fatty liver disease (FLD). We investigated the association between smoking and the risk of FLD by using a meta-analysis of cohort studies. Methods: PubMed and EMBASE were searched using keywords from their inception to September 2023 to identify relevant studies. Results: Out of 806 articles searched from the databases, a total of 20 cohort studies were included in the final analysis. In the meta-analysis, smoking was significantly associated with an increased risk of FLD (odds ratio/relative risk/hazard ratio, 1.14; 95% confidence interval, 1.05–1.24; n = 20). Subgroup analyses showed a significant positive association between them in prospective cohort studies (odds ratio/relative risk/hazard ratio, 1.15; 95% confidence interval, 1.05–1.18; n = 5) but not in retrospective cohort studies and cross-sectional studies based on cohort studies. In the subgroup meta-analysis by gender in Asians, smoking significantly increased the risk of FLD in men, while there was no significant association between FLD and smoking in women. Conclusions: This meta-analysis showed that smoking increases the risk of FLD. In addition to well-known risk factors of FLD, clinicians should recommend smoking cessation for the management of FLD.

Gastroenterology Insights doi: 10.3390/gastroent15040075

Authors: Romilda Cardin Debora Bizzaro Francesco Paolo Russo Francesca D’Arcangelo Francesco Ideo Filippo Pelizzaro Chiara Carlotto Milena Minotto Fabio Farinati Patrizia Burra Giacomo Germani

Background and Objective: Drug-induced liver injury (DILI) is increasingly becoming a cause of acute hepatitis. The study evaluated the role of liver-specific microRNAs (miRNAs) and keratin-18 (K-18) markers M30 (apoptosis) and M65 (necrosis) as biomarkers of acute hepatitis. Methods: Sixty-eight patients were sub-grouped as DILI, HBV- and alcohol-related acute hepatitis. Five healthy controls were included. The expression of plasma miR-21-5p, miR-34a-5p and miR-122-5p was evaluated by RT-qPCR analysis using healthy volunteers as reference. M30 and M65 were determined with ELISA kits. Results: All markers were significantly higher in the acute liver disease patients compared to controls. In DILI, miRNA levels positively correlated with M30, M65 and ALT. miR-122-5p had the highest AUC of 0.73, sensitivity of 76.2 and specificity of 72.2 in identifying DILI from other groups. Patients with hepatocellular-pattern DILI showed higher miR-122-5p and miR-21-5p compared to patients with cholestatic or mixed pattern. A new score to discriminate DILI versus other causes of acute hepatitis was developed using the identified risk factors as follows: 0.012 × miR-34a-5p + 0.012 × miR-122-5p − 0.001 × M30 + 2.642 × 1 (if mixed pattern) + 0.014 × 1 (if hepatocellular pattern) + 1.887. The AUC of the score was 0.86, with a sensitivity and specificity of 81%, better than the values of the single markers. Conclusions: Liver-specific miRNAs and K-18 could be promising serum biomarkers of DILI, especially when used in combination.

Gastroenterology Insights doi: 10.3390/gastroent15040074

Authors: Luisa Bertin Mohamad Nasrallah Carlo Redavid Erica Bonazzi Daria Maniero Greta Lorenzon Caterina De Barba Sonia Facchin Marco Scarpa Cesare Ruffolo Imerio Angriman Andrea Buda Matteo Fassan Carmelo Lacognata Brigida Barberio Fabiana Zingone Edoardo Vincenzo Savarino

Background/Objectives: Restorative proctocolectomy with ileo-anal pouch anastomosis (IPAA) remains the preferred surgical treatment for ulcerative colitis (UC). However, complications like pouchitis can occur. This study aimed to describe patients who underwent IPAA for inflammatory bowel disease (IBD) at Padua Hospital from 2005 to 2023 and identify risk factors for pouchitis. Secondary objectives included evaluating the effectiveness of biological therapy in chronic antibiotic-refractory pouchitis (CARP), Crohn’s disease of the pouch (CDP), and Crohn’s-like inflammation of the pouch (CDLPI), and assessing risk factors for pouch failure. Methods: This retrospective, observational study included 109 patients whose data were collected from medical records. Univariate logistic regression was used to analyze associations between preoperative and postoperative factors and outcomes such as acute pouchitis and pouch failure. The effectiveness of biological therapy was assessed by measuring changes in the Pouchitis Disease Activity Index (PDAI) and the Modified Pouchitis Disease Activity Index (mPDAI) over a 12-month treatment period. Results: Univariate logistic regression revealed significant associations between preoperative extraintestinal manifestations (OR 3.569, 95% CI 1.240–10.720), previous diagnosis of Crohn’s disease (OR 10.675, 95% CI 1.265–90.089), and transmural inflammation at cross-sectional imaging before surgery (OR 3.453, 95% CI 1.193–9.991) with an acute pouchitis risk. Pouch failure was significantly associated with a previous diagnosis of Crohn’s disease (OR 9.500, 95% CI 1.821–49.571) and post-surgical fistulas (OR 41.597, 95% CI 4.022–430.172). Biological therapy led to a significant reduction in the PDAI score in patients with CARP, decreasing from a median of 10 to 4 (p = 0.006). Similarly, in patients with CDP or CDLPI, the mPDAI score was significantly reduced from a median of 9 to 1 (p = 0.034), with remission achieved in 5/6 (83.3%) of these patients. Conclusions: This study provides valuable insights into the management of IPAA patients and highlights the importance of early identification and treatment of risk factors for pouchitis and failure. Biological therapy demonstrated significant effectiveness in reducing disease activity in patients with CARP, CDP, and CDLPI, suggesting its role as a crucial component in managing these complications.

Gastroenterology Insights doi: 10.3390/gastroent15040073

Authors: Xavier Zonna Conor Banta Nariman Hossein-Javaheri

Inflammatory bowel disease represents a wide range of pathologies and disease states including Crohn’s Disease (CD) and Ulcerative colitis (UC). Despite extensive research, the exact immunopathogenesis of Crohn’s disease remains unclear, but a variety of studies over the years have pointed to yeast as a potential source antigen of uncertain significance. The aim of this review is to summarize the current literature investigating the association between Crohn’s disease patients and their responses to yeast. To do this, we performed a literature review by looking at clinical and translational research regarding the immunopathogenesis of Crohn’s disease, yeast and its associated biomarkers, and overall patient response to dietary yeast published between 1 January 1990 and 1 October 2024 that were indexed on PubMed and Google Scholar with the majority written in English. It was found that antibodies against Saccharomyces cerevisiae (ASCA) have proven to be highly specific for CD during the workup of IBD and may have diagnostic value for the purpose of excluding ulcerative colitis. For CD patients, there appears to be a dysregulated immune response to antigens like yeast that results in abnormal mucosal permeability and thus increases antigen presentation to the immune system. In addition, ASCA and its immunoglobulin modifications have been shown to have significant potential in the prediction of CD onset and disease course. Interestingly, although other abnormally structured antibodies can be found in CD patients’ serum for years preceding diagnosis, there appears to be no relation between ASCA and dietary yeast sensitivity by CD patients. In conclusion, significant research efforts have been made in recent years to explore the role of diet in the disease course and management of patients with Crohn’s disease. The immunological role of antigens including yeast in CD is complex and may represent an important pathogenetic factor in addition to influencing the specific phenotype of the disease. Unfortunately, no single specific diet is superior for the management of IBD, and individualized patient treatment by experts in the field is best for adjunctive therapy. New studies characterizing the microbiome of CD patients and also using immune markers/gene modifications to predict disease outcomes have shown to be quite promising. However, further research is required to investigate the CD yeast response and its role in the pathogenesis, diagnosis and treatment of CD.

Gastroenterology Insights doi: 10.3390/gastroent15040072

Authors: Sabine Hazan Mathilda von Guttenberg Adriana C. Vidal Norman M. Spivak Alexander Bystritsky

Background: The gut–brain axis, significantly influenced by the gut microbiome, is a growing focus in mental health research. This study aimed to investigate gut microbiome differences between anxious and non-anxious participants. Methods: A convenience sample of 119 participants consisted of 56 participants with self-assessed low to zero levels of anxiety and 63 with self-assessed mild to severe levels of anxiety, using the self-rated Generalized Anxiety Disorder 7-item (GAD-7) test. Fresh stool samples were collected for bacterial DNA extraction. DNA library preparation was performed using shotgun methodology, sequenced with the NextSeq 500/550 High Output v2.5 300 cycle kit, and mapped using minimap2. Bioinformatics analysis was conducted using One Codex. Results: The study participants were all of white race/ethnicity and the mean age, 54 (anxious group) vs. 55 (non-anxious) yr old, was not different between groups (p = 0.75). In the anxious group, 33% were females versus 25% in the non-anxious group, p = 0.46. Six percent of the anxious group reported a prior diagnosis of depression and 8% had irritable bowel syndrome, compared to none in the non-anxious group (p = 0.02, p = 0.006, respectively). Mann–Whitney tests revealed higher relative abundances of the genera Clostridioides (p = 0.011) and Bacteroides (p = 0.002) in the anxious group. Conversely, the anxious group had lower levels of the genera Bifidobacterium (p = 2.118 × 10−10), Faecalibacterium (p = 0.020), and the Phylum Actinobacteria (p = 1.516 × 10−8). Conclusions: Our findings corroborate previous studies, showing significant gut microbiome differences between anxious individuals and their non-anxious counterparts. These results support further exploration of microbiome-centric anxiety research.

Gastroenterology Insights doi: 10.3390/gastroent15040071

Authors: Cristina Maria Marginean Denisa Pirscoveanu Sergiu Marian Cazacu Marian Sorin Popescu Iulia Cristina Marginean George Alexandru Iacob Mihaela Popescu

Non-alcoholic fatty liver disease (NAFLD) is the main cause of chronic liver disease globally. NAFLD is a complex pathology, considered to be the hepatic expression of metabolic syndrome (MetS). It is supposed to become the main indication for liver transplantation in the coming years and is estimated to affect 57.5–74.0% of obese people, 22.5% of children and 52.8% of obese children, with 50% of individuals with type 2 diabetes being diagnosed with NAFLD. Recent research has proved that an increase in adipose tissue insulin resistance index is an important marker of liver injury in patients with NAFLD. Despite being the main underlying cause of incidental liver damage and a growing worldwide health problem, NAFLD is mostly under-appreciated. Currently, NAFLD is considered a multifactorial disease, with various factors contributing to its pathogenesis, associated with insulin resistance and diabetes mellitus, but also with cardiovascular, kidney and endocrine disorders (polycystic ovary syndrome, hypothyroidism, growth hormone deficiency). Hepatitis B and hepatitis C, sleep apnea, inflammatory bowel diseases, cystic fibrosis, viral infections, autoimmune liver diseases and malnutrition are some other conditions in which NAFLD can be found. The aim of this review is to emphasize that, from the clinician’s perspective, NAFLD is an actual and valuable key diagnosis factor for multiple conditions; thus, efforts need to be made in order to increase recognition of the disease and its consequences. Although there is no global consensus, physicians should consider screening people who are at risk of NAFLD. A large dissemination of current concepts on NAFLD and an extensive collaboration between physicians, such as gastroenterologists, internists, cardiologists, diabetologists, nutritionists and endocrinologists, is equally needed to ensure we have the knowledge and resources to address this public health challenge.

Gastroenterology Insights doi: 10.3390/gastroent15040070

Authors: Ancuța Năstac Alexandru Constantinescu Octavian Andronic Dan Nicolae Păduraru Alexandra Bolocan Bogdan Silviu Ungureanu

The integration of artificial intelligence (AI) into healthcare, particularly in the field of gastroenterology, marks a significant advancement in the diagnosis and treatment of pancreatic disorders. This narrative review explores the application of AI in enhancing Endoscopic Ultrasound (EUS) imaging techniques for pancreatic pathologies, focusing on developments over the past decade. Through a comprehensive literature search across several scientific databases, including PubMed, Google Scholar, and Web of Science, this paper selects and analyzes 50 studies that highlight the role, benefits, precision rates, and limitations of AI in EUS. The findings suggest that AI not only improves the quality of endoscopic procedures, as acknowledged by a majority of gastroenterologists in the UK and USA, but also offers a promising future for medical diagnostics and treatment, potentially addressing the shortage of specialists and reducing morbidity and mortality rates. Despite AI’s infancy in clinical applications and the ethical concerns regarding data privacy, its integration into EUS has enhanced diagnostic accuracy and provided minimally invasive therapeutic alternatives. This review underscores the necessity for further clinical data to evaluate the applicability and reliability of AI in healthcare, advocating for a collaborative approach between physicians and AI technologies to revolutionize the traditional clinical diagnosis and expand treatment possibilities in gastroenterology.

Gastroenterology Insights doi: 10.3390/gastroent15040069

Authors: Erica Bonazzi Greta Lorenzon Daria Maniero Caterina De Barba Luisa Bertin Brigida Barberio Renato Salvador Michele Valmasoni Fabiana Zingone Matteo Ghisa Edoardo Vincenzo Savarino

The esophagus, traditionally viewed as a sterile conduit, is now recognized as a dynamic habitat for diverse microbial communities. The emerging evidence suggests that the esophageal microbiota plays an important role in maintaining esophageal health and contributing to disease. The aim of this systematic review was to synthesize the current knowledge on the esophageal microbiota composition, its variation between healthy individuals and those with esophageal diseases, and the potential mechanisms through which these microorganisms influence esophageal pathology. A systematic literature search was conducted using multiple databases, including PubMed, Scopus, and Web of Science, to identify relevant studies published up to July 2024. The inclusion criteria encompassed original research articles that used molecular techniques to characterize the esophageal microbiota in human subjects, comparing healthy individuals with patients affected by esophageal conditions such as gastroesophageal reflux disease (GERD), Barrett’s esophagus, eosinophilic esophagitis, and esophageal cancer. The primary outcomes were the composition and diversity of the esophageal microbiota, and the secondary outcomes included the correlations between microbial profiles and disease states. The esophageal microbiota of healthy individuals was dominated by Gram-positive bacteria, particularly Streptococcus. Conversely, the esophageal microbiota is considerably altered in disease states, with decreased microbial diversity and specific microbial signatures associated with these conditions, which may serve as biomarkers for disease progression and as targets for therapeutic intervention. However, the heterogeneous study designs, populations, and analytical methods underscore the need for standardized approaches in future research. Understanding the esophageal microbiota’s role in health and disease could guide microbiota-based diagnostics and treatments, offering novel avenues for managing esophageal conditions.

Gastroenterology Insights doi: 10.3390/gastroent15040068

Authors: Masahiro Okada Ryoji Aoki Yujiro Nakazawa Kenichiro Tago Kazushi Numata

Liver masses are routinely evaluated using ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). MRI may be used for further investigation in cases with atypical findings and difficult diagnoses. Hepatocellular carcinoma (HCC) is a common malignancy, and it is important to know the exact spread and number of HCCs, as there are numerous treatment options. In addition, it is important to know how the differentiations of HCCs are reflected on the images, and what the subtypes of HCCs look like on the images. Elastography with US and MRI is increasingly used to measure liver stiffness, and non-invasive assessment of liver fibrosis is also possible. This review describes the diagnosis of HCC on commonly used CT and MRI, and also touches on the frontiers of imaging diagnosis of liver parenchymal changes such as liver cirrhosis.

Gastroenterology Insights doi: 10.3390/gastroent15040067

Authors: Antonietta Gerarda Gravina Raffaele Pellegrino Giovanna Palladino Annalisa Zanini Alessandro Federico Fabiana Zingone

Background: Regular physical activity (PA) is desirable, regardless of age, even in patients with chronic conditions such as inflammatory bowel disease (IBD). Aims: This study aims to assess PA levels and related barriers/facilitators in IBD patients, stratifying them into age groups (with a threshold of 50 years). Methods: The International PA Questionnaire (IPAQ) assessed PA levels regarding resting metabolic rate (Met) in minutes per week (min/wk). Patient-reported outcomes 2 (PRO-2) evaluated disease activity. Results: Among the 237 enrolled patients, PA rates were found to differ significantly in terms of patients being sufficiently active (55% vs. 39.8%), inactive (39.6% vs. 59.1%), and engaging in health-enhancing PA (5.4% vs. 1.1%) between patients under and at least 50 years old, respectively (p < 0.001). Overall, PA levels followed this trend, being higher in younger patients [892 (446.5–1439) vs. 545.25 (257–1210.47) Met min/wk, p = 0.007]. Individuals aged at least 50 years tend to have lower PA at regression analysis (OR: 3.302, p = 0.018). Patients aged at least 50 years perceived IBD as more of a barrier to PA (p = 0.04). Bowel urgency is a significant barrier, especially in older patients (p = 0.022). Conclusions: Age is an unmodifiable factor impacting and influencing PA levels. Strategies to recover exercise levels in older IBD patients should be encouraged.

Gastroenterology Insights doi: 10.3390/gastroent15040066

Authors: Caesar Ferrari Bilal Ashraf Zainab Saeed Micheal Tadros

Therapeutic development for metabolic-dysfunction-associated steatohepatitis (MASH) trails behind the success seen in hepatitis C virus (HCV) management. HCV, characterized by a viral etiology, benefits from direct-acting antivirals (DAAs) targeting viral proteins, achieving cure rates exceeding 90%. In contrast, MASH involves complex metabolic, genetic, and environmental factors, presenting challenges for drug development. Non-invasive diagnostics like ultrasound, FibroScan, and serum biomarkers, while increasingly used, lack the diagnostic accuracy of liver biopsy, the current gold standard. This review evaluates therapies for MASH, including resmetirom (Rezdiffra) and combinations like pioglitazone and vitamin E, which show potential but offer modest improvements due to MASH’s heterogeneity. The limited efficacy of these treatments highlights the need for multi-targeted strategies addressing metabolic and fibrotic components. Drawing parallels to HCV’s success, this review emphasizes advancing diagnostics and therapies for MASH. Developing effective, patient-specific therapies is crucial to closing the gap between MASH and better-managed liver diseases, optimizing care for this growing health challenge.

Gastroenterology Insights doi: 10.3390/gastroent15040065

Authors: Paul Carrier Marilyne Debette-Gratien Jérémie Jacques Véronique Loustaud-Ratti

Ascites is a common syndrome characterized by an excess of fluid in the peritoneum. While cirrhosis is the most common cause, a wide range of other conditions—such as cancer, right heart failure, and tuberculosis—can also lead to ascites, and multiple etiologies may be present simultaneously. Effective diagnosis and management are essential, primarily relying on clinical examination and paracentesis, guided by specific tests.

Gastroenterology Insights doi: 10.3390/gastroent15040064

Authors: Karina Alejandra Pedroza-García Miriam Aracely Anaya-Loyola Dolores Ronquillo María del Carmen Caamaño David Masuoka Jorge Palacios-Delgado Jorge L. Rosado

Introduction: Autism spectrum disorder (ASD) comprises a group of developmental disorders characterized by deficits in social interaction and behavioral patterns. Children with ASD may face nutritional challenges, primarily due to their restrictive behaviors and frequent gastrointestinal issues. Objective: The objective of the present study was to assess nutritional status, dietary habits, and intestinal permeability in a sample of individuals with ASD. Methods: A cross-sectional study was conducted with 24 children and adolescents (both sexes), aged 4 to 18 years, living in two cities of Mexico (Aguascalientes and Querétaro). Weight and height were measured, and body mass index for age was calculated and compared using WHO Z-scores. Diet was assessed through three 24 h dietary recalls and a food frequency questionnaire. Intestinal permeability was evaluated using a lactulose/mannitol test by HPLC. Results: A high prevalence of malnutrition was observed; 12.5% of the participants were underweight, and 45.8% were overweight or obese. Children had a low intake of fiber, vitamin E, folate, potassium, zinc, and phosphorus and a high intake of sodium. On average, the intestinal permeability ratio was 0.09 ± 0.05, with 54.2% of the children exhibiting high intestinal permeability. Conclusions: It is advisable to develop food counseling strategies for children with ASD to prevent micronutrient deficiencies, promote healthy weight, and improve gastrointestinal integrity.

Gastroenterology Insights doi: 10.3390/gastroent15040063

Authors: Denitza Kofinova Yanko Pahnev Edmond Rangelov Ivan Vasilevski Olga Bogdanova Elena Ilieva Hristo Shivachev

Splenic epidermoid cysts are rare benign congenital tumors. However, if the cyst is not completely removed, it can reoccur. Laparoscopic splenectomy in children is being conducted more often, but it is a therapeutic challenge in cases of a giant cyst. We report a case of a 15-year-old girl who presented with nausea, anorexia and abdominal pain. The ultrasound showed a giant well-defined hypoechoic cyst with diffuse internal echoes. Computed tomography revealed a cystic mass (92/124/102 mm) without contrast enhancement. Anti-Echinococcus ELISA IgG was negative, and serum tumor markers CA 19-9 79.1 U/mL (N < 34) and CA-125 39.6 U/ML (N < 35) were elevated. Before the operation, the girl was vaccinated for Haemophilus influenzae, Pneumococci and Meningococci. Laparoscopic splenectomy was performed. The patient’s postoperative course was uneventful. Histopathology indicated a cyst walled by multilayered squamous epithelium positive for cytokeratin AE1/AE3. The diagnosis epidermoid cyst was confirmed.

Gastroenterology Insights doi: 10.3390/gastroent15040062

Authors: Kinga Skoracka Michał Michalak Alicja Ewa Ratajczak-Pawłowska Anna Maria Rychter Agnieszka Zawada Agnieszka Dobrowolska Iwona Krela-Kaźmierczak

Background: Celiac disease (CD) has been linked with increased susceptibility to osteoporosis; therefore, we aimed to explore whether, in a group of patients with CD, body composition parameters impact bone parameters. Methods: This study covered 56 adults—47 women and 9 men—with CD, and 20 healthy controls—16 women and 4 men. Densitometry of the lumbar spine (L1–L4) and femoral neck (FN) was conducted using dual-energy X-ray absorptiometry (DXA). Body mass was measured by bioimpedance method. Furthermore, serum 25(OH)D and ionized calcium concentration were determined. Results: We found osteopenia in the FN in 19.65% of patients and in L1–L4 in 26.79% of the patients. One patient displayed evidence of osteoporosis in the L1–L4 region, while two patients (3.57%) exhibited similar findings in the FN. Significant positive correlations were observed between bone mineral density (BMD) and body mass, fat-free mass (FFM), muscle mass, and basal metabolic rate (BMR) for both L1–L4 and the FN, and body mass index (BMI) of L1–L4. Conclusions: In conclusion, people with CD are at an increased risk of decreased BMD. Patients with lower body mass, FFM, muscle mass, BMI, and BMR more often present with osteopenia and osteoporosis.

Gastroenterology Insights doi: 10.3390/gastroent15040061

Authors: Paola Ilaria Bianchi Nicola Aronico Giovanni Santacroce Giacomo Broglio Marco Vincenzo Lenti Antonio Di Sabatino

Celiac disease is an immune-mediated condition triggered by gluten ingestion in genetically predisposed individuals. The global prevalence of celiac disease is significant, affecting approximately 1.4% of women and 0.7% of men, with incidence rates of 17.4 and 7.8 per 100,000 person-years, respectively. The clinical presentation of celiac disease may range from overt diarrhea and malabsorption to more subtle features such as nutritional deficiencies and extraintestinal manifestations. It is the most common cause of global malabsorption in Western countries. A life-long gluten-free diet is the only available treatment for celiac disease. Moreover, a gluten-free diet is often adopted by individuals without celiac disease, either to address non-celiac gluten sensitivity or for other reasons. This review aims to explore the current understandings of the nutritional consequences of untreated celiac disease and the impact of the gluten-free diet itself. Physicians and dietitians specializing in celiac disease should focus on providing a well-rounded nutritional scheme to address deficiencies caused by the disease and prevent the instauration of new nutritional imbalances.

Gastroenterology Insights doi: 10.3390/gastroent15040060

Authors: Isabel Jaén-Torrejimeno Diego López-Guerra Adela Rojas-Holguín Antonio Enrique Gómez-Martin Gerardo Blanco-Fernández

Background: The involvement of the inferior vena cava in advanced abdominal tumors is a surgical challenge, given the high postoperative morbidity and poor long-term prognosis. Our goal was to analyze our experience, perioperative management, and results. Methods: We retrospectively evaluated short and long-term results of surgical resections of tumors with associated inferior vena cava resection performed in our facilities between 2012 and 2023. Results: A total of 25 patients were selected for our retrospective study: 3 with renal carcinoma, 5 with sarcoma, 12 with metastatic lesions, 2 with adrenal tumors, 1 pancreatic tumor, 1 extra-adrenal paraganglioma and 1 with hepatocellular carcinoma. Postoperative severe complications (Dindo-Clavien score ≥ IIIa) affected 36% of patients and the mortality rate was 8%. Partial resection with primary repair was performed in 13 patients (52%), with patch reconstruction in 6 (24%), and vascular reconstruction with prosthesis in 6 patients (24%). The mean disease-free survival was 7 months (IQR 2.5–11.5). Graft thrombosis occurred in 2 patients during follow-up. Conclusions: In selected patients, the resection of the inferior vena cava is a complex surgery with an assumable morbimortality and relative survival improvement.

Gastroenterology Insights doi: 10.3390/gastroent15030059

Authors: Suja P. Davis Rachel McInerney Stephanie Fisher Bethany Lynn Davis

Background/Objective: Inflammatory bowel disease (IBD) diagnosis in the elderly falls under two categories: those diagnosed at a younger age and transitioning to the elderly group (>60 years) and those diagnosed at ≥60 years of age. Although it is difficult to calculate the incidence of IBD among elderly adults precisely, it is estimated that around 10–15% of IBD in the US are diagnosed after 60 years, and approximately 13% of IBD cases are diagnosed after the age of 65 globally. The objective of this systematic review is to assess the therapeutic needs of elderly adults with IBD, focusing on quality of life (QOL), symptom presentation, mental health management, IBD medication utilization patterns, surgical outcomes, and healthcare utilization to identify gaps in IBD management. Methods: We identified 42 published articles through a database search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses from October 2023 to June 2024. We conducted the quality appraisal of the selected studies using the Joanna Briggs Institute (JBI) critical appraisal tools. Results: Our findings indicate decreased health-related QOL, more colonic and less penetrating disease in elderly Crohn’s disease patients, and comparable symptoms between elderly and younger ulcerative colitis patients. Despite an increased trend in prescribing biologics, the elderly show decreased response rates and poor remission. Higher healthcare utilization is noted among elderly IBD patients, alongside insufficient attention to their mental health concerns. Conclusions: The findings from this systematic review offer a comprehensive synthesis of the management of elderly adults with IBD and highlight several unmet needs that warrant attention in future research and clinical practice considerations.

Gastroenterology Insights doi: 10.3390/gastroent15030058

Authors: Marina Fortea Leen Hacour Francesc Sancho Carlos Boada Cesar Sevillano-Aguilera Ana María. González-Castro Eloisa Salvo-Romero Beatriz Lobo Danila Guagnozzi Laurens J. Ceulemans Jacques Pirenne Carmen Alonso-Cotoner Javier Santos Ricard Farré Maria Vicario

Introduction: Esophageal inflammatory diseases are frequent diagnoses in clinical practice and have diverse etiologies, the most common being those associated with the exposure to gastric content, drugs and allergens. In diseases, the immunological component is well identified in endoscopic biopsies, which mainly contain the epithelium and the lamina propria; however, deeper layers are less studied. Moreover, the esophageal capacity of sensing luminal compounds is poorly understood. Methods: In transmural sections from proximal, middle and distal esophagus obtained from deceased patients, we performed a phenotypic analysis of the main immune cell populations and acid-sensing receptors by immunohistochemistry and immunofluorescence methods. Results: A total of nine donors were studied (absence of pathology, optimal tissue preservation and orientation). We found the following: (1) the vascular papillae and the lamina propria are the most infiltrated layers by the lymphoid lineage (T and B lymphocytes), followed by the epithelium, while the smooth muscular layers are mainly populated by the myeloid lineage (macrophages and mast cells); (2) intraepithelial macrophages are consistently found along the esophagus; and (3) eosinophils are absent in all the esophageal layers. The acid-sensing receptors ASIC-1, ASIC-2 and δENAC are expressed in the esophageal epithelium and in the lamina propria, yet only ASIC-2 is expressed in the muscularis mucosae. Conclusions: The human esophagus contains a differential distribution of immune cells and acid-sensing receptors across its layers. This study extends the esophageal histological knowledge previously described and reinforces its role as a defensive and sensing organ.